HCA Healthcare UK The Christie Private Care

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question outstanding. At this inspection, the rating has remained outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

The service had set clear standards for staff to deliver consistent, responsive, and personalised care. Care was tailored to meet individual and community needs, prioritising inclusivity, and accessibility. We saw evidence of detailed care plans reflected responsiveness to diverse requirements. Translation services and communication aids were available. People received accurate, up-to-date information and were encouraged to provide feedback, ideas, and complaints, which were used for learning and improvement. Staff received advanced communication training for end-of-life conversations, enhancing available support.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patient’s care plans fully reflected their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act. We saw evidence of reasonable adjustments being made for a patient with hearing loss. A preference of face-to-face communication and British Sign Language (BSL) interpreter was noted, with actions such body position when speaking with patient, written summaries and advance booking of BSL interpreter identified. The service made reasonable adjustments to ensure patients with additional needs understood their condition and be involved in their care planning ensuing care was respectful and non-discriminatory while remaining clinically appropriate.

In April 2024, the service had passed a recognised clinical service excellence programme 3 year reassessment which supported hospitals to deliver optimum, patient-focused treatment and care.

We saw evidence that initial appointments and future care plans were shaped in partnership with each person and their relatives and carers. Staff could give examples of how they based patient care around individual needs and preferences such as religious requirements; we saw patient feedback which stated they were grateful staff had an insight into their culture and were prepared to adapt care to meet individualised needs. Patients told us they found the team respectful and supportive of their beliefs.

OPD appointments identified patients living with dementia or a learning disability. Staff told us teams escalated any dementia-related admissions and created individualised care plans. Staff from all specialities, including dietitians, physiotherapists, doctors, nurses, catering and housekeeping, attended daily MDT meetings to discuss patient needs and preferences.

Staff completed structured care plans on the electronic patient record system shared with the parter NHS trust.

Staff told us additional requirements were recognised early and that appropriate reasonable adjustments were put in place for patients with autism, learning disabilities or dementia.

We saw multiple instances of this through our assessment. For example, staff had provided tailored support for a patient with dementia and arranged a DoLS authorisation and allocated 1:1 nursing care to ensure the patient’s safety. They reviewed the patient’s “Who Am I” document to understand their preferences, communication needs and triggers, and planned care accordingly. Staff had adapted their approach by sitting at the doorway when continuous presence in the room caused distress. They also considered their likes, dislikes and usual routines to reduce anxiety.

Patients and those close to them were regularly involved in planning and making shared decisions about their care and treatment. For example, we saw evidence that staff supported patients through best interest meetings with their next of kin and arranged admission times that best suited patients and carers.

We observed positive interactions between staff and patients. We saw staff understood their needs and provided appropriate care and treatment.

Staff received mandatory training in equality and diversity and training data showed that compliance averaged 99%.

Staff had access to a corporate policy on supporting adults and children with learning disabilities and autism and received mandatory training in learning disability and autism. Training data showed compliance averaged 99% for all staff groups across the service. In addition to the mandated e learning, 22% of staff members had attended a face-to-face study day with an external provider. Leaders told us that this higher level of training was not a requirement but had supported staff further in their role to identify and make reasonable adjustments to meet the needs patients.

Staff told us they completed corporate dementia training and used resources such as a dementia box, which included activities such as fidget toys, painting crafts, and a dementia orientation clock with lights/pictures to signify day/night for inpatient rooms.

Accessible toilets were available in all departments and were equipped with nurse call buzzers and emergency pull cords.

Patients had access to ‘language line’ that provided immediate interpretation in more than 200 languages, including British Sign Language. Face to face interpreters could be arranged when required. Patient information leaflets were also available in Braille and in multiple languages on request.

The service provided a range of additional therapies for patients who wanted additional support. In addition to individual outpatient therapeutic provision, the psychology & wellbeing service organised and ran several groups. These aimed to help patients diagnosed with cancer adjust and cope with their condition, treatment and prognosis, including those nearing the end of life. This included the moving forward group, the living with cancer group, the men’s health seminar and a complementary therapy service.

The psychology and wellbeing service was available to both patients and their families including children over the age of 18. Although the service did not have a dedicated mental health team, the service had a corporate mental health pathway referral and transfer policy, to support patients with complex mental health needs. When patients had known mental health needs prior to admission, staff liaised with their existing mental health team and GP.

The complementary therapy service was available for all patients to access, at any stage of their cancer pathway. There were 2 complementary therapists who delivered the service Monday- Friday across the OPD. The team offered a range of therapy services including massage, reflexology, anxiety management, relaxation and self-care techniques. The team also supported patients through difficult procedures, treatments and scans, such as needle anxiety management.

We scored the service as 4. The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Care was joined-up, flexible and supported choice and continuity with input from an MDT.

Planning and delivery of services was aligned to meet the evolving needs of the population that the department served, staff told us this involved analysing demographic data, health trends, and patient feedback. The provider had also examined the prevalence of specific conditions and healthcare needs unique to its population. In doing this the senior leadership team had recruited specialists in fields where they felt there was a lesser provision to provide good care, treatment and support to patients within the OPD, such as cardiology and dermatology.

Patient forums had the aim of gathering patients views on what else the service could provide to ensure the service was able to meet the changing needs of the population they served.

Patients’ care and treatment was delivered in a way that met their needs from services that were co-ordinated and responsive. Patients were seen in a timely manner with most appointments planned in advance.

The service shared information technology systems with the partner NHS trust which meant patients could interchange between both services and all records were accessible by staff from both services. Staff across all specialities could also access the information they needed to deliver safe and coordinated care. For example, Physiotherapists had access to all scans, imaging, nursing and medical notes.

The provider had provisions in place for patients who contacted their psychologist out of hours by email, seeking support. Email signatures of all psychologists were amended in June 2025 to include information on where to seek support in a crisis. We saw evidence they included several sources of support, internal to TCPC and external, which ensured more than one pathway to support was available.

This supported timely decision making, avoided duplication and promoted a coordinated and continuous journey for patients across both providers. The effective partnership working consistently delivered care that exceeded what is typically expected from a single service.

To further enhance the range of specialist palliative and supportive care services available, the service had also implemented a service level agreement with an external provider. This meant the service had 3 additional consultants and 2 additional CNS that specialised in supportive oncology. Consultants provided a 24-hour on call service for advice and ward rounds as required alongside regular outpatient clinics. A CNS was present on-site Monday-Friday 9am-5pm. Patients were referred to the service by the resident doctor team with the approval of the treating consultant for support with symptom management and advance care planning.

All patients received dedicated, disease specific support from a CNS throughout their cancer pathway who coordinated care between consultants, MDTs and community services. Support included advance care planning, financial guidance and signposting to external support services. CNSs also supported patients and families with planning significant events, travel and practical arrangements.

Patients’ advance care planning discussions were documented electronically which meant all staff involved in their care could access up to date information.

The service primarily operated as a private healthcare provider. This allowed pathways and resource planning to be structured around the needs and expectations of private patients. We reviewed service activity and patient type between November 2024 and November 2025. During this period, there were 819 inpatient admissions and 1,198 day cases. Private patients accounted for 99.7% of activity, with 0.3% NHS patients.

Staff kept accurate and complete records to facilitate communication and coordination which promoted continuity of care. We reviewed 6 patient records and found they were complete and contemporaneous.

Patients were appropriately transferred to other departments within the service and were also offered a designated urgent appointment service if needed. Additional services were delivered through service level agreements with the partner NHS trust, including critical care, complementary therapies, speech and language therapy, information technology, palliative care and echocardiography.

The service aimed to offer appointments to patients on the same day either within TCPC or within other HCA Healthcare UK facilities.

Clinical staff could deliver remote consultations, so patients could avoid unnecessary travel. Consulting rooms across the OPD were equipped appropriately to allow remote consultations to take place confidentially.

Staff told us that most patients who visited the service were people who lived locally, and people who worked in the local area who found it convenient. There was a small percentage of international patients who used the service.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The Accessible Information Standard (AIS) is a legal requirement introduced in 2016 to ensure that adults and children who have a disability, impairment or sensory loss receive information in a way that they can access and understand, and any communication support that they need is identified, recorded and provided. The service had processes in place to ensure that patients received information that met their communication needs and was compliant with the AIS standards.

For example, during the first contact with the service patients are asked about their communication requirements such as large print, easy read, interpreters, visual or hearing impairment. Staff could flag patient communication needs on the electronic patient record system and when patients were transferred to another provider, staff shared their communication needs as part of the referral process.

For patients that had hearing difficulties and used hearing aids, the service had a hearing loop service. Information about care, consent, confidentiality and complaints was given in written and verbal formats. Information leaflets were available in languages spoken by patients.

People were signposted to external resources where appropriate, including charities and support groups. Adjustments were made to how information was shared, including the use of visual prompts, simplified text, or preferred communication methods.

Staff told us if a patient or their family members were unable to read and write, the CNS team would read consultant letters aloud so that patients were able to understand the information. Patients were then given the chance to ask questions in their own time. Staff communicated with family members to ensure they were also informed.

The CNS team showed patients their results in graph format to help with understanding the trajectory and meaning behind the numbers.

Information governance systems included confidentiality of patient records. Staff kept detailed records of patients’ care and treatment. The majority of record keeping was made electronically. Patients also had a folder containing paper records, such as letters between services and printed blood results which was mostly used for reference.

