During our inspection we visited the Mersey Ward, Conway Ward and Sulby Ward, including the teenage and young adults unit. We spoke with patients and staff on all the wards we visited. We spoke with 16 staff of different grades. We spoke with eight patients and some of their relatives.

Patients spoke positively about their experience at the Clatterbridge Cancer Centre NHS Foundation Trust. One said “The staff have been great at helping me to overcome my embarrassment, and I’m not used to needing any help”. Others told us staff treated them with sensitivity, and one patient commented that staff “could be good fun” but said they were very careful when assisting them and helped them relax “because they are good at this work”. One nurse told us “If anyone asks where I work I feel so proud when I tell them”.

Patients understood the care and treatment choices available to them and were given appropriate information and support regarding their care or treatment.

We saw that staff were well supported and had regular personal development reviews. Training was monitored and we saw evidence that staff had the opportunity to attend more specialist training courses when appropriate. There were enough staff on duty at the time of our inspection and we saw that additional staff could be accessed at short notice if required.

Records were kept securely and could be located promptly when needed.

During our inspection at The Clatterbridge Cancer Centre NHS Foundation Trust we visited all three inpatient wards; Sulby ward, Mersey ward and Conway ward. We spoke with eight staff members, including ward managers, nurses and a psychologist. We also spoke with two patients on each of the wards we inspected.

The patients we spoke with were very positive about all aspects of their care and treatment. They said that prior to being admitted they had met their consultant who had explained everything and asked for their consent to the suggested treatment. They said they were asked for their consent again after they were admitted and prior to their treatment commencing. Patients told us that staff regularly checked they were all right and not in any pain. They said staff fully explained everything that was happening with regard to their treatment and support.

Comments from patients included “[The staff] treat you as an individual not as a number or a disease”, “I can’t fault anything to do with the oncology department”, and “[The staff] are amazing, absolutely amazing”.

Staff told us that they felt well supported at work and received regular training. They said they had the opportunity to increase their knowledge of their area of work and extra training courses were well advertised.

We saw that the trust carried out regular checks on all aspects of the service they provided. Where improvements could be made action plans were put in place and monitored.

Patients and relatives interviewed expressed that they were very satisfied with the care and treatment given to them during their stay at Clatterbridge Centre for Oncology. They told us that they were treated with respect and dignity, their needs were assessed and they were given plenty of information in a form they could understand to help them make choices regarding their care and treatment.

The hospital’s own patient survey results and results from the NHS patient survey corroborated this evidence. A large proportion of inpatients expressed satisfaction within both surveys with care and treatment, privacy, dignity, information and treatment with respect.

Patients told us at interview and within surveys that generally they were very satisfied with the care given in respect of meeting their nutritional needs. They also told us that the food choices, availability, presentation, and special diets were of good quality. We were told that staff support and assist patients where required and that mealtimes were protected and well organised.

Our rating of services went down. We rated them as good because:

• We rated safe, effective, responsive and well-led as good. We rated caring as outstanding.
• We took into account the hospital’s previous rating from our last inspection for three core services. Following our recent inspection the combined ratings meant we rated four services as good and two as outstanding.
• We cannot compare the ratings for outpatients and diagnostics services as at our last inspection we rated these services together. However, we found that areas of concern in these services at our last inspection had been addressed at this inspection.
• Across the trust, services largely performed well. We were not concerned regarding the overall quality of cancer care. Our concerns were linked to important issues that underpin cancer care and ensure there are effective systems and processes within hospitals.
• We continued to rate caring as outstanding. Throughout the organisation staff were committed to delivering patient centred care. Patients were at the heart of what the trust did and decisions it took. Staff respected individuals and supported them practically and emotionally.
• We improved the overall hospital rating in safe to good.
• We continued to rate effective as good. The hospital continued to ensure that patients had good outcomes because they received care and treatment that met their needs.
• We continued to rate responsive as good because most people’s needs were met through the way the services were organised and delivered.
• At core service level, we rated well-led as good because the leadership and culture promoted high-quality person-centred care.

However:

• Our rating in well-led for medicine went down because the hospital did not comply with some legal requirements. Further information can be found in the medicine report.
• We rated safe in diagnostics as requires improvement. We were concerned regarding patient safety, storage of records and mandatory training levels in relation to life support training. The trust did not comply with some legal requirements in relation to these issues. Further information can be found in the diagnostics report.
• The hospital’s governance systems did not enable senior staff to have oversight of issues that impacted on patient care and allow them to address risks sufficiently in a timely way. Further information can be found in the well-led overall report and evidence appendix.
• The hospital did not ensure there were always enough suitably qualified, competent and experienced staff with relevant levels of life support training (including basic, immediate and advanced life support) deployed within the service at all times.
• We had concerns relating to records storage.
• All the concerns relating to legal requirements were raised with the hospital at the time of our inspection and action was taken to address them.