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Inspection Summary


Overall summary & rating

Good

Updated 28 March 2018

Midland Eye is operated by Aspen Healthcare. Aspen Healthcare is a group healthcare provider that provides independent services across the UK. The Midland Eye clinic is an ambulatory day surgery clinic with no inpatient beds or wards. Facilities include an operating theatre, an anaesthetic room, a small recovery area, a pre-assessment room, a diagnostic room, three consultation rooms and two patient waiting areas.

The service provides surgery, and outpatients and diagnostic imaging. We inspected both of these core services. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 26 and 27 September 2017, along with an unannounced visit to the hospital on 11 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 main service provided by this clinic was surgery. 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 Midland Eye as good overall.

We found good practice in relation to surgery and outpatients:

  • Patients were protected by a strong comprehensive safety system, and a focus on openness, transparency and learning when things went wrong.

  • The safety systems in place kept patients safe from avoidable harm, which was reflected in an excellent track record in safety.

  • Staffing levels were appropriate to keep people safe at all times.

  • The clinic invested in staff training, skills and competence. Competence of staff was integral to achieving the service’s aim of providing first class healthcare.

  • There was a comprehensive suite of policies and procedures that supported staff in providing high quality, safe and effective care. The policies and procedures were reviewed regularly and were in line with current best practice guidelines and legislation.

  • Patients had good outcomes because they received effective care and treatment that met their needs. Outcomes were routinely monitored and reviewed alongside patient experience to assess quality of care.

  • Staff treated patients with compassion, kindness, dignity and respect. Patients were respected and valued as individuals and were empowered as partners in their care.

  • The clinic provided patient centredcare and treatment. Services were organised and tailored to meet the needs of the individual patients. The clinic delivered services in a way that ensured flexibility, choice and continuity of care.

  • The leadership, management and governance of the clinic assured the delivery of a high-quality person-centred care, supported learning and innovation, and promoted an open and fair culture.

  • Governance and performance management arrangements were proactively reviewed and reflected current best practice.

  • Risks were clearly identified and monitored effectively. Performance issues were escalated to the relevant committees and the board through clear structures and processes.

  • Patients and staff were highly respected and valued. A full and diverse range of patients’ views and concerns were encouraged, heard and acted on.

  • Information on patient experience was reported and integrated with performance data to give a clear and accurate all round picture of quality and safety.

We found areas of practice that require improvement in relation to surgery and outpatients:

  • We found that patient identifiable information was not always present on all pages within the paper notes and the authorised signature sheet at the front of the notes were not always completed. Correspondence letters to other health professionals did not always have a penned signature present. On our return visit, the clinic had put things in place to ensure that these issues were rectified

  • The clinic did not have a designated area for recovery and patients had to recover in the shared waiting area. Although no patients raised this as an issue, staff recognised that the shared waiting and recovery area was not ideal for patients privacy.

  • The clinic was not currently submitting data to the Private Healthcare Information Network (PHIN).

Following this inspection, we told the provider it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 28 March 2018

We rated safe as good because:

  • Patients were protected by strong and comprehensive safety systems. There was a clear culture of openness, transparency and learning when things went wrong.

  • All staff were fully committed to reporting incidents and near misses, and safety concerns raised by staff were highly valued as integral to learning and improvement.

  • There was a detailed investigation of incidents. There was ongoing, consistent progress towards safety goals reflected in an excellent track record of safety.

  • All staff were encouraged to participate in learning to improve safety as much as possible, including participating in local and national safety programmes.

  • The comprehensive safety systems took account of current best practice and the whole team were engaged in reviewing and improving safety and safeguarding systems.

  • Innovation was encouraged to achieve sustained improvements in safety and an excellent track record in harm free care.

  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients safe at all times. Staff shortages were responded to quickly and adequately.

  • There were effective handovers to ensure staff could manage risks to patients. Staff were up to date with training in all safety systems.

However:

  • We found that patient identifiable information was not always present on all pages within paper records, authorised signature sheets were not always completed and correspondence letters to other health professionals did not always have a penned signature present.

  • The clinic did not have a designated area for recovery and patients had to recover in the shared waiting area. However, we saw risk assessments and controls in place to mitigate limitations within the clinic setting.

Effective

Good

Updated 28 March 2018

We rated effective as good because:

  • Care and treatment was evidence based. New evidence based techniques and technologies were used to support the delivery of high quality care.

  • All staff were actively engaged in monitoring and improving quality and outcomes. Opportunities to participate in benchmarking, peer review and accreditation were proactively pursued. High performance was recognised by credible external bodies.

  • Staff were proactively supported and funded to acquire new skills and share best practice. Development of staff skills, competence and knowledge were recognised as essential in providing high standards of quality care and treatment.

