Innovate Diagnostics

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. Leaders had systems for identifying and responding to deteriorating patients in the department. People received treatment and care to reduce the risk of avoidable harm, which included following safety standards. There were safety processes arranged before procedures started, with staff working together to ensure the right patient had the correct imaging. Medicines were managed safely. Patients were safe from neglect, abuse and discrimination. Patients gave informed consent prior to procedures and where they were unable to consent, those close to them were involved in decisions made in their best interests.

At our last assessment we rated this key question good. At this assessment the rating has remained good. Patients were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses in line with their own local procedure. The service had a current incident reporting and reviewing policy, which reflected relevant national guidance. For example, managers investigated, monitored, and analysed incidents to identify themes or trends. The leadership team discussed these in quarterly meetings and ensured sufficient action was taken to reduce the risk of recurrence as a standard agenda item. During our inspection we saw that there were no repeated trends or complaints.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. We looked at the service’s incident book, which was used to record and manage incidents. There were 3 incidents in the past year. We reviewed these and found they were reported accurately and actions were taken immediately where possible. 

Staff received feedback from investigation of incidents, both internal and external to the service. There had been no Never Events reported in the preceding year. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures have been followed.

Staff understood the Duty of Candor (DOC). The service had policies in place to guide staff when to use DOC. We saw evidence that patients were informed when incidents occurred.

The service provided mandatory training for all staff. Managers monitored mandatory training compliance and alerted staff when they needed to complete updates.

Staff received and kept up to date with their mandatory training. Clinicians and physiologists working for the service were contracted to work on specific shifts. These clinicians otherwise had substantive roles within the NHS. The service relied on the NHS employers to provide them with proof that all clinicians and physiologists were trained in line with their own mandatory internal training. This included training around safeguarding, mental health and learning disabilities. We saw evidence that the service regularly kept up to date with this training with their internal records. 

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

Safety and continuity of care was a priority throughout patients’ care pathway. Patients were assessed prior to the physiological diagnostic testing, and all images were based on a formal request from a member of the medical team within the NHS, health insurers or other private healthcare providers. 

There were systems and processes to ensure the correct patients were assessed throughout the patient journey and they only received the procedure which was intended. This was managed by the receptionist who was able to identify the patients and which clinician they would be seeing. We walked the patient pathway and tracked patient care from admission to discharge. We saw that patients would arrive at reception and be directed by reception staff. From this point the clinicians or the receptionist would guide patients to the next part of their journey within the service until discharged. Staff said patients that needed time for extensive tests such as heart monitors would be given information on how to use and return these devices.  We were told that patients had a direct line to the service so they could report issues and have them rectified as soon as possible. Suitably skilled and qualified staff accompanied patients in all areas and undertook the required diagnostic procedures.

Patient records were electronic and kept securely through their own systems. IT connectivity was consistently available across the service to meet the needs of staff completing records. We reviewed 10 patient records and found they contained the necessary information to support safe and effective care. Risk assessments were in place and reflected patients' individual needs and risks. Records demonstrated that care procedures and clinical pathways were clearly documented, enabling staff to deliver care in a consistent and safe manner. 

Care and assessments were planned and organised with people, together with partners and communities in ways which ensured continuity. 

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as the NHS, effective communication allowed for seamless transfer. Patients' results were shared with cardiologists, who drafted reports based on the findings. Cardiologists then completed a blinded peer review of each other's reports, providing an independent review process to help ensure patients received objectively accurate and consistent reports. Final reports were sent to the patient's care provider within 3 days.

The service worked with patients and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff demonstrated an understanding of their safeguarding responsibilities and were able to describe the actions they would take if they had concerns that a patient was at risk of abuse or neglect. This was confirmed through discussions with staff during the assessment. Safeguarding policies and procedures were in place and provided guidance on recognising different forms of abuse, reporting concerns, working with external agencies, and preventing harm. Staff had access to systems for recording incidents and safeguarding concerns, including incident reporting records. 

Safeguarding training formed part of mandatory training arrangements, with clinical staff completing safeguarding training through their NHS employment and the provider monitoring compliance. The provider also ensured its 3 permanent staff received appropriate training through external training organisations. Chaperones were available where required to support people's safety and dignity. 

At the time of the inspection, arrangements for people who did not speak English as their first language were not always effective, as interpreters were not readily available. However, leaders told us they had subsequently implemented a process to ensure access to translation and interpretation services when required. Staff were aware of the provider's equality and diversity policy, which promoted respectful and inclusive care. Equality and diversity training was completed through staff members' NHS employment and monitored by the provider. These arrangements supported the protection of people from discrimination, harassment, and psychological harm.

The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patients’ needs, which was safe, supportive and enabled patients to do the things that mattered to them.

The service worked with patients to understand and manage risks. The assessment and care met patients' needs in a way which was safe and supportive.

