Public Board of Directors papers 30 June 2022

Presentation MR Linac, Professor Ananya Choudhury, Honorary Academic Consultant & Cynthia Eccles, Consultant Research Radiographer

Public Meeting of the Board of Directors

Thursday 30 th June 2022 at 12.45pm in Trust Administration

Presentation: MR Linac, Professor Ananya Choudhury, Honorary Academic Consultant & Cynthia Eccles, Consultant Research Radiographer


24/22 Standard business a Apologies

Chair Chair Chair CEO

b Declarations of interest

* *

c Minutes of previous meeting – 26 th May 2022 d Action plan rolling programme, action log & matters arising

2 8

25/22 Key reports

* *

a Chief executive’s report b Clinical leadership report c Integrated performance report d Digital Services update


*/ p


28 65



26/22 Approvals


a Schedule of reservation of powers



27/22 Board assurance

a Board assurance framework 2022/23 b Audit Committee Report – June 2022

* *

CEO 95

Committee Chair


28/22 Any other business


Date and time of the next meeting Thursday 29 th September 2022


paper attached

Key: CEO Chief Executive Officer EMD Executive Medical Director ECN Executive Chief Nurse COO Chief Operating Officer CIO Chief Information Officer CCIO Clinical Chief Information Officer EDoF Executive Director of Finance




Public meeting of the Board of Directors Thursday 26 th May at 12.45 pm Trust meeting room 6 and through virtual access

Present: Chair: Chris Outram (CO), Chairman

Roger Spencer (RS), Chief Executive Officer Kathryn Riddle (KR), Non-executive director Dr Jane Maher (JM), Non-executive Director Robert Ainsworth (RA), Non-executive Director Prof Kieran Walshe (KW), Non-executive Director Grenville Page (GP), Non-executive Director Alveena Malik (AM), Non-executive Director Prof Chris Harrison (CJH), Medical Director and Deputy CEO Bernie Delahoyde (BD), Chief Operating Officer Eve Lightfoot (EL), Director of Workforce Prof Janelle Yorke (JY), Executive Chief Nurse Dr Neil Bayman (NB), Executive Medical Director Sally Parkinson (SP), Interim Director of Finance Prof Richard Fuller (RF), Director of Education

Minutes: Louise Westcott (LW), Company Secretary In attendance: Jo D’Arcy, Assistant Company Secretary

Prof Adrian Bloor, Consultant Haematology Oncology Ruth Clout, Practice Educator Angela Leather, Transplant Coordinator Karen Dodd, Clinical Nurse Specialist, Haem TYA Anne-Marie Hamilton, Clinical Practice Facilitator

Clinical presentation: Professor Adrian Bloor, CAR-T therapy service developments AB introduced the service and noted that Dr Amit Patel was leading this service but very sadly died last year. AB outlined why we deliver CAR-T therapy and the treatment that was previously available to these patients as well as the science behind CAR-T and how they harness patients’ t-cells to fight cancer. CAR-T is a toxic therapy and patients can end up in intensive care. The pathway was outlined, we have been doing this since 2018 and the therapy is relatively new across the whole of Europe. Angela explained that patients are seen in clinic and assessed for fitness for treatment, they go to panel and then come in for harvest of cells. Some patients need interim treatment as the cells take 6 weeks before they come back and are ready to be used for treatment. Karen noted the aphesis process, the patient comes in for collection at 8am, is checked and put onto the machine where lymphocytes are taken from the patient. Ruth explained that once a date is arranged for the treatment they come in for 3 days of chemotherapy and then the infusion of the CAR-T product. The cells are quick to infuse, toxicity is checked and cytokine syndrome and neurological toxicity is monitored. This is intense for the patient for many days. Patients are usually in for about 2 weeks and then followed up. Ruth gave a brief tour of the unit and showed the Board the facilities. AB outlined a patient story of a 23-year-old female who didn’t respond to standard treatment. She was then given CAR-T therapy in 2019 and is now cured. In terms of the UK data, there have been about 800 patients, with 600 treated. There’s an attrition rate as some are not well enough to complete therapy. Activity projections were outlined, we