The patient records we reviewed were up to date and clearly written with a focus on patient outcomes. Staff told us when patients are transferred to a new team, there were no delays in staff accessing their records. This enabled staff to readily access treatment notes at any time. This also enabled authorised clinicians to access records where care and treatment plans were shared or transferred. The electronic system was secure, and care records, including emails, were encrypted. Only authorised staff could access the system.

There was a corporate health records’ management policy and a process for the management of health records for the TCPC. Both documents were in date and had a review date.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients we spoke with knew how to give feedback about their experiences of care.

The service had a complaints policy that set out the required procedures, including offering patients a face-to-face meeting to discuss their concerns if they wished. The policy stated that complaints should be acknowledged within 3 days and a full response provided within 20 working days, or within 20 days of a face-to-face meeting. The complaints policy included the process to follow for unresolved complaints and signposted to external organisations such as the Independent Sector Complaints Adjudication Service (ISCAS) for private funded patients and the Parliamentary and Health Service Ombudsman (for NHS patients).

Staff told us they received feedback on the outcome of the investigation of complaints and the service acted on the findings to ensure learning was embedded and lessons were learnt.

Managers described how they responded quickly to informal concerns, often resolving issues before they escalated, while still providing patients with clear information on how to make a formal complaint if they chose. This included replacing the existing call bell system with a new model designed to safely reduce noise levels, which had previously affected both patient experience and staff working conditions

The OPD had received zero complaints in the previous 12 months. Although there had been zero complaints, staff knew how to handle complaints appropriately. When patients complained or raised concerns verbally, they told us they received feedback and action had been taken. Staff told us they felt confident to advocate for patients if needed and could provide examples of when this had been done.

Patient and family and/ or carer feedback was collected through surveys and follow-up conversations throughout the patient’s journey. People told us they felt heard and that their suggestions had been taken seriously. Staff adapted approaches based on feedback, including changes to consultation room layout and scheduling flexibility. We saw evidence patient views informed planning for future service development and delivery. Between November 2024 and November 2025, 1344, patient feedback surveys had been completed.

Patients and their families could give feedback on the service and their treatment, and staff supported them to do this. We observed staff were proactive in engaging with patients and families about their experiences and frequently asked how they were. This happened during and after appointments. The service offered personalised handwritten feedback cards. The feedback cards were designed collaboratively with the patient user group, and we observed these cards throughout the departments. Patients could scan a QR code to access the survey and staff said this meant they could gain more timely feedback on the care and overall experience. Feedback from this included, ‘This is a safe, unique and supportive space for anyone who lives with cancer, we can talk about our care and treatment and take control of the next steps, I find it very empowering….’ Another stating, ‘I am truly grateful for the team.’

People were given time and space to explore issues at their own pace, with flexibility built into the model of care, one patient told us, ‘I feel I have really connected with the staff, I do not feel alone.’

Managers described how they responded quickly to informal concerns, often resolving issues before they escalated, while still providing patients with clear information on how to make a formal complaint if they chose. This included replacing and updating furniture in the OPD clinic rooms which had previously affected both patient experience and staff working conditions.

Leaders told us that feedback was regularly reviewed and that improvements were displayed on posters in patient areas. We observed this practice during our assessment.

Patients scored staff highly for involving them in decisions about their care. Between November 2024 and November 2025, 100% of patients said they trusted and had confidence in the staff.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Managers planned and organised services to meet the changing needs of those who accessed the service. Staff demonstrated a good understanding of patients who used the service. The team also tailored care to meet the ongoing needs of the population, such as a drop in phlebotomy clinic, where patients who required blood tests could arrive without an appointment. Patients told us it was very convenient if they had been attending another appointment in the hospital for example. One patient told us they were always seen with very little waiting time.

The service minimised the number of times patients needed to attend the hospital, by ensuring patients had access to the required staff and tests within the same OPD visit. Decisions about appointment frequency were always made in patients’ best interests. The service was flexible, and staff planned treatments on patents’ wishes. Facilities and premises were appropriate for the services being delivered.

Nurses were always on shift and available to support the allied health professional team in clinical tasks. A dedicated on call team maintained this service when the OPD was closed. The service had systems to help care for patients in need of additional support or specialist intervention.

The service had a very small did not attend (DNA) rate and there had been zero cancelled OPD appointments by consultants at the time of the assessment in 2025.

People told us they were seen in a timely way and were able to contact clinical staff directly between appointments if needed.

There had been 18,752 OPD appointments booked between November 2024 and October 2025. This consisted of 99.7% privately funded patients and 0.3% NHS funded patients. Staff told us that the number of people attending OPD was increasing.

The service participated in internal audit processes to review effectiveness of the OPD; we saw evidence that 85% of patients were seen within 15mins of arriving with 92% of those satisfied with the waiting time.

Additional time was allocated for patients with high levels of anxiety or mental health needs, allowing them the opportunity to ask questions and process information. Staff offered visits to the wards to reduce preprocedural anxieties. Cultural and religious needs, including Sabbath observance and specific dietary requirements, were also accommodated.

Clinical staff could deliver remote consultations, so patients could avoid unnecessary travel. Consulting room across the OPD were equipped appropriately to allow remote consultations to take place confidentially.

Staff told us they monitored and took action to minimise missed appointments within the OPD with immediate follow up. The nursing team contacted the consultant’s secretary or the patient straight away to understand reasons for the missed appointment. There was a rescheduling policy and depending on the patient’s response and the nature of their healthcare needs, there would be an option to reschedule. This was coordinated efficiently to ensure the patient received timely care

Physical premises, resources and equipment were accessible including accessible toilets and bathrooms. Hearing loops were available for patients with hearing impairments, patients could access interpretation services including British Sign Language and information materials were available in braille and multiple languages upon request.

We scored the service as 4. The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff within the service, along with the senior leadership team, had promoted a culture where patients felt empowered to give their views and understood their rights. For example, the service had a patient user group made up of current patients, former patients, staff and managers. The group met every few months to discuss patient experience and identify opportunities to improve the quality of care and support provided. This meant patients could contribute directly to service development and improvements that reflected their views and experiences.

The provider had undertaken equality impact assessments to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

All staff were committed to ensuring equitable access, outcomes, and experiences for all patients, including those with learning disabilities, autism, dementia, and mental health needs. This was supported in several ways including, hospital patient passports and ‘this is me’ documents. Staff demonstrated an exceptional commitment to promoting equality and removing any barriers to patients accessing care and support. For example, we reviewed a patient case study where a patient receiving long term treatment experienced significant changes in their personal circumstances and had complex communication needs which affected their ability to engage with their care and appointments. Staff responded proactively by adapting treatment schedules to suit the patient's situation, adjusting communication methods and working closely with the patient and their family to ensure they could continue to access the service without disadvantage. Staff arranged additional practical support and guidance to help the patient manage safely at home. The personalised and coordinated approach had promoted equity in outcomes for the patient and enabled the patient to remain fully involved in decision making and maintain their treatment plan despite the challenges. Bereavement support was extended to the family, including follow up contact by the CNS to provide support and ensure holistic consideration of the family's wellbeing.

The CNS told us that they had realistic time frames in which they could plan patients care and achieve the best possible outcomes for the needs of their patients.

The provider reviewed their policies in line with service planning to ensure they reflected the nature of the work provided as an outpatient service. Leaders told us that information from safeguarding referrals, complaints involving vulnerable patients and repeat attendance patterns was reviewed to identify inequities. Patient experience, incidents and clinical outcomes were monitored against demographic characteristics such as disability, ethnicity, age and deprivation to monitor inequalities across different patient groups.

At the time of our inspection, 100% of staff were trained in equality, diversity, inclusion and human rights. Staff engaged with local community representatives who provided additional education, guidance and resources to support the delivery of inclusive care. Further training sessions were arranged to enhance staff confidence in caring for patients with diverse religious, cultural or spiritual needs. From this experience, the service had developed links with a Jewish community support organisation that offered person centred support for people affected by cancer. This included emotional, physical, social and practical assistance. Staff told us that this partnership had enhanced access to culturally sensitive support for patients.

We scored the service as 4. The evidence showed an exceptional standard. People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of patients with complex needs and patients were supported to transition to other services or community resources when appropriate.

Staff told us of examples where they had made provisions for family members to support them through difficult conversations and stages of their loved one’s journey.

We saw feedback from patients about the service with one saying, ‘I have made some significant improvements to my life for which I will be forever grateful through changing my thought process about the future and making decisions to take better control….’ Another said, ‘I can plan for the future and I have accepted my new normal with the help of the staff….’

Staff told us there was a focus to encourage future care planning discussions at an early opportunity. At TCPC, do not attempt cardiopulmonary resuscitation (DNACPR) were called ‘Allow a Natural Death’ (AaND), staff told us this language helped challenging conversations with the focus placed on ensuring a dignified and peaceful death. The discussions prior to completing AaND forms usually took place with the medical team, patient and family and CNS support within the OPD.

As part of an annual review of end of life care at TCPC, an audit was undertaken in November 2025 to understand if conversations were routinely happening with patients regarding their wishes and preferred place of death (PPD). Twelve patients were selected at random with the audit showing 100% of patients had PPD confirmed and documented and 75% of patients achieved their PPD. There was good clinical justification for those who did not achieve their PPD and we saw evidence this was discussed with patients and family.

The service followed a holistic approach to palliative care including following the 4 Ls approach; live, loved, listened to, leaving. This supported staff and families to promote quality of life, choice, relationships and spirituality for patients nearing the end of life.