We spoke with five patients and observed their care and treatment with their consent as part of our inspection. We also spoke with the manager, a staff member and the doctor who was providing care and treatment on the day. The patients were positive about their care. Comments included “I would recommend this place to anyone”.

We sampled five treatment records that showed that patients’ needs were assessed, care and treatment was delivered in line with their individual treatment plan. Patients using the service were given information to help them understand the care and treatment choices available to them. One patient told us they had a thorough assessment and “everything was explained clearly”. Another patient told us the after care they had received was “excellent”.

We found patients received care and treatment in a clean environment with infection control measures in place to minimise the risk and spread of infection. There was an internal audit system that the staff followed. This included different aspects of the service and health and safety. The provider took account of complaints and comments to improve the service.

During this inspection we spoke with six people who had used the service and four staff including the registered manager.

People we spoke with all confirmed that they had received sufficient information to enable them to make an informed decision about the treatment they would receive. We found that appropriate systems were in place for people to give consent to the treatment.

People we spoke with were all positive about the treatment they had received. One person said: "The treatment was first class. The surgeon explained everything".

All the people we spoke with told us they would recommend the clinic. One person said: "I have already recommended it. I have been very pleased with the treatment and the staff here". Another person we contacted after the inspection told us: "My friend recommended the clinic and I have also recommended it to others".

We found that the service had sufficient and suitably skilled staff. One person said "All the staff from customer services when I first made the appointment to the staff in the clinic have been very professional and helpful". Another person said: "They have been friendly and helpful and have answered all the questions I have had".

Systems were in place to monitor the quality of the service provided and people were asked for their views.

We found that the service had an effective complaints system and concerns that people had made were responded to appropriately.

Optimax Laser Eye Clinics Southampton is operated by Optimax. Facilities include one treatment room, one topography room, two consultation rooms, a counselling room, a preparation room, a recovery room, a reception area and a male, female and disabled access toilet. The clinic is set over two floors, with disabled access. Patient facilities are all on the ground floor.

The hospital provided laser eye surgery, refractive lens exchange and intraocular surgery for cataracts, all with topical anaesthetic. The clinic did not offer treatments to patients under 18, those with certain medical conditions, or women who were pregnant.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 and 6 December 2017 along with an unannounced visit to the location on 15 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, 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:

• All staff complied with the use of personal protective equipment.
• There was learning following incidents
• Equipment was effectively maintained, and safely used. All staff were trained to give basic life support. Medicines were managed safely and staff were competent to administer and supply medicines
• Patients told us that that all risks and benefits were discussed with them prior to surgery

• The service used the World Health Organisation’s ‘Five Steps to Safer Surgery’ checklist well for intraocular surgery. The service also had a policy and procedure in for verifying patient identification for laser treatment that was being used effectively.

• Policies, procedures and treatments were based on recognised national standards and guidance. Staff were competent to carry out the duties allocated to them. Laser staff had additional training to carry out their duties safely.
• Procedures for obtaining consent were robust and in line with national standards and guidance.
• Care was delivered in a compassionate manner and privacy and dignity was maintained at all times. Patients were involved in discussions about their treatment options. Staff recognised when patients were anxious and offered reassurance
• Patients had continuity of care throughout their procedure and aftercare. Appointments were available on weekends, if necessary.
• The facilities and premises were appropriate for the services that were being delivered.
• Complaints were managed in line with the service’s policy.
• There was a clear leadership structure from service level to senior management level.
• All staff we spoke with reported they had a good relationship within the regional surgical teams.
• Patient feedback was encouraged and was used to improve the service.

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

• The service did not contribute to the National Ophthalmic Database Audit (NODA).
• Patient outcomes were not benchmarked with other services.
• Interpretation services, whilst available, had to be paid for by the patient
• All information leaflets were only available in English.
• At the time of the inspection the senior management team agenda and medical advisory board agenda was not complete or consistent to support sharing and learning.
• The risk register had not been reviewed regularly.

• Following this inspection, we told the provider that it 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

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Deputy Chief Inspector of Hospitals