SWAG Cancer Alliance Board Organisation Development project September 2019

1. SWAG Cancer Alliance Board Organisation Development project September 2019

2. Key themes from OD Diagnostic (March-April) What’s working well Identity and purpose Governance Systems Leadership Planning and processes Engagement including clinical

3. Overview of progress on OD action plan

4. Key context & common themes from OD work Continued development of local systems (STPs/ICS) and own OD processes Change in SWAG leadership: Sunita as p/t Alliance Manager/interim MD LTP implementation planning process • National guidance and requirements including single alliance cancer plan • SWAG approach General support for draft roles & responsibilities for SWAG/STPs but request to simplify Recognition of inherent tension in STPs with local financial pressures and wider strategic remit and nationally mandated Alliance with focus on national cancer priorities Recognition of need for continued strong SWAG programme management tracking investment & impact – demanding in complex evolving local systems Need for great senior strategic alignment across STPs/ICS with SWAG - how to reflect this in overall governance? Support for enhanced clinical engagement Local pick up of national priorities with transformational funding attached increasingly challenging where tight local funding & unrealisable savings. PCNs in early stages of development and very variable

5. NB Red = added since draft presented to Board Current “The Alliance is committed to taking the recommendations of Achieving World-Class Cancer Outcomes and making them a reality to the people of the Alliance. This will build on the many examples of excellence and innovation and a history of collaborative working. “ From SWAG Delivery Plan Jan 2017 Proposed The Alliance vision is to improve outcomes and experience of care for the cancer patients and populations of SWAG. The Alliance is a membership network and vehicle whose purpose is to ensure patients are at the heart of the system and to add value to and support Integrated Care Systems and STPs in the delivery of the National Cancer Programme and NHS Long Term Plan. The Alliance works collaboratively to plan and deliver improvements locally and across the wider system, sharing learning, good practice and resources across organisations. Proposed SWAG CA revised vision

6. SWAG CA Purpose Transformational objectives • Facilitate collaboration between multiple partners to improve cancer outcomes and access across SWAG • Across STP systems • Pan-STPs • Facilitate clinical collaboration and pathway mgmt.: • Co-ordinate and encourage collaboration to overcome system constraints to deliver quality services • Facilitating clinical groups, to develop pathways, protocols, patient guidelines, keeping up to date with national guidance/clinical guidelines • Searching out good practice, peer learning opportunities • Facilitate more joined-up services and sustainability, e.g. services for rarer cancer sites where multiple providers operate but lack population critical mass & struggle with workforce. • Ensure that pathways reflect patient and public feedback • Facilitate system wide intelligence on Cancer to inform STP/ICS decision-making (including workforce challenges) Transactional objectives • Agree the strategy for cancer across an area in collaboration with providers and commissioners • Lead service transformation: • Oversee a programme of transformation and investment • Co-ordinate Cancer Fund bids and create momentum for change/driving improvements • A conduit to : • Primary Care Networks (where early detection of Cancer is one of 7 priorities by 2022/23] • NHSE/I – Funding streams for initiatives • Influence Spec Commissioning and National programme • Link and coordinate with Radiotherapy Network • Supporting delivery of National Cancer Plan, including 28 day and 62 day standard. The CA should NOT act as a regulator or, commentator or performance manager

7. Organisation design principles for the Alliance Organisational arrangements in the Alliance must: Focus on Cancer outcomes and experience of care for patients and the wider population, with an emphasis on reducing inequalities Organise the Alliance as a collaborative network with distributed leadership Align with the configuration of emerging ICS and current STPs Design for subsidiarity (decisions are made as close to the patient as possible) based on roles and responsibilities at each level of the CA system • Issues are dealt with at the most immediate (or local) level consistent with their resolution • The Alliance acts where the objectives of the proposed action cannot be sufficiently achieved by or within STPs, by reason of the scale or where the effects of the proposed action are better achieved at Alliance level • Allow for local differences between ICS/STPs Be strategically consistent with the National Cancer Programme, NHS Long Term Plan, and locally flexible for ICS/STPs in its delivery Be co-designed with clinicians, patients and key stakeholders as our default way of working