haven’t treated as many patients as predicted because of Covid. Other indications are being looked at for CAR-T and we are learning more about which patients are going to respond well to the treatment. CO thanked the team and invited questions. AB noted that we are working collegiately with GM partners to deliver CAR-T. It’s a very costly treatment and did get NICE approval. The cost should come down as the technology moves on. RA asked about the neurological problems and cooperation with Salford. AB noted this works well and there are also new drugs that can be used for neurological toxicity. Additional support has not been required to the extent it was feared e.g. critical care, outreach etc. EL asked about referrals. AB noted that referrals are regional, N Wales and Liverpool and as far south as Stoke. They come through the MDT. KW asked why CAR-T is effective for blood and not solid tumour cancers. AB responded that there are issues of penetration of the tumour, immunotherapies tend to work better on blood cancers. There is research on going. 19/22 Standard business a Apologies Apologies were received from Tarun Kapur (TK), Non-executive Director and Prof Fiona Blackhall (FB), Director of Research b Declarations of Interest No declarations of interest noted. c Minutes of the previous meeting – 28 th April 2022 The minutes were accepted as a correct record. d Action plan rolling programme, action log & matters arising Item Action a Chief executive’s report RS noted the deescalating position for covid. On 19 th May the incident response was deescalated from level 4 to level 3. This moves away from command & control. The pressures in the system are highlighted in the context of recovery plans being delivered. The pressures for emergency and planned care are as bad now as they have been throughout the pandemic. The Christie has no significant delays in treatment delivery. Diagnostic pathways in other providers are suffering significant delays. We are offering mutual aid for Priority 2 cancer surgery. RS noted the celebration activities for our staff outlined in his report. There is a stakeholder update attached which outlined that the system is on schedule to initiate the ICS from 1 st July with the Integrated Care Board in place and continuing its recruitment to that Board. We continue to talk to colleagues in Cheshire & Mersey as we are also a partner in their ICS. GP asked about the discussions going on around the capital envelope for All items from the rolling programme are noted on the agenda. The Annual Report & Accounts comes back to the joint Audit/Quality Assurance meeting in June for approval. 20/22 Key Reports


organisations providing care nationally. RS responded that this is a nuance for us, we span different populations & ICS’s as well as having a large proportion of our activities as regional & national. Approximately 85% of our activity is currently funded through specialised commissioning. These are not typical and ways are being explored to see how this can be arranged going forward. SP is on the working group looking at this and the future of specialised commissioning. We need to wait to see what we can do and we are involved in the discussions. Safe – there were no serious incidents (SI’s) and no never events, 1 major incident and 4 moderate incidents all of which are going through process. There are 5 risks over 15, 2 at 20 and 3 at 15. No MRSA and 8 C Diff with no lapses of care. There was 1 case of e-coli post 48 hours and 2 covid nosocomial infections. Responsive – 11 new complaints in month and 40 PALs contacts. Average length of stay was 6.75 days and there were 2 cancelled operations on the day. Access – 18 weeks was 97.8%, slightly down on the previous month. 62 days achieved just over 80% (after validation), 24 days was 82.1% and there were 30 104 day waiters – these were tracked and treated with 24 days. Activity at month 1 is roughly in line with plan. Surgical operations and elective care are slightly behind plan. New patients are slightly below, follow up are on plan. Treatments are on or above plan for SACT and radiotherapy. HR – PDR and essential training are at a stagnant level, overall absence was still high in April and this is significantly improved in May. PDRs and training are now recovering and there is a plan to spread this out over coming months to keep a higher compliance. Vacancies – there’s been an increase in our establishment. Turnover rate is at around 15%, this is high. Finance  Deficit £226k compared to £220k deficit plan,  EBITDA surplus £1.9m,  I&E deficit £1.7m  Cash balance £152m  Debtor days of 10  Capital expenditure at 39% below NHSI plan  CIP - £1.9m has been identified against a plan of £11.8m JM asked about the workforce figures relating to voluntary resignations. EL noted that these are across the board and isn’t a particular group. This compares to other organisations as retention nationally shows a heightened figure post covid. HCA staff are leaving and this is a pay question. They can go to non-NHS and get better pay. We are looking at supporting staff, at a living wage and analysing the rich data from exit interviews etc. We are monitoring this very closely. RA asked about CIP and if they will be recurrent. SP noted that a percentage will be non-recurrent. £1.9m will be recurrent and this will be updated monthly. RA asked about audits being closed without being complete. JY responded that this is normal and that some become futile as they progress. RA asked about VAT recovery and whether it is better than plan for the

b Integrated performance, quality & finance report BD outlined the key points from the report for month 1.


Paterson. SP responded that it is. CO asked about the cancer targets and the figures being comparable to pre covid. BD noted there have been some rule changes that have helped and we strive to treat patients as quickly as we can. There have been issues as a result of covid. We want to be in the green on these standards. CO asked about comparative performance nationally. RS noted that we are doing well as an organisation but not as a system and we’re working as a system to improve this. There is a lot of good practice but much more to do. Diagnostic capacity is a real problem. GP asked about an incident relating to a portacath infection that resulted in death. JY noted that this is a consented known complication & these were not previously reported. There was no lapse in care. KW asked about activity targets and if they are different as well as whether we are funded if we over or under perform. BD noted that overperformance can be funded through the ERF. Planned activity is 104%. There is a requirement for the system to achieve the activity plan as well if we are to get any additional funding. Report noted. c Medical directors report - Education update RF presented the paper. He noted that there’s been a huge amount of activity across education excluding students and doctors in training. The recovery from covid gives opportunity for education at many levels and engagement events have taken place to draw ideas in. There’s a recognition that education at The Christie is a partnership event and we are looking at an over arching education brand for the Christie. There’s more pressure to take more undergraduate students so we must be sure we can do this very well if we expand. We are harnessing work done in radiotherapy education. A coached and mentored approach has worked very well and a change from the previous approach and encourages more involvement in the organisation. We are working with Macclesfield around placements there. Postgraduate medical education – really challenging for junior docs and have had abnormal experience of training. Looking at how we support transition into the service and alignment with a broader service review. There’s been an appreciation from junior doctors of this. In terms of workforce related activity we are pushing forward concrete plans around a people development group with education and workforce. There is an accessible education focus, looking to maximise opportunities. External education activities – remote delivery is very active, Gateway-C is now in Wales & Scotland. RF noted that the award from the Royal College of Radiotherapists was very nice to see. CO invited questions. JM noted the good report and the tension between being a leader and having to work in the GM system. RF noted that we work with the Academic Health Science Centre to see if there’s a better blueprint of cancer education and to see what we can share. Working across organisations will make this easier and better. Because of this broader blueprint of what cancer education is, we can


