Introduction
Transforming Cancer Care in Cheshire and Merseyside was a major NHS programme that lasted a number of years from the early 2010s into the early 2020s.
It came about after a landmark review looking at cancer incidence, services and outcomes in Cheshire and Merseyside. The resulting report (Baker Cannon report, 2008) recommended major changes in how and where non-surgical cancer care was delivered.
Transforming Cancer Care was delivered by The Clatterbridge Cancer Centre NHS Foundation Trust (CCC) and spanned three separate but related pieces of work:
- The opening of a new specialist cancer centre in Liverpool (CCC-Liverpool)
- The development of a networked model of care across Cheshire and Merseyside, and
- The integration of North Mersey blood cancer services (haemato-oncology) into CCC.
Five years on, we have completed a full evaluation of what has been delivered and whether Transforming Cancer Care’s aims are being achieved.
This is a summary of that evaluation.
Cancer has been the biggest cause of death in Cheshire and Merseyside for many years. People in much of our region are more likely to develop and/or die from cancer compared with the average in England.
In 2008, the NHS in Cheshire and Merseyside asked two national experts – Professor Mark Baker and Mr Roger Cannon – to carry out a full review with the aim of developing world-class cancer services.
At the time, specialist cancer care such as radiotherapy and chemotherapy for most patients in Cheshire and Merseyside was focused on just one site – The Clatterbridge Cancer Centre in Wirral.
The cancer centre:
- Was located in the south of the region, not the centre of the population it served;
- Was on a hospital site with no acute services such as A&E or intensive care – unwell patients had to go to other hospitals and the most pioneering clinical trials couldn’t be offered there; and
- Was understaffed in terms of consultant doctors, compared to other cancer centres, and some posts were hard to recruit to.
The resulting Baker Cannon report (2008) recommended major investment and a raft of changes aimed at enhancing care for critically unwell patients, making specialist cancer care more accessible, and significantly increasing research and clinical trials.
Recommendations included:
- A new cancer centre in Liverpool, in addition to the existing Wirral site.
- Providing radiotherapy across three sites – Aintree, Liverpool and Wirral.
- Providing chemotherapy through a network of sites across Cheshire and Merseyside.
- Greater focus on cancer research and clinical trials.
- Recruiting more consultants specialising in cancer (oncologists)
The NHS quickly responded and the Transforming Cancer Care programme was formally established:
- A site next to the Royal Liverpool University Hospital was identified as the best location for the new cancer hospital.
- Patients, staff, partner organisations and the public helped to shape the changes, including clinical services and the hospital design. There was extensive engagement throughout, including formal public consultation in 2014.
- In 2015, it was agreed that blood cancer services (haemato-oncology) in North Mersey should come together under the management of The Clatterbridge Cancer Centre (CCC). Transforming Cancer Care and the plans for the new Liverpool cancer hospital expanded to include this.
- The new Clatterbridge Cancer Centre – Liverpool opened in June 2020.
- Transforming Cancer Care concluded in February 2022, when management of blood cancer services at Aintree transferred to CCC.
Then and now
2010
- Single site for majority of specialist cancer care (Clatterbridge Cancer Centre – Wirral)
- Rural location not centrally located – no acute specialties on site
2025
- Three specialist Clatterbridge Cancer Centres (Aintree, Liverpool Wirral)
- Radiotherapy on three sites (Aintree, Liverpool Wirral)
- Network of seven chemotherapy clinics across Cheshire and Merseyside, Isle of Man and Lancashire
- ‘Clatterbridge in the Community’ providing cancer treatment at home or in the workplace
- Clinical Decisions Unit, 24/7 Hotline (urgent care advice for patients) and on-site access to acute specialties including intensive care
- Patients with all types of cancer – i.e. blood cancers and solid tumours – can access the same specialist wraparound support in Liverpool
- First-in-human trials and highly-specialist treatments including CAR-T therapy
What we achieved
| Aim | Outcomes | Achieved |
|---|---|---|
| Cancer hospital located closer to the centre of the population served reducing the need for patient journeys |
CCC-Liverpool closer for 63% of population, including areas of highest need 97% patients now live within 45 minutes travel time Networked model with clinics in local hospitals across Cheshire and Merseyside Clatterbridge in the Community nurses providing treatment in patients’ homes and workplaces |
Yes |
| Located next to an acute hospital, improved access to intensive care without an additional on-call rota |
CCC-Liverpool is next to Royal Liverpool University Hospital, connected by link bridges Full access to intensive care when needed |
Yes |
| Able to carry out first-in-human and high-risk phase 1 trials and class 2 gene therapy studies |
Clatterbridge is now a leading centre for first-in-human cancer vaccine studies Research partnerships including ECMC, BRC and CRF |
Yes |
| Improved access to other clinical specialties. Ambulance transfers eliminated for inpatients who need general acute services |
