Optical Express Clinic White City is operated by Optical Express Limited. Optical Express is a nationwide company providing general optometric services. The service provides intra-ocular lens exchange, cataract and phakic intra-ocular lens implant surgery under local anaesthetic and intravenous sedation, for adults aged 18 years and above. Cataract and lens exchange procedures include the use of a laser machine.

The clinic is based on the first floor within Westfield’s White City shopping complex, and is set over two floors. Facilities include a theatre, anaesthetic room, laser room, surgeon examination room, a pre-operative and post-operative room.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 16 and 18 October 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 clinics, 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:

• There was a positive culture of incident reporting and an effective process for the investigation of incidents. Shared learning was recorded and circulated to staff.Managers supported staff to deliver effective care and treatment, including through meaningful and timely supervision and appraisal.
• Staff were up to date with all core mandatory topics and had received an annual appraisal. Patient treatment was provided by competent, suitably trained staff. There was a clear and appropriate approach to support and manage staff when their performance was poor or variable.
• All clinic staff we observed treated patients with respect and dignity throughout all interactions at the clinic. Feedback from patients was overwhelmingly positive about the caring nature of the staff looking after them.
• Facilities and premises were appropriate for the services being delivered. Services were available at the patient’s convenience and were accessible to those who had disabilities.
• The clinic followed best practice guidelines and was determined to set realistic expectations for patient’s outcomes after surgery.
• The governance arrangements in place meant there was oversight of quality, risks, and the challenges that needed to be address.

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

• The consent policy did not reflect Royal College of Ophthalmologists 2017 for 7 day cooling off period between the initial consent meeting with the surgeon and the final consent by the surgeon.
• Patient information leaflets were not available in different languages or formats.

• There were no formal interpreting services available and patients were asked to bring a family member or their own interpreter to the clinic with them.

Amanda Standford

Interim Deputy Chief Inspector of Hospitals London