Greater Manchester Cancer Vanguard Innovation Establishing New Cancer

Greater Manchester Cancer Vanguard Innovation Establishing New Cancer Standards Dr Roger Prudham, Deputy Medical Director, Pennine Acute Trust Vanguard Showcase Event 17 th January 2017

Greater Manchester Cancer Vanguard Innovation Our team: § § § § Roger Prudham – Standards Lead John Lear – Deputy Ben Taylor – Radiologist Brian Benatar – Histopathologist Paula Daley – User Involvement Manager Saeed Shakibai – Person affected by cancer Coral Higgins – NHS Manchester CCG Paul Shenton – Project Manager

Greater Manchester Cancer Vanguard Innovation This evening’s panel: § § § Dr Roger Prudham – Standards Lead Dr John Lear – Deputy Debbie Johnston – Accreditation consultant Dr Roland Valori – Clinical Director of Accreditation, RCP Vanessa Denvir – service user representative

Greater Manchester Cancer Vanguard Innovation What are we aiming for? § Develop a system to record, measure and improve cancer standards for Greater Manchester, the Cancer Vanguard & beyond § System based on Global Rating Scale methodology used nationally and internationally for improvement in endoscopy services - now BSI PAS 1616 2016 § Cancer is first cross-cutting service § Embed continuous standard measurement & assurance (to patients, commissioners and providers) § Embed quality improvement and knowledge sharing

Greater Manchester Cancer Vanguard Innovation Overview: outputs from the Clinical Service Accreditation Alliance (CSAA) Roland Valori - Gastroenterologist Clinical Director of Accreditation, RCP Vanguard Showcase Event January 17 th

Greater Manchester Cancer Vanguard Innovation Provenance 2013 - coming together to form an alliance Doctors Patients Clinical Services Accreditation Alliance Nurses (CSAA) Regulator AHPs Scientists Pharmacists

Greater Manchester Cancer Vanguard Innovation Ambition of the CSAA To have all clinical services engaged in accreditation schemes – perhaps forty in total.

Greater Manchester Cancer Vanguard Innovation JAG Accreditation Engagement Acute Hospital Community Unit Independent Sector Total Assessed: Criteria met 133 24 49 186 Assessed: Improvements required 26 2 1 29 Assessed: Accreditation not awarded 33 0 0 33 Not assessed: Visit pending 7 0 5 12 Not assessed 12 14 107 133 Total 211 40 162 413 Status

Greater Manchester Cancer Vanguard Innovation JAG Accreditation § § § § Improved important outcomes Reduced future costs Reduced risk Improved patient experience Empowered clinical leaders and their teams Completely changed the culture Required collaborative working nationally and locally

Greater Manchester Cancer Vanguard Innovation Closing the Performance Gap performance the standard self assess against the requirements status quo time

Greater Manchester Cancer Vanguard Innovation Closing the Performance Gap accreditation performance the standard peer review self assess against the requirements status quo time

Greater Manchester Cancer Vanguard Innovation Purpose, Policy and Priorities purpose policy GOAL

Greater Manchester Cancer Vanguard Innovation Healthcare - actors § § § Patients Third sector Commissioners Regulators: CQC, GMC, NHSI Trust Boards Health and Wellbeing Boards (HWB) Health Education England (HEE) Public Health (PHE) Colleagues & Associations Local government and social care Department of Health Other NGOs

Greater Manchester Cancer Vanguard Innovation Purpose, Policy and Priorities purpose policy GOAL Effective Enduring Extendable

Greater Manchester Cancer Vanguard Innovation Historic methods of achieving change Audit and feedback – GIRFT – ‘Right Care’ – National audits Demonstration projects – Modernisation Agency – Innovations – Vanguard sites Incentives - Targets - Payments (e. g. QOF, best practice tariffs) Education - CME/CPD System changes - Reorganisation - Transformation

Greater Manchester Cancer Vanguard Innovation Failing to improve A ed are u w na n co t o o t e inc v n n im t o t i ort s B lt cu iffi d o to Effective Health Care 1999; 5(1)

Greater Manchester Cancer Vanguard Innovation We Function at the Operational Level Strategic Organisational Operational

Greater Manchester Cancer Vanguard Innovation A self assessment framework of requirements enables teams to become better organised Strategic FRAMEWORK Organisational Operational

Greater Manchester Cancer Vanguard Innovation

Greater Manchester Cancer Vanguard Innovation The Framework forces conversations Clinical team Primary care Hospital Patients Local government Commissioner/payer Conversations deliver change: local patients and leaders ask each other questions, agree what should be done and assess each others contribution

Greater Manchester Cancer Vanguard Innovation BSI ‘Standard’ – a generic specification for all Clinical Services – customisable for each service Clauses of the Standard: 1. Leadership, strategy and management 2. Operational delivery of the clinical service 3. Systems to support clinical service delivery 4. Person-centred treatment and/or care 5. Risk and safety 6. Clinical effectiveness 7. Clinical service users with complex needs 8. Staffing a clinical service 9. Improvement, innovation, and transformation 10. Educating the future workforce BSI: British Standards Institution

Greater Manchester Cancer Vanguard Innovation • Generic • Patient centred • Value Focused http: //shop. bsigroup. com

Greater Manchester Cancer Vanguard Innovation Effective, enduring and extendable • Principles • Processes

