Royal Eye Infirmary

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence there was an inclusive and positive culture of continuous learning and improvement based on meeting the needs of patients who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This is the first assessment for this service. This key question has been rated requires improvement.

The service was in breach of regulation; there was no audit process to ensure records were consistently meeting standard. Processes did not identify and mitigate fire safety issues, trip hazards, gaps in laser safety, and gaps in staff training.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities.

The service worked within the trust’s overall vision, strategy and values. The vision was to provide outstanding integrated care. The service had a long-term clinical strategy to improve performance. Although, staff we spoke with did not always know the vision, values or strategy of the service. However, staff were patient focussed and spoke about improving people’s vision and lives.

Leaders told us the vision of the service was to treat everyone as quickly as possible and safely, and to continue to bring waiting time down. They aimed to listen, learn and improve. There was also a desire to improve staff sickness and welfare and make the service a better place to work.

Staff felt respected, supported and valued. Staff reported the leadership culture was inclusive, and they felt valued and respected. Relationships between staff of all grades were positive, with strong teamwork and collaboration.

Staff we spoke with felt proud to work at the service. Staff said they worked well together as a team and enjoyed their work.

Patient information including discharge information included a statement of the trust’s policy on zero tolerance of discrimination, harassment, bullying or abuse.

The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders usually had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

At the time of our assessment, the service was going through an organisational restructure. Leaders said this was a challenging time but felt supported by colleagues and the wider team. Leaders told us they had access to development opportunities and gave examples of how the trust supported them to attain new qualifications to support the leadership of the service.

Leaders understood the pressures to deliver care. At the time of our assessment there were significant demands for eye surgery across the healthcare system.

Staff survey results from 2024 showed almost all staff had confidence their immediate line manager would help them with problems, listened to them and encouraged them at work,

Staff said senior leaders were approachable, but they were not aware of who all the senior leadership team at the Royal Eye Infirmary were.

The service fostered a generally positive culture where patients felt they could speak up and their voice would be heard.

The service had access to an up-to-date freedom to speak up policy supported by a variety of other policies and procedures designed to enable people to raise concerns. There were named freedom to speak up guardians.

Managers had access to feedback from people. They had access to feedback from patients and staff and used feedback to investigate concerns. Managers understood the importance of staff being able to raise concerns without fear of retribution.

Staff survey results for 2024 showed they would feel secure raising concerns about unsafe clinical practice. They also felt the provider acted on concerns raised by people using the service. However, during our assessment some staff told us they did not always feel listened to.

Staff told us they had used the freedom to speak up process to raise concerns about the systems and processes within the service. This was an open case at the time of our assessment.

The trust’s freedom to speak up team held an engagement event at the Royal Eye Infirmary in March 2025 to promote speaking up.

Staff said there was a whistleblowing policy and process, and they knew how to access these.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

The service was part of the trust’s equality, diversity and inclusion strategy which had 3 aims and objectives to help address challenges in the workplace. The trust had processes to monitor and report on gender, ethnicity and disability pay gaps. There was also a variety of staff networks and support groups with the aim of making a positive difference in the workplace.

The services at the Royal Eye Infirmary were included in the trusts reporting for workforce race equality standards (WRES).

Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well. Staff told us they felt the provider met their needs.

Staff survey results from 2024 showed most staff felt the organisation made reasonable adjustments to enable them to carry out their work.

Staff received training in equality, diversity and human rights. Records showed 78% of staff were up to date with training,

Staff told us they felt everyone was treated fairly. They said the service would support their personal needs and they gave us examples of when this happened.

The evidence showed significant shortfalls. The service did not have clear systems to identify issues in a timely way. However, the service had clear responsibilities, roles, systems of accountability.

The service did not always have complete audit programmes to manage the safety and quality. During our assessment we did not find concerns in the completion of records. However, the service did not have a process to monitor the standards of record keeping. This meant the service could not be assured that actual practice was consistently in line with best practice meaning there may have been missed opportunities to identify learning and drive improvement.

Systems and processes did not always identify issues in a timely way. For example, processes did not identify fire safety issues, tripping hazards, or laser safety issues we identified on the inspection. However, the governance processes for the Royal Eye Infirmary were being reviewed and improved.

Governance at Royal Eye Infirmary was embedding, they were 12 months into going live with a new framework which focussed on risk, incidents, and complaints. The governance lead recognised they needed to integrate and separate out different areas of Royal Eye Infirmary, and bring their own unique reports into governance, and be able to drill down into different areas. There was a clear governance meeting structure.

The service regularly reviewed risks. They maintained a risk register to evaluate and mitigate risks that posed a threat to the safety and quality of service provision. There was a named person responsible for completing each action. Managers and staff were aware of risks reflected on the risk register. Significant risks such as wait times were identified and escalated to board.

The service had plans to cope with unexpected events and had a business continuity plan, which included major incident plans.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of each policy.

The service had clear staff job descriptions. Each job role had specific roles and responsibilities and set out the expectations. Staff understood their roles and who to report to in the service.

The service sub-contracted some clinical work to other providers. This was manged through contract reviews.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. Staff share information and learning with partners and collaborate for improvement.

In July 2025 Healthwatch staff and 2 volunteers visited the Royal Eye Infirmary on 3 separate occasions to gather feedback on experience and impact of recent service improvements. Healthwatch have offered to work with Royal Eye Infirmary to support recommendations and improvements outlined in their reports and to offer assistance with reviewing patient communications for clarity and accessibility and to help strengthen understanding of the needs of people using the service. Healthwatch said the Royal Eye Infirmary were receptive to this offer.

The provider is part of One Devon, this allows them to work with neighbouring units and get good advice and learning and share their own successes.

The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation.

Staff said continued medical education was important. This had led to improvements. The staff survey for 2024 showed staff felt they were always learning. This was better than the trust average. Continued medical education was planned in advanced and theatre lists were cleared to protect time for learning.

However, we were told demand outstripped capacity and leaders were working to support workforce with the stressors of the workload. Therefore, this did not always allow time for further learning, improvement and innovation.

For the Royal Eye Infirmary, it was known the demand was going to increase by 20% over the next 10 years. The service was exploring how best to manage this.