GREATER MANCHESTER INTEGRATED STROKE SERVICE ESTABLISHING THE GOVERNANCE FRAMEWORK TO SUPPORT INTEGRATED ACUTE STROKE CARE 1
CONTENTS 1.0 INTRODUCTION...3 2.0 SERVICE AIMS...4 2.3 Comprehensive Stroke Centre (CSC):...5 2.4 Primary Stroke Centres (PSC):...6 2.5 District Stroke Centres (DSC):...7 2.6 An Integrated Stroke Service...7 3.0 LEADING & MANAGING THE SYSTEM...8 4.0 CRITICAL GROUPS...9 4.1 PCT Chief Executives...9 4.2 PCT Chief Executive & Acute Trust Chief Executive Joint Meeting...9 4.3 Greater Manchester and Cheshire Stroke Network Board...9 4.3.1 Greater Manchester & Cheshire Cardiac and Stroke Network Team...9 4.3.2 Clinical Governance Group...10 4.4 Co-ordinating Commissioner...11 4.4.1 Commissioning Projects Committee...11 4.5 NHS Directors...12 4.6 Commissioning Business Service (CBS)...13 5.0 FUNCTIONAL GOVERNANCE ARCHITECTURE...13 6.0 CONCLUSION...15 APPENDIX ONE - STROKE NETWORK BOARD TERMS OF REFERENCE...16 APPENDIX TWO - STROKE CLINICAL GOVERNANCE GROUP TERMS OF REFERENCE...Error! Bookmark not defined. APPENDIX THREE CARDIAC & STROKE COMMISSIONING PROJECTS COMMITTEE TERMS OF REFERENCE...19 2
1.0 INTRODUCTION 1.1 The Association of GM PCTs is developing a networked model of acute and hyper acute stroke services serving the whole of the population of Greater Manchester. The model will establish integrated stroke care across early hours Comprehensive and Primary Stroke Centres and local District Stroke Centres. 1.2 Recent work to develop the Target Operating Model for the service sought to determine all the necessary processes, interfaces and integration points between all participants in the provision of the service. The work outlined The key organisational implications The gaps between future Operating Model and current state to support implementation planning and to determine the Route Map to reach the Target Operating Model The need to establish the governance framework directing the implementation and delivery of integrated acute stroke services. 1.3 This Paper begins that process by considering the arrangements supporting the leadership, direction and control of the hyper acute elements of integrated service. The report seeks to maintain a focus on who does what and on whose authority and does not describe in detail the tasks to be undertaken or seek to undertake those tasks. 1.4 In developing an integrated model of stroke care, the GM health system is required to design a governance structure which provides assurances to organisations in relation to activities crossing organisational boundaries. Governance between organisations has been defined as: The means by which organisations, whether in the public or private sector, can mutually assure themselves and their wider stakeholders that they have in place the mechanisms to align their Governance arrangements where their activities inter-relate. GBO requires a greater accountability, transparency and mutual aid awareness when dealing with any form of development or incident at the boundary of services which enables, challenges or threatens individuals, the wider public wellbeing or the reputation of the organisation. 1 1.5 The governance of the model will need to ensure delivery is able to respond to: Patient & Media expectations for joined up services and simple accountability; Targets which span the points of patient handover; Intentions to commission services and outcomes rather than institutions and episodes; and The management of greater rates of transfers between organizations. 1.6 It is clear that both commissioners and providers need to act collectively in order to deliver the changes successfully. The first task, therefore, is to establish the mechanisms and arrangements through which that collective activity can be discharged. Those arrangements, which this report begins to describe, recognise the passage of the project from its initial planning phase towards managed implementation or doing phase. This paper, therefore, proposes a transition from Project Governance (developed and agreed in support of design and implementation) to System Governance (in 1 Integrated Governance II: Governance Between Organisations, Dr. John Bullivant, Professor Michael Deighan, Professor Bryan Stoten and Andrew Corbett-Nolan; published June 2008 by the Institute of Healthcare Management 3
support of oversight and assurance). The focus of the project board, commissioners, providers, network and the network sub-structures necessarily moves to support this shift in activities. 1.7 This report seeks to inform an effective governance framework cutting across all PCTs and providers in Greater Manchester to: Lead and direct the new service design, planning and delivery Support strategic decision making Manage effective risk management Support issue resolution and arbitration Provide oversight and assurance of the effectiveness and efficiency of the new services Commission the new services Undertake effective contract and performance management. 1.8 The report recognises the importance of being clear about the authority under which the key facilitative or enabling teams (such as the Network Team) act, and the need to ensure the team does not acquire inappropriate responsibilities. The report also aims to encourage clarity on the role of the network and its members whilst recognising that the product of the network is recommendation and advice. Consequently, the report encourages proper location of decision rights with the appropriate accountable body. Finally, the report recognises the importance of co-operation, both between commissioners and providers and between providers to ensure a seamless service across organisational boundaries, and to support effective onward management and improvement of the service. 2.0 SERVICE AIMS 2.1 The aspirations for the National Stroke Strategy are that high quality acute care will be delivered through: 1. implementing national standards of stroke care, including the development of stroke wards/units and multidisciplinary care teams; 2. extending access to 24/7 acute stroke consultation; 3. extending access to 24/7 CT scanning; 4. increasing the number of appropriate patients receiving t-pa; 5. improved professional links between staff in different hospitals that increases the probability of getting the right patient to the right level of care in the right time frame. 6. enhancing the level of resources and access to National Standards of stroke rehabilitation; 7. enhancing educational programmes and the transfer of stroke care skill sets to health care professionals; and 8. reducing the length of hospital stay and increasing the number of stroke survivors who return home to their families and communities. 9. coordinating of discharge planning and interhospital patient transfers 2.2 Points 1-5 relate directly to improving acute care for stroke patients and the intention is to achieve these goals by developing a hub and spoke model of specialist acute services in Greater Manchester. The Greater Manchester model for the Integrated Acute Stroke Service suggests three levels of acute service for stroke patients: a comprehensive stroke centre, a primary stroke centre and district stroke centre. So as to emphasise the interdependence of the elements of the trans Greater Manchester acute service, we suggest that we call this integrated delivery of care the Greater Manchester Integrated Stroke Service (GMISS).It is vital to stress that improvements are needed in all elements 4
