Meeting of the Board of Dire 2010 in the boardroom

Meeting of the Board of Directors

Thursday 25th January 2018 at 12.45 pm

Trust Administration meeting room 6

Public Meeting of the Board of Directors Thursday 25th January 2018 at 12.45 pm in Trust Administration

Presentation: The Power of Participation - Ben Heyworth, Macmillan Survivorship Network

Manager & Rachel Daniel, Head of Corporate Affairs & Engagement

Key:

Page 01/18 Standard business

a Apologies Chair b Declarations of interest Chair c Minutes of previous meeting – 30th November 2017 * Chair 3 d Action plan rolling programme, action log & matters arising * CEO 9&11

02/18 Key reports a Chief executive’s report * CEO 13 b Executive medical directors report * EMD 21 c Integrated performance report */p Exec dirs 25

03/18 Approvals a The Christie Strategy 2018-2023 * EMDS 59

04/18 Board assurance a Board assurance framework 2017/18 * CEO 79

05/18 Any other business Chair Date and time of the next meeting Thursday 29th March 2018

CEO EMD

Chief Executive Officer Executive Medical Director

* paper attached v verbal p presentation

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DRAFT Public minutes of the meeting of the Board of Directors of The Christie NHS Foundation Trust held on Thursday 30th November 2017 at 12.45pm in the trust administration meeting room centre, The

Christie NHS Foundation Trust

Present: Christine Outram (CO) Neil Large (NL) Kathryn Riddle (KR) Prof Kieran Walshe (KW) Jane Maher (JM) Robert Ainsworth (RA) Tarun Kapur (TK) Roger Spencer (RGS) Fiona Noden (FN) Jackie Bird (JB) Joanne Fitzpatrick (JF) Chris Harrison (CH) Wendy Makin (WM) Eve Lightfoot (EL)

Chairman Non-Executive Director Non-Executive Director Non-executive director Non-Executive Director Non-Executive Director Non-Executive Director Chief Executive Chief Operating Officer Executive Director of Nursing and Quality Executive Director of Finance & Business Development Executive Medical Director Executive Medical Director Director of Workforce

In Attendance: Louise Westcott (minutes) Company secretary Agenda item: 40/17c

Prof Richard Cowan (RC) Consultant Clinical Oncologist & Director of Education Cathy Heaven (CHv) Associate Director of Education

41/17a Sue Mahjoob (SM) Freedom to Speak Up Guardian

Observing: Kerri Farnsworth (KF) Insight Programme for aspirant NHS NEDs Roger Bowman Public governor Catherine Taylor Scientist training programme Rachel Hall Scientist training programme Peter Sitch Scientist training programme Rukaiya Ali Scientist training programme

Presentation: Surgical education - Mr Chelliah Selvasekar, consultant colorectal and laparoscopic surgeon

CS introduced himself. He gave an overview of the surgical education that we engage in at the Trust. We are looking to provide high quality care and excellent outcomes. We want to lead on surgical education. Skills courses (key & basic) are done for people from all over the world but primarily from the UK. We get very good feedback on the skills courses.

MRCS course – good uptake and good feedback. There is also a Christie in house surgical course FRCS (General Surgery) road to success. Trainees from across the world are attending. The Christie model has been used as a framework. This is now run in India annually at MIOT. We are looking to expand on this.

International fellowships – we have fellows from Sri Lanka and India. There is also a focus on training the trainers and this is done annually. This has been shown to improve clinical practice.

We also run laparoscopic surgery training twice yearly, in 2018 the course is in Manchester. Christie is a designated national training centre for Lapco and our feedback is excellent. STEPS laparoscopic Colorectal Course – we are selected as the centre in the North to provide this.

We collaborate with other centres in the North West on our training.

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There are courses for the surgical care practitioners also. Also specialised surgical MDT courses – designed to streamline referral & improve collaborative working, to engage with referring units and discuss patient related outcomes.

We lead the surgical stream of the MCh/MMed programme that’s delivered with WWL and Edge Hill University. There is an MSc with the University of Manchester run through the School of Oncology – the Masters in surgical oncology.

Achievements – collaboration & partnerships, fit with the strategy of The Christie, School of Oncology & with the surgical divisions strategy. Courses cover skills, knowledge and non-technical skills for all those involved in surgery

The challenges include restructuring & reconfiguration across the NHS, the workforce crisis, Brexit and any potential impact on funding and staffing, surgical training (unclear career path) and NHS service & training.

We want to expand the portfolio internationally and deliver our multiprofessional educational development in robotic surgery. We now have a huge portfolio of surgical education.

CO thanked CS for his presentation & welcomed questions.

CO asked if there is anything that the board can do to further help. CS responded that there is a big opportunity to have a hub in India and increase our international reach there.

NL asked what the financial impact is of all this. CS responded that currently year on year there is at least £10k profit. There are about 20 surgeons and all are trainers.

RC added that we need inspirational leaders in different areas and CS and his team have got this going from nothing and taken the initiative to move this on. They have created huge opportunities through partnerships e.g. Royal College of Surgeons Edinburgh. We can learn from different partnerships.

WM asked if there were plans to open up opportunities to surgical associates given the difficulties in the middle grade workforce. CS responded that we are working to increase skills courses through the Christie.

CH commented that the enthusiasm is fantastic and we have a lot of opportunity as a result. We have opportunities in India that are now expanding to other areas such as radiotherapy.

CO added that we have a national & international role and education is a key part of what we aim to do.

No Item Action 39/17 Standard business

a Apologies None were noted

b Declarations of interest No declarations of interest were made.

c Minutes of the previous meeting held on 26th October 2017 The minutes of the meeting held on 26th October 2017 were accepted.

d Action plan rolling programme, action log & matters arising The items on the rolling programme were captured on the agenda. All items on the action

log will be reviewed in the meeting.

40/17 Key reports a Chief executive’s report

RGS highlighted a few issues; • CQC report close down – the CQC as part of an engagement visit, attended

theatres to look at issues that we had followed up as a result of our inspection action plan. This is now closed.

• Awards – RGS noted some recent awards such as the research awards for Dr

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No Item Action Choudrey & Prof Radford and the radiotherapy student of the year, who is now a member of our staff. WM received a lifetime award from Macmillan, the board congratulated WM on a unique and important achievement.

Questions were invited. CO commented that the vanguard update was very interesting and the work is looking very good. CH added that nationally we are looking at timed pathways of care, the work the Manchester vanguard has done has been the basis of this national work. This is very important. RGS added that many work streams are coming to the evaluation phase and some of this will come through to board in due course.

b Executive Medical Directors report CH highlighted the appointment of the new NHS England medical director, Steve Harris.

CH noted that he is a good appointment & has a background of being a medical director in the NHS that will be beneficial. WM noted the SAS education leads (staff & specialty doctors) – these are experienced and senior doctors, we are doing work to ensure they feel valued. This is an important role. WM also noted the changeover in clinical directors for critical & acute care and diagnostic radiology. They were thanked for their work over the many years in their roles. The new appointees were also welcomed. CO extended board thanks to them.

c School of Oncology – Directors update WM welcomed RC and CHv to present on the School of Oncology.

RC thanked CHv for preparing the report and introduced her. CHv picked out some highlights – objectives are set into 4 categories. Some objectives are being refreshed to move from a school of oncology to a centre of academic excellence. The School describes its spheres of activity under four strategic goals. Core activity of the school is aligned to these areas, with the Kostoris Library and Information Service, and the Education Centre supporting the delivery of activity across all areas. The goals are; • To develop all staff and students at The Christie to achieve their full potential • To lead the development of cancer education for Greater Manchester • To deliver a high quality to cancer professionals nationally • To develop the Christie International School of Oncology The School of Oncology is planning education to work more closely with research to deliver translational research into practice. We are making sure that where we have world renowned clinicians that we are using these individuals and supporting them well. The apprenticeship levy is on target to achieve target numbers of apprenticeships. We are projecting that by the end of 2 years we will have spent about 30% of what we have paid in. It will take time to take full advantage of the levy. Regionally the cancer board have adopted the cancer education strategy. For the Vanguard there is now full evaluation available, there is a clear increase in GP confidence in referring onto cancer pathways, they are now looking to take this forward to GPs across the country. CHv noted the Masters in specialist practice with the University of Manchester, this has been very successful and brings income and prestige. This looks to develop CNS’s and advanced practitioners further in cancer practice. NL asked what the financial impact is. CHv responded that we are not running as a loss. 50% of income goes into the division; other School of Oncology income covers the team and is then invested back into the school. The next report is to include more financial data. JF asked about the apprenticeship levy. She asked what more the board can do to help make further progress. CHv responded that we now need to look at Masters and degree level apprenticeships. Developing the pathways will take time and this needs to be across GM. JB asked for an update on the apprenticeship route for associate nurses and AHP’s. CHv responded that there is discussion in GM but progress has been disappointing. JB added that HEI’s need to lead on this as yet we are not clear which universities will be doing this. RC added that we have the opportunity to move ahead of other people.

CHv

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No Item Action KW asked if the trusts levy payments run in years. CHv responded that it does and that we could potentially lose some of this money. CO commented that the additional objectives look very good and asked how the school came to this list. CHv responded that there were a series of strategic meetings with senior people to discuss the priorities and this is the conclusion. RC added that our ambition to be a leading centre means that we must be much more tied in together with research & education to look at overall academic interaction. KR noted that the undergraduate feedback is excellent; we need to build on this with the apprenticeships. CH added that the objectives are excellent as they are tangible. We will know when we have achieved them. RA asked what might prevent us from achieving the objectives and who the competition is. RC responded that we are unique as an NHS organisation in having education for all staff but there is competition in specific areas. We are very well placed and have an excellent reputation for education. JM noted that the primary care gateway c has been very successful and asked how we aim to make this available more widely. CHv noted that lots of people want to get involved. We are looking at a licensing model so that people can opt into what’s there and will also help us to develop further. We are working with CCGs and alliances as well as charities and industry. There is a balance in trying to get it out there whilst also continuing to have control over it to further develop it. RC updated on the internal fellowships – there is a constant conflict between the impact we could have and the resources we have. We are looking at ways to engage overseas clinicians. We are looking to run a Manchester Cancer conference. This would be an MDT conference for anyone involved in cancer. This is planned for late 2018. We are also looking at Proton Beam Therapy and how we ensure that we have an educational approach to the inevitable interest we will have in people coming to learn. There is a shortage of training opportunities internationally. We are therefore looking at the possibility of setting up an international proton school. NL asked how we know if the staff are going to be properly trained in order to deliver the service here. WM responded that our staff are trained radiation oncologists who have had opportunities to work on sabbaticals in US trusts and who have experience and training that they are passing to other staff. JF added that we can pick this up in the Proton board and feedback more fully to board. RC highlighted that the international fellows programme have a long history and we have a vibrant number of fellows. We recognise that the fellows work slightly in isolation and the learning experience & output is variable. The School of Oncology is aiming to deliver a consistent fellowship programme to ensure quality experience and output. These individuals are predominantly doing research. Strong fellowship schemes are a marker of the best education centres. We aim to have a fellowship scheme with a fellowship board that will vet the process, set the standards and advertise the programme. We would then look at a bigger and better funded programme. The fellows would be higher calibre and more productive. We can attract good people and they can provide some clinical service which will help overall in the Trust. CH noted that this is what the overseas healthcare providers want. TK asked if we would have to cap this. RC responded that as long as the funding is there and we have the structure then we can do this. JM asked what the barriers are. RC responded that GMC registration is an issue. RC stressed that these fellows could be other health professionals’ not just doctors. We are getting a clearer research strategy that can help us focus the fellows along the research strategy. KW asked how we are assured about the safety & expertise of these people. WM responded that we have to ensure the staff meet appropriate requirements and they are connected into our processes through the appraisal & revalidation process. These wider consequences need to be considered. CH added that having a structured programme is one way of ensuring we have the correct calibre of people.

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No Item Action CO thanked RC and CH for their report.

d Integrated performance report – month 7 FN reported on a successful month:

Quality: 98.1% patient satisfaction survey, chemotherapy treatment turnaround 91.7%, pharmacy turnaround at 78.9%. 1 cancelled operation on the day and staff PDR’s are at 89.3%. The exception reports describe cancelled operations on the day, length of stay, pharmacy waiting times, infection control and CIP. There has been 1 MRSA bacteraemia case in October, 2 CDiff cases and 10 cases of e-coli. Safe staffing levels have been achieved; there has been 1 SI panel, 0 SI incidents, 8 executive reviews, 11 complaints, 7 inquests, and there are 3 risks at 16 and 1 risk at 20 (relates to CIP). Access: all targets have been achieved. Length of stay is 7.05 days, patients treated YTD is above plan (+0.19%), sickness is at 3.33% and agency spend is under the agency cost ceiling at 98.7%. Finance: The EBITDA surplus is £13,076k (£1,881k under plan), I&E surplus is £4,860k (£2,083k under plan). Cash balance is £32,953k. 74% of CIP has been achieved in year (59.8% recurrently). There are weekly meetings to look at CIP to ensure we achieve the target. Debtor days are at 24. Ratings: Governance SOF (single oversight framework) 1, Financial sustainability risk rating SOF 1 Questions were invited. KR asked about the coroners’ inquest and the reference to staffing shortages. WM clarified that this was at another trust, our oncologist may have been at the inquest. WM has asked colleagues to involve us if a death has occurred and the patient was on a Christie pathway. KR noted the excellent work of PALs and the good comments. RA noted that the CIP thermometers need to be updated. RA asked if there are any implications for patient safety of the high bed occupancy. JB responded that there is international evidence in general acute hospitals that says high bed occupancy can impact on higher levels of infection. The level for bed occupancy nationally has been upped to 92% for the winter. The trust has higher occupancy in wards 4, 11, 12 and Palatine Centre.. JB updated on infection control. We are now monitoring e-Coli cases; nationally we need to reduce the rates by 50%. CDiff – we are on trajectory currently but will be testing more samples as more bugs are around in Winter. We haven’t had any lapses in care. We have had one MRSA case; this patient was well throughout and was discharged on time. In this case the source of the MRSA was not found in the line & this was an incidental finding. NL asked why elective work is down but income is up. JF responded that this relates to low volume, high cost activity (e.g. transplants). There is further work being undertaken around coding to better understand this. CO asked about the 1 cancelled operation on the day. FN informed board that this is an unusual case and there were some issues in planning for the patient. Learning has been disseminated to the teams as a result. WM left the meeting.

