Oaklands Hospital

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• 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 people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we did not rate this key question due to differences in our assessment methodology. As such, this is the first rated assessment for this service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The service worked in line with national guidance and was delivered by competent and qualified staff that worked well together. Performance and outcomes were closely monitored with clear procedures on how to respond to findings.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at referral information and pre-procedure documentation for patients attending for conventional (plain-film) X-ray, ultrasound, MRI and bone density (dual energy x-ray absorptiometry, DEXA) scans. We also looked at what typical standard checks would be made prior to CT/MRI scans with contrast. Depending on the type of scan and procedure, the service may require details such as estimated glomerular filtration rate (eGFR) and height/weight measurements, as well as allergy and pregnancy status. We observed that staff double-checked pre-filled information with patients prior to any procedure for accuracy.

The records we looked at showed that additional details could be included where necessary in a free-text box or as part of the patient’s clinical history, as well as additional booking information where, for example, a longer appointment time could be requested if this was necessary for the patient.

Patients told us that staff had considered their needs and preferences prior to any procedure and had given them appropriate pre-procedure advice to ensure they could complete it successfully. Patients were encouraged to contact the service in advance of their appointment if they had additional mobility needs or further queries, and we heard from patients who had done so and found the service to be responsive and flexible to their needs.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff we spoke with were experienced, knowledgeable and had the appropriate qualifications to meet the needs of their patients. Teams had easy access to specialist input, such as medical advice from radiologists, whenever this was required.

Policies and procedures for different imaging types were reviewed regularly, effective and comprehensive in scope and referenced current guidance. For example, the service’s DEXA policy referenced the most recent guidance from the Royal Osteoporosis Society and the service’s ultrasound policy referenced the British Medical Ultrasound Society (BMUS) and the Society of Radiographers (SoR). The service made use of Local Safety Standards for Invasive Procedures (LocSSIPs) and World Health Organisation (WHO) safety checklists appropriately for typical procedures such as knee arthrograms, which were signed by all involved staff and uploaded to patient records.

The service also audited their clinical performance to optimise its effectiveness. This included a bimonthly check of a sample of images to ensure they met quality requirements, such as correct positioning and exposure levels, and the most recent audit demonstrated full compliance. The service also analysed any rejected images to highlight any individual performance concerns or learning opportunities. The most recent reject rate for the X-ray equipment in the service was 2%, demonstrating no current significant concerns.

Patients who were undergoing CT scans of their bowels (CT colonography) received nutrition and hydration information before their scan, which included bowel preparation guidance and the benefits and potential consequences of the use of laxative agents to improve the quality of the scan. Patients with dietary needs such as diabetes were advised to contact the service in advance of their appointment so medical advice could be provided.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once. 

Staff we spoke with felt that colleagues within the radiology team and beyond were very supportive and positive to work with and communication was easy. Admin staff served as the main point of contact for enquiries, and they had close relationships with and could access clinical staff or managers to solve problems quickly. We noted that there had been recent increases in operational activity to improve waiting times and service pressures, and staff from across the service had felt they had worked together particularly well to achieve this.

Staff from other areas of the hospital had also recently had the opportunity to participate in ‘Day in the Life’ schemes, to better understand the workload and experiences of colleagues who worked in other areas of the hospital. We spoke to a staff member from the outpatient bookings team whose job responsibilities included tracking the waiting times of scans. The staff member spent a day with the radiology service and observed their routine practice and could describe how useful the experience was and what practical lessons were taken away and implemented in the bookings office.

Throughout the assessment we saw the service working constructively with other areas of the hospital to ensure patients were seen in a timely way and that their needs were considered. The service liaised frequently with both the inpatient and outpatient teams as they could typically facilitate scanning for these patients flexibly whenever needed to streamline the journey, and so would work carefully to find gaps in clinic lists to make this possible.

Reports also provided ongoing care information and advice for the referrer to review and action. For example, reports from dual-energy X-ray absorptiometry (DEXA) scans included further care recommendations aligned with the National Osteoporosis Guidelines Group (NOGG) and advised on the patient’s 10-year probability of a bone fracture.

The service met as a team each morning and held wider minuted meetings regularly, which included service updates and safety actions, training compliance, and gave opportunities for staff to raise queries and concerns.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff demonstrated that they would be able to advise how patients could get further information on healthy lifestyles, typically by talking to their referrer.

Patient literature did contain information about the risks and benefits of radiation to help staff make informed decisions about their care, which put the risks of radiation exposure from scans in context and explained why extra care is taken for patients who may be pregnant.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Audits took place consistently across the department that measured a variety of aspects of routine work. Most audits were completed and reported by designated staff and the results were immediately entered into a digital system for service managers to review. The system enabled managers to view the audit schedule for the coming year and collate findings and actions into one list for better oversight. Audits were completed and findings were acted upon in a timely way.

Audits undertaken by the service covered a broad range of clinical activity and information. For example, the ‘X-ray audit’ examined each step of a patient’s clinical episode in detail to ensure all aspects of care were correct throughout. Further to this, specific areas such as hand hygiene or accurate documentation were reviewed in their own independent audits to make sure no areas were missed.

Audit findings were also typically benchmarked across other comparative hospitals within the provider network, to highlight variances and drive improvement. The service advised that they were not a significant outlier in any routinely reported audit activity.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took practical steps to enable patients to make their own decisions. Where this was required, consent was sought before procedures were carried out and this was documented appropriately. The service understood and followed national guidance on the importance of informed consent and establishing mental capacity in line with the Mental Capacity Act 2005. As such, the provider had an effective consent and mental capacity policy which had been recently reviewed.

Consent processes and documentation were audited regularly in the service, and recent audits for various scan types demonstrated full compliance. We spoke with patients who told us they were fully involved in decision making and had been well-informed by staff. For fee-paying patients, the cost and payment methods had been fully explained in advance, with no unexpected charges.