Spire South Bank 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

The service did not have clear responsibilities, roles, systems of accountability and good governance. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The service did not have a clear shared vision, strategy and culture. Not all leaders understood the context in which the service delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience to lead effectively. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. Staff did not always encourage creative ways of delivering equality of experience, outcome and quality of life for patient.

However, we found:

The service fostered a generally positive culture where patients felt they could speak up and their voice would be heard. The service valued diversity in their workforce. The service understood their duty to collaborate and work in partnership. Staff shared information and learning with partners and collaborated for improvement.

This is the first assessment for this service. It was previously inspected with outpatients in 2016, and this key question was rated requires improvement. This key question has been rated requires improvement. This meant patient’s needs were not always 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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

The hospital had a vision for what it wanted to achieve and a strategy to turn it into action. The vision was to be a regional centre of excellence, delivering outstanding care and the healthcare provider of choice. However, this was not embedded in the diagnostic imaging service and staff were not aware of the strategy. Following our inspection, the service introduced an imaging strategy with areas to improve. For example, to carry out individual and team meetings with staff, carry out meaningful appraisals, recognise and build staff talent, embed quality improvement, use available capacity and introduce workable performance indicators. Whilst the strategy was in place, it had not been fully embedded at the point of our follow up inspection on 18 May 2026. However, progress had been made with having appraisals with staff, team meetings, daily safety huddles and putting a progress with quality audits.

Staff did not always feel respected, supported and valued. Staff described the morale being low following a recent service change resulting in redundancies. They did not feel supported by management following the redundancies in adapting to the staffing changes. However, staff were generally positive about working within the hospital and felt they could approach leaders regardless of concerns they had about redundancies. Relationships between staff of all grades were positive, with evidence of teamwork and collaboration. Furthermore, staff felt valued by their immediate line manager and colleagues.

At the time of our inspection, we found limited evidence of individual staff achievement, and success being recognised and celebrated. However, following our inspection, the service provided us with a list of staff nominated for the 2025 end of year ‘spire for you’ award nominations which showed 2 staff members had been nominated by staff.

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

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty and did not show that they understood the impact their behaviours and leadership had on patient outcomes and experience.

The service was managed by an imaging manager. The imaging manager reported into the director of clinical services who was part of the senior management team with oversight of clinical services across the hospital.

Leaders did not have the range of experience, skills and abilities to run the diagnostic service at the time of our inspection. They did not have an effective understanding and oversight of the priorities and issues the service faced. During our inspection, the management team were unable to provide us with information as they did not have the answers or understand where to get relevant information.

The imaging manager started in post in January 2026. They had limited management experience and were not given adequate specialist diagnostic imaging guidance from the provider to support them in taking on the management role. They did not have a sufficient handover form the outgoing manager and the induction period was restricted as they were still carrying out significant clinical activities in the department. This meant the service did not have an appropriate level of management support since the departure of the outgoing manager in January 2026.

There was limited evidence of effective contingency plans in place to ensure adequate oversight and leadership of radiation protection. The imaging manager had completed radiation protection training the week before our inspection and had subsequently become the designated radiation protection supervisor (RPS). This meant there was no RPS in post within the diagnostic imaging department since January 2026. The new RPS had not had time to carry out RPS duties at the time of our inspection. There was a RPS trained person in theatres, but they did not have oversight of the diagnostic imaging department. Staff were not aware of any contingency arrangement in place. The senior management team told us an arrangement was in place to seek advice from the RPS at another Spire Hospital. However, this was not documented.

The MRI safety lead role was also unclear at the time of our inspection. Staff did not know who this person was.

Following our inspection, the senior management team took immediate action to improve leadership and management of the service. An experienced regional manager was identified to provide a period of intensive 1 to 1 coaching and practical on-site advice and guidance to the imaging manager. We observed this was in place during our follow up inspection on 18 May 2026. The imaging manager was taken away from clinical duties to enable them to focus on their management role and embedding governance processes.

During our follow up inspection, MRI safety lead roles had been identified and formally assigned in departmental operating procedures. Senior managers advised us they intended to identify a radiographer within the team to undertake RPS training to ensure there were appropriate contingencies in place in the event of the diagnostic imaging managers absence. As an interim, the RPS at another site would be contacted to provide this role in the event of absence.

Staff spoke positively about the imaging manager. They felt they were visible and approachable to staff and patients. Staff recognised the new manager had not had time to induct into the role; however, they were very supportive and confident in their skills and abilities moving forward as a manager.

