Updated 12 May 2023
The Christie NHS Foundation trust provides specialist oncology services. There are around 3,400 staff employed at the trust. It is the largest single site cancer centre in Europe, treating more than 60,000 patients a year. Around 95% of patients receive ambulatory care on an outpatient basis.
Based in Manchester, the trust serves a population of 3.2 million people across Greater Manchester and Cheshire; more than a quarter of the patients are referred from elsewhere across the UK.
From the main hospital site, the trust provides radiotherapy, chemotherapy, outpatient and acute oncology, complex surgical care, research and education, specialty diagnostics and other regional and national services. The UK’s largest brachytherapy (internal radiation) service is on the main site. The trust holds numerous speciality international accreditations and was the first NHS organisation in the UK to deliver high energy proton beam therapy.
Other sites, closer to some patients’ homes, are known as the ‘Christie@Salford’ and the ‘Christie@Oldham’; these provide radiotherapy, chemotherapy and acute and outpatient oncology. The ‘Christie@Macclesfield’ provides radiotherapy, chemotherapy, haematology and outpatient services in addition to acute oncology services”. The trust also gives chemotherapy care in ten community locations and offers outpatient appointments and blood tests closer to people’s homes. There is a 24 hour, 365 days a year telephone ‘hotline’ for patients, families and professionals to use; there are around 35,000 hotline contacts each year.
We carried out an unannounced inspection of the acute medical services on 11 and 12 October 2022, as part of our continual checks on the safety and quality of healthcare services. We also carried out an announced well led inspection from 15 to 17 November 2022 as part of our continual checks and because we had concerns raised with us around culture and senior leadership of the trust.
At our last inspection we rated the trust overall as outstanding. We also inspected the well-led key question for the trust overall.
We did not inspect surgical services during this inspection, (which was previously rated as requires improvement) because the service had made the improvements necessary to meet legal requirements as set out in the action plan the trust sent us after the last inspection. We did not inspect other core services of critical care, end of life, outpatients or diagnostics which were previously rated as overall good or outstanding.
Our rating of the trust went down. We rated it as good because:
In medicine we rated safe as requires improvement. Effective, caring, responsive and well led as good.
We took into account the current ratings of the 5 services not inspected this time.
The trust ratings for safe went down, we rated it as requires improvement. Effective, caring and responsive remained outstanding.
The rating for well led went down, we rated it as requires improvement.
At this inspection we found that;
- Staff told us that some senior leaders were not always visible or approachable. There were gaps in assurance for requirements of the Fit and Proper Persons Requirement (FPPR) (Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014).
- Very senior executives were heavily invested in the promotion and protection of the trust’s reputation. This impacted negatively on some staff; staff did not always feel supported and valued. A minority of staff expressed reservations about raising concerns and others did not always feel listened to. Although, staff remained focused on the needs of patients receiving care.
- Equality, diversity and inclusion had not been effectively prioritised within the trust in the previous 3 years. Staff, particularly those with particular equality characteristics, did not always feel engaged or supported.
- There were some fundamental strategies which were waiting final ratification.
- Some essential policies had passed their review date.
- The trust reported and investigated complaints, incidents and mortality but these were not always completed in a timely manner. Learning was not always shared with relevant staff across the trust.
However:
- Leaders had the skills, abilities and experience to run the trust. Most leaders understood the priorities and issues the trust faced.
- The trust had a vision for what it wanted to achieve, and a strategy developed with relevant stakeholders. The vision and strategy were focused on aiming to provide the best care for local people and those in wider areas.
- The trust had a culture where patients and their families could raise concerns without fear. Leaders and staff actively and openly engaged with patients. The trust engaged with external stakeholders and local partners to help improve services for patients.
- Leaders mostly operated consistent, effective governance processes and were clear about their roles.
- Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
- The trust collected data and information and analysed it. Staff could find the data they needed, to understand performance, make decisions and improvements. Data or notifications were consistently submitted to external organisations as required.
- All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.
How we carried out the inspection
During our inspections we spoke with a variety of staff, including allied health professionals, nurses, doctors, research staff, health care support staff, and consultants. We also spoke with patients and relatives. We visited clinical areas and non-clinical areas across the hospital site. We reviewed patient records, regional and national data and other information. We also reviewed other information sent to us from external sources.
We held several staff focus groups to enable staff to speak with inspectors. The focus groups included nursing staff, allied health professionals, research and innovation teams, junior doctors and consultants. We also held focus groups with the non-executive directors, governors and staff from networks for those with particular equality characteristics.
During the well led inspection we spoke with senior leaders, directors, executive directors and non-executive directors of the board.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.