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Window to the Womb Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 9 September 2019

Window to the Womb is operated by D I Harries Limited, and is located in central Chester-le-Street, a town in County Durham. The service operates under a franchise agreement with Window to the Womb (Franchise) Ltd. The service is an independent healthcare provider offering antenatal ultrasound imaging and diagnostic services to self-funding or private patients over 16 years of age.

Window to the Womb has separated its services into two clinics. These are comprised of a ‘Firstscan’ clinic, which specialises in early pregnancy scans (from six to 15 weeks of pregnancy), and a ‘Window to the Womb’ clinic, which offers later pregnancy scans (from 16 weeks of pregnancy).

We inspected the service using our comprehensive inspection methodology. We carried out a short-announced inspection on 27 June 2019; giving staff two working days’ notice. We had to conduct a short-announced inspection because the service was only open if patient demand required it.

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 fundamental standards.

Services we rate

We had not previously inspected this service. We rated it as Outstanding overall.

We found the following areas of good practice:

  • The service made sure staff were competent for their roles. Staff had the right qualifications, skills, training and experience to keep people safe from harm and deliver effective care and treatment. There were established referral pathways to NHS antenatal care providers.

  • Staff understood how to protect patients from abuse and the service had systems to do so.

  • There were clear processes for staff to raise concerns and report incidents; and staff understood their roles and responsibilities. The service treated concerns and complaints seriously, and had systems to investigate them. Lessons learned were shared with the whole team and the wider service.

  • The service operated an open and honest culture, and there was a national freedom to speak up guardian, and an alternative (independent) dispute resolution service; if needed.

  • The environment was appropriate for the service being delivered, was patient centred, and was accessible to all women.

  • We saw extensive evidence of positive feedback from women who had used the service; including from women who had received difficult news, and those who had experienced pregnancy loss.

  • Staff understood the importance of obtaining informed consent, and involved patients and those close to them in decisions about their care and treatment.

  • The service had a vision for what it wanted to achieve, and consistently engaged well with patients and staff to plan and manage services.

We found the following areas of outstanding practice:

  • We saw all staff at the service (including scan assistants) had received safeguarding children and young people, and safeguarding adults’ level three training. In addition to this, we saw that staff mandatory training at the location included documented six-monthly review and understanding checks of Window to the Womb safeguarding policies.

  • There were high levels of emotional support available to women and their companions. Scan assistants acted as chaperones, to ensure women felt comfortable and received optimum emotional support. All staff received communication training to offer emotional support. We also saw scan assistants periodically assessed sonographers for their quality of customer care and communication skills, and findings were fed-back to them. The service purposely ran early pregnancy and later pregnancy clinics at different times to ensure that women who had experienced pregnancy loss or were anxious about their pregnancy did not share the same area with women who were much later in their pregnancy. Staff had received enhanced bereavement and communication training. The service also benefited from a dedicated ‘quiet room’, which could be used if women and their companions had received difficult news.

  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent care to flourish. The registered manager was a registered bereavement midwife of ten years standing with extensive of practice in large NHS teaching hospitals; they brought this breadth of experience to leadership of the service. Leaders strived to deliver and motivated staff to succeed; personal and professional staff development was positively encouraged and there was a deeply embedded system of leadership development and succession planning. The service was committed to promoting training, research and innovation. For example, the service had formed a collaboration with a local (Russel group) university and assisted them with performing research scans for fetal research. They had participated in a study exploring auditory simulation in the womb, and another study exploring the effects of hyperemesis and smoking on the fetus. At inspection, we saw that the service was currently involved in a study exploring fetal taste preferences. They were also due to assist with an upcoming study exploring the effects of maternal anxiety and depression on fetal neural development.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Good

Updated 9 September 2019

We had not previously inspected this service. We rated safe as Good because:

  • 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 understood how to protect patients from abuse and the service had systems to do so.

  • The service had suitable premises and equipment and looked after them well. The environment promoted the privacy and dignity of women using the service.

  • Staff completed and updated risk assessments for each patient. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • There were clear processes for staff to raise concerns and report incidents. Staff understood their roles and responsibilities to raise concerns and record safety incidents. Lessons learned were shared with the whole team and the wider service.

Effective

Updated 9 September 2019

We do not currently rate the effective domain for diagnostic imaging services. However, we found:

  • The service used current evidence-based guidance and good practice standards to inform the delivery of care and treatment.

  • Referral pathways to other agencies were in place for staff to follow to benefit patients.

