The bunting is up in the reception area at Clatterbridge Cancer Centre Foundation Trust to proclaim its outstanding rating from the Care Quality Commission. But, jokes chief executive Andrew Cannell, that presents a dilemma familiar from recent Christmas celebrations: how long should they stay up after the event?

Twelfth Night is not yet here for the trust – its CQC rating was only announced at the start of February – and no one can blame it for celebrating. But Cannell, chief executive for nearly eight years and director of finance for six before that, prefers to praise his staff rather than claim the credit for himself.

“They are so passionate about what they do,” he says. “What has made us outstanding and what will keep us in that position is listening to the clinicians. They are throwing out the challenges to us. When I first applied for the job there was something different about the atmosphere here – it was so light, very welcoming and people walked around with a smile on their face.”

He describes his leadership as “collegiate” by default and stresses the importance of effective team working through the hospital. “I’m keen we hold ourselves to account – individually and as a team. At the end of the day, boards and executive teams need to make judgements and stand by them – but sometimes they are based on imperfect information,” he says. He insists he is naturally optimistic person but also a bit of risk taker – perhaps surprising in a former finance director. “It’s necessary to get buy-in to take risks. I’m always keen to emphasise we will try something but it may not necessarily work.”

Winning hearts and minds

He says care is what wins the “hearts and minds” of the clinicians – they want to know that that leaders understand the service the trust provides. “It sounds trite but it’s about showing an interest in what people do and being willing to engage. We should be making it easy for clinical teams to deliver outstanding performance.
“There seems something pretty straightforward about having a focus and being able to articulate a vision for clinical services that allows teams to see [that we’re willing to engage].”

One of the largest networked cancer centres in the UK, Clatterbridge provides oncology services for a population of 2.3m, treating more than 30,000 patients a year. It has inpatient beds at its main site ten miles from Liverpool city centre and outreach services at other sites, including many acute hospitals across Merseyside and Cheshire. The trust delivers chemotherapy and radiotherapy for solid tumours, and low energy proton beam therapy for eyes, but unlike the Royal Marsden and the Christie, it doesn’t do cancer surgery. Cannell calls it “small but perfectly formed”.

Moving to the new Royal

The culmination of Cannell’s work as chief executive – and probably his greatest challenge as well – will be a series of changes which will see inpatient care shifted to a new city-centre hospital, physically linked to the new Royal Liverpool Hospital but designed specifically for cancer care. The trust will also take on blood cancer oncology services, with around 250 staff transferring from the Royal Liverpool in July. Cannell says the move will improve accessibility for patients from the most deprived areas of Liverpool and increase its turnover by 25%.
“It’s exciting and a little bit daunting,” he says. “It’s a positive statement around the opportunities for collaboration. But the push for it came from the clinicians.” Taking on new services, meant adding new floors to the original plans for the new hospital. “We would not have done that if there was any diffidence or anxiety from the clinicians,” insists Cannell.

He says it’s “really difficult to deliver 21st century cancer care” in an isolated location. “We are not on an acute site, there are limitations to what we can do. This does allow us to address the future in terms of capacity.”
Building relationships and developing a shared vision with commissioners and other stakeholders – including politicians – has been “pretty fundamental” in funding and planning the move, says Cannell, especially as it was first mooted just as financial markets collapsed in 2008.

The trust was helped by having relatively low average costs for treatments (so-called ‘reference costs’) . Cannell worked to persuade commissioners that by funding 100% of reference costs they could help the trust build up a substantial surplus which could be used to part-fund the new hospital, with the rest coming from a loan from the Independent Trust Financing Facility and a public appeal.

Overcoming cynicism

“It’s exciting and a little bit daunting… it’s a positive statement around the opportunities for collaboration.”

Then there was the small matter of selling the move to local politicians. “We had to do a lot of work around this not being about taking services away,” says Cannell. “There was a lot of cynicism which we had to work hard to overcome. We worked with local politicians…they trusted the institution and leadership, and knew the great work our clinicians were doing.” It helped, he says, that his former chair was also very politically astute.

