Royal Eye Infirmary

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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 people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people 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 for this service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’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 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.

Staff completed care records accurately. During our assessment we reviewed care records which showed accurate and complete information about the care and treatment people received. Staff used a range of tools to assess and review people’s care and treatment needs.

Staff were knowledgeable about the service user group they provided care for. Staff felt processes enabled them to respond to people’s changing needs.

The service had processes to book interpreters if the person required communication support during appointments. Records showed if interpretation could not be found, the appointment was postponed.

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.

Staff followed up-to-date policies to plan and deliver care and treatment according to best practice and national guidance. There were processes to manage and review policies and procedures to make sure they were up-to-date.

The service informed people of any preparation needed prior to attending an appointment.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. Staff shared information about patients at effective handover meetings within their teams. Daily staff huddles were held at the start of each day to discuss any issues affecting service delivery including staffing levels, workloads, required training. Staff told us they receive key information by email.

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.

During our assessment we saw displays of information designed to promote healthier lives. In all outpatient waiting areas, there were information leaflets relating to specific eye conditions and how to effectively manage those conditions. There were information leaflets on stopping smoking to improve health. Also, there was information produced by a Parkinsons charity with information to support people living with Parkinsons.

The trust’s website contained various patient information guides to support people with their condition and to live healthier lives.

During our assessment of the service, staff were identifying people who were eligible for flu vaccination and provided the service by trained staff during outpatient appointments.

The evidence showed some shortfalls. The service did not meet people’s expected access to treatment. However, there were improvements overtime.

The maximum number of weeks patients should wait to be seen by a doctor is set by the NHS Constitution to try and make sure people were seen in a timeframe that means their medical condition will not get worse while they were waiting. The longest time the Constitution says people should wait is 18 weeks for most non urgent referrals. Risks to people increase the longer they wait.

Ophthalmology referral to treatment performance when we assessed the service showed there were no people waiting over 78 weeks to be seen. However, the proportion of people waiting more than 52 weeks was 2.73% against a national performance of 0.44%. There were 842 people waiting for treatment longer than 18 weeks, which was 37.15% of people waiting.

The service monitored waiting lists for specialties. There were increased waiting times for macular treatment. The service was impacted by staff turnover in this specific area. There were plans to improve availability of staff performing injections.

The service carried out reviews of the waiting list and had plans to improve performance.

Feedback gathered by system partners showed people generally felt that they had been seen quickly, but there were issues with waiting from initial referrals. Feedback collected about glaucoma care included 1 person saying, “I should be seen every 4 to 6 months, but I am being seen once a year.” Another person said, “Royal Eye Infirmary has very long waits.”

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had up-to-date policies and processes to support staff in gaining informed consent. Staff understood and could explain how to gain consent from adults and children to provide care and treatment. During the assessment we observed staff explaining the purpose of the appointment, and what to expect during and after the appointment. Records showed consent was gained for care and treatment.

Staff understood their responsibilities where a person lacked capacity.

The booking process was able to capture support a patient needed during an appointment. For example, translators or advocates. The service used this to plan care.