Quality report 2021-2022

Quality Report 2021/22

The Christie NHS Foundation Trust Quality Report 2021-22

Quality Report Part 1: Statement on quality from the Chief Executive

Everything we do at The Christie is aimed at achieving the best quality care and outcomes for our patients. I am pleased to introduce this year’s quality report which once again builds on our established foundations of delivering high quality services which continue to be rated as Outstanding by the Care Quality Commission. 2021/22 has been another challenging year experienced by the NHS. The COVID-19 pandemic has continue to need changes in the way services are organised and delivered. At The Christie we have continued to focus on the quality of care and treatment we give to our patients. Without a doubt, the strength of our underlying patient centred culture, highly motivated and compassionate staff, oncology expertise and organisational culture enabled us to respond in an agile and effective way to the new demands COVID-19 placed on us all. We continue to do all we can to make sure our patients get the treatment, information and support they need. Our track record of publishing information on the quality of our services continues, with our integrated quality, finance and performance report published monthly which demonstrates our achievements on each of the three components of quality; patient experience, safety and effectiveness of care. This annual report shows the progress we have made over the past 12 months and our quality improvement plans for the future. Through the on-going hard work and commitment of all our staff we continued to provide high quality care and services to our patients and their families. We continue to be one of the top scoring Trusts for quality of care in the national inpatient survey. During the course of 2021/22 we have continued to work hard on presenting readily available information for our patients about the quality of our services. Information screens outside each ward and department provide live information about safe staffing levels and achievement of safety standards. Feedback from our patients on the Friends and Family Test has consistently scored high as a recommendation of a place for care. During 2021/22 a quality accreditation programme for the wards continued and all of our wards have been accredited to ‘Gold’ standard, the best that can be achieved. All three of our radiotherapy centres have maintained The Christie Quality Mark accreditation which means our patients will have the same high standards of care whether they come to the main site at Withington or to the centres in Salford and Oldham. We are also implementing this same standard across our systemic anti-cancer therapy services at other sites. The Board has a quality assurance committee which scrutinises, monitors and provides assurance on our quality programmes and further assurance is given by our governors’ quality committee through which our council of governors supports and advises on current quality and priorities for the future. It is the voices of our patients and their families that really make the difference both in assuring us that we get it right most of the time and more importantly letting us know when we get it wrong and allowing us to make changes. We are extremely grateful to the many people who as healthand

1

The Christie NHS Foundation Trust Quality Report 2021-22

social care partners, governors, members, patient representatives and our patients take the time to support and advise us.

The Board of Directors is strongly committed to building on our existing high standards of quality and we aim to maintain our reputation for excellence throughout the coming years, especially at a time when any additional resources available to the NHS remain limited. Our results show that we provide high quality care and we want to maintain this through the implementation of our quality plan which is a supporting plan to our five year strategy.

I am pleased to present this report to you and to certify the accuracy of the data it contains.

Roger Spencer Chief Executive Officer 21 st June 2022

2

Part 2: Priorities for improvement and statements of assurance from the board 2.1 Quality priorities for 2021/22

1. Improving Pressure Ulcer Management We will continue to provide safe and effective skin care to patients and education and support to staff. This will be evidenced by: • A 10% reduction in the number of patients who develop moisture associated skin damage (MASD) during admission based on the baseline data collected in 2019/20. • There will be no more than 30 Category 2 pressure ulcers, (deep tissue injury and unstageable pressure ulcers) developed during admission. • We will maintain our standard of no category 3&4 pressure ulcers developed during admission 2. Improving patient safety and experience during a national pandemic through the use of digital technology We will continue to provide safe and effective patients care and experience. This will be evidenced by: • Increasing the number of outpatient follow up clinics undertaken using digital technology by 20% based on the 2019/20 baseline. • Improve patient access to friends and family by introducing new digital technologies. • We will triangulate patient experience through survey results, compliments, PALS and complaints contacts. Improving the Pharmacy Experience We will continue to reduce pharmacy waiting time and improve patient experience by introducing new models of delivery. This will be evidenced by: • A 20% increase in the number of eligible patients utilising the pharmacy medication delivery service. • We will evaluate patient experience through survey results, compliments, PALS and complaints contacts. 3

3

1. Improving Pressure Ulcer Management In 2021/22, we aimed for: • A 10% reduction in the number of patients who develop moisture associated skin damage (MASD) during admission based on the baseline data collected in 2019/20. • There will be no more than 30 Category 2 pressure ulcers, (deep tissue injury and unstageable pressure ulcers) developed during admission. • We will maintain our standard of no category 3&4 pressure ulcers developed during admission. In order to monitor pressure ulcer levels more effectively, we have begun to monitor them per 1000 occupied patient bed days. This demonstrates a general reduction through the year:

