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Clinical Leads Clinical Lead

Area

Dr Fath-Ordoubadi

Cardiac

Dr Khalil Kawafi

Stroke

Dr Mike Picton

Renal

Dr Simon Hardy

Vascular

Dr Mark Kellett

Neurological Conditions

Dr Sandeep Ranote

Child and Adolescent Mental Health

Prof Paul French

Mental Health

Dr Karen Bancroft

Maternity

Dr Geraldine Skailes

Cancer

Dr Susan Salt

Palliative and End of Life Care

Dr Sara Shackleton

Palliative and End of Life Care

Dr Mark Robinson

Children

Dr Naresh Kanumilli

Diabetes

Dr Amanda Thornton

Dementia

Julie Cheetham Deputy to Associate Director Maternity Children and Young People Julie.cheetham2@nhs.net

Maqsood Ahmad OBE Mental Health, Dementia, Neurological Conditions, Learning Disabilities, Palliative and End of Life Care maqsood.ahmad@nhs.net

INT RO DUCT IO N & ACHEIVEMENTS

John Herring Cancer john.herring@nhs.net

Julie Rigby Cardiovascular Disease and Neurological Conditions julie.rigby@nhs.net

2015/ 16

Foreword

Vision

The Strategic Clinical Network is proud of its continuing contribution to improving the health of the people of Greater Manchester, Lancashire and South Cumbria and April 2016 marked the beginning of a new dawn. On 1st April we saw South Cumbria and Lancashire joining with Cheshire and Merseyside Strategic Clinical Network and becoming known as the North West Coast Strategic Clinical Network, who will work closely with North West Coast Academic Health Science Network. At the same time the geography of Greater Manchester encompassed parts of Eastern Cheshire to be known as Greater Manchester and Eastern Cheshire Strategic Clinical Network as they join Greater Manchester Academic Health Science Network and forge ahead to support the Greater Manchester Health and Social Care Partnership.

The health and wellbeing of local people, and the care they receive, will be comparable with the best in the world.

These changes have largely come about as a result of the recommendations in the review of centrally funded improvement and leadership development functions led by Ed Smith, NHS England’s Deputy Chair and published in July 2015.

This report outlines much of the work that has been done. We are especially pleased when the Network has achieved ‘cross area working’ such as perinatal mental health, cardiac assessment prior to renal transplantation and end of life care for neurological conditions which have led to improvements in patient care. It is clear that clinicians welcome this cross-disciplinary work that is one of the great strengths of the clinical networks.

The review outlined the importance of the role of the Clinical Networks continuing role to Support health systems and improve health outcomes of local communities by connecting commissioners, providers, professionals and patients and the public The Strategic Clinical Network has also forged across a pathway of care to share best practice collaboration with other agencies and groups and innovation, measure and benchmark quality including Public Health England, Health Education and outcomes, and drive improvement. England, Manchester Academic Health Science Network, Healthier Lancashire and the Greater The review also recommended that AHSNs and Manchester Cancer Provider Board. The willingness Strategic Clinical Networks should be streamlined to work with others makes the integration in and their business plans aligned, so that they operate as a single support entity for their member Greater Manchester with the Academic Health Science Network a natural way forward. commissioners, providers and professionals.

Our Purpose Improve people’s health substantially by developing strategies that have wide clinical ownership and can be successfully implemented.

Our Values • Working together for patients • Respect and dignity • Commitment and quality of care • Compassion • Improving Lives

Despite all the many challenges that the national review brought and a significant cut to the SCN budget both the clinicians and the managers who work as part of the clinical network support team have worked hard to find innovative ways to improve services for the benefit of patients.

• Everyone counts

Janet Ratcliffe Associate Director janet.ratcliffe@nhs.net

A forum where clinicians, healthcare managers, patients, carers, and members of the public work in partnership to improve health outcomes for the population


Clinical Leads Clinical Lead

Area

Dr Fath-Ordoubadi

Cardiac

Dr Khalil Kawafi

Stroke

Dr Mike Picton

Renal

Dr Simon Hardy

Vascular

Dr Mark Kellett

Neurological Conditions

Dr Sandeep Ranote

Child and Adolescent Mental Health

Prof Paul French

Mental Health

Dr Karen Bancroft

Maternity

Dr Geraldine Skailes

Cancer

Dr Susan Salt

Palliative and End of Life Care

Dr Sara Shackleton

Palliative and End of Life Care

Dr Mark Robinson

Children

Dr Naresh Kanumilli

Diabetes

Dr Amanda Thornton

Dementia

Julie Cheetham Deputy to Associate Director Maternity Children and Young People Julie.cheetham2@nhs.net

Maqsood Ahmad OBE Mental Health, Dementia, Neurological Conditions, Learning Disabilities, Palliative and End of Life Care maqsood.ahmad@nhs.net

INT RO DUCT IO N & ACHEIVEMENTS

John Herring Cancer john.herring@nhs.net

Julie Rigby Cardiovascular Disease and Neurological Conditions julie.rigby@nhs.net

2015/ 16

Foreword

Vision

The Strategic Clinical Network is proud of its continuing contribution to improving the health of the people of Greater Manchester, Lancashire and South Cumbria and April 2016 marked the beginning of a new dawn. On 1st April we saw South Cumbria and Lancashire joining with Cheshire and Merseyside Strategic Clinical Network and becoming known as the North West Coast Strategic Clinical Network, who will work closely with North West Coast Academic Health Science Network. At the same time the geography of Greater Manchester encompassed parts of Eastern Cheshire to be known as Greater Manchester and Eastern Cheshire Strategic Clinical Network as they join Greater Manchester Academic Health Science Network and forge ahead to support the Greater Manchester Health and Social Care Partnership.

The health and wellbeing of local people, and the care they receive, will be comparable with the best in the world.

These changes have largely come about as a result of the recommendations in the review of centrally funded improvement and leadership development functions led by Ed Smith, NHS England’s Deputy Chair and published in July 2015.

This report outlines much of the work that has been done. We are especially pleased when the Network has achieved ‘cross area working’ such as perinatal mental health, cardiac assessment prior to renal transplantation and end of life care for neurological conditions which have led to improvements in patient care. It is clear that clinicians welcome this cross-disciplinary work that is one of the great strengths of the clinical networks.

The review outlined the importance of the role of the Clinical Networks continuing role to Support health systems and improve health outcomes of local communities by connecting commissioners, providers, professionals and patients and the public The Strategic Clinical Network has also forged across a pathway of care to share best practice collaboration with other agencies and groups and innovation, measure and benchmark quality including Public Health England, Health Education and outcomes, and drive improvement. England, Manchester Academic Health Science Network, Healthier Lancashire and the Greater The review also recommended that AHSNs and Manchester Cancer Provider Board. The willingness Strategic Clinical Networks should be streamlined to work with others makes the integration in and their business plans aligned, so that they operate as a single support entity for their member Greater Manchester with the Academic Health Science Network a natural way forward. commissioners, providers and professionals.

Our Purpose Improve people’s health substantially by developing strategies that have wide clinical ownership and can be successfully implemented.

Our Values • Working together for patients • Respect and dignity • Commitment and quality of care • Compassion • Improving Lives

Despite all the many challenges that the national review brought and a significant cut to the SCN budget both the clinicians and the managers who work as part of the clinical network support team have worked hard to find innovative ways to improve services for the benefit of patients.

