London Centre for Refractive Surgery is operated by Ultralase Eye Clinics Limited. The service is for day cases only. Facilities include an operating treatment room, for treatment of refractive eye conditions, an assessment room, recovery room and patient preparation room.

The service provides lens surgery only, which includes refractive lens exchange and implantable contact lenses. The clinic is situated on the ground floor of a multi-occupied building in London Harley Street. No NHS funded treatment is completed at this clinic.

We inspected this service using our comprehensive inspection methodology. We carried out this announced inspection on 15 November and 29 November 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.

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:

• Incidents were investigated to assist learning and improve care. Patients were treated in visibly clean and suitably maintained environment and their care was supported with the right equipment.
• The staffing levels and skills mixed were sufficient to meet patient demand and staff assessed and responded to patient risk.
• All staff had completed their mandatory training and had received an appraisal. Care and treatment was provided by competently trained staff that formed part of a multidisciplinary team.
• Patient records gave detailed information of the patient’s pathway of care and were kept safe.
• Medicines were stored safely and given to patients in a timely manner.
• Staff kept patients well informed throughout the pathway, ensuring their understanding and consenting patients verbally and with written consent.

• Patients were positive about the care and treatment they had received. We observed staff treating patients with compassion and kindness. Staff always respected patient privacy and dignity.

• There was a positive culture where staff were comfortable in raising concerns and issues, staff felt the local leadership team were approachable and supportive.

• The service demonstrated they took immediate action to improve the quality of their service.
• There was appropriate management of quality and governance and managers were aware of the risks and challenges they needed to address.

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

• Patient information leaflets, documents, and consent forms were only provided in English.
• Staff feedback in the form of engagement surveys were not happening.

Following this inspection, we told the provider that should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals