25 Harley Street

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. Leaders had systems for identifying and responding to deteriorating patients in the department. Children and young people received treatment and care to reduce the risk of avoidable harm, which included following safety standards and safety checks prior to entering the scanning areas. There were safety processes arranged before procedures started, with staff working together to ensure the right patient had the correct imaging. Children and young people were safe from neglect, abuse and discrimination. Patients and their guardians gave informed consent prior to procedures.

This was the first time we have rated this key question. We have rated it as good. Children and young people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff. 

The service managed patient safety incidents well. Staff we spoke with told us they recognised and reported incidents and near misses in line with the local procedure. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. 

The service had a current patient safety incident response policy, which outlined the provider’s approach to a patient safety incident and referenced national guidelines. The policy listed the updates that had been made, and it was clear to staff what had been updated. It had a review date and included an equality impact assessment which had been considered before the new policy was ratified. 

The service had not recorded any incidents in the last 12 months involving children and young people . However, we saw evidence of other incidents being investigated, and action taken to reduce the risk of recurrence or affecting care for children. In the last 12 months, 3 incidents had been reported in the imaging department. The system for managing incidents was electronic. Staff knew how to raise a concern and were able to do so, this was reviewed by the director of clinical services (DCS). We reviewed the 3 reported incidents and found that they had been investigated, and learning identified and shared with staff in staff meetings and via newsletters. For example, one incident identified information on a referral letter was not sufficient under the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R). Learning was shared with radiographers and administrators who were reminded to review referrals before imaging took place and to obtain a new request if it had not been completed to the standard required. All incidents were recorded in the incident log which detailed the incident and action taken as a result of learning identified. 

The director of quality and risk met with the director of clinical services (DCS) weekly and reviewed all open incidents and discussed what actions were in progress. The outcome of this meeting was reviewed at the monthly integrated governance meeting (IGM), where the timeline of an incident was reviewed. The meeting minutes and quality report for the IGM demonstrated that incidents and complaints were reviewed and heads of department were responsible for cascading learning to teams via department meetings. The quality report identified themes and reviewed the top 3 incident categories. The data was broken down to for managers to understand where in the department the incident occurred or complaint related to. The data showed between April to June 2026 (Q2) no patient harm or adverse diagnostic outcomes were identified. Leaders told us this meeting provided an opportunity for learning from across all the provider’s locations including from incidents at other locations. 

There had been zero reported never events in the preceding year. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed. Staff we spoke with knew what never events were reportable.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. There had not been any repeated themes or trends in the year prior to our assessment.

Staff we spoke with knew how to report risks and felt confident to do so. They told us they were supported by senior leaders and received individual feedback following investigations. Staff understood the duty of candour and told us they would speak with the young person and their family in an open and transparent way giving patients and families a full explanation if and when things went wrong.

The provider recorded 25 complaints across 2 outpatient locations in the last 12 months, 1 of which was a patient of the diagnostic services at this location, however they were not a child or young person. The complaint was not about clinical delivery and was investigated in line with the complaints process and resolved. 

The service worked with children, young people and their families and healthcare partners to establish and maintain safe systems of care, and safety was monitored using appropriate tools. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

Safety and continuity of care was a priority throughout the patient’s care pathway. Children and young people were assessed prior to diagnostic imaging, and all images were based on a formal request from a clinician in line with the ionising radiation (medical exposure) regulations (IR(ME)R) 2017. Patients were referred for imaging by clinicians working within the provider’s locations for example their outpatient centres and hospital and general practitioners. The service did not offer emergency scans, and all imaging was by pre-arranged appointment, including appointments made on the day. 

There were procedures in place to identify and treat deteriorating patients. All staff received basic life support training and records demonstrated 100% compliance. Radiographers also received immediate life support training for paediatric patients. Compliance was 95% which achieved the service’s target of 85% of staff trained. Radiographers and radiology healthcare assistants (HCAs) received training in National early warning score (NEWS2), at the time of our inspection data demonstrated 100% compliance with this training. NEWS2 is a nationally recognised tool used by clinicians to assess patients and determine if they are deteriorating. Paediatric early warning score (PEWS) is a nationally recognised tool used by clinicians for assessing paediatric patients to determine if they are deteriorating. Staff received training in PEWS as part of the ILS training.

