InHealth Waterloo

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. The service had systems for identifying and responding to deteriorating patients. 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. Managers listened to concerns about safety and investigated and reported safety events. Lessons were learnt and shared across the service to continually identify and embed good practice. 

The service managed patient safety incidents well. Managers investigated incidents and shared lessons learned with the whole team during team meetings and huddles at the beginning of each shift. Staff were aware of their responsibilities for reporting incidents and near-misses and were able to explain how this was done. The service used an electronic incident reporting form and staff told us they received feedback on the incident they reported. 

We viewed team meeting minutes and saw incidents and lessons learned were discussed. Staff we spoke with could describe the latest incidents and learning,

Staff understood their responsibilities with regards to duty of candour. If and when things went wrong, they apologised, were open and transparent and gave patients honest information with suitable support. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

There had been 1 moderate harm and 10 low harm incidents recorded in the 12 months preceding our inspection. Themes were mainly around booking issues resulting in gaps in the scanner schedule and inaccurate recording on documentation. Clinical incidents were investigated by the superintendent radiographer while non-clinical incidents were reviewed by the operations manager. 

The provider had a Patient Safety Incident Response Framework (PSIRF) policy to ensure patient safety incidents were managed consistently throughout the organisation. We saw that the service had investigated incidents in line with this process. The incident log showed details of actions taken to prevent reoccurrence of the incident, investigation details and key learning points. The operations manager then shared incident learning with the team and the wider InHealth organisation. There had been no never events reported in the last 12 months. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed. 

The service provided mandatory training in key skills to all staff. Staff received and kept up to date with their mandatory training. The data showed a completion rate of 94% compliance which was higher than the provider’s target of 90%. Managers monitored mandatory training and alerted staff when they needed to complete updates.

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.

There were systems and processes to ensure the correct patients were treated throughout the patient journey and they only received the procedure which was intended for them. We walked the patient pathway and tracked patient care from their arrival to the completion of their appointment. 

There was an admission criterion for both private and NHS patients. These criteria set out where there were limitations in the service and therefore risks were minimised by excluding some patients. Contrast scans were offered to patients above the age of 18. A contrast scan is a medical imaging test that uses a special substance called a contrast agent to make specific organs, blood vessels, or tissues stand out more clearly. Children over the age of 14 were seen by the service for non-contrast scans only however staff told us they rarely scanned children at the service.

For patients who self-referred, there was an up-to-date management of self-referrals policy which detailed inclusion and exclusion criteria including that patients must be 18 years old or above and that details of the patient’s GP must be provided. 

Referrals were checked by staff against the criteria at several points in the patient journey from the initial clinical triage managed centrally by the provider, and again by the radiographers at the service location followed by another check when the patient arrived for their appointment at the service. 

Patients we spoke with understood the timeframe in which they would receive their scan report and results. The service tracked whether routine investigation reports were sent to referrers within 5 working days for NHS and 3 working days for privately funded patients. The service achieved a 97% compliance rate across both reporting streams. 

All patients were required to complete MRI safety questionnaires. The safety questionnaires included asking patients if they had a cardiac pacemaker, defibrillators or other devices in their chest, if they were pregnant or if they had other metal objects on their person. We saw these were completed. Family members were asked to complete a visitor’s safety questionnaire prior to the scan if they were accompanying a patient. The service had an up to date pregnancy policy. Gowns were available for patients to change into. All referrals included patient identification, contact details, clinical history and examination requested, and details of the referring clinician/practitioner.

For scans requiring contrast (dye), patients completed a questionnaire to identify if they had any renal problems which may prevent them receiving contrast. Any known patient allergies were noted on a patient’s record.

Patient referrals were checked at the point of referral for any potential safety alerts that required further investigation. For example, whether the patient had any implants or medical devices such as pacemakers.

The service had access to a MR medical physics expert. Staff could access them if they had any concerns about equipment or patient eligibility for a scan. 

There was signage outside of the scanning rooms which identified safety risks and indicated when scanning was in progress. We observed posters in waiting areas and in changing cubicles which provided patients with information about pregnancy and diagnostic imaging. 

Staff knew how to respond to any sudden deterioration in a patient’s health. There was a deteriorating patient assessment form which staff would fill out in the event of a patient deterioration. 

All radiographers undertook adult immediate life support training and paediatric basic life support training and were able to describe the process for managing deteriorating patients. 

There were procedures in place for the removal of a patient who became unwell in a scanner and staff were able to describe incidents where patients were removed from scanners in an emergency. The service also undertook six monthly simulation training exercises to ensure that staff knew what to do if a patient needed to be moved out of a scanner in an emergency. 

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer. 

Staff were able to explain the process to escalate unexpected or significant findings at examination and upon reporting. In the case of NHS patients, an urgent report request was sent to the external reporting provider.  For private patients, the reporting radiologist was contacted by a member of staff to advise them of the urgent report to ensure it received prompt attention. The reporting radiologist would then inform the patient’s GP. 

