Nuffield Health Manchester Diagnostic Suite

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

The service had enough staff to provide safe care. Premises and equipment were clean and well maintained, and risks were assessed and addressed promptly. Leaders maintained comprehensive oversight of safety incidents and used learning to improve practice, and the service had invested in an effective and flexible workforce. Staff completed mandatory training, understood safeguarding responsibilities, and followed radiation protection requirements.

However, we found a concern where staff had not followed the intended medicines stock recording processes, which had resulted in documentation inaccuracies.

We have not awarded this service a score for Safe.

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

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong, proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Managers championed openness and honesty in reporting incidents across all areas of the service. Staff considered incidents as opportunities to improve and learn, and those we spoke with understood the reporting process and how incidents were managed. Managers fed back actions and learning from incident reports to staff in an appropriate and timely way, and staff provided examples of how the service had implemented meaningful changes in response. Staff we spoke with had a strong awareness of the duty of candour.

The service used the provider’s own incident reporting software, which enabled managers to review, record investigations, and report the outcome of each incident. Additionally, the service had implemented an in-house incident dashboard, designed to deliver insights and trend analyses in a more accessible format. This tool streamlined the incident review process and assisted leaders to make data-driven decisions that improved outcomes across the service. All new and ongoing incidents were discussed in a weekly incident review meeting, supported by this dashboard. The service recorded a total of 104 incident submissions in the 12 months prior to our inspection, which demonstrated a consistent reporting culture.

The dashboard included an incident tracker so that managers could continually review the progress of any investigations and identify who had oversight of each one. Staff reviewed and updated any associated actions during each incident review meeting. We saw that where incidents or learning opportunities were related to the service’s external partners, there were effective lines of communication to share information with them routinely.

We saw evidence in weekly incident review meetings that opportunities for thematic analysis were identified, and that ‘deep dives’ of recent incidents took place routinely, that was facilitated by the incident tracker. Recent topics identified included unexpected patient arrivals, medication receipting, and scanning protocols education.

The provider had a comprehensive Patient Safety Incident Response Framework (PSIRF) policy that ensured patient safety incidents were managed consistently. The provider made information booklets available for both patients and staff to guide them through the investigation process, in addition to mental health support documents. We saw the service investigated incidents in line with this process, including a medicines administration incident in 2023 that had appropriately triggered the correct type of investigation in line with the service policy.

While the service had no recorded never events or any incidents of severe or fatal harm, managers had developed a “PSII lite” process to more effectively investigate certain incidents with low severity to ensure no learning opportunity was missed. Staff used a structured Situation, Background, Assessment, Recommendation (SBAR) template in incident reports. We saw an example of this from earlier in the year, where a software update had led to an administrative error when uploading patient scans to the relevant portal- while this issue was identified immediately and designated as a low severity incident, the service undertook a ‘PSII lite’ with a structured review in recognition of the potential risk of patients being attributed to the wrong scans, and changed processes to ensure teams were advised of software changes in advance. A follow-up review took place 2 months after the initial incident and confirmed that admin errors had been reduced due to these measures.

We scored the service as 3. The evidence showed a good standard. The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Referrals were vetted by clinical staff in line with clear admission criteria before being accepted. Administrators also checked documentation and requested additional details when key information was missing, such as a patient’s address or date of birth. The service did not accept patients who were acutely unwell, required inpatient care, lacked mental capacity, or could not cooperate with scan requirements.

For privately funded patients, the service had clear referral pathways that guided staff through vetting referrals, booking appointments, reporting scans, and returning results. Each stage had measurable targets, and staff escalated cases promptly if targets were not met. Most patients were able to attend their scan within a few days of contacting the service, regardless of the type of scan. Stakeholders told us they had confidence in the safety of the service and had worked with them for many years.

Most steps of the administrative process for NHS patients were managed by the associated NHS trust. Staff could access the trust’s electronic patient record when needed, for example to check whether a patient had already received a scan as part of another pathway. This helped prevent duplication and supported safe care. Service leaders met monthly with NHS trust colleagues to review pathway pressures and align policies. Minutes were recorded, and action plans were updated at each meeting. Stakeholders told us these arrangements worked well and supported safe and effective care.

Staff had a clear understanding of their scope and relationship with other services, and we saw that staff supported patients who were transitioning between providers. For CT and MRI scans, a radiography assistant helped escort patients between areas and kept them and any friends and family informed throughout.

