Thomas Linacre Centre

On this page

• 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

We looked for evidence that the service met people’s needs. At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

Staff had considered the needs of patients accessing the service and were experienced in putting patients at the centre of their care. Services had considered patient feedback and worked to ensure people from all backgrounds could access the service.

However, radiologist cover was not always sufficient to ensure patients accessing breast services had an equal experience, which affected the continuity and timeliness in care for some people.

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 3. The evidence showed a good standard. The service made 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.

People who used the service told us their needs were considered prior to being seen and scan procedures were undertaken in accordance with their expectations and preferences. Staff told us they discussed people's individual clinical and personal needs with them prior to commencing scans.

The mobile breast screening units were periodically moved between locations across south Lancashire to ensure that people requiring screening across a broad geographic area could access services conveniently. Services at the location had access to both phone interpretation services and video British Sign Language (BSL) interpretation, with hearing loop provision if this was required.

Imaging staff working at the location had completed training on both delirium and dementia and had excellent compliance with these at the time of inspection. Staff told us that they were confident to work with patients with learning disabilities, dementia or who were neurodiverse, and could demonstrate training in line with the Oliver McGowan code of practice accordingly.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

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

Imaging services monitored various operational metrics, which included patient attendance rates and uptake rates of breast screening specifically, waiting times for different types of referrals and scan types, and compliance with national targets including the 6-week wait for diagnostic testing target (DM01).

We noted that the consistent provision of breast ‘one-stop’ clinics (where patients could attend an appointment with a breast consultant, have a breast scan, and learn the results from this scan at the same visit) had been a longstanding challenge for the service. This appeared to be primarily due to radiologist staffing limitations and the inability to source cover, which meant that even the baseline level of provision of ‘one-stop’ clinics was not being met.

This meant that patients would have to speak to a consultant, return to the location for their scan, and then potentially return for a third time so that the results and next steps could be discussed. Staff told us that this could cause delays in patients receiving timely treatment. We were provided with data that showed in the previous 2 months to the inspection, 24% patients did not attend a routine clinic with ‘one-stop’ provision due to radiologist leave, sickness, training or a vacancy and cover was not available. Further, outpatient breast services also regularly arranged additional clinics or bookings to support demand, which also did not always have imaging support, and so were not ‘one-stop’ clinics. Leaders told us that various factors were responsible for this concern, and that improvement plans which included the recruitment of additional radiologists were underway.

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.

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

Services provided information that complied with the Accessible Information Standard, and we saw examples of easy-read information and appointment letters that were produced in the patient’s preferred language, including braille. Information and leaflets were widely available across the service, and a library of all patient information leaflets was accessible online and through a QR code.

The trust had an effective interpreting and translation policy that considered typical situations where these services would be needed, and staff training rates in information governance was above the trust’s target compliance. We saw signage that demonstrated consideration for British Sign Language (BSL) users so that video interpreters could be arranged at short notice if this was required. Mobile breast screening units do not routinely use interpretation services in line with NHS breast screening programme guidance, although units still have access to interpreters in the case that positive identification or consent cannot be obtained from a patient prior to their scan.

Online information about the breast screening service was available from the trust’s website, with contact details and further guidance available. However, the locations of each of the breast screening units had not been kept up to date on all sites. The service had also developed a walkthrough video of the department to better inform patients about what they will experience at their appointment.

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.

There was information on display at the location to advise patients and visitors how to provide feedback about their care and treatment or make a formal complaint.

In the last 12 months, the breast screening service had recorded 7 concerns and 10 compliments at the location. Other imaging services had recorded 2 concerns and 0 compliments, which reflected the smaller level of activity by comparison. We also saw examples of communications with patients about their concerns that were professional and sensitive in tone, acknowledged failings and said sorry meaningfully. No recent complaints had been escalated to independent adjudicators and been upheld.

Patient feedback had been gathered, which had considered people’s protected characteristics and demonstrated that their experience was overwhelmingly positive. However, we did not see evidence of further analysis or action plans that had been produced in response to this feedback.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

People using imaging services at the location were either seen as part of the national breast screening programme or referred from their GP or another provider for scans. While it was clear that services had made efforts to reduce barriers for people who are most likely to have difficulty accessing care, the symptomatic breast service could not demonstrate that all patients were seen in a consistently timely way.

The provision of ‘one-stop’ clinics (where patients could attend an appointment with a breast consultant, have a breast scan, and learn the results from this scan at the same visit) was not consistent across the service. Radiologist cover was not sufficient to support ‘one-stop’ provision routinely and was also unable to support additional clinics that were arranged at shorter notice by the outpatient breast service to meet demand. This meant that a significant proportion of patients did not have access to ‘one-stop’ provision, dependent on the clinic they were booked into.

Staff also highlighted an additional concern where patients with symptomatic breast issues were typically able to choose the provider they were referred to. These patients may not be aware of the variation in the availability of 'one-stop' services across different locations. As a result, there was a risk that some patients would experience less timely or comprehensive assessment compared to what might have been available at another provider. The service was aware of the variability in waiting times performance and advised this was partly due to the burden of the breast screening service covering a larger catchment to support improved access for patients from neighbouring areas. We saw evidence of ongoing efforts to secure additional resource to support more timely and consistent delivery for all patients.

However, the breast screening service worked to ensure that patients from across the catchment area and from different backgrounds could access the service. Staff in all areas including breast services were familiar with making reasonable adjustments for patients. While the setting and equipment could not accommodate all mobility needs on mobile breast screening units and the bone density (dual energy X-ray absorptiometry, DEXA) scanner, pathways were in place to ensure these patients could still be seen at other locations managed by the provider trust.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

In line with national breast screening programme guidance, the breast screening service had a cancer service improvement lead (CSIL) to improve access and reduce inequalities related to breast screening. As part of their work, the service had completed a health equity audit which considered patients who may face inequalities in access and experience because of their protected characteristics under the Equality Act 2010. The audit also gave effective consideration of other relevant groups, which included homeless people, sex workers, prisoners, and asylum seekers. However, while the audit appropriately considered that transgender people faced additional barriers to accessing services and had liaised with GPs to help address these, the audit had inappropriately considered gender identity under a ‘sexual orientation’ heading.

Staff had completed mandatory e-learning in equality, diversity and inclusion. The provider had an equality, diversity and inclusion strategy, which outlined a commitment to embed diversity, promote equal opportunities and support non-discriminatory practices when delivering care and treatment. Local policies and procedures included effective equality impact assessments.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

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