Fastrack Scan is operated by Ecospirito Ltd. The service is mobile and provides dual energy x-ray absorptiometry (DEXA) scans from a 7.5 tonne mobile unit.

We inspected diagnostic imaging services, which is the only service provided.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 2 April 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

We have not previously inspected this service. At the inspection on 2 April 2019, we rated this service as Inadequate overall.

We found areas of practice that were inadequate:

• Staff did not have the skills and training to keep people safe from avoidable harm and to provide the right care and treatment. The service did not provide mandatory training in key skills to all staff. Staff had not completed mandatory training, with the exception of the registered manager. However, there was enough staff to meet the demands of the service.

• Staff did not demonstrate an understanding of how to protect patients from abuse. Staff had not completed safeguarding training on how to recognise and report abuse.

• The service did not have processes to control infection risk well. Staff were not compliant with best practice for hand hygiene, in accordance with national guidelines. There was no infection prevention and control policy in place. Audits were not carried out and there were no cleaning schedules in place.

• The provider did not have suitable premises. There were no handwashing facilities in working order. Environmental risk assessments had not been completed. Out of date consumables were stored in the first aid kit. However, we saw evidence that scanning equipment had been serviced within the last 12 months.

• Arrangements were not in place to assess and manage risks to patients. Risks associated with radiation were not displayed. Local rules were not dated, displayed, or signed by all staff and they were not reflective of current guidance. Staff did not have the appropriate training to manage deteriorating patients.

• There was no clear process for managing incidents. Incidents were not investigated and details of discussions about incidents were not recorded. There was no evidence that lessons were learned and discussed with the team.

• Care and treatment provided was based on out of date national guidelines and standards. There was no process in place to ensure staff were following guidance. There were limited policies in place, no audits were carried out by the provider and no peer reviews had been undertaken.

• The service did not monitor the effectiveness of care and treatment and was therefore unable to identify and act upon areas that required improvement.

• There was no evidence that staff were competent for their roles. Staff’s work performance was not appraised and supervision meetings were not held with them. This meant that staff were not supported to be competent in their roles and the effectiveness of the service was not monitored.

• Staff did not understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They had not received any training and written consent was taken without risks associated with radiation being explained.

• Staff did not always communicate information about the scan and what it entailed with patients and those close to them. Risks associated with undertaking scans, whilst low, were not always communicated to patients.

• The service did not always take account of patients’ individual needs. Staff described some exclusion criteria, but this was not formally documented.

• The service did not have a complaints policy or process in place and patients did not know how to raise a complaint. Therefore, we could not be assured that the service treated concerns and complaints seriously, investigated them and learned lessons were shared with all staff.

• While the registered manager had the skills, knowledge, and experience to perform DEXA scans, they had not establishedsuitable and effective policies and procedures to fulfil all of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service did not have managers at all levels with the right skills and abilities to run a service providing high-quality care. Leaders had no awareness of the employment checks and training that were required to keep patients safe.

• There was no vision for what the service wanted to achieve and workable plans to turn it into action.

• The culture was not focussed on safety and quality. There were no mechanisms in place for providing staff with the appropriate training or sharing of information.

• There was a lack of governance arrangements in place. The limited arrangements that were in place were not adequate to ensure high standards of care could be maintained.

• We were not assured that effective systems were in place to identify, reduce and eliminate risks, and to cope with both the expected and unexpected.

• While the provider used electronic systems with security safeguards, it did not always collect, manage and use information well to support its activities.

• There was no evidence of engagement with patients outside of the scan appointment. Views and experiences of patients were not collected, and therefore the service was unable to shape and improve the service based on feedback.

We found a limited number of areas of good practice:

• Staff kept accurate records of patients’ demographics and scans, and transferred them appropriately to referring clinicians.

• Staff undertook scans for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Staff had the ability to minimise patients’ anxieties about the scan, if required.

• People could access the service when they needed it.

Following this inspection, we formally notified the provider that their registration in respect of carrying out a regulated activity was suspended for eight weeks, under Section 31 of the Health and Social Care Act 2008. The notice of urgent suspension was given because we believed that a person or persons will or may be exposed to the risk of harm if we did not take this action. The letter included the concerns we identified during this inspection. In order for the suspension to be lifted, we must be assured that a person or persons will not be exposed to the risk of harm when we inspect the service again. On the basis of this inspection, the Chief Inspector of Hospitals has recommended that the provider be placed into special measures.

We also told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notice(s) that affected Fastrack Scan. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central region)