St Luke’s Radiology is operated by the

St Lukes Radiology partnership.

The service is based within the residential nursing home, St Luke’s Hospital, in Headington, Oxford. It provides diagnostic imaging and treatment of muskuloskeletal and spinal disorders with interventional ultrasound procedures.

Its main office, a consulting room, waiting area and two imaging rooms (for

computed tomography (CT) and ultrasound imaging)

are on the ground floor. The service also has an X-ray room in the basement below the main consulting room, with access via stairs or a lift.

The service receives referrals from doctors, dentists and specific registered health professionals who have completed training in the application of ionising radiation. It also receives self referrals from patients. St Luke’s Radiology undertakes a range of other services, including medicolegal reporting, training, research and auditing of radiological reports, that are not registered as activities by the Care Quality Commission.

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

We inspected this service using our comprehensive inspection methodology. We carried out a short notice (48 hours) announced inspection on 23 October 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. For diagnostic and imaging inspections, we do not rate ‘effective’.

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.

• St Luke’s Radiology had safe systems for delivering diagnostic imaging services. The consultant radiologists were extremely experienced in their fields of musculoskeltal radiology and demonstrated a passion for improving services for patients.

• All staff were trained for their roles and there was a systematic appraisal and training programme.

• Patient records and images were stored and transferred securely, using protected, electronic platforms. The organisation had set up a secure cloud-based data management system and complied with the General Data Protection Regulation.

• Patients said they were treated with kindness and staff were professional, courteous and explained things well.

• The imaging equipment was regularly maintained and safety tested and the local rules defined safe operating procedures. The service had appointed a radiation protection supervisor who ensured they were compliant with regulations, standards and guidance relating to ionising radiation. This was audited by their appointed radiation protection advisor.

• Staff were aware of policies and procedures for delivering safe care, including those relating to safeguarding adults and children. These were reviewed and were aligned to the Ionising Radiation (Medical Exposure) Regulations, to promote safe practices.

• Staff took learning from incidents seriously. The service had revised its checklist for interventional radiology, based on the World Health Organisation checklist, to add an additional check following a near miss. Staff understood the duty of candour regulation and information on this was on display in the service.

• There was clear leadership of the service and staff felt supported and able to raise concerns. Issues were reviewed for learning and to improve practices, and staff had regular meetings. These were used for staff to discuss areas for improvement, celebrate successes and learn about any company changes.

• The service was accessible to people with mobility impairments and for those for whom English was not their first language. Staff were familiar with the Mental Capacity Act 2005, and how to support people who might not be able to give consent.

• Patients did not have to wait long for their pre-booked appointments, and they received the results promptly. There was no waiting list.

• Patients gave positive feedback about the service and there had been no complaints in the past year. The service displayed their procedures for managing complaints, should patients have any concerns.

We found areas of outstanding practice:

• The service invested in state-of-art scanning equipment to support improved diagnostic outcomes and reduced exposure to radiation.

• The radiologists had an extensive range of professional and clinical skills which they applied in their practice.

• They sought feedback from patients to help identify improvements in ultrasound interventional radiology and patient treatment plans. This included asking patients to complete a pain diary over a two week period, as well feedback on their experience of attending the service.

However

• There was no system to ensure medicines were stored within the temperature range recommended by their manufacturers.

• Policies omitted guidance on, for example, identifying and reporting child sexual exploitation and female genital mutilation and the duty of candour.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

We spoke with two people who received a service from St Luke’s Radiology, the Consultant Radiologist and two members of staff. People we spoke with were complementary about the care and treatment they had received. People told us staff were “polite, very courteous and professional”.

People’s privacy, dignity and independence were respected. Staff interactions with people were friendly and respectful. We saw that the treatment room door was closed at all times when people were being consulted or receiving treatment. We reviewed the treatment records of three people. Entries were made in people’s records when they attended for treatment. These clearly reflected the treatment and advice people told us they had received.

People were protected from unsafe or unsuitable equipment. There was a record of annual service checks. Routine checks were completed and these included the radiation dose. Procedures were in place to ensure that equipment was clean and ready for the next person's use.

Decisions about care and treatment were made by the appropriate staff at the appropriate level. Staff working in the clinic had relevant training and qualifications to carry out the X-rays and scans that the service user needed. People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard because the provider did not ensure that all staff had undertaken training in mandatory areas.

Although were not able to speak to people using the service due to the nature of service being provided, we did speak to staff. Staff told us that training was provided for all staff on a regular basis and was relevant to their work and people who use the service. Staff told us that training was also practical and that they felt supported in delivery of patient care and also in enhancing their knowledge and skills.

People we spoke to told us that they felt involved in the delivery of patient care and were supported. People informed us that they had been involved in the pioneering project and equipment within the department. Staff had appropriate qualifications and knowledge in the use of equipment within the service. Staff were involved in the monitoring and maintenance of the equipment in use.They felt that this helped with valuing staff. Staff were aware of ensuring people's consent was documented and written prior to treatment. Staff told us that they ensured people confidentiality and privacy at all times. This included ensuring that documents were kept safe and secure while adhering to data protection regulation.