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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of regulation for good governance, the service did not assess, monitor and improve the quality and safety of the service in line with best practice guidance.

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.

We scored the service as 3. 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.

We reviewed 6 care records during our assessment. The electronic system allowed for clear and legible records. Staff completed health assessments and developed care plans to meet the needs identified during assessment.

We scored the service as 1. The evidence showed significant shortfalls. The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

It was not clear how the service was benchmarking and working against best practice guidance. For example, the Royal College of Ophthalmologists guidance was not used to develop and improve the service.

There was no participation in clinical audit. With no regular audit the service was unable to ensure quality of care and compare to outcome standards for this specialised service. The clinical lead for urgent care told us they were exploring introducing audits and would discuss in their clinical medical education meeting in December 2025 for doctors to implement. This would help with benchmarking and quality improvement initiatives and help to better evaluate the service provided and monitor and improve outcomes.

The team included a range of specialists required to meet the needs of patients in the service. This included doctors, nurses and advanced care practitioners. There was access to imaging services.

Staff had mostly received in date annual appraisals. Appraisals compliance in September 2025 was 90% for outpatient and urgent care nursing staff. However, staff survey results for 2024 showed only 8% of staff felt appraisals helped perform their job and 25% felt able to access clinical supervision opportunities. Both were below the trust average.

Staff told us they had a trust induction and were orientated in the departments they were working in. Nursing staff completed a range of competencies within the first year of their post, this was signed off by the nursing lead. There was confusion whether this also needed to be signed off by the clinical lead. There was no specific training for working with children and young people and we were told this was part of their professional training.

There was no process for ongoing supervision for nursing staff. Data was not provided to evidence staff competencies and supervision.

Junior medical staff had supervision and a senior specialty doctor was always available to provide advice. One doctor in their final year of training reflected they had good training and learning opportunities.

Staff told us they were well supported to attend additional courses and were provided with time to do this.

Clinical medical education sessions were held every 2 months, however, staff in urgent care found it difficult to attend due to the urgent nature of their work.

We scored the service as 3. 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 held morning huddles which included the urgent care and outpatient team.

The senior doctor in urgent care supported junior staff. We observed nursing, allied health professionals and medical staff asking each other for advice and support when making decisions about people’s care and treatment. Nursing staff told us they were well supported by doctors and able to ask questions.

Following discharge from urgent care, the electronic system automatically sent a letter to the patient and to their GP. However, during our review of records, we identified for nursing consultations, where a patient did not see a doctor, a discharge letter was not sent. This appeared to be an error in the system. The trust no longer completed record audits and therefore this had not been picked up as an issue.

The service networked with the Minor Eye Conditions Service. This is a collective name for optician locations which provide urgent eye assessments.

We scored the service as 3. 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.

Staff supported patients to live healthier lives, we observed staff speaking to patients about how they could make healthy lifestyle choices and habits to benefit their condition. Patient leaflets were available in the department and on the trust’s website.

We scored the service as 1. The evidence showed significant shortfalls. The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Performance and patient outcome data was limited in urgent care and did not help monitor and improve the service. The service was able to tell us in the last 12 months there were a total of 1800 attendances (1699 adults and 101 children), 100% adults and 98% of children were seen within 4 hours. Overall, 0.2% of patients attending were admitted to hospital and 66% resulted in an outpatient referral.

Key governance metrics for emergency eye care in an urgent care setting were not being used. For example, left department before being seen for treatment rate, reattendance rate, time to initial assessment, time to treatment, total time in urgent care, percentage of patient who should be discharged at first visit and were, percentage of patients diagnosed and managed accurately.

Staff used recognised tools and technology to improve the detection and response to deterioration in patients eye condition. Patients would be booked in for follow up appointments to monitor their condition and outcomes.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

The service obtained people’s verbal consent to provide care and treatment. If a surgical procedure was required a consent form would be completed in urgent care with the senior doctor. Please see surgery ASG.

The service had up-to-date policies and processes to support staff in gaining informed consent. We observed staff gaining consent and explaining care and treatment.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity staff made decisions in their best interests, 2 doctors were required to complete this.