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Leicester Nuffield Alliance MRI Unit Good

Inspection Summary


Overall summary & rating

Good

Updated 11 January 2019

Leicester Nuffield Alliance MRI Unit is operated by Alliance Medical Limited. The service has a reception area with an accessible toilet. Through the controlled access door, there is a clinical preparation area, patient changing room and toilet, staff changing room, the Magnetic Resonance Imaging (MRI) scanning room with a 1.5T (tesla) MRI scanner and a viewing/control room.

The service only provides diagnostic imaging through MRI scanning, therefore we only inspected diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 13 November 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 previously did not have the authority to rate this type of service, however now we do. We rated it as Good overall.

We found the following areas of good practice:

  • There was a safety focused culture within the unit. Staff had a comprehensive policy to follow when identifying significant findings on the scan, as well as thorough use of the ‘pause and check’ flow chart prior to commencing a scan.

  • There was a system and process in place for identifying and reporting potential abuse. Staff were supported by individuals with more enhanced training in safeguarding and there were clear channels of escalation which staff were aware of. Staff also had access to a paediatric nurse from the host hospital for when children and young people attended for scanning appointments.

  • Clinical environments were visibly clean and tidy, and were suitable and appropriate to meet the needs of the patients who attended for appointments, as well as relatives and children who accompanied them.

  • Staff had comprehensive corporate policies to follow which were based on evidence-based best practice and nationally recognised policies.

  • There was a corporate audit plan in place which the service contributed towards, as well as completing local quality checks of scans and reports.

  • Feedback from patients was positive during our inspection and we observed some examples of high quality care, from compassionate and professional staff.

  • There was a strong teamwork ethic amongst the staff who directly worked within the MRI unit, as well as strong multidisciplinary team working with staff from the host hospital.

  • The referral to scan and reporting times were well within the expected timeframes.

  • There were processes in place to ensure the individual needs of patients were met.

  • There were few complaints raised against the service, and the complaints which were raised were dealt with in line with corporate policy.

  • Governance processes were well-embedded and there were clear channels for escalation of concerns and cascade of information from the top.

However, we also found areas of practice which the service needed to improve:

  • At the time of our inspection we observed low morale amongst staff. Staff told us this was due to the changes in management and the way it had been handled. Staff had previously escalated concerns and suggestions, however these had not been addressed or actioned.

  • There were corporate policies and training in place for the management of medicines. However, there were concerns raised by staff about their roles and responsibilities regarding the checking and administration of intravenous contrast and self-administration of medicines.

  • Paediatric life support training was well below the expected standard for the service and did not follow corporate policy. However, the service was supported by a resuscitation team and paediatric nurse from the host hospital.

  • There were no processes in place to enable staff to undergo clinical supervision and staff reported not having the opportunity to complete continuous professional development and training requirements due to limited staffing.

  • The service did not formally record waiting times on the day of appointments, despite there being a delay on the day of our inspection.

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

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)

Inspection areas

Safe

Good

Updated 11 January 2019

We rated safe as Good because:

  • There were processes in place to ensure patients were protected from avoidable harm and abuse. Staff knowledge of safeguarding was strong and there were clear processes for escalation.
  • The MRI unit was visibly clean and tidy, and staff followed correct infection prevention and control practices when providing care and treatment to patients.
  • There was a process in place for staff to follow when escalating significant pathology/findings from the MRI scan. Staff were knowledgeable of this process and could give examples of when they had needed to do this.
  • Staff adhered to recognised safety checks when performing a MRI scan on a patient. All staff used the ‘pause and check’ checklist prior to completing a scan on a patient.
  • Staff took patient and staff safety seriously in the department. All patients, staff and visitors completed a safety checklist prior to entering the MRI room. The department also routinely practiced cardiac arrests scenarios to ensure a seamless response to emergency situations.
  • There was an incident reporting policy and procedure in place which all staff were aware of. The service had a positive approach to incident reporting and learning from all incidents, regardless of level of harm.

