HCA Healthcare UK The Christie Private Care

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question good. The rating has remained good. This meant people were safe and protected from avoidable harm. We assessed 8 quality statements.

The service delivered care that made people feel safe, supported and involved in care decisions. Safety events were thoroughly investigated and reported, with lessons learned to embed good practices. The service collaborated with people to maintain safe care systems, ensuring continuity when moving between services and departments. Incident reporting, with learning was actively promoted to enhance services. Regular audits and benchmarking underscored a commitment to evidenced based practice.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff were trained in incident reporting and understood what needed to be escalated and reported. The hospital provided incident data that included both medical care, radiotherapy and outpatient services. See medical care report for more detail about incident data. Staff told us they felt comfortable raising concerns and had access to debrief support when needed.

Learning from safeguarding incidents was shared through a variety of meetings and communication methods. All staff we spoke with could describe learning from incidents and how it had been shared in team meetings. Staff received feedback from the investigation of incidents, both internal and external to the service.

The service had a system for reviewing incident trends through weekly Complaints, Litigation, Incidents and Patient Experience (CLIP) and Learning and Improvement Panels (LIP). We saw evidence of effective oversight and monitoring of safety actions generated with robust follow up and evidence of continued learning and change in practice such as updates to documentation and improved handovers between departments. The meetings were multidisciplinary and involved senior clinical leaders, governance staff, and operational managers. This ensured that learning was understood through multiple lenses and that proposed improvements were feasible and aligned with the principles of proportionality, system learning and continuous improvement.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong. Staff we spoke with gave examples of when they had fulfilled the duty of candour. One related to a delay in stopping a patient’s medication before an appointment. Staff ensured the patient received treatment with minimal delay and worked with colleagues to identify the cause of the problem.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s booking processes ensured that enough information was provided in advance to assess whether needs could be safely met. Staff had access to patients’ clinical histories before appointments, supporting safe triage.

Risk assessments were carried out prior to appointments and treatment with information shared appropriately with care teams. Staff knew about and dealt with any specific risk issues, for example, staff worked with colleagues internally and in NHS services to deal with risks such as deteriorating conditions.

Reception staff made initial patient checks such as personal details and chaperone requests on the patient’s arrival at the department. The OPD was open 8am to 8pm Monday to Friday and had medical cover throughout this time. Staff could also access the critical care and emergency support provided by the partner NHS trust.

Patients and carers could use the partner NHS trust’s telephone hotline, a 24 hour telephone helpline service available to patients and carers for advice and management on the side effects and complications of cancer treatments outside of appointment times. One patient told us their consultant had called them within an hour of calling the hotline with advice and reassurance.

Patients saw a named clinician at a pre-planned time, with some seeing dieticians and nurses on the same visit. We saw evidence of effective handovers between teams. One patient we spoke to said that this worked very well and enabled a seamless care pathway.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

At the time of our assessment, 97% of medical and nursing staff within OPD had up to date safeguarding training relevant to their roles with 100% of all other staff in the OPD up to date with their training.

There was a designated safeguarding lead who staff could contact for advice and escalation. Staff we spoke with told us that the safeguarding team were easily accessible if required and could give examples when they had contacted them for advice and what the outcomes were.

Safeguarding concerns were recorded and referred appropriately, with oversight maintained through regular governance meetings.

Staff told us how they would escalate safeguarding concerns and knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff gave examples and appropriate action was taken to reduce the risk of ongoing harm, including investigation and cooperation with safeguarding partners.

Staff followed safe procedures for any children visiting OPD and assessed this on an individual basis.

More detail about the safeguarding processes at this location can be found in the medical care section of this report.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Patients told us they were informed about any risks and how to keep themselves safe. They were familiar with the 24 hour ‘hotline’ telephone helpline service that was available if they had concerns about their physical health.

There was a proactive approach to anticipating and managing risk to the people who used the services. We saw that the OPD had appropriate staffing levels and patients did not wait long to be seen by doctors or nurses.

There was no waiting list for OPD and staff had multiple care pathways meaning patients could see a consultant, nurse and undergo treatment on the same day.

There had been no safety incidents recorded within OPD in the 12 months prior to our assessment. We reviewed 4 sets of patient notes, all the required information was available, such as risk assessments and signed consent to treatment forms where required.

The OPD displayed photographs of the staff working in the department so patients and relatives could identify staff when needed.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients. Staff were able to give an example of a time a patient had deteriorated in the OPD, appropriate monitoring and quick action was taken meaning a positive outcome. The patient and their family later thanked staff.

Staff told us that as this was a rare occurrence within the OPD, they maintained training and simulated practice to ensure they were prepared. Staff told us resuscitation simulations provided them with the opportunity for learning within a safe environment and to discuss and improve processes.

We saw evidence that over 95% of all staff were trained in basic life support (BLS) with 100% of nurses and doctors trained in immediate life support (ILS).

There were clear care pathways in place so that treatment was appropriate, timely and effective. Where there were clinical risks identified, we saw an alert was visible on each patient’s electronic record. For example, we observed a patients record with a high risk score for malnutrition. This score was shown on the appointment list so that staff were aware of the risk and could highlight any issues to the medical staff.

We saw staff spoke with patients and ensured they understood their care and treatment.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

All of the areas we inspected in the OPD were clean, well maintained and free from clutter. The housekeeping manager conducted weekly reviews of cleaning checklists. In October 2025, 270 checklists were audited across the medical division and outpatients, demonstrating 96% compliance. Any discrepancies were promptly addressed with housekeeping assistants.

The waiting area in the department was spacious and there were refreshments and reading materials available. There was a separate waiting room available for those who required a quieter area.

There were hand sanitizers on the walls at the entrance and throughout the department. We observed staff decontaminate their hands on entry and exit to consultation rooms as well as before and after any patient interactions.

There was access to personal protective equipment (PPE) such as gloves and aprons in all consultation rooms and the phlebotomy room and we saw that staff used this appropriately. Each room had a sink with hand hygiene products and paper towel dispensers. All were replenished regularly.

Consultation rooms were fitted with call bells. Patients were not routinely left alone during clinic appointments, and the call bell system was maintained as a best practice safety measure. We saw evidence that the OPD had achieved 98% in a recent environmental audit.

Sharps containers were clearly labelled with the date and the name of the staff member assembling, locking and disposing of them. Bins to accommodate different types of waste were clearly identified, enabling safe disposal by staff.

Staff were aware of the appropriate equipment needed for each consultation and checked the availability of these before each appointment.

The staff we spoke with told us that they had adequate and appropriate equipment in the department to carry out the treatments. They also told us they had access to specialist items from the day care unit and could request items to be ordered from the senior leadership team.

The department used external contractors to check on safety and maintenance of the equipment used in the department. We saw evidence of up to date audits for devices which included servicing dates and next service due dates.

The emergency resuscitation trolley followed the partner NHS trust’s policy and stock list and was in clear sight of staff in the middle of the department. The contents were secured with a tag, and weekly checks of non-secured items were recorded. A QR code was scanned to ensure all contained items were in date, this was checked in real time during the assessment and all confirmed to be in date.

We saw evidence of zero missed resuscitation trolley audits in the last 6 months for the OPD.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were 2 whole time equivalent registered nurses and 2 healthcare assistants employed in the OPD. Staff told us they were flexible and able to cover shifts easily. There were 13 clinical nurse specialists (CNS) who each had a tumour group specialism. Three nurses had completed the McMillan nurse training with more nurses due to be trained, there was also full time administration support for the team.

CNSs worked through a personal and professional development plan that was tailored to their specialism, to ensure patients received high quality care. This was reviewed on a regular basis so that any new guidance could be incorporated in forthcoming learning. ‘Lunch and Learn’ events and ‘Specialist Awareness Days’ were held throughout the year for staff led by subject matter experts. We saw evidence of high attendance by staff to these events.

The OPD and adjacent day case service was managed by the same staff member. There was no reliance on agency staff, and continuity of care was maintained across services. Staff from the day case service could be called on for support in the OPD if required.

Staff we spoke with all agreed that the current staffing was appropriate. We saw evidence that there was enough staff to keep people safe and patients told us they felt safe within the service.

A weekly meeting led by the head of clinical operations, matron daily huddles and reviews by the nurse in charge ensured there were enough staff on duty to care for patients.

The Matron’s ‘Assurance Walk Round’ provided a structured quality and safety review within the OPD. Its purpose was to ensure visible leadership, compliance with regulatory standards, and promote a culture of continuous improvement.

During the walk round, the matron assessed key domains including environment and safety, patient care and experience, documentation and compliance and staffing numbers. We saw evidence that the OPD was fully compliant.

Staff told us that any staff shortages could be immediately escalated to a member of the executive team or duty manager 24 hours a day. In the last 6 months there had not been any incidents relating to staffing reported for the OPD.

Staff received mandatory training and spoke positively about training opportunities. The mandatory training was comprehensive with staff able to request additional or new training to ensure they could meet patient needs. At the time of our assessment, 97% of clinical staff and 100% of non-clinical staff within the OPD were up to date with mandatory training. Managers monitored all training and alerted staff when they needed to be updated.

All new staff received a full induction tailored to their role before they started work. Staff who had recently completed the induction spoke positively about the experience and said managers and clinical leads were supportive. Staff told us they had an opportunity to attend a ‘new starters breakfast’ with the senior leadership team which built positive professional relationships.

At the time of our assessment the OPD had 1 vacancy. The department was fully staffed at the time of our assessment. There had been no turnover of clinical staff in the previous 12 months, and the service had low sickness rates. The service had robust performance management processes to use if staff performance issues arose. This was a centralised process with support from a dedicated human resources team.

See the medical care section of the report for detailed information about medical staffing.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The environment was visibly clean and well maintained, with cleaning schedules in place and monitored. We saw ‘I am clean’ stickers were visible and in date.

Cleaning records were up-to-date and demonstrated that OPD areas were cleaned regularly. All public areas had cleaning schedules. We looked at a sample of 5 checklists and found them to be up to date.

Staff completed hand hygiene audits each month. The compliance was at 100% for all elements.

Staff followed infection control procedures aligned with best practice, including protocols for room cleaning between appointments. Infection prevention and control (IPC) training compliance was 99% and the latest IPC audit from November 2025 demonstrated that 100% of clinical staff complied with relevant infection control protocols.

The service had an infection control lead and monthly meetings. We saw evidence that audits were conducted periodically to maintain compliance.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes when administering and recording medicines. There were no controlled drugs (CDs) administered in the OPD.

Staff reviewed patients' medicines regularly at appointments and provided specific advice to patients and carers about their medication. We saw evidence of this in patient’s records and speaking with the clinical team.

For our detailed findings on medicines, refer to the medical care section of the report.