PETCT Mobile Services

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

WELL-LED Key question summary: We reviewed shared direction and culture, capable, compassionate and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusivity, governance, management and sustainability, and learning, improvement and innovation. Shared direction and culture: The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff knew and understood what the vision, values and strategy were, and their role in achieving them. Capable, compassionate and inclusive leaders: Leaders had the skills and abilities to run the service. They were visible and approachable. They supported staff to develop their skills and take on more senior roles. Freedom to speak up: All of the staff we spoke to knew how to contact the freedom to speak up team. The service had an open culture where patients, their families and staff could raise concerns without fear. Workforce equality, diversity and inclusivity: The service promoted equality and diversity to make sure it was fair and accessible to everyone. Governance, management and sustainability: There were effective structures, processes and systems of accountability to support the delivery of the service. There were arrangements for identifying, recording and managing risks, and mitigating actions. Learning, improvement and innovation: All staff were committed to continually learning and improving services.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders told us that they consulted staff on proposed changes to service delivery and took a team approach to implementing change. All the staff we spoke to told us they enjoyed working for the provider and within their teams. Without exception they said they were part of a learning, not blame, culture. Senior leaders told us they understood staff working on mobile units may feel a sense of isolation and not a part of the wider organisation. To ensure staff did not feel forgotten or left out senior leaders worked to make mobile staff feel a valued member of the organisation. For example, at Christmas they understood staff may not be able to join the head office Christmas party so sent them all a sum of money so they could make a local arrangement. In the run up to Christmas they sent tubs of chocolates to each unit. On international radiographers’ day each member of the team was sent a special muffin through the post. On very hot or very cold days staff were given an allowance to purchase ice lollies and hot drinks. Staff told us there was a virtual all-staff meeting held every two weeks. The meeting was held at lunchtime to try and ensure as many people could attend as possible. The meeting was recorded for staff unable to attend so they could watch at a time that suited them. The provider had an employee forum that met 4 times a year to discuss concerns raised by PET-CT mobile services staff. The outcome of these meeting fed into the organisations wider staff forum meetings. Employee forum representatives met with the executive board twice a year to ensure the voice of staff was heard at the highest level. Training for employee forum representatives was provided to support them in this role.

The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and providing excellent patient care.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. As part of the providers succession planning all radiographers and technologists had been invited to complete a leadership course. It was anticipated this course would give them an understanding of the difference between management and leadership and equip them with the confidence and skills to become managers/leaders of the future as well as improve their ability to communicate with others. Another part of the providers succession planning was to give technologists and radiographers the opportunity to complete reviews of services and set up new services. This provided staff with experiential management learning opportunities. Staff told us managers and senior service leaders had an open-door policy and they felt able to go to their managers with any questions or concerns about the service.

There were clear priorities for ensuring sustainable, compassionate, inclusive and effective leadership, and a leadership strategy and development programme, which included succession planning. There were processes to support new leaders joining the service, this included guidance on supporting them to develop supportive relationships with staff. Governance meeting minutes showed leaders understood the challenges to quality and sustainability and could identify the actions needed to address them.

Leaders and staff understood the importance of staff being able to raise concerns without fear of retribution, and appropriate learning and was action taken because of concerns raised. The culture encouraged openness and honesty at all levels within the organisation, including people who used services, in response to incidents. Staff said they did not have a fear of speaking out. Staff were aware of the freedom to speak up service, but they told us they had not used this service as they felt problems were resolved within the department through honest and frank discussions of problems as they arose.

The provider had a freedom to speak up guardian. They were supported by freedom to speak up champions so staff had access to a range of people across the organisation that they could approach for support. Freedom to speak up guardians received the training needed to carry out this role. Twice a year the freedom to speak up guardian produced a report for the executive board so themes and trends could be identified, and actions and learning documented.

Leaders told us they fostered inclusion and belonging for their staff by respecting, valuing, and recognising the contribution of all staff. They recruited talented staff, including staff recruited internationally, so they could make better decisions informed by staff who represented the communities they served. They told us they invested in their staff to empower and grow them by supporting their career journeys. Staff told us they felt valued by the organisation especially in terms of the development opportunities they were given. Staff at all levels told us they had the opportunities to complete internal and external learning to improve their skills and knowledge as well as their career prospects. The organisation supported Pride events to show lesbian, gay, bisexual, and transgender (LGBT) social and self-acceptance. The organisation shared a calendar of equality, diversity and inclusion events that were celebrated internationally throughout the year, with staff. Some of the events were celebrated at head office. This showed staff the organisation understood, and valued differences between communities and recognised some of the struggles they faced.

