Analysis

How nurses helped shape the NHS’s latest cancer hospital into something incredible

Despite the COVID-19 pandemic, Clatterbridge Cancer Centre - Liverpool opened its doors in June, and nurses were pivotal in its planning and day-to-day operations

Despite the COVID-19 pandemic, Clatterbridge Cancer Centre - Liverpool opened its doors in June, and nurses were pivotal in its planning and day-to-day operations

  • 11-storey hospital is latest hub in Clatterbridge Cancer Centre trusts network across Cheshire and Merseyside
  • Clatterbridge Cancer Centre Liverpool is part of a 162 million programme of investment to expand and improve cancer care
  • Hub delivers specialist care, including pioneering immunotherapy and radiotherapy, to 2.4 million people in the region
Clatterbridge Cancer Centre - Liverpool

Opening a new specialist cancer hospital in the midst of a pandemic sounds like the challenge of a lifetime, but Clatterbridge Cancer Centre NHS Foundation Trust was determined its new hospital in Liverpool would open to patients on

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Despite the COVID-19 pandemic, Clatterbridge Cancer Centre - Liverpool opened its doors in June, and nurses were pivotal in its planning and day-to-day operations

  • 11-storey hospital is latest hub in Clatterbridge Cancer Centre trust’s network across Cheshire and Merseyside
  • Clatterbridge Cancer Centre – Liverpool is part of a £162 million programme of investment to expand and improve cancer care
  • Hub delivers specialist care, including pioneering immunotherapy and radiotherapy, to 2.4 million people in the region
Clatterbridge Cancer Centre - Liverpool

Opening a new specialist cancer hospital in the midst of a pandemic sounds like the challenge of a lifetime, but Clatterbridge Cancer Centre NHS Foundation Trust was determined its new hospital in Liverpool would open to patients on time.

The Clatterbridge Cancer Centre - Liverpool opened in June, only a month or so later than originally planned, and is the culmination of plans eight years in the making.

‘We asked a lot of our staff to pull out all the stops to get this done and stay focused,’ says the trust’s chief executive Liz Bishop. ‘But one of the good things to come out of COVID-19 is everyone working together.’

The 11-storey hospital is the new hub in the trust’s extensive network of oncology services across Cheshire and Merseyside. This includes existing cancer centres in Wirral and Aintree; clinics in hospitals across the region; and a team of specialist nurses who treat patients at home or at work.

Clatterbridge Cancer Centre – Liverpool part of visionary plan to meet regional needs

Dr Bishop, who qualified as a nurse in 1986, joined the trust in 2018 when progress towards the new building was in full flow.

Liz Bishop

‘I saw a visionary plan to create something different to meet the needs of the regional population,’ she says. ‘And a big part of it was building this new hospital. It was a once in a career opportunity and too good to miss.’

Research carried out more than a decade before showed that the hospital needed to move from the Wirral to better meet the needs of its patients, as more than 60% came from north of the Mersey.

‘It’s all about the patients,’ says Dr Bishop. As it is close to the Royal Liverpool University Hospital, patients who deteriorate and need critical care don’t have to travel.

‘Being co-located with the university also supports the research agenda for future cancer patients,’ she says.

Cancer incidence in Cheshire and Merseyside is the third highest in England, according to the University of Liverpool’s North West Cancer Research Centre.

In many ways, opening during the pandemic was perfect timing, says Dr Bishop, given the increasing demands for extra beds and uncertainty about how the virus may affect people with cancer.

‘The rooms in the new hospital are all single, with en-suite facilities, so patients could feel safe here,’ she says.

Clatterbridge by numbers

  • 32,000 patients were treated by the Clatterbridge Cancer Centre NHS Foundation Trust in 2019-20
  • 1,500 members of staff work at the trust, including 362 registered nurses and 204 healthcare support workers
  • 1,082 days – the time it took to construct Clatterbridge Cancer Centre - Liverpool (work started in 2017)
  • The new hospital has 110 single rooms with private bathrooms over 11 floors, with the majority having floor-to- ceiling windows
The majority of Clatterbridge Cancer Hospital - Liverpool’s rooms have floor-to-ceiling windows
  • Floors three, four, five and six have rooftop courtyards with cityscape views towards the River Mersey
  • 2.4 million of the population is served by Clatterbridge Cancer Centre – Liverpool, in Cheshire, Merseyside and surrounding areas, including the Isle of Man. For the first time, chemotherapy and other drug therapies, radiotherapy, inpatient and outpatient care, cancer support and rehabilitation, bone marrow transplant and urgent cancer care are together on the same site
  • The new hospital is part of a £162 million programme of capital investment to expand and improve cancer care, including investing in existing sites in Wirral and Aintree, which continue to provide outpatient cancer treatments. The trust also runs clinics at other regional hospitals and a community team delivering anti-cancer therapies in patients’ own homes

Rapid move to 90% remote consultations and chemotherapy in patients’ homes

Alongside completing the final stages of the building work, the centre also had to respond quickly to the needs of patients. ‘We had 7,200 patients who needed to be shielded,’ says Dr Bishop, whose previous role was deputy chief executive at the Royal Marsden NHS Foundation Trust in London.