• Everyone counts

Janet Ratcliffe Associate Director janet.ratcliffe@nhs.net

A forum where clinicians, healthcare managers, patients, carers, and members of the public work in partnership to improve health outcomes for the population


Clinical Leads Clinical Lead

Area

Dr Fath-Ordoubadi

Cardiac

Dr Khalil Kawafi

Stroke

Dr Mike Picton

Renal

Dr Simon Hardy

Vascular

Dr Mark Kellett

Neurological Conditions

Dr Sandeep Ranote

Child and Adolescent Mental Health

Prof Paul French

Mental Health

Dr Karen Bancroft

Maternity

Dr Geraldine Skailes

Cancer

Dr Susan Salt

Palliative and End of Life Care

Dr Sara Shackleton

Palliative and End of Life Care

Dr Mark Robinson

Children

Dr Naresh Kanumilli

Diabetes

Dr Amanda Thornton

Dementia

Julie Cheetham Deputy to Associate Director Maternity Children and Young People Julie.cheetham2@nhs.net

Maqsood Ahmad OBE Mental Health, Dementia, Neurological Conditions, Learning Disabilities, Palliative and End of Life Care maqsood.ahmad@nhs.net

INT RO DUCT IO N & ACHEIVEMENTS

John Herring Cancer john.herring@nhs.net

Julie Rigby Cardiovascular Disease and Neurological Conditions julie.rigby@nhs.net

2015/ 16

Foreword

Vision

The Strategic Clinical Network is proud of its continuing contribution to improving the health of the people of Greater Manchester, Lancashire and South Cumbria and April 2016 marked the beginning of a new dawn. On 1st April we saw South Cumbria and Lancashire joining with Cheshire and Merseyside Strategic Clinical Network and becoming known as the North West Coast Strategic Clinical Network, who will work closely with North West Coast Academic Health Science Network. At the same time the geography of Greater Manchester encompassed parts of Eastern Cheshire to be known as Greater Manchester and Eastern Cheshire Strategic Clinical Network as they join Greater Manchester Academic Health Science Network and forge ahead to support the Greater Manchester Health and Social Care Partnership.

The health and wellbeing of local people, and the care they receive, will be comparable with the best in the world.

These changes have largely come about as a result of the recommendations in the review of centrally funded improvement and leadership development functions led by Ed Smith, NHS England’s Deputy Chair and published in July 2015.

This report outlines much of the work that has been done. We are especially pleased when the Network has achieved ‘cross area working’ such as perinatal mental health, cardiac assessment prior to renal transplantation and end of life care for neurological conditions which have led to improvements in patient care. It is clear that clinicians welcome this cross-disciplinary work that is one of the great strengths of the clinical networks.

The review outlined the importance of the role of the Clinical Networks continuing role to Support health systems and improve health outcomes of local communities by connecting commissioners, providers, professionals and patients and the public The Strategic Clinical Network has also forged across a pathway of care to share best practice collaboration with other agencies and groups and innovation, measure and benchmark quality including Public Health England, Health Education and outcomes, and drive improvement. England, Manchester Academic Health Science Network, Healthier Lancashire and the Greater The review also recommended that AHSNs and Manchester Cancer Provider Board. The willingness Strategic Clinical Networks should be streamlined to work with others makes the integration in and their business plans aligned, so that they operate as a single support entity for their member Greater Manchester with the Academic Health Science Network a natural way forward. commissioners, providers and professionals.

Our Purpose Improve people’s health substantially by developing strategies that have wide clinical ownership and can be successfully implemented.

Our Values • Working together for patients • Respect and dignity • Commitment and quality of care • Compassion • Improving Lives

Despite all the many challenges that the national review brought and a significant cut to the SCN budget both the clinicians and the managers who work as part of the clinical network support team have worked hard to find innovative ways to improve services for the benefit of patients.

• Everyone counts

Janet Ratcliffe Associate Director janet.ratcliffe@nhs.net

A forum where clinicians, healthcare managers, patients, carers, and members of the public work in partnership to improve health outcomes for the population


Major Achievements in 2015/2016 Palliative and End of Life Care Network: Several pieces of guidance around Palliative and End of Life Care have been reviewed and updated, including the Just in Case Medication for last weeks/days of life guidance providing a consolidation of the list of subcutaneous drug, doses and frequency of administration that localities use for local advice. Also reviewed and updated in 2015 were the North West End of Life Care Model 2015, Pain and Symptom Control Guidelines and Dying Person in the Last Days and Hours of Life Guidelines. EPaCCS: A growing number of all our localities are live with some form of EPaCCS (Electronic Palliative Care Co-ordination Systems). Working with the Greater Manchester AHSN, we supported the delivery of NHS England’s objective to have a 70% rollout of electronic palliative care coordination systems across England by August 2015. Vocational rehab: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, a vocational rehabilitation project has been established in Lancashire and South Cumbria which aims to develop an evidence base for commissioners on the types of services that best support cancer patients in securing employment. Once developed, this evidence base will support commissioners in implementing services which improve employability and quality of life for cancer patients. The project will initially run as a two year pilot through Lancashire County Council Employment Support, Skills, Learning and Development Service. Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Pathway for Critical Limb Ischaemia (CLI): A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. Guideline for swollen legs: A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required. Stillbirth Guideline & Integrated Care Pathway: Following on from the success of Version 1 of the Stillbirth Guideline & Integrated Care Pathway (ICP) 2014/5, the Maternity, Children and Young Peoples network project Special Interest Group made additional changes based on feedback from its use in practice and recent clinical guidance. Version 2 of the Stillbirth Guideline & ICP was launched in December 2015. The guidance and ICP are now embedded in local providers and has also been adopted by other SCNs and gained national and international interest.

Maternity Quality Improvement Dashboard: The SCN Maternity, Children and Young Peoples’ network prioritised a project to specifically develop and analyse a network-wide maternity data set as part of its work programme. All trusts are completing and submitting monthly returns to the Network, who are collating and analysing the reports along with Special Interest Group to identify areas of best practice and areas for improvement. The completion of which is a key performance indicator included within the Greater Manchester Maternity specification as is provider representation at the group. The agreement of a set of indicators that should be developed to help local maternity systems to track, benchmark and improve the quality of maternity services is a key recommendation from the national maternity review – Better Births published in March this year. Palliative and end of life special interest groups: Four specialist interest groups were successfully established across Lancaster and Greater Manchester, each producing a programme of work, these being: Education and Training, Research and Audit, Care Coordination,Transforming Care. The Special Interest Groups have been embedded in the work of the SCNs and they are a standing item on the advisory group. NICE and education programme: The SCN is supporting implementation of the NICE guideline on ‘Suspected cancer: recognition and referral’ (2015) by producing an education resource that can be used to cascade training to GPs and nurse practitioners, developing an implementation model that provides practical advice on the systems that need to be in place to ensure effective implementation, developed generic 2ww referral forms that can be adapted by localities to reflect their pathways. Education and training network: We have managed and facilitated a cancer education and training network in Greater Manchester (GM), Lancashire and South Cumbria (LSC) since 2014. In 2016, as part of the reorganisation of the SCN structure, we have divided this to better meet the needs in GM and LSC respectively. Peer Review: The SCN has continued to support the Lancashire & South Cumbria clinical network groups in responding to the annual National Cancer Peer Review process. Working closely with the Chairs of the clinical network groups and other members, levels of compliance have been maintained year on year, thereby ensuring that all cancer services across the network footprint are working to the same standards. Improving Outcomes Guidance (IOG): The SCN continues to support commissioners to develop and achieve IOG compliant services in Greater Manchester, Lancashire and South Cumbria. Increased levels of IOG compliance in haematology services, for instance, are increasing patient safety and improving clinical delivery. We are also improving the clinical delivery of head and neck services by centralising the most specialist functions and future work will involve specialised urology surgery centralising onto one site within the Network. Psycho-Oncology - Macmillan paper, LSC work: The Greater Manchester Psycho-Oncology Pathway Group and the Lancashire & South Cumbria Psycho-Oncology Network Group have agreed to work together as a group of clinicians. This work has been facilitated by the Network alongside Manchester Cancer. As well as sharing good practice in regard to the treatment of Mental Health problems for people with a cancer diagnosis, they will also be looking at developing guidance which will support commissioners in decision making when commissioning these services in the future. ACE wave 2 - GM: In Greater Manchester the SCN worked in partnership with commissioners and providers on a proposal to the ACE Team to pilot the delivery of multi-diagnostic centres across the region. The Greater Manchester pilot was identified as one of five national sites for 2016/17 and will be delivered in Oldham and South Manchester in the first phase. ADHD Guidance for Children and Young People: The SCN has developed guidance for commissioners and providers on delivering services for children and young people who have or are suspected to have ADHD. The guidance is underpinned by clinical evidence and has been welcomed by key stakeholders across Greater Manchester. Implementation of the guidance across the region will happen in 2016/17. Supporting Greater Manchester’s new Cancer Vanguard: The Christie in partnership with Manchester Cancer and Trafford CCG successfully bid to develop a new Cancer Vanguard whose aim is to establish a single system provider for Greater Manchester Cancer Services. The focus will be on driving improvements in clinical outcomes and patient experience across the entire patient journey including health promotion, diagnosis and care. The SCN will work in partnership with the new Vanguard in 2016/17, strengthening relationships and adding value in areas where large numbers of stakeholders across a variety of organisations are required to work together to imrpove cancer outcomes.