There were policies and processes to ensure the service was inclusive and fair. These included directions to ensure all staff and patients were treated equally regardless of age, gender, ethnicity, sexuality, and religious beliefs. They also contained information on how to promote inclusivity within the service. For example, asking patients their preferred name and using this throughout their appointment ensured transgender people, and others, had their human rights respected and their personal choices accepted.

Staff at all levels told us they were clear about their roles and understood what they were accountable for, and to whom. They told us they had regular opportunities to meet, discuss and learn from the performance of the service. Leaders said they felt supported by the governance process which they described as robust. The leaders told us they had a carbon reduction plan. Work vehicles were typically electric cars, and solar panels were used to power some elements of the mobile units. They used hybrid generators which enabled them to lower their carbon footprint. Generators are typically consistently powered by fuel, hybrid generators are more expensive but require an intermittent source of fuel and therefore burn less fuel overall.

There were effective structures, processes, and systems of accountability to support the delivery of the strategy and good quality, sustainable services. These were regularly reviewed and improved. All levels of governance and management functioned effectively and interacted with each other. The governance structure included 4 radiation protection committees, a research committee, a medicines quality committee and a governance and risk board. We looked at meeting minutes from a number of committees and the board meetings. Minutes contained information about incidents, risk and risk management, up to date information on compliance with mandatory training, staffing, environmental sustainability, and compliance with key performance indicators. We saw radiation protection advisors committee meeting minutes that demonstrated staff met regularly to share information and learn from incidents and audits. We saw the risks on the risk register matched what staff told us were the risks facing the service. There was a fortnightly risk meeting for the mobile site managers and a monthly newsletter about risk that was emailed to all staff. There was a process for reviewing the NHS contract for each mobile site four times a year.

We did not collect enough evidence from patients about this quality statement to express their views in this report.

At trust sites where the service being delivered supplemented a trust's own PET-CT service staff told us there was a lot of collaborative working. For example, if either the trust or providers PET-CT scanner went down they would support each other to ensure patients scans went ahead the same day, especially if a patient had already received their radioactive tracer. The organisation had won a number of awards including one for partnership working.

Partners told us they had strong working relationships with the provider’s staff and they worked collaboratively for the benefit of patients.

Audits on radioactivity exposure from scans were carried out by the provider and trusts. They shared the outcomes of the audits so learning could be used by both organisations to improve patient care.

Staff told us about the opportunities they had to enrol on fully funded university run courses. Clinical assistants could enrol on a 2-year course to become radiographers. Radiographers had the opportunity to enrol on a variety of courses to develop new radiographic competencies and complete leadership qualifications. The provider had an approved business case to introduce 2 new mobile units into its fleet within the next 12 months and a further 2 units in the following 12 months to replace the oldest 4 mobile units. The new units would have scanners that provided an enhanced image quality to increase diagnostic accuracy and scanned patients in a shorter time period (meaning less exposure to radiation). The provider had engaged with patients to improve their experience off being scanned in a mobile unit. Patients had recommended the use of ambient lighting in the take up rooms as well as access to a music streaming service to aid relaxation, both of which the provider had implemented in the newest mobile units. Patients had also recommended installing a light fitting in the ceiling of the scan rooms that mirrored the effect of a skylight on a sunny day. The providers business model meant staff could be redeployed to 1 of the organisations static PET-CT sites if the scanners stopped working and could not be mended quickly. This also meant, in locations that were close to static sites, patients could be transported and scanned the same day in the event a scanner stopped working. The provider was involved in neuroimaging research to help improve diagnostics and treatment for dementia and Parkinson's disease. The research was taking place on one of the mobile units, the morning was used to scan diagnostic patients and the afternoon was used to scan research patients.

There were systems to support improvement and innovation work including service improvement workstreams and a service improvement meeting that fed into the governance meeting structure.