FN / JF

41/17 Other reports

a Annual report of the Freedom to Speak Up Guardian (FTSUG)

SM introduced herself. SM reminded board where that the role came from the Francis review. Each trust has to implement this according to the requirements of the organisation. The aim is to get to the point where speaking up is business as usual. The boards support in this was acknowledged. In year 1 the job has been about establishing and promoting the role. SM looked at the number & types of concern that have been raised. There are low numbers (3 to 5 a quarter) and no patient safety issues. No themes have come out, it’s also been encouraged for staff

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No Item Action to talk to whoever they feel comfortable speaking to, it doesn’t have to be the FTSUG. SM conducted a survey to look at what should be focused on. Possible reasons for not raising concerns were explored, 60% rated The Christie as a place staff can raise concerns, 49% had not previously been aware of the role. Issues were raised around support regarding difficult staff relationships. The survey went to the Workforce Committee and is progressed through that committee. The action plan is also monitored through this group. In year 2 the aim is to continue to raise the profile of the role, identify and deal with barriers and to make a difference. The workforce team are looking at training for managers in dealing with difficult situations. RGS added that there is a lot of freedom to do what we want to do with this role. RGS noted that SM has done a very good job in implementing the role. JM commented that this is reassuring; she asked whether the staff who were in the 40% were in particular staff groups. SM responded that they weren’t. EL added that this correlates with the staff survey results. The staff survey for this year may correlate more with the work of the FTSUG. KW asked if the exit interviews ask about 'speaking up'. EL noted that they don’t specifically reference it but we could look at adding this. KR asked if SM attends induction to speak to new starters. SM confirmed that she does and that she tries to speak to everyone in the foyer so that there is a personal touch. SM added that there is excellent support from a senior level that makes this role easier. CO added that the board are very happy to support in whatever way is helpful.

EL

42/17 Board assurance

a Board assurance framework 2017/18

RGS presented the BAF. There are no major changes and no significant changes were suggested. Board were asked to suggest any other possible updates to the BAF following discussion in the October meetings. None were raised.

43/17 Any other business

No items noted.

Date of the next meeting:

Thursday 25th January 2018

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Agenda item 01/18d

Month From Agenda No Issue Responsible Director

Action To Agenda no

January 2018 Annual reporting cycle Integrated performance report COO Monthly report 02/18c

Integrated performance report COO Monthly report By email

March 2018 Annual reporting cycle Corporate planning (corporate objectives / BAF 2018/19)

Executive directors

Approve next year's annual plan

Annual reporting cycle Letter of representation & independence Chair Directors to signAnnual reporting cycle Register of directors interests Chair Report for approvalAnnual reporting cycle Integrated performance report COO Monthly reportAnnual reporting cycle Declaration of independence (non-executive

directors only)Chair For completion by NEDs

Annual reporting cycle Chair ApproveSix monthly compliance with NICE safe staffing guidelines

CN&EDoQ Review

Workforce plan DoW UpdateEPR update

April 2018 Annual reporting cycle Integrated performance report COO Monthly reportAnnual reporting cycle Annual compliance with the CQC

requirementsCN&EDoQ Declaration / approval

Register of matters approved by the board CEO April 2017 to March 2018Annual reporting cycle Research report on key issues, progress

against objectives and future plansEMD Review

Annual reporting cycle Annual Corporate Objectives CEO Review 2017/18 progress

Staff friends & family test DoW ResultsWRES update DoW Annual updateModern Slavery Act update CEO Chief Efecutive's report

Public Meeting of the Board of Directors - 2018

Action plan rolling programme after November 2017 meeting

February 2018 - no meeting

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Month From Agenda No Issue Responsible Director

Action To Agenda no

May 2018 Annual reporting cycle Integrated performance report COO Monthly reportAnnual reporting cycle Annual reports from audit & quality assurance

committeesCommittee

chairsAssurance

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

EDoF&BD Approve

Monitor provider licence Self certification declarations EDoF&BD To approve the declarationsAnnual reporting cycle Education report EMD Review

June 2018 Annual reporting cycle Integrated performance report COO Monthly reportResponsible Officer report IEMD Medical Appraisal &

Revalidation Annual report

Integrated performance report COO Monthly report By email

Integrated performance report COO Monthly report By email

Sepember 2018 Annual reporting cycle Integrated performance report COO Monthly reportCompliance with NICE Safe Staffing Guidelines

CN&EDoQ Six month review

14/16f, 19/17c & 30/17b Organisational development plan (incl WRES & Personal Development Reviews (PDR))

DoW Six month review

Annual reporting cycle Risk Management strategy CN&EDoQ Annual review

October 2018 Annual reporting cycle Corporate objectives & board assurance framework

CEO Interim review

Annual reporting cycle Research report on key issues, progress against objectives and future plans

EMD Six month review

Freedom to speak up FtSUG Annual report

November 2018 Annual reporting cycle Integrated performance report COO Monthly reportAnnual reporting cycle Education report on key issues, progress

against objectives and future plansEMD Six month review

August 2018 - no meeting

July 2018 - no meeting

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Action log following the board of directors meeting held on

Thursday 30th November 2017

Public

No. Agenda Action By who Progress Board review

1 40/17c More financial information to be added to the School of Oncology report CHv

May 2018 Board of Directors

2 40/17d CIP thermometers to be updated in the Integrated Performance report FN Complete Monthly

3 41/17a Reference to ‘speaking up’ to be added to exit interviews EL Complete N/A

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Agenda item 02/18a

Meeting of the Board of Directors Thursday 25th January, 2018

Report of Chief executive

Paper Prepared By Roger Spencer

Subject/Title Chief executive’s report

Background Papers n/a

Purpose of Paper To keep the board of directors updated on key external developments & relationships

Action/Decision Required The board is asked to note the contents of the paper

Link to:

NHS Strategies and Policy

Link to:

Trust’s Strategic Direction

Corporate Objectives

Achievement of corporate plan and objectives

Impact on resources and risk and assurance profile

You are reminded that resources are broader than finance and also include people, property and information.

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

CBE - Commander of the British Empire BEM - British Empire Medal OECI - Organisation of European Cancer Institutes MDT - Multi Disciplinary Team

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Agenda item 02/18a

Meeting of the Board of Directors Thursday 25th January, 2018

Chief executive’s report

1. New Year’s Honours

Many congratulations to Professor Caroline Dive, deputy director of the Cancer Research UK Manchester Institute, who has been made a Commander of the British Empire (CBE) in the New Year’s Honours list for her work with Christie colleagues on early cancer detection. Congratulations also go to fundraiser and charity partner governor Janice Moss who has been awarded the British Empire Medal (BEM) in recognition of her 20 years of fundraising for The Christie as chair of the Altrincham and Sale Fundraising Group. Further information can be found at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/671148/NY18_Queens_List_-_Final_.pdf

2. Awards On the 27th November, 2017 a Medal of Honour presentation took place for Professor Nic Jones. Former Director of Manchester Cancer Research Centre Professor Jones was awarded the Medal in recognition of his contributions to cancer research locally, nationally and internationally. Further information can be found at http://www.staffnet.manchester.ac.uk/news/display/?id=19188

3. The Organisation of European Cancer Institutes (OECI) On the 8th and 9th March 2018 the OECI will attend the trust to carry out a peer review reaccreditation. Our first accreditation was in 2010 where we achieved the status of a Comprehensive Cancer Centre. Six auditors will attend and they will interview teams and carry out inspections of our services. There are two levels of measures we have had to complete, one quantitative and one qualitative, and these were submitted to the auditors in October. Further information can be found at: www.oeci.eu/Accreditation/Page.aspx?name=OECI_STANDARDS

4. Cancer Vanguard Vanguard Innovation projects continue to make good progress in a number of key areas. An update for the programme is attached to this report. Regular showcases to highlight progress in specific projects can be found here. Further information can be found at http://www.gmcancervanguardinnovation.org/

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5. Health and Social Care Partnership The national tender process for genomic lab re-designation has commenced. The genomic services from Manchester, Liverpool and Preston have combined to develop a comprehensive bid that will demonstrate accelerated adoption of genomic medicine in cancer and rare diseases. The Christie genomic services are key components of the cancer infrastructure and expertise and we are committed to aligning with our partner providers to ensure the Northwest genomic services lead the UK. The teams from Manchester University Foundation trust and The Christie are making significant progress in collectively planning and implementing improvements to the Haematological diagnostics services for Greater Manchester. Key steps on the deployment of a unified digital system are underway alongside a growth in capacity to ensure quick turn around times and supported MDTs. The Christie is working closely with partners on the reorganisation of Urology and Gynaecology surgery. Capacity has been developed at The Christie to accommodate the first phase of additional prostate surgery on the path to the Christie being the dedicated Prostate surgical centre for Greater Manchester. Further information can also be found at http://www.gmhealthandsocialcaredevo.org.uk/

6. Site Developments Paterson Fire Following an extensive forensic investigation, Greater Manchester Fire and Rescue Service has now issued its fire investigation report detailing the cause of the fire that took place at the Paterson building in April last year. We welcome the completion of this report. This building is owned by The Christie and is leased to our University of Manchester partner, and is the headquarters of the Cancer Research UK Manchester Institute. Greater Manchester Fire and Rescue Service has concluded that the most probable cause of the fire on the roof of the Paterson building was welding operations or operations allied to welding, being undertaken by the roofing contractor, or persons under its control. The fire occurred when the remains of hot welding rods and welding spatter came into contact with combustible materials that had accumulated on the plant room floor. There were no casualties and no patients at The Christie were in danger. Much of the cancer research taking place within the building was salvaged. Staff responded robustly putting well practised contingency plans into place to minimise disruption. We are now working with our partners on ambitious plans to redevelop the Paterson building. In conjunction with The University of Manchester and Cancer Research UK, our aim is to provide a purpose built, state-of-the-art, world class cancer research facility to ensure that The Christie and Manchester remain international centres of excellence and continue to lead the way with cancer research breakthroughs. We will share further details of these proposals with you in the near future. Proton Beam Therapy Centre Building works remain on programme and are due to be completed in April 2018. Works are focused on internal finishes and external cladding. The Varian equipment installation and commissioning is continuing and all major equipment is now installed. Radiation detection equipment and safety systems are now installed, Varian produced proton beam in the cyclotron in December 2017.

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The MRI scanner was delivered to plan on 11th December 2017 and installation is now complete with ‘Go-Live’ Application training planned in April. The CT fit out is being completed by Interserve with final handover planned in February. The overall project remains on programme to deliver the first patient treatment on 31st August 2018 Outpatients Redevelopment The phase 1 works to the ground floor of the Proton building started on Monday 15th January and will finish in August 2018. The works to the centralised phlebotomy are due to commence in May 2018. Tiered Car Park Our planning application for the provision of tiered parking for staff on Cotton Lane which will provide an additional 407 spaces was approved at the Manchester City Council planning committee on 11th January. A condition of the planning permission was a section 106 expansion of the controlled parking zone. A full business case is now being developed. Christie @ Cheshire East Design proposals are being developed for a new Satellite Radiotherapy Centre incorporating an expanded Chemotherapy unit at Cheshire East Hospital in Macclesfield. A feasibility study is now in progress that will include an option appraisal and the preferred location, overall cost, capital cost and revenue consequences of the development. Linear Accelerators 1 & 2 Linear accelerators 1 & 2 are due for replacement as part of the linac replacement programme included within the five year capital plan. Linac 1 has been replaced during and Linac 2 will commence in February 2018. Further information can be found at http://www.christie.nhs.uk/about-us/our-future/our-developments/our-developments-latest-news/

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GREATER MANCHESTER CANCER VANGUARD INNOVATION PROGRAMME

PROGRESS UPDATE JANUARY 2018 EXECUTIVE SUMMARY

Key developments in Vanguard Innovation projects include: Prevention The digital support behind our efforts to recruit cancer champions continues to bear fruit and the cancer champions Facebook page now has more than 900 ‘likes’. A number of small grants have been made available for organisations to deliver a diverse range of events, which are now under way, aimed at recruiting more cancer champions. The icangm.co.uk website, which allows individuals to sign up, has also helped recruitment since its launch late last year. We have now recruited 2,050 individuals and nearly 50 organisations. Early diagnosis Following the success of our multidisciplinary diagnostic clinic at Withington hospital, a possible collaboration is being discussed with the team behind the ACE2 project, which has clear early diagnosis links. Every patient who used the MDC in Withington – there were 71 in total – rated the service as either good or very good. A pilot is now under way to test outpatient self-referral online tool. The programme’s algorithm allows users to assess the likelihood they have cancer, having recorded their symptoms, or the risk they will get cancer in future. The tool, which can assess cases for five types of cancer, is being piloted in one south Manchester GP surgery and two community pharmacies. Talks are in hand with a number of GP surgeries to pilot the tool in waiting areas. Early feedback suggests the system is very popular. The seven trusts that provide pathology services in Greater Manchester collected 2,500 slides (from 1,500 patient cases) as part of a digital pathology pilot. The project aimed to demonstrate the benefits of the latest developments in digital technology as they relate to pathology services. A ‘lessons learnt’ workshop in December heard very positive feedback from pathologists. An evaluation report is being compiled while the project team is also producing a film that highlights the benefits of the new technology. Primary care online cancer education platform The education project team continues to market Gateway-C, the platform that is designed to support GPs in identifying the early signs of cancer. A total of 73 per cent of all GP surgeries in Greater Manchester – 365 surgeries – have now enrolled on courses. The team is now testing the system’s relevance to community pharmacists and is discussing links with national partners. Living with and beyond cancer A shared decision-making tool based on the Goals of Care Initiative is being piloted with 24 patients currently receiving chemotherapy with palliative intent in three Christie clinics (HPB, lung and colorectal). The pilot will run until March A stakeholder event for patients and carers was scheduled to take place in January at The Christie to deliver data analysis and feedback from the living with and beyond cancer pilots. The event’s focus was on implementation of the Recovery Package and featured breakout sessions led by cancer champions.

Greater Manchester Cancer

Vanguard Innovation

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Communications and engagement Vanguard Innovation was represented at the Britain Against Cancer conference in December in central London, along with London Cancer Vanguard colleagues. This is the largest event of its kind in the UK and marked the launch of the All Party Parliamentary Group on Cancer’s report into the progress of the national cancer strategy. Our website has recently been updated with items about our aftercare conference and our cancer intelligence service. The site had nearly 1,700 page views in the last 30 days and our Twitter following now stands at more than 1,200. Final preparations are in hand for our second communities of practice meeting in February, which will comprise our Cancer Vanguard partners and the cancer alliances. The clinical focus will be on optimum timed pathways.

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Agenda item 02/18b

Meeting of the Board of Directors Thursday 25th January 2018

Report of Executive Medical Director

Paper Prepared By Yvonne Clooney

Subject/Title Executive Medical Director’s report

Background Papers n/a

Purpose of Paper To bring to the attention of the Board of Directors current issues relating to the Trust or external network

Action/Decision Required To note

Link to:

NHS Strategies and Policy Cancer Outcomes Framework

Link to:

Trust’s Strategic Direction

Corporate Objectives

All objectives of the Trust

Impact on resources and risk and assurance profile

You are reminded that resources are broader than finance and also include people, property and information.

Nil

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

RCR – Royal College of Radiologists CBE – Commander of the Order of the British Empire BRC – Biomedical Research Centre IMatch - Innovate Manchester Advanced Therapy Centre Hub HSJ – Health Service Journal SoO – School of Oncology

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22

Agenda item 02/18b

Meeting of the Board of Directors

Thursday 25th January 2018

Executive Medical Director’s Report

1. Consultant Clinical Excellence awards 2017 Four out of five of our doctors have received national recognition for their work in the 2017 ACCEA applications. Dr Ananya Choudhury, Dr Ed Smith and Dr Tim Sommervaille were all successful in their applications for national level bronze awards, and Professor Andrew Wardley had a renewal of his silver award.

