The Christie Foundation Trust Annual Report and Accounts 2021-22

Annual Report and Accounts 2021/22

The Christie NHS Foundation Trust Annual Report and Accounts 2021/22

The Christie NHS Foundation Trust Annual Report and Accounts 2021/22

Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006

© 2022 The Christie NHS Foundation Trust

The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Contents

Page

Overview Chair and Chief Executive’s Statement

2

Our Performance About us

4 6 9

Dominated but not defined by the pandemic

Radiotherapy

Christie Medical Physics and Engineering Systemic Anti-Cancer Treatment Service (SACT)

11 12 13 14 15 18 19 21 23 27 31 36 37 38 41 43 44 46

Haematology Anaesthetics, Theatre & Surgery

Clinical Support Services

Pharmacy Inpatient Services

Radiology

Research and Innovation School of Oncology

Our Financial Performance 2021/22 Focusing on people who count

Our strategy Greener NHS

Awards and Accolades Our generous supporters

Membership: keeping people involved

Quality report

Accountability report Directors’ report Our council of governors

94

109 115 123 133 134 135

Staff report

Remuneration report

System oversight framework

Statement of compliance with NHS FT Code of governance

Statement of the Chief Executive’s responsibilities as Accounting Officer of The Christie NHS Foundation Trust

Annual governance statement

1 3 6

Independent auditor’s report to the council of governors of The Christie NHS Foundation Trust

149

Accounts 2021/22 Foreword to the accounts Financial statements 2021/22

15 7 1 58 1 6 3

Notes to the accounts

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Chair and Chief Executive’s statement

Welcome to our Annual Report and Accounts for 2021/2022. As the entire world has continued to be consumed with the effects of the COVID 19 global pandemic, The Christie has remained determined to ensure cancer care has safely continued throughout, and we are proud to celebrate another successful year - defined, but not dominated, by the pandemic. The latest wave of the COVID-19 outbreak once again affected each and every one of us and has been a very difficult and worrying time for our patients and our staff. And we applaud each and every member of our team at The Christie who have made patient care our highest priority. We have continued to ask great things of our staff where exceptional circumstances have become normal, and for that we couldn’t be more proud. Throughout the pandemic, The Christie has operated as a protected site, working under strict biosecurity measures to ensure we have been consistently able to treat our patients safely. We continue to be amazed by our patients, who have adapted to the necessary changes in the best spirit possible. We understand how difficult it has been to ask patients for example to restrict visiting, but everyone has responded with positivity and acceptance, remaining reassured by all we have done for the safety of both those in our care and our staff. Following the Government’s decision to end some COVID-19 restrictions in early 2022, we continue to take a approach to the easing of measures in our hospital. The vulnerability of our patients to the virus mean it is vital that we adopt this approach. But right now, we are very much business as usual for our patients, including those who have been affected by COVID-19. We also continue to provide some additional treatment for patients who may usually have received their cancer care in other hospitals across our network. Whilst we have plans in place to maintain services should a

further wave of COVID-19 infection take place, we are developing plans that will continue to support the sustained delivery of our services going forward as well as supporting the full recovery of cancer service across other care providers in our Greater Manchester system. Whilst it is important to recognise the impact that COVID-19 has had on our organisation, it is equally important to ensure that it does not overshadow another important year of progress and development for The Christie. We are continually striving to improve the care we offer to our patients and to develop our cancer research and education. We remain focused on our strategy. Our four key themes; Leading cancer care, The Christie experience, Local and specialist care, and Best outcomes remain as important as ever as we adapt to new circumstances and evolving demands. This Annual Report contains many examples of our pursuit of innovation and progression towards being a world-class cancer centre. This year we were delighted to open our new treatment centre in Macclesfield, where clinically appropriate patients can receive gold standard Christie care nearer to their own homes, including radiotherapy, chemotherapy and holistic support. Mainly funded through The Christie Charity, this development is a perfect example of how public support and our fundraisers play a key role in making what we do possible. Another building project continuing to take shape is our new research facility, currently known as the Paterson Redevelopment Project, which is now nearing completion on our Withington site. This will be a purpose-built biomedical cancer research facility, allowing us to develop our research capability like never before. Hand in hand with our partners, The University of Manchester and Cancer Research UK, this new

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

centre will help us achieve our ambition of leading the world in clinical trial recruitment, supporting the development of new and kinder cancer therapies. Whilst some delays have been inevitable, research progress does not stall. Despite the challenges we have faced, our programme of clinical trials has continued, giving patients access to new treatments and new hope. Alongside our research activities, our expertise also remains in demand. We have been able to continue progression in both The Christie School of Oncology and The Christie International. Our world-renowned clinicians continue to be in demand across the globe for their knowledge and experience in cancer care and education. The Christie is proud to achieve everything it does through a whole team effort. None of our achievements would be possible without our staff, partners, governors, members, volunteers, charity, patients and so many others we work with across Greater Manchester and Cheshire, as well as nationally and internationally. We would like to say thank you to all those involved for your commitment and dedication in our goal to provide the very best care for our patients and for your continued support during another difficult year. As we look ahead to 2022/2023, we know that there will be further challenges to face. But as we continue to move forward, we look ahead with positivity.

Christine Outram Chairman

Roger Spencer Chief Executive

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

About us

As renowned world experts in cancer care, research and education, at The Christie we are incredibly proud of our reputation locally, regionally, nationally and internationally. Absolutely everything we do is driven by our goal to constantly improve services for our patients and to provide the best cancer care possible. We have over a century of expertise in our field, and we ensure that experience is used to keep us at the forefront of cancer care and driving innovation. The Christie is one of Europe’s leading cancer centres, treating over 60,000 patients a year. We provide a regional service and have ambitions nationally and internationally. We are based in Manchester and serve a population of 3.2 million across Greater Manchester and Cheshire, but as a national specialist around a quarter of our patients are referred to us from other parts of the country. We employ over 3,000 staff and had an annual turnover last year of £412 million. We are the largest radiotherapy provider in the NHS. We are also the largest provider in Europe, with one in 20 radiotherapy treatments delivered by The Christie. We are one of only two cancer centres worldwide to offer both MR-linac and high energy proton beam therapy. We deliver chemotherapy treatment through the largest chemotherapy unit in the UK, as well as via 14 other sites across Greater Manchester and in patients’ homes. We are a specialist tertiary surgical centre concentrating on rare cancers, specialist procedures and multidisciplinary cancer surgery. We are one of the largest hyperthermic intraperitoneal chemotherapy (HIPEC) centres in western Europe and one of only two in the UK to provide this treatment for appendiceal and colorectal tumours. We have one of the largest

robotic centres and the largest complex pelvic cancer team in the UK. This year we were delighted to open our new centre in Macclesfield. The new centre provides a range of holistic services including radiotherapy, chemotherapy, immunotherapy, hormone therapies, haematology treatments, outpatient care, nurse led clinics, counselling services, an information centre, palliative care and a wider range of clinical trials. It will deliver 12,500 radiotherapy treatments every year and 6,800 chemotherapy, immunotherapy and hormonal treatments. The centre includes specialist examination rooms, a new chemotherapy suite, a CT scanner where treatments are planned, counselling and complementary therapy rooms, a cancer information centre, a charity centre and a refreshment area. The Christie NHS Foundation Trust was the first specialist trust to be rated as ‘Outstanding’ twice (in 2016 and 2018) by the health regulator the Care Quality Commission (CQC). It referred to The Christie as ‘a leader in cancer care’ and ‘a pioneer in developing innovative solutions to cancer care.’ The CQC praised the Trust’s staff which it said ‘go the extra mile to meet the needs of patients and their families’ and that they were ‘exceptionally kind and caring.’ Our expertise is widely sought. Nationally, The Christie’s School of Oncology was the first of its kind in the UK to provide undergraduate education, clinical professional and medical education. Christie International allows us to share our learnings and reputation as a world leading centre of excellence to generate revenue through offering guidance and commercial partnerships with the proceeds being invested into cancer services for NHS patients.

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Our performance

Maggie’s Charity, it was the first of its kind in the North West. Our Charity is one of the largest NHS Charities in the UK, providing enhanced services over and above what the NHS funds. It has over 50,000 supporters who helped raise £13.2m this year. With 81p in every pound raised going directly to the patients, we work hard to make sure that the money donated to us is spent where the hospital needs it most. All our achievements and successes are only possible due to our dedicated and specialist staff, hardworking volunteers, generous and loyal supporters and fundraisers and our interested and enthusiastic public members, all bringing with them a wealth of experience, knowledge and understanding. The key issues and risks that could affect us as a Foundation Trust in delivering our objectives are managed on a monthly basis by our board assurance framework which can be viewed through the public board papers available on our website. Our overall performance in 2021/2022 has been excellent. The Christie is one of only eight specialist trusts in England deemed to have maximum autonomy and no potential support needs by NHS Improvement. This places us in the top 15% of NHS providers in the country. This Annual Report contains many examples of our pursuit of innovation and progression which embrace our vision for a truly world-class cancer centre.

We are ranked as the most technologically advanced cancer centre in the world outside North America, and have been named, by the National Institute for Health Research (NIHR), as one of the best hospitals providing opportunities for patients to take part in clinical research studies. The Christie is one of Europe's experimental cancer medicine centres and an international leader in research and development with around 650 clinical studies ongoing at any one time. The NIHR Manchester Clinical Research Facility at The Christie provides a high quality, dedicated clinical research environment for our patients to participate in trials. We are part of the Manchester Cancer Research Centre (MCRC) working with The University of Manchester and Cancer Research UK. The MCRC partnership provides the integrated approach essential to turn research findings in the laboratory into better, more effective treatments for patients. Building on Manchester’s strong heritage in cancer research, the MCRC provides outstanding facilities where scientists, doctors and nurses can work closely together. With our partners, we are currently building a new world class transformational research facility to replace the Paterson building which was destroyed by fire in 2017. We are also one of seven partners in the Manchester Academic Health Science Research Centre. We share a common goal of giving patients and clinicians rapid access to the latest research discoveries and improving the quality and effectiveness of patient care. There are only six health science centres in the country. The Christie is home to a Lord Norman Foster designed Maggie’s Centre which is based on our site and offers emotional and practical support to our patients and their families. Run by the

