CESP (Somerset) LLP @ Musgrove Park Hospital is operated by Consultant Eye Surgeons Partnership (Somerset) LLP. The service is provided at Musgrove Park Hospital. Facilities include operating theatres, a day surgery ward, and outpatient facilities.

The service provides cataract day surgery and follow up outpatient appointments for adults. All patients are NHS funded and surgery is undertaken as part of a contract with a local acute NHS trust in an attempt to reduce waiting times for cataract surgery. Surgery is undertaken on a Saturday with follow up outpatient clinics taking place at least once a month, also on a Saturday. All surgery is carried out using local anaesthesia. All patient activity is part of the surgery pathway.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 September 2017, along with an unannounced visit to the service on 30 September 2017. We inspected surgery for adults.

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 patient’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 patients told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated this service as requires improvement overall.

We found practice which required improvement:

• We found that clinical complications were not always individually reviewed and learning taken from them.
• No resuscitation trolley checks were completed in theatres on a Saturday while CESP (Somerset) were providing a service.
• No checks were made of fridge temperatures on a Saturday while CESP (Somerset) were providing a service.
• Medicines were not always managed safely or administered by suitably qualified staff.
• Records were not always stored in a way to maintain patient confidentiality.
• Safeguarding vulnerable adults was not given sufficient priority.
• World Health Organisation five steps to safer surgery checklists were not evident in all patients records.
• The provider did not have a complaints leaflet specifically for their service.
• There were underdeveloped governance arrangements to ensure that quality and safety were a top priority.
• There were limited governance arrangements in place to identify, capture and manage risks.

We found good areas of practice:

• All areas visited were visibly clean and actions were taken where standards of cleanliness dropped below what was expected.
• All patient records were complete, legible and up to date.
• Most staff were up to date with mandatory training. There were robust systems in place to ensure that the organisation had oversight of training, competency and validation.
• Evidence based care and treatment was provided which reflected best practice.
• Patient outcomes were positive and benchmarked as better than other similar services.
• A multidisciplinary approach was embedded as part of the service. This included between theatre, ward and outpatient staff.
• There were processes in place to ensure that consent and the Mental Capacity Act were fully considered.
• Patients that had been cancelled in the last 12 months were quickly rebooked.
• Patients received compassionate care from staff who were thoughtful and spent time to ensure that patients’ needs were fully met.
• Staff involved patients as active partners in their care and took the time to ensure that emotional support was provided.
• Patients, staff and the local acute NHS trust were positive about how the service was run. Patients were pleased they were able to have Saturday appointments and were positive about the impact on waiting times.

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 two requirement notices that affected surgery. Details are at the end of the report.

Amanda Stanford - 

Interim Deputy Chief Inspector of Hospitals