Community Health and Eyecare Limited (CHEC - Worcester)

On this page

• 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

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.

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

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. We reviewed 10 patient records and found that a comprehensive pre assessment had been completed during which any issues were identified. These were then addressed through good communication. Care plans were personalised and addressed each individual’s needs. Staff updated care records as necessary. One care plan for a patient who had bumped their head at a recent birthday party was updated to ensure they remained comfortable during the operation.

We reviewed 4 endoscopy patient records and found that a comprehensive preassessment had been undertaken at which any issues were identified. These were then addressed through good communication. Care plans were personalised and addressed the individual’s needs. Staff updated care records when necessary. World Health Organisation safer surgery checklists, which have been shown to reduce complications and mortality by over 30% percent, had been used in each case we reviewed. These were audited regularly to drive improvements to safety. Records included consent from the patient and medications used in the procedure.

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. Staff developed care plans at the patient’s preassessment. This was to ensure the service could meet the needs of the patient. Patients were offered a choice of food and fluid during their stay. This was appropriate to the needs of patients receiving a short procedure.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Audits were undertaken locally and outcomes compared across the services. The service measured the number of Posterior Capsule Ruptures following eye surgery. The national average rate of this complication was 1.1%. However, the rate of this complication at CHEC Worcester is 0.38%. This was better than the national average. The team also measured visual acuity both pre and post operation to ensure they could measure the success of the surgery to the patients quality of life.

Endoscopy staff participated in clinical audit, benchmarking and quality improvement initiatives. Audits were undertaken locally and outcomes compared across the services. The service reconciled the histological specimens taken at procedure with those reported on. It also measured the turnaround times of histology specimens. Results were entered onto the patient’s electronic patient record and the GP and relevant multidisciplinary team made aware of any findings that required further investigation. The endoscopy lead was copied into any referrals, and they ensure that patients who needed to be were entered onto the two-week wait system.

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. Information about patients’ care and treatment was held on an electronic record. This could be sent to a different provider of healthcare if required.

Staff held a daily huddle prior to each operating list so they were aware of the plan for that day. Staff reported that these meetings did not contain information about incidents that occurred either on site or across the organisation. Monthly team meetings had not happened frequently due to changes in the management. Flash Alerts were pinned to the information board about many issues staff needed to be aware of. However, not all staff were aware of what these contained and the importance of reading these in case of a change to practice. Patients were given a discharge letter in case they needed urgent treatment following surgery. However, ophthalmology patients were also given a phone number to enable them to contact the service 24 hours a day, 7 days a week if they were concerned post-surgery.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff discussed health concerns with patients and provided additional information and support. This included a patient who had bumped their head who was given guidance on suitable pain relief and signs to watch for that might indicate possible complications. Staff also discussed safe driving with patients who continued to drive despite experiencing problems with their vision. The service supported people to live healthier lives and aimed to reduce their future care needs where possible. The service had a number of leaflets available which supported good eye health. These were printed on yellow paper to assist those patients with visual impairments. The service had a number of leaflets available which supported good gut health. Patients were advised in respect of smoking cessation and healthy living options at preassessment.

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 routinely monitored the outcomes of cataract surgery for patients. The service submitted operative data to the National Ophthalmic Database to monitor the quality of outcomes for the service. The National rate of the complication of Posterior Capsule Rupture (PCR) was 0.78% in 2023. The CHEC Worcester PCR rate was 0.38% of patients, this was better than the national average. In the last 6 months (January to June 2025) the service had no patients who experienced a refraction of less than 2.5 which is much better than the average. There had been no planned or unplanned returns to theatre following cataract surgery between January and July 2025. Audits demonstrated that team briefings prior to surgery were always completed. Key performance indicators demonstrated that 1.2% of patients experienced cancellation on the day of surgery in the first six months of 2025 (January - June). These cancellations were not related to staffing issues but generally were patient related.

The endoscopy service monitored outcomes for patients. They audited records of biopsies undertaken and ensured that patients were seen or discussed at multidisciplinary team meetings in a timely manner. This improved the opportunity for a positive outcome for patients. The company measured the successful completion of endoscopies, the number of biopsies taken and the number of polyps removed and measured against key performance indicators. Whilst these results were positive the provider could not split the individual location data yet.

Patients were informed about their rights relating to consent and staff respected these when delivering person-centred care and treatment. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

The service had effective consent processes at each stage of each patient’s care and treatment. Staff clearly recorded consent in the patients’ records. We found good standards of documentation in patient records in relation to consent and capacity. For example, staff documented their discussions with referrers and patients about levels of confusion and anxiety and assessed the extent to which patients could understand their care.

Staff were trained and could recognise patients who may lack capacity to make decisions. Staff gained consent from patients for their care and treatment in line with legislation and guidance and based on all the information available. Where patients living with dementia or reduced mental capacity were referred for treatment, staff worked with referrers in advance to understand their level of need. We were informed of 1 patient who had attended, and their level of comprehension had deteriorated, and staff were concerned that they did not understand the procedure. Therefore, surgery was postponed until everyone could be assured that the patient understood what was going to happen. Staff involved the patient and their carer in decision-making and ensured care was clinically appropriate.

Endoscopy staff were aware of the challenges particularly in rectal endoscopy to ensure that the patients continued to consent throughout the procedure. They checked with patients and offered further sedation if required to ensure the procedure was as comfortable as possible for the patient. Where patients retracted consent the process was stopped and removal of the scope discussed with the patient. The patient was involved in the next actions decision.