We inspected Boston House as part of the comprehensive inspection of Wrightington Wigan and Leigh NHS Foundation Trust

Our key findings were as follows:

• Staff were experienced and had good levels of training and competency to carry out their role. The unit was effective at identifying and reporting incidents and safety concerns. Lessons were learnt when things went wrong and action was taken by staff when improvements needed to be made. The outpatients and diagnostic imaging service developed the service they provided by improving quality and safety by actively looking for ways to improve.

• Staff compliance with mandatory training was satisfactory and staffing levels were sufficient to safely meet the needs of patients. The environment was visibly clean and hygienic and equipment was clean and maintained correctly.

• Care was planned and delivered in line with evidence based guidance and practice. Staff followed National Institute of Clinical Excellence (NICE) guidelines and adopted best practice for eye care treatment and diagnosis. There was a good multidisciplinary team with good access to a range of specialties. We found that teams worked well together and worked flexibly to support each other and the needs of the patients. This led to a holistic service for patients who reported good outcomes following their treatment.

• Patients told us they felt they received an excellent service. They reported that the staff were kind and considerate and that they were treated with respect and dignity, they said they were listened to, kept informed and were involved in the treatment they received.

• The outpatient and diagnostic imaging service met the national target time of 18 weeks between referral and treatment known as referral to treatment times (RTT). They responded to individual patients’ needs and tailored services to meet the individual patient requirements. They listened to patient feedback and complaints and responded by modifying revising processes to improve the patient experience.

• The unit was well led on a local level, staff felt valued, supported and listened to and there was a positive culture within the unit. However, local management sometimes failed to adhere to quality assurance reporting practice to document the work they had done. Though action was taken managers could not always offer written evidence of this.

However, there were areas of practice where the trust could make improvements.

The unit should:

• The unit should ensure improvements to quality assurance documentation to record the actions taken to address issues following audits, investigations and action plans.

• The unit should comply with Trust resuscitation policy and use standardised equipment. They should obtain a further defibrillator, an arrest trolley and emergency medicines and provide access to such equipment on both floors of the unit.

The unit should establish and use a formal process for assessment of mental capacity; this should be documented in patient’s notes. They should document their determination of best interests when they undertake this process and record the options and final decision in the patient’s records.

Professor Sir Mike Richards

Chief Inspector of Hospitals