Nuffield Health Manchester Diagnostic Suite

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we did not rate this key question due to differences in our assessment methodology. As such, this is the first assessment of effective for this service. This key question has been rated outstanding.

The service had systems to ensure that patients achieved the best outcomes possible and staff were highly motivated to achieve this. The service had a comprehensive audit programme and innovative approaches to improve quality and consistency in the imaging and reporting process. Teams demonstrated that they worked together in harmony to ensure patients did not need to tell their story more than once, and appointments were arranged and scan reports produced within tight targets that demonstrated consistently strong performance. Following the scan, patients consistently told us their experience was supportive of good outcomes and that “they only had positive comments from walking through the door to leaving.”

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Clear admission policies guided staff on the information required before patients attended the service. To ensure appropriate pre-assessment, a cardiologist triaged cardiac CT and MRI scans, which are more complex than conventional scans. Staff were proactive in obtaining all necessary information to accept referrals and either contacted referrers or arranged required tests when details were missing.

The service managed multiple referral streams from private providers. Administrative staff understood triage requirements and escalated potential delays promptly. They quality-checked referrals and contacted patients the same day with appointment details. Patients received clear information about their procedure and pre-assessment safety questions by email and were encouraged to contact the service with any concerns. Safety questionnaires, including pregnancy status and vital statistics, were completed in person at the appointment.

Staff told us they could easily access information such as care records, policies and guidance relevant to their role. The service reported that 100% of appropriate staff had completed training in health record keeping, and 96% had completed information governance and cyber security modules.

Individual needs were considered at referral so appropriate arrangements could be made. NHS e-referrals included flags for interpreter or sensory requirements, and the service was notified if hospital transport would be needed for a patient. Private referrals varied in their content, but staff actively worked to ensure suitable arrangements were in place for each patient and would call them if this was not clear.

We scored the service as 4. The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Clinical guidelines and pathways were based on national standards, including guidance from the National Institute for Health and Care Excellence (NICE) and Medicines and Healthcare products Regulatory Agency (MHRA) safety guidelines for MRI equipment. The provider’s central governance systems ensured the service was informed of any changes to national guidance, safety policies, or referral pathways and the service responded to changes quickly.

The service was highly motivated to innovate and improve upon the standards offered by a diagnostic imaging service. It was in the process of adapting the standards for radiology events and learning meetings (REALMs), produced by the Royal College of Radiologists, to suit an independent healthcare setting. These biannual meetings were intended to anonymously review discrepancies between practitioners and reporters with an aim to improve consistency, using a sample of scans undertaken by the service. Leaders told us this would be introduced in conjunction with the service’s existing image peer review process, and we saw that the terms of reference of these meetings had already been established, and audit templates finalised.

Images were reported on in a consistent way, and we saw for example that radiologists annotated reports with numerical codes to clearly communicate potential tuberculosis (TB) findings on chest x-rays. The service used a radiology World Health Organisation (WHO) safety checklist to confirm all safety steps before and after specific procedures. This included checks on Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER) compliance, risk factors, patient details, and post-procedure instructions.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The service held daily huddles to share information about clinics and patients. These were well attended, and a template was completed and shared after each meeting for staff to review during the day. Huddles included patient and staff numbers and any additional considerations, such as expected visitors or clinical concerns. They also outlined daily individual responsibilities, including roles in a resuscitation situation, quality control checks, and the designated fire safety officer and first aider for the day. Staff told us huddles were invaluable for raising concerns and sharing updates, and that they always felt well-informed about the service.

Leaders were visible during huddles and throughout the day to support operations. Staff said leaders were accessible, approachable, and responsive when concerns needed to be escalated. Services worked in a coordinated way across both registered locations, and staff found it easy to contact colleagues at other sites when needed. Staff told us they all worked well together and described teamwork as a key strength of the service.

To optimise the effectiveness of their workforce, leaders had participated in developing a bespoke staffing model, which was currently being reviewed and disseminated on a national level by the provider for use in all their imaging services nationally. Manchester Diagnostic Suite was a leading centre in the development and trial of this tool.

The admin team was highly engaged in supporting daily operations. Weekly admin huddles were held with service leads to coordinate clinic lists, image reporting, staff rotas, interpretation requirements, maintenance, telephony, and patient communications. Admin staff acted quickly to resolve issues, and their colleagues held the admin team in high regard, describing them as responsive and effective even during busy periods.

The service had targets regarding time taken for medical staff to report on scans, and the admin manager oversaw this process and had established escalation pathways in the case that these targets were exceeded, as well as contact radiologists at short notice if there was an urgent query. Progress was reviewed daily, and updates were communicated to service leads on a weekly basis in an agreed format. It was rare that a scan would not be reported on within 5 working days, which is significantly quicker than the expected turnaround time of 28 days for routine NHS scans.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The provider’s strategy focused on promoting health and wellbeing and aimed to “advance, promote and maintain health and healthcare of all descriptions.” One of its core values was to “inspire individual and collective health and wellbeing.”

The service considered patients’ holistic needs, particularly through health assessment packages offered by the provider. Patients were entitled to a free gym pass as part of a health assessment which could include imaging delivered at this location. We also saw health promotion activity in the local community and health information displayed within the service to encourage healthier lifestyles.

We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service carried out a wide range of audits covering key areas of diagnostic imaging. These were scheduled and completed on time and included clinical audits such as cannulation, radiation dose, and WHO checklist compliance, as well as quality audits for radiation protection, health and safety, and medicines management. Audits completed in the previous four months showed high compliance. In rare cases where results fell below target, we saw evidence of remedial actions and mitigations being implemented promptly.

The service periodically held mock inspections led by senior leaders to assess the service’s compliance more broadly across multiple areas and using various internal standards to inform this process. We saw action plans had been produced from these inspections with achievable targets, and the service itself could demonstrate improvements across various areas in response to this mock inspection process.

Image quality was also audited regularly, and the service could demonstrate how these audits were linked to the delivery of the service. For example, it was found that limitations of the scanning equipment meant that MRI scans of certain anatomies such as the prostate were not of a sufficiently high quality to guarantee that radiologists would identify a pathology every time it was present, and so the service had discontinued accepting patients for these scans. The service also undertook an image reject analysis each quarter of all images taken, to ensure their reject rate was suitably low. Results were analysed to determine which anatomies had the highest reject rates and what the causes of this were, which included patient position and inadequate inspiration. While image rejects were already below target, the service had actions to reduce this further to continually improve. In the last quarter, no scans needed to be repeated for any reason, and there were no unplanned returns following contrast injection.

The admin team also tracked the performance of scan report times and patient bookings closely, to ensure the service met its key performance indicators (KPIs) in these metrics. For example, we saw that the average wait time for cardiac scans was 1 week, and almost all patients had had their scans reported on by the cardiologist on the same day as their scan. We spoke to patients during the inspection who confirmed that they had been informed about this target and when they could expect a result.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service followed a clear consent policy that described consent processes in detail. Additional guidance was available for complex cases involving mental capacity, and this was accessible to all staff. Policies stated that patients must have mental capacity and provide valid, informed consent before imaging. Clinical staff demonstrated strong awareness of consent requirements and their responsibilities. They gave examples of how consent was obtained and explained the steps they took when capacity was in doubt, including practical measures to support people in making their own decisions. Staff understood that consent was a dynamic process, particularly for MRI scans where anxiety or claustrophobia could affect decision-making.

Consent documentation was audited routinely, and we saw examples confirming that risks and benefits were explained clearly to patients. Procedures ensured that people who did not speak English as a first language could still give informed consent, using telephone interpreters for routine procedures or face-to-face interpreters for higher-risk procedures.