  • Discharge of patients was proactive and planned at the earliest possible stage and were reflective of individual circumstances and preferences. Staff members had specialist vocational qualifications in discharge.

  • Multi-disciplinary team work was effective. All staff were committed to working collaboratively.

  • Staff had appropriate access to information. Information systems to manage and share information were fully integrated and provided real-time information across teams and services.

  • Consent practices and records were actively monitored and reviewed to improve how patients are involved in making decisions about their care and treatment. Consent processes were appropriately followed.

  • The clinic worked with external specialist organisations and patients to inform the development of tools and support to aid informed consent.

However:

  • The provider was not submitting data to PHIN at the time of our inspection.

Caring

Good

Updated 28 March 2018

We rated caring as good because:

  • Feedback from patients was consistently positive about the way staff treated them.

  • There was a strong, visible patient-centred culture.

  • Staff were highly motivated and inspired to offer care that was kind, promoted dignity and maintained a supportive and strong relationship.

  • Staff recognised and respected patients’ needs as a whole and always took their personal, cultural, social and religious needs into account.

  • Staff were fully committed to working in partnership with patients and empowered patients to have their own voice.

  • Staff spoke with patients in a manner they could understand.

  • Patients’ individual preferences and needs were always reflected in how care was delivered.

  • Staff understood the effects of treatment on the patient. Patients’ emotional and social needs were valued by staff and were embedded in their care and treatment.

  • Costs of procedures were provided at the first possible opportunity in a sensitive and appropriate manner.

However:

  • The clinic did not have a designated area for recovery and patients had to recover in the shared waiting area. Although no patients raised this as an issue, staff recognised that the shared waiting and recovery area was not ideal for patients privacy.

Responsive

Good

Updated 28 March 2018

We rated responsive as good because:

  • Services were planned and delivered to meet the needs of local people.

  • There was timely access to initial appointment, diagnosis and treatment.

  • The service was flexible and allowed patients to access services at a time that suited them.

  • There were innovative approaches to providing integrated patient-centred pathways of care that involved other service providers, particularly for patients with multiple and complex needs.

  • The service took into account the needs of different people. Staff took a proactive approach to understanding the needs of different patient groups.

  • Complaints and concerns were managed appropriately. Feedback from patients was highly valued and was recognised as integral for improving the way in which the service was delivered.

Well-led

Outstanding

Updated 28 March 2018

We rated well-led as outstanding because:

  • The leadership, management and governance of the Midland Eye assured the delivery of a high-quality patient-centred care, that supported learning and innovation, and promoted an open and fair culture.

  • There was a clear statement of vision and values that were driven by quality and safety. A comprehensive, clear and achievable strategy with well-defined objectives was in place and was proactively reviewed.

  • Strategic objectives were supported by an effective and comprehensive quality framework that provided measurable outcomes that were cascaded throughout the service.

  • The clinic was proactively working with organisations to improve care outcomes and to tackle health inequalities.

  • Governance, risk and performance management arrangements were comprehensive, proactively reviewed and reflected current best practice.

  • Risks were clearly identified and monitored effectively. Performance issues were escalated to the relevant committees and the board through clear structures and processes.

  • The comprehensive audit programme and processes included within, worked well and had a positive impact on quality governance with clear evidence of action to resolve concerns.

  • There were high levels of staff satisfaction across all equality groups. Staff were extremely proud of working for the clinic and spoke highly of the open, transparent and no-blame culture.

  • All staff members were highly respected and valued. A full and diverse range of patients’ views and concerns were encouraged, heard and acted on.

  • Information on patient experience was reported and integrated with performance data to give a clear and accurate all round picture of quality and safety.

  • There was strong collaboration and support across all functions locally and with staff at other Aspen sites. There was a clear common focus on improving quality of care and patient experience.

  • The leadership was strong and drove continuous improvement; staff were accountable for delivering change.

  • Safe innovation was encouraged and celebrated. There was a clear and proactive approach to seeking out and embedding new models of care.

  • Consultant ophthalmologists were innovators in their field.

However;

  • The provider was behind on implementing provisions for submission of data to PHIN. The deadline set by the CMA was September 2016.
Checks on specific services

Outpatients and diagnostic imaging

Good

Updated 28 March 2018

The outpatients’ service was small and compact and the management team, governance systems and staffing were the same across the surgery and outpatients service.

We do not repeat information throughout the report but cross-reference to the relevant section of the surgery section.

We rated this service as good because it was safe, caring and responsive. Well-led was outstanding. There is currently not enough evidence nationally to give a rating for effectiveness of outpatient services.

Surgery

Good

Updated 28 March 2018

Surgery was the main activity at the clinic. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

All management and governance systems, along with staffing were managed jointly with outpatients’ services.

We rated this service as good as it was safe, effective, caring and responsive. Well-led was outstanding.