Community Health and Eyecare Limited (CHEC - Coventry)

Updated 8 November 2023

The provider, Community Health and Eyecare Ltd, was registered in August 2012 and is a company built by Optometrists and Ophthalmologists to deliver eye services in the community. The patient target group were patients who could be seen in the community, mainly outpatient work for all eye conditions. Services were delivered across the country in purpose built surgical centres, GP surgeries and via mobile units. At the time of the inspection, the provider had registered locations across the country. They had also diversified to provide endoscopy services at 7 of their locations including the Coventry location. The endoscopy service was separated from the ophthalmology service and was located on the first floor of the building. The ophthalmology service and patient waiting areas were located on the ground floor.

The Coventry location is a purpose -built centre which provides surgical services and outpatient ophthalmology appointments for NHS patients under local NHS contracts. Endoscopy services are provided for NHS patients who are referred directly by their GP. The provider was in the process of securing regular NHS contracts with their integrated care board (ICB).

There was a suitable car park which was free for patients and staff, and in addition, the provider ran a minibus service to collect patients and return them home after surgery if they were unable to drive. The provider also had a contract with a local taxi service to transport patients. These services were offered free of charge to patients.

Referrals to the service were managed centrally by a Referrals Management & Bookings Manager (RMBM) from a central Referral & Booking Centre (RMBC) directing patients through choice to various clinics in the UK. The RMBM was supported by a team of patient coordinators and clinicians.

The Coventry centre was managed by a hospital manager supported by a regional manager who was also the Registered Manager, and a team which consisted of:

• Ophthalmology Consultants
• Optometrists
• Registered Nurses
• Ophthalmic Technicians
• Endoscopy Lead
• Endoscopy Nurses
• Administration Staff

They are registered to provide the following regulated activities;

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder or injury

Services provided at this location include:

• Outpatient appointments
• Cataract surgery
• YAG laser. (Yttrium Aluminum Garnet is a laser treatment used to correct cloudiness in the eye.)
• Minor procedures around the orbital rim
• Glaucoma monitoring
• Pre assessment for cataract surgery and endoscopy procedure
• Endoscopy procedures

This is the first time we have inspected and rated this service.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 2 August 2023.

To get to the heart of patients’ experiences of care, we ask the same 5 questions of all services: are they safe, effective, caring, responsive to people’s needs, and well led.

The main service provided was surgery. All ophthalmology care and treatment including care provided in the outpatients department is reported in the surgery section. We also inspected medical services where endoscopy procedures were carried out.

Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Updated 8 November 2023

We have not previously inspected this service. We rated it as outstanding because:

• The service provided access to rapid ophthalmological care in the local area. There was a clear focus on equity and equality in all aspects of care and used a structured equality impact assessment to ensure they met diverse needs. Staff provided good care and treatment and managed pain well. The systems to manage and share the information that was needed to deliver effective care were fully integrated and provided real-time information across teams and services. The senior team monitored the effectiveness of the service and made sure staff were competent. Consent practices and records were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
• There was a strong, visible person-centered culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who used the service, those close to them and staff were strong, caring and supportive. These relationships were highly valued by staff and promoted by leaders. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. People’s individual needs and preferences were central to the planning and delivery of tailored services. The services were flexible, provided choice and ensured continuity of care.
• The service used innovative approaches to providing integrated person-centered pathways of care that involved other service providers, particularly for people with multiple and complex needs. The service was committed to reducing health inequalities and disparities in the regional health economy and implemented strategies to ensure access to care was equitable. The service worked extra hard to meet the needs of people, took account of patients’ individual needs, and made it easy for people to give feedback. They had used innovative approaches to ensure people could access the service when they needed it and the senior team were proactive in maintaining substantively shorter waiting times.
• There was a clear focus on equity and equality in all aspects of care. The service benchmarked policies, procedures, and training against a structured equality impact assessment to ensure they met diverse needs. This incorporated the service’s obligations under the Equality Act (2010). Staff had implemented a policy to support transgender patients and ensured care was delivered in accordance with best practice.
• There was a clear management structure with defined lines of responsibility and accountability and strong collaboration and support across all functions with a common focus on improving quality of care and people’s experiences. The leadership team drove continuous improvement and staff were accountable for delivering change. Leaders ran services well using reliable information systems and supported staff to develop their skills. The strategy and supporting objectives were stretching, challenging and innovative while remaining achievable. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients and the community to plan and manage services and all staff were committed to improving services continually.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept very good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.

Updated 8 November 2023

We were unable to rate this service because there was not sufficient evidence to support a rating.

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and understood how to manage safety well. The service had systems and processes to control infection risk well. Staff assessed risks to patients, acted on them and kept very good care records. They managed medicines well. The service knew how to manage safety incidents.
• Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
• There was a clear management structure with defined lines of responsibility and accountability. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

Medical service is a small proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the surgery section.

Endoscopy services were the only medical service provided and had been recently implemented. They had conducted 43 endoscopy procedures since starting the service.

Updated 8 November 2023

This is the first time we have rated this service. We rated it as outstanding because;

• The service provided access to rapid ophthalmological care in the local area. There was a clear focus on equity and equality in all aspects of care and used a structured equality impact assessment to ensure they met diverse needs. Staff provided good care and treatment and managed pain well. The systems to manage and share the information that was needed to deliver effective care were fully integrated and provided real-time information across teams and services. The senior team monitored the effectiveness of the service and made sure staff were competent. Consent practices and records were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
• There was a strong, visible person-centered culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who used the service, those close to them and staff were strong, caring and supportive. These relationships were highly valued by staff and promoted by leaders. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. People’s individual needs and preferences were central to the planning and delivery of tailored services. The services were flexible, provided choice and ensured continuity of care.
• The service used innovative approaches to providing integrated person-centered pathways of care that involved other service providers, particularly for people with multiple and complex needs. The service was committed to reducing health inequalities and disparities in the regional health economy and implemented strategies to ensure access to care was equitable. The service worked extra hard to meet the needs of people, took account of patients’ individual needs, and made it easy for people to give feedback. They had used innovative approaches to ensure people could access the service when they needed it, and the senior team were proactive in maintaining substantively shorter waiting times.
• There was a clear focus on equity and equality in all aspects of care. The service benchmarked policies, procedures, and training against a structured equality impact assessment to ensure they met diverse needs. This incorporated the service’s obligations under the Equality Act (2010). Staff had implemented a policy to support transgender patients and ensured care was delivered in accordance with best practice.
• There was a clear management structure with defined lines of responsibility and accountability and strong collaboration and support across all functions with a common focus on improving quality of care and people’s experiences. The leadership team drove continuous improvement and staff were accountable for delivering change. Leaders ran services well using reliable information systems and supported staff to develop their skills. The strategy and supporting objectives were stretching, challenging and innovative while remaining achievable. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients and the community to plan and manage services and all staff were committed to improving services continually.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept very good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.