Archived: Consultant Eye Surgeons Partnership (Bristol) LLP

South West Eye Surgeons LLP provides specialist eye treatments for adults and children and young people at their outpatient facility - Consultant Eye Surgeons Partnership (Bristol) LLP (the service). The service is in the process of changing its name and currently is registered with the CQC as Consultant Eye Surgeons Partnership (Bristol) LLP but is working under its parent name of South West Eye Surgeons LLP. The service provided care mostly to adults but also to a limited number of children and young people.

We inspected the whole service using our comprehensive inspection methodology.

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.

We rated this service as inadequate overall.

• There were limited systems and processes to provide oversight of the quality and safety of the services provided. The service did not have an oversight on safety, as there were no reliable systems and processes in place to monitor incidents, risk and performance.

• There were no official monitoring arrangements for consultants who worked at the service. Although all staff employed worked within a local NHS trust and were known to the partners, there was no evidence of training undertaken by staff or evidence of employment checks being carried out.

• There were no arrangements in place for granting practising privileges and reviewing employment checks and the content of all staff files lacked consistency.

• There was no evidence of how current evidence based guidance, standards, best practice and legislation was identified and used to develop the service.

• Records were not always maintained of medical photography.

• There was no evidence of how the provider and senior managers monitored and used current evidence based guidance, standards, best practice and legislation to develop the service.

• The outcomes of people’s care and treatment were not always monitored regularly. There was limited documentation of audits carried out and no documentation of the discussion, learning or feedback.

• There was limited oversight that staff had the right training, only carried out surgery they were skilled for and had the correct employment checks.

• Staff did not receive regular appraisal or training and development opportunities.

• Quality did not receive sufficient coverage in executive meetings and was not documented in other relevant meetings. There was no evidence of performance monitoring or of assurance gained about the quality and safety of the service.

• There were no processes in place to review key items such as the strategy, values, objectives, plans or the governance framework.

• Leaders did not have the necessary experience or support to lead effectively. Leaders were not always clear about their roles and their accountability for quality

We found good practice in relation to outpatient care:

• Staff said they felt able to report incidents although they had not had the need to do so. Most staff understood their responsibilities under the duty of candour.

• We observed good hand hygiene practice in clinical areas and patients confirmed this.

•    During the reporting period, there were no incidences of healthcare-acquired infection.

  Medicines were stored securely.

• Patient records were secured, well maintained and clear to follow.

• There were sufficient staff on duty at the time of our inspection to meet patients’ needs.

• Consultants and nursing staff understood the relevant consent and decision-making requirements of legislation and guidance. There was evidence that consent practices were in line with guidance and best practice.

• Patients were given the opportunity to take a period of reflection following a consent discussion and prior to surgery.

• Feedback from people who use the service, those who are close to them and stakeholders was positive about the way staff treated people.

• Patients were involved and encouraged to be partners in their care and in making decisions about their treatment and support.

• There were transparent and easy to understand pricing structures.

• Staff responded compassionately when patients needed help.

• Patients reported they had timely access to initial assessment, diagnosis and treatment. However, the provider did not monitor this.

• Patients had timely access to initial assessment, diagnosis and treatment.

• We observed good examples of care and treatment. Patients told us they felt supported and well cared for.

• Information was on how to make a complaint or raise a concern.

• Patient information could be provided in large print and Braille format.

• There was clear communication between multidisciplinary teams and administrative staff and external partners.

• No complaints had been made to the service.

• The organisation actively sought the views of patients and staff about the quality of the service provided.

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 the service improve. We also issued the provider with one warning notice and four requirement notices. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Hospitals Directorate)