The quality improvement was monitored and measured through Friday FoCUS (Focus on Care Understanding Safety), a multi-professional learning event twice a month. We met all of the aims within this objective in 2021/22:

Target 21/22

Actual 21/22

Pressure ulcers developed after admission (all grades)

30

24

Category 3 and 4 pressure ulcers developed after admission Moisture associated skin damage

0

0

87

70 (this is a 20% reduction)

NHSI guidance advises that NHS Trust’s should no longer use the definition of avoidable or unavoidable. This has therefore not been included in this report. Despite achieving a reduction we continue to proactively review any pressure ulcers of Grade 2 and above to contribute to further improvement. Themes arising from Root CA investigations have been identified as: • Inaccurate calculation of pressure ulcer risk factors • Covid 19 patients acutely unwell and unable to move the mask or NG or reposition the patient • Increase in inpatient activity • Variation in practice when conducting a head to toe skin inspection • Variation in practice when conducting a repositioning regime for patients at risk of pressure ulcers • Requirement to initiate a repositioning regime for patients at risk of pressure ulcers • Requirement to increase knowledge about Skin changes at the end of Life.

4

The improvement in both pressure ulcers and moisture associated skin damage were achieved by: • Implementing a new risk assessment tool PURPOSE-T (Pressure ulcer risk primary or secondary assessment Tool) which assess the risk in real terms than using the scoring is introduced. This was successfully implemented in practice on the 22 nd of June 2021. • Ongoing teaching on prevention of medical device related pressure ulcer and use of soft silicone under the oxygen tubing is introduced and ongoing. • Provide ongoing training for the Link Nurses to disseminate the action plan on the ward regularly. Last Link nurses study day was on 16 th 24 th March 2022. • Review of the CODE standard for Pressure ulcer management updated with evidence-based practice to ensure sustainability of quality care delivery. • Developed E-learning and uploaded to Learning zone under School of Oncology to access for all levels of staff (AHP). • Developed educational videos on how to complete aSSKINg bundle, Purpose-T reducing pressure from devices and uploaded to HIVE and circulated to the wards to form part of new staff induction. 2. Improving patient safety and experience during a national pandemic through the use of digital technology Introduction During the Covid pandemic several initiatives have completed or have started at The Christie to contribute towards improving patient safety and experience through the use of digital technology. Patient Entertainment System – a new patient entertainment system from a company called ‘wifi sparks’ was implemented. The system gives patients access to Movies, TV and national newspapers through a tablet device. The project also introduced a guest wi-fi service. Bleeps – a bleeps project is in the final stages of implementation. The project improves patient safety, replacing a legacy crash bleep service with a bleep ‘app’ that can be used on any mobile phone. The project is anticipated to result in an improved response to emergency bleep calls. Attend Anywhere – The Christie, along with other trusts in Greater Manchester, have renewed the licence for the remote consultation software ‘Attend Anywhere’. The renewal is for a two-year period. Digital Services CCIO’s are looking to introduce an initiative to increase the number of virtual appointments using the software. Future Developments The Christie have been successful in securing multi-year funding from the NHS unified tech fund. The funding totals over £4.5M across several workstreams. There are three funded workstreams: • Teaching on Skin changes at the end of life. Current Initiatives of note include:

• Patient Communications • Electronic Medications • Electronic Referral

• Patient Communications

Pain Point Themes

5

Communication via letter: Departments primarily communicate information to Patients via paper-based letters and telephone calls. These letters are generated by both clinical, administrative and operational staff via different solutions. ‘Report’ style letters are typically generated by the clinician or their secretary via CWP and DocMan. ‘Administrative’ letters (e.g. clinic appointments, treatment bookings) are typically generated by administrative or operational staff via The Christie PAS (CareFlow). A recurring theme highlighted by staff and Patients was the number of different letter templates used within The Christie. Circa 197,000 letters were issued in 2019/20 using 216 different letter templates. Patients are often provided with appointments less than a week after initial contact/referral and letters sent by post can take up to 7-10 days to be delivered. Communication via phone: Patients are currently only able to contact The Christie staff by phone via The Christie hotline, telephone numbers provided on letters or telephone numbers provided on an ad hoc basis by staff. Patients are often unsure who they should speak to about different issues (e.g. appointment information, transport booking, medications advice). Digital Communication: FireText has previously been used by the trust to offer one-way SMS communication. This solution has been under-utilised since purchase as it does not meet the needs of staff or Patients. Both staff and Patients expressed that utilisation of SMS and email communication could offer significant benefits. Technical staff have advised that gov.notify will provide the required functionality for generic communication via SMS and email. Boundaries around two-way direct clinician to patient communication through SMS and email should be reviewed as this is likely to meet the requirements for non-generic communications. Accessibility: Staff and Patients raised concerns around accessibility of Patient Communications. Limited consultation has taken place to assess the communication needs and preferences of patients. Patient communication accessibility issues have been raised on the internal risk register. Patient impact: It was noted that a fairly significant burden is also placed on Patients to manage their care and to flag issues such as missing appointments. Finally, a consistent theme raised by both staff and Patients was direct Patient access to medical information including appointment bookings, test results and medication information. Stakeholders expressed a preference for accessing this information through a ‘Patient Portal’ or app. High Level Benefits Improved user experience; Reduction in Patient related risks associated with the Patient Communications process; Increased clinical efficiency; Increased administrative efficiency; Utilisation and expansion of existing technical capabilities. • Electronic Medications There are over 60,000 patients treated in The Christie NHS Trust each year, with an estimated increase of over 13,000 in the next year. Almost every patient requires medicines during their stay. Medicine prescription and administration is largely based on paper charts. An electronic medication and prescribing system will enable the prescribing, supply and administration of medicines electronically bringing improved patient safety, productivity, financial and quality of care benefits. The Electronic Prescribing and Medicines administration system will provide: o Integrated (full) view of a patient’s medication history o Electronic communication of a prescription or medicine order o Clinical decision support including allergy and interaction checks o Audit trail by recording prescriptions and administration electronically The High-Level Benefits will be: o Improved patient safety due to reduction in medicine errors, adverse reactions and serious incidents caused by pen and paper-based processes. 6

