Transcript Slide 1

WCC assessment report for
external circulation
plus aspiration
February 2010
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MCCN external WCC report plus aspiration v.1.1.ppt
Contents
1.
Introduction
2.
Approach
3.
Overview
•
Key findings
•
Recommendations
•
Development opportunities
4.
Numerical rating of MCCN against the 11 WCC competencies
5.
Achievement versus aspiration against the 11 WCC competencies
6.
Detailed feedback from external stakeholders, by competence
Appendix
A.
B.
C.
D.
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Names of external interviewees
Names of internal interviewees
Development ideas from MCCN staff
Details on the WCC aspiration against the WCC competencies
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Introduction
Background
Gary Belfield, the Director of Commissioning for the Department of Health, wrote in June 2009 that World Class
Commissioning (WCC) continues to be the key driver for improved health outcomes, reduced health inequalities
and higher quality care. He emphasised that given the economic environment, transformational improvements in
commissioning are needed to deliver efficiency gains and value for money.
Against this background the Merseyside and Cheshire Cancer Network (MCCN) documented evidence of the
varied ways in which they support WCC, structuring their report around the 11 WCC competencies. This
document has been well received by PCTs for which it serves as an input to their response to the WCC
assessment process.
MCCN then went further and gained funding to assess themselves against the WCC competencies, in order to
confirm the value they are adding and to continue to improve by acting on the feedback they would receive.
This report
Atos Origin was asked to conduct the assessment of the MCCN against the WCC competencies. The assessment
was to be a pilot and light touch. This report presents the findings of that assessment.
The bulk of the findings are presented as quotes from the external stakeholder interviewees.
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Approach
Assessment strategy
Inputs to the assessment included interviews with MCCN staff, a document review and interviews with external
stakeholders. The bias in making the assessment has been towards the views of the external stakeholders rather than to
the self-assessments and documents provided by staff. This may have tended to reduce the MCCN’s scores as there
was a degree to which interviewees were unaware of the full set of the MCCN’s activities in support of a competence.
Also those interviewed were only a partial set of relevant stakeholders and the interviews were short. However, given the
limited time available for this pilot and the emphasis on seeking developmental feedback, this was felt to be the fairer
balance.
Interviewees
Seventeen external stakeholders were interviewed and 18 members of MCCN staff. Their names are shown in the
Appendix. Internal interviewees were invited to explain their role and to discuss which of the 11 WCC competencies were
relevant. They talked about their work in relation to the 11 WCC competencies and outlined key development
opportunities they could see.
External interviewees were questioned about:
How they interfaced with MCCN
Whether they had seen / used the document from the MCCN showing how it contributed to the WCC competencies
Their views on the value of the assessment exercise
Their overall views on the MCCN
Their view on how the MCCN was performing on each of the 11 competencies in turn, giving a rating between 1 to 4
to show which level of the competence was being achieved and their ideas on development opportunities
Any closing comments.
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Approach
The numerical ratings
The external interviewees were invited to supply a numerical rating of how the MCCN is doing on the 11 WCC
competencies. Fourteen of the 17 external interviewees felt able to do so. In all cases these ratings were given to
support the MCCN’s further development rather than as a performance appraisal. Therefore the overall numerical
ratings provided in this report are approximate, being the median of the scores supplied during interviews lasting
not more than one hour, and in some cases considerably less.
Relevant feedback
More helpful in many ways than the numerical scores are the comments made by the interviewees on what the
MCCN does well and on what it might do more of in the future. This feedback is presented as quotes for each of
the 11 WCC competencies.
Ratings for the sub-competencies
Each competence has 3 sub-competencies which serve to illustrate the competence more fully.
There was not time in the interviews for the external stakeholders to break their scores down to the level of the
sub-competencies. However in a few cases they did they offer a score for one or two of these.
Atos has provided an indication of how the MCCN scored on these sub-competencies. This rating is the Atos
consultant’s judgement, based on the overall comments made by the external interviewees and on the evidence
supplied by MCCN employees in internal interviews and documents.
Aspiration
At the workshop at the end of the assignment MCCN discussed with four Directors of Commissioning (DoCs) from
PCTs in their region what level of achievement they should aspire to for each of the 11 competencies. The results
of this discussion are shown in the Appendix. The DoCs’ view was that MCCN should take the spirit of the
competency descriptors as their guide in setting the aspiration and ignore certain specific activities which could
only be evidenced by the PCTs themselves.
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Overview
Key Findings
• The MCCN is highly valued and thought to be one of the best of the 28 cancer networks
• There is an imbalance between the substantial range and depth of the MCCN offerings and the individual
PCT’s capacity to capitalise on them
• The role of the MCCN perhaps needs clarifying with respect to PCTs e.g. in terms of the ways in which it
should help PCTs with commissioning and the extent to which it should focus on enabling effective PCT
performance
• Membership and the feeding of information into and back from the MCCN Task Force and Clinical Network
Groups (CNGs) needs reviewing to ensure that the value of these groups is maximised
• The MCCN is well placed to support Gary Belfield’s emphasis on achieving efficiency gains and value for
money
• The MCCN’s emphasis on encouraging the collection of real time data is vital
• The scope for MCCN to support the PCTs with WCC is huge; they can aspire to achieving Level 3 or 4 in six
of the competencies.
Recommendations to support a future WCC assessment
• MCCN case studies would be a helpful way of encapsulating their contribution (and would also help to
improve consistency and the sharing of best practice)
• The WCC assessment for CNs should be modified to ask what they are doing to help PCTs achieve
• In terms of documentation, provision of a communications strategy would be helpful
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Overview
Development opportunities
The MCCN could:
• help the PCTs develop the management processes involved in commissioning (e.g. the initiative that Eugene
Lavan has taken at Halton and St Helens), including ways of accessing data and presenting information
• get a cancer CQUIN
• help PCTs understand options for QIPP (quality, innovation, productivity and prevention) in cancer services
including the consequences of disinvestment
• do more to ensure that information presented at CE level in the Task Force is cascaded down to those in
PCTs who need to use it
• do more to ensure that CNG decisions are communicated effectively
• explore how to use the current groups, particularly the clinical groups, to engage with the wider clinical teams
• work jointly with the PCT communications leads to get its voice heard more widely
• do more to engage with social care
• strengthen its links with the public health network (CHAMPS)
• build on the public health approach to scenario modelling
• invest in 2 or 3 primary care leads and use them to engage systematically with GPs
• do more to facilitate learning and practice development across the GP / clinician interface e.g. with face-toface or online action learning sessions involving GPs and clinicians
• increase consistency among MCCN ADs over the data they use with the localities and who it is that provides
this data (PCTs v. the MCCN Performance Improvement Manager)
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Numerical rating of MCCN
against the 11 WCC
competencies
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Median ratings from external stakeholders
November/ December 2009
WCC competencies
1
Locally lead the NHS
Work with community partners
Engage with public and patients
Collaborate with clinicians
Manage knowledge and assess needs
Prioritise investment of all spend
Stimulate the market
Promote improvement and innovation
Secure procurement skills
Manage the local health system
Efficiency and effectiveness of spend
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Level achieved
2
3
4
MCCN achievement against aspiration
November/ December 2009
WCC competencies
Level achieved
1
2
3
4
Locally lead the NHS
Work with community partners
Engage with public and patients
Collaborate with clinicians
Manage knowledge and assess needs
Prioritise investment of all spend
Stimulate the market
Promote improvement and innovation
Secure procurement skills
Manage the local health system
Efficiency and effectiveness of spend
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aspiration
median rating
from external
stakeholders
November /
December
2009
For details of
how this level
of aspiration
was set, please
see the
Appendix.
Detailed feedback from external
stakeholders, by competence
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Competency 1: Assessment
Competency
Are recognised as
the local leader of
the NHS
Measure
Level 1
Level 2
Level 3
Level 4
Reputation as the local leader of the NHS
Reputation as a change leader for local organisations
Position as an employer of choice
Relevant feedback:
“It’s the most developed of the clinical networks, very ably led with good people. However they will find WCC a critical and
challenging process”
“Cancer-based campaigns in the PCTs are all based on MCCN material”
“Staff retention, shared vision, personal development and motivation is high, indicating an employer of choice”
“It’s the best run network in the country”
“They led reconfiguration of radiotherapy services effectively”
“I see confusion in their role over leading versus advising. They slip between the two in a convenient way.”
Recommendations going forward:
“You can’t have leadership where there is no management. The MCCN needs to help PCTs develop the management processes
involved in commissioning”
“We (the stakeholders) seem to be good at getting out of joint. The MCCN are only partially successful at controlling awkward
providers – the politics are awful. They need to focus on reducing the level of tension”
“Further clarification by the MCCN is needed of who should take decisions”
“I think I should know the MCCN’s position on the radiotherapy reconfiguration – where we should put the hub and spoke. Have
they circulated clearly articulated recommendations?”
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Competency 2: Assessment
Competency
Measure
Works collaboratively with community
partners to commission services that
optimise health gains and reduce
health inequalities and deliver
increased productivity
Level 1 Level 2
Creation of Local Area Agreement based on joint needs
Level 3
Level 4
NA
Ability to conduct constructive partnerships
Reputation as an active and effective partner
Relevant feedback:
“Cancer doesn’t feature in the LAA because it doesn’t require the local authority to target it – the targets are obesity, smoking etc.
Addressing cancer is more a NHS activity.”
“The MCCN is the ring-holding lynchpin between PCTs, provider Trusts, Specialised Commissioning etc. Without the MCCN it
would be more difficult for PCTs to conduct constructive partnerships. They enable sub-competency B absolutely”
“The high representation from providers on the Task Force is striking – 6 provider CEs usually arrive, whereas the representation
from the PCTs is inconsistent. It’s unfortunate that PCT CEs don’t / can’t give it the same priority”
Recommendations going forward:
“The MCCN is weak in leading primary care professionals. It needs to invest in 2 or 3 primary care clinical leads and use them to
engage systematically with GPs”
“The MCCN should not deliver Level 3 for sub-competencies B and C; this should be done by the PCTs. The MCCN need to
promote better ownership by PCTs”
“It’s always helpful to have successful outcomes clearly documented. Perhaps the MCCN could do more of this, with an emphasis
on showing the impact it has had.”
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Competency 3: Assessment
Competency
Proactively build continuous and
meaningful engagement with the
public and patients to shape
services and improve health
Measure
Level 1 Level 2
Level 3
Level 4
Influence on local health opinions and aspirations
Public and patient engagement
Improvement in patient experience
Relevant feedback:
“The patient representation on the MCCN Task Force is brilliant”
“They do fantastic work with the Patient Group – surveys, collating trend data etc and they are getting more in touch with the
public. Their work will help us claim a 3 on this competence”
“They do sterling work around patient engagement – but shouldn’t it be PCTs doing the engaging, with support from the CN?”
“With the public there is more to be done e.g. in generating awareness of cancer, in collaboration with the PCTs. The i-van is a
good initiative here.”
“If you asked people on the street, I don’t think they would know who the MCCN are”
Recommendations going forward:
“With other networks e.g. Public Health and Specialised Commissioning there is more regularity of reports and glossy
brochures. When the MCCN do produce reports they are exceptionally good. Could they do more to generate public
awareness?”
“The MCCN needs to do more to ensure that members of the public take up appointments within the two week window”
“There is more to do for the public – defining and delivering key messages to head-teachers, the 20-year old man in the street,
etc, etc”
“PCT Communications Departments have good links with local media. There is an opportunity for the MCCN to work through
them to get itself heard. We have just looked at how PCT Communications Leads could work jointly and we should ask: ‘How
can the MCCN join in?’”
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Competency 4: Assessment
Competency
Lead continuous and meaningful
engagement of a broad range of
clinicians to inform strategy and
drive quality, service design, and
efficient and effective use of
resources
Measure
Level 1 Level 2
Level 3
Level 4
Clinical engagement
Dissemination of info to support clinical decision making
Reputation as leader of clinical engagement
Relevant feedback:
“The MCCN have been really helpful in ensuring quality via peer review. They have the wider footprint and can pull loose strands
together “
“I meet a range of clinical specialists through the MCCN that I would never otherwise meet. They have excellent linkages in place.”
“The MCCN facilitates discussion that usually rises above the interests of individual organisations, so the debate is of a network of
impartial clinicians”
“Their engagement with clinicians merits a good 3 – they make the clinicians think they are their own ideas”
“They strive to engage and are largely successful. Primary Care is a law unto itself”
Recommendations going forward:
“The MCCN should write a special paper outlining how many clinicians are involved in each of their CNGs. We should major on
this in the WCC submission”
“They need to do more to engage with social care”
“I don’t see the MCCN relating to a wide spectrum of clinicians (including Public Health clinicians) across individual Trusts. A
breadth of clinicians need engaging for change to happen. Change is driven by showing who is doing well and who not so well.
They could also strengthen their offer by facilitating learning and practice improvement across the GP / clinician interface, e.g. by
promoting action learning sessions to work to improve a patient pathway”
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Competency 5: Assessment
Competency
Manage knowledge and
undertake robust and regular
needs assessments that establish
a full understanding of current
and future local health needs and
requirements
Measure
Level 1 Level 2
Level 3
Level 4
Analytical skills and insights
Understanding of health needs trends
Use of health needs benchmarks
Relevant feedback:
“The MCCN have got so much better at this”
“The MCCN has funded data systems in every Trust in order to capture staging data on when cancer is diagnosed”
“The Network Director presented some very impressive modelling around oncology issues”
“I’m not sure what validity I would give to some of their evidence. They fall down on getting the data. Currently they are having to
use disparate epidemiological data, rather than having patch by patch local data.”
“They do not have a robust segmentation of the population”
Recommendations going forward:
“The MCCN needs to increase feedback on real time issues across the patch. We need their help in refining the way we do this
within the cost envelope”
“They need to do better on analysing the needs of the population. They should have more people with a cancer clinical
background doing the analysis. They should be doing better in measuring improvement in the population. They should be able to
appraise in terms of priorities.”
“What we actually need is very good data. Until we have this e.g. on outcomes and staging, there is no point applying specialist
clinical analysis”
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Competency 6: Assessment
Competency
Prioritise investment of all
spend in line with different
financial scenarios and
according to local needs,
service requirements and the
values of the NHS
Measure
Level 1 Level 2
Predictive modelling skills and insights to understand impact
of changing needs on demand
Prioritisation of investment and disinvestment to improve
population’s health
Incorporation of priorities into strategic investment plan to
reflect different financial scenarios
Level 3
Level 4
Relevant feedback:
“We have all signed up to radiotherapy being available at the Royal; the MCCN facilitated but could not make this investment
decision”
“The MCCN could be rated as a 3 for how it prioritises within the slice of funding available to it, but it does not impact relative
prioritising of funds by PCTs”
“The MCCN do not prioritise, they come with a list of initiatives on cancer and say to us, do all of them”
“The MCCN doesn’t prioritise at all, not even within cancer, they have a shopping list”
“The CN can only co-ordinate this. It’s Work in Progress; we cannot be over-enthusiastic”
“The MCCN does not succeed in getting information presented at CE level in the Task Force to cascade down to those in the
PCTs who need to use it”
Recommendations going forward:
“The MCCN could build on the Public Health approach to scenario modelling e.g. to look at the role of alcohol in cancer or the
impact of sun-bed usage on life expectancy”
“There are very tough times ahead. The MCCN must advise on best value – not just good value – are they equipped for this?”
“To help them we need to involve them more fully in what we do so they understand the challenge, what we need in business
cases, etc”
“They need to help us prioritise against the rest of the population’s health needs. They must make sure they do the overview they should say ‘This is where we see the gaps’. They need to be more aware of our commissioning cycle so they can input
at the appropriate time”
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Competency 7: Assessment
Competency
Effectively stimulate the
market to meet demand and
secure required clinical and
health and well-being
outcomes
Measure
Level 1 Level 2
Knowledge of current and future provider capacity and capability
Level 3
Level 4
Alignment of provider capacity with health needs projections
Creation of effective choices for patients
Relevant feedback:
“The MCCN has a much bigger role to play in commissioning now that cancer has come out of Specialised Commissioning”
“The MCCN is exactly enacting sub-competency B at level 3, but I do not look to MCCN to make a great contribution overall to
this “
“Co-ordinated commissioning via the MCCN is beginning to have an impact. They have done some very good work – e.g. their
role in breast services”
“The CN’s evidence is useful in showing how they have enabled contestability and challenged around quality etc.”
Recommendations going forward:
“The MCCN needs to think out of the box and get a different model for service provision, separating oncology from radiotherapy.
We should have a more coherent and centralised system – the hub and centre of research, where patients have treatment.
Instead we have a dispersed and distributed model with a lack of concentrated expertise and facilities, meaning we can’t attract
the best talent and we can’t compete against the best worldwide standards of cancer care”
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Competency 8: Assessment
Competency
Measure
Promote and specify continuous
improvements in quality (e.g.
CQUIN, IQI) and outcomes
through clinical and provider
innovation and configuration
Level 1 Level 2
Level 3
Level 4
Identification of improvement opportunities
Implementation of improvement initiatives
Collection of quality and outcome information
Relevant feedback:
“The Improving Outcomes Guidance (IOG) is the bible. The MCCN drives the delivery of the IOG standards”
“They have done marvellous work on IOGs”
“With their comprehensive programme on bowel cancer the MCCN is edging towards a level 4, as the programme included
investigation, treatment and prevention. They have evidence of implementing change and seeing improved outcomes.”
“They have shown innovation in how we connect with communities in need e.g. going into schools, successfully lobbying for the
removal of cigarette machines etc”
“Really innovative clinicians from elsewhere in the world are not found round here. However, the MCCN Director has been very
helpful on appointing a Professor of Oncology at Liverpool University”
Recommendations going forward:
“The CN needs to evidence near real time monitoring – perhaps this is ultimately the staging data”
“If the CN worked in with the QIPP programme, which is taking over from ‘Transforming Community Services’, they could help
us continue to innovate even in times of a financial squeeze. The MCCN already excel at harnessing cloud-cuckoo-land
University innovation and turning it into something really useful”
“Patients in research trials do better. We need to get a Professor of Oncology at Liverpool University. To do this we must have a
critical mass of treatment facilities in one place with an academic team overseeing it”
“They should get a cancer CQUIN”
“They should look across a whole patient pathway and facilitate the service redesign and a streamlined QIPP implementation”
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Competency 9: Assessment
Competency
Secure procurement skills
that ensure robust and
viable contracts
Measure
Level 1 Level 2
Level 3
Level 4
Understanding of provider economics
Negotiation of contracts around defined variables
Creation of robust contracts based on outcomes
Relevant feedback:
“This competence is not applicable. The MCCN can advise but contracting is via the PCT or the Specialised Commissioning Team”
“This is not as relevant because the MCCN don’t procure, though they have provided advice on negotiation variables in contracts
we set with Trusts. This is not their core business.”
“We have not got procurement skills. The PCT have had to get a team of experts to advise them and it takes forever. It requires
getting busy clinicians e.g. from Leeds to help. The MCCN needs to help the PCT develop contracting skills for dealing with
tenders e.g. how to specify outcome measures and financial measures. (We used to have contract management skills in the NHS
but we have lost them).”
“They write the service specifications for specialist and palliative care”
Recommendations going forward:
“The MCCN should be working closely with PCTs and facilitating so strongly that common solutions are agreed”
“The issue to grapple with is how does the MCCN close an identified gap in commissioning by getting it embedded within the
contractual process”
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Competency 10: Assessment
Competency
Effectively manage systems
and work in partnership with
providers to ensure contract
compliance and continuous
improvement in quality and
outcomes and value for money
Measure
Level 1 Level 2
Level 3
Level 4
Use of performance information
Implementation of regular provider performance discussions
Resolution of ongoing contractual issues
/ NA
Relevant feedback:
“They have done useful work with the performance dashboard to show, for example, the amount spent per patient in Liverpool”
“The MCCN are not responsible for competency 10, but they do help PCTs with it. They pick up intelligence and feedback to
commissioners to enable them to have more fruitful conversations with providers. However, we have not yet got timely data (no
more than 6 weeks old) so level 3 cannot be achieved”
“This is the PCT’s job. MCCN don’t do contracting. PCTs don’t want them to do contracting. PCT staff have seen big changes
over the last 2 years. We see ourselves as commissioners working with key providers to develop services.”
“They run a monthly Performance Management meeting using data e.g. on cancer waiting times, and highlight where standards
have not been achieved”
Recommendations going forward:
“The CN needs to help us look at developments and investments and prioritise. They need to help us streamline services so they
are responsive, efficient, VFM. This requires supporting the Acute Trust clinicians in working together and then putting their output
in the context of the wider cancer community to highlight knock on effects, better value, productivity.”
“CQUIN pathways etc offer the MCCN a big potential to develop. They have to strive to get a voice with the Directors of Finance
and Directors of Commissioning groups”
“They could use CQUIN to facilitate the definition of what clinical audits should be done within the hospital using case notes,
linking with hospital clinical audit departments”
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Competency 11: Assessment
Competency
Ensuring
efficiency and
effectiveness of
spend
Measure
Level 1 Level 2
Level 3
Level 4
Measuring and understanding efficiency and effectiveness of spend
Identifying opportunities to maximise efficiency and effectiveness of spend
Delivering sustainable efficiency and effectiveness of spend
Relevant feedback:
“None of us do this very well”
“The CN’s job is just to get the idea of this on to the table”
“In last six months MCCN has changed its focus towards efficiency and modernisation”
“MCCN is an excellent example of the importance of adequately resourcing in terms of skills and numbers of staff if the job is to
be done well”
Recommendations going forward:
“The CN should major on helping PCTs prioritise investment to get the greatest cancer health outcomes in the long term e.g. if
you spend £X on cancer awareness campaigns you will reduce late presentations by 20%”
“Can the CN turn round and respond differently to the acute change in our economic circumstances? Re-clarify their role – give
more priority to supporting PCTs as we are paying them. Ensure that we don’t have PCTs going bankrupt. Don’t have every acute
Trust trying to offer the same service”
“The MCCN needs to clarify its contribution to QIPP – which services are not absolutely necessary and what would be the
consequences if we were to disinvest?”
“The CN can have a big role in the effectiveness agenda. It will be a growth area, helping to get clinicians into the mindset of
taking waste out of their services”
“A new agenda has currency – QIPP. The MCCN should produce a plan for what they will do for QIPP.”
“They could do a lot of background work to help PCTs understand ‘What if we don’t do this?’ “
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Appendix
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External Interviewees - November / December 2009
Role
Name
PCT Chief Executives
Kathy Doran, Wirral; Helen Bellairs, Western Cheshire;
Leigh Griffin, Sefton
PCT Directors of Commissioning
Eugene Lavan, Halton and St Helens; Tina Wilkins, Sefton; Kathy
Gritzner, Wirral; Leonie Beavers, Liverpool
University of Liverpool
John Caldwell, VC and Dean of Medical School
Directors of Public Health
Fiona Johnstone, Halton and St Helens; Matt Ashton, Knowsley;
Hannah Chellaswamy, (Deputy) Sefton
Acute Trust Chief Executives
Tony Bell, Royal Liverpool
North West Specialised
Commissioning
Alison Rylands, Director of Public Health; Martin Stanley,
Commissioning Manager
Strategic Health Authority
Jane Higgs, Assistant Director of Performance
CISSU
Pamela Bethel, Chief Operating Officer; Carole Hodgekinson,
Contracting Specialist
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Internal Interviewees – November / December 2009
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Name
Role
Anne Hines
Lead Pharmacist
Anita Corrigan
Nurse Director
Alison Williams
Associate Director
Tracie Keats
Project Manager
Gloria Payne
Patient and Public Involvement Manager
Chris Barker
Communication and Web Manager
Jon Hayes
Deputy Network Director
Adrienne Betteley
End of Life Programme Lead
Ian Connolly
Performance Improvement Manager
Anna Murray
Information Analyst
Michelle Timoney
Associate Director
Pat Higgins
Network Director
Ray Murphy
Patient and Carer Involvement Lead
Dr Ged Corcoran
Medical Director
Linda Devereux
Associate Director
Kathy Collins
Associate Director
Paul Mackenzie
Health Inequalities Manager
Dr Daniel Seddon
Public Health Consultant
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Development ideas from MCCN staff
Competency 1
We need to find more ways of ensuring that the PCTs do the talking, not the MCCN.
We need to find a way of testing how well clinicians on the CNGs are bringing the views of their organisation to the table
and taking the conclusions and recommendations from the table back to be actioned on the ground.
Competency 2
We need to broaden our concept of who is a community partner. This could include those businesses which promote sunbed use – hair salons for example.
Competency 3
We could collaborate more with charities e.g. the Breakthrough breast cancer charity.
To get patient representation absolutely right, e.g. for lung cancer, we need to get better at using their relatives to describe
their experience.
Competency 4
We could do more to support clinical commissioners as commissioners i.e. those in PECs, Medical Committees and GP
Consortia / Partnerships. We need to think about how we influence PCTs to support their clinical cancer leads – how do we
help them get traction? This is necessary to overcome the lack of clarity in decision-making authority in PCTs. Practice
Based Commissioning remains an area that we must facilitate more strongly.
Competency 5
We need to do all we can to stimulate the systematic collection of raw data via our Performance Framework. This would
free up our Performance Improvement Manager to use the intelligence from the data to drive improvement in cancer
outcomes.
The ADs should spend time with our Performance Improvement Manager to think through what data, data interpretation
and information management skills they need in order to use the intelligence from the data most effectively out in our
localities. We should aim to increase consistency in the support we give our localities.
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Development ideas from MCCN staff
Competency 8
Our CNGs could be more proactive in promoting innovation. We need to be more explicit about what we expect from our
CNG chairs.
Competency 9
We do not have specific procurement skills, but I am not sure if it is appropriate that we should. It is for the PCTs to have
these skills.
The ADs need a method of judging the collective benefits derived from the provision of a service at the end of the
contracting period.
Competency 10
With the Performance Framework we are developing, we need to ensure that information flows into it from the PCTs as well
as from the CN. We need a shift from the CN driving it to the PCTs owning it and using it. A goal would be that GPs go into
the framework and look at their performance relative to others.
How do we define quality? Is it compliance with a pathway? If Yes, how do we test this compliance?
Competency 11
We have increased cancer spend by 30% over 4 years. Now we need to ensure the efficiency and effectiveness of the use
of that resource.
We need agreed consistent pathways across the network for how the MCCN can intervene. We need agreed timelines on
each pathway, so that we can show evidence against the pathway that there has been a breach.
CNGs can be cosy – no one holds them to account. We need CNGs to have more challenging conversations with clinicians
e.g. why does your patient stay in hospital for 10 days when other consultants’ patients stay for 5 days?
We need to know how much is spent on particular pathways – do the PCTs know this?
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WCC aspiration for MCCN
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Introduction
The following slides give a view on the level to which the MCCN might aspire for each of the three subcompetences for the eleven WCC competences. Descriptors for all competencies should be re-worded to include
the phrase “for cancer care and end of life care”.
A yellow circle indicates the aspiration and a plum coloured circle indicates the current rating.
This view was developed in discussion between the MCCN and four Directors of Commissioning from PCTs in its
region, after the WCC MCCN assessment data collection exercise had been carried out.
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Level achieved
WCC competencies
1
2
3
4
Locally lead the NHS
Work with community partners
Engage with public and patients
Collaborate with clinicians
Manage knowledge and assess needs
Prioritise investment of all spend
Stimulate the market
Promote improvement and innovation
Secure procurement skills
Manage the local health system
Efficiency and effectiveness of spend
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aspiration
median rating
from external
stakeholders
November /
December
2009
Competency 1: Level of aspiration
Competency
Are recognised as the local
leader of the NHS for cancer
care and end of life care
Measure
Level 1
Level 2
Level 3
Level 4
Reputation as the local leader of the NHS
Reputation as a change leader for local organisations
Position as an employer of choice
Reputation as the local leader of the NHS: Level 4
Level 4 requires data on patient experience and reputation levels by different population and partnership groups for cancer
care and end of life care. This is achievable.
Reputation as a change leader for local organisations:
Level 4 is achievable.
Level 4
Position as an employer of choice: Level 4
Level 4 concerns MCCN recruiting high quality staff for all positions it has in commissioning. This is achievable.
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Competency 2: Level of aspiration
Competency
Works collaboratively with community
partners to commission services that
optimise health gains and reduce
health inequalities and deliver
increased productivity
Measure
Level 1 Level 2
Creation of Local Area Agreement based on joint needs
Level 3
NA
Ability to conduct constructive partnerships
Reputation as an active and effective partner
Relevant feedback:
“Cancer doesn’t feature in the LAA because it doesn’t require the local authority to target it – the targets are obesity,
smoking etc. Addressing cancer is more a NHS activity.”
“The MCCN should not deliver level 3 for sub-competencies B and C; this should be done by the PCT. The MCCN need to
promote better ownership by PCTs”
Creation of Local Area Agreement based on joint needs:
Cancer does not feature in the LAA.
NA
Ability to conduct constructive partnerships: Level 2
Above level 2 needs to be delivered by the PCTs.
Reputation as an active and effective partner: Level 2
Above level 2 needs to be delivered by the PCTs.
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Level 4
Competency 3: Level of aspiration
Competency
Proactively build continuous and
meaningful engagement with the
public and patients to shape
services and improve health
Measure
Level 1 Level 2
Level 3
Influence on local health opinions and aspirations
Public and patient engagement
Improvement in patient experience
Influence on local health opinions and aspirations:
Level 4
Level 4 requires delivery by the PCT, but the MCCN can support them in major ways with this.
Public and patient engagement: Level 4
Level 4 requires delivery by the PCT, but the MCCN can support them in major ways with this.
Improvement in patient experience: Level 4
Level 4 involves delivery of improvements in the quality of care – in which the MCCN can be hugely helpful to PCTs.
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Level 4
Competency 4: Level of aspiration
Competency
Measure
Lead continuous and meaningful
engagement of a broad range of
clinicians to inform strategy and
drive quality, service design, and
efficient and effective use of
resources
Level 1 Level 2
Level 3
Level 4
Clinical engagement
Dissemination of info to support clinical decision making
Reputation as leader of clinical engagement
Relevant feedback:
“Their engagement with clinicians merits a good 3 – they make the clinicians think they are their own ideas”
Clinical engagement:
Level 4 is achievable.
Level 4
Dissemination of information to support clinical decision making:
Level 4 requires the PCT to have devolved health budgets to PBC.
Level 3
Reputation as a leader of clinical engagement:
Level 4
MCCN plays a central role in supporting PCTs in developing a track record of clinicians leading initiatives to improve quality
and productivity.
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Competency 5: Level of aspiration
Competency
Manage knowledge and
undertake robust and regular
needs assessments that establish
a full understanding of current
and future local health needs and
requirements
Measure
Level 1 Level 2
Level 3
Analytical skills and insights
Understanding of health needs trends
Use of health needs benchmarks
Analytical skills and insights: Level 4
Although the evidence in Levels 3 and 4 is for the PCT to demonstrate, the MCCN can contribute in major ways.
Understanding of health needs trends: Level 3
Level 4 requires the PCT to create a programme.
Use of health needs benchmarks:
Level 3
Level 4 requires the PCT to have developed plans.
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Level 4
Competency 6: Level of aspiration
Competency
Prioritise investment of all
spend in line with different
financial scenarios and
according to local needs,
service requirements and the
values of the NHS
Measure
Level 1 Level 2
Predictive modelling skills and insights to understand impact
of changing needs on demand
Prioritisation of investment and disinvestment to improve
NA
population’s health
Incorporation of priorities into strategic investment plan to
reflect different financial scenarios
NA
Relevant feedback:
“The MCCN could be rated a 3 for how it prioritises within the slice of funding available to it”
Predictive modelling skills and insights to understand impact of changing needs on demand:
The MCCN will be developing its work considerably in this area.
Prioritisation of investment and disinvestment to improve population’s health:
Not the MCCN’s job.
NA
Incorporation of priorities into strategic investment plan to reflect different financial scenarios:
Not the MCCN’s job.
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Level 3
NA
Level 3
Level 4
Competency 7: Level of aspiration
Competency
Effectively stimulate the
market to meet demand and
secure required clinical and
health and well-being
outcomes
Measure
Level 1 Level 2
Knowledge of current and future provider capacity and capability
Level 3
Level 4
Alignment of provider capacity with health needs projections
NA
Creation of effective choices for patients
Relevant feedback:
“The MCCN has a much bigger role to play in commissioning now that cancer has come out of Specialised Commissioning”
Knowledge of current and future provider capacity and capability:
Level 4 requires the PCT to have specific resources.
Level 3
Alignment of provider capacity with health needs projections: Level 2
Level 2 requires MCCN to significantly support PCTs in market management.
Creation of effective choices for patients:
Not the MCCN’s job.
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Competency 8: Level of aspiration
Competency
Promote and specify continuous
improvements in quality (e.g.
CQUIN, IQI) and outcomes
through clinical and provider
innovation and configuration
Measure
Identification of improvement opportunities
Level 1 Level 2
Level 3
Implementation of improvement initiatives
Collection of quality and outcome information
Identification of improvement opportunities: Level 4
A level 4 is achievable if we assume that the major role in delivering the 4 is through MCCN rather than PCT activity.
Implementation of improvement initiatives: Level 4
A level 4 is achievable if we assume that the major role in delivering the 4 is through MCCN rather than PCT activity.
Collection of quality and outcome information: Level 4
A level 4 is achievable if we assume that the major role in delivering the 4 is through MCCN rather than PCT activity.
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Level 4
Competency 9: Level of aspiration
Competency
Secure procurement skills
that ensure robust and
viable contracts
Measure
Level 1 Level 2
Level 3
Level 4
Understanding of provider economics
Negotiation of contracts around defined variables
NA
Creation of robust contracts based on outcomes
NA
Relevant feedback:
“This competence is not applicable. The MCCN can advise but contracting is via the PCT or the Specialised Commissioning
Team”
“This is not their core business”
“The MCCN write service specifications for specialist and palliative care”
Understanding of provider economics:
Level 2 is achievable.
Level 2
Negotiation of contracts around defined variables: NA
MCCN cannot achieve this.
Creation of robust contracts based on outcomes: NA
Negotiations and contract finalisation can only be undertaken by PCTs.
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Competency 10: Level of aspiration
Competency
Effectively manage systems
and work in partnership with
providers to ensure contract
compliance and continuous
improvement in quality and
outcomes and value for money
Measure
Level 1 Level 2
Use of performance information
Implementation of regular provider performance discussions NA
Resolution of ongoing contractual issues
Relevant feedback:
“The MCCN are not responsible for competency 10, but they do help PCTs with it.”
“This is the PCT’s job. PCTs don’t want MCCN to do contracting.”
Use of performance information: Level 2
Level 3 concerns the contents of PCT contracts.
Implementation of regular provider performance discussions:
Only the PCTs can do this.
NA
Resolution of ongoing contractual issues: NA
This sub-competence concerns management of the PCT’s contracts.
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NA
Level 3
Level 4
Competency 11: Level of aspiration
Competency
Ensuring
efficiency and
effectiveness of
spend
Measure
Level 1 Level 2
Measuring and understanding efficiency and effectiveness of spend
Identifying opportunities to maximise efficiency and effectiveness of spend
Delivering sustainable efficiency and effectiveness of spend
NA
Measuring and understanding efficiency and effectiveness of spend: Level 4
This sub-competence is about PCT understanding, which is in the MCCN’s remit to address.
Identifying opportunities to maximise efficiency and effectiveness of spend:
MCCN can enable PCTs to achieve this sub-competence fully.
Delivering sustainable efficiency and effectiveness of spend: NA
MCCN cannot performance manage the PCTs’ providers
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Level 4
Level 3
Level 4