Optical Express, Birmingham is run by Optical Express. Optical Express is a nationwide company providing general optometric services. The UK headquarters for Optical Express is based in Glasgow. Some corporate services are based there such as the clinical services team and the training team.

In addition to optometric services, Optical Express Birmingham Clinic provides laser vision correction procedures under topical anaesthetic and intra ocular lens (refractive) surgery for the treatment of cataracts and refractive error under local anaesthetic to adults only, aged over 18 years. The clinic undertook laser vision correction procedures approximately four days a month (whole day sessions) and intra-ocular lens procedures approximately six days a month.

The clinic is located on the ground floor of a multi-occupied office building. It was shared with a small Optical Express optical practice which provides a general optical service including contact lenses, eye health screening and examinations as well as pre- and postoperative intra-operative lens and laser vision correction assessments.

Facilities included a laser treatment suite, surgeons’ examination room, YAG laser, femtosecond laser, screening, intra ocular, utility, post-operative, anaesthetic and pre-operative and optometrist examination rooms. A femtosecond laser is a laser which emits optical pulses with a duration well below 1 ps (→ ultrashort pulses), i.e., in the domain of femtoseconds (1 fs = 10−15 s). It thus also belongs to the category of ultrafast lasers or ultrashort pulse lasers. YAG laser is a non-invasive surgery which returns your vision to the level it reached after your initial lens replacement procedure.

Patients were self-referring, self-funded patients with visual problems caused by a refractive error such as short sight, long sight, astigmatism and cataract. The treatment of refractive error is not classed as a medical condition so is not treated by the NHS.

We inspected this service using our comprehensive inspection methodology. We carried out our inspection on the 5 July and 6 July 2018.

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 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:

• Systems and processes were in place to keep staff and patient safe. Staffing levels were good and staff were competent to carry out their duties. There were effective infection prevention and control procedures in place, all areas were visibly clean and well equipped. Patients received a thorough assessment prior to treatment, were monitored during treatment and were given emergency contact numbers following their discharge.

• Policies, procedures and treatments were based on nationally recognised best practice guidance. Regular audits were carried out on a range of topics. Patient outcomes were measured and benchmarked. There was a comprehensive staff training programme in place including laser safety. Robust consent procedures were in place.

• Care was delivered in a compassionate way and patients were treated with dignity and respect. Patient were kept informed throughout their care and encouraged to ask questions. Staff recognised when patients may need additional support.

• Patients could access services and make appointments at their convenience. The service was accessible to people who used mobility aids such as wheelchairs.

• Managers were visible and respected by staff. Staff felt valued. There was a culture of honesty and openness. Patient feedback was encouraged. Effective recruitment processes were in place.

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

• Formal staff engagement surveys were not taking place.

• Staff sometimes left doors open when consulting with patients which meant there was a risk of conversations being overheard and patient’s confidentiality being breached.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals