SpaMedica Portsmouth

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• 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

This is the first assessment for this 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 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

The service had a clear exclusion criterion in place to determine which patients were appropriate for care. Staff completed a health assessment of the patient from the point of arrival at the service. Porters greeted the patient and asked them how they were feeling and offered hydration. Clinical staff then undertook comprehensive health assessments and risk analysis, such as blood pressure, if they lived alone, checking they had not driven to an appointment if they were having treatment.

Staff developed care plans that met the needs identified during assessment. We saw that relevant information such as past medical history, current medications and allergies was noted within electronic systems and on all paper records. This was to ensure that this information was available to all staff were aware of this information and necessary measure were taken.

We reviewed 10 patient records during our assessment. We saw that all patients had undergone screening checks to ensure they were well enough to proceed with treatment. Patients who were too unwell to undergo treatment still underwent health checks to ensure the opportunity to check health & wellbeing was maximised. Leaders told us that if patients attended and were identified to have previously unidentified health concerns these would be made known to the patient and their GP informed to support with this.

Patient notes were comprehensive, and all staff could access them easily. Staff completed registration details by hand and then added them to a digital cloud-based record. Staff could access clinic letters, imagery, optometry data, and diagnostics securely and remotely. This meant patients received efficient care and referrals were handled promptly.

Patients’ communication needs were assessed and met to maximise the effectiveness of their care and treatment. Patients who required additional communication support, such as translators or signers were supported with this and interpreters/signers were booked to attend the hospital.

Staff updated care plans when necessary. We saw examples of when patients, having treatment to both eyes separately, had attended on separate dates for treatment. The notes for these patients reflected changes in medical diagnoses that had occurred between attendances and their notes reflected this to ensure the most current information was known to all staff.

Staff had received specific training to support them to engage with patients with additional needs. Staff underwent mandatory training in a range of patient needs including sensory impairment & deaf awareness. All staff had completed training nationally recognised and mandated training in supporting patients with learning disabilities and autism.

We scored the service as 3. The evidence showed a good standard. 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.

Patients received care, treatment and support that was evidence-based and in line with good practice standards. Updates regarding evidence-based care and treatment was filtered through the governance meetings and shared with staff at monthly team meetings and morning huddles.

The provider’s document storage system ensured staff were up to date with national legislation, evidence-based good practice and required standards. These included the Royal College of Ophthalmologists (RCOpth), the World Health Organisation (WHO), and the National Institute for Health and Care Excellence (NICE).

All policies were centrally uploaded and alerted staff to new policies for them to read. This supported staff to provide consistent care across the service as the policies were identical in all provider locations they may attend to work. This meant staff were able to access policies and processes easily and ensure it contained the most up to date guidance. Leaders could see who had read the policies and reminded staff who were overdue to read them. We reviewed several policies and saw they were all up to date and referenced national legislation and guidance.

Staff followed established service-wide governance processes to ensure compliance and maintain standards. Staff consistently reviewed performance and compliance using a comprehensive audit schedule. Where compliance was below 95% the frequency of the audit was increased until compliance was regained.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Staff spoke with enthusiasm about the audits they undertook within the service and how they identified improvements. Audits included clinical documentation, consent, laser safety, and infection prevention and control.

Staff engaged in an integrated approach to assessing, planning and delivering care and treatment to all patients who used services. The team included or had access to the full range of specialists required to meet the needs of patients in the service. Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed they could improve the way their service delivered care.

At provider level, there was a surgical training programme, which supported NHS trainee ophthalmic surgeons’ professional development through simulated “dry-lab” suites, theatre exposure and supervised cataract practice. "Dry-lab" theatres are blended teaching spaces that combine traditional lectures with practical, hands-on learning, often in a "dry" environment that doesn't involve real life hazards. This helped to accelerate surgical confidence and competence.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They recognised the importance of working closely with other services such as optometrists.

When patients received care from a range of different staff, teams or services, it was co-ordinated effectively. All relevant staff, teams and services were involved in assessing, planning and delivering patients’ care and treatment and staff worked collaboratively to understand and meet patients’ needs.

Staff shared information about patients at morning meetings that the whole team attended. During this meeting the team discussed all patients who were due to be seen. The meeting gave essential information such as key roles for the day, including the fire warden and person in charge and also assigned roles to staff for the day such as tannoy checks, room temperature checks and pharmacy checks.

On days where surgery was performed there was a surgical safety huddle at the start of each operating list where the theatre team discussed each patient individually including any additional needs such as allergies. Surgeons and scrub nurses worked together to make sure patients received the correct lens prior to surgery.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. Staff requested care summaries from the GP where required. All patients who needed surgery underwent a pre-operative assessment to ensure they had all the information they needed and were fit to proceed with surgery.

Staff held regular and effective multidisciplinary meetings to discuss patients, including when they when they had specific needs to ensure these could be supported. There was also a sight support service which offered practical or emotional support to blind people managed by sight support officers. We saw this being promoted in the main entrance with clear and prominent signage.

All locations for the provider worked closely together to maximise efficiency and reduce waiting times to benefit patients. Leaders and staff worked together across the provider, SpaMedica, to ensure safe levels of staffing and oversight were maintained at all times.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff provided relevant information promoting healthy lifestyles and support to patients on an individual basis where this could improve eye health. Surgical teams provided each patient with individualised postoperative advice to promote a rapid recovery, including in relation to their work, hobbies, and sports.

We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Outcomes for patients were positive, consistent, and met expectations, such as national standards. The service had a lower-than-expected risk of complications for elective care than the England average. The provider had developed a provider level surgical risk profiling tool which allowed them us to identify patients at higher risk of complications and put them on specific surgical lists, led by experienced specialist surgeons. This ensured surgeons were skilled and prepared to deal with potential complications, with time specifically allocated to dealing with the increased complexity.

There was a provider level drive to exceed the national target for posterior capsular rupture (PCR). Patients at high risk of PCR we placed on specialist complex operating lists. The service had an average PCR rate of 0.38% compared to the national average of 1.1%. PCR is a complication that may occur during surgery when the capsular bag that holds the lens breaks. This meant their patients at this service were 3 times less likely to experience a PCR complication during cataract surgery.

The service benchmarked themselves against other hospitals in the provider network and they performed consistently to a high standard. The service had completed 694 surgeries since opening, and no patients had returned to theatre with a complication. There had been no re-admissions and no unexpected admissions for following surgery.

Patients spent time under observation until clinical staff were satisfied it was safe for them to leave, and the patient felt comfortable doing so. Staff provided post-operative instructions to each patient to make sure they recovered quickly and safely. They spent time with each patient in recovery to answer questions about how to look after themselves at home and what to do if they had unexpected side effects.

Patients reported on the outcomes of their surgery. The service gathered information post-operatively to see if patients were happy with their outcomes. Patient feedback we reviewed stated the service had ‘exceeded their expectations’.

Staff monitored and improved quality and outcomes by taking part in regular audits including national clinical audits. Staff provided data to the National Ophthalmology Database Audit (NOD) and the Royal College of Ophthalmologists, who measured outcomes of cataract surgery.

Audits were conducted on each surgeon to monitor the outcomes monthly to check for effectiveness of treatments. These were reviewed and monitored by the medical director.

When patients had their appointments, treatments or operations cancelled at the last minute, managers made sure they were rearranged as soon as possible and within national targets and guidance. Patients who were cancelled for medical reasons were added to a temporarily unfit waiting list. The team called the patient regularly to get an update on their condition. When they were medically fit for surgery, they were rebooked as soon as possible. At the time of the assessment, there was a 11 day wait for surgery from outpatient attendance, this was considerably lower than the national average.

There was participation in relevant local and national clinical audits and other monitoring activities such as reviews of services, benchmarking and peer reviews. The peer review process was a mock CQC audit which aimed to improve care for their patients and embed and celebrate good practice. Staff used peer review to identify areas for improvement and obtain support to make changes. There was a comprehensive checklist based on the CQC assessment framework for hospital managers to follow.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Patients received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. All patients were given both written and verbal information about their treatment, in advance, to support making decisions and informed consent. There was a clear policy in place outlining expectations regarding consent and this was in date. This was in line with RCO guidelines that state consent should include a two-stage process in which consent forms are available to the patient from the time of the and patients are given an open line of communication with their surgeon for follow-up questions during a cooling off period.

Staff understood the importance of ensuring patients fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Staff clearly recorded consent in the patients’ records.

Staff had the appropriate skills and knowledge to seek verbal and written informed consent before providing care and treatment to their patients. The service mostly ensured patients were consent in line with their policy.

We looked at 11 consent forms within patient notes and saw consent was clearly recorded in all these records. However, 8 of the 11 forms which did not state if a copy of the consent form was offered or provided to the patient. Patients should be offered, and if required, provided with a copy of their consent form to ensure they have a record of their informed decision-making process, and that the patient received and understood the necessary information about a procedure, its alternatives, and potential risks and benefits.

The service audited the completion of consent forms; we saw that the most recent consent audit had a compliance of 96%. We saw that this audit had also identified the need to document if a consent form had been offered for patients, and the record we reviewed were within the same period of time. Leaders provided assurance and evidence that demonstrated that the staff group this covered had been reminded of the need to document this.