Hospital leaders were visible and approachable. However, they did not always recognise the challenges and impact of lack of management and oversight within the imaging department.

Leaders had taken incidents seriously and knew how to deal with concerns when raised which promoted a positive culture in the service.

The hospital carried out staff surveys; however, the data was unable to be broken down to the diagnostic imaging service due to it being a small team and maintaining anonymity. Patient feedback was regularly reviewed and was generally very positive about the service. Managers displayed you said we did information to demonstrate they had acted on feedback.

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 to raise concerns and offer ideas; the culture allowed staff to be confident their voices were heard. Most staff felt safe and confident to approach managers and the senior management team.

There were freedom to speak up guardians across the Hospital. The diagnostic imaging team were aware of them and generally considered they were approachable. New staff were given the opportunity to meet freedom to speak up guardians as part of their induction. A ‘quiet’ room was identified each day for staff to access to speak to freedom to speak up guardians.

Most staff told us when they had raised valid concerns they were supported, without fear of detriment. When concerns were raised, leaders investigated sensitively and confidentially. Departmental managers and Hospital leaders were made aware when whistleblowers had raised serious concerns. Risk registers and management reports contained analysis of concerns over time and associated action plans.

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.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for everyone.

An equality, diversity and inclusion (EDI) action plan had been implemented for 2026. There were 3 main areas to increase the diversity of the workforce, support reasonable adjustments around disability and raise awareness and celebrate cultural events and celebrations. During our inspection, we found evidence this plan had been embedded within the diagnostic imaging department.

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 with protected characteristics generally felt positive about working within the service and supported. For example, staff were given time and space to pray and staff felt included in cultural celebrations.

Leaders acted to improve where there are any disparities in the experience of staff with protected equality characteristics. They put high value on having diverse workforce to improve outcomes for patients.

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 they would be able to report behaviour or attitudes which were negative in style.

The service did not have clear responsibilities, roles, systems of accountability and good governance. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance arrangements were in place at hospital level but were not consistently or effectively embedded within the diagnostic imaging service. There were no regular team meetings, limiting communication, oversight and feedback. The imaging manager lacked capacity to attend governance forums, resulting in poor escalation and limited visibility of departmental risks.

Service assurance tools in place were not effective in identifying imaging risks and were not consistently and routinely completed. From April 2025 to March 2026, 3 assurance reports had been reported to the senior management team, and the imaging manager had attended 3 meetings in this time. There had been no assurance reports produced in 2026. Risks we identified during our inspection had not been identified through the assurance reporting tool. This was reflected through our inspection as most of the concerns we escalated were unknown risks or concerns. Senior leaders did not have effective oversight of the diagnostic imaging service.

There was an annual radiation protection committee (RPC) which the imaging manager attended and chaired. There was an agenda and minutes for the meetings showing actions to be completed, timescales and the responsible person. For example, radiation protection training compliance, audits, equipment quality assurance (QA) and risk assessments were discussed. However, there was no reference to justification and referral quality, audit cycles, dose optimisation reviews or emergency preparedness. The committee had oversight of risks and requirements of the radiation regulations, however, there was limited oversight of the risks we identified through our inspection.

There was no system in place to routinely update key diagnostic imaging policies, procedures and local rules. During our inspection, we found departmental documentation had not been updated to reflect recent changes. For example, local rules within the department had not been updated to reflect management changes and responsible people. Some documentation to support safe and effective care was not consistently updated to guide staff. For example, diagnostic reference levels and scanning protocols had not been updated.

Oversight of performance, quality and safety was inconsistent and was not routinely used to identify concerns and drive improvements. For example, service performance was monitored but we did not see evidence of it being used to benchmark against national performance and used as an opportunity to improve the service and outcomes for patients. There was no clinical audit programme. For example, at the time of our inspection, they did not carry out peer reviews of radiology reports against findings, discrepancy audits, or image quality and rejection audits. Furthermore, there were no meetings in place to discuss any discrepancies in line with best practice. An assurance report produced in May 2025, raised concerns the service did not have capacity to carry out regular audits, yet this does not appear to have been followed up. The management and leadership team did not have oversight or awareness this was not being carried out at the time of our inspection.