use this to support cancer education more widely. We must get the internal learning & education right to then get the external right. RF noted the work going on to work with non-medical staff as well as medical. Need to use the assembled talent around the table to inspire staff, we will have ‘poster’ people. AM asked about mentoring and if that’s something the Trust is looking at. RF noted the Maguire Unit and its work, mentoring is part of this, and we are looking at how we expand this and keep it affordable. KW congratulated the change in name to Christie Education rather than School of Oncology. He asked about the University links and thinking around this relationship. RF noted that there’s cooperation and competition with the University. Professionals want bespoke CPD and the universities are not looking at this so we are looking at how we can fill this gap. We may look at fellowships / Masters qualifications etc. There is peaceful coexistence with the University of Manchester. There is also AHP work through the University of Salford where we do the specialist bit of the training. d Annual sustainability report JY noted that this is first annual report to come out of the agreed plan that was approved at Board last June. There’s an engaged team and we are making good progress. There is still some time to make more progress towards the aims. There’s a new BAF risk around sustainability to progress this. Target is to achieve net zero by 2040. GP asked about the air quality in GM. JY responded that this isn’t one of the measurements, we are looking at what we can do as an organisation. We are progressing towards understanding what our position is and how we get better. KR asked about whether we have enough electric charging points to encourage staff to have electric cars. JY responded that the Christie fleet have priority on the charging points but we do have enough and also have scope to expand them. JM asked whether the impact of patient travel has been taken into account. RS responded that we have done significant work to improve this. For example we have surpassed the miles saved with the Macclesfield site. It is estimated that we will save 750k patient miles a year. Care closer to home is making significant improvements in this. e EPPR annual report BD presented the report. This gives a summary of the work in year. We have been running an emergency planning room for 2 years. There have also been digital incidents that have required us to run incidents. We have plans to do a desktop exercise in digital and we test & refresh business continuity plans continuously. RS noted that this will be looked at through the assurance committees going forward and reported to Board.

21/22 Approvals a Update on CQC and regulatory activities

JY noted that this used to be part of the approval process but is now for noting. The report shows where the CQC landscape currently is and where it is going. We still don’t know exactly what the inspection regime will look like, it will now be based on data and risk. There is a draft list of oncology markers for inspection,


with implementation expected after 2023. We await the detail. We meet regularly with the CQC and have been told we are not a high-risk organisation. We do anticipate we may get a well-led inspection and we are preparing for this now. CO noted there is a new Chief Inspector of Hospitals coming into post. GP asked about a system-based review. JY noted that this is the direction and may explain the pause in activity. AM asked if there are any possible indicators in the oncology assessment that we may struggle on. JY noted that we need to have a real focus on learning from incidents etc. Learning is a real focus. KW noted that the discussion on system-based inspection is confusing and using data to spot issues is very difficult. Being part of inspection teams in other organisations is important to learn around what they are doing. RS noted that invites are coming and we will do this. CH noted that where we struggle is where CQC don’t understand what a system or a Trust issue is. 62 days is a good example of this. b NHS Provider License conditions: self-certification declarations RS noted the self-certification declarations that we need to approve. This is an annual requirement that was previously submitted to the regulator. We now need to make this assessment and have it available should we be asked by the regulator for a Board approved declaration. Approved. 22/22 Board Assurance a Board assurance framework 2022/23 RS noted that the BAF has been significantly updated to reflect the risks to the corporate objectives in year. GP asked about high target risk scores where we are averse to the risks. New risks reflect the changing environment this year to previous years. For example changes in workforce and the financial regime. This will change as the year goes on and the BAF is regularly reviewed.

23/22 Any other business No items raised.

