HCA Healthcare UK The Christie Private Care

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question outstanding. At this assessment the rating remained the same. This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

We assessed 7 quality statements.

The service had a shared vision, strategy and culture based on patient outcomes, patient experience, people and growth. We saw evidence and impact of the strategy in action throughout our assessment. The service was led by capable, compassionate and inclusive leaders with well‑defined responsibilities. They had the experience and capacity to deliver excellent, sustainable care and manage risk effectively. The service collaborated seamlessly with partners, shared learning and worked collectively to improve care. There was a strong culture of continuous learning, innovation and improvement.

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.

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 strategy that was fully aligned with both the corporate mission and the corporate cancer strategy. There was a strong commitment to system-wide collaboration and leadership.

The HCA Healthcare UK’s mission (2022) was to deliver high-quality healthcare by working together as ‘One HCA’. The mission outlined seven key commitments, including providing seamless patient support, strengthening consultant engagement, and being an exceptional employer with exceptional staff’. This was underpinned by organisational values of ‘unique and individual’, ‘kindness and compassion’, ‘honesty, integrity and fairness’, and ‘loyalty, respect and dignity.

HCA Healthcare UK’s cancer strategy (2025) outlined a seamless, end‑to‑end cancer care pathway. The strategy emphasised integrated access points across the entire cancer pathway to ensure smooth transitions between services and the use of advanced technology to support accurate diagnosis and effective treatment. It also highlighted care delivered through expert MDTs and a network of over 300 oncologists, access to innovative treatment options including a dedicated clinical trials facility, and personalised support from a named clinical nurse specialist for every patient.

The hospital had its own vision and strategy that was underpinned by these strategies. It had been developed locally with input from both patients and staff. For example, through the patient user group and ‘vital voices’ staff feedback survey. We saw that the vision and strategy was displayed in staff areas that we visited.

The strategy focused on four core pillars designed to support high‑quality, patient‑centred care and organisational development. These comprised of patient outcomes - to consistently deliver exceptional outcomes by promoting continuous learning, reducing harm, and benchmarking performance against the highest industry standards. Patient experience - strong commitment to providing compassionate, personalised and outstanding care. People - attract, develop and retain talented staff who feel valued and empowered. It also aimed to create a positive workplace culture where colleagues feel a sense of belonging and have opportunities for growth and development. Growth - collaboration with consultants to innovate, invest and expand services and through strong partnerships to deliver high‑quality care while supporting sustainable business growth. We saw evidence and impact of the strategy in action throughout our assessment.

Leaders told us the strategy was designed with the understanding that cancer care is not static. The hospital’s clinical lead was an active member of the corporate cancer strategy group and described how learning and innovation from different HCA sites were routinely shared across the organisation. Leaders highlighted that their service worked in partnership with local specialist centres and often piloted new approaches which were then escalated to the strategy group and adopted more widely.

Leaders told us that they worked closely with the partner NHS trust to review and maintain shared oversight of their strategy. They told us this was a regular agenda item at the joint venture board and explained that recent discussions had helped both executive teams maintain a clear and aligned understanding of their strategic direction. We saw evidence of this in the joint venture board meeting minutes from October 2025, which showed that leaders had discussed the hospitals future vision and the growth priorities.

All staff we spoke with were knowledgeable about the vision and strategy. Leaders monitored and reviewed progress against the strategy through structured processes, including mid‑year and end‑of‑year staff reviews, to assess how well the service and individuals upheld the organisation’s mission and values. They told us there was strong oversight of this and high levels of compliance. Heads of department also worked with staff to develop training needs analyses to support ongoing development.

Leaders told us they regularly observed staff demonstrating the organisation’s strategy and values in their daily practice, and they were able to share examples that were consistent with what we saw throughout our assessment.

