InHealth Community Diagnostic Centre - Hornchurch

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. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people 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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff considered incidents as opportunities to improve and learn, and those we spoke with understood the reporting process and how incidents were managed. Managers fed back actions and learning from incident reports to staff in an appropriate and timely way, and staff provided examples of learning in response to previous incidents. Staff generally understood the duty of candour, although it had not needed to be applied. There had been no incidents reported by the service that met the threshold for implementing the formal duty of candour during the 12 months prior to our inspection visit.

The service used electronic incident reporting software, enabling managers to review incidents, record investigations and document outcomes. The service recorded 48 incident submissions in the 12 months before our inspection. This indicated that staff were using the incident reporting system regularly to record safety events and concerns, supporting an open and consistent approach to reporting. Clinical incidents were investigated by the superintendent radiographer, who identified actions. Non-clinical incidents were reviewed by the operations manager, with support from the operations support manager. The operations manager was responsible for sharing incident learning with the team and wider organisation. There had been no reported never events in the preceding year. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed. Incident themes included poor image quality, missed or delayed escalation of urgent findings and cancellations due to equipment failure.

The provider had a comprehensive Patient Safety Incident Response Framework (PSIRF) policy that ensured patient safety incidents were managed consistently. We saw the service investigated incidents in line with this process, including an incident related to an unexpected implant.

We saw that learning from incidents was shared with the team in regular team meetings and by email. Learning was also shared with other InHealth community diagnostic centres, which helped to promote consistent practice, reduce the risk of similar incidents happening elsewhere and support improvements in practice and patient experience. The incident investigations we reviewed showed that incidents were examined, learning was identified and appropriate actions were taken.

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

Most patients seen by the service were privately funded patients. The provider had a policy and systems in place for managing referrals from non-medical referrers. For patients who self-referred there was a policy which included inclusion and exclusion criteria and required patients self-referring to provide their GP details to ensure escalation of significant findings. However, the policy for the management of self-referrals was overdue for review at the time of our inspection.

Referrals were vetted by staff against clear admission criteria before being accepted. The provider had a clinical triage standard operating procedure. However, staff gave mixed feedback about whether requests were triaged by clinical staff within the service or centrally within the company. It was therefore unclear whether triage arrangements were clearly understood and applied consistently, which could increase the risk of people being accepted for scans without the right level of clinical review. Following the inspection the provider advised that referrals were primarily triaged by a dedicated central team of radiographers; however, the service’s radiographers were also trained to undertake triage against the same organisational standards when required.

Some patients told us that the clinicians who referred them had not received their scan report and they needed to forward this on themselves. This could delay clinicians reviewing results, planning follow-up care and making timely decisions about ongoing treatment. The provider tracked whether routine investigation reports were sent to referrers within 5 working days. In the 12 months before our inspection, the service achieved the provider’s 95% target most months.

Radiographers were able to describe the correct process for managing deteriorating patients. We saw evidence that cardiac arrest scenario training had taken place, but the record of this lacked sufficient detail to indicate whether the correct process had been followed. All the radiographers had completed immediate life support training. Staff told us they carried out routine observations during the scan procedure and people whose health deteriorated would be promptly transferred to hospital by ambulance if they required emergency treatment. Incident data we reviewed showed there had been one instance where a person required emergency transfer to hospital during the 12 months prior to our inspection visit.

During our inspection the service’s operations policy was overdue for review and contained outdated information. The magnetic resonance (MR) local rules for the service had also not been updated since they were due to be reviewed in October 2023. Staff were also not aware of how to contact the MR expert. This meant there was limited assurance that staff had access to up-to-date specialist guidance, which could affect how consistently MR safety risks were identified and managed. Following the inspection the provider stated that staff were advised to raise any MRI specific queries via the internal ticketing system. These were automatically sent to the MRI clinical lead and the MR medical physics expert for advice.

People who used the service told us they were kept informed about their care and treatment at all stages, from their initial booking through to their scan procedure and reporting of their scan results.

The service worked with people and partners to help keep people safe from abuse, avoidable harm and neglect, and shared safeguarding concerns quickly and appropriately.

The safeguarding policy provided guidance for staff on how to identify and report any safeguarding concerns, including making referrals internally and to external agencies, such as local authority safeguarding teams.

Staff told us they had completed safeguarding training and knew how to identify and report safeguarding concerns. Although the service did not see patients under 16 years old, staff also completed level 1 and 2 children’s safeguarding training. Safeguarding mandatory training compliance for the service was 100%. Staff said people were advised before their appointment that children under 16 should not accompany them.

Staff completed training specific for their role on how to recognise and report abuse, in line with current guidance for adults and children. Records showed all administrative and radiographer staff had completed at least level 2 adult and children’s safeguarding training. 

The organisation had a safeguarding lead and deputy safeguarding leads in place. They had completed level 4 safeguarding training, in line with national guidance. Staff knew how to find their contact details and understood how to seek advice and support on safeguarding issues when needed.

There had been no safeguarding incidents reported by the service during the 12 months prior to our inspection.

The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were processes in place to escalate unexpected or significant findings identified during the MRI scans. However, the service incident log highlighted the need for stronger safety-netting. As several incidents involved missed or delayed escalation of findings, unclear advice given to patients on when to attend A&E and gaps in documentation. This could delay patients receiving the appropriate clinical advice, treatment or follow-up and increase the risk of deterioration not being identified or acted on promptly.