o Real-time decision support by having a single and comprehensive view of a patient’s current and historical drug record o Reduction in infection rates through improved antimicrobial stewardship and staff burden on prescription auditing. o Reduced length of stay due to less delays in prescribing and administering medicines and preparing discharge letters. o Improved reporting on patient-level costing and monitoring of key performance indicators. o Streamlined operational and clinical processes by implementing more efficient processes for medicines administration and prescribing. o Modernisation addressing a core digital capability requirement for the trust. o Improved communication of real-time information between prescribers, pharmacy, and nursing.

• Electronic Referrals There are currently disparate referral channels into the Trust and a poor experience for patients. Joining up the clinical acceptance and prioritisation of the referral with the booking process is complex. There is currently an army of staff working hard to ensure optimum prioritisation, but this is complicated by the lack of a standard approach. This is a clear ‘Core digital capability’ issue, which has divisional support. There were over 26000 referrals to The Christie NHS Trust last year, with an estimated increase of over 13,000 in the next year which means number of issues with referral management is going to rise. The referral management process includes: Referral submission from the UK and internationally, referral completeness checks (minimum dataset), adding information (minimum dataset) from the referral to patient record, referral triage by a doctor High-level outcomes and benefits Reduced clinical risk due to reduction in delayed or lost referrals thanks to unified processes for processing; Less staff time spent on chasing missing information and scanning and uploading documents; Improved clinical effectiveness due reduced waiting time to first appointment; Transparency and timely reporting on referrals processing, warnings about delays; Real-time view of referral processing, the ability to monitor and evaluate key performance indicators; Increased patient satisfaction. 3. Improving the Pharmacy Experience Over the year, pharmacy aimed to reduce prescription waiting times and improve patient experience by introducing new models of delivery. Objectives set for the year included: • A 20% increase in the number of eligible patients utilising the pharmacy medication delivery service. • Evaluation of patient experience through survey results, compliments, PALS and complaints contacts. In common withmany clinical services, the impact of the ongoing Covid19 pandemic resulted in significant challenges for pharmacy. Despite this, the service supported significant increases in activity, with on-site dispensing growing from 24,900 prescription items per month to 28,700 prescription items per month by year-end (a 15% increase). Pharmacy achieved a 30% increase in home medication deliveries (from 16,538 in 2020/21 to 21,511 in 2021/22) and our Christie@Home nursing team administered almost 7,500 treatments, a 25% increase on the previous year. On-site waiting times unfortunately remained relatively static despite the increased activity, hampered by the reducing reliability of our robotic dispensing system which is coming to the end of its working life. However, the Trust has approved purchase of a new robot dispensing system and a new outpatient pharmacy (scheduled to open late in 2022/23) which are anticipated to improve the patient experience by reducing prescription turnaround times and providing a more comfortable waiting space for patients. Pharmacy reported the results of two patient satisfaction surveys in 2021/22, both relating to medication delivery services during Covid19 lockdowns:

7

• Clinical trial medication delivery service from the Trust’s clinical trial dispensary, allowing patients to remain on their study despite covid restrictions: 94% of patients satisfied • Delivery service from The Christie Pharmacy dispensary: 94% agreed it was easy to arrange the delivery and 98% agreed it was easy to receive the delivery. As in previous years, the number of complaints and PALS contacts fortunately remained low. For 2022/23, the pharmacy team is working on additional service developments, aiming to expand and enhance medicines delivery systems, with a particular emphasis on improving communication, to implement more robust emergency delivery arrangements and support the expansion of Christie@ (other hospitals) satellite services.

