During the inspection we spoke with 31 people who used the service and 9 members of staff. We also checked the patients' records and observed the environment and communication between staff and the patients. We visited clinics 1, 2, 4, 5 and the Accident and Emergency department. We also inspected the Richard Desmond Children's Eye Centre including Children's Accident and Emergency Department and the day case unit.

People felt that staff provided them with information about their treatment. A person said staff gave them “a lot of time”. People felt that their questions were answered by the staff and they received “a very good service”. This indicated that patients had information about their care and treatment to be able to make decisions.

People had access to healthcare information through the leaflets and television screens in the waiting areas. People felt that the staff were "effective". One person told us that staff "were thorough, checked everything". People described the hospital as being "second to none".

Arrangements were in place to make sure that patients were protected from abuse. The Trust's safeguarding policy, which had been recently updated, was detailed and most staff were aware of the procedures to follow to record and report any incidents of abuse. We noted that staff had support and training to enable them to provide care and treatment that met people's needs.

Over 7th and 8th February 2012, nine compliance inspectors conducted visits to eleven clinics/ departments and one ward at Moorfields Eye Hospital in City Road as follows:

We visited Accident and Emergency Department (A&E), Clinic 2, Clinic 3, Clinic 4, Clinic 5, Clinic 11, Retinal Therapy Unit, Mackellar Day Care Ward, the Patient Advice and Liaison Services (PALS) and Patient Advice and Support Services (PASS). At the Richard Desmond Children’s Eye Centre, we visited the Children’s Accident and Emergency Department and Fourth Floor Children's Clinic. We conducted observations in all the areas we visited, spoke to 42 patients and 18 staff in total and looked at patient records.

Patients who use the services spoke highly of the hospital and of its reputation for providing excellent specialist care, and praised the hard work and positive attitude of the staff. People told us they felt involved in their care and treatment and had sufficient information to make informed decisions.

Very few people we spoke to had concerns or complaints about the service they had received. However few people were aware of the procedures for putting forward suggestions or making complaints to the Trust. The main complaint reported by a small number of people was of long waiting times on occasions in outpatient clinics and in A&E. However waiting times in A&E did not exceed the four hour government target. A minority of patients spoke of experiencing inconvenience when needing treatment and being confused about whether to attend A&E or the clinic where they were previously treated. A number of patients were not clear about how to manage their treatment after advice that staff had given them. However we found no areas of non-compliance with the Health and Social Care Act 2008 (HSCA) and some areas for improved practice. This was in order to ensure that the Trust continues to maintain compliance and to build on its reputation of providing a high quality of service to its patients

• We found many improvements in surgery and outpatients since the last inspection.
• Action had been taken to reduce potential risks to patients undergoing surgery: improved compliance with the World Health Organisation safety check list.
• Staff followed infection prevention and control procedures and areas we inspected very visibly clean.
• Staff knew the action to take if they had concerns that a patient was being abused.
• Care and treatment provided was based on national guidance and evidence of its effectiveness.
• In surgery, outcomes for some treatments were better than the national standard.
• There was effective multidisciplinary working in surgery and outpatients.
• We observed many positive caring interactions between staff and patients in surgery and outpatients. In surgery patients told us staff went above and beyond to ensure they were comfortable.
• Care and treatment was responsive to the needs of patients. Support was available for people living with a learning disability or dementia and visual aids were available for people who were visually impaired.
• Access times for surgery from time of referral were better than the England average.
• The divisional structures had been reviewed and strengthened.
• Staff told us they were supported by their local managers and were encouraged to access development opportunities. There was a positive culture and staff were proud to work for the trust.
• There was a commitment to improving services and both services had systems to monitor the quality and safety of care provided.

However:

• In outpatients more work was needed to improve learning from complaints and incidents and reduce the number of patients who did not attend for their appointment.
• In surgery the risk registers for theatres did not always reflect risks specific to the service.
• In outpatients some staff were not aware of the trust’s values or the strategy.
• The environment in the outpatients was limited and the trust had taken some action to improve it and more work was planned.
• Vacancies for non-registered staff were above the trust target.