The Christie Foundation Trust scored well against its UK peers for its provision of cancer care, but seeking accreditation as European Comprehensive Cancer Centre in 2010 has brought a fresh perspective and highlighted the importance of comparative data
The Christie Foundation Trust is a standalone cancer centre in Manchester treating more than 14,000 new patients from throughout the UK each year and is internationally recognised for bringing together high standards of innovative cancer care, research and education, while at the same time providing local services through a network of radiotherapy and chemotherapy services including on primary care premises.
Our services score highly in the English cancer peer review programme and we obtain high ratings in the National Cancer Patients survey, but until two years ago we were struggling to make true comparisons between ourselves and other cancer centres across Europe.
That changed with the development of the Organisation of European Cancer Institute’s accreditation and designation programme that offered us the chance to compare ourselves with the major European centres in, for example, Stockholm, Paris, Brussels, Barcelona, Budapest and Milan and with the almost 100 Organisation of European Cancer Institutes (OECI).
Wary of becoming involved in another frustrating paper chasing exercise we thought long and hard about whether we should put ourselves forward for the comprehensive assessment that is required to become an accredited European Comprehensive Cancer Centre.
Following a detailed review of the standards and expectations and undergoing a three-day auditor training course we submitted our application in January 2010.
‘Crucially, we had to show how we brought together the three strands of clinical care, research and education to produce the best patient outcomes’
There followed an intensive period of preparation including a site visit from the OECI team to assess our preparedness, collation and submission of evidence of our compliance against the six groups of standards including strategic management, screening and prevention, clinical care, research and innovation, teaching, and patient experience.
Crucially, we had to show how we brought together the three strands of clinical care, research and education to produce the best patient outcomes, this being the hallmark of a comprehensive cancer centre as defined within Europe.
Finally, we underwent an intensive and searching three-day site visit by a multi-professional team of oncologists, nurses and managers from countries across the EU, including Portugal, Sweden, Holland and France.
By the end of the process we were very much aware that there were areas in which we could improve but we were also proud that we had been able to answer the majority of questions with good evidence, and in particular get across to our visitors the benefits of our integrated approach and the added value of working with other hospitals as part of a network of services.
The immediate feedback was promising but we had to wait three weeks before we saw the final report that confirmed that we had made the grade and would be officially accredited as a European Comprehensive Cancer Centre of Excellence subject to a satisfactory plan to address the recommendations of the reviewers. It was with huge relief and pleasure that we attended the OECI annual conference to receive the award on behalf of the hospital.
Two years on and it is time for us to submit a progress report to show how we have maintained and improved our standards since the visit. It is also a good time to reflect on the experience to see what we learned and whether we would recommend it to others.
‘We quickly found that while the European approach went into less depth about the activities of individual cancer teams it covered a much broader range of topics’
Our first reflection is that our experience of the English cancer peer review programme put us in an extremely good position when it came to marshalling the evidence files needed. This was helped by the electronic submission system but years of preparing for peer review meant that we had ample evidence already available.
We quickly found that while the European approach went into less depth about the activities of individual cancer teams it covered a much broader range of topics, including looking at how cancer research was part of our normal activities and the degree to which cancer education was also built into the normal activities of the institution.
Of course the use of English for the European standards helped us enormously but in talking with our reviewers the pitfalls of terminology were brought home sharply as we grappled with various different meanings of the term “medical oncologist” when trying to compare our workforces and their workloads.
Another term that needed some explanation to our visitors was “network” that they at first found difficult to grasp. Descriptions of the network as a system of care managing the way that patients flow along pathways were understood while notions of central teams trying to influence care without formal authority or financial levers were not.
The visit certainly tested our evidence and assumptions about our services, identifying as recommendations the three things that we ourselves knew we needed to address: the risks associated with the transition from an entirely paper-based system to an entirely electronic record, improving communications with GPs and strengthening our referral pathways from other hospitals.
Our procurement of a new electronic patient record, our web portal that gives GPs direct access to their patients’ records and our local development of an integrated cancer system within the Manchester Academic Health Sciences Centre are all examples of initiatives that grew out of, or were given added impetus by, the accreditation programme.
It is good to know that despite our different approaches cancer centres across Europe have many similarities and that innovations not just in therapeutics but also in service design are imperative for delivering the cancer care of the future.
Getting an external objective view is always useful in avoiding complacency and creating momentum for change. The opportunity for senior leaders from elsewhere to come and review our services was one that will have lasting value beyond achievement of accredited status.
So would we recommend other cancer services should apply for accreditation under the scheme? Yes, we would and we are pleased to note that other UK centres, for example The Integrated Cancer Centre at King’s Health Partners and the Cambridge Cancer Centre, are currently listed as going through the assessment process.
‘The opportunity for senior leaders from elsewhere to come and review our services was one that will have lasting value’
But it isn’t only large centres which are part of Academic Health Science Centres that can benefit or should consider the process. The OECI scheme sets comparative criteria and accreditation standards for four types of institutions: cancer units, cancer centres, cancer research centres and comprehensive cancer centres allowing those going through the assessment to judge how they compare with institutions beyond England.
At the other end of the scale we would encourage the OECI to think more about how the programme might assess whole systems of cancer care including new models such as the two integrated cancer systems now established in London and being developed in Manchester, which have some parallels in other European countries.
By gradually building the data base of participating organisations and systems we will get a more comprehensive and informative view about how cancers care is really provided.
For the Christie Foundation Trust, participation in the OECI accreditation programme enabled us to start answering the question frequently posed by our board of directors: how do we compare with other cancer centres and how can we justify our claim to be one of Europe’s leading centres? Unless we look beyond our national borders we will be missing opportunities to learn and improve.
‘Unless we look beyond our national borders we will be missing opportunities to learn and improve’
The programme has also given Dr Chris Harrison the enormous privilege of leading audit teams to review the major cancer centres in Amsterdam and Brussels and now as chair of the OECI’s accreditation Committee to see and assess the reviews of other centres. For Marie Hosey, training as an auditor and participating in audits has given a new perspective on our own approach and performance system.
As we discovered in the North-west cancer regional peer review programme a decade ago there are often as many benefits and lessons for the reviewers as for those being reviewed.
And for the future? Clearly comparative measurements of our organisations and the processes by which we deliver cancer care are of value in promoting better understanding and standardising approaches between centres, but in our view this isn’t nearly enough.
Comparable data on the outcomes of care is much more difficult to collect and assess but this is essential if we are going to make true comparisons and benchmarks with a view to working out which are the most effective and efficient ways of organising cancer care.
For example, what are the relative benefits as measured by outcomes (effectiveness, safety, patient experience, research quality, teaching outcomes and equity) of the more dispersed network approach often found in the UK as compared with more centralised model of cancer institutions found in some EU countries? Putting this type of data alongside population registry data for whole communities could give additional insights for cancer policy.
We are very proud to have been accredited by an international body and will work hard to continue justify this recognition. It is something that gives our patients additional confidence in the work we do and helps us to think beyond the immediate issues of NHS life and to see ourselves within the wider European regulatory system and market. Increasing movement of professionals, patients and services across national boundaries makes this wider view an imperative.
The OECI programme is a great starting point and we believe that UK-based cancer institutes of all types should consider participating as a way of benchmarking themselves and participating in a wider debate about cancer care, bearing in mind the need for better data on outcomes.
For us it was an important experience and it is good to know that we have made the grade as a comprehensive cancer centre and that at last we can start to answer the questions from the board with some real comparative data.
Dr Chris Harrison is medical director, Caroline Shaw is chief executive and Marie Hosey is head of performance at The Christie Foundation Trust.