The Care Quality Commission (CQC) has rated The Christie NHS Foundation Trust as good, following inspections carried out from October to November.
CQC carried out an unannounced inspection of the acute medical services at the Christie’s main site as part of its continual checks on the safety and quality of healthcare services. Inspectors also undertook an announced well-led inspection of the overall trust in part due to information of concern received from whistle blowers regarding the culture and leadership of the trust.
Following this inspection, the overall rating for the trust has changed from outstanding to good. Well-led has dropped from outstanding to requires improvement, and safe has declined from good to requires improvement. Being effective, caring and responsive all remain rated as outstanding.
Acute medical services at the Christie’s main site have changed from outstanding to good. Safe has dropped from good to requires improvement. Being well-led, effective, caring and responsive all remain rated as good.
The Christie NHS Foundation trust provides specialist oncology services. It is the largest single site cancer centre in Europe, treating more than 60,000 people a year. The trust serves a population of 3.2 million people across Greater Manchester and Cheshire; more than a quarter of people using the trust are referred from elsewhere across the UK.
Ann Ford, CQC’s director of operations in the north, said:
“When we inspected The Christie NHS Foundation Trust, we found most leaders understood the priorities and issues the trust faced and were focused on providing the best care to people. Its vision was to be a leader in cancer care and provide the best experience and a high standard of care to people.
“However, staff didn’t always feel supported and valued, with some telling us they felt they couldn’t raise concerns or weren’t listened to when they did. Although the trust had made some changes to improve the culture, more work needs to be done to address the issues we identified.
“I want to thank the staff who came forward to give feedback, I know speaking up in these circumstances isn’t easy, but it’s important it happens because it helps us understand where organisations may need to turn their attentions to identify and address any issues.
“In medical care, we found staff treated people with compassion and kindness, respected their privacy and dignity and met people’s individual needs. They also provided emotional support to people, families and carers. They advised them on how to lead healthier lives, supported them to make decisions about their care, and made sure they had access to good information. However, they didn’t always carry out risk assessments in a timely manner which potentially put people at risk of harm.
“We did see some outstanding practice at the trust. There was a strong focus on research and innovation to improve outcomes for people with cancer and the trust and everyone involved should be proud of that important work.
“We have told the trust where it needs to make a number of improvements and we will return to check that these have been made and fully embedded.”
In well-led, inspectors found:
- The trust had a vision for what it wanted to achieve, and a strategy developed with relevant stakeholders.
- Leaders and staff actively and openly engaged with people. The trust engaged with external stakeholders and local partners to help improve services for people.
- Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.
- 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.
However:
- Staff told us that some senior leaders were not always visible or approachable.
- Equality, diversity and inclusion had not been effectively prioritised within the trust in the previous three years. Staff, particularly those with particular equality characteristics, did not always feel engaged or supported.
- 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.
In medical services at the Christie’s main site, inspectors found:
- The service had enough staff to care for people and keep them safe. Staff understood how to protect people from abuse, and managed safety well. The service controlled infection risk well. Staff kept good care records. The service managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, gave people enough to eat and drink, and gave them pain relief when they needed it.
- The service planned care to meet the needs of local people, took account of people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
- Leaders ran services well using reliable information systems and supported staff to develop their skills.
However:
- The service provided mandatory training but not all staff completed it on time including mandated annual updates.
- Medical staff did not always complete life support and safeguarding training in a timely manner.
- The service did not always manage medicines well.
- Some essential policies were passed their review date.