On the day of our inspection we spoke with four people who told us they were happy with the service provided. All the people we talked to were happy with the service they had received. People told us they were clear about the process of making contact if they had any concerns following treatment and felt staff had the skills to support them effectively. We looked at the files of six people who had received treatment. We looked at four personnel files and spoke with four members of staff.

Members of staff we spoke with demonstrated a good understanding of infection control and how to minimise the spread of infection. They told us they had all received infection control training and documents we reviewed confirmed this. We spoke with members of staff who told us that development needs were identified in line with business and personal development objectives. People we spoke with told us they were aware of the complaints policy and were confident that if they raised any concerns, these would be dealt with appropriately and swiftly. During this inspection we looked at the records of six people who had received treatment and found that they were accurately maintained.

We spoke to four people who received treatment from the hospital. We also spoke to two members of staff and to the registered manager.

People said they were satisfied with the service they received. People described the treatment they received as meeting their expectations. One person said, “It’s brilliant. I can now see perfectly.” Another person said the treatment exceeded their expectations. One person, however, said the treatment had not met their expectations but said they were still receiving treatment.

People told us they were consulted about the treatment and we saw people had signed consent to treatment forms. People also said the staff treated them well.

We saw the hospital maintained records for each person’s stages of treatment.

The hospital had systems for the prevention and control of infection. This included systems of audit to check for cleanliness and safe hygiene. All areas of the hospital seen were clean.

Staff had access to a range of relevant training courses. Staff were also supported by regular supervision. We saw records of staff competency assessments.

We found the service had a comprehensive system for assessing its own performance and for making any improvements. These included patient satisfaction surveys and audits of the hospital’s compliance with the Care Quality Commission’s essential standards.

Optegra Solent Eye Hospital is operated by Optegra UK Limited. Optegra is part of a nationwide company, which has seven hospitals and three outpatient clinics in the UK. The hospital provides services to adults over 18 only.

The hospital was opened in 2010. It is located on the ground floor of a multi-business development in Whitely, Hampshire. The hospital had five consulting rooms, a reception area, seven diagnostic rooms, three operating theatres (one operating theatre was not in use), a treatment room and pre and post operative areas. The main services provided were ophthalmic surgery and ophthalmic outpatients.

Surgical services provided included cataract surgery, refractive eye surgery, oculoplastic surgeries, retinal diagnostic, general ophthalmic surgical services, and ophthalmic disease management. During the 12 months prior to our inspection, the hospital recorded 1,995 surgical procedures. Of these 50% were for cataract surgery, 13% refractive lens exchange, 9% refractive laser treatments and 28% other procedures including laser procedures to address complications, age related macular degeneration (AMD) injections, retinal procedures, oculoplastic surgeries and glaucoma procedures.

During the 12 months prior to our inspection the hospital recorded 6,658 outpatients appointments with the majority of these patients (65%) seen for follow-up after surgery. Others were seen for an initial consultation with the optometrist or for diagnostic tests including glaucoma and cataract screening. Patients receiving AMD injections were also seen in the outpatients department.

We inspected this service using our comprehensive inspection methodology. We have reported our inspection findings against the two core services of Surgery and Outpatients. We carried out the announced part of the inspection on 16 and 17 October 2017, along with an unannounced visit to the hospital on 30 October 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this hospital/service as requires improvement overall.

• We found that nursing staff were undertaking the extended role of dispensing medication for patients to take home without adequate training or competency.
• We observed nursing staff pre-operatively administering eye drops to patients before the surgeon had marked the eye to be operated on. This action did not comply with the World Health Organisation (WHO) surgical safety checklist supporting information, which recommends the site to be operated marked before any pre-medication administered.
• The resuscitation trolleys were not tamper proof at the time of our inspection. Staff had not consistently checked the resuscitation trolley in outpatients and diagnostics to ensure they were ready and safe to use.
• Permanent clinical staff compliance with mandatory training for basic life support was at 71%. This was against a target for all staff in therapeutic contact with the patient to have undertaken basic life support training.