  • 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 had the skills, knowledge and experience to deliver effective care and treatment; and staff of different disciplines worked together as a team to benefit women and their families.

  • Staff understood the importance of obtaining informed consent, and when to assess whether a patient had the capacity to make decisions about their care.

Caring

Outstanding

Updated 9 September 2019

We had not previously inspected this service. We rated caring as Outstanding because:

  • Staff cared for patients with compassion. We observed staff were warm, kind and welcoming whey they interacted with women and their companions. There was significant feedback from patients, which was overwhelmingly positive, and confirmed that staff treated them well and with kindness.

  • Sonographers took time explaining procedures to women before and during ultrasound scans, left adequate time for patients and their companions to ask questions, and provided detailed explanations, and accompanying written feedback. Scan assistants acted as chaperones during ultrasound scans to ensure women felt comfortable and received optimum emotional support.

  • Staff provided emotional support to patients to minimise their distress. Emotional and bereavement guidelines and patient information was available; and staff received training to deliver difficult news and offer emotional support. Although not practising under the qualification at the location, there was access to a registered midwife who specialised in bereavement. The service benefited from a dedicated ‘quiet room’, which could be used if women and their companions had received difficult news.

  • To help ensure good standards of communication, scan assistants periodically assessed sonographers for their quality of customer care and service, standard of communication, and overall customer experience.

  • The Window to the Womb service at the location worked alongside a local charity to hold quarterly ‘meet the mummies’ tea and coffee mornings for new mothers who had used the service to meet each other. Staff had also facilitated special events for service users; for example, gender reveals and engagement proposals.

Responsive

Good

Updated 9 September 2019

We had not previously inspected this service. We rated responsive as Good because:

  • The service planned and provided services in a way that met the needs of local people. The environment was appropriate for the service being delivered, patient centred, and accessible to all women.

  • Key information about what different ultrasound scans involved were available on the service’s website and could be accessed in any recognised world language. The website also offered a ‘read out loud system’ to allow the visually impaired to gain information with ease. The service had contracted a telephone interpretation service, for staff to use during appointments with non-English speaking women. All staff had received mandatory equality and diversity training.

  • Women could book their scan appointments in person, by phone, or through the service’s website. The franchise had also developed a secure smart device application; which had a booking facility. There were very low rates of non-attendance (less than 1%). If a woman suffered a miscarriage before their appointment, staff would refund the deposit payment immediately.

  • The service treated concerns and complaints seriously, and had effective systems to investigate them and learn lessons from the results, and share these with all staff. Patients could contact head office or an independent dispute resolution service, if they felt their complaint had not been satisfactorily resolved by the registered manager.

Well-led

Outstanding

Updated 9 September 2019

We had not previously inspected this service. We rated well-led as Outstanding because:

  • Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development and succession planning. The registered manager had a deep understanding of issues, challenges and priorities in their service, and beyond.

  • The registered manager promoted a positive culture, creating a sense of common purpose based on shared values. Leaders strived to deliver and motivated staff to succeed. Staff at all levels were proud of the service as a place to work and speak highly of the culture.

  • The service had systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected. Leaders regularly reviewed how the service functioned and ensured that staff at all levels had the skills and knowledge to use systems and processes effectively. The service used local audit and key performance data to monitor and improve service quality, and safeguarded high standards of care by creating an environment for excellent care to flourish.

  • The service had policies and procedures in place to promote the confidential and secure processing of information held about patients. The information used in reporting, performance management and delivering quality care was consistently found to be accurate, valid, reliable, timely and relevant.

  • There were consistently high levels of constructive engagement with staff and people who use services. The service engaged well with women, staff and the public to plan and manage appropriate services and collaborated with partner organisations effectively.

  • There was a fully embedded and systematic approach to improvement. The service was committed to improving services by learning from when things went well or wrong, and promoting training, research and innovation.

Checks on specific services

Diagnostic imaging

Outstanding

Updated 9 September 2019

Window to the Womb (Chester-le-Street) is an independent healthcare provider offering antenatal ultrasound imaging and diagnostic services to self-funding or private patients over 16 years of age. The service offers an

early pregnancy clinic (from six to 15 weeks of pregnancy), and a later pregnancy clinic (from 16 weeks of pregnancy).

Depending on the type of scan performed, these might involve checking the location of the pregnancy, dating of the pregnancy, determination of sex, and fetal presentation at the time of appointment. Patients are provided with ultrasound video or scan images, and an accompanying verbal explanation and written report.