Date and time of the next meeting Thursday 30 th June 2022 at 12:45pm


Meeting of the Board of Directors - June 2022 Action plan rolling programme after May 2022 meeting

Agenda item 24/22d


From Agenda No


Responsible Director


To Agenda no

Annual reporting cycle Integrated performance & quality report and finance report


Monthly report


Workforce update incl FTSU development session

Quarterly review / training

To July 2022 WAC

Digital update

Progress report

26/221c 26/22a

June 2022

Annual reporting cycle Annual report, financial statements and quality accounts (incl Annual governance statement / Statement on code of governance)



Integrated performance & quality report and finance report


Monthly report

By email

July 2022 - no meeting

Integrated performance & quality report and finance report


Monthly report

By email

August 2022 - no meeting


Monthly report

Annual reporting cycle Integrated performance & quality report and finance report

Trust Draft Sustainable Development Management Plan 2021 - 2024 Compliance with NICE Safe Staffing Guidelines Emergency Preparedness, Resilience and Response assurance process



Six month review



Approval of compliance status Provide update to Board

Annual reporting cycle


MIAA audit recommendation Anti-bribery briefing

Annual reporting cycle Corporate objectives & board assurance framework

Interim review Monthly report Six month review Progress report Quarterly review Annual report Monthly report Six month review

Integrated performance & quality report and finance report

Annual reporting cycle Executive medical directors report - Research review (key issues, progress against objectives and future plans)

October 2022

Digital update Workforce update

Freedom to speak up guardian


Annual reporting cycle Integrated performance & quality report and finance report Annual reporting cycle Executive medical directors report - Education review (key issues, progress against objectives and future plans)


November 2022


December 2022 - no meeting

Integrated performance & quality report and finance report


Monthly report

By email



From Agenda No


Responsible Director


To Agenda no

Annual reporting cycle Integrated performance report Annual reporting cycle Risk Management strategy 2021-24


Monthly report Annual Review

January 2023


Integrated performance & quality report and finance report


Monthly report

By email

February 2023 - no meeting

Annual reporting cycle Corporate planning (corporate objectives / BAF 2022/23) Annual reporting cycle Letter of representation & independence Annual reporting cycle Integrated performance & quality report and finance report Annual reporting cycle Declaration of independence (non-executive directors only) Annual reporting cycle Register of directors interests

Executive directors

Approve next year's BAF

Chair Chair COO Chair DoW IEMD

Directors to sign Report for approval

Monthly report

For completion by NEDs

March 2023

Digital Update Workforce update

EMD/Dep CEO Update

Quarterly review

Responsible Officer report

Medical Appraisal & Revalidation Annual report

Annual reporting cycle


Approve Review

Six monthly compliance with NICE safe staffing guidelines


Annual reporting cycle Integrated performance & quality report and finance report


Monthly report

Register of matters approved by the board

April 2022 to March 2023

Annual reporting cycle Medical directors report - Research update (key issues, progress against objectives and future plans)


April 2023

Annual reporting cycle Annual Corporate Objectives

Review 2022/23 progress

Modern Slavery Act update Board effectiveness review


Chairman FTSUG

Undertake survey Quarterly update

Freedom to speak up Guardian report

Annual reporting cycle Integrated performance & quality report and finance report


Monthly report

Provider licence

Self certification declarations


To approve the declarations Declaration / approval

Annual reporting cycle Annual compliance with the CQC requirements Annual reporting cycle Medical directors report - Education update


Review Update

May 2022

Annual sustainability report

For approval

Emergency Preparedness, Resilience and Response (EPRR) annual report 2021-22

Annual reporting cycle Annual reports from audit & quality assurance committees

Committee chairs



Agenda item: 24/22d

Action log following the Board of Directors meetings held on Thursday 26 th May 2022

No. Agenda


By who


Board review

No actions arising from the meeting


Agenda item 25/22a

Meeting of the Board of Directors Thursday 30 th June 2022

Subject / Title

Chief executive’s report


Chief executive

Presented by

Roger Spencer

Summary / purpose of paper

To keep the board of directors updated on key external developments & relationships The board is asked to note the contents of the paper


Background Papers


Risk Score


Link to: 

Achievement of corporate plan and objectives

Trust’s Strategic Direction

Corporate Objectives

MAHSC - Manchester Academic Health Science Centre NIHR - National Institute for Health and Care Research PCAF - Pre-doctoral Clinical Academic Fellowship FoSH - Federation of Specialist Hospitals ACRA - Advisory Committee on Resource Allocation

You are reminded not to use acronyms or abbreviations wherever possible. However, if they appear in the attached paper, please list them in the adjacent box.


