On the day of our inspection no surgery was taking place, a follow-up clinic was taking place for people who had previously received treatment. We looked at four personnel files and spoke to three staff. We also spoke to three people and looked at the files of six people who had received treatment.

People told us they had sufficient information before consenting to treatment and were able to ask staff questions. All the people we talked to were happy with the service they had received. We found the provider was responsive to people's needs and one person told us the provider had: "Tried everything to get you to where you want to be." People were clear about the process of making contact if they had any concerns following treatment and felt staff had the skills to support them effectively.

Staff we spoke with demonstrated a good understanding of infection control and how to minimise the spread of infection. Staff told us they had all received infection control training and documents we reviewed confirmed this.

We saw evidence that staff had requested and gained consent of managers to complete additional training courses. We had at a previous inspection identified concerns in how the provider monitored staff registrations and in record keeping. At this inspection we found that new, more effective systems had been established to resolve this and the provider had changed working practices to ensure all required checks were completed and recorded appropriately.

During and after the inspection visit we spoke to four people who had used the service. We looked at three care files, spoke with four staff and looked at five personnel files. We also looked at a number of operational documents to inspect this service.

We saw that the providers had involved patients in their care by giving them lots of information about their procedures, one person told us, “I was given everything and got it all explained to me”. Patients were very happy with the care they received one person said, “I could not fault it, absolutely excellent”. Although this was a hospital it was not open 24hrs, but sound provision was in place for out of hours cover.

Health and safety measures protected people using the service. The equipment used to provide treatment was maintained with contracts in place, and safety measures were observed with any equipment which presented a higher risk to people using the service, visitors or staff.

Staff were supported in their roles to continually improve. A schedule of audits of the service were in place and the results were used to make a positive effect for all the people involved with the service.

Record keeping was an issue for the provider, and presented a potential risk to people using the service that the records would be inaccurate or misleading.

Optegra Birmingham is an eye hospital located in the centre of Birmingham, within the Aston University campus. It is approximately three miles off junction six of the M6 motorway.

The hospital provides services to adults only. In the UK, Optegra operates seven dedicated eye hospitals in Birmingham, Hampshire, Manchester, London, Surrey and Yorkshire and Central London. Optegra Eye Hospital Birmingham is registered with the Care Quality Commission and was acquired by Optegra UK Ltd in April 2010. The site was previously known as Aston University Day Hospital. The service covers the complete patient pathway, from ophthalmic consultations and diagnostics through to disease management or treatments including day surgery for adults.

The hospital is open Monday to Saturday. The service welcomes patients through three main routes; NHS, those who have access to private medical Insurance, and those who choose to self-fund.

Optegra Eye Hospital Birmingham provides a comprehensive range of ophthalmic services to patients. These include refractive, ocular plastic, retinal diagnostic, surgical services and ophthalmic disease management. Specific services cover:

• outpatient ophthalmic consultations
• ophthalmic diagnostics
• cataract diagnostics and treatment including surgery
• retinal disease/injury diagnostics and management or treatment including surgery and anti- vascular endothelial growth factor injections
• corneal disease/injury diagnostics or treatment including surgery
• glaucoma diagnostics and disease management or treatment including surgery
• conjunctiva, sclera, eyelid and eyebrow, lacrimal, globe and orbit disease/ injury diagnostics and management or treatment including surgery. Optegra Birmingham does not offer cosmetic surgery.
• Minor injuries and non-urgent treatments.

The hospital is set on one floor (ground) and has six consulting rooms, a reception area, four patient liaison rooms, four diagnostic rooms and a lift. It also has an IT server room, a patient surgery waiting area, staff room, laser refractive theatre, staff changing areas, a clinical office, nurses’ office, two pre-operative areas, an ophthalmic operating theatre and an administration office and board room.

During the year before our inspection (1 August 2016 to 31 July 2017) the hospital recorded 2,744 surgical procedures. These included 363 refractive intra ocular lens surgeries, 2,109 cataract surgeries, 14 vitreoretinal surgeries, four age-related macular degenerative injections, six oculoplastic surgeries , 141 refractive laser eye surgeries and 107 glaucoma surgeries.

In the 12 months before our inspection, staff saw 2,032 patients for initial consultations and 3,373 patients for follow-up appointments. Four of these patients were 18 to 24 years of age.

We inspected this service using our comprehensive inspection methodology. We have reported our inspection findings against the two core services of surgery and outpatients. We carried out the announced part of the inspection on 6 September 2017, along with an unannounced visit to the hospital on 10 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 – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated this service as good overall because:

• Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.
• Staff assessed, monitored and managed risks to patients on a day-to-day basis.
• Staff managed medicines consistently and safely. Medicines were stored correctly, and disposed of safely.
• The environment and equipment were clean and maintained to a good standard throughout the hospital.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Staff planned and delivered patients’ care and treatment in line with current evidence-based guidance, standards, best practice and legislation.
• Staff worked collaboratively across disciplines to meet the range and complexity of patients’ needs.
• Staff obtained consent to care and treatment in line with legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004. Staff supported patients to make decisions and, where appropriate assessed and recorded their mental capacity.
• Feedback from patients who used the service and those who were close to them was positive about the way staff treated patients.
• Staff treated patients with dignity, respect and kindness during all interactions. Patients told us they felt supported and that staff cared about them
• Staff considered and acted on patients’ needs and preferences to ensure they delivered services in a way that was convenient. Staff reflected the importance of flexibility, informed choice and continuity of care in the services provided.
• Patients could access the right care at the right time. Staff managed access to care in a way that took account of patients’ needs, including those with urgent needs.
• The telephone and online system was easy to use and supported patients to make appointments, bookings or obtain advice or treatment.
• Patients knew how to give feedback about their experiences and could do so in a range of accessible ways, including how to raise any concerns or issues.
• The interim managers had the experience and capability to ensure that the strategy could be delivered and risks to performance identified and addressed.
• The interim leadership was knowledgeable about issues and priorities for the quality and sustainability of services, understood what the challenges were and were acting to address them.
• There was a clear statement of vision and values, driven by quality and sustainability.
• The board and other levels of governance in the organisation functioned effectively and interacted with each other appropriately.
• There was a strong participation in research.
• The eye services monitored performance and produced a clinical outcomes report that reviewed complication rates and clinical outcomes data for various procedures performed at the hospital.

However:

• There was no root cause analysis for a never event that took place in 2016.
• Not all staff had signed to say they had read the ‘local rules’ to assure themselves that risk of radiation to patients was minimised.
• Not all lasers conformed to BS EN 60601-2-22 standards to assure the use of equipment kept patients safe from avoidable harm.
• The hospital did not submit data to Private Healthcare Information Network (PHIN) in accordance with legal requirements regulated by the Competition Markets Authority (CMA).
• Not all surgeons held the Royal College of Ophthalmology Certificate in Laser Refractive Surgery.

Heidi Smoult

Deputy Chief Inspector of Hospitals