The Princess Royal Hospital

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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.

We have not previously assessed this key question for Diagnostic Imaging as a standalone service. At this assessment we rated effective as Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. There was a breach of regulation around turnaround times for some examinations.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed patient’s needs. Scans and X-rays were delivered in line with evidence-based, guidance, standards and best practice.

The service had an MRI and CT operational procedure and local safety rules. These had been reviewed in 2025 and were due to be reviewed in 2028. We found these were in date and reflected best practice. The service had local protocols for both CT and MRI, which had been approved for different pathways and were in date. The service had a named radiation protection supervisor and a named radiation protection advisor to access for advice. Staff were aware of who these individuals were.

Staff shared key information to keep patients safe when handing over their care to others. When a patient was having an inpatient scan following an operation such as a cardiac procedure, staff ensured relevant information was handed over when necessary.

Staff said patients did not routinely require pain relief. If this was required, it would be administered from the ward/department prior to attending radiology. Walk in patients would be advised on pain relief. Staff assisted patients into comfortable positions for imaging wherever possible.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. We saw notice boards displaying up to date guidance to staff.

Polices and processes took account of changes to the Royal Colleges guidelines and National Institute of Care and Excellence (NICE) guidelines.

The service monitored radiation doses to ensure doses were kept as low as reasonably possible. The service completed a yearly audit of patient doses against local and national diagnostic reference levels for all types of imaging. The results from these audits demonstrated patient doses were lower than diagnostic reference levels.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The service completed regular audits to monitor staff compliance with the latest guidance. These included clinical practice, documentation and quality, governance and compliance. The service demonstrated compliance based on its audit results completed in the last year. The service had a comprehensive compliance and quality assurance framework for the department, it ensured that the service captured accurate data around patient safety such as IR(ME)R and pregnancy checks, equipment safety and accuracy, staff competency and compliance. Most audits were ongoing, with significant activity and updates recorded for May 2026.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided staff with supervision meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development, and appraisal of their work performance. Managers ensured that staff had access to regular team meetings. However, many staff we spoke with told us that this was not always possible, due to workload, management availability and that often due to constraints within the service, team meetings were often cancelled.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Many staff told us there were great opportunities to further develop in role and all training was available at the trust. Managers ensured that staff received the necessary specialist training for their roles.

The service demonstrated good practice through the development of Radiology Events and Learning Meetings (REALMs), aligned to the Royal College of Radiologists’ standards. This approach aimed to embed a more consistent and structured imaging quality assurance process, supporting learning, improving practice and enhancing clinical outcomes.

We scored the service as 3. The evidence showed a good standard. 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.

Radiographers, radiologists and other professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff reported healthy working relations across staff groups. We saw and heard examples of effective team working which was based on mutual respect and trust.

Radiology staff worked closely with referrers to enable patients to have a prompt diagnosis and treatment pathway. If they identified concerns from scans, they escalated them to the referrer. This ensured staff could share necessary information about the patients and provide holistic care.

The service worked well with other departments in the hospital to provide an imaging service for outpatient appointments and inpatient. The service worked with local healthcare providers who were currently supporting their mammography services.

Staff shared information about patients at an effective safety daily huddle meetings within the team (for example, shift to shift). The teams had effective working relationships, including good handovers, with other relevant teams within the organisation.

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, reduced their future needs for care and support.

The service had a range of health promotion information available via the provider website. This included promoting mental health, stress awareness, international men’s health week and bladder cancer awareness.

The service had posters and information packs in the waiting area of the department. These displayed relevant information about health and safety associated with radiation and diagnostic scans. These prompted patients to ask staff for support if they had any questions. However, the information that was on display was all in English.

We scored the service as 2. The evidence showed some shortfalls. The service routinely monitored people’s care and treatment to continuously improve it. However, outcomes were not always positive and consistent to meet both clinical expectations and expectations of people themselves.

Leaders monitored waiting times for examinations and reporting turnaround, with an intention to update referrers monthly. While some pathways met or were close to targets, such as 2 week wait ultrasound and fluoroscopy reported within 1–2 weeks, overall performance was inconsistent. NHS England guidance states that no verified report should exceed four weeks following image acquisition; however, all outpatient plain X-ray examinations, including 2 week wait referrals, were reported at 5 weeks at the time of inspection. Waiting times for cardiac CT scans were significantly prolonged at 27 weeks, with total turnaround times of 29–30 weeks, with staff identifying limited cardiologist availability as a key constraint. Leaders had implemented a range of actions to improve performance, including outsourcing and insourcing arrangements, recruiting to the advanced practice radiographer reporting workforce, opening a community diagnostic centre, and deploying additional capacity such as a mobile MRI unit and targeted waiting list initiatives. These actions, supported by clinical prioritisation processes, had contributed to improvements in cancer pathways and reductions in long waits. However, reporting capacity remained fragile due to pressures within the radiologist workforce, particularly during periods of leave or sickness, and staff reported limited availability of radiologists to support training. As a result, MRI performance remained variable, particularly for cardiac pathways where waits exceeded 6 weeks. Overall, despite targeted mitigation and some improvements, ongoing delays and workforce constraints reduced assurance that diagnostic services were consistently meeting national standards.

Managers and staff undertook a comprehensive programme of repeat audits to monitor improvement over time, with findings used to drive changes in care and treatment. There were established rolling peer review processes for radiologists, reporting radiographers and sonographers, supported by a standard operating procedure for image quality monitoring. This included structured feedback on both suboptimal and exemplary imaging, with a formal action plan initiated where individuals recorded three instances of suboptimal imaging within a rolling year. The service completed a broad range of audits, including medicines management, clinical practice, documentation and quality, and had adapted the World Health Organisation surgical safety checklist to reflect local procedural requirements. Audit outcomes were generally positive, and where improvements were identified, action plans were developed and monitored. Managers ensured learning was shared through team meetings, newsletters and other communication channels, supporting staff understanding and contributing to improvements in patient outcomes.

Staff used recognised tools to support the early detection and response to clinical deterioration, contributing to patient safety and improved outcomes, and were able to reflect on emergency situations, including a case of anaphylaxis, where they acted promptly and effectively as a team and expressed pride in their collective response.

The provider considered health inequalities and took steps to ensure that outcomes across patients with protected characteristics were in line with the wider community.

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 took all practical steps to enable patients to make their own decisions. They followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the trust policies related to consent, mental capacity, deprivation of liberty and restrictive practice, as relevant.

Where possible, staff gained consent from patients for their care and treatment in line with legislation and guidance. Consent for MRI was sought and included discussion about the benefits, potential complications, the risks and alternative options. We observed staff seeking verbal consent before providing care or treatment. Patients were involved in decision making at all levels

Where specific requests had been made by patients for a same sex health care professional, this was discussed and provided whenever possible. Chaperones were provided if requested and we saw posters advertising chaperones in each area of the department.

Interpreters, including British Sign Language interpreters, were used to support patients to provide informed consent. However, staff reported challenges in consistently accessing face-to-face interpreters but could access telephone interpreters. The service had an up-to-date consent policy, and patients were provided with written information about the consent process and relevant treatment information prior to appointments, including guidance on seeking consent from young patients under 18.

Patients were sent an information leaflet explaining the MRI or CT procedure including what they needed to do prior to the appointment, when they arrived, the examination and results. Patients we spoke with confirmed they had completed a safety questionnaire and had given their consent for the procedure they had attended for.

Staff received and maintained up-to-date training in the Mental Capacity Act and Deprivation of Liberty Safeguards, were aware of how to access current policies, and demonstrated a clear understanding of how and when to assess capacity, including how to carry out and document assessments where required.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.