The Cheshire and Merseyside Acute and Specialist Trusts Provider Collaborative (CMAST) includes all acute and specialist providers in the Cheshire and Merseyside system [1], and aims to ensure the coordination of an effective provider response to current system and NHS priorities including: ongoing pandemic response; NHS service restoration and elective recovery; support and mutual aid; sharing best practice; increasing standardisation; and reducing variation (NHS Cheshire and Merseyside). Five work programmes have been established to support these aims, each with a chief executive as senior responsible officer (SRO) and a chair sponsor. One of these five programme is focused on driving collaboration, transformation, and continuous improvement for diagnostics across Cheshire and Merseyside.
The SRO for the Cheshire and Merseyside diagnostics programme is Dr Liz Bishop, chief executive of The Clatterbridge Cancer Centre NHS Foundation Trust (CCC) and Liverpool Heart and Chest Hospital NHS Foundation Trust (LHCH). The programme recognises the key role diagnostics play within overall system recovery. It provides the opportunity to manage diagnostic capacity at the system level and identify where gains can be made by working across all providers. To support these aims the programme is hosted by CMAST, reporting to the Cheshire and Merseyside integrated care board (ICB), as well as reporting into the NHS England national and regional diagnostics board.
A key strength of CMAST has been the consensus from all acute and specialist trusts on the priorities of the system, which has enabled them to make decisions on behalf of the system, particularly when funding has been made available at short notice. The CMAST diagnostics programme has been successful in securing £52m for CDCs, establishing 10 CDCs [2] across the system. Due to these efforts and success of the diagnostics programme, Cheshire and Merseyside has the largest concentration of CDCs in the country, with all 10 sites selected based on viability and population need. The system was an early pioneer, opening the first CDC in England, St Helens CDC in July 2021.
The Paddington CDC, which opened in July 2023, is unique among the other CDCs in Cheshire and Merseyside. The Paddington CDC is a completely standalone building specifically designed for diagnostics. It is the first phase of a wider development transforming the formerly privately-run Rutherford Cancer Centre North West.
Working jointly with partners in the collaborative, alongside other partner organisations including NHSE’s regional and diagnostic teams enabled CCC to move quickly to acquire the building on behalf of CMAST when it became available. As the building had been a health care setting, and equipped to a high specification, when the building became available it was an ideal candidate to convert into a CDC. CCC took it over in March 2023, and the new CDC launched in July 2023. The site is now owned and operated by CCC, on behalf of the system and supported collaboratively by partners across CMAST, as well as the Cheshire and Merseyside Cancer Alliance.
Getting the building set up and operational required huge amounts of collaboration across CMAST. Early engagement took place with Liverpool University Hospitals NHS Foundation Trust (LUHFT) as the key referrer and the neighbouring CDC at Liverpool Women's NHS Foundation Trust. To support the mandate given to the CDC to deliver additional diagnostic capacity to all patients in Cheshire and Merseyside, the CDC offers CT, MRI, ultrasound, and phlebotomy, with scope, and plans, to expand. As these diagnostic tests are not solely for suspected cancer pathways, and do not form part of cancer pathways operated by CCC, the Paddington CDC demonstrates how the trust has taken on a key role to deliver capacity for greater benefit for the system, and with the aim of improving the experience, outcomes, and access for patients in Cheshire and Merseyside. This approach is not unique amongst CMAST Trusts and reflects the focus that is being placed on overall system performance, requiring all partners to consider and participate in improving performance.
Similarly, CMAST partners have been working together on international recruitment, including with local universities to consider the future pipeline of diagnosticians and support staff on behalf of the system to support effective workforce modelling for the future.
As a result of working collaboratively, the CMAST diagnostics programme has seen a 12% increase in MRI activity, 17% increase in gastroscopy activity and a 21% increase in activity across all key diagnostic tests (87,000 per month in 2021, 105,000 per month in 2023).
[1] Alder Hey Children’s Hospital NHS Foundation Trust, Countess of Chester Hospital NHS Foundation Trust, East Cheshire NHS Trust, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool University Hospitals NHS Foundation Trust, Mid Cheshire Hospitals NHS Foundation Trust, Mersey and West Lancashire Teaching Hospitals NHS Trust, North West Ambulance Service NHS Trust, The Clatterbridge Cancer Centre NHS Foundation Trust, The Walton Centre NHS Foundation Trust, Warrington and Halton Teaching Hospitals NHS Foundation Trust and Wirral University Teaching Hospital NHS Foundation Trust.
[2] St Helens CDC, Clatterbridge Diagnostics Centre, Victoria Infirmary Northwich CDC, Ellesmere Port CDC, Liverpool Women’s CDC, Southport CDC, Warrington & Halton CDC, Shopping City CDC, Paddington CDC and East Cheshire CDC.