Royal Manchester Eye Hospital

Updated 19 March 2019

Royal Manchester Eye Hospital is a large specialist ophthalmic teaching hospital that provides a comprehensive secondary care service to the population of Central Manchester population and a tertiary ophthalmic service to North West England and beyond. Acute services are accessed by a population beyond central Manchester.

The surgical service treated adults and children and young people with five theatres. There is a 17 bedded in patient area with a surgical assessment lounge that has accommodation for eight patients and five side wards. There is a day surgery facility with 16 chairs. Surgical treatment is also provided at Trafford and Withington.

The out-patient department sees a quarter of the out-patient activity of the trust and services are provided across the trust. There are two shop fronts in the north and south of the city which provide a range of services for patients.

Updated 19 March 2019

• Staff knew how to protect patients from abuse and the service worked with other agencies to do so, staff had received training on how to recognise and report abuse and were able to give examples of when they had done this.
• The service controlled infection risk well. Equipment and premises were kept clean and there were systems and processes in place to prevent the spread of infection. The hospital measured its infection rates and there had been no reportable infection since October 2017.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. Outcomes were reviewed every month so that changes could be implemented quickly. They compared their results with other services to try to improve them. Rates of posterior capsular rupture were low. The hospital was a national trainer for a new technique for some glaucoma patients.
• The service made sure that staff were competent for their roles. There was a culture of continuous learning and development at the hospital and protected time for research. New roles had been developed with appropriate training, education and competency assessments. There was oversight of training and development at a senior level.
• Care was holistic at the eye hospital and staff were very aware that a diagnosis of sight loss would dramatically affect people’s lives. Patient feedback about their care was very positive and people felt comfortable at the hospital.
• There was strong emotional support at the hospital and patients could access psychological support. Staff supported patients to access services in their own communities to try to prevent social isolation. There was specific support for children and their families and feedback about this service was extremely positive.
• The service met the individual needs of patients who needed additional support. There were examples of the individual support to patients with a learning disability or autism so that the best outcomes for the patients could be achieved.
• The hospital was working to support children and young people and their transition to adult services. There was senior clinical support for this and an audit was in place to identify those patients who were in the transition phase of their treatment. Patients saw the same medical consultant through into the adult clinics.
• Leadership from all professions working in the eye hospital was effective and robust. Managers were capable, experienced, clinically knowledgeable and competent and staff told us that they had confidence in them. Many of the managers were leaders in their own professions both nationally and internationally.
• There was a strong culture of risk management and service improvement at the hospital with systems in place to escalate issues of risk and patient safety up and down the organisation. The hospital were aware of their financial situation and this was part of the accountability oversight framework.
• Staff worked collaboratively to develop new models of care, innovation was encouraged and there was protected time for research among health professionals in the department.
• However; Not all patient records were fully completed and there were issues around the availability of patient records for out-patient clinics.
• The safer steps to safer surgery including the World Health Organisation checklist were not

always fully completed.

Updated 19 March 2019

We had not rated this service before. We rated it as outstanding because:

• There were systems and processes in place to keep people safe. Staff had received training and were competent in their roles. Infection risk was controlled and there had been no reportable infections in the last year. There were enough staff to keep people safe from avoidable harm and staff reported incidents and these were investigated by managers and there was feedback to staff.
• The service provided treatment based on national guidelines. Multi-disciplinary team working produced the best outcomes for patients and the effectiveness of services was measured. There was a culture of innovation and learning and staff received protected time for research. New roles were being developed to address gaps in service provision and to develop staff.
• Care was holistic and feedback from patients was extremely positive. Patients were supported at the hospital and in their communities and there was specific support for children and their families. There was psychological support for patients if necessary.
• The service supported patients with additional needs and this was individualised. There was ongoing work for children in the transition from children’s’ to adult’s services. There were waiting list pressures due to issues in the health economy and capacity issues and the service had addressed these with new ways of working.
• Clinical leadership across all professions was very strong and there was a positive culture in the hospital. Senior managers were aware of the issues across the health economy and of the financial issues that affected the hospital. Risk was well managed and there were systems and processes in place to improve patient safety and improve quality.

However:

• Not all patient records were fully completed and there were issues around the availability of patient records for out-patient clinics.

Updated 19 March 2019

We hadn’t rated this service before. We rated it as outstanding because:

• The service was working across the health economy to standardise treatment and to set standards of practice. There was a culture of learning and continuous development to improve services and patient outcomes. New roles were being developed, implemented and audited to address gaps in staffing.
• The hospital was leading the implementation of new techniques for surgery and training colleagues across the country in these techniques which were improving patient outcomes.
• Services were safe and there were systems and processes in place to maintain and improve patient safety. Staffing levels were good and staff had received appropriate training for their role.
• The service provided compassionate care for patients and privacy and dignity was respected. There was emotional support for patients and their relatives.
• There was additional support for patients with cognitive impairment, autism and learning disabilities. Young people were well supported in the transition from children’s services to adult services.
• Leaders were capable and experienced and there was strong multi-professional leadership from all professions at the hospital. There were systems in place to improve patient safety and to improve performance; risk was well managed and there was improving staff engagement. All staff recognised a positive culture at the hospital and were proud to work there. Senior staff were very proud of their workforce.