The Mid and South Buckinghamshire NHS Diagnostic Service is operated by Care UK. Facilities include one static magnetic resonance imaging (MRI) scanner, the use of a mobile MRI scanner, one plain X-ray, and ultrasound services.

The service is based on the ground floor of a building that is shared with the musculoskeletal service also run by Care UK. The service receives referrals from GPs, consultants or other approved healthcare professionals. For example, advanced nurse practitioners and advanced physiotherapy practitioners. It also has a daily walk-in X-ray service.

The service provides diagnostic imaging for adults over the age of 17 years. It is registered to provide the regulated activity of diagnostic and screening procedures.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced visit (the service did not know we were coming) to the service on Thursday 17 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 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

This was the first time we rated this service. We rated it as Good overall.

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 had enough 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 understood how to protect patients from abuse and the service worked well with other agencies to do so.

• The service controlled infection risks effectively.

• The service reviewed and updated risk assessments for each patient, using referral forms and safety checklists for patients undergoing MRI scanning.

• The service effectively managed patient safety incidents and shared learning with staff.

• The service provided care and treatment based on national guidance and evidence of its effectiveness.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. The service evaluated images to ensure they were of good quality.

• The service ensured staff were competent for their roles by ensuring staff received regular appraisals and their performance monitored.

• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

• The service could plan appointments that met patients’ needs including weekend and evening appointments.

• The service met the needs of the local community and the environment was fit for purpose and comfortable for patients, including those with mobility needs.

• The service cared for patients and their carers with compassion and kindness. The service supported carers to be with patients for reassurance during their imaging procedures.

• The service took account of patient’s individual needs for example following patient feedback staff developed an advice leaflet regarding how to deal with claustrophobia whilst in the MRI scanner.

• The service and staff took complaints and concerns seriously and investigated them in a timely manner, learned from the results and shared the learning with staff.

• Managers promoted a positive culture that supported and valued staff. Staff reported their team worked well together and staff trusted and respected each other.

• The service improved service quality and safeguarded high standards of care by creating an environment for good clinical care.

• The service effectively managed risks and could cope with both the expected and the unexpected. The service had a local clinical governance lead to monitor and maintain the risk register.

• The service collected, analysed, managed and used information to support all its activities, using secure electronic systems with security safeguards.

• The service engaged with both staff and patients to plan and manage appropriate services.

• The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation. The service held regular education updates for staff with an outside orthopaedic surgeon.

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

• The service printed out hard copies of policies and we found some were not up to date.

• The service did not have its own service development strategy

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

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

We spoke to six people who had a diagnostic test during our visit. All of them spoke positively of their experience and the care provided to them by staff. One person told us "Everything has been very professional. I felt welcome as soon as I walked through the door." Another person told us "My radiographer was first class, answered all my questions and was very thorough. I am very clear about what happens next."

We found that people were provided with information about the tests and procedures and were treated with kindness and respect by all the staff. Information about patients was held confidentially throughout the service.

We found that staff understood the importance of protecting vulnerable patients and knew what to do if they suspected abuse.

The staff we spoke to were trained, supervised and supported and went about their work in a polite and professional manner.

We found that the provider took steps to assess and monitor the quality of the service it provided. It also undertook a wide range of audits to manage the risks associated with its activities and actively sought feedback from patients in order to improve.