We spoke with two people who used the service. They said their treatments were clearly explained to them and they had signed to confirm they consented to the planned treatment. One person said, “I have been having treatment for about five years and the staff are very professional and kind.” Another person said, “My treatment was excellent my sight has improved, because the treatment was successful.”

People’s care and treatment was planned according to their particular needs. The provider acted to ensure the safety and welfare of people who used the service. We saw that each person had an individual treatment plan which took account of personal factors, such as their medical history and occupation, which might affect their treatment options and after care.

There were effective systems in place to reduce the risk and spread of infection. Appropriate guidance was available and had been followed.

Staff received appropriate professional development. We saw staff had accessed various training to maintain their qualifications and ensured they had the skills to meet people’s needs. Staff we spoke with told us they had received the training and support they needed to do their job well.

The hospital had effective systems to regularly assess and monitor the quality of service people received. We saw surveys had been used to gain people’s views and a system for raising concerns was in place. Regular checks had been made to assess how the hospital was operating.

We saw the provider had a consent policy in place which covered all areas of consent. We looked at care records of four people who used the service. Each record contained a consent form that showed the above policy had been followed with correctly dated signatures on consent forms both during pre-operative assessment and on the day of the procedure.

The records we looked at included pre-assessment notes which included information about the person's medication, medical history and allergies. They also contained eye tests and anaesthetic checks. Care was supported by a surgical pathway care plan which we saw was completed in each case.

We found there were effective systems in place to reduce the risk and spread of infection and staff were appropriately trained. There were enough qualified, skilled and experienced staff to meet people’s needs in all the areas of the hospital.

People were made aware of the complaints system. This was provided in a format that met their needs. We asked for and received a summary of complaints people had made and the providers' response.

However, there was a concern found regarding the maintenance of up to date medicines for emergencies.

We spoke with one person who uses the services and the person stated that they could not fault the care they receive.

Optegra Yorkshire Eye Hospital is operated by Optegra UK. The hospital provides a range of ophthalmic services to NHS funded and private-fee paying adults only. These include refractive, ocular plastic and retinal diagnostic and surgical services and ophthalmic disease management.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 November 2017, along with an unannounced visit to the hospital on 14 November 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 the hospital was surgery. The hospital also provides outpatient services for adults. We inspected the surgery and outpatients services. The surgery and outpatient services worked closely together with staff working between disciplines. Where our findings on surgery – for example, management arrangements – also apply to outpatient services, we do not repeat the information, but cross-refer to the surgery core service.

We rated this hospital as good overall. This was because: -

• There was a policy for managing and reporting incidents and staff understood how to report incidents.

• There were no never events or serious incidents reported by the hospital during the last 12 months. Incidents were investigated to assist learning and improve care.

• The staffing levels and skills mix was sufficient to meet patients’ needs. Patients received care and treatment by trained, competent staff that worked well as part of a multidisciplinary team. The majority of staff had completed their mandatory training and annual appraisals.

• There had been no safeguarding concerns raised by the services during the past 12 months. Most staff had completed adults and children safeguarding training and were aware of how to identify abuse and report safeguarding concerns.

• Patients received care in visibly clean and appropriately maintained premises. Suitable and well maintained equipment was available to support patients. Resuscitation equipment was available for use in an emergency.

• The theatre staff completed safety checks before, during and after surgery and demonstrated a good understanding of the ‘five steps to safer surgery’ procedures, including the use of the World Health Organization (WHO) checklist.

• The services measured patient outcomes through clinical audits. Audit data and patient reported outcomes measures (PROMs) showed the hospital performed in line with national and local standards for lens exchange treatments and cataract surgery.

• Staff sought consent from patients before delivering care and treatment. Staff understood the guidance around ‘cooling off’ periods and we saw that minimum cooling off periods of at least one week were observed.

• Staff understood the legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards.

• Patients and their relatives spoke positively about the care and treatment they received. Patients were kept fully involved in their care and the staff supported them with their emotional needs.

• Feedback from patient surveys showed that patients were positive about the care and treatment they had received.

• The hospital provided a 24 hour helpline for advice to patients outside of normal working hours. Consultants were available during normal working hours to review patients if staff felt medical input was required.

• The initial patient consultations allowed staff to plan the care and treatment in advance so patients did not experience delays in their treatment.

• The average waiting time from referral to treatment was approximately seven weeks for NHS funded patients and approximately eight weeks for private fee paying patients. There were no procedures cancelled or rescheduled between July 2017 and September 2017.

• The hospital was accessible for patients with mobility issues and wheelchair users. Patient complaints were managed effectively and information about complaints was shared with staff to aid learning.

• There was effective teamwork and clearly visible leadership across the hospital. There was routine public and staff engagement and actions were taken to improve the services.

• The hospital’s vision and values had been cascaded and staff had a clear understanding of what these involved.

• There was a clear governance structure in place. Key risks to the services were recorded and managed through the use of a risk register. Audit findings and quality and performance was routinely monitored.

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

• Patients were informed about off-licence use of cytotoxic medicines as part of the consent process. However, the Mytomicin C consent form referred to an international medicines regulator and not the licensing authority for medicines in the UK.

• The hospital did not routinely submit data to the Private Healthcare Information Network (PHIN) in accordance with legal requirements regulated by the Competition Markets Authority (CMA).

• We found some medicines openly stored in cupboards within unlocked consultation rooms in the outpatient’s area.

• Outpatient clinic wait times (from arrival to being seen) were not routinely monitored by the service.

• We did not see patient information readily available in different format, such as large print that would be useful for patients with impaired sight.

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 Region)