The admission criterion for children and young people was detailed in the provider’s outpatient service criteria policy. The criteria set out which patients the service could not treat as they were unable to meet their individual needs. For example, the service was an ambulatory service and did not see acutely unwell patients. The referring clinician assessed the patient to make sure they were well enough for the service, as the service did not provide diagnostic imaging for emergency care. Leaders told us the service did not accept patients under 18 years old for a DEXA scan or 8 years old for an Xray, however this was not detailed in the outpatient service criteria meaning staff might not be aware of the age limits. Senior leaders told us the service did not have a definitive lower age limit for paediatric patients, and this was assessed on an individual patient basis with input from parents and guardians. However, we did not see evidence of the individual assessments being completed at the time of the inspection. We were told the age of the patient was checked against the referral to ensure the child or young person were assessed to meet the criteria for scanning. The criteria stated all children, and young people must be flagged to the lead paediatric nurse and assessed as appropriate by trained staff before being accepted into the service meaning all patients were assessed by someone trained in the care of children and young people.

There were systems and processes to ensure the correct patients were treated throughout the patient journey and they only received the scan which was intended. We did not observe staff speaking with children and young people and their families before the scan to confirm who they were and why they were there as there were no children and young people booked into the service on the day of the assessment. Staff told us they would speak with the child, young person and their guardian to check their information. The children and young person’s referral pathway detailed the checks that would take place, including confirming the patients details at different stages with the child, young person or guardian, for example at reception when they first arrived and during pre-examination safety checks.

Risk assessments were carried out for all patients when they attended the department. Patient questionnaires were completed prior to the procedure taking place, these included asking if a patient was pregnant. Pregnancy screening was completed for girls aged 12 and over and any child under 12 years old where menstruation had started. If a patients’ answer indicated they were unsuitable for a scan, staff would discuss this with the patient and their guardian. 

Patient records were a mixture of electronic, and paper based and were kept securely. Referrals on the day were paper based and scanned on to the patient’s record at a later date. 

Staff could access interpreting services for patients. This could be arranged in advance when the appointment was being booked or on the day to ensure patients and their guardians could understand were communicated with in a way they understood. 

The service worked with children, young people and their guardians, and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff understood how to protect children and young people from abuse and the service worked well with other agencies to do so. Staff received children's safeguarding training. The level was dependent on their role and outlined in the safeguarding policy. All staff received level 1 and 2 safeguarding children. Data showed 87% of staff had completed their training which met the providers target of 85%. All registered clinical staff received level 3 safeguarding children training. At the time of the inspection the compliance rate was 75% which was one member of staff who had yet to complete their training. This staff member had the training booked a month after the inspection. To mitigate the risk associated with this, the staff rota ensured there was another level 3 trained clinician on every shift and the paediatric lead and director of clinical services who had completed level 4 children’s safeguarding and was the safeguarding lead was onsite every day. The service had access within the large provider network to a level 5 trained safeguarding lead via telephone if needed. 

We observed posters displaying the names of safeguarding leads across the service including their contact details. This ensured staff had access to the contact details of the safeguarding leads who they could call for advice and support. 

The safeguarding children and young people policy was in date, had version control and reflected the national guidance. The policy detailed the level of training required by role and the frequency training should be updated. The management of missed appointments was detailed in the safeguarding children and young people’s policy. The term “was not brought” was used when a child or young person did not attend as expected. The process for following up on missed appointments was detailed for staff including that all conversations were documented in the patients notes and that staff must complete the “was not brought” form.

Staff we spoke with knew how to make a safeguarding referral and who to inform if they had concerns. In the last 12 months the service had not made any safeguarding referral. Leaders told us about the last referral they made which identified good practice among staff. Staff identified concerns that might not have been immediately obvious and reported in line with the safeguarding policy.  

