My-iClinic is operated by My-iClinic Limited. The clinic opened in 2012 and offers outpatient and day surgery facilities in North London. The clinic is situated on the ground floor of a residential block and includes one operating theatre, a pre and post-operative area, three consultation rooms as well as four separate areas designed for tests to be carried out.

The service provides surgery, services for children and young people, and outpatients and diagnostic imaging. During our reporting period of April 2016 to March 2017, the hospital recorded 345 visits to theatre, all of which were for cataract surgery. The clinic only performed surgery on adults. There were 458 outpatient attendances recorded, 14 of which were by children and young people under the age of 18. Children were treated for squint (an eye condition, where the eyes do not look in the same direction. This means that one eye may not focus on an object someone is looking at.) The majority of outpatient attendances were for pre-operative and post-operative cataract consultations; 74 attendances were for laser procedures post cataract surgery and 19 for intravitreal injection for the treatment of age related macular degeneration.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on the 19 September 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 hospital was surgery. Where our findings on surgery service– 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 requires improvement overall because:

• There was no system to ensure the correct storage of medicine in the outpatient area.
• Although the clinic used a surgical safety checklist, we observed some steps of the checklist were not fully embedded in practice.
• Daily checks of the sterilisation machine were not routinely completed, which was not in line with manufacturer's guidance.
• Cleaning products were not stored in locked cupboards as required by the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
• The service did not participate in National Audits and there were no system in place to monitor clinical outcomes and benchmark against similar services.
• There was limited local audits to monitor compliance against the local policies.
• There was no Medical Advisory Committee in place to provide oversight on quality.
• Discussions during the discharge process were not held in private and could be overheard by other patients.
• Although the clinic offered services to children and young people, staff did not have access to a paediatric nurse. This was not in line with Royal College of Nursing guidance.
• Although the leadership team were aware of some of the risks within their service, these risks were not formally recorded on a risk register or regularly discussed to ensure these risks were being mitigated.
• The clinic did not have a laser protection advisor to provide the appropriate professional assistance in determining hazards and assessing risks related to laser use.
• The waiting area did not have a children's area and there were no activities or toys available.

However:

• We saw that systems were in place to ensure a good level of cleanliness and hygiene throughout the clinic.
• Systems were in place for staff to report incidents and we saw incidents were investigated and staff received individual feedback.
• A maintenance schedule was in place to ensure all equipment at the clinic was maintained and serviced.
• Theatre list and clinics were planned in advance and there were enough staff with the right skills to ensure patients received safe care.
• Patient care pathways were based on National Institute for Health and Care Excellence (NICE) and Royal College of Ophthalmology guidelines.
• Staff were up to date with their mandatory training and we saw staff also received additional competency training for the specific tasks that they undertook.
• Pain was assessed post-operatively and we saw patients received appropriate advice on how to manage their pain after discharge.
• The rate of post-operative complication was lower than the national average.
• Without exception, patients told us they were treated with kindness and compassion by all staff.
• Patients spoke positively about the service and the care they had received.
• Patients were fully involved in their care and staff explained procedures to them as well as providing them with clear written information.
• Staff spoke very positively about the leadership of the service; staff felt engaged and enjoyed working at the clinic.
• We saw effective communication and partnership working between the different professional groups.
• Patients were able to self-refer to the hospital and the service arranged appointment and surgery times to meet the needs of the individual patient. This included staggered surgery times to ensure patients were not waiting for long periods of time.
• The management team worked hard to engage staff and we saw staff views were listened to. Attempts were also made to engage with the public and promote the services offered by the clinic.

Amanda Stanford

Deputy Chief Inspector of Hospitals

No treatments or consultations were taking place on the day of our visit. We spoke with staff and viewed patient records. Staff files, equipment maintenance records and policies. The operating surgeons were away, and we spoke with a staff nurse and reception staff. We arranged to speak to patients who had received treatment recently on the telephone to obtain their feedback about the service. People told us "my experience has been wonderful, if only other services could be as good as this" and "the space in the clinic was so comfortable, which helped calm me."

Detailed information was available for prospective users of the service in the form of patient’s guides, also available on the provider's website, describing the various eye treatments and surgery. This information covered important details such as potential risks and side effects of treatments and the suitability of the various treatments available. Such information supported people to make informed choices.

Records showed treatment and surgery was carried out in line with evidence based pathways which were devised by the staff team There were arrangements in place to deal with foreseeable emergencies. The clinic appeared clean throughout and infection control measures were maintained. Equipment in the clinic was mostly new, in good operational order and regularly checked.

We found some concerns about the monitoring of quality in the practice and we also identified that staff supervision and appraisals were not taking place.

We reviewed records and spoke to staff. We reviewed staff files and equipment maintenance records. We spoke to with two patients who used the service and were satisfied with the care and treatment received.

We reviewed consent forms signed by the patient’s who use the service. We were told by staff that these forms were signed before patient’s received any care and treatment.

We spoke with two patients who used the service who told us that their needs were assessed and treatment was planned and delivered in line with their individual care.

We spoke to the staff who told us about the training they receive. We saw the qualifications for all the staff. Staff received appropriate professional development in terms of supervision and appraisal although this was not recorded. The Doctors at the clinic had had supervision and appraisals which were recorded.