CES Medical – Tunbridge Wells

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

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 patients 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 is the first assessment for this service. This key question has been rated outstanding. This meant patient’s needs were met through outstanding organisation and delivery.

We have not awarded this service a score for Well-led.

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

Leaders had established a strong organisational culture underpinned by a clear sense of purpose and direction. The service's values aligned with those of the wider provider and promoted openness, fairness, inclusion and respect for human rights. The needs of patients and local communities were central to decision-making, and leaders demonstrated a comprehensive understanding of the challenges affecting the population they served.

A well-defined vision and supporting objectives guided service development and improvement. Staff understood the organisation's priorities and how their individual contributions supported the achievement of wider goals. Leaders demonstrated a clear commitment to delivering high-quality ophthalmology services and improving outcomes for people accessing care locally.

The provider fostered an inclusive working environment where equality, diversity and staff wellbeing were actively promoted. Systems were in place to identify and respond to individual staff needs throughout the employment lifecycle, including recruitment, supervision, return-to-work discussions and staff engagement activities. Leaders reviewed support arrangements regularly and adapted them where necessary. Staff could access a range of reasonable adjustments, including flexible working opportunities, workplace modifications, assistive equipment and personalised wellbeing support. These arrangements reflected the provider's commitment to meeting its responsibilities under equality legislation and ensuring staff could work effectively and safely.

Policies and procedures supported a respectful workplace culture and included arrangements for addressing bullying, harassment and inappropriate behaviour. Freedom to Speak Up processes were embedded, encouraging staff to raise concerns and share feedback. Leaders used information from staff surveys and engagement activities to inform wellbeing initiatives and service improvements, demonstrating a proactive approach to supporting the workforce.

Staff consistently described a positive working environment where they felt appreciated, respected and supported by colleagues and managers. Teamworking was strong across all staff groups, and relationships between staff and leaders were collaborative and constructive. Staff spoke positively about the leadership team and described them as approachable, responsive and supportive.

Staff were optimistic about the future direction of the service and engaged with planned developments. Clear governance arrangements supported accountability and role clarity. Staff had defined responsibilities through documented job descriptions, supported by structured induction processes and a clear management framework. Ongoing supervision, appraisal and training helped ensure staff remained competent and understood their responsibilities, while governance processes provided oversight of compliance and performance. These arrangements contributed to safe, effective and well-led care.

Leadership arrangements were well established, and leaders demonstrated a strong understanding of the service, its workforce and the environment in which care was delivered. They promoted the organisation's values through their day-to-day practice and fostered a culture centred on openness, respect and accountability. Leaders were experienced, knowledgeable and well placed to guide the service, with a clear awareness of how leadership behaviours influenced both staff experience and patient outcomes.

Those in leadership positions had the expertise and capability required to oversee the service effectively and were aware of current challenges, priorities and opportunities for development. Staff described leaders as visible, accessible and approachable, and told us they felt encouraged to develop professionally and progress within the organisation. Leaders also demonstrated a commitment to staff wellbeing by modelling healthy working practices, including taking regular breaks, maintaining appropriate working hours and promoting a positive work-life balance.

Robust governance and leadership arrangements supported the safe and effective operation of the service. Senior leaders were appointed through formal recruitment processes, supported by appropriate pre-employment checks and assurances regarding their suitability for their roles. Ongoing performance management included appraisal, supervision and training, ensuring leaders remained competent and accountable. These arrangements provided assurance that organisational responsibilities were understood and effectively managed.

Leaders responded appropriately when concerns or incidents were identified and promoted a culture in which learning and improvement were encouraged. They maintained oversight of service performance through regular engagement with clinical areas and staff, enabling them to gain firsthand insight into operational issues and the quality of care being delivered.

Staff views were actively sought and valued. Leaders used a comprehensive staff survey to understand workforce experience and identify opportunities for improvement. The most recent published survey, completed in 2025, achieved a response rate of 91%, demonstrating a high level of staff engagement. Findings indicated that staff were generally positive about their working environment, with many reporting enthusiasm for their roles and confidence in the organisation. The 2026 survey had recently been completed and was undergoing analysis at the time of our assessment.

