• Hospital
  • Independent hospital

University of Wolverhampton

Overall: Requires improvement read more about inspection ratings

Walsall Campus, Gorway Road, Walsall, WS1 3BD (01902) 321120

Provided and run by:
University of Wolverhampton

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Background to this inspection

Updated 14 January 2020

Healthscan is operated by the University of Wolverhampton. The service opened in February 2019. It is a diagnostic imaging service based on the Walsall campus of the University of Wolverhampton. The service accepts referrals from consultants based at Walsall Manor Hospital only.

The service has had a registered manager in post since February 2019. However, at the time of the inspection, a new registered manager was in the process of being appointed.

We inspected this service on 20 November 2019 using our comprehensive inspection methodology. The inspection was unannounced (staff did not know we were coming).

The facility is based within the William Penny Brookes building at the University of Wolverhampton. It is located on the first floor and is accessed by stairs or a lift. The service has one dual energy x-ray absorptiometry (DEXA) scanner unit and offers appointments Monday to Friday from 9am to 3.30pm. A DEXA scan uses low dose x-rays to take measurements to work out the strength (density) of patient’s bones. The facility includes a designated waiting area and reception, the scan room, two staff offices and a cleaning cupboard.

There is an arrangement in place for the service to offer DEXA scans or bone densitometry scans to adults over the age of 18. However, there was no formal written service level agreement with the local NHS trust who referred patients for DEXA scans.

There are two designated parking spaces close to the building, reserved for patients attending for scan appointments.

The service consists of one senior radiographer and a registered manager who is a nurse.

Arrangements for emergency patient care i.e. in the event of cardiac arrest, are via a 999 call to the paramedic ambulance service. Staff have basic life support training and there is first aid equipment in the clinic and a defibrillator is available within the building.

Overall inspection

Requires improvement

Updated 14 January 2020

Healthscan is operated by University of Wolverhampton. The service is based within the University of Wolverhampton facilities on the Walsall campus.

Facilities include one dual-energy X-ray absorptiometry (Dexa) scanning unit which is used for diagnostic imaging. There is a reception, waiting area and two staff offices.

The service provides diagnostic imaging to adults over the age of 18 years of age.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection (staff did not know we were coming) on 20 November 2019.

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 rate

We have not previously rated this service and cannot therefore compare ratings with the last inspection. We rated it as Requires improvement overall.

We rated it as Requires improvement because:

  • Staff did not receive training in the Mental Capacity Act 2005 meaning they may not always be able to recognise, and respond appropriately to, patients who were unable to provide consent to treatment.

  • Complaints information was not clearly displayed. This meant that patients may not easily be able to make a complaint as details of the process were not widely available.

  • Governance around the service contract and performance was not in place as there was no formal contract agreement , agreed key performance indicators, or contract meetings.

  • There was minimal audit happening in the service which gave no assurance for performance or outcomes and no means of identifying any areas for service improvement.

  • The service did not routinely document patient’s consent to receiving a scan. Assurance in effective consent processes could not be provided.

However, we found the following areas of good practice:

  • We found that the clinical environment was appropriate for the service delivered and was visibly clean. Infection prevention control processes were followed by staff.
  • There was good compliance with IR(ME)R 2017 regulations and there were effective local rules to ensure radiation was managed safely.
  • The service’s policies and procedures were based on national guidance and evidence-based practice was being delivered.
  • The service was able to be responsive to referrals and reported they offered appointments with minimal waits for patients.
  • We saw that staff displayed a caring approach and patients provided positive feedback about the service.

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 (Midlands region)

Diagnostic imaging

Requires improvement

Updated 14 January 2020

  • Staff did not routinely document patient consent and did not receive Mental Capacity Act training. The service was therefore unable to demonstrate they had appropriate conversations about consent to a scan when patients may not have capacity to make decisions.

  • It was not always easy for people to give feedback and raise concerns about care received as complaints information was not clearly displayed.

  • Staff provided good care and treatment but did not monitor the effectiveness of the service. Staff did not routinely complete audits and therefore could not use this information to improve the service.

  • The service could not demonstrate that they provided care in a way that met the needs of local people. Although staff told us that patients could access the service when they needed it and received the right care promptly, they could not provide evidence to support this.

  • The service did not routinely collect performance information in order to be able to monitor and improve services.

However:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service generally controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. 

  • Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.