GenesisCare Centre for Radiotherapy at Cromwell Hospital

On this page

• 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

Leaders and staff had a shared vision. Leaders were visible and knowledgeable. Staff understood their roles and responsibilities. Managers worked with people to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas. However, although steps had been taken to improve morale and shared culture, it remained a work in progress. A staff survey that collected centre level data had not been carried out for more than a year and were below the national Genesis average. The structure did not always support staff to embed the values of the organisation which sometimes contributed to low morale. Staff did not always feel supported to give feedback. There was no Care Quality Commission registered manager in post although a substantive centre leader had recently been recruited. We were not assured that arrangements for escalating matters regarding consultant conduct were fully in place.

At our last assessment we rated this key question outstanding. At this assessment the rating changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 64 (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 had a shared vision, good governance, good collaboration with other services and effective innovative practice. However, although steps had been taken to improve morale and positive shared culture, it remained a work in progress. Staff survey results were all lower than the national Genesis average, and a centre specific survey had not been carried out for more than a year. It was not possible to identify how the service managed the conduct of its consultants with practising privileges.

Assessment findings:

The current centre leader was an interim appointment, seconded from their national role with the organisation, following the previous manager leaving at short notice. A long-standing centre leader had also left in September 2024.

We found that an investigation report into a medication error six months ago had affected staff morale and the service was working to positively change its shared direction and nurture a no blame culture. This was supported by strategies being rolled out nationally by the organisation. For instance, the GenesisCare way, ‘town hall’ events for all staff, an ‘our voices’ initiative and newsletters. A ‘kudos’ recognition for a team or individual had also been initiated by human resources (HR). The organisation’s shared vision, values and ‘non negotiables’ had been refreshed in the last six months. It was reported this was a result of senior leadership listening to the needs of its local teams and was designed to enable better team ownership. These values were distilled down to being passionate about being brilliant, caring for everyone and consistently doing the right thing. It was too soon to measure the impact of these changes because they were recent and because a staff survey had not been carried out for more than a year. However, we were told how the service lived these values was being measured through audits, appraisals and patient surveys.

The governance structure gave authority to centralised senior managers. For example, there were national heads of service for infection control, radiotherapy, health and safety, quality and engineering, who all held responsibility for quality assurance. They were supported by centralised teams and visited the location and guided staff on improvement, policy and practice. This was reaffirmed at governance meetings which were centralised and attended by members of staff from the location.

Staff we spoke with told us there was sometimes a disconnection between the central management teams and the location which had affected the culture of the service. They stated this had influenced morale and led to a sense of disempowerment. A recent investigation into a medication incident had prioritised individual error above human factors and systemic failure, which did not follow the ‘no blame’ policy of the provider. The provider reported this had been conducted in line with their investigation process and disciplinary policy.

We spoke with 11 members of staff who told us they placed the patient at the centre of the treatment process, always considering their welfare and holistic needs. This was demonstrated through interactions we witnessed and patients we spoke with. Staff provided good care and the genuineness of their caring attitude came across to us and was reinforced by patient interactions we observed.

A company-wide staff survey from March 2025 showed the organisation scored highly for a sense of pride, job satisfaction and good reward and recognition. However, we were told that it was not possible to break these results down to the location.

The most recent staff survey that collected centre level data was carried out in June 2024. This predated leadership changes and cultural challenges that had arisen since the medication incident. The highest positive scores were for overall engagement and a sense of purpose (68 and 57% respectively). ‘Overall, I am satisfied with decisions made at Genesis’ and ‘I believe meaningful action will be taken as a result of this survey’ scored the lowest positive score percentages of 13% for each. All results were down on the previous year’s positive score percentage and all were lower than the national Genesis average.

The interim centre leader had made positive progress on nurturing a sense of no blame culture which was evidenced in the increase of reported incidents and concerns. Staff told us recent changes had improved the working culture. However, this remained a work in progress.

Leaders understood the context in which the service delivered care. However, the structure did not always support staff to embed the values of the organisation which sometimes contributed to low morale. There was no Care Quality Commission (CQC) registered manager in post and no application pending for this role.

Assessment findings:

The current centre leader was an interim appointment, seconded from their national role with the organisation, following the previous manager leaving at short notice. They had taken positive steps towards improving the culture of the service. A long-standing centre leader had also left in September 2024. There was no CQC registered manager in post and no application pending for this role at the time of inspection. This was a breach of the provider's registration. However, following our visit we were informed a substantive centre leader had been appointed and a registered manager's application would follow.

There were clear local reporting lines and accountability. There was a lead radiographer for each of the three machines and one for the administrative department who all reported to the clinical services lead. The clinical services lead reported into the interim centre leader who reported to national chief operating officer. The daily safety huddle identified leads for each part of the service and included a staff recognition section to commend good practice.

The service was part of Genesis Cancer Care UK Ltd who had several locations nationally. Nationally, there were heads of services such as radiotherapy, health and safety, quality, engineering and exercise medicine. Heads of service or members of their national teams visited the service regularly to provide support and for quality monitoring. However, staff told us this was sometimes a source of disconnection between the centre and the location which sometimes contributed to low morale.

Arrangements were in place for people to speak up and for their voice to be heard. However, staff did not always feel supported to give feedback. The service was working positively to nurture a no blame culture which needed further embedding.

Assessment findings:

There was a freedom to speak up policy in place. There was a national Freedom to Speak Up Guardian who was supported by a team of seven speaking up champions based in both central teams and the provider's locations. There was also a specific mailbox for speaking up and reporting whistleblowing information. It was reported that relevant information would be fed back to the centre leader to address. The centre leader told us nothing had been escalated back to them in the relatively short time they had been in post. Prior to our visit we had received information that the FTSU arrangements were not always effective, for example staff were not always assured confidentiality would be maintained or that there would be no repercussions if they spoke up. Staff reported that they did not always feel supported to speak up, although this was now improving.

The national freedom to speak up guardian is in a national role who's closest centre is Maidstone. We also have a team of seven speaking up champions based in centres. Of these, two are in central teams so cover all sites - we also have another guardian in Surrey and Elstree.

The interim centre leader had made good progress on nurturing a positive culture. This was evidenced by the increase of reported incidents and staff raising concerns. Staff told us this had improved the working culture of the service. While this was a positive, it was a work in progress which needed further embedding into the service's culture.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Assessment findings:

The service's redefined vision included a commitment to valuing people and prioritising their experiences and the outcomes of those who use the service. The values included a commitment to be caring, respectful, kind and inclusive, empathetic, approachable and supportive to everyone. Staff told us the interim centre leader had made good progress on a positive working culture based on these principles.

There were opportunities to learn and for career progression as the service provided relatively new treatments and practice. The service considered diversity and inclusion fundamental to their values and were committed to celebrating diversity and empowering people to bring their whole selves to work. Staff told us they were proud of their work and dedicated to providing good patient care.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate. However, we were not assured that arrangements for escalating matters regarding consultant conduct were fully in place.

Assessment findings:

The service had clear responsibilities in place to ensure good governance. There were lines of accountability for assurance of quality and safety through national quarterly committees at which the service was represented. This included national committees for radiation protection, pharmacy, safety and risk, infection prevention and control, and health and safety. There were set agendas and action logs for each committee, which was responsible for functions such as audits, learning from incidents and managing risks and concerns. Information was fed back into the service's local monthly all staff meetings. There was a national clinical reference group which included keeping up to date with changes to guidance and the latest evidence-based publications. This was used to inform changes to policy and practice

At a local level, daily huddles and catch ups with every service lead took place. This meant risks and concerns could be escalated and actioned in real time. Monthly all staff meetings followed a set format which included learning from incidents and concerns, feedback from national committees, patient satisfaction, risks, staffing and specialist training. Internal audits were completed by the 14th of each month and fed into the work of the national committees.

There were close working relationships with the co-located acute hospital who provided several services managed through service level agreements. This included portering, security, cleaning, RMO, dietitians, clinical nurse specialist, facilities, medical support and estates. The centre leader also met regularly with the hospital matron and chief RMO and services were monitored for quality and safety through audit. The integrated cancer care committee included the service's heads of department who met monthly with leads from the acute hospital to discuss any concerns. A consultant development meeting monitored cross working and discussed new treatments, developments and onboarding of new doctors.

The process for granting practising privileges to doctors was managed by the provider nationally. Up to date information of every doctor with practising privileges was available through the intranet. We reviewed this information while on site and found this included the status of their indemnity, appraisal and scope of practice. It was reported the service had 13 MR-Linac specialists and clinical oncologists with practising privileges, with one taking the lead for the service for others to raise local issues with.

There was a newly appointed national medical director who chaired the medical advisory committee (MAC). We were provided with six months of MAC minutes which demonstrated its function was the approval, suspension and removal of practising privileges. Other functions of the MAC were shared across the clinical reference groups to ensure expertise and specialist knowledge on matters of clinical best practice. Each clinical reference group was chaired by the medical director with a multidisciplinary team of doctors, physicists and radiographers for each of the main tumour groups.

We reviewed the MAC terms of reference dated July 2025. Responsibilities were stated as advising on cases, the granting, renewal, restriction, suspension, withdrawal or refusal of practising privileges, advise on clinical matters relating to individual consultants and eligibility. Locally, one of the specialists with practising privileges took the lead for others to raise local issues with. It was reported that any concerns would be escalated to the head of quality and to the medical director. The MAC terms of reference stated that matters regarding consultant conduct could be escalated to the MAC. However, six months' worth of MAC minutes made no reference to conduct and did not demonstrate it was fulfilling this function.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Assessment findings:

Clinical and operational leaders engaged with external stakeholders, such as the co-located acute hospital and other referring clinical services. They shared support services with the co-located hospital and could call upon medical support from them when it was required. The nature of the specialist services provided meant they collaborated and worked to share learning and information with other specialist clinicians and partners. Within the larger network of GenesisCare services they worked to share learning and resources with services that provided similar treatments.

The service had a focus on innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute effective practice and research.

Assessment findings:

The service carried out MRI-Linac treatments which was relatively new technology. It combined high resolution magnetic resonance imaging (MRI) with a linear accelerator (Linac) for radiation therapy. It was underpinned by research, new techniques and adaptations and supported by clinical reference and education groups. We were provided with examples of research that had been conducted by practitioners from the service, who spoke at international conferences and contributed to publications.

Monthly multidisciplinary expert clinical reference groups, composed of members from the five tumour groups, were supported by the medical director. The groups focussed on best practice and innovation in each field.

The clinical escalation group was a provider wide group of principal radiographers, physicists and dosimetrists who, along with the head of radiotherapy and head of medical physics, worked with the service to peer review cases where a consultant had recommended treatment outside standard radiotherapy treatments. This meant innovative practice was effective.