Sunderland Eye Infirmary

Updated 10 June 2020

Sunderland Eye Infirmary is a specialist ophthalmic hospital in the UK. The service provides a comprehensive tertiary and secondary ophthalmic care service to the population of Sunderland and the immediate surrounding area.

Sunderland Eye Infirmary provides a whole range of ophthalmic services for the population of Sunderland and the immediate surrounding area, specialist services include a cataract treatment centre, glaucoma unit and a macular unit. An inpatient ward comprised of 22 beds accommodating 18 adult and four paediatric patients.

The emergency department (ED) provides emergency ophthalmic services 24 hours a day, seven days a week, for approximately 33,000 patients each year. It cares for adults and children, including trauma and non-trauma patients. It is one of only two open access eye emergency departments in the country. It is part of the ophthalmology directorate; other services at the hospital include surgical facilities and an outpatients department.

The hospital was part of the division of surgery which also included the clinical directorates of general surgery, vascular, urology, trauma and orthopaedics, ophthalmology and head and neck.

There were two operating theatres situated on the Sunderland eye infirmary dedicated to ophthalmic surgery for both adult and paediatric patients. A cataract suite is also available for patients requiring cataract surgery.

The outpatient department was also located in the hospital. Outpatient clinics were held in various areas of the site and outpatient area A and outpatient area B had separate reception areas for patients to check in.

The outpatient departments provided a variety of clinics including general ophthalmology outpatient clinics, macular and glaucoma clinics and cataract clinics. The service saw adults and children. There were 42,403 outpatient appointments between April 2019 and June 2019. The trust provided information stating 14,253 were seen at the Sunderland Eye Infirmary.

The children and young people seen at the hospital are cared for in a four bedded bay on Haygarth ward.

Updated 10 June 2020

• We rated responsive as outstanding. We rated safe, effective, caring and well led as good.
• In outpatients people could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. The referral to treatment indicators were a positive outlier and were better than the England overall performance. The service was inclusive and took account of patients’ individual needs and preferences. It was easy for people to give feedback and raise concerns about care received.
• The service had enough nursing and medical staff during the day with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. A business case had been submitted to increase the out of hours nursing support. Staff knew how to apply training and understood how to protect patients from abuse. All areas were visibly clean and tidy and clinical waste was managed well. Staff kept detailed records of patients’ care and treatment. The service safely prescribed, administered, recorded and stored medicines. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff told us they assessed patients to see if they were in pain and gave pain relief in a timely way. Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Staff supported patients to make informed decisions about their care and treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients and relatives. They understood patient's personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions.
• The service had a clear leadership structure and staff told us leaders were approachable, supportive, well respected and visible. We found the department had a culture of openness and inclusivity. Staff we spoke with felt they were valued and respected by colleagues and senior staff. There were established governance arrangements and regular meetings within the department, which fed into directorate and trust governance. Risks and incidents were well managed and escalated appropriately.

Updated 10 June 2020

We did not rate this service at this inspection. We inspected only the safe key question. See below.

Updated 10 June 2020

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff had training on how to recognise and report abuse and they knew how to apply it. The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system. The service was inclusive and took account of patients’ individual needs and preferences.
• People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted and provided opportunities for career development.
• Leaders operated governance processes, throughout the service.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
• Leaders and staff actively and openly engaged with patients and staff to plan and manage services. All staff were committed to continually learning and improving services.

Updated 10 June 2020

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patient's personal, cultural and religious needs. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. All patients we spoke with described their care in positive terms.
• The service planned enough medical, nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service provided care and treatment based on national guidance and evidence-based practice. The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used agreed personalised measures that limit patients' liberty.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care. Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• Staff had training on how to recognise and report abuse, and they knew how to apply it.
• Staff gave patients enough food and drink to meet their needs and improve their health. Staff followed national guidelines to make sure patients fasting before surgery were not without food for long periods.
• Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
• The service planned and provided care in a way that met the needs of local people and the communities served. The service was inclusive and took account of patients’ individual needs and preferences.
• People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with national standards. Although a slight decrease in performance had been noticed staff had identified the reasons for this and had plans in place for recovery.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. The service had a vision for what it wanted to achieve and a strategy to turn it into action.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Leaders had governance processes. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. However, we did not see issues escalated, discussed and externally shared in an effective way.
• Leaders and teams used systems to manage performance effectively. They identified relevant risks and issues and identified actions to reduce their impact.
• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However:

• Staff did not consistently use available systems to monitor the effectiveness of care and treatment.
• The service did not have effective systems and processes to ensure staff received resuscitation training at an advanced level, despite them being identified on the emergency on-call emergency rota. Also, despite admitting children only one member of staff was trained in paediatric life support.
• The design of the building did not comply with current recommendations for inpatient facilities. Maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well.
• Leaders and staff did not continually actively engage with patients and staff to plan and manage services.
• Although the service provided mandatory training in key skills to staff. In surgery, the 90% target was only met for four of the 13 mandatory training modules for which medical staff at Sunderland Eye Infirmary were eligible.

Updated 10 June 2020

• The department had enough staff with the right qualifications, skills, and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Staff identified and quickly acted upon patients at risk of deterioration. Records, medicines and incidents were managed safely within the department. Times to initial assessment were in line with national guidance.
• Staff always had access to up-to-date, accurate and comprehensive information on patients’ care, and treatment was based on national guidance. Staff supported patients to make informed decisions about their care and treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned and provided care in a way that met the needs of local people and took account of patients’ individual needs. Most people were treated and discharged in line with national standards. It was easy for people to give feedback and raise concerns about care received.
• Leaders had the skills and abilities to run the service. Staff felt respected, supported and valued. The service had clear governance and risk management systems in place. Information was managed well in the department.

However:

• We found items of out of date stock in the department.
• We were not provided with detailed evidence of audit activity within the department.
• Arrival to treatment times varied and were not always in line with national standards.