Establishing New Cancer Standards Dr Roger Prudham, Deputy Medical Director, Pennine Acute Trust

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

2. Greater Manchester Cancer Our team: Vanguard Innovation • 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

3. Greater Manchester Cancer This evening’s panel: Vanguard Innovation • 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

4. Greater Manchester Cancer What are we aiming for? Vanguard Innovation • 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 continuousstandard measurement & assurance (to patients, commissioners and providers) • Embed quality improvement and knowledge sharing

5. 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 17th

6. Greater Manchester Cancer Vanguard Innovation Provenance2013 - coming together to form an alliance Patients Clinical Services Accreditation Alliance (CSAA) Nurses Doctors Regulator AHPs Pharmacists Scientists

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

8. Greater Manchester Cancer JAG Accreditation Engagement Vanguard Innovation

9. Greater Manchester Cancer JAG Accreditation Vanguard Innovation • 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

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

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

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

13. Greater Manchester Cancer Healthcare - actors Vanguard Innovation • 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

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

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

16. Greater Manchester Cancer Failing to improve Vanguard Innovation A B no time to sort it not convinced too difficult unaware Effective Health Care 1999;5(1)

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

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

19. Greater Manchester Cancer Vanguard Innovation

20. Greater Manchester Cancer The Framework forces conversations Vanguard Innovation 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

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

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

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

24. Greater Manchester Cancer Principles of the Approach Vanguard Innovation • 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

25. Greater Manchester Cancer Processes – CSAA Workstreams Vanguard Innovation • 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

26. Greater Manchester Cancer Vanguard Innovation Getting the processes right Accreditation of providers (UKAS) WS 1 RCOA RCP RCPsych WS 1 CHKS WS 2 WS 6 Scheme1 WS 4 Scheme2 WS 3 WS 5 Scheme3 Service 40 schemes Service

27. Greater Manchester Cancer Work stream 6: Stages in the development of an accreditation scheme Vanguard Innovation Scheme 1

28. Greater Manchester Cancer CSAA – current position Vanguard Innovation • 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

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

30. Greater Manchester Cancer Thank-you Vanguard Innovation Scheme 1

31. Greater Manchester Cancer Examples… Vanguard Innovation

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

33. Greater Manchester Cancer Accomplished in Year One: Vanguard Innovation • 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

34. Greater Manchester Cancer To be delivered in Year Two: Vanguard Innovation • 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

35. Greater Manchester Cancer People affected by cancer: Clause of ‘Person Centred Care’ Vanguard Innovation • 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

36. Greater Manchester Cancer Summary Vanguard Innovation • 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

37. Greater Manchester Cancer Vanguard Innovation

38. Greater Manchester Cancer 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 M13 Vanguard Innovation Vanguard Innovation Email: cancervanguard.gm.@nhs.net Web: gmcancervanguard.org Twitter: @GM_Ca_Vanguard