Optical Express - Manchester Clinic is operated by Optical Express . The service provides vision correction by intraocular lens surgery and laser treatment. Facilities include pre-screening facilities, consulting rooms, one operating theatre and a laser treatment suite.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 December 2017, along with an unannounced visit to the hospital on 19 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.

We regulate refractive eye surgery services 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:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses; they were fully supported when they did so. Lessons learned were communicated through clinical directives issued by the corporate team, by email to staff members, at team meetings and at pre-surgery safety briefs.

• There were clearly defined systems and processes to keep people safe and safeguarded from abuse and staff were aware of these.

• The clinic was visibly clean and we saw that clinic staff undertook daily cleaning duties.

• We saw that mandatory training records demonstrated that training records were up-to-date.

• Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

• Clinical procedures and treatment aligned with recognised national standards and guidance. Policies were accessible to staff and up-to-date.

• Staff had the skills they needed to carry out their roles effectively and in line with best practice. The learning needs of staff were identified and training was in place to meet those learning needs.

• Staff received supervision as required and timely appraisal. Relevant staff were supported through the process of revalidation.

• Staff could access the information they needed to assess, plan and deliver care to people in a timely way. Electronic records were accessible to staff throughout the organisation.

• Consent was managed as a two-stage process and patients were given a cooling off period prior to the day of surgery.

• People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff were positive. People felt supported and said staff looked after them.

• Patients we spoke to described being “really pleased with the service” and being very happy with the outcome of the surgery.

• We saw staff members giving clear explanations to patients before giving care during the each examination and treatment to ensure they understood what to expect and why it was being done.

• Facilities and premises were appropriate for the services being delivered. Reasonable adjustments to improve access to the service were accommodated where possible.

• Patient information was comprehensive and the consent forms were detailed and easy to read.

• People could access the right care at the right time and at a location convenient to them.

• Complaints and concerns were taken seriously and staff were informed of any learning from complaints.

• The local leadership promoted a positive, safe and efficient experience for patients and strong teamwork amongst staff.

• There was a positive open culture; staff spoke about feeling happy working as a team and being confident to raise concerns with management.

• The governance structure included corporate and consultant meetings to monitor and discuss clinical standards, patient safety and patient experience.

• There was robust performance monitoring for consultants supported by an annual clinical audit report produced for each consultant.

• The company had initiated a reward programme in 2017 for staff called ‘Wonderful Wednesday’ to recognise good performance.

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

• Checking procedures between individual members of the surgical team took place at various stages prior to surgery; however, we did not see the surgical team formally participate together in the ‘sign in’ and ‘time-out’ stage of the surgery safety checklist.

• A consent policy (September 2017) was in place, but did not reflect The Royal College of Ophthalmologists (RCO) guidance (April 2017) for a recommended seven day cooling off period between the initial consent meeting with the surgeon and the final consent by the surgeon.

• There was no hazard sign outside the room storing gas cylinders or evidence of ventilation to the room.

• Where the patient had surgery on both eyes during two separate procedures, it was difficult to identify which five steps to safer surgery checklist linked to each surgery due to gaps in documentation of the date the procedure took place.

• On review of an incident report recording a near miss, the supporting investigation notes viewed during inspection did not demonstrate clear root cause analysis methodology.

• Staff were unable to access patient information in other languages.

• Management did not undertake a staff engagement survey or ‘pulse check’ to monitor job satisfaction and identify and address any ‘hot spots’ or issues that might be causing low morale or stress.

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 one requirement notice that affected refractive eye surgery. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals