Essex Vision at Westland Medical Centre is operated by Essex Ophthalmology Services Ltd. The provider is based on the first floor of a two storey purpose built building. Facilities include a minor operating theatre, laser room, two consulting rooms and outpatient and ophthalmic diagnostic facilities.

The service offered a range of ophthalmic treatments and surgery for conditions such as glaucoma, medical retina disease, diabetic retinopathy, corneal disease, macular disease, oculoplastic procedures, and orthoptics (treatment of the irregularities of the eyes).

The service provides surgery services and outpatient and diagnostic imaging for a number of eye conditions for patients over the age of 18. We inspected these services under the frameworks for surgery and outpatient inspections.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 December 2017 with an unannounced visit to the service on 21 December 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.

The main service provided by this service was surgery. 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 service as good overall.

We found good practice in relation to surgical care:

• Patients received care in visibly clean and suitably maintained premises and their care was supported with the right equipment.
• The service used evidence based practice from the National Institute of Health and Care Excellence and the Royal College of Ophthalmologists.
• The service was well staffed and all staff had undertaken mandatory training including appropriate safeguarding training. There was no agency staff used.
• The consultants worked well together and provided cover for each other if necessary.
• Access and flow of patients through surgery was well managed with processes in place to minimise the risk to patients. Patient feedback was good and the service provided quality care to patients.
• Leadership was strong from senior staff and from consultants with regular meetings to review and disseminate information and patient related issues to staff.

We found good practice in relation to the outpatients service:

• The outpatient department (OPD) processes for referral into the service worked well and the provider was able to allocate appointments in a timely manner due to the efficiency of the systems in place and referral to treatment times were always less than two weeks. This ensured patients were able to access care rapidly.
• Referrals to the service reduced outpatient appointments at local hospitals, and offered patients a more accessible service in the community with lower waiting times.
• Staff took a patient-centred approach in the interactions we observed and regularly asked the patient if they could be made more comfortable
• The service would regularly run Saturday and Wednesday afternoon clinics to facilitate working patients and elderly patients who would require family members to attend with them.
• There were procedures in place for safety of the use of lasers in the OPD. Fire safety was part of the induction process and risk assessments had been completed to reduce the risk of fire in all parts of the service.

However, we also found the following issues that the service provider needs to improve:

• The application of the duty of candour was not included in the incidents policy.
• Additional audit activity needed to be developed for patient outcomes.
• There was no information available for patients whose first language was not English.
• Laser protection protocols were not signed as read by consultants working with the service.
• The resuscitation bag was not sealed and tamper proof.

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. On our unannounced return we found some improvements had been actioned.

Amanda Stanford

Deputy Chief Inspector of Hospitals