All staff were required to complete a disclosure baring service (DBS) check prior to starting work at the service. At the time of our inspection data showed all radiology staff were 100% compliant. As per the providers policy, staff were required to renew their DBS check every 3 years. There were 4 members of staff who were currently being processed for a new DBS check before their existing one was out of date.

The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet children and young people’s needs which was safe, supportive and enabled patients to do the things that mattered to them.

The service worked with children and young people to understand and manage risks.  The treatment and care met patients' needs in a way which was safe and supportive. Staff told us they spoke with children and young people when trying to position them prior to the scan or Xray. This ensured the best possible image was taken and reduce the risk of an unclear image. Parents could remain with children wearing the appropriate safety equipment to help their child remain in position and create a clear image. If the Xray needed to be repeated, this would expose the patient to unnecessary levels of radiation. 

The service operated pause and stop which is a key patient safety measure in the imaging process. The standard operating procedure (SOP) listed the key areas of practice to reduce the risk of error. Staff we spoke with were aware of pause and stop and understood it was an important safety measure for every patient. 

The service carried out comprehensive risk assessments to help protect staff and patients from ionising radiation exposure. The service contracted an annual report carried out by the radiation protection adviser (RPA). This included an action plan with mitigations in place such as ensuring that patients and staff maintained a safe distance from the source of radiation.

All radiographers and radiology HCAs completed radiation protection training. At the time of the inspection the service was 100% compliant, meaning all staff were appropriately trained to understand the risk associated with ionising radiation.

The service did not have an emergency department. If a child or young person deteriorated and needed a higher level care, the service would call emergency services for an immediate transfer to a local NHS hospital. To provide emergency care while waiting for emergency services to arrive there were resuscitation grab bags which were easily accessible to staff in the event of an emergency and there were 2 resuscitation trolleys located in the clinical areas which included equipment suitable for children and young people. The service had a Resuscitation of children and young people policy which stated when a child was in in the outpatient centre, which included the service, at least one member of staff on site should be paediatric immediate life support (pILS) trained and that all staff granted practicing privileges must complete annual paediatric basic life support training (pBLS). This meant there was immediate support for deteriorating paediatric patients.

Staff completed a paediatric assessment tool for all patients under the age of 18. This tool required more information, so it was clear whether a paediatric nurse had to be in attendance at the time of the appointment, for example, if a child had additional medical needs such as type 1 diabetes. All forms were sent to trained staff to be reviewed before an Xray could proceed. 

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care.  Where they were unable to do so, they mitigated the risks. 

The design, maintenance and use of facilities, premises and equipment kept people safe and staff were trained to use equipment. The service had 1 imaging suite for Xrays. We reviewed the maintenance agreements and found that the equipment was regularly reviewed. The Xray service report was submitted in February 2026 and found no concerns. The service had an equipment replacement plan showing the year they expected to replace equipment.

The service had a contract in place with a radiation protection adviser (RPA) who offered support 24 hours a day 7 days a week. They assisted in the assessment of the environment and signed off areas as compliant with IR(ME)R. Screens were used to ensure staff safety when taking Xray’s. 

Staff wore lead aprons to protect themselves from radiation. Parents and carers were given these aprons to wear if they needed to be present. The aprons were audited annually, audits reviewed showed the equipment had been signed off as safe for use. Staff could refer to the standard operating procedure which advised staff to report any equipment failure to area managers. At the time of the assessment staff had not needed to raise any concerns. 

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. For example, the lead apron audits were carried out quarterly identifying if any action needed to be taken and staff were made aware the aprons were safe to use. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective processes for ensuring repair of or obtaining a replacement for broken or missing equipment. 

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the provider’s policy. Hazardous substances were stored safely and information about products was available to staff. 

The environment used for patient care reduced the risk of patient harm, and included for example, safe flooring and handrails. Fire safety equipment was available, and we observed fire extinguishers throughout the building. Fire exits were clear and free from obstruction.

