London Vision Clinic is operated by London Vision Clinic Partners Limited. The clinic has no overnight beds as the service only offers day case procedures. The clinic is set up over four floors, with lift access to each floor. Facilities include two operating theatres (one for laser surgery and the other for cataract surgery), 10 consultation rooms, four testing rooms and one medication room. There were two relaxation rooms as well as two separate reception areas.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on the 12th December 2017, along with an unannounced visit to the clinic on the 18th 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.

The main service provided by this hospital was Refractive Eye Surgery. 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:

• A maintenance schedule was in place to ensure all equipment at the clinic was maintained and serviced.
• Theatre lists and clinics were planned in advance and there were enough staff with the right skills to ensure patients received safe care.
• Without exception, patients told us they were treated with kindness and compassion by all staff. Patients spoke positively about the customer service and the care they had received.
• The clinic had a dedicated research team, who monitored patient outcomes and we saw patients received good outcomes following refractive surgery at the clinic.
• The clinic had bespoke electronic medical record software which allowed staff to document all stages of the patient’s journeys. Records we reviewed all contained the necessary assessments and documentation.
• All staff were aware of the process of reporting incidents and we saw that clinic managers investigated all incidents and provided feedback to staff.
• Staff followed safe systems for the management of medicines including the use of cytotoxic medicines.
• All staff we spoke with were very complimentary of the leadership of the service and told us that the management team were very visible and approachable; they felt ‘like a family.’
• Surgeons at the clinic were highly skilled and had also been involved in developing laser equipment along manufacturers.

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

• The consent policy did not reflect the Royal College of Ophthalmologist’s standards 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 a safeguarding adult policy and at the time of the inspection. Staff had not received training on safeguarding adults, although training was booked for April 2018.
• Hot water temperature recording in both operating rooms were below the recommended temperature, which was not in line with HTM 04-01 Safe water in healthcare premises.
• Although the senior management team were aware of some the risks within their service, these risks were not formally recorded on a risk register.
• The clinic did not have a Medical Advisory Committee is in place to provide oversight of the quality and safety at the clinic.
• We observed some staff did not follow best practice with regard to infection prevention and control, as their arms were not bare below the elbow.
• The clinic did not offer a translation service and patients were asked to bring their own interpreters, which meant that family members were often used to interpret.

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 a requirement notice that affected surgery. Details are at the end of the report.

Amanda Stanford

Interim Deputy Chief Inspector of Hospitals