Breaking down barriers to services: We know many communities experience barrier to services. The team attended an awareness session particularly focusing on the needs of trans people regarding early diagnosis. For example looking at what can be done to inform and encourage trans men to attend cervical screening if they have a cervix, and how we can increase awareness of prostate cancer for trans women. This year we’ve been working to develop plans for both community awareness and support for clinicians to be educated to meet the needs of trans people. Cancer Champions: Following on from the success of Cancer Champion work in GM last year a similar project was rolled out across Lancashire. The SCN liaised between Public Health England and Community CVS in Blackburn with Darwen to deliver an awareness session to aimed at increasing screening uptake in each CCG. Following on from the training session 16 organisation will receive a small contribution towards delivering interventions to communities who we know experience additional barriers to services eg. BME people and trans people. A session in Barrow in Furness is also booked in for early April. Oncology and Acute Oncology Review – development of a future model of care: The SCN, in collaboration with CCG and Acute Trust stakeholders, developed a project to review and make best evidence recommendations in regard to the provision of an Oncology and Acute Oncology service model across Lancashire & South Cumbria.

Pre-emptive transplant pathway: A project is underway to refine and optimise the pre-emptive transplant pathway, specifically the cardiac work up element. The aim is to create a common pathway to be adopted by CMFT, SRFT and LTHTR. After much discussion around the pathway and current ways of working, all three centres are in the process of finalising their internal process pathways accordingly. Improving access and waiting times for mental health: The SCN is working to improve EIP (Early Intervention in Psychosis) and IAPT (Improving Access to Psychological Therapies) NICE access rates and waiting time targets. We have supported the Northern Mental Health Operations Steering Group, worked in partnership with the North West Psychological Practitioners Network (PPN North West) and delivered workshops and presentation to Heads of Commissioning, providers and the Regional Medical Director. Continuing the sharing of good practice and service improvement, the SCN has established an IAPT steering group representing local areas across Greater Manchester and delivered EIP masterclasses. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020.

Network Clinical Groups: The SCN continue to support and administer a range of clinical network groups in Lancashire & South Cumbria enabling them to meet, develop network-wide clinical guidelines and audits, work plans and hold annual education events. This also contributes towards improved compliance with national Peer Review quality standards.

Supporting Commissioning Leadership: The SCN was joined by over 70 organisations at the Manchester Business School to participate in the first Mental Health Leadership Programme. Designed for the voluntary sector and organisations working with seldom heard groups, the event supported the Five Year Forward View and national mental health priorities to develop voluntary sector leaders, not just at a national level, but also locally.

Masterclass Education Series: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, the SCN provides support to the successful Masterclass series. The Masterclasses are tumour specific or cross-cutting themed events aimed at healthcare professionals with an interest in oncology. The series focus on the breadth of understanding of a specific tumour site. These events are extremely popular with healthcare professionals and attract a regular attendance of over 160 delegates.

Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’.

Best Practice Follow-Up Research Project: The SCN completed a study on oncology patient follow-up, and to gain perspectives from NHS staff about alternative models. The study comprised of a literature review, a qualitative interview study and a synthesis of the findings to produce preliminary recommendations for the future implementation of alternative follow-up models that can improve patient experience and outcomes while also reducing cost.

New Learning Disabilities Clinical Advisory Group established: We are supporting work across GM and Lancashire CCGs to scope existing learning disability provision, access and capacity across Greater Manchester to prevent and better respond to crisis presentations locally and address health inequalities and premature death. Greater Manchester and Lancashire were identified as Fast Track areas and successfully bid for matched funding from a national £10 million fund. Each area developed a Transforming Care Project Plan and is now working towards implementation. This work is led by the Greater Manchester Commissioners Network and the Lancashire and South Cumbria Commissioners Network which are supported by the SCN. To support this work the SCN hosted two successful Community Learning Disabilities Teams workshops.

Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Be Clear on Cancer: The SCN supports the National Be Clear on Cancer (BCOC) campaigns which are led by Public Health England in partnership with NHS England and Cancer Research UK. The campaigns aim to increase awareness of the signs and symptoms of cancer and improve survival outcomes through earlier detection. GP Strategic Leads and Cancer Champions are utilised to deliver key messages from the BCOC campaigns. The SCN has also engaged with local media to ensure that BCOC campaign messages are delivered locally alongside the national BCOC campaigns. Cancer Research UK Bowel Screening Campaign: The SCN has helped to promote the Cancer Research UK Bowel Screening Campaign, which aims to raise awareness of the NHS Bowel Cancer Screening Programme (benefits/eligibility) and encourage participation (particularly among 60 - 74 year olds). Vascular: A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Diabetes toolkit: A tool kit for diabetes has been developed, fronted by a set of recommendations that propose to local commissioners and providers ways to improve information and structured education for people with diabetes. The tool kit includes the minimum standard of information to be provided, how to re-enforce the information, how to review structured education and improve referral, awareness, attendance, recording and support from family. The recommendations and tool kit have recently been approved by local commissioners.

Our work on dementia: We have been working with schools on dementia awareness among young people, supporting Lancashire Dementia Voices (LDV) within Lancashire, to continue to raise awareness around dementia from a Dementia person’s perspective and what matters to them. We held a consultation on the newly proposed NHS England Well pathway for Dementia in November 2015 and from this have worked on Dementia awareness in BAME communities and we are working on the development of an integrated and holistic dementia care pathway. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required.


Major Achievements in 2015/2016 Palliative and End of Life Care Network: Several pieces of guidance around Palliative and End of Life Care have been reviewed and updated, including the Just in Case Medication for last weeks/days of life guidance providing a consolidation of the list of subcutaneous drug, doses and frequency of administration that localities use for local advice. Also reviewed and updated in 2015 were the North West End of Life Care Model 2015, Pain and Symptom Control Guidelines and Dying Person in the Last Days and Hours of Life Guidelines. EPaCCS: A growing number of all our localities are live with some form of EPaCCS (Electronic Palliative Care Co-ordination Systems). Working with the Greater Manchester AHSN, we supported the delivery of NHS England’s objective to have a 70% rollout of electronic palliative care coordination systems across England by August 2015. Vocational rehab: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, a vocational rehabilitation project has been established in Lancashire and South Cumbria which aims to develop an evidence base for commissioners on the types of services that best support cancer patients in securing employment. Once developed, this evidence base will support commissioners in implementing services which improve employability and quality of life for cancer patients. The project will initially run as a two year pilot through Lancashire County Council Employment Support, Skills, Learning and Development Service. Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Pathway for Critical Limb Ischaemia (CLI): A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. Guideline for swollen legs: A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required. Stillbirth Guideline & Integrated Care Pathway: Following on from the success of Version 1 of the Stillbirth Guideline & Integrated Care Pathway (ICP) 2014/5, the Maternity, Children and Young Peoples network project Special Interest Group made additional changes based on feedback from its use in practice and recent clinical guidance. Version 2 of the Stillbirth Guideline & ICP was launched in December 2015. The guidance and ICP are now embedded in local providers and has also been adopted by other SCNs and gained national and international interest.

Maternity Quality Improvement Dashboard: The SCN Maternity, Children and Young Peoples’ network prioritised a project to specifically develop and analyse a network-wide maternity data set as part of its work programme. All trusts are completing and submitting monthly returns to the Network, who are collating and analysing the reports along with Special Interest Group to identify areas of best practice and areas for improvement. The completion of which is a key performance indicator included within the Greater Manchester Maternity specification as is provider representation at the group. The agreement of a set of indicators that should be developed to help local maternity systems to track, benchmark and improve the quality of maternity services is a key recommendation from the national maternity review – Better Births published in March this year. Palliative and end of life special interest groups: Four specialist interest groups were successfully established across Lancaster and Greater Manchester, each producing a programme of work, these being: Education and Training, Research and Audit, Care Coordination,Transforming Care. The Special Interest Groups have been embedded in the work of the SCNs and they are a standing item on the advisory group. NICE and education programme: The SCN is supporting implementation of the NICE guideline on ‘Suspected cancer: recognition and referral’ (2015) by producing an education resource that can be used to cascade training to GPs and nurse practitioners, developing an implementation model that provides practical advice on the systems that need to be in place to ensure effective implementation, developed generic 2ww referral forms that can be adapted by localities to reflect their pathways. Education and training network: We have managed and facilitated a cancer education and training network in Greater Manchester (GM), Lancashire and South Cumbria (LSC) since 2014. In 2016, as part of the reorganisation of the SCN structure, we have divided this to better meet the needs in GM and LSC respectively. Peer Review: The SCN has continued to support the Lancashire & South Cumbria clinical network groups in responding to the annual National Cancer Peer Review process. Working closely with the Chairs of the clinical network groups and other members, levels of compliance have been maintained year on year, thereby ensuring that all cancer services across the network footprint are working to the same standards. Improving Outcomes Guidance (IOG): The SCN continues to support commissioners to develop and achieve IOG compliant services in Greater Manchester, Lancashire and South Cumbria. Increased levels of IOG compliance in haematology services, for instance, are increasing patient safety and improving clinical delivery. We are also improving the clinical delivery of head and neck services by centralising the most specialist functions and future work will involve specialised urology surgery centralising onto one site within the Network. Psycho-Oncology - Macmillan paper, LSC work: The Greater Manchester Psycho-Oncology Pathway Group and the Lancashire & South Cumbria Psycho-Oncology Network Group have agreed to work together as a group of clinicians. This work has been facilitated by the Network alongside Manchester Cancer. As well as sharing good practice in regard to the treatment of Mental Health problems for people with a cancer diagnosis, they will also be looking at developing guidance which will support commissioners in decision making when commissioning these services in the future. ACE wave 2 - GM: In Greater Manchester the SCN worked in partnership with commissioners and providers on a proposal to the ACE Team to pilot the delivery of multi-diagnostic centres across the region. The Greater Manchester pilot was identified as one of five national sites for 2016/17 and will be delivered in Oldham and South Manchester in the first phase. ADHD Guidance for Children and Young People: The SCN has developed guidance for commissioners and providers on delivering services for children and young people who have or are suspected to have ADHD. The guidance is underpinned by clinical evidence and has been welcomed by key stakeholders across Greater Manchester. Implementation of the guidance across the region will happen in 2016/17. Supporting Greater Manchester’s new Cancer Vanguard: The Christie in partnership with Manchester Cancer and Trafford CCG successfully bid to develop a new Cancer Vanguard whose aim is to establish a single system provider for Greater Manchester Cancer Services. The focus will be on driving improvements in clinical outcomes and patient experience across the entire patient journey including health promotion, diagnosis and care. The SCN will work in partnership with the new Vanguard in 2016/17, strengthening relationships and adding value in areas where large numbers of stakeholders across a variety of organisations are required to work together to imrpove cancer outcomes.

Breaking down barriers to services: We know many communities experience barrier to services. The team attended an awareness session particularly focusing on the needs of trans people regarding early diagnosis. For example looking at what can be done to inform and encourage trans men to attend cervical screening if they have a cervix, and how we can increase awareness of prostate cancer for trans women. This year we’ve been working to develop plans for both community awareness and support for clinicians to be educated to meet the needs of trans people. Cancer Champions: Following on from the success of Cancer Champion work in GM last year a similar project was rolled out across Lancashire. The SCN liaised between Public Health England and Community CVS in Blackburn with Darwen to deliver an awareness session to aimed at increasing screening uptake in each CCG. Following on from the training session 16 organisation will receive a small contribution towards delivering interventions to communities who we know experience additional barriers to services eg. BME people and trans people. A session in Barrow in Furness is also booked in for early April. Oncology and Acute Oncology Review – development of a future model of care: The SCN, in collaboration with CCG and Acute Trust stakeholders, developed a project to review and make best evidence recommendations in regard to the provision of an Oncology and Acute Oncology service model across Lancashire & South Cumbria.

Pre-emptive transplant pathway: A project is underway to refine and optimise the pre-emptive transplant pathway, specifically the cardiac work up element. The aim is to create a common pathway to be adopted by CMFT, SRFT and LTHTR. After much discussion around the pathway and current ways of working, all three centres are in the process of finalising their internal process pathways accordingly. Improving access and waiting times for mental health: The SCN is working to improve EIP (Early Intervention in Psychosis) and IAPT (Improving Access to Psychological Therapies) NICE access rates and waiting time targets. We have supported the Northern Mental Health Operations Steering Group, worked in partnership with the North West Psychological Practitioners Network (PPN North West) and delivered workshops and presentation to Heads of Commissioning, providers and the Regional Medical Director. Continuing the sharing of good practice and service improvement, the SCN has established an IAPT steering group representing local areas across Greater Manchester and delivered EIP masterclasses. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020.

Network Clinical Groups: The SCN continue to support and administer a range of clinical network groups in Lancashire & South Cumbria enabling them to meet, develop network-wide clinical guidelines and audits, work plans and hold annual education events. This also contributes towards improved compliance with national Peer Review quality standards.

Supporting Commissioning Leadership: The SCN was joined by over 70 organisations at the Manchester Business School to participate in the first Mental Health Leadership Programme. Designed for the voluntary sector and organisations working with seldom heard groups, the event supported the Five Year Forward View and national mental health priorities to develop voluntary sector leaders, not just at a national level, but also locally.

