PRagmatic7IssueAugust 2013

How Peer Review fits into the new NHS structureSince April 2013 the National PeerReview programme (NPRP) has beenhosted by NHS England as part of NHSImproving Quality (NHS IQ) deliveryteam. NHS IQ has brought together theco-ordination of improvementprogrammes into one organisation. Theaim is a more co-ordinated approachwith a core team responsible forcommissioning improvementprogrammes, based on the 5 domainsof the NHS Quality Framework. Thedelivery team comprises of staff fromvarious improvement programmeswhose organisations ceased to exist onthe 31st March, including the NationalCancer Action Team, National End ofLife Care Programme, NHS Diabetesand Kidney Care, NHS Improvementand NHS Institute for Innovation andImprovement.

The delivery team has a fixed term of ayear after which NHS IQ willcommission a variety of deliverypartners to support the programmes,some of which may be employed withinthe core team or other organisations.

In March 2014 the current hostingarrangements for NPRP will come to anend and the programme will need toestablish a new commissioner and host.Over the past months there has beensignificant support for the programmeand in fact much interest from otherdisease leads to implement peer review,particularly following the Francis reportinto Mid-Staffordshire Hospitals. Therehave been a number of challenges notleast the impact of the changes of thenetwork structures and the supportavailable for network groups andNSSGs.

This has required us to implementinterim arrangements for reviewingthese teams and we have adopted aflexible approach to the assessments.

The planned programme continueshowever and we are currently pullingtogether the national report for2012/13 and continue to provideinformation to all stakeholders on thequality of all cancer services. There issignificant interest from CCGs andspecialised commissioners in theinformation we can provide on theservices they commission and also fromthe Area Teams that provide the localoversight for NHS England.

Director’s WelcomeWelcome to our latest version ofPRagmatic, it has been a while sinceour last update and it’s been a quite ayear, with the closure of the NationalCancer Action Team, the National PeerReview Programme (NPRP) hascontinued on in leaps and bounds inthe new world. This edition seeks tobring you up to speed on theorganisational & programme changes,

development of new measures, thenew process for user reviewers andour innovative web tool for patients.

Thank you to everyone whocontributed to this edition.

Ruth Bridgemanruth.bridgeman@nhsiq.nhs.uk

National Peer Review Programme

A guide to the new NHS in EnglandThe King’s Fund has put together a succinct introduction to the new NHS in6.5 minutes. This animation explains how the NHS fits together in the newenvironment, see here:

www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england

There have been significant changes tothe network structures. The 28 Cancernetworks have been absorbed into the12 new Strategic Clinical Networks(SCNs) which cover; cancer,cardiovascular disease (includingcardiac, stroke, diabetes and renaldisease), maternity and children’sservices and mental health, dementiaand neurological conditions. This hashad a dramatic effect of the resourcesand support available for all thenetwork groups in cancer.

There has been widespread recognitionof the value of the NSSGs andrecognition that maintaining clinical“networking” groups is important.There have been a number of meetings

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Changes to the PeerReview Measures As part of the on-goingprocess for reviewing thecancer measures there havebeen a number of changesmade for the 2013/12 round of peer review.

The changes have been made to:

• Ensure the measures reflect the on-going development in services;

• Take account of the changingstructure of cancer services;

• Enable the continued shift fromprocess to outcome measures; and

• Balance the need for qualityassurance against the workload ofteams.

Changes to Network Site

Specific Groups (NSSGs)

and Network Groups

with the SCNs to work through howthese groups can be supported with thelimited resources that are now availableand who should provide the support. Ithas been agreed that the role &function of network clinical groups postthe NHS reorganisation requires review.Partly due to SCNs not having theresources to support site specific activityin the same way and partly due toprogress on implementing ImprovingOutcomes Guidance (IOGs), meaningthe focus of pathway discussions impliesreview of membership, and partly as insome cases expanded SCN footprintsallow for richeraudit/inequalities/variation discussions.Network level measures and/orinterpretation of measures would thenbe reviewed to ensure alignment.Whilst this is being worked through inthe new world the following changesto the measures have been made:

• Network board measures for NSSGshave been included in the NSSGmeasures.

