Spire Little Aston Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. Leaders had systems for identifying and responding to deteriorating patients in the department. People received treatment and care to reduce the risk of avoidable harm, which included following safety standards and safety checks prior to entering the MRI. There were safety processes arranged before procedures started, with staff working together to ensure the right patient had the correct imaging. Medicines were managed safely. Patients were safe from neglect, abuse and discrimination. Patient’s gave informed consent prior to procedures and where they were unable to consent, those close to them were involved in decisions made in their best interests.

This is the first assessment of diagnostic services as an individual service group (it was previously inspected and rated with outpatients in 2019). We rated this key question good. Patients were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff and leaders actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared widely across the service and more widely with the other provider locations, where appropriate.

The service had a current incident reporting and reviewing policy, which reflected the provider and national guidance.  

Leaders had implemented the NHS Patient Safety Incident Framework to develop effective systems and processes to respond, learn and improve from patient safety incidents. Incidents were comprehensively investigated and there was clear analysis of incident data and trends with comparison with previous reporting periods. Incidents were discussed at the hospital clinical governance meetings, to review trends and lessons learnt. There was a rapid review of incidents that needed immediate investigation and action.  

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses in line with the local procedure. Managers investigated incidents and 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. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

There had been 48 reported clinical incidents between 1 July 2025 to 30 June 2026, 6 were identified as low harm and 42 no harm. We saw evidence incidents were investigated, and sufficient action taken to reduce the risk of recurrence. We looked at the electronic system for managing incidents.; recent examples included adverse drug reaction and extravasation (this is the accidental leakage of fluid, such as blood or a harsh medication such as contrast solution from a blood vessel into the surrounding tissue and can cause pain, swelling potential severe tissue damage). Managers debriefed and supported staff after any serious incident.

There were no never events in the preceding year. Never Events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. All clinical incidents were reviewed to check if procedures were followed and if needed any learning was identified.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. We saw an incident where the patient was found to have appendicitis, the radiologist immediately contacted the patient’s consultant and arrangements were made for the patient to attend their local NHS hospital with a disk of the images, copies of the test report, a copy of the blood results and a copy of the patient transfer form. Another patient was identified to have a spinal joint dislocation. The radiologist requested the patient to attend a local NHS accident and emergency for an urgent review with images and patient records.

Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring. For example recent excess temperatures and very high humidity had made it unsafe to use the MRI scanner (was a national issue) and resulted in patient cancellations for MRI scans. The new air handling unit was left on overnight to control humidity in the background. When manufacturers were contacted it was identified the unit cut off overnight and as a result it was unable to control the humidity. The information was shared nationally to the central imagining group and advice regarding the range of safe humidity for different machines was also shared nationally following the findings. In addition the timeliness advice was sought and actioned meant the MRI was back operational within 3 days which was a shorter time than other sites.

Another example of when there was immediate risk identified was following a cancellation of MRI for a patient with hair extensions, patient information had been updated to include hair extensions as these have metal clips. Staff had been notified of the change; MRI safety booking guide sheets were updated and shared learning sent to all the team. Staff have had discussions with the bookings team about the concept that no matter what body part was being scanned the entire MRI room was magnetic and so any metal object including hair extensions were unsafe.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents, both internal and external to the service.

Managers used changes in national guidance, incidents, safeguarding and appraisals to identify gaps in learning.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

Safety and continuity were embedded as core principles throughout the entire patient pathway. There were systems and processes to ensure the correct patients were treated throughout the patient journey and they only received the procedure which was intended.

A fully integrated, collaborative approach united patients, their families and carers, staff teams to ensure a safe, seamless experience including when patient interacted with multiple services.

Patient records were a mixture of electronic and paper based and were kept securely. The IT connectivity was consistently available across the service to meet the needs of staff and records were available to other treating clinicians when required.

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, we saw records which identified there was effective communication, which allowed for seamless transfer.

