Ultrasound Direct Ltd is operated by Ultrasound Direct Limited. The service had one registered location with 32 satellite clinics located around England. Two satellite clinics was based in Ireland (Belfast and Newry).

The service provides diagnostic imaging services (ultrasound scans) to the local community. We inspected diagnostic imaging services at this location and a selection of satellite clinics.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 14 August 2018 and six short notice announced visits to satellite clinics across England between 15 August to 23 August 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 only service provided at this location was diagnostic imaging.

Services we rate

We previously did not have the authority to rate this service, however we now have the authority to rate these services. We rated it as good overall.

We found the following areas of good practice:

• There was a system and process in place for identifying and reporting potential abuse. Staff could provide examples where they had needed to escalate concerns.

• The service had a positive approach to learning from incidents and complaints. They reviewed all incidents regardless of level of harm and complaints to identify if any learning opportunities were evident.

• There was a robust process in place for the escalation of unexpected findings during ultrasound scans. The service had developed links with local acute healthcare providers to enable a seamless onward referral for patients experiencing complications with pregnancy, as well as a well embedded referral process for non-pregnancy related complications. We saw examples of staff escalating unexpected findings during our inspection.

• There was a proactive approach to training and continuous professional development for staff who worked at the service. The introduction of the Ultrasound School was an innovative way of ensuring staff remained clinically up to date and competent whilst giving staff the opportunity to develop new skills and competencies.

• Patients were cared for by clinically competent and professionally adept staff. The service took competency seriously and the processes for overviewing competency seriously and had entered staff with no professional registration on to the Society of Radiographers register.

• Feedback from patients was overwhelmingly positive during our inspection and we observed some examples of high quality care and treatment provided to patients. Patients were engaged with and encouraged to be partners in their care and treatment provided.

• Clinical environments were visibly clean and tidy, and were suitable and appropriate to meet the needs of the patients who attended for appointments, as well as relatives and children who accompanied them.

• Appointments were scheduled to meet the needs and demands of the patients who required their services. Throughout the regions which the service covered, they had arranged for seven-day services to be available, with a wide range of appointment times to suit patients. Same day appointments were also available for patients who required them.

• The vision and values were understood and well embedded in staff’s daily work. Staff felt supported by a leadership team who were credible, approachable and visible. Staff were proud to work at the service and there were high levels of satisfaction across all staff groups.

• There were governance systems in place to monitor the high-quality and sustainable care being provided to patients.

• The service had systems in place to acquire feedback from staff and patients to enable them to continually improve the service being provided.

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

• We found issues regarding the environment of some of the clinical locations which did not fully support good infection prevention and control practices. Some locations did not have a handwashing sink immediately available for staff and some locations had carpeted floors in the ultrasound scanning room.

• The clinical assistant staff group had not previously been required to complete mandatory training. Senior management had recognised this as an issue and had implemented a training programme for all clinical assistants to complete. This programme was due for completion by November 2018. We saw this was on trajectory at the time of our inspection.

• The service had minimal processes in place to demonstrate patient outcomes. Senior management had already identified this and had recently implemented an annual audit programme and audit meeting for oversight of this.

• The human resources (HR) process were being changed to a new system at the time of our inspection, this made viewing staffing files difficult. The staff files we did review were not all complete, however some of this was related to the transfer from the old HR system to the new.

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)