We spoke with patients who said they felt listened to, risks had been explained to them, and they were involved in decisions about their care and treatment. We observed staff providing person-centred care and responding appropriately to people's individual needs. For example, during a cardiac stress test, a patient became unsettled and required time to stop and compose themselves. Staff recognised this promptly, spoke with the patient to understand their needs, and agreed for them to sit in the reception area where they could be closely observed and supported. This allowed staff to continue monitoring the patient's wellbeing while providing reassurance and ensuring they felt safe and comfortable. This demonstrated a flexible and compassionate approach to care that placed the person's immediate needs at the centre of decision-making.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

The design, maintenance and use of facilities, premises and equipment supported the delivery of safe care. Staff were trained and competent to use the equipment required for their roles, and equipment was maintained and checked in accordance with manufacturers' instructions and national guidance. The service did not use equipment that emitted ionising radiation and therefore did not require controlled or restricted radiation areas.

The layout of the service supported the patient pathway and enabled patients to access diagnostic investigations easily. Consultation and diagnostic rooms contained equipment appropriate to the procedures undertaken, including echocardiography machines and equipment used for cardiac stress testing. We reviewed equipment maintenance records and found portable electrical equipment had undergone Portable Appliance Testing (PAT) where required. Safety equipment, including fire extinguishers, was within service dates and subject to routine checks.

The provider had arrangements in place for the safe storage and management of substances hazardous to health. Control of Substances Hazardous to Health (COSHH) products were stored securely and access was restricted to authorised staff. Staff understood the risks associated with hazardous substances and there were processes in place to reduce the risk of accidental exposure.

The environment was visibly clean, well maintained, and free from obvious hazards. Staff had access to emergency equipment and clear procedures to respond to patients should the need arise. The premises allowed staff to observe patients in communal areas and provide timely assistance when required. There were wheelchairs provided on request, for patients who needed assistance with their mobility. Staff would liaise with patients prior to appointments to ensure they can support patients’ mobility needs. The environment used for patient care reduced the risk of patient harm, and included for example, safe flooring. 

Leaders maintained oversight of equipment and completed daily checks to ensure it was safe and ready to use.  Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair of replacement of broken or missing equipment. The service had suitable facilities to meet the needs of patients’ families, when necessary, who were able to wait in reception or use the onsite cafe. 

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the service’s policy. Hazardous substances were stored safely and information about products was available to staff.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patients’ individual needs.

The service had enough staff including clinical and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

The service provided appointments on staff availability rather than public needs, which meant that all appointments were fully staffed. If appointments would need to be rescheduled, these were normally organised around staff availability. 

The service did employ medical staff. However, this was to peer review diagnostic reports and send the reports to their healthcare provider. This work was normally completed with cardiologists off site and was only completed on their own timeframe. Therefore, cardiologists were always available to complete reports. 

Staff said the service was safe. They were able to take breaks during their shift which was moulded around appointments. Patients felt their needs were met. We observed staff attending to patients in a kind and supportive way. Patients appeared comfortable and were engaged in conversations because there were sufficient staff.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. For example, support staff suggested that it would be beneficial for them to have First Aid training which management arranged for them. This not only provided additional training but also meant that more staff were able to provide emergency care if required. 

Managers made sure staff attended team meetings or had access to the information shared when they could not attend. Staff meetings were recorded quarterly; there were times when meetings were missed due to staff not being available. However, due to the team being very small and effective communication constantly took place, this was not a significant risk.  We saw notes from team meetings and other general information was monitored between meetings.

Procedures were carried out by professionals with appropriate seniority and specialty training. Staff employed were also employed in the NHS, assurances with training and qualifications were shared with them from their employers’ NHS locations. Therefore, we were assured they were appropriately trained. 

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean. 

The service was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. The service did not have foot operated bins in clinical areas, which was against national guidelines. However, once we raised this on site, the service took immediate actions to address this. Therefore, the risk of cross contamination was mitigated.

The service did have carpets, which was not in line with national guidelines for clinical rooms. However, due to the service not providing any type of personal or clinical care, the risk was minimal. Viewing the risk assessment, we found that this to be a low risk. 

There was a provider infection and prevention and control (IPC) policy and supporting guidance that was accessible to staff. The service had a programme of IPC audits, for example, running taps to limit legionella and cleaning audits for clinical assessment rooms.

We saw staff were following infection control principles including compliant handwashing and the use of personal protective equipment (PPE), as outlined in the service’s PPE standard operating procedure. We saw staff clean equipment after patient contact and disposed of single use equipment such as Echocardiogram (ECG) electrodes.

Staff understood the process for managing the spillage of body fluids and had the necessary equipment and PPE. Staff supported IPC measures by following the uniform policy. For example, nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows.

The service made sure that medicines and treatments were safe and met patients’ needs, capacities and preferences. Staff involved patients in planning, including when changes happen.

The service had a limited need for medicines as its primary activity involved the use of electrocardiogram (ECG) equipment and did not routinely administer medication. However, emergency medicines were available and appropriately stored for use in the event of an anaphylactic reaction, ensuring staff could respond promptly should this medical emergency occur. Emergency medicines were kept in an accessible container. staff told us these were administered through a standard operating procedure (SOPs). These were only to be used in the event of resuscitation.