Download Cancer Pathways - NHS NEW Devon CCG

Project Mandate
Forward to [email protected] on completion
Project name: Right Care Cancer and Tumours
SRO (if identified): John Finn
Parent Programme:
Programme Manager: Lynne Kilner
Submitted by: Yash Patel
Date: 25 September 2015
This document is to be used to outline the high level requirements and rationale of the project.
The PMO will be the gateway for the Project Mandate submissions. The PMO will also liaise with the business
area making the submission, as to the outcome of the approvals process.
Guidance on sections
Purpose of proposed project and background
Provide an overview of the background and purpose of the project. This should give enough detail as to the
overall objectives and expected benefits of the project, and the case for change.
Explain the context of the project.
Whether the project will be a stand-alone activity to fulfil a particular business requirement or whether it is part
of a bigger programme.
Scope
Describe the major deliverables of the project and what is in scope and what is out of scope.
Outline Business Case – Justification
Include any high level investment, savings and service delivery justifications.
Include estimated timelines as to the expected timescales for delivery of the project and delivery of benefits,
including major milestones. Provide a high level summary of costs/investment and a timeline of return (pay
back) on investment.
Include the names of stakeholders/groups you are aware of who may be involved or interested in the
proposed project.
Quality
Include any quality and equality implications, and control measures.
RAID (Risks, Assumptions, Issues, Dependencies)
Describe any known risks or issues likely to impact the delivery of the project.
Describe any dependencies around the project both internal and external to the organisation, including any
required links or interfaces with other projects or business areas.
Describe the constraints within which the project must operate, e.g. there may be constraints on the amount of
resources available to the project or the location of the project team.
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1.
Background and Purpose of Proposed Project
The CCG has invested in a Cancer Deep Dive which was carried out by Arden & GEM CSU. This
was followed by a Cancer workshop at which CCG staff from a variety of teams considered which of
the findings to take forward into a cancer QIPP programme of work.
The deep dive pack identifies total variance from upper quintile of £3.38M across three pathways:
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Urological cancers
Haematological cancers
Skin cancers
Alternative services (such as outpatient clinics) was not measured in the deep dive and it is
estimated that 40 per cent of the variance may need to be invested in alternative services, therefore
the total potential saving is £2.03M with an in-year opportunity of £507k.
This mandate is for all three pathways.
Stakeholders for this project will include: NEW Devon CCG, acute providers, NEW Devon GPs,
patients, third sector, South West cancer network, Public Health England, NHS England and the
public.
2. Scope
In scope
Focus pack findings – key indicator review
Financial savings
Nominated cancer pathways including outpatients
Impact of NG12
Coding quality
Out of scope
Improving quality other than where NHS
NEW Devon CCG is not meeting
constitutional requirements
Specialist Commissioning
The project will review all of the activity in the pathways identified in the deep dive analysis plus
referral mechanisms and outpatient appointments.
Each pathway current practice will be compared with best practice to identify where variance exists.
Where necessary a best practice pathway will be developed to include prevention, primary care and
secondary care elements. Variance will also be assessed across acute providers, between general
practice surgeries and across CCG localities.
The project will become part of a whole CCG cancer programme under the planed care control
centre that will bring all cancer improvement activity in the CCG under a single mandate to ensure a
focussed approach is established and maintained.
3. Outline Business Case – Justification
It is the intention of this project to carry out a full best-practice analysis review and consolidation of
urological, haematological and skin cancer pathways and practices within NEW Devon CCG’s health
economy.
Any other related pathway workstreams currently taking place within the CCG will be considered
and incorporated into this work to ensure:

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there is no double counting of possible benefits
all opportunities for change are considered as part of any potential pathway redesign work.
It is envisaged that benefits will be available from the beginning of Quarter 4 2015/16.
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The project will consider national guidance and best practice and any CCG policies in place to
ensure these are being followed or to agree any allowable variations.
Pathway
Indicator
Secondary care admissions
per 100,000 population
Secondary care spend per
Skin
100,000 population
Secondary care admissions
Haematology
per 100,000 population
Secondary care spend per
Haematology
100,000 population
Day-case admissions per
Urology
100,000 population
Secondary care spend per
Urology
100,000 population
CCG Value
Upper
Quintile
Total gain if CCG
matched upper
quintile
338.2
218.9
1,301 fewer admissions
£269,582
£184,062
£1,809k reduction
409.7
215.6
1,796 fewer admissions
£375,260
£331,788
£1,014k reduction
110.4
61.6
460 fewer admissions
£329,564
£287,741
£559k reduction
Skin
The deep dive suggests that there is a higher reliance than peer on day case and inpatient services,
the deep dive pack did not measure outpatient activity. Therefore the total saving assumes an
investment in clinic-based activity of 40 per cent of the potential shown. The size of the investment
will be investigated as part of the redesign. Therefore savings targets are as follows:
Pathway
Skin
Haematology
Urology
Total
Variance
£,000s
1,809
1,014
559
Total Saving
£,000s
1,085
608
336
2015/16 saving
£,000s
271
152
84
3,382
2,029
507
4. Quality
It is expected that the programme will not produce any adverse effects on the quality of any service
and is likely to provide improvements in quality through improvements in pathways. A QEIA will be
completed for each project. At this juncture the programme is focusing on maximising the financial
benefits from any project rather than improvements in quality except where NHS Devon CCG fails to
meet constitutional standards. However, it is mandatory that quality is maintained at current
standards and efforts will be made to improve quality standards where possible.
5. Dependencies

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Member GP engagement with the NHS Right Care methodology
Outcomes from deep dives into areas which are shown to be the best opportunities using the
NHS Right Care methodology.
Full project team availability
Provider engagement with the process and the outcomes
6. RAID

The Deep Dive data is incomplete as it only includes admitted patient care information i.e.
emergency, day-case and elective. We would need to broaden the scope to include out-patient
data.
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The total savings identified in the Deep Dive analysis does not take account of movement from
a day-case to an outpatient (which might be a more appropriate care setting) thus reducing the
overall gains.
We also need to look at 2WW referral data.
We need to take account of existing work-streams which overlap with the cancers and tumour
project to avoid double counting savings. Specifically:
o Dermatology QIPP
o CF 29 (elective efficiencies)
Insufficient capacity within the CCG staff to create enough teams to carry out the work
Lack of support from member GPs so that there are insufficient ‘champions’
Any suggested opportunity may be undermined by CCG staff and/or stakeholders undermining
the credibility of the data and their advice being accepted
New Cancer strategy and NICE guidance will potentially see an increase in activity which
undermines the potential savings.
Insufficient capacity within the CCG staff to create enough teams to carry out the work
Lack of support from clinicians
Any suggested opportunity may be undermined by CCG staff and/or stakeholders undermining
the credibility of the data and their advice being accepted
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