The Manor Alliance MRI Unit is operated by Alliance Medical Limited. Facilities include a static Magnetic Resonance Imaging (MRI) scanner only.

The service is co-located on the second floor of an independent host hospital. The service receives referrals from consultants within the host hospital, local GP’s and occasionally from NHS trusts.

The service provides diagnostic imaging for children and adults. It is registered to provide the activity of diagnostic and screening procedures.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced visit (the service did not know we were coming) to the service on Wednesday 3 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

This was the first time we rated this service. We rated it as requires improvement overall.

We found areas of practice that require improvement in relation to diagnostic imaging:

• All staff had received training on how to protect patients from abuse. However, the safeguarding lead could not demonstrate a level of safeguarding knowledge relevant for their role.

• Staff kept detailed records of patients’ care and treatment, however staff did not ensure consistency when recording in the patients records.

• The service provided care and treatment based on national guidance, however not all guidance had been version controlled, was up to date and the service could not assure themselves staff had read it.

• The service did not have processes in place to monitor the effectiveness of care and treatment in the unit. There were limited quality assurance audits for both the safety of the MRI machine and image quality.

• The service had enough staff with the right qualifications and skills, however, the service did not provide the radiographers protected time for continuous professional development.

• Risk assessments were not completed for all staff who worked within the MRI scanning area.

• Staff were well presented however they did not use effective control measures to prevent the spread of infection.

• Managers in the service did not have the right skills and abilities to run a service providing high quality sustainable care and we were not assured all senior members of the team were equipped with the appropriate skills to manage others.

• The service did not have a comprehensive local governance framework that allowed them to review performance and safeguard high quality care.

• The service engaged well with patients to plan and manage appropriate services. However, engagement with staff was lacking.

• Although the service was committed to improving services by learning from when things went well or wrong, there was a lack of emphasis on staff training, research and a lack of innovation.

However, we found good practice in this service:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff completed and updated risk assessments for each patient, managed patient safety incidents well and followed best practice when prescribing, administering, recording and storing medicines.

• Patients had access to enough hydration services to meet their needs and monitored patients to see if they were in pain during procedures.

• Staff of different professional groups worked together as a team to benefit patients.

• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

• The service cared for patients and their carers with compassion and kindness. The service supported carers to be with patients for reassurance during their imaging procedures and the service took account of patient’s individual needs.

• The service planned and provided services in a way that met the individual needs of local people. Patients could access the service and appointments in a way and at a time that suited them.

• The service had a complaints policy and treated concerns and complaints seriously.

Following this inspection, we issued the service with a warning notice and told the provider that it must take some actions to comply with the regulations and that it should make other improvements. Details are at the end of the report.

Nigel AchesonDeputy Chief Inspector of Hospitals (London and South)

During this visit we looked at five outcomes which we found to be compliant. The majority of people who used the service were referred from the Nuffield hospital. The person would be seen in outpatients and then referred straight for the MRI Scan. The consultant would take consent during the clinic consultation and we saw evidence of this on the referral forms. Anyone who required an MRI scan was taken through a safety checklist prior to the scan being completed. The procedure was fully explained to each person. We also saw evidence that local protocols were in place for more complex scans. The staff were prepared for emergencies and were able to call upon the emergency medical team from the Nuffield Hospital.

Whilst we did not speak to any people who used the service we did see the results of a patient satisfaction survey completed in February 2013. The survey was completed every month and consistently the provider scored 100% for people being very satisfied with the service.