Care and support was planned and organised with people, together with partners and communities in ways which ensured continuity.

The service worked with patients and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

Staff received adult and children's safeguarding training. Data showed 100% of diagnostics staff had received both adult and children’s level 3 safeguarding training. There were current safeguarding policies, and these reflected the national guidance for adults and children, including where children were visitors.

There were both adult and children’s safeguarding leads within the hospital. Each day the hospital safety huddle included whether any child or young person was attending for each department (including imaging).

Staff knew how to make safeguarding referrals and who to contact if they had concerns. The hospital had 4 safeguarding leads, all trained to level 4, including the interim hospital director, director of clinical services, clinical governance manager and a physiotherapist. Their photographs were displayed throughout the hospital, ensuring safeguarding support was visible, accessible and readily available to staff.

Safeguarding leads present in the hospital was identified during the daily safety huddle and was also identified on the staff duty board, so staff were fully aware who to contact if they had any potential safeguarding concerns. There was a safeguarding lead onsite Monday to Friday and they were available on call out of usual office hours including weekends. Staff knew how to contact them.

Safeguarding concerns were considered when an incident occurred and a referral or further advice sought, when necessary. There were links to external agencies and staff knew what happened when they raised concerns.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The director of clinical services who was one of the safeguarding leads had oversight of safeguarding within the service. Where relevant, staff checked that people claiming Lasting Power of Attorney had the appropriate documents to support this. Patients knew what to expect and when they would be next seen by a nurse or doctor.

Staff followed safe procedures for visitors attending the department. The service had an up to date chaperone policy, and posters were available within the department informing patients chaperones were available.

The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patient’s needs which was safe, supportive and enabled patient to do the things that mattered to them.

The service worked with patients to understand and manage risks. The treatment and care met patients' needs in a way which was safe and supportive.

We spoke to 7 patients and observed 5 patient diagnostic procedures during our onsite assessment. Patients told us and we observed that patients were listened to, risks were explained, and they were involved in decisions about their treatment. For example, staff explained to a patient having a cardiac MRI how they might feel as their heart rate increased; they also confirmed they could hear and see the patient throughout the procedure and where the call bell was if they needed assistance.

Patients completed MRI safety questionnaires. The safety questionnaires asked patients if they had cardiac pacemaker, defibrillators or other devices in their chest. Female patients aged between 12 and 55 years undergoing tests involving ionising radiation completed a form to exclude pregnancy. There was also a notice in the main xray reminding all patients to disclose to staff if they maybe pregnant. Pregnancy test results for patients undergoing x-rays in theatre were available to staff on the electronic patient record system.

Family members were asked to complete a visitor’s safety questionnaire prior to the scan. We observed radiology department assistants and then radiographers run through the questionnaire with patients before their scan to ensure they were safe to proceed. Gowns were available for patients to change if their clothing contained metal, such as metal zips. All referrals included patient identification, contact details, clinical history and examination requested, as well as details of the referring clinician.

Patients were asked to complete risk assessments before they attended for their diagnostic test. We reviewed 6 patient records for evidence of completion of risks assessment of patients and found all were appropriately completed and checked by the radiographer prior to the diagnostics test.

The service used The Society of Radiographers “Pause and Check” system. Pause and check consisted of the 3-point demographic checks to correctly identify the patient, as well as checking with the patient the site to be imaged, the existence of previous imaging and for the operator to ensure the correct imaging modality was used. We observed staff always used the 3-point demographic checks in line with the correct procedure. The service provided a pause and check safety audit which showed 100% compliance with the 3-point ID checks.

Staff carried out further checks on patients who were to receive contrast media as part of their examination, and they also had access to point of care kidney function blood testing to ensure patients with known kidney problems or a greater risk of low kidney function were safe to receive contrast.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely.

The imaging department was in 2 separate units: Xray (including ultrasound, mammography and fluoroscopy) were on the first floor and MRI and CT scanning were on the ground floor. When the mobile MRI unit was onsite this was accessed from the MRI unit with the vehicle parked outside the department. Each unit had a reception desk with waiting area, preparation area, changing cubicles. The MRI scanning room also had a separate examination room and MRI control room with the post processing and reporting area.

The design of the environment followed national guidance. Warning lights were visible in areas where examinations involving ionising radiation took place. Staff were aware of controlled areas in both MRI and other services involving ionising radiation, and access to them was restricted.

The service had a new MRI scanner which became operational in May 2026. An additional separate external scanner could be booked with the provider with arrangements (both staff and equipment) managed by the provider and not the location. All scans undertaken during the onsite assessment where were carried out on internal scanner. The MRI mobile unit was located when onsite (usually 1 day a week) outside the MRI department. The MRI department had been updated in to incorporate the new MRI machine. The Xray department had also been reconfigured to enable new machines to be available whilst also enabling good access for patients including those patients who may be transferred to the department on a trolley. Where required areas were secure and afforded protection to patients. Access was restricted by either keypads or fobs.

We checked the equipment and found all single use items were in date. Staff members and other staff were able to access the scanner in an emergency if needed. The service had enough suitable equipment to help them to safely care for patients. All the equipment used in the scanner met the Medicines and Healthcare products Regulatory Agency (MHRA) safety guidelines for MRI equipment.

Staff and patients only walked into the secure patient area when permitted to do so. MRI local safety rules were in place and reflected best practice. There was signage which detailed the magnet strength and safety rule. The MRI scanners were fitted with emergency buttons which stopped scanning and switched off power to the magnet.

There were handover forms used when equipment was handed to engineers and physicists for servicing and testing, as according to guidance and best practice.

There was suitable equipment provided and used correctly, such as for patients who needed assistance with their mobility or to transfer onto equipment. Staff carried out daily safety checks of specialist equipment. There was ready access to resuscitation equipment in the department. There were emergency procedure sheets for all MRI scanners.

Fire safety equipment (including nonmagnetic fire extinguishers for the MRI room) were available and had been serviced. Fire exits were clear and free from obstruction.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. There were effective means of ensuring repair of replacement of broken or missing equipment.

Patients could summon assistance and help as needed and we saw how patients were shown how to do this.

Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the trust policy. Hazardous substances were stored safely and information about products was available to staff.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

Staff included 3 team leaders, 7 specialist radiographers diagnostic imaging manager, senior radiographers, radiographers, radiology assistants and administration staff. The service had a small number of bank radiographers who were used when needed based on the demands of the service. The service did not use agency staff.

The service had no vacancies and during the assessment the actual staffing levels were as planned. Sickness absence was low at 3.9% which was lower than the rest of Spire Little Aston Hospital (4.7%) and Spire Healthcare (4.9%) in the 12 months before the inspection.

We viewed 5 staff files and saw they all had an up-to-date enhanced disclosure and barring check on file. Where applicable, there was evidence of valid professional registration. All new staff (including bank staff) had a full induction tailored to their role before they started work. Managers supported staff to develop through constructive recorded, annual appraisals more frequent 1 to 1 check ins. All radiologists were required to provide evidence of appraisal and re-validation.

Managers reviewed the number and grade of clinical staff, assistants and other key roles, needed for each shift in accordance with provider and or national guidance. The imaging manager said they completed a daily staffing tool a week in advance and to staffing requirements to keep the service safe. In addition staffing was daily to reflect any last-minute changes such as staff sickness. Any variance to requirements (such as staff training) and then signed off by the clinical director.

The service did not employ any medical staff, 30 radiologists held practising privileges and reported on patient scans. Practicing privileges are granted to healthcare professionals with the right qualifications, skills and experience to provide services within a specific healthcare facility, like a hospital or clinic, without being directly employed by that facility. Checks on practising privileges was undertaken by a central Spire Healthcare team who checked appraisals were undertaken and complete. Radiologists who had practising privileges were required to provide an up to date appraisal. The imaging manager said if an appraisal had not been completed, they would be informed and the consultant would be paused from practising at Spire Little Aston Hospital until the appraisal had been returned and was complete. At the time of we checked 5 radiologists files all had an up to date appraisal completed.

Staff said they felt the service was safe. They were able to take breaks during their shift. Patients appeared comfortable and were engaged in conversations because there were sufficient staff.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. For example, staff could receive management training, mammography training when requested and 1 staff member said they had undertaken recognised MRI safety officer training to support their role.

The service provided mandatory training in key skills to all staff. Staff received and kept up to date with their mandatory training. The data showed a completion rate of 99.9% for diagnostics staff. Managers monitored mandatory training and alerted staff when they needed to complete updates.

Clinical staff completed training on recognising and responding to patients with for example, patients with mental health needs, learning disabilities and dementia.

Managers made sure staff attended team meetings or had access to the information shared when they could not attend. We saw general information was shared on notice boards.

Managers supported staff to develop through constructive recorded, annual appraisals of their work and regular clinical supervision. If poor staff performance was identified, this was dealt with in a supportive way, with a view to improvement.

Diagnostic imaging procedures were carried out by professionals with appropriate seniority and speciality training.

The service was open 7 days a week when patient demand required. When the department was closed (including over overnight) there was an identified team to undertake urgent x-rays and a service level agreement for a third party to report urgent diagnostic tests when a consultant radiologist was not available.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.

The department was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. The last 2 National Standards for Hospitals Cleanliness (undertaken both monthly and quarterly) audits showed an average compliance of 99%.

There was a provider infection and prevention and control (IPC) policy and supporting guidance that was accessible to staff.

There was a programme of infection and prevention and control audits including for example, hand hygiene, aseptic non touch technique, sharps audits and standard infection control and precautions audits. The service performed well in local IPC audits. In the most recent audits, the scores showed 100% compliance with infection prevention and control measures in all clinical areas within the diagnostics department.

Staff used records and data to identify how well the service prevented infections.

Staff cleaned equipment after patient contact and labelled equipment to show when it was last cleaned.

There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections.

We saw staff were following infection control principles including compliant handwashing and the use of personal protective equipment (PPE) as outlined in the service’s PPE standard operating procedure.

Staff supported infection prevention and control measures by following the uniform policy. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination.

There was an infection prevention and control nurse who worked across 3 Spire hospitals and visited Spire Little Aston Hospital once or twice a week. They provided advice and support to staff and carried out some spot checks.

The service made sure that medicines and treatments were safe and met patient’s needs.

The service used systems and processes to safely prescribe, administer, record and store medicines including imaging contrast. We saw there was appropriate arrangements in place for the storage and management of medicines. Audits for the storage and security of medicines and patient group directives identified 100% compliance.

Staff ordered contrast media and other medicines from the internal pharmacy and safely stored them in locked cabinets, Keys were securely stored in staff areas. We viewed a sample of medicines and found them to be in date. Emergency medicines were accessible.

The service had embedded patient group directions (PGDs) for contrast media and selected other drugs. PGDs allow qualified health professionals, in this case radiographers, to administer specific medicines to a pre-defined group of patients without needing an individual prescription or direct instruction from a doctor.

Staff completed medicines records accurately and kept them up to date. There was effective governance of medicines, for example, staff audited and checked medicines stock weekly and recorded medicines available against medicines used. An additional medicines audit was undertaken monthly to review medicines and check dates of expiry. The pharmacist also did a monthly audit to review storage arrangements (including temperatures medicines and contrast were stored at) medicine records and dates of medicine expiry).

Staff learned from safety alerts as ‘flash alerts’ and incidents to improve practice. There was a review of medicines errors and steps to prevent recurrence.