Moorfields Eye Hospital

Updated 23 November 2022

• We found many improvements in surgery and outpatients since the last inspection.
• Action had been taken to reduce potential risks to patients undergoing surgery: improved compliance with the World Health Organisation safety check list.
• Staff followed infection prevention and control procedures and areas we inspected very visibly clean.
• Staff knew the action to take if they had concerns that a patient was being abused.
• Care and treatment provided was based on national guidance and evidence of its effectiveness.
• In surgery, outcomes for some treatments were better than the national standard.
• There was effective multidisciplinary working in surgery and outpatients.
• We observed many positive caring interactions between staff and patients in surgery and outpatients. In surgery patients told us staff went above and beyond to ensure they were comfortable.
• Care and treatment was responsive to the needs of patients. Support was available for people living with a learning disability or dementia and visual aids were available for people who were visually impaired.
• Access times for surgery from time of referral were better than the England average.
• The divisional structures had been reviewed and strengthened.
• Staff told us they were supported by their local managers and were encouraged to access development opportunities. There was a positive culture and staff were proud to work for the trust.
• There was a commitment to improving services and both services had systems to monitor the quality and safety of care provided.

However:

• In outpatients more work was needed to improve learning from complaints and incidents and reduce the number of patients who did not attend for their appointment.
• In surgery the risk registers for theatres did not always reflect risks specific to the service.
• In outpatients some staff were not aware of the trust’s values or the strategy.
• The environment in the outpatients was limited and the trust had taken some action to improve it and more work was planned.
• Vacancies for non-registered staff were above the trust target.

Updated 6 January 2017

We rated services for children and young people as good overall because:

• There were systems for reporting and learning from incidents and staff were aware of them and their responsibilities under duty of candour.
• Areas we inspected were clean and child friendly with secure entry.
• The service had its own pharmacy open Monday-Friday 9-5.30pm and staff had access to a pharmacist outside of these hours. Medicines and controlled drugs were stored securely and checked in line with hospital policy.
• Children were admitted as day cases but if they needed to stay overnight the hospital had agreements to transfer them to other local trusts which provided children’s services.
• Staff were aware of the child protection policy and procedures and had access to a named nurse. They could describe the action they should take if they suspected potential or actual abuse.
• Nursing staff levels were in line with the Royal College of Nursing standards for staffing levels in children and young people’s services (2013) and the majority of staff were trained to care for children. In recovery there was only children’s trained nurse but, the other staff were experienced in caring for children.
• Policies and guidance had been developed in line with current best practice guidance including guidance from the Royal College of Ophthalmologists (RCOphth) and the Royal College of Paediatrics and Child Health (RCPCH) and consultants had contributed to the development of national best practice guidelines published by the Royal Colleges.
• Staff were sensitive to the needs of children and young people and were quick to recognise, and respond, when they needed some additional support or quiet time.
• Parents were involved in their child’s care and treatment and we observed staff speaking with children and young people in a way that enabled them to gain a full understanding of their treatment plan and take an active role in decision making.
• Children, young people were overwhelmingly positive about the kindness and compassion of staff.
• The service had increased the number of consultants to meet the increasing demand on the emergency department and some action had been taken to improve the flow of patients through the outpatient’s services to reduce repeated attendances and waiting times as much as possible.
• Children and young people could usually be accommodated with others of the same gender or a similar age according to their needs and preferences. The service was sensitive to the needs of children and young people with a learning disability or autism and arranged their care to minimise waiting times.
• There were a range of activities and toys to available to keep children and young people occupied and they also had access to the family support service.
• The service had systems for monitoring the quality and safety of the care provided and information was shared with staff at quarterly half day governance meetings.
• Staff felt they were treated equally and were encouraged in their development and to put forward their views.
• There was a strong culture of putting children and young people first and they had been involved in the development of the service and improving patient experience.

However:

• There was no information to demonstrate the consistent use of the WHO safer surgery checklist in children’s and young people’s services and a general surgical audit indicated poor compliance.
• There was no clear strategy for the future development of the service.
• There were no clear quality targets or priorities for the service.

