We visited Visualase Laser Eye Clinic on 4 December 2013. We found the reception area to be warm, clean and inviting. On arrival patients were greeted by the receptionist. The reception area offered leaflets and information about the clinic and treatments available. One of the leaflets available contained details of patient feedback. Some of the comments included, ‘Having laser eye treatment has changed my life’ and ‘It’s just brilliant. The best thing ever. I would recommend Visualase to anyone considering laser eye correction’. Another said, ‘The experience had been fantastic and the service I received excellent. My eyesight is amazing I would recommend Visualase to anyone’.

The theatre was located on the ground floor and was accessible to people with limited mobility. There were also toilet facilities on the ground floor. We were told patient consultations were carried out in private and there was a recovery room available for patients to relax after their surgery.

We looked at a sample of patients records and we saw consent forms were signed by patients prior to any surgery taking place.

We observed comments and complaints were taken seriously by the clinic and dealt with in an appropriate manner. A number of compliments card were displayed from patients thanking the staff for care and support before and after their treatment.

We visited Visualase Eye Clinic on 13 February 2013. We found the reception area was warm, clean and bright. There were leaflets available offering information about treatments and procedures.

The theatre is located on the ground floor and was accessible to people with limited mobility. There were also toilet facilities on the ground floor. We were told that patient consultations were carried out in private and there was a recovery room available for patients to relax in after their surgery.

We looked at a sample of patients records and we saw that consent forms were signed by patients prior to any surgery taking place.

There were no patients to speak with on the day of our visit. We looked at some of the Thank You cards that had been sent to the clinic. Some of the comments included: “The team were very professional and I was made to feel comfortable”. Another said, “I would just like to say a big Thank You to you all. The support I received during my surgery was absolutely fantastic”.

We observed that comments and complaints were taken seriously by the clinic and dealt with in an appropriate manner.

We did not see any negative comments on any of the completed surveys we saw.

One person said, “It was important to meet my consultant before hand given that I was very apprehensive about the treatment. The consultation was free and I was under no obligation so there was no pressure”.

Another said, “My anxieties were dealt with in a professional manner”. We also saw, “Being able to speak with the consultant and see all the equipment prior to the treatment helped put my mind at ease”.

Other comments included, “The care and aftercare I received was excellent” and “There is no room for improvement”.

One person said, “The surgeon explained fully and honestly the limitations of treatment due to the condition of my eyesight. I therefore had no unrealistic expectations or post-operative disappointment”.

Another said, “In all my years of dealing with companies and health care staff I’ve never received this level of knowledge and care”.

On every survey we saw, the person said they would recommend Visualase to their family and friends.

Visualase Laser Eye Clinic is operated by Visualase Limited.

The service provides refractive eye surgery for self-funded patients over 18 years old. Facilities include a reception area, two assessment rooms, a consultation room, disabled toilet, a theatre suite and recovery room.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 July 2017, along with an unannounced visit to the clinic on 3 August 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:

• Patient’s records were stored securely, legible, completed and updated appropriately.
• There were robust systems in place for the maintenance of equipment including service level agreements with external organisations.
• Registered staff had been employed for several years with consultant-led medical cover.
• Outcomes of laser surgery were monitored via a computerised software system and benchmarked against other providers with the same equipment.
• Ninety per cent of staff had received an annual appraisal.
• There was effective multi-disciplinary working at the clinic.
• Patients were seen by the consultant at each stage with a comprehensive consent process.
• All patients, and those close to them, were treated with privacy dignity and respect. We saw that staff were kind and compassionate whilst delivering care and treatment.
• Patients we spoke with were happy with the service that they had received.
• The provider’s annual patient feedback survey was overwhelmingly positive about their experiences with the provider.
• Consultations took place in individual consultation rooms before and after procedures.
• Patients were encouraged to be accompanied by someone close to them.
• Patients were self-referred with appointments made individually and flexibly.
• The clinic was open six days a week and on Sundays, as required, for post-operative check-ups.
• Patients were given access to 24 hour helpline services for the duration of the post – operative treatment and after-care was available as long as was needed.
• The clinic was accessible for patients with reduced mobility.
• A hearing loop was available for patients with a hearing impairment.
• There had been no written complaints and any concerns were dealt with promptly.
• There was clear leadership with supportive team working.
• Recruitment checks had been completed for all staff employed.
• There was a positive culture, with staff working there for many years.
• Alternative treatments were being introduced to offer more patient choice.

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

• There was a paper incident reporting system, however; records showed that these only recorded complications of the treatment.
• There was no mandatory training programme in place, following the initial induction, with only the clinic manager having received current life support training.
• The safeguarding policy only listed the contact details of the local safeguarding boards and records showed that only two of the staff had completed safeguarding training for adults.
• The processes for the management of specialised medicines were not robust with no evidence of a policy or risk assessment in place.
• The systems in place for infection prevention and control did not follow current national guidance.
• There were no systems in place for the recognition or treatment of anaphylaxis (an extreme and severe allergic reaction) or sepsis (a serious complication of an infection).
• Newly-appointed staff followed an induction programme, however; competencies were not re-assessed following initial training.
• Staff had not received training about the Mental Capacity Act (2005).
• The consent form for Laser-Assisted Subepithelial Keratomileusis (LASEK) did not include that the drug Mitomycin was unlicensed for use in ophthalmic surgery.
• There was no interpreter service or information available in languages other than English.
• There was no vision or strategy for the service.
• There was no overall management of organisational risks or formal governance arrangements and no formal minuted meetings.
• There was no audit programme in place.
• We were told the appraisal process reviewed training needs, however; did not include all development needs of staff.
• Policies had been reviewed, and shared with all staff, at least every three years, however; did not always reference guidance.

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 requirement notices. Details are at the end of the report.

Name of signatory

Edward Baker

Chief Inspector of Hospitals