8. The Strategic roles of the Cancer Alliance and ICS/STP: • Local: ICS/STP • Facilitate collaboration between multiple partners • Lead service transformation across the ICS/STP in partnership with the CA and service providers • Oversee the ICS/STP programme of transformation and investment • Co-ordinate Cancer plans at ICS/STP level and create momentum for improvement and transformation in outcomes and access • Identify and escalate issues needing CA support • Work in partnership with CA to achieve ambitions detailed in the Long Term Plan • Cancer Alliance: • Supra-STP/ICS • Oversight of whole cancer population • Facilitate system level transformation to improve outcomes and access • Sponsor proof of concept and innovation projects on behalf of the system • Facilitate system wide intelligence on Cancer to inform STP/ICS decision-making • Assess impact for service provision of national guidance and standards for Cancer services provision • Impact assessments for proposed cancer pathway changes • Work in partnership with ICS/STP and Primary Care Networks to achieve ambitions detailed in the Long Term Plan Shared Functions • Co-ordinate and encourage clinical collaboration to deliver quality cancer services • Facilitate clinical groups, to develop pathways, protocols, patient guidelines, in line with national guidance • Develop and support peer review for compliance in standards of cancer service provision and clinical variation. • Facilitate learning opportunities and sharing of good practice Two way reporting

9. Strategic roles of Cancer Alliance and ICS/STP: (v2 based on STP-SWAG bilaterals) • Local: ICS/STP • Facilitate collaboration between multiple local partners • Lead service transformation across the ICS/STP in partnership with the CA and service providers • Oversee the ICS/STP programme of transformation and investment • Co-ordinate Cancer plans at ICS/STP level and create momentum for improvement and transformation in outcomes and access • Identify and escalate issues needing CA support • Cancer Alliance: • Supra-STP/ICS • Oversight of whole cancer population • Identify & initiate CA system wide level transformation to improve outcomes and access • Sponsor proof of concept and innovation projects • Provide system wide intelligence on Cancer to inform local decision-making • Assess impact of national guidance and standards for Cancer services provision • Undertake Impact assessments for proposed cancer pathway changes Shared Functions • Co-ordinate and encourage clinical collaboration to deliver quality cancer services • Facilitate clinical groups, to develop pathways, protocols, patient guidelines, in line with national guidance • Develop and support peer review for compliance in standards of cancer service provision and clinical variation. • Facilitate learning opportunities and sharing of good practice • Partner to deliver Long Term Plan ambitions Two way reporting

10. The Operational roles of the Cancer Alliance and ICS/STP: • Cancer Alliance: • Supra-STP/ICS • Work with partners to agree the system strategy for cancer • Oversee local planning and implementation of the National Cancer Plan objectives • Provide guidance and advice on population-wide performance within SWAG • Co-ordinate Cancer Transformation Fund allocations and hold ICS/STP systems to account for agreed delivery of plans against the funding. • Broker flexibility and resources across the Alliance system to support SWAG-wide operational delivery of National Cancer Planning guidance • Local: ICS/STP • Oversee the local delivery of the National Cancer Strategy across the ICS/STP • Agree the local plan for cancer across the ICS/STP • Collective responsibility for operational delivery and performance against the National Cancer Plan, including all Cancer Standards • Oversee the planning and management of CA Transformation Funding to ensure proper application and accountability within the ICS/STP • Ensure ICS/STP co-ordination of all cancer investment to contribute to the local delivery of the National Cancer Plan. Shared Functions • Ensure robust system-wide governance and foster collective accountability • Ensure transparent and open communications Two way reporting

11. Operational roles of Cancer Alliance and ICS/STP: (v2 based on STP-SWAG bilaterals) • Cancer Alliance: • Supra-STP/ICS • Lead work with partners to agree the SWAG wide cancer strategy and planning and implementation of the National Cancer Plan objectives • Provide performance improvement support and advice on SWAG-wide and local system performance • Co-ordinate Cancer Transformation Fund allocations and hold ICS/STP systems to account for agreed delivery of plans against the funding. • Broker flexibility and resources across the Alliance system to support SWAG-wide operational delivery of National Cancer Planning guidance • Lead delivery of SWAG wide initiatives where appropriate and agreed • Local: ICS/STP • Contribute to development of SWAG cancer strategy and develop aligned local delivery plans • Accountable for operational delivery and performance against the National Cancer Plan, including all Cancer Standards • Ensure planning and management of devolved CA Transformation Funding to ensure proper application and accountability within the ICS/STP • Ensure ICS/STP co-ordination of all cancer investment to contribute to the local delivery of the National Cancer Plan. • Lead delivery of wider network initiatives as agreed Shared Functions • Ensure robust system-wide governance and foster collective accountability • Ensure transparent and open communications Two way reporting