• Responsibilities for these measureshave been changed and are beingapplied flexibly depending on localarrangements.

• Network groups for rehabilitation,psychology, complementary therapiesand the partnership forum have beensuspended. However, rehabilitationand psychology have been included inthe new pathway measures in thenew format for measures.

Interactive Pathways for Rehabilitationwill soon be available on the NHS IQwebsite www.nhsiq.nhs.uk However inthe interim you can still findRehabilitation pathway information onthe NCAT websitehttp://ncat.nhs.uk/our-work/living-beyond-cancer/cancer-rehabilitation#tab-bestpracticepathways

Also, under the Patient Informationmeasure (applicable to all tumour sites)

it states that where available the MDTshould provide written information forthe patient in the format of the NHSInformation Prescription. If you are notaware of the initiative please take amoment to familiarise yourself with thisgreat resource that helps patientscoordinate their care:http://www.nhs.uk/Planners/Yourhealth/Pages/Information.aspx

New Measures

widespreadrecognition of thevalue of the NSSGs

the developmentof core principles

New Measures Format

The following new measures havebeen published:

• Revised Haematology

• Hepato-Pancreato-Biliary – thesereplace the pancreatic measures fromUpper-GI and liver metastases’measures from the Colorectalmeasures.

Following a review of the outcomes ofself-assessment against the specialistpalliative care measures, it has beendecided that further detailed review isrequired. The peer review team andSPC advisory group are working withthe national clinical director for end oflife care to support the development ofcore principles for the service.

A new format has been introduced tobetter reflect the developments incancer services and the shift to a moreoutcomes focus. This has beenintroduced for Lung and Breast and allthe new measures. This new formatwill be rolled out across all topics for2013.

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Keith became a user reviewer 2009and Chair of the NUSG in the sameyear. He was an active PatientRepresentative in the Mount VernonCancer Network. He was well-respected by both service users andNHS Professionals a like. Keith had hisown unique style, often being directand challenging, but most of all hewas intelligent, enthusiastic and hada great sense of humour whichensured that he made things happenfor us all. We are all so proud of whatKeith achieved. He was a truegentleman and professional of anolder era but had all the enthusiasmof a younger man. He was motivatedby new technology and wasresponsible for driving thedevelopment of the website ‘MyCancer Treatment’.

Time to RememberSadly, in the last 9 months we have lost two valuedmembers of the NUSG, Keith Foster and Steve Brothwell

Up until only a few weeks before hedied he was still busy emailing us,coming up with suggestions for workprogrammes, challenging us withtricky questions and developingmarketing plans to help promote ourwebsite.

We will remember him fondly andwork hard to continue his work toimprove cancer services for everybodywho follows behind him. Keith passedaway in March 2013.

Ruth Bridgeman

It is with great regret that I have toshare with you the sad news that myfriend and cancer colleague SteveBrothwell passed away in December2012. Steve and I met at the GreaterMidlands Cancer Network where hebecame more and more involved inworking to improve the patientexperience for cancer patients. He notonly became Chair of the NorthStafford Cancer forum, set up and ranThe Moles support group, he was ViceChair at the network before steppingup to become Chair of the networkbefore its closure. He also talked onlocal radio and campaigned MP’s tomention a few of the things he did.Steve became a user reviewer in 2010and Vice Chair of the NUSG in 2011,where he worked with enthusiasm,experience and knowledge on the MyCancer Treatment website.

Sian Hallewell, Vice-Chair NUSG

KeithFoster

SteveBrothwell

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www.mycancertreatment.nhs.ukHave a look at the site and find out about your local cancer services:

My Cancer Treatment (www.mycancertreatment.nhs.uk) is a new patientresource that provides easy access to all peer review reports, providinginformation to help patients decide where to be treated.

This initiative was strongly driven bythe National User Steering Group(NUSG), who strongly felt that allpatients and carers should be able toeasily access the reports detailing thequality and performance of NHS cancerservices. This also supports the currentgovernment agenda for transparency.

NUSG representatives were involved inall stages of the development and sincegoing live select members have beenactively involved in promoting the toolin their local areas, disseminatinginformation to GP surgeries, libraries,partnership groups and informationcentres. John and Sian wereinterviewed on local radio on BBC Essexand Shropshire. You can listen to John’sinterview on BBC Essex with DavidMonk here:http://www.mycancertreatment.nhs.uk/news/in-the-media/

We have recently agreed to work inpartnership with Macmillan CancerCare, accepting a two year grantagreement. We will work in together tofurther develop the tool and execute apromotional campaign. We willdisseminate information to allMacmillan information centres, as well

as pharmacies, GP surgeries and othercommunity centres, as well as hostinglaunch events. It is very exciting for MyCancer Treatment to have the supportof a well-known and respected cancercharity and we look forward toworking with them.

My Cancer Treatment is also proudlysupported by eight other cancercharities, who are included inappropriate reports to help signpostpatients and carers to their services.

We have also received support fromMaggie’s Caring Cancer Centres, whoare displaying posters and leaflets intheir five centres across England; WestLondon, Cheltenham, Oxford,Nottingham and Newcastle.

SINCE GOING LIVE IN

DECEMBER

2012THE SITE HAS ATTRACTED

23,564VISITORSAND CURRENTLY AVERAGES

92VISITORSA DAY, WITH

14%OF VISITORSRETURNINGTO THE SITE

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http://www.cquins.nhs.uk/download.php?d=/resources/key/Guide_to_Writing_Peer_Review_Reports_2013.pdf

Guide to Writing Reports

Before the ‘My CancerTreatment’ website wentlive, we trialled the sitewith one of our partners,Breakthrough BreastCancer, asking for views andfeedback from patients, aswell as Cancer Networkstaff and Trusts. One keyconcern was the languageof the reports and whetherpatients and carers couldunderstand them.

We’ve produced the Guideto help everyone who isinvolved in writing reports,whether they are panelmembers on external visits,people who sit on InternalValidation panels or TrustCancer Teams completingself-assessments.

This will help improve thelanguage and the contentof the reports, ensuringthat the website fulfils itspurpose of helping cancerpatients and carers to makean informed choice aboutwhere they receive theircancer care.

Often the most challenging part of anyPeer Review is writing the report!

The Guide is being distributed to all Trusts, cancer teams and Peer Reviewers. It isavailable to download on the CQuINS website here:

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User Reviewer SurveyOctober to December 2012A big thank you to all those who took the time to respondto the survey that took part in October-December 2012. Ofthe 228 people on the database, we received 124 completedquestionnaires (54%) and people who hadn’t respondedwere contacted by telephone.

What we learnt:The majority wish tocontinue as User PeerReviewers. However, 74people asked for theirdetails to be removedfrom the database and wereceived notification from3 family members thatreviewers had sadlypassed away.

Training for User Reviewers variedconsiderably but all comments werevery positive. The general consensuswas that future training shouldinclude:

• A run through of paperwork,explanation of the measures and theevidence required

• Practise session

• Timetable of a review day

• Buddying

The current training meets theserequirements with the exceptions of abuddying scheme. The results andcomments from the survey werepresented at the National User SteeringGroup Meeting on 24th April 2013 andhave helped to shape the way that newUser Reviewers are recruited,supported and trained in the future.

Key findings:

Should a user reviewerhave a cancer experience?

80said yes

15said no

Should there be a fixedterm of ‘office’?

19said yes

76said no

How long should a fixedterm of office be?

How many internal andexternal reviews haveyou undertaken over the2 year period?

Between 2 and 10

yearsBetween 0 and 49

Training

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New Process forRecruiting andSupporting UserReviewersA new process for recruiting, supporting andutilising user Reviewers has recently been agreed.

The Peer Review Team appreciates andacknowledges that User Reviewersremain a valuable and powerful part ofPeer Review visits. We have beenpassionate advocates of Peer Reviewover the years and many will bedisappointed when they are asked tostand down. However we need to ensurethat patients and carers with morerecent experiences of cancer have theopportunity to contribute to the PeerReview Programme.

The results of the survey undertaken insummer 2012 were widely discussed andconsidered in the context of the need to:• Recruit people with recent personal

cancer experiences;

• Fill gaps where there are shortages ofexpertise;

• Ensure there is consistency in therecruitment and retention of allreviewers, including healthcareprofessionals.

There are currently more than 150 userreviewers on the database which hasmeant that many people who haveapplied for Peer Review visits have notbeen offered a place on a panel. Thereare more than 50 User Reviewers whosepersonal experience of cancer was morethan 6 years ago.

Main changes agreed with the NUSGinclude:• User Reviewers will normally be

appointed for a period of 3 years;

• The database of User Reviewerswill be reviewed annually inSeptember

• User Reviewers will have ‘first hand’experience of services in the last 3years;

• An expectation that all new UserReviewers will access Peer Reviewdocuments on VIMS (Visit InformationManagement System); and

• Users identified by the Regional or theExecutive team as having particularskills or responsibilities will, with theagreement of the Executive Group beoffered a further 3 year term of office.

There will be a 3 year timetable forintroducing and managing the newprocess.

The VIMS was introduced in late 2011.The process of how User Reviewers arematched to vacancies has beenimproved: • All User Reviewers are circulated details

of forthcoming reviews.

• Users indicate which reviews they areavailable for and a table is sent to theRegional teams.

• The Regional teams select reviewteams, taking into account:− new user reviewers− the balance of team− reviews anticipated to be complex or

sensitive− distance to be travelled

New Reviewers will have access to a‘buddying system’ and receive feedbackfrom Quality Managers at their firstreview.

recent ‘first hand’experience

Update on:

ReviewerExpenses

Expenses will now bereimbursed by cheque whichwill be sent to your homeaddress, or the addressspecified on your expenseform. As usual forms are tobe sent to the NVMU, whonow will also be responsiblefor processing the forms, asopposed to the Financedepartment. This is greatnews as it means increasedefficiency, with expensesbeing processed weekly andcheques sent everyWednesday.

We would also like to takethis opportunity toapologise for the previousdelay some of you haveexperienced and assure youthat the backlog has beencleared and expenses willnow be paid within threeweeks of the NVMUreceiving the form.

There is a newprocess for approvingall expenses andhonorariums.

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NUSG Members

Chairing Team:Julie Oldroyd - User Co-Chair)

Sian Hallewell - User Vice-Chair

Tim Jackson - NHS Co-chair /Macmillan Nurse Director

http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/APPG/APPGC-Cancer-across-the-Domains-consultation-response-form.pdf

All Party ParliamentaryGroup on Cancer(APPGC) ‘Cancer Acrossthe Domains’ PublicConsultation

Service Users:North Region: Julie Oldroyd, Sian Hallewell, Liz Greer and Hugh Butcher

South Region: John Lancaster, Pat Mortimer and Jaff Newton

PPI FacilitatorColin Sloane

Peer Review Officers:Ruth Bridgeman - Programme Director

Dr John Schofield- Clinical Advisor

James Heasman- Quality Manager, South

Millie Forde- Assistant Quality Manager, North

National CancerPatient ExperienceSurvey (NCPES)

Sign the petitionto keep it going!The National Cancer Patient ExperienceSurvey currently collects feedback frommore than 70,000 patients a year. Howeverdespite its crucial role, continuation of thissurvey is under review by NHS England.Help make sure this vital survey continuesand sign the Macmillan petition to ensurethe National Patient Experience Surveycontinues, sign here:

http://campaigns.macmillan.org.uk/ea-action/action?ea.client.id=70&ea.campaign.id=21269&forwarded=true

Keeping cancer at the top ofthe parliamentary agenda, theAPPGC is producing a reportsetting out what they believeshould be the cancer prioritiesacross each of the fivedomains of NHS England. Tohelp shape the report they areasking for people’s views; ifyou would like to contributeplease complete the documentbefore 31st August.

How to Contact Us

There have been many changesto the NUSG over the last 18months to mirror the changesmade within the Peer Reviewteam. Membership reduced from27 to 13 and is evenly splitbetween the North and Southregions. If you would like toemail us with any views orconcerns, our address is:

Thank you,Julie Oldroyd and Sian Hallewell, Co-Chair and Vice-Chair of the NUSG

user.reviewer1@gmail.com

All programme’s staff contactdetails available on: www.nationalpeerreview.nhs.uk