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Dominated but not defined by the pandemic

During 2021/22, many of our efforts have continued to revolve around providing safe, quality services for our patients during an unprecedented global pandemic. Yet despite the pressure our response to COVID-19 has placed upon our organisation, we are proud to have been able to ensure our care has remained of the highest standard possible throughout. As mentioned throughout this report, there are many examples of how both our patients and staff have adapted to the changes we had to implement, and of the dedication and determination of every single person in The Christie team to ensure we deliver the highest levels of care, and that we continue our progression and innovation as we maintain our ambition to develop a truly world-class cancer centre. During the pandemic, The Christie has operated as a protected site, working under strict biosecurity measures to ensure we have been consistently able to treat our patients safely. We continue to be amazed by our patients, who have adapted to the necessary changes in the best spirit possible. We understand how difficult it has been to ask patients for example to restrict visiting, but everyone has responded with positivity and acceptance, remaining reassured by all we have done for the safety of those in our care. And we applaud each and every member of our team at The Christie who have made patient care our highest priority. We have continued to ask great things of our staff where exceptional circumstances have become normal, and for that we couldn’t be more proud. Right now, we are very much business as usual for our patients, including those who have been affected by COVID-19. We also provide some additional treatment for patients who may usually have received their cancer care in other hospitals across our network. Whilst we have

plans in place to maintain services should a further wave of COVID-19 infection take place, we are developing plans that will continue to support the sustained delivery of our services going forward as well as supporting the full recovery of cancer service across other care providers in our Greater Manchester system. The Christie is working closely with the cancer alliance to accelerate the recovery of cancer services across Greater Manchester. Actions include The Christie providing additional cancer surgical capacity to support mutual aid arrangements with other hospitals. Following the Government’s decision to end COVID-19 restrictions, we continue to take a risk based approach to the easing of measures onsite. The vulnerability of our patients to the virus mean it is vital that we adopt this approach. As we continue our strive to get our services back to normal, our strategy at The Christie remains focused on four key themes: Leading cancer care, The Christie experience, Local and specialist care, and Best outcomes. Our desire is to always give the very best care and treatment to our patients, and we work tirelessly to ensure everything we do is focused on this goal. Feedback is one of the main ways we identify our strategy is working, and we continue to perform well in surveys and patient feedback exercises. The Christie once again received excellent results in the annual 2020 national inpatient survey. This is testament to the incredible hard work and excellence of our staff particularly our ward nurse leaders. The survey shows how The Christie scored against 137 other NHS trusts throughout England in a series of 45 questions considering all aspects of the inpatient experience. The Christie scored ‘much better than other trusts’ in around half of the survey questions (22 out of 45) and ‘better or somewhat better than other trusts’ in a further 21 out of 45 questions. In two of the survey questions, The Christie scored the same as

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

which has been particularly important as part of our drive to keep people safe during the pandemic. Another new building project which took major strides forward this year was our new research facility, currently known as the Paterson Redevelopment Project (PRP), which is now being built at The Christie to replace the fire-damaged Paterson building, which will be a purpose-built biomedical cancer research facility bringing together three powerhouses of innovation – The Christie, The University of Manchester and Cancer Research UK. Construction work is on track on the new facility which will be home to several hundred scientists, doctors, nurses and support staff who will be at the heart of our ambition to lead the world in clinical trial recruitment, supporting the development of new and kinder cancer therapies. Prior to the COVID-19 pandemic, our research and innovation team was already operating more than 650 clinical trials at any one time and was one of the biggest cancer clinical trials centres in Europe. Through our NIHR Manchester Clinical Research Facility at The Christie, staff and patients benefit from a large, high quality, dedicated clinical research environment where patients can participate in complex and early phase clinical trials. Research teams have continued to achieve the recruitment of the first patients to a number of UK, European and global clinical trials meaning that The Christie patients have had unique access to many pioneering therapies. Much of our research work is funded through donations and our Charity has continued to support the work of the Trust through its fundraising activities and delivers projects, equipment and improvements that are over and above what the NHS funds. Our Charity has faced another difficult year, with many fundraising events and activities put on