Onsite access to acute specialties via link bridges to Royal Liverpool next door Acutely-unwell patients can be assessed and cared for in CCC-Liverpool (with in-reach from Royal Liverpool teams, if needed) Any transfers required take place via link bridge, not ambulance |
Yes |
|
Increase consultant doctor numbers to be comparable with other cancer centres Ability to recruit and retain the best staff |
Consultant numbers now strong and compare well with other centres Tumour site reference groups (SRGs) of consultants specialising in particular cancers, providing cross-cover and peer review Opportunities for real career progression and innovation across all staff groups e.g. nursing career pathway and consultant radiographer roles Significantly improved ability to recruit and retain staff. Consistently strong and steady improvement on national staff surveys |
Yes |
|
Unite blood cancer services in Liverpool so they work as one team, managed by The Clatterbridge Cancer Centre (CCC) Achieve the scale needed to deliver the most pioneering blood cancer treatments, services and clinical trials |
Blood cancer services previously provided by the Royal Liverpool and Aintree are now one team, managed by CCC Uniting as one blood cancer service has significantly increased ability to provide these highly specialised treatments and trials. Examples include:
|
Yes |
| Integrate blood cancer and solid tumour cancer care, so all patients (including teenagers and young adults, TYA) can benefit from the same wraparound support |
Blood cancer care in Liverpool now integrated with solid tumours – patients have access to the same support Integrated TYA service covering blood cancers and solid tumours |
Yes |
The whole aim of Transforming Cancer Care was to improve patient outcomes and experience. There is plenty of evidence that this has been achieved, although it’s a goal that never ends – we are always looking at how we can deliver even better patient care.
Patient outcomes and reducing inequalities
- CCC has seen a 9 percentage point rise in one-year survival for people with lung cancer in areas of greatest deprivation – it now compares well with survival for patients from the most advantaged areas.
- CCC has the lowest 30-day mortality for breast cancer nationally, despite treating the highest proportion of patients from the most deprived areas.
- The new model has helped to reduce cancer mortality in Cheshire and Merseyside and narrowed the gap with the national average (latest data, 2020).
- Service innovations – including immunotherapy toxicities and metastatic spinal cord compression (MSCC) – are enabling patients to stay on treatment for longer and enjoy better quality of life. MSCC life expectancy has risen from 30 days to 7 months for patients treated with radiotherapy alone, or more than 12 months for patients who were also suitable for surgery.
- A new rapid diagnostic service means people with suspected blood cancer can have any tests they need much more quickly, leading to faster diagnosis and earlier treatment where needed.
- Ward space at CCC-Wirral has been repurposed as intermediate care beds, supporting Wirral health services to care for patients in a community setting and reducing pressure on acute hospital beds.
Patient experience
- CCC is consistently one of the top-performing trusts in the National Inpatient Survey, with patients praising the facilities in their rooms and the care from staff.
- More than 95% of patients rate their care positively in the Friends and Family Test and National Cancer Patient Experience Survey.
- Art, light and atmosphere are an intrinsic aspect of the care environment in the new hospital. 100% of patients participating in our Arts for Health activities say it helped their wellbeing and cancer journey.
- CCC-Liverpool scores over 90% across the board in Patient Led Assessment of the Care Environment (PLACE) inspections.
- Waiting times for care at CCC are generally good, despite significantly increased patient numbers and challenges across the NHS.
Access to specialist care
- Over 97% of patients now live within 45 minutes’ travel time of specialist cancer care.
- CCC’s unique networked model of care includes:
- 3 Clatterbridge Cancer Centres in Aintree, Liverpool and Wirral serving the north, centre and south of the region respectively;
- Clatterbridge treatment and outpatient clinics in hospitals across the region – from Ormskirk to Chester, Halton and St Helens; and
- Clatterbridge in the Community nurses giving chemotherapy and other treatments in patients’ homes and workplaces.
- Urgent and emergency care for people with cancer is much more accessible without needing to go to A&E. There is now a Clinical Decisions Unit at CCC-Liverpool, SDEC (same day emergency care) at CCC-Wirral, 24/7 Hotline providing urgent advice and assessment, and acute oncology teams in hospitals across the region supported by cancer specialists from CCC.
- Inpatients now have onsite access to specialist support from acute medical and surgical teams, if needed, without being transferred by ambulance to another hospital.
- Highly-specialist treatments such as CAR-T are now available in Liverpool, thanks to the facilities available there (CCC-Liverpool and Royal Liverpool), and the city’s new integrated blood cancer team.
- Teenagers and young adults (TYA) aged 16 to 24 can now access bespoke services and support regardless of where they live and what cancer they have. Previously services were split across different hospitals. TYA patients now benefit from wraparound care supporting emotional wellbeing and providing peer support alongside their cancer treatment.
