InHealth Waterloo

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of patient who used services and wider communities.  We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant the service was well managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The provider had an overarching vision and strategy which staff were aware of. Managers within the service promoted a positive culture that supported and valued staff which created a sense of common purpose based on shared values.

Staff were aware of the provider’s vision and mission to provide high-quality services within local communities to over 7 million patients by 2030, however not all staff were able to recall the provider’s values of ‘trust, passion, care and creativity.’ 

The provider’s purpose, vision and mission were publicly available, including on its website. While staff knew the overall vision of the provider, they were unaware of local plans to achieve it. The registered manager was newly in post and had plans to support the provider's overarching vision by analysing did not attend (DNA) data and ensuring effective scanner utilisation. 

Managers within the service promoted a positive culture that supported and valued staff which created a sense of common purpose based on shared values. Staff described a supportive, collaborative team and a patient-focused environment with 96% of staff responding in the provider staff survey agreeing that patient focus was a priority for the organisation. 

Staff were passionate about their work and there was an open and honest culture within the team. They told us any issues they escalated were resolved quickly and constructively and that there was a culture of collective responsibility with patient safety as a priority. 

Team and individual staff achievements were recognised and celebrated. Staff were thanked for their work at team meetings and one to ones. The service had an employee of the month scheme, an excellence in everything award and managers told us they ensured that positive feedback was shared with team members on an ad-hoc basis as well as at team meetings and daily huddles.  

The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively.

The service was led by the operations manager who was also the registered manager. The operations manager was supported by the operations support manager who line managed the clinical assistants and a superintendent radiographer who line managed the radiographers.

All staff without exception, spoke of good teamwork within the service and told us that they were supported to explore development opportunities. Staff told us their managers supported them to develop their skills and take on more senior roles.  Staff also described management as being flexible to their individual needs so that they manage family commitments. 

Staff told us that managers kept them informed of any changes at provider level and daily huddles allowed them to touch base with the team to understand the requirements for the day. They told us that managers were visible and approachable to staff as well as patients.

There was inclusive and effective leadership at all levels. Senior leaders we spoke with demonstrated high levels of experience, capacity and capability needed to deliver sustainable care. The operations manager was new in post but had a strong understanding of issues, challenges and priorities in their service and had plans to make further improvements in areas for example, reducing missed appointments and strengthening staff recognition. 

The service fostered a positive culture where patients felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged raise concerns and the culture of the service allowed staff to be confident their voices were heard. 

Staff told us they felt listened to by their managers and were confident about raising concerns and that they would be acted upon. 

The provider had a Freedom to Speak Up (FTSU) policy and we saw posters in staff areas which informed staff on how they could contact and raise concerns with a FTSU Guardian.  

Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported, without fear of detriment. When concerns were raised, managers investigated sensitively and confidentially.

Patients, their families and carers were provided with information to explain how they could raise a concern and how this would be investigated. Staff were encouraged to respond to immediate concerns or complaints with a view to resolution. 

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work. Staff told us they had opportunities to apply to go on training courses, apprenticeship and mentorship programmes. 

The provider had an equality, diversity and inclusion policy and staff received training in equality and diversity. The provider demonstrated its commitment to workforce equality, diversity, and inclusion (EDI) through transparent reporting of its Workforce Race Equality Standard (WRES) data and Gender Pay Gap reports and continuous cultural engagement. They actively promoted an inclusive culture by hosting storytelling and cultural appreciation sessions, celebrating cultural diversity in weekly company-wide newsletters.

Staff survey results showed that 5% of staff reported that they had experienced inequality in the workplace that made them contemplate leaving the organisation. However, 79% of staff felt equality, diversity and inclusion were valued at InHealth. The operations manager had acknowledged that scores could be improved upon and had put in place actions around wellbeing and raising concerns such as signposting to support available for wellbeing, encouraging mental health first aider training and signposting to different ways to raise concerns as well additional relevant training available.

Staff we spoke with felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style. 

Managers spoke of how they would ensure they offered staff reasonable adjustments to support them to carry out their roles well. 

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on information about risk, performance and outcomes, and shared this with others when appropriate.

Leaders operated effective governance processes, throughout the service. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. 

Staff we spoke with had a good awareness of governance arrangements and knew how to escalate their concerns. All staff were clear about their roles and understood what they were accountable for and to whom. 