Updated 12 March 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings. We rated it as good because:

• Outpatients at Moorfields Eye Hospital at City road had made many improvements since the last inspection.
• From August 2017 to July 2018 the trust’s referral to treatment time (RTT) for non-admitted pathways was consistently better than the England overall performance.
• The trust had introduced a new divisional structure with improved quality roles, focus and responsibility.
• The service provided care and treatment based on national guidance and was involved in innovative projects and trials to help with a range of eye conditions.
• A health information hub was available with staff around to help patients and provide many leaflets on different eye conditions.
• Availability of ‘floorwalkers’ to monitor patient wellbeing had improved since the last inspection.

• There was a multi-disciplinary clinic specifically for patients with complex learning disability needs which was run jointly by optometrists and orthoptists.

• The trust had introduced self-check-in kiosks which had been specifically designed for visually impaired patients.

However:

• Certain areas of the outpatients department were confined in terms of space however, the space committee had done work to improve this since the last inspection and were continuing to work to make the building more clinical.

Updated 12 March 2019

Our rating of this service improved. We rated it as outstanding because:

• Staff completed and updated risk assessments for each patient. The World Health Organisation’s Five Steps to Safer Surgery checklist was fully embedded and adhered to in surgery, this was an improvement since our last inspection.
• The service controlled infection risk well. The service was visibly clean and clutter free and staff adhered to appropriate infection prevention and control measures.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it. The majority of staff had completed up-to-date mandatory training, with the service meeting or surpassing the trust’s targets for mandatory training compliance in all modules.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Policies were readily available to staff. They were clear and up-to-date and based on best practice guidance.
• All staff cared for patients with compassion. All of the patients we spoke with spoke highly of the caring attitude of staff.
• We observed examples of positive, caring interactions between staff and patients and their families. Staff made significant efforts to ensure patients felt safe and well cared for.
• The service took account of patients’ individual needs. The service had measures in place to meet the differing needs of individual patients, including patients from different backgrounds and locations and patients with additional needs.
• People could access the service when they needed it. Access to and flow through the patient journey was highly effective.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. Staff spoke highly of the leadership at all levels.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community Staff shared in the trust’s vision and values.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. There was a positive culture throughout the service. Staff felt that they could contribute to the vision of the service and that their contribution was recognised and appreciated.
• There was a clear governance structure in place.

However:

• The management of risk was not always dynamic or proactive.

Updated 6 January 2017

We rated the accident and emergency department as good overall because:

• There were effective systems to minimise risk to patients including reporting and learning from incidents and infection prevention and control policies and practice.
• Adults and children were protected from the risk of abuse because staff were aware of the policies and procedures and the action to take if they suspected potential or actual abuse.
• Patients were cared for by competent staff who had the relevant skills and experience and had completed their mandatory training.
• Care and treatment was evidence based and the hospital participated in national and local audits to monitor patient outcomes. Clinicians were involved in the development of national standards and guidelines.
• Performance against the four hour waiting time national standard was above 95% and unplanned re-attendances were below the national average.
• There was good multidisciplinary working and the hospital worked closely with other local trusts who could provide care for patients with other general health problems.
• We observed staff being courteous towards patients and providing compassionate care. Patients told us they felt safe in the unit and involved in decisions about their care and treatment.
• The number of patients attending the department was increasing year on year and the hospital had taken some action to cope with the increased demand on the service.
• The service was able to care for patients with specific needs such as those with a learning disability or dementia. For patients whom English was not their first language information was available in different languages along with an interpreter service.
• Most staff were positive about their managers and said they were visible and supportive and appreciated their hard work.
• Systems to monitor risk and the quality of care were effective.
• Some staff felt they were not treated equitably and had raised their concerns with senior staff who had taken action including providing staff were with specialist training on different types of discrimination and how people from different cultures could perceive each other.

However:

• The waiting area for children was not suitable and did not meet their needs; space was limited and some children and their families used the adult waiting area
• There was a poor ventilation system in the A&E which meant at times the waiting area was very hot and there was a lack of storage space for patient’s notes.
• Some nursing staff were unsure about their responsibilities in relation to the Mental Capacity Act 2005.
• Patient privacy was not always maintained due to insufficient space between treatment cubicles.
• Patient engagement was limited to surveys and patient feedback forms.