12. Current SWAG structures

13. SWAG Cancer Network Site Specific Groups: Brain Breast CUP Colorectal Gynae Haem Head & Neck Lung Sarcoma Skin Urology Upper GI/HPB Regional/National Bath, Wiltshire and Swindon Cancer Steering Group Agreed Terms of Reference Clinical Lead: Amelia Randle Somerset CCG Macmillan GP Executive Lead: James Rimmer CEO WAHT Somerset Cancer Steering Group SWAG Cancer Alliance BoardInterim Managing Director: Sunita Berry SWAG Programme Manager: Patricia McLarnon Bristol, North Somerset, South Gloucestershire (BNSSG) Cancer Steering Group Gloucestershire Cancer Steering Group Transformation Steering Groups LWBC Group Prevention & Early Diagnosis All Cancer Steering Groups map to the local STP geography SWAG Operational Group Taunton &Somerset NHS FT also looks to the Peninsula Alliance

14. SSGs/Clinical Leads Interim Managing Director: Sunita Berry Clinical Lead: Amelia Randle Somerset CCG SWAG Programme Manager: Patricia McLarnon Prevention & Early Diagnosis Dr Sadaf Haque LWBC Dr Dorothy Goddard 1 WTE Pathway Project Manager 1 WTE Prevention & Early Diagnosis Project manager .6 Mac PPE Lead .8 Mac LWBC Evaluation/Commissioning Prof Raj Persad – Prostate Pathway Mr Mike Thomas – Colorectal Pathway Dr Henry Steer – Lung Pathway Project Support: Emma Derrick Amin Support: Harriet Munday Communications Lead to be appointed

15. STP/ICSs: Bristol, North Somerset and South Gloucestershire • STP Cancer Working Group reporting to STP in place • Chaired by SRO with system engagement • SRO, Peter Brindle, Medical Director of Clinical Effectiveness • BNSSG CCG. • Co-lead Gemma Artz, Head Of Performance Improvement (Planned Care) NHS Bristol, North Somerset & South Gloucestershire CCG • Telephone: 0117 900 2650 / 07969271130, • gemmaartz@nhs.net • Co –lead Andy Newton, Head of Planned Care • NHS Bristol, North Somerset & South Gloucestershire CCG • Tel: 0117 900 2199, Mobile: 07919 558 633 • anewton1@nhs.net • Clinical Lead, Dr Alison Wint • Specialised Care Clinical Lead & Macmillan GP at BNSSG CCG

16. STP/ICSs: Bath, Swindon and Wiltshire • STP Cancer Working Group. Andy and Jon co-chair an information sharing based cross BSW group. Not functioning as a governance group. • SRO, tbc by Nikki Millin, Interim STP Director of Strategy by end October 2019 • Lead Andy Jennings • Senior Commissioning Manager • NHS Wiltshire Clinical Commissioning Group • Tel: 01380 733 939 • Mob: 0755 7565 695 • Email: andyjennings@nhs.net • Clinical Lead, Dr Jon Cullis, Consultant Haematologist, Salisbury DH

17. STP/ICSs: Somerset • STP Cancer Working Group: under review by David Freeman • SRO, David Freeman, Chief Operating Officer, Somerset CCG • Lead: Rachel Rowe, Head of Long Term Conditions, Operations Directorate • Somerset Clinical Commissioning Group. • Wynford House | Lufton Way | Lufton | Yeovil | Somerset | BA22 8HR • Email:  rachael.rowe@nhs.net   | Telephone: 01935 385074 | • Clinical Lead,

18. ICSs: Gloucestershire • One Gloucestershire Cancer Clinical Programme Group. Chaired by Dr Hein le Roux. • Works on cross-system priorities and projects with range of stakeholders incl lay reps within overall Clinical Programme. • SRO, Ellen Rule, Director of Transformation and Service Redesign at Gloucestershire Clinical Commissioning Group, Interim Programme Director ICS • Lead, Kathryn Hall, Associate Director, Service Improvement and Redesign • Mobile: 07917 596942 Desk: 0300 4211402 •  NHS Gloucestershire Clinical Commissioning Group, Sanger House, Valiant Way, Gloucester Business Park, Brockworth, Gloucester, GL3 4FE • Clinical Lead, Dr Hein Le Roux , Deputy Chair CCG