Cobalt Health

Cobalt Health is operated by Cobalt Health and provides services to patients across Gloucester, Hereford and Worcester. The Cobalt Imaging Centre in Cheltenham opened in 2006. The centre provides Positron emission tomography–computed tomography (PET/CT) (a nuclear medicine technique), Computed Tomography (CT), Cone Beam Computed Tomography (Cone beam computed tomography is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone), 3.0T Magnetic Resonance Imaging (MRI) (medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body), high field open MRI, ultrasound and digital radiography. The service also provides a fleet of six mobile MRI scanners and one mobile CT scanner which are located in various regions across the UK. Cobalt Health also provides consultation rooms for orthopaedic surgeons to facilitate a one-stop service for outpatients, with diagnostic imaging carried out during the consultation.

The service provides diagnostic imaging services for patients over the age of 18.

We visited the clinical imaging centre in Cheltenham and six mobile units. Cobalt Health also provides a satellite service at The Institute of Translational Medicine Imaging Centre at the Queen Elizabeth Hospital (QEH) in Birmingham. This is a satellite MRI facility supporting a wide range of research and clinical service for the QEH. However, this location was not inspected during this inspection as it was recently inspected in January 2019 and rated good.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 9, 10 and 17 July 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We rated it as Good overall.

• The service provided mandatory training in key skills. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The risk of infection was managed well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities and premises kept people safe.
• Staff completed and updated risk assessments for each patient and removed or minimised risks.
• There were sufficient numbers of staff with the necessary skills, experience and qualifications to meet patients’ needs. The service made sure staff were competent for their roles. Managers appraised staff’s work performance.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
• Staff monitored the effectiveness of care and treatment in line with contractual arrangements with commissioners. The service had been accredited under relevant clinical accreditation schemes.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, provided emotional support to patients, and supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care. People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were exceeding national standards.
• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They supported staff to develop their skills and take on more senior roles.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However, we found the following issues that the service provider needs to improve:

• Patient group directions used by the service did not have the required authorisation as recommended by national guidance.
• Risk assessments were not always documented to provide an audit trail behind the rational for the decision.
• Daily cleaning records were not maintained to demonstrate cleaning had taken place.
• There was limited documentation regarding additional patient care carried out by the service.
• Further work around audit was required as there was not always a formal process to identify the actions required to make the necessary improvements where audits had not met required targets.
• There were limited risks associated with children attending the service on the risk register.
• We were not assured that risks were being regularly reviewed and discussed and that mitigating actions were being acted on. It was unclear whether actions associated with risk mitigation had been completed and implemented.
• Meeting minutes did not always identify the depth and detail behind discussions held.
• There was no evidence to demonstrate that recommendations from the staff survey had been acted on or implemented.

We also found areas of outstanding practice:

• Staff worked closely with the referring NHS trust to carry out additional scans when significant findings were identified. This prevented patients from having to return to the service for additional scans which could lead to a delay in accessing treatment.
• The provider offered 800 free scans to support the local NHS trust to meet demand and ensure timely diagnostic scans for patients.
• 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.
• Cobalt Health provided facilities free of charge to accommodate a breast screening service provided by the local NHS trust to help them meet demand.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.