All staff we spoke with described a positive and supportive culture where they felt genuinely valued by colleagues and leaders. They told us they were encouraged to contribute ideas, felt listened to, and professional development was supported. Staff consistently spoke with pride about their work, demonstrating a strong commitment to delivering high‑quality, compassionate care and achieving the best possible outcomes for patients.

Many staff also described a strong sense of psychological safety and said leaders were supportive of wellbeing initiatives and encouraged staff to identify improvements. They often described the culture as being open and honest and that this had strengthened over recent years, with increased investment in speaking‑up processes and leadership commitment to maintaining a safe and supportive environment.

All staff were invited to participate in bi-annual staff surveys called ‘vital voices’. Metrics included personal, team, manager and organisation. Managers had access to their own teams' results for discussion with their staff.

We reviewed the most recent hospital wide staff ‘vital voices’ feedback from May 2025. The response rate was 86% with a total of 163 responses out of 189 and had increased compared to the previous survey in September 2024 (82%). The key measure for the engagement index was an average of the scores recorded for ‘personal accomplishment’, ‘feeling motivated’ and ‘recommending the service as a great place to work’.

The engagement score in May 2025 was 73%, compared with 74% in the previous survey, a score of 78% reported across other HCA locations. However, there was an increase in scores for ‘feeling motivated’ and ‘recommending the service as a great place to work’.

The highest‑scoring areas related to staff feeling safe, clear about expectations, respected and cared for. Physical safety scored the highest at 91%, followed by performance expectations (88%) and respect (86%). Staff also reported strong levels of psychological safety, empowerment, collaboration and role fit, with scores ranging from 81%–83%.

The lowest‑scoring areas were for ‘positive change happening in response to the survey’ (55%) and ‘career growth] (63%). ‘Work‑life balance, recognition and belonging’ scored between 72%–74%, while ‘communication, support and access to resources’ were rated slightly higher at 75%–77%.

We saw that the service had implemented timely action plans to act on staff feedback. Each department had its own action plan outlining both strengths and areas for improvement. In one department for example, belonging and career growth had been identified as priorities, and leaders had implemented clear ‘you said, we did’ actions in response to staff feedback. We saw that the action plan for resident doctors included actions to drive improvements for higher degree opportunities, educational, research and quality improvement opportunities.

The service had grievance and disciplinary procedures in place to provide guidance to staff on how to raise concerns about their employment and to ensure that any issues of conduct were managed fairly, consistently and in line with organisational policy.

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.

The service was led by capable, compassionate and inclusive leaders with clearly defined responsibilities. They demonstrated the high levels of experience and capacity needed to deliver excellent and sustainable care and ensure effective management of risk.

The chief executive officer (CEO) had overall responsibility for the services provided at the hospital. The chief nursing officer (CNO), held the role of registered manager, and reported directly to the CEO. The CNO held full clinical and governance accountability for the service.

The leadership structure included direct reports from the head of governance, senior nursing and surgical leads, with additional oversight of resident doctors, pharmacy, allied health professionals, psychology and clinical educators.

The chief operating officer (COO) held operational and financial responsibility. Their direct reports included the consultant liaison officer, executive assistant and pathway support manager, alongside day‑to‑day oversight of non‑clinical teams such as catering, hotel services, medical secretaries and patient access.

Medical leadership was provided by a senior consultant clinical oncologist. They were also a medical advisor for Leaders in Oncology Care (LOC) provided by HCA Healthcare UK and had held the role as medical advisory committee (MAC) chair for 10 years.

Leaders told us they had strong access to support and development within their roles. They had either finished the year‑long corporate executive development programme or were actively completing it. They described feeling well supported through regular one‑to‑one meetings, mentoring and peer support from senior colleagues. They told us that they received ongoing guidance through established corporate nursing networks and regular contact with senior corporate executives.

Medical leadership was supported through participation in senior management meetings and a corporate quarterly medical governance forum. They described the meetings as supportive, and that information including incident data was reviewed to ensure the provider hospitals were implementing changes consistently. Additional support was provided by the medical director at the NHS partner trust who offered collaborative input on new and emerging issues.