8

2.2 Our quality ambitions for 2022/23 1. Improving patient falls prevention and management

We will continue to develop our programme of falls prevention and management interventions to keep patients safe. We want to learn from all our patient falls, not just those that result in harm. This will be evidenced by: • There will be no more than 3.35 inpatient falls per 1000 occupied bed days • We will introduce improved falls prevention and management awareness training to front line clinical staff • We will relaunch our Falls Prevention Group with a new format to monitor the delivery of our ambitious falls action plan • We will develop the way we learn from Outpatient falls through our new Outpatient Falls Prevention leads This quality improvement will be monitored and measured monthly through the Falls Prevention Group, and a report will be provided for information to Friday FoCUS (Focus on Care Understanding Safety) meetings every 2 months. 2. Review, reintroduction and expansion of the Christie Quality Mark for all Christie satellite sites The Christie Quality Mark Accreditation was introduced in response to our patients expressed need to be assured that wherever they receive their treatment they can feel confident that it is of the same high standard. We will restart the programme of the Christie Quality Mark accreditation that was paused during covid and expand to new sites not previously accredited. This will be evidenced by: • The standards and process for accreditation will be reviewed to ensure it meets current service delivery and practices. • A full programme of inspections will be planned to include all sites that deliver chemotherapy and radiotherapy treatments. • All sites will be inspected as per the planned programme. • An engagement and re-education programme will be initiated with all sites to ensure a full understanding of the Quality Mark and the expectation for sites to achieve accreditation. This quality assurance and improvement accreditation process will be measured through the monitoring of the programme of accreditations and by the production of individual assessment reports that will be presented to Quality Assurance Committee. 3. Development and expansion of the Christie Quality CODE The Christie CODE Quality Scheme is a framework for measuring the quality of CARE provided to patients by OBSERVATION, clear DOCUMENTATION and patient and staff EXPERIENCE, with areas accredited according to a comprehensive set of standards. We will continue the development and expansion of the Christie Quality CODE to include new areas not previously accredited. This will be evidenced by: • The Clinical Research Facility (CRF) and the Acute Ambulatory Care Unit (AACU) will undertake their initial CODE accreditation. • A programme of revalidation will be established to revalidate all previously accredited wards. • Two new standards (‘Care of the patient in last days of life’ and ‘Care of the patient with 9

diabetes or risk of hyperglycaemia’) will be formally included in all new and ongoing CODE accreditations. This CODE accreditation process will be measured through the monitoring of the programme of accreditations and the production of individual assessment reports that will be presented to an Executive quality panel to give the formal accreditation decision.

10

The Quality Improvements in the hospital are underpinned by our Quality Plan which was rolled over for 2021/22. A new quality plan is being developed for the coming year 2022/23. The driver diagram below sets out our overarching ambitions:

11

2.3

Statements of assurance from the Board

2.3.1 Review of services During 2021/22 The Christie NHS Foundation Trust provided 14 relevant national health services:

1. Critical care 2. Haematology and transplantation 3. Specialist surgery 4. Endocrinology

5. Clinical oncology 6. Medical oncology

7. Acute oncology 8. Chemotherapy 9. Radiotherapy including intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT) 10. Brachytherapy and molecular imaging 11. Teenage and young oncology 12. Radiology 13. Christie Medical Physics & Engineering 14. Proton Beam Therapy The Christie has reviewed all the data available to them on the quality of care in all 14 of these relevant services. This takes place through monthly performance reviews, at our Management Board and Risk and Quality Governance Committee. The income generated by the relevant health services reviewed in 2021/22 represents 100% of the total income generated from the provision of NHS services by The Christie for 2021/22. 2.3.2 Participation in clinical audits and national confidential enquiries During 2021/22, 11 national clinical audits and 1 national confidential enquiries covered relevant health services that The Christie NHS Foundation Trust provides. During 2021/22, The Christie participated in 100% national clinical audits and 100% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that The Christie was eligible to participate in and participated in during 2021/22 are as follows: 1. Bowel cancer (NBOCAP) 2. ICNARC Intensive Care National Audit and Research Centre Case Mix Programme (CMP) 3. Lung cancer (NLCA) 4. National Cardiac Arrest Audit (NCAA) 5. National Emergency Laparotomy Audit (NELA) 6. National Prostate Cancer Audit 7. Oesophago-gastric cancer (NAOGC)

8. National Audit of Care at the End of Life (NACEL) 9. Learning Disabilities Mortality Review (LeDeR) 10. National Acute Kidney Injury Programme (NAKIP)

12

11. National Comparative Audit of Blood Transfusion programme: Patient Blood Management against NICE Guideline NG24 2021 12. NCEPOD Transition from child to adult services study

