At the cutting edge

Source: National Health Executive Jan/Feb 2013

Caroline Shaw, chief executive of The Christie NHS Foundation Trust, was among the NHS leaders recognised in the new year’s honours, being appointed CBE. NHE spoke to her about the honour, her management style, and the ways the trust is trying to get more involved in the wider Greater Manchester health economy.

The Christie’s Caroline Shaw was – unsurprisingly – “absolutely delighted” at being appointed CBE for services to the NHS when NHE spoke to her in early January.

“Personally, it’s fantastic, but it’s also absolutely fantastic on behalf of The Christie. It’s recognition of the work and the people who work here, and the delivery of care and what we do for our patients.

“I’ve come from being a nurse, a midwife – from the ward to the board. I’m a working mum with two children: it’s about making sure you don’t pull the ladder up behind you, and instead you encourage other people to do it and take the opportunities.”

We asked Shaw how her management style has changed during her time at The Christie.

She said: “When I came to the Christie, we had some performance and some financial problems – though clinical care has always been exceptional, as have clinical outcomes and our research.

“So when I first came, I was quite prescriptive and challenging and set stringent performance frameworks. Now, we’ve been an FT since 2007: we’ve had a lot of staff development, organisational development, and I’d say I’ve now got a much more facilitative style, with a more external focus rather than internal. I’m more focused on some of the bigger-picture issues and development in the future, and wider collaboration.

“The organisation is sound; it’s got strong performance with a fantastic executive team and strong clinical leadership.

“You’ve got to be savvy and not take anything for granted: we’re continually assessing what we need and changes we need to make, developments we need to implement.

“[Our senior managers] have undergone some quite significant changes in their personal roles, but that’s because the organisation’s changed. As the organisation changes and develops, your management team and style have to change with it.”

Looking outwards

A key aim now, she said, is collaborating with other local, regional and international organisations to improve health outcomes.

“As a leading cancer centre, we’ve taken on a role across Greater Manchester to develop cancer services. I’m going to be chairing a board with the other providers in Greater Manchester to look at developments for the future.

“It’s about how we can get more involved in the care pathway, not just in tertiary services, but also when patients are being diagnosed, and how we can make all the services in Manchester more effective.

“I’m developing the leadership agenda, for cancer services in Greater Manchester and nationally.”

The structural NHS reforms and the efficiency agenda have not passed The Christie by – and dealing with those challenges is another area where collaboration is important, Shaw said.

“Absolutely we are affected. The financial picture for us all in the NHS is that you’ve got to be very focused and more efficient – delivering more for the activity we’re providing.

“It’s a challenge for us all, as provider organisations. We’re energised though and for us, I see the changes as an opportunity. It’s fantastic that we can start getting some real engagement locally with CCGs, working with them and cancer patients on new pathways into The Christie to reduce duplication.

“Sometimes we’re seen as an ‘island of excellence’ in isolation – but we can play a big part with the local health economy on doing things differently. We’re not isolated: ‘we’re here to work with you’.

“We’d like to build relationships between local GPs and the consultants and nursing staff here to make the difference for local patients. On a wider scale, we’re keen to develop more relationships with people like the Royal Marsden.”

2020 Vision

The organisation launched its new strategy at its annual members meeting in September, with its ‘2020 Vision’ as its guiding principle and framework. “Anything we do at The Christie has to be about enacting and making the 2020 Vision real,” Shaw told us.

Following 12 months of formal consultation on its priorities, with input from Manchester Business School, the Vision was launched with four clear themes: being a leading cancer centre (regionally, nationally and internationally); developing The Christie ‘experience’; local vs specialist care and developing local cancer services but also very specialised cancer services; and clinical outcomes, demonstrating to patients that the trust has the best mortality and morbidity rates.

“If you come into the hospital, all members of staff talk about the 2020 Vision, they’re able to articulate it and describe what part they play in the delivery of it: that’s from a domestic right up to the top consultants.

“We’ve also put a lot of time and energy into our School of Oncology and our educational programme, both from a national and international relationship point of view. There are some exciting developments happening there in 2013.

“On patient experience, we’re one of the first organisations to implement the Friends & Family test, which you’d expect us to do.

“Underpinning it is a leadership programme for all our ward sisters and charge nurses, so every person who manages and leads a ward or a department at The Christie will go through a bespoke development programme focused on making it even better for our patients.”

Facilities and sites

The Christie, in conjunction with other Manchester trusts, has Department of Health approval for a specialist proton beam centre at its Withington site, with another centre to be based at University College London Hospital. About 1,500 patients a year will benefit from the cutting-edge facilities by 2017.

The Christie already provides chemotherapy in eight other hospitals, and has two radiotherapy centres. Shaw told us: “We’ve also just agreed a business case for, and are now securing, a ‘chemo van’ that will go around some of the market towns in Greater Manchester to deliver chemotherapy. We’ve also started to deliver chemotherapy at some of the LIFT centres. We’re really changing the way we deliver very specialised services on the Withington site, but have this plan that you shouldn’t have to travel more than 20 minutes for chemo or radiotherapy.”


Shaw said the trust is being “really aggressive” in its research development, with work underway to ensure it does more research, more international studies, and more collaboration with other big centres in Europe, internationally and locally.

She said: “We are noticing that patients themselves are using the internet to look at clinical trials and research; we’re getting a lot more attention from patients themselves, asking to come to us for treatment. That will grow in the future, particularly with patient choice. We’d like to see it grow.

“The UK is pretty small: nobody has to travel that far to get to The Christie. In America, people use air travel to get to the right treatment and specialists at the right time.

“That will grow organically as patients find out about us. But also, commissioners in the future might start specialising and rationalising some of the very specialised services to cancer centres – the proton centre is a prime example of that. If you think about the patient population we’re serving, 3.2m in Greater Manchester, it’s fantastic for research and trials.”

She told us she considered The Christie to be hovering in or near the top 10 cancer centres in the world, adding: “The Dana-Farber Cancer Institute, Memorial Sloan-Kettering Cancer Center – those are the kind of places we want to be considered alongside. My ambition for the Christie is for us to be one of the top five cancer centres in the world.”

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