Thomas Linacre Centre

On this page

• 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.

Services were delivered by competent and qualified staff that worked together well and assessed their own performance across various areas to improve patient outcomes.

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.

We looked at 9 patient records and a selection of referral information for different patients during the inspection, from various specialities. Care plans and health assessments were completed and discussed with patients during appointments and documented contemporaneously.

While not always fully legible when handwritten, clinic records demonstrated that patients’ individual needs were considered, and care plans were devised to meet these assessed needs. When we spoke with patients, they told us that they felt their needs were considered during the appointment and they were given sufficient opportunities to ask questions.

We saw an example of a self-assessment tool used by the breast care nurses that allowed patients to record their concerns, which covered practical, family/relationship, emotional and spiritual concerns. Breast care nurses told us this would help inform their future treatment or be an area of discussion during appointments so further information or support could be provided.

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. We saw evidence of role-specific training for staff on induction, and that additional training opportunities had recently been provided to staff up to postgraduate levels. Teams had access to specialist input where required, which included audiologists for Ear, Nose and Throat (ENT) clinics and a pharmacist for designated oncology clinics.

Appraisals, or performance development reviews (PDRs), were conducted in a timely way and the outpatients service was fully compliant at the time of inspection. Some staff told us that they felt like appraisals were a “tick-box exercise”, although those that we reviewed had documented appropriate discussions and contained basic objective setting opportunities for staff at various levels.

Staff participated in quality improvement projects, with one member of staff in outpatients having recently achieved a gold award from the trust for quality improvement. In 2025, the ENT service at the trust had undergone a review as part of the national Getting It Right First Time (GIRFT) programme, which highlighted both outpatient efficiency and integration with the audiology service as clear strengths, and advised on development opportunities to reduce did not attend (DNA) rates across the service. The audiology service had also recently achieved reaccreditation with the Improving Quality in Physiological Services (IQIPS) scheme following a comprehensive on-site assessment.

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.

We saw evidence of multidisciplinary team (MDT) working across a range of outpatient services offered. 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, and multiple staff told us that their teams often had a ‘family’ feel.

We attended a breast MDT meeting, which was attended by medical, nursing and AHP staff and provided an effective forum to routinely discuss approximately 100 patients each meeting, with documented outcomes for each. We observed records of weekly team meetings across various specialities including breast, ENT, audiology, and the outpatient teams, which were each well attended and contained useful and relevant information for staff.

However, some staff felt that there was a disconnect between the operational clinical work that took place on site and the booking and administration of these clinics, which occurred elsewhere. Various staff had told us about errors over the last 12 months when clinics were either overbooked inappropriately or with no notice, or clinics had been booked when doctors were not available. In such a case, clinical staff were obliged to manage the consequences of this and deliver bad news to patients, with limited recognition of the personal impact this had on them from senior leaders or the booking teams.

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.

Information was provided for people to support healthier lifestyles. For example, we saw mental health awareness information and adverts for services in the community to support men’s health on display. Medical staff also told us that they would sensitively provide support and guidance regarding living healthy lifestyles to patients where this was a concern, for example while discussing the risk factors involving cancer, or other conditions.

The location had a Macmillan Cancer Information and Support Service available on site, which could support patients at any stage of their diagnosis with support and information, which included lifestyle and wellbeing advice. A patient we spoke with said that the service had made a meaningful difference to their life and had helped with coordinating appointments with their workplace. The location also had a café which provided healthy food and snack options.

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.

Audits were routinely carried out in the outpatient service to monitor compliance to good practice. Actions were identified through audits that led to improvements at reaudit over a broad range of areas of clinical and operational activity. The service could generate an overview of the compliance of certain audits to identify and act on changes more quickly.

Audits were undertaken by other medical specialities that were hosted by the location. These included patient attendance rates, documentation accuracy and analyses of further referrals or admittances to inpatient care for certain conditions or following certain treatments. Audit data was used to drive improvement and informed service level reviews, with a focus on improving patient experiences.

We also reviewed the audiology service’s clinical audit programme in further detail, which demonstrated a mixture of vertical and horizontal audits that were clear in their purpose and findings, and produced actions in cases of non-compliance.

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. Consent was sought before procedures were carried out and this was documented, where relevant, in patient records that we reviewed. Letters sent to patients following their appointments included a summary description of treatment options that were available to the patient and the decisions made, to improve patients’ own understanding.

Consent audits were undertaken by individual specialities whose activity spanned multiple sites beyond the scope of this inspection. When we reviewed the most recent consent documentation audit for the general surgery and colorectal teams, this demonstrated good compliance which had improved from a poorer position in previous years. The most recent consent audit in audiology had also demonstrated a 100% rate of compliance.