Thomas Linacre Centre

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

We looked for evidence that people were protected from abuse and avoidable harm.

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.

The service had a proactive incident reporting culture and there were enough staff with sufficient training to keep people safe. Premises and equipment were clean and well-maintained, and audits assured leaders that the environment and clinical practice was safe.

However, staff in some imaging areas were not always familiar about emergency resuscitation arrangements, and resuscitation equipment was not always sufficiently accessible.

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.

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

In the previous 12 months, the breast screening unit had reported 21 incidents, of which 1 had scored a harm level of moderate or above, related to a fall outside a mobile screening van. Other imaging services at the location had reported 8 incidents, of which none had scored a harm level of moderate or above. For each incident, actions had been taken and learning demonstrated in a timely way, where this was appropriate. Relevant incidents were reviewed at a directorate level where trends or further analysis could be considered, and these meetings appropriately produced actions with named responsible staff and due dates.

Staff demonstrated a good understanding of what incidents should be reported and told us they felt confident in doing so. Incident reports advised staff of when the duty of candour and compassionate engagement processes were required as part of the Patient Safety Incident Response Framework (PSIRF). We also saw evidence that staff received feedback from incidents that they had reported.

We saw recent examples of incidents that underwent effective specific investigation processes as part of PSIRF, which included an after-action review and a thematic review. We also saw evidence of compassionate communication with patients following incident reviews being conducted.

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.

Breast and other imaging services’ referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met prior to the appointment. In line with national requirements, the breast screening unit had referral guidelines that outlined the set criteria by which patients were eligible for breast screening.

The services worked with patients at the point of referral and admission to understand patients’ additional needs and made reasonable adjustments to meet these, such as longer appointments, or the use of assistive technology.

The trust used a Picture Archiving and Communication System (PACS) which is used within the NHS. Staff could access diagnostic images from patients’ NHS records and likewise share images generated at the hospital. Patient records and findings from breast screening were also stored on a bespoke national system in line with national guidance.

The breast screening unit had a policy in line with Public Health England (PHE) for patients who attended their appointment, but only partial or incomplete mammograms were obtained. Information was given to patients in the case that this occurred which informed them of reasons why full imaging was not obtained and how to rebook, if this was needed.

The breast screening unit had identified delays in some patient pathways, which included processing breast imaging referrals. The service had appropriately reported the associated risks of harm and escalated these where necessary, and existing controls and assurances had been identified and evaluated in these cases.

Radiology leads had determined that issues with the timely provision of ultrasound services across the trust, including at the Thomas Linacre Centre, were an extreme risk due to persistent vacancies and recruitment issues. This meant that patients referred for ultrasound examinations were not always seen within the 6-week national target, which could delay their treatment. We saw that the concern had been regularly reviewed and mitigations put in place over previous years, but this remained a significant concern.

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 could share concerns quickly and appropriately when there was a concern. However, medical staff were not always compliant with safeguarding training targets.

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

Radiography and support staff across the location were trained to the appropriate level in safeguarding. They demonstrated good understanding of their responsibilities and were able to give examples of how they could identify and help protect vulnerable adults and children at risk of harm, including those with protected characteristics under the Equality Act 2010. Compliance with mandatory training in safeguarding was above trust targets for all imaging staff groups at the location. There were also safeguarding champions in place across imaging services and covering multiple types of scanning at the location to support good practice.

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.

People who used the service told us they underwent initial assessments and staff discussed and explained key risks to them prior to commencing scan procedures. They told us staff carried out regular observations and kept them informed during their procedure. There were clear processes in place to manage significant or urgent findings identified during scans. Where any concerns were identified, staff told us that patients were informed as soon as possible about the findings by an appropriately knowledgeable and qualified person.

Staff communicated with patients to ensure they understood their care and treatment and gave us examples of how they would adapt their practice to manage patients experiencing anxiety or distress in a positive way. Patients told us that they were aware of how to raise concerns or ask questions, and posters were visible across the service that encouraged patients to do so, as well as how to access advocacy services and the trust’s patient relations team.

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.

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

Breast screening services and other imaging services were located in two distinct areas on the ground floor of the site, and each comprised its own waiting room and procedure rooms. A desk in the main lobby could direct patients to the correct area, which each had a reception desk for patients to check in at. Parking, signage and facilities were sufficient for patients with a variety of needs, and corridors and waiting areas were clean and pleasant environments throughout.

The mobile breast screening units could demonstrate appropriate health and safety audits had been undertaken and any action plans had been reviewed. Because the mobile units only undertook routine imaging, sharps and specialist waste risks did not need to be considered. The provider had determined that no resuscitation equipment such as automated external defibrillators (AEDs) were required for the mobile units. Mobile units periodically moved sites to improve accessibility to patients across south Lancashire, and the schedule and risks of each location had been considered, including the exact placement of the unit.

The breast screening unit did not require a full resuscitation trolley but did have an automated external defibrillator (AED) which was checked routinely by staff as required, and leaders had recently toured the area with a resuscitation specialist from the trust to ensure this was appropriate and in keeping with the trust’s policies. However, not all staff based at the other imaging services on site could demonstrate sufficient knowledge of resuscitation procedures in the event of an emergency. Staff were aware that equipment was located on another nearby suite but were unsure where exactly and what door code was needed to access this.

Equipment and rooms had externally commissioned radiation safety reports where needed, and areas had appropriate signage and controlled areas required for radiation safety. Personal protective equipment (PPE) such as lead aprons were available and audited routinely, although these were not needed to be used regularly. Staff wore radiation monitors to ensure that they weren’t receiving unintended doses of radiation during their practice, and these were reviewed routinely.

We were provided with registers of the imaging equipment requiring routine checks and servicing at the location. All imaging equipment was in good condition and had been appropriately serviced, with contracts with external providers for maintenance where this was needed.

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.

Staffing levels:

The breast screening service consisted of 49 staff and was led jointly by a clinical lead and an operational lead, who reported to the clinical director of radiology at the trust. Other imaging services at the location consisted of a smaller number of radiographers and sonographers who would attend the site on rotation, with management oversight usually based elsewhere. Locum staff were implemented to meet demand, which was predominantly in ultrasound.

Imaging services were staffed appropriately to meet demands, and trainees and newly qualified staff were well supported. The breast screening unit followed national NHS breast screening programme guidance in determining its establishment. There were enough radiographers in total to ensure flexibility and business continuity across both services. However, there was evidence that due to ongoing vacancies, absences and growing demand, the establishment of radiologists was not sufficient to meet the needs of the breast service. This issue is discussed further in the ‘care provision, integration and continuity’ section of this report.

Staff training:

Staff were assigned core statutory and mandatory training modules that were aligned with the UK Core Skills Training Framework (CSTF) as well as additional local e-learning modules. Service leads had responsibility for ensuring compliance with this: the breast screening unit overall training compliance rate was 97% for all assigned modules recorded, and the trust’s radiographer and sonographer staff group also demonstrated compliance of 95% and 97% respectively, which was above trust targets in all cases.

Employees of the trust were contractually required to join the DBS Update Service as per their recruitment policy, and the trust followed NHS Employment Check Standards. We saw examples of completed induction and supervision forms for new starters in the service, with a comprehensive local checklist and training record.

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.

Both the breast screening unit and other imaging services we inspected were clean, with stocked handwashing facilities in both public areas and toilets. Furniture was appropriate for the environment and was in good condition. Cleaning records were up to date and demonstrated that cleaning was undertaken regularly, and we found ‘clean’ stickers that were in date on high-use equipment. Water flushing records were up to date and demonstrated that this was being done so regularly to control the risk of exposure to pathogens, in line with the trust’s management of water systems policy.

Staff followed ‘bare below the elbow’ guidance and broadly maintained good infection prevention and control (IPC) practice. Staff had appropriate training in IPC levels 1 and 2, and we saw evidence of annual spot audits of each area, conducted independently by the trust’s IPC team. Compliance was satisfactory and no major concerns had been highlighted, and each finding was documented in an action plan with timescales for completion.

Services had considered good IPC practice for various procedures and had an effective policy for the cleaning and disinfection of ultrasound probes, which included for transvaginal and endoanal procedures.

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.

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

Across the imaging services at the location, a small number of medicines were used only in the breast screening unit, which were local anaesthetics to support certain procedures. The service had 2 relevant staff were fully compliant with medicine safety training, and medicines stock was secure, organised and in date. We saw evidence of appropriate fridge temperature checks. A monthly inspection of safe and secure medicines handling was undertaken by a pharmacy assistant of each area of the location. These inspections demonstrated continual excellent practice.

The breast screening unit were planning to commence contrast-enhanced imaging procedures and so were implementing procedures to manage contrast media in addition to other medicines stock. Patient group directions (PGDs) for the administration of contrast agents had been developed in collaboration with the trust’s authorising pharmacist, with clear roles and requirements for the participating staff and inclusion and exclusion criteria for patients.