High-quality leadership was sustained through safe, effective and inclusive recruitment and succession planning. Leaders described a strong organisational commitment to high‑quality leadership and emphasised the importance of succession planning. The executive development programme was highlighted as the main approach for developing future senior leaders. This was supported by talent mapping tools.

Leaders gave examples of internal progression, including staff who had moved from department based roles into senior managerial positions through structured development and exposure to leadership forums. They explained that defined career pathways were now in place, with development opportunities extending from band 5 roles through to senior leadership.

The service also described a recent corporate initiative that standardised roles and supported clearer progression routes. All new managers completed a 6 day leadership programme focused on team management and handling complex situations, and aspiring leaders could also access this training. Staff were further supported by career coaches who helped identify development opportunities and guide progression.

Development was tailored to individual interest. Leaders told us that some doctors were supported to attend MAC meetings or explore leadership responsibilities where this aligned with their career goals.

All staff told us they felt well supported and valued by both managers and senior leaders. They consistently spoke positively about senior leaders and managers being compassionate, highly visible and approachable within the service.

We saw how leaders celebrated the positive achievements of staff through numerous awards that were displayed throughout departments.

Managers and leaders were regularly present in clinical areas, enabling them to address issues quickly and maintain close engagement with staff and patients. Staff we spoke with confirmed this. Staff told us there was a genuine “open‑door” culture and gave examples of when they had raised concerns or shared ideas with senior managers and leaders and that feedback had been acted upon.

Leaders told us they engaged with new staff through quarterly welcome breakfasts, which helped build relationships, understand early experiences and gather suggestions for improvement. They emphasised an approachable style of leadership, focusing on people rather than job titles.

The clinical lead engaged with teams in several ways, including attendance at MAC meetings, time spent on the wards speaking with resident doctors about their wellbeing and development, and being accessible to consultants for advice. A regular MAC newsletter provided further opportunities for communication about decisions and service updates.

Partners told us they observed leaders at all levels consistently demonstrating the skills, knowledge and integrity required for effective leadership. They described open communication and regular shared governance meetings that supported transparency and joint learning. They also noted ongoing challenges with desk space but said that managers and leaders worked proactively to ensure fair and equitable allocation that considered staffs individual needs.

We looked at results from the hospital wide May 2025 staff survey for the metric ‘manager and leadership’ which included 7 questions. The highest scores were performance expectations (88%), care about wellbeing (83%), psychological safety (82%) and feeling empowered (82%). Lowest scoring questions included support (75%) and recognition (72%). Of the 7 questions, 4 questions had slightly decreased and 3 had slightly increased and 1 question stayed the same when compared to September 2024 results. All 7 questions had scored lower than the overall average for other HCA locations.

Data specific to speciality showed that the oncology department scored 80% for the questions ‘I receive meaningful recognition when I do a good job’ which was higher than the overall average for other HCA locations. For the haematology transplant unit, 62% of staff felt that positive change would happen as a result of the survey compared to 61% for other HCA locations.

The service had a robust fit and proper persons (FPPR) process in place to carry out comprehensive checks to assure that all leaders were suitable, safe and fit to hold their roles.

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.

There were processes and systems in place so that staff were supported to raise concerns. Freedom to Speak Up (FTSU) was managed at a corporate level and leaders told us this maintained independence and objectivity. This included a network of speaking up champions. At the time of our assessment, this network consisted of around 50 staff members who were trained to listen to staff concerns and provide supportive, confidential guidance.

There were 2 trained speaking up champions that were available at a local level and based at the service. They were employed in clinical roles, with the FSTU champion role performed in addition to their core duties. They told us that they were well supported by the corporate FSTU lead and the wider network of speaking up champions. They told us they received structured training, including role‑play scenarios and guidance on confidentiality. They met quarterly with the corporate lead to discuss themes, shares updates and developments.

