Meet Your Miracle- Coventry

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes, based on best available evidence. At our last inspection we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care did not always achieve good outcomes or was inconsistent.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us they asked if patients had any communication needs. We saw in the terms of agreement they said they could provide explanations where patients did not understand. There were appropriate referral pathways into the NHS to make sure that patients' needs were addressed. We saw an example of where the service were concerned about a patients mental health and spoke to the patients GP. We saw no evidence of discrimination when staff made care and treatment decisions. We did not see evidence of training for staff to support autistic people and people with a learning disability.

The service did not always deliver people's treatment in line with up-to-date national guidance and best practice. The policies available were brief, lacked detail required to inform staff of policy and procedure and did not always have the most up to date national guidance and legislation. For example, the confidentiality policy referred to the Data Protection Act 1998 rather than 2018. Staff were not able to easily follow policies as they were not accessible. In Chesterfield, to access policies, they had to email head office for them to be sent to them. We saw policies in Coventry clinic, but they did not have a date on them or a version number, so we were not able to ascertain if they were up-to-date. However, there were some local policies and procedures in place which were in line with current legislation and national evidence-based guidance from professional organisations, such as the NICE and the British Medical Ultrasound Society (BMUS). Following our assessment, a new policy booklet was updated including version numbers and dates. This had been printed and laminated in all locations for staff to refer to.

The service followed the `As Low As Reasonably Achievable' (ALARA) principles; this was in line with national guidance (Society and College of Radiographers (SCoR) and BMUS, Guidelines for Professional Ultrasound Practice (December 2023)). This meant sonographers used minimum frequency levels for a minimum amount of time to achieve the best result.

The service worked well across teams and services to support people. Where patients were referred to the NHS, the sonographers called the EPAU department to ensure they could be seen. Each patient was given their scan pictures and a summary of what the sonographer had seen to give to the EPAU staff. Staff at Chesterfield stated it was difficult at times due to the opening times at the local EPAU and had to signpost patients to emergency departments where EPAU was not open.

The service supported people to manage their health and wellbeing where able. The staff referred patients to local NHS hospitals where further support was needed. They also advised patients to continue to attend their NHS scans for appropriate diagnostic scanning.

The service did not always monitor the effectiveness of people’s treatment to continuously improve it. Sonographers took part in an assessment process to ensure the accuracy and quality of ultrasound scan images. We saw these were completed for 3 out of the 5 sonographers evidence was provided for within the last 12 months; 2 of them were completed early 2023. Where action was required, this was discussed. However, we saw only 1 check for each sonographer and therefore were not assured sonographers image quality was checked regularly to ensure learning and used for improvement. The service kept a record of women referred to NHS antenatal care providers. There were 24 referrals to EPAU for Coventry and 53 referrals to EPAU for Chesterfield in 2024. Summary of reasons included absence of a heartbeat, and no pregnancy observed but client sure of dates. They did not routinely follow up these referrals to monitor outcomes or review anomaly detection rates.

The operations manager told us they looked at all wrong gender scans and may bring the woman back for a re-scan. We did not see any wrong gender scans documented within Chesterfield or Coventry clinics as incidents. We were told this information was held at head office.

The service told people about their rights around consent. All patients were sent a terms of agreement when they booked their appointment. All patients had to sign this at booking or on the day of the scan; it was held within their record for 28 days. The terms of agreement described consent to the patient and what happened during the scan. We overheard a patient stating they did not want to consent to their pictures being used and queried the waver for NIPT. The consent within the clinic was completed on an electronic device. If a patient did not agree to sharing their images this was added to their notes and an alert was added to their system notes. When the patients had their scan, consent was implied as they had already signed their terms of agreement.