Ramsay Diagnostic UK provides diagnostic imaging services to Ramsay Health Care Hospitals across England. The service is part of the Ramsay Health Care Global group and managed from offices based in London and Bedford.
The service provides mobile computerised tomography (CT) and magnetic resonance imaging (MRI) to 18 Ramsay hospitals on a scheduled basis. There are three CT scanners and eight MRI scanners.
We inspected this service using our comprehensive inspection methodology. We carried out short notice inspections on the 9 April and 7 May 2019.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
Services we rate
This was the first inspection of this service using this methodology.
Summarise:
We rated it as Good overall.
We found the following areas of good practice:
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
- The service managed infection risk well. Staff kept equipment and the premises clean. They used control measures to prevent the spread of infection. The service had suitable premises and equipment and looked after them well.
- Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
- The service provided mandatory training in key skills to all staff and made sure everyone completed it. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
- The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
- The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. 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 provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
- Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
- The service made sure staff were competent for their roles and staff worked together as a team to benefit patients.
- Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the service policy and procedures when a patient could not give consent.
- Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress. Time was taken to explain the procedure and staff encouraged questions. Staff involved patients and those close to them in decisions about their care and treatment. All discussions around the reason for the investigation were completed prior to the appointment. Referring consultants explained the rationale for investigations.
- The service planned and provided services in a way that met the needs of local people and the service took account of patients’ individual needs.
- People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
- The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
- Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care. Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
- The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff.
- Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
- The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish. The service had effective systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
- The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
- The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation.
However, we also found the following issues that the service provider needs to improve:
- We saw that staff did not use a sterile surface for preparing cannulation equipment and did not have a clinical trolley for use when administering contrast media. This was escalated during inspection, and clinical trolleys installed and disposable sterile kits for cannulation were implemented.
- Regulations IR(ME)R regulations. IR(ME)R regulations were changed in January 2018. Posters were out of date. This was escalated to the senior management team who informed us that these had been provided by the external provider, and they would contact them and request the posters to be amended.
- Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. See details at the end of the report.
Heidi Smoult
Deputy Chief Inspector of Hospitals (Central Region).