Archived: Ct Dent Ltd (London)

Updated 10 September 2019

Ct Dent Ltd (London) is operated by C.T. Dent Limited. Ct Dent Ltd (London) began operating in March 2007. The company was created to provide third-party healthcare professionals with dental imaging and diagnostic scanning services.

The service has six satellite sites in the UK. These are in Manchester, Birmingham, Nottingham, Bristol, Leeds and Colchester. The London centre is the centralised location of the service handling all communication, data processing, document storage and it is where the senior management team is based. All satellite sites are managed from London.

Ct Dent Ltd (London) operates as a referral centre, accepting referrals from third-party healthcare professionals for dental and maxillofacial diagnostic imaging, carrying out the imaging and returning the results to the referrer. It also provides a service for radiology reporting. The service receives referrals from healthcare professionals for both 2D and 3D imaging; often this is associated with treatment involving dental implants.

We previously inspected this service in October 2018 and rated the service inadequate overall. This was because we identified concerns around the safety and governance of the service. We issued the provider with a warning notice in response to breaches of regulation.

The service has had a registered manager in post since 2013.

Updated 10 September 2019

Ct Dent Ltd (London) is operated by C.T. Dent Limited. The service provides diagnostic dental imaging services for patients referred by third-party dental and medical healthcare professionals.

The service provides 2D (dental panoramic, cephalometric and skull X-rays) and 3D (cone beam computed tomography) scanning services to both private and NHS patients. Cephalometric analysis is the analysis of the dental and skeletal relationships of a human skull. It is frequently used by dentists, orthodontists, and oral and maxillofacial surgeons as a treatment planning tool.

Cone beam computed tomography (CBCT) is a low-dose medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone. CBCT is used for dental and maxillofacial imaging for the purpose of treatment planning and diagnosis in implant dentistry. In addition, the service used CBCT for implant planning, orthodontics, endodontics, oral medicine, airway studies and temporomandibular joint imaging.

The service also provides intra-oral scanning service which uses light and imaging sensor technology, rather than X-rays, to create 3D surface models of dental and connective tissues.

The service operates a flexible online appointment system and walk-in service seeing both children and adults, referred by both private and NHS providers.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 July 2019. We previously inspected this service in October 2018 and rated the service inadequate overall.

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.

Services we rate

Our rating of this service improved. We rated it as Good overall.

We rated it as good because:

• The service had made improvements to address the areas of concern identified during the last inspection.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff monitored the effectiveness of care and treatment. Staff worked well together to make improvements and achieve good outcomes for the benefit of patients.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• People could access the service when they needed it. The service planned care to meet the needs patients, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the referral community to plan and manage services. Staff were committed to improving services continually.

However:

• The frequency of mandatory training updates and the quality and content of their policies on safeguarding did not meet with best practice recommendations.
• There was no specifically designated sink for clinical staff to wash their hands.
• The service did not have formal processes to provide ongoing review and assessment of staff competency.
• The service did not have any formal process to provide ongoing monitoring or management of service level agreements (SLAs) with third-parties.
• Although the service had effective systems and processes to identify and control risk, systems and processes for reviewing risks were relatively new and not yet fully embedded.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Updated 10 September 2019

Diagnostic imaging was the sole activity of the service. We rated this service as good because it was safe, caring, responsive and well-led. We do not rate the effective domain for this type of service.