Staff carried out regular observations and had systems to ensure they could communicate with the patient during their scan procedure. Staff recognised that anxiety and claustrophobia were common among patients attending for scans and explained that they did their best to reassure patients. However, staff told us there were no opportunities to extend appointment times or for patients who were nervous to visit the service beforehand to see the scanner and meet staff, which could help reduce the risk of an incomplete scan. Following the inspection the provider advised that appointment bookings were managed centrally, and reasonable adjustments could be made where a need was identified.

Information was requested at the point of referral to help ensure patients could be seen safely, and systems flagged when patients might need additional support, such as wheelchair access. Patients received clear information about their scan and what to expect before attending. Safety screening questionnaires were completed, signed and uploaded to patient records. However, the concerns identified in escalation processes and documentation showed that these systems were not always used effectively to maintain safe continuity of care.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service had some suitable arrangements to maintain the safety of the premises, facilities and equipment, and the MRI suite generally supported the delivery of safe care. However, we found shortfalls in how environmental and equipment-related risks were managed.

Access to the premises was not always secure and estate issues were not always resolved promptly. During our inspection, the fob access system to the MRI waiting area had been broken for two months, creating a risk that unscreened visitors or personnel could enter the MRI controlled area. The risk was recorded on the service risk register, and following the inspection managers continued to follow this up with the relevant contractor. The service controlled the risk by ensuring staff escorted patients through the MRI sub-waiting area and by displaying a no-entry sign on the door leading to this area.

During our inspection, we found an ultrasound machine from another community diagnostic centre was stored in a consulting room. The device was not password protected and contained patient data and images. This meant there was a risk that confidential patient information could be accessed inappropriately. The service took prompt action to address this and deleted the patient information from the scanner.

During the inspection, the MRI scanner was not operational because of a fault. Data showed that in the month before our inspection, the scanner was unavailable for 9 days, resulting in a total of 86 hours of downtime. This negatively affected people’s access to appointments and led to patient cancellations. However, patients were contacted and prioritised for rebooking and had access to appointments at other sites to minimise disruption.

All the areas we inspected were well maintained, free from clutter and suitable for providing safe care and treatment. There was sufficient space for storage of equipment and consumables. Most areas were accessible for people with mobility needs. However, the absence of automatic doors meant some people may need assistance to enter or move between parts of the service, which reduced the independence and ease of access for people using mobility aids or wheelchairs.

The service had suitable waiting areas and enough toilets for staff and service users, including disabled toilets. The MRI suite had two separate changing areas for people using the service, including a disabled patient changing room fitted with an emergency pull cord.

The service had suitable systems for managing fire safety, including fire risk assessments and routine testing of fire safety systems and equipment. The service had portable appliance testing and maintained an equipment maintenance record. However, the MRI scanner contrast pump was not being serviced. Although this equipment was not in use, it remained connected to the MRI scanner and was available in the clinical environment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff to keep people safe. The service had 2 radiographers and a superintendent radiographer. The radiographers were supported by 2 clinical assistants. The operations manager or operations support manager were on site once a week. The sickness rate over the previous 9 months was reasonably low, at 3%. There was a pool of relief radiographers, who provided support including during periods of sickness or leave. The service did not routinely use agency staff.  All radiographers held up to date registrations with the Health and Care Professions Council (HCPC).

Local induction ensured staff were competent to perform their required role. For clinical staff this was supported by a MRI competence and performance framework which covered key areas applicable across all roles including equipment, and clinical competency skills relevant to their job role and experience.

Both substantive and relief staff were required to complete mandatory training and maintain compliance with the provider’s standards. Mandatory training records we reviewed showed staff were up to date with their training.

Staff told us they received annual appraisals. All eligible staff had completed their appraisals.

The service supported staff to develop specialist skills that improved care delivery. For example, supporting staff to train as radiographers and a clinical assistant was being supported to complete cannulation training.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas we inspected were clean and well maintained. Hand washing facilities and hand sanitising gels were available throughout the service, and reminders on best practice were displayed in bathroom areas. Audits of hand hygiene were performed regularly and demonstrated good performance, with full compliance in the metrics assessed.

Staff followed good practice and complied with ‘bare below the elbow’ guidance. They had access to personal protective equipment (PPE) when needed and followed the provider’s infection prevention and control (IPC) policies. IPC training formed part of mandatory training, and staff understood their responsibilities for cleaning the environment and equipment appropriately.

Domestic staff were employed by an external contractor and cleaned general areas only. Clinical staff could not clearly describe the correct process for cleaning the MRI bore in line with MRI safety best practice. Following the inspection, leaders told us staff had been advised of the correct procedure and that a specialist tool had been acquired to support safe cleaning.

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

The service did not prescribe or administer any medicines, including controlled drugs, for routine scan procedures. The service did not undertake any MRI scans that required the use of contrast media (a substance used to enhance scan images).

The service only kept emergency medicines, for use in medical emergencies which were stored appropriately in the control room and were within their expiry dates. These could be administered if needed by trained Immediate Life Support trained radiographers. Monthly checks of the resuscitation trolley we reviewed were up to date.