Opus Diagnostics is operated by Berkshire Medical and Imaging Centre Ltd. The service is located on a small business park in Ascot, close to the train station and was purpose built. It provides diagnostic imaging to support the treatment of musculoskeletal disorders.

The service is on two floors. The reception and main waiting room are on the ground floor, with secured access to the magnetic resonance imaging (MRI) and X-ray rooms, changing rooms and toilet. The MRI unit uses magnetic fields and radio waves to produce detailed images of the insides of the body and the X-ray equipment uses radiation to create images.

On the first floor there are separate rooms for the dual-energy X-ray absorptiometry (DEXA) unit and the ultrasound scanner. The DEXA unit uses X-rays, most commonly to assess bone density, and the ultrasound equipment produces scans from high-frequency sound waves. In addition, on the first floor there is a nursing station and small waiting area, the office, a radiology reporting room, a staff kitchen and a further toilet. As well as stairs, there is a lift to the first floor and the facilities have been designed to accommodate people in wheelchairs.

The service is registered to provide two regulated activities; diagnostic and screening procedures and treatment of disease, disorder or injury. It provides diagnostic imaging for adults, children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out the short-notice (48 hours) announced inspection on 13 December 2018 and telephoned patients to ask them about their experiences of care on 18 and 19 December 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.

We rated this service as Good overall.

We found the following good practices at this diagnostic and imaging service:

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

• Staff understood how to protect patients from abuse.

• Staff kept the premises clean, for the most part.

• Staff reviewed and updated risk assessments for each patient, using the referral forms and tailored patient questionnaires.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe.

• Staff kept detailed records of patients’ care and treatment.

• The service followed best practice when prescribing, giving, recording and storing medicines.

• The service had systems to manage patient safety incidents.

• The service had contracted support from an accredited Radiation Protection Advisor and a Medical Physics Expert.

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

• The service offered people appointment times to reflect their needs and preferences, for example if they required fasting or were diabetic.

• Managers monitored the effectiveness of care and used the findings to improve them. They carried out multi-disciplinary meetings to evaluate images and techniques to improve image quality for the benefit of patients.

• The service made sure staff were competent for their roles. There were systems to check staff professional registrations, appraise their work and provide support.

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

• The service planned and provided services in a way that met the needs of local people. The environment was appropriate and comfortable for patients, including those with mobility needs.

• The service arranged appointment times to suit patients.

• The service supported carers to be with patients for reassurance during their X-ray, using a recognised consent procedure to explain the risks of ionising radiation exposure to the carer.

• The service had not received any concerns or complaints since opening in July 2018 but staff recognised the importance of taking complaints seriously and learning from them.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action. Service managers were involved in developing these plans.

• Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff reported their team worked well together and staff trusted and respected each other.

• There was a strong emphasis on patient-centred care. Staff promoted openness and honesty and understood how to apply the duty of candour.

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

• The service had engaged with local organisations to plan services, and had plans to seek patient feedback once more established.

• The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation. The service held regular learning meetings involving the radiographers, radiologists and orthopaedic surgeons to improve the quality of their images.

We found areas of practice that required improvement:

• There were gaps in the systems for monitoring equipment cleaning.

• A staff member had started work, although in a shadowing capacity, without having completed all the safe recruitment checks.

• The governance arrangements were not clear and had not been evaluated. There was not a systematic approach for reviewing all aspects of quality and safety.

• The provider had not developed a means of identifying and managing risks to the service going forward.

• The provider’s policies did not always reflect the specific activities carried out by the service. For example, the accident and incident reporting policy and procedure did not refer to accidental or unintended exposure to radiation or how to report such incidents.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)