Prema

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This is the first assessment for this recently registered service. This key question has been rated good.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders and staff had a united vision and organisational culture. They worked together to achieve this. All staff understood how they contributed to the organisation’s work to positively impact on the lives of patients and the service’s overall business goals and values.

Staff felt the service was supportive of diversity and inclusiveness.

The provider had a good understanding of the regional health system, including demands on the private and public sectors for ophthalmological services. As a result, the provider had been maximizing theatre utilisation, expanding relationships with other specialist providers, and developing their services and treatment options that were otherwise difficult to find. For example, the provider was working towards developing a pain management service. In addition, the service provided care for patients who presented with eye conditions at other providers who did not have the skills or were not equipped to treat them.

We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The CQC Registered Manager held overall responsibility for Prema services. There were two directors who, together with the with the director of operations and director of clinical services, were responsible for the day to day running of the service.

Leaders were knowledgeable about issues and priorities influencing the quality of the service. They could explain clearly how the teams were working to provide high quality care. Leaders were visible in all areas of the service and staff were familiar with who they were. Staff were confident that their leaders were competent, supportive and treated them fairly.

The directors had developed and facilitated a collegiate professional culture in which staff worked with support and mutual respect regardless of their contract or frequency of work. The provider supported debriefs by different staff, including nurses and operating department practitioners, as part of a collaborative approach to care.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The services had a Freedom to Speak Up policy that encouraged staff to report safety concerns internally, before involving external stakeholders. Some staff we spoke with were not aware of how to raise concerns through this route but had not felt the need to do this. All staff we spoke with told us they felt able to raise concerns with their manager directly.

The provider used feedback from patients to improve their service. For example, it had been recognised by the provider that they did not have a separate consent process for off-label medications. They took action to improve the consent process and introduced an additional consent form specifically for off-label medications.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff felt they were treated fairly. Staff we spoke with reported they had not experienced bullying or harassment because of their protected characteristics. We observed a mutually respectful and supportive culture amongst the permanent team, which they extended to colleagues on self-employed, bank, or agency contracts. They also reported being able to work flexibly when the service’s needs allowed for this.

The provider had an Equality, Diversity and Human Rights policy to support fair recruitment. This also included a strategy for equality and equity.

We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes.

The provider had an extensive information governance framework. The provider reviewed policies and procedures according to an annual schedule and updated these where national guidance or learning changed. The director of operations had joined the service to support the maintenance of policies and procedures and the oversight of service delivery. This resulted from the registered manager’s analysis of the service and work to identify opportunities for improvement.

The service monitored patient outcomes and used this information to make improvements. Leaders monitored theatre staff performance and supported staff in personal development when this was needed. A director of operations and director of clinical services ran the service on a day-to-day basis. They were responsible for auditing performance, delivering the service and ensuring things ran smoothly.

Additional governance and oversight, such as clinical governance, human resources and medical staff oversight was managed by a combination of the directors, director of operations and clinical service manager.

The service maintained a risk register and this was managed by the provider leadership team. We saw the risks listed matched those described to us by staff during the inspection.

We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff and leaders collaborated with all relevant external stakeholders. The directors were active in regional, national, and international professional networks.

There was shared learning and collaborative improvement within and across these various provider networks. Senior leaders described how these networks collected data to identify new ideas and worked together to assess whether new technologies or processes could improve outcomes for patients.

They had developed a wide range of relationships with public and private providers that led to care provision for increasingly complex needs.

We focus on continuous learning, innovation and improvement across our organisation and the local system. We actively contribute to safe, effective practice and research.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They actively contribute to safe, effective practice and research.

The provider collected and analysed clinical outcome data. This was used to inform medical staff appraisals, make changes to patient suitability criteria and treatment algorithms.

The directors of the service were consultants of long-standing across the industry and had set up Prema with governance structures compliant with regulatory requirements. They drove the service forward with a focus on innovative care to meet the needs of patients with complex conditions.

The provider had steadily built capacity in line with its strategy and an analysis of need in the region and healthcare sector.