People we spoke with said that they were informed about the treatments that would help them and they had time to consider these options. They said they were happy with the treatment, care and support they received. They said they were able to ask questions and gain advice from their consultant about the treatment options available to them.

During our visit we spoke with three people who said they were very happy with their treatment and the quality of service provided to them. One person said "Staff were very good and went out of their way to help me. It was a first class service.” Another person told us that they were happy with the way the consultant looked after them. They told us they were seen very quickly and the service was excellent.

Members of staff we spoke with had received training about safeguarding people. They were clear about the appropriate action that would need to be taken if they became aware of an allegation or suspected abuse.

We found members of staff were well supported and the consultants were continuing with their professional development. We found all consultants working had been appraised.

There were systems in place to monitor the effectiveness of the service and liaised with the NHS Trust who provided the facilities, equipment and support staff required to undertake treatment. The service undertook regular audits and the results were shared with members of staff.

CESP (Portsmouth) is operated by Consultant Eye Surgeons Partnership (Portsmouth) LLP. The partnership is composed of six ophthalmic surgeons. CESP (Portsmouth) provided surgery at a local NHS hospital under a service level agreement which will be referred to as the host hospital throughout this report.

The host hospital facilities included three operating theatres, one with laminar flow (a system of circulating filtered air to reduce the risk of airborne contamination), X-ray, outpatient and diagnostic facilities. There was a bright, comfortable reception area where hot and cold drinks were available.

Because the host hospital is a separate registered provider these aspects are not included in this report.

We inspected the service using our comprehensive inspection methodology and inspected only the surgical element of the refractive eye service. We carried out the announced part of the inspection on 28th November 2017, along with an unannounced visit to the hospital on 1st December 2017.

The service specialises in intra-ocular surgery to remove cataracts and replace them with implanted plastic lenses, usually under topical anaesthesia. Other treatments designed to improve vision after cataract surgery were also offered, including laser therapy.

CESP (Portsmouth) provided elective ophthalmic services to around 155 private patients yearly. Patients were generally referred by their optometrist and either funded their own treatment or paid through an insurer. These people had visual problems caused by the formation of cataracts, where the natural lens in the eye becomes cloudy.

Once accepted for surgery, patients were seen and managed using the same protocols, procedures and documentation as the host hospital. They were treated at the end of the host hospital theatre list, which was usually conducted at the eye day case unit in the host hospital. Under a service level agreement with CESP (Portsmouth), the host hospital provided all the facilities and support staff required as well as prescribed medication and medical devices such as intra-ocular replacement lenses.

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 because:

• There were inconsistencies with record keeping in patients’ notes.

• Governance and oversight of the service level agreement with the host trust was not robust.

• We identified concerns regarding medicines management.

• We identified infection prevention control and cross-contamination risks.

• The patient leaflets did not include information on how to complain and how to obtain the advice in different languages.

• The vision and strategy did not sufficiently support risk management, succession planning and business sustainability.

However, we also found areas of good practice:

• Through the management consultancy firm CESP (Portsmouth) employed, purpose-designed software that used clear visual indicators to calculate and show compliance with key safety and regulatory guidelines.

• There was a designated lead for safeguarding vulnerable adults and partners were trained appropriately to recognise and report suspected abuse in vulnerable adults.

• Partners were up to date with mandatory training and there were effective systems in place to ensure that the organisation had oversight of mandatory training, competency and validation.

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.

• Robust arrangements for obtaining consent ensured legal requirements and national guidance were met.

• Patients were treated with compassion and their privacy and dignity were maintained.

• A multidisciplinary approach was actively encouraged and we saw good examples of positive interaction between providers and partners.

Amanda Stanford

Deputy Chief Inspector of Hospitals