Although Clatterbridge Centre for Oncology celebrated its 40th anniversary in 1998, its roots can be traced back a century and more - to the Liverpool Hospital for Cancer and Diseases of the Skin, founded in 1862, by James Seaton Smythe, Surgeon. He set up the institution at 17 Islington and, seven years later, bequeathed the hospital the princely sum of £10,000, the first of many legacies which help, and continue to help, support the work of caring for cancer patients, researching into the cause of the disease and seeking a cure.

In 1882, the hospital moved to a new site at number 1, Myrtle Street, Liverpool where it was later renamed 'The Radium Institute'. The first Roentgen ray apparatus was purchased in 1901 and, gradually, the centre grew to be one of the two major radiotherapy centres in north west England.

An ambitious scheme was proposed in the 1920s to demolish the old hospital and erect a new, eight-floor building devoted to cancer treatment and research. The foundation stone of the new building was laid in November 1931 but was only partially completed by the outbreak of World War II and, because of the war and the subsequent foundation of the National Health Service in 1948, was never finished. (Above : Opening of the 1st Phase Radiotherapy Centre by Lord Cohen of Birkenhead)

The Liverpool Radium Institute and Hospital for Cancer, as it became known, was in the early days of the NHS, the headquarters of the Liverpool Regional Radiotherapy Service.

In the early 1950's a decision was taken to relocate services away from Liverpool city centre. The Ministry of Health, keen to expand cancer services, was acutely aware that space was not available at the cramped city site yet it had, in 1951, allocated a four million volt linear accelerator to the Liverpool region. With the mounting mistrust of international political leaders, the Ministry decided that, with an atomic war possible, the centre of Liverpool was not the place to develop the radiotherapy speciality and in general, advised against the development of capital buildings in a heavily populated area. It was also considered advisable to have a department of radiotherapy allied to a general hospital.

After much discussion Clatterbridge was selected to be the new centre for the development of radiotherapy services.

In Liverpool the Radium Institute, renamed the Liverpool Clinic, became the Regional Centre for Nuclear Medicine, retained some services, and also incorporated a laboratory for endocrine research in an extensive out-patient department.

However, over the water in rural Wirral, after extremely detailed planning procedures - and the collapse of the first firm of builders - the new Regional Radiotherapy Centre was opened on 28 March 1958 by Lord Cohen of Birkenhead, President of the General Medical Council and Chairman of the Central Health Services Council, the most eminent physician in the land at the time.

Phase 1:

(Right: the first Linear Accelerator 1958-1987) The unit was known as Clatterbridge Hospital West - Radiotherapy Unit and its first medical director was Dr J. S Fulton. It consisted of a purpose-built treatment unit containing the Mullard 4 Mev linear accelerator with planning and dose calculation facilities, as well as three wards, an operating theatre, a physics workshop, mould room and medical records office. The linear accelerator was up and running by early 1959 and treated between 60 and 80 patients a day!

In all, 70 patient beds were available in the three wards. Dee and Mersey wards accommodated 28 patients and Weaver 14 and all three wards were in converted military huts. Other services accommodated in huts were the theatre and the out-patients clinic, scientific and technical services and secretarial support. Life appeared relaxed in those days. There was even a putting green on the grass that surrounded the entrance circle!

Phase 2:

The second phase of the development was completed by 1962 when two further buildings were adapted as hostel wards. The number of beds available had risen to 121, with 15 hostel beds in Clatterbridge main hospital. In this phase, the physics workshop and the mould room were improved and a radium store and a medical photographic unit were opened in adapted huts. This phase was officially opened by Dr Fulton. New equipment was added to that brought over from Liverpool, providing the services of deep and superficial x-ray treatment sets.

Demand for radiotherapy increased rapidly and, with up to 90 patients a day being treated on the linear accelerator, a shift system of working had to be introduced. Not only that, but it also became obvious that extra equipment would be required. Throughout this time the numbers of patients referred to the hospital for both in-patient and out-patient treatment continued to rise.

Phase 2a:

In 1966, as part of Phase 2A, a second complete treatment unit with a new linear accelerator was installed and began to treat patients at the start of 1968. This was followed, shortly after, by two Cobalt units as well as planning and dose calculation rooms.

Phase 3:

Four years of careful planning, preparation and construction intervened before the third phase was completed. On 21 July 1970, Professor Sir Brian Windeyer, Vice Chancellor of the University of London and latterly Director of the Merseytein Institute of Radiotherapy at the Middlesex Hospital in London performed the opening ceremony of the new extensions. This was especially appropriate, since Sir Brian had advised and assisted the Regional Hospital Board from its first intention to create a radiotherapy centre at Clatterbridge. The hospital had expanded to include two more wards, an out-patients department, medical records department, Matron's Office, the Cancer Registry - already recognised as one of the most successful and comprehensive registry services in the country - medical and nursing staff offices, finishing kitchen, patients' and staff dining rooms and staff changing accommodation.

Up to 1974 planning for radiotherapy was carried out on a simulator mainly manufactured in-house by the staff of the mechanical workshop. The first modern simulator was installed in 1974, to be followed by a second in 1984. (a Phase 3 Ward)

The value of computerisation for radiotherapy dose calculation was increasingly recognised and an agreement was made with a Liverpool computer centre to process patient data. This was eventually superceded by the hospital's own computer which filled a whole room! Computing power increased rapidly and in 1981 an RT/Plan was installed to remain in use up to 1994. The completion of this phase marked out the centre as a viable unit, although there remained the question of re-housing those sections which remained in huts.

