Archived: Optical Express - Northampton Clinic

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 22 November 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:

An incident reporting process and policy was in place and staff understood their responsibilities to raise concerns and incidents. Optical Express – Northampton Clinic is operated by Optical Express. Facilities include one laser treatment room, one surgeon’s examination room, two discharge rooms and one consultation room.

The service provides refractive eye surgery.

• There had been no infections from September 2016 to August 2017.
• All staff had received mandatory training and basic life support training.
• All staff were trained to level 2 safeguarding adults and level 3 safeguarding children.
• All areas of the clinic were visibly clean and cleaning mechanisms were in place.
• The humidity and temperature of the laser room was checked regularly and recorded.
• All equipment was regularly serviced and maintained.
• All medications in the clinic were in date.
• All records were stored securely and complete and up to date.
• Patients had appropriate preoperative risk assessments completed prior to surgery.
• The clinic used the World Health Organisation’s ‘Five Steps to Safer Surgery’ checklist appropriately.
• Arrangements were in place for the provision of a laser protection advisor and laser protection supervisor.
• An emergency generator was in place and checked regularly.
• Policies were easily accessible and contained relevant information for staff.
• Patients had their needs assessed in line with national guidance.
• Patient outcomes were monitored through the surgeon’s performance. These showed positive outcomes for patients.
• All staff had evidence of their professional registration, disclosure and barring service checks and yearly appraisals.
• The surgeon held a Royal College of Ophthalmology Certificate in Laser Refractive Surgery.
• Staff from any clinic could access patient records. This meant that if patients attended for follow up appointments at another clinic, they still had access to the relevant medical records.
• Staff were encouraging and supportive to patients.
• Patients’ privacy and dignity was maintained.
• 94% of patients would recommend the service to their friends and family.
• Patients were given accurate information regarding the risks and benefits of the procedure and any associated costs.
• Relatives were encouraged to join patients in the recovery room.
• Patients were given the choice of other local clinics to go to for their preoperative and follow up appointments.
• From review of the patient records, all patients observed the seven day cooling off period. This is to ensure that patients have sufficient time to think about the procedure and confirm that they want to go ahead.
• All areas of the clinic were wheelchair accessible.
• All complaints were dealt with in a timely manner.
• The clinic had strong leadership in place, with a longstanding manager in post.
• All patients were provided with a copy of the terms and conditions before undergoing surgery.
• A local strategy was in place to improve areas of development within the clinic.
• A corporate governance structure was in place.

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

• The medication keys were not kept securely when the clinic was closed.
• Bariatric equipment was not available for patients over a certain weight. However, these patients were not listed as inadmissible in the clinical suitability guidance. As such, there was a risk that these patients could be admitted, without appropriate equipment.
• Consent consultations occurred over the telephone prior to surgery. However, the consent was then reconfirmed on the day of surgery in person.
• The consent policy was not in line with national guidnace.
• Due to limited opening days, patients often had to attend follow up appointments at different clinics.
• There were no formal translation services in place.
• There was no hearing loop in place.
• There was no local vision for the service, however, there was a corporate vision.
• The risk register was reviewed yearly as a minimum, or on addition of a new risk or in the event of an incident where control measures identified in an existing risk assessment have failed.

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. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)