InHealth Community Diagnostic Centre - Hornchurch

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• 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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 providers vision and strategy and was not consistently understood and embedded across the service. The service did not have a local strategy or plan to demonstrate how it would contribute to the provider’s wider vision, and strategy.

The provider’s purpose, vision and mission were publicly available, including on its website. We saw that these were shared in presentations during team meetings. However, the local service did not have its own strategy or plan showing how it would contribute to the provider’s wider vision. Staff we spoke with were aware of the provider’s overarching ambition and could describe its mission to provide healthcare to 7 million patients by 2030, demonstrating some alignment with the organisation’s strategic direction. However, this understanding was not consistently embedded beyond this high-level aim. Not all staff were able to describe the provider’s values.

Staff were positive about their work. They told us there was a friendly, safety-focused and open culture and that they received good support from managers. They told us there was a positive culture within the service and that staff worked well as a team. There was a culture that prioritised patient safety with 90% of staff who responded in the provider staff survey agreeing that patient safety was a key priority for the organisation.

The service had inclusive leaders at all levels 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 overall lead for the service was the operations manager, who was also the registered manager. At the time of our inspection the registered manager had been in post for 2 months. He was being supported by the community diagnostic centres accreditation and training lead for InHealth, the previous registered manager for the service.

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

Leaders had a good understanding of the services they managed. Staff were positive about the visibility and approachability of leaders, despite the service being the smaller of the two locations they oversaw. Managers told us they aimed to prioritise the wellbeing of the team and valued their staff.

The provider and management team were invested in developing the skills of their staff and supported them to pursue additional qualifications relevant to their role as part of their continuing professional development commitments, which included qualifications up to graduate and postgraduate levels.

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

The provider’s Freedom to Speak Up (FTSU) policy provided guidance around raising concerns anonymously, with particular emphasis on reducing inequalities and eliminating discrimination. Staff could raise concerns internally through their line manager/senior leadership team or to an FTSU Guardian, whose contact details were available and visible throughout the service.

Staff told us they felt confident they could raise any issues with their managers and that managers listened to them. Staff survey results also indicated high staff agreement with questions related to feeling safe to speak up about concerns.

People and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from people, carers and staff and used it to make improvements.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff told us the service had an inclusive working culture, and they were treated with respect and equity. Staff told us managers engaged with them regularly and they felt confident any concerns they raised would be listened to. Staff we spoke with told us they were treated fairly and with respect.

Staff received training in equality, diversity and human rights and the provider had equality, diversity and inclusion policies in place to provide support and guidance. This was incorporated into the service’s recruitment policies and processes. Managers told us equality, diversity and inclusion were all embedded in the culture of the service.

Staff survey results presented a mixed picture. While 80% of staff who responded agreed the provider valued equality, diversity and inclusion, 81% said they had experienced inequality in the workplace in the previous 12 months that had made them consider leaving the organisation. As part of the providers equality, diversity and inclusion annual report they had taken a structured approach to improving equality and inclusion. This included embedding equality, diversity and inclusion objectives across the organisational strategy, strengthening a zero-tolerance approach to discrimination and harassment, prioritising inclusive recruitment practices and accessibility initiatives. Leaders used staff feedback to shape improvement actions through engagement activities.

The provider’s workforce was diverse and representative, and this was generally reflected within the service. Staff were supported with access to development opportunities, with colleagues from minority ethnic backgrounds showing high engagement with training and progression initiatives. However, data we reviewed showed some inequalities remained, including in perceptions of equal career progression opportunities, and lower representation at senior leadership level, although targeted actions had been implemented to address these areas.

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

There was a clear corporate and local governance framework which oversaw service delivery and quality of care. Performance was monitored at a local and corporate level. Progress in delivering services was monitored through key performance indicators.

The service managed risks, issues and performance. The service maintained a risk register that aligned closely with the concerns and priorities we identified during our inspection. Leaders reviewed risks regularly, monitored the identified risks and created actions to mitigate or remove them.

Routine audit and monitoring of key processes took place to monitor performance against safety standards and organisational objectives. These included image quality reviews, hand hygiene audits and patient identification audits. The service had a local audit schedule which appropriately showed areas of improvement and actions for improvement were recorded on the providers system for incident reporting and management processes. We saw evidence of action plans being developed in response to audits.

The provider’s clinical governance team worked with the radiology reporting organisations to conduct peer and quality reviews. This helped provide assurance about the accuracy and quality of scans performed and reported and supported learning and improvement where issues were identified.

Policies and protocols were reviewed regularly by the provider. Quality documentation was version-controlled, and most was reviewed regularly to ensure alignment with regulatory and best-practice updates.

Staff told us they felt informed and involved in quality discussions. They described how learning from reviews of incidents and complaints was communicated through governance and team meetings. For example, following an MRI safety incident the learning was shared with other community diagnostic centres within the provider.

The service had an operations policy, but this was overdue for review and some information was outdated, including the service days of operation. This reduced assurance that staff had access to current guidance and that local arrangements were accurately reflected in governance documents.

There was an appropriate policy for business continuity planning. Plans covered potential disruptions such as equipment failure, power outages and severe weather.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

People who used the service told us care and treatment was generally well co-ordinated, and staff engaged and kept them informed about their scan procedure and the reporting of scan results.

The location maintained close working relationships with various independent health providers who routinely referred people to the service for scans. The service had integrated its provision for both NHS patients and privately funded patients into its overall delivery.

The process of flagging urgent findings was generally shared in an efficient manner to external providers. Staff could describe these processes in detail.

The service did not routinely engage with local communities due to the nature of the services they provided.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff told us there was a culture of learning, innovation and improvement across the service. They told us learning from audits, incidents and people’s feedback was shared to aid learning and improvement between providers community diagnostic centres. We saw evidence of shared learning and improvement during our inspection.

The service held several external accreditations, demonstrating compliance with recognised standards for governance, safety and quality. Accreditation reviews provided an additional mechanism for assurance and improvement.

The service had implemented a novel process using artificial intelligence (AI) tools to enhance the efficiency of MRI scans by monitoring the actual time spent scanning patients and comparing this to scheduled appointment times which would enable the reduction of appointments. Managers also told us that this could facilitate performance reviews and identify where support is needed for staff. However, managers explained this was new technology for the service, and its impact had not yet been fully assessed.

Managers told us the service had completed a sustainability audit in the last year and taken action to improve environmental sustainability, including changing to more sustainable light bulbs and using timed temperature controls.