The Newcastle Clinic is operated by Newcastle Clinic Ltd . The Newcastle Clinic had provided a magnetic resonance imaging (MRI) service from Newcastle since 2007, primarily to offer an open sided MRI service to the private health sector in the North East of England and Scotland and to assist local NHS Trusts on an as required basis. The open design of the equipment was especially suited to accommodate patients that were claustrophobic or obese or due to their size or condition or could not tolerate a conventional MRI scanner.

In 2011 a new open sided scanner was commissioned and installed producing imaging of a much higher quality than had been achieved before. In 2013 agreements with North East commissioning support (NECS) were put in place to offer general practitioners (GP's) direct access to the service through the special funding request (SFR) process for patients who fitted specific criteria.

The service provided mmagnetic resonance imaging (MRI) which is a medical imaging technique used in radiology to form pictures of the anatomy and physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. This service was provided to both adults and children.

The service provided image intensification. The Newcastle Clinic offered nerve route blocks(NRB) and facet joint injection (FJI) for pain relief and diagnostic purposes since 2007 to the private health sector. Local agreements are also in place to receive referrals from local NHS trusts.

The service had a consultant led ultrasound service which had been in place since 2011, receiving referrals primarily from local physiotherapists.

The service provided an Ultrasound scan service for adults and children. An ultrasound scan, is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. An ultrasound scan can be used to monitor an unborn baby, diagnose a condition, or guide a surgeon during certain procedures.

We inspected only the MRI part of this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 November 2018.

The building had an entrance lobby and reception desk, a patient waiting area with access to same sex and disabled toilet facilities. There were 13 consultation/treatment rooms and diagnostic facilities consisting of a MRI scanner room with a supporting MRI control room, a laser ultrasound room and an X-ray room. The first floor was used as office accommodation.

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 rated it as Requires improvement overall.

We also found the following issues that the service provider needs to improve:

• The service had a policy and procedure for risk management, however, the service did not have a risk register for either corporate or patient risks.

• All Gadolinium contrast consent forms and MRI safety forms should be signed by the radiographer. During inspection we found not all computer based MRI safety records and Gadolinium contrast consent forms had been signed by a radiographer.

• Radiographers should sign the appendix at the back of the policy for the administration of Gadolinium contrast to say they had read it. During inspection we reviewed the policy and none of the radiographers had signed to say they had read it.

• The service should have an incident reporting system. We saw evidence three incidents involving patients had been recorded in the accident book but not as incidents.

• During inspection a local rules document for staff was reviewed, it was out of date having last been updated in 2017 and scheduled for review in August 2018. A MRI local rules document outlined local systems of work and safety practices which all staff were expected to have read and signed to say they understood them.

• The fire record test book with times and dates when the evacuation plan had been tested could not be found during the inspection.

• During inspection the services` policy for consent to examination or treatment with reference to the mental capacity act was reviewed and found to be out of date. The review date had been April 2018. No radiography staff had signed to say they had read the policy in the first instance.

• The service did not have a business continuity plan.

• During inspection we checked 22 paper copies of policies, procedures and guidance documents and found 21 were out of date.

We found the following areas of good practice:

• The service had the only open sided MRI scanner in the north of England.

• The service reported MRI results either on the same day for hospital inpatients or within three to five working days for other referrals.

• The environment and equipment was visibly clean.

• MRI safe equipment was clearly labelled.

• MRI safety notices were clearly displayed.

• MRI staff received positive patient feedback from patients who had been scanned.

Following this inspection, we told the provider that it must take one action to comply with the regulations and that it should make six other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Sarah Dronsfield

Head of hospital inspections North East.

We asked people their views of the service following individual appointments. Comments received were very positive and referred to the environment, staff attitude and treatment received. One person who used the service said the procedure had “… gone well. I was scared before I came to the clinic, the people here are good and reassured me”.

We were also told that “it is great here, good staff and good facilities. Nothing negative, reception good and beats the hospitals.”

We observe people waiting for their appointments and saw they were reassured beforehand through the use of a chaperone, appropriate music and a comfortable environment.

We saw that there were information leaflets at the reception area and throughout the building that encouraged people who used the service to make complaints, suggestions or concerns known. There were leaflets explaining patient information collected and how this was protected, used and stored.

We did not ask people their views of the service as they were attending for individual appointments and we did not want to interrupt the scanning process or place any additional stress on individuals.

We did observe scanning in progress and saw that people who used the service were reassured during the process through the use of a chaperone, appropriate music and a comfortable environment.

We saw that there were information leaflets at the reception area and throughout the building that encouraged people who used the service to make complaints, suggestions or concerns known. We also saw that there were leaflets explaining the patient information collected about people who used the service and how this was protected, used and stored.