Spire Harrogate Clinic

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 that people and communities had the best possible outcomes because their needs were assessed. We checked that 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 that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This is the first assessment for this service where we rated this key question as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

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, wellbeing and communication needs with them.

Staff completed comprehensive assessments before diagnostic investigations were undertaken to ensure examinations were appropriate, safe and met individual patient needs. We reviewed 4 patient records and found patient identification checks had been completed, referrals were clear and fully completed by the referring clinician, and all referrals had been appropriately vetted before investigations took place.

Where diagnostic procedures involved exposure to ionising radiation, staff completed the necessary safety checks and obtained consent in line with local procedures. Patient screening forms were completed, including pregnancy screening where applicable, and these were reviewed and confirmed by the radiographer before proceeding with the investigation.

The nature of diagnostic appointments meant patients were generally attending for short periods and investigations did not routinely require nutritional or hydration assessments. However, patients had access to drinking water and could request refreshments if required.

The service had recently introduced a pain management consultant who provided specialist support for patients requiring pain management interventions. Pain management lists were undertaken on alternate Tuesdays. During these sessions, the nursing team completed surgical safety documentation and monitored patients' physiological observations to support safe care. Although pain management activity was undertaken within the service, there were no pain management audits specific to the diagnostic department.

Staff took steps to ensure patients remained comfortable during diagnostic procedures. Patients attending for X-rays and MRI scans were asked whether they were experiencing pain before the investigation commenced. Staff used positioning aids and offered additional support, such as music during MRI examinations, to help patients feel comfortable and reduce anxiety.

The service recognised the needs of people who may require additional support. Patients who were anxious or had learning disabilities were invited to visit the department before their appointment to familiarise themselves with the environment and equipment. Staff had completed learning disability training and demonstrated an awareness of how to adapt care and communication to meet individual needs.

Staff had also completed dementia awareness training, and a senior team member had undertaken Dementia Friends training. The service had developed links with external organisations to improve understanding of the experiences of people living with dementia and to enable staff to signpost patients and families to relevant support services when needed.

We scored the service as 3. The evidence showed a good standard. The service 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 and current evidence-based good practice and standards.

The service demonstrated a commitment to delivering care and treatment in line with current legislation, national guidance, professional standards and evidence-based practice. Staff participated in a comprehensive programme of clinical audit, bench marking and quality improvement activity to monitor compliance and drive improvements in service delivery.

The radiology audit schedule included quarterly audits of patient safety, documentation, image quality, hygiene standards and post-examination processes. Additional audits included monthly infection prevention and control reviews and six-monthly Radiation Protection Supervisor (RPS) audits. Audit activity focused on key areas such as surgical safety, environmental cleanliness, sharps management and compliance with post-procedure processes, providing assurance that diagnostic services were being delivered.

The service maintained a detailed audit programme to monitor compliance with the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2017 and Ionising Radiations Regulations (IRR) 2017. Audits focused on patient identification, documentation, equipment quality, dose recording, justification, training, pregnancy inquires, risk information, medical exposures, accidental incidents, medico-legal issues, carers, communication, and referral processes.

Audits were undertaken on a quarterly or annual basis and were led by the Radiation Protection Supervisor and imaging team. This provided assurance that regulatory requirements were understood and embedded in practice.

We reviewed 8 audit reports completed by radiography staff and external specialists. Five audits demonstrated 100% compliance. Where audits identified areas for improvement, action plans were developed and monitored. For example, an IR(ME)R audit identified 3 actions, all of which had been completed and were subsequently monitored through the imaging documentation audit programme to ensure improvements were sustained.

The service sought independent assurance through external review. Staff told us annual audits were undertaken by Radiation Protection Advisers (RPAs). Records confirmed that 4 IR(ME)R documentation reviews had been completed during 2025/2026, providing additional oversight of compliance with radiation safety requirements.

The service had systems in place to ensure policies and clinical procedures remained current and evidence based. Staff told us policies were reviewed every three years, with an electronic policy tracker providing reminders when reviews were due. Clinical protocols were subject to review every 2 years. At the time of assessment, no protocol reviews had yet been required because the review period had not been reached since the clinic opened.

