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Medical Imaging Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 11 September 2019

Medical Imaging Partnership (MIP) has provided a mobile magnetic resonance imaging (MRI) scanning service since 2010 at Crawley hospital. In 2019 MIP has one relocatable scanner at Crawley Hospital, West Sussex.

In addition, a mobile ultrasound service is provided at the Vale Medical Centre, Haywards Heath. The ultrasound scans are performed by a consultant radiologist who holds practising privileges with MIP.

The mobile services provided by MIP at Crawley and at the Vale involve diagnostic assessment of patients referred under contracts with local NHS trusts, a local social enterprise organisation and a local pathway for musculoskeletal patients from Central Sussex, private patients both insured and self-pay.

The mobile services are managed from the MIP Head Office in Pease Pottage. This site also hosts the Referral Management Centre, Picture Archiving and Communication System and the logistics department which oversees radiology reporting, logistics and scheduling.

At the time of inspection, only the relocatable scanner at Crawley was in use. The mobile MRI scanner (MIP02) was not in use by MIP. It had been leased out and the plan was that the relocatable scanner would be returned and in place at the Crawley site later in 2019.

We inspected the service under our independent single speciality diagnostic imaging framework, using our comprehensive inspection methodology. We carried out an announced inspection on 17 July 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.

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.

Services we rate

We rated this service as Good overall.

We found good practice in relation to diagnostic imaging:

  • The service provided mandatory training in key skills to all staff.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient.

  • 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.

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

  • Staff assessed and monitored patients regularly to see if they were in pain.

  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.

  • The service made sure staff were competent for their roles.

  • Staff of different kinds worked together as a team to benefit patients.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • Patients were treated with dignity and respect. The interactions we observed showed staff being professional and compassionate. We heard staff speak to patients in a friendly yet professional manner.

  • Referrals were responded to rapidly. Patients could be offered immediate appointments in case of an emergency.

  • Timely reporting was monitored and facilitated with information technology systems allowing results to pass quickly to referrers. Urgent or unexpected findings triggered an immediate process, ensuring results were seen promptly by consultants.

  • Corporate functions supported clinical activity at site level with policies, procedures, resources and effective communication cascaded to ensure that provision met objectives for patient care.

  • We found an open and candid approach to incident and complaint management. Staff we talked with understood their role to ensure duty of candour was routinely applied.

  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

We found areas of practice that required improvement:

  • Only 33% of staff had received infection prevention control training.

  • Staff were not aware of protected time arrangements to complete mandatory training.

  • Daily cleaning records were not signed and updated regularly.

  • Safety checks were not signed and updated regularly.

  • There were no hand sanitizers or hand washing sink for patients and visitors in the unit.

  • Equipment such as needles and syringes were kept on the premises despite not being necessary for the provided procedures.

  • Equipment on the unit did not always have a magnetic resonance (MR) safety label on them.

  • Of the 12 policies we reviewed 8 were outdated and in need of review.

  • The service was in the process of embedding a formalised staff annual appraisal programme. Although this programme was in place for the last four months not all members of staff had a designated date for their appraisal. Completion rates were below the expected standard of 100% completion.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 11 September 2019

We rated safe as  requires improvement because:

  • The mandatory training record for infection prevention was 33%.

  • Staff were not aware of protected time arrangements to complete their mandatory training.

  • Moving and handling training did not have a practical component in line with regulation.

  • Staff did not consistently sign and update the daily cleaning records.

  • Staff did not consistently sign and update safety checks.

  • There were no hand sanitizers or hand washing sink for patients and visitors in the unit.

  • Equipment such as needles and syringes were kept on the premises despite not being necessary for the provided procedures.

  • Equipment on the unit did not always have an MR safety label on it.

  • The cleaning cupboard contained open electrical circuits and chemicals for cleaning and was left unlocked. This was easily accessible to patients and posed adverse risks to patients’ safety. The door had a lock however, staff could not locate the keys. We raised our concerns with the leadership team following our inspection and the cleaning products were placed in a more suitable locked cupboard and the storage cupboard was locked.

However:

  • Staff demonstrated awareness of safeguarding and knew how to report concerns. The service had policies in place to support staff.

  • The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • Staff completed comprehensive risk assessments for all patients and visitors to the unit. These were recorded in a safety questionnaire and patients’ risk assessments were stored in patient records.

  • The unit had equipment risk assessments for the scanner and fire.

  • Staffing levels and skills mix were planned and reviewed appropriately.

  • Records were stored safely and kept confidential.

Effective

Updated 11 September 2019

Caring

Good

Updated 11 September 2019

We rated caring as 

good

because:

  • Staff treated patients with respect, dignity and compassion and ensured their privacy was maintained.

  • All patients we spoke to gave consistently positive account of their experience with the unit and its staff. They told us staff were professional, polite and courteous.

  • Staff supported patient’s emotional wellbeing in a way that minimised their worries and scan related anxieties.

  • Patients, relatives and carers were given information in a way they understood.

  • The service encouraged patients to participate in their care and treatment and took time to address their concerns.

Responsive

Good

Updated 11 September 2019

We rated responsive as good because:

  • People’s needs were met through the way services were organised and delivered.

  • People’s individual needs were identified, and their choices and preferences were considered prior to booking.

  • Patients had timely access to diagnostic imaging scanning. The service was responsive to urgent referrals.

  • The service used the learning from complaints and concerns as an opportunity for improvement. Staff could give examples of how they incorporated learning into daily practice.

Well-led

Good

Updated 11 September 2019

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to manage the service.

  • The provider had a clear vision and a set of values, with quality and safety as the top priorities.

  • The service had a positive culture that was person-centred, open, inclusive and empowering. Leaders, managers and staff had a well-developed understanding of how they prioritised safe, high-quality, compassionate care.

  • There were governance frameworks that supported the delivery of good quality care. The service undertook quality audits, and information from these assisted in driving improvement and giving all staff ownership of things that had gone well. Action plans were identified on how to address things that needed to be improved.

  • Management systems could identify and manage risks to the quality of the service. The service used the information to drive improvement within the service.

  • Electronic patient records were kept secure to prevent unauthorised access to data. Authorised staff demonstrated they could be easily accessed when required.

  • There was a focus on service development and innovation. Leaders, managers and staff considered information about the service’s performance and how it could be used to make improvements and improve innovation within the service.

However:

  • We found policies that were outdated and in need of review.

  • The service was in the process of embedding a formalised staff appraisal programme, but this fell below the expected standard of 100% completion.

Checks on specific services

Diagnostic imaging

Good

Updated 11 September 2019

The provision of MRI scanning services, which is classified under the diagnostic imaging and endoscopy core service was the only inspected service at this location. We rated this service as good overall.