Agenda item 25/22a

Meeting of the Board of Directors 30 th June 2022 Chief executive’s report

1. Situation Report The impact on our operational services of COVID-19 is minimal. Our Trust escalation remains at level 2 due to the number of vacancies in various clinical departments, which requires regular interventions and monitoring to avoid any impact on service delivery. In line with updated national guidance we have reviewed our biosecurity measures via the clinical advisory group and there have been no changes in the past month. On site activities and footfall has increased with no impact in terms of increased impact of Covid 19 on our patients and services. Our focus continues to be to provide all cancer care and treatment for our patients and to ensure we play our part in the GM cancer recovery plans. We are continuing to provide mutual aid for other providers across GM for cancer surgery and we are making progress at making progress to take on direct management of oncology clinics across GM. 2. Planning submission 2022/23 As part of the Greater Manchester Integrated Care System (GM ICS) we must set our financial plan as part of a system plan. The national planning round is near completion and each system must submit their respective activity, finance and workforce assumptions. The clinical divisions have submitted these with the total Christie submission forecasting delivery of volumes exceeding the activity in 2019/20 (the national requirement). Each part of the Greater Manchester system is required to break even which the GM ICS are working towards. In terms of capital planning for 2022/23, the same rules apply as for the revenue planning, that the plan needs to be an aggregate GM ICS plan and must fit within the prescribed capital budget. We submitted our required plan to the required deadline. 3. Annual Report & Accounts 2021/22 The Annual Report & Accounts 2021/22 was approved at the joint meeting of the Audit & Quality Assurance Committee in May 2022. The final audited and signed version of the Annual Report & Accounts has now been submitted to NHSEI by the required deadline. 4. Appointments NIHR Pre-Doctoral Clinical Academic Fellowship Scheme Professor Janelle Yorke, Chief Nurse and Executive Director of Quality has been appointed as Chair, NIHR Pre-Doctoral Clinical Academic Fellowship Scheme The NIHR Pre-doctoral Clinical Academic Fellowship (PCAF) Scheme supports award holders to undertake Masters’ level academic training and to prepare an application for a doctoral level research training Fellowship whilst maintaining clinical practice.


AHSC Honorary Clinical Chairs The exceptional contribution of three Christie colleagues to cancer services, research and education has been recognised by the Manchester Academic Health Science Centre (MAHSC) and awarded Honorary Clinical Chairs for 2022: - Professor Omer Aziz (colorectal and peritoneal cancer surgeon) has been recognised for his leadership of practice-shaping research in peritoneal cancers and his dedication to teaching and training internationally to improve outcomes for patients with these rare tumours. - Professor Ed Smith (Clinical Oncologist) is an international opinion leader in the field of Proton Therapy having led the realisation of the first UK-based NHS proton beam therapy service since its inception in 2008 and chairs the national Proton Research Committee. - Professor Raffaele Califano (Medical Oncologist) has led on several landmark practice changing clinical trials improving outcomes for lung cancer patients with advanced disease and is an internationally recognised educator committed to developing the next generation of oncologists. The MAHSC Honorary Clinical Chairs are awarded annually by The University of Manchester’s Faculty of Biology, Medicine and Health Promotions Committee. University of Liverpool Honorary Clinical Professor of Oncology Professor David Thomson has been appointed as an Honorary Clinical Professor at the University of Liverpool in recognition of his expertise in radiotherapy and proton beam therapy research, having achieved a substantial national and international reputation in his field of head and neck oncology as a consultant at The Christie. Professor Thomson’s appointment will support closer head and neck cancer research links between Manchester and Liverpool to develop a globally impactful research In May 2022 we were visited by a Food and Safety Standards Specialist from the Environmental Health Department of Manchester City Council, as part of their routine inspection schedule to assess compliance with food safety legislation. The main kitchen that supplies the Restaurant and provides patient meals was inspected in detail. An inspection of a sample of ward kitchens was also undertaken. The inspection covers: • handling of food • how food is stored programme improving outcomes for patients with head and neck cancer. 5. Environmental Health Inspection – Food Hygiene Rating scheme

• how food is prepared • cleanliness of facilities • how food safety is managed

The inspection resulted in the Trust maintaining a Food Hygiene Rating Score of Level 5. This is the highest possible score and indicates that the hygiene standards are very good and fully comply with the law.


6. Response to specialised commissioning consultation We have been invited to comment on the proposed methodology by which target funding allocations will in future be set for specialised services for ICS populations. The methodology has been recommended to NHSE/I by the Advisory Committee on Resource Allocation (ACRA), the independent expert body comprising of clinicians, public health experts, NHS managers and academics that has advised government on health service allocations since 1997. Initial review of the proposal indicates there are factors that have been omitted from the proposed funding calculation including deprivation which will make a significant difference depending on the geographical location of the population being served. The deadline for response to the consultation is 30 th June and we will provide a response as the Christie and also as GM ICB and via the Federation of Specialist Hospitals (FoSH). 7. Greater Manchester NHSI/E have confirmed the constitution for the Greater Manchester Integrated Care Board and work continues on the Readiness to operate statement between the ICB and the Provider Federation Board. Included in the readiness to operate statement is the intention for the Provider Federation Board to lead the system responsibility for 8 health programmes including Cancer. The Cancer operating model is based on the Alliance leadership for the cancer system. This is in line with national guidance and transition arrangements are in place. This includes the transfer of the CCG cancer commissioning role into the Cancer Alliance and the development of the cancer system performance mechanism. Confirmed Appointments to Greater Manchester Integrated Care Board Chair – Sir Richard Leese Chief Officer for Population Health and Inequalities - Sarah Price Chief Officer for Strategy and Innovation – Warren Heppolette In addition 9 of the 10 places in Greater Manchester place leads have been confirmed. 8. Estate Developments The Paterson project continues with a major milestone of the final works for the gas supply being started this month along with planning for the important Home Office validation works. The Automatic Number Plate Recognition (ANPR) system will be switched on in June allowing for a more efficient way of managing the Trust’s car parks. Work is underway on other major projects including the energy centre, installation of the MR scanner, pharmacy outpatients facility and replacement of the linear accelerators at the Oldham site. Chief Executive Officer – Mark Fisher Medical Director – Manisha Kumar Finance Director – Sam Simpson Chief Nurse – Mandy Philbin

