Optical Express - Southampton (The Avenue) Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff used strict patient suitability criteria to identify which patients could safely receive care and treatment at this service. If patients were temporarily unsuitable for treatment, staff undertook a 90 day follow up review to ensure patients were optimised for surgery. When prospective patients were deemed unsuitable for treatment, this was documented in patient records. In the most recent 6 months of patient suitability data, 138 patients had their treatment postponed or cancelled. This meant leaders could be assured staff acted on changes to patient’s needs and circumstances appropriately.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them.

The services’ clinical guidance and standards were informed by their International Medical Advisory Board (IMAB). Members of IMAB met at least once per year to review best practice guidance and standards, along with the newest international evidence and technological advances. This meant senior leaders could be assured the safety and performance of this service was similar to other services they delivered.

The service used strict preassessment guidelines to ensure they only treated patients who could have their needs met at this location. These guidelines were informed by an internationally recognised anaesthesia risk tool, the American Society of Anesthesiologists (ASA) physical status classification system, to specify which patients were suitable for the 2 defined pathways at this location. Patients cared for under the category 1 pathway received Consultant Ophthalmologist led care treated with topical anaesthesia only. Patients cared for under the category 2 pathway received Anaesthetist led care for patients requiring conscious sedation.

The service used the ‘Stop before you block’ safety initiative. However, this was no longer the best practice standard and had been replaced by a new national initiative 'Prep Stop Block' by the same Safe Anaesthesia Liaison Group (SALG) and Regional Anaesthesia UK (RA-UK). When the updated safety check was published, senior leaders reviewed this and made the proportionate decision to not alter the existing process. Staff said the ‘Stop before you block’ safety checks worked well and felt the ‘Prep Stop Block’ initiative would not improve patient safety. There had been no incidents of wrong- site blocks.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Teams collaborated well with each other, ensuring information about patients’ needs were communicated seamlessly at each stage of handover. Staff had access to all the information they needed to appropriately assess, plan and deliver people’s care treatment and support.

When patients were referred outside of the service for further care or treatment, staff recorded all correspondence to the electronic patient record. The service followed up on whether patients received the care and treatment they needed. Teams worked effectively with external professionals for the benefit of patients. For example, staff would occasionally contact a patients’ GP to check whether patients with additional needs were safe for surgery.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Records showed patients submitted information about their health and lifestyle before being assessed for surgery. Optometrists used this information to support discussions around patient expectations for surgery and suitability for different treatment options. The 5 patient records we reviewed showed this had occurred.

The service promoted monthly health initiatives through their blogs and email newsletter subscriptions. They shared information on how linked conditions, such as stress, heart and liver health impacted on eye health. The service also used social media and the clinic waiting room television to promote healthier living and wellbeing. This included areas such as regular exercise, health eating and limiting alcohol and tobacco use.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service always collected patient feedback through a patient experience questionnaire on the day following surgery. In the 2024 clinical and patient reported outcomes data shared with us, 93.9% of 985 patients responded that they felt they were properly consented for surgery and 83.7% would choose to have vision correction surgery again. Most patients were satisfied with the vision correction they experienced.

The service monitored individual consultant ophthalmologist performance for different procedures, incidence of complications, type and number of complications both during and after surgery. The highest proportion of complaints was for visual outcome following intraocular lens surgery. Central clinical communications were routinely shared with the service demonstrating benchmarking to improve patient experience and outcomes. Leaders showed an example where lens selection was advised by the central team based on clinical outcomes data.

Also, senior leaders measured and compared their national surgical outcomes with the international community by publishing their data in peer reviewed journals.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

At the initial assessment, patients were given information about different treatment options which were suitable for their concerns. Following this, the patient met with their consultant ophthalmologist to discuss their chosen treatment option through video call or telephone, and the formal informed consent document was signed. The service used a routine 1 week cooling off period. When patients wished to expedite this due to time constraints, they were first offered alternative locations before agreement to bypass the 1 week cooling off period. This was in line with the Royal College of Ophthalmologists Recommendations for Professional Standards for Refractive Surgery. The service protected patients from harm by ensuring they understood the risks and documented the decision with an additional consent record. On the day of surgery, patients re-confirmed consent with the consultant ophthalmologist, countersigning the consent record. This meant patients were given the appropriate amount of time to reflect on their decision and could change their mind to refuse treatment if they wanted to.

If a patient required an off-label medication like Mitomycin C due to their underlying condition, patients were given the right information to make an informed decision about their care and treatment. This was recorded to their consent form, additional to the informed consent decision for their surgical procedure.

In the 2024 clinical and patient reported outcomes data shared with us, 93.9% of patients responded to the service’s own survey that they felt properly consented for surgery.

Staff said that if there were communication needs identified at the first assessment with the optometrist, they would organise a translator to provide accurate interpretation at the virtual consent discussion with the consultant ophthalmologist and on the day of surgery. This meant staff could be confident patients understood the risks and benefits of their treatment and had made an informed decision based on this information.