We spoke with three people who used the service. We also spoke with two members of staff and an interim manager appointed by the provider. We looked at six people’s treatment records and staff training and development records. We also reviewed the systems the provider had in place to deal with people’s complaints.

Most people told us that they were happy with the results of their laser eye surgery and had received sufficient information about the treatment options available to them. One person said “I was given advice about the surgery, and any risks were explained by the staff”. People also told us they had received an assessment of their eyes and their health to make sure they were suitable for eye surgery and had received their treatment in a clean environment. They told us the staff were professional and well trained to do their jobs. One person said “the surgeon was brilliant” and were pleased with the results of their chosen procedure. People told us if they had any complaints they would raise these with the manager and the staff and were confident they would take their complaints seriously.

We found that people received sufficient information about their treatment and care and received surgery that met their individual needs. We also found that people were cared for in a clean environment and that staff adhered to good infection control procedures. There was an effective complaint system in place and staff were supported with training and professional development to make sure they had the necessary skills to do their jobs.

At the time of the inspection visit the registered manager was not in post. The provider might find it useful to note that not having a registered manager in position could lead to regulatory action and prosecution.

We spoke with four people who had recently had laser eye surgery at the clinic. They told us they were happy with the treatment and care provided by the staff. They said that they had received an assessment to check their eyes and general health before they had surgery; this was to make sure they were suitable for the surgery and that the right procedure had been chosen to meet their individual needs.

They also told us that the staff had given them information about the risks and benefits of the surgery and what to expect after they had received treatment. They said they had to sign a consent form, to say they understood the treatment, including any risks and that they were happy to go ahead with the surgery.

We looked at the improvements the service had made to the management of medicines and saw that procedures were in place to manage these appropriately. People also told us that staff gave them information about any medicines they were prescribed so they could understand how to take them safely.

The registered manger had also made a number of improvements to the recruitment procedure. This was so they could make sure staff were of suitable character and were registered with their professional council.

The day we visited was a non clinic day, so there were no patients for us to talk to.

Staff told us that it was a nice place to work and that they felt supported. They also said that training was provided and that yearly appraisals took place.

Optimax Laser Eye Clinics – Milton Keynes is operated by Optimax Clinics Limited. The clinic opened in July 2009. Facilities include one treatment room where laser eye surgery is performed, a topography room, two consultation rooms, a counselling room, a preparation room, a recovery room and two reception areas. The clinic is set over two floors, with disabled access.

The service provides refractive eye surgery to patients aged over 18.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 October 2017, along with an unannounced visit to the hospital on 12 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 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:

• Despite the lack of an incident reporting policy, there was a strong culture of reporting incidents.

• The environment was visibly clean.

• All staff had completed their mandatory training.

• The theatre environment met guidance set by the Royal College of Ophthalmologists.

• Patient retreatment rates were within acceptable limits.

• Pain relief was available to patients to take home following surgery.

• The surgeon who performed the laser surgery held the Certificate in Laser Refractive Surgery.

• There were appropriate consent processes.

• Staff provided compassionate care to patients.

• All patient feedback we received was very positive.

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

• There was no incident reporting policy.

• We found some pieces of equipment which were past their expiry or servicing date.

• The service did not use the World Health Organisation’s ‘Five Steps to Safer Surgery’ checklist. The patient verification checklist used was not robust or embedded in practice.

• There was no specialist spillage kit available to clean any spillages of cytotoxic medicines.

• Non-clinical staff had access to medicines.

• Not all staff who worked with cytotoxic drugs had demonstrated competence in this area.

• Patient outcomes were not benchmarked against other services.

• All information leaflets were only available in English.

• Interpretation services, whilst available, had to be paid for by the patient.

• There was no vision or strategy for the service.

• The clinic manager had limited autonomy to make improvements to the service.

• Not all risks identified on inspection were on the service’s risk register.

• Emotional support was provided to patients, where needed.

• Patients had continuity of care throughout their procedure and aftercare.

• The facilities and premises were appropriate for the services that were being delivered.

• Appointments were available on weekends, if necessary.

• Complaints were managed in line with the service’s policy.

• There was a clear leadership structure.

• All required staff had appropriate indemnity insurance.

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 two requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)