Optegra Surrey Eye Hospital is part of a nationwide company, Optegra UK Limited. The hospital has no inpatient beds but provides an ophthalmic surgery and outpatient service. Facilities include one ophthalmic operating theatre, one laser refractive theatre, outpatient and diagnostic facilities. The hospital provides services to adults only

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 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 services provided at this hospital included ophthalmic disease management, refractive eye surgery, oculoplastic, retinal diagnostic and general surgical services. The surgery and outpatient services worked closely together with staff working between departments. 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 because

• Openness and transparency about safety was encouraged. We observed a positive approach in theatre to completion of the safe surgery checklist in line with World health organisation (WHO) ‘Five steps to safer surgery’. Comprehensive auditing and a culture of “No WHO, no operation’ ensured all staff were engaged with the process.

• The hospital maintained standards of cleanliness and hygiene. We observed environment to be visibly clean and tidy with good use of personal protective equipment and good hand hygiene practices throughout the hospital.

• The hospital had developed a safe staffing policy and had a locally developed tool used to ensure staffing was appropriate across the hospital.

• There was a comprehensive annual audit plan and we saw that the results were discussed at staff meetings and areas for improvement were identified and actioned.

• Staff we spoke to had completed an appraisal and told us that the appraisal process was of value.

• There were processes to gain consent that were in line with legislation and guidance. The process for seeking consent was monitored.

• Staff routinely collected information about people’s care, treatment and outcome. The hospital had access to an eye science department, whose role was to collate outcome data and for all consultants. All Consultants had access to their data. Each quarter this outcome data was benchmarked across the business.

• Staff monitored laser protection processes and we saw the laser protection supervisors were up to date with training.

• Patients told us they were well looked after and that the staff were caring and kind. We observed positive interactions by staff and that patients were cared for in a professional and compassionate way throughout the hospital

• The development of a patient liaison role focussed on giving the patient a constant point of contact throughout their stay and supported continuity of care.

• There was flexibility in the planning and delivery of services which met the patient needs. There was flexible management of theatre operating time and clinics.

• There was no waiting list of patients for refractive eye surgery. There were no breaches of the 18 week pathway recorded for NHS patients.

• The service recognised that patients had individual needs and might need support with communication and were able to provide assistance in hearing and translation.

• There was clear patient information on how to make a complaint and complaints received were managed in line with policy. Learning from complaints was shared with staff.

• There were clear lines of management responsibility and staff knew who their line managers were and spoke of their managers as being approachable and supportive.

• There were corporate values and a statement of purpose which was displayed around the hospital

• The hospital undertook a caring, responsive, effective, well led, safe (CREWS) audit on a regular basis which measured the readiness of the hospital to receive patients in line with the safety and compliance.

• There was a comprehensive integrated governance structure in place.

• Active staff engagement included open communication and a staff recognition scheme.The annual colleague engagement programme showed staff engagement to be very good.

• Patient feedback was collected and results were acted on with a focus on learning and improving services.

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

• We identified concerns in relation to a lack of policies and staff competencies around dispensing and labelling of medicines. Eye drops were administered before the correct operative site had been marked which would increase the risk of an error occurring.

• In theatres, staff explained that medicines were prepared for dispensing before the doctor had prescribed them. This meant that there was a risk if the prescribed medicines deviated from the ones normally prescribed this might go unnoticed.

• There were no competency documents for Healthcare Technicians to ensure that staff had adequate skills and knowledge to care for patients.

• The anaesthetic machine in theatre was not checked on a daily basis. Staff told us the machine was not used, in which case it should been taken out of use or checked in line with guidance.

• There was no capnography monitoring available for use during sedation in line with guidance. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommendations for Standards of Monitoring during Anaesthesia and Recovery 2015.

• The resuscitation trolleys checked were tamper evident which meant the integrity of the emergency equipment could not be assured. We were told that new tamper evident trolleys were on order.

• Records showed that the hospital generator was not checked on a regular basis which did not give assurance that the generator would work in the event of a power failure.

• Mandatory training completion rates across the whole service were at 68% at the time of our inspection, this was worse than the hospital target of 95%.

• Training records showed that of the 35 staff listed there were 14 staff that had no basic life support or intermediate life support training. No formal administration of oxygen training was undertaken in line with guidance

• The training record for laser training was incomplete and did not give assurance that all staff had received training.

• The training database did not reflect that all staff had completed an induction programme.

• Staff had some basic training in dementia awareness and no training in learning disabilities. There were no care pathways in place for these patient groups.

• The risk register did not show a date when the risk stated was expected to be resolved.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements to help the service improve. We also issued the provider with one requirement notice that affected Optegra Surrey Eye Hospital. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

All three people whom we spoke with confirmed that the staff had provided them with enough information that helped them with their choices and decision making. They said, ‘the information they received included details of risks, benefit and expected outcomes’.

People told us they were happy with the service provided by the hospital. They said, “The hospital and staff are accommodating and appointments are flexible to meet our needs”. One person said “I was given appropriate information and support regarding my care and treatment”. Another person told us, “I wanted a specific treatment but, that treatment was not suitable for me. The consultant advised me on the treatment which was suitable, and I made the choice of treatment I wanted”.

We found the hospital had an effective recruitment policy in place and people who used the hospital were enabled to make complaints which were acted upon by the management.

Four people who used the service told us that they were provided with good information about their treatments and the cost of the different treatments. They told us that they found the written information provided very helpful and informative. They said, “The staff were always polite and helpful.”

We spoke to four people who used the services provided. They told us they were very happy with the service they received. They told us the staff respected them and listened to what they had to say about their treatment. An example given was, “I am having surgery today and I will have the second one next week.”

The people we spoke with told us the Ophthalmic Consultant made sure they understood their treatment and choice by giving information in a way they could understand. One person told us, “The Consultant spent time discussing my ophthalmic care needs and gave me options to consider before making any decisions.” Another person said “I had a full and thorough discussion regarding the health of my eyes before I made any decisions.”

People who used the service told us they signed their consent forms on the day of their surgery after the Consultant had discussed the procedure with them again.

People who used the service told us they were involved in the planning of their care; that the opthalmic consultant discussed their care options and treatments with them. People told us they were fully involved in all aspects of their care. They said that they felt that staff respected and recognised their individuality and human rights.

One person told us, “I have been using this service for a number of years and I am very happy. The staff respect me and they listen to what I have to say about my treatment.”

People we spoke with told us that the practice was comfortable and accommodating and that appointments were flexible to meet their needs.

People who used the service told us they felt safe and that they were in “good hands.” They said staff were knowledgeable and were able to answer their questions and queries.

People told us they were very happy with the care they received. They said they had been asked to complete a questionnaire on the services they received, and as a result patients were now kept up to date with waiting times. People told us they were informed of any delays within ten minutes and they were updated regularly if the delay was prolonged.