Cobalt Health

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• 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. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people 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.

Description: We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

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 had a strong, proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The safety performance over time was consistent and reliable. Managers monitored the number of incidents across all locations and services and held monthly incident meetings to identify themes and trends and acted where necessary. Incidents of significant or unintended exposure to radiation were reported externally and fully investigated with clear actions. There had been 12 incidents reported in the 12 months prior to our assessment. The incidents we reviewed varied in type and severity, indicating a proactive and positive reporting culture. Incidents and learning was shared across all locations.

Specialist safety roles were embedded and highly visible, acting as system leaders for safe practice. Leaders demonstrated and reinforced that every safety concern was valued, responded to compassionately and used to strengthen collective learning. The service was also developing a patient safety plan and had recently appointed a Head of Patient Safety to oversee and develop this, which also involved patient input into its design.

Staff understood their responsibilities to raise concerns, to record safety incidents, concerns and near misses. Staff felt empowered and trusted to raise safety concerns or propose improvements. All relevant staff, services, partner organisations and people who used services were involved in reviews and investigations. We reviewed a medication administration error incident which showed clear actions taken as a result.

Teams worked together to identify and share learning including dose optimisation. The service had effective arrangements to respond to relevant external safety alerts, recalls, inquiries, investigations and reviews. The imaging service ensured unintended exposures were notified to relevant regulatory bodies. At the time of our assessment there had been no reportable incidents in the 12 months leading up to our assessment.

Leaders and staff strived for continuous learning, improvement and innovation. The provider participated in the Quality Standards for Imaging (previously ISAS) accreditation schemes and in 2026 was transitioning to BS 70000. Staff regularly worked together to resolve problems which led to improvements and better working relationships, both internally and with external partners.

The service actively sought out learning from other organisations, adapted this insight to improve its own practice, and routinely shared its learning and innovations with partners to strengthen care provision. The patient safety lead had identified a theme of images being transferred to the incorrect patient folder on the CT scanner at the Gloucester CDC. The team spoke with local partners including the manufacturer and determined the fault (previously scanned patient folders not falling off the system) would most likely be fixed with a software update, which was already planned and booked. As an interim measure, all scans were checked at the end of each list to ensure all images had correctly transferred.

Description: We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

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 worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service carried out comprehensive risk assessments for people who used services and staff identified and responded appropriately to changing risks to people. There were procedures for the collapse of a patient in MRI, and staff were clear on the process for safely evacuating a patient. These procedures were regularly practiced and developed by the lead paramedic who regularly arranged training sessions and tailor-made scenario-based training. Where parents or carers accompanied patients into the scanner, the same thorough questionnaires were used to ensure the safety of all.

There was a user-friendly online referral portal for all referrers, both medical and non-medical (such as physiotherapists and chiropractors). Each portal had clear guidance on what scans each type of referrer could request.

All clinical staff received training in Immediate life support (ILS) and had access to onsite Advanced Life Support (ALS) trained paramedics or nurses at all static sites. Data provided showed 100% compliance for ALS training and 95.4% for ILS training.

Staff followed processes to ensure the right person got the right radiological scan at the right time. Audits showed 100% compliance.

The service followed the Royal College of Radiologists standards for the communication of radiological reports and fail-safe alert notifications.

The service ensured the radiation protection advisor (RPA) and the medical physics expert (MPE) were easily accessible for providing radiation protection advice. The service had Radiation Protection Supervisors (RPS) in the departments which used ionising radiation.

Staff identified patient risks using local policies which were in line with national standards and guidelines.

The service had clear local rules (Ionising Radiation Regulations) and employer’s procedures (Ionising Radiation (Medical Exposures) Regulations) which protected staff and patients from ionising radiation.

Staff followed national protocols to check and ensure requests for imaging procedures were appropriate for the patient. Where there were multiple IT systems, the service ensured information was shared and accessed securely when required.

The service ensured imaging requests were appropriate and included the relevant information to allow for requests to be justified in accordance with IR(ME)R. All requests were justified by a radiologist. Protocols for each request were recorded against the referral for both the technologist or a radiographer to access.