Leaders demonstrated a realistic understanding of workforce challenges and openly acknowledged concerns relating to workload, staffing capacity, resources, role clarity and staff involvement in decision-making. They had developed a detailed action plan in response to these findings, focusing on improving communication, strengthening workforce sustainability, enhancing role definition and supporting staff retention. Planned actions included reviewing staff benefits, clarifying hybrid working arrangements, developing management capability and improving access to equipment and resources. This showed leaders used staff feedback constructively to support continuous improvement and workforce wellbeing.

Arrangements were in place to support leadership development and ensure future sustainability. Succession planning formed part of the organisation's strategic approach and was reviewed regularly by senior leaders. Key leadership positions had identified deputies and development pathways to support continuity of leadership. Opportunities for leadership development included mentoring, internal programmes and external sector-specific training. The provider had also established contingency arrangements to maintain leadership oversight during periods of unexpected absence, helping to ensure the continued effective management of the service.

The service promoted a culture in which staff were encouraged to speak openly and felt confident that their views, concerns and suggestions would be listened to and acted upon. Leaders and staff demonstrated openness, honesty and transparency in their day-to-day practice, fostering an environment where concerns could be raised without fear of negative consequences.

Clear mechanisms were in place to support staff to escalate concerns. These included access to managers, senior leaders and human resources processes, as well as formal Freedom to Speak Up and whistleblowing arrangements. Staff were aware of the procedures available to them and understood how to raise concerns when required.

The provider had embedded systems to support speaking up and promote psychological safety. This included a designated Freedom to Speak Up Guardian, opportunities for anonymous reporting and a clear commitment to ensuring staff would not experience detriment as a result of raising genuine concerns. Training on topics such as equality, diversity, human rights and whistleblowing formed part of induction and ongoing development, helping to ensure staff felt informed and supported to speak up.

Staff feedback mechanisms demonstrated that the majority of staff felt able to raise concerns and were confident that incidents, risks and unsafe practice would be appropriately investigated and addressed. Leaders supported this culture through regular engagement with staff, wellbeing conversations and a proactive approach to meeting individual needs. Where behaviours did not reflect organisational values, leaders used established human resources processes to address issues fairly and consistently while maintaining a focus on learning and improvement.

Staff told us they felt comfortable challenging poor practice and raising concerns when necessary. They were confident that leaders would respond appropriately and provide support throughout the process. Leaders handled concerns sensitively and confidentially and ensured significant issues were escalated to both local and provider-level leadership when required. Records demonstrated that concerns were monitored and reviewed through governance processes, with trends identified, action plans developed and progress tracked to support continuous improvement.

The provider demonstrated a strong commitment to creating an inclusive workplace where diversity was valued and staff were treated fairly. Leaders promoted equality, inclusion and respect across the organisation and had arrangements in place to identify and address any inequalities affecting staff experience, opportunity or progression.

Workforce information was routinely monitored to understand representation and experiences across staff groups, including those with protected characteristics. Recruitment processes were designed to support fairness and minimise potential bias through structured selection methods, anonymised shortlisting and the involvement of diverse interview panels. Equality, diversity and inclusion formed part of staff induction, while managers received additional training to support inclusive leadership and increase awareness of unconscious bias.

Leaders used a range of measures to identify and address potential disparities within the workforce. This included regular review of workforce metrics, annual assessments of pay equity and ongoing engagement with staff from under-represented groups. Equality impact assessments were embedded within organisational policies and decision-making processes, ensuring equality considerations were routinely evaluated when implementing change.

Staff told us they had equitable access to opportunities for development and career progression. Opportunities to participate in projects, apply for new roles and undertake further study were available through transparent and open application processes. Leaders worked to ensure employment practices supported equality of opportunity throughout the staff employment journey.

The service maintained a culture that did not tolerate bullying, harassment or discrimination. Staff told us they felt respected by colleagues and leaders and believed concerns about inappropriate behaviour would be taken seriously and addressed appropriately. Systems were in place to support staff from protected groups and those from historically under-represented or marginalised backgrounds.

