Archived: Newmedica Community Ophthalmology Service

Updated 20 November 2017

Newmedica Community Ophthalmology Service is operated by New Medical Systems Limited. The service opened in December 2016 and is an ophthalmological day surgery unit providing cataract operations. Class four laser therapy treatments and follow up appointments are provided at a local outpatient facility under a service level agreement. The service is contracted to provide services to the NHS communities of Bristol, North Somerset and South Gloucestershire.

The service has had a registered manager in post since February 2017 and is registered with the Care Quality Commission to deliver the following regulated activities,

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

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 September 2017 along with an unannounced visit to the service on 20 September 2017. This service had not been inspected previously.

Updated 20 November 2017

Newmedica Community Ophthalmology Service is operated by New Medical Systems Limited. The service provides NHS day surgical services for adults. Facilities include one operating theatre, and three recovery rooms. The service also provides neodymium-doped yttrium aluminium garnet (YAG) laser therapy at a separate outpatient facility.

We inspected the day surgical unit only using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 September 2017 along with an unannounced visit to the service on 20 September 2017.

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.

Services we rate

We rated this service as good overall.

We found good practice in relation to surgical care:

• Staff said they felt able to report incidents and that there was a good reporting culture. Lessons were learned and actions were taken when things went wrong
• Staff understood their responsibilities under the duty of candour, although staff had not had to apply this regulation.
• There were processes, systems and audits to assure services were delivered safely.
• There were reliable systems to prevent and protect people from healthcare-associated infections. We observed good hand hygiene practice in clinical areas and patients confirmed this.
• There were safe arrangements for the management of waste and clinical specimens to prevent accidental injury or cross contamination
• During the reporting period, there were no incidences of hospital-acquired infection.
• Staff followed protocols to manage medicines safely and all medicines were stored and administered safely and securely.
• Patient records were well maintained and clear to follow and securely stored.

• We observed good compliance with the World Health Organisations (WHO) surgical safety checklist.

• There were sufficient staff on duty at the time of our inspection to meet patients’ needs.
• Staff recruitment data, such as references and qualifications were held in an electronic database, which could be accessed at any time by local management staff.
• Consultants and nursing staff understood the relevant consent and decision-making requirements of legislation and guidance. Consent practices were in line with guidance and best practice.
• Feedback from people who used the service, those who were close to them and stakeholders was positive about the way staff treated people.
• Patients had timely access to initial assessment, diagnosis and treatment.
• Care and treatment was only cancelled when necessary and no operations had been cancelled during the reporting period.
• There was equal access to people who were visually impaired and had physical disabilities.
• Information was provided pre-operatively on how to make a complaint or raise a concern.
• The organisation actively sought the views of patients and staff about the quality of the service provided
• There was an effective governance framework to deliver good quality care and good arrangements for identifying, recording and managing risks

However

• Senior staff had not received training in the duty of candour.
• Whilst good practice was observed during the inspection, we could not see the overall performance statistics for compliance with the World Health Organisation (WHO) surgical safety checklist.
• The WHO checklist was not yet fully implemented for those patients undergoing class four laser therapy laser treatment at the outpatient facility.
• Whilst Newmedica collected patient feedback data and gave all patients feedback cards, they had a low response rate. This was being looked into during the time of our inspection.
• There was a systematic programme of clinical and internal audit but it was not fully embedded into practice. Some of the audits had only recently started due to the infancy of the service.
• Procedures to identify a deteriorating patient were limited..
• Some of the staff mandatory training data was held at corporate level and staff at local level could not easily access this information

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (hospitals directorate)

Updated 20 November 2017

Surgery was the only activity at the day-case unit.

We rated this service as good overall for the safe, caring, responsive, effective and well-led domains.