‘From a nurse point of view, it’s integral that you get involved because we understand how nurses want to work. We wanted to make this special for our patients and a good working environment for staff’

Fiona Courtnell, operation and transformation manager for chemotherapy

‘We moved rapidly to 90% remote consultations, ramping up chemotherapy in patients’ own homes. We had to continue with business as usual, but not lose sight of the plan. We had a lot of support to continue the drive to open as quickly as possible.’

Nurses have played a pivotal role in helping to shape the new hospital, says Fiona Courtnell, who joined Clatterbridge in 2011 as a newly qualified nurse and is now operation and transformation manager for chemotherapy.

Nurses integral to planning and running the cancer centre

‘I’ve been in from the first stages, seeing it through from a piece of paper to taking part in consultations and weekly meetings,’ she says.

‘From a nurse point of view, it’s integral that you get involved because we understand how nurses want to work. We wanted to make this special for our patients and a good working environment for staff.’

Smitha Binoy

Patients receiving chemotherapy now sit in large, comfortable reclining chairs, in individual bays separated by glass partitions, where they can plug in their own devices and enjoy panoramic views across the city. There is also a social space for those who want company, although COVID-19 has postponed the use of that area temporarily. ‘We’ve had some amazing feedback,’ she says. ‘The patients love it.’

Smitha Binoy joined Clatterbridge as outpatients’ manager in March, three months before the new hospital opened.

‘It’s a brand new department, with a new team and set-up,’ she says. ‘It’s been hard, but exciting. We’ve had many challenges, including dealing with vulnerable patients during a pandemic. But they’re a brilliant team who are supporting each other.’

How nurses helped ensure Clatterbridge Cancer Centre – Liverpool is fit for purpose

Mike Varey

While plans may look foolproof on paper, the devil is in the detail for clinicians, who need to understand precisely how they will deliver services in practice.

‘I was filling in the clinical gaps, from the perspective of the patient and how we would deal with something – for example, an emergency situation – as a nurse or doctor,’ says acute oncology advanced nurse practitioner Mike Varey, who was seconded to the project management office to help steer the move.

Specialist knowledge of cancer patient pathway is crucial

Clinical practitioners bring a vital level of detail. ‘Clinicians will ask whether the patient can walk, do they need an escort, do they need a bed and if so, is there somewhere they can wait without blocking a corridor? It’s the knowledge of that patient pathway. You can do it on a piece of paper and implement it – until you find it doesn’t work,’ says Mr Varey, who joined Clatterbridge Cancer Centre NHS Foundation Trust in 2003.

Fortunately his views were listened to throughout the process. ‘If I raised something clinically, other team members would say, you’re the expert on that. I’ve always been patient-focused and, if you plan something without thinking of what’s best for them and how they might be affected, it’s not going to work in practice. With cancer, the patient experience is important.’

Challenge of moving inpatients to new hospital during COVID-19 pandemic

COVID-19 threw up various practical problems, such as some items of equipment not being available because of lockdown, with alternatives needing to be sourced.

Many services, including haematology and oncology, are under one roof for the first time

Moving inpatients to the new hospital was the biggest challenge, with numbers whittled down as much as possible, leaving the remaining 20 or so to transfer on the same day – two days before the hospital opened to outpatients.

‘We had to think about how many patients could go in one ambulance because of COVID. But it went well. Having patients here felt like the biggest achievement,’ Mr Varey says.

With the haematology department completing their transfer from the Royal Liverpool Hospital in September, many services are now under one roof for the first time.

‘Haematology and oncology staff have never been together before,’ says Mr Varey. ‘Everyone has been separate in the past and this move has made us a stronger unit, appreciating each other’s skills. It’s an exciting time of learning and development.’

Nurses and consultants work together in an open environment

Despite the challenges, Dr Bishop is delighted with the end result. ‘It’s surpassed my expectations,’ she says. ‘The day we brought the first patients in was emotional. The feedback we’ve had so far has been phenomenal. Some have said it’s like coming into a five-star hotel.’

Changes include no separate offices for consultants. ‘I see many more staff now day-to-day as we’re working together in an open environment. It’s improved communication between the various teams.’

Among the many attractive features are terraces where patients can enjoy views across the city. ‘The architects have tried to design a space that feels healing,’ says Dr Bishop.

‘We’ve created something incredible for patients and nurses to work in.’

Six tips on managing change in your workplace

Fiona Courtnell
  1. Good communication is everything, says Clatterbridge Cancer Centre NHS Foundation Trust chief executive Liz Bishop. ‘We’ve tried to be open and transparent with staff. We also haven’t assumed that saying something once is enough. You need to make sure it’s a two-way conversation, where they can tell you what’s not quite working.’
  2. Get your team right, with everyone knowing who is responsible for what, says Dr Bishop. ‘They need to gel and work together.’
  3. Don’t be afraid to say when you don’t understand something or don’t know if it will work, advises acute oncology advanced nurse practitioner Mike Varey. ‘Don’t feel you have to know everything about everything, because no one does. Be open to any kind of learning experience.’
  4. Acknowledge people’s worries and concerns, says Mr Varey. ‘It may be that you can’t do anything about them, but you can still understand and support them. At least they know someone is listening.’
  5. Keep the excitement going, says operation and transformation manager for chemotherapy Fiona Courtnell. ‘And ask everyone how they think things should be done. We took all their ideas on board.’
  6. Get involved in any proposed changes, advises Ms Courtnell. ‘If you don’t like something or think it could be better, you need to have your say.’

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