Cobalt Health

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence people and communities had the best possible outcomes because their needs were assessed. We checked people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment this key question was not rated. At this assessment we rated it as Outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

We have not awarded this service a score for Effective.

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

Description: We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, well-being and communication needs with them.

Quality Statement Score: Your judgement of the quality and safety of the topic area

3. We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, well-being and communication needs with them.

Staff made reasonable adjustments so people with a disability could access and use services on an equal basis to others.

Support with transport was available to service users with mobility issues, including hospital transport. Staff told us it could be challenging if transport patients were booked later on lists. There were processes to keep patients safe if transport was delayed.

The service took account of individual needs of people with mental health conditions, and the service had 5 mental health first aiders accessible to staff, but had access to signpost patient to support mental health service in the local NHS trust.

People were supported during referral, transfer between services and following their examinations or procedures. Cobalt Health had strong links with local carer’s networks and could signpost people for ongoing support. All patients received information and follow up advice in a format or language they could understand.

Staff worked across services to coordinate people's care and treatment. In plain film imaging staff explained, if they saw patients had multiple examinations booked, they would strive to carry them out at the same time to save the patient from returning for a second visit. This also helped optimise waiting lists.

The service used an online booking process which meant patients accessing Cobalt Health services were appointed quickly as they were mostly less complex, routine and follow up scans This allowed the service to maximise its throughput and capacity, especially at the community diagnostic hubs, where the hosting local NHS trust had oversight of bookings.

Patient’s pain was assessed and managed, particularly for those people where there were difficulties in communicating. Patients were advised to tell staff if they felt any pain during MRI scans and during other procedures such as joint injections. Staff had access to pain scales such as Wong-Baker and Abbey to help communicate with patient with communication barriers.

Description: We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Quality Statement Score: Your judgement of the quality and safety of the topic area

4. We scored the service as 4. The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

People received a range of care and treatment options based on substantiated evidence and were responsive to their individual needs, preferences and aspirations.

Staff assessed patient’s physical, mental health and social needs, and their care was delivered in line with legislation, standards and evidence-based guidance, including National Institute for Health and Care Excellence (NICE). Staff identified vulnerable patients, such as diabetic patients, or frail patients requiring fasting or drinking before treatment. Risks to these patients were mitigated through clear communication about preparation for scans and making sure vulnerable patients were booked at an appropriate time.

The service was a leader in innovation (in partnership with an established, world-renowned university) and was involved in over 60 research project including pitch side scanning for head injuries in contact sports, 3D printing of tumour for surgical planning and heat pump introduction on MRI scanning units. Staff were empowered to participate in research programmes and to develop and share innovations with other services, both locally and nationally.

Staff monitored, and medical physics teams audited, radiation doses to ensure they were kept as low as reasonably practicable (ALARP) and diagnostic referral levels (DRLs) had been established for all procedures undertaken.

By using a clinical governance group, the service ensured it identified and implemented relevant best practice and guidance. The service audited their practice locally and identified action points.

There were rigorous, inclusive and evidence-driven systems which continually enhanced people’s care and treatment. Advances in research carried out and funded by the service had led to changes in treatment pathways and screening programmes. For example, the service was trialling the use of 5-minute MRI scans to improve the efficiency and uptake of local prostate screening.

The service participated in national benchmarking clinical audits, for example, NHS England targets for dose reduction in lung cancer screening. Data supplied showed the national target dose for this type of scan was 2msv. Cobalt had successfully reduced their average dose to 0.6msv while still achieving acceptable diagnostic scans.

All necessary staff, including those in different teams, services and organisations, were involved in assessing, planning and delivering care and treatment. There were multiple examples of radiologist multidisciplinary team (MDT) working involving diagnostic imaging providing as an essential and integral part of the pathway. The lung screening programme and the CDCs often saw patients for scans and reported them immediately. This meant patients could receive their results from staff from the local NHS trust, the same day, along with next steps.

Description: We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Quality Statement Score: Your judgement of the quality and safety of the topic area

4. We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people using the service only needed to tell their story once.

Relevant teams, services and organisations were always involved in coordinating people’s care. Staff identified vulnerable patients or those who needed additional support and adjusted where possible. This meant their appointments were undertaken at an appropriate time of day and when support was available, such as transport.

MDT meetings were planned and held with representatives of all teams involved in a patient’s treatment pathway, including any external providers or NHS trusts. These meetings were recorded as contemporaneous notes. Radiologists working for Cobalt often worked for the local NHS trust and had established MDT links.

Radiologists held quarterly Radiology events and learning meetings (REALMS) which could be attended in person or remotely. Meetings were also recorded to ensure all radiologists had the opportunity to hear discussions about interesting and unusual cases. The Medical Director checked who had accessed recordings to ensure all relevant staff had oversight of discussions.

The service helped and contributed to some one-stop screening services involving different disciplines of staff working together. At the time of our inspection this included the lung screening programme and some types of scans undertaken at the CDCs.

Radiologists attended MDT meetings within the NHS Trusts where they held substantive contracts. Suitable preparation time for any imaging within the organisation was included as part of job planning.

