Oaklands Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

Services were planned and delivered to meet people's needs, took account of their individual circumstances and requirements, and made it easy for people to give feedback about their experiences. People could access the service when they needed it.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People who used the service told us their needs were considered prior to being seen and scan procedures were undertaken in accordance with their expectations and preferences. Staff told us they discussed people's individual clinical and personal needs with them prior to commencing scans. We saw staff reviewing patient’s records and histories prior to seeing them to ensure they were fully informed.

Staff told us that they were confident to work with patients with learning disabilities, dementia or who were neurodiverse. Staff in the service were fully compliant with dementia awareness e-learning training. However, not all staff in imaging had fully completed both tiers of training in learning disability and autism in line with the Oliver McGowan code of practice. Leaders told us that senior staff had undertaken the face-to-face component of the training first with a plan to roll this out to all staff in future.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service planned and provided care in ways which met the needs of local people and the communities it served. For example, the service had made changes to their long-term plans to ensure they continued to offer bone dual energy X-ray absorptiometry (DEXA) scans in response to discussions with the local integrated care board (ICB) who had identified this as a particular need in the community.

The service had systems to monitor various operational metrics such as waiting times for different types of referrals and compliance with national targets such as the 6-week wait for diagnostic testing target (DM01). The service also monitored the time taken for each consultant to review and report on scans, and consultants confirmed that other staff would prompt them if reports were close to exceeding the required timeframes. Once reports had been approved and finalised, they were sent to the referrer within 24 hours. Certain metrics were communicated to partners such as private providers and the ICB to ensure performance met the agreed requirements.

For routine scans such as conventional (plain film) X-rays and ultrasounds, procedures were in place to allow patients attending for outpatient consultations to be referred for and receive scans the same day. Similarly, inpatients could also have X-rays taken when required either on a mobile scanner in their own room or could be taken to the department at a time convenient for them and their care needs.

Patients told us that the timeliness and integration of care was a highlight of the service. In cases where they had attended appointments previously, patients found the service easy to contact and more flexible when compared to other providers. The service had procedures to ensure that patients who did not attend appointments were contacted to make alternative arrangements and took reasonable mitigations for non-attendance into consideration.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. The service had processes in place to ensure that patients received information that met their communication needs and was compliant with the AIS standards.

Information leaflets were widely available across the service for patients to read and take away, including details of each procedure and information on how to raise a complaint. The content of the leaflets was clear to the reader and advised patients how to get in touch with the service should they have further queries or concerns. Leaflets could also be provided in alternative languages or easy read formats if required. However, we noted that many of the leaflets had exceeded their review date. Leaders told us that they were aware of this issue, which was due to using up printed stock prior to having changed providers.

Patients were also emailed information before their appointment, which included risks and benefits of the procedure and any contraindications that would prevent the scan from taking place. We saw staff ensure that patients were fully informed about and understood the procedure or scan as part of the consenting process, and phones were available in each clinic room to facilitate telephone interpreters where required, and in-person interpreters were arranged for more involved procedures such as when medicines were provided.

The provider had a ‘Facility Rules’ document which committed all staff to follow information governance requirements in line with the UK General Data Protection Regulation (GDPR). The service made notifications to external bodies as needed, and internal documentation was readily available to guide staff on what occurrences required notification. There had been no Information Commissioner's Office (ICO) reportable data breaches relating to the service in the 12 months prior to our assessment.

The service had a complaints policy that set out the required procedures, including offering patients a face-to-face meeting to discuss their concerns if they wished. The policy stated that complaints should be acknowledged within 3 days and a full response provided within 20 working days, or within 20 days of a face-to-face meeting. The complaints policy included the process to follow for unresolved complaints and signposted to external organisations such as the Independent Sector Complaints Adjudication Service (ISCAS) for private fee-paying patients and the Parliamentary and Health Service Ombudsman (PHSO) for NHS patients.

Information for patients about how to raise complaints was displayed in various areas, and leaflets that provided detailed guidance on the complaints escalation process for both NHS and fee-paying patients, as well as expected timeframes, were clearly available throughout the service. Patients told us that they knew how to complain or would be comfortable to find out about this if needed. Radiology had not had any complaints in the last 12 months.

The service engaged patients for feedback using friends and family test cards which were readily available and provided routinely at the conclusion of the visit. These cards did not include means to survey radiology patients specifically and instead queried patients if they had attended for outpatient, day patient or inpatient appointments. However, radiology-specific information was included in patient-reported experience measures (PREMs) that was collected and collated electronically, and the patient uptake of this was strong and demonstrated good scores that could be analysed for trends and themes.

Patient feedback was considered routinely in clinical governance committee meetings which were attended by all heads of service, including the radiology manager. These meetings included analysis of both broader changes in patients’ overall experiences as well as deep-dives into specific complaints.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

People who used the service could be referred through a number of routes, such as from GPs, other private providers and insurers, or from within other teams in the hospital, sometimes on the same day. In approximately the last 12 months, the radiology service had conducted over 25,000 examinations, the largest area of activity of which were ultrasound procedures.

Hospital and service managers closely monitored waiting times and were motivated to ensure that people could access imaging services as promptly as possible. Waiting times for each scan type were displayed in staff areas for ease of understanding. At the time of assessment, waiting times for all scan types were 5 to 6 weeks and image reporting times varied between 2 to 5 weeks. We noted that there had been delays in previous months which had been related to unexpected funding and commissioning changes beyond the service’s control, and subsequent improvement plans had been implemented and had worked to improve waiting times close to previous levels.

We spoke with both NHS and fee-paying patients who both felt that the service was quick to contact them and agree an appointment date that was convenient for them, and that expected timelines were clearly communicated. Some patients advised us that they had been contacted for an appointment within hours of their referral to the service having been made.

The service had procedures in place to manage and rearrange cancelled appointments, and how to respond to patients who did not attend (DNA). Individual circumstances would be considered although the service would discharge the patient back to the referrer in the case of multiple DNA instances. The DNA rate could be calculated for each scan type, which was very low for MRI scans at 2.6%, but higher for CT scans at 10% (although significantly fewer patients were seen for CT overall). In the last 6 months, 7 days of clinic lists were lost due to faults with the scanning equipment, although patients in these cases were rebooked as soon as possible.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views, and demonstrated that they understood the diverse community they served. As such, staff had completed and were compliant with mandatory e-learning in equality, diversity and inclusion. Provider policies and procedures also included effective equality impact assessments.

While friends and family test surveys did not query this, other experience surveys in routine use queried the patient’s gender and ethnic/cultural group to help identify any evidence of discrimination. We saw evidence of one patient who described their disability and had completed the form to highlight their positive experience, however other protected characteristics under the Equality Act 2010 such as disability status, sexual orientation or gender reassignment were not routinely queried and so the service could not be assured it was not discriminating in these areas.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The nature of the diagnostic scan procedures provided by the service meant most people attended the service once, unless multiple scans were specified as part of their initial assessment. As such, there was no requirement for the service to provide routine after care support or follow up appointments. However, people were provided with information on how to contact the service if they had any queries about the scan procedure or for any queries around reporting of scan results. The referring clinician or organisation was responsible for any ongoing care and treatment needs.

Patients we spoke with told us that staff discussed their scan procedure and expectations for scan results during their appointment.