Programme Highlight Report February 2015

West Midlands Strategic Clinical Networks and Clinical Senate Programme Highlight Report February 2015 West Midlands Strategic Clinical Networks and Clinical Senate

OFFICIAL Programme Highlight Report Highlighting the work programme and monthly achievements of the West Midlands Strategic Clinical Network and Clinical Senate Version number: 1 First published: 2.2.2015 Prepared by: Richard Hancox, Associate Director Classification: Official Draft V1 Contents Contents... 2 1 Executive summary... 3 2 Programme Updates... 3 2.1 Cancer Network... 4 2.2 Mental Health, Dementia and Neurological Conditions... 5 2.3 Maternity and Children... 6 2.4 Cardiovascular... 7 2.5 Cross Cutting Programmes... 8 2.6 Clinical Senate... 9 2

OFFICIAL 1 Executive summary The West Midlands Strategic Clinical Networks and Clinical Senate serve a population of approximately 6 Million people living across the West Midlands. There are four Strategic Clinical Networks (SCNs), as follows: o Cancer o Mental Health, Dementia & Neurological Conditions o Maternity & Children, and o Cardiovascular. Each SCN delivers a portfolio of projects across its clinical work streams aimed at improving outcomes for everyone. The core objectives for the SCNs, delivered in conjunction with our stakeholders, are: i. optimisation of care pathways across commissioning systems to deliver the right care, in the right place at the right time to improve quality, ii. reducing premature mortality and morbidity by addressing unwarranted iii. variation in primary care, providing strategic clinical advice on issues relating to service review, reconfiguration and redesign. A summary of the current SCN work programmes, outputs and achievements in the last month are presented on pages 4-8 of this Report The West Midlands Clinical Senate supports service change, including early clinical advice to commissioners to help inform the development of proposals: strategic clinical advice to commissioners on relevant clinical guidance/ best practice advice to support commissioners in developing their case for change, options appraisal and proposed clinical models as well as providing independent clinical advice as part of the NHS England s service change assurance process: independent clinical advice in the form of a formal report which will be considered as part of the NHS England assurance process for service change proposals. The current work programme for the Clinical Senate, including the status of each project, is presented on the final page of this Report. I hope you will find this summary of current projects undertaken by the West Midlands SCNs and Clinical Senate helpful. If you are interested in finding out more about any of the specific projects highlighted within this report, please contact the SCN or Senate leads identified at the bottom of the relevant page. Richard Hancox Interim Associate Director West Midlands Strategic Clinical Network and Senate 3

2 Programme Updates 2.1 Cancer Network Project Outputs Achievements delivered this period Understanding & Improving quality in early diagnosis of cancer What does good practice in early diagnosis of cancer in primary care Work continues on the development of the Improved early detection of cancer look like? - Report. Early Diagnosis toolkit across the West Midlands. A Data dashboard detailing rates and variance in cancer diagnosis across the West Midlands Specification for business intelligence support submitted to host Sub-Regional Delivered by: March 2016 Working with CCGs to develop solutions to help GPs to detect cancer sooner. Executive Team for approval Improving standard of care in Cancer survivorship and rehabilitation Improved cancer survivorship services across the West Midlands Produce report for CCGs to support commissioning services for cancer survivors that will include Recovery Package and best practice examples. o Mapping of current services for cancer survivors within primary care. o Development of Expert Advisory Groups (EAGs) to link with existing relevant expert groups to provide information and guidance. o Support identified CCG s to develop pilot site for the recovery package o An event to promote and showcase findings. Data analysis and modelling for WM now completed Regional event held 22nd Jan very good attendance & feedback Presentation of findings provided to stakeholders at SCN event Improving Cancer waiting times Reduction in waiting times for patients being diagnosed and treated for Cancer Pathway maps for six key tumour types Commissioner workshop and associated guidance on cancer waiting time standards Last 20 patient reviews for six key tumour types Review of diagnostic capacity within the West Midlands Development of tertiary referral protocol and guidance Local plan developed and delivery underway Work continues to align available resources and delivery of the programme as National requirements are clarified Would you like to get involved or learn more about our work in Cancer? Contact Network Manager Ben Parfitt (Ben.Parfitt@nhs.net)

OFFICIAL 2.2 Mental Health, Dementia and Neurological Conditions Project Outputs & Milestones Achievements delivered this period Patient questionnaires finalised and circulated to MS nurses - 47 patient questionnaires have been received to date, initial analysis of patient questionnaires commenced Optimising the MS Pathway. Comprehensive understanding of where and what services are provided across the West Midlands for MS patients that identifies gap in service provision and commissioning. Meeting the Dementia challenge (Phase 2) Increase the proportion of Dementia patients with a Dementia diagnosis to 66% across the West Midlands Mental Health Crisis Care Concordat To support the West Midlands Health Economies and partners to deliver the declarations and action plans to meet the MHCCC A report for specialist commissioners which will incorporate best practice in MS services and current patient experience. An analysis of the likely impact of potential changes to pathways, including the costs created by new drugs treatments A review of the specialised commissioning / CRG service specification for MS West Midlands Dementia diagnosis data dashboard Report on current Memory Assessment Services An event to highlight outcomes from initial data analysis and examples of good practice. Delivery of West Midlands wide MHCCC event in partnership with DOH, Mind, WM Police and ADASS Physical Health for people with SMI Conduct a literature review on the issue Descriptors of elements of the Convene an expert advisory group to review the evidence and distil pathway that need to be examples of best practice commissioned across Develop a Commissioner toolkit to identify all aspects of the delivery of primary and secondary care physical healthcare and support the understanding of the roles and A tool to allow local training across responsibilities of the various elements of primary and secondary care primary and secondary care to be To suggest methods for incentivising delivery of the physical healthcare delivered pathway, including use of CQUIN and Locally Enhanced Services Develop a training package to be adapted and used locally for joint training in primary care and CMHT re the physical healthcare needs of those with SMI Would you like to get involved or learn more about our work in Mental Health, Neurological Conditions & Dementia? Contact Network Manager Bernie County (Bernie.County@nhs.net) Birmingham pathway finalised Coventry and Stoke pathway maps updated Working with UHB to use their patient level data to identify potential different delivery models to build sufficient system capacity. WMSCN Dementia Event held on 25.11.14: over 100 delegates representing 80% of CCGs in the West Midlands, including GPs, Consultants and commissioners from across health and social care attended. Presentations and next steps feedback circulated regionally to share good practice Started initial planning stages for joint working with ADASS to identify good practice in dementia pathways across health and social care. Positive feedback from MIND on both the extent of partnership working and the outcomes from the joint meeting. Gathering of intelligence and data to understand commissioning plans, service specifications and KPIs in relation to Parity of Esteem. 5

2.3 Maternity and Children OFFICIAL Project Outputs & Milestones Achievements delivered this period Maternity Gap Analysis phase 2 Phase 2 of the SCN maternity project will take forward a number of Implementation of the immediate recommendations from the Maternity Gap Analysis (Phase 1): Engagement and support of all key stakeholders recommendations from the o Bereavement & Aftercare. Progress with all actions in line with Project Maternity Gap Analysis (Phase 1) o Cardiotocogram (CTG) Interpretation. delivery plan Report o Restricted Fetal Movement (RFM) o Post-partum haemorrhage (PPH) Key national clinicians met to determine the Neonatal Pricing Pathway Previously Transitional Care The Project Initiation Document has the support of the neonatal Critical Care CRG, with further approval given by NHSE Operations and Pricing Director and Monitor clinical categorisation of babies to be included within the pathway Interdependencies with other national pricing work have been identified and a draft plan devised Single Number Develop a model for adoption for a Single Number for specialist care Gaining NICE accreditation A process accredited by NICE for current and future Obstetric, Neonatal and Paediatric guidelines. Delivered by:march 2015 Develop a best practice model for a Single Number service for referring pregnant women, babies and children for specialist care of any kind A NICE Accredited process for developing guidelines accredited for 5 years. Development of a joint process manual across Obstetrics, Neonatal and Paediatrics, and an improved process of development to meet NICE criteria. Development of a patient engagement strategy and conflict of interest policy. Roll out of guidelines audit tool across the West Midlands Approval gained at BCH Investment Committee SCT confirmed that negotiations continue but the service is anticipated to be approved for implementation in 15/16. Application form completed, outstanding information added to process manual and application submitted to NICE. Website page completed with live links for parent representatives Reduction in Inappropriate Paediatric Report highlighting variation of referral rates across Attendances at A&E Work with the GP lead and general practitioners/ acute care paediatricians to develop mutually acceptable care pathways. Workshops to be held that communicate the benefit of these guidelines General Paediatric Surgery Network Ensure national standards of care for patients are being met Project handover to BCH Project (BCH project reported and Ensure adequate support and guidance is available to primary care and supported by WMSCN) - secondary care providers of General Paediatric Surgery. Improve training opportunities both for trainees and Consultant Surgeons. Paediatric Spinal Surgery Waiting list review, capacity Report of findings, including recommendations and an analysis of areas of modelling, review against service concern for the West Midlands, within the defined scope, to support ongoing specifications and BSS guidelines, SCN/ SCT work plan and commissioning decision-making. best practice and standard setting including usage of non-invasive spinal rods Delivered by: April 2015 Would you like to get involved or learn more about our work in Maternity & Children? Contact Network Manager Kate Burley (Kate.Burley@nhs.net) Approval given to proceed with the pilot stage of the project. Clinical Lead appointed to drive this project forward with peer group across the West Midlands. 6

2.4 Cardiovascular egfr Implement and evaluate a region-wide approach to the early detection of deteriorating kidney function in the community or in a hospital outpatient setting. Delivered by: November 2016 OFFICIAL Project Outputs & Milestones Achievements delivered this period Next steps established for implementation within Report on variation in management of patients with progressive Hereford Chronic Kidney Disease (CKD) Software installed and being tested at Walsall; o Report on uptake of egfr system in pathology funds being transferred laboratories and engagement of GP practices Alternative system being explored at o Report on the impact of the egfr system on nephrology Wolverhampton (due to incompatibility of IT outpatient clinics systems with HEFT software) o Report on the percentage of patients presenting late in Worcester Pathology IT Lead liaising with IT 2015/16. colleagues in HEFT to find a solution. All learning collated and shared with ASSIST- CKD (national project) and East Midlands SCN Atrial Fibrillation (AF) Increased detection and more effective treatment of AF across the West Midlands Familial Hypercholesterolaemia (FH) Establishing a robust and comprehensive FH service for the residents of the West Midlands Delivered by: May 2015 Complex Device Insertion (CRT/ICD) A West Midlands wide approach to commissioning and implementation of NICE guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure (Ta314), and National Complex Invasive CRG specification. Increase in detection of AF prevalence and optimal management using 2014/15 QOF data (available Oct 2015). Increase proportion of CCGs with AF included in their commissioning intentions (compare 2013/14 with 2014/15). Gap analysis of AF patient pathways in West Midlands Present findings at a stakeholder event in February 2015 Reduction in Strokes through pro-active AF management Develop a robust service model including a patient pathway and service specification to deliver an integrated service for diagnosis and treatment of patients with FH to influence commissioning. Review and evaluate all current lipid clinics including current capacity. Develop an out of hours protocol to ensure 24 hour care Develop a West Midlands service specification based on the national CRG specification to ensure consistency and a basis for performance monitoring Develop an MDT pro forma to be used for all cases (approved and nonapproved) Develop a regional audit to add to the established NICOR audit, which will be current and shared across the West Midlands Intelligence gathering re: examples of good practice around the Region and Country to support the AF event in February 2015 Work progressing with PHE on CCG/GP profiles in readiness for the event in February 2015 Audit of all current Lipid Clinic activity across the West Midlands completed Applications for grant submitted to British Heart Foundation on behalf of the West Midlands FH steering group for 5 WTE FH nursing posts. Agreement from Bristol Genetics Laboratory to support a WM-wide FH service model. Agreement received from Queen Elizabeth Hospital lead Rare Disease Centre clinician to host West Midlands FH Service. Draft protocol for out of hours management of device-related issues agreed 24 hour cover regional/local model to be agreed and implemented by all Trusts by the end March 2015 Draft MDT pro forma completed Draft minimum service specification completed Group agreed NICE audit pro forma to be used as basis for regional audit (with local additions) Would you like to get involved or learn more about our Cardiovascular Network? Contact Network Manager Rob Wilson (RobWilson@nhs.net) 7

OFFICIAL 2.5 Cross Cutting Programmes Project Outputs & Milestones Achievements delivered this period End of Life, Palliative Care A report covering West Midlandswide service profile of palliative/end of Life Care services and where appropriate The project aims to produce a West Midlands-wide service profile of palliative/end of Life Care services and where appropriate co-produce, share this national learning and embed into commissioning guidance. Citizen involvement/engagement exploring patient/family feedback & experience in relation to death and dying Building and developing relationships with stakeholders co-produce, share this national With a whole person/parity of esteem approach`, this project seeks to work Reporting to Ministers on the progress of the learning and embed into collaboratively with a variety of stakeholders, nationally and within the Preferred Priorities for Care (and LCP withdrawal) commissioning guidance. region. The project also encompasses the objectives of National Palliative Event planning in progress for a multi-party event Care Network, with regard to the delivery against national funding titled Using data to make a difference to the Delivered by: March 2016 population of the West Midlands at End of Life to be held on 5th February 2015 Ongoing development of Communication Plan, including: website; project tracker; West Midlands profile; stakeholder database Appointment of two new nationally funded Clinical Leads (0.1wte each). Quality in Primary Care Comprehensive understanding of best practice in Primary Care across the West Midlands Delivered by: March 2016 A report that draws together the three aims of the Primary Care programme that addresses issues to deliver ambitions to reduce premature mortality: o Continue to work with the 20 Practices to implement Productive General Practice Tool o Define with GP Practices the format to engage utilisation of the tool kit. o Produce a tool kit of Best Practice Models for Making Every Contact Count. Attended WM AHSN Integrated Primary Care Advisory Group Meeting partnership planning against Five Year Forward View for the Primary Care Programme of work. Links made with WM AHSN with respect to partnership working through the Citizen s Senate Would you like to get involved or learn more about our cross cutting programmes? Contact Project Leads carol.reilly@nhs.net (Primary Care) or lauratooley@nhs.net (Palliative Care) 8

2.6 Clinical Senate OFFICIAL Project Aim Current status BSBC Stroke To provide clinical assurance of the Birmingham, Solihull and Black Country Stroke Agreement pending for publication of final report Review Services Reconfiguration Programme as part of NHS England s stage 2 assurance processes. Urgent Care (case Study) Arthroplasty (Case Study) HPB Cancer Shropshire & Telford Future Fit Programme The Future of Acute Hospital Services in Worcester. The Clinical Senate Urgent Care Group s remit is to undertake a needs-based investigation into urgent care across the West Midlands. The purpose of this work is to look at the long-term trends in both patient demographics and clinical practice; with a view to recommending what type and mix of clinical workforce and clinical skills should be planned for in the future. This project will inform and influence workforce planning, as well as overall system design, in order to respond to changing demand patterns. To enable the Clinical Senate to give an informed opinion as to the best practice for follow up following arthroplasty (hip and knee) To enable the Cancer Working Group to undertake a needs-based investigation into the provision of HPB services across the West Midlands. To provide informal advisory and expert critical challenge, to the service models being developed in the Future Fit: Shaping Healthcare Together programme as part of NHS England s stage 1 assurance process. To assess the clinical quality, safety and sustainability of the Summary Model of Care, developed by the Task Groups working to the Clinical Sub Committee of the FoAHSW Programme Board. To confirm the clinical quality, safety and sustainability of the clinical model(s) prior to public consultation; including reviewing the comments and recommendations of the 1st stage assurance ICRP and other comments on the original - Summary Model of Care. If you want to know more about the work of the Senate contact: Senate Manager Angela Knight Jackson angela.knightjackson1@nhs.net Senate administrator karen.edwards14@nhs.net The Clinical Senate is currently negotiating publication via national Peer Review journals Work completed shared with Network to assist in future scoping work Verbal report presented at the Clinical Senate Council (January 2015) Report to be signed off at Clinical Senate Council (March 2015) Report presented and approved at the Clinical Senate Council (January 2015) Report to be published on website (January 2015) Phase 1 Stage 1 Review Panel report presented and approved at the Clinical Senate Council (January 2015) Phase 1 Stage 1 Review Panel report to be published on website (January 2015) Planned Phase 2 Stage 1 Review Panel Meeting rescheduled to March 2015 Fourth day of Review Panel Meeting to be completed (January 2015) Stage 2 report to be completed (February 2015) Report to be presented at Clinical Senate Council (March 2015) 9