The Xray suite did not have a panic alarm for staff for staff to obtain assistance in the event of an emergency. Leaders told us that staff could dial the internal emergency number from the telephone on the desk. However, as the desk was small the telephone was on a shelf which might impede a call being made in an emergency in a timely manner. There was an emergency call cord which alerted the nurses station that support was needed which mitigated the risk. 

The waiting area did not have a separate seating area for children and young people. The waiting areas were spacious and patients were not sitting closely together. Children and young people had to be accompanied by a parent or guardian at all times so they were not left alone in the seating area. The Xray paediatric pathway stated that once the child or young person had checked in at reception radiographers were informed and patients were called into have the Xray as early as possible to minimise the wait time.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

The service had enough staff with the right qualifications, skills, training and experience to keep children and young people safe from avoidable harm and to provide the right care and treatment. Leaders told us the service had a paediatric nursing lead who was accessible in the outpatient centre and a paediatric nurse was available when children were on the premises. Staff requirements were reviewed with the Director of Clinical Services, Outpatient Clinical to ensure children were treated by appropriately trained staff. Radiographers did not need have specialist paediatric training in line with The Society and College of Radiographers as radiographers were expected to be competent with patients from birth to adulthood. 

Staff included 5 whole time equivalent (WTE) radiographers and 2 WTE radiology healthcare assistants (HCA). The service had access to 10 bank radiographers who were used based on the demands of the service. These staff were deployed across all London locations for the provider depending upon their specialism. The service had 2 vacancies for additional radiology HCAs and were currently recruiting to these roles. During the assessment the actual staffing levels were as planned and we were told the service would book appointments according to their capacity. However, staff told us bank staff were used regularly and overtime was to fill rotas. This meant there was limited opportunities for clinical development including training in other specialist areas. 

New staff and bank staff had a full induction tailored to their role before they started work. Managers supported staff to develop through annual appraisals and regular meetings to discuss their performance and objectives. Staff told us they found these useful and was a chance for them to discuss development opportunities and how they could manage this around the staffing rotas. 

The service did not directly employ radiologists or other medical staff and had consultant radiologists working under practising privileges. There was a practising privileges policy in place which outlined how medical professionals could obtain practising privileges and the internal process to follow. This included confirming professional registrations and qualifications and that individuals only operated in a set scope of practice. The medical advisory committee (MAC) reviewed and signed off practising privilege applications meaning there was senior oversight of who was granted practising privileges. The care of children and young person policy set out that a review of those with paediatric practising privileges should take place bi-annually and permissions granted inline with the scope of their NHS practice. Paediatric activity was evaluated alongside their appraisal to ensure continuing professional development. The granting of paediatric practising privileges had to be reviewed by the children and young person advisory committee alongside senior leaders before a decision to approve practising privileges could be signed of at MAC. 

Staff received mandatory training, data showed that the service met their target of 85% as over 85% of staff had completed their mandatory training in each module, except for level 3 safeguarding where mitigation was in place. Radiology specific training had been completed by 100% of staff the training was applicable to. Radiographers received refresher training on using the equipment, this included information about ionising radiation regulations and what this meant for staff safety. 

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection, prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean. The department was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. We observed staff clean equipment after patient contact in line with the provider’s IPC policy.

There was a provider infection, prevention and control (IPC) policy and supporting guidance that was accessible to staff. This included information about audits that took place and the uniform dress code.

There was a programme of infection prevention and control audits including for example, the hand hygiene, personal protective equipment (PPE) and clinical waste audits. We reviewed the last 3 audits and found there was 100% compliance.

The service performed well in housekeeping audits. We reviewed the audits from February 2026 and found that the service was 100% compliant. The audit included an action plan to list any actions required, the action owner and updates until the action was closed. At the time of the inspection there were no open actions. 

Staff adhered to the provider’s uniform policy. We observed nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for effective hand washing.  

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.