More information about our new developments can be found at:










Agenda Item 25/22b

Meeting of the Board of Directors Thursday 30 th June 2022

Subject / Title

Clinical Leadership report

Prof Janelle Yorke, Executive Chief Nurse Dr Neil Bayman, Executive Medical Director Prof Janelle Yorke, Executive Chief Nurse Dr Neil Bayman, Executive Medical Director This paper outlines the current clinical leadership structure and roles at The Christie.


Presented by

Summary / purpose of paper

Board are asked to note the updates to the clinical leadership structure and roles at The Christie


Background papers


Risk score

See BAF 2022/23

Link to:  Trust strategy  Corporate objectives

Delivery of the Corporate Objectives 2022/23

R&I Research & Innovation CCIO Clinical Chief Information Officer AHP Allied Health Professional ACN Associate Chief Nurse CNS Clinical Network Services IPC Infection Control & Prevention

You are reminded not to use acronyms or abbreviations wherever possible. However, if they appear in the attached paper, please list them in the adjacent box.

CPCR Christie Patient Centred Research CNS Clinical Networked Services division CSSS Clinical Support & Specialist Surgery division NIHR National Institute for Health and Care Research

UoM University of Manchester COO Chief Operating Officer CPD Continuing Professional Development


Agenda item 25/22b

Meeting of the Board of Directors Thursday 30 th June 2022 Clinical Leadership report

1 Background There have been a several changes at executive and senior management level over the last 2 years bringing different approaches to the divisional structures and associated leadership. Engagement exercises over the last 2 years have highlighted the need to strengthen clinical leadership. This paper outlines the current clinical leadership structure and roles at The Christie. 2 Senior Medical Leadership Over the last 2 years, the medical director team at The Christie has expanded to eight appointed roles, and consists of the Executive Medical Director, the Directors of R&I and Education, two Divisional Medical Directors, and three Associate Medical Directors. Medical representation at Board of Directors is provided by the Executive Medical Director, the Director of R&I and the Director of Education. The Associate Medical Director for Quality and Patient Safety is affiliated to but does not hold direct accountability for the Quality and Standards Division. The Associate Medical Director for Digital is a medical CCIO role working alongside a CCIO for nursing/AHP. The Associate Medical Director for Clinical Outcomes leads the Clinical Outcomes Unit supported by Digital. Responsible Officer duties are delegated by The Executive Medical Director and are discharged by Dr Daniel Saunders. Figure 1: Senior medical leadership structure


3 Senior Nursing/AHP Leadership The Chief Nurse senior leadership team has undergone recent transformational change to enhance representation of the nursing and Allied Health Professional (AHP) workforce across the organisation. This includes a new Associate Chief Nurse (ACN) post for Clinical Network Services (CNS) to enable a triumvirate leadership model that mirrors CSSS. The Quality & Standards Division has been re-modelled into two key themes – Patient Experience and Patient Safety. The previous ACN for Quality & Standards has been modified and will lead the Patient Experience theme and the recently developed ACN for Infection Control & Prevention (IPC) has been enhanced to lead the Patient Safety theme (incorporating IPC). Following HEE funding we appointed the Trust’s first AHP Lead, 3 days per week for a fixed term of 12 months. The leadership team are working through options to support this post substantively. Following a successful application to NIHR/UoM we have recently appointed our first post doctoral research fellow in nursing – this is a UoM contract but the post-holder (Dr Briggs) is based in Prof Yorke’s research team Christie Patient Centred Research (CPCR). This new Honorary ACN Research post will lead the further development of clinical-academic career

pathways for nurses and AHPs at the Christie. Figure 2: Senior nursing/AHP leadership structure

4 Clinical Divisions Medical leadership of the clinical divisions has been strengthened by the appointments of the Divisional Medical Directors for CNS and CSSS. The senior divisional leadership for both divisions is a triumvirate of the Divisional Medical Director, Divisional Associate Chief Nurse and Divisional Manager.


