Source · CQC inspection

Moorfields at St George's

Provider Moorfields Eye Hospital NHS Foundation Trust Type NHS Healthcare Organisation Region London Last inspected 12 Mar 2019

Overall rating: Good  View full CQC report

Domain ratings

Five CQC key questions
Safe
Good
Effective
Good
Caring
Good
Responsive
Good
Well-led
Good

Earlier inspection findings

pre-2024 framework · 1 must-do 18 should-do

Must-do actions (1)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 1
Must do
Safe
In outpatients at Moorfields at Bedford review all clinics’ waiting lists to ensure they are current and accurately reflect patients’ progress through their treatment pathway. They must ensure there is effective system to monitor patient’s pathway fully. Where learning is identified, and actions agreed, in response to untoward incidents the trust must ensure it is shared and implemented promptly to prevent reoccurrence.
Regulation: Regulation 12 (Safe care and treatment)
⚠ Although staff recognised incidents and reported them appropriately the service did not always manage patient safety incidents well. Managers investigated incidents and shared lessons learned with the whole team and the wider service, however, actions were not always taken promptly in response to incidents. In 2017 the service identified an …

Should-do actions (18)

Recommended improvements to enhance service quality.

Should-do action 1 of 18
Should do
Well-led
Ensure risk is proactively managed, including identifying specific, localised risks to the service and recording these on the risk register, reflecting on previous incidents to inform the inclusion of risks on the register.
Should-do action 2 of 18
Should do
Safe
Continue to reduce vacancies for non-registered staff.
Should-do action 3 of 18
Should do
Well-led
Improve staff awareness of learning from incidents and complaints.
Should-do action 4 of 18
Should do
Responsive
Continue to work to improve ‘did not attend’ rates and data completeness for patient journey times.
Should-do action 5 of 18
Should do
Safe
Continue to work to improve records storage and the environment.
Should-do action 6 of 18
Should do
Safe
Continue to reduce vacancies for non-registered staff.
Should-do action 7 of 18
Should do
Safe
The service should continue to ensure that patients’ records are locked and kept secure at all times.
Should-do action 8 of 18
Should do
Effective
The service should ensure that all patients’ individual pain needs are met.
Should-do action 9 of 18
Should do
Responsive
The service should address on how they keep patients informed of waiting times on the day of their surgery.
Should-do action 10 of 18
Should do
Responsive
The trust should review the possibility of staggering appointment times for patients to reduce waiting times prior to surgery.
Should-do action 11 of 18
Should do
Safe
Ensure the children’s waiting and clinical areas are separated from the adults.
Should-do action 12 of 18
Should do
Responsive
Ensure there are no delays to appointments and waiting times or any potential delays are clearly and accurately communicated with patients.
Should-do action 13 of 18
Should do
Responsive
Increase capacity in glaucoma and cataract clinics to minimise treatment waiting times and ensure referral to treatment times are improved.
Should-do action 14 of 18
Should do
Safe
The trust should address the OPD environment the crowding of the department and the cramped the waiting area.
Should-do action 15 of 18
Should do
Responsive
The trust should improve how patients find the location of the Moorfields OPD from the main reception at St George’s Hospital.
Should-do action 16 of 18
Should do
Responsive
The trust should improve their ‘did not attend’ rate for Moorfields at St George's.
Should-do action 17 of 18
Should do
Safe
The trust should review the treatment areas in a corridor outside the main outpatient area to ensure staff are not isolated.
Should-do action 18 of 18
Should do
Well-led
The trust should continue to involve patients in the plans for the development of the service.

Location details

CQC ID: RP604
Local authority: Wandsworth
Region: London

Inspection report

Type: Location
Date: 12 March 2019
Rating: Good
Actions: 1 must-do 18 should-do
AI-extracted 2 Jun 2026

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