Thomas Linacre Centre

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we did not rate this key question due to differences in our assessment methodology. As such, this is the first assessment for this service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Imaging services closely monitored their performance to ensure good outcomes for patients, which included a robust variety of clinical and local audits. Services worked in line with national guidance and were delivered by competent and qualified staff that worked well together.

We have not awarded this service a score for Effective.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Admission policies were in place to provide guidance for staff around the assessments required prior to imaging procedures, which were aligned with national guidelines appropriately. Factors such as the requirement of a supportive person to accompany the patient, the date of their most recent mammogram, and previous medical history were detailed so that the radiographer could consider the justification of the screening mammogram.

People who used the service told us staff considered their needs and preferences prior to the scan and gave them appropriate pre-procedure advice to ensure they could complete it successfully. Patients were advised to contact the service in advance of their appointment if they had additional mobility needs or further queries, to ensure the procedure could be carried out at the location.

We looked at 5 patients’ records following their scan. While documentation in the breast screening unit was good, this was less consistent in the other imaging services at the location, where we found that patient ID checks were not consistently documented. This aligned with 4 low severity or near-miss incidents related to documentary errors in the last 12 months at the location, which had since each been resolved appropriately. The service had previously undertaken audits of compliance with patient identification procedures and action plans had been produced accordingly.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff we spoke to were experienced, knowledgeable and had the appropriate qualifications to meet the needs of their patients. There was role-specific training for staff on induction, and teams had access to specialist input such as medical advice from radiologists or breast consultants, where required. We saw evidence of recent staff training in contrast-enhanced mammography to prepare for the upcoming implementation of these procedures.

Appraisals, or performance development reviews (PDRs), were conducted in a timely way and most staff were compliant at the time of the inspection, with 90% compliance in both the breast screening unit and the trust’s relevant radiographer and sonographer staff group. Where staff had developed personal and professional objectives, they were supported by their appraisers to manage these. Staff we spoke with did not feel that poor staff performance was an issue across the service.

Staff followed various imaging pathways and protocols for scanning different anatomies, that were up to date and in line with national guidance. Safety policies, local rules and risk assessments associated with the scanning process were up to date and had been read by each member of staff to confirm they understood them as appropriate. The breast screening unit had also developed local safety standards for interventional procedures (LocSSIPs), which included core biopsies, excisions of benign lesions, and fine needle aspirations guided by ultrasound or X-ray. World Health Organisation (WHO) checklists for appropriate procedures were used and stored in patient records appropriately.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

This section was partly assessed using findings that apply to the whole location, which are included in the equivalent section of the outpatients report.

Multidisciplinary teams (MDT) worked between imaging services and other disciplines and included appropriate and effective communication of results from diagnostic scans and other procedures from the staff in imaging services to professionals managing the condition or concern.

Staff told us that despite service pressures, colleagues were compassionate and would support each other when work was challenging. Most staff felt that their working relationships were a source of positivity and made their work more effective.

Radiographers worked on a rotational basis at the mobile screening units to ensure that everyone could be involved with the activity and meetings taking place at the main breast screening unit. Recent meetings in the breast screening unit had effectively communicated information such as service updates, changes to policies and procedures, and important staff reminders.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

This section was assessed using findings that apply to the whole location, which are included in the equivalent section of the outpatients report.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

In line with NHS breast screening programme guidance, the breast screening unit completed audits of partial mammography processes, technical recalls and repeats, staff radiation doses, and hand hygiene. The service also routinely provided data as part of the central return data set (KC62), which is analysed externally as part of a national and regional benchmarking and quality assurance process, and includes a variety of metrics with an aim to ensure national cancer targets are achieved and the screening programme is managed effectively.

We saw widespread evidence of continuous clinical audit activity across various service areas of diagnostic imaging, which included accuracy of documentation, image quality of breast ultrasound, and target breach analyses. Audit data was used to drive improvement and informed service level reviews, with a focus on improving patient experiences.

The trust also had an effective electronic peer review process amongst sonographers, where 5% of scans were considered for the quality assurance (QA) of clinical practice. Peers would assess images aligned with professional body guidance, including the British Medical Ultrasound Society and Fetal Anomaly Screening Programme criteria, and make a judgement on the wording of reports. A process for any identified significant concerns was in place, and overall findings were reviewed regularly at service meetings. The breast unit also provided an example mammographic image assessment tool as part of their peer review process.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took practical steps to enable patients to make their own decisions. Where this was required, consent was sought before procedures were carried out and this was documented appropriately. Services understood and followed national guidance on the importance of informed consent and establishing mental capacity in line with the Mental Capacity Act 2005.

The breast screening unit had processes for establishing consent in line with NHS breast screening programme guidance. The policy advised appropriately that staff must ensure the patient understood the procedure, including the implications of radiation and compression inherent in mammography.

Staff understood that while attendance implied consent on behalf of the patient, this could be withdrawn at any time prior and during imaging. The breast screening service had audited the number of patients in the previous 12 months where patients had attended but not screened due to where consent had been withdrawn.

The breast screening service also had local safety standards for interventional procedures that included consent requirements in the process for staff to follow. For some procedures, only verbal consent was required to proceed, whereas more invasive procedures such as core biopsies or wire localisation procedures required signed consent.