Thomas Linacre Centre

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

The service treated patients with compassion, ensured their privacy and dignity was respected and took into consideration their specific needs, particularly for people with dementia.

We have not awarded this service a score for Caring.

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

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We observed staff attitudes and behaviours when interacting with people that showed they were discreet, respectful and responsive, and provided patients with help and emotional support at the time they needed it. Staff told us that they felt comfortable advocating for patients where they felt a concern needed to be raised, and it was clear that ensuring a good patient experience was central to their work. Staff would prepare for and accommodate longer appointment times for patients where they were expecting to deliver bad news or have difficult conversations.

The service maintained the dignity of patients by ensuring appointments and examinations took place in private rooms and that additional or observing staff were all introduced appropriately with patients’ consent to continue. Staff followed procedures to keep personal information confidential, including locking monitors when not in use. The trust had an effective information assurance policy and data protection act compliance procedure, which the service followed.

When there were delays in clinic, staff made efforts to ensure patients were informed of this and that they were supported throughout. Patients attending various specialities told us that staff were kind, sensitive, and acted professionally throughout their care journey. Patients also appreciated the volunteers present at the entrance of the building, who would direct patients to the correct areas for their appointments and help with general enquiries and parking concerns.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service was experienced in making adjustments for patients who needed them to ensure they could access care appropriately. Outpatient areas were fully accessible, and systems were in place to ensure appointments and procedures could be safely and compassionately delivered for patients with mobility requirements. The service followed the trust’s policies on arranging telephone, video or in-person interpreters for patients who needed this, and we saw examples of patient literature that could be provided in different languages that were aligned to local demographics.

Outpatients staff working at the location had completed Tier 2 Oliver McGowan training on learning disability and autism and a separate course on dementia and had 100% 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 making adjustments for these patients was a regular part of their work.

We saw multiple pieces of contemporaneous feedback from patients who were grateful to the service for accommodating their needs, which had included allowing additional clinic time to facilitate a good experience for those with health anxiety, being reviewed by telephone where this was medically appropriate, or routinely arranging dedicated tours of the location for neurodiverse patients. Each outpatient suite had safe spaces such as unused clinic rooms or counselling areas where patients could wait in comfort and away from busier areas, if they needed this.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients told us they felt fully involved in their care and treatment. Patients’ queries were responded to well and staff were able to clarify information and advise patients of their options. Friends or relatives were welcome to accompany patients for their appointments, and this was made clear on appointment invitation letters. The trust also had text reminder service to ensure patients stayed informed ahead of their attendance.

Clinic rooms and waiting areas had posters to inform patients that a chaperone could be requested. The service had an effective chaperone policy, which appropriately considered the needs of people with various cultural and religious values, patients lacking capacity, and children and young people. We asked staff about chaperoning arrangements, and they were confident in their capacity to act as a chaperone where required, although some staff did tell us that acting as such could put additional pressures on the service.

We spoke to patients who had told us that they were easily able to rearrange appointments when this was needed. We also saw examples of the service ringing patients when there had been a cancellation, to offer opportunities to be seen sooner if this was preferred.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were on hand to respond to people’s needs on entering the building. Volunteers were present and easy to approach, who could anticipate people’s needs and were able to give verbal directions or take people along to departments as required. A café was also present in the entrance to the building which provided snacks and meals.

Staff were very familiar with the type of clinics that were held on each day and used their knowledge of the clinics to anticipate needs. Staff ensured that people were comfortable and kept aware of who they would see next, although we noted that delays regularly occurred particularly when clinics had been overbooked. Drinks and facilities were available for patients while they waited, and staff made efforts to ensure patients were informed of delays regularly.

The service recognised that many concerns could be resolved informally during the patient’s visit, and so it was standard procedure that if the patient had a complaint or concern, this could be raised with a senior member of staff or outpatient lead so it could be resolved with them in person as soon as possible. In cases where such a staff member wasn’t available, the complainant could provide their phone number and expect a call the same day.

The service had 2 dementia champions and had clearly demonstrated that it had considered the needs of people with dementia across the outpatient service. We saw posters that provided information about the Herbert Protocol to help ensure the safety of people with dementia who go missing, and advice on what steps to take in the case that people or staff identify such a person. The service also provided general interest information on the healthcare experiences of people with dementia to better inform staff and the public.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

The trust had a wellbeing at work process which included guidance on having sensitive and meaningful conversations about the wellbeing of staff, in addition to effective flexible working, attendance management and stress management policies. The trust also offered a staff physiotherapy service, a psychological support service, and a 24/7 Employee Assistance Programme. Staff sickness rates for outpatients were 4.0% in the previous 12 months, which was below both the organisational and regional NHS staff averages.

The trust had signed the sexual safety in healthcare organisations charter and developed an effective sexual misconduct policy in response to recent legislation. The trust also had zero tolerance for abuse against staff, and we saw posters throughout the service that advised patients and visitors of this.

Feedback from staff about their experience and wellbeing at the service was mixed. While most staff were positive about their relationships with colleagues both within and across other services, most staff across various areas felt as though their working conditions had deteriorated in recent years due to increasing pressures and demands. This concern is described further in the ‘Shared direction and culture’ section of the report.

While staff appraisals, or performance development reviews (PDRs), were not always completed by the appraisee’s line manager, a more senior member of staff could fulfil this role on their behalf. Appraisers did not have explicit training on appraisal or performance development, and some staff told us that they felt as though the PDR process was a “tick-box exercise”. However, we reviewed appraisals for staff at multiple levels and saw that they did contain some basic objective setting and career development considerations.