Community Health and Eyecare Limited (CHEC - Slough)

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This meant we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff carried out detailed pre‑assessment to ensure patients were safe and suitable for cataract surgery. They reviewed key clinical factors such as cardiovascular or respiratory conditions, diabetes, anticoagulation, allergies and any recent surgery. This helped them judge whether a patient could proceed safely or whether additional time or optimisation was needed (for example, ensuring a patient’s medical conditions, such as blood pressure, diabetes or medicines were stable before surgery).

For example, patients with stable heart conditions were generally able to go ahead, while those who had recently experienced a deep vein thrombosis (DVT — a blood clot in a deep vein, usually in the leg), pulmonary embolism (PE — a blood clot in the lungs), heart attack or stroke usually required a period of recovery before surgery could be considered. Patients with severe symptomatic heart failure were identified as unsuitable.

Staff also looked at wider needs, including hearing, mobility, implanted devices and the patient’s health on the day of surgery. This holistic approach supported consistent decision‑making and helped reduce avoidable risk.

Staff developed integrated care plans that met patient needs identified during assessment. We reviewed 12 care plans and saw that these met the needs of patients.

Staff communicated with patients in ways that supported their understanding of care and treatment. They adapted communication methods to meet individual needs, particularly for patients with communication difficulties.

Staff used visual aids, translation applications, and interpreters for patients who did not speak English as their first language. They provided a loop system for patients with hearing impairments, promoting inclusive and accessible communication across the service.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Managers provided staff with regular supervision, including meetings to discuss care management, reflect on and learn from practice, and receive personal support and professional development. Staff also received annual appraisals in which they reviewed their performance and worked with their manager to set personalised objectives that supported the effective delivery of evidence‑based care. In addition, managers ensured that staff had access to regular team meetings. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. They ensured that staff received the necessary specialist training for their roles. For example, the Laser Protection Supervisor (LPS) completed laser safety training, the infection prevention and control (IPC) lead received additional IPC‑specific training, and the manual handling lead undertook enhanced manual handling training to support their responsibilities.

Staff followed up‑to‑date policies and standard operating procedures to plan and deliver high‑quality care aligned with best practice and national guidance. We reviewed several policies, these had clear creation and review dates, along with references to current national guidelines. There were effective systems in place to communicate updates in guidance through staff meetings, and we saw notice boards displaying the most recent information to support staff in their practice.

Policies were aligned to Royal College of Ophthalmologists (RCOphth) and National Institute for Health and Care Excellence (NICE) guidelines, as well as Getting It Right First Time (GIRFT), the NHS Standard Contract and the best‑practice expectations to deliver high‑quality, value‑for‑money cataract services set out by RCOphth, GIRFT and the NHS England National Eye Care Recovery and Transformation Programme (NECRTP).

We looked particularly at the pathway for people admitted for day‑case cataract surgery and YAG laser treatment under NHS Choices (the system that allows NHS patients to choose where they receive their care and treatment).

Staff could access policy documents and standard operation procedures (SOPs) on the hospital’s database. They used the provider’s Cataract Surgery SOP to support safe and consistent care. This clearly outlined responsibilities and key safety steps, such as identity checks, consent, dilation protocols, the WHO checklist, equipment standards and postoperative processes.

The YAG Capsulotomy policy was similarly clear and comprehensive. It detailed training requirements, staff roles, patient consultation, equipment preparation, procedural steps and post‑procedure care. It also set out eligibility criteria, consent processes and the treatment technique, supporting staff to deliver the procedure safely and consistently.

Staff also followed a diabetic cataract post‑operative protocol that set out the clinical steps required to monitor and support people with diabetes after cataract surgery, recognising their higher risk of delayed healing, infection and blood‑sugar fluctuations.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked collaboratively across clinical, surgical, and non-clinical roles to plan and deliver safe care. We observed effective multidisciplinary working and communication between staff in theatres and outpatient areas. We saw good interactions among members of the team.

The service held regular and effective multidisciplinary meetings to support communication and co-ordinated working. Staff attended a daily morning communication meeting to ensure alignment on operational priorities. Leaders facilitated a weekly reflection meeting every Friday, providing protected time for staff to raise concerns, discuss challenges, and share learning. Staff also participated in monthly formal staff meetings, and the minutes indicated consistently good attendance.

Patient’s records showed input from a range of clinicians, with information shared appropriately to support a consistent approach to care and treatment pathways. We reviewed an example where the service liaised with a patient’s GP to optimise diabetes management ahead of a planned procedure.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, optometrists and specialist teams).

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff promoted healthy lifestyles and reinforced this with key information. The provider’s website included information on treatment options and simple explanations of why patients may benefit from these. Staff assessed each patient’s health at every appointment and provided support for any individual needs to live a healthier lifestyle. They offered patients advice or signposted to the relevant services to meet these needs.