The provider had implemented a Race Equality Action Plan and used Workforce Race Equality Standard (WRES) data to monitor staff experience, recruitment outcomes and progression opportunities for staff from different ethnic backgrounds. Leaders reviewed this information alongside staff feedback to identify areas for improvement and develop targeted initiatives. These included widening recruitment outreach, providing mentoring opportunities, supporting staff networks and delivering training to promote anti-racist practice and reduce bias. Freedom to Speak Up arrangements and equality policies further reinforced a culture of fairness, accountability and inclusion.

The provider also ensured staff with disabilities or individual needs were appropriately supported through reasonable adjustments. Examples included flexible working arrangements, remote working options, adjusted working patterns and other tailored support measures designed to enable staff to perform their roles effectively and maintain their wellbeing.

The service had well-established governance arrangements that supported the delivery of safe, effective and sustainable care. Clear lines of responsibility and accountability were in place at all levels of the organisation, enabling staff and leaders to make informed decisions based on performance, quality and risk information. Systems supported the secure sharing of information where required and ensured governance processes remained effective and responsive.

Leadership and accountability structures were clearly defined. Strategic oversight was provided by the provider's directors, while operational leadership was led by the Registered Manager and Clinical Lead. Clinical oversight at site level was supported by designated lead clinicians, with professional accountability maintained through practising privileges arrangements. Governance structures were subject to regular review to ensure they remained appropriate to the needs of the service.

Governance activity was embedded throughout the organisation and supported through a structured programme of meetings and committees. Clinical, operational and quality information was routinely reviewed and escalated through governance channels to ensure leaders maintained oversight of service performance. Directors met regularly with clinicians, and site leads participated in scheduled governance meetings to discuss quality, safety and organisational performance.

Leaders maintained oversight of compliance through regular monitoring and review processes. Risks relating to areas such as medicines management, fire safety, environmental safety and controlled drugs were identified, discussed and managed through agreed action plans. Responsibilities for actions were clearly allocated, and progress was monitored to ensure improvements were implemented and sustained. Leaders demonstrated a culture of openness and learning, recognising areas requiring improvement and providing support where needed to strengthen compliance.

Arrangements were in place to ensure risks associated with financial pressures, resources and operational demands were appropriately recognised and escalated. Leaders had introduced systems to improve consistency and oversight, including standardised monitoring tools, electronic recording systems and shared digital documentation platforms. These measures strengthened accountability, enhanced transparency and supported effective management of quality and safety.

Clinical performance was subject to ongoing scrutiny. The clinical leadership team reviewed practising privileges applications and monitored the outcomes achieved by individual clinicians. Where concerns were identified, established processes were followed to investigate and address issues appropriately. Clinicians were required to demonstrate ongoing professional development, including completion of annual continuing professional development requirements, which were reviewed as part of practising privileges renewal arrangements.

Staff understood their responsibilities and were clear about their individual roles. Job descriptions outlined expectations and accountabilities, and staff involved in audit, quality monitoring or governance activities understood their responsibilities within these processes. This supported consistent oversight and effective management of service quality.

Information systems enabled staff to access the data required to monitor performance, identify improvement opportunities and support decision-making. Records and reporting systems were secure and integrated, and statutory notifications and external reporting requirements were completed when necessary. Leaders ensured key information was communicated through regular meetings and staff updates, helping staff remain informed about service performance and organisational priorities.

Risks were identified, recorded and monitored through a formal risk management process. The risk register was regularly reviewed and used to monitor the effectiveness of mitigation measures. Staff contributed to discussions about risks and service improvements, supporting a collaborative approach to quality and sustainability. Key risks included information technology infrastructure, procedural funding arrangements and the maintenance of medical equipment. These were routinely reviewed, with controls and mitigation actions in place.

