Optical Express Southampton is operated by Optical Express Limited. It is a nationwide company offering general optometric services which are outside the scope of registration and refractive eye surgery and laser vision correction procedures using Class 4 and Class 3b lasers for adults aged 18 years and above. We inspected refractive eye surgery only at this service.

The clinic is based on the ground and first floors of a multipurpose building in Southampton which was accessible by stairs.

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.

The clinic was not operational every day, therefore there was only one staff member based there, which was the surgery manager. The surgery manager was on an extended absence of leave for one year from the clinic and another surgery manager was covering. Treatment lists were staffed by a regional surgery team that travelled and covered the Southampton, Reading and London areas who visited the clinic on surgery days.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 16 November 2017, along with an announced visit to the clinic on 6 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 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:

• The service had systems for the reporting, monitoring and learning from incidents.

• Staff were aware of how to report incidents. Patient safety was monitored and incidents were investigated to assist learning and improve care.

• Staff received level two training for both safeguarding children and adults. A policy was in place and staff were aware of the responsibilities in reporting any safeguarding concerns.

• Patients received care in visibly clean and suitably maintained premises

• 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 prescribed and administered to patients appropriately ensuring that they understood how to administer them.

• All staff 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 appropriate management of quality and governance and managers were aware of the risks and challenges they needed to address.

• Systems and processes were in place to keep staff and patient safe. There were good infection prevention and control procedures in place.

• Patients received a thorough assessment prior to treatment, were monitored during treatment and were given emergency contact numbers following their discharge.

• 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.

• There was a comprehensive staff training programme in place including laser safety.

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

• There was a process for the reporting, monitoring and learning from complaints.

• There was clear visible leadership within the services. Staff were positive about the culture within the service and the level of support they received.

• Managers were visible and respected by staff. Staff felt valued. There was a culture of honesty and openness. Patient feedback was encouraged. Effective recruitment processes were in place.

• The organisation recognised and rewarded staff through their weekly staff reward scheme.

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

• The consent policy did not reflect Royal College of Ophthalmologists Guidance 2017 for a 7 day cooling off period between the initial consent meeting with the surgeon and the final consent by the surgeon.

• The clinic did not have access to any interpreting services and patients were asked to bring their own interpreter. This meant that staff might not be clear if patients had fully understood the risks and benefits of the surgery.

• Patient information leaflets, documents, and consent forms were only provided in English.

• Staff feedback, in the form of engagement surveys had not taken place.

Following this inspection, we told the provider that it should make some 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