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Inspection Summary


Overall summary & rating

Good

Updated 17 April 2019

Barnet MRI Centre is operated by InHealth Limited. The service is situated in a unit shared between the provider and the NHS host trust. The unit sees both NHS and private patients on an outpatient basis; as well as providing a service for inpatients from the host trust. Both adults and children under 18 years old are seen at the unit.

The unit contains one MRI scanner that belongs to a third party. The unit is separately staffed by InHealth. The opening hours are Monday to Friday, 7am until 9pm, and Saturday and Sunday, 8am until 8pm.

The service is part of the host trust’s ‘one stop shop’ for prostate and breast cancer clinics.

We inspected this location under our diagnostic and imaging inspection methodology. We carried out our visit as an unannounced inspection lasting one day, on 24 January 2019, with two CQC inspectors and a specialist advisor.

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

This was the first time we rated this service. We rated it as good overall.

We rated this service as good because:

  • Staff completed and updated risk assessments for each patient. MRI safety questionnaires were completed by all persons entering the MRI scanning room to ensure their safety. This included patients and staff. There was a specific protocol in place for any pregnant patients requiring a scan. Staff escalated any concerns to an appropriate clinician immediately before the patient left the unit.
  • Staff treated patients with kindness and understanding. They reassured patients and, where necessary, sat with them throughout their scan to support and reassure them.
  • There was effective multidisciplinary working between staff working across the provider and the host trust. The superintendent radiographer attended the daily bed meeting to establish the patients requiring MRI scanning for that day. Certain appointment times were kept free to accommodate the host trust inpatient scan requests.
  • The service planned and provided services in a way that met the needs of local people and people could access the service when they needed it. Patients could be seen seven days a week, from early in the morning until late at night.

However:

  • There was no service level agreement (SLA) between the host trust and the provider, or with any third party for the provision of services at the location. This included cleaning of the shared unit, attending crash calls and waste management.
  • There was no security in place to prevent unauthorised entry to the unit. This was a risk to patients and staff alike. A business case had been put forward to address this issue; however, at the time of our inspection, there was no security in place.
  • Patients did not always have their privacy and dignity maintained. The scanning viewing room was also the team office and therefore did not afford privacy to the patient inside the scanner.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South East England)

Inspection areas

Safe

Good

Updated 17 April 2019

We rated safe as good because:

  • Staff completed and updated risk assessments for each patient. MRI safety questionnaires were completed by all persons entering the MRI scanning room to ensure their safety. This included patients and staff. There was a specific protocol in place for any pregnant patients requiring a scan. Staff escalated any concerns to an appropriate clinician immediately before the patient left the unit.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up to date and easily available to all staff providing care.
  • The service followed best practice when giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.

However:

  • Although the service controlled infection risk well, and all areas we visited were visibly clean, the service lacked effective systems and processes to ensure standards of cleanliness and hygiene were maintained. There was no service level agreement between the provider and the host trust to provide cleaning services and staff did not routinely review cleaning schedules or audits.
  • There was no security in place to prevent unauthorised entry to the unit. This was a risk to patients and staff alike. A business case had been put forward to address this issue. However, at the time of our inspection, there was no security in place.

Effective

Insufficient evidence to rate

Updated 17 April 2019

We currently do not rate effective for this type of service.

However, we found:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness.

  • Staff were aware of the need for informed consent and we saw that each patient signed a consent form prior to their procedure.
  • There was effective multidisciplinary working between the provider and the host trust. The superintendent radiographer attended the daily bed meeting to establish the patients requiring MRI scanning for that day. Certain appointment times were kept free to accommodate the host trust inpatient scan requests.
  • The provider scanned patients seven days per week, from early in the morning until late at night to provide access to a variety of patients.

Caring

Good

Updated 17 April 2019

We rated caring as good because:

  • Staff interactions were kind, caring and professional.
  • Patient feedback was actively sought and used to improve the service.
  • Staff provided emotional support to patients to minimise their distress.
  • Patient feedback was positive about the service. The service could provide a chaperone if required.

However:

  • Patients did not always have their privacy and dignity maintained. The scanning viewing room was also the team office and therefore did not afford privacy to the patient inside the scanner. 

Responsive

Good

Updated 17 April 2019

We rated responsive as good because:

  • The service planned and provided services in a way that met the needs of local people.
  • Services were planned to take account of the needs of different people.
  • Patients were offered a choice of appointments and we saw that the service was planned in a way to allow for timely access to diagnostic imaging.

However:

  • Bariatric patients were not able to be seen at the unit, and had to be referred to an alternative unit.
  • Signposting to the unit was minimal and difficult to see. The unit was hidden behind the ambulance parking bay and behind repair works being carried out. Access to the unit was difficult for those with mobility issues as the ramp needed to be replaced.

Well-led

Good

Updated 17 April 2019

We rated well-led as good because:

  • Staff told us they felt supported, respected and valued by the organisation. Staff told us the local leaders were visible and approachable.
  • The leadership team for the provider were clear on vision and strategy for the unit.
  • There was an effective governance framework to support the delivery of good quality care.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • Patients’ views and experiences were gathered and acted on to shape and improve the services and culture.

However:

  • There was no service level agreement (SLA) between the host trust and the provider (or any third party) for the provision of services at the location. This included cleaning of the shared unit, attending crash calls and waste management.
Checks on specific services

Diagnostic imaging

Good

Updated 17 April 2019

Diagnostic and imaging services at

this location were shared with the host trust. It consisted of one MRI scanner

and shared facilities.

We rated this service

as good overall.