Risk management arrangements were comprehensive and provided senior leaders with ongoing assurance regarding organisational risk. Risks were routinely discussed at clinical governance meetings and escalated to board level where appropriate. Leaders maintained oversight of risk ratings and mitigation measures, and records demonstrated that risks remained stable and effectively controlled. This supported the delivery of safe and well-governed services.

A comprehensive programme of clinical and non-clinical audits was used to monitor performance and drive improvement. Audit findings were reviewed by leaders, and where opportunities for improvement were identified, action plans were developed and monitored to ensure required changes were implemented and sustained.

The service had effective business continuity arrangements to support the delivery of care during periods of disruption. Potential risks, including workforce shortages, equipment failure, changes in demand and environmental incidents, had been assessed and incorporated into business continuity planning. Emergency response procedures and supporting action plans were available to guide staff in the event of significant disruption, providing assurance that essential services could be maintained.

Information governance arrangements were robust. No data breaches had been reported, and systems were in place to ensure patient information was managed securely and confidentially. Policies were current, accessible to staff and subject to oversight by leaders, who maintained responsibility for ensuring documentation remained accurate and up to date.

Performance, quality, workforce and financial information were monitored through a structured assurance framework. Leaders reviewed key performance indicators through regular governance meetings, with findings reported to senior leaders and directors to support effective organisational oversight. These arrangements enabled leaders to monitor performance, identify emerging issues and take action to maintain the quality and safety of the service.

The service used bank staff to help maintain staffing levels and service delivery. During the previous quarter, one theatre list was cancelled because staff were unavailable; however, this was an isolated incident, did not affect patient safety and was not part of a wider pattern. Leaders were aware of the potential impact on service continuity and had taken proactive steps to strengthen staffing arrangements, including offering permanent contracts to bank staff. Many staff chose to remain on bank contracts because they preferred the flexibility this provided.

The service worked with other organisations to provide joined‑up care for patients. Staff and leaders worked closely with local and system partners, including GP representatives and community optometrists. This helped create clear referral pathways, support information sharing and ensure patients received the right care and follow‑up. Electronic referral systems were used to help manage referrals safely and efficiently.

Leaders were involved in local meetings and worked with partners when developing services. For example, they took part in discussions about local eye care pathways, including glaucoma services, to make sure services met the needs of the local population.

The service collected feedback from patients and partner organisations and used this to make improvements. Feedback came from the Friends and Family Test and direct patient comments. Leaders used this information to improve patient pathways and how the service was delivered. They also responded to feedback from partners by making referral processes clearer and increasing clinic capacity to improve access.

Staff and leaders were visible within the service, and patients were given information on how to provide feedback or raise concerns. Leaders were working to improve engagement with a wider range of community groups, including people from ethnic minority backgrounds, showing a commitment to improving access and reducing inequalities.

The provider also supported the local community and charities. For example, the service made donations to charities that help women and children access healthcare and took part in fundraising activities.

The service encouraged a culture of learning and improvement across the organisation. Staff could share feedback in different ways, including team meetings, one‑to‑one discussions and surveys. Leaders listened to this feedback and took action where needed. Staff said they felt comfortable speaking up and contributing ideas to improve the service.

The service supported staff development. Appraisals were carried out and included clear goals, training needs and opportunities to develop skills. Clinical staff also received regular supervision, helping to ensure care was safe and effective.

Staff were involved in service improvement. For example, the cataract patient pathway was reviewed to reduce the number of visits to improve compliance with national guidance. Workshops were also held to improve patient journeys and overall experience.

Leaders made changes to improve efficiency, including introducing virtual follow‑up appointments. They used feedback and performance data to identify further areas for improvement and had plans to review more pathways.

The service continued to strengthen how it monitored performance, including developing digital tools. Leaders were also expanding training opportunities, such as minor operations, laser treatments and specialist masterclasses, to support staff skills and best practice.

Results were shared with staff in monthly meetings, helping the team learn and make improvements.

Overall, the service showed a strong focus on learning and improving. For example, after learning from a Care Quality Commission visit at another site, the service introduced a survey for patients having YAG laser treatment to better understand outcomes and improve the service further.