Island Osteoscan

Island Osteoscan is operated by the registered provider, Miss Vivien White. The service provides dual-energy X-ray absorptiometry (DEXA) scans to measure bone density. The service is contracted by the local clinical commissioning group to carry out DEXA scans for the local NHS trust osteoporosis service. The service does not employ any staff. The provider, Miss Vivien White, carries out all the DEXA scans provided by the service.

A bone density scanning clinic is held at Island Osteoscan clinic approximately twice a week. Patients attending the bone density scanning clinics are mainly NHS patients. Patients attending the clinic receive bone density scans that are provided by Island Osteoscan. However, the overall running and organisation of the Island’s osteoporosis service, which includes the bone density scanning clinic, is carried out by the local NHS trust osteoporosis specialist nurse. The NHS trust specialist nurse receives all referrals for DEXA scans, reviews and triages the referrals and plans the clinic attendance list. Appointment letters are sent to patients by the NHS trust specialist nurse. Island Osteoscan does not carry out DEXA scans on children and young people under the age of 18.

Both the provider and the NHS trust specialist nurse are present at all bone density scanning clinics, with the clinic being led by the NHS trust specialist nurse. Patients are received into the clinic by the NHS trust’s specialist nurse where she reviews the patient’s clinical information, the patient then has their DEXA scan, carried out by Island Osteoscan, in an adjoining room, following which they return to see the specialist nurse to receive their results and any treatment plans.

Island Osteoscan also carry out two to three private DEXA scans per year. The provider has an agreement with an independent consultant who is present at all private scans and who interprets and provides scan results to patients.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 22 August 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We rated it as Requires improvement overall.

We found areas of practice that require improvement

• The provider did not operate a formalised governance process. The provider did not have documented policies and procedures to support the delivery of the service. There were no service specific policies and procedures to support the running of the service, Island Osteoscan. There was no process to manage incidents relating to the delivery of the service, no policy about mandatory training of the provider or other staff attending the clinic, no policy about managing the safety of the environment and equipment and no policy about managing the risk of cross infection. The provider had not acted to fulfil their contractual agreement with the local clinical commissioning group.

• Other than the quality assurance process for the safety of the scanning machine, the provider had no processes to monitor the quality and performance and manage risks of the DEXA scanning service they provided.

• The provider did not have a formal process to manage complaints about the service.

• The provider did not consider national guidance to determine what level of children’s and young people’s safeguarding training they needed to complete.

However, we found areas of good practice:

• The service provided DEXA scans based on national guidance and evidence-based practice.

• The provider and the NHS specialist nurse worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.

• The provider supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions.

The design, maintenance and use of facilities, premises and equipment kept people safe and the provider was trained to use them.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• The provider planned and provided the service in a way to meet the needs of local people and the communities served. The provider made reasonable adjustments to help patients access the service.

• Clinics ran to time and patients received results of their scans during their clinic appointment.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. We told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected Island Osteoscan. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and south)