Accuvision Eye Care Clinic London is operated by Accuvision Limited. Facilities include one laser treatment room, outpatient and diagnostic facilities.

The service provides laser vision correction procedures and outpatient diagnostics for adults. Patients are self-referring and self-funded with visual acuity problems (failing eyesight).

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 4 December 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.

Services we do not rate

We regulate refractive eye surgery but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Systems and processes were in place to keep staff and patients safe. The service had systems in place for the reporting, monitoring and learning from incidents. Staff knew how to report incidents.

• There were good infection prevention and control procedures in place, all areas were visibly clean and well equipped.

• Staff used an adapted ‘five steps to safer surgery’ World Health Organisation (WHO) checklist to minimise errors in treatment, by carrying out a number of safety checks before, during, and after each procedure. Patients received a thorough assessment prior to treatment and were given an emergency contact number following their discharge.

• Staff were competent to carry out their duties.Additional training was provided to staff who used laser eye equipment, which ensured patient procedures were carried out safely.

• Policies, procedures and treatments were based on nationally recognised best practice guidance. Regular audits were carried out on a range of topics. Patient outcomes were measured and benchmarked and showed excellent results.

• Care was delivered in a compassionate way and patients were treated with dignity and respect. Patients were kept informed throughout their care and encouraged to ask questions. Staff recognised when patients may need additional support.

• There was a system in place for obtaining patient feedback. Patient feedback results were positive and patients we spoke with and comment cards reflected this.

• Clinic appointments were available at the patients’ convenience.

• Managers were visible and respected by staff. Staff felt valued. There was a culture of honesty and openness.

• Policies were in place for key governance topics such as information governance, incident management, risk assessment or management of complaints. Royal College of Ophthalmology standards were incorporated throughout policies and procedures.

However, we also found the following issues that the service provider needs to improve:

• The service did not perform adapted WHO safer surgery checklist audits

• Although patients were given sufficient time to reflect on their decision to go ahead with the procedure, written consent was obtained on the day of surgery, which was against recommendations of the Royal College of Ophthalmologists.

• Translation or interpreter services were not available through the service.

• The service did not perform formal staff surveys.

Following this inspection, we told the provider that it should make 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 (London)

We found:

• Staff used equipment safely. Laser room protocols were in place and ‘Local Rules’ were complied with.
• Records were accurately maintained and stored securely.
• Patients were assessed for any clinical risks or deterioration. There was an on call system for out-of-hours urgent contact.
• There were sufficient numbers of ophthalmologists, optometrists, technicians and nurses available to treat and support patients through consultations and procedures during their appointments.
• The results of local clinical audit demonstrated positive outcomes for patients.
• Staff sought patients consent to care and treatment in line with legislation and guidance.
• Surgeons undertaking laser eye surgery at the clinic were registered with the GMC and had a broadly based knowledge of ophthalmology.
• Laser technicians were competent.
• There was a clear leadership structure and scheme of delegation in place.
• Patient feedback was collected, analysed and acted upon.

However, we also found:

• The service recorded adverse clinical events for individual patients, but there was no further incident reporting or formal learning system in place.
• There was no system, such as a risk register, in place to identify and mitigate clinical, operational or organisational risks to the service.
• None of the surgeons providing treatment at the clinic held the Certificate in Laser Refractive Surgery as recommended by The Royal College of Opthalmologists.

We did not speak to people using the service as on the day of the inspection there were no people available who had received treatment at the service. We looked at the results of 159 patient feedback questionnaires returned between September 2011 and December 2012. The majority of respondents rated the information they were provided with prior to treatment as "very satisfactory" or indicated that they were "delighted" with it. The majority of people indicated they were "delighted" with the professionalism of the consultant.

Prior to treatment people were required to complete a medical history form and this was discussed with staff before any treatment was provided. Follow-up appointments were arranged at the clinic to monitor the outcome of treatment. There was an emergency policy and procedure in place which staff were aware of. People could contact the service out of hours if they had any concerns.

On the day of the inspection the service was clean and tidy. There were appropriate policies and procedures in place to maintain the cleanliness of the service and reduce the risk of infection.

Staff undertook appropriate training on an annual basis and had annual appraisals where their performance was discussed and areas for development highlighted.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There were no people who use the service present when we visited the clinic. However there were current feedback questionnaires they had filled in. These told us people were very positive about the service they received and felt safe using it. They were given enough suitable information about the service to be fully involved in their treatment. They were made aware of any risks attached to the particular treatments and this enabled them to choose the most appropriate, after thorough consultation with the clinic staff.

People who use the service also told us that staff treated them in a dignified and respectful way and consultations took place in areas that up-held their privacy. This also included how their records were kept.

They did not comment directly about the clinic's quality assurance systems but confirmed that the clinic provided follow up after care.