Internal audits to monitor quality and operational processes were carried out but did not effectively identify areas of non-compliance. Audit measures included assessing standards for documentation, the environment, infection prevention and control (IPC), pause and check compliance, and medicines management. However, during our inspection, we found some areas of poor compliance with IPC practice had not been identified through audits. Audits of patient group directions (PGD) for the administration of contrast showed 100% compliance, yet we found the PGDs were not implemented in line with medicines management guidance. This resulted in them being removed from practice and the administration of contrast being suspended for 72 hours whilst the PDG's were reviewed, updated and implemented.

Managers did not have immediate access or oversight of diagnostic machine QA outcomes. QA is a process for staff to follow to carry out regular checks of equipment to ensure it is safe to use. For example, staff had not been carrying out QA for all imaging modalities at the time of our inspection as they did not know how to. This had not been escalated as a risk or acted on until after out inspection.

The service had arrangements for identifying, recording and managing risks. However, concerns we identified through our inspection were not always identified as a risk or effectively mitigated. For example, the mammography machine was on the risk register due to the concerns about image quality. However, despite there being concerns from radiologists about image quality, there was limited evidence of action being taken to proactively and routinely monitor image quality. Following our inspection, the mammography machine was taken out of service.

Arrangements for the confidentiality of data were generally robust. However, during our inspection, we were made aware of a mobile telephone application being used to share patient data with radiologists. For example, it was used to request urgent reviews of scans or to confirm imaging protocols for specific scans. Staff found the tool useful and enabled a quick response back from radiologists. Whilst the app used end to end encryption, was designed for sharing of sensitive information and complied with UK and EU standards, GDPR and ISO 27001, it had not been authorised or signed off for use by the hospital. Following our inspection, it was taken out of use.

There was a medical advisory committee led by a chair and supported by the service leadership, which included approval of practicing privileges and review of clinical outcomes of individual doctors. If there were any concerns with performance, there were processes to follow and if necessary, information would be shared with professional bodies as required.

The service had a business continuity plan which would be put into operation in the event of an unexpected disruption to the service, this included a short-term disruption plan. We found there were risk assessments for the down time of the scanners.

Following our inspection, the service took immediate action to address concerns we raised throughout our inspection. This included reviewing and embedding governance structures within the diagnostic imaging service. They had reinstated daily huddles and quarterly team meetings to provide staff with an opportunity to discuss governance issues. A quality audit schedule had been established but it had not been carried out at the point of our follow up inspection. The imaging manager had been removed from clinical duties to enable them to embed governance structures and maintain oversight of quality, safety and performance. Whilst we were assured by the rapid actions taken, the improvements had not been fully embedded at the time of our follow up inspection.

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

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, staff acted quickly to clarity referral information to ensure this did not delay the patient having a scan. The service worked with other departments at the hospital to embed seamless pathways for patients.

The service had a collaborative relationship with external partners based on transparency and openness with all stakeholders about performance. Managers reported NHS performance to stakeholders and commissioners and worked alongside other providers to support better access to healthcare.

Leaders and staff engaged with patients and staff to plan and manage services.

The service did not always focus on continuous learning, innovation and improvement across the diagnostic imaging service and local system. Staff did not always encourage creative ways of delivering equality of experience, outcome and quality of life for patient. Staff did not always actively contribute to safe, effective practice and research.

There was limited evidence of staff being committed to continuous learning and improving services. We did not see evidence of quality improvements being implemented. For example, there were no audits in relation to the quality of images to identify learning or improvement. However, following our inspection, the service implemented an assurance plan in response to our feedback. During our follow up inspection on 18 May 2026, we observed this was in place and improvements had been made.

Staff in the diagnostic imaging service did not have a good understanding of quality improvement methods. Staff told us limited quality improvement work had been carried out at the time of our inspection.

There were processes for learning when things went wrong or of good practice, either locally or nationally. We were told about learning being implemented in response to an incident relating to contrast leaking from a cannula.

The service generally reviewed and invested in equipment to improve service delivery. For example, they had purchased a new fluoroscopy machine, ultrasound machine and had upgraded the ambient experience package in the MRI suite. However, other equipment such as the mammography machine had been taken out of action due to concerns about the quality to meet standards in new guidance around breast screening.

Staff were supported to have the time to develop their skills around improvement and innovation and to pursue areas of interest in the service.

Staff and leaders were committed to patient experience, and we observed positive interactions with patients. Where they saw a need, they worked together to find a solution, for example supporting patients with additional needs to attend for a scan.