The national clinical audits and national confidential enquiries that The Christie participated in, and for which data collection was completed during 2021/22, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. Name of audits and enquiries Numbers submitted (eligible) Percentage of Eligible Submitted NBOCAP 100/100 100% ICNARC (CMP) 345/345 6m to 30 Sep; awaiting national report 100% NLCA 100%

Treatment data only submitted via COSD data – recorded against Trust first seen

NCAA

6/6

100%

NELA

1/ 28

4%

NPCA

Data submitted via COSD –

100%

recorded against Trust first seen

NOGCA

460/460

100%

NACEL

66/66

100%

LeDeR

0/0

100%

NCABT (PBMaNG)

40/40

100%

NAKIPg

6609/6609

100%

NCEPOD (TfCtAS)

ongoing

NA

13

2.3.3 Participation in clinical research The Christie has a long history of supporting research through its 100 plus year history; this was recognised in 2007 with the creation of a dedicated Research and Development Division, now Research and Innovation (R&I) Division. The R&I Division serve a population of 3.2 million and is the largest cancer research network in the country. The success of research is demonstrated by a varied portfolio of studies, strong recruitment of patients on to clinical trials and academic publications with a high impact. Currently the portfolio of Christie research is made up of early phase clinical trials (35%), late phase clinical trials (41%) and other research including basic science, biobank and observational studies (24%). The number of patients receiving health services provided or sub-contracted by The Christie in 2021/22 that were consented during this period to participate in research was 4167. When excluding COVID-19 studies, this represents a 58% increase in consented patients from 2020/21 and a 17% increase from 2019/20. Since 2015/16 there has been a 79% increase in patients consented to research studies at The Christie. 2.3.4 Quality goals and the CQUIN framework Due to the national COVID-19 pandemic, the payment approach was amended. The element of funding that would traditionally have been conditional on achievement of CQUIN milestones The Christie NHS Foundation Trust is required to register with the Care Quality Commission (CQC) and its current registration status is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983. The Christie NHS Foundation Trust has no conditions on registration. The Care Quality Commission has not taken enforcement action against The Christie NHS Foundation Trust during 2021/22. 2.3.6 CQC Responsive Inspection The Christie NHS Foundation Trust has not been part of any responsive inspections during 2021/22. We have however continued regular engagement with the CQC in relation to the COVID -19 pandemic. 2.3.7 CQC Inspection Programme The Christie NHS Foundation has not been part of any CQC Inspection Programme during 2021/22. 2.3.8 Data Quality The Christie is due to submit records during 2021/22 to the secondary uses service (SUS) for inclusion in the hospital episode statistics which are included in the latest published data. The percentage of records in the published data are as follows: was unconditional for 2021/22. 2.3.5 Care Quality Commission

14

% of records in published data which included the patient’s valid NHS number

% of records in published data which included the patient’s valid general practitioner registration code

Admitted patient care

99.8% 99.8%

99.7% 99.6%

99.70%

Outpatient care

Accident and emergency care

Not applicable

Not applicable

2.3.9 Information Governance The Christie NHS Foundation Trust’s Data Security and Protection Toolkit compliance overall score for 2020/21 resulted in standards met. Mersey Internal Audit Agency, the Trust’s internal auditors, provided assurance to the evidence provided in the Data Security and Protection Toolkit. The 2021/22 Data Security and Protection Toolkit assessment is covering from May 2021 to June 2022 having been taken out of alignment with finical reporting periods in recognition of the impact of the pandemic. The Trust is working towards continued compliance, with internal auditor verification in place. 2.3.10 Payment by Results / Information Governance The Christie NHS Foundation Trust was not subject to the Payment by Results (PbR) clinical coding audit during the reporting period. An IG clinical coding audit took place in March 2022, by the Trust’s NHS Digital approved auditor the results of this audit are as follows: % Correct Primary diagnosis 92.0% Secondary diagnosis 91.3% Primary diagnosis 95.8% Secondary diagnosis 91.9% 2.3.11 Data quality The Christie NHS Foundation Trust as part of its quality improvements programme will be taking the following actions to improve data quality: • Establishment of 2 Data Quality Officer posts within the Performance Team – in the last year an increased number of daily/weekly quality checks have been completed across a wider variety of data items. Further expansion of the daily and weekly reports to coincide with separating the Access target and Data Quality reports from the current Access meeting. • Plan to split the weekly Access meeting (access targets and data quality currently reviewed) into separate fortnightly meetings at which Access Targets and Data Quality are discussed separately. It is believed by splitting the meeting will improve the focus on Data Quality • RTT overview – 2 sessions over 2 days to provide an overview to assistant service managers and support managers from the Trust operational teams in how the Trust PAS manages RTT. This was facilitated by Performance Management and a system specialist from the Trust PAS provider. 20 members of staff from across the Trust attended.

15

• The Trust continues to use the mini-spine dashboard for the identification of Master Patient Index (MPI) discrepancies between the Trust MPI and the NHS National Spine. • Re-introduction of the Radiology Information System (RIS) User Group. This meeting will bring together all of the imaging services who utilise RIS with an aim to improve the consistency with which activity is recorded across all of the teams. • Worked, and continue to work, collaboratively with commissioners to respond to data challenges

16

2.3 Reporting against core indicators

The Christie Performance 2020/21

The Christie Performance 2021/22

National average

National Highest/ lowest

NHS Outcomes Framework

Indicator

Preventing people from dying prematurely. Enhancing quality of life for people with long-term conditions.

The value and banding of the summary hospital-level mortality indicator (“SHMI”) The percentage of patient deaths with palliative care coded at either diagnosis or specialty level

This is not applicable to The Christie as we are a specialist cancer hospital.

The Christie NHS Foundation Trust considers that this indicator is not applicable to the Trust as all our patients have a cancer diagnosis and are not part of the inclusion criteria.

The Christie Performance 2020/21

The Christie Performance 2021/22

National average

National Highest/ lowest

NHS Outcomes Framework

Indicator

Helping people to recover from episodes of ill health or following injury

The Trusts patient reported outcome measures scores for: i. groin hernia surgery ii. varicose vein surgery iii. hip replacement surgery iv. knee replacement surgery

This is not applicable to The Christie as we are a specialist cancer hospital.

The Christie NHS Foundation Trust considers that this indicator is not applicable to the Trust as all our patients have a cancer diagnosis and are not part of the inclusion criteria.

NHS Outcomes Framework

Indicator

The Christie Performance 2020/21

The Christie Performance 2021/22

National average

National Highest/ lowest

Helping people to recover from episodes of ill health or following injury

The percentage of patients aged: i. 0 to 14 ii. 15 or over Readmitted to a hospital which forms part of the Trust within 28 days of being discharged from hospital which forms part of the Trust.

This is not applicable to The Christie as we are a specialist cancer hospital.

The Christie NHS Foundation Trust considers that this indicator is not applicable to the Trust as all our patients have a cancer diagnosis and are not part of the inclusion criteria.

17

NHS Outcomes Framework

National average 2020/21

Indicator

The Christie Performance 2020/21

The Christie Performance 2021/22 Available on NHS Digital August 2022

National Highest/Low est 2020/21

The Trust’s responsiveness to the personal needs of its patients

Ensuring that people have a positive experience of care

H - 85.2% L – 67.3%

74.5%

84.4%

The Christie NHS Foundation Trust considers that this data is as described for the following reasons: to show the percentage of patients receiving a good experience of care whilst under the care of The Christie. The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required: This will be reviewed through monthly Board level scrutiny of patient satisfaction surveys and the National Friends and Family test.

NHS Outcomes Framework

Indicator

The Christie Performance

The Christie Performance

National average

National Highest/ Lowest

The percentage of staff employed by, or under contract to, the Trust who would recommend the trust as a provider of care to their family or friends.

Ensuring that people have a positive experience of care.

This is no longer applicable; this has been replaced by the PULSE quarterly survey that commenced in April 2021

The Christie NHS Foundation Trust considers that this data is as described for the following reasons: to show the percentage of staff who would recommend The Christie as an organisation that provides good quality care for their family or friends. The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required: This will be reviewed through quarterly Board level scrutiny of the outcomes of the National Staff Friends and Family Test.

18

NHS Outcomes Framework

Indicator

The Christie Performance 2020/21

The Christie Performance 2021/22

National average 2020/21

National Highest/Lowest 2020/21

The percentage of patients admitted as an inpatient to the Trust who would recommend the trust as a provider of care to their family or friends.

Ensuring that people have a positive experience of care.

H - 100% (Jan-21 - Apr- 21 data) L - 54.4% (Jan-21 - Apr- 21 data)

94.9% (Jan-21 - Apr-21 – suspended due to COVID)

95.80%

95.40%

The Christie NHS Foundation Trust considers that this data is as described for the following reasons: to show the percentage of patients admitted to the Trust who would recommend The Christie as an organisation that provides good quality care for their family or friends. The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required: This will be reviewed through monthly Board level scrutiny of the National Friends and Family test.

NHS Outcomes Framework

Indicator

The Christie Performance 2020/21

The Christie Performance 2021/22

National average 2021/22

National Highest/ lowest 2021/22

Percentage of patients who were admitted to hospital and who were risk assessed for venous thromboembolism

Treating and caring for people in a safe environment and protecting them from avoidable harm.

VTE was suspended in March 2020 due to COVID. This has still not re-commenced, therefore there are no figures for VTE.

The Christie NHS Foundation Trust considers that this data is as described for the following reasons: to show the percentage of patients admitted to The Christie that have had a full risk assessment of venous thromboembolism. The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required: This will be reviewed through monthly Board level scrutiny of the results of the venous thromboembolism assessments on admission.

19

NHS Outcomes Framework

The Christie Performance 2020/21

The Christie Performance 2021/22

National average 2020/21

National Highest/ Lowest 2021/22

Indicator

Rate per 100,000 bed days of cases of C.difficile infection reported within the trust amongst patients aged 2 or over.

Treating and caring for people in a safe environment and protecting them from avoidable harm.

National data not available

H – 87.2 L - 0

84.3

25

The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required: This will be reviewed through monthly Board level scrutiny of the results of the C.difficile numbers and through the monthly review with our commissioners. **The Christie rate is high due to a relatively small number of bed days in comparison to the number of C- Diff cases. The number of cases only rose by 1 in 2021/22

NHS Outcomes Framework

The Christie Performance 2020/21

The Christie Performance 2021/22

National average 2020/21

National Highest/ Lowest 2020/21

Indicator

Treating and caring for people in a safe environment and protecting them from avoidable harm.

The number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

H - 5411 L – 466 H – 27 L – 0 H- 1.95% L- 0%

2887 0 0.00%

4635 12 0.26%

41053 12 0.26%

The Christie NHS Foundation Trust considers that this data is as described for the following reasons: to record the incidences of patient safety, the rate of incidences and the percentage of severe harm or death of patient safety incidences within The Christie. The Christie NHS Foundation Trust intends to take the following actions to improve this percentage and so the quality of its services, by continuing to monitor compliance to the above target and to take any remedial action if required This will be reviewed through the quarterly Patient Safety and Experience report.

20

2.4 Staff who “Speak Up” The Christie is fully committed to promoting an open and transparent culture across the organisation to ensure that all members of staff feel safe and confident to speak out. When staff feel confident and safe to speak up the following benefits are achieved: • The Trust is made aware of situations that could potentially impact on patient care. • The Trust has the opportunity to take action so that any detrimental consequence is avoided. • The Trust has the opportunity to learn. • Staff are able to share their anxiety about a situation and therefore reduce their stress. • Staff feel a greater sense of engagement, inclusion and support for Trust values. Every opportunity is taken to raise the profile of the importance of raising concerns and the support available and this has remained a priority during the pandemic. The Freedom to Speak Up service was referred to in bulletins, well-being guides as well as working from home support guide. Given the requirement to work from home for many staff, the Freedom to Speak Up Guardian has adapted the way in which they interact. This has included attending induction and medical inductions and other team meetings virtually, producing video introductions and adding information to the intranet. Senior staff have supported speaking up by sharing their reflections on speaking up and listening as video clips. Some of these clips have been used in student training. It is important that staff are able to choose a way to raise their concerns in a way that is right for them and that they are confident they will be supported both during and after raising their concern. The message that they will not suffer any detriment as a result of raising their concern is of equal importance. Staff are encouraged to speak with whoever they feel is most appropriate for them; this could be their manager, the Freedom to Speak Up Guardian, the HR team, any member of the Senior team or the non-executive director with a responsibility for Freedom to Speak Up. Those who receive the concern have a clear responsibility to listen, thank the person raising the concern and keep them updated with progress in a manner that is right for them. Freedom to Speak Up Champions have been introduced to give wider diversity in who staff can speak up to. They promote a safe speaking up culture and act as a valuable resource for discussing with individuals their query or concern and signposting individuals to the relevant people, policies or frameworks. Those who raise concerns with the Freedom to Speak Up Guardian are asked for their views on their experience of raising a concern, including any detriment so that any shortcomings are identified and addressed. The NHS staff survey also provides information on staff views on speaking up that is used to make improvements.

21

Part 3: Other Information Review of quality performance in 2021/22

In February 2009, The Christie adopted a framework for quality reporting (see diagram) which provides the framework for monthly quality accounts reporting as part of our regular performance reports and this annual document. The Board of Directors believes that quality of care should where possible be reported and scrutinised frequently so that adverse trends can be identified early. The monthly quality performance for the Trust as a whole are reviewed at the Management Board with key senior clinical leaders, as well as the Directors of Research and Education. Quality metrics for individual divisions are reviewed as part of the regular performance review meetings with the executive team. Any matters of concern are followed up either through the divisional meetings or through the Risk and Quality Governance Committee. The Board’s Quality Assurance Committee is responsible for providing board assurance on quality issues. Reports on quality of care are made to the Council of Governors meetings and a governor sub-committee on quality receives reports and assurance of the quality work of the Trust. The executive team regularly reviews the quality of care within the hospital through visits to clinical areas, through a programme of Executive walk rounds. Non-Executives and Governors also undertake regular visits to clinical areas to see at first hand the quality of care and environment and to hear directly from patients about their experience of the hospital. These visits have not taken place over the past year due to COVID-19. This will be reviewed in 2022/23. This section of our quality accounts draws on monthly performance reports and includes additional annual indicators for which annual reporting is appropriate. The data is drawn from regular surveys, audits or routine data systems that have been established to provide a focus on and assurance about quality of care.

Components of Comprehensive Cancer Centre

Education

Research

Clinical Service

Safety

Effectiveness

Experience

Patient experience Satisfaction levels with care provided at The Christie are extremely high and all our efforts are directed towards ensuring the best possible experience for patients at a time of enormous stress and worry for them and their families. PLACE Assessment Due to the national COVID-19 pandemic, the 2021/22 PLACE assessments were suspended. However, a PLACE lite assessment was completed November 2021, where clinical and non-clinical staff undertook an assessment of outpatient areas to provide internal assurance. The intention is to complete The Christie PLACE assessment September 2022 implementing updated guidance from the national steering group regarding the assistance of voluntary bodies participating in the process.

22

Patient experience stories to the Board Board meetings are held on the last Thursday of the month at 12.45pm. There are no meetings in February, July, August or December.

Date

Presenter

Topic

Dr Richard Berman

Supportive Care services at The Christie during the pandemic Clinical Advisory Group formation and impact during Covid-19 Teenagers and Young Adults (TYA) and Endocrinology

Thursday 29 th April 2021

Thursday 27 th May 2021

Dr Dan Saunders

Anna Castleton / Hanna Simpson

Thursday 24 th June 2021

July

No meeting

August Thursday 30 th September 2021

Mr Chelliah Selvasekar Matt Bilney

Christie mutual aid

Thursday 28 th October 2021

Visit to inpatient wards

Thursday 25 th November 2021

Bernie Delahoyde

Macclesfield Cancer Centre

December

No meeting

Thursday 27 th January 2022

COVID-19 meeting

February

No meeting

Thursday 31 st March 2022

Vidiya Kasapandian / Kerry Millington

Critical Care and Outreach Service

The Christie CODE

The Christie CODE is our framework for measuring the quality of care provided to patients through observation, clear documentation and patient and staff experience. The CODE has enabled ward leaders and their teams to adopt quality assurance and improvement as the underpinning foundations of their everyday practice in a coherent, focused and systematic way, whilst supporting our culture of openness and candour. This framework strengthens professional leadership, empowers doctors, nurses, allied health professionals and other team members to lead and deliver quality improvements at ward level for patient benefit.

23

There are 14 standards covering the fundamentals of nursing care, plus management and leadership. Each standard is based on current evidence of best practice, national legislation, and regulatory guidance. The aim of the scheme is: • To put patients at the centre of everything we do. • To celebrate excellence. • To demonstrate commitment to quality improvement. • To have methodological rigour and draw on the evidence base in the development of standards and in the process used to assess levels of performance. • To share best practice. • To be inclusive of all multi-disciplinary staff who make a substantial contribution to the delivery of clinical care. All six of our wards are accredited with ‘gold’ status and all of them have demonstrated maintenance of the CODE standards through annual re-accreditation, this process continued throughout the COVID-19 pandemic. Two additional standards for diabetes care and end of life care have been successfully piloted and will be an integral part of the accreditation process going forward. More information on The Christie CODE can be found at http://www.christie.nhs.uk/about- us/about-the-christie/christie-quality/the-christie-code-quality-scheme/ Quality Strategy 2017 – 2020 Everything we do at The Christie is directed at achieving the best quality care and outcomes for our patients and The Care Quality Commission rating of ‘outstanding’ was underpinned by our five year strategy which is underpinned by our plans for quality and workforce. Our plans affirm the organisation’s commitment to improving quality and delivering safe, effective and personal care, within a culture of learning and continuous service improvement. Following consultation across the organisation, in September 2017 we launched the three year plan for 2017 – 2020. Aimed at staff, patients’ carers and stakeholders this plan sets out how we will govern, measure, recognise, transform and improve quality in care, acknowledging the significant impact that excellent leadership, collaboration and the culture within our organisation has on the experience and outcomes for patients and the experience and empowerment of our staff. We will continue to strengthen professional leadership, empowering doctors, nurses, allied health professionals and all our other clinical and non-clinical staff to lead and deliver quality improvements. This builds on the positive and proactive work that has already been undertaken to maintain patient safety, deliver effective treatments and enhance the patient experience. We will continue in our drive to improve the quality of care for our patients by ensuring cost effectiveness and efficiency through the creative use of finite resources. As with everything we do at The Christie, our service is underpinned by meaningful communication and the provision of care by compassionate, committed, and competent staff.

24