East Anglia Ultrasound Services

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• 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

This means 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.

At our last assessment we did not rate this key question. At this assessment, this key question has been rated requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the regulation for person centred care.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Quality Statement Score: 2

Description: We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure a fully holistic approach when assessing needs.

People’s needs were assessed using a medical questionnaire, completed by the patient or their carer before each appointment. The questionnaire included questions about medical conditions, medications, allergies, previous hospital stays, scans, and blood tests. We reviewed 5 patient records during our assessment and found that the questionnaires had been fully completed before each appointment. This helped ensure that patients’ needs were regularly reviewed.

The service did not always ensure a fully holistic approach when assessing patient needs. The medical questionnaire did not include questions about accessibility and communication needs. Staff told us that as a result, there had been occasions where they had not been aware of a patient’s additional needs until they arrived for their appointment. This impacted on staff’s ability to prepare or make necessary adjustments ahead of time. Following our assessment, leaders stated that they had updated the questions included in the medical questionnaire.

Quality Statement Score: 1

Description: We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 1. The evidence showed significant shortfalls. Nationally recognised guidance and quality and safety standards were not consistently implemented within the service. There were no audits being conducted to assess staff compliance with national guidance.

Leaders did not ensure consistent implementation of nationally recognised guidance and standards relating to quality and safety within the service. For instance, there was no established process for conducting routine quality and safety checks on ultrasound equipment. This was not in line with the Society of Radiographers (SoR) and British Medical Ultrasound Society’s (BMUS) ‘Guidelines for Professional Ultrasound Practice’ (2023). In addition, refillable gel bottles were used within the service, which did not comply with the 2021 National Patient Safety Alert ‘The safe use of ultrasound gel to reduce infection risk’. Furthermore, most staff had not completed training on supporting patients with learning disabilities and autism. This falls short of the statutory requirement introduced by the Care Quality Commission in 2022, for all registered health and social care providers to ensure staff receive appropriate training in these areas. Following our assessment, leaders stated that all staff had completed training on supporting patients with learning disabilities and autism.

Leaders had not ensured that clinical protocols provided staff with clear, comprehensive and up-to-date guidance for performing the full range of examinations offered by the service, or for making appropriate patient referrals. This was not in line with national guidance (SoR and MBUS ‘Guidelines for Professional Ultrasound Practice’ 2023). For example, protocols were missing for some ultrasound examinations provided by the service. Where protocols did exist, they often lacked essential information, did not include review dates, or were overdue for review. As a result, staff may have been relying on outdated or incomplete guidance, increasing the risk of inconsistent or unsafe practice. Following our assessment, leaders stated that protocols and referral pathways had been reviewed and were in the process of approval.

Although service policies were based on national guidance, they did not always reflect the services provided. For example, the service’s Ultrasound Policy and Procedure stated “competence in carrying out ultrasound scans will be reviewed annually with a competency assessment” and “ultrasound reporting must be subject to quality assurance (QA),” in line with SoR and MBUS ‘Guidelines for Professional Ultrasound Practice’ 2023. However, at the time of our assessment, no staff competency assessments had been completed and there was no QA process in place for ultrasound reporting. This demonstrated a failure to implement key safety and quality measures outlined in the service’s own policies.

At the time of our assessment, there was no evidence that audits had been carried out to monitor staff compliance with national guidance.

Quality Statement Score: 3

Description: We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people.

During our assessment, we observed positive interactions among team members, and staff spoke positively about teamwork within the service.

Staff generally worked across healthcare disciplines and collaborated with other agencies to support patient care. Staff communicated with GPs or other healthcare professionals to share reports and images, with patients’ consent. Leaders had also developed relationships with local GP practices and early pregnancy units (EPU). However, the service did not have referral pathways or contacts for fetal medicine units (FMU). As a result, when concerns were identified through Non-Invasive Prenatal Testing (NIPT), staff referred patients back to their midwife for ongoing management, rather than making a direct referral to an FMU. This meant patients may have experienced delays in accessing specialist fetal medicine input. However, staff were able to offer access to a geneticist or genetic counsellor through the service’s contractual arrangement with a pathology service. Leaders noted that efforts had been made to build relationships with FMUs, but they were advised that referrals must be made by midwives.

