ACES (Cromwell Road) is operated by Anglia Community Eye Services. The service, which was founded in 2007, is an independent provider of NHS Eye Services, where patients are able to receive eye care in the community from Consultant Ophthalmic Surgeons. The location at Cromwell Road is one of four locations in the ACES group.

Facilities at ACES Cromwell Road include two operating theatres, one laser treatment room, four consultation rooms and six diagnostic rooms.

The main service provided is non-laser cataract surgery. Other surgery provided at the service includes eyelid and lacrimal (eyelid) surgery and outpatient clinics. The service provides all surgery under local anaesthetic only. All patients attending the service for consultation or treatment are at least 18 years of age.

ACES Cromwell Road has had a registered manager in post since May 2015.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 September 2017 along with a further announced visit to the service on 6 September 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.

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.

Services we rate

We rated this hospital good overall.

We found the following areas of good practice in relation to surgery:

• Although some elements of it require improvement, the overall standard of the service provided outweighs those concerns. We have deviated from our usual aggregation of key question ratings to rate this service in a way that properly reflects our findings and avoids unfairness.
• There were robust incident reporting processes. All staff we spoke with knew how to report and escalate incidents. Staff were clear about their responsibilities in relation to the duty of candour.
• There were effective infection prevention and control measures.. All areas within the surgical department were visibly clean.
• Medical records were complete, legible and up to date.
• Staffing within the surgery department was planned in advance and sufficient to meet the needs of the patients.
• There were systems to record all implants used during surgical procedures.
• Senior nursing and managerial staff monitored staff competencies for both nursing and medical staff.
• The service had received consistently positive feedback from patients. All patients we spoke with reported staff were kind and caring whilst maintaining their dignity and privacy.
• Senior staff ensured the service was planned and delivered to meet the needs of patients. Access to the service was seamless and in a timely manner.
• The service had an effective governance framework. Clinical governance meetings demonstrated a good attendance by a broad range of staff.
• Staff reported a positive culture within the service. Staff described senior managers as “supportive and approachable”.

However, we also found areas for improvement:

• We found cytotoxic medicines that had not been risk assessed, managed or stored safely. We highlighted our concerns to the registered manager who took prompt action in the suspension of this medicine prior to implementation of appropriate risk assessments, policy amendments and provision of guidance for staff.
• We found an out of date medicine in an emergency resuscitation trolley. Staff had not checked this equipment on a regular basis. However, when we raised our concerns, the registered manager took immediate action to replace the out of date medicine and implement new checking procedures.
• The risk register did not contain all risks relevant to the service; the use of cytotoxic medicines was not on the service’s risk register. However, when we raised our concerns, the registered manager took immediate action to address our concerns.

We found the following areas of good practice in relation to outpatient care:

• All staff we spoke with knew how to report and escalate incidents and safeguarding concerns. We saw evidence that learning as a result of incidents was shared with staff.
• All outpatient areas, both clinical and non-clinical were visibly clean, well-organised and free from clutter.
• Equipment was well maintained and serviced within recommended periods. Personal protective equipment (PPE) was available for staff where required.
• The service had an acceptance and exclusion criteria in place, which clearly outlined patients who were clinically safe to access the service.
• Staffing within the outpatient department was sufficient to meet the demand of patients.
• The service had received consistently positive feedback from patients. During our inspection we saw that staff treated patents in a kind and friendly manner, treating them with respect.
• Staff working within the outpatient department told us they were well supported and encouraged to develop in their role.

However, we also found areas for improvement:

Following this inspection, we told the provider 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 Anglia Community Eye Services Cromwell Road details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals