The Steering Group is asked to consider the value of these roles and the arrangements that needed to make them effective.

Transcription

1 South West Cancer Network Development of Operational Delivery Networks for Cancer in the South West Review of the South West Cancer Steering Group Author Jonathan Miller Date 13 January 2014 Recommendation The Steering Group is asked to: 1. Consider the appointment of Clinical Directors for each of the Network Support Functions in the South West. 2. Consider developing the Clinical Network Support Functions into Operational Delivery Networks. 3. Consider changes to the Membership of the South West Cancer Steering Group in light of items 1 & 2. The South West Strategic Clinical Network (SW SCN) has established two Network Support Functions in the North and South parts of the South West. These two functions have been funded for 12 months by the SW SCN. Providers have been asked to pick up the funding of these functions after the initial 12 months. This paper sets out options for developing these Network Support Functions into Operational Delivery Networks for Cancer and how this would enable the South West Cancer Steering Group to become a smaller more effective group. NHS England is currently reviewing the role of NHS Improving Quality, Clinical Senates and Strategic Clinical Networks and for staff funded from NHS England programme budgets. Initial findings are expected in late January with final arrangements agreed by March 2015 including the funding available in the South West for 2015/16. This means that confirmation of the arrangements for the South West will need to happen after March. This paper therefore sets out options for consideration that will support a quick decision on the arrangements after March. 1. Appointment of Clinical Lead for each Network Support Function The SW SCN proposes funding for 12 months clinical leads for each Network Support Function. This would be for 2 sessions per week at an estimated cost of 80,000. Funding after the first year may be from the SW SCN or local providers (depending ion the outcome of the NHS England review) or commissioners. The Clinical Leaders would work with and represent the Clinical Directors for Cancer in their local cancer providers. Local chairs of Network Clinical Groups would be appointed by and be accountable to the Clinical Leaders. The Steering Group is asked to consider the value of these roles and the arrangements that needed to make them effective. 2. Development of an Operational Delivery Network for Cancer Four operational delivery networks (ODNs) have been mandated nationally. The four key success factors for ODNs set out by the Chief Nursing Officer and Chief Medical Officer are: Improved access and egress to and from services at the right time; Improved operating consistency; Improved outcomes; Increased productivity.

2 The role of Cancer Network Support Functions is currently the organisation of clinical networking. These clinical groups are responsible for the agreement of consistent guidelines and outcomes locally and identifying actions for providers or commissioners to support service developments. The role of these functions could expand to include operational and strategic arrangements between providers. This could be confined to the agreement of the operational arrangements for the flow of patients between providers but could extend to include agreements by providers on the best solution for service configuration to discuss with commissioners. The establishment of an Operational Delivery Network would require a Network Executive Board Governance Arrangements Governance arrangements would need to be agreed for Cancer ODNs. Appendix 1 contains a national Governance Framework Toolkit for ODNs. This underpins the development of service level agreements for the existing ODNs in the South West. The accountability arrangements will need to be tailored in light of the funding for any Cancer ODN. The Steering Group is asked to consider the benefits of developing ODNs for Cancer in the South West. 1. Work that ODNs could perform 2. Resources required and funding sources 3. Governance requirements 3. Review of the South West Cancer Steering Group The current Steering Group draws its members from all acute providers and CCGs as well as representatives from NHS England and patient groups. There are 73 members with over 30 people attending on average. Pending agreements on the preceding issues we propose to revise the membership as follows: a. Acute providers are represented by their clinical lead for their Network Support Function or ODN and a nominated manager. If clinical leads are appointed but without a formal ODN, providers will need to agree how these individuals can represent them at the Steering group. This may be though the existing cancer manger and lead nurse groups that the Peninsula and ASWG have with perhaps Cancer Clinical Directors also attending these meetings. b. CCGs nominate a lead for each part of the South West (aligned with the network Support Function). This would require CCGs to agree how they are represented. This may align with the Units of Planning. c. NHS England has members from the SCN, Specialised Commissioning and Operations and Delivery. d. Two patient representatives This would mean a membership of about twelve. 4. Issues 4.1. The South West Geography Following a review of NHS England regional structures the SW SCN covers one and a half NHS England Sub Regions: All of the South West Sub-Region o South Gloucestershire CCG o Bristol CCG

3 o North Somerset CCG o Somerset CCG o NEW Devon CCG o South Devon & Torbay CCG o Kernow CCG Part of Central South England Sub-Region o Gloucestershire CCG o Bath & North East Somerset CCG o Wiltshire CCG o Swindon CCG The cancer patient flows for three of the providers in the South West SCN are with providers outside of the SW SCN. Great Western Hospitals NHSFT refers mainly to Oxford for specialist cancer services. Its clinicians are able to attend network groups supported by Thames Valley SCN. Salisbury NHSFT refers mainly to Southampton for specialist cancer services. Its clinicians are able to attend network groups supported by Wessex SCN Gloucestershire Hospitals NHSFT provides specialist cancer services for both Worcester Acute Hospitals NHSFT and Wye Valley NHST. Its clinicians are able to attend network groups supported by either the SW SCN or West Midlands SCN depending on patient s flows. Following the national review of SCN the SW SCN will need to agree more formal arrangements for these three hospitals to ensure they have as good arrangements as are developed in the South West Overlap of Cancer Arrangements with other Groups The role of the SW Cancer Steering Group and Cancer ODNs (if developed) needs to be considered in light of other arrangements being developed for ODNs, other SCN Groups and other formal and less formal networks, groups and meetings. It would be helpful for the Cancer Network to be part of overall system leadership arrangements that allowed for escalation to senior decision makers and allows for the impact of cancer recommendations to be considered alongside other series.

4 Appendix 1 Operational Delivery Networks Governance Framework - Toolkit August 2013

5 Operational Delivery Networks Governance Framework Toolkit Classification: General Organisation Document Purpose Guidance Title Author Operational Delivery Networks Operational Delivery Networks. Governance Framework Toolkit Sue Shepherd Date and Version August 2013, Version 1.1 Linkages Circulation Description Point of Contact NHS Commissioning Board; Operational Delivery Networks; The Way Forward NHS Commissioning Board; NHS Standard Contract Section B Part 1 Service Specifications; Operational Delivery Networks Operational Delivery Networks Governance Framework Value for Money Framework Provider organisations Commissioner organisations SHA Cluster organisations Senates Operational Delivery Networks Strategic Clinical Networks NHS England This Toolkit underpins the Operational Delivery Networks Governance Framework. It is designed to assist ODNs in identifying and evidencing current Network governance systems and processes. The Toolkit provides an illustrative RAG rated scoring mechanism to facilitate a visual overview of the assessment process and highlight any gaps or areas for further development. Sue Shepherd Mid Trent Critical Care Network and East Midlands Major Trauma Network Contact Details East Midlands Ambulance Service NHS Trust Beechdale Road Bilborough Nottingham NG8 3LL Electronic copy available from sue.shepherd@emas.nhs.uk Sue Shepherd, August 2013, Version 1.1 Page 2

6 Operational Delivery Networks Governance Framework Toolkit This Toolkit, designed to assist Operational Delivery Networks to monitor progress against their governance arrangements, underpins the Operational Delivery Networks Governance Framework 1. It is recommended that this Toolkit be completed on an annual basis and submitted to the relevant Network Executive/Oversight Group. Any issues or risks should be discussed openly at the Network Executive/Oversight Group and a plan developed to address any concerns. A RAG rated scoring mechanism is included to facilitate a visual overview of the assessment process. This is scored as follows: Network: Assessment criteria: Red = Problem meeting criteria Amber = Good progress made with work ongoing ODN Governance Framework - Toolkit Name of person completing form: Green = Criteria fully met Telephone Number: Date Completed: Version : Network Team Network Role WTE Members Contract Type Tenure with end date Host/Secondin g Or ani atio Funding Source 1 Shepherd, S. C. April Operational Delivery Networks, Governance Framework. Unpublished available at sue.shepherd@emas.nhs.uk Network Organisational Structure (insert Network organogram here, indicating lines of responsibility/accountability) Sue Shepherd, August 2013, Version 1.1 Page 6

7 Governance Framework Outcomes Part 1 Structure and Scope The purpose and remit of the Network is clearly defined The Network boundaries and scope are confirmed The Network membership model is defined and agreed. This includes clear rules of engagement for Network members (including PPI representatives) and an accountability structure. Monitoring and dispute resolution processes are in place An Executive/Oversight Group is identified within the Network Structure with clearly defined responsibilities The Network Executive/Oversight Group is constituted in line with regional network plans. Representative members attend meetings. A process is in place to review membership to maintain relevance Terms of Reference for the Network Executive/Oversight Group are written and approved, with an agreed timescale for review. This includes delegation of authority and responsibility to the Board in accordance with the Network Model Terms of Reference for all other Network Groups are written and approved, with an agreed timescale for review The Network organisational structure is designed to facilitate delivery of the Network objectives. This is approved by the Network Executive/Oversight Group appropriate to the Network Model Network standards are agreed and implemented for the administration of all Network meetings and the Network operates within the agreed standards The Network Chair s roles and responsibilities are defined and approved by the Network Executive/Oversight Group The Network Chair is appointed and tenure of appointment and accountability arrangements are agreed Deputising arrangements are in place in the absence of the Network Chair The Network Management Model is designed with clear lines of responsibility and accountability and includes Network and Host organisation line management arrangements. This is approved by the Network Executive/Oversight Group The Network Chair holds line management responsibilities for relevant Network Team members in line with the agreed Network Management Model Sue Shepherd, August 2013, Version 1.1 Page 7

8 A process is in place with the host organisation for the appointment of Network Team members. Contracts are in place (Permanent/Secondment/Honorary) for team members and are signed by the relevant host and seconding Trusts Network team members are appointed and the tenure of each appointment is agreed as appropriate to each role An annual Personal Development and Review process is in place for all members of the Network Team. PDRs are undertaken on an annual basis and team and personal objectives reflect Network objectives and individual personal development plans. Progress against objectives are evidenced Changes to the constitution of the Network, including changes in Network team staffing, are approved by the Network Executive/Oversight Group The Network funding model is established (define 1 year, 3 year, 5 year) Supporting organisations have agreed their financial contribution to the Network and a process is in place to extract/obtain the money in year The Network annual budget/financial plan is developed and budget management and monitoring arrangements are in place and approved by the Network Executive/Oversight Group. This includes a mechanism for the management of any under or over expenditure A regional risk sharing agreement is in place should the Network cease to exist. This includes agreement in respect of any financial implications to the host organisation Stakeholder Support and Engagement A Network Patient and Public Involvement strategy is developed and implemented as appropriate and patient views inform critical care service development. This is ratified by the Network Executive/Oversight Group A Network communication and engagement strategy is developed and implemented taking account of internal and external relationships. This is ratified by the Network Executive/Oversight Group A mechanism is in place to facilitate joint working between networks and senates in the Network region. A partnership agreement is in place where appropriate A mechanism is in place to ensure links to the relevant national Clinical Reference Groups The Network is a registered stakeholder with the relevant national Clinical Reference Groups A mechanism is in place to facilitate joint working with specialised commissioners, local Clinical Commissioning Groups and the Area Team as appropriate. This includes links to the relevant regional and national Programme of Care (commissioning) leads Sue Shepherd, August 2013, Version 1.1 Page 8

9 A contractual agreement is developed between the Network and the host organisation defining clear rules of engagement and decision making processes. This is signed by the appropriate executive/management leads Monitoring and Reporting Network annual objectives and work plan are written and ratified by the Network Executive/Oversight Group A mechanism is in place to monitor progress against the Network annual objectives and work plan. Progress reports are submitted to the Network Executive/ Oversight Group and shared with other Network Groups within an agreed timeframe Other Network Groups (i.e. Clinical Group; Lead Nurse Group; Transfer and Audit Group; Service Improvement Group) objectives and work plans are developed in line with the Network Annual Objectives The Operational Delivery Network Service Specification is defined and agreed on an annual basis with the Area Team. This includes relevant annual Network outcomes and outputs A mechanism is in place to monitor progress against the Operational Delivery Network Service Specification. Gaps are identified and an annual action/improvement plan is developed. This is signed off by the Network Executive/ Oversight Group A Network Commissioning Framework/Service Specification 1 is developed/identified Network agreed key performance indicators are linked to local, regional and national standards and are included in relevant commissioning frameworks/service specifications as appropriate A mechanism is in place for Network provider organisations to clearly identify derogation of relevant clinical service (against nationally mandated service specifications) to the Network Team The Network team is consulted on derogation of service and provides appropriate advice to providers and commissioners Derogation of service has been agreed by commissioner and provider organisations and action plans have been developed collaboratively by the Network and the relevant provider organisations A process is in place to assist Network provider organisations in identifying compliance against set standards outlined in service specifications. The Network provides support, as and where appropriate, to member provider Trusts to achieve standards (responsibility for compliance remains with the provider Trust) An annual account of Network activities and outcomes is published demonstrating improvements to support achievement within the current Network funding model 1 Author s note: National Service Specifications for specialised services are currently being developed by the National Clinical Reference Groups. Where appropriate these will supersede current Commissioning Frameworks Sue Shepherd, August 2013, Version 1.1 Page 9

10 A Network Peer Review/Quality Assurance Framework/Tool with a template action/improvement plan is developed/identified and a mechanism of assessment is agreed A Network facilitated external/internal peer review/quality assurance process is undertaken with relevant member organisations. Completed action/improvement plans are submitted to the Network Executive/Oversight Group A summary Network action/improvement plan is developed following peer review/quality assurance with key milestones and an agreed mechanism for review Network audit structures and reporting and monitoring processes are agreed and implemented Network standardised operating policies and procedures and care pathways are developed and implemented with an agreed review process A mechanism is in place to identify Network clinical governance issues with an agreed process to investigate critical incidents and share findings Risk Management Risk management and assurance processes are in place to ensure risks are identified, analysed, evaluated, controlled, monitored and communicated appropriately Risk sharing agreements are established across provider organisations A Network escalation plan is developed in the event of a major incident/surge with links to appropriate organisations for effective Emergency Preparedness, Resilience and Response (EPRR) arrangements Member organisation draft service development/reconfiguration plans are shared with the Network and ratified by the Network Executive/Oversight Group as appropriate Network specification agreements are in place with Independent/Third Sector partners as appropriate The contractual agreement between the Network and the host organisation includes the provision of relevant accommodation, facilities and corporate services and an outline of associated costs. The agreement ensures that HR support for Network staff employed by the host organisation is in line with NHS HR policies/procedures The contractual agreement with the host organisation confirms Network compliance with the host organisation s standing orders and standing financial instructions The contractual agreement with the host organisation outlines the responsibilities and accountability of the host organisation in line with the Operational Delivery Network specification Sue Shepherd, August 2013, Version 1.1 Page 10

11 Added Value and Benefits A mechanism is in place to capture the added value and benefits of the Network. This is communicated to Network stakeholders on annual basis A mechanism is in place to ensure that outcomes from the Network peer review/quality assurance process inform service design and delivery A mechanism is in place to capture learning from Network wide audit and research with evidence of service change and development Quality and Service Improvement A Network wide annual service improvement programme/plan is developed and approved in line with Network and national priorities Service improvements are identified and implemented and best practice is shared widely to inform and improve service delivery and quality of safe patient care An agreed set of Network benchmarking measures/dashboards are captured and audited in a timely manner and outcomes are shared as appropriate A Network research and education strategy is developed with key milestones and a review process Links are established with local Education and Training Boards and education providers A Network Workforce Framework is developed with key milestones and a review process Clinical governance issues are included as a standing agenda item on Network Clinical and Executive/Oversight Group meetings with an agreed mechanism for feedback and shared learning PPI representative members attend Network groups to inform service development and delivery as appropriate Respect Network members apply the rules of engagement Network members show consideration for colleagues and demonstrate respect for member organisation culture Ambiguity is reduced through collaboration and co-operation across pathways of care Leaders in the Network respect the opinion of Network members working collaboratively for the benefit of patients Trust The Network has a clear sense of purpose The work of the Network is focussed around the patient Sue Shepherd, August 2013, Version 1.1 Page 11

12 The Network fosters a culture of sharing and support and members are encouraged to participate in the work of the Network without fear of recrimination Creativity and innovation is encouraged The Network demonstrates openness and transparency in decision making processes Information and data is shared openly and honestly Relationships Leaders in the Network work with colleagues to develop and maintain sound relationships Patients are involved in shaping the Network The Network consists of multi-professional, multidisciplinary staff working in partnership Network members work together and share best practice and are actively involved and engaged in the work of the Network The Network has an agreed process for conflict management Integrated working reduces duplication of effort and improved productivity and effectiveness The Network explores new ways of working and embraces change Accountability structures are designed to take account of formal and informal relationships Support The Network model supports a culture of shared learning and collaboration with strong leadership and clarity of purpose There is widespread clinical involvement and support in the Network The Network utilises the skills and expertise of members The Network has an education and research strategy outlining opportunities for shared learning, training and development Network member organisations are equal partners in the Network All staff in the Network are supported by their employing organisation when participating in Network activities Commitment Network members and member organisations deliver the work of the Network Patient pathways are developed in line with the Right Care Principles Staff work collaboratively across the Network Sue Shepherd, August 2013, Version 1.1 Page 12

13 The Network has a shared vision and objectives with a clearly defined work plan The Network has a communication strategy The Network demonstrates clinician and user involvement Engagement Constituent member organisations are actively engaged in the Network Staff participating in the Network are actively engaged The Network facilitates the collaborative design and delivery of patient led services Equity and access to care is improved Patient experience, outcomes and quality of care are improved Sue Shepherd, August 2013, Version 1.1 Page 13