the highest mark given to any trust in England. This was for the time patients had been on the waiting list before being admitted to hospital and patients feeling that staff told them who to contact if they were worried about their condition or treatment after they left hospital. The Christie was also the highest scoring trust in the North West in 11 of the 45 survey questions. The Christie is proud to be the largest radiotherapy provider in the NHS. We are also the largest provider in Europe, with one in 20 radiotherapy treatments delivered at The Christie. We are one of only two cancer centres worldwide to offer both MR-linac and high energy proton beam therapy (the other is MD Anderson in Texas, US). This year saw the continued expansion of our state-of-art radiotherapy treatment using the MR-guided linear accelerator (MR-linac) which is the first machine of its kind to do real-time MRI scans while it targets X-ray beams at tumours, making it more accurate and reducing side effects. Being able to more specifically target tumours and avoid more healthy tissue around them means the machine can use target X-rays better. The £5.3M machine was part-funded by donations to The Christie Charity and this year we were delighted to able to begin to treat patients with lung cancer with this important new technique. As our patient numbers continue to grow, providing care closer to home is becoming ever more important and this year we were delighted when our plans for a new Christie cancer centre in Macclesfield came to fruition when we opened the doors to patients for the first time in December. The new building provides a purpose built unit for more than 1,500 patients attending up to 40,000 appointments every year. During 2021/22, we have also seen the further development of our services to provide chemotherapy closer to and in patients’ homes,

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

saying they would recommend the hospital to family and friends. The success of our clinicians also continues to be celebrated with many receiving praise regionally and nationally for their work. Elsewhere in this report the awards and accolades we are rightly proud of are celebrated. As a foundation trust, we are accountable to the communities we serve, and as such our public members play an essential part in sharing their opinions, shaping our future and making a vital contribution to how our services are developed. We acknowledge their extremely valuable input. This report looks back on the highlights of the last 12 months but also establishes our plans and aspirations for the year ahead. Whilst there is still much uncertainty about how the COVID-19 pandemic will continue to impact on The Christie throughout the next 12 months we are as well prepared as possible to make sure patients get the treatment, information and support they need. Without a doubt, the strength of our underlying patient centred culture, highly motivated and compassionate staff, oncology expertise and organisational culture will ensure that we can respond in an agile and effective way to any new demands placed upon us. As we look ahead to 2022/23, we know that there will be further challenges to face, in particular the need to respond to an increase in demand for our services from patients as a continued after effect of the pandemic. We are determined to continue to put patients at the heart of everything we do and do everything possible to provide the best possible treatment and care in the year ahead. We remain focused on innovation and improvement to ensure that all of our services are truly world-class.

hold due to the pandemic. Fortunately, as restrictions were eased in the latter part of the year, some of our events began to be reinstated. We remain incredibly grateful to those who have been able to support us throughout the year, albeit in a way that is different to normal. The Charity has over 50,000 supporters who helped raise £13.2m this year. This year saw the continued growth of our School of Oncology with our team delivering high-quality education and training to students, staff, and the national/international cancer workforce. The Christie School of Oncology is a world class teaching centre, bringing together professional and pre-registration education, plus continuing professional development activities into one structure. During this period, placements for 562 Manchester medical students were delivered. The team continues to thrive in the changed world of virtual training and conferencing with more than 5,000 delegates welcomed virtually. Alongside the School of Oncology, our Christie International arm continues to make progress, offering expertise and education to other cancer Commercial Services to deliver a new hospital in Abuja, Nigeria over the next decade. Clinical and technical expertise alongside education and training will be provided to establish the oncology unit at the hospital, which also specialises in cardiology and haematology. Headed up by clinical lead, Dr Lip Lee the £1.37M project will help further enhance the Trust’s reputation as a world leading cancer centre, provide an opportunity to reinvest in The Christie’s NHS services and further develop staff involved. Everything we achieve at The Christie is only possible because of our staff and their hard work and dedication. We continue to perform well in staff surveys, with the majority of employees centres across the globe. This year, we announced a collaboration with Kings

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Radiotherapy

Whilst the year 2021/22 saw the challenges brought about by the COVID-19 pandemic continue, it also saw the activity of the Radiotherapy services recover in line with demand. Up to the end of February 2022, the number of radiotherapy booking forms submitted (762) was consistent with that seen pre-pandemic (2019/20) whilst the number of fractions delivered is down by 1402 fractions per month. This reduction in fractions is directly attributable to the hypofractionation of breast radiotherapy, delivering it in 5 attendances instead of 15. Although this change was introduced as a mechanism to reduce footfall during the pandemic, it has continued to deliver excellent outcomes whilst making immeasurable gains in terms of patient experience. Furthermore, it has created capacity to continue with innovation and the development of new techniques, including: • The expansion of Stereotactic Body Radiotherapy (SABR) activity, including the introduction of a single fraction lung treatment technique; • The full roll-out of the breast Deep Inspiration Breath Hold (DIBH) technique across all centres; and • The introduction of daily imaging for bladder and prostate patients. The satellite centres have once again been a key part of our service improvement in year. The team at Salford have continued to drive advancements in Stereotactic Radiosurgery (SRS) working with the Radiotherapy Education team to create an SRS Digital Learning Platform and Christie Medical Physics & Engineering (CMPE) on the migration of SRS treatment planning onto the Raystation platform. The team at Oldham have received positive feedback nationally for their work on frailty assessment in radiotherapy, also recognised by their recent success in the Trust’s