The speaking up champions told us they were visible and well known across the departments and that the service fostered a positive speaking‑up culture. All staff we spoke with were aware of the FTSU process and who the 2 speaking up champions were. We observed posters across departments that signposted staff to the FTSU service with pictures and contact details for the champions. Champions also attended lunch‑and‑learn sessions and attended team meetings and the resident doctors colleague council.

Champions gave examples of concerns being managed sensitively and effectively. They described appropriate follow‑up, options for anonymity, and timely resolution with feedback to staff. They told us staff felt comfortable raising concerns and that senior leaders were approachable and responsive. They shared examples of when they had shared issues with senior executives including the CEO who had supported them with timely resolutions.

There was a corporate freedom to speak up policy which was in date and had been updated in September 2025. The policy included guidance on how to raise a concern and encouraged staff to report concerns even if they were in doubt. The policy explained who staff could contact and that they were not limited to their local speaking up champions. It also included resources for independent advice and external reporting.

We looked at FTSU information data which showed that between January and November 2025 there had been 5 cases. Leaders told us that no themes or patterns had been identified from these cases.

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.

The service had a corporate Diversity, Equity, Inclusion and Belonging (DEIB) Hub on the internal intranet, providing colleagues with access to support networks, colleague groups and updates on DEIB activity. Although staff could access the organisation’s DEIB Hub, there was limited evidence of local, face‑to‑face DEIB engagement or activity.

Corporate DEIB support included partnerships with a global Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) inclusion and recruitment platform, a national programme that encouraged employers to recruit and support disabled people, and an international consultancy service that advised organisations on implementing effective diversity and inclusion practices.

Although the corporate wider DEIB strategy applied to their service, leaders confirmed there was no local DEIB plan specifically for the service.

The service told us that new colleagues are asked to complete ethnicity and disability declarations during onboarding. They provided workforce ethnicity data for November 2024 and November 2025 but were unable to supply equivalent information for disability declarations.

However, staff described a supportive environment where leaders took proactive steps to assist colleagues experiencing personal, mental health or neurodiversity‑related challenges. They told us that onsite psychological support could be accessed confidentially, and in some cases the service helped staff receive appointments more quickly. They described the reasonable adjustments that had been put in place where needed, including changes to shift patterns, workload and shift specific responsibilities following occupational health assessments. Managers were described as responsive and flexible, ensuring colleagues who were struggling received regular check‑ins and appropriate modifications to their duties.

The service had an active colleague council which was a staff listening forum designed to strengthen the voice of colleagues and act as a structured bridge between staff and senior leadership. The council was chaired by an elected colleague for a two‑year tenure, with colleagues across all departments encouraged to attend. Staff could raise any issues through their nominated departmental representative.

The council operated in a clear governance structure. Locally, the chair coordinated meetings, gathered staff feedback and worked with leaders to progress actions. They met quarterly with senior corporate leaders and attended national colleague council meetings in London four times a year. The chair told us that this enabled the sharing of ideas and good practice across other HCA sites. We reviewed recent colleague council minutes and saw evidence that the chair had shared learning from the latest national council meeting with staff. Staff survey results were also a main focus of discussions.

Minutes from both local and national meetings were available for staff to access via the intranet.

The chair reported that leaders were receptive to ideas and operated an open‑door culture, although some issues, such as sick pay and maternity pay, required change at a central level and therefore progressed more slowly. However, they said there had been improvements in these areas over time.

The council worked to strengthen communication with resident doctors, supported by a monthly newsletter sharing updates, achievements and development opportunities.

Anonymised staff feedback was encouraged through suggestion boxes and QR‑code submissions, and staff described the council as an important way for staff to have a voice.

The service had a corporate diversity and inclusion policy that was in date and had been updated in May 2025. The policy provided a framework that outlined how equality, diversity and inclusion were fully embedded in employment practices and promoted awareness and understanding of inclusive behaviours.

The service also had a bullying and harassment policy, which was in date and had been updated in December 2024. The policy promoted a working environment where bullying, harassment, victimisation and unlawful discrimination were not tolerated. The policy provided a clear framework for raising and addressing concerns.

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.

The corporate governance structure was comprised of multiple executive boards, such as the cancer executive board, medical governance board, health and safety and risk board, information governance board, artificial intelligence board and clinical governance board. Each board was supported by a wide range of specialist subcommittees.

The cancer executive board demonstrated outstanding governance processes through its comprehensive network of national specialist subcommittees. There was an extensive range of tumour‑specific and service‑specific groups including breast, brain, urology, haematology, gynaecology, sarcoma, head and neck, skin and Systemic Anti‑Cancer Therapy (SACT). This meant patients could access a breadth of specialist support from consultants and expertise at a national level.

There was also a clearly defined and highly effective local governance structure, reinforced by regular senior‑level and multidisciplinary oversight meetings. Weekly complaints, litigation, incidents and patient experience (CLIP) meetings took place, enabling leaders to triangulate data, identify emerging trends, escalate issues or concerns and share learning across the organisation’s hospital sites.

Mortality and morbidity (M&M) meetings took place monthly to review patient outcomes, discuss complex cases or unexpected deaths, and identify learning to strengthen patient safety and clinical practice. Over the previous 12 months, the service recorded 50 deaths, all of which were expected. Leaders told us the service did not benchmark its mortality outcomes against other sites because its patient population was more complex with higher acuity. However, mortality review findings were shared quarterly to support wider learning.

There were also weekly mortality review meetings to provide oversight of all in‑hospital deaths. This promoted timely and appropriate completion of mortality reviews and strengthened learning and improvement across the organisation’s hospital sites.

Monthly learning improvement panel (LIP) meetings took place that included high level incident monitoring and review of themes and trends. The meetings also incorporated shared learning across the organisation’s hospital sites and provided updates on ongoing quality improvement projects.

The quality governance committee and heads of departments met monthly. Meeting minutes showed meetings were well attended, robust, comprehensive and well‑coordinated. Key governance topics discussed included finance, IPC, incidents, updated NICE guidance and policy updates, safety alerts, mortality, shared learning, the risk register and risk management, clinical effectiveness and patient experience.

In addition, quarterly clinical operating reports (QCOR) provided further monitoring and oversight of key quality, clinical and risk metrics.

Collectively, these meetings demonstrated a structured and consistent approach to governance, with clear escalation routes, documented actions and regular monitoring of quality, safety and performance across the service.

There was also a well‑established governance framework with regular meetings across all clinical and operational teams. We saw evidence of consistent monthly team meetings for the clinical nurse specialists, oncology, physiotherapy, psychology, radiotherapy and resident doctor teams, as well as structured activity review and monthly meetings within the haematology service. Pharmacy held frequent huddles alongside formal monthly team meetings with documented action plans. The patient access team also met monthly to review performance and operational issues. In addition, quarterly meetings of the local radiation protection committee and radiation user group demonstrated systematic oversight of radiation safety. Recent meeting minutes showed that governance was embedded across the service, with routine monitoring, clear communication and regular review of quality, safety and operational matters.

The service benchmarked its performance against 10 other HCA Healthcare UK facilities on a monthly basis and used the results to drive improvements. The service was performing at a high level and ranked within the top 5 for key areas such as accommodation, admission, consultant, patient involvement and discharge.

Monthly and quarterly clinical operating report dashboards were used to monitor performance in real time across a range of metrics including incidents, infection rates and patient experience. Leaders told us that this helped staff spot trends, variations and emerging risks early and supported timely action and improvement.

Leaders explained that internal key performance indicators were aligned with Private Healthcare Information Network (PHIN) indicators, enabling the service to understand how its outcomes compared with regional and population‑level trends, as well as with other independent sector providers.