Stakeholders described effective communication when concerns arose. In one example, a routine chest x-ray for a visa medical identified an incidental finding of lung cancer. Staff escalated this quickly and informed the referrer without delay, enabling the patient to access appropriate care. This demonstrated a strong focus on patient safety and responsiveness.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff demonstrated a strong understanding of safeguarding concerns relevant to an imaging department. Clinical staff were trained in adult safeguarding to level 2, and designated staff were trained to level 3. Although children and young people were only occasional users of the service (usually for chest x-rays linked to visa or immigration requirements) staff also completed safeguarding training for children at levels 1 and 2. Staff recognised that even if not patients themselves, children accompanying adults could present safeguarding risks and understood their responsibility to act in such a case.

The service had clear safeguarding policies, and staff were aware of these. When asked, all staff could name the designated safeguarding lead for both children and adults. Details of local and national safeguarding leads, who had higher levels of safeguarding training, were displayed in staff areas alongside flowcharts showing the steps to take if a safeguarding or Prevent concern (a UK counter-terrorism initiative) was identified. The service also had a specific flowchart for reporting concerns related to female genital mutilation (FGM), which can be a particular risk in ultrasonography.

The service had not needed to make any safeguarding referrals in the last 12 months. However, staff demonstrated confidence in the process and could explain how they would escalate concerns promptly if required.

We scored the service as 3. The evidence showed a good standard. The service worked well with people to fully understand and manage risks by thinking holistically. They provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Information was requested at the point of referral to ensure patients could be seen safely. For example, some scans required a recent eGFR (estimated glomerular filtration rate) result in order to be triaged safely. If certain information was not provided in the referral, staff would either contact the referrer or could arrange tests for the patient themselves, if they had been referred from within the provider organisation, to help prevent delays and support safe care.

Patients received clear information about their scan and what to expect before attending, usually by email. Safety screening questionnaires tailored to the scan type were completed before the procedure, signed, and uploaded to the patient’s record. The service audited these records, and compliance rates were typically well above the service’s 90% target. Staff escalated any concerns identified in questionnaires to senior clinical staff before the scan took place.

We saw staff discuss and explain key risks to the patient prior to commencing scan procedures. Staff carried out regular observations and had systems to ensure they could communicate with the patient during their scan procedure. Staff recognised that anxiety and claustrophobia were common among patients attending for scans and were experienced in managing this. For example, if a patient became distressed during an MRI scan, staff paused the procedure to allow the patient time to relax before continuing. Patients who were nervous could visit the service beforehand to see the scanner and meet staff, reducing the risk of an incomplete scan.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service was located in a secure area on the first floor of a larger building, which had accessible parking, a wheelchair ramp, and a lift capable of accommodating mobility equipment such as wheelchairs. Evacuation procedures considered the different needs of people using the service. Fire and patient assistance alarms were accessible and checked regularly. Corridors and communal areas were clean and free from clutter, and stock rooms were well organised. Staff areas and consultation rooms were accessible by electronic fob, and this system was checked routinely. The service had named health and safety and fire officers who had completed appropriate training.

A resuscitation trolley was located close to the area of greatest risk, and staff checked the contents and documented these checks regularly. Portable oxygen cylinders were stored securely near the trolley. Staff managed sharps in line with regulations, and clinical waste contracts ensured safe disposal of specialist waste, which was stored in a secure ground-level area of the building.

The design of the service met radiation protection regulations. Warning signs were visible and audited regularly. While not regularly used, lead gowns were available and underwent routine visual and radiographic integrity checks. Staff wore personal dosimeters to monitor their radiation exposure, and procedures were in place if exposure levels were high. Controlled areas were clearly marked, and comprehensive local rules were in place. Risk assessments covered a wide range of scenarios to prevent unintended exposure for patients and staff. The service was appointing a new Radiation Protection Advisor (RPA) following the retirement of the previous individual, who had routinely completed annual audits of radiation safety.

Staff carried out routine safety and quality assurance checks of imaging equipment, which had comprehensive annual servicing within required timeframes. Leaders responded quickly to equipment concerns; for example, when temperatures in the CT scanner room were found to be high, the service installed coolers and introduced regular temperature checks to prevent overheating. Leaders told us that they had arranged for the MRI scanner to have a SIM card fitted to enable out-of-hours fault alerts through text message, ensuring prompt response. Scanning equipment had emergency stop functions, and staff knew how to use these.

