The Care Quality Commission
  • Hospital
  • Independent hospital

Archived: The London Eye Hospital

Overall: Requires improvement read more about inspection ratings

4 Harley Street, London, W1G 9PB (020) 7060 2601

Provided and run by:
London Eye Hospital Limited

All Inspections

11 and 16 October 2017

During an inspection looking at part of the service

The London Eye Hospital is a private hospital providing a range of eye treatments and surgical procedures to adults. All patients are self-funding. Although they offer treatments for a wide range of eye conditions, they specialise in lens implants and cataract treatment. One of the procedures carried out as part of the service is lens implants for patients with age-related macular degeneration (AMD) which is a progressive disease of the macula (the central area of the retina) and a cause of sight loss. The total number of lens implant surgeries carried out between September 2016 and September 2017 was 379.

The London Eye Hospital is operated by The London Eye Hospital Limited. There are two locations linked to London Eye Hospital Limited, namely 4 Harley Street and 29a Wimpole Street. Both locations are named The London Eye Hospital. Number 4 Harley Street provides the outpatient service for the hospital where pre and post-operative consultations take place. Number 29a Wimpole Street is the site where all the surgical procedures take place. This report relates to 4 Harley Street only.

We carried out this inspection in response to concerns received in August 2017 about the type of lens implanted in surgery between 2014 and 2015 at the Wimpole Street location and some aspects of pre and post-operative care and treatment provided at this hospital. We responded to these concerns by carrying out an unannounced inspection on 11 October 2017. The inspection did not address all our key lines of enquiry but focused only on the issues raised by the information received. The inspection focused on safeguarding, consent, complaints, patient outcomes, and governance arrangements. Prior to this responsive inspection, we had carried out a comprehensive inspection of the service in December 2016.

Summary of the information triggering the responsive inspection.

In August 2017, we received information raising concerns about aspects of treatment and care provided at the London Eye Hospital (both locations). These concerns were about:

  • The safety of the type of lens patients consulted on at this location and had implanted at the Wimpole Street location where surgery takes place.
  • Failure to seek patients’ consent to care and treatment in line with legislation and guidance by staff at the hospital.
  • Patients not being informed of the risks related to the lens implant surgery.
  • A lack of systems and processes to allow patients using the service to make complaints.
  • Failure to monitor patient outcomes at the hospital.
  • Staff failing to observe patients’ privacy during pre-operative checks.

Inspection findings

  • The service stopped implanting the type of lens we had received concerns about in August 2015.
  • There was evidence staff sought patients’ consent and explained the risks of surgery prior to surgery taking place.
  • Staff informed patients of the risks related to the lens implants at various stages of consultation.
  • The hospital had a complaints procedure in place and information about how to make a complaint was available to patients attending the hospital.
  • There was some monitoring of patient outcomes using both audits and post-operative appointments.
  • Staff observed patients’ privacy during consultation and post-operative checks.

However, we identified areas of poor practice where the service needs to make improvements: 

  • Staff had not completed mental capacity training at the time of our inspection. They subsequently completed this training.
  • There was no indication in patients’ records that the service monitored compliance with the seven day ‘cooling off’ period or that it had been discussed with patients.
  • Although there were systems and processes to protect people using the services from abuse and improper treatment, three out of 16 staff had not completed safeguarding training. The three staff completed training following our inspection.
  • There was some monitoring of patient outcomes but there was no routine measurement of whether the service was effective.
  • The hospital did not respond to four out of ten complaints within 20 working days as per their policy.
  • The service did not have a registered manager at the time of our inspection. Having a registered manager is a condition of registration with the Care Quality Commission.

Following the inspection we told the provider that it should take some action to help improve the service  even though a regulation had not been breached. The details are at the end of this report.

Importantly the provider should:

  • Ensure there is a registered manager for the service.
  • Routinely collect and measure patient outcomes in order to assess the overall effectiveness of the service.
  • Ensure mental capacity training is part of the mandatory training for staff.
  • Ensure all staff are trained in safeguarding (adults and children) to the appropriate level.
  • Record minutes of clinical governance meetings.
  • Ensure effective communication between management in relation to complaints investigation and any delays.
  • Ensure there is a seven-day ‘cooling off’ period for patients consulting for lens implant surgery.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

6 and 7 December 2016

During a routine inspection

This report refers to outpatient services provided by the hospital at 4 Harley Street. Patients consulted at the location had their procedure performed at another location managed by the provider (London Eye Hospital, 29a Wimpole Street, London). Surgery, performed at that location, was the main activity of the hospital and we reported on it in a separate report. Where our findings on outpatient or surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the relevant section of the report. 

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? 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 regulations. The main service provided by this hospital was surgery. We rated the outpatient services as requires improvement overall. However, caring and responsiveness of the hospital are rated as good.

We rated the hospital as requires improvement because:

  • Medicines were not always managed safely. Medicines were dispensed without a valid prescription being completed.
  • Waiting lists were not monitored and there was not enough consultant time available to deliver the EyeMax treatment for the volume of patients requesting it.
  • There were no systems in place to triage patients on the waiting list. The hospital were dependent on individuals contacting the hospital to make them aware that there condition had deteriorated.
  • Structures to monitor the governance and risk management systems were not effective. For example the hospital did not have a robust enough system of local audit in place. This meant improvements were not always identified or action taken.
  • There was no formal strategy or supporting business plans that staff were aware of, which reflected the vision and values.

However:

  • Patients’ needs were assessed and care was delivered in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines. For example, protocols were followed with regard to national guidance for cataract surgery.
  • Staff were knowledgeable about safeguarding procedures and knew who they would report any concerns to.
  • We observed care provided by staff. Throughout the outpatient department, all staff were helpful and professional, putting patients and their relatives at ease.
  • Patients and relatives told us there privacy and dignity were always respected and staff were kind and understanding.
  • Staff told us that local leadership within outpatients was good.  The manager was approachable, supportive and staff worked together as a team. Staff were proud of their service and were keen to ensure patients received the best care.

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, even though a regulation had not been breached, to help it move to a higher rating. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals