All inspections: Mediscan Diagnostic Services Limited

We carried out a review of the data available to us about Mediscan Diagnostic Services Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Mediscan Diagnostic Services Limited, you can give feedback on this service.

Our rating of this location improved. We rated it as good because:

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 had implemented systems to manage safety. Staff completed and documented patient risk assessments. The service had established appropriate systems and processes to improve control of infection risk. Staff kept care records. The service had implemented systems for managing safety incidents and learned lessons from them.
Staff provided good care and treatment and gave patients enough to drink. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available to suit patients' needs.
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.
The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with patients to plan and manage services and all staff were committed to improving services continually. The service made it easy for people to give feedback about treatment and care

However:

There was some inconsistency in the correct identification of ultrasound equipment units seen at the satellite clinic and recorded in the service’s equipment asset registers.
Audit processes had been implemented for safeguarding, IPC and equipment checking but outcomes were not yet fully embedded due to the limited clinical activities at the time of inspection.
Electronic systems used for patients having transvaginal or invasive scans did not allow patients to directly record their consent and this practice was not consistent with the service policy.
The service did not have a process for applying ‘pause and check’ guidance from the British Medical Ultrasound Society for relevant scan procedures.
Wider service risks were not always clearly considered or identified in risk registers and there was duplication between the quality improvement action plan and the risk register.
The service did not have a documented strategy or vision although staff were broadly aware of the organisation’s values.
Governance and risk management systems were not yet fully embedded due to the limited levels of clinical activity in the service.

Our rating of this location improved. We rated it as requires improvement:

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 had implemented systems to manage safety. The service had introduced systems and processes to improve control of infection risk. Staff kept care records. The service had implemented systems for managing safety incidents and learned lessons from them.
Managers had systems for monitoring the effectiveness of the service and made sure staff were competent.
The service made it easy for people to give feedback about treatment and care
Leaders ran services using information systems and supported staff to develop their skills. Staff felt respected, supported and valued. Staff were clear about their roles and accountabilities.

However:

Patient risk assessments were not always clearly identified and documented. We saw some ultrasound equipment units remained onsite which had not been identified in current maintenance servicing contracts. There was a lack of consistency in quality assurance checks for ultrasound equipment. There was a lack of contingency plans in the event of equipment failure at satellite locations.
Audit processes for safeguarding, IPC and equipment checking had been identified but not yet embedded due to limited clinical activities at the time of inspection.
Wider service risks were not always clearly considered or identified in risk registers and there was some duplication between the quality improvement action plan and the risk register.

Our rating of this location stayed the same. We rated it as inadequate because:

Staff did not always understand how to protect patients from abuse. There was not a robust system and process in place for the appropriate and timely referral of safeguarding concerns.
The service did not always control infection risk well and some policies were still not fully reflective of the service and it was unclear what monitoring processes had been implemented.
The design, maintenance and use of equipment did not always keep people safe.
There was limited assurance that there were robust systems and processes in place for the appropriate and timely referral, triage and escalation of patient care. There was limited evidence that the risk to patients and staff during care and treatment had been considered and mitigating actions identified.
Records were not always stored securely and easily available to all staff providing care.
The service did not always manage patient safety incidents well. Staff did not always recognise and report incidents and near misses. Managers did not always investigate incidents or shared lessons learned with the whole team and the wider service.
There remained concerns about the competency and recruitment checks for agency staff.
We had concerns raised with us from patients that it was not easy to contact the provider and raise complaints.
Whilst steps had been taken to strengthen the leadership structure, leaders did not all have the skills and abilities to run the service. The service was receiving support from external agencies to fulfil leadership roles and there was not a robust process in place to ensure sustained long-term effective leadership capacity and capability to assess, monitor and improve the quality and safety of services provided.
Leaders did not operate effective and governance processes, throughout the service and so staff at all levels could not be clear about their roles and accountabilities.
Whilst some improvements had been made to systems and processes in relation to the management of risks, issues and performance. There was not a robust system and process in place to assess and monitor the improvements that had been implemented and risk management processes were not robust.

However:

The service provided care and treatment based on national guidance and evidence-based practice. Improvements had been made to quality assurance processes and the service had implemented an audit schedule.
The service made sure staff were competent for their roles. Improvements had been made to the appraisal process for staff and there were plans to hold supervision meetings with them to provide support and development.
Consent documentation for intimate ultrasound examinations had been updated to meet with national guidance and the policy had been updated to reflect this.
There was a process for people to give feedback and raise concerns about care received. The service investigated complaints and included patients. Improvements had been made to the process to evidence lessons learnt and share them with all staff.
The service recognised that work to improve the culture in the organisation was required but had not progressed this since the last inspection. Leaders we spoke with felt valued and supported in their roles.
Some improvements had been made to policies and monitoring processes.

Following our inspection, we took enforcement action under section 29 in which we issued two warning notices, due to risks identified with safe care and treatment and good governance.

Our rating of this location stayed the same. We rated it as inadequate because:

Staff did not always understand how to protect patients from abuse. There was a lack of clarity about the training staff had received about how to recognise and report abuse and they did not always know how to apply it.
The service did not always control infection risk well. The infection prevention and control policies were not fully reflective of the service or provide clarity to staff about how to use control measures to protect themselves and patients.
The policy for waste management was not fully reflective of the service and there was missing information.
There was limited assurance that there were robust systems and processes in place for the appropriate and timely referral, triage and escalation of patient care.
Records were not always stored securely and easily available to all staff providing care.
The service did not have robust systems in place to safely prescribe, administer, record and store medicines.
The service did not always manage patient safety incidents well. Staff did not always recognise and report incidents and near misses. Managers did not always investigate incidents or shared lessons learned with the whole team and the wider service.
Although some improvements had been made to quality assurance processes, we found some out of date documentation, there remained limited evidence that managers had processes in place to make sure staff followed guidance and there was limited evidence of audits undertaken.
Managers did not always appraise staff’s work performance or hold supervision meetings with them to provide support and development. Whilst some improvements had been made to staff training, records were not always accurate or up to date and so we could not be assured that they provided appropriate oversight of staff training.
There was limited evidence of lessons learnt and shared with all staff in relation to complaints.
Whilst steps had been taken to strengthen the leadership structure, leaders did not all have the skills and abilities to run the service. They did not always understand and manage the priorities and issues the service faced. They did not always support staff to develop their skills and take on more senior roles.
Staff did not always feel respected, supported, and valued. The service did not always have an open culture where patients, their families and staff could raise concerns without fear.
Leaders did not operate effective and governance processes, throughout the service. Policies and procedures were not reflective of the services provided and so staff at all levels could not be clear about their roles and accountabilities.
Leaders did not always use systems to manage performance effectively. They did not have effective risk management processes in place to identify and escalate relevant risks and issues or identified actions to reduce their impact.

However:

There had been improvements made to cleaning checklists and ultrasound equipment cleaning processes.
The design and maintenance of premises and equipment kept people safe.
The service provided care and treatment based on national guidance and evidence-based practice.
Consent documentation for intimate ultrasound examinations had been updated to meet with national guidance and staff were aware of the process.

Following our inspection, we took enforcement action which included the use of our urgent enforcement powers under Section 31 of the Health and Social Care Act 2008. We extended the suspension up until the 25 November 2021 due to risks identified with safeguarding, assessing and responding to risk, medicines, incidents, recruitment processes leadership and governance and risk management systems.

Our rating of this location stayed the same. We rated it as inadequate because:

The service did not always provide mandatory training in key skills to all staff or make sure everyone completed it.
The service did not recognise and respond appropriately to abuse or discriminatory practice. There was insufficient attention to safeguarding children and adults. Staff did not always have the correct level of safeguarding training.
The service did not recognise and report incidents. Managers did not manage patient safety well and share lessons learnt with the whole team.
The service did not clinically triage each patient referral.
The service did not store records safely or securely.
The service did not manage patient safety incidents well. Staff did not recognise and report incidents. Managers did not investigate incidents and did not share lessons with the team.
Leaders did not have the skills and abilities to run the service and did not understand and manage the priorities and issues the service faced. Policies and procedures were not reflective of the services provided.
The service did not always have an open culture and staff did not always feel respected, supported, and valued.
There were poor governance processes throughout the service and with partner organisations, and so staff at all levels could not be clear about their roles and accountabilities. There was a lack of robust processes to ensure safe, high quality care was delivered.
There were poor risk management processes in place which did not allow for identification and escalation of relevant risks and issues or identify actions to reduce their impact.

However:

Staff member onsite said they felt respected, supported, and valued.
Portable Appliance Testing (PAT) of electrical equipment had been completed and was in date.
The Infection Control Prevention policy had been updated.

Our rating of this service went down. We rated it as inadequate because:

The service did not always control infection risk well. The infection control policy did not provide clear guidance for staff to follow in how to use equipment and control measures to protect patients. They did not always keep equipment and the premises visibly clean and monitoring processes were not robust.
The design, maintenance and use of facilities, premises and equipment did not always keep people safe and there was limited evidence that staff had received appropriate training in the use of equipment. The service did not have robust systems in place for the oversight of equipment maintenance and we found equipment that posed a risk to patients’ safety.
There was not a robust process in place for the oversight of staff resuscitation training and the policies in place for staff to follow in respect of deteriorating patients were not fully reflective of the service provided. Staff used early warning scores for patient observations on the endoscopy unit, however our review of records identified mixed adherence to the completion of these.
The service did not have robust systems and processes in place to safely prescribe, administer, record and store medicines.
There was limited access to policies and procedures for staff and managers did not always check to make sure staff followed guidance, there were limited evidence of audits undertaken by the provider.
The service did not always make sure that staff were competent for their roles there was limited evidence of staff competencies and required training compliance was low. Managers did not always appraise staff’s work performance or hold supervision meetings with them to provide support and development.
Patients were not always supported to make informed decisions about their care and treatment. Consent documentation did not always meet with national guidance and there was a lack of clarity about the consent process.
Leaders did not operate effective governance processes, throughout the service. Policies and procedures were not reflective of the services provided and so staff at all levels could not be clear about their roles and accountabilities.
Leaders did not always use systems to manage performance effectively. They did not have effective risk management processes in place to identify and escalate relevant risks and issues or identified actions to reduce their impact.

However,

Staff could describe how to identify and quickly act upon patients at risk of deterioration or those with unexpected findings.
The service provided care and treatment based on evidence-based practice.
Staff had regular opportunities to meet, discuss the service and learn.

Following our inspection we took enforcement action which included the use of our urgent enforcement powers under Section 31 of the Health and Social Care Act 2008. We imposed conditions on the provider which prevented them from carrying out any invasive diagnostic procedures and told them that they must make improvements in relation to infection prevention and control, equipment maintenance, medicines management, staff competencies, leadership and governance and risk management systems.

Mediscan Diagnostic Services Limited is operated by Mediscan Diagnostics Services Ltd. The location has been registered to deliver diagnostic and screening procedure services since June 2013.

The location, which is also the provider’s head office, is the call centre, administrative and managerial centre from which the provider’s national diagnostic imaging services are managed. The provider delivers a range of services including ultrasound scanning and magnetic resonance imaging scanning, which are regulated by CQC. The location does not host any clinics on site.

We inspected this service using our comprehensive inspection methodology. We carried out a short-announced inspection between 22 and 24 October 2018.

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.

We have not previously rated this service. We rated it as Good overall, because:

Safe care and treatment was provided by staff that had received mandatory and safeguarding training appropriate to their roles. Staff were aware of how to raise safeguarding concerns, and appropriately assessed, responded to and recorded any relevant patient risks. Staff followed infection control protocols and equipment was appropriately cleaned. There were sufficient staff, who worked flexibly, to meet the needs of the service. Staff knew how to recognise and report incidents.
Staff provided effective care in line with evidence-based practice, national and professional guidelines. Staff were appropriately qualified and had the skills and knowledge to undertake their roles effectively. They understood the need for consent and made adjustments for patients who required additional support. The provider monitored its clinical outcomes and used these to improve its services.
Care was delivered by staff who were compassionate and helped to maintain people’s privacy and dignity. Staff supported their patients, and took time to fully explain the procedures being carried out and gave people time to ask questions.
The provider continually assessed demand at its clinics, and planned its services to meet the needs of the local population. Staff took account of individual patient’s needs, including those who needed additional support or who were living with mental health conditions or learning disabilities. Clinics were planned flexibly to meet patient need, and patients were given a choice of appointments. Complaints were taken seriously, reviewed in the clinical governance meetings and learning was shared with staff.
The provider’s leaders had the appropriate skills and knowledge to lead the service, and they had a vision and plans in place for future development of the service. Leaders could describe the potential risks to the service, and these were appropriately reviewed through the clinical governance and information governance committees. The service engaged well with patients and with referrers and there supported a culture of continual learning and improvement.

However, we also found the following issues that the service provider needs to improve:

The provider’s risk register scored and mitigated, but did not define, the impact of each identified risk.
There were some limited gaps in the provider’s documentary recruitment evidence for consistent compliance against its recruitment policy.

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.

Mediscan Diagnostic Services Limited

All Inspections

6 July 2023

During a monthly review of our data

21-22 June

During a routine inspection

8-9 March2022

During an inspection looking at part of the service

16 and 17 November 2021

During an inspection looking at part of the service

17 and 18 August 2021

During an inspection looking at part of the service

10 - 11 June 2021

During an inspection looking at part of the service

6 April 2020, 7 April 2021 and 14 April 2021

During an inspection looking at part of the service

22 to 24 October 2018

During a routine inspection

Ellen Armistead

Deputy Chief Inspector of Hospitals North