The service ensured the ‘requesting’ of an X-ray or other radiation diagnostic test, was only made by staff / persons in accordance with IR(ME)R. The service held a list of approved referrers, both medical and non-medical.

Patients were provided with leaflets of ongoing advice after their procedure in a format they could understand, including easy read for children.

There were positive and collaborative relationships with external partners and there was transparency and openness with all stakeholders about performance.

Description: We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

3. We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service shared safeguarding concerns quickly and appropriately. Staff, employed by the service and by agencies, received safeguarding training at the correct level for their roles and could identify when to report abuse and how. There was clear oversight of all safeguarding incidents reported, and actions were recorded which included learning and outcomes of the incident. Staff confirmed this was shared with them through regular staff meetings and updates. Training compliance was between 97.3% and 100% across all levels of safeguarding adults and children training. Several registered staff in key locations had undertaken level 3 training in both adults and child safeguarding and all clinical and non-clinical staff had undertaken level 2.

Information regarding safeguarding from abuse, sexual safety and domestic abuse was displayed where service users could see it. Staff were able to access a named or designated professional for advice 24 hours a day.

The service had a chaperone policy for all patients; staff were aware of and understood the use of chaperones. Staff explained on mobile machines or smaller static sites, it was not always possible to meet every patient request, such as only having female staff. Where this was known in advance, the Cobalt bookings teams tried to accommodate the patient’s wishes. However, where bookings were overseen by the local NHS trust, this was not always possible.

Staff had received training in Deprivation of Liberty Safeguards (DoLS). DoLS is a legal framework within the Mental Capacity Act 2005 in the UK. It was aimed to help protect vulnerable individuals who lack the mental capacity to consent to care or treatment arrangements which may restrict their liberty. Staff could give examples of where they had been concerned about a patient being prevented from leaving a scanner by the staff who had accompanied them and escalated their concerns appropriately. Training data showed 87.8% compliance, with future training booked for new starters. Staff understood the principles of Gillick competence and described how if they had to ask about pregnancy, patient under the age of 18 were given the opportunity to answer away from their parent or guardian.

Description: We work with people to understand and manage risks by thinking holistically so care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

4. We scored the service as 4. The evidence showed an exceptional standard. The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The service carried out comprehensive risk assessments for people who used services, and these were reviewed every 2 years or more frequently if risks changed. Staff had access to all relevant risk assessments in an online database.

The service had local rules (Ionising Radiation Regulations) and employer’s procedures (Ionising Radiation Medical Exposures Regulations) which protected staff and patients from ionising radiation. Staff were trained in radiation safety and data showed between 90.5% to 95.5% compliance across the different levels of training.

The service had local policies for the risk assessment and prevention of contrast-induced nephropathy. These followed National Institute for Health and care Excellence (NICE) Acute kidney injury guidelines and the Royal College of Radiologists standards for intravascular contrast agent administration.

The imaging service ensured people (including patients and staff) who were or may be pregnant always informed a member of staff before they were exposed to any radiation in accordance with IR(ME)R and for staff in accordance with Ionising Radiation Regulations. Audit data showed this was not always being done in CT, however there was a clear action plan and subsequent audits showed improvement. Mitigation showed the areas of non-compliance were linked to the need for inclusive pregnancy checks on all patients (male and female).

Inclusive pregnancy checks were undertaken, recorded and audited as part of the annual IR(ME)R audit programme. Staff had also modified forms to be able to record patient sex at birth so where a patient had stated they were male at birth; they would not have to be checked for possible pregnancy in future.

Staff enabled patients to give feedback on the service they received. Patients we spoke with said they felt supported by staff. We saw evidence patient choice was respected when deciding which treatment option to choose.

The service did not have an emergency department (A&E) or a process whereby service users could be transferred from the imaging department to a ward. If a patient’s health was deteriorated, staff called 999 to request an emergency ambulance to take the patient to the nearest emergency department. There was however a paramedic on site who could be called to provide support to the patient until they could be transferred to an emergency department. The imaging centre was located in a purpose built modern wing of the building which ensured access in emergencies.

