Thomas Linacre Centre

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• 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

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

Leaders were well qualified, had a strong understanding of the services they managed, and were keen to invest in their staff and develop the service further. The breast screening service in particular had fostered close and effective links with a variety of community partner organisations to help raise awareness and increase uptake of their service.

However, staff did not always have sufficient opportunities to speak up to someone other than their own manager and were not always engaged with before changes were made to their service.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had a values and behaviours framework which had been produced in collaboration with staff. The framework consisted of ‘People at the Heart; Listen and Involve; Kind and Respectful; and One Team’, and guidance was available on how this should be embedded into services. The trust also had produced “Our Strategy 2030”, a strategic plan for the decade 2020-2030, which consisted of priorities and themes intended to guide how services should develop.

The divisional strategy for 2023-2030 included radiology and breast screening, and as part of this strategy breast imaging services had been expanded at other locations in the trust. Divisional strategic priorities included improving cancer diagnosis and treatment performance and to increase elective activity. While we did not see evidence of local objectives that were clearly aligned to the divisional strategy, appraisal documentation did demonstrate that the breast screening service prioritised maximising screening activity for eligible patients, which was broadly consistent with the divisional strategy.

When we spoke with imaging staff, they were positive about the culture and morale of their service, although recognised the challenges of increasing demand. All staff demonstrated an understanding that attributes such as mutual respect or focusing on patient-centred care were important, which was mostly aligned with the trust’s values.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff from the breast screening unit told us that leaders were effective in managing the service and were visible and accessible if problems arose. Staff from other imaging services told us that senior leaders did not typically attend the location as it was a comparatively small and low risk aspect of their remit, but were contactable by phone in the event of a concern.

Leaders engaged with staff about personal and professional development opportunities and staff told us they felt appropriately supported in this. Leaders themselves demonstrated a strong understanding of the services they managed and could explain how teams and structures worked to provide high quality care. We saw examples of further study that leaders had undergone to improve their experience and skills, which included healthcare leadership and operations management qualifications, as well as further clinical skills. For example, the clinical lead for breast screening services had recently attended a contrast enhanced mammography study prior to the broader implementation of contrast across the service.

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

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 at the location did not have freedom to speak up (FTSU) champions or equivalent roles who could raise awareness, promote a positive speaking up culture, or signpost staff with concerns. There had been 0 FTSU concerns raised from imaging services at the location in the last 12 months, and staff did indicate some understanding of whistleblowing procedures, with all relevant staff groups demonstrating good FTSU training compliance.

There was evidence that senior leaders did not empower staff to give their views and staff at the location from all areas had expressed concerns about recent changes to the security arrangements of the building. This concern is addressed further in the equivalent section of the outpatients report.

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 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.

Staff at all levels were clear about the organisational structure, their roles and accountabilities. The breast screening unit had split its operational oversight into a distinct clinical lead role and an operational manager role, and each had an appropriate deputy in place in the case of absences, who were competent to step into the role when required. Between the 2 leads, they shared management responsibilities of approximately 20 clinical staff and assistants in addition to administrative and clerical support, who worked across 2 sites in the trust and in 3 mobile breast screening units. Other imaging services at the location were overseen by modality leads who had a broader oversight of clinical activity across multiple locations. Medical staff were managed separately and reported to their clinical director.

We saw examples of both clinical and operational audits that were sufficient to provide assurance and oversight of the type of clinical activity taking place at the location. Both services had an appropriate risk register which included risk ratings, mitigations, and review dates, and staff and leaders demonstrated good awareness of these risks. Business continuity plans were in place and effective at managing associated risks in this area.

Regular team meetings took place in the breast screening service, which followed a set agenda that included service updates, evaluating performance and issues, and opportunities for staff to raise concerns or other business. Actions from each meeting were carried through to the next, with individuals highlighted as responsible for each action appropriately. Agendas and minutes of higher-level meetings across both the breast screening service and other imaging services, such as quality and safety and operations management meetings, which had consistent agendas and minutes accessible to the required staff.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

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

The breast screening unit worked in collaboration with a large variety of other stakeholders with an aim to improve breast screening awareness and uptake across their catchment area. This included local councils and learning disabilities teams, integrated care boards (ICBs) and the voluntary sector. The service continually reviewed the effectiveness of their uptake and had identified specific communities and GP practices where this was lower, so that focused efforts could be made to improve performance.

The breast screening unit had a cancer service improvement lead (CSIL) who worked extensively within the local area to improve screening rates and had implemented new and innovative way to achieve this. This included holding a British sign language (BSL) supported session with a Deaf community support group, visits to women’s refuges, holding targeted sessions in lower-uptake GP practices and producing a quarterly newsletter for all GPs to improve awareness and access. The service had also recently attended a local pride event and established a working group with a local LGBTQ+ community group to offer support and raise awareness. The service had additionally arranged tours of the service with a local learning disability team to ensure that patients under that service could be accommodated properly.

The service also worked in line with national breast screening programme guidance and attended regular meetings of a cancer strategy group, which worked with the local council, combined authority and ICB to ensure the delivery of the service was as effective as possible.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, 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 to safe, effective practice.

The service demonstrated a commitment to learning and innovation. Staff were supported to attend conferences, study days and continuing professional development (CPD) activities, and competencies were reviewed annually. The breast imaging service was in the process of implementing new technologies to the service, such as contrast-enhanced mammography.

Incidents and findings from audits had led to further discussions within the team and improvements in the service. For examples, errors in establishing recent mammography history prior to scanning had led to further discussions within the team and changes to processes to avoid the risk of overexposing a patient to radiation.

It was clear that staff across the services were continuously involved in quality improvement and clinical audit projects. Recent standalone clinical audits assessed the completion of certain aspects of documentation, the number of examinations undergoing technical repeat processes, the suitability of breast imaging referrals, and image quality. Staff across imaging services at the location were involved in identifying learning needs and contributing to service development, and there was evidence of continuous improvement through feedback, audit, and risk review.