Window to the Womb

On this page

• 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.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We saw risk assessments for people using the service which covered before, during and after the appointment. The risk assessment checked the suitability of the person for the booked service and the service had a clear inclusion and exclusion criteria. There were clear actions for staff to follow if an issue was identified.

Information was provided to people using the service, for example, the accuracy and limitations of the selected scan or regarding emergency symptoms and the need for this scenario to be managed through the NHS urgent/emergency pathways. Staff provided examples of patients referred into local NHS services and knew how to act swiftly in emergency situations. Patients requiring referrals were given their scan reports to share with NHS midwives or clinicians to ensure continuity and clarity of care. We saw reports were clear and concise. Where necessary reports detailed what had been identified with a recommendation to seek further assessment in hospital or with the patient’s GP. Staff told us a clinical lead sonographer was available to provide a second opinion or advice, where needed.

The service used an electronic booking system which allowed staff to identify repeat bookings. Staff had clear guidance on scan frequency and would speak to people regarding reasons for appointments if multiple appointments had been made in a short space of time.

Patients were asked about latex allergies in the pre scan questionnaire, and we observed the sonographer checked this again prior to scanning. We observed staff checking the patients were comfortable during their scans.

The service planned and delivered people’s care and treatment with them, including what is important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider had responsibility for reviewing and updating policies in line with NICE guidance and evolving best practice. All policies we saw were current and in date. Staff told us they could access policies in both paper and online formats. The policies and guidance developed by the service were clearly indexed and methodically organised. Updates to policies were cascaded simultaneously across all clinic locations to ensure consistent care delivery. Updates were discussed during team meetings and daily huddles. Staff told us they were given adequate time to review changes and confirmed they signed off to acknowledge understanding.

We spoke with patients using the service and no concerns were raised about the service’s ability to deliver good, evidence-based practice. Staff assessed and met peoples’ needs according to the scan being carried out. For example, water was offered to those who needed a full bladder. The clinical lead sonographer conducted an annual review and assessment of sonographers’ skills. We saw detailed records documenting the assessment and grading given, including observation of multiple scans, the identification of any training needs and the feedback provided. Managers conducted monthly record audits which detailed any findings, actions required, target dates and evidence required for completion. Sonographers had opportunities for peer review of scans with other sonographers across the franchise and held strong relationships with local colleagues.

We saw the annual audit schedule which included physical clinic inspection, health and safety, infection control, emergency planning, operational delivery, policies and procedures, client feedback, and staff performance including sonographers. Action plans with completion timelines were developed in response to audit findings. We saw evidence that the clinic was compliant in all areas.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked consistently well together to provide person-centred support and care throughout their journey. They allowed time before the clinic to communicate any concerns about people attending the clinic. Staff communicated well with people and would ensure people did not attend unnecessarily for example, reminding people to bring ID and their pregnancy records. We saw positive communication between managers and staff, and team collaboration was evident across the service.

People using the service felt the team worked and communicated well together. They appreciated staff understanding of their needs and wishes. Scan assistants worked alongside sonographers in the scanning room, each understanding their role in the process. We observed the staff supporting each other and building a good rapport with the patients and the people with them.

Managers told us the service participated in a franchise network collaboration, which consisted of bi-annual meetings, with 55 clinics attending. The service also participated in regional leadership audits and peer support was available via online portals. Managers described strong links with local GPs and NHS services and established referral pathways to local hospitals. Staff were able to articulate a clear process for handing over information to the local NHS services. Patients were only referred into the NHS when it was appropriate. It was clear from records we saw, when patients required transfer of care to NHS services the service communicated effectively and worked collaboratively with NHS colleagues.

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.

Posters were displayed and leaflets available promoting health awareness. This included information on mental health and anxiety, breast and ovarian cancer awareness and men’s health. Posters providing domestic abuse support were displayed on toilet doors.

People were able to identify individual concerns and health conditions at the point of booking and during their time with the sonographer. The sonographer was able to direct people to appropriate support services.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The registered managers conducted regular clinical and environmental audits, focusing on key performance indicators (KPIs) such as incidents, inaccuracies, complaints, and scan times. These KPIs were set by the franchiser and used to benchmark performance against other clinics. The clinic consistently met scan targets. Although the service had targets, people using the service consistently reported feeling valued and respected.

The service clearly fostered a strong culture of continuous improvement. Data was used to monitor outcomes and plan for improvements. The service encouraged feedback from people and monitored the number of complaints; any themes were identified. Monthly team meetings included discussion of complaints and audit results. Findings were used to drive improvements and consistently achieve positive outcomes for people. Peer review was embedded in practice we saw evidence that sonographers reviewed each other’s scans monthly. This process was underpinned in the Clinical Governance and Standards Policy which clearly detailed peer review frequency and responsibilities and second opinions. The policy also provided information on collaborative learning and mentorship, shared knowledge and a sign off process for new sonographers. Staff were clearly passionate about their roles and would strive to help the patient have the most positive experience possible. Marketing materials emphasised care and compassion, both online and in-person.

The service had a comprehensive Ultrasound Scanning Manual for sonographers which clearly detailed the scope of their role, what they look and don’t look for.

Digital scan images were stored securely and shared for further review. This ensured high standards in equipment use and image quality.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service provided information on their website detailing the nature of scans available and the timescales at which it was appropriate to book for each scan. Staff ensured all patients received comprehensive information prior to their scan and took all practical steps to enable patients to make their own decisions. Information including a technology and safety briefing, terms and conditions, scan limitations, a crib sheet outlining what was and wasn’t included in the scan package, and details regarding medical records, consent, and data usage. A pre-scan questionnaire and declaration form required patients to confirm they were receiving appropriate pregnancy care and consented to information sharing with the NHS. Information was clearly displayed for an interpreter service available to patients where English was not their first language. This service was available in different forms such as over the phone, remote video and onsite interpreting. Written information was also available in other languages.

The website also provided clear information on the process for blood tests. Staff told us the laboratories used for blood testing would not process the request without completed consent forms.

All staff had completed training on the MCA and consistently applied its principles, including seeking consent and offering choices in line with MCA requirements. There was a comprehensive Informed Consent and Mental Capacity Policy in place with clear processes outlined for staff to follow.

Staff were able to describe the process for assessing capacity. Staff explained they would not carry out a scan or take bloods if a person did not have capacity to consent, although this situation had not arisen. Staff were knowledgeable about applying Gillick and Fraser guidelines appropriately. These guidelines help determine a young person’s ability to consent to medical treatment, with Fraser guidelines specifically addressing contraception and sexual health. The service only provided procedures for individuals aged 16 and over and maintained an up-to-date consent policy.

On arrival, patients signed a wellbeing report, which included questions about any history of anxiety, pain or bleeding. These details and ID checks were completed again in the scan room. Staff clearly documented consent in patient records. We saw evidence the service conducted quarterly audits on consent. Compliance was recorded with any actions required and feedback given. Compliance was consistently high.