Cobalt Health

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

We previously rated well led as Good. At this assessment we have rated well led as Outstanding. This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

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.

Description: We have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

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 very clear shared vision, strategy, and culture. 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 people and their communities.

The service had a realistic vision and strategy for achieving the priorities and delivering good quality sustainable care. Through good working relationships, partnerships with other stakeholders, and an understanding of the local health and care landscape, the service was working to identify areas in which it could support the NHS and to expand services further in the future.

The strategy delivered measurable improvements in population health, access to care and people’s experience and outcomes, including demonstrable reductions in health inequalities. Equality, diversity and inclusion were embedded as core strategic priorities, with anti-racism and stigma awareness integral to long-term care models, workforce strategies and service transformation. Staff working in the lung cancer screening programme were aware of social and financial barriers which may prevent people from more deprived areas from attending traditional imaging departments, due to transport or financial costs. Through positive experiences, championing of patient stories and word of mouth, managers reported an increase in the number of patients identified and accepting invitations for screening.

In the lung screening programme, staff with local knowledge had established prime locations for the placement of scanners (often near large housing estates and in supermarket car parks), where natural foot fall would be higher. This helped remove some of the travel barriers to attending screening appointments.

Managers were aware of a national shortage of some staffing groups and planned their staffing to mitigate these risks. They were actively engaged in additional training to extend some roles. Managers were liaising with universities to encourage suitably qualified staff to seek employment at the hospital.

Staff felt supported, respected and valued which was reflected in the 2024 staff survey results. Staff felt positive and proud to work in the organisation. Staff we spoke with told us the culture and communication had improved. The 2026 staff survey was underway at the time of our assessment.

The service also captured student experiences and data from the 2024/2025 cohort, this showed 100% of students found the placement enjoyable and educational.

The culture was centred on the needs and experience of people who used services. The service demonstrated an inclusive, culturally sensitive and non-discriminatory person-centred approach, ingrained in the values of the service. This was evident in everyday interactions with staff, people who used the service and the public. People felt respected, listened to and safe, and services were designed around what matters most to communities served. We saw multiple examples of improvements made to services because of patient feedback. Some of these improvements were significant, such as the reporting safety net.

Staff were proud of the service and consistently reported high levels of engagement, pride and trust in leadership. They reported the service was an inclusive, supportive and empowering place to work. Staff felt alignment with and ownership of the service’s culture, vision and values. There was also a strong emphasis on the safety and well-being of staff with multiple newsletters, events, awards and support programs open to staff. Managers gave us multiple examples of support provided to staff on an individual and personal level which took a holistic view of each staff members’ individual needs.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

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 exceptionally 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.

Leaders had the skills, knowledge, experience and integrity they needed. They understood the challenges to quality and sustainability, and could identify the actions needed to address them, such as identifying contracts which were operating at a loss.

The provider ensured all staff underwent appropriate checks as required by Schedule 3 of the HSCA 2008 (Regulated Activities) Regulations 2014. This was carried out before staff began their employment with the service for both permanent and agency staff.

Safety was promoted in recruitment practice, arrangements to support staff, disciplinary procedures, and ongoing checks. We viewed 9 personnel files and saw evidence of appropriate Disclosure and Barring Service (DBS) checks relevant to the role of the staff member.

Leaders understood challenges for the service and were very active and visible to staff.

The management structure ensured there was senior support and specialist advice for staff when the needed it.

Leaders acted where behaviours or performance fell below expected standards, irrespective of seniority or role.

There were clear priorities for ensuring sustainable, compassionate, inclusive and effective leadership, and the leadership strategy included succession planning and staff development. There were plans to expand the use of apprentices and to train up existing staff into more specialist modalities such as ultrasound.

Description: We create a positive culture where people feel they can speak up and their voice will be heard.

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 fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff felt able to speak up without fear of retribution. Staff knew who the freedom to speak up champions and guardians were and how to contact them. Freedom to speak up staff had attended additional training to support their role. Staff were confident in raising concerns with line managers and felt supported by them.