The service had established links with mental health, learning disability and dementia link nurses for advice and guidance.

The service had well established pathways and co-ordination between diagnostic imaging and other services, including point of care testing for eGFR (a type of kidney function test) at the Cheltenham site, which helped the effectiveness of the service. Diagnostic test results were available to support timely MDT decisions on cancer care and helped the local trust achieve its national cancer waiting times and standards.

Description: We support people to manage their health and well-being so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Quality Statement Score: Your judgement of the quality and safety of the topic area

3. We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and well-being to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People who used services felt supported to manage their own health, care and well-being and to maximise their independence. For example, patients told us they were very happy with the amount and level of information they received after their scans. They were confident they knew what to do if they had a problem and knew how they would get their results. There were well established links with local carer’s networks and staff could direct patients to the local hospital to access additional support to manage their condition such as cancer support groups.

People were told what to do if they needed to seek further help if their condition deteriorated after receiving care or treatment in the diagnostic imaging department, such as after receiving joint injections through the Musculo-skeletal (MSK) ultrasound service.

Description: We routinely monitor people’s care and treatment to continuously improve it and to ensure outcomes are positive and consistent, and they meet both clinical expectations and the expectations of people themselves.

Quality Statement Score: Your judgement of the quality and safety of the topic area

4. We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they fully met both clinical expectations and the expectations of people themselves.

Audit processes monitored patient outcomes and compliance with best practice guidelines. Approaches to monitor and improve people’s outcomes were rigorous and inclusive. Radiologists used the electronic reporting system to flag urgent images and for administrative staff to share information with referrers. Diagnostic referral levels were audited annually to ensure patients received radiation doses as low as reasonably practicable which was overseen by the dose optimisation committee as part of the radiation protection committee.

The service was an exemplar in its actions to improve outcomes for people likely to experience health inequalities and those with protected equality characteristics. The service provided approximately 60 free cancer scans per month to the local NHS trust to help it meet demand and ensure timely diagnosis.

Cobalt Health provided facilities free of charge for the local NHS trust to carry out ‘one stop’ clinic for patients referred for musculoskeletal complaints. Patients could receive scans and advice or treatment without the need for further waiting to attend for scans.

Staff participated in relevant quality improvement initiatives, such as local and national clinical audits, bench-marking, approved accreditation schemes, peer review, research, trials and other quality improvement initiatives. All relevant staff were involved in activities to monitor and used information to improve outcomes. For example, a sample of reports undertaken by the third-party reporting agency were audited every month. Data from March 2026 showed only 1 minor discrepancy out of the 24 scans audited. Actions taken in respect of this report were clearly recorded.

Staff worked proactively to enable equally good outcomes for all by recognising barriers preventing this. They acted on information by taking purposeful steps to listen and respond to people’s experiences. They allocated resources and embedded continuous learning and innovation to reduce inequalities in outcomes. For example, a patient attended for an MRI in acute pain, and staff worked with the patient, family and GP to ensure they received appropriate pain medication and sedation to achieve the best imaging possible for the patient, allowing for their mobility issues.

The service held regular audit meetings to learn, feedback and monitor progress of actions. For example, the service held an overarching audit schedule which clearly showed progress against each expected audit. No audits were out of date at the time of our assessment.

The service followed up on the effectiveness of any procedures, such as joint injections and other interventional radiology procedures to assess impact on overall pain levels and quality of life. Patients kept pain journals post procedure and shared them with staff for ongoing assessment.

Description: We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Quality Statement Score: Your judgement of the quality and safety of the topic area

3. We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood the relevant consent and decision-making requirements of legislation and guidance. Staff monitored the process for seeking consent and reviewed it to ensure it met legal requirements and followed relevant national guidance. We saw staff explain procedures well, and copies of the consent form were given to the patient in advance of the procedure. Gillick competence was understood in MRI. Children had autonomy to accept or refuse imaging. Patient under the age of 18 were also given time away from parents/guardians to ask questions, especially around pregnancy.

Staff were trained and understood the relevant consent and decision-making requirements of legislation and guidance. Training data showed between 97.3% - 100% compliance across all levels of training.

Staff discussed imaging and treatment options with people and encouraged to be part of the decision-making process. For example, some scans such as MRI required a degree of independence to be able to lay still to tolerate the whole scan. Staff showed patients what was required of them before any imaging was undertaken, including if they were concerned about claustrophobia. The service held a service level agreement with a mental health NHS trust to provide open MRI scanning.

Managers monitored consent processes to ensure it met legal requirements and followed relevant national guidance. Audit data for invasive ultrasound guided procedures showed 100% compliance between January 2025 and December 2025. This included the use of World Health Organisation (WHO) safer surgical checklists as part of the audit.

Staff explained if they had any concerns about people’s possible lack of mental capacity, they escalated them to the radiologist on duty for advice.

Staff were aware of do not attempt cardio-pulmonary resuscitation (DNACPR) orders when patients came to department for procedures. Where appropriate, patient information was transported with patients when attending for a scan or procedure. The Cobalt Health generally saw lower risk, mobile patients where possible. However, staff were able to access patient’s full electronic clinical record if needed.