Moorfields at St George's

Moorfields Eye Centre at St George’s Hospital (St George's site) is part of Moorfields Eye Hospital NHS Foundation Trust (the trust). The trust has 32 centres in and outside of London. It provides a networked satellite model of care at Moorfields Eye Hospital City Road and across three geographical networks: Moorfields North, Moorfields South and Moorfields East. Services provided include surgery, outpatients and professional support to other eye services managed by other organisations.

Moorfields Eye Centre at St George's Hospital is located in the Lanesborough Wing of St George’s University Hospitals NHS Foundation Trust (host trust). The centre provides comprehensive outpatient, diagnostic and surgical services for the local population. The department has an urgent care clinic (UCC) which is open from 9am to 5pm, Monday to Friday.  Outside of these hours the on-call ophthalmologist attends to emergencies admitted to Duke Elder ward, an appropriate medical or surgical ward or patient's attending St George's A&E.  In addition the out of hours service provides the hub for the South West Thames on-call services, with patients being referred from Epsom and St Hellier, Kingston and Croydon A&E services.

We carried out an announced inspection of Moorfields Eye Centre at St George's Hospital from  9 – 13 May 2016.

Overall Moorfields Eye Centre at St George’s Hospital is rated as requires improvement.  

Our key findings were as follows:

• There were significant on-going problems with the environment in the outpatients department (OPD) wards and theatres.

• There was insufficient space in the outpatients department and patient comfort and privacy was compromised. Male and female patients were on occasion cared for in the same bays on Duke Elder Ward, this was in breach of national guidance. The environment in theatres wasn't child friendly.

• In theatres, long standing problems with ventilation meant that at times theatre lists had to be cancelled. Air changes in one anaesthetic room did not always comply with best practice. 

• Outpatient clinics often over ran and patients were not kept informed about waiting times.

• The World Health Organisation (WHO) surgical safety checklist had not been fully embedded in operating theatre practice.

• The uptake of appraisals was below the trust's target for some staff groups.

• Risks to the service were identified but, responsibility for taking action and timescales for action were not clear.

• A service level agreement had been developed to formalise the relationship between the trust and the host trust but, this was not yet agreed and in place at the time of the inspection.

• There were enough staff to care for patients.

• Areas we inspected were clean and there was good compliance with infection prevention and control procedures.

• Patients on the Duke Elder ward who became unwell were cared for, in the first instance, by medical staff who worked for Moorfields Eye Centre at St George’s Hospital. Guidelines had been developed for patients on Duke Elder ward who became unwell and required the care of medical teams based at St George’s University Hospitals NHS Foundation Trust.

• Staff were aware of the signs of potential and actual abuse and knew the action to take to protect children and adults. Although the trust had a rolling programme for Level 3 safeguarding training no permanent staff at this location had completed it.

• Care and treatment was delivered in line with best practice and staff had ready access to, and followed, protocols and guidelines driven by national guidelines and best practice..

• There was good multidisciplinary team working involving staff from a range of specialities.

• Patients had access to drinks, and sandwiches were provided for patients post surgery.

• We found staff were caring and patients spoke positively about them. They told us staff spent time explaining their assessments and treatment options.

• Patients were largely treated in a timely manner with the hospital meeting national access standards.

• Staff were positive about the support they received from managers and said they were visible and approachable.

• A translation service was available for patients for whom English was not their first language.

• Involvement of patients in service development/improvement was limited.

• Risks to the service were identified but, responsibility for taking action and timescales for action were not clear.

• Staff remained enthusiastic and committed to providing good care despite the poor environment they were working in.

However, there were areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Take action to ensure the theatre environment meets with national guidance
• Reduce the number of mixed sex breaches on Duke Elder ward
• Take action to improve the environment in the outpatients department and on the wards
• Ensure the WHO safer surgery checklist is consistently implemented for all surgical procedures including the five steps of team brief, sign in, time out, sign out, and debriefing.
• Improve recording of risks and ensure all information is included on risk registers.

In addition the trust should:

• Improve the uptake of appraisals.
• Reduce the theatre cancellation rate.
• Consider how the theatre environment could be made more child friendly.
• Ensure resuscitation equipment is easily accessible to staff working in the OPD and UCC at all times.
• Ensure all anaesthetic equipment is checked and checks are recorded.
• Consider how reasonable adjustments could be made for people with visual impairment.
• Ensure staff are aware of the electronic flagging system for vulnerable patients, such as those living with dementia or a learning disability in the outpatients department.
• Ensure patient's records are available when they attend for an appointment..
• Improve engagement with patients and members of the public in service development/improvements.
• Ensure the service level agreement between Moorfields Eye Hospital NHS Foundation Trust and St George’s University Hospitals NHS Foundation Trust is finalised and implemented to ensure medical cover and estates management are working effectively.

Professor Sir Mike Richards

Chief Inspector of Hospitals