All of the people we spoke with were happy with the standard of service they had received. On person told us, "The service has been very good." Another person told us, "Excellent service, I was given plenty of information to help me make my decision to go

ahead" and," Absolutely thrilled with the result."

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person said;" Staff took me through the options and outcomes so I had a good understanding of what would happen." Another person said;" I was given written information that told me what could be achieved with treatment."

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person said;" I'd come back for any eye surgery, it was so effective for my first cataract removal."

Effective infection prevention and control procedures were in place to reduce the risk of infections. People we spoke with said the clinic was spotlessly clean and tidy.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

Systems were in place to ensure people's complaints were fully investigated and resolved, where possible, to their satisfaction.

CESP North East LLP (Consultant Eye Surgeons Partnership) provides ophthalmic surgery and an outpatient service at Nuffield Health Newcastle under a service level agreement with the Nuffield Health Newcastle hospital which is referred to as the host hospital throughout this report.

The host hospital provided CESP North East access to private bedrooms if needed, a day case suite and consulting rooms with a bright, comfortable reception area where hot and cold drinks were available.

There was also an outpatient service supported by diagnostic imaging for children, adults and young people. All surgery was carried out on one or two days a month. We inspected surgery and outpatients using our comprehensive inspection methodology.

To understand 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 performance against each key question as outstanding, good, requires improvement or inadequate.

We carried out the announced part of the inspection on 22 and 23 February 2018. 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 services provided by CESP North East were ophthalmic consultations and the diagnosis, treatment and management of long term ophthalmic conditions. Ophthalmic surgical procedures were undertaken as day cases. The most commonly performed surgery was cataract extraction and lens implant, minor lid operations (excision lesions of eyelid), strabismus and YAG laser capsulotomy.

Where our findings on ophthalmic surgery, e.g. management arrangements, also apply to outpatient services, we do not repeat the information but cross-refer to the surgery core service.

We rated CESP North East as good overall.

We found the following good practice in surgery:

• During the previous twelve months there were no never events, serious incidents, complaints or safeguarding alerts reported regarding surgery.

• Throughout the hospital, ward and reception areas, clinical and anaesthetic rooms and recovery areas were visibly clean, tidy and in good decorative order.

• All medicines were stored safely and securely and processes were in place including medicines reconciliation to ensure these were safe for use.

• CESP North East surgeons worked well with the theatre team and all staff adhered to and followed the five steps to safer surgery checklist.

• CESP North East provided care and treatment in line with national guidance and best practice from the Royal College of Ophthalmologists and National Institute for Health and Care Excellence (NICE).

• Patients were given information about pain relief and this included being assessed during and after procedures using a pain score numerical tool.

• All consultants participated in audits of cataract patients which showed improvement in visual acuity in all patients audited.

• All consultants limited their private practice to those subspecialist areas that they also practice in the NHS.

• Patients told us the consultants had discussed the benefits and risks of their surgery and answered their questions prior to them giving consent to proceed with their surgery.

• We observed patients were treated with care, compassion, and respect by all staff they had contact with during their pathway.

• Patients told us that they were fully involved in their care and treatment;

• The registered manager had the skills, knowledge and experience to lead the service.

• We received positive feedback about the consultant team and were told they were approachable and hospital staff said they were happy working with CESP North East on a provider and individual level.

• Consultants were aware of the vision, strategy and aims for CESP North East and had an input in their development.

• CESP North East was proactive in seeking patients’ views and their experience of care and treatment received; audits provided showed 93% of patients viewed the service provided as either excellent or very good.

However, we also found the following areas of improvement in surgery:

• We observed that the theatre (Theatre 3) used for procedures during our inspection was in need of updating and repair.

• CESP North East did not have:

  • an incident reporting policy separate to the host hospital.

  • a complaint procedure separate to the host hospital.

  • a surgical risk register separate to the host hospital and processes for assessing risks were not fully developed.

We found the following good practice in the outpatients department:

• During the previous twelve months there were no never events, serious incidents or safeguarding alerts reported regarding the outpatient department.

• The department was well decorated, bright, maintained to a high standard and had hot and cold drinks facilities for the use of patients and visitors.

• All medicines were stored safely and securely and processes were in place including medicines reconciliation to ensure these were safe for use.

• There was a designated team who worked in outpatients, there were adequate numbers of skilled staff to meet the needs of people using CESP North East.

• We observed good multidisciplinary working and communication between the teams in the clinic during the outpatient clinics observed.

• Patients were treated with care, compassion, and respect by all staff during their visit to the outpatient department.

• Consultations were conducted in a friendly, calm and informative manner and time was taken to answer any questions or concerns raised. Patients told us they felt reassured following their consultation.

• The average wait to receive an appointment following surgery was a maximum of two weeks.

• CESP North East was proactive in seeking patients’ views and their experience of care and treatment received.

Following this inspection, we told the provider of actions it should take, even though a regulation had not been breached, to help the service improve.

Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals