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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. Template Version: PMO-0.5b Page 1 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: 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: 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. Template Version: PMO-0.5b Page 2 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 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. Template Version: PMO-0.5b Page 3 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 Template Version: PMO-0.5b Page 4