Colchester Clinic is operated by Diagnostic Healthcare Limited. Colchester Clinic is an independent health provider delivering a range of non-obstetric ultrasound and dual-energy X-ray absorptiometry (DEXA) scans. It is a stand-alone purpose-built diagnostic and screening facility providing scanning services to NHS patients contracted by the local NHS community trust.

We inspected the service using our comprehensive inspection methodology. We carried out an unannounced inspection on 29 January 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, 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 rated this service as requires improvement overall. We rated it as requires improvement for the safe and well-led domains, and good for the caring and responsive domains. We do not currently rate the effective domain.

We rated the service as requires improvement because:

• Staff were not always familiar with or adhering to best practice and local policy in relation to hand hygiene and infection prevention and control (IPC) processes.

• The spot checks and audits of IPC compliance did not document actions to address issues identified, to reduce the risk of them reoccurring.

• The environment was challenging, as it was not sufficiently spacious in the waiting area to allow for private conversations.

• Staff working in the DEXA room did not know where the local rules for the DEXA room were and were not able to confirm they were aware of what they entailed or whether they had signed a copy of them.

• There was no trefoil (radiation warning) sign at the entrance to the DEXA room to clearly show the words ‘x-ray’ and ‘controlled area’, although the service addressed this immediately when we raised it.

• There was no formal patient records audit carried out locally by the service.

• Not all staff were clear on the correct process and policy for reporting incidents.

• We had concerns that the environment did not allow for maximum respect for patient privacy and dignity.

• There was no policy around whether sonographers should ‘break bad news’ or refer it to the patient’s GP to discuss with the patient, which meant there was potential for inconsistencies in how sonographers treated concerning results and difficult conversations.

• On days when the clinical lead was not on site, there was a lack of clear interim site leadership, although the lead would be contactable over the telephone for support. It was generally only once a month that this lead was not on site.

• There was limited evidence of a clear vision and strategy at local level to outline steps for targets to achieve or continuous development, although there was a corporate vision at provider level.

• Not all risks we identified on our inspection were captured on the risk register and staff could not identify their main risks for the Colchester location specifically.

• The provider wide staff survey was carried out every three years and the last survey was completed in 2015 which meant they were overdue their staff survey and therefore were not receiving regular feedback from staff. There were no additional staff surveys carried out at local service level.

However, we also identified the following areas of good practice:

• The service had achieved a 100% compliance rate with staff completion of mandatory training.

• Staff we spoke with understood their roles and responsibilities in regards to safeguarding.

• The service maintained its environment and equipment well.

• There were clear processes to escalate concerns to patients’ GPs.

• Records were clear, up-to-date, accurate and secure; there were systems to ensure GPs had prompt access to scan records.

• The service had systems and processes to ensure staff were competent for their roles including a comprehensive induction programme.

• There was evidence of good multidisciplinary team working.

• Staff displayed a kind and compassionate approach and communicated with patients in a caring way.

• The service planned and provided services in a way that met the needs of local people. The service took account of patients’ individual needs.

• The service had a clear exclusion and inclusion criteria and only booked patients in accordance with this to ensure they would be able to meet their needs.

• Staff felt well supported by service leads and each other and there was a positive team-based culture.

• Staff confirmed they received important updates and information from the clinical site lead verbally and through emails.

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 two requirement notices that affected Colchester Clinic. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central Region)