- More patients can now benefit from stem cell transplants.
- Blood cancer patients in Liverpool now have access to the same wraparound care and support as patients with other types of cancer – this includes a 24/7 hotline if they need urgent advice about symptoms or side-effects.
- Clatterbridge Cancer Centre – Wirral (CCC-Wirral) remains an important and busy site for specialist cancer care. There has been investment (£3m in 2023/24) in estates improvements.
- Capacity at CCC-Wirral has been repurposed to support the wider NHS, with the creation of a community diagnostic centre and intermediate care centre.
Another key reason for Transforming Cancer Care was the fact that patients didn’t have access to clinical trials of the most innovative and advanced new treatments. The cancer hospital’s location on a site with no intensive care or acute medical care meant it wasn’t safe to offer early-phase and first-in-human trials.
Being so far away from the university also limited the scope for interaction between academic and clinical research teams.
Opening the new CCC-Liverpool next to a large acute hospital and the University of Liverpool has meant patients can now access first-in-human and early-phase trials. Clinical and academic research teams work closely together.
As a result:
- First-in-human trials of new treatments are now available for patients at CCC – this is only possible thanks to the new hospital and its onsite access to intensive care.
- CCC is now widely recognised as a pioneer site for cancer vaccine research, with several important global trials. Examples include MOAT (a vaccine for head and neck cancer).
- There is now a dedicated early-phase trials unit with inpatient beds, as well as clinical trials units at CCC-Liverpool, CCC-Wirral and CCC-Aintree.
- CCC has forged important research partnerships including a biomedical research centre (BRC) with The Royal Marsden, the new Liverpool clinical research facility (CRF) and renewed experimental cancer medicine centre (ECMC) status.
Transforming Cancer Care brought major changes in how and where some teams work. Change of that scale can be difficult so it would be natural to assume that this would negatively affect staff satisfaction and engagement. In fact, the complete opposite occurred:
- Staff satisfaction at CCC has consistently improved, year on year, as measured by the NHS National Staff Survey.
- One of CCC’s strategic priorities is to ‘Be a Great Place to Work’. Its ability to recruit and retain the best people has significantly increased, attracting very high-calibre candidates and carrying low vacancy rates.
- The new model of care has been accompanied by new roles and opportunities for progression, including a nursing career pathway that can take people from entry-level healthcare assistants through to roles in advanced clinical practice.
- There has been a real focus on staff health and wellbeing, involving people in decisions that affect them, encouraging Freedom To Speak Up, and to using feedback to continually improve staff experience.
Challenges and lessons learned
Any major transformation usually faces some challenges and there are always opportunities to learn lessons for the future. Some of the main challenges are highlighted below.
| Challenge | Action taken and lessons learned |
|---|---|
| The global COVID-19 pandemic brought the world to a standstill just three months before CCC-Liverpool was due to open. Work on the new hospital continued but numbers on site were restricted and supply chains were affected. |
Teams responded quickly as circumstances changed, mindful of people’s safety. The commissioning period post-handover was reduced. Workarounds and temporary solutions were found for supply chain issues. As a result, the new hospital opened on time and on budget despite the pandemic. |
| Problems with commissioning of the new aseptic pharmacy unit meant drug production had to move back to CCC-Wirral temporarily. | Teams worked exceptionally hard to address the issues so the aseptic unit at CCC-Liverpool could reopen. |
| The shift from shared wards to 100% single inpatient rooms meant adjusting to a completely new way of nursing. It also increased social isolation for patients during COVID-19 when visiting was restricted. | Nursing numbers were adjusted to allow greater visibility of patients. Staff have adapted to the new way of working. Although alternatives (e.g. video calls) helped patients stay in touch with family and friends, it’s clear that restrictions on social contact affected patients’ wellbeing. |
| Opening a new hospital on a new site involves negotiating and agreeing a wide range of relationships with new partners and suppliers. These have had to be refined as time has passed. | Improvements have been made, where needed, to ensure quality and value for money. |
| Changes in how NHS capital projects are funded have meant that CCC has not been able to fulfil its original plans for investment in estates improvements. | CCC is working with Clatterbridge Cancer Charity to look at options for further investment in modernising and improving the site. |
Conclusion
Transforming Cancer Care was a hugely significant investment for the NHS in Cheshire and Merseyside and the benefits are already clear. The new CCC-Liverpool – which created extra capacity for specialist cancer treatment – has been essential in helping the NHS meet the surge in demand post-COVID.
It would simply not have been possible for CCC to see and treat the volume of patients it now cares for if it wasn’t for Transforming Cancer Care. Patients can now access clinical trials and new treatments that they previously had to travel to other regions to receive.
Perhaps, most importantly, the initial data on clinical outcomes and cancer survival suggests that it is making a real difference, helping more people to live longer and feel better after their diagnosis.
