Archived: Clinical Diagnostix Ltd

Clinical Diagnostix Ltd has been established for approximately 10 years. Services provided include; mobile echocardiography (echo), ambulatory electrocardiogram (ECG), ambulatory blood pressure (BP) monitoring and, exercise tolerance testing to NHS and private patients in the community or hospital settings. Echocardiography uses ultrasound to visualise the moving heart, great vessels and valves and can include doppler (a specialist instrument) to establish blood flow. The procedure lasts approximately 30 minutes is pain free and delivered in a clinic setting. Ambulatory ECG is used to determine rhythm abnormalities. Ambulatory BP monitoring is useful in establishing white coat hypertension and exercise tolerance testing demonstrates what happens when a patient’s heart is put under stress. White coat hypertension is a syndrome whereby a patient's feeling of anxiety in a medical environment results in an abnormally high reading when their blood pressure is measured.

The service sees adults and children from the age of 16 years although the number of 16 to 18-year olds is very low (five in the reporting period August 2017 to August 2018) .

We inspected this service using our comprehensive inspection methodology and diagnostic imaging framework. We carried out the announced part of the inspection on 2 October 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. 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 time we rated this service. We rated it as Good overall.

We found the following areas of good practice:

• Good induction processes were in place for new staff, 100% of staff had attended annual mandatory training updates.

• Staff had the appropriate level of safeguarding training and checks were in place to protect vulnerable persons.

• Reliable systems were in place to prevent and protect people from health care acquired infections.

• The environment and equipment used was appropriate to deliver the service.

• Staff could recognise when a patient had an urgent medical condition and systems were in place to refer to urgent medical services.

• There were adequate staff levels to deliver safe care to patients and meet current demand.

• Patient information was managed in a way that kept people protected from avoidable harmand records were stored securely.

• Staff could recognise and report incidents. An incident management policy was in place and incident reporting forms were carried by staff.

• The service adhered to evidence based guidance for echocardiogram, ambulatory blood pressure (BP) monitoring, ambulatory electrocardiograph (ECG) and exercise tolerance test.

• Ten percent of all echocardiogram reports and images per month were audited by an external auditor.

• Staff had the skills, knowledge and expertise to deliver an effective service.

• Staff liaised with other health care professionals involved in the care of the patient.

• Staff understood the principles of consent and the Mental Capacity Act.

• We observed staff treating patients with kindness and compassion, 100% of patients in the most recent patient survey said they were given all the privacy they needed during the test.

• Patients described being ‘put at ease’, ‘made to feel relaxed’ and one patient said they felt apprehensive but staff helped them to relax and reduced their anxiety.

• Patients and those close to them were given adequate information about the test, knew what to do next and when the test results would be available.

• The service was delivered in locations which met the needs of individuals and appointment times were flexible.

• All locations had good wheelchair access and interpreting services could be arranged with commissioners if required.

• Waiting lists were short and met key performance indicator standards, clinics ran on time.

• Report were sent to the referring clinician within two working days.

• Leaders had the capability and capacity to manage the service. They could articulate the challenges faced but also, due to its compact size, respond quickly to patient and commissioner feedback.

• There was a culture of openness and honesty which was demonstrated during our inspection. Staff felt valued and supported.

• The directors held governance meetings regularly, service level agreements and contract meetings were held with commissioners which meant the service was reviewed regularly.

• The service had a clear business continuity plan in place which described the action that would be taken in the event of a major incident or business disruption.

• Information was managed securely and in line with relevant regulation.

• The provider actively sought feedback from patients via an annual patient survey. The last patient survey was overwhelmingly positive in all aspects.

However, we also found the following areas for improvement:

• The provider did not undertake hand hygiene audits.

• There was no service schedule for the ambulatory blood pressure machine.

• Four out of seven staff had not had a formal appraisal meeting with their line manager.

• The provider did not have a duty of candour policy, and duty of candour was not reflected in the incident or complaints policies.

• Staff meetings were not taking place.

• There was no formal risk register in place.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)