In the 12 months prior to our assessment, there had been two cases raised with the freedom to speak up team. The FTSUG presented an annual report to the leadership board.

Staff contributed to staff surveys and felt action was taken in response. For example, in response to feedback in the 2024 staff survey, leaders had developed and compiled a comprehensive action plan, based on feedback from staff. For example, town hall events were created to improve communication and management, and leadership training was rolled out to middle grade managers.

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

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 valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were actively engaged so their views were reflected in the planning and delivery of services and in shaping the culture.

Staff felt supported, respected and valued. Most felt positive and proud to work in the organisation.

There was a strong emphasis on the safety and well-being of staff. There was a monthly staff newsletter which celebrated staff achievements and feedback plus various other initiatives including health and well-being champions.

The service met its statutory responsibilities for the health and safety of staff. Steps were taken to support staff, and well-being was supported through resources, rest, and cultivating a positive work environment. There was culturally sensitive and non-discriminatory support for those who were struggling at work, which had a positive impact on the care they delivered to people.

Staff worked as a team and shared responsibility for providing good, safe care and resolving issues together.

Equality and diversity were promoted within and beyond the organisation. Staff, including those with protected characteristics under the Equality Act, felt they were treated equitably which was reflected in the latest staff survey.

Staff were able to request reasonable adjustments and changes to working arrangements which were considered by managers.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

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 clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Governance arrangements were clear, coherent and continuously tested, enabling effective decision-making, accountability and delivery of the organisational strategy.

Governance systems were proactively reviewed to ensure they remained fit for purpose, proportionate and responsive to emerging risks, system changes and population needs. Reviews occurred annually and were overseen internally by the board of trustees.

Staff at all levels were clear about their roles and they understood what they were accountable for, and to whom. Organisational structure charts and governance structure charts were clear and accessible to staff.

Arrangements with partners and third-party providers were governed and managed effectively to encourage appropriate interaction and promoted coordinated, person-centred care. There was a comprehensive structure tor reviewing contracts.

Governance of partnerships, joint working arrangements and shared services had clear shared objectives, defined accountabilities, and joint risk management. The service played a lead role in the wider health and care system by supporting collaboration which delivered improved health and care outcomes. For example, the Manchester screening programme had recently surpassed 1000 early diagnosed lung cancers and was actively sharing learning from the programme including ways to engage and encourage people from deprived areas to engage with the screening programme.

There was a range of committees with specialist responsibilities. For example, the radiation protection committee reported incidents and actions to the overarching radiology review management group meeting. Minutes from meetings were detailed and clear with evidence of actions taken.

Leaders were assured of service performance through analysis of quantitative data, qualitative insight, audit, lived experience and external assurance. Focus was on patterns, trends and root causes, rather than isolated metrics, and this intelligence was used to challenge, learn and improve.

There was a systematic programme of clinical and internal audit to monitor quality, operational and financial processes, and systems to identify where action should be taken. The audits were reviewed at the relevant committee meetings and reported to the overarching governance committees.

Risk registers were clear and up to date and there was alignment between the recorded risks and what staff said was ‘on their worry list’. For example, the service clearly recorded the risk around operating some contract at financial loss.

Potential risks were considered when planning services, for example seasonal or other expected or unexpected fluctuations in demand, or disruption to staffing or facilities. Senior managers gave us examples for where referral numbers had increased following an advertising campaign and how they had flexed to meet this temporary demand. Managers told us about the impact of supply chain disruption and explained how they had factored this into any planned upcoming maintenance to ensure the MRI scanners were fully operational. The service was also exploring helium free 1.5T and 3T scanners.

The service implemented external alerts such as MHRA or patient safety alerts through regular team meetings which were minuted and disseminated to those who were unable to attend. Where serious enough, staff kept written records to confirm which staff had seen the alert or update.