Masterclass Education Series: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, the SCN provides support to the successful Masterclass series. The Masterclasses are tumour specific or cross-cutting themed events aimed at healthcare professionals with an interest in oncology. The series focus on the breadth of understanding of a specific tumour site. These events are extremely popular with healthcare professionals and attract a regular attendance of over 160 delegates.

Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’.

Best Practice Follow-Up Research Project: The SCN completed a study on oncology patient follow-up, and to gain perspectives from NHS staff about alternative models. The study comprised of a literature review, a qualitative interview study and a synthesis of the findings to produce preliminary recommendations for the future implementation of alternative follow-up models that can improve patient experience and outcomes while also reducing cost.

New Learning Disabilities Clinical Advisory Group established: We are supporting work across GM and Lancashire CCGs to scope existing learning disability provision, access and capacity across Greater Manchester to prevent and better respond to crisis presentations locally and address health inequalities and premature death. Greater Manchester and Lancashire were identified as Fast Track areas and successfully bid for matched funding from a national £10 million fund. Each area developed a Transforming Care Project Plan and is now working towards implementation. This work is led by the Greater Manchester Commissioners Network and the Lancashire and South Cumbria Commissioners Network which are supported by the SCN. To support this work the SCN hosted two successful Community Learning Disabilities Teams workshops.

Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Be Clear on Cancer: The SCN supports the National Be Clear on Cancer (BCOC) campaigns which are led by Public Health England in partnership with NHS England and Cancer Research UK. The campaigns aim to increase awareness of the signs and symptoms of cancer and improve survival outcomes through earlier detection. GP Strategic Leads and Cancer Champions are utilised to deliver key messages from the BCOC campaigns. The SCN has also engaged with local media to ensure that BCOC campaign messages are delivered locally alongside the national BCOC campaigns. Cancer Research UK Bowel Screening Campaign: The SCN has helped to promote the Cancer Research UK Bowel Screening Campaign, which aims to raise awareness of the NHS Bowel Cancer Screening Programme (benefits/eligibility) and encourage participation (particularly among 60 - 74 year olds). Vascular: A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Diabetes toolkit: A tool kit for diabetes has been developed, fronted by a set of recommendations that propose to local commissioners and providers ways to improve information and structured education for people with diabetes. The tool kit includes the minimum standard of information to be provided, how to re-enforce the information, how to review structured education and improve referral, awareness, attendance, recording and support from family. The recommendations and tool kit have recently been approved by local commissioners.

Our work on dementia: We have been working with schools on dementia awareness among young people, supporting Lancashire Dementia Voices (LDV) within Lancashire, to continue to raise awareness around dementia from a Dementia person’s perspective and what matters to them. We held a consultation on the newly proposed NHS England Well pathway for Dementia in November 2015 and from this have worked on Dementia awareness in BAME communities and we are working on the development of an integrated and holistic dementia care pathway. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required.


Major Achievements in 2015/2016 Palliative and End of Life Care Network: Several pieces of guidance around Palliative and End of Life Care have been reviewed and updated, including the Just in Case Medication for last weeks/days of life guidance providing a consolidation of the list of subcutaneous drug, doses and frequency of administration that localities use for local advice. Also reviewed and updated in 2015 were the North West End of Life Care Model 2015, Pain and Symptom Control Guidelines and Dying Person in the Last Days and Hours of Life Guidelines. EPaCCS: A growing number of all our localities are live with some form of EPaCCS (Electronic Palliative Care Co-ordination Systems). Working with the Greater Manchester AHSN, we supported the delivery of NHS England’s objective to have a 70% rollout of electronic palliative care coordination systems across England by August 2015. Vocational rehab: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, a vocational rehabilitation project has been established in Lancashire and South Cumbria which aims to develop an evidence base for commissioners on the types of services that best support cancer patients in securing employment. Once developed, this evidence base will support commissioners in implementing services which improve employability and quality of life for cancer patients. The project will initially run as a two year pilot through Lancashire County Council Employment Support, Skills, Learning and Development Service. Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Pathway for Critical Limb Ischaemia (CLI): A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. Guideline for swollen legs: A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required. Stillbirth Guideline & Integrated Care Pathway: Following on from the success of Version 1 of the Stillbirth Guideline & Integrated Care Pathway (ICP) 2014/5, the Maternity, Children and Young Peoples network project Special Interest Group made additional changes based on feedback from its use in practice and recent clinical guidance. Version 2 of the Stillbirth Guideline & ICP was launched in December 2015. The guidance and ICP are now embedded in local providers and has also been adopted by other SCNs and gained national and international interest.

Maternity Quality Improvement Dashboard: The SCN Maternity, Children and Young Peoples’ network prioritised a project to specifically develop and analyse a network-wide maternity data set as part of its work programme. All trusts are completing and submitting monthly returns to the Network, who are collating and analysing the reports along with Special Interest Group to identify areas of best practice and areas for improvement. The completion of which is a key performance indicator included within the Greater Manchester Maternity specification as is provider representation at the group. The agreement of a set of indicators that should be developed to help local maternity systems to track, benchmark and improve the quality of maternity services is a key recommendation from the national maternity review – Better Births published in March this year. Palliative and end of life special interest groups: Four specialist interest groups were successfully established across Lancaster and Greater Manchester, each producing a programme of work, these being: Education and Training, Research and Audit, Care Coordination,Transforming Care. The Special Interest Groups have been embedded in the work of the SCNs and they are a standing item on the advisory group. NICE and education programme: The SCN is supporting implementation of the NICE guideline on ‘Suspected cancer: recognition and referral’ (2015) by producing an education resource that can be used to cascade training to GPs and nurse practitioners, developing an implementation model that provides practical advice on the systems that need to be in place to ensure effective implementation, developed generic 2ww referral forms that can be adapted by localities to reflect their pathways. Education and training network: We have managed and facilitated a cancer education and training network in Greater Manchester (GM), Lancashire and South Cumbria (LSC) since 2014. In 2016, as part of the reorganisation of the SCN structure, we have divided this to better meet the needs in GM and LSC respectively. Peer Review: The SCN has continued to support the Lancashire & South Cumbria clinical network groups in responding to the annual National Cancer Peer Review process. Working closely with the Chairs of the clinical network groups and other members, levels of compliance have been maintained year on year, thereby ensuring that all cancer services across the network footprint are working to the same standards. Improving Outcomes Guidance (IOG): The SCN continues to support commissioners to develop and achieve IOG compliant services in Greater Manchester, Lancashire and South Cumbria. Increased levels of IOG compliance in haematology services, for instance, are increasing patient safety and improving clinical delivery. We are also improving the clinical delivery of head and neck services by centralising the most specialist functions and future work will involve specialised urology surgery centralising onto one site within the Network. Psycho-Oncology - Macmillan paper, LSC work: The Greater Manchester Psycho-Oncology Pathway Group and the Lancashire & South Cumbria Psycho-Oncology Network Group have agreed to work together as a group of clinicians. This work has been facilitated by the Network alongside Manchester Cancer. As well as sharing good practice in regard to the treatment of Mental Health problems for people with a cancer diagnosis, they will also be looking at developing guidance which will support commissioners in decision making when commissioning these services in the future. ACE wave 2 - GM: In Greater Manchester the SCN worked in partnership with commissioners and providers on a proposal to the ACE Team to pilot the delivery of multi-diagnostic centres across the region. The Greater Manchester pilot was identified as one of five national sites for 2016/17 and will be delivered in Oldham and South Manchester in the first phase. ADHD Guidance for Children and Young People: The SCN has developed guidance for commissioners and providers on delivering services for children and young people who have or are suspected to have ADHD. The guidance is underpinned by clinical evidence and has been welcomed by key stakeholders across Greater Manchester. Implementation of the guidance across the region will happen in 2016/17. Supporting Greater Manchester’s new Cancer Vanguard: The Christie in partnership with Manchester Cancer and Trafford CCG successfully bid to develop a new Cancer Vanguard whose aim is to establish a single system provider for Greater Manchester Cancer Services. The focus will be on driving improvements in clinical outcomes and patient experience across the entire patient journey including health promotion, diagnosis and care. The SCN will work in partnership with the new Vanguard in 2016/17, strengthening relationships and adding value in areas where large numbers of stakeholders across a variety of organisations are required to work together to imrpove cancer outcomes.

