Nuffield Health Manchester Diagnostic Suite

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

Services were planned and delivered to meet people's individual needs and made it easy for people to give feedback about their experiences. People could access the service and get information in an appropriate format when they needed it.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff were able to describe how they would make reasonable adjustments, such as allowing flexibility in patients’ appointment times and allowing them to be accompanied by a relative or carer during their treatment. At the point of an appointment being made, patients were informed of how to contact the service to inform them of any additional information, and staff discussed people's individual clinical and personal needs with them prior to commencing scans.

We saw an example how the service accommodated autistic people by ensuring all staff who would be seeing them had read their healthcare passport to better understand their needs. The MRI clinical lead contacted the person in advance of their appointment and ensured that extra time for the appointment was provided, as feeling rushed was a particular concern.

We noted that while 100% of staff had completed e-learning on autism awareness to facilitate a person-centred approach for this group, it was not clear if this included live and interactive training that was co-delivered by people with a learning disability and autistic people, in line with the Oliver McGowan Code of Practice. Certain designated staff had completed training modules in understanding dyslexia and using and respecting people’s pronouns, but dementia awareness was not a part of the service’s core training matrix as advised by the Dementia Training Standards Framework 2018.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Managers and the admin team planned clinics to meet the demands of patients and referrers. Scans were appropriately triaged and booked in advance in accordance with service procedures. This enabled managers to plan what resources were required to undertake each procedure before patients attended their scheduled appointment. These considerations included the availability of medical cover and staff with specific competences, chaperones and hospital transport. Triaging staff sought input from referrers or consultant radiologists if they required further information or advice about people’s eligibility or referral requirements and in relation to the delivery of scan images and reports.

Patients told us their scan procedures were well coordinated, and staff planned and delivered their scan procedures in a way that met their needs. Issues that caused delays with scan images or reports were rare and patients were kept informed on these occasions. We saw one example of a case where a national system outage prevented a mammogram from being reported in advance of a patient’s surgery, and staff took various measures on a short timescale over a bank holiday weekend to ensure that their surgery could still proceed as planned.

Facilities and premises were appropriate for the services being delivered. MRI and CT scanners had a joint control room, from which staff could operate the scanner and easily observe patients during their scans. The service had processes to undertake scans outside of typical working hours if there was an urgent need.

Patients told us their scan procedures were well coordinated and delivered in a way that met their needs, and that they had not experienced any issues or delays with their appointment. Waiting areas were spacious and accommodating and provided a suitable environment for people waiting for scans, and hot and cold drinks were available to those attending the service.

During our inspection we saw one member of the service team attend the adjacent NHS trust to engage with them directly so that the appropriate transport arrangements could be arranged for a patient after their scan in a timely way. Admin staff also worked hard to liaise with clinical teams and contact patients on waiting lists to fill last minute cancellations, ensuring they had opportunities to be seen sooner if they wanted. We also saw an example of how the team proactively aligned patients’ appointments with other engagements they had, for their convenience.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided clear and accessible information with general clinic information also available online in video and written formats. Email confirmation of appointments was sent to patients with clear guidance on how to reach the service, and calls could be offered as an alternative if this was preferred. The service had access to a telephone interpretation service with common spoken languages. For complex scans, the service booked in-person interpreters to ensure that patients had a full understanding of the risks associated with the procedure. Patients told us staff provided them with necessary information about their scan and that staff appropriately answered any questions they had.

We saw notice boards that included information for staff and patients. Information leaflets were readily available, and key literature was available to print in alternative languages for patients who needed it. Staff told us they could provide written information in different languages or other formats if required, and we saw examples of such patient handouts.

The service was compliant with the General Data Protection Regulation (GDPR) when communicating fees and ensuring data security. We saw records that showed 100% of appropriate staff had completed training in health record keeping and 96% had completed information governance and cyber security modules appropriately.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Provider information about how to raise complaints or give feedback was visible and available in waiting areas. This described the complaints procedure, which appropriately focused on local resolutions as a priority (stage 0 complaints) and how complaints can be escalated if concerns persist (stage 1-3 complaints). The service stated that it would aim to resolve stage 0 complaints within 2 working days and stage 1 complaints within 20 working days, and the complainant would be kept informed if investigations took longer. The service also had arrangements and provided information on external adjudication processes for both NHS or privately funded patients. The provider was in the process of piloting and rolling out patient experience forums in order to better learn, listen and act on people’s experiences.

At the time of inspection, the service had not received any formal complaints in the previous 12 months, and the only issues raised had been associated with parking and directions concerns, which had been addressed appropriately.

The service made use of patient feedback, and the reception team were encouraged to offer feedback forms to people following their attendance, the results of which were analysed and reported to staff on a quarterly basis. The service also considered feedback from online review sites, although these are not externally validated and there were only a limited number of reviews per year.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

People who used the service could be referred through several routes, which included the provider’s own referral pathway, other independent health provider routes, or as an NHS patient. The service provided guidance on the appropriate considerations to take for when a patient did not attend their appointment, which included their specific vulnerabilities and individual characteristics appropriately. We noted that the service's inclusion criteria did not include an equality and diversity statement, meaning that it was unclear if any potential discrimination based on patient’s protected characteristics had been considered in the development of these criteria.

There were two cases in the 12 months prior to the inspection where appointments for some patients had to be rebooked, which included a fault with the CT scanner and a national issue with the provider’s image storage software. The service told us that patients were made aware of this and rebooked prior to their attendance in each case. A small number of patients also had scans rearranged when the associated NHS trust had not appropriately arranged an interpreter in keeping with service policy. The service monitored such cases and leaders told us that they made efforts where possible to minimise reoccurrence of these issues.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The nature of the diagnostic scan procedures provided by the service meant it was not possible to easily identify or differentiate outcomes for people with protected characteristics. However, we looked at data around incidents, the work culture of staff and feedback from people who used the service and this did not identify any disparity in care experiences, adverse outcomes or inequalities for people with protected characteristics. Service policies and procedures contained equality and diversity statements, where consideration of potential discrimination against protected characteristics was demonstrated. The service additionally had a robust equality, diversity and inclusion policy.

We noted that 96% staff had appropriately completed core training in equality, diversity and inclusion. When asked, staff were able to describe the processes for embedding equality including how they ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act 2010, when making care and treatment decisions.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The nature of the diagnostic scan procedures provided by the service meant most people attended the service once, unless multiple different scans were specified as part of their assessment. People who used the service told us that the staff discussed their scan procedure and expectations for scan results as part of their initial assessment. Staff told us timelines for scan reporting were explained to people.

The nature of the services provided also meant there was no requirement for the service to provide routine after care support or follow up appointments. However, leaders told us that patients were welcome to contact the service if they had any queries about the reporting process or how they could access reports through their referrer, and they were provided with information on how to do so.