InHealth Diagnostic Centre is operated by InHealth Limited. The service provides diagnostic imaging services to the local community. It is a stand-alone purpose-built diagnostic screening facility.

InHealth was established 25 years ago to meet some of the health economy’s most pressing challenges – reducing waiting times, speeding up diagnoses, saving money, improving patient pathways and enhancing the overall patient experience. Efficiency models from manufacturing programmes were adapted to develop healthcare services focused on continuous quality improvement. The organisation was successful in winning contracts and has grown due to its access to capital for investment, its ability to design and adapt healthcare solutions to meet changing demands, demonstrate value for money and to work collaboratively with its NHS and private sector partners.

Milton Keynes InHealth Diagnostic Centre opened in 2010. The centre provides magnetic resonance imaging (MRI) scans, computed tomography scan (CT) scans, dual-energy X-ray absorptiometry (DEXA) scans and ultrasound for both NHS and private patients. The unit is registered with the CQC to undertake the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury. The site provides a service for adult patients only (aged 18 and above). The site operates 7 days a week between the hours of 8am and 8pm.

Milton Keynes InHealth Diagnostic Centre is based in a double storey building in the centre of Milton Keynes. The service has one ultrasound scanner, a CT scanner a MRI Scanner and a DEXA machine. The service provides contracted imaging to NHS funded patients. Each year, the local hospital trust commission approximately 500 MRI scans. The local clinical commissioning group commissions approximately 5000 musculoskeletal MRI scans and 930 DEXA scans and a local private provider commissions approximately 200 musculoskeletal MRI scans. The service also carried out CT scans and non MSK MRI for a local private provider.

The service had out sourced image reporting to a third party. Most reporting was completed locally by in-house radiologists. However, the service outsourced to ensure they kept within the tight key performance indicators for reporting turnaround times and national targets when the providers’ radiologists did not have capacity.

A review was carried out at the location to assess compliance with the Ionising Radiation Regulations 2017 (IRR17) and the Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17) in May 2018. Overall compliance with IRR17 and IRMER was good. The Imaging Services Manager and radiology staff were aware of the local rules and procedures and these documents are reviewed on a regular basis. Most of the recommendations following this audit related to updating the current documentation to comply with the implementation of the new IRR17 and IRMER regulations. Some minor changes to the procedures were recommended to reflect local arrangements.

The service had not been the subject of an external investigation between August 2017 and August 2018.

We inspected diagnostic imaging services at this location.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 11 September 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.

The service provided at this location was diagnostic and screening procedures and treatment of disease, disorder or injury.

Services we rate

We previously did not have the authority to rate this service. We rated it as good overall.

We found the following areas of good practice:

• Staff received effective training in the safety systems, processes and practices.

• There was evidence that staff received feedback from incident reporting processes.

• There were sufficient numbers of staff with the necessary skills, experience Patients had their needs assessed and their care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice and qualifications to meet patients’ needs.

• Staff felt supported to do their job and developed in their roles.

• There was evidence of regular team meetings.

• Staff were caring, kind and engaged with patients.

• We observed a focused and individual approach to patient care.

• Information about the needs of the local population was used to inform how services were planned and delivered.

• Leaders had the skills, knowledge, experience and integrity needed both, when they were appointed and on an ongoing basis.

However, we found areas of practice that the service needed to improve:

• At the time of inspection, it was not clear if staff were aware of the changes made by the introduction of the Ionising Radiation Regulations 2017 (IRR17) and the Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17).

• We did not see evidence locally of a capital replacement plan for the MRI scanner, the CT scanner, the DEXA Scanner and the ultrasound machine. All the diagnostic equipment on site was between eight and twelve years old and heading towards being at the end of their working lives. While the service had service level agreement to ensure all pieces of equipment were regularly checked and serviced, at local level, the service was not aware of a plan to replace the equipment. This issue was not on the local risk register.

• There was limited storage available for stock items in the CT room.

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.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central)

We spoke with two people who used the service and three members of staff. We also spoke with the registered manager of the service. We looked at three people’s treatment records and copies of complaints received by the provider. We also looked at staff recruitment information.

People told us they had received a good service at Inhealth Diagnostic Centre. They also told us that the staff had explained to them about the tests they needed. For example one person told us that the staff had informed them what to expect when they had an MRI (Magnetic Resonance Imaging) scan. They also told us that staff had completed an assessment before they received their scan to check they were suitable for the test they needed. People told us they would be happy to raise any complaints or concerns they had with the staff and were confident these would be taken seriously.

We found that people were given information regarding their treatment and care and received diagnostic tests that met their health needs. We also found that staff with the right skills had been recruited and that the provider had an effective complaints system. We found that equipment was maintained in a safe way and was suitable for people who used services.