However:

  • Despite corporate medicines management policies and medicines mandatory training, staff voiced concerns about their roles and responsibilities in relation to the checking and administration of intravenous contrast and patients self-administering benzodiazepine within the scanning room.

  • Paediatric life support training was well below the expected standard for the service and did not follow corporate policy. However, the service was supported by a resuscitation team from the host hospital.

Effective

Updated 11 January 2019

We do not rate effectiveness.

  • Policies, procedures and guidance was based on national policies, legislation and best practice guidance including those released by bodies such as National Institute for Health and Care Excellence (NICE) and the Society and College of Radiographers.

  • The service participated in the corporate audit programme as well as local auditing including quality audits of scans and reports.

  • There was strong multidisciplinary team working between staff in the MRI unit and staff from the host hospital.

  • Staff were knowledgeable about the Mental Capacity Act and consent requirements, especially the requirements around Gillick competency.

However:

  • There were no processes in place for staff to complete clinical supervision. Staff also indicated there was little opportunity for them to develop their roles further through continuous professional development and role specific training.

Caring

Good

Updated 11 January 2019

We rated caring as Good because:

  • Patients we spoke with were all positive about the service they received and the staff who provided the service. Our own observations during the inspection supported positive interactions between staff and patients.

  • Staff treated patients with dignity and respect at all times, and endeavoured to ensure the confidentiality of patients

  • Staff provided emotional support to patients when required and were able to provide examples where they had done this.

  • There were systems in place for the service to collect patient satisfaction and feedback on a regular basis through the use of the friends and family test (FFT). Results from the FFT were constantly in the high nineties with the most current compliance rate recorded at 100%.

Responsive

Good

Updated 11 January 2019

We rated responsive as Good because:

  • The clinical environments were suitable and appropriate to meet the needs of the patients.

  • The service made a concerted effort to meet the individual needs of patients. For example, interpretation services were available for patients whose first language was not English and staff knew how to access this.

  • The service had a positive approach to the complaints they received (which were low in numbers) and the management of complaints.

  • The service had low numbers of patients who did not attend for their scans or cancelled at short notice. This was monitored through the quality score card each month.

However:

  • The service did not provide a range of appointments times and dates to meet patient need. Scans were only available Monday to Thursday, with times no later than 7pm.

  • The service did not locally monitor ‘on the day’ waits despite the service running behind on the day of our inspection. Staff however told us this was rare.

Well-led

Good

Updated 11 January 2019

We rated well-led as Good because:

  • Governance systems were in place which all staff were aware of and involved in. There was evidence of information and issues being escalated upwards, as well as information being cascaded downwards through the system.

  • There was a process in place to identify and assess risks in the service, with ongoing monitoring of them through the governance system.

  • There was a corporate vision and set of values in place which staff were aware of and aligned to.

  • There was locally good team work and team ethic amongst the frontline staff. All staff were supportive of each other and trusted each other.

However:

  • There were some local cultural issues in the unit since the appointment of a new manager. There was recognition that this had impacted morale of staff and this was only just beginning to improve.

  • Staff had previously escalated some concerns and suggestions for improvements to the service, however these were not listened to and no action taken. This had impacted the perceived approachability of managers and engagement of staff.

  • All staff participated in the corporate staff survey, however there was no feedback to local teams about the satisfaction of staff.

Checks on specific services

Diagnostic imaging

Good

Updated 11 January 2019

Diagnostic imaging, more specifically the provision of Magnetic Resonance Imaging (MRI) scanning was the only service provided at this location. We rate this service as good overall because patients were protected from avoidable harm and abuse. Care and treatment was provided based on best practice and provided by competent staff. Feedback from patients was positive and we ourselves observed positive examples of compassionate care. Patients could access care and treatment in a timely way and there were flexible appointment times to meet patient needs. There was a vision and set of values which staff were aligned to and governance processes were in place to provide adequate assurance of service provision.