Staff worked collaboratively within an exemplary culture to anticipate and expertly manage deterioration, emergencies and clinical risks safely. Identifying risk was proactive and continuous, using innovative and evidence-based approaches including tailor made scenario-based training, developed and delivered by the paramedic onsite. For example, training had taken place around recognising respiratory deterioration as the service had identified a number of pulmonary embolisms (a blood clot in the lung) as incidental findings.

Resuscitation bags were easily accessible to staff in the event of an emergency. They were located throughout the department. The bags were fully equipped and provided by a third-party company. Staff checked these bags on a regular basis and in line with policy. Bags were designed to replicate the emergency bags the paramedics used so equipment and emergency medicines could be found quickly in an emergency.

Description: We detect and control potential risks in the care environment and make sure the equipment, facilities and technology support the delivery of safe care.

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 detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities and premises kept people safe. The imaging service ensured non-ionising and ionising radiation had arrangements to control the areas and restrict access.

Equipment was maintained and serviced in line with manufacturer guidance or whenever issues arose. Resuscitation equipment was readily available for both adults and children and staff checked it regularly.

Staff and carers used personal protective equipment when needed. Lead aprons and lead screens were checked annually for their integrity and syringe shields were provided in PET/CT. Radioactive spillage training was undertaken by 92.9% of staff.

The provider had an equipment quality assurance programme and were carrying this out on all CT, PET/CT, x-ray, ultrasound and MRI equipment. Quality assurance checks took place at the appropriate time as recommended by the medical physics experts, manufacturers recommendations and in line with best practice guidance.

The service held an asset register which showed the ages of equipment and helped senior staff and managers plan in capital replacement projects. Backup systems supported ongoing essential service if there was a failure.

Arrangements for managing waste and clinical specimens kept people safe.

The imaging service undertook risk assessments for all new or modified uses of radiation, which took account of occupational safety as well as considering risks to people who used services. All assessments we reviewed were in date of review.

IT systems helped managers monitor demand and capacity of the service for future planning. For example, the operations centre used a third-party company to oversee the logistics and maintenance for all its scanners and associated equipment such as generators. This system also tracked and monitored maintenance and fault reporting.

Managers explained the service was piloting new generation of generators which used batteries alongside a traditional generator to improve the environmental impact of running the mobile fleet of scanners.

The provider undertook assessments and reviews of their activities under the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Engineering support was supplied by formal maintenance contracts and overseen by a third-party company. Maintenance of the scanners could be planned, and issues or breakdowns were responded to promptly. The third-party contract performance was monitored by the operations manager and fed into the overall clinical governance meetings.

The service monitored staff for radiation exposure and staff told us they saw their dose reports in PET/CT. In other modalities, staff radiation doses were monitored in line with best practice and guidance.

Description: We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care meets people’s individual needs.

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 there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care, which met people’s individual needs.

Staff had regular appraisals and one to one conversations. Data submitted showed 90.48% of staff had received a performance review at the time of our assessment.

Staffing levels and skill mix were planned and reviewed so people always received safe care and treatment, and staff did not work excessive hours. Actual staffing levels and skill mix compared well with the planned levels and cover was provided for staff absence.

Arrangements for handovers and shift changes ensured people were safe and allowed time for staff to plan, complete equipment checks and obtain any additional information required to perform safe scans, such as blood test results.

There were enough radiologists and radiographers to meet the demands of the service. Radiologists were available to provide advice each day. Radiographers, paramedics and healthcare assistants from third-party agencies had received inductions and training and the service kept detailed up to date records.

The service used teleradiology services to meet reporting demands. As part of third-party contracts with these services, each company had to complete declarations they and their employees were compliant with all Royal College of Radiologist (RCR) standards required to report MRI, CT, PET/CT and x-ray images. In addition the service bought in reporting sessions from local NHS trust. This strengthened the relationship with the trust and enabled better patient care as radiologists often wrote the patient report for the MDTs they themselves attended.

Services ensured relevant staff continued registration with relevant bodies and gave support with revalidation where necessary.

Staff who were undergoing training, such as student radiographers, were adequately supervised in accordance with legislation set out under IR(ME)R.

