Memorandum by Clatterbridge Centre for
Oncology (FTM 06)
OUR EXPERIENCE OF FOUNDATION TRUST STATUS
INTRODUCTION
1. Clatterbridge Centre for Oncology NHS
Foundation Trust (CCO) welcomes the Health Select Committee's
session on Foundation Trusts and the opportunity to provide input
on this topic.
2. CCO is one of the largest cancer centres
in the UK serving a population of 2.3 million covering Merseyside,
Cheshire, North Wales, the Isle of Man and South Lancashire.
3. In 2006 CCO became a Foundation Trust
following a process to test the business planning and financial
systems to ensure the Centre was "Fit for Purpose".
4. The Wirral-based Trust employs 650 staff,
provides specialist radiotherapy and chemotherapy services and
delivers more than 112,000 treatments to patients every year.
Visiting medical and nursing teams also deliver specialist cancer
services at hospitals across the region.
5. The Trust has state of the art imaging
services to detect and plan treatment together with supportive
care from nursing and allied health professionals to address the
palliative aspects of care and needs of family supporters. This
is greatly assisted by our Macmillan Information Centre.
6. Most patients are treated as out-patients
or day cases and much of the chemotherapy is delivered at the
associated general hospitals that are nearest to the patients.
7. CCO is a Trust that understands the importance
of living by its values. Our vision is to provide world class
cancer care, this is backed up with our values: putting people
first; achieving excellence; passionate about what we do; always
improving our care; committed to our future.
8. Our people shaped our values and by demonstrating
that we use these to inform how we conduct our business there
is a real, shared energy across the Trust. This is evidenced by
our staff and patient surveys that scored CCO within the top 20%
best performing Trusts in 2007.
9. We provide involvement opportunities
for service users, carers, staff, and members of the public through
a membership scheme. We currently have almost 6,000 members.
10. For the final quarter of 2007-08 the
Independent Regulator, risk rated CCO as "Green" for
Governance, "Green" for Mandatory Services and "5"
for finances.
THE FOUNDATION
TRUST STATUS
DIFFERENCE AT
CCO
11. Foundation Trust status has enabled
us to change the way that we think and work. We believe that three
drivers have been important in doing this:
11.1 Assessment to become a Foundation
Trust—the assessment process in becoming a Foundation
Trust is meant to ensure that your system, processes and Board
are fit for purpose. We found this assessment very helpful not
only as a one off check but in challenging the way that we think
and operate on an ongoing basis.
11.2 Local involvement—members
and especially Governors are there to ensure that as a Foundation
Trust we listen to local views and have in place active processes
to seek such views. We have found this very helpful in shaping
our overall strategy and especially useful in agreeing our plans
for a satellite radiotherapy unit (discussed below).
11.3 Knowing that success is down to us—Foundation
Trust status brings freedoms and responsibilities. We believe
that success or failure is down to ourselves as we are not only
more accountable for day to day delivery but are also able to
take a greater role in determining our future. For us this has
been achieved by working in partnership with our local commissioners
and other NHS organisations in the Cheshire and Merseyside Cancer
Network. We now better understand our ability to improve the care
provided for our patients by influencing the cancer network as
a whole and the people who sit around its table.
ACHIEVEMENTS AS
A FOUNDATION
TRUST
12. We now have more financial freedom to
develop our services in the way we want. We closed this year with
a £3.4 million surplus and we intend to invest part of that
in a major refurbishment of our wards, including the development
of a dedicated teenage cancer unit and the refurbishment of our
outpatient facility with improved privacy for patients, increased
numbers of clinic rooms and additional consultant offices.
13. New accommodation has been provided
to support the research and development directorate and to bring
them into one place within the Trust.
14. From a quality perspective we are one
of only a few Trusts in the country to be awarded the ISO:9001:2000
registration across all departments and we are only the second
Trust in the country to have been awarded NHSLA level 3, which
assesses our policies and systems.
15. We have agreed plans to develop a £16m
satellite radiotherapy facility in Aintree. The proposed development
will house three radiotherapy treatment machines and a range of
support services to benefit the wider Merseyside community.
16. The Aintree development will bring enormous
benefits to our patients. For example, a patient living in Southport
currently faces a 60 mile round trip when receiving treatment
at CCO. The centre at Aintree would cut the journey time in half
and save patients' travel costs. We are on course to have the
new centre in operation by December 2010—for us, Foundation
Trust status has meant that good ideas can become a reality quickly.
17. By investing surpluses and using our
borrowing freedoms as a Foundation Trust we have been able to
progress our plans for the radiotherapy satellite facility more
quickly than we would otherwise have been able to. One major benefit
is that we can now raise our own funding by utilising Foundation
Trust prudential borrowing. Using this approach also means that
we can build the facility using the Procure 21 process, meaning
that we will own the facility, rather than PFI where we would
not.
18. Our success has created greater confidence
in our ability to deliver and this in turn has produced a further
commitment from Primary Care Trusts to provide CCO with an additional
£15 million to provide a second radiotherapy satellite centre
in central Liverpool. Taken together this means over £30
million of investment and up to six new linear accelerators (these
are the machines used to treat cancer using radiotherapy).
19. The ability to reinvest surpluses in
local priorities means that there is a tangible incentive for
Foundation Trust Boards and Governors to deliver strong financial
control and NHS targets. This means that good financial control
has, for us, led to improved quality through our ability to reinvest.
20. However, we know that our freedoms come
with greater responsibilities and the need to manage risk effectively.
As a result our Board is focused not only on our long term strategy
but on what patients expect us to deliver today. To help with
this we have produced a new Delivery Plan which has been launched
with staff and we are now busily re-aligning our reporting structures
around this.
21. On a final point our Governors were
involved in both the appointment of a Non Executive Director and
our Chief Executive. They have also been involved in the selection
of our new external auditors.
THE FUTURE
22. We see Foundation Trust status not as
badge but as a journey. There are things that we need to work
on and improve, especially around engagement with our members—as
we are new to being a mutual organisation we are still learning.
Four key themes in our journey are:
22.1 Using strong external partnerships
and clear internal values to improve our services to patients.
22.2 Improving how we involve staff, Governors
and the wider membership to shape priorities and change front
line services.
22.3 Using our freedoms as a Foundation
Trust and our fundraising as a cancer charity to supplement our
core services and add extra value—what we call internally
"service plus".
22.4 Utilising new technology to improve
patient outcomes—We are the UK's only proton therapy centre
with over 20 years experience in treating eye cancers. We have
ambitions to use this expertise and bid for new high energy equipment
which will enable us to establish a UK proton service for the
treatment of cancer in children. (Proton Therapy is less damaging
to surrounding tissue than radiotherapy. When used to treat children
it reduces the risk of secondary cancers in later life.)
June 2008
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