Yorkshire Eye Specialists LLP @ Nuffield Health York Hospital

Yorkshire Eye Specialists York is operated by Yorkshire Eye Specialists Limited Liability Partnership (LLP). The provider uses the facilities of Nuffield Health Hospital in York which has 40 beds. Yorkshire Eye Specialists provides treatment of ocular disease, disorder or injury that may require surgical intervention in order to successfully treat or manage ocular conditions. Treatment is provided for a wide range of ophthalmic disorders, including, but not limited to cataract, glaucoma, strabismus, eyelid disorders, excision of lesion, blepharoplasty and squints.

We inspected this provider using our comprehensive inspection methodology. We carried out the announced part of the inspection on 22 January 2018, along with an unannounced visit on 26 February 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main services provided by this provider were treatment of disease, disorder or injury, surgical procedures and diagnostic and screening procedures. We inspected two core services. These were outpatients and diagnostic services and surgical services. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

We rated the service as good overall.

We found the following areas of positive practice:

• At the time of the inspection, there were no waiting lists for access to surgery or outpatients’ services.

• All patients were treated by staff in a professional and courteous manner. Additionally, their privacy and dignity was maintained. Staff treated all patients with respect and as individuals, taking into account their personal needs.

• The provided contacted every patient who did not attend an appointment by telephone, to discuss the reasons for non-attendance and to reiterate the importance of attending appointments to prevent further deterioration of eyesight.

• There were systems in place to keep people safe and safeguarded from harm.

• Patient outcomes in relation to cataract surgery were monitored to ensure high quality care for patients.

• There were mechanisms to manage risk. We examined the minutes of the Medical Advisory Committee (MAC) from March 2018. These showed that risk and incidents had been discussed including looking for trends and safer ways to work with patients.

• The provider had appropriate processes in place to assess patient risk. The provider used the World Health Organisation (WHO) safety checklist for cataract surgery.

• The environment was visibly clean, procedures were in place to prevent the spread of infection, and equipment was well maintained and appropriate for the service.

• There were systems in place to ensure the safe storage, use and administration of medicines.

• Laser safety was managed and records were appropriately maintained.

• The provider held contemporaneous and fully completed patient records both electronically and on paper.

• There were adequate numbers of suitably qualified, skilled and experienced staff. Mandatory training completion was high and all staff had received an appraisal within the last year.

• The provider had robust arrangements in place for obtaining consent for patients having surgery or other procedures at the service.

However, we found the following areas of concern:

• There was no assurance that the medicines supplier was appropriately registered.

• The provider did not monitor the memorandum of understanding they had signed with the host hospital.

• Audits around patient’s outcomes were not carried out for all procedures. The provider conducted clinical outcomes for cataract surgery but we saw no evidence of clinical audits of the other types of surgery conducted by the provider.

• There was no hearing loop in place at the time of the inspection.However, the provider told us that they could arrange a sign language interpreter or hearing loops for patients with severe hearing loss if required.

• The provider allowed patients to use family members as interpreters during the clinic consultation stage on two occasions, which was not best practice.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)