The patient accommodation which remained in the converted huts was soon to be tackled and work began in 1972. As a result, by 1974, all huts had been replaced by new, purpose-built wards. The Wirral Manx Society provided generous support for these developments. Snowdon, Dee, Conway, Snaefell, Mersey and Sulby, are now familiar ward names, and a new theatre, medical offices, medical records office and administrative areas, plus a Clinical Research Unit - were all brought into use. This was the first time that all clinical radiotherapy services for Mersey Region had been housed in one, permanent building.

The centre also changed its name - to the Mersey Regional Centre for Radiotherapy and Oncology.

Yet even these developments could not satisfy rising demand and, by the late 1970s, it became apparent that the unit needed to expand again to meet extra patient numbers and new treatment techniques. The Mullard 6 was replaced with a Phillips SL75-14 accelerator (which is till in use now in 1998) and one of the Cobalt units with a Dynaray 4 accelerator.

By 1980, the unit could boast three accelerators, one Cobalt unit, simulator and imaging services and new ward accommodation. Yet some services, such as the mould room, technical and scientific and photography still remained in converted huts.

At this time the decision was made to replace the use of traditional radium with a remote Caesium afterloading system. The first low dose rate Selectron was installed in 1981 with the second in 1982. Rooms were specially designed at the far ends of Dee and Mersey Wards. The radiation risks to staff have been dramatically reduced and treatment times for patients are also shorter. In 1992-93 the Centre installed a high dose Selectron in a specially constructed room adjacent to the theatre. This provided even greater benefits for patients by reducing treatment times still further. Patient numbers, though, were still rising and a decision was taken to undertake large-scale expansion at the unit. Between 1984 and 1987, two new bunkers were built, and four new accelerators replaced three old ones. All the remaining huts were replaced. In order to house the new equipment, the remaining Cobalt machine was removed. The first accelerator, installed in 1958, was also removed at this time, just short of its 30th birthday.

A new imaging facility was built and the CT scanner (left)was installed in 1984, the Gamma camera in 1988 and the MRI scanner in 1992/3. In addition the Medical Research Council, in 1980, chose Clatterbridge as a centre at which a Cyclotron would be installed for Proton and Neutron trials and this was installed in 1984. Come the 1990s, and Clatterbridge possessed five accelerators, two simulators, CT, Gamma camera and MRI with all services housed in purpose-built accommodation. New dose calculation computer facilities were added, capable of multi-plane calculation.

By this time the consultant staff were holding clinics in over 23 locations across the region, providing a better service for patients and consolidating the links with physicians and surgeons.

The far-reaching Government changes to the NHS saw the unit become a Trust in 1992. Clatterbridge Centre for Oncology, as it became known, still sees patient numbers rising with an average of 50 patients treated on each accelerator every day. Over 6000 new patients are registered at the hospital each year. As radiotherapy becomes more complex each treatment takes longer and machines may treat less patients each day now than in past years.

Developments continue apace. The new entrance foyer, with information desk, WRVS Shop and adjacent patients' dining room were completed in 1994. Extensive refurbishment of wards has been undertaken and an improved 'hotel' facility has been incorporated into Snaefell ward. Patients undergoing treatment can live as close a life to normal as possible, and the ward becomes almost home from home.

Research:

The importance of co-ordinated clinical and statistical research was recognised and over a long and continuing period of time many generous donations have been made. Next door to the hospital, the new research building marked an important step forward. The building of the Cancer Research Laboratories began in 1979 and The J K Douglas Laboratories now provide the focus and facilities for genetic research and the headquarters of the Innovations Delivery Group. A Cancer Research Fund was first proposed in 1926 and its work continues to this day.

It is a tradition which persists especially at Clatterbridge and the present Cancer Gene Appeal will help research into a vital but largely unexplored gap in our present knowledge. The hospital has also been keen to promote the educational development of its own staff and others. In 1959 a school of radiography was established and in 1981 began to teach the three year diploma course which in turn became an honours degree course in 1992. A small Clinical Education Department was constructed in 1990 and two years later was validated to run the post-registration nursing course in Oncology. The Centre now provides multi-professional education for a wide range of health care staff. Library facilities are an essential component of educational and professional development and in 1997 links were established with Wirral Hospital Trust to ensure access to the merged libraries established in the Post-Graduate Medical Centre.

Chemotherapy:

Chemotherapy has been part of the hospital's activity since the 1970s and consultants were amongst the first to use the multiple drug chemotherapy. The complexity of the chemotherapy regimens has increased, as have the numbers of patients included in clinical trials. Ever conscious of its responsibility to provide treatment in the most appropriate way for its patients, the hospital has developed Chemotherapy clinics in various parts of the region. An in-house educational initiative has provided nurses with the knowledge and skills to administer complex chemotherapy and staff travel from the hospital to provide treatment for patients in hospitals near to where they live. In 1995 part of a ward was converted to provide a dedicated chemotherapy day case unit which has been much praised by patients and staff alike. Chemotherapy is now, in 1998, the fastest growing area of the centres activity.

Into the future:

Life has changed dramatically since the early days of the hospital in 1958. The hospital staff has expanded in number and in variety. The growth and expansion of treatment and support services has been driven largely by the motivation and commitment of large numbers of individuals. The effective functioning of any hospital depends not just on clinical staff but on medical records staff, physicists, technicians and all those people who keep the hospital safe and clean and patients fed. In 1998 Clatterbridge Centre for Oncology can boast a staff of dedicated people providing for patients, service that are second to none. The Centre has repeated requests for visits from the UK and beyond, and through presentations, publications and teaching is extending its influence ever wider. The present-day Clatterbridge Centre for Oncology is a world away from the turn-of-the-century forerunner of the Radium Institute in Liverpool.

With the Goverments publication of the Calman-Hine report in 1995 cancer services remain at the forefront of our nation's health agenda. As new treatments and new discoveries are made, Clatterbridge Centre for Oncology intends to develop and grow as one of the front runners in the treatment of cancer and the care support of those affected by it.