The Medical Eye Clinic is operated by The Medical Eye Clinic Limited. The clinic has no inpatient beds. Facilities include one operating theatre, a non-invasive laser room, a pre-surgery preparation room and a post-surgery recovery area. Consulting rooms were shared with a separate optometry company that used the same premises as The Medical Eye Clinic.

The clinic treats ophthalmic patients, both private and NHS (via direct contracts with NHS trusts). Types of surgery carried out include: cataract surgery and laser capsulotomy treatment.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 October 2017 and an unannounced visit to the clinic on 20 October 2017. We did not inspect the entire pre-surgery consultation process and post surgery follow up care because this was provided as part of a service agreement with a separate organisation.

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.

Services we rate

We rated this service as requires improvement overall.

• There were omissions in the safety risk assessments and operational protocols to keep patients safe. The risk assessment and associated guidance around the use of the non-invasive laser was not comprehensive. Expectations regarding the management of controlled drugs were not clearly defined in an operational policy.
• The system for ensuring all members of the surgery team had knowledge of essential safety systems and processes was not robust. The clinic did not have a policy for mandatory training. Minimum requirements for mandatory training were identified for some but not all staff. Leaders did not have clear oversight of the training completed by the clinicians that made up the team on surgery days.

• There were adequate numbers of medical and nursing staff present on surgery days. However, the accountability of all members of the team was not well defined because not all members of the team had an employment contract.

• The practising privileges policy referred to outdated legislation and was not specific regarding the training requirements for this group of staff.

• The service did not contribute data to the Private Healthcare Information Network.
• Staff did not always respect the confidentiality of patients in their care when giving verbal handovers to other members of the team
• There was no system for engagement of foreign language or sign language interpreters should these be required. There was no hearing loop at the clinic.
• The arrangements for governance did not always operate effectively. There had been no recent review of the governance arrangements or the information used to monitor safety performance.
• The senior team did not have clear oversight of all safety procedures. There were some omissions and inaccuracies in the safety reports that were used by the medical advisory committee to monitor safety performance.
• The audit programme did not monitor staff compliance with all relevant safety protocols. For example, the medicines management policy was not regularly audited. There were no hand hygiene audits.
• Not all risks were mitigated within a reasonable time frame, such as completion of staff disclosure and barring checks.
• Essential policies and protocols were not always current (the practising privileges policy) or comprehensive (the medicines management policy).

However, we also found the following areas of good practice:

• Staff were aware of the protocol for reporting incidents. The senior team ensured that actions were taken and lessons were learnt as a result of incidents reported.
• There were systems to minimise the risk of healthcare associated infection. The environment and facilities were visibly clean. Staff adhered to the infection control policy.
• The team consistently followed World Health Organisation guidelines on the use of safer surgery checklists to minimise risk of harm to patients undergoing surgery. Use of the checklist was carefully monitored by the anaesthetist and the lead nurse. It was evident during our inspection that all members of the team respected the importance of using these checklists.
• Medicines were stored securely and at manufacturer recommended temperatures. Patient records were stored securely to maintain patient confidentiality.
• Patient’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. The senior team discussed research and guidelines in the medical advisory committee. We saw the team adhered to best practice in the use of the safer surgery checklist.
• Accurate and up-to-date information about effectiveness was shared internally and was understood by staff. This was used to improve care and treatment and people’s outcomes. Surgical outcomes were closely monitored and regularly compared to published data to benchmark the effectiveness of the treatments.
• There was effective multidisciplinary working across the whole team and educational sessions were offered to optometrists outside the team.
• Patients had comprehensive assessments of their needs. All necessary patient information was accessible to the team. Staff were aware of consent processes and these were based on best practice and current legislation.
• Staff took time to minimise patient’s anxiety. Patients were involved and encouraged to be partners in their care and in making decisions. Patients were encouraged to ask questions and staff gave clear and detailed explanations to queries. Patients told us they felt reassured and informed.
• Staff respected the dignity of patients. Staff introduced themselves by name and role and considered the individual preferences of patients.
• The premises and facilities were designed to meet the needs of patients. The theatre and consulting rooms were accessible on ground level.
• The surgery pathway was focussed on individual needs. Patients could choose to see an optometrist in their local area for follow up care.
• Patients were individually assessed for their suitability for treatment taking into account known risk factors.
• Patients did not wait long for their care. There was no waiting list for treatment and clinics ran on time. During our inspection, clinics ran on time.
• Leaders of the service were focussed on the quality of clinical outcomes and the safety of procedures within theatre.
• There was a vision to develop the service that included diversification of surgery procedures offered to patients and more joint working with NHS providers. Feedback from NHS commissioners was positive.
• The service sought the views and experiences of patients and this. Feedback from was consistently positive.
• Leaders were visible and accessible to staff. All staff were proud to deliver patient centred care.

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 service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)