The leadership structure reporting into the senior divisional team is a Clinical Directorate model. This divisional leadership model ensures that professional accountability reports through the professional leadership structure, with operational accountability via the senior team to the Chief Operating Officer. The Chief Pharmacist and the Director of Regional Physics continue to report directly to the COO. Table 1. Clinical Divisional Structure and Leadership

5 Leadership Development Development of our clinicians in leadership positions is essential to ensure that we are well led, continually learning, and evolving our practice to meet the strategic aims of The Christie and NHS overall. Significant investment has been made recently to fund courses and programmes for new or aspiring senior/middle leaders. All new Clinical Leads are invited to participate in the regional Emerging Frontline Clinical Care Leaders 9-month programme. The Chief Nurse Leadership Award has supported a number of Nurses and AHPs to undertake Masters level study in leadership, alongside the Level 7 apprenticeship that our non-clinical managers can also undertake. The Christie Leadership Series runs quarterly and aims to provide CPD for leadership skills and behaviours. HR & School of Oncology are collaborating with the Responsible Officer to identify opportunities and resources to establish peer-to-peer development, reflective, collective leadership practice, and behaviour-focused learning required to meet the needs of the organisation. Speciality Group Leadership Clinical leadership for the new models for cancer planning and service delivery within the integrated care system will be through cancer pathway specific Speciality Boards. A cancer-site specific Speciality Group model is being developed at The Christie to mirror the system-based Speciality Boards, and provide clinical leadership across services for the multi-disciplinary teams providing care for a cancer type (e.g. breast cancer, colorectal 6

cancer, lung cancer etc). Speciality Groups will be responsible for: • defining standards of care and driving service improvement


• integrating service delivery with research and education • reporting clinical outcomes

The Speciality Group Clinical Leads will interface with the Cancer Alliance Speciality Boards and contribute to development of strategy, transformation and influencing pathway priorities at a system level.

7 Recommendation Board are asked to note the updates to the clinical leadership structure and roles at The Christie.


Integrated Performance Quality & Finance Report






Well Led



Safe •Incident Reporting •Serious Incidents & Never Events •Moderate Incidents •Learning from Incidents •Radiation Incidents

Caring •Patient Experience •Friends & Family

Responsive •Cancer Standards •Referral Analysis •Length of Stay •Activity •Complaints/PALS •Inquests •Claims

Effective •Healthcare Associated Infections •Mortality Indicators & Survival Rates •Quality Improvement & Clinical Audit •NICE Guidance •HR Metrics – Sickness •HR Metrics – PDRs & Essential Training

Well-Led •Finance – Executive Summary •Finance – Income •Finance – Expenditure •Finance – Capital •Finance – COVID Revenue & Capital

•Harm Free Care •Pressure Ulcers •Inpatient Falls •Corporate Risks •Safe Staffing

•Workforce Metrics •Research Metrics




The Integrated Performance, Quality & Finance report presents a summary dashboard that provides an overview of performance.

Safe • There were 8 incidents reported with the classification of moderate in May, details of which can be found on slide 8. All the incidents are still progressing through to full root cause analysis. No never events were reported in month.

• Slide 9 provides details of shared learning from incidents following Executive Reviews. • There are 4 Trust level risks scored at 15+. Details of these can be found on slides 12 & 13. • Safer staffing numbers have met the required acuity levels to ensure appropriate levels of safety and care for our patients. Responsive

• The 62 day cancer waiting time standard has not been met in May. Our position subject to validation is 69.9% for 62 days. The standards for Upgrade & Screening patients have also not been met with positions subject to validation of 79.3% & 50%. Within the 62 day performance we also failed to achieve the internal 24 day standard with a performance of 79.9%. All 62 and 24 day breaches are reviewed to ensure any delays are understood and plans can be implemented to mitigate any future delays . The number of patients waiting over 104 days as at the end of the month has reduced significantly from April. The majority of these patients were referred late in the pathway and often referred to the Trust over day 100. All 31 day targets and 18 week RTT standards have been achieved in May. Performance against the CWT thresholds is constantly monitored. • Referrals in May increased from April and were both higher than May 2021 and the 21/22 average. • Activity levels are now monitored against a 22/23 plan rather than a GM recovery trajectory set around 19/20 activity levels. As at month 2 Chemotherapy deliveries continue to be above plan, Radiotherapy fractions are on plan and all other points of delivery are below plan but by small margins. Effective • There were 4 cases of C-Difficile, 7 cases of E-Coli & 3 cases of MSSA in May that were deemed attributable to the Trust. No lapses in care have been identified. • There was 1 case of hospital acquired nosocomial Covid-19 infections in May. Well – Led • The trust is reporting a month 2 position of £446k deficit compared to a £439k deficit plan within the latest plan submission of an annual control total deficit of £2.6m. • The month 2 EBITDA position is a surplus of £3,777k • The cash balance is £147,055k. • Performance to month 2 is £6,670k (44%) below the proposed plan submitted to NHSE&I, reflecting the Paterson scheme and vat recovery benefits achieved against it.






1. Safe

1.1 - Incident Reporting

There has been no significant variation in the number of patient safety incidents reported in May.

The severity of major and death relate to known complications and clinical events. All are progressing through the investigation process prior confirmation of being directly attributable to the final documented harm.



