We carried out a routine inspection of the Midland Eye Institute on 6 December 2013. We looked at how people were involved and treated at each stage of their care and treatment. We looked at the process used by the service to assess the quality of care given to people. We spoke with staff and we spoke to five people who used the service.

Midland Eye Institute offered a wide range of specialist eye treatments including cataract surgery, clear lens exchange and corneal grafts. The finance manager told us approximately 90% of their work was for cataract surgery and approximately 50 % of referrals came from the NHS.

We observed staff interacting with people with dignity and respect.

We spoke with five people who used the service. Most were very happy with their care and treatment, one stated, ”Superb treatment as always, was here three years ago, standards still maintained 110% thanks to all.”

We reviewed how staff were recruited and trained. We spoke with four staff members and examined eight staff records. We found staff training records and competency assessments were inconsistent. We noted the provider was in the process of implementing a staff training and competency assessment database to improve this

We looked how the service measured quality. We saw the service had an audit process in place and carried out regular quality monitoring activities. This was part of an ongoing programme to improve care for people who used the service.

On the day of the inspection there were surgical procedures in progress so we were not able to view the treatment and recovery room, but we did observe people being admitted to the service, waiting to be seen and post operatively. We spoke to four people following treatment who told us that were delighted with the care they had received. One person said “I have been well looked after” and all praised the staff for their professional yet friendly manner.

We were able to look at staff rotas, policies and procedures, risk assessments and patient records. We also spoke to members of staff who told us they had worked for the provider for a number of years and they really enjoyed their job “it is like a family”.

There was a general view that the service was professional, that people were treated respectfully and given enough information to make choices about their treatment. Comments also suggested that the staff were very competent and that people were happy with the service they received and would return for further treatment. One person said “it is nice to be treated as a person and not a number”.

We visited the service on 15 March 2012. The registered manager told us that the service treated people over eighteen years old. These were private patients and also NHS patients for some small procedures.

We saw from patient files that people were given clear information before consultations and surgical procedures. This included information about the consultant, about their condition and about any surgical procedure.

We spoke to the relative of a person who was undergoing surgery on the day of our visit. They told us that the service had sent a lengthy form explaining the procedure, the risks and the possible outcomes. The patient was asked to sign each paragraph to show they had read and understood it. Their consent signature then had to be witnessed.

We saw that the service had systems for assessing and managing risks. Workers had undertaken training in risk management. This included issues that can affect consent such as mental capacity.

We saw that the provider had quality assurance systems in place. The service engaged and acted on the advice of specialist health and safety and risk management consultants to undertake periodic audits. This included a laser protection advisor. Patient satisfaction information was gathered and this included a review in 2011 of the average waiting times experienced at the clinic by private patients.

On the day of our visit we spoke to a person who told us that they had been brought with a number of other people from Staffordshire for their NHS funded treatment. They had just had surgery. They told us "it couldn't be better, it's perfect...no I didn't have to wait today. The nurses were very nice." We asked the person if they were told what to expect and what was happening. They said, " I'm a bit deaf and the doctor raised his voice so I could hear better. I told them I have arthritis and they made sure that I was positioned comfortably."

Another person from Staffordshire told us that they had an appointment for twelve noon that day and were still waiting at one forty five. They said they were relieved however to be getting their NHS funded treatment that they had waited some time for.

We saw that nurses and reception staff were friendly. They treated people with warmth and respect and made sure that people had refreshments while they waited.

The manager is registered with us.

Midland Eye is operated by Aspen Healthcare. Aspen Healthcare is a group healthcare provider that provides independent services across the UK. The Midland Eye clinic is an ambulatory day surgery clinic with no inpatient beds or wards. Facilities include an operating theatre, an anaesthetic room, a small recovery area, a pre-assessment room, a diagnostic room, three consultation rooms and two patient waiting areas.

The service provides surgery, and outpatients and diagnostic imaging. We inspected both of these core services. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 26 and 27 September 2017, along with an unannounced visit to the hospital on 11 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 Midland Eye as good overall.

We found good practice in relation to surgery and outpatients:

• Patients were protected by a strong comprehensive safety system, and a focus on openness, transparency and learning when things went wrong.

• The safety systems in place kept patients safe from avoidable harm, which was reflected in an excellent track record in safety.

• Staffing levels were appropriate to keep people safe at all times.

• The clinic invested in staff training, skills and competence. Competence of staff was integral to achieving the service’s aim of providing first class healthcare.

• There was a comprehensive suite of policies and procedures that supported staff in providing high quality, safe and effective care. The policies and procedures were reviewed regularly and were in line with current best practice guidelines and legislation.

• Patients had good outcomes because they received effective care and treatment that met their needs. Outcomes were routinely monitored and reviewed alongside patient experience to assess quality of care.

• Staff treated patients with compassion, kindness, dignity and respect. Patients were respected and valued as individuals and were empowered as partners in their care.

• The clinic provided patient centredcare and treatment. Services were organised and tailored to meet the needs of the individual patients. The clinic delivered services in a way that ensured flexibility, choice and continuity of care.

• The leadership, management and governance of the clinic assured the delivery of a high-quality person-centred care, supported learning and innovation, and promoted an open and fair culture.

• Governance and performance management arrangements were proactively reviewed and reflected current best practice.

• Risks were clearly identified and monitored effectively. Performance issues were escalated to the relevant committees and the board through clear structures and processes.

• Patients and staff were highly respected and valued. A full and diverse range of patients’ views and concerns were encouraged, heard and acted on.

• Information on patient experience was reported and integrated with performance data to give a clear and accurate all round picture of quality and safety.

We found areas of practice that require improvement in relation to surgery and outpatients:

• We found that patient identifiable information was not always present on all pages within the paper notes and the authorised signature sheet at the front of the notes were not always completed. Correspondence letters to other health professionals did not always have a penned signature present. On our return visit, the clinic had put things in place to ensure that these issues were rectified

• The clinic did not have a designated area for recovery and patients had to recover in the shared waiting area. Although no patients raised this as an issue, staff recognised that the shared waiting and recovery area was not ideal for patients privacy.

• The clinic was not currently submitting data to the Private Healthcare Information Network (PHIN).

Following this inspection, we told the provider it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals