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 this assessment the rating is good. This meant people’s needs were met through good organisation and delivery.

Across all outpatient specialities, the service put patients at the centre of their care and worked to ensure their views and concerns were considered and acted upon.

However, the provision of outpatient breast services was not always sufficient to meet demand, some groups experienced worse waiting times than others, and information was not always provided in a timely or accurate way.

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 were fully informed and involved in making shared decisions. For example, some patients chose to follow a symptom management care plan rather than a more invasive treatment option, and staff supported them in this. Staff recognised and knew patients from their previous encounters and could anticipate their needs and wellbeing in advance of seeing them.

Patient-initiated follow-up (PIFU) options were available to patients across various specialities, which allowed them to either request to be seen sooner than their next scheduled appointment or in advance of being discharged from the service, without the need for rereferral. Posters were visible in various areas advising patients of this scheme and medical staff told us these were used regularly as a management option.

The breast care service was available to patients from the time they first attend with a breast problem and was an open-ended service, which allowed patients to have continual access to information, counselling or help with symptom management. We also saw that various specialities could refer or direct patients to services and groups that could help support them holistically, such as charitable schemes or local wellbeing groups for people with cancer.

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.

The outpatient service monitored various operational metrics, and the outpatient lead attended relevant meetings to discuss and improve these. This included patient attendance rates, waiting times for new referrals and follow-up appointments, and compliance with national targets including the 28-day faster diagnostic standard (FDS) and 62-day referral to treatment targets for patients with cancer diagnoses.

Except for surgery, most operational activity relating to breast cancer occurred at the location. Performance in target times for breast cancer referrals had deteriorated through the 2025-2026 period. Information provided by the service showed it had fallen below the national targets for the 28-day FDS since June 2025 and for the 62-day referral to treatment standard since May 2025. Notably, on average fewer than 50% of breast cancer patients had received definitive treatment within 62 days of receipt of referral from the period August-November 2025, which was the most recent data provided. The trust had a comprehensive cancer recovery plan which included both diagnostic and treatment aspects of breast pathways, and had multiple associated actions that were being reviewed and progressed regularly with an aim to improving compliance with these targets.

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. While a baseline level of ‘one-stop’ clinics were available, additional clinics or bookings were regularly arranged to support demand that also did not have imaging support and so were not ‘one-stop’ clinics. 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 receiving timely treatment. Leaders told us that various factors were responsible for this concern, and that improvement plans which included the recruitment of additional radiologists were underway.

Some staff told us that clinics were occasionally cancelled at short notice, meaning that clinic lists needed to be quickly rearranged. We asked the service for the number of times in recent months where clinics were cancelled at short notice but were not provided any validated data on this.

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We spoke with patients who, while happy with the clinical and supportive information they had been provided with on the day, were surprised to learn that their breast appointment was not a ‘one-stop’ clinic as expected. Leaders told us that until recently, appointment invite letters had advised patients that their visit would have ‘one-stop’ support even when this was not the case or could not be guaranteed. We saw evidence that the new appointment invite letter template had already been implemented and did not include information about the ‘one-stop’ provision.

There was a significant backlog in the approval of breast clinic letters meaning that over 500 letters were awaiting approval, with some over 5 months overdue at the time of inspection. In reviewing this concern, the service had identified that this may affect the continuity and safety of patients’ care and increase patient anxiety. Mitigations and action plans had been put in place to decrease the severity of this risk, which included process changes and releasing staff from other commitments to approve letters. The service had also piloted a semi-automated system for outcome letters to better manage the risk in future.

The information about the Breast Unit on the trust’s website incorrectly advised that the service was “meeting all targets set by the Department of Health and the cancer network”, which was contradictory to the 28-day FDS or 62-day referral to treatment performance data collated by the provider.

However, the service 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. 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. 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.

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 displayed in the waiting room and in clinic rooms to advise patients and visitors how to provide feedback about their care and treatment or make a formal complaint. We saw examples of positive patient messages, including smaller and more personal comments, being fed back directly to the relevant staff by leaders.

In the last 12 months, the service had recorded 39 formal complaints and 14 compliments which related to outpatient disciplines at the location, and the service graded complaints by severity, responded to them in a timely way and recorded outcomes for each. We also saw examples of communications with patients about their concerns that were professional and sensitive in tone, acknowledged failings when this was the case and said sorry meaningfully. No complaints about the location had been escalated to independent adjudicators.

Patient feedback was analysed and reported by the trust’s patient experience and engagement group, which produced an annual report and held regular meetings with an effective agenda. However, patient experience at these meetings was only discussed at a divisional level and there was no evidence that complaints or feedback were analysed by service leads at the level of the location.

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 who used outpatient services would typically be referred by their GP or from a different medical specialty. Different specialities each had inclusion and exclusion criteria, systems of prioritising higher-risk referrals, and different typical waiting times.

The breast service could not always demonstrate that patients referred to the service would receive equally timely access to treatment, because 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. The service provided us with data that showed that 32% of new patients in May and 30% of new patients in November 2025 attended a clinic that did not have ‘one-stop’ support and so faced treatment delays compared to patients who did. Leaders told us that various factors were responsible for this concern, and that improvement plans including additional recruitment of radiologists were underway. This concern is further discussed in the “Equity in access” section of the associated Diagnostic Imaging report for this location.

However, staff in all areas including breast services were familiar with making reasonable adjustments for patients, particularly people with learning disabilities and dementia. Staff told us patients were able to bring someone with them if required but could be supported by a chaperone if they required support in their appointment and had attended alone. We also saw that the service was fully accessible for wheelchairs and equipment such as hoists were provided to enable appropriate care to take place for patients who could not otherwise transfer to a bed for examination.

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.

Staff had completed mandatory e-learning in equality, diversity and inclusion and followed the provider's 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. Policies and procedures included effective equality impact assessments.

Patient feedback was routinely gathered through data from the friends and family test, which included equalities monitoring information on 5 of the 9 recognised protected characteristics, and patient experience surveys covered all of them. We spoke with patients during the inspection from various backgrounds who did not feel as though they experienced differences in their treatment on account of their protected characteristics.

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.

Staff supported patients to make decisions about their care and treatment and their future, ensured all relevant healthcare professionals and other relevant agencies were involved in planning the care and treatment of people with complex needs.

The service’s breast care nurses were experienced in discussing patients’ diagnoses and treatments, were available for as long as the patient needed even after remission and recognised the longer-term consequences of cancer. We saw tools used during appointments that assisted clinicians in making personalised care plans.