We reviewed the employer's procedures required under Regulation 6 of IR(ME)R 2017. These clearly defined the responsibilities of the employer in relation to patient safety and radiation protection. Written protocols, quality assurance programmes for diagnostic procedures and equipment, and reviews of diagnostic reference levels and radiation doses were all in place, current and embedded within practice. Staff demonstrated a good understanding of these requirements during discussions and observations.

The department maintained 56 imaging policies, all of which were current and based on recognised standards and guidance. Local rules for X-ray, MRI and C-Arm equipment had been reviewed within required timescales and were readily available within clinical areas. We observed staff were familiar with these documents and understood how they applied them in their daily practice.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked collaboratively to ensure patients received coordinated care and timely access to specialist advice when required. The multidisciplinary team included, or had access to, the range of healthcare professionals necessary to support the delivery of diagnostic services, including radiologists, nurses and other clinical staff.

Staff told us there were effective working relationships between teams both within the clinic and across the wider Spire Healthcare network. Information about patients, clinical risks and operational issues was routinely shared through daily multidisciplinary safety huddles and team handovers. We observed the morning safety huddle, where staff discussed patient activity, staffing, safety matters and any issues requiring escalation. This helped ensure staff had the information required to provide safe and coordinated care throughout the day.

Staff described good communication between departments and told us they could access specialist support and advice when needed. A group-wide consultant radiologist communication system was available through a generic email network, enabling staff to seek advice and contact radiologists across the organisation.

The service was supported by radiologists who worked at a local NHS trust and visited the clinic weekly. Staff told us this facilitated professional collaboration, access to specialist expertise and continuity in radiology reporting processes.

The diagnostic service accepted referrals for young people aged 13 years and over. The service had arrangements in place to ensure children and young people received care from appropriately skilled clinicians. Diagnostic images and investigations relating to patients under the age of 18 were reported by a paediatric radiologist, ensuring specialist oversight and interpretation of imaging results.

We scored the service as 4. The evidence showed an exceptional standard. The service always supported people to manage their health and well being to fully 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.

The service demonstrated a commitment to supporting people to improve their health, well being and understanding of healthcare through community engagement, health promotion and inclusive practice.

Staff actively engaged with the local community to promote awareness of healthcare careers and the role of diagnostic services. During British Science Week, clinic staff visited a local primary school and delivered educational sessions to approximately 90 Year 5 pupils. The sessions focused on the role of radiographers and how diagnostic imaging contributes to patient care. Pupils were introduced to healthcare science through interactive discussions about anatomy, X-rays and imaging technologies, helping to increase understanding of health and healthcare professions from an early age.

The clinic also hosted patient-focused educational events aimed at supporting people to make informed decisions about their health and well being. For example, menopause information events provided people with opportunities to access specialist advice, increase their understanding of menopause-related health issues and explore available support and treatment options.

The service promoted preventive healthcare through outreach activities within the local community. Complimentary health checks were offered at local businesses and community events. These included assessments of blood pressure, blood glucose levels, oxygen saturation levels and respiratory rate. This enabled people to identify potential health concerns, understand health risks and seek further medical advice where appropriate.

Staff had access to current public health and infection prevention information through professional networks. Named staff were members of the Infection Prevention Society, enabling them to access and share relevant guidance, resources and emerging information with colleagues. This supported awareness of wider population health issues and good practice within the service.

The service promoted equality, diversity and inclusion through a range of colleague network groups, including included lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+), Race Equality and Mental Health First Aider networks. Staff told us these groups provided opportunities to share experiences, access support and contribute to a more inclusive workplace culture. Educational events and awareness initiatives were organised throughout the year to celebrate different cultures and promote understanding of diverse communities. Leaders had recently introduced LGBTQ+ educational events to further strengthen inclusivity and awareness across the organisation.

The service also recognised the needs of people living with dementia. Dementia-friendly care was supported by a designated dementia lead who ensured resources, tools and approaches were available to help staff provide appropriate support to people living with dementia and cognitive impairment. Staff had completed dementia awareness training and could signpost people and families to additional support services when required.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service had systems in place to monitor clinical outcomes, patient safety and the effectiveness of diagnostic practice. Staff used audit findings, clinical guidance, training and quality assurance processes to support continuous improvement and optimise patient outcomes.