• There were some gaps in patients’ records who had undergone laser treatment in outpatients and diagnostics. In one records out of 24 (4%) we reviewed the consent forms missing, and in three patient records out of 24, (12%) there was no record of the treatment undertaken on paper or electronically.

• There was some non- compliance with laser rules with 3B type of laser. For example, the key needed to operate the laser, was left in the laser when the outpatient consulting room was unattended. This was a concern as the room had a keypad entry, but could be entered by any member of staff who knew the key pad number, who may not be an authorised user of the laser.

• Not all staff were bare below the elbow in outpatients and diagnostics, and there was inconsistency with the use of personal protective equipment in outpatients and diagnostics.

• The service had a range of polices that were revised and updated, but the range did not cover all risks to patients. For example, there was no sepsis or antimicrobial policy.
• The hospital did not contribute to any national audits with regard to clinical outcomes. A local audit calendar was in place, but audits had not taken place as planned.
• There were gaps in the recruitment and ongoing monitoring of consultant practising privileges checks. This meant the registered manager did not have assurance of consultants’ compliance with the provider’s practising privileges policy.
• The service were not proactive in meeting individual needs patients may have. For example, there were no bariatric chairs, no adaptations for people living with a dementia.
• Mental Capacity Act training and deprivation of liberty safeguards training was at 29% for clinical staff.

• There was a risk register for the service. However, the provider had not developed an action plan to manage all identified risks. This included risks relating to waiting times in 2015, which remained outstanding.

• The hospital had only held one medical advisory committee meeting (MAC) in 12 months. The lack of MAC meetings meant the consultant ophthalmologists with their expert knowledge were not involved in monitoring governance processes at the hospital or as a committee supporting with decision making involving consultants.
• We reviewed the minutes of four of the hospital governance and risk meetings. Agenda items were inconsistent for example two meetings followed the suggested structure and two covered limited aspects of the agenda. This meant the opportunity for example to review the audit calendar, learn from any audits undertaken, review the risk register and discuss training issues/ compliance was not always taken.
• The service had not implemented the Workforce Race Equality Standards 2015 (WRES).

However, we also found areas of good practice:

• Staff followed their internal process for reporting incidents, and there was evidence of learning. All procedures and clinics went as planned.

• Staff working in the operating theatre demonstrated good compliance with the five steps to safer surgery (World Health Organisation –WHO) check list in the operating theatre.
• The hospital had recently put a standard operating procedure in place, and a risk assessment undertaken when cytotoxic medication used.

• The service followed national guidance and best practice by the Royal College of Ophthalmologists and National Institute for Health and Clinical Excellence (NICE) in relation to patient care pathways.
• Optegra as an organisation undertook clinical outcome audit activity. The hospital had an eye sciences department, whose role was to collate outcome data on refractive lens exchange (RLE), cataract surgery and laser surgery. The eye sciences team collected data for all Optegra hospitals each quarter and presented the data across the UK.
• Patients were positive about their interactions with staff and the care they received within the department. They told us staff treated them with dignity and respect. Staff monitored patients’ pain during procedures, and patients felt reassured and put at ease.

• The service was planned to meet the needs of patients. Referral to treatment times were not formally monitored, but patient feedback did not raise concerns about waiting times for treatment. Information leaflets were provided, and a monthly open meeting to support patients in making informed choices about their treatment.
• The service recognised people who required additional support to communicate and provided assistance in hearing and translation.
• The service did learn from concerns and complaints

• Staff were proud of the organisation as a place to work and spoke highly of the supportive culture. Staff we spoke with were happy with their working environment felt they all worked well together as a team. The leadership team were open and honest about where they felt the hospital needed to improve and responded proactively to the concerns we raised.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected the surgery and outpatients and diagnostic core services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals