CES Medical - Chatham

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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

We looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient's 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 since registering to provide a regulated activity. This meant patient’s outcomes were consistently good, and patient’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The service made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed care records on site and found the service assessed and recorded patients’ health, wellbeing, and communication needs consistently. Records showed staff completed appropriate clinical assessments, considered individual risks, and documented consent. The service clearly recorded patients’ communication needs and provided information in a way patients could understand. Care records demonstrated that staff involved patients in decisions about their care, explained treatment options and aftercare clearly, and reviewed needs at key stages of the pathway to ensure care and treatment remained effective.

Patients booked to have a YAG laser capsulotomy (a quick, painless outpatient procedure to treat cloudy vision) had to attend a pre-assessment appointment. Staff shared key information to keep patients safe when handing over their care to others. Following outpatient appointments or operative procedures, staff communicated relevant outcomes and clinical information to the referring clinician to support continuity of care.

The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff mostly followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The provider had attempted to obtain training to adopt the Patient Safety Investigation Response Framework and were awaiting training at the time of the assessment. We were told about the commitment to follow this framework when they could effectively embed it. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance to staff.

Polices and processes took account of changes to the Royal Colleges guidelines and National Institute for Health and Care Excellence guidelines.

We reviewed 5 care records for evidence of completion of care plans and risks assessment of patients and found all were completed correctly.

The provider delivered minor operations as a same‑day discharge service with no routine follow‑up. Patients were given a telephone number to contact at any time if they had concerns or experienced problems after the operation. The service managed patient safety through careful pre‑procedure assessment, strict infection control, and clear aftercare instructions. The team reviewed any concerns reported by patients or the NHS through formal clinical governance processes.

The service worked well across teams and services to support patients. Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff reported healthy working relations across staff groups including between medical and nursing teams. We saw and heard examples of effective team working which was based on mutual respect and trust.

Teams and services shared information to ensure continuity of care. Following each episode of care clinicians sent a discharge summary or clinic letter to the referring clinician. Patients left the clinic with information about the treatment they had received and how to contact the service if they had concerns. The provider had an on-call rota of clinicians who responded to patient concerns within 30 minutes of receiving a call.

The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

The provider supported patients to live healthier lives by promoting eye health, preventing avoidable sight loss and supporting independence. This included early detection and management of eye conditions, patient education and improved access to care closer to home, helping to reduce health inequalities and support overall wellbeing.

Patients undergoing elective operations had access to information about their condition, their treatment and how best to prepare for surgery. Staff spoke with them about how best to optimise their outcomes after surgery and how to modify their choices to ensure better health.

The evidence showed a good standard. 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.

Staff monitored the effectiveness of care through audit and bench marking, using the findings to improve practice and achieve good patient outcomes. The service participated in national and provider‑led audits, including the National Ophthalmology Database. The provider audited YAG capsulotomy procedures; a 6‑monthly audit of 85 cases identified 3 post‑operative complications, one of which was reportable and was submitted to the Royal College of Ophthalmologists.

The service had been accredited under relevant clinical accreditation schemes. The provider held appropriate professional registrations and accreditations to deliver a community ophthalmology service safely and effectively. Clinical staff were appropriately registered with their professional regulators, including the General Medical Council, Nursing and Midwifery Council and Health and Care Professions Council. Care delivery was aligned with guidance from the Royal College of Ophthalmologists, and the service participated in relevant clinical audits to support quality assurance. Together, these arrangements provided assurance that care was delivered in line with national standards and professional requirements.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. During the assessment we observed patient appointments and saw staff obtained verbal consent from the patient before the examination.

Staff followed the service’s policies related to consent. Staff gained consent from patients for their care and treatment in line with legislation and guidance. The most appropriate doctor sought consent for surgery and included discussion about the benefits, potential complications, the risks and alternative options. Patients signed their consent forms at the consultation before the procedure. Staff then rechecked consent on the day of the procedure. The service completed consent audits and shared outcomes with staff.

Interpreters were available to support patients to give informed consent, including for British Sign Language and face to face interpreting when necessary.