InHealth Waterloo

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment, this key question was not rated. At this assessment this key question has been rated good. This meant care and treatment were planned and delivered in line with people’s assessed needs, current guidance and evidence-based practice.

We have not awarded this service a score for Effective.

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

The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients’ individual needs were considered at the point of referral. Interpreter services were available for patients who did not speak English as their first language. Leaflets and MRI safety questionnaires could also be translated into different languages. British sign language interpreters could also be arranged. 

Appointment letters encouraged patients to contact the service if they had any questions or concerns about their appointment.

Scans were planned and delivered in line with evidence-based guidance, standards and best practice. The service had an MRI operational procedure and local safety rules. We found these were in date and reflected best practise. The service had local MRI protocols which had been approved for different pathways which were in date. 

Pre-scan assessments were comprehensive and identified any risks. Patients told us staff considered their needs during their pre-scan assessments for example if they had reduced mobility, they supported the patient by providing a MRI safe wheelchair to use while the patient was at the service. Staff were knowledgeable about how they would support patients with communication needs or those that needed extra support for example if they were anxious about their scan.

Staff assisted patients into comfortable positions for imaging wherever possible including using positional pads which ensured thermal safety and helped patients feel more comfortable during their scan. 

Patients had access to drinking water as needed or required. There was a water dispenser for patient use.

The service planned and delivered patient’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff had access to policies and procedures based on national guidance on the provider’s intranet. Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. All policies we looked at contained a current creation and review date, and clear references to current national guidelines such as the Medicines and Healthcare products Regulatory Agency (MHRA) safety guidelines for MRI equipment.There were systems to communicate changes in guidance through meetings and email updates. 

Policies and processes took account of changes to the Royal Colleges guidelines and National Institute for Health and Care and Excellence (NICE) guidelines. MRI scan protocols and pathways were developed centrally by the corporate provider. Staff knew how to access these on the provider’s intranet. 

Staff completed risk assessments for each patient on arrival, using a recognised tool, and reviewed this regularly, including after any incident. The service used The Society of Radiographers “Pause and Check” system. Pause and check consisted demographic checks to correctly identify the patient, as well as checking with the patient the site to be imaged, the existence of previous imaging and for the operator to ensure the correct imaging modality was being used. We observed staff conducting checks in line with the correct procedure. 

The service had a comprehensive audit schedule. Audits covered, hand hygiene, patient identification checks, MRI scan documentation, MRI image quality, emergency evacuation and environmental audits. Audits were carried out weekly, monthly and annually and as required depending on results, to assess clinical practice in accordance with local and national guidance. Audit results were discussed at team meetings as well as at quarterly governance meetings. 

The service worked well across teams and services to support patient. Staff made sure patient only needed to tell their story once by sharing their assessment of needs when patient moved between different services.

Staff at all levels worked collaboratively as a team to benefit patients. They supported each other to provide good care. 

Staff reported good working relations across staff groups. We saw and heard examples of effective team working which was based on mutual respect and trust. Daily huddles at the beginning of shifts ensured staff were aware of any updates, allocation of tasks and planning and coordination of scans booked for the day. 

Managers told us they were able to communicate with colleagues across the provider’s others locations for advice and support. 

Staff worked closely with the referrers to enable patients to have a prompt diagnosis and treatment pathway. If they identified concerns from scans, they escalated them to the referrer. Radiographers escalated abnormal findings to radiologists through the picture archiving and communication system (PACS).

The service communicated effectively with external partners and undertook scans for local NHS providers and private referrers such as healthcare insurers. 

The service generally supported patients to manage their health and wellbeing to maximise their independence, choice and control. 

There was information on diagnostic imaging procedures available in the patient waiting area. There were information leaflets and posters displayed in the waiting area about what would happen during a scan, what preparation was required prior to a scan and self-care advice following a scan. 

Within the patient changing cubicles we saw posters about mental health support and contact information. We also saw posters about safeguarding, septicaemia and meningitis awareness. 

There was health information on the provider’s website about screening programmes. However, there was limited health promotion information available.

We did not look at Monitoring and improving outcomes during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. 

All staff understood the requirements of the Mental Capacity Act 2005. Staff completed mandatory training on the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

We saw that staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff we spoke with understood the need for consent and gave patients the option of withdrawing consent and stopping their scan at any time. The service used consent forms that all patients were required to sign at the time of booking in at the service. Records we reviewed showed that consent had been recorded. 

Staff made sure patients consented to treatment based on all the information available. Patients told us staff had  talked with them about the benefits, potential complications, and risks related to their scan.

Patients were sent an information leaflet explaining the MRI procedure including what they needed to do prior to the appointment and when they arrived.

We observed staff seeking verbal consent before providing care or treatment. Patients we spoke with confirmed they had completed a MRI safety questionnaire and had given their consent for the procedure they had attended for.

Where specific requests had been made by patients, for a same sex health care professional, this was discussed and provided whenever possible.

Interpreters were used to support patients to give informed consent (including for British sign language). 

The service had a consent policy which was up-to-date and provided patients with written information about the consent process prior to attending for appointment. The policy also referenced how staff should seek consent from young people under the age of 18 years of age.