GenesisCare Centre for Radiotherapy at Cromwell Hospital

On this page

• 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

The service had recently placed a focus on improving their learning culture where people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

At our last assessment we rated this key question good. At this assessment the rating has remained good.This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The service had recently placed a focus on improving their learning culture where people felt safe to raise concerns.

Assessment findings:

The service had recently placed a focus on improving their learning and no blame culture. A medication incident had occurred six months ago and was not reported as an incident at the time. An interim centre leader had been in place for four months. In that time there had been an increase in the number of incidents and near misses being reported which was attributed to an improving reporting and no blame culture. This was confirmed by staff we spoke with. Incident numbers for the last year demonstrated an increase in the number of incidents being reported. Staff reported incidents through a digital reporting system, reviewed by managers and graded for severity of risk and allocated for investigation. Learning was communicated in staff meetings, daily huddles and a monthly all staff meeting. Records of the daily huddles and team meeting minutes demonstrated that learning, good practice and concerns were shared with teams.

The daily huddle identified the centre leader, departmental leads, first aiders, fire marshals and recognised good staff practice. Key information from each department was recorded such as staffing levels, activity for the day and weekly numbers of referrals for each treatment machine. Incidents and concerns were also covered. Items reported within the huddle were risk assessed for follow up, allocated for action and reported back into subsequent huddles.

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.

Assessment findings

There were clear referral, admission, discharge and follow up processes which meant there was continuity of care, including when people moved between different services. Essential information about patients was received which enabled the service to meet peoples' individual needs. Daily morning safety huddles ensured there was good continuity of care when people moved between different services. Care was coordinated with the co-located acute hospital which enabled a smooth transition for patients between the two. The service was well organised to manage patients who needed to move to another service within the GenesisCare network to continue treatment from a specific radiotherapy machine to meet their individual needs.

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.

Assessment findings:

Compliance rates showed that all staff received training in safeguarding practice that was appropriate for their role. The organisation had two national safeguarding leads who could be called on for advice and support and all staff were aware of their contact details. All patients were called prior to their arrival to identify any specific needs which included if they required a chaperone. Staff were aware of what might constitute a safeguarding concern, and we were given examples of how concerns had been safely addressed and escalated.

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.

Assessment findings:

The service assessed patient's individual needs and risks using a recognised tool which was reviewed regularly. Radiographers completed an assessment of each patient at the booking stage which included a triage process to assess appropriateness of starting treatment. Assessment was ongoing throughout the person's time with the service. Daily huddles assisted to identify and plan for potential patient risks for the day and the following day's patients.

Arrangements were in place to respond to any deterioration in a patient's condition. The resident medical officer (RMO), provided by the co-located acute hospital, provided support should a patient experience complications in treatment such as a reaction to contrast, issues with cannulation or a significant drop or rise in their blood pressure. They were also available as a link with the hospital if a higher level of care was needed. It was reported the RMO had been called upon for assistance once in the last three months and two months ago a patient was readmitted to the acute hospital following the service raising concerns about their condition. A resuscitation trolley was available within the service and a resuscitation team was provided by the co-located acute hospital to support the radiographers, who were trained in intermediate life support, in the event of an emergency.

Staff in the MR-Linac treatment team told us they had completed a test emergency scenario for cardiac or respiratory arrest with the co-located acute hospital's resuscitation team two months ago.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Assessment findings:

The service had measures in place to detect and control potential risks in the clinical environment. There was a local and national radiation protection supervisor supported by a local and national physics team. All GenesisCare radiation protection supervisors were involved in group forums that supported their work and shared expert safety knowledge. Radiographers were monitored for radiation levels which were investigated if above normal levels.

Equipment, facilities and technology supported the delivery of safe care. Systems were in place to monitor servicing and machine downtime for analysis and escalation. GenesisCare had its own national engineering team on call to respond to equipment issues. Manufacturer support was also available for additional maintenance and upgrades. In the event of a machine breakdown, arrangements were in place to transfer patients to other GenesisCare sites, that included specific arrangements with the GenesisCare service closest service. To ensure the site could meet the patient's individual treatment needs a matched machine matrix was used to check the machine was suitable for the treatment required.

There was a national equipment replacement strategy that aimed to replace two machines a year. It was reported this was supported by investment from the corporate board to keep up with technology and the latest equipment.

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. However, vacancies and sickness had placed extra demands on staff.

Assessment findings:

There was forward planning and monitoring of staffing to ensure patient's individual needs were met. Monitoring staffing took place at a strategic level and in daily safety huddles. In the daily safety huddles staffing against planned treatments for the day was reviewed and adjusted where necessary. Staff worked together to provide safe care that met people's individual needs. The service did not use bank or agency staff. To cover vacancies and sickness, GenesisCare had a regional team of radiographers who rotated between services to cover gaps in staffing. Staff told us there were currently vacancies and some sickness among radiographers which placed a higher workload on staff. At present it was not always possible for the four regional radiographers to cover all the gaps in staffing. Data showed that three radiographers had recently been recruited but were yet to start.

Staff retention was supported by a retention strategy which offered training and career pathways for staff in this specialist service. The service offered rotational opportunities with the closest located GenesisCare site, which provided staff with a range of experience and development. Staff also told us there were funds available for specialist training specific to their role but currently no time to complete these due to current staffing challenges.

A new staff rota system had recently been introduced as a result of feedback from staff which gave staff more advanced notice of shift patterns. This supported more flexible working agreements to account for personal circumstances.

Annual appraisals were in place for all staff which included three check ins per year. There was an online checking system which enabled managers to monitor staff progress with online and practical training modules. There was an online checking system which enabled managers to monitor staff progress with online and practical training modules. The service had a training compliance rate of 97% against a target of 95% for both training and appraisal completion.

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.

Assessment findings:

The service assessed and managed the risk of infection through a service level agreement with the co-located acute hospital who provided cleaning services. GenesisCare had a national lead for infection prevention and control (IPC) who completed audits of cleanliness and hygiene. The most recent audit occurred three weeks prior to our visit and was followed up with a meeting with the acute hospital's IPC lead to address and action the findings. Meaningful monitoring of hand hygiene was taking place through peer review audit. Results showed areas for improvement and actions continuously monitored. This meant hand hygiene was being taken seriously. The service was represented at the provider's IPC link practitioner forum which acted as a source of knowledge and support with new guidance, audits and themes for learning.

The service was implementing NHSE's National Standards of Healthcare Cleanliness 2025, which meant new daily checklists in clinical areas were specific to the clinical use of each space.

Medicines were stored safely and securely in a locked cabinet, and the keys were accessible to authorised staff members only. The storage environment was clean, tidy and temperature was monitored daily.

If required after radiation treatment, patients could be referred to the co-located acute hospital for observation and treatment on the main ward for monitoring of possible side effects such as pain or nausea.

There was a service level agreement (SLA) with the co-located acute hospital for the provision of dispensing prescriptions. The agreement meant that prescriptions were sent by the patient's doctor, to the pharmacy for dispensing to the patient. Pharmacy staff counselled patients on how to take or use the medicines. At the time of our visit, controlled drugs (CDs) were being kept on site as part of that SLA with the co-located acute hospital, for use by the service's staff to specifically support patients undergoing stereotactic radiosurgery.

Following our visit, we were told these medicines had been removed and were now dispensed from the co-located acute hospital pharmacy as part of the service level agreement. As this change occurred following our visit, we were unable to evidence this change in practice.

Radiographers who worked with patients undergoing stereotactic radiosurgery and handled medicines, had received medicines management training. Following a recent incident relating to medicines, all staff had been requested to read the updated medicines management policy and sign to confirm they had read it.