The service had a contractual arrangement with a pathology service for NIPT and other blood tests, which included a process for tracking samples and receiving results. Leaders had a named contact at the pathology service, to address any issues or concerns. However, they did not hold regular meetings with the provider or formally review performance data. As a result, leaders could not be confident in the quality, timeliness, or reliability of the pathology service. Leaders stated that issues with the pathology service were rare and were promptly resolved when escalated. Leaders also stated that they were able to monitor the processing of blood tests through a portal, which was accessible 24 hours a day.

There were no staff meetings in place. Regular staff meetings could have supported multidisciplinary discussions and shared learning. Instead, the service relied on a communication book for staff to share updates with each other. Leaders introduced staff meetings following our assessment.

Quality Statement Score: 3

Description : We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard. 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, reduce their future needs for care and support.

Staff supported patients to live healthier lives. For instance, information leaflets were available in the waiting area for breast awareness and screening, as well as nutrition and lifestyle advice for menopause. Staff could also refer patients to partner organisations for further support, including a menopause clinic as appropriate.

The service offered health scans, which could help with the detection or exclusion of common health issues.

Quality Statement Score: 2

Description: We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 2. The evidence showed some shortfalls. Leaders did not carry out a programme of repeated audit to monitor the effectiveness of care and treatment.

Leaders did not implement a structured programme of regular audits to assess quality of care provided. This included the absence of audits for ultrasound examinations and corresponding reports. According to current professional guidance from SoR and BMUS (2023) it is recommended that 5% of all examinations and reports be reviewed. Without such audits, there was a risk that issues related to image quality and report accuracy may go undetected, potentially compromising patient outcomes. Leaders began to implement an audit programme following our assessment.

Leaders actively sought patient feedback regarding the outcomes of their scans. The service sent a feedback survey to all patients after their appointment, and staff followed up with phone calls when appropriate. Patients expressed high levels of satisfaction, reflected in the strong positive responses. Leaders closely monitored patient feedback to identify areas where patient outcomes could be improved. Leaders produced an annual presentation with a detailed analysis of patient feedback to support service development.

Leaders monitored data on the numbers of returning patients, patients who were offered a free repeat scan, and those who were offered an NHS scan. In 2024, 50.6% of patients returned to the service, while only 0.7% needed a free repeat scan. Only 0.9% of patients needed to be offered an NHS scan in 2024. This data demonstrated that people who used the service experienced positive outcomes.

Staff used technology to support patients effectively. For example, for prompt access to blood test results.

Quality Statement Score: 3

Description: We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff demonstrated a general understanding of the importance of informed consent, even if they couldn’t always clearly explain the specific requirements of legislation and guidance such as the Mental Capacity Act 2005. Staff took all practical steps to enable patients to make their own decisions. Staff took time to explain procedures, such as scans or blood tests, and responded to patients’ questions, before proceeding. They adapted their communication approach based on each patient’s individual needs.

When patients lacked the capacity to make decisions, staff recognised the need to consult individuals with power of attorney and to make decisions in the patient’s best interests. Staff also reported that if they had concerns that they may not be able to meet the needs of a patient who lacked the capacity to consent to the scan or test, they could cancel the appointment and refer the patient to another provider.

Although staff were not always able to clearly describe the principles of Gillick competence, they understood that children between the ages of 16 and 18 had varying levels of maturity and understanding, which impacted on their ability to consent to care and treatment. Staff said that they would adapt their approach based on each young person’s ability to consent.

Staff completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards as part of adult safeguarding training.

Staff obtained consent for care and treatment in line with legislation and guidance. Patients signed consent forms before their appointments, including consent to share information and results with other healthcare professionals if necessary. We reviewed 5 patient records during our assessment and found that consent forms had been completed appropriately. However, managers did not formally monitor the consent process, for example, through audits. This limited the registered manager’s ability to identify and address potential gaps in staff compliance.