1. Safe

1.2 - Serious Incidents and Never Events

Never Events – are defined are serious incidents that are wholly preventable The last Never Event occurred in January 2020 which was the only incident in the last 5 years.

Serious incidents There were 0 serious incidents declared in May.



1. Safe

1.3 – Moderate+ Incidents

May 2022 Reference





Moderate A known complication of nephrostomy exchange where a patient required admission for IV antibiotics

Formal complaint response to family. Review via interventional radiology M+M.

Clinical impact, patient requires repeat procedure. Progressing to full patient safety investigation. Clinical impact, patient required admission to CCU, however has made full recovery. Review by SACT delivery group.


Moderate Cytology samples were not received following a day case invasive procedure.


Moderate A patient suffered a cardiac arrest following administration of chemotherapy.


Moderate A positive microbiology result was not reviewed. The patient subsequently required admission for IV antibiotics

Clinical impact, patient required admission. Progressing to full patient safety investigation.


Moderate Deviation from process for monitoring of CMV status in a transplant patient

Clinical impact unknown at present. Progressing to full patient safety investigation.

Clinical impact, patient progressing to surgery. Progressing to full patient safety investigation


Moderate There was a missed opportunity to refer spinal fractures identified on imaging to a surgical team in a timely manner


Moderate A referral was not processed correctly, resulting in a patient being lost to follow up for 9 months.

Clinical impact, progression of lesion. Progressing to full patient safety investigation

Clinical impact unknown at present. Progressing to full patient safety investigation. Reportable under IR(ME)R


Moderate Incorrect plan used for 4/5 fractions of radiotherapy resulting in irradiation of anatomy outside of treatment field



1. Safe

1.4 – Learning - Patient Safety Incidents

Agreed learning and revised severity outcome following executive reviews April 2022 Ref Description Root cause Learning


There is no automated upload of scans performed at the other trust to CWP as, whilst the scanner is part of the regional PET CT service, it has a different RBV number. The automated upload to CWP only occurs for scanners with an RBV of RBV01. The Clinical Oncologist and ST were not aware of this and so relied on results being drawn into CWP.

Delayed PET-CT results showed suboptimal coverage of disease site, however radiotherapy had already commenced

Clinicians will need to review PET Portal to check PET Scan reports for Trust 2 until alternative solutions can be investigated



1. Safe

Following procedural documentation. Education on validation Importance of validation and change control in other areas

W68343 Stem cells compromised during freezing process.

Failure to follow process


Need to reinforce monitoring of lying and standing blood pressures

W68464 Inpatient fall resulting in neck of femur fracture It is likely that an episode of AF caused the patient to fall/collapse


The nurse-led protocol does not detail parameters for an urgent medical review in addition to the deferral process

Need for a clear monitoring and follow up process when patients are deferred


W68402 Communication failure regarding abnormal blood results

Telephone clinic process followed however misplacement of the outcome resulted in appointments not being schedules

Single point of failure identified within booking process and rectified

W68192 Delay in scheduling venesection treatment at The Christie Haematology @ Tameside




1. Safe

1.5 - Radiation Incidents

There was 1 IRMER reportable patient safety incident in May. The incident is subject to a full investigation.


IRMER – Ionising Radiation (Medical Exposure) Regulations


1. Safe

1.6 – Harm Free Care

There were 3 hospital acquired pressure ulcers reported with minor harm in May.

There were 3 in-patient falls with harm in May - all minor harm There were 2.9 falls per 1000 occupied bed days in month, and 3.2 YTD. This compares to a national average of 6.63 falls per 1000 occupied bed days.

All harms are discussed at Friday FoCUS (a multi-professional forum for shared learning) 38


1. Safe

1.7 - Corporate Risks

There are 4 Trust-wide 15+ risks in May 1 risk reduced in score (3259) Description Score


No change to risk score. Alongside all GM ICB organisations and inline with the national timetable the Trust submitted full 22/23 plans for workforce, activity and finance on 28th April 2022. The Christie financial deficit at the time of submission was £2.6m which, when aggregated with all other GM ICB organisations, gave a GM financial plan revenue deficit of £187m, in addition to a system oversubscription against the permitted capital envelope of £59.3m. Early feedback from regional and national NHSE/I teams on the April system submission suggests that, whilst the vast majority of ICB areas across England have submitted financial deficits, the GM submitted deficit is one of the highest in the country and not considered to be within an acceptable range and therefore not approved as the final plans for the ICP. Consequently further steps are required across GM to improve financial plans and reduce the current planning deficit. This work is ongoing and whilst some improvement has been made including an additional £72m national funding to support the System achieve break even, there remains a substantial revenue and capital gap to close by the next planning submission in mid June.

Financial risk 2022-23 (ID 3219)


Risk of negative impact on engagement levels, staff health & wellbeing and delivery of services, due to Trust-wide staffing gaps. (ID 2438)

15 Management Board Approval for International Recruitment received - Work commenced to source candidates Just R work progressing



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