Leicester Nuffield Alliance MRI Unit is operated by Alliance Medical Limited. The service has a reception area with an accessible toilet. Through the controlled access door, there is a clinical preparation area, patient changing room and toilet, staff changing room, the Magnetic Resonance Imaging (MRI) scanning room with a 1.5T (tesla) MRI scanner and a viewing/control room.

The service only provides diagnostic imaging through MRI scanning, therefore we only inspected diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 13 November 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.

Services we rate

We previously did not have the authority to rate this type of service, however now we do. We rated it as Good overall.

We found the following areas of good practice:

• There was a safety focused culture within the unit. Staff had a comprehensive policy to follow when identifying significant findings on the scan, as well as thorough use of the ‘pause and check’ flow chart prior to commencing a scan.

• There was a system and process in place for identifying and reporting potential abuse. Staff were supported by individuals with more enhanced training in safeguarding and there were clear channels of escalation which staff were aware of. Staff also had access to a paediatric nurse from the host hospital for when children and young people attended for scanning appointments.

• Clinical environments were visibly clean and tidy, and were suitable and appropriate to meet the needs of the patients who attended for appointments, as well as relatives and children who accompanied them.

• Staff had comprehensive corporate policies to follow which were based on evidence-based best practice and nationally recognised policies.

• There was a corporate audit plan in place which the service contributed towards, as well as completing local quality checks of scans and reports.

• Feedback from patients was positive during our inspection and we observed some examples of high quality care, from compassionate and professional staff.

• There was a strong teamwork ethic amongst the staff who directly worked within the MRI unit, as well as strong multidisciplinary team working with staff from the host hospital.

• The referral to scan and reporting times were well within the expected timeframes.

• There were processes in place to ensure the individual needs of patients were met.

• There were few complaints raised against the service, and the complaints which were raised were dealt with in line with corporate policy.

• Governance processes were well-embedded and there were clear channels for escalation of concerns and cascade of information from the top.

However, we also found areas of practice which the service needed to improve:

• At the time of our inspection we observed low morale amongst staff. Staff told us this was due to the changes in management and the way it had been handled. Staff had previously escalated concerns and suggestions, however these had not been addressed or actioned.

• There were corporate policies and training in place for the management of medicines. However, there were concerns raised by staff about their roles and responsibilities regarding the checking and administration of intravenous contrast and self-administration of medicines.

• Paediatric life support training was well below the expected standard for the service and did not follow corporate policy. However, the service was supported by a resuscitation team and paediatric nurse from the host hospital.

• There were no processes in place to enable staff to undergo clinical supervision and staff reported not having the opportunity to complete continuous professional development and training requirements due to limited staffing.

• The service did not formally record waiting times on the day of appointments, despite there being a delay on the day of our inspection.

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

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)