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The Christie Main Site Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 12 October 2018

Our rating of services stayed the same. We rated them as outstanding because:

  • The culture across all the services we inspected was extremely positive. Staff at all levels were very proud of their organisation and the work they did.
  • The trust ensured that there were sufficient numbers of staff who possessed the right skills and experience deployed at all times.
  • The trust valued patients consistently as individuals; we saw and heard examples of staff going the extra mile to meet the needs of patients and their families.
  • The services provided care and treatment in line with national guidance and evidence based practice. The hospital was a leader in the field of cancer care and pioneered new initiatives and procedures.
  • The trust services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice and continuity of care.
  • The trust leaders were prominent and respected in cancer treatment and procedures. The trust provided expertise and guidance for other members of the healthcare economy. They worked in collaboration with leaders of cancer care locally and nationally.
  • The trust engaged with people well. There were many engagement opportunities for staff and the public. These opportunities were varied and substantial. There was evidence of consistently high levels of constructive engagement with staff and people who use services.

However:

  • The surgical directorate did not always demonstrate effective learning from incidents. They did not always recognise and share learning in a timely way. The governance systems in place meant critical information was not always shared across disciplines and did not reach some staff who might benefit and who might be in a position to prevent similar incidents from reoccurring in the future.
  • Some audit systems were not robust enough to identify potential safety issues. The Association for Peri-operative Practice (AfPP) audit tool and the World Health Organisation (WHO) checklist audits did not provide adequate assurance in some high risk processes.
  • Patients’ records were not integrated, different disciplines entered information in different places, some electronically and some hand written. This meant all the patients information was not available in one place and posed a risk that some information may be missed.
  • The management team had not fully implemented the Local Safety Standards for Invasive Procedures (LocSSIPs) based on the National Safety Standards for Invasive Procedures (NatSSIPs) as recommended by the National Patient Safety Agency.
Inspection areas

Safe

Good

Updated 12 October 2018

Effective

Outstanding

Updated 12 October 2018

Caring

Outstanding

Updated 12 October 2018

Responsive

Outstanding

Updated 12 October 2018

Well-led

Outstanding

Updated 12 October 2018

Checks on specific services

Chemotherapy

Good

Updated 12 October 2018

Our rating of this service went down. We rated it as good because:

  • The service had enough staff with the right qualifications, skills and experience to keep people safe from avoidable harm and to provide the right care and treatment. This included patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • The service controlled infection risk well and had suitable premises and equipment.
  • Patient risk was well managed and there were systems and processes in place to safeguard patients from harm.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Patients were valued as individuals; we saw and heard examples of staff going the extra mile to meet the needs of patients and their families.
  • The service was planned and provided in a way that met the needs of the local people and individuals by delivering treatment closer to home where possible.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care and promoted a positive culture that supported and valued staff
  • There was a clear vision and strategy with workable plans to deliver a patient focused experience.
  • Managers had oversight of the chemotherapy risks and were taking steps to reduce and mitigate them.
  • Computer systems and training records were not easily accessed. Temporary laptops were used on the unit as a stop gap until handheld bedside devices were available.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However:

  • We found measures had not be taken to review all treatment protocols in a timely manner. This had also been identified on our previous inspection.

Critical care

Good

Updated 18 November 2016

We have judged that overall, the critical care services provided at The Christie NHS Foundation Trust were good because,

  • There were systems in place for reporting and learning from incidents.

  • There were sufficient numbers of suitably skilled nursing and medical staff to care for patients

  • The unit had no never events, or serious incidents reported for critical care, between February 2015 and January 2016.

  • The service took part in the intensive care national audit and research (ICNARC) data so we were able to bench mark its performance and effectiveness alongside other similar specialist trusts. The trust performed well overall.

  • Incidents were reported and acted upon and used continuously as a service improvement tool. Safety thermometer data was collected and displayed in public areas for patients and relatives to view. The results were also shared with staff, together with the results from relative’s surveys.

  • The trust had an outreach team with 12 critical care trained, dedicated members of staff who supported wards in the early detection and treatment of acutely unwell patients.

  • The team had a dedicated follow-up service who saw all medical patients on discharge from critical care, together with surgical patients who had been in critical care for more than four days or more, patients who required respiratory support and those experiencing delirium.

