CESP (Portsmouth) @ Queen Alexandra Hospital

Updated 14 June 2018

Consultant Eye Surgeons Partnership (CESP) LLP was established in 2007. CESP (Portsmouth) is a consultant-led partnership of ophthalmic specialists, who all had substantive posts with a local NHS trust which will be referred to as the host hospital throughout this report.

The service primarily served the communities of Portsmouth and the surrounding areas in Hampshire. It also accepted patients’ referrals from outside this area.

A limited liability partnership (LLP) is a business arrangement commonly used in professional practice, in which each owner (partner) is not legally responsible for another’s misconduct or negligence. The LLP was set up in response to changes in the way private practice was managed within NHS hospitals.

CESP (Portsmouth) comprised of six ophthalmic specialists, one of whom was a non-practicing partner. The registered manager and nominated individual was Mr William Green, who had acted as the LLP lead since 2012.

CESP (Portsmouth) provided elective ophthalmic services to private patients aged 18 or over, who had been referred by their optometrist or had self-referred with visual problems caused by the formation of cataracts. The consultants specialised in intra-ocular surgery to remove cataracts and replace them with implanted plastic lenses, usually under topical anaesthesia. Other treatments designed to improve vision after cataract surgery were also offered, including laser therapy.

In addition to the service agreements with the host trust, the LLP had contracted with a medical business management company to coordinate patients’ bookings and the flow of records as well as control the LLP’s own staff records, files and policy documents.

Updated 14 June 2018

CESP (Portsmouth) is operated by Consultant Eye Surgeons Partnership (Portsmouth) LLP. The partnership is composed of six ophthalmic surgeons. CESP (Portsmouth) provided surgery at a local NHS hospital under a service level agreement which will be referred to as the host hospital throughout this report.

The host hospital facilities included three operating theatres, one with laminar flow (a system of circulating filtered air to reduce the risk of airborne contamination), X-ray, outpatient and diagnostic facilities. There was a bright, comfortable reception area where hot and cold drinks were available.

Because the host hospital is a separate registered provider these aspects are not included in this report.

We inspected the service using our comprehensive inspection methodology and inspected only the surgical element of the refractive eye service. We carried out the announced part of the inspection on 28th November 2017, along with an unannounced visit to the hospital on 1st December 2017.

The service specialises in intra-ocular surgery to remove cataracts and replace them with implanted plastic lenses, usually under topical anaesthesia. Other treatments designed to improve vision after cataract surgery were also offered, including laser therapy.

CESP (Portsmouth) provided elective ophthalmic services to around 155 private patients yearly. Patients were generally referred by their optometrist and either funded their own treatment or paid through an insurer. These people had visual problems caused by the formation of cataracts, where the natural lens in the eye becomes cloudy.

Once accepted for surgery, patients were seen and managed using the same protocols, procedures and documentation as the host hospital. They were treated at the end of the host hospital theatre list, which was usually conducted at the eye day case unit in the host hospital. Under a service level agreement with CESP (Portsmouth), the host hospital provided all the facilities and support staff required as well as prescribed medication and medical devices such as intra-ocular replacement lenses.

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 requires improvement overall because:

• There were inconsistencies with record keeping in patients’ notes.

• Governance and oversight of the service level agreement with the host trust was not robust.

• We identified concerns regarding medicines management.

• We identified infection prevention control and cross-contamination risks.

• The patient leaflets did not include information on how to complain and how to obtain the advice in different languages.

• The vision and strategy did not sufficiently support risk management, succession planning and business sustainability.

However, we also found areas of good practice:

• Through the management consultancy firm CESP (Portsmouth) employed, purpose-designed software that used clear visual indicators to calculate and show compliance with key safety and regulatory guidelines.

• There was a designated lead for safeguarding vulnerable adults and partners were trained appropriately to recognise and report suspected abuse in vulnerable adults.

• Partners were up to date with mandatory training and there were effective systems in place to ensure that the organisation had oversight of mandatory training, competency and validation.

• Care was delivered in line with national guidance and the outcomes for patients were good when benchmarked.

• Robust arrangements for obtaining consent ensured legal requirements and national guidance were met.

• Patients were treated with compassion and their privacy and dignity were maintained.

• A multidisciplinary approach was actively encouraged and we saw good examples of positive interaction between providers and partners.

Amanda Stanford

Deputy Chief Inspector of Hospitals

Updated 14 June 2018

Elective intra-ocular surgery was the main activity of the service.

Outpatient consultations were provided as part of the assessment before and after ophthalmic surgery. These consultations did not form part of this inspection and are not represented in this report.

We rated this service as requires improvement. We rated safe and well-led as requires improvement because some elements of infection control, medicines management, governance and how risks to the organisation itself were managed needs more evidence to provide full assurance.