“We had excellent support from local authorities,” he adds. “There was a joint health overview and scrutiny committee of seven to eight authorities and it was unanimously approved. We had to be clear that this would not disadvantage other acute hospitals, even if we were moving to the Royal’s complex.

Cannell admits that starting that process today would be harder because of the risk of being swept up in the “febrile atmosphere” surrounding reform, but is confident the development is a “fixed point” in the STP for the area.

He doesn’t want the development to be seen as centralising services. “We very much go to the patient or to their locality,” he says. “That’s important to us, but we do come up against the hard edge of financial viability. We have a mantra of ‘local where possible, central where necessary’. It’s in constant tension.” He concedes this can mean “some of the consultants spend too much time on the road going from one site to another”.

Entrepreneurial steps

Cannell’s has also encouraged some entrepreneurial steps which offer opportunities for the trust to make some extra income and cut its costs. These include private cancer services run in conjunction with a Dublin hospital which shares the same public service ethos. He believes this initiative may help to attract and retain staff, although demand is limited. “It turns a surplus, but not a massive one… That was a challenge – there were some very small-C conservative consultants who saw opening it as anathema,” he says.

Clatterbridge has also developed its pharmacy side through a subsidiary company, which buys medicines and could provide support to other trusts within the context of the STP. Recently, the trust has set up a property, estates and hotel services company, known as PropCare, which will build and service its new hospital.

Cannell sees it as one of the initiatives from which he has learnt most. “This was first considered some three years ago, but stalled, not least because there was unfounded concern that it was a vehicle to back-door privatisation of these services and that staff would be disadvantaged,” he explains.

“My reflection is that better preparation and engagement, whilst taking longer, would ultimately have delivered a quicker route to the objective with less anxiety all round. Taking stakeholders with you on a journey is never as simple as the optimist in me may naively assume. I’m glad to say that subsequent efforts have addressed the issues, and the board, wider leadership team and significantly, the staff most directly affected, see PropCare as a solution to help improve our services rather than causing a problem.”

Unique culture

As a highly specialist organisation dependent on attracting top quality staff, Cannell sees it as essential that the trust provides quality training and development opportunities and the right workplace culture.

The trust has its own ‘culture programme’, which focuses on consistently encouraging positive behaviours. Board members take part in staff shadowing, patient safety walks and executive roadshows, keeping them in contact with grassroots staff. “I really believe we have a unique culture at Clatterbridge and part of that culture is the sense of openness that we have been able to foster so our staff feel empowered to approach board members directly,’ he says.

Clinicians and senior managers have also been taking part in a two-month-long programme on how to deal with challenges internally, based around the best-selling mind management book, The Chimp Paradox. If that sounds like waffle, the book’s author, Professor Steve Peters, who delivered one of the sessions, is credited with helping Britain’s cyclists to Olympic success. “Senior colleagues who you might have thought are quite cynical, have given up eight evenings to it, with very good feedback,” he says. Around half the consultant body have taken part.

“This programme helps people become more resilient. There’s a danger people end up on a hamster wheel and don’t create time to think about doing things differently. Hopefully we will see happier and more content consultants and managers!

“We have to find better ways of using the skills we have,” says Cannell. Change will involve consultants doing things only consultants can do, while other healthcare professionals pick up and lead on other aspects of care. This will be particularly important as the trust has seen ever rising referral rates.

System leadership makes a difference

Apart from a year in local government, Cannell has worked in the NHS since leaving university. System leadership will be where the difference is made at scale, he says, and there are lessons the NHS can learn about the response to austerity from other sectors like local authorities. “The discipline local authorities have had to bring to bear… they seem to have done it well with a lot of dignity, at least until recently. There’s a sense they had done it without the sky falling in.

“I would not do the job of a large acute teaching trust chief executive for all the tea in China,” he says. “The challenges they face day-to-day and all the performance standards make it very difficult to go the extra mile. You are running to stay still.

“It’s commonplace to say that in the future people will have many careers,” he concludes. “That’s true of the health service – there are so many ways that you can go and many contexts in which you can work – it’s very exciting. Whatever the shape of the NHS, healthcare is a job for life!”