Breaking down barriers to services: We know many communities experience barrier to services. The team attended an awareness session particularly focusing on the needs of trans people regarding early diagnosis. For example looking at what can be done to inform and encourage trans men to attend cervical screening if they have a cervix, and how we can increase awareness of prostate cancer for trans women. This year we’ve been working to develop plans for both community awareness and support for clinicians to be educated to meet the needs of trans people. Cancer Champions: Following on from the success of Cancer Champion work in GM last year a similar project was rolled out across Lancashire. The SCN liaised between Public Health England and Community CVS in Blackburn with Darwen to deliver an awareness session to aimed at increasing screening uptake in each CCG. Following on from the training session 16 organisation will receive a small contribution towards delivering interventions to communities who we know experience additional barriers to services eg. BME people and trans people. A session in Barrow in Furness is also booked in for early April. Oncology and Acute Oncology Review – development of a future model of care: The SCN, in collaboration with CCG and Acute Trust stakeholders, developed a project to review and make best evidence recommendations in regard to the provision of an Oncology and Acute Oncology service model across Lancashire & South Cumbria.

Pre-emptive transplant pathway: A project is underway to refine and optimise the pre-emptive transplant pathway, specifically the cardiac work up element. The aim is to create a common pathway to be adopted by CMFT, SRFT and LTHTR. After much discussion around the pathway and current ways of working, all three centres are in the process of finalising their internal process pathways accordingly. Improving access and waiting times for mental health: The SCN is working to improve EIP (Early Intervention in Psychosis) and IAPT (Improving Access to Psychological Therapies) NICE access rates and waiting time targets. We have supported the Northern Mental Health Operations Steering Group, worked in partnership with the North West Psychological Practitioners Network (PPN North West) and delivered workshops and presentation to Heads of Commissioning, providers and the Regional Medical Director. Continuing the sharing of good practice and service improvement, the SCN has established an IAPT steering group representing local areas across Greater Manchester and delivered EIP masterclasses. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020.

Network Clinical Groups: The SCN continue to support and administer a range of clinical network groups in Lancashire & South Cumbria enabling them to meet, develop network-wide clinical guidelines and audits, work plans and hold annual education events. This also contributes towards improved compliance with national Peer Review quality standards.

Supporting Commissioning Leadership: The SCN was joined by over 70 organisations at the Manchester Business School to participate in the first Mental Health Leadership Programme. Designed for the voluntary sector and organisations working with seldom heard groups, the event supported the Five Year Forward View and national mental health priorities to develop voluntary sector leaders, not just at a national level, but also locally.

Masterclass Education Series: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, the SCN provides support to the successful Masterclass series. The Masterclasses are tumour specific or cross-cutting themed events aimed at healthcare professionals with an interest in oncology. The series focus on the breadth of understanding of a specific tumour site. These events are extremely popular with healthcare professionals and attract a regular attendance of over 160 delegates.

Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’.

Best Practice Follow-Up Research Project: The SCN completed a study on oncology patient follow-up, and to gain perspectives from NHS staff about alternative models. The study comprised of a literature review, a qualitative interview study and a synthesis of the findings to produce preliminary recommendations for the future implementation of alternative follow-up models that can improve patient experience and outcomes while also reducing cost.

New Learning Disabilities Clinical Advisory Group established: We are supporting work across GM and Lancashire CCGs to scope existing learning disability provision, access and capacity across Greater Manchester to prevent and better respond to crisis presentations locally and address health inequalities and premature death. Greater Manchester and Lancashire were identified as Fast Track areas and successfully bid for matched funding from a national £10 million fund. Each area developed a Transforming Care Project Plan and is now working towards implementation. This work is led by the Greater Manchester Commissioners Network and the Lancashire and South Cumbria Commissioners Network which are supported by the SCN. To support this work the SCN hosted two successful Community Learning Disabilities Teams workshops.

Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Be Clear on Cancer: The SCN supports the National Be Clear on Cancer (BCOC) campaigns which are led by Public Health England in partnership with NHS England and Cancer Research UK. The campaigns aim to increase awareness of the signs and symptoms of cancer and improve survival outcomes through earlier detection. GP Strategic Leads and Cancer Champions are utilised to deliver key messages from the BCOC campaigns. The SCN has also engaged with local media to ensure that BCOC campaign messages are delivered locally alongside the national BCOC campaigns. Cancer Research UK Bowel Screening Campaign: The SCN has helped to promote the Cancer Research UK Bowel Screening Campaign, which aims to raise awareness of the NHS Bowel Cancer Screening Programme (benefits/eligibility) and encourage participation (particularly among 60 - 74 year olds). Vascular: A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Diabetes toolkit: A tool kit for diabetes has been developed, fronted by a set of recommendations that propose to local commissioners and providers ways to improve information and structured education for people with diabetes. The tool kit includes the minimum standard of information to be provided, how to re-enforce the information, how to review structured education and improve referral, awareness, attendance, recording and support from family. The recommendations and tool kit have recently been approved by local commissioners.

Our work on dementia: We have been working with schools on dementia awareness among young people, supporting Lancashire Dementia Voices (LDV) within Lancashire, to continue to raise awareness around dementia from a Dementia person’s perspective and what matters to them. We held a consultation on the newly proposed NHS England Well pathway for Dementia in November 2015 and from this have worked on Dementia awareness in BAME communities and we are working on the development of an integrated and holistic dementia care pathway. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required.


Major Achievements in 2015/2016 Palliative and End of Life Care Network: Several pieces of guidance around Palliative and End of Life Care have been reviewed and updated, including the Just in Case Medication for last weeks/days of life guidance providing a consolidation of the list of subcutaneous drug, doses and frequency of administration that localities use for local advice. Also reviewed and updated in 2015 were the North West End of Life Care Model 2015, Pain and Symptom Control Guidelines and Dying Person in the Last Days and Hours of Life Guidelines. EPaCCS: A growing number of all our localities are live with some form of EPaCCS (Electronic Palliative Care Co-ordination Systems). Working with the Greater Manchester AHSN, we supported the delivery of NHS England’s objective to have a 70% rollout of electronic palliative care coordination systems across England by August 2015. Vocational rehab: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, a vocational rehabilitation project has been established in Lancashire and South Cumbria which aims to develop an evidence base for commissioners on the types of services that best support cancer patients in securing employment. Once developed, this evidence base will support commissioners in implementing services which improve employability and quality of life for cancer patients. The project will initially run as a two year pilot through Lancashire County Council Employment Support, Skills, Learning and Development Service. Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Pathway for Critical Limb Ischaemia (CLI): A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. Guideline for swollen legs: A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required. Stillbirth Guideline & Integrated Care Pathway: Following on from the success of Version 1 of the Stillbirth Guideline & Integrated Care Pathway (ICP) 2014/5, the Maternity, Children and Young Peoples network project Special Interest Group made additional changes based on feedback from its use in practice and recent clinical guidance. Version 2 of the Stillbirth Guideline & ICP was launched in December 2015. The guidance and ICP are now embedded in local providers and has also been adopted by other SCNs and gained national and international interest.