Quality Improvement and Clinical Audit (QICA) Awards. Christie @ Macclesfield This year saw the culmination of the Macclesfield project, opening on 13 th December 2021. This is part of our strategy to bring advanced radiotherapy closer to home. The first patient was treated on the 7 th February, swiftly followed by their first lung SABR treatment on 18 th February. March has seen Macclesfield open its second machine alongside its first chemo radiotherapy indication (anus), which will soon be followed by bladder and gynaecological indications. Research It has been a year of firsts on the Magnetic Resonance Linear Accelerator (MRL), with the first Cervix, Lung and Head and Neck patients treated on the machine. Also notable is our first full fractionated cervix treated in 2021 using this technology - a world first! In addition to their clinical duties, throughout the year the MRL team have produced 5 published journal papers and have had material accepted at 6 separate conferences. From a trials perspective, 2021 was the first full year using the trials implementation process. This system allows the team to more accurately gauge the resource implications of developing a new trial, whilst providing an increased level of oversight and transparency to all stakeholders prior to set up. Since it was introduced, the system has seen a 100% uplift in the number of trials being given radiotherapy support. Proton Beam Therapy PBT activity has remained consistent with last year, with 290 patients having completed treatment by the end of February exceeding the full year projections of 207 patients set by NHS England – and this is despite the opening of University College London Hospitals NHS

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Our performance

Foundation Trust (UCLH) in December 2021. Paediatric capacity has been well utilised due to the closure of overseas PBT providers, with a particular focus on the general anaesthetic (GA) provision. The introduction of new working practices has led to improvements in both safety and efficiency, changes that will be retained as we move out of the pandemic. Work with the University of Manchester, Radiotherapy Education and Radiotherapy Research teams has continued supporting a record number of submissions to professional conferences and scientific journals alongside the continued success of the International Proton School. The Christie team were awarded the Chief Allied Health Professions Officer (CAHPO) Award for Creative Provision of Placements thanks to the delivery of the Clinical Placement Expansion Programme which gave undergraduate students the opportunity to develop key knowledge and skills relating to PBT supporting the national profile of PBT and future radiographer recruitment.

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Christie Medical Physics & Engineering

Christie Medical Physics & Engineering (CMPE) provides physics and engineering expertise for treatment and research at The Christie. In addition to providing and supporting core services at The Christie we provide medical physics services to other NHS trusts throughout the North West region and have clinical scientists, technologists and engineers at The Christie and the centres in Oldham, Salford and more recently Macclesfield. We are organised into several operational groups; radiotherapy physics, protons physics, imaging physics and radiation protection, nuclear medicine and medical illustration. The imaging physics and radiation protection group includes the specialist areas of diagnostic x-ray imaging, radiation protection, magnetic resonance imaging, ultrasound and optical radiation. The group supports activities at The Christie and also provides scientific support services to many hospitals in the North West and other private healthcare organisations. The size of the group and the specialist skills of the employees means it is well placed to take a lead role in the establishment of sustainable physics services to the North West Imaging Network. The nuclear medicine group provides diagnostic nuclear medicine, Positron emission tomography and computed tomography (PET-CT) and molecular radiotherapy (MRT) services at The Christie, alongside providing support to regional and national services. We are currently in the process of commissioning our new gamma camera, have begun refurbishing our radiopharmacy, and are working to expand our PETCT and MRT services to meet the increase in demand for both throughout the north-west of England.

The radiotherapy physics group provides clinical, scientific, and engineering support to radiotherapy services at The Christie and at its three satellites for both photons and protons. Treatment planning activity through the year has remained high and has now slightly exceeded pre-pandemic levels. Key achievements for the year include expansion of the SABR programme, clinical implementation of a new treatment planning system, RayStation, and commissioning the Macclesfield satellite. Treatment Planning Activity:

The PBT physics group have continued to support the expansion of the clinical proton service through increased patient numbers and the commissioning of new clinical indications (neuroblastoma, Wilm’s tumour and Lymphoma). We have continued to support existing clinical trials e.g. Torpedo which is recruiting ahead of schedule and developing new techniques for trials due to open in 2022 including a proton trial in breast cancer. In addition to this clinical development, the team have collaborated with the Precise research group on their projects (e.g. FLASH PBT) and with our colleagues at UCLH in supporting them while opening their centre.

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The Christie NHS Foundation Trust Annual Report and Accounts 2021-22

Systemic Anti-Cancer Treatment Service (SACT)

In 2021/22 over 77,000 SACT treatments were administered to patients across all our SACT treatment facilities. The development of new immunotherapy treatments for more disease groups and an increase in maintenance therapies meant that more patients were continuing on treatment for longer and increased planning was required to continue to manage this. The COVID-19 pandemic has continued to pose challenges over the last year. Activity has increased and we have now recovered to pre pandemic numbers. We have continued all our bio-security measures to ensure the safety of our patients and staff. Over the last year we have learnt we can continue to treat our patients safely with minimal disruption to their treatment pathway. We continue to look at new ways to manage staffing levels and activity. This year, in addition to our establishment, we introduced 8 Health Care Assistants and 2 Nursing Associates to the team to help with communications and to support patients and trained nurses with the delivery of treatment. Staff in all our units have worked hard to ensure treatment services have continued throughout the pandemic.