Leaders maintained oversight of the governance arrangements for medicines management through use of a third party who prepared and stocked emergency bags. These bags were then subject to regular checks by staff including the onsite paramedics who reported any issues or discrepancies.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

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 clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Staff understood their responsibilities to raise concerns, to record safety incidents, concerns and near misses, and to report them internally and externally. All staff knew how to report incidents using the electronic system.

The service reviewed and investigated safety and safeguarding incidents and events when things went wrong. All relevant staff, services, partner organisations and people who used services were involved in these reviews and investigations.

Learning from lessons was shared to make sure action was taken to improve safety. Senior staff and medical physics staff attended dose optimisation meetings where discrepancies from dose audits were discussed, and actions identified.

Managers ensured radiation incidents were fed into risk management structures, and for accidental and unintended exposures (SAUE), notified to CQC in line with legislation. At the time of our assessment, there had been 12 identified incidents of SAUE, but not all requiring notification.

There were strong external relationships which supported research, improvement and innovation. Staff and leaders regularly proactively engaged with external partners, including those in research, and embedded evidence-based practice into the service. For example, the service was actively looking for ways to reduce doses as part of the CT lung screening programme. National dose limit targets were set at 2 mSv but the service was achieving around 0.6mSv, which meant doses were much lower than national targets.

There were positive and collaborative relationships with external partners to build a shared understanding of challenges within the system and the needs of the relevant population, and to deliver services to meet those needs.

The service was well integrated with the local integrated care board (ICB) and was working alongside NHS partners to identify areas of the healthcare landscape where they saw potential for future delays, ensuring they were ready to step in and support key services and screening programmes if the need arose. For example, prostate screening.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

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 focus on continuous learning, innovation, and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. They actively contribute to safe, effective practice, and research.

There was a fully embedded and systematic approach to continuous quality improvement, which leaders understood was key to delivering high-quality care.

Leaders and staff strived for continuous learning, improvement and innovation. Staff were involved in over 60 research projects and had awarded multiple research grants to both staff working for Cobalt and some externally. For example, one staff member was researching and designing new gowns for patients undergoing breast imaging to better maintain dignity as a lot of current breast imaging requires the patient to be undressed from the waist up. Another example was where the service was utilising its 3T MRI scanner to scan sporting head injuries pitch side as part of a nationwide research project in partnership with a university.

The service was taking a leadership role in quality improvement, by seeking opportunities to learn from improvements made elsewhere, and by proactively sharing its learning with other services. Staff were given the opportunity to attend conferences and present their work, including research projects. For example, one research trial (which utilised 5-minute 3T MRI scans to help detect prostate cancer), had the potential to change and improve current national prostate screening programmes.

The service continuously innovated across multiple services, which resulted in demonstrable improvement in people’s outcomes and to services. The lung screening programme actively used Artificial Intelligence (AI) as a first read for all scans. This helped risk rate scans so radiologists could prioritise those with suspected abnormalities.

The service had achieved external accreditation from multiple organisations including QSI (formerly ISAS). They also held various health and safety accreditation including ISO 9001, ISO 14001, ISO 45001 and in 2026 was transitioning to BS70000. ISO accreditation means an organisation demonstrates its competence to audit and certify its management systems.

The service invested in its people to ensure quality improvement was embedded in the work of all its staff. There was a clear strategy for developing staff capabilities. Additionally, staff were empowered to think of research projects which, where there was proven need or value, were funded by the service. Staff were strongly encouraged to consider where innovation could improve outcomes, and were given the time and opportunity to learn, create and adopt those innovative ideas. For example, the service was scoping the possibility of developing a small CT scanner which could be deployed to care homes where a resident had a suspected head injury as a first line alternative to calling an ambulance.

Staff were able to allocate time to work together to resolve problems and to review individual and team objectives, processes and performance. This led to improvements in patient care and better working relationships within the service and with partner agencies.

Leaders fostered an open culture of trust, which was honest about challenges and mistakes, and used these as opportunities for learning. Leaders actively listened to staff, monitored and assessed improvement and innovations, and enabled collective problem solving and continuous improvement.