2. IMatch bid to Innovate An ambitious bid has been made by The Christie to Innovate UK in conjunction with other

partners to scale up advanced therapies in Manchester, both cancer and non-cancer. This would be taken forward by a new public-private sector consortium, led by The Christie, together with Manchester University NHS Foundation Trust, The University of Manchester and nine businesses with specific expertise in different aspects of delivering advanced therapies. The businesses are: Cellular Therapeutics, Aptus Clinical, Chaucer, Datatrial, Formedix, Asymptote, AstraZeneca, Agenus and The Christie Pathology Partnership.

The work will focus on: coordinating patient cell collection; processing and storage of patient cells, development of efficient patient cell tracking systems and collection of comprehensive patient information. We hope to hear the outcome of this imminently and for the project to commence later this year.

3. Health Innovation Manchester appoint Chief Executive Officer

Professor Ben Bridgewater, a former cardiac surgeon who was named as one of the UK’s top 50 health innovators, has been appointed as Health Innovation Manchester’s Chief Executive Officer. He has held a number of high profile clinical and leadership appointments, developed an active research programme (focused on analysis methodologies / hypothesis testing) and introduced the pioneering practice of cardiac surgery data disclosure. He was named by the HSJ as a leading innovator in 2013 and 2014. He will join Health Innovation Manchester in February.

4. School of Oncology wins funding for an International Cystic Fibrosis Conference

The School has produced and won a bid for £100k from Vertex Pharmaceuticals to deliver an international Cystic Fibrosis Conference in April 2018. Our events team have worked closely with the Cystic Fibrosis Team in Manchester to win this bid and will now manage this conference and provide booking facilities. They will also create a new website and app for the conference. This is the first of what we hope will be many opportunities for our events team to work as conference managers outside the field of cancer.

23

24

Integrated Performance & Quality Report December 2017

Responsive Effective

Safe Caring

Well Led

25

Month 9 (December) Performance Report

Introduction The Integrated Performance and Quality report presents a summary dashboard that provides an overview of performance. Exception reports set out information about breach of standards highlighted red as well as any other areas of concern within the report, together with action taken and projected performance. Overall Performance In month and for Q3 our 62 day performance has been met. We have had 1 surgical patient who had their procedure cancelled on the day, details of which are within the exception report. Our length of stay remains slightly above plan. There is one risk rated at 20, 3 risks rated at 16 and 4 risks rated at 15 in month, full descriptions of the risks can be found in section 2. Quality In month the patient satisfaction survey results remain high with a 98.8% positive response score. Patient safety There have been no cases of MRSA bacteraemia and one case of C-difficile that was unavoidable and therefore not attributable to the Trust in month. Finance In month the Trust is achieving (£77k above plan) the NHSI Control Total and our position assumes meeting all criteria for Sustainability and Transformation Fund (STF) core funding. The recurrent CIP is at 75.4% and is behind trajectory. The risk of delivery against the CIP target is currently at a score of 20. Weekly meetings are taking place to monitor progress, with additional measures being implemented in the New Year. Under the Single Oversight Framework, our Use of Resources score is 1.

26

27

1. Responsive 1.1 National Standards

1.1.1 Cancer Standards – 62 Days – (Trust Level)

National Standard Standard / Threshold Q3 Dec-17Cancer Standards - 62 Days 85% 88.3% 89.2%

Cancer Standards - 31 Days 96% 98.1% 97.4%

18 Weeks - Incomplete Pathw ays 92% 98.6% 98.5%

Diagnostic Waiting Times - CT 100% 100%

Diagnostic Waiting Times - MRI 100% 100%

Radiotherapy Average Waiting Times - Palliative 14 Days 9 9

Radiotherapy Average Waiting Times - Radical 28 Days 25 24

Delivering Same Sex Accommodation - Breaches 0 0 0

6 Weeks

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-1762 day CWT 65.0% 72.0% 67.9% 71.6% 73.2% 68.6% 57.5% 70.8% 70.2% 67.3% 70.5% 59.6% 64.8%62 day (Adjusted) 83.6% 87.8% 85.5% 87.9% 87.1% 90.8% 85.2% 90.5% 82.5% 85.5% 88.4% 87.9% 89.2%62 Day Standard 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

62 day CWT 62 day (Adjusted) 62 Day Standard

Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/1862 day CWT 70.5% 67.0% 69.3% 65.7%62 day (Adjusted) 87.1% 88.1% 86.0% 88.3%62 Day Standard 85% 85% 85% 85%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

62 day CWT 62 day (Adjusted) 62 Day Standard

28

1.1.2 Cancer Standards – 62 Days – (Networked Services)

1.1.3 Cancer Standards – 62 Days – (Cancer Centre Services)

1.1.4 Cancer Standards – 31 Days

1.1.5 18 Weeks Incomplete Pathways

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Apr-17

May-17

Jun-17

Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

Dec-17

62 day (Adjusted) -NS Division 88.2% 96.0% 87.5% 91.8% 88.5% 91.3% 90.3% 88.5% 88.2%

62 Day Standard 85% 85% 85% 85% 85% 85% 85% 85% 85%

62 day (Adjusted) - NS Division 62 Day Standard

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

Apr-17

May-17

Jun-17

Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

Dec-17

62 day (Adjusted) -CCS Division 82.6% 74.2% 86.7% 92.3% 63.6% 63.0% 81.8% 86.2% 84.0%

62 Day Standard 85% 85% 85% 85% 85% 85% 85% 85% 85%

62 day (Adjusted) - CCS Division 62 Day Standard

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

31 Day Performance 31 Day Standard

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

31 Subsequent (surgery) 31 Subsequent Standard (surgery)

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

31 Subsequent (drug) 31 Subsequent Standard (drug)

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

31 Subsequent (XRT) 31 Subsequent Standard (XRT)

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

18 Weeks Incomplete Compliance Incomplete Standard

29

1.1.6 Diagnostic Waiting Times – CT 1.1.7 Diagnostic Waiting Times - MRI

1.1.8 Radiotherapy Waiting Times (Ready To Be Treated To Treated)

1.1.9 Delivering Same Sex Accommodation 1.1.10 70 Day Target

1.2 Trust Internal Standards

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

CT - 4 Wk Compliance CT - 6 Wk Compliance

6 Week Standard

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

MRI - 4 Wk Compliance MRI - 6 Wk Compliance

6 Week Standard

0

2

4

6

8

10

12

14

Palliative Avg Waiting Time (days) Palliative Threshold

0

5

10

15

20

25

30

Radical Avg Waiting Time (days) Radical Threshold

0

1

DSSA Breaches DSSA Standard

0102030405060708090

100

16-17 Q3 16-17 Q4 17-18 Q1 17-18 Q2 17-18 Q4 17-18 Q4

Actual Predicted

Trust Internal Standard Standard / Threshold Dec-1731 Day Internal Standard 85% 88.3%

Pharmacy Waiting Times 80% 70.9%

Chemotherapy Waiting Times - All patients 80% 91.7%

Chemotherapy Waiting Times - 2 Day patients 90% 94.1%

Cancelled Operations On The Day For Non-Clinical Reasons 0 1

Number of Surgical Operations — 261

Number of PET Scans — 512

Inpatient Length Of Stay 7 Days 7.05

30

1.2.1 Internal 31 Day Standard 1.2.2 Pharmacy Waiting Times

1.2.3 Chemotherapy Waiting Times

1.2.4 Cancelled Operations On The Day For Non-

Clinical Reasons 1.2.5 Number of Surgical Operations

1.2.6 Inpatient Length Of Stay – ALL (Rolling 12

Months) 1.2.7 Elective (Rolling 12 Months LOS)

80.0%82.0%84.0%86.0%88.0%90.0%92.0%94.0%96.0%98.0%

100.0%

31 Internal Day 31 day Internal Standard

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Waiting Time Compliance Threshold

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Waiting Under 1 hour Compliance - (ALL Patients) Threshold

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Waiting Under 1 Hour Compliance - (2 Day Patients) Threshold

0

1

2

3

4

Cancelled Operations On The Day - Non Clinical Reasons

Threshold

0

50

100

150

200

250

300

350

Number of Surgical Operations Undertaken

6.75

6.80

6.85

6.90

6.95

7.00

7.05

7.10

7.15

Inpatient Length Of Stay - (Days) - ALL Patients Threshold

5.40

5.50

5.60

5.70

5.80

5.90

6.00

6.10

Inpatient Length Of Stay - (Days) - Elective

31

1.2.8 Non Elective (Rolling 12 Months LOS) 1.2.9 Transfers (Rolling 12 Months LOS)

1.2.10 Longest Inpatient Length of Stay (LOS) (at month end)

Patient admitted on 10th November 2017 and as of 31st December 2017 had been an inpatient for 51 days. 1.2.11 LOS Over 30 Days 1.2.12 LOS Over 30 Days

Discharged – Breakdown by Admission Type

1.2.13 Patients Recruited to Trials 1.2.14 New Studies Opening to Recruitment

1.2.15 Studies Open to Recruitment or in Follow

7.407.457.507.557.607.657.707.757.807.857.90

Inpatient Length Of Stay - (Days) - Emergency

17.00

18.00

19.00

20.00

21.00

22.00

23.00

Inpatient Length Of Stay - (Days) - Transfers

0

5

10

15

20

25

30

35

Patients Discharged In Month Still IP As At End Of Month

0

5

10

15

20

25

30

35

Electives Emergencies Transfers

0

500

1000

1500

2000

2500

Actual Predicted

020406080

100120140160180

Actual Predicted

0

100

200

300

400

500

600

700

Total Studies

32

1.3 Activity

1.3.1 Summary Activity – In Month & YTD

Point of Delivery Plan Actual VarianceDay Cases 830 796 -4.14%

Elective 403 379 -5.98%

Non Elective Emergency 442 606 37.06%

Non Elective Non Emergency 17 11 -36.51%

OP First Attendances 1170 1169 -0.11%

OP Follow up Attendances 6605 6772 2.54%

Telephone Consultation 2213 2454 10.88%

Homecare Treatments 154 180 16.91%

OP Follow up Attendances Chemotherapy Review 4087 4008 -1.93%

OP Follow up Attendances Radiotherapy Review 1253 1269 1.31%

Supportive Care Hormonal Drug Review 340 312 -8.26%

OP Procedures 828 867 4.71%

AHP Attendances 637 494 -22.42%

Chemotherapy Delivery 5544 5389 -2.80%

Radiotherapy Treatment 7888 7441 -5.67%

Month 9 Activity 32412 32147 -0.82%Month 9 Cumulative Activity 104300 105929 1.56%

Core / Unbundled

Point of Delivery High Level Total Plan Total Activity Variance % Variance Total Plan £ Total Actual £ Variance £

Day Cases 830 796 -34 -4.14% £521,482 £529,623 £8,141Elective 403 379 -24 -5.98% £2,088,219 £2,744,033 £655,814Non Elective Emergency 442 606 164 37.06% £1,096,154 £1,562,898 £466,745Non Elective Non Emergency 17 11 -6 -36.51% £88,205 £67,050 -£21,155OP First Attendances 1170 1169 -1 -0.11% £242,831 £246,599 £3,768OP Followup Attendances 6605 6772 167 2.54% £676,134 £698,935 £22,802Telephone Consultations 2213 2454 241 10.88% £67,559 £81,194 £13,635Homecare Treatments 154 180 26 16.91% £169,527 £165,717 -£3,810OP Followup Attendances Chemotherapy Review 4087 4008 -79 -1.93% £457,986 £449,023 -£8,963OP Followup Attendances Radiotherapy Review 1253 1269 16 1.31% £140,313 £142,151 £1,838Supportive Care Hormonal Drug Review 340 312 -28 -8.26% £38,363 £35,154 -£3,209OP Procedures 828 867 39 4.71% £169,567 £171,250 £1,683AHP Attendances 637 494 -143 -22.42% £61,625 £29,978 -£31,647Chemotherapy Delivery 5544 5389 -155 -2.80% £1,624,553 £1,569,072 -£55,481Radiotherapy Treatment 7888 7441 -447 -5.67% £1,127,501 £1,068,618 -£58,882

32,412 32,147 -265 -0.82% £8,570,017 £9,561,296 £991,279Figures are an extract from the Trust’s total activity position.

December

Core

Unbundled

Grand Total

Core / Unbundled

Point of Delivery High Level Total Plan Total Activity Variance % Variance Total Plan £ Total Actual £ Variance £

Day Cases 2753 2707 -46 -1.68% £1,729,124 £1,842,186 £113,063Elective 1336 1184 -152 -11.40% £6,924,094 £7,508,688 £584,594Non Elective Emergency 1312 1629 317 24.14% £3,253,101 £3,922,067 £668,966Non Elective Non Emergency 51 32 -19 -37.77% £261,769 £186,944 -£74,826OP First Attendances 4007 4159 152 3.79% £834,103 £873,285 £39,182OP Followup Attendances 22596 22156 -440 -1.95% £2,319,992 £2,276,471 -£43,521Telephone Consultations 6698 7258 560 8.35% £207,604 £247,674 £40,070Homecare Treatments 511 491 -20 -3.82% £562,116 £456,950 -£105,166OP Followup Attendances Chemotherapy Review 12603 13817 1214 9.63% £1,412,365 £1,547,886 £135,520OP Followup Attendances Radiotherapy Review 4019 4279 260 6.47% £450,192 £479,325 £29,132Supportive Care Hormonal Drug Review 1030 1062 32 3.10% £116,215 £119,637 £3,422OP Procedures 2845 3164 319 11.20% £584,555 £635,050 £50,495AHP Attendances 2111 1835 -276 -13.09% £204,334 £115,800 -£88,534Chemotherapy Delivery 17116 16885 -231 -1.35% £5,013,446 £4,839,555 -£173,891Radiotherapy Treatment 25310 25271 -39 -0.15% £3,617,579 £3,660,651 £43,072

104,300 105,929 1,629 1.56% £27,490,589 £28,712,169 £1,221,580Figures are an extract from the Trust’s total activity position.

Core

Unbundled

Grand Total

Q3

33

1.3.2 1st Cut Data

1.3.3 External Referrals

Core / Unbundled

Point of Delivery High Level Total Plan Total Activity Variance % Variance Total Plan £ Total Actual £ Variance £

Day Cases 8216 8016 -200 -2.43% £5,159,924 £5,405,478 £245,554Elective 3988 3487 -501 -12.56% £20,662,377 £22,065,345 £1,402,968Non Elective Emergency 3922 4465 543 13.84% £9,723,943 £10,955,995 £1,232,052Non Elective Non Emergency 154 108 -46 -29.73% £782,462 £640,230 -£142,232OP First Attendances 11938 12204 266 2.22% £2,484,557 £2,568,992 £84,434OP Followup Attendances 67374 66053 -1321 -1.96% £6,916,884 £6,777,450 -£139,434Telephone Consultations 20016 21688 1672 8.35% £620,216 £748,856 £128,640Homecare Treatments 1523 1612 89 5.81% £1,677,426 £1,482,631 -£194,794OP Followup Attendances Chemotherapy Review 36912 41185 4273 11.58% £4,136,536 £4,614,002 £477,466OP Followup Attendances Radiotherapy Review 12168 13341 1173 9.64% £1,363,037 £1,494,431 £131,393Supportive Care Hormonal Drug Review 3061 3304 243 7.95% £345,298 £372,194 £26,896OP Procedures 8491 9522 1031 12.14% £1,744,346 £1,960,821 £216,475AHP Attendances 6301 5703 -598 -9.49% £609,758 £414,434 -£195,324Chemotherapy Delivery 49834 49397 -437 -0.88% £14,593,498 £14,334,160 -£259,338Radiotherapy Treatment 76630 75309 -1321 -1.72% £10,952,862 £10,890,741 -£62,122

310,528 315,394 4,866 1.57% £81,773,127 £84,725,760 £2,952,633Figures are an extract from the Trust’s total activity position.

Unbundled

Grand Total

YTD

Core

1st Cut of Data Total Activity Refreshed Total Activity 1st Cut Variance Refreshed VarianceApr-17 31305 31695 3.18% 4.05%

May-17 35602 36349 1.67% 4.19%

Jun-17 34614 35283 -3.03% -1.07%

Jul-17 33816 34593 -1.50% 0.66%

Aug-17 36466 36917 1.13% 2.27%

Sep-17 33882 34628 -2.50% -0.36%

Oct-17 35885 36366 0.19% 1.45%

Nov-17 36495 37416 1.25% 3.81%

Dec-17 32147 -0.82%

0

200

400

600

800

1000

1200

1400

1600

1800

External Referrals (16-17) External Referrals (17-18)

34

1.3.4 Activity Against Plan

1.4 Infection Control

0100200300400500600700800900

10001100

Inpatients Plan

0

200

400

600

800

1000

1200

Daycases Plan

0

200

400

600

800

1000

1200

1400

1600

OP First Attendances Plan

0100020003000400050006000700080009000

OP Follow Up Attendances Plan

0

200

400

600

800

1000

1200

1400

OP Procedures Plan

0

1000

2000

3000

4000

5000

6000

7000

Chemotherapy Delivery (Treatments) Plan

0100020003000400050006000700080009000

10000

XRT Delivery (Fractions) Plan

National Standard Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18MRSA Bacteraemia 0 0 0 0 0 0 1 0 0

National Threshold 0 0 0 0 0 0 0 0 0 0 0 0

C-Diff icile Avoidable 0 0 0 0 0 0 0 0 0

C-Diff icile Unavoidable 2 3 2 1 1 0 2 3 1

C-Diff icile Avoidable + Unavoidable 2 5 7 8 9 9 11 14 15

C-Diff icile Avoidable + Unavoidable Threshold 2 3 5 6 8 10 11 13 14 16 17 19

35

1.4.1 MRSA Bacteraemia 1.4.2 C-Difficile

1.4.3 MSSA Bacteraemia 1.4.4 GRE Bacteraemia

1.4.5 E-Coli 1.4.6 Klebsiella Species

1.4.7 Pseudomonas Aeuriginosa

0

1

2

3

4

5

MRSA bacteraemia Threshold

02468

101214161820

Avoidable + Unavoidable Avoidable Threshold (National)

0

1

2

3

4

5

MSSA bacteraemia

0

1

2

3

4

5

GRE bacteraemia

0

10

20

30

40

50

60

70

80

E-Coli - Pre 48 Hrs E-Coli - Post 48 Hrs

17/18 Reduct ion Trajectory

0

1

2

3

4

5

Klebsiella Species

0

1

2

3

4

5

Pseudomonas Aeuriginosa

36

1.5 Financial Summary In Month

1.5.1 Income & Expenditure

• Month 9 EBITDA position has a surplus of

£17,568k (£1,662k below plan). • Month 9 I&E surplus is £6,772k (£2,154k

below plan). • We are achieving the NHSI Control Total, our

position assumes meeting all criteria for Sustainability and Transformation Fund (STF) core funding (£77k above plan).

• Our finance score is 1 under the Single Oversight Framework.

• CIP delivery stands at 83.3% in year and 75.4% recurrently.

• Agency spend in month and cumulatively is below the NHSI ceiling.

1.5.2 Trust Performance against Budgets

1.6 Balance Sheet & Liquidity

• Cash balances stand at £37,197k (115.8% of

plan). • Debtor days have increased to 24 in line with

year-end and quarterly trend in relation to the NHS Agreement of Balances exercise and the raising of quarterly invoices.

• Capital expenditure stands at 82.5% of the internal plan.

Gre

en =

Ambe

r =

Red

=

UOR - Financial Sustainability Balance sheet sustainability - Capital service cover (times) 20% 2.5 1.75 1.25 2.6 1

UOR - Financial Sustainability Liquidity - Liquidity (days) 20% 0 -7 -14 41.6 1

UOR - Financial Eff iciency Underlying performance - I&E margin (%) 20% 1% 0% -1% 3.8% 1

UOR - Financial Controls Variance from plan - I&E margin variance (%) 20% 0% -1% -2% 0.0% 2

UOR - Financial Controls Agency Spend (%) 20% 0% 25% 50% -14.2% 1

Overall NHSI Risk Rating Use of Resources (UoR) Metrics 1 2 3 1

Income & Expenditure: YTD Overall f inancial position variance (%) - (underspend)/overspend against plan - bottom line

<0% <0 to 3% >3% 24.1%

Income & Expenditure: YTD Overall f inancial position variance (%) - (underspend)/overspend against plan - control total

<0% <0 to 3% >3% -1.0%

CIP Performance Underperformance against target - In year to current month (%) excluding reserves mitigation

<12% >12 to 50% >50% 12.3%

CIP Performance Underperformance against target - Full year impact - in year (%) <12% >12 to 50% >50% 16.7%

CIP Performance Underperformance against target - Full year impact - recurrent (%) <12% >12 to 50% >50% 24.6%

Capital Expenditure Exchequer Capital Spend to date (£'000) £42,797Cash Balance Current balance to date (£'000) £37,197Cash Balance Percentage of planned value >90% 80-90% <80% 115.8%

Principal purpose cap Income derived from principal purpose exceeds income derived from other purposes

<50% <50% to 99% >100% 27.2%

Debtor Days Average length of time debt is outstanding <16 >20 24

Public Sector Payment Policy Trade creditors paid cumulatively w ithin 30 days (%) >95% 90-94% <90% 97.1%

Public Sector Payment Policy Trade creditors paid cumulatively w ithin 10 days (%) >80% 65-80% <65% 86.3%

Trust Objective Themes & Performance Indicators

Wei

ght

Tolerances

Cur

rent

Mon

th

Dat

a

NH

SI ri

sk ra

ting

Sep-

17

Oct

-17

Nov

-17

M9 Target

Dec

-17

Apr-

17

May

-17

Jun-

17

Jul-1

7

Aug-

17

0

2000

4000

6000

8000

10000

12000

14000

Actual (£000's) Trust Plan

0.05.0

10.015.020.025.030.035.040.045.0

Liquidity Days - Actual Plan

37

1.6.1 Exchequer Cash Balances 1.6.2 % Staff Clinical-Non-Clinical

1.6.3 Aged Debt

£0

£5,000

£10,000

£15,000

£20,000

£25,000

£30,000

£35,000

£40,000

£000

's

Cash Balances Cash Flow Plan

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Medical staf f Nurse staff Clinical staff Non clinical staff Total agency/other

02000400060008000

100001200014000160001800020000

0-30 Days 31-60 Days 61-90 Days 90-180 Days >180 Days

38

1.7 CIP The annual target for CIP in 2017-18 is £9.5m in year and £7.5m recurrently. As at month 9, £7,909,210 has been achieved and removed from budget in year and £5,654,091 has been achieved recurrently. • Against the targets, 83.3% has been delivered in year and 75.4% recurrently.

• In month 11 PIDs were submitted, with 3 PIDs releasing £87K in-year savings and £297K recurrently. • There are 14 active schemes anticipated to deliver a further £69K of in year savings and £230K

recurrently.

39

1.8 Agency

1.9 Exception Reports

Quarter Target Actual Actual + Risk Assessed Value of SchemesQ1 30% 31.2% 35.3%

Q2 50% 48.7% 53.4%

Q3 88% 75.4% 78.5%

Q4 100%

Division / Area of Spend Apr May Jun Jul Aug Sep Oct Nov DecCancer Centre Services £6,963 £10,529 £6,845 £19,279 £16,590 £33,109 £20,043 £19,874 £27,870Cancer Netw orked Services £8,564 £16,225 £16,441 £8,490 £15,787 £9,559 £17,544 £18,605 £18,111Finance & Business Development £5,248 £35,453 £52,860 £55,507 £48,247 £44,823 £41,966 £25,081 £14,543Estates & Facilities £2,165 £2,733 £1,266 £2,474Medical Physics £5,305 £5,305 £6,512 £5,444 £5,444PMO £13,517 £18,855TOTAL Actual - in month £34,292 £81,062 £76,145 £83,275 £88,094 £95,529 £87,330 £71,478 £65,968NHS Improvement Expenditure Ceiling - in month £88,500 £88,500 £88,500 £88,500 £88,500 £88,500 £88,500 £88,500 £88,500% of Ceiling Used - in month 38.75% 91.60% 86.04% 94.10% 99.54% 107.94% 98.68% 80.77% 74.54%TOTAL Actual - cumulative £34,292 £115,354 £191,499 £274,775 £362,869 £458,398 £545,728 £617,206 £683,173

NHS Improvement Expenditure Ceiling - cumulative £88,500 £177,000 £265,500 £354,000 £442,500 £531,000 £619,500 £708,000 £796,500

% of Ceiling Used - cumulative 38.7% 65.2% 72.1% 77.6% 82.0% 86.3% 88.1% 87.2% 85.8%% of Total Pay Bill (Target) 1% 1% 1% 1% 1% 1% 1% 1% 1%% of Total Pay Bill (Actual) 0.36% 0.81% 0.78% 0.85% 0.90% 0.93% 0.84% 0.69% 0.64%

40

41

42

2. Safe 2.1 Safe Staffing

2.1.1 Breakdown by ward

2.2 Bed Occupancy

DAY NIGHTHours Hours

Registered NursesTotal monthly PLANNED 16019.5 11168

Total monthly ACTUAL 15312.5 10773.25Average Fill Rate % 95.6% 96.5%

Care StaffTotal monthly PLANNED 7361.5 3189.5

Total monthly ACTUAL 6984.5 3126.25Average Fill Rate % 94.9% 98.0%

22297 13899.5Average Fill Rate % 95.4% 96.8%

ALL StaffTotal monthly PLANNED 23381 14357.5

Total monthly ACTUAL

Hours Planned Hours Actual Hours Planned Hours ActualCritical Care Unit 1612.5 1500 1562.5 1487.5Palatine Trt Centre 3451.5 3087.5 2475 2262.510 Ward-Surg Onc Unit 1709.5 1688.5 1287.5 1262.511 Ward 2104.5 2072 1457 1433.512 Ward 2131 2061.5 1269 126904 Ward 2411 2344 1363 1304.25Oncology Assessment Unit 2020 1979.5 1250 125001 Ward 579.5 579.5 504 504TOTAL 16019.5 15312.5 11168 10773.25

Hours Planned Hours Actual Hours Planned Hours ActualCritical Care Unit 422.5 397.5 0 0Palatine Trt Centre 1209 1092 787.5 75010 Ward-Surg Onc Unit 903.5 903.5 462.5 42511 Ward 1276 1209 423 434.7512 Ward 1261 1218 364.25 364.2504 Ward 1238 1187 552.25 552.25Oncology Assessment Unit 783 729 600 60001 Ward 268.5 248.5 0 0TOTAL 7361.5 6984.5 3189.5 3126.25

Registered Nurses DAY NIGHT% Fill Rate % Fill Rate

93.0% 95.2%89.5% 91.4%98.8% 98.1%98.5% 98.4%96.7% 100.0%97.2% 95.7%

94.1% 100.0%

98.0% 100.0%100.0% 100.0%95.6% 96.5%

Care Staff DAY NIGHT% Fill Rate % Fill Rate

90.3% 95.2%100.0% 91.9%94.7% 102.8%

92.6% 100.0%94.9% 98.0%

96.6% 100.0%95.9% 100.0%93.1% 100.0%

Ward

BM

RU

WA

RD

4

WA

RD

11

WA

RD

12

Pal

atin

e W

ard

Acu

te

Onc

olog

y U

nit

War

d 1

War

d 10

Crit

ical

Car

e

Dec-16 57% 92% 94% 93% 90% 76% 73% 81% 54%Jan-17 82% 95% 95% 96% 94% 79% 82% 82% 57%Feb-17 77% 96% 96% 95% 94% 82% 86% 89% 56%Mar-17 74% 94% 96% 98% 96% 79% 87% 89% 72%Apr-17 68% 92% 94% 95% 94% 76% 88% 83% 65%May-17 63% 97% 96% 97% 97% 79% 89% 89% 50%Jun-17 64% 98% 98% 97% 98% 84% 87% 90% 67%Jul-17 76% 94% 95% 95% 94% 80% 82% 86% 57%

Aug-17 55% 91% 92% 94% 91% 76% 89% 86% 54%Sep-17 42% 95% 96% 96% 92% 81% 88% 81% 61%Oct-17 55% 94% 95% 93% 90% 81% 82% 86% 62%Nov-17 44% 97% 94% 97% 92% 76% 85% 83% 60%Dec-17 66% 88% 90% 88% 93% 72% 91% 80% 52%

Efficiency Benchmark = 85%

43

2.3 Clinical Incidents

2.3.1 Pressure Ulcers – (Cumulative Totals) 2.3.2 Inpatient Falls – (Cumulative Totals)

2.4 Clinical Governance

2.4.1 Inquests

Outstanding from November

2.4.2 Claims & payments

2.4.3 Serious Incident Panels

None 2.4.4 Serious Incidents Reported

None

Grade Incident Type Additional Details LocationGrade 3

(Moderate)Care/Monitoring Appointment for medical review betw een chemotherapy cycles w as not made for a patient found to be

experiencing signif icant peripheral neuropathy. OUTRE

Administration of medication Incorrect administration of medication resulted in patient having vasovagal episode. PALAT

Collision w ith an object Patient suffered skin tear after catching arm on side of commode. WARD11

Accident Patient cut hand on faulty tap in bathroom. PSEED

Medical equipment Blood blister found w hen dressing removed, caused by three w ay tap. PALAT

Medical equipment Minor skin tears caused upon removal of surgical drapes. THEAT

Medical equipment Skin tear to right arm believed to be caused by transpore tape f ixing iv line in situ. THEAT

Inpatient fall Patient fell on w ard and complained of pain in head and back. Radiological review show ed evidence of old fracture but no new injuries.

WARD4

Inpatient fall Patient fell on w ard and suffered small cut above right eye. WARD4

TOTAL = extravasations (16)

Grade 2 (Minor)

0

5

10

15

20

25

30

2016/17 Total 2017/18 Total 17/18 Reduct ion Trajectory

0

5

10

15

20

25

2016/17 Total 2017/18 Total 17/18 Reduct ion Trajectory

Coroner Staff called VerdictStockport YES Natural Causes

Bolton NO Died as a consequence of naturally occurring disease and the exacerbating effects of recognised complications of necessary chemotherapy treatment.

Heyw ood NO Died as a result of the recognised complications of necessary medical treatment.

Rochdale YES Died as a result of the rare but recognised complications of medical therapy (Naproxen)

Coroner Staff called VerdictHeyw ood NO Industrial Disease

Bolton YES Misadventure

Bolton NO Died as a consequence of naturally occurring disease exacerbated by recognised complications of necessary chemotherapy and immunosuppression treatment.

Heyw ood YES Natural Causes

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17Clinical Negligence 14 18 17 16 16 15 16 15 14 15 14 17 16

Employer Liability 5 5 6 5 5 4 4 4 4 5 5 5 6

Public Liability 2 2 2 2 2 2 2 2 2 2 2 3 4

Payments £7,207 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £1,000

44

2.4.5 Executive Reviews

2.4.6 Top Operational Risks

Ris

k N

umbe

r

Risk

Cur

rent

risk

sc

ore

Targ

et d

ate

for r

educ

tion

of ri

sk s

core

Control measures

1

2017/18 Recurrent Trust Wide Cost Improvement Programme not achieved

20 31st Mar 2018

• Weekly escalation meetings in place. Cash releasing schemes accelerated

• Key cash releasing transformation programs prioritised. Increased drive on reducing costs and risk assessed recurrent cost reduction.

• MARS programme initiated. • Vacancy vet process in place.

2

Ability to maintain high levels of patient care and experience in our inpatient wards due to increased staff turnover and the national shortage of Registered Nurses.

16 31st Mar 2018

• Off duty planned in advance, bank shifts available via health roster.

• Monthly monitoring in place in relation to roster compliance • Weekly and daily review with Matrons • Working with HR on workforce planning, retention and

recruitment schemes. • Trial of Associate Practitioner role on IP area. • Over established HCA roles to commence January to support

3 NEW

Failure to meet 62 day target, resulting in delays to patient care, reduced patient care and reputational risk of non-compliance with national cancer target at Trust and Cancer Network level.

16 28th Feb 2018

• Daily PTL meetings • Additional capacity for theatres and outpatients, including

weekend lists and third sessions • Review of all breach pathways • Review of referral pathways

4

Risk to patient safety due to overdue maintenance of medical devices in clinical services.

16 28th Feb 2018

• External contractor appointed to help reduce the backlog. • Introduction of management changes, providing support and

additional resilience to the service.

5

Increased number of admission deferrals for treatment, acute admissions and inter-hospital transfers due to demand outstripping current capacity across our Inpatient beds.

15 31st Mar 2018

• Utilisation of beds flexibly to manage peaks in demand • Bed modelling to understand current and future bed capacity

requirements to inform new build • Communication with local hospitals to ensure the treatment

plan of patients under their care is appropriate. • Monitor impact of the agreed patient flow policy (Dec 17).

6

Commercial in confidence 15 30th June 2018 • Commercial in confidence

7

Impact on patient care due to shortages of ANPs due to recruitment and retention of staff

15 30th Mar 2018

• Close working with junior doctor team to maintain service to teams A, B, C, EAS, brachytherapy, brachytherapy clinic and out of hours cover.

• Recruitment in progress. • Trainee ANPs in post to qualify summer 2018. • Use of temporary staff. • Review of services provided by team.

Date of executive

review

Incident Report

Number

Incident Date Description Root Cause

07/12/17 W37165 11/10/17 No prior assessment of appropriateness of admission

• A w alk in policy to be developed and incorporated into the patient f low policy.

Patient factors – patient self-presented at ORTC know ing she w as clinically unw ell and required urgent treatment. The patient w ished to receive that care at The Christie.

07/12/17 W37077 03/11/17 Issues around consent for a surgical procedure

• For SI panel 22.1.18 For SI panel

14/12/17 W37199 10/11/17 Consent policy not follow ed • Wording of patient information leaflet to be review ed

Mis-communication

• Ongoing audit to review patients having SACT

• Mismatch code to be rew ritten and suite of Business Rules created for all SACT reporting

21/12/17 W36309 06/09/17 Missed opportunities to prevent AKI

• For SI panel 15.1.18 For SI panel

Missing ‘Administration’ column from lookup table prevented accurate recording

14/12/17 W37194 08/11/17 Recording of chemotherapy activity

Outcome

45

Ris

k N

umbe

r

Risk

Cur

rent

risk

sc

ore

Targ

et d

ate

for r

educ

tion

of ri

sk s

core

Control measures

8

Impact on patient care due to gaps in junior doctor establishment within Surgery/Urology.

15 30th Mar 2018

• Utilisation of international training fellowships (ITF) and research fellowships

• 2 Colorectal appointments, December 2017 and April 2018. • Urology appointment - commences February 2018. • Plastics appointment • Gynaecology vacancy - recruitment in process, January 2018. • 2 clinical fellows recruited to for a period of 6 months

2.4.7 Exception Reports

None

46

3. Effective 3.1 Clinical Effectiveness

3.1.1 Treatment Survival

3.1.2 Wrong Route Chemotherapy 3.1.3 Critical Care Unit Mortality Rates

3.1.4 Inpatient Deaths

The Christie process for learning from deaths follows the NHSI guidance, 2017. All in-patient deaths are screened and where flagged by one or more triggers, an independent structured case note review is undertaken. Reviews are discussed by the Mortality Surveillance Group and the findings and actions from these are reported to the Executive Review meetings. Quarterly reports are made to Patient Safety and Quality Assurance Committees

90.00%91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

Radical XRT 90 day survival rate

76.00%

78.00%

80.00%

82.00%

84.00%

86.00%

88.00%

90.00%

92.00%

Palliative XRT 30 day survival rate

90.00%91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

Final chemotherapy 30 day survival rate

90.00%91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

30 day post surgery survival rate

0102030405060708090

100

Intrathecal administrat ions Wrong route chemotherapy

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Unit mortality Total mortality

Dec-17Elective/planned admission 3Non Elective/emergency admission 13TOTAL 16Mortuary screened triggers (including reported to the coroner) - 9Medical Triggers - 3Nursing Triggers - 1(note there may be more than one trigger)

Number of NHS Christie onsite deaths

Number of deaths that have triggered Structured Casenote Review (SCR) 9

47

4. Caring 4.1 Patient Satisfaction Surveys & Outpatient Satisfaction Surveys

4.1.1 Patient Satisfaction – recommended. 4.1.2 Patient Satisfaction – not recommended

Since April 2017 responses for Main Outpatients have been merged back into the overall data. This has resulted in a very small decrease in the overall satisfaction score. However, the range of variation is less than 1% over the last 12 months and results remain in the upper quartile. 4.2 Complaints

Questions Strongly Agree Agree Disagree % Rec % Not Rec

Acceptable IP admission w aiting time 44 20 5 92.8% 7.2%

Acceptable OP treatment w aiting time 43 40 13 86.5% 13.5%

Acceptable OP test w aiting time 3 0 0 100.0% 0.0%

Informed of pharmacy w aiting time 8 13 1 95.5% 4.5%

Informed of medical physics scan w aiting time 9 1 0 100.0% 0.0%

Acceptable w aiting time to be seen by doctor 43 104 11 93.0% 7.0%

Treated w ith respect by staff 285 92 0 100.0% 0.0%

Involved in decisions 213 120 1 99.7% 0.3%

Given enough privacy 216 95 2 99.4% 0.6%

Access to call bell 63 8 0 100.0% 0.0%

Member of staff to talk to 187 119 3 99.0% 1.0%

Treated w ith compassion 202 93 1 99.7% 0.3%

Received required care 223 108 1 99.7% 0.3%

Received necessary information 229 112 3 99.1% 0.9%

Received suff icient pain control 211 99 2 99.4% 0.6%

High standard of cleanliness 246 120 3 99.2% 0.8%

Recommend Christie services 292 81 0 100.0% 0.0%

TRUST Score 2517 1225 46 98.8% 1.2%

91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

Recommended % Threshold

0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%

Not Recommended % Threshold

Complaint Grade Primary Concern by Complainant1 3 Organisation and communication

2 4 Delays, treatment and support follow ing death

3 4 Treatment and delays

4 4 Prescribing issues, availability of consultant

48

4.2.1 Complaints Comparison 4.2.2 PALS Contacts

4.3 Friends & Family Test 4.3.1 Inpatients 4.3.2 Outpatients

4.3.3 Inpatients by Ward

0

2

4

6

8

10

12

2017/18 Total 2016/17 Total

020406080

100120140160180

2017/18 Total 2016/17 Total

91.00%92.00%93.00%94.00%95.00%96.00%97.00%98.00%99.00%

100.00%

Threshold % Recommended

92.50%93.00%93.50%94.00%94.50%95.00%95.50%96.00%96.50%97.00%

Threshold % Recommended

1 - Extrem

ely Likely

2 - Likely

3 - Neither likely

nor unlikely

4 - Unlikely

5 - Extrem

ely unlikely

6 - Don't K

now

01 Ward (Dept 33) 27 5 0 0 0 1 36 33 91.7%

03 Ward (Dept 48) 0 0 0 0 0 0 1 0 0.0%

04 Ward (Dept 52) 27 1 0 0 0 1 77 29 37.7%

10 Ward-Surg Onc Unit (Dept 4) 44 6 0 0 0 0 124 50 40.3%

11 Ward (Dept 4) 20 2 0 1 0 1 101 24 23.8%

12 Ward (Dept 4) 15 1 1 1 0 0 104 18 17.3%

CTU Inpatient Ward (Dept 1) 7 0 0 0 0 0 14 7 50.0%

Endocrine Ward (Dept 63) 3 1 0 0 0 0 13 4 30.8%

Haematology Day Unit (Dept 26) 28 4 0 0 1 1 82 34 41.5%

Integrated Procedure Unit (Dept 2) 62 4 1 0 1 2 148 70 47.3%

Oncology Assessment Unit (Dept 14) 17 2 0 0 0 0 215 19 8.8%

Palatine Ward (Dept 27) 18 1 0 0 0 0 66 19 28.8%

Planned Admission & Transfer Suite (Dept 25) 14 1 0 0 0 0 33 15 45.5%

The BMR Unit (Dept 16) 20 0 1 0 0 0 69 21 30.4%

Total 302 28 3 2 2 6 1083 343 31.7%

Ward name

Total responses in each category for each wardTotal

Number of people

eligible to respond

Total responses for each

ward

Response rate for each

ward

49

4.4 Staff Friends & Family Test

4.5 Executive Walk rounds 5th December 2017 – PAT Suite – Chief Operating Officer Things to be proud of:

• All very proud of the team on the unit, they all work very well together to get things done for the benefit of the patients

• The unit allows nursing staff and support staff to develop a range of clinical skills so is very good for personal development.

• The team will regularly stay and look after patients after their shift ends to ensure patients are looked after. Challenges:

• Patient flow is a big issue; some patients regularly wait for long periods to get to a ward in a window-less waiting room.

• There are not enough sinks on the unit for hand washing • Poor patient experience when transferring patients late at night • Staff often stay late to look after patients therefore getting home late. This is also a problem when walking to

the car park as there are no lights on the car park after 10pm. • There is no geyser or dishwasher in the kitchen which makes it harder to provide drinks and food to patients • There is no food trolley so patients are given microwave meals that take time to prepare – can be difficult if

there are a lot of patients to feed. • MSCC patients wait for long periods for transport as they need a crew / stretcher – they need to be prioritised

but aren’t as they are deemed as being in a ‘place of safety’ • Radiotherapy patients awaiting transport outside the unit wait too long for paid taxis. • Alarm system is linked to the Haematology Unit so sounds on the unit

Things to take forward: • Patient flow – need to look at why patients are waiting for so long & how this can be addressed – Chief Nurse

meeting with matrons to look at solutions • Additional sinks on the unit for hand washing – estates are looking at where they need to be fitted and getting

them put in • Boiler fitted in the kitchen for a geyser to make drinks for patients – estates will fit • Lights on in the car park after 10pm – system installed to bring lights on when ID badge is swiped • Structure of service needs addressing to start earlier and avoid so many late finishes • Catering – need to set up a more flexible arrangement for feeding patients

12th December 2017 – Clinical Trials Unit – Director of Workforce Things to be proud of

• Staff will always put patients first • New team members feel supported by their colleagues who are willing to share knowledge and provide

explanations • Staff feel they are not just a number but part of a team • Supportive and approachable manager • Link roles are useful and enable staff to expand their knowledge and skills, learning is shared • Daily safety huddle bring whole team together • Staff value wellbeing events/garden party

Challenges • Difficulty in getting information about when chemotherapy will be ready which makes it hard to keep patients

informed • Long waits to get medication from Pharmacy • Recruitment of staff – advertised as 1 year fixed term which could stop people applying • Length of time for staff, from being recruited to starting • Problems in getting ID card when the responsible person for ID cards is not available • Space an issue for storage of personal belongings

50%55%60%65%70%75%80%85%90%95%

100%

% recommend as a place to work % recommend as a place for treatment

0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%50.0%

% response

50

Things to take forward/consider • Printer with fax facility required • Additional lockers required • The recent change to Pharmacy service should improve the patient experience • Career progression and opportunities to learn are important in retaining staff

4.5.1 Exception Reports

51

5. Well Led 5.1 Trust Headcount & FTE

5.2 Trust Sickness

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-172694 2715 2711 2712 2715 2734 2740 2730 2747 2756 2728 2797 27982474 2486 2485 2480 2480 2503 2504 2501 2518 2533 2501 2563 25672567 2565 2565 2568 2598 2632 2611 2626 2632 2627 2656 2665 2694

TrustTotal HeadcountTotal FTEEstablishment

2300

2400

2500

2600

2700

2800

2900

Total Headcount Total FTE Establishment

Division Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 YTDCancer Centre Services 3.10% 3.51% 3.57% 4.05% 4.09% 3.19% 3.54% 3.80% 3.91% 3.59%Christie Medical Physics and Engineering 1.02% 0.87% 0.73% 0.95% 1.25% 1.36% 2.03% 2.50% 1.65% 1.33%Clinical Netw orked Services 2.61% 2.72% 2.58% 2.92% 3.48% 3.06% 3.24% 4.42% 4.52% 3.30%Corporate Development 3.60% 3.30% 2.60% 3.28% 3.52% 0.87% 0.54% 0.00% 1.91% 2.20%Education (School of Oncology) 1.20% 2.44% 3.56% 2.32% 0.36% 0.11% 1.12% 2.79% 1.05% 1.71%Estates & Facilities 3.50% 3.29% 4.95% 5.22% 5.31% 5.74% 7.18% 9.17% 6.47% 5.57%Finance & Business Development 3.29% 2.54% 1.75% 1.63% 1.35% 3.27% 3.23% 2.63% 2.77% 2.55%Medical Director's Off ice 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%Performance 0.00% 0.00% 0.00% 1.66% 6.32% 4.56% 7.03% 5.88% 0.00% 2.60%Quality and Standards 5.89% 3.14% 0.00% 0.00% 0.00% 0.20% 0.82% 0.00% 0.41% 1.29%Research and Development 3.66% 4.52% 5.20% 4.21% 5.22% 5.15% 4.12% 4.05% 3.24% 4.41%Service Transformation 1.45% 0.70% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.26%Trust Administration 0.00% 0.00% 0.00% 0.00% 0.59% 0.00% 6.25% 6.25% 0.00% 1.41%Workforce 1.40% 2.58% 3.80% 3.46% 5.38% 5.01% 6.21% 9.09% 7.12% 5.13%Grand Total 2.79% 2.98% 3.13% 3.28% 3.63% 3.33% 3.64% 4.31% 3.87% 3.43%RAG Rating (>=Apr-16): <=3.4 GREEN; >3.4 RED** This includes Corporate Development, Education, Performance, Quality and Standards, Trust Admin and Workforce

0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%5.00%

Threshold Trust total

52

5.3 PDRs

5.4 Essential Training

5.5 Staff Turnover

Division Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17Cancer Centre Services 84.24% 88.85% 90.07% 85.96% 89.00% 90.10% 89.26% 87.78% 84.90%Christie Medical Physics and Engineering 80.31% 75.88% 77.72% 76.33% 87.00% 87.80% 88.56% 90.50% 88.89%Clinical Netw orked Services 86.68% 88.96% 87.40% 86.68% 86.00% 84.49% 86.19% 85.09% 85.92%Corporate Development 71.88% 93.75% 71.88% 93.55% 91.00% 88.24% 91.18% 97.37% 100.00%Education (School of Oncology) 81.82% 80.00% 78.72% 95.83% 94.00% 97.87% 95.92% 97.92% 97.92%Estates & Facilities 79.74% 76.99% 80.00% 75.00% 86.00% 95.80% 97.06% 96.62% 96.62%Finance & Business Development 82.35% 78.87% 77.61% 82.84% 88.00% 83.46% 88.46% 90.77% 90.70%Medical Director's Off ice 0.00% 0.00% 50.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%Performance 86.67% 81.25% 82.35% 77.78% 67.00% 66.67% 94.44% 100.00% 100.00%Quality and Standards 100.00% 93.75% 92.86% 86.67% 100.00% 100.00% 93.33% 93.33% 93.33%Research and Development 80.97% 77.95% 81.32% 86.49% 89.00% 89.29% 87.55% 89.12% 89.71%Service Transformation 42.86% 33.33% 100.00% 83.33% 86.00% 85.71% 100.00% 100.00% 100.00%Trust Administration 66.67% 83.33% 83.33% 100.00% 100.00% 100.00% 100.00% 1000.00% 100.00%Workforce 94.34% 92.86% 95.74% 95.56% 96.00% 90.91% 88.37% 86.36% 82.61%Grand Total 83.47% 84.29% 84.88% 84.50% 88.00% 88.50% 89.26% 89.11% 88.46%RAG Rating (>=June-15): >=94.5% GREEN; 85<>94.5 AMBER; <=84.5 RED

Division Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17Cancer Centre Services 91.11% 89.80% 89.74% 90.18% 90.00% 87.15% 88.09% 88.83% 89.23%Christie Medical Physics and Engineering 95.37% 95.25% 95.32% 93.46% 94.00% 87.97% 90.71% 92.35% 92.52%Clinical Netw orked Services 87.35% 86.95% 88.20% 88.18% 88.00% 82.94% 85.06% 84.73% 85.18%Corporate Development 97.92% 94.50% 96.74% 97.61% 95.00% 93.84% 97.29% 99.04% 97.42%Education (School of Oncology) 97.68% 96.46% 96.32% 96.30% 98.00% 95.57% 98.18% 96.71% 95.56%Estates & Facilities 94.94% 95.26% 96.15% 95.45% 95.00% 88.01% 89.33% 92.20% 91.55%Finance & Business Development 95.16% 94.96% 95.56% 96.66% 96.00% 89.38% 93.92% 93.87% 94.56%Medical Director's Off ice 90.00% 90.00% 90.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.67%Performance 98.22% 97.16% 94.64% 93.67% 99.00% 87.34% 89.45% 93.44% 89.87%Quality and Standards 96.27% 97.36% 97.66% 97.35% 86.00% 92.49% 94.12% 98.39% 92.34%Research and Development 94.99% 94.19% 93.73% 94.20% 95.00% 91.53% 92.05% 94.54% 92.84%Service Transformation 94.81% 95.56% 95.37% 94.21% 95.00% 93.39% 95.83% 95.70% 95.87%Trust Administration 98.47% 96.91% 97.94% 99.48% 100.00% 94.85% 97.94% 98.68% 96.39%Workforce 98.40% 96.24% 95.01% 97.46% 96.00% 92.24% 94.77% 94.19% 93.38%Grand Total 91.25% 90.74% 91.20% 91.31% 91.00% 86.78% 88.50% 89.15% 89.23%RAG Rating (>=June-15): >=94.5% GREEN; 85<>94.5 AMBER; <=84.5 RED

Leavers Headcount Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17Dismissal 0 1 1 0 0 0 0 4 5 0 1 3 2

End of Fixed Term Contract 0 5 4 4 2 4 2 3 8 8 4 0 1

Mutually Agreed Resignation 0 0 0 0 0 0 0 0 0 0 0 0 0

Redundancy 0 0 1 1 0 0 0 0 0 0 0 1 0

Retirement 3 2 2 2 4 1 2 0 1 1 3 1 3

TUPE 1 0 0 1 2 0 0 0 0 0 0 0 0

Voluntary Resignation 20 28 26 14 25 17 14 22 28 12 29 22 35Others 0 0 0 0 0 0 0 0 1 0 1 0 0

Grand Total 24 36 34 22 33 22 18 29 43 21 38 27 4112 Month Turnover % Headcount 16.96% 15.36% 14.46% 14.09% 14.40% 13.28% 12.96% 12.86% 13.03% 12.19% 13.51% 13.48% 14.38%Adjusted 12 month Turnover %* 15.11% 13.74% 12.77% 12.43% 12.67% 11.70% 11.46% 10.00% 10.96% 10.09% 10.22% 11.14% 11.77%

* Turnover based on substantive leaving reasons only (Dismissal, M.A.R.S, Redundancy, Retirement, Voluntary Resignation, Other)

53

5.6 Exception Reports

54

6. Appendix 6.1 62 Day by Tumour Group

6.1.1 Brain/CNS

6.1.2 Breast

6.1.3 Gynaecological

6.1.4 Haematological (Excluding Acute Leukaemia)

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

0 0 0 0

0 0 0 0

0 0 0 0

0.0 0.0 0.0 0.0

100.0% 100.0% 100.0% 100.0%

100.0% 100.0% 100.0% 100.0%

17/18

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

16/17

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

54 41 66 44

52 37 62 44

2 4 4 0

0.0 1.0 1.0 0.0

96.3% 90.2% 93.9% 100.0%

100.0% 94.9% 96.9% 100.0%

17/1816/17

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

Total treats

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

56 53 65 66

40 41 47 46

16 12 18 20

8.0 5.0 7.0 7.0

71.4% 77.4% 72.3% 69.7%

71.4% 80.4% 77.0% 76.7%

17/18

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

16/17

30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%110.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

12 10 18 20

6 5 9 9

6 5 9 11

1.0 0.0 1.0 1.0

50.0% 50.0% 50.0% 45.0%

75.0% 100.0% 81.8% 81.8%

17/18

Adjusted Position

16/17

Total treats

Compliances

Breaches

Christie breaches

CWT %

55

6.1.5 Head & Neck

6.1.6 Lower Gastrointestinal

6.1.7 Lung

6.1.8 Other

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

44 48 43 42

26 39 39 34

8 9 4 8

1.0 0.0 0.0 0.0

59.1% 81.3% 90.7% 81.0%

92.9% 100.0% 100.0% 100.0%

17/18

Adjusted Position

16/17

Total treats

Compliances

Breaches

Christie breaches

CWT %

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

58 49 57 54

34 28 35 27

24 21 22 27

4.0 1.0 3.0 5.0

58.6% 57.1% 61.4% 50.0%

81.0% 93.3% 85.4% 73.0%

17/1816/17

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

100 91 101 89

78 70 74 59

22 21 27 30

0.0 2.0 3.0 1.0

78.0% 76.9% 73.3% 66.3%

100.0% 94.6% 92.5% 96.7%

17/18

Breaches

Christie breaches

CWT %

Adjusted Position

Total treats

Compliances

16/17

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

6 10 8 4

4 3 5 2

2 7 3 2

0.0 1.0 0.0 0.0

66.7% 30.0% 62.5% 50.0%

100.0% 60.0% 100.0% 100.0%

17/18

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

16/17

56

6.1.9 Sarcoma

6.1.10 Skin

6.1.11 Upper Gastrointestinal

6.1.12 Urological (Excluding Testicular)

20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

10 12 8 7

7 11 3 2

3 1 5 5

1.0 0.0 2.0 1.0

70.0% 91.7% 37.5% 28.6%

77.8% 100.0% 42.9% 50.0%

17/18

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

16/17

60.0%65.0%70.0%75.0%80.0%85.0%90.0%95.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

34 25 35 33

28 21 25 26

6 4 10 7

4.0 1.0 3.0 1.0

82.4% 84.0% 71.4% 78.8%

77.8% 91.3% 80.6% 92.9%

17/18

Total treats

Compliances

Breaches

CWT %

Adjusted Position

16/17

Christie breaches

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

59 65 64 61

28 19 32 32

31 46 32 29

4.0 5.0 3.0 1.5

47.5% 29.2% 50.0% 52.5%

77.8% 65.5% 84.2% 91.4%

17/18

Total treats

Compliances

Breaches

Christie breaches

CWT %

Adjusted Position

16/17

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q4 Q1 Q2 Q3

17/18

CWT % Adjusted Position

National Standard DH Suggested Standard

Q4 Q1 Q2 Q3

35 36 24 43

17 14 8 21

18 22 16 22

1.0 1.0 4.5 3.0

48.6% 38.9% 33.3% 48.8%

89.5% 87.5% 47.1% 77.8%

17/18

Christie breaches

CWT %

Adjusted Position

Total treats

Compliances

Breaches

16/17

57

Owners Fiona Noden, Chief Operating Officer

Wendy Makin, Medical Director Joanne Fitzpatrick, Director of Finance & Business Development

Jackie Bird, Chief Nurse and Executive Director of Quality Eve Lightfoot, Director of Workforce

Marie Hosey, Assistant Chief Operating Officer – Performance & Operational Standards

Report Produced by Andrew Gibson – Deputy Head of Performance

58

Agenda item 03/18a

Meeting of the Board of Directors

Thursday 18th January 2018

Report of Executive Medical Director Strategy

Paper Prepared By Louise Westcott, Company Secretary

Subject/Title The Christie Strategy 2018-2023

Background Papers Strategic Plan Document for 2014-19

2020 Vision

Purpose of Paper To summarise the main themes and the progress against them of The Christie Strategy 2018-2023

Action/Decision Required Management Board are asked to approve the Christie Strategy 2018-2023

Link to:

NHS Strategies and Policy

GM Cancer Plan

Link to:

Trust’s Strategic Direction

Corporate Objectives

All 8 Strategic Objectives (as detailed in the paper)

Impact on resources and risk and assurance profile

You are reminded that resources are broader than finance and also include people, property and information.

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

59

60

Meeting of the Board of Directors Thursday 25th January 2018

The Christie Strategy 2018-2023

1 Introduction This paper presents the refreshed Christie strategy for 2018-2023. This builds on the existing

2020 Vision and goes further with the strategy we are currently working to. Within this paper our main ambitions are identified against the 4 themes from the 2020 Vision. These are 1) Leading cancer care; 2) The Christie Experience; 3) Local & Specialist Care and 4) Best Outcomes.

2 Background We have been through an extensive process of consultation and engagement throughout the

organisation over the past 9 months to develop the strategy. We have spoken to key staff from across the Trust as well as consulting with the board and the council of governors.

In setting the ambition for the next 5 years we continue to refer to our 8 corporate objectives.

These are;

1 To demonstrate excellent and equitable clinical outcomes and patient safety, patient experience and clinical effectiveness for those patients living with and beyond cancer.

2 To be an international leader in research and innovation which leads to direct patient benefits at all stages of the cancer journey.

3 To be an international leader in professional and public education for cancer care.

4 To integrate our clinical, research and educational activities as an internationally recognised and leading comprehensive cancer centre.

5 To provide national and local leadership through system collaboration to deliver excellent cancer care.

6 To maintain excellent operational and financial performance.

7 To be an excellent place to work and attract the best staff.

8 To play our part in the local healthcare economy and community.

We have also developed our vison document ‘2025 Vision’. This describes our overarching strategic themes and aspirations as well as describing our successes over the past 5 years. Once approved, this document will be published on our website. The strategy presented in this paper describes in more detail how these themes will be taken forward until 2023. The 2025 Vision is attached as an appendix to this paper.

3 Recommendation Board are asked to approve the refreshed Christie strategy for 2018 – 2023.

61

62

The Christie Strategy 2018-2023

Main themes

Leading cancer care The Christie experience Local & specialist care Best outcomes

We want to build on the success of our collaboration with UoM and

CRUK & go further on the integration of research, teaching and clinical

care

We will implement The Christie quality accreditation schemes

(CODE & quality mark) at all Christie locations to ensure the highest standards across all Christie

services

We will extend our network of radiotherapy centres to provide better

access to specialist treatments across the region

We will offer access to trials to all eligible patients receiving our care to

ensure more patients get the best possible treatment for their cancer

We will be the 1st NHS high energy proton centre in the UK, developing the service, research & education so that UK patients no longer have to

travel abroad for this treatment

We will develop a dedicated Oncology of Later Life service to ensure we meet the needs of an

ageing population

We will establish the GM Prostate Cancer Centre as an international centre of expertise, integrating all

aspects of prostate cancer treatment, research & education

We will work with partner organisations to establish up to 2

multi-disciplinary Diagnostic Centres to enable earlier diagnosis of cancer

across Greater Manchester

We will establish an international network of Christie affiliated

organisations

We will deliver a new model of outpatient care in a new state of the

art outpatients department

We will provide greater access to minimally invasive cancer treatments

such as robotic surgery & interventional radiology

We will work with partner organisations led by Manchester Foundation Trust to develop a

precision diagnostic service for the rapid adoption of genomic medicine

We will provide national leadership for specialist radiotherapy &

radiotherapy research

We will build on the success of the networked care model established in GM & explore opportunities to

form partnerships with non-surgical oncology services outside of GM

We will continue building on the enhanced supportive care model for

outpatients, which incorporates acute oncology support, by expanding to

other sites

We will develop a Christie centre for cancer survivorship incorporating a hub

of expertise for late effects management, supportive care and

research

We will establish The Christie multi-disciplinary international fellowship programme through the School of

Oncology

We will lead on the provision of GM PET services for cancer & work with

partner organisations to enhance access across a wider population

We will further develop our clinical outcomes centre to continuously

improve practice through live collection & interpretation of clinical

data

63

The Christie Strategy 2018-2023

Theme Ambition Lead Current position Next steps

LCC

We want to build on the success of our collaboration with University of Manchester and CRUK & go further on the integration of research, teaching and clinical care

EMDS

Discussions ongoing with partners about strategy, the building & business relationships Funding sources being explored Update to Board Time Out December 2017

Prepare feasibility case for Management Board and Board of Directors in April 2018 Regular updates to Board OBC to June MB / BoD FBC to November MB / BoD CFC approval December 2018

LCC

We will be the 1st NHS high energy proton centre in the UK, developing the service, research & education so that UK patients no longer have to travel abroad for this treatment

EDoF &BD

Build and fit out progressing to plan Contract with NHSE being finalised

On track to treat 1st patient in August 2018

LCC We will establish an international network of Christie affiliated organisations EMDS Scheme being developed Scheme to be approved

LCC We will provide national leadership for specialist radiotherapy & radiotherapy research

EMD

Responding to national radiotherapy strategy consultation Implementing advanced radiotherapy technology (Proton Beam / MR Linac)

Proton beam therapy to be operational in August 2018 MR Linac to be operational in November 2018 Further development of the research & education programme

LCC We will establish The Christie multi-disciplinary international fellowship programme through the School of Oncology

EMDS In the process of creating a single model programme for all clinical & academic fellows

Agree scheme and undertake recruitment programme

TCE

We will implement The Christie quality accreditation schemes (CODE & quality mark) at all Christie locations to ensure the highest standards across all Christie services

CN&DoQ

CODE Programme developed for ambulatory care Quality Mark programme developed

CODE programme to be developed for clinical teams Roll out of CODE & Quality mark programmes to all Christie locations

64

Theme Ambition Lead Current position Next steps

TCE We will develop a dedicated Oncology of Later Life service to ensure we meet the needs of an ageing population

EMD Detailed proposals in development Business plan to Management Board by end 2018/19 Will require commissioner support

TCE We will deliver a new model of outpatient care in a new state of the art outpatients department

COO

Phase 1 business case approved by Board in October 2017 Procurement undertaken & partner approved November 2017

New OP department to be operational by September 2018 Phased closure of department 42 – December 2018 to February 2019 Evaluation of phase 1 – March 2018 Phase 2 business case to be developed – for approval March 2019

TCE

We will build on the success of the networked care model established in GM & explore opportunities to form partnerships with non-surgical oncology services outside of GM

EDoF &BD

Discussions with potential partners in progress Updates to board on progress

L&SC We will extend our network of radiotherapy centres to provide better access to specialist treatments across the region

EDoF &BD

Business case for additional radiotherapy centre in development

Business case to Management Board February 2018 Update to BoD Time Out & feasibility paper to CFC in March 2018

L&SC

We will establish the GM Prostate Cancer Centre as an international centre of expertise, integrating all aspects of prostate cancer treatment, research & education

COO Plan in place and transition arrangements being agreed

Business case to Management Board and Board of Directors in May 2018

L&SC We will provide greater access to minimally invasive cancer treatments such as robotic surgery & interventional radiology

COO

Business case for interventional radiology approved by Management Board December 2017 – subject to commissioner support

Interventional radiology business case to Board in April 2018 subject to commissioner support

L&SC

We will continue building on the enhanced supportive care model for outpatients, which incorporates acute oncology support, by expanding to other sites

COO

Pilots of Enhance Supportive Care clinics being undertaken Working with Christie @ Oldham to assess potential for clinic

Included in commissioning intentions for 2018/19

65

Theme Ambition Lead Current position Next steps

L&SC

We will lead on the provision of GM PET services for cancer & work with partner organisations to enhance access across a wider population

COO National PET 1 contract Board approval January 2018

Awaiting NHSE decision award of contract Implementation if approved

BO

We will offer access to trials to all eligible patients receiving our care to ensure more patients get the best possible treatment for their cancer

EMDS

Training plans being worked up to enable delivery of trials in other locations Pilot of data platform tool initiated for decision support on trial eligibility

Implementation of outcome of pilot / trial

BO

We will work with partner organisations to establish up to 2 multi-disciplinary Diagnostic Centres to enable earlier diagnosis of cancer across Greater Manchester

EMDS Discussions with other trusts and Manchester Cancer about possible approach

Bring forward proposals following agreement

BO

We will work with partner organisations led by Manchester Foundation Trust to develop a precision diagnostic service for the rapid adoption of genomic medicine

EMD The Christie is one of the core providers responding to the National ITT for the North West Genomic Hub

Await outcome

BO

We will develop a Christie centre for cancer survivorship incorporating a hub of expertise for late effects management, supportive care and research

COO Detailed proposals in development Business case to CFC in early 2018

BO

We will further develop our clinical outcomes centre to continuously improve practice through live collection & interpretation of clinical data

EDoF &BD

Business case in development EPR business case to come to Management Board and Board of Directors in March 2018

66

Leading cancer treatments and improving outcomes for patients:

Our 2025 Vision

67

68

The Christie specialises in cancer treatment, research and education and is the largest single site cancer centre in Europe.

Treating more than 44,000 patients a year from across the UK, we became the first UK centre to be officially accredited as a comprehensive cancer centre and have our own dedicated hospital charity.

In 2016 we were rated ‘Outstanding’ by the Care Quality Commission and acknowledged as one of the top three hospitals nationally. Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “We found the care at The Christie NHS Foundation Trust to be of exceptional quality.”

The Christie employs nearly 3,000 staff, all of whom are determined to provide the best possible cancer care and patient experience. Some of the developments we have made in the last few years are outlined here. We have built a state of the art specialised haematology and teenage and young adult unit as well as creating excellent facilities at our Oak Road entrance for our ambulatory patients.

Our experts have been pioneering cancer research breakthroughs for more than 100 years and The Christie is well known for many world-firsts which have advanced cancer treatment on a global scale.

Housing the largest single site early phase clinical trials unit in the UK, we have an excellent reputation as an international leader in research and innovation, which is further strengthened by being a partner in the Manchester Cancer Research Centre (MCRC) and Health Innovation Manchester.

A core element of The Christie is education. With its own School of Oncology, the first of its kind in the UK, The Christie educates healthcare professionals from across the country, enhancing the patient experience and promoting developments in cancer care.

While continuing to focus on our specialist areas of cancer treatment, research and education, The Christie has used the findings from extensive consultation as part of the 20:20 Vision process to drive the Trust forward, and further enhance services, not just in the UK, but across the world. Following on from this process we now want to look again at the ambitions we have to continue to improve services for our patients. The 2025 Vision expands on the work we have done and describes our ambitions for the future.

Our vision continues to focus on the four themes identified through our engagement exercise for the 2020 Vision:

1. Leading cancer care 2. The Christie experience 3. Local and specialist care 4. Best outcomes

This document highlights our ambitions and plans surrounding each of these themes and has been developed through a process of consultation with our staff, board and governors. The information here will give you a clearer understanding of our direction, and what we hope to achieve over the coming years.

About The Christie

69

You said

The Christie is recognised as an international centre of excellence with even more potential for its clinical experts to lead cancer care and treatment for the benefit of patients.

Our pledge to you

We will continue to lead the development of cancer treatment, research and education so that by 2025 The Christie will be a leading organisation in the UK in addressing the burden of cancer.

What we are doing now

We have become the hospital of choice in the UK for the treatment of cancer. The production and publication of disease specific outcome data alongside the CQC classification of ‘outstanding’ has ensured The Christie remains at the forefront of the fight against cancer. The UK’s first NHS high energy proton beam therapy centre will open at The Christie in 2018.

We have developed a regional centre for brachytherapy to provide cutting edge treatments for patients with prostate and cervical cancer.

We have integrated our specialised haematology and teenage and young adult services into the £12m dedicated Palatine Treatment Centre to provide first class care.

Through the collaboration with The University of Manchester and Cancer Research UK, we have completed phase 1 of the Manchester Cancer Research Centre, alongside the successful international academic recruitment drive to keep Manchester at the forefront of cancer research globally.

We routinely publicise our outcome data through our monthly performance reports and annual quality accounts on our website.

1. Leading cancer care

70

Our ambition for the future

We want to build on the success of our collaboration with The University of Manchester and Cancer Research UK and go further on the integration of research, teaching and clinical care.

We will be the first NHS high energy proton centre in the UK, developing the service, research and education so that UK patients no longer have to travel abroad for this treatment.

We will establish an international network of Christie affiliated organisations.

We will provide national leadership for specialist radiotherapy and radiotherapy research.

We will establish The Christie multi-disciplinary international fellowship programme through our School of Oncology.

71

You said

Patients and families have an attachment to The Christie as a “wonderful and special place” which makes them feel safe and understood.

Our pledge to you

We will build on the success of the patient and staff experience recognised by the CQC ‘outstanding’ rating. We will go further in understanding and acting upon the needs of our patients throughout and after their treatment.

What we are doing now

We have been rated as ‘outstanding’ by the Care Quality Commission and acknowledged as one of the top three hospitals nationally.

We have developed The Christie School of Oncology to have national impact. The School consistently receives the highest level feedback for its full range of programmes.

In partnership with Maggie’s, we have developed a purpose built Maggie’s Centre on The Christie site to provide holistic care for patients and carers.

We have developed a partnership with the Manchester University NHS Foundation Trust for the delivery of acute medical services that ensures our patients receive optimum care.

2. The Christie Experience

72

Our ambition for the future

We will implement The Christie quality accreditation schemes (CODE & quality mark) at all Christie locations to ensure the highest standards across all Christie services.

We will develop a dedicated ‘Oncology of Later Life’ service to ensure we meet the needs of an ageing population.

We will deliver a new model of outpatient care in a new state of the art outpatients department.

We will build on the success of the networked care model established in Greater Manchester and explore opportunities to form partnerships with non-surgical oncology services outside of Greater Manchester.

73

You said

Patients and families are prepared to travel to The Christie for specialist services but want some services to be provided locally where this is possible.

Our pledge to you

We will further expand our networked care model and the breadth of services available in the communities to ensure fewer patients have to travel to receive the best care.

What we are doing now

The CQC found the care at The Christie to be of exceptional quality. We deliver cutting edge treatments via our network of radiotherapy centres.

We have expanded our chemotherapy service to deliver treatment through the largest chemotherapy unit in the UK, as well as via 10 other sites, our mobile chemotherapy unit and in patients’ homes. We have exceeded our target of 80% of clinically appropriate patients receiving treatment within 30 minutes of their home.

In partnership with Alliance Medical we have successfully won and are implementing the National PET 1 contract. This means that we are the national educational lead for the delivery of Positron Emission Tomography (PET).

We have doubled the number of our patients that can be treated by robotic surgery to ensure the residents of Manchester have access to the latest minimally invasive surgical cancer treatments.

3. Local and specialist care

74

Our ambition for the future

We will extend our network of radiotherapy centres to provide better access to specialist treatments across the region.

We will establish the Greater Manchester Prostate Cancer Centre as an international centre of expertise, integrating all aspects of prostate cancer treatment, research and education.

We will provide greater access to minimally invasive cancer treatments such as robotic surgery and interventional radiology.

We will continue building on the enhanced supportive care model for outpatients, which incorporates acute oncology support, by expanding to other sites.

We will lead on the provision of Greater Manchester PET services for cancer and work with partner organisations to enhance access across a wider population.

75

You said

Patients value The Christie as a place where they get the latest cancer treatments, trials and technologies to increase their life expectancy and quality of life.

Our pledge to you

We will continue to offer the latest technology and develop new treatments for the future, making our data on outcomes of treatments available to the public.

What we are doing now

We are leading the three cancer themes in the Manchester Biomedical Research Centre.

We are building what will be the first NHS high energy proton beam therapy centre.

Through our academic investment plan, we have recruited world experts to contribute to our work on experimental cancer therapeutics, radiotherapy related research and discovery research in tumour specific themes such as lung, prostate, melanoma and pancreatic cancer.

We have expanded the range of procedures undertaken robotically and doubled the operating capacity.

We have continued to grow our research output across all therapies, from experimental therapies to the latest diagnostics and palliative care.

We have provided patients with important information about their treatment via data on effectiveness, safety and patient experience.

4. Best outcomes

76

Our ambition for the future

We will offer access to trials to all eligible patients receiving our care to ensure more patients get the best possible treatment for their cancer.

We will work with partner organisations to establish up to two multi-disciplinary Diagnostic Centres to enable earlier diagnosis of cancer across Greater Manchester.

We will work with partner organisations, led by Manchester University NHS Foundation Trust, to develop a precision diagnostic service for the rapid adoption of genomic medicine.

We will develop a ‘Christie Centre for Cancer Survivorship’ incorporating a hub of expertise for late effects management, supportive care and research.

We will further develop our clinical outcomes centre to continuously improve practice through live collection and interpretation of clinical data.

77

Keep up-to-date with all our news from the latest Christie developments to charity events.

The Christie NHS Foundation TrustWilmslow RoadManchester M20 4BXUnited Kingdom

Phone 0161 446 3000Fax 0161 446 3977www.christie.nhs.uk

Join the conversation on TwitterFollow us @TheChristieNHSFollow our charity @TheChristie

Join us on Facebookwww.facebook.com/TheChristieNHSwww.facebook.com/TheChristiecharity

Follow our charity on Instagramwww.instagram.com/christiecharity 78

Agenda Item 04/18a

Meeting of the Board of Directors Thursday 25th January 2018

Board Assurance Framework 2017/18

Report of Chief Executive Officer

Paper Prepared By Louise Westcott, Company Secretary

Subject/Title Board Assurance Framework 2017/18

Background Papers Board assurance framework 2016/17. Corporate objectives 2017/18, operational plan and revenue and capital plan 2017/18.

Purpose of Paper To note the refreshed Board Assurance Framework (BAF) 2017/18

Action/Decision Required To consider any updates to the Board Assurance Framework (BAF) 2017/18

Link to:

NHS Strategies and Policy

• NHS Cancer Reform Strategy

• NHS Financial Regime, NHS Planning Guidance, Payment by Results, Monitor annual planning review, Monitor Risk Assessment Framework

Link to:

Trust’s Strategic Direction

Corporate Objectives

• Trust’s strategic direction

• Divisional implementation plans

• 2020 vision strategy

• Key stakeholder relationships

Resource Impact

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

BAF Board assurance framework EDoN&Q Executive director of nursing & quality EDoF&BD Executive director of finance & business

development EMD Executive medical director COO Chief operating officer DoW Director of workforce

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Agenda Item 04/18a

Meeting of the Board of Directors Thursday 25th January 2018

Board Assurance Framework 2017/18 1 Introduction

The board assurance framework (BAF) 2017/18 was presented to the board and the Quality Assurance Committee in November. Further review of the board assurance framework has taken place by the executive team since the board meeting. The changes identified since the BAF was presented to board in November are;

• 1.4 Not achieving projected reduction in the number of falls – likelihood score changed from 2 to 3 due to current performance being over threshold

• 8.1 Impact on our ability to obtain planning approval for future capital developments – assurance updated to reflect approval of planning application for tiered car park

2 Suggested updates in January There are no suggested updates to the risks following discussion in January.

3 Recommendation

The Board is asked to note the board assurance framework (BAF) 2017/18 that reflects the risks to achievement of the corporate objectives. The Board is also asked to consider any further updates following discussion.

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BOARD ASSURANCE FRAMEWORK 2017-2018

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1.1 Risk to patients and reputational risk to trust of exceeding the HCAI thresholds EDoN&Q 4 3

Patients with known or suspected HCAI are isolated. Medicines management policy contains prescribing guidelines to minimise risk of predisposition to C-Diff. Need to maintain Gram negative bacteraemia. RCA undertaken for each known case. Induction training & bespoke training if issues identified. Close working with NHS England at NIPR meetings.

None identified 12Levels reported through performance report to Management Board and Board of Directors and quarterly to NHS Improvement.

None identified 12 12 12 12 12

1.2Failure to learn from patient feedback (patient satisfaction survey / external patient surveys / complaints / PALS)

EDoN&Q 2 2

Monthly patient satisfaction survey undertaken and reported through performance report. Negative comments fed back to specific area and plans developed by ward leaders to address issues. Action plans developed and monitored from national surveys. Complaints and PALs procedures in place.

None identified 4

Management Board and Board of Directors monthly Integrated performance and quality report. National survey results presented to Board of Directors. Action plans monitored through the Patient Experience Committee

None identified 4 4 4 4 4

1.3 Non achievement of the quality outcomes for the 2017-18 CQUINS indicators. EDoN&Q 2 4

Leads nominated for each CQUIN goal. CQUINs steering group (strategic and operational) are in place with strategic and operational representation agreed. Rigour introduced around submission and quality assurance of quarterly reports. Timescales established for provision of data.

None identified 8Monitoring of performance data and contract KPIs occurs at various monthly meetings and feeds to CQUINS steering group.

None identified 8 8 8 8 8

1.4 Not achieving projected reduction in the number of falls EDoN&Q 3 3

Collaborative projects in place. All falls come through executive review process. Call don't fall initiative. Falls group. Introduction of the TAB system. Executive review group looks at attribution of avoidable / unavoidable

None identified 9

Numbers reported through integrated performance report to Management Board and Board of Directors. 2016/17 saw a 41% reduction in the number of falls from the previous year.

None identified 6 6 6 9 6

1.5 Risk of exceeding the thresholds for the number of pressure ulcers EDoN&Q 4 3

Tissue viability nurse in post. System for assessment of ulcers / grading used. Training across the trust (focus on theatres/critical care). Each Pressure Ulcer reviewed through Executive panel chaired by Executive Director of Nursing & Quality. New system of mattresses has been implemented (allows to change from a static to dynamic mattress). Nursing e-proforma changed so staff cannot put ‘self-management’ as code thereby ensuring that pressure area management question is asked of each patient on each shift.

None identified 12

Regular reports to Quality Assurance committee and board (through the integrated performance report). No grade 3 or 4 hospital aquired pressure ulcers. Outturn position at end of 16/17 was the same number of pressure ulcers as in the previous year with a slightly higher level of activity.

None identified 12 12 12 12 9

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2.1 Risk to Christie Research profile and funding if fail to perform strongly against national metrics EMD 2 3

New performance management system implemented (Jan 17) to track real time delivery; new set-up review group established (Aug 2017) to make recommendations for improvements; regular review at disease team quarterly assurance meetings; SLAs being established with each service department involved in set up and delivery.

None identified 6

Weekly review of 70 day performance. All industry metrics reported through to the Research Divisional Board and Management Board; quarterly review of Disease Group performance

None identified 8 8 6 6

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3.1Non delivery of the School of Oncology strategy due to increased pressure within operational service delivery

EMD 2 3

Refresh of the School of Oncology strategy in consultation with the divisions. ERG work to identify true costs of supporting trainees in practice. Ongoing Job Planning activity to increase transparency of educational input. Ongoing work with senior managers and divisions to look at longer term models to backfill posts

Continuing difficulty in back filling senior staff despite funding availability

6 School of oncology board reports to Management Board. None identified 6 6 6 6 6

Corporate objective 1 - To demonstrate excellent and equitable clinical outcomes and patient safety, patient experience and clinical effectiveness for those patients living with and beyond cancer

Corporate objective 2 - To be an international leader in research and innovation which leads to direct patient benefits at all stages of the cancer journey

Corporate objective 3 - To be an international leader in professional and public education for cancer care

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4.1Failure to meet DH/Treasury timescales of the construction of the Proton Beam Therapy (PBT) build.

EDoF&BD 2 4Project board established. Process for risk escalation defined. Build and equipment contract signed and agreed. Operational plan being progressed. Build progressing to time.

None identified 8

PBT project reports to Management Board on a monthly basis as part of Capital report. Capital spend monitored through the finance report to Board. Operational plan will report to Transformation board

None identified 8 8 8 8 8

4.2 Impact of private providers for Proton Beam therapy on our PBT service EDoF&BD 4 2 Working with NHSE on a pro-active communication plan. Ramp up plan developed

and linked with UCLH None identified 8 PBT project reports to Management Board on a monthly basis as part of Capital report. None identified 8 8 8 8 6

Gynaecology - Commissioning agreement for gynae-oncology surgical services to be provided across 2 sites, namely The Christie and CMFT. GM transformation team completed review of service delivery..

2 different service delivery models in GM. Continue to provide commissioned services None identified

Urology - urology service specification complete. Awaiting commissioner decision regarding delivery model None identified

Remain within 2016/17 contract. Commissioner led review implemented. The Christie fully involved with review, within the GM transformation team.

None identified

Out of scope of project (One Manchester), been able to discuss current provision of services with review team. Review complete. Surgical strategy complete None identified Out of scope of project. None identified

4.4 Loss of trials due to no processes for accessing funding for excess treatment costs for trials EDoF&BD 3 4 Communicating with specialist commissioners on how to access funding. Informed

lead clinicians to ensure no patients are enrolled on inappropriate trials. None identified 12 Reports to research governance committee and commissioner meetings None identified 12 12 12 12 12

4.5Lack of a solution to the patient and relative accommodation issue for the Proton Beam Therapy service

EDoF&BD 2 4

Revenue funding secured through NHSE. Reviewing options for hotel accommodation in the city centre. Ronald McDonald approached to explore options for increasing capacity - initial agreement to prioritise PBT families. Fundraising approach being explored to expand current accommodation.

None identified 8 PBT steering group and Strategic Plan Implementation Board. None identified 8 8 8 8 8

4.6 OECI reaccreditation not achieved EDoN&Q 2 3

Work centrally coordinated based on OECI measures. Timeframes for re accreditation identified. Funding identified. Project group formed. Reaccreditation submission made and acknowledged by OECI. Considered at November OECI board, accreditation process progressing.

None identified 6Previous accreditation achieved. Evidence being collated for submission. Date of accreditation confirmed 8th / 9th March.

None identified 6 6 6 6 6

4.7Lack of evidence to show progress against the ambition to be leading comprehensive cancer centre

EMD(S) 2 3Regular (bi-annual) board reports. Participation in OECI . Baseline measures identified and presented to Board of Directors. Discussion at time out in March 2017. Looking at how we can be part of International Benchmarking.

Availability of comprehensive data with which to compare ourselves

6Designated as the most technologically advanced cancer centre in the world outside North America. In segment 1 (Single oversight framework). Board discussion

None identified 6 6 6 6 6

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5.1 GM devolution changes have an adverse impact on The Christie objectives EMD(S) 2 5

Input into the business case. MOU produced and shared with board between ''AGMA and all Greater Manchester CCGs and NHS England'. Key directors attending GMH&SC boards and committees.

Uncertainty around impact. 10

Regular Management Board and Board of Director reports from CEO. Presentation to CoG. Greater Manchester Health & Social Care Strategic Plan and Terms of reference for GM Provider Federation Board approved at BoD Jan 16.

None identified 10 10 10 10 8

5.2 Non-delivery of our refreshed chemotherapy strategy

COO / EDoF&BD 3 4 Option appriasal of mobile unit versus static/hospital based provision. Refreshed

chemotherapy strategy approved. None identified 12 Reports to Management Board None identified 12 12 12 12 8

5.3 The Christie Pathology Partnership objectives not achieved impacting on clinical service

COO/ EDoF&BD 2 4 The Christie Pathology Partnership board established. Operational management

reviewed. None identified 8 Reports to BoD from The Christie Pathology Partnership board meetings. None identified 8 8 8 8 8

5.4Not delivering the operational, clinical and financial objectives of the system leader role in the ACC Vanguard

EDoF&BD EMD 2 5

Part of the National Cancer Vanguard with The Royal Marsden and UCLH. Project team established. Detailed project plans in place. 2017-18 funding secured. Classed as innovation arm of cancer system board.

None identified 10 Regular reports to Management board and Cancer System Board None identified 10 10 10 10 10

5.5 Tariff structure resulting in a recurrent loss of income EDoF&BD 2 5 Participating at national level to influence development of specialist tariffs. Contract

for 17-18 agreed. Tariff agreed. Activity growth confirmed.

Changes in specialist commissioning as a consequence of GM Devolution

10 To continue to report through Manaagment Board and Board of Directors via the Finance report. None identified 10 10 10 10 10

5.6 Reputational damage caused by an adverse CQC inspection at The Christie Clinic

COO / EDoF&BD /

EMD3 4

Concerns regarding operational management and turnover of senior operational leaders at TCC raised throug JV Board. COO appointed. Mock inspection completed 12th September by Christie team. Inspection date delayed.

No permanent clinical director in post 12 Governance reports to TCC Board None identified 12 12 12 12 4

Corporate objective 4 - To integrate our clinical, research and educational activities as an internationally recognised and leading comprehensive cancer centre

4.3Risk of comprehensive cancer centre status due to loss of surgery at The Christie due to uncertainty of commissioning within Greater Manchester

COO 3 5 15 15 15 15 15 10

Corporate objective 5 - To provide leadership within the local network of cancer care

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6.1 Key performance targets not achieved COO 2 4

Executive led monthly divisional performance review meetings. Integrated performance & quality report to Management Board and Board of Directors monthly. Digital Maturity board meeting monthly (includes cyber security). Wholly owned subsiduary established to provide pharmacy dispensing services.

None identified 8 Continued achievement of all key performance targets None identified 8 8 8 8 4

Exec led monthly divisional performance review meetings. Finance report to Management Board and Board of Directors monthly None identified Continued achievement of a Single Oversight Framwork

segment 1. Use of resources - 1 None identified

Commissioner contract signed for 2017/18. Agreement of control total for 2017/18 with NHSI. Growth monies allocated to divisions to ensure delivery of activity target. CIP target set.

Changes in specialist commissioning as a consequence of GM Devolution

Monthly board report. Portfolio board reviewing progress on CIP delivery None identified

6.3 Non delivery of transformation schemes (CIP) EDoF&BD 4 4

Transformation team to continue to work across clinical and corporate divisions to identify and achieve efficiency and improve environment. Monitor progress through Portfolio Board. Schemes developed on a transformational basis across inpatient, outpatient and trust wide pathways. Targets for identification and delivery of savings have been agreed at Transformation Board. Escalation meetings established. Director of Transormation appointed.

None identified 16 Progress monitored through integrated performance report to Management Board and Board of Directors None identified 16 16 16 16 4

6.4 Current EPR unable to support delivery of operational objectives EDoF&BD 3 4

External analysis undertaken to identify options to address issues with CWP (clinical web portal). Option appraisal to Board of Directors in Autumn 2017. Additional staff appointed. New CIO appointed.

Internal capability & expertise to support system going forward. CWP built on an outdated platform

12 Reports to Management Board & Board of Directors. Review of CIO and CCIO roles None identified 12 12 12 12 8

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7.1 Target reductions in sickness levels not achieved DoW / COO 3 3 Adherence with sickness management policy monitored through performance review meetings. None identified 9 Monthly sickness levels as reported in Integrated

performance and quality report None identified 9 9 9 9 9

7.2Reduction in quality of service due to the impact of new shared service models affecting our ability to recruit and retain staff

DoW 2 2

Working with GM health & social care devolution and attending relevant meetings. Communication with existing staff in teams impacted by proposed shared service models (HR, Finance, Pathology, Radiology, Pharmacy, IT). Engagement with trade unions.

None identified 4No current impact on recruitment & retention. Involvement in key Greater Manchester Health & Social Care Partnership committees

None identified 6 6 6 4 4

7.3 Underutilisation of the apprenticeship levy DoW 3 3Workforce committee monitoring progress. Divisional engagement. School of Oncology leading across the trust and externally with the development of higher apprenticeships.

None identified 9 Regular report to board None identified 9 9 9 9 9

7.4 Risk of non compliance against PDR action plan to achieve Trust standard DoW 3 2 Performance review meetings. Information shared with managers on compliance.

Redesigned systems and paperwork.Trustwide performance at 88.5% 6 Regular reporting to Management Board and Board of

Directors through the performance report. None identified 6 6 6 6 6

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8.1 Impact on our ability to obtain planning approval for future capital developments. EDoF&BD 3 3

Close working with Manchester City Council (MCC) on implementing the green travel plan . The strategic planning framework approved and includes current and future requirements for travel to site. Options for non-clinical staff accommodation off site are being considered. Communication with residents through the Neighbourhood Forum and newsletters. Green travel plan and sustainability plan in place.

None identified 9

Met the 15/16 & 16/17 green travel milestones. Agreement by MCC of strategic development plan. 5 year Capital Plan delivery. Monitored through Management Board & Board of Directors. Continue to meet green travel targets. Monthly meetings with Manchester City Council (MCC). Capital programme shared with MCC and Board of Directors. Plans for tiered car parking approved Jan 18.

None identified 9 9 9 9 6

8.2 Targets set by the NHS sustainable development unit (SDU) guidance are not achieved. EDoF&BD 3 2

Sustainable development management committee meet quarterly. National returns submitted. Quarterly reports on each requirement produced and progress monitored.

Not achieving target for energy & carbon reduction 6 Sustainable development and carbon reduction quarterly

key issue reports to board of directors None identified 6 6 6 6 6

Corporate objective 7 - To be an excellent place to work and attract the best staff

Corporate objective 8 - To play our part in the local healthcare economy and community

Corporate objective 6 - To maintain excellent operational, quality and financial performance

6.2 Financial performance target not achieved EDoF&BD 4 4 16 16 16 16 16 4

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Chairman: Christine Outram Chief Executive: Roger Spencer

The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX Tel: 0161 446 3000 Fax: 0161 446 3977 www.christie.nhs.uk