A rolling replacement schedule was in place for scanning equipment, and the service demonstrated they had considered the age of the MRI and CT equipment as a known risk.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service employed a mix of substantive and bank radiographers, and there were enough staff to meet operational needs. Leaders adjusted staffing levels flexibly by using bank staff when required, for example to cover unexpected absences. During our inspection, we observed that staffing levels were appropriate to meet patient needs and maintain excellent flow through the service. Patients we spoke with confirmed they did not experience delays.

The current staffing establishment included one radiology manager, two lead radiographers, and six radiographers, three of whom worked in bank posts. The sickness rate over the previous 12 months was exceptionally low, averaging at under 2%.

The service also employed 12 radiologists alongside other medical specialities such as cardiologists where required, working under practicing privileges arrangements. The recruitment, clinical activity and competence of medical staff was appropriately reviewed as part of the service’s medical advisory committee (MAC).

The provider had effective recruitment and induction procedures to ensure staff shared the organisational values and had the appropriate skills to work safely and effectively. Recruitment was managed jointly between the provider’s corporate team and the local service using a digital human resources system.

The service demonstrated a commitment to developing staff into specialist roles to improve care delivery. For example, one radiographer was supported by the service to undertake external training in cardiac MRI, and a radiography assistant was similarly supported to qualify as a registered radiographer. Leaders also described clear processes for managing poor performance.

The provider had a clear policy outlining essential training for each role, alongside core training required for all staff. Both substantive and bank staff were required to complete mandatory training and maintain compliance with the provider’s standards. Substantive staff completed training through the provider’s online platform, which gave managers oversight of compliance for each module, in addition to tracking Disclosure and Barring Service (DBS) updates. Bank staff submitted evidence of training completed elsewhere, and where this did not meet the provider’s requirements, they completed additional modules on the provider’s platform. We saw that mandatory training compliance met targets across both staff groups, and all staff maintained an enhanced DBS in line with policy. We saw an example of how the service’s governance processes ensured that staff whose DBS certification had expired would not be offered shifts until this was actioned.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas we inspected were clean and well maintained, with suitable furnishings. Hand washing facilities and hand sanitising gels were available throughout the service, and reminders on best practice were displayed in bathroom areas.

Staff followed good hand hygiene practice and complied with ‘bare below the elbow’ guidance. They had access to personal protective equipment (PPE) when needed and followed the provider’s infection prevention and control (IPC) policies. IPC training formed part of mandatory training, and staff understood their responsibilities for cleaning the environment and equipment appropriately.

Domestic staff were employed by an external contractor and cleaned general areas only. They did not enter MRI or CT scanner rooms. During our inspection, we found mop heads left attached and on the floor after use in a utility room, which was not in line with best IPC practice. This was raised with leaders during the inspection, who acted on this finding immediately.

The provider had an overall IPC lead, and the service had 2 designated IPC leads. Service leads carried out routine hand hygiene and aseptic non-touch technique (ANTT) audits, which demonstrated full compliance. Monthly legionella tests were arranged through an external provider, and no concerns had been identified. The service had access to additional IPC expertise through the provider’s corporate structure, which included their Director of IPC, a subject matter expert, an infection control doctor, and a chief pharmacist.

We scored the service as 2. The evidence showed some shortfalls. We found some inconsistencies in the management of medicines at the service, where staff in practice did not always follow the intended procedures, indicating they had not been embedded fully.

The service had a lead radiographer who had additional responsibilities that included medicines management. Medicines for routine clinical use were stored securely in a utility room requiring electronic fob access, in a locked medicines cabinet that was securely attached to the wall. The service did not use any controlled drugs. Medicines processes had been audited routinely and medicines management were discussed in an explicit meeting every 3 months, and a pharmacy contact was available for further support where needed.

We found some inconsistencies between the medicines stock procedures and staff practice, which meant that the quantity of stored medicines present was not in line with the levels stated in the record. This appeared primarily due to human error, where medicines were taken for use on the day of inspection and not recorded as such contemporaneously. When we identified this, the service made efforts to support staff with the intended processes and correct the records appropriately during the inspection and later provided their full incident response to this finding.

The service also kept emergency medicines and portable oxygen cylinders for life support and resuscitation purposes only, stored on a tag-sealed trolley that was appropriately stocked and checked routinely. The service ensured different staff members routinely checked the contents of the trolley to encourage familiarity and prevent individual errors.