The organisation's Recognition of the Deteriorating Patient (CLINI 54) guidance provided staff with information on recognising and responding to deterioration in adults, including the use of recognised assessment tools and escalation processes. Staff had completed training in recognising the deteriorating patient and participated in simulation exercises designed to improve their response to clinical emergencies and support patient safety. However, guidance relating to the recognition and management of deterioration in children was not available within the service.

Staff effectively used technology to support care and improve outcomes. Diagnostic imaging systems enabled timely reporting of investigations and prompt access to results. Staff also had access to information technology support when required to maintain service continuity and effective communication of diagnostic findings.

The service monitored staff exposure to ionising radiation through dose badge audits. Audit results demonstrated that all monitored staff received radiation doses well within recommended safety limits, and no exposure incidents required further investigation. This provided assurance that radiation protection measures were effective and that staff were working within safe practice standards.

Radiation dose audits demonstrated the service was actively working to keep radiation exposure as low as reasonably practicable (ALARP) while maintaining image quality. Radiation dose levels were bench-marked against recognised diagnostic reference levels to support patient safety. As part of this process, audits undertaken between December 2024 and February 2026 reviewed 10 lumbar spine X-ray examinations. A group of radiologists reviewed the data and concluded that the clinic's institutional diagnostic reference levels were lower than national reference levels while maintaining satisfactory image quality. This supported the adoption of lower radiation dose levels and demonstrated a commitment to minimising patient exposure.

The service routinely reviewed image quality and diagnostic performance. Audit results showed reject rates had improved from 15% to 12% over a six-month period. Leaders told us this improvement resulted from ongoing work relating to patient positioning, image review and staff feedback. Reducing image rejection rates helped minimise the need for repeat examinations and unnecessary radiation exposure. Marker compliance was consistently maintained at 100%. 

However, audits identified a reliance on digital image marking during specific examinations and this learning was shared with all colleagues. Annual re-audits were scheduled to monitor progress and sustain improvements.

The January 2026 Ionising Radiation Regulations 2017 (IRR17) compliance audit identified several areas requiring further development. The service implemented an action plan in response to the findings and demonstrated that most actions had been completed. Two recommendations remained ongoing, relating to imaging processes and a proposal to increase the frequency of hip injection audits. Leaders maintained oversight of these actions through governance processes and monitoring arrangements.

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.

The service had comprehensive policies and procedures in place to support staff in obtaining valid consent and ensuring people were involved in decisions about their care and treatment. Consent guidance was readily available and provided staff with clear information on obtaining informed and voluntary consent, assessing mental capacity in accordance with the Mental Capacity Act 2005, and involving family members, representatives or others where appropriate. The policy covered consent for both adults and children and included guidance on advance decisions, lasting powers of attorney and best-interest decision-making.

Staff demonstrated an understanding of the principles of consent and told us they took practical steps to ensure people were able to make informed decisions about their care. Information was provided in a way people could understand, and staff were able to adapt their communication to meet individual needs where necessary.

We reviewed 2 patient records involving diagnostic procedures that required exposure to ionising radiation. Records confirmed that consent had been obtained before the procedures were undertaken and that the required safety checks had been completed.

Staff told us no patients who lacked mental capacity had attended the diagnostic service during the assessment period. However, they demonstrated a good understanding of the Mental Capacity Act and were able to describe the actions they would take if a patient lacked capacity to make a specific decision. Staff explained they would undertake and document a decision-specific capacity assessment and make best-interest decisions where required, taking account of the person's wishes, feelings, beliefs, values, culture and previous preferences.

The service monitored compliance with consent requirements through audit activity. In 2025/26, radiology documentation was reviewed as part of the Clinic 02 Consultant Documentation Audit. The audit achieved an overall compliance score of 94%; however, consent-related questions did not achieve the required compliance target. In response, the service developed an action plan identifying five areas for improvement. Evidence provided during the assessment demonstrated that all actions had been completed.