  • We reviewed the critical care patient experience survey for the period of March 2015 to March 2016. 87% of relatives rated the staff as ‘Excellent’ when asked at how caring they were towards their relative and 12.5 % rated the care as ‘Good’ when asked the same question.

  • Staff and relatives gave us many examples of staff interacting with patients in a caring manner that went above and beyond their general role.

  • The unit had overnight accommodation attached to the unit, available for relatives to stay. It was clean and well equipped with en-suite shower facilities.

  • The complementary therapy team attended the unit daily, Monday to Friday, and offered therapies to patients and relatives, such as; head and neck massage, aromatherapy and visualisation. relatives.

  • There was a comprehensive selection of clinical governance meetings both within the trust and at Network level.

  • There was an effective governance structure in place, which ensured that all risks to the unit were discussed within the trust and through regional networks.

End of life care

Outstanding

Updated 18 November 2016

Overall we rated EOL care at the Christie as outstanding because:

  • Incident reporting systems were in place and learning from incidents was discussed. There had been no recent serious incidents related to end of life care.

  • There was an audit plan in place and actions from audits were contained within action plans and being addressed.

  • The service held a weekly multi-disciplinary team (MDT) meeting where cases and new referrals were discussed. Representation from a wide number of different disciplines attended and we saw evidence of good collaborative working across the different agencies and teams.

  • We saw evidence that people’s individual needs were being considered at end of life and that discussions with patients and their families were taking place. Referrals to the SCT team were priority rated and ward staff told us the SCT responded quickly to requests for their input.

  • The service was deemed compliant with NICE guidance by NICE.

  • The SPC team used an innovative approach to their structure, which was recognised by NHS England and is now being rolled out across cancer centres throughout the country.

  • The service achieved six out of eight performance indicators in the NCDAH 2016. An action plan was in place to address the other two indicators.

  • Staff provided sensitive, caring and individualised personal care to patients who were at the end of their life.

  • Awareness of the specialist team was embedded in all clinical areas of the hospital. They were professional, responsive and supportive of patients, relatives and staff.

  • The service was carrying out trials and initiatives to improve EOL care for patients within the trust but also across other organisations.

Medical care (including older people’s care)

Outstanding

Updated 18 November 2016

We gave the medical care services at The Christie Main Site an overall rating of ‘Outstanding’. This was because: -

  • Patients and relatives spoke very positively about the care and treatment they received. We made observations about the care people received and carried out a Short Observational Framework for Inspection (SOFI). Throughout our observation we saw excellent interactions between staff and patients. Staff interaction was kind, compassionate and very caring. Staff frequently engaged with the patients and their discussions with patients were friendly and sincere.

  • Patient feedback from surveys such as the NHS Friends and Family Test, the cancer patient experience survey (CPES) 2013/14 and CQC’s adult inpatient survey 2015 showed there was a high level of patient satisfaction and the feedback about the care and treatment provided was very positive.
  • Patients were supported with their emotional and spiritual needs and were able to voice any concerns or anxieties. Patients and their relatives gave positive examples ranging from how their privacy and dignity was maintained to how staff across all levels consistently took the time to speak with them and supported and encouraged them in a positive way.
  • There was a holistic and person-centred care approach to the delivery of care for patients across all age groups. We saw positive examples where patient’s individual needs were met, such as patient activities that were planned and based on their personal preferences.
  • Patients and their carers were offered a range of free of charge complimentary therapies and services such as ‘Look good, Feel Better’ and ‘Colour Me Beautiful’ to promote self-esteem. Patients spoke positively about the availability and accessibility of these services.
  • Patients and their relatives were offered a food voucher to use in the hospital’s canteen if they did not like the food offered on the regular ward menus.

  • There were systems in place to support vulnerable patients, such as patients living with dementia or a learning disability. The environment and facilities for teenage and young adult patients were age-appropriate and these patients were provided with a broad range of recreational activities.

  • Services were planned and delivered to meet the needs of local people. Patients were admitted and discharged from the services in a timely manner. The services consistently achieved the 18 week referral to treatment standards and the 31-day and 62-cancer wait time standards during 2015/16.

  • Patient safety was monitored and incidents were investigated to assist learning and improve care. Patients received care in visibly clean and appropriately maintained premises. Suitable equipment was available to support patients. Patient records were completed appropriately. The staffing levels and skills mix was sufficient to meet patients’ needs.
  • The services monitored patient outcomes and cancer patient survival rates across a range of specialties and cancer types. Audit records showed patient outcomes had improved over time and survival rates for cancer patients were similar to or better than the England average for most cancer types.
  • There was effective teamwork and clearly visible leadership within the services. Key risks to the services, audit findings and quality and performance was monitored though routine departmental and divisional governance and quality meetings.