There was a flowchart which staff followed for urgent conditions or where an urgent referral was required. In these situations, an emergency referral form was completed, and the images would be sent to the local accident and emergency department. The patient would then be sent via transport arranged by the service to the local AE for treatment. 

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. 

We reviewed the service’s safeguarding policy which was in date and available on the provider’s intranet. The policy detailed individual responsibilities and processes for reporting and escalation of concerns. 

We also saw relevant telephone numbers and contact details of the safeguarding lead on the walls in consultation rooms and in scanner control rooms. 

All staff were trained to level one and two in both adult and child safeguarding. Compliance rates for staff was 100%. The superintendent radiographer was trained to level 3 safeguarding and would oversee the scanning of children over the age of 14 who were scanned at the service. Managers could also access the safeguarding lead for additional support. InHealth hosted monthly safeguarding supervision sessions where safeguarding leads delivered presentations on topics such as modern slavery. Staff could also ask questions and discuss any safeguarding incidents with the safeguarding team at these events.

All staff we spoke with demonstrated a good understanding of safeguarding vulnerable adults and children. Staff were able to identify the potential signs of abuse, the process for raising concerns and what would prompt them to make a referral. Staff knew how to escalate concerns to the operations manager who was trained to level 3 safeguarding and safeguarding lead for InHealth who was level 4 safeguarding trained. There had been no safeguarding referrals made by the service in the 12 months prior to our inspection. 

Chaperones were not required for standard routine MRI scans however clinical assistants told us they were sometimes required to be chaperones for InHealth staff who used the consultation rooms for ultrasounds and echocardiograms. These services were registered under a different InHealth location and did not form part of our inspection. However the service told us that the provider was in the process of developing a policy which outlined the requirements and responsibilities for staff using the premises in order to establish a consistent approach to managing room utilisation across the provider’s community diagnostic centre sites.  

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

The service worked with patients to understand and manage risks.  The treatment and care met patients' needs in a way which was safe and supportive. During scans, staff spoke to patients from the control room to reassure them and to let them know how long they had left in the scanner. Appointment slots ranged from 30 minutes to an hour depending on the type of scan. Staff told us patients could let the central booking team know if they could have some extra time at the appointment if they were nervous or phobic so time could be spent ensuring the patient was comfortable before starting the procedure. 

Patients we spoke to told us they felt listened to, risks had been explained, and they were involved in decisions about their care and treatment. They told us they were able to make an appointment easily and, on a day and time that best suited their needs.

All referrals were triaged by radiographers who reviewed and confirmed patient suitability for scans. The central booking team ensured that patients with additional needs were flagged. For example, if a patient had reduced mobility, the service would be notified so that a member of staff could go down to the building’s reception to collect and support the patient up to the service’s reception on the first floor of the building. If a patient used a wheelchair, they were booked into another InHealth location as the entrance into the building had steps which made it inaccessible for wheelchair users. 

The service generally detected and controlled potential risks in the care environment. However, there were chairs placed opposite the scanner rooms, which could potentially restrict the space required for swift movement during an emergency. Some staff were also unsure about the meanings around MR conditional stickers on equipment such as fire extinguishers and whether they were safe to use in scan rooms. 

The design, maintenance and use of facilities, premises and equipment generally kept people safe. However, there were some chairs placed in the area opposite the entrance to the MRI scanners where patients waited for their turn to be scanned. This meant that the space in front of the scanner rooms was not clear and there would potentially not be enough physical space for the resuscitation team to manage a patient who had to be extracted from the scan room in the event of a medical emergency. Placing chairs directly outside the MRI scanner doors also compromises patient privacy and dignity, as waiting individuals can see patients exiting the scan rooms. 

The service had suitable systems for managing fire safety, including fire risk assessments and routine testing of fire safety systems. However, while staff were aware of fire procedures and this was part of their mandatory training, some staff were unsure about what the MR conditional stickers on the fire extinguishers meant and whether they were safe to use in the scan rooms in the event of a fire. MR conditional fire extinguishers are specially built with non-magnetic components so they do not get pulled into a powerful MRI machine with dangerous force and therefore can be used in a clinical setting scan room. This meant that in the event of a fire, some staff may not know which equipment they can safely use. 

There was clear signage warning people of the MR controlled access area including a tensile barrier which was drawn across the door when the scanner was in use to further prevent unauthorised access. Staff had enough space to move around the scanner and for scans to be carried out safely. During scanning all patients had access to an emergency call alarm and ear plugs. Patients could also speak to the radiographer through a microphone.

The service had suitable waiting areas and enough toilets including a disabled toilet for service users and staff. 

There were 3 changing cubicles, including an accessible changing cubicle for those with mobility needs, which had lockers so that patients could secure their belongings while they were having their scan.

