On the day of our inspection visit we had the opportunity to speak with one person who had returned to Face & Eye for further treatment for cataracts.They told us that they were very happy with the information and treatment they received on their first visits to the clinic and were therefore happy to return for further treatment.

People only gave their consent to any proposed treatment once they were clear about the options available to them. Once a decision was made, the details were re-confirmed with the person and a consent to treatment form was signed.

We looked at thirteen patient files and found them to be detailed and consistent in their contents and information. We found that a high standard of hygiene and cleanliness was maintained throughout the premises with daily and weekly checklists in place for general clinic areas and theatre set up and shutdown. All staff had received infection control training.

During our tour of the premises we found all parts to be in an excellent state of repair. Records were in place to indicate that equipment servicing and maintenance checks were being maintained.

We found that the provider had suitable systems in place for receiving, handling and responding to complaints.

On the day of our visit to the clinic no treatments were taking place but we did have the opportunity to speak with one patient who had returned to the clinic for their post operation meeting with the consultant following their surgery.

They told us they were extremely happy with everything about the treatment they had received at the clinic. We were told they were involved ‘every step of the way’ in discussions about their planned surgery and consultations took place with the Consultant Surgeon both pre and post operatively. Comments included, “I was fully informed about all parts of the treatment and options available to me, including the costs. I also signed to give my consent.”

Information about each person was kept electronically, with some information being kept in paper format.

We spoke with two members of staff and asked them if they felt they were supported to do their job. They told us they were supported and that the training in particular was very good.

The registered manager carried out monthly audits (checks) of various aspects of the service in accordance with good practice and good clinical governance. The audit schedule for 2013 included, infection control, patient records, surgical site infections, training files, health & hygiene, health & safety, fire safety and use of laser equipment.

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Face and Eye Clinic is operated by Manchester Eye and Cosmetic Clinic Limited. The facilities include a reception with a comfortable chaired area, one operating theatre, three consulting rooms, one diagnostic room, one treatment room/laser room and four day case chairs in the post-operative discharge area.

The service provides surgery and outpatients. We inspected surgery and outpatient services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 10 October 2017, along with an unannounced visit to the service on 19 October 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 clinic 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:

• There were systems in place to protect patients from avoidable harm and learn from incidents.
• The service was visibly clean and well maintained. There were systems in place to prevent the spread of infection.
• There were effective systems in place to ensure that equipment was safe and ready for use.
• There were effective arrangements in place to ensure staff had, and maintained the skills required to do their jobs.
• Care was delivered in line with national guidance and outcomes for patients’ were good.
• The service had developed local safety standards for invasive procedures which included the use of the World Health Organisation checklist (WHO) for all surgery performed. The use of the WHO checklist ensures the correct procedure is competed on the right patient.
• There were arrangements for obtaining consent ensuring legal requirements and national guidance was met.
• The individual needs of patients were taken into account to ensure patients received safe care and treatment
• Patients’ could access care when they needed it and were treated with compassion. Their privacy and dignity was maintained at all times.
• The service management team had the confidence of patients and their team. Staff felt motivated and supported by the management team.

We found good practice in relation to outpatient care:

• The reception area was clean, modern and bright and provided ample seating for patients to sit and relax.
• We saw that patients were greeted by professional reception staff on arrival at the clinic.
• Patients were encouraged to complete patient surveys so the service could learn from their feedback.
• There was hot and cold drinks on offer for all patients who attended the clinic.
• Patients did not have to wait long following arrival before being seen by their consultant.
• There was a booking system in place to ensure patients were seen in a timely way from referral to treatment.
• There were safety procedures in place for the use of the laser.
• There were procedures in place to support patients who requested a chaperone during their consultation.

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

• Access to the theatre was not secure which did not comply with Health Building Note (HBN) guidance.
• There was not a formal meeting structure in place for a Medical Advisory Committee to ensure that the medical team were regularly updated as to their performance and review their outcomes for their patients.
• There was no assurance system that all the staff had read and signed they had understood policies, procedures and risks associated with the clinic or their areas of responsibility as policies and risks were updated.

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. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)