Optical Express Harley Street is operated by Optical Express Limited. Optical Express is a nationwide company offering general optometric services. The clinic provides laser vision correction procedures for adults aged 18 years and above. The clinic is based on the ground floor of a multipurpose building in London.

The clinic has pre-screening amenities, consultation rooms, and a laser treatment suite, which consists of a laser treatment room and surgeon’s treatment room.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 September 2017, along with an announced visit to the clinic on 22 September 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 services but we do not currently have a legal duty to rate them. 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:

• Patient safety was monitored and incidents were investigated to assist learning and improve care.
• Patients received care in visibly clean and suitably maintained premises and their care was supported with the right equipment.
• The staffing levels and skills mix was sufficient to meet patients’ needs and staff assessed and responded to patient risks.
• Patient records were detailed with clear plans of the patient’s pathway of care.
• Medicines were stored safely and given to patients in a timely manner.
• All staff had completed their mandatory training and annual appraisals. Care and treatment was provided by suitably trained, competent staff that worked well as part of a multidisciplinary team.
• There was clear visible leadership within the services. Staff were positive about the culture within the service and the level of support they received.
• There was appropriate management of quality and governance and mangers 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.
• There were no formal interpreter services available for patients. Patients were advised to bring their own interpreter to the clinic, or use a family member.
• There was no organisation vision or strategy in place.
• Staff feedback, in the form of engagement surveys were not happening
• The consent policy stated a “cooling off” period of three days prior to surgery procedure. The new Professional Standards for Refractive surgery (April 2017) recommends a “cooling off” period of one week, less so in exceptional circumstances. While the clinic did provide patients with a terms and conditions document, which supplied information on the procedures available and the associated risks and benefits, which patients took away with them. The actual time frame between the confirmed consent with the surgeon and actual treatment was usually three days.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals