Multiple failings in trust’s handling of £20m Roche deal, leak reveals

A draft investigation report into the issues at the Christie Foundation Trust, obtained by HSJ, details a series of problems with the leadership of the research and innovation department, as well as failures by the board of directors.

The report, which was commissioned by the trust and is marked “confidential”, looked at multiple staff concerns around a research deal that was announced with pharma giant Roche and two of its subsidiaries.

It accuses managers, executives and the trust board of an “underlying systemic failure” to implement recommendations from two previous reports, in 2012 and 2018, which would have improved the culture and practices in the research division. It found a “pervasive culture which impedes rather than enables the unique assets of The Christie to be leveraged for research”.

The report, by Professor Andrew Hughes, chair of experimental cancer medicine at Manchester University, has been carried out separately to an NHS England-led investigation which is wider in scope but will look at the same issues.

The strategic partnership announced with Roche was intended to involve The Christie providing blood samples from 5,000 patients per year, with two of the company’s subsidiaries, Flatiron Health and Foundation Medicine, building a “clinico-genomic database”. It appears to have been paused earlier this year.

Mr Hughes’ report has supported many of the concerns raised by Karen Rai, who briefly managed the project for the trust in 2019. Ms Rai has told HSJ that trust bosses ignored concerns at the time and believes she and others were sidelined and pushed out from their roles because they were seen as a trouble makers. Her treatment appears to have been outside the scope of Mr Hughes’ report but she expects it to be addressed by the NHSE review.

But the report has found:

• The project was announced via press release in December 2018 with “insufficient due diligence on alternative options” and no formal procurement process.
• At one stage the trust appears to have ignored its own legal advice to hold a formal procurement exercise, with the report saying: “Internal procurement and external legal advice (Bevan & Brittan) leaned towards conducting a formal procurement exercise… with an associated timescale of 6 months. An alternative instrument (VEAT Notice) was however initially selected, with the merits of requiring only a 10-day notification period to prospective alternative service providers.”
• “Discordant views were not actively solicited, captured in risk logs, managed and mitigated… a bullish stance was maintained throughout of ‘pushing-through’ an original concept despite weight of evidence to the contrary.”
• Risks had not been identified nor mitigated before the collaboration was announced.
• Senior leaders and decision makers had “insufficient awareness/training of the complexities and challenges required to develop and launch (let alone maintain) strategic collaborations of this scale”, while relevant experts were not brought into discussions.
• The financing of the deal was unclear, with the initial press release suggesting Roche would invest £20m over three years, but it subsequently emerged this would be an “in-kind” contribution through staff allocated to support the project, and through discounts on testing activity.
• Despite a “crescendo of concern” building up from staff, the project remained green-rated and described as “on track to deliver benefits” in management meetings.
• The trust’s lawyers felt it was “not as clear as we might hope that any research…[carried] out will be for the benefit of the trust at all”.
• The project would have required a “seismic” step-change in capacity and capabilities, with widespread sample collections having to be taken during routine care. But there was no resource for sample collection and additional operational processes, causing issues in the blood room and a number of incidents including a patient confidentiality breach.

One of the documents reviewed by Mr Hughes was a letter outlining “concerns from the consultant body”, which was attached to his report.

This said: “The atmosphere is difficult to work in and staff are feeling demotivated, disengaged, confused and isolated. Managers do not feel supported by the MD [managing director Wes Dale] and therefore find it difficult to support their teams.

“Staff raising concerns feel they are seen as a threat, subjected to bullying and intimidation behaviours and side-lined. There seems to be a disregard for following HR policies and procedures.”

It added: “Staff feel that the MD is not receptive to deviation from Roche’s original plan, did not engage any attempts to learn from local and national projects of a similar nature and even in the face of expert clinical and non-clinical advice continues to prioritise what Roche want, rather than consider how Roche’s initial offering could be modified to deliver what is best for Christie patients and staff.

“Staff also feel concerned that the MD appears to have used Roche funded conference attendance to inform his decision making, which does not appear objective.”

The Christie said in a statement: “There is currently an investigation under way and as such it would not be appropriate for us to comment. The trust is committed to protecting the confidentiality of staff that wish to, or have already contributed to, the investigation.

“It is important to note that the concerns raised by the investigation do not relate to patient care in any way.”

“Patients are, and always will be our priority, and we remain committed to providing the very best standards of care and treatment in a world class cancer centre.”

NHS England and Roche were also approached for comment.