Lakeside Medical Diagnostics

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a vision and a focus on providing a safe and responsive ultrasound service to service users.

Staff were positive about the service and expressed pride in working for the service.

The service collaborated with external partners to align its vision and strategy with local health economy plans. This helps to reduce patient waiting times in the local area. s.

The service fostered a caring and inclusive culture, staff told us they felt respected, supported, and valued. They remained focused on meeting patients’ needs and worked effectively to achieve positive outcomes for people they cared for.

However, staff reported that there were no team meetings until recently. Evidence showed meetings started on 28 January 2026. Often communication would be verbal or via personal messaging. Staff acknowledge it was hard to organise team meetings as everyone’s working hours were different but that it would be good to have one.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always demonstrate the skills, knowledge, experience and credibility to lead effectively.

The managers we spoke to demonstrate a strong understanding of the service and how it operated. However, they showed little knowledge of policies and governance.

Staff we spoke with were positive about the support they received from their manager but developmental opportunities did not arise as it is ‘just an ultrasound clinic.’

However, the service had a management structure in place with key lines of responsibility.

Managers were visible in the service and approachable for patients and staff. Staff reported managers were well respected, highly visible, approachable and supportive.

Managers were passionate about the services they led and worked collaboratively with their teams, fostering a positive, engaged, and cohesive working environment

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

The service did not have dedicated Freedom to Speak up Guardian. However, the manager told us they operated an open door policy and encouraged staff to speak with them or other senior colleagues if they had concerns.

The service had a Caldicott Guardian to oversee the appropriate use and protection of patient information.

Patients and carers had opportunities to give feedback about the service they received in formats that reflected their individual needs.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service promoted workforce equality, diversity and inclusion through established policies and staff completing the mandatory training module.

Staff that we spoke with did not raise any concerns about the inclusive working culture and said they were treated with respect and equality.

Staff were confident that concerns raised would be listened to. The staff we spoke with did not raise any concerns of unfair treatment, discrimination or harassment in the diagnostic imaging department.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. The servicey did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance was not consistent. On the provider website the services policies were out of date. On the day of the visit assessment we were informed a particular policy does not exists and cannot be found. It was found towards the end of the day without appropriate dates and authors. staff initially told us they did not have a policy and were unsure where it was held. The evidence provided in the data request showed some inconsistencies where some policies which had relevant dates and some others did not.

The registered manager reported an open‑door policy but had not held an all‑staff meeting. Data requests The evidence showed one meeting held at the end of January 2026. Minutes were recorded but there iwas no evidence that these were communicated to those who did could not attend.

A shared resuscitation trolley was available withing the building however, responsibility for the trolley rested with another provider. That provider undertook daily and weekly checks. The service did not demonstrate how it assured itself that these checks were completed and that the trolley was safe and ready to use.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The process of flagging urgent findings from ultrasounds was shared in an efficient manner to external providers. There was a policy in place to support this.

The service did not benchmark against other providers or collaborative working with other hospitals or departments to improve services.

However, managers engaged with external stakeholders such as commissioners.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

There was no evidence of benchmarking within the service.

Although the service had a succession and staff development policy, discussions with staff indicated there was no evidence of active staff or leadership development such as training courses, audits or continuous professional development (CPD).

However, there was evidence of efforts to improve services for patients through a recent patient survey.

The service also provided evidence of having a business continuity plan in place.