Optical Express Nottingham Clinic is operated 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 Nottingham Clinic provides laser vision correction procedures under topical anaesthetic and intra ocular lens (refractive) surgery for the treatment of cataracts and refractive errors under local anaesthetic to adults only, aged over 18 years. Treatment sessions take place approximately seven days per month. Between 15 and 20 patients are treated per session.

The clinic is set out over three floors. Facilities include an operating theatre, a laser treatment room, an anaesthetic room, pre and post-operative rooms, discharge room, dirty utility room and four examination rooms.

Patients are 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 the announced part of the inspection on 23 August 2017, along with an unannounced visit to the clinic on 3 September 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 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 good 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 patient s may need additional support.
• Services were available at the patients convenience. Reasonable adjustments had been made for wheelchair users.
• 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:

• Duty of candour was not clearly described or defined  in relevant policies and procedures.
• Some doors to rooms containing sharps, medicines or Control of Substances Hazardous to Health (COSHH) products were accessible to unauthorised persons.
• Patient information leaflets were not available in different languages or formats.
• Patient information on how to make a complaint did not include information about the Optical Complaints Consumer Service.
• There did not appear to be a vision or strategy in place.
• Staff engagement surveys were not taking place.

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