The provider helped people to live healthier lives in several ways. It recognised the emotional impact of surgery and signposted patients to appropriate mental health and crisis support. Information on the website reassured patients that their wellbeing was valued before and after treatment and directed them to services that could offer urgent help if needed.

The provider gave patients clear, accessible advice to support safe recovery at home. The website included practical guidance such as how to administer eye drops correctly and why blinking rather than rubbing the eyes was important after treatment, helping people reduce risks and improve outcomes.

Staff worked proactively with other healthcare professionals to ensure patients were in the best possible health before undergoing procedures. For example, records showed that the team liaised with a patient’s GP to optimise diabetes management ahead of surgery, promoting safer care and supporting effective recovery.

The organisation supported people to live healthier lives through its partnership with the Royal National Institute of Blind People (RNIB). Throughout 2024/25, the provider reported giving patients with sight loss access to an Eye Care Liaison Officer (ECLO). The ECLO provided important emotional and practical support to help prevent avoidable sight loss and improve the wellbeing of people living with eye conditions, ensuring they received timely guidance and advice to manage their condition effectively.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service participated in clinical audit, benchmarking, and quality improvement initiatives, including contributing data to the National Ophthalmology Database (NOD) to monitor patient outcomes.

Staff monitored patient outcomes, including complications and infection rates after cataract surgery. This included tracking posterior capsular rupture (PCR), the most common intra‑operative complication, which involves a tear in the thin membrane that supports the lens and increases the risk of post‑operative problems. Between 1 April 2023 and 31 March 2024, PCR occurred in 0.5% of the service’s 2,331 cataract operations, comparing favourably with the national NOD rate of 0.7%. Leaders investigated these incidents and acted, ensuring learning was shared and appropriate improvements were embedded across the service.

The service did not have sufficient validated vision‑loss data for the period for NOD to publish comparable results. The service also reported no cases of endophthalmitis over the same period, an important indicator of safe practice, as endophthalmitis is a serious internal eye infection that can lead to permanent sight loss if not treated promptly.

Staff implemented a local audit programme to review key areas of practice, such as medical records, infection prevention and WHO safer surgical checklist compliance. Managers told us they used audit findings to identify areas for improvement and make changes where needed. The provider considered health inequalities and took steps to ensure that outcomes for people with protected characteristics were monitored and remained in line with the wider community.

Staff used recognised tools to detect and respond to ophthalmic clinical deterioration, supporting patient safety and improving outcomes.

Private activity formed only a small part of the hospital’s overall work, and the service was predominantly NHS‑focused. However, the service submitted data to the Private Healthcare Information Network (PHIN), which helps provide transparency for patients choosing private healthcare.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff were knowledgeable about consent and decision‑making requirements, including those set out in the Mental Capacity Act (MCA) 2005, and knew how to access advice when needed. They had completed MCA training, with 100% compliance in November 2025.

The provider had an up-to-date consent policy, and consent was embedded within the patient pathway. The service sent patient’s information leaflets, which included consent in advance of procedures. Staff ensured formal consent forms were signed on the day of admission and confirmed with patients that their decision had not changed before treatment, helping ensure consent remained current and informed.

Leaders audited compliance with their consent policy and monthly audit results from May to October 2025 confirmed that 100% of patients were consented correctly prior to surgery.

We saw evidence that the team had activated ‘stop-the-line’ in October 2025 due to consent issues. Staff appropriately recognised, reported and escalated that consent was not current. The surgeon re‑completed consent before treatment went ahead. This demonstrated consistent monitoring and safe, lawful consent practices. Staff reported the incident in line with their incident reporting policy.

Staff followed their internal process for seeking consent from patients in line with legislation and guidance, and this was clearly recorded. We observed staff asking patients’ verbal consent prior to examinations, observations and delivery of care. We reviewed 12 patient records and noted the consent forms were completed in full.

The service predominantly carried out cataract surgery and provided patients with clear information and consent forms. These explained the procedure, its benefits and risks, what to expect on the day, and how to seek help if any concerns arose. Patients received equivalent information for YAG laser capsulotomy (which treats posterior capsule opacification, a common cause of blurred vision after cataract surgery) and for minor eyelid procedures. All information included details of intended outcomes, potential complications and the steps involved, and directed patients to a 24/7 helpline for support if adverse effects occurred.

Patients said they were involved in decision-making about their care and treatment. They could describe the risks and benefits that they were told about prior to surgery.

The service provided chaperones if requested, and interpreters supported patients to give informed consent, with face‑to‑face interpreting when needed. We saw evidence that staff reported an incident where an interpreter had not been available, and they appropriately cancelled the surgery and rescheduled the patient to ensure interpreter support was available.

Staff sought permission before sharing patient information with family or friends. We saw in the December 2024 meeting minutes staff were reminded staff that discussing patient information with family or friends should only occur when explicit permission had been given. This was because doing so without approval would constitute a GDPR breach (a breach of data protection law that requires organisations to keep personal information secure and confidential).