We observed staff and patients walking into the secure patient area when permitted to do so. MR local safety rules were in place and reflected best practise. We saw that staff carried out daily quality assurance checks on the MRI scanners. 

During our inspection we checked the service dates for equipment. All the equipment we checked were within the service date. All non-medical electrical equipment was electrical safety tested. 

We viewed servicing records for the MRI scanners which were up to date. We also viewed fault logs which were in every room and also engineer handover forms which were detailed and comprehensive. Staff told us they had a good relationship with manufacturers and they came quickly when a fault was reported.

We checked the emergency trolley and found that it was secured with a plastic snap lock, so it was clear if someone had accessed the resuscitation equipment. Equipment was checked monthly with expiry dates documented on the record check sheets which were signed to confirm checks had been made. We checked various consumables and found that they were sealed and in date. We saw that spill kits were also available. 

Waste management was handled appropriately, with different colour coding for general waste, and clinical waste. All clinical bins were seen to be operated with lids and were not overfilled. Waste management and removal including those for contaminated and hazardous waste was in line with national standards.

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 patient’s individual needs.

The service had enough clinical staff 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. 

Staff included 1 whole time equivalent (WTE) superintendent radiographer, 10 radiographers, 10 clinical assistants. They were supported by an operations manager and operations support manager. There were 3 bank clinical assistants who were used based on the demands of the service. The service did not use agency staff. 

The service had 4 radiographers and 4 clinical assistants on shift every day. The operations manager was on call 7 days a week out of hours and on site 5 days a week. They could adjust staffing levels depending on the needs of patients. 

All radiographers held up to date registrations with the Health and Care Professions Council (HCPC).

New staff had a full local induction tailored to their role before they started work. Clinical staff followed an MRI performance and competence framework which covered clinical competency skills and equipment. Managers supported staff to develop through constructive recorded, annual appraisals and clinical supervision of their work.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge.

Managers made sure staff attended team meetings or had access to the information shared when they could not attend. They monitored mandatory training rates to ensure staff were up to date. 

The service generally assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies.  Staff used equipment and control measures to protect patients themselves and others from infection. They kept equipment and the premises visibly clean. 

We observed all areas of the service to be visibly clean and well maintained. Hand sanitisers were available in all areas including at the point of entry to consultation rooms and reception areas. Throughout our inspection, all staff were observed to be ‘bare below the elbow’ and adhered to infection control procedures, such as hand washing and using hand sanitisers. Staff had access to personal protective equipment (PPE).

Hand hygiene audits were performed monthly and showed consistently good compliance. 

We viewed the provider’s infection, prevention and control (IPC) policy which was in date and accessible on the provider’s intranet.

Infection control was included in mandatory training for staff and training compliance rate was 100%.

Staff followed manufacturers’ instructions for routine disinfection. This included the cleaning of medical devices between each patient and at the end of each day. 

Patients we spoke with were satisfied about the level of cleanliness of the service. 

Domestic staff were employed by an external contractor and cleaned the general areas. We viewed cleaning records which were up to date and demonstrated that all areas were cleaned regularly. 

Clinical staff were able to describe the correct process for cleaning the MRI bore in line with MRI safety best practice. 

The service performed well in local infection, prevention and control (IPC) audits. In the most recent audits, the scores showed compliance with infection prevention and control measures in all clinical areas.  

We looked at the service’s last legionella risk assessment document which had been carried out by an external provider in March 2025. There were a number of actions required in the report but it was not clear whether they had been completed. This was not on the risk register at the time of our inspection. The registered manager who was new in post sent through completed water flushing audit records and a recent defects report which confirmed that some of the issues had been resolved. For further assurance and to establish a current baseline, the service had commissioned the external contractor to undertake a new legionella risk assessment and had also implemented a digital logbook to improve record retention, oversight and continuity during management changes. We were told any risks arising from the new risk assessment would be added to the risk register.

The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences.

The service used systems and processes to safely prescribe, administer, record and store medicines. 

All patient allergies were documented and checked on arrival at the service. When contrast was used, batch numbers were recorded in the patient record. 

The service used contrast media (dye) which are chemical substances used in some MRI scans. Medicines including contrast media were stored in a locked cupboard and access was restricted to authorised staff only. There were no controlled drugs in the department. We checked a sample of medicines and found they were in date. Storage rooms were appropriately stocked and tidy. We checked consumable equipment cupboards and found that all items we sampled were in date and packaging was intact, indicating it was sterile and safe for use in patient care.

There was a patient group direction (PGD) folder with a sign off sheet for radiographers who administer PGDs which was up to date. A Patient Group Direction (PGD) is a written instruction for the administration of medicines to individually named patients where each patient on the list has been individually assessed by that prescriber. 

Medical oxygen cylinders were store securely and administered under PGDs.

Staff learned from safety alerts and incidents to improve practice. This was discussed at team meetings.