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Inspection Summary


Overall summary & rating

Good

Updated 2 January 2019

York Diagnostic Imaging is operated by University of York. The service provides diagnostic and imaging services for adults and children and young people. The service provided is limited to the use of Magnetic Resonance Imaging (MRI) and musculoskeletal (MSK) and neurological imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 22 October 2018.

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 this service as Good overall.

We found good practice in relation to:

  • The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment. All staff were up to date with mandatory training.

  • The service had suitable premises and equipment and this was well maintained.

  • Staff had received training with regard to safeguarding children and vulnerable adults, which included mental capacity and consent.

  • Staff learned from recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team.

  • The service was planned and provided in a way that took account of the patients and service users views and feedback. The service monitored the effectiveness of their service and used the findings for improvement.

  • Staff were competent, had clear objectives and received regular reviews and appraisals.

  • Staff worked well together as a team and with service users, patients and suppliers to benefit patients and provide a good service.

  • We observed that all staff were polite and courteous to patients from arriving at the department to when they left. Patients told us they were happy with the service and that they had been talked through what to expect at every stage of the process.

  • Patients told us the service was easy to access. There was no waiting list and around 80% of patients received their scan within five working days of referral.

  • The service had a vision for what it wanted to achieve and identified actions developed with the views of staff, patients and service users taken into consideration.

  • The service had not received any complaints in the last 12 months and was responsive to patient feedback.

  • The service had systems and processes in place to minimise risks and manage issues and performance.

However, we also found the following issues that the service provider needs to improve:

  • The provider must ensure that the records management, consent and safeguarding policies are reviewed in line with current best practice guidance and have any incorrect information removed or amended to ensure guidance complies with current legislation and best practice.

  • We were concerned that staff did not always recognise or report incidents which meant there were lost opportunities for learning and improvement.

  • Policies and protocols were not always referenced or dated.

  • There was no programme of audit in place to monitor compliance with policies and protocols such as infection prevention and control, or to monitor outcomes such as; image quality or appropriateness of referrals.

  • There were no adaptations to the environment, such as posters, or decoration to make the environment child friendly and staff needed to consider how they would adequately meet the needs of patients who could not speak English. The service did not routinely make health promotion information available for service users.

  • The service used a number of methods of receiving and transferring patient information to and from referrers which increased the risk of information loss or breach of confidentiality.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and 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 one requirement notice. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region)

Inspection areas

Safe

Good

Updated 2 January 2019

Are services safe?

We rated safe as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The service had enough staff with the right qualifications, skills, training and experience to provide the right care and treatment.
  • The service had suitable premises and equipment and this was well maintained.
  • Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff had received training with regard to safeguarding children and vulnerable adults.
  • Staff learned from recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team.

However, we also found the following issues that the service provider needs to improve:

  • We were concerned that staff did not always recognise or report incidents which meant there were lost opportunities for learning and improvement.
  • The safeguarding policy needed to be reviewed and updated in line with current best practice guidance.
  • There was no programme of audit in place to monitor compliance with infection control policies such as hand hygiene and cleaning standards.
  • There was no process in place for the testing of the defibrillator, or an at a glance protocol or flow chart to assist staff if they needed to raise an emergency response.

Effective

Updated 2 January 2019

Caring

Good

Updated 2 January 2019

We rated caring as Good because:

  • We observed that all staff were polite and courteous to patients from arriving at the department to when they left.

  • Patients told us they were happy with the service and that they had been talked through what to expect at every stage of the process.

  • Staff provided emotional support to patients to minimise their distress.

  • Staff explained what would happen in a way patients could understand and gave them the opportunity to ask questions.

  • Costs to patients were available on the YDI website so they were aware of these before or at referral.

Responsive

Good

Updated 2 January 2019

We rated responsive as Good because:

  • The service was planned and provided in a way that took account of the patients and service users views and feedback.

  • Patients told us the service was easy to access.

  • There was no waiting list and from August 2017 to July 2018 78% of patients received their scan within five working days of referral.

  • The service took account of patients’ individual needs.

  • The service had not received any complaints in the last 12 months and treated any concerns received from feedback cards seriously. Concerns were shared with all staff and improvements made.

However, we also found the following issues that the service provider needs to improve:

  • There were no adaptations to the environment, such as posters or decoration to make it child friendly.

  • Staff needed to consider how they would meet the needs of patients who could not speak English.

Well-led

Good

Updated 2 January 2019

We rated well-led as Good because:

  • The service had managers with the right skills and abilities to run the service.

  • The service had a vision for what it wanted to achieve and identified actions developed with the views of staff, patients and service users taken into consideration.

  • Staff were supported and managers and staff had a sense of common purpose and shared values.

  • The service had an inclusive culture and staff wanted to continually improve the quality of its service.

  • The service had systems and processes in place to minimise risks and manage issues and performance.

  • The service engaged well with patients, staff, stakeholders and suppliers to plan and manage appropriate services.

  • The service was committed to improving services by learning from when things go well and when they go wrong.

However, we also found the following issues that the service provider needs to improve:

  • The service had a number of methods of receiving and transferring patient information to and from referrers which increased the risk of information loss or breach of confidentiality.
Checks on specific services

Diagnostic imaging

Good

Updated 2 January 2019

We rated this service as good overall with ratings of good for safe, caring, responsive and well-led. CQC does not rate effective for diagnostic imaging services. There were areas of good practice and a small number of things the provider must do to improve.

We issued the provider with one requirement notice. Details are at the end of the report.