Maternity Quality Improvement Dashboard: The SCN Maternity, Children and Young Peoples’ network prioritised a project to specifically develop and analyse a network-wide maternity data set as part of its work programme. All trusts are completing and submitting monthly returns to the Network, who are collating and analysing the reports along with Special Interest Group to identify areas of best practice and areas for improvement. The completion of which is a key performance indicator included within the Greater Manchester Maternity specification as is provider representation at the group. The agreement of a set of indicators that should be developed to help local maternity systems to track, benchmark and improve the quality of maternity services is a key recommendation from the national maternity review – Better Births published in March this year. Palliative and end of life special interest groups: Four specialist interest groups were successfully established across Lancaster and Greater Manchester, each producing a programme of work, these being: Education and Training, Research and Audit, Care Coordination,Transforming Care. The Special Interest Groups have been embedded in the work of the SCNs and they are a standing item on the advisory group. NICE and education programme: The SCN is supporting implementation of the NICE guideline on ‘Suspected cancer: recognition and referral’ (2015) by producing an education resource that can be used to cascade training to GPs and nurse practitioners, developing an implementation model that provides practical advice on the systems that need to be in place to ensure effective implementation, developed generic 2ww referral forms that can be adapted by localities to reflect their pathways. Education and training network: We have managed and facilitated a cancer education and training network in Greater Manchester (GM), Lancashire and South Cumbria (LSC) since 2014. In 2016, as part of the reorganisation of the SCN structure, we have divided this to better meet the needs in GM and LSC respectively. Peer Review: The SCN has continued to support the Lancashire & South Cumbria clinical network groups in responding to the annual National Cancer Peer Review process. Working closely with the Chairs of the clinical network groups and other members, levels of compliance have been maintained year on year, thereby ensuring that all cancer services across the network footprint are working to the same standards. Improving Outcomes Guidance (IOG): The SCN continues to support commissioners to develop and achieve IOG compliant services in Greater Manchester, Lancashire and South Cumbria. Increased levels of IOG compliance in haematology services, for instance, are increasing patient safety and improving clinical delivery. We are also improving the clinical delivery of head and neck services by centralising the most specialist functions and future work will involve specialised urology surgery centralising onto one site within the Network. Psycho-Oncology - Macmillan paper, LSC work: The Greater Manchester Psycho-Oncology Pathway Group and the Lancashire & South Cumbria Psycho-Oncology Network Group have agreed to work together as a group of clinicians. This work has been facilitated by the Network alongside Manchester Cancer. As well as sharing good practice in regard to the treatment of Mental Health problems for people with a cancer diagnosis, they will also be looking at developing guidance which will support commissioners in decision making when commissioning these services in the future. ACE wave 2 - GM: In Greater Manchester the SCN worked in partnership with commissioners and providers on a proposal to the ACE Team to pilot the delivery of multi-diagnostic centres across the region. The Greater Manchester pilot was identified as one of five national sites for 2016/17 and will be delivered in Oldham and South Manchester in the first phase. ADHD Guidance for Children and Young People: The SCN has developed guidance for commissioners and providers on delivering services for children and young people who have or are suspected to have ADHD. The guidance is underpinned by clinical evidence and has been welcomed by key stakeholders across Greater Manchester. Implementation of the guidance across the region will happen in 2016/17. Supporting Greater Manchester’s new Cancer Vanguard: The Christie in partnership with Manchester Cancer and Trafford CCG successfully bid to develop a new Cancer Vanguard whose aim is to establish a single system provider for Greater Manchester Cancer Services. The focus will be on driving improvements in clinical outcomes and patient experience across the entire patient journey including health promotion, diagnosis and care. The SCN will work in partnership with the new Vanguard in 2016/17, strengthening relationships and adding value in areas where large numbers of stakeholders across a variety of organisations are required to work together to imrpove cancer outcomes.

Breaking down barriers to services: We know many communities experience barrier to services. The team attended an awareness session particularly focusing on the needs of trans people regarding early diagnosis. For example looking at what can be done to inform and encourage trans men to attend cervical screening if they have a cervix, and how we can increase awareness of prostate cancer for trans women. This year we’ve been working to develop plans for both community awareness and support for clinicians to be educated to meet the needs of trans people. Cancer Champions: Following on from the success of Cancer Champion work in GM last year a similar project was rolled out across Lancashire. The SCN liaised between Public Health England and Community CVS in Blackburn with Darwen to deliver an awareness session to aimed at increasing screening uptake in each CCG. Following on from the training session 16 organisation will receive a small contribution towards delivering interventions to communities who we know experience additional barriers to services eg. BME people and trans people. A session in Barrow in Furness is also booked in for early April. Oncology and Acute Oncology Review – development of a future model of care: The SCN, in collaboration with CCG and Acute Trust stakeholders, developed a project to review and make best evidence recommendations in regard to the provision of an Oncology and Acute Oncology service model across Lancashire & South Cumbria.

Pre-emptive transplant pathway: A project is underway to refine and optimise the pre-emptive transplant pathway, specifically the cardiac work up element. The aim is to create a common pathway to be adopted by CMFT, SRFT and LTHTR. After much discussion around the pathway and current ways of working, all three centres are in the process of finalising their internal process pathways accordingly. Improving access and waiting times for mental health: The SCN is working to improve EIP (Early Intervention in Psychosis) and IAPT (Improving Access to Psychological Therapies) NICE access rates and waiting time targets. We have supported the Northern Mental Health Operations Steering Group, worked in partnership with the North West Psychological Practitioners Network (PPN North West) and delivered workshops and presentation to Heads of Commissioning, providers and the Regional Medical Director. Continuing the sharing of good practice and service improvement, the SCN has established an IAPT steering group representing local areas across Greater Manchester and delivered EIP masterclasses. Supporting Liaison Mental Health: The SCN has worked in partnership with providers to establish a Liaison Mental Health advisory panel, engaging with clinical lead professionals to provide expert advice and information on the national objective of establishing Core24 Liaison mental health services in all acute hospitals by 2020.

Network Clinical Groups: The SCN continue to support and administer a range of clinical network groups in Lancashire & South Cumbria enabling them to meet, develop network-wide clinical guidelines and audits, work plans and hold annual education events. This also contributes towards improved compliance with national Peer Review quality standards.

Supporting Commissioning Leadership: The SCN was joined by over 70 organisations at the Manchester Business School to participate in the first Mental Health Leadership Programme. Designed for the voluntary sector and organisations working with seldom heard groups, the event supported the Five Year Forward View and national mental health priorities to develop voluntary sector leaders, not just at a national level, but also locally.

Masterclass Education Series: In collaboration with Lancashire Teaching Hospitals NHS Foundation Trust, the SCN provides support to the successful Masterclass series. The Masterclasses are tumour specific or cross-cutting themed events aimed at healthcare professionals with an interest in oncology. The series focus on the breadth of understanding of a specific tumour site. These events are extremely popular with healthcare professionals and attract a regular attendance of over 160 delegates.

Support for GM Devolution: To support GM Devolution, the SCN has facilitated a consultation to understand health challenges across Greater Manchester, and using our strong links and networks with voluntary and community organisations we ran a workshop to understand the issues and challenges the community faces. We also facilitated an Equality Impact Analysis (EIA) to identify within the plans for devolution across GM that the changes excludes or disadvantage any individual or groups including those with ‘protected characteristic’.