The continuous development of our Outreach Services has resulted in improved patient experience, a reduction in patient travel time and has released capacity on the main hospital site. We are aiming to deliver over 1,000 additional treatments at Macclesfield this year. In addition to the growing Outreach Service, we have been successful in securing funding for 3 years with the Charity to allow us to provide a Bloods Closer to Home Service, initially this is for our treatment patients with further expansion planned trust wide. The Christie@Macclesfield – December 2021:

Developments during 2021/22 • Continued to expand the Immunotherapy portfolio within the service • Introduction of more Hospice sites to treat more patients locally • Bloods Closer to Home • Our New Christie@Macclesfield unit opened • Continued to develop Pre-Treatment Consultations • Innovation Centre – Pump project • Expansion of our home care services • iQemo Scheduling

We are continuing to increase the number of patients being treated locally or within their own homes where possible. In 2021 we secured additional space in local Hospices. This has allowed us to expand our service with no disruption to patients’ treatment.

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The Christie NHS Foundation Trust Annual Report and Accounts 2021-22

Haematology

This year saw continued developments in the Haematology service with new complex treatments as well as new targeted treatments, which has resulted in the service adapting quickly while maintaining high standards of care. Like all services, there have also been changes to services required as a result of the COVID-19 pandemic. Our Haematology service provides inpatient, ambulatory, day case, apheresis and outpatient services in dedicated facilities at The Christie site. Haematology@Services In December 2021, the Haematology service provided by The Christie opened at Macclesfield to become our second full haematology @service, in addition to the Tameside service. The new Macclesfield service will provide expert local Haematology service to the population of East Cheshire, North Staffordshire and High Peak.

patients. However, this is expected to resume again as restrictions lift and there are plans for new protocols for ambulatory care in 2022.

CAR-T/Transplant Despite adjustments that were required to safely manage high risk transplant patients during COVID-19, transplant activity has remained steady overall with the CAR-T service growing. This is expected to grow further in 2022/23 as new products become licenced.

Palatine Ambulatory care Our dedicated ambulatory care facility is for haematology and TYA patients undergoing treatments via 24 hour infusion pumps to enable them to have treatment at home or in a home like environment. This facility opened in November 2018 and has now treated over 530 patients. Due to COVID-19 restrictions, the growth in activity through ambulatory care has slowed, in particular with relation to transplant

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Anaesthetics, Theatre and Surgery

Beyond COVID-19: the recovery plan While there has been a reduction in the number of new cancer cases last year, reflecting the impact of COVID-19 to primary and secondary care, diagnosing and referring new cancer cases to tertiary services; in 2021/22 we have seen activity increasing and returning back to pre-pandemic levels. Unfortunately, there is a recognised significant backlog of patients requiring non cancer surgery across GM. The Christie is providing additional cancer surgery capacity by mutual aid arrangements to facilitate the GM recovery plan and releasing surgical capacity locally. Our Services We provide a crucial service to local, regional and national populations. The majority of our work is based on rare and specialist cancers under the remit of specialised and highly specialised commissioning, whilst ensuring patients being treated non-surgically, within the comprehensive centre, are supported appropriately. The following specialties are represented within the directorate: • Anaesthetics and specialist oncology intensive care • Colorectal and Pseudomyxoma peritonei (PMP) oncology surgery • Gynaecological oncology surgery • Plastic oncology surgery • Urological oncology surgery The critical care service at the Oncology Critical Care Unit (OCCU) complements a comprehensive array of cancer specialties including oncological surgery, clinical and medical oncology and haematology. The eight-bedded unit is a mixed Level 3/Level 2 service. The Christie Private Care (TCPC) is a joint venture with a private health care provider (HCA) to improve and expand private patient services. In December 2020, The Christie opened 2 new TCPC dedicated operating theatres. These have been used flexibly throughout 2021 to provide additional capacity for elective cancer surgery.

Our directorate of Anaesthetics, Theatre and Surgery is a specialist tertiary centre that concentrates on rare cancers, specialist procedures and multi-disciplinary cancer surgery. Recovering from the COVID-19 pandemic, our teams of surgeons, anaesthetists, nurses and allied health care professionals are working in collaboration with health providers across Greater Manchester (GM). Response to the COVID-19 Pandemic Since March 2020, in response to the national lockdown, our surgical, anaesthetic and theatre teams have re-evaluated the clinical pathways for delivering clinical care. Cancer surgery continued whilst new clinical processes were put in place to ensure the safety of both patients and staff. Surgical activity was performed with agreed COVID-19 precautions and biosecurity measures in place. We introduced additional PPE and updated our training and essential advice. All patients have been clinically reviewed and prioritised for surgery according to national guidelines and agreed oncological prioritisation criteria. In addition, we continued to deliver safe cancer surgery for our patients, The Christie has been a designated cancer surgery hub site within Greater Manchester. Over 700+ patients have been referred for surgery via the surgical cancer hub supporting fair and equitable access to life saving cancer treatment during the pandemic. This was only possible with the commitment and enormous flexibility of our staff, not only surgical, medical and nursing but all professionals facilitating patients’ flow through the challenged and stretched system at the time. Systematic and regular testing was introduced for all staff involved in patient care as well as for all patients admitted to the hospital, which significantly reduced the risk of COVID-19 intra-hospital transmission.

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Clinical Support Services

Clinical Support Services play an important role across the entire Trust, working closely with other professionals and in many areas. The highly skilled teams are often leading in areas of innovation and research to ensure our patients’ and families physical and emotional needs are met. Services offered are both clinical and non-clinical in nature and integrate with oncology treatment systems to enable improved outcomes for all. Response to the COVID-19 Pandemic The Support Services teams have continued to demonstrate their resilience and transferable skills over the past 12 months by adapting services and creating new ways of working to support both patients and staff alike. The team have also supported the Trust’s Staff Screening Service and implemented the COVID 19 Information line to support patients and their carers with queries relating to COVID-19. Several of the services also contribute to the Trust’s Mental Health and Wellbeing Support for Staff. Our Services and their achievements Nutrition and dietetics The dietetic service has continued to deliver the service during the pandemic, continuing with telephone clinics for outpatients and the PanDA research trial for HPB patients. During this year, the team have reviewed and updated the Trust nutrition policy and developed standard operating procedures for the care of enteral feeding tubes. The service is currently looking at carrying out a pilot on ambulatory enteral feeding service to improve outcomes for head and neck patients. Physiotherapy/Occupational therapy (OT) During the pandemic, our Physio and OT teams risk assessed their patient cohort transferring appropriate patients to virtual appointments and re-focused their teams to work in staggered shift patterns alongside the Medical and Nursing staff on our inpatient wards.

The team continued to provide vital support to patients requiring respiratory and Malignant Spinal Cord Compression (MSCC) specialised care on the Oncology Critical Care Unit. Speech and language therapy The Speech and Language Therapy team has continued to adapt the service to meet the challenges of supporting patients during the pandemic, providing both face to face and remote consultations. As a team they presented at a Cancer Rehabilitation study day and a Head and Neck study day. They also had a publication in an international journal, submitted two abstracts to a national oncology conference, and jointly produced a paper with dietitians about the AHP role in Proton Beam Therapy. Pathology Pathology services at The Christie are provided by The Christie Pathology Partnership (CPP); a joint venture between SYNLAB and The Christie NHS Foundation Trust. During the COVID-19 pandemic, The Christie Pathology Partnership supported onsite rapid COVID-19 swab testing for all patient admissions at The Christie to enable CPP has also supported the Trust with the Greater Manchester Surgery Hub to ensure cancer patients treatment continued during the pandemic. The service is working with other external partnerships in the review of GM Pathology and Cytogenetics, and the digitalisation of Pathology. CPP also provides the Bereavement and Mortuary Services. Transport and interpreters The transport and interpreter services are integral to the operational services across the Trust. They have worked closely with local taxi services and private firms to minimise waits. safe and effective patient flow and bed management, supporting vital clinical management decisions.

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Clinical support services

around their beliefs or worldview. Over 2021/22 they have developed protocols to reach out more consistently to patients receiving care in the last days of life, and long stay patients. The chaplaincy team have continued to work on site throughout the pandemic and have initiated regular online mindfulness sessions, in which over 100 staff members have engaged so far. Art Service The art room offers patients, their care givers and our staff the opportunity to spend some time in a supportive and non-clinical safe environment. The service has continued to run remotely throughout lockdown with Zoom art classes for patients and staff. Face-to-face classes have taken place off-site, in preparation for an exhibition in conjunction with the Van Gogh live exhibition in Salford. Complementary health and wellbeing The COVID -19 pandemic has seen the complementary health & wellbeing service revisit its care-pathway for patient support. Stress management and mindfulness techniques, hypnotherapy and use of essential oils in the form of aroma sticks to ‘anchor’ any feeling of relaxation, are now fundamental to each session, both face-to-face and virtual. In addition to the change in process with regard to supporting patients, the team applied for and were given approval to re-purpose some of their charity funding to initiate a free staff service. Those working in patient-facing roles have been undertaking the role of carer and family support, following the Trust making the difficult decision to exclude relatives from the site. Employees required to work from home, were immediately excluded from social contact with colleagues, had to adapt to using their home as an office and often struggled with practical issues relating to technology. The staff service is run on a referral

The waiting area facilities have been improved along with the introduction of beverages. To compliment the Trust’s biosecurity measures, the way in which the interpreter services are delivered has been adapted to ensure footfall across the Trust is minimised and to ensure our patients’ communication needs are met. Working closely with external providers, the telephone on demand interpretation service has been increased to minimise face to face contact and by working closely with the Digital Team, a Video Interpretation Service has been introduced. The Trust is also participating in the Greater Manchester Interpreter Service procurement tender exercise; with the aim to improve services across Greater Manchester. Cancer Information Centre (CIC) During COVID-19. the service has been working remotely utilising phone, email, and social media platforms. It has recently re-opened on site with a skeleton service for two days per week. A key part of the team’s role is to support patients experiencing hair loss through the side effects of treatment, providing them with emotional support, information and advice. The wig service has been operating throughout the pandemic with appointments conducted either remotely or at an off-site salon which has remained open to provide support solely to the Christie patients in a COVID-19 safe way. The Cancer Information Centre has also supported the COVID-19 information line to support patients with COVID-19 enquiries and referring to partner services in Greater Manchester. Chaplaincy The chaplaincy team is committed to supporting patients, carers and staff at a time when they may be experiencing challenges

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

system, which to our knowledge is unique within the UK. Psycho-Oncology The Psycho-Oncology service adapted well to the increased mental health acuity of both inpatients and outpatients during the pandemic. The team rapidly created both virtual and face to face assessment and treatment services for those patients requiring intensive support to facilitate their cancer treatment and beyond including the use of virtual psychological interventions. The team has developed its research agenda by being awarded a grant by Manchester Academic Health Sciences Centre to understand the impact of trauma and post-traumatic stress disorder (PTSD) on patients living with cancer. Referrals & Bookings Over the past two years the Trust has gradually been moving towards implementing a central service for Referrals and Bookings. To date we have successfully achieved one referral point of access for Medical Oncology, Clinical Oncology, Plastic, Urology, ENT Surgical and Haematology@ Tameside. Working closely with the digital team, a new digital telephone system (calling system) is now operational. Recently the team have being involved with the opening of The Christie@Macclesfield and have successfully transferred the care of all Haematology referrals including the registering and booking all follow up appointments. Whilst the past twelve months have been challenging due to continued improvements in the patient pathway and administration functions of the team, the team have remained resilient and have adapted positively to the changes. We look forward to continuing our work over the next 12 months with clinicians, the digital and transformation teams to improve the patient pathway and administration processes.

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The Christie NHS Foundation Trust Annual Report & Accounts 2021-22

Pharmacy

Response to COVID-19 Pharmacy has continued to play a key role in supporting patients and clinicians during the pandemic. Initiatives minimising on site attendance including home-delivery have continued during 2021/22. The department also continues to play a key role in the planning and implementation of the Trust’s COVID-19 vaccination programme. Despite the challenges of the pandemic, teams have continued to develop and innovate. In year developments include: • Establishment of the Christie@Macclesfield pharmacy service. • Pilot Pharmacy led urology out-patient clinic at Christie@Oldham. • Leading the GM Pharmacy Hub collaboration project across NHS hospitals to improve the efficiency of the medication supply chain. • Implementation of a Clinical Trial Courier service, ensuring that patients continue to have access to innovative treatments. • Replacement of aseptic unit isolators. • Approval of plans for the re-provision of TCP facilities to support outpatient and homecare dispensing, including a new robotic dispensing system, improved patient waiting area and a medication counselling private consultation room. • Development and implementation of an extended weekend working arrangement within the pharmacy department in order to deliver a sustainable, high quality safer service for both patients and staff.

The Pharmacy vision is to provide high quality, sustainable, safe and innovative pharmacy services to all Christie patients within a working environment that consistently values, supports and engages staff whatever their professional discipline or experience. The Clinical Pharmacy team supports the delivery of chemotherapy services at the main Christie site and the Christie@ chemotherapy centres across Greater Manchester (GM), as well as providing a comprehensive range of services in both outpatient and inpatient settings. This includes medicines reconciliation and optimisation, support to the day case Systemic Anti-Cancer Therapy (SACT) delivery units and non-medical prescriber support in a variety of outpatient clinics. Within the Clinical Pharmacy service there is a Homecare pharmacy team which provides specialist pharmacy services to the Christie at Home team, Outreach service and liaises with external Homecare providers. The service is also responsible for the provision of the cyclical dispensing scheme. The Aseptic Services Unit (ASU) prepares high quality medication in accordance with Industry regulations. A significant amount of activity is in the preparation of chemotherapy for clinical trials. A leader in ‘first-in-human’ trials, the Clinical Trials team supports over 500 clinical trials a year by ensuring the safe storage, handling, prescribing and administration of clinical trial medicines for oncology and haematology patients. Set up in December 2017, The Christie Pharmacy Ltd (TCP) is a wholly owned subsidiary of the Trust and provides pharmacy dispensing services to outpatients, inpatients and outreach locations, in addition to the procurement of medication. The teams work collaboratively with each other and pharmacy staff are integral members of the multidisciplinary teams across the various services and disease groups.

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