Managers identified key risks to their department and recorded them on the service wide risk register. We reviewed the risk register, and at the time of our assessment, 8 risks had been identified. All risks were linked to its relevant department and had a named accountable member of staff assigned to them. A scoring system was used to indicate whether risks were low, moderate or high. Control measures were put in place to mitigate the risks, and all risks had a review date and had been regularly reviewed and updated.

Managers and senior leaders we spoke with showed a clear and well‑informed understanding of risks across their departments.

The risk register was shared at the monthly quality governance committee and heads of departments meetings. We also noted that risks were clearly displayed on posters across departments to support staff awareness.

Updates from NICE guidance were reviewed by leaders and policies were updated where necessary. At the time of our assessment, there were no policies flagged as being out of date.

The Medical Advisory Committee (MAC) at the service met regularly to discuss topics such as; risks, practising privileges, complaints and clinical training. The MAC was well represented across all specialities. The head of resident doctor services was a member of the MAC to provide strategic oversight.

There was a systematic programme for clinical and internal audit. Audit data showed a sustained high performance across the key indicators monitored. The results of audits were reviewed and presented each month during the heads of departments and governance meetings. Subsequent action plans were implemented and reviewed, and learning was shared across all HCA sites where appropriate.

We reviewed the database used to monitor consultants’ practising privileges and found that it demonstrated robust compliance. We also looked at 5 practising privileges files and found they were all well organised and contained all appropriate up to date documentation.

Performance was discussed at the quarterly quality meetings with local and corporate leaders, where any variances or risks were explored and actions agreed.

Managers were aware of their responsibility to report notifiable incidents and any incidents related to the General Data Protection Regulation (GDPR). The service reported there had been no data breaches that were reportable to the Information Commissioner's Office (ICO) in the past 12 months.

The service had access to corporate policies that provided support and guidance for emergency preparedness and business continuity.

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 and leaders demonstrated highly effective partnership working with key organisations to support care provision, service development and joined-up care. This included a strong and collaborative partnership with the partner NHS trust.

The service had an extensive range of service‑level agreements (SLAs) with the partner NHS trust to provide access to a wide spectrum of clinical and non‑clinical support. There were 25 SLAs that included specialist services such as critical care, radiology, pathology, physiotherapy, lymphoedema, occupational therapy, dietetics, speech and language therapy, nuclear medicine, radiotherapy, medical physics and neurology. Additional agreements covered supportive and palliative care, diabetes management, stoma care, transplant services, and complex discharge support.

Non‑clinical provision included hard and soft facilities management, IT, medical records, infection prevention and control, medical device maintenance and resuscitation services.

The service held quarterly joint board meetings with the partner NHS trust. These meetings focused on key strategic and operational themes, including digital transformation, growth, capacity planning and operational development. Governance and quality reports highlighted incident trends, medication safety improvements, unplanned readmissions, and complaint levels. Mortality review outcomes were discussed, with learning shared with teams. Further key points included policy updates, IPC priorities, and financial performance. Operational updates also addressed activity levels for specific cancer treatments and service expansion plans.

The service had an SLA with an external provider to further enhance the range of onsite specialist palliative and supportive care services available. This additional provision meant that the service had more specialist care to support the palliative and end of life care needs of patients and their carers.

The service had expanded access to radiotherapy by working in partnership with the partner NHS trust to provide treatment closer to patients’ homes. Other collaborative work had been undertaken with the NHS trust and an external technology provider to implement advanced technology.

Dietitians had partnered with specialist suppliers to develop nutritional products better suited to patients’ needs.

Staff and leaders engaged with patients, staff, partners, and national networks to share learning and were focused on continuous improvements to the service. For example, the patient user group, colleague council forums and patient stories we reviewed showed that feedback was actively used to drive learning, service improvements and positive change across the organisation. For example, the service had worked in partnership with a faith-based community support group following patient feedback.