Best Practice Follow-Up Research Project: The SCN completed a study on oncology patient follow-up, and to gain perspectives from NHS staff about alternative models. The study comprised of a literature review, a qualitative interview study and a synthesis of the findings to produce preliminary recommendations for the future implementation of alternative follow-up models that can improve patient experience and outcomes while also reducing cost.

New Learning Disabilities Clinical Advisory Group established: We are supporting work across GM and Lancashire CCGs to scope existing learning disability provision, access and capacity across Greater Manchester to prevent and better respond to crisis presentations locally and address health inequalities and premature death. Greater Manchester and Lancashire were identified as Fast Track areas and successfully bid for matched funding from a national £10 million fund. Each area developed a Transforming Care Project Plan and is now working towards implementation. This work is led by the Greater Manchester Commissioners Network and the Lancashire and South Cumbria Commissioners Network which are supported by the SCN. To support this work the SCN hosted two successful Community Learning Disabilities Teams workshops.

Development of the cancer dashboard toolkit: A comprehensive cancer data toolkit has been developed for stakeholders which provides information on prevalence, incidence, mortality, screening, 1 year survival, routes to diagnosis, cancer waiting times and patient experience. The toolkit is available on-line on the SCN website. Be Clear on Cancer: The SCN supports the National Be Clear on Cancer (BCOC) campaigns which are led by Public Health England in partnership with NHS England and Cancer Research UK. The campaigns aim to increase awareness of the signs and symptoms of cancer and improve survival outcomes through earlier detection. GP Strategic Leads and Cancer Champions are utilised to deliver key messages from the BCOC campaigns. The SCN has also engaged with local media to ensure that BCOC campaign messages are delivered locally alongside the national BCOC campaigns. Cancer Research UK Bowel Screening Campaign: The SCN has helped to promote the Cancer Research UK Bowel Screening Campaign, which aims to raise awareness of the NHS Bowel Cancer Screening Programme (benefits/eligibility) and encourage participation (particularly among 60 - 74 year olds). Vascular: A pathway for Critical Limb Ischaemia (CLI) has been developed and adopted by local services across the network area. Local training has also been provided on the identification and management of CLI. A guideline for swollen legs; in particular Deep Vein Thrombosis has been adopted by Greater Manchester providers. A community model of care has been developed to improve access to vascular services in Lancashire. This has been now approved by Lancashire commissioners. Diabetes toolkit: A tool kit for diabetes has been developed, fronted by a set of recommendations that propose to local commissioners and providers ways to improve information and structured education for people with diabetes. The tool kit includes the minimum standard of information to be provided, how to re-enforce the information, how to review structured education and improve referral, awareness, attendance, recording and support from family. The recommendations and tool kit have recently been approved by local commissioners.

Our work on dementia: We have been working with schools on dementia awareness among young people, supporting Lancashire Dementia Voices (LDV) within Lancashire, to continue to raise awareness around dementia from a Dementia person’s perspective and what matters to them. We held a consultation on the newly proposed NHS England Well pathway for Dementia in November 2015 and from this have worked on Dementia awareness in BAME communities and we are working on the development of an integrated and holistic dementia care pathway. Faith Champions project: The Faith Champions project is specifically targeted to identify and train members of the faith community to help further develop and support the mental health agenda. This group was specifically chosen to provide support and services to those more vulnerable members of the community who usually do not engage with the services and authorities. Working with these organisations we are engaging with hard to reach groups and reduce the level of health inequality across GMLSC. The aim is to train up to 120 individuals who are already embedded as community leaders or members of faith groups who can provide support and guidance as well act as a signpost to further services and treatments should they be required.


Clinical Leads Clinical Lead

Area

Dr Fath-Ordoubadi

Cardiac

Dr Khalil Kawafi

Stroke

Dr Mike Picton

Renal

Dr Simon Hardy

Vascular

Dr Mark Kellett

Neurological Conditions

Dr Sandeep Ranote

Child and Adolescent Mental Health

Prof Paul French

Mental Health

Dr Karen Bancroft

Maternity

Dr Geraldine Skailes

Cancer

Dr Susan Salt

Palliative and End of Life Care

Dr Sara Shackleton

Palliative and End of Life Care

Dr Mark Robinson

Children

Dr Naresh Kanumilli

Diabetes

Dr Amanda Thornton

Dementia

Julie Cheetham Deputy to Associate Director Maternity Children and Young People Julie.cheetham2@nhs.net

Maqsood Ahmad OBE Mental Health, Dementia, Neurological Conditions, Learning Disabilities, Palliative and End of Life Care maqsood.ahmad@nhs.net

INT RO DUCT IO N & ACHEIVEMENTS

John Herring Cancer john.herring@nhs.net

Julie Rigby Cardiovascular Disease and Neurological Conditions julie.rigby@nhs.net

2015/ 16

Foreword

Vision

The Strategic Clinical Network is proud of its continuing contribution to improving the health of the people of Greater Manchester, Lancashire and South Cumbria and April 2016 marked the beginning of a new dawn. On 1st April we saw South Cumbria and Lancashire joining with Cheshire and Merseyside Strategic Clinical Network and becoming known as the North West Coast Strategic Clinical Network, who will work closely with North West Coast Academic Health Science Network. At the same time the geography of Greater Manchester encompassed parts of Eastern Cheshire to be known as Greater Manchester and Eastern Cheshire Strategic Clinical Network as they join Greater Manchester Academic Health Science Network and forge ahead to support the Greater Manchester Health and Social Care Partnership.

The health and wellbeing of local people, and the care they receive, will be comparable with the best in the world.

These changes have largely come about as a result of the recommendations in the review of centrally funded improvement and leadership development functions led by Ed Smith, NHS England’s Deputy Chair and published in July 2015.

This report outlines much of the work that has been done. We are especially pleased when the Network has achieved ‘cross area working’ such as perinatal mental health, cardiac assessment prior to renal transplantation and end of life care for neurological conditions which have led to improvements in patient care. It is clear that clinicians welcome this cross-disciplinary work that is one of the great strengths of the clinical networks.

The review outlined the importance of the role of the Clinical Networks continuing role to Support health systems and improve health outcomes of local communities by connecting commissioners, providers, professionals and patients and the public The Strategic Clinical Network has also forged across a pathway of care to share best practice collaboration with other agencies and groups and innovation, measure and benchmark quality including Public Health England, Health Education and outcomes, and drive improvement. England, Manchester Academic Health Science Network, Healthier Lancashire and the Greater The review also recommended that AHSNs and Manchester Cancer Provider Board. The willingness Strategic Clinical Networks should be streamlined to work with others makes the integration in and their business plans aligned, so that they operate as a single support entity for their member Greater Manchester with the Academic Health Science Network a natural way forward. commissioners, providers and professionals.

Our Purpose Improve people’s health substantially by developing strategies that have wide clinical ownership and can be successfully implemented.

Our Values • Working together for patients • Respect and dignity • Commitment and quality of care • Compassion • Improving Lives

Despite all the many challenges that the national review brought and a significant cut to the SCN budget both the clinicians and the managers who work as part of the clinical network support team have worked hard to find innovative ways to improve services for the benefit of patients.

• Everyone counts

Janet Ratcliffe Associate Director janet.ratcliffe@nhs.net

A forum where clinicians, healthcare managers, patients, carers, and members of the public work in partnership to improve health outcomes for the population


Greater Manchester, Lancashire and South Cumbria Strategic Clinical Networks