Optegra Eye Hospital London is an eye hospital located in Marylebone, Central London. Optegra Eye Hospital London is part of a nationwide company, Optegra UK Limited, which has seven hospitals and three outpatient clinics in the UK. The hospital provides services to adults over the age of 18 only.

The hospital opened in January 2016. The premises are two former Georgian and Victorian residential properties which have been refurbished to create an ophthalmic hospital.

The hospital is set over six-floors and has six consulting rooms, a reception area, five diagnostic rooms, three operating theatres including one used for minor laser procedures, a treatment room, four patient liaison rooms and pre and post-operative areas.

The hospital provides surgery; outpatients and diagnostic imaging. Services provided include refractive eye surgery, ocular plastic, retinal diagnostic, general surgical services and ophthalmic disease management.

We inspected this service using our comprehensive inspection methodology. Because refractive eye surgery accounts for the majority of services provided by the hospital, we have reported our inspection findings against the refractive eye surgery core service. We carried out the announced part of the inspection on 17 and 18 October 2017, along with an unannounced visit to the hospital on the 27 October 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 refractive eye surgery service as in the case of Optegra Eye Hospital, London. 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:

• Staff knew how to report incidents, what incidents to report and were informed of incidents through staff meetings and emails.

• 100% of staff had completed their mandatory training.

• Staff had a good understanding on information governance.

• The hospital was visibly clean and tidy and there was no incidence of a hospital acquired infection in the reporting time period.

• Theatre practices met the Association for Perioperative Practice (AFPP) guidelines.

• All the equipment used in the hospital was recorded in the medical devices database, which was in line with best practice.

• The theatre department used three different types of laser machines and protective eye goggles that were colour coded to identify which machine these were to be used for.

• We saw that implants bar codes with unique traceable reference numbers were recorded in patients’ medical records, through the use of stickers.

• Controlled drugs (CD) were stored correctly within the hospital. All CDs we looked at were in date.

• A room where patient records were held had restricted access and was only accessible via key card entry.

• The hospital adhered to the World Health Organisations (WHO) Surgical checklist which was audited monthly for compliance.

• Staff had access to the laser protection advisor.

• The system that held the disclosure barring checks (DBS) records was able to identify, and highlight in red out of date DBS checks.

• The hospital was up to date in staff appraisals.

• Optegra used an electronic based system for storing clinical records. This was accessible to other Optegra hospitals should the need arise for patients to be seen at another site.

• We observed compassionate care and very positive interactions by all staff.

• Staff treated patients, and those close to them, with respect and dignity.

• The hospital arranged open days to give information to patients about different procedures and to answer their questions about treatment.

• The entrance of the building had been adapted to accommodate wheelchair users. Each floor within the building was accessible via a lift and set of stairs.

• Staff told us they all worked well together as a team. We saw teamwork was particularly good within theatres with each staff member having a voice and an equal place within the team.

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

• There was one never events in the last 12 months.

• There was one serious incident reported in the last 12 months.

• Staff had a poor understanding of the meaning of safeguarding.

• There was no policy on the treatment of sepsis.

• We found that registered nurses did not have the appropriate training to dispense medications, such as artificial tears, anti-inflammatories and antibiotics.

• The resuscitation trolley in the ward did not comply with national guidelines.

• Unique patient identification stickers were not used on all pages of patients notes.

• No member of staff was currently trained in advanced life-support training or equivalent.

• The hospital did not participate in any national audits.

• There was no service level agreement with another provider for emergency transfer of patients should there be an emergency at the hospital.

• There was some confusion amongst staff about the precise roles and responsibilities of some individual staff members.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notice(s) that affected the refractive eye surgery core service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals