Spire Little Aston Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of patient who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This is the first assessment of diagnostic services as an individual service group (it was previously inspected and rated with outpatients). We rated this key question outstanding. This meant patient’s needs were met through good organisation and delivery.

We have not awarded this service a score for Well-led.

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

The service had a clear shared vision, strategy and culture that built on the organisational vision and strategy. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of patients and their communities.

The imaging department had a vision and objectives for what it wanted to achieve and turn it into action. There was also a clinical strategy which included patient safety and regulation readiness, patient experience, clinical effectiveness, quality improvement, and innovation, workforce support and development, operational excellence(efficiency) and growth and service expansion. The hospitals' purpose was to make a positive difference in people's lives through outstanding personalised care and the imaging department objectives and clinical strategy supported this.

Leaders supported the wider health economy in ways such as increasing community-based engagement and supporting other organisations including a local hospice through fundraising. They also maintained regular engagement with the Integrated Care Board to ensure services were aligned with local health priorities and population needs. Additionally, the hospital had GP liaison officers who worked with GPs to build relationships, facilitate communication, and support collaborative pathways of care.

Staff were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. We heard several examples of staff who had been promoted into more senior roles.

The service had a diversity champion; they told us how they had arranged events such as liaising with the restaurant to offer staff the opportunity to taste food from other cultures. They had also produced a diversity calendar for staff with different dates and decorated the hospital with flags. They kept staff up to date with any new events via an email and were supported in their role by senior leaders.

The service had an open culture where patients, their families, and carers as well as staff could raise concerns without fear.

Staff felt respected, supported, and valued. Staff reported that the leadership culture was inclusive, and they felt valued and respected. Relationships between staff of all grades were positive, with strong teamwork and collaboration.

Leaders held staff forums every 3 months where they could feed back to staff and staff could just go along and have a chat about anything. Leaders told us how they had glass doors to their offices so staff would feel it easier to approach them.

Team and individual staff achievement and success was recognised and celebrated. Staff were thanked for their work. For example, we saw a staff members had gone above to ensure a patient with an undiagnosed life-threatening condition was transferred for urgent treatment. The staff member had been given a recognition award. Staff who had their achievement recognised were displayed on poster of a tree providing information on how the person had made a difference to care provided.

Staff felt motivated about the future and planned changes for the service speaking positively about the new MRI and ultrasound machines.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

Leaders had a range of experience, skills and abilities to run the service, and they understood and managed the priorities and issues the service faced. Leaders were visible and approachable in the service for patients and staff. Staff felt the leaders supported them to develop their skills and take on more senior roles.

The diagnostic imaging department was led by the imaging manager who was an experienced clinician and manager. They worked clinically within the imaging department and had completed the Spire Healthcare Leadership and Management Development programme. They ensured they were visible and approachable for staff, completing a walkaround each morning and operating an open office door policy. Staff spoke very highly of the imaging manager, stating they were approachable and supportive, personally and professionally.

There were 3 team leaders within the imaging department, 1 for x-ray and mammography and 1 for CT and another for MRI. The radiology manager reported to the director of clinical services, who reported to the hospital director.

Staff told us the imaging manager and other senior managers visited clinical areas at the start of the day to check on staff wellbeing and offer support where required. Staff told us leaders were approachable and accessible and that they felt supported respected and valued. Staff said they were proud to work for the service. One member of staff said they had recently returned to the service highlighting the positive culture of the department and the hospital.

There was strong collaboration, team-working and support and a common focus on improving the quality and sustainability of care and patients’ experiences. The culture of the service centred on the needs and experience of the patients who used services. Staff were passionate about delivering high quality care and treatment for patients.

Leaders at all levels understood the top risks in the service and mitigations in place. They used learning from incidents, as well as staff and patient feedback to improve the service.

Leaders had taken incidents seriously and knew how to deal with concerns when raised which promoted a positive culture in the service. Leaders attended the imaging department to assess for themselves how the service was running.

The Spire Healthcare Annual Report 2025 explicitly identified Little Aston Hospital as an example of effective operational delivery within the hospitals business all without major capital investment.  

In addition to mandatory, statutory and role-specific training requirements, the imaging manager and senior managers demonstrated a strong commitment to workforce development, leadership capability, quality improvement and professional excellence through a wide range of additional training, education and development opportunities.

The provider had a Leadership and Management Development programme which included a New Managers Programme (NMP). The programme was an in-house Spire Healthcare development initiative designed to equip new managers with the essential skills, knowledge and behaviours needed to excel in their roles and lead successful teams. The programme was specifically aimed at colleagues with six months or less people management experience and included: managers and team leaders. The course consisted of a two-day residential course and 1-day virtual follow-up session. One of the imaging team leaders had completed this course.

To reinforce learning, participants attended locally delivered Mastering Management sessions. The Mastering Management Programme 2026 included sessions on handling difficult conversations, communicating and listening in a pressurised environment, developing great relationships, developing others and maximising growth, delegating effectively and maximising time and being a consciously inclusive manager. Spire Healthcare also offered an Advanced Managers Programme for experienced leaders, 90% of Heads of Department (including the imaging manager) had attended this.

The service fostered a generally positive culture where patients felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged raise concerns and offer ideas; the culture allowed staff to be confident their voices were heard.

Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported, without fear of detriment. When concerns were raised, leaders investigated sensitively and confidentially. The local senior leadership and provider level were made aware when whistleblowers had raised serious concerns. Risk registers and management reports contained analysis of concerns over time and associated action plans.

Staff were able to raise concerns through the Freedom to Speak Up Guardian and were aware they could do this and who they were. There was also 2 Freedom to Speak up ambassadors and a Freedom to Speak Up consultant in the hospital.

Patients, their families and carers were provided with information to explain how they could raise a concern and how this would be investigated. Staff were encouraged to respond to immediate concerns or complaints with a view to resolution. There were policies to support the complaints process.

Staff were able to enter concerns on the electronic incident recording system and select the category Freedom to Speak Up. They could leave their name if they wished or raise the concerns anonymously. Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported, without fear of detriment. When concerns were raised, leaders investigated sensitively and confidentially.

The service valued diversity in their workforce. It had an inclusive and fair culture which had improved equality and equity for staff.

Leaders acted to improve where there were any disparities in the experience of staff with protected equality characteristics.

Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment.

Staff told us they had opportunities to apply for project work, new roles and to undertake external studies through an open application process. Staff felt everyone was treated fairly and that they would be able to report negative behaviour or attitudes.

Staff were offered reasonable adjustments to support them to carry out their roles well. For example, we heard how staff hours had been adjusted to support staff members when it was needed. Leaders told us how arrangements could be made to work flexibly if needed. They gave examples of when staff had been able to do specific shifts to meet their needs and how there were a range of shifts available such as long and short days.

The hospital had an equality and inclusion strategy how they would deliver it. These were placed under headings such as Encourage, Celebrate, Educate, and Equip and Adapt and Approach.

There was a hospital diversity including LGBTQ+ champion. They had also established colleague network groups such as LGBTQ+, race equality, and Mental Health First Aiders. There were 3 mental first aiders in post whose role was to act as a point of contact and reassurance for those experiencing mental health issues and emotional distress.

Leaders also promoted a comprehensive calendar of events and initiatives that celebrated different cultures and traditions. These had included Race Equality Week and International Women’s Day, with others planned for the year ahead. The hospital had also hosted LGBTQ+ educational events such as lunch and learn speaker sessions, and a podcast had been introduced to promote a more inclusive workforce.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style.

Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well. For example, additional equipment including a height adjustable worktable within the MRI control room and changed working hours including shorter days or not working a late shift followed by an early shift.

The service had clear responsibilities, roles, systems of accountability and effective governance. Staff used these to manage and deliver high-quality, sustainable care, treatment and support. Staff always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The hospital had an integrated quality governance and assurance structure that had been developed to provide guidance and support for all meetings taking place across the group from ward to board. The structure included various meetings and committees. These included a quarterly Hospital Safety, Quality and Risk Committee, Quarterly Health and Safety Committee and a Quarterly Medical Advisory Committee.

There was also a health and safety subcommittee with various subgroups as well as a Patient Safety Sub Committee, a quarterly patient experience group, bi-monthly head of department meetings and a monthly departmental team meeting. There was also a whole hospital weekly rapid response meeting. Minutes from all meeting were shared at the local medical advisory committee (MAC).

There were systems and processes in place relating to practicing privileges. The hospital had a medical governance co-ordinator who ensured these systems were implemented effectively with oversight from the hospital director.

The hospital MAC ensured new consultants (including radiologists) were only granted practising privileges if deemed competent and safe to practice. All radiologists carried out procedures within their scope of practice within their substantive post in the NHS. This was monitored centrally and any consultant whose practice showed an increase or decrease in activity would be reviewed. Any outlier for incidents such inaccurate reporting would be reviewed with the consultant. We reviewed minutes from the MAC meetings and found these followed a standard agenda.

Oversight of diagnostic imaging waiting lists was reviewed at a weekly capacity meeting and forecasting meeting which was attended by the senior management team.

The imaging department had monthly team meetings which included topics such as risk, safety, complaints, incidents, learning, complaints, policy updates and audit results and actions. We reviewed the minutes from the most recent Hospital Quarterly Safety, Quality and Risk Committee meetings and saw topics that were discussed included mandatory training, risk, incidents, and audit.

Key performance indicators relating to area such as clinical incidents, safeguarding, waiting time for diagnostic imaging tests and waiting time for reporting diagnostic imaging tests and complaints were monitored through the hospital’s Excellence in Care Delivery and Safety Dashboard and Dashboard meetings.

The hospital had a risk register which included identified risks for the imaging department. The risks were colour coded and had recently been reviewed. Top risks were age of the ultrasound machines, (This was being addressed with the purchase of a new machine), incorrect patient details and concealed pregnancy. Risks were discussed in the imaging team meetings. Risks were clearly identified and a formal log of these was used to keep oversight and manage mitigations and/or bring to resolution.

We reviewed the last 3 senior management team meetings and noted topics discussed included quality improvement, training, complaints, service level agreements, waste and carbon and quarterly fire updates from the engineer.

The hospital operated a succession planning framework since 2021 incorporating talent mapping, contingency planning, and leadership development. This was reviewed every 6 to 12 months to maintain workforce resilience.

We noted that the hospital had implemented various initiatives one of which had resulted in in a saving of 2018 kg of C02, equivalent to approximately 7 trees planted annually, one car removed from the road, or 1 house powered for a year.

Leaders made sure that accurate information was discussed and shared with key staff. For example, information was shared via the daily safety huddles, team meetings, drop ins and emails.

Audit processes and the outcomes were used to ensure quality of services was maximised. Where improvements were required, leaders ensured action plans and the monitoring of these led to positive changes.

The service had plans to cope with unexpected events and had a business continuity plan which included major incident plans.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of each policy.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions, and these set out expectations and responsibilities. Where senior staff had designated tasks related to audit and monitoring quality of services, they understood what was required of them.

Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

The service had not reported any data breaches and systems were secure. Patient identifiable information was handled correctly.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for patient. Staff share information and learning with partners and collaborate for improvement.

The hospital had service level agreements (SLA) in place with local trusts and organisations to support the services offered at the hospital. We saw SLA for transfer of patients to local NHS trusts and intensive care units when required.

Staff and leaders at the service collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service. For example they maintained regular engagement meetings with the Integrated Care Board (ICB) to ensure services were aligned with local health priorities and population needs. We saw the hospital engaged with local cancer services, private health insurance companies, local NHS trusts and other private hospitals to share information.

Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

The GP Liaison Officers (GPLOs) worked closely with local GP practices to build strong relationships, facilitate communication, and support collaborative pathways of care. These activities enabled the service to contribute to a joined-up approach to healthcare delivery and improve outcomes for patients across the wider health and social care system.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. Staff often encouraged creative ways of delivering equality of experience, outcome and quality of life for patient. Staff actively contributed to safe, effective practice and research.

There was an established, significant and sustained culture of continuous and creative learning, innovation and improvement based on evidence and local need. This delivered improved outcomes, equality of access, and quality care for patients.

Staff were committed to continually learning and improving services. There were processes for learning when things went wrong or of good practice, either locally or nationally. Staff were supported to have the time to develop their skills and leaders encouraged innovation.  

Quality improvement projects (QIP) were embedded practice and staff we spoke with had a good understanding of quality improvement methods and had been trained in this area of work. We were told about some of the areas of quality improvement projects in the last 12 months work included:

• The booking accuracy project had implemented a standardised protocol template to give all the information bookings needed when speaking to a patient in a clear and easy to deliver way. This initiative had reduced the percentage of incorrectly booked CT scans from 70% before the project to 10-25% in the following months.
• Did not attend (DNA) MRI appointments had reduced from an average 8.3 DNA rate in the months before the QIP to 1 patient each month in the following months since.
• A QIP had ensured there was a direct line for patients on a Sunday to make changes to booked appointments.

Staff were supported to have the time to develop their skills around improvement and innovation and to pursue areas of interest in the service. Leaders encouraged innovation and we heard about the following examples: The effective use of point of care blood testing had positively impacted patient flow, efficiency and overall patient experience. The project improved the timeliness of results, and enhanced patient experience.

Staff and leaders were committed to excellence that centred on the patient experience. Where they saw a need, they worked together to find a solution, for example the new MRI had reduced appointment times for the patients and freed up addition capacity, the new mammography machine had the ability to introduce a contrast mammography service for asymptomatic mammography and will be on the forefront of mammography service