Local governance processes were achieved through quarterly team meetings and daily huddles. Mandatory training performance, incidents and lessons learned, complaints and feedback, risk register, audits and action plans were discussed at team meetings. The operations manager also attended quarterly governance meetings with the wider InHealth team so that managers from across sites could discuss and share learning from incidents, complaints and audits. 

Information on safety alerts, never events, incidents, cancellations, medicine management, patient safety alerts, medical device alerts, lessons learned, Medicines and Healthcare products Regulatory Agency (MHRA) alerts and latest NICE guidance, was disseminated at team meetings.  

All staff were able to access policies and procedures and all staff had access to the provider’s intranet. 

Managers used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. The service had plans to cope with unexpected events and had a business continuity plan, which included major incident plans. Plans covered disruptions such as power outages and equipment failure. 

The issues and risks which managers identified were in line with what we found on inspection and there was alignment between these, and the risks outlined on the local risk register. Risks for the service included uneven flooring due to a previous leak creating a trip hazard, the table of one of the scanners not being able to be lowered which increased the risk of falls. Risks had actions in place and dates of reviews to monitor progress. 

During the inspection, managers told us staffing levels outside of core hours differed from core hours. This meant that there would be 2 radiographers and 2 clinical assistants on site between 6.30am and 8.30am and between 7pm and 9pm rather than the usual 4 radiographers and 4 clinical assistants. A manager was always available on-call during the extended hours and patients who required additional support such as those requiring mobility support or requiring interpretation services could not be booked into these slots. A risk assessment was in place to ensure that staff could maintain patient and staff safety during these hours. We saw this risk assessment during our inspection which listed the risks and mitigation in place. 

There was a formal audit plan in place in the imaging department which outlined the frequency of the audits and dates of the audits. Audit results were fed back at the quarterly governance meetings but also discussed at service level between managers during the weekly meetings. Anything that was highlighted from the audits would then be discussed at team meetings, one to ones or daily huddles for items requiring immediate action. 

Audit processes and the outcomes were used to ensure quality of services was maximised. Where improvements were required, managers ensured action plans and the monitoring of these led to positive changes. 

The service had not reported any data breaches and systems were secure. We saw that computers were logged out of when not in use and patient identifiable information was handled correctly.

We reviewed several provider policies and found these were up to date and readily available to staff. The accuracy and validity of each policy was maintained at provider level but managers locally could feed back around policies. 

The service had a business continuity plan which would be put into operation in the event of an unexpected disruption to the service, this included a short-term disruption plan. We found there were risk assessments for the down time of the scanners.

Assurance around the quality of scans was ensured by the provider’s clinical governance team who worked with radiology reporting organisations and conducted quality and peer reviews. Any issues and learnings were then disseminated to all of the community diagnostic centres so learning could be shared. 

Staff told us they felt informed about safety incidents which were shared at team meetings and daily huddles. They told us they appreciated learning that was shared with them from other InHealth sites so that they could embed learning at their site and be mindful of potential risks and issues that had been identified.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for patients. Staff shared information and learning with partners and collaborated for improvement.

Learning was shared among the InHealth sites at quarterly governance meetings. At these meetings, operations managers from different InHealth sites would present information from incidents and learning. The operations manager would then disseminate the learning from this meeting to the rest of the team by email.

Managers also held monthly meetings with the InHealth team who used the consultation rooms for ultrasounds and echocardiograms to discuss any issues or updates. 

Staff were engaged in the planning and delivery of the service. Staff told us that they felt able to report to their managers when new equipment was needed and this was acted upon swiftly by the provider.

Staff openly engaged with patients and encouraged them to share their views on the quality of the service through feedback forms on electronic tablets. Patients told us that they were always kept informed about their scan and next steps following their scan.  

Staff and leaders at the service collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service.  Provision for both NHS and privately funded patients was integrated into the overarching service delivery.

Due to the type of services provided, the provider did not engage with local communities or organisations to plan and manage services.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for patients.

Staff were committed to continuous learning. Staff told us they were supported by their managers to develop their leadership skills and access development opportunities. 

The service sought new ways to improve services for patients and learning from incidents, audits, and feedback was shared with the other community diagnostics centres. The operations manager was keen to begin quality improvement projects to maximise scanning efficiencies such as monitoring did not attend rates and finding better ways to gain feedback from service users to further improve the service. 

In order to improve environmental sustainability, staff told us that the service no longer used disposable cups for their water/coffee machines and had a collection of mugs that staff and patients could use. Staff had also been given reusable water bottles to bring to work to cut down on single use plastic bottles.