Archived: Cavendish Imaging Birmingham

Cavendish Imaging Birmingham is operated by Cavendish Imaging Ltd. The imaging centre has one imaging room with one cone beam CT scanner and one other imaging machine capable of producing orthopantomogram (OPG) and cephalometric x-ray images. OPG imaging is mainly used to take panoramic images of the jaw and mouth. Cephalometric imaging is used in the treatment of orthodontic conditions, and by ear, nose and throat specialists to image the airway of patients with, for example, sleep apnoea. The service had no beds or operating theatres.

The imaging centre provides diagnostic imaging only.

The service saw several thousand patients in 2018, with a mix of NHS funded and other funded. The service undertakes imaging on all ages of patients, including children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 27 February 2019, giving the provider 24 hours notice to allow key staff to be available and travel to the location.

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

We rated it as Requires improvement overall.

We found areas of practice that require improvement in diagnostic imaging:

• Systems, processes and standard operating procedures were not always reliable or appropriate to keep people safe. Policies did not support staff to safeguard patients from abuse and harm. However, staff understood how to protect patients from abuse and staff had training on how to recognise and report abuse, and they knew how to apply it.

• Staff did not always have the right skills and competencies to respond to patient risks. However, staff kept clear records and asked for support when necessary.

• Imaging staff did not always have the right skills, training and experience to provide the right care and treatment to children and young people. However, the service had enough imaging staff with the right imaging qualifications to keep people safe from avoidable harm.

• Managers did not regularly or robustly monitor the effectiveness of care and treatment or use the findings to improve them. Participation in external audits and benchmarking was limited. Staff did not use the results of monitoring to effectively improve the quality of care.

• The service did not ensure staff had the right skills, knowledge and experience to deliver care to all patients, including children and young people. However, the service appraised staff’s work performance.

• We found staff did not understand how to assess capacity in children and young people. However, staff understood how and when to assess whether an adult patient had the capacity to make decisions about their care. They followed the service policy and procedures when an adult patient could not give consent.

• Managers at all levels in the service did not consistently have the right skills, knowledge and abilities to run a service providing high-quality sustainable care.

• The service did not demonstrate workable plans to turn its vision and strategy into action. However, the service had a vision for what it wanted to achieve.

• The service did not have a systematic approach to improving service quality and safeguarding high standards of care.

• The service did not have good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

• The service did not analyse, manage and use information well to support all its activities. However, the service did collect information and used secure electronic systems with security safeguards.

• The service had a limited approach to obtaining the views of staff, people who use the service, external partners and other stakeholders. However, the leadership team did share positive feedback with individual staff.

We found good practice in relation to diagnostic imaging:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean.

• The service had suitable premises and equipment and looked after them well.

• The service had enough radiography staff with the right qualifications to keep people safe from avoidable harm. However, radiography staff did not always have the right skills, training and experience to provide the right care and treatment to children and young people.

• The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to staff providing care.

• The service could describe how it would manage patient safety incidents. Staff could explain what incidents should be reported and how. Managers described the process for investigating and reporting on incidents, both clinical and non-clinical.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

• Staff assessed patients to see if they were in pain.

• Staff of different professions worked well together as a team to benefit the patient. Doctors, nurses and other healthcare professions supported each other to provide good care.

• 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.

• Staff involved patients and those close to them in decision about their care and treatment.

• The service planned and delivered services to meet the majority of the needs of local people. However, we found the service did not consistently plan services to meet the needs of children, young people and those close to them.

• The service took account of the individual needs of adult patients. However, the service did not consistently meet the individual needs of children, young people and those close to them.

• People could access the service when they needed it. However, the service had no process to monitor the referral to scan times of patients.

• The service could describe how they would treat concerns and complaints, investigated them and learn lessons from the results, and shared these with all staff.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. However, we found inconsistencies in the application of this.

• The service demonstrated some commitment to improving services, promoting training, research and innovation. However, the learning from incidents was not always clear and communicated well within meeting minutes.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected Cavendish Imaging Birmingham. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals