The Clatterbridge Cancer Centre NHS Foundation Trust

Updated 16 April 2019

The Clatterbridge Cancer Centre NHS Foundation Trust is one of the UK’s cancer centres providing highly specialist cancer care to a population of 2.3m people across Cheshire, Merseyside and the surrounding areas including the Isle of Man. Care is funded by patients local clinical commissioning group and NHS specialist commissioners.

The trust is predominantly based in Clatterbridge, Wirral but also in a radiotherapy treatment centre in Aintree, Liverpool and the haemato-oncology service. The haemato-oncology service was acquired in 2017 and is currently based in an acute trust in Liverpool. The trust also operates specialist chemotherapy clinics in seven of Merseyside’s district hospitals and deliver a treatment at home service.

At the time of our inspection the trust had 103 beds, based in six wards, including a clinical decisions unit. The trust also had 22 chairs based within the haemato-oncology unit and a further 117 chairs for treatment of patients with solid tumours. The trust ran approximately 370 outpatient clinics per week. From August 2017 to July 2018 the trust had 7,656 inpatient admissions (127% increase on the previous year), 388,923 outpatient attendances (15% increase on the previous year) and 106 deaths (38% increase on the previous year). At the time of our inspection the trust employed 1,126 staff.

We last inspected the trust in June 2016 and published our report in February 2017. At that inspection the trust was given an overall rating of outstanding. The trust were also issued with requirement notices, which impacted on their rating in the safe domain.

Currently the trust provides chemotherapy, radiotherapy, medicine, outpatients, diagnostics and end of life care.

Updated 16 April 2019

Our rating of the trust went down. We rated it as good because:

• We rated safe, effective, responsive and well-led at core service level as good and caring as outstanding. We rated three of the trust’s six services as good. In rating the trust, we took into account the current ratings of the three services not inspected this time. As we reported the trust’s services under one hospital location (Clatterbridge), these ratings also apply to that hospital.
• We rated well-led for the trust overall as requires improvement. This means the overall rating for well-led is requires improvement.
• Since our last inspection the overall rating for the trust went down. Although we still found that services largely performed well, directors’ files did not have all the information contained within them to meet every aspect of the fit and proper legal requirements; we had concerns regarding governance systems and processes and in relation to having sufficient numbers of staff that were life support trained. This meant we could not give it a rating higher than requires improvement in the well-led (leadership) at trust level.
• Across the trust, services largely performed well. We were not concerned regarding the overall quality of cancer care.
• We continued to rate caring as outstanding. Throughout the organisation staff were committed to delivering patient centred care. Patients were at the heart of what the trust did and decisions it took. Staff respected individuals and supported them practically and emotionally.
• We improved the rating of the safe domain to good. Across most services patients were protected from avoidable harm and abuse.
• We continued to rate effective as good. The trust continued to ensure that patients had good outcomes because they received care and treatment that met their needs.
• We continued to rate responsive as good because most people’s needs were met through the way the services were organised and delivered.
• At core service level, we rated well-led as good because the leadership and culture promoted high-quality person-centred care.

However:

• At the time of our inspection we had concerns regarding the trust’s fit and proper person process, a legal requirement. We were not assured that disclosure and barring service checks were in place for nine of the trust’s 17 directors. Whilst three of the directors were relatively new, legal requirements are clear that all staff acting at director level must have a disclosure and barring service certificate in place. We escalated our concerns at the time of our inspection and the trust took action to mitigate the risks.
• The trust’s governance systems did not enable the trust leadership to have oversight of issues that impacted on patient care, outcomes, allow them to sufficiently address risks and the early identification of shortfalls in care and performance.
• The trust did not have a process in place at the time to evidence that there  were always enough suitably qualified, competent and experienced staff with relevant levels of life support training (including basic, immediate and advanced life support) deployed within the service at all times.
• In medicine we rated the well-led domain as requires improvement. Although we largely found that this service performed well, the service did not meet legal requirements relating to staff competencies, staff training and addressing known risks in a timely way.
• In diagnostics we rated the safe domain as requires improvement. Although we largely found that this service performed well, the service did not meet legal requirements relating to safe care and treatment and addressing known risks in a timely way.
• All of the concerns relating to legal requirements were raised with the trust at the time of our inspection and immediate action was taken to address them.