Moorfields Eye Hospital NHS Foundation Trust Quality Report 162 City Road, London EC1V 2PD Date of inspection visit: 9 - 13 May 2016 Tel: 020 7253 3411 Date of publication: This is auto-populated when the Website: www.moorfields.nhs.uk/ report is published This report describes our judgement of the quality of care at this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations. Ratings Overall rating for this trust Good ––– Are services at this trust safe? Requires improvement ––– Are services at this trust effective? Good ––– Are services at this trust caring? Good ––– Are services at this trust responsive? Requires improvement ––– Are services at this trust well-led? Good ––– 1Moorfields Eye Hospital NHS Foundation Trust Quality Report This is auto-populated when the report is published Summary of findings Letter from the Chief Inspector of Hospitals This was the first inspection of Moorfields Eye Hospital • In surgery, improvement was required to fully embed NHS Foundation Trust under the new methodology. We the World Health Organisation safer surgery have rated the hospital as good overall, accounting for checklist, in terms of both documentation and the the delivery model of care and the large volume of quality and staff engagement in the process. activity which takes place at the City Road Hospital site. • Some clinic waiting areas were extremely warm at We carried out an announced inspection between 9 - 13 times and, although temperature monitoring took May 2016. We also undertook unannounced visits during place, actions did not fully address the heat. the following two weeks. • Availability of ‘floorwalkers’ to monitor patient We inspected four core services: urgent and emergency wellbeing in waiting areas was limited. Staff care, surgery, outpatients and diagnostics, and children throughout the outpatient clinics were busy and told and young people's services. This trust operates across us they rarely had time to take their full breaks multiple outreach locations. Due to the unique delivery during their shift. model of this organisation we inspected services at the • No emergency buzzers were available in the City Road and St George's sites. We also inspected a radiology department, which could delay staff range of the outreach sites as part including: accessing help in an emergency. • Surgery and outpatients at Bedford Hospital • Within children’s and young people’s services there • Surgery at Ealing Hospital were low glass walls around the atriums on each • Surgery at Croydon Hospital floor with a hand rail approximately a metre above • Surgery at Mile End Hospital the floor. This was a potential safety issue, as a child • Outpatient and diagnostics at Queen Mary's or other person could attempt to climb over the Roehampton Hospital barrier and fall to the ground floor below. There was • Outpatient and diagnostics at Purley War Memorial also the possibility that toys or other objects could Hospital be thrown over the barrier. The risks had been • Outpatient and diagnostics at Barking, Havering and identified on the risk register and they were assessed Redbridge Hospital as ongoing. Divisional leaders said the controls in Our key findings were as follows: place were felt to be sufficient to manage the risk. Safe At the St George’s site: • Mandatory training levels in some areas were below • There were some long standing problems with the trust targets including resuscitation training and ventilation system which affected both the theatre adult life support. preparation room (theatre 4) and anaesthetic room (theatre 5). This issue was reviewed by the At the City Road site: Moorfields infection control team and an external • The paediatric waiting area in the A&E was NHS microbiology team who assessed the risks. unsuitable for the purpose it was being used. We saw They advised changes in practice to mitigate the paediatric patients and their families waiting in the risks, which we were advised have been main waiting area with adult ED patients. implemented. Estates staff told us that they felt the equipment could breakdown at any point. • There was a lack of storage space for patients’ notes in ED and the administrative office was overcrowded • The urgent care clinic reception area and treatment with boxes, which presented trip hazards and a cubicles lacked privacy and confidentially was barrier to evacuation. compromised. 2Moorfields Eye Hospital NHS Foundation Trust Quality Report This is auto-populated when the report is published Summary of findings • The outpatients department was crowded and the • Care was delivered in line with relevant national waiting area in was very cramped: the chairs for guidelines and we saw appropriate policies, patients were very close together. There was a procedures and clinical guidelines, which referenced separate waiting area for patients in wheelchairs these. however this only accommodated two wheelchair • Care was delivered by an experienced team of users. When we visited the ceiling leaked due to ophthalmologists and ophthalmic trained nurses heavy rain, this meant that some of the chairs could delivered care and treatment based on a range of not be used as they were wet. best practice guidance. • Staff working in treatment areas in a corridor outside • The continuing development of staff skills, the main outpatient area were isolated. competence and knowledge was recognised as • At the Bedford site; being integral to ensuring high quality care. Nurses and health care assistants felt well supported with • We observed some poor infection control practice good supervision and good training opportunities. with regards to slit lamps decontamination. • Consent practices and records are actively • Patients undergoing surgery under a general monitored and reviewed to improve how people are anaesthetic were transferred to the day surgery unit involved in making decisions about their care and at Bedford hospital but staff caring for these patients treatment. had not received ophthalmic training. Caring However, we found many good examples of safe care including: • Feedback from people who use the service, and those who are close to them, was continually • Wards and other patient areas were clean and staff positive about the way staff treated them. Patients were seen to be adhering to hand hygiene policies thought the care they receive exceeds their and protocols. Audit results for cleanliness and expectations. infection prevention control demonstrated a good track record and improvements and infection rates • Friends and Family Test results were consistently were low. good across surgical services. • Adequate staffing levels and skills mix was a high • Staff were seen to spend time talking to patients, or priority and were planned, implemented and those close to them to ensure they received the reviewed to keep people safe at all times. Minimal information in a way they could understand and staff shortages were responded to by senior nursing were given time to ask questions. leaders using internal bank staff and rarely agency • We observed staff providing compassionate care and staff. treating patients with dignity and respect. • Safeguarding vulnerable adults was given sufficient • Staff provided emotional support to patients and priority by staff who were aware to ensure patients were able to access the hospital multi-faith immediate safety and to discuss concerns. chaplaincy services, when required. Patients also • Radiation safety processes, including access to lead had access to the trust counselling service and the vests and radiation monitoring, were suitable. The eye clinic liaison office. environment in which radiation was used was fit for • In children’s and young people’s services, staff purpose and protected staff and patients from demonstrated the relationships they developed with unnecessary exposure to radiation. patient’s using the service, and their commitment to Effective ensuring they had a positive experience. • Care was evidence based and services participated in local and national audit. 3Moorfields Eye Hospital NHS Foundation Trust Quality Report This is auto-populated when the report is published Summary of findings • Complex conditions and procedures were explained • At St George's there was no signage or information to children and young people in a way that enabled available for patients about waiting times and this them to gain a full understanding of their treatment meant that patients did not know how long they plan and take an active role in decision making. would need to wait. The department did not monitor this performance data. Responsive • At St George's the main outpatient reception area was • The trust met the target for the national referral to situated so that patient’s confidentiality and privacy treatment pathway (RTT) target of 18 weeks for was maintained. However, the reception area where outpatient appointments. They had robust systems patients booked into the UCC was situated next to the for monitoring RTT performance. waiting area close to where patients sat, which meant • The trust consistently met the 4-hour ED waiting that patients privacy and confidentially was time standard, and also measured against a locally compromised. derived 3-hour target. • Cancellation rates were high for hospital cancelled appointments in Moorfields South (both St George’s • There were clear patient pathways that eased the and Croydon). flow of patients within the A&E. The department had • Service planning for satelite clinics at Moorfields North implemented an ‘active triage’ system whereby required improvement. We observed these clinics patients with non-emergency conditions were were often overbooked due to the lack of a system for referred to the urgent care clinic. knowing when consultants were on leave. We were • Patients and relatives told us they appreciated told that at Moorfields Queen Mary’s Hospital clinics having local services which meant that they didn’t were often cancelled at very short notice and that have to travel far.