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Inspection carried out on 11 and 16 October 2017

During a routine inspection

The London Eye Hospital is a private hospital providing a range of eye treatments and surgical procedures to adults. All patients are self-funding. Although they offer treatments for a wide range of eye conditions, they specialise in lens implants and cataract treatment. One of the procedures carried out as part of the service is lens implants for patients with age-related macular degeneration (AMD) which is a progressive disease of the macula (the central area of the retina) and a cause of sight loss. The total number of lens implant surgeries carried out between September 2016 and September 2017 was 379.

The London Eye Hospital is operated by The London Eye Hospital Limited. There are two locations linked to London Eye Hospital Limited, namely 4 Harley Street and 29a Wimpole Street. Both locations are named The London Eye Hospital. Number 4 Harley Street provides the outpatient service for the hospital where pre and post-operative consultations take place. Number 29a Wimpole Street is the site where all the surgical procedures take place. This report relates to 29a Wimpole Street only.

We carried out this inspection in response to concerns received in August 2017 about the type of lens implanted in surgery between 2014 and 2015 at the Wimpole Street location and some aspects of pre and post-operative care and treatment provided at this hospital. We responded to these concerns by carrying out an unannounced inspection on 11 and 16 October 2017. The inspection did not address all our key lines of enquiry but focused only on the issues raised by the information received. The inspection focused on safeguarding, consent, complaints, patient outcomes, and governance arrangements. Prior to this responsive inspection, we had carried out a comprehensive inspection of the service in December 2016.

Inspection carried out on 6 and 7 December 2016

During a routine inspection

The London Eye Hospital is a private hospital that provides a range of eye treatments and surgical procedures to adults who are self- funding. They specialise in providing cataract treatment and lens implants. Their location at 29a Wimpole Street, which this report refers to, is their surgical site where all surgical procedures take place.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? We rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with regulations.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service section.

We rated the surgical services as good overall. However, we found that the hospital required improvement in well-led domain. It was unclear how the medical advisory committee (MAC) functioned and how consultants might play an active role within it.

We rated this hospital as good overall because:

  • Staff spoke with compassion about patients. Doctors were kind and respectful towards the patient and took time to ensure they answered questions and concerns in full.

  • Local management of the surgery site was robust and well-led.

  • Staff told us they were confident to raise any issues with senior management. They told us the London Eye Hospital was a good place to work.

  • Procedures were scheduled to accommodate patient’s travel times or specific needs related to other illnesses. There was a 24 hour telephone support line available to patients.

  • There was a clearly defined patient pathway. Consultants were available to patients post-operatively.

  • There was a clearly defined complaints process.

  • Care was delivered in line with relevant national guidelines.

  • Staff had up to date training in the use of machines used at the hospital. We saw completed competencies for all staff directly employed by the provider.

  • There was evidence of good internal multidisciplinary working.

  • Staff understood their responsibility with regards to ensuring there was patient consent to all procedures.

However:

  • There was a nine months waiting list for a particular ophthalmic procedure.

  • The hospital did not have a written long term strategy.

  • Clinical governance meeting minutes did not have an attendance list and there was no update on actions from the precious meeting.

  • The risk register lacked consistency and detail. The incident log was not always updated to indicate how the incident was resolved.

  • There was no data available to assess clinical outcomes in line with the Royal College of Ophthalmologists Cataract Surgery Guidelines September 2010.

  • There was no provision for doctors to meet with each other on formal basis to share common themes.

  • Two consultants’ intermediate life support training was overdue at the time of our inspection. There was no record kept of consultant’s competencies or any mandatory training done by them.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help it move to a higher rating. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 9 January 2014

During a routine inspection

We spoke to three people who used the service on the day of the visit and looked at the care records of four other people who had used the service in the last six months.

The people we spoke with all had a positive experience of their treatment. One person said that their eyesight was now "infinitely better." We were told that all the staff had been "reassuring during the surgery." One person said that the care had been "very good." We saw that the care records were well organised and contained detailed information to support clinical decision making for ongoing care and treatment.

We found that the treatment options, risks and after-care were explained prior to any procedure being carried out. People were also given advice and time to consider their options before making the decision about treatment. One person said " I was not rushed." Another person felt that the consent form and information was in small type and should be made larger as most people attended the clinic due to vision problems.

We saw that there were effective systems and procedures in place to ensure that the equipment was well maintained and conformed to government safety standards where required.

People told us that they found the staff at the clinic to be very helpful. We saw from the staff records that all the necessary staff checks had been completed.

We saw there was a complaints system in place, with information and complaints forms readily available to people who used the service.

Inspection carried out on 11 February 2013

During a routine inspection

In recent feedback people rated the information they were provided with about their treatment and procedure as "good" and the staff attitude and professionalism as "very good". In their comments people said that staff were "very nice and helpful" and that they "had time to answer all the questions we had". The service had access to translators if necessary and was accessible to people using wheelchairs.

Appropriate checks were made before, during and after procedures to ensure that people were safe. People who had used the service rated their treatment as "very good" and said that their procedure had been carried out with "care and consideration". Staff had been trained in what to do in a medical emergency and there were emergency drugs and equipment available.

On the day of the inspection the service was clean and tidy. There was a specific policy setting out what cleaning needed to be undertaken and when. Personal protective equipment was available throughout the service. Infection control checks and audits were undertaken on a regular basis.

When staff started at the service they underwent an induction. All staff underwent mandatory training in appropriate topics and there was a procedure in place for staff to receive annual appraisals.

People were asked to provide feedback and comment on the service and this was reviewed by senior staff. Audits were conducted to monitor the quality of the services being provided.