The Pavilion Clinic is a joint venture between BMI Healthcare (52%) and Global Diagnostics Limited (48%). Global Diagnostics Limited is the registered provider and the service is based within the BMI Three Shires Hospital in Northampton.

The senior management of the service is provided by BMI Healthcare staff who work collaboratively with Global Diagnostics Limited. The registered manager is the general manager of the Three Shires Hospital.

Staff working within the service are employed by Global Diagnostics Ltd, with the exception of the imaging manager who is employed by BMI Healthcare.

Facilities include two general x-ray rooms, one with fluoroscopy, ultrasound and an MRI scanner. The service provides diagnostic imaging to inpatient, outpatient and the hospital’s operating theatre. Approximately 48% of the patients attending the service are NHS funded, with the remaining 52% being privately funded. Patients are predominately from within Northamptonshire, however, national and international patients frequently visit the department for investigations.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice inspection on 26 February 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. We do not rate effective for diagnostic imaging services.

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 inspection of this service using this methodology. We rated it as Outstanding overall.

Summary

We found the following areas of outstanding practice:

• Services were tailored to meet the needs of the individual patients and delivered in a way to ensure flexibility, choice and continuity of care. People could access the service when they needed it. Waiting times for investigations were minimal and arrangements to treat patients were in line with good practice.

• All referrals were scheduled an appointment on the same day as receipt in the department. This meant that there was no waiting list, with all referrals allocated an appointment slot within 24 hours of receipt of referral.

• All images were reviewed and reported on by a radiologist within one week of the investigation being completed. The majority of images were reported on the same day.

• The service had managers with the right skills and abilities to run a service providing high-quality sustainable care. Local leadership was integral to the drive to improve the delivery of high quality patient centred care. Leaders had a shared purpose, strive to deliver a high-quality service and motivate staff to succeed.

• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff were satisfied within their roles and felt supported and proud to work for the organisation.

• There was a systematic approach to continually improving the quality of services and safeguarding high standards of care. Compliance was monitored and performance management arrangements proactively reviewed and reflected best practice.

• There were effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

• Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new and more sustainable models of care.

• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services. They worked collaboratively with partner organisations effectively.

We found the following areas of good practice:

• Mandatory training was provided to all staff, and managers had processes in place to ensure compliance.

• Staff were aware of safeguarding and understood how to protect patients from abuse and escalate concerns.

• Infection control risks were well managed. Staff kept themselves, equipment and the premises clean. The service had suitable premises and equipment and looked after them well.

• Patient safety was maintained and there were processes in place to monitor risks.

• Staff were appropriately trained and experienced.

• Patient records were kept up to date and accurately reflected treatments that were given.

• Medicines were stored well. Patients received the right medication at the right dose at the right time. This included radiation doses, which were monitored and administered within guidelines.

• The service ensured that there were processes in place to ensure radiation protection.

• The service managed patient safety incidents well. Incidents were investigated and staff shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

• Care and treatment was based on national guidance and managers checked to make sure staff followed guidance. The quality of images was regularly assessed through audits and case reviews.

• Staff were competent for their roles and were encouraged to develop. Performance was reviewed and supervision was provided.

• Staff across the whole hospital worked collaboratively to provide a seamless service.

• The service flexed its availability to provide a 24-hour service, although the main business hours were Monday to Friday 8am to 8pm.

• Staff cared for patients with compassion and provided emotional support. All feedback from patients was positive and described a caring and friendly service.

• Patients felt involved with their care and knew what to expect.

However:

• Mandatory training compliance was below the service target of 100% for 17 out of 25 topics.

Following this inspection, we told the provider that it should make some 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)

We spoke with one person who received care on the day of our inspection. They told us that their appointment had been arranged through their consultant and the service they received was perfect. They told us that the radiographer had explained what was going to happen and talked them through the imaging process.

We observed radiographers communicating with people who used the service before, during and after their diagnostic procedures. We saw that the radiographers were informative, reassuring and calm.

We spoke with the porter who explained how he ensured that people were transported to the x-ray department safely and with dignity. We observed that the porter spoke with the person using the service and their relatives in a kind and considerate way.

We found that people were informed of the fees before receiving care. People had their scans read by experienced radiologists and staff received appropriate professional development.

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 found a purpose built imaging department that was well equipped. We spoke with staff that were knowledgeable about their roles and had received training that met the needs of the people who used the service.