Staff received training to make them aware of the potential needs of people with mental health, learning disability, autism or dementia needs. Training records showed training compliance was 100%.

Radiographers and other healthcare professionals were able to train for additional tasks or research, and the service provided small grants to enable this. Managers were open to any requests for additional training where it would benefit the service.

Staff were given time to undertaken mandatory training. Overall mandatory training compliance was 95.4% for all staff against 95% service wide target. Where training compliance was below this target, for example, clinical moving and handling, the service had clear oversight of barriers and had already taken steps to address the gaps by putting on extra training. We saw similar mitigation recorded for all training which was short of the 95% target.

Bank and agency staff had 89.6% compliance against mandatory training requirements. Again, the service had clear oversight of barriers and had planned, booked additional training in core subjects such as ILS. Compliance was monitored centrally. We reviewed 6 HR files and saw evidence of all necessary checks including DBS and mandatory training.

The service had an established programme to train apprentice radiographers and currently had 1 staff member on the course.

Description: We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

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

3. We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff took precautions when seeing people with suspected communicable diseases. Where possible, booking staff sought to obtain as much relevant information about a patient before they attended for their scan. In the event of a patient attending with an infectious disease, staff had access to onsite cleaning staff and materials. If a patient was vulnerable to infection, patients were booked towards ends of lists to minimise contact with other patients.

The service maintained high standards of cleanliness and hygiene through comprehensive infection training and staff awareness. The service had reliable systems to prevent and protect people from a healthcare-associated infection. Data showed 91.1% compliance for both level 1 and level 2 infection control training.

Staff had access to personal protective equipment (PPE) should they require it. Audits showed good staff compliance with hygiene processes including hand hygiene and logs of cleaning had no omissions. We reviewed a selection of hand hygiene audits from all sites and saw 100% compliance. Service wide annual audits showed 99.6% compliance against all audited standards.

The service had cleaning procedures for ultrasound probes using a recognised 2 step cleaning system.

Staff were provided with clean uniform and were familiar with the uniform policy around covering uniform when travelling to and from work.

Staff we saw were all bare below the elbow and compliant with the service’s infection, prevention and control policy.

Description: We make sure medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

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

3. We scored the service as 3. The evidence showed a good standard. The service made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed the services policies for medicine administration. Medicines were ordered, transported, stored and disposed of safely and securely, including contrast agents and oxygen cylinders

Staff carried out comprehensive allergy and safety checks before all scans, including those involving contrast medium. This information was stored on the radiology computer system and a warning flag alerted staff to previous allergies.

Staff used Patient Specific Directions for each scan which involved intra-venous contrast. We saw radiologists record this on the electronic system of the type, strength, amount and flow rate of contrast required for each scan.

Staff in PET/CT ensured the right radiopharmaceutical activity was sourced, prepared and injected into the correct patient. Radiopharmaceuticals were ordered in advance and according to the vetted request (vetting is the process of checking a request for a scan is appropriate and correct). Depending on the number of patients on the list for the day, the service could have multiple deliveries of radiopharmaceuticals. This was because the half-life of the isotope was quite short and would not last all day. Staff manually drew up and checked the activity of the injection using a tool on the booking system. This helped calculate the volume of radiopharmaceutical to draw up based on the time of injection and half-life of the radioisotope. Injection details were entered onto the system, and all injections were double checked and countersigned by a second nuclear medicine practitioner.

The lead Radiologist held an appropriate IR(ME)R practitioner Administration of Radioactive Substances Advisory Committee (ARSAC) license for the administration of each radiopharmaceutical. This was stored and coordinated to ensure it was up-to-date and reflected the types of examinations being undertaken in the service. We reviewed the license for the service and found it was in date. Information on the license reflected the examinations undertaken with a clear line of delegation for injecting radiopharmaceuticals.

Radiopharmaceuticals, contrast media and other medicines were stored correctly and in line with manufacturer guidance.

Saline was used in prefilled syringes and did not require a Patient Group Direction (PGD) because this was classed as a medical device. PGDs were in use for saline which was drawn up manually or used in automatic injectors.