The colleague council had also generated several positive changes. Examples included sustainability initiatives such as a pilot blister‑pack recycling scheme, which was later taken up by other sites. There had been improved arrangements for resident doctors who were unable to leave clinical areas during shifts, with meals made available to ensure fairness across roles. Through networking with other council chairs, the service also adopted practices implemented successfully elsewhere.

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.

Staff and leaders had a strong understanding of how to make improvement happen and the service promoted a strong culture of continuous quality improvement. Leaders told us this was overseen locally through the learning and improvement panel (LIP).

Feedback from staff we spoke with showed a strong sense of trust between leadership and staff.

Staff were supported to prioritise time to develop their skills around improvement and innovation. Quality improvement (QI) training was available to staff who wanted to develop their skills in leading or contributing to improvement initiatives. QI champions presented new proposals for approval at LIP meetings and provided progress updates.

The QI approach included measuring outcomes and impact, and staff shared examples of QI work specific to their departments. This included a project aimed at increasing compliance with electronic documentation of observations during blood transfusions. Managers and staff had identified that, although staff were completing the required observations, these were sometimes entered incorrectly or not uploaded to the electronic system. The QI project introduced targeted changes to address this and resulted in significantly improved accuracy and completeness of electronic observation records.

Medical staff shared examples of quality improvement work that had been undertaken that focused on improving flow, discharges and prescribing issues. This had led to improvements in processes for out of hours prescriptions and out of hours management of VTE.

Leaders also shared examples of local QI projects. One project focused on standardising the screening process for patients who may be suitable for home parenteral nutrition in order to support a more consistent and evidence‑based approach.

Another project looked at whether there was a link between serious fungal chest infections and the use of steroids in patients receiving a specific targeted antibody-drug as their first treatment for Acute Myeloid Leukaemia. It examined how the amount of steroid given, and how long patients were on them, might influence their risk of infection over a 12–24‑month period.

In addition to its local quality improvement work, staff had also supported a corporate initiative to strengthen handovers, helping to improve patient safety and communication.

The service was committed to making improvements and learning from patient experience and feedback. In the previous 12 months before the assessment, the service had completed a discharge improvement project. This had led to the implementation of the discharge coordinator role for 4 days a week. Staff described several benefits of the project and the new role, including improved planning for upcoming discharges, quicker preparation of discharge medications (particularly at weekends) and designated pharmacy support for discharge planning.

Patient feedback data showed an improvement in satisfaction with the discharge process between January and March 2025, with satisfaction increasing by over 20%, from 61% to 83%.

The service celebrated learning and innovation through ‘reasons to be proud case studies’. We saw numerous examples of this across the different departments. One example described how the radiotherapy team had successfully introduced surface‑guided radiotherapy (SGRT), a technique that uses cameras to monitor a patient’s body position to improve accuracy during treatment. Staff underwent extensive training, including sessions with international specialists, to ensure the technique was implemented safely and effectively. Staff reported that initial results showed treatments were delivered quickly and accurately, with patients reporting that the process was straightforward. The new approach was expected to remove the need for tattoo‑based markings in future, improving patient experience.

Staff and leaders ensured that patients using the service were involved in developing improvement and innovation initiatives. For example, the service had worked to enhance food choices after patients highlighted a need for plainer food options. The patient user group took part in tasting sessions that led to the creation of a special’s menu, providing patients with a greater variety of ‘comfort’ foods.

Patients had reported difficulty finding the private care facilities within the partner NHS hospital. In response, senior leaders worked with NHS partners to approve their own branded signage. The patient user group reviewed the proposed designs and their suggestions were used for the final design.

The service had strong external relationships that supported improvement and innovation. This included developing a Myeloma CAR‑T pathway in partnership with an external provider, offering a treatment option not currently available within the NHS.

There were processes in place to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged staff to speak up with ideas for improvement and innovation. For example, monthly newsletters were shared with staff across departments that included key updates such as learning from incidents, celebrating good care and dates for upcoming teaching sessions. Governance messages were also shared and staff were invited to contribute ideas or feedback for future editions.