Centre for Sight Oxshott

Centre for Sight Oxshott is an eye care centre located in Sussex. It was established by the medical director and principal surgeon in 1997.

Centre for Sight Limited operates as a single organisation managed centrally at its East Grinstead location. The Surrey centre in Oxshott undertakes surgical procedures once a month. Oxshott and London centres are open for part of the week and staffed by an administrator at each location. These centres provide local access for patients. Most Centre for Sight staff are based at East Grinstead where all support functions are located. Staff rotate between locations as required with centrally managed rotas.

Centre for Sight Oxshott provides services for adults,children and young people.

The Oxshott centre opened in 2012 and is on the High Street in Oxshott.

The centre is set over two-floors and has one theatre and a small outpatients department with two consulting rooms and a reception area.

Services provided include refractive lens exchange, cataract surgery, laser vision correction, corneal grafts, implantable contact lens and intraocular implants.

We inspected this service using our comprehensive inspection methodology. We have reported our inspection findings in the two core services of Surgery and Outpatients. We carried out the announced inspection on 16 October 2017 and an unannounced inspection on 25 October 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.

The main services provided by this centre was surgery and outpatients. 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 this centre as good overall. This was because;

Patients were consistently positive about the care and treatment they received. All patients we spoke with reported staff were kind and caring whilst maintaining their dignity and privacy.

The management team had a good knowledge of how services were provided and were quick to address any shortcomings that were identified. They accepted full responsibility and ownership of the quality of care and treatment within their centre and encouraged their staff to have a similar sense of pride in the centre.

The care delivered was planned and delivered in a way that promoted safety and ensured that people’s specific care needs were met.

Medical Advisory Committee (MAC) meetings were undertaken quarterly. MAC meeting minutes showed they were used to discuss improvements to patient care and to ensure care was evidence based.

There was an effective system for identifying and reporting risk. Staff were proactive in identifying risk and near misses.

There was effective incident reporting processes. All staff we spoke with knew how to report and escalate incidents.

There were effective infection, prevention and control measures. All areas were visibly clean.

Care and treatment promoted good quality of life and was based on best available evidence.

Patient outcomes exceeded patient expectations.

The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated.

Managers monitored staff competencies annually.

The service had an effective governance framework in place.

There was a positive staff culture with many staff having worked at the centre for a very long time; these core staff offered stability and continuity.

Staff ensured the care and treatment was planned and delivered to meet the needs of patients. Access to the service was seamless and timely.

We found areas of outstanding practice in surgery:

Patients had access to a number of different forms of information, which ensured they were able to make an informed decision regarding treatment.

There were processes and equipment available in theatre in the event of an unexpected complication. Staff practised scenarios involving unexpected complications.

World Health Organisation ‘Five Steps to Safer Surgery’ checklists in theatre were consistently thorough, with full staff engagement and consultant led.

There was thorough safety checking processes within theatre.

There were effective processes to monitor complications and patient outcomes. Patient outcomes were explained in terms patients could understand.

There was a common focus on improving quality of care and people’s experiences.

There were high levels of staff satisfaction across all staff groups. Staff spoke highly of the culture.

However, we also found areas for improvement:

The provider should review guidance on the use of capnography (measuring carbon dioxide) during intravenous sedation.

We found the following areas of good practice in relation to outpatient care:

Ninety-per cent of patient records were electronic which met they could be accessed at any of the three Centre for Sight locations ensuring continuity of care.

Each patient was allocated a coordinator who was the patient’s key worker throughout their treatment.

Patients received a thorough assessment of their vision needs, which included hobbies, lifestyle and their post-surgery expectations.

The leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care.

However, we also found areas for improvement:

The provider should ensure there is an effective audit trail of prescriptions.

The provider should ensure prescriptions are stored securely in line with NHS Protect Security of prescription guidance.

Following this inspection, we told the provider that it should make some 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