Radiotherapy

Outstanding

Updated 18 November 2016

The radiotherapy service at the Christie hospital provided safe and effective care for its patients. Up to date techniques and technologies were used to ensure that patients received treatment to improve their outcomes and to reduce the short and long term effects of radiotherapy treatment. There was a focus on research and clinical trials.

There was strong evidence of multi-disciplinary working and continuing education for staff. Care was very patient focused and holistic with a strong focus on maintaining physical and mental well-being during treatment.

Targets were met and there was good governance, risk management and quality assurance in the department.

However there were some issues with staffing of radiographers in one part of the department.

Surgery

Good

Updated 12 October 2018

Our rating of this service went down. We rated it as good because:

  • The culture was extremely positive and staff were very proud of their organisation and the work they did. There were sufficient numbers of staff who possessed the right skills and experience.
  • The directorate reported positive outcomes and reduced complications. There were low levels of healthcare associated infections and high levels of harm free care.
  • The service identified and mitigated patient risk well. The service was good at identifying patients who were at an increased risk of deterioration and sepsis and had systems in place to react in a timely way.
  • The surgical directorate had prominent and respected leaders in surgical cancer treatment and procedures. They were recognised as a centre of excellence and provided expertise and guidance for other members of the healthcare economy. They worked in collaboration with leaders in cancer care locally and nationally.
  • The service provided care and treatment in line with national guidance and evidence based practice. The service was a leader in this field and pioneered new initiatives and procedures in cancer surgery which were later adopted as best practice elsewhere.
  • Staff were exceptionally kind and caring and provided holistic patient centred care. They went the extra mile to ensure their patients felt their experience was the best they could provide and the patient was at the centre of care for the whole person.
  • The directorate provided specialist bespoke surgical treatments to patients with unusual, complex, advanced cancers. They provided tailor made treatment plans in collaboration with other disciplines to improve outcome and survival rates, reduce complications and lengths of stay and the need for multiple interventions and improve quality of life.

However:

  • The surgical directorate did not always demonstrate effective learning from incidents. They did not always recognise and share learning in a timely way. The governance systems in place meant critical information was not always shared across disciplines and did not reach some staff who might benefit and who might be in a position to prevent similar incidents from reoccurring in the future.
  • The audit systems in place were not robust enough to identify potential safety issues. The Association for Peri-operative Practice (AfPP) audit tool and the World Health Organisation (WHO) checklist audits did not provide adequate assurance in some high risk processes.
  • Patients’ records were not integrated, different disciplines entered information in different places, some electronically and some hand written. This meant all the patients information was not available in one place and posed a risk that some information may be missed.
  • The management team had not fully implemented the Local Safety Standards for Invasive Procedures (LocSSIPs) based on the National Safety Standards for Invasive Procedures (NatSSIPs) as recommended by the National Patient Safety Agency.

Outpatients

Outstanding

Updated 12 October 2018

We rated this service as outstanding because:

  • There were systems and processes in place to keep people safe and free from avoidable harm. Staff knew how to protect patients from abuse and worked with other agencies to do so. Infection control was well managed and clinics were well staffed.
  • Nursing staff and health care assistants received appropriate training and there were processes to monitor and record staff performance. Staff of all grades worked together to provide appropriate care and treatment for patients.
  • The department used appropriate national guidance and patient outcomes were monitored to improve performance and services. Staff were aware of their responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff were caring and compassionate and patients and their carers were involved in decisions about their care. Care was holistic and took into account the needs of the carer as well as the patient. Patients were confident about the care that they received and they trusted the staff.
  • The service met the needs of local people and took account of the individual needs of patients. There were multi-disciplinary systems in place to support children and young people who were living with a parent with cancer or who had cancer themselves. Complaints were few and were addressed locally if possible.
  • The service had a vision and strategy and the new outpatient department had been developed using feedback from staff and patients. There were effective governance systems in place and risk was monitored and managed. There was a positive culture in all the departments we visited and staff said that they enjoyed working at the hospital. Volunteers were well managed and provided an enhancement to the patient experience.