Greater Manchester Cancer Vanguard Innovation Principles of the Approach • • • Patient-centric Aligns perspectives Collaborative Improves outcomes Provides Assurance Meets the needs of a variety of stakeholders Facilitates quality improvement Reduces Burden Assists sharing of best practice Is transformational Levers better value for money

Greater Manchester Cancer Vanguard Innovation Processes – CSAA Workstreams 1. 2. 3. 4. 5. 6. Devising standards for accreditation schemes Learning from current schemes Mapping potential schemes Creating a service accreditation standard Defining IT needs Creating a template for a scheme Goal: Improve consistency while minimising cost, confusion and burden

Greater Manchester Cancer Vanguard Innovation Getting the processes right Accreditation of providers (UKAS) WS 1 RCOA RCPsych WS 1 WS 2 WS 4 Service CHKS WS 6 Scheme 1 Scheme 2 WS 5 Service Scheme 3 WS 3 40 schemes

Greater Manchester Cancer Vanguard Innovation Work stream 6: Stages in the development of an accreditation scheme Scope Prepare Develop Operationalise Establish steering group and assess the position Workshop Provider of scheme Establish systems Alignment & objectives Working groups Costing model Personnel Engage & gather support PAS framework review Leadership & governance Pilot sites Scheme 1 Feasibility & business case IT Platform Planning and timescales Training (services & assessors) QI work Marketing & comms Publicity/launch

Greater Manchester Cancer Vanguard Innovation CSAA – current position • The work streams have been completed • Conversations with clinical services has begun • CSAA will transition to HQIP to – maintain the outputs of the CSAA – provide governance and guidance – support new specialities prepare for accreditation Scheme 1

Greater Manchester Cancer Vanguard Innovation Improvement team Assurance provider Scheme 1 Accreditation Governance body Two national teams working together

Greater Manchester Cancer Vanguard Innovation Thank-you Scheme 1

Greater Manchester Cancer Vanguard Innovation Examples… 6. Clinical effectiveness Sub-clause 6. 1 General Requirement Supporting Info CQC KLOE Map 6. 1. 1 The clinical service, where relevant, identifies and participates in local audit/assessment programmes and national audit/assessment programmes. Minutes reflecting National Bowel Cancer Audit Project service performance, actions taken and assurance that actions are achieved. E 2. 4 Supporting info CQC KLOE Map 8. Staffing a clinical service Sub-clause 8. 1 Workforce planning Requirement Business meeting minutes, highlights and 8. 1. 1 A review of the workforce in exception reports. terms of skill mix, and an impact assessment is undertaken a minimum of once a year, or whenever there is a significant change in the clinical service. S 5. 3, E 3. 1 E. g. - Operational delivery plan, business 8. 1. 2 The clinical service has a meeting minutes. workforce development plan in anticipation of future demands on the clinical service. S 5. 3

Greater Manchester Cancer Vanguard Innovation How might this look for a user?

Greater Manchester Cancer Vanguard Innovation Accomplished in Year One: § Developed a Standards of Care Dashboard § Liaised with people affected by cancer and health professionals in development of a new Psychological & Emotional Support sub-clause § Presented project overview to pathway boards § Aligned project with BSI PAS 1616 / CSAA clauses

Greater Manchester Cancer Vanguard Innovation To be delivered in Year Two: § Data Analyst resource in post § Psychological & Emotional support element completed and incorporated into standards framework. § Gathering of colorectal pathway data to be extended to two additional trusts § Map standards in skin & breast into accreditation system § Present data as ‘proof of concept’ to GM cancer system board

Greater Manchester Cancer Vanguard Innovation People affected by cancer: Clause of ‘Person Centred Care’ § Patient experience will be a key domain across the whole system § Some themes may be bespoke for pathways or providers § Mature top-scoring patient experience will publish evidence that quality improvement as defined by patients for experience is shared and validated by patients § Each standard must be: specific, measurable and improve outcome and/or patient experience 4. Person-centred care 4. 9 Sub-clause Requirement Supporting info Psychological & Emotional Support 4. 9. 1 The clinical service ensures that Key points on the pathway where bad news at key points in the patient's journey may be communicated to the patient where significant news is imparted, the include diagnosis, during treatment, patient is offered the appropriate level recurrence, palliation & end-of-life. of psychological & emotional support.

Greater Manchester Cancer Vanguard Innovation Summary § Develop a system to record, measure and improve cancer standards for Greater Manchester, the Cancer Vanguard & beyond § Specifically, create standards for colorectal, skin and breast pathways across GM, via workshop-based consultation (to commence Mar ‘ 17) with relevant clinicians § Complete the development of a new Psychological & Emotional effects sub-clause to be included in Person Centred Care (Feb ‘ 18) § Instigate the collection of data & evidence from the colorectal pathways at UHSM and Pennine in order to pilot and test standards

Greater Manchester Cancer Vanguard Innovation

Greater Manchester Cancer Vanguard Innovation Our next showcase: CANCER INTELLIGENCE SERVICE 28 February 2017, from 5. 15 pm until 6. 15 pm The Blackett Theatre, Schuster Building, University of Manchester, Brunswick Street, Manchester M 13 Vanguard Innovation Email: cancervanguard. gm. @nhs. net Web: gmcancervanguard. org Twitter: @GM_Ca_Vanguard