PET CT Mobile Services are operated by Alliance Medical Limited. The mobile services are registered to the service provider’s Head Office in Warwick.

The service provides diagnostic imaging services, positron emission tomography–computed tomography (PET-CT) to the local community, as agreed via NHS England. We inspected mobile diagnostic imaging services at two locations. Positron emission tomography–computed tomography is a nuclear medicine technique which combines, in a single gantry, a positron emission tomography scanner and an x-ray computed tomography scanner, to acquire sequential images from both devices in the same session, which are combined into a single superposed image. Positron emission tomography (PET) scans are used to produce detailed 3-dimensional images of the inside of the body. The images can clearly show the part of the body being investigated, including any abnormal areas, and can highlight how well certain functions of the body are working. PET scans combined with CT scans produce more detailed images. PET scanners work by detecting the radiation given off by a substance injected into the patient’s arm called a radioactive tracer as it collects in different parts of the body. In most PET scans a radioactive tracer called fluorodeoxyglucose (FDG) is used, which is like naturally occurring glucose (a type of sugar) the body treats it in a similar way. By analysing the areas where the radioactive tracer does and doesn't build up, it is possible to work out how well certain body functions are working and identify any abnormalities. For example, a concentration of FDG in the body's tissues can help identify cancerous cells because cancer cells use glucose at a much faster rate than normal cells. The services also used 18-fluoroethylcholine (FEC).

The mobile service operates from eight mobile units. Each vehicle is moved to each mobile site on the required days. The eight mobile units visit 17 different hospital sites across the country each week.

Patient scans are booked and coordinated by a team of booking administrators who are located at various static units and supported by a bookings coordinator and regional seniors who support the mobile service 5 days per week and out of hours via an on-call facility.

The patient scans are reported either by reporters from the local scanning trust, or one of Alliance Medical Limited (AML) supporting teams of registered reporters.

Operating hours for mobile scanning services are typically 7:30am until 7:30pm, however this may vary depending on geographical location and local capacity requirements. AML currently offers mobile scanning services six days per week Monday to Saturday inclusive.

We inspected this service using our comprehensive inspection methodology. We carried out two unannounced inspections to two different locations on 11 December 2018 (Wolverhampton) and 19 December 2018 (Guildford).

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 only service provided at this location was diagnostic imaging.

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:

• There were systems in place to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff provided a focused and individual approach to patient care.
• Staff were caring, kind and engaged appropriately with patients.
• Staff told us they received feedback from incident reporting processes. We saw evidence of change to practice from incident investigation.
• The service provided care and treatment based on national guidance and evidence of its effectiveness.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them.
• The service made sure staff were competent for their roles.
• The service planned and provided services in a way that met the needs of local people.
• The service took account of patients’ individual needs.
• The service treated concerns and complaints seriously.
• Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
• The service had systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

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

• When administering fluorodeoxyglucose (FDG) or 18-fluoroethylcholine (FEC) to patients, the service should review the opportunity for a second clinician to check the dosage prior to administering. While there were checks when the radiopharmaceutical was dispensed, drawn up and level of radioactivity measured, a final four or five-way check immediately prior to injection of patient verses, demographics, verses intended exam, verses radioactive medicinal products (RMP) identity verses RMP activity, would be a useful ‘fail-safe’.

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.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)