of this integrated stroke service and in the system itself. Improvements in one element only, however well intended, will not bring the step improvement in care and treatment required across Greater Manchester. Figure 1 Service Model 2.3 Comprehensive Stroke Centre (CSC): 2.3.1 Basic characteristics: It should be open every day throughout the year for 24 hours per day It should have neurosurgical facilities available for the treatment of intracranial haemorrhage. It should co-ordinate the neuroradiological input for both the comprehensive stroke centre and the two primary stroke centres. It should support the coordination of training, audit and clinical governance across the comprehensive stroke centre, the primary stroke centres and the district centres 2.3.2 Evidence of dealing appropriately with present acute stroke caseload: Performance on National 2008 Sentinel audit: The centre should demonstrate how it plans to achieve a rating of at least 90. Patient numbers: The early hours service should have the capacity and resource to admit up to 8 patients per day and be able to thrombolyse at least 4 patients per day. They should be able to accommodate at least four TIA patients, at any one 5
time, with an abcd2 score of 4, for immediate investigation. (Based on current projections which may be subject to change). Length of stay: Except in exceptional circumstances, patients who are not deemed appropriate for thrombolysis should not stay with the service for more than twenty four hours after the decision has been taken and for those who are thrombolysed, they should not remain on the unit for more than 48 hours after thrombolysis has been completed. This does not apply to those patients for whom the CSC also happens to be their DSC. Call to needle time of 100 minutes ideally with a maximum of 130 minutes. For this to occur there must be immediate access to safe medical diagnosis and immediate reporting of the CT scan from a specialist in neuroradiology. For patients with a non-haemorrhagic stroke, apart from those who have received thrombolysis, aspirin should be administered within 90 minutes of arrival. There should be evidence-based protocols for avoiding complications, swallow assessments and early mobilization. A protocol for TIAs, in line with the attached pathway, with patients being seen by a member of the stroke team within an hour of arrival at hospital 2.4 Primary Stroke Centres (PSC): 2.4.1 Basic characteristic: It should be open every day throughout the year accepting patients from: o Minimum 7am to 7pm Monday to Friday o Maximum 7am to 11pm seven days per week 2.4.2 Evidence of dealing appropriately with present stroke caseload: Performance on National 2008 Sentinel audit: The centre should demonstrate how it plans to achieve a rating of at least 90. Patient numbers: The early hours service should have the resource and capacity to admit up to 6 patients per day and be able to thrombolyse at least 3 patients per day. They should be able to accommodate at least 2 TIA patients, at any one time, with an abcd2 score of 4, for immediate investigation. (Based on current projections which may be subject to change). Length of stay: Except in exceptional circumstances, patients who are not deemed appropriate for thrombolysis should not stay with the service for more than twenty four hours after the decision has been taken and for those who are thrombolysed, they should not remain on the unit for more than 48 hours after thrombolysis has been completed. Except for those patients for whom the centre is also their local DSC Call to needle time of 100 minutes ideally with a maximum of 130 minutes. For this to occur there must be immediate access to safe medical diagnosis and immediate reporting of the CT scan from a specialist in neuroradiology. For patients with a non-haemorrhagic stroke, apart from those who have received thrombolysis, aspirin should be administered within 90 minutes of arrival 6
There should be evidence-based protocols for the avoiding complications, swallow assessments and early mobilization. A protocol for TIAs, in line with the attached pathway, with patients being seen within an hour of arrival at hospital 2.5 District Stroke Centres (DSC): 2.5.1 Basic characteristic: A stroke unit with the capacity and resource to receive acute stroke patients who present 24 hours after the onset of symptoms and are not eligible for thrombolysis. A stroke unit with the capacity and resource to receive patients from the comprehensive and primary stroke centres as soon as the patient is ready for transfer. To include patients not deemed appropriate for thrombolyis < 24 hours after the decision has been taken; for patients who have been thrombolysed: < 48 hours after thrombolysis has been completed. 2.5.2 Evidence of dealing appropriately with present stroke caseload: Performance on National 2008 Sentinel audit: The centre should demonstrate how it plans to achieve a rating of at least 90. Willingness to take an active role in a Greater Manchester wide prospective audit. A commitment to ensure that all appropriate patients are admitted to stroke unit beds less than 12 hours after admission to hospital. As per NICE guidance systems of referral need to be in place to identify adult inpatients who have a new acute stroke; to assess those suitable for thrombolysis and to ensure all receive acute care or support from the stroke team. Secondary prevention; provision of an individualised and comprehensive strategy for stroke prevention in the appropriate format. To include medical and lifestyle risk factors in line with the National Clinical Guidelines. Identification of referrals to early supportive discharge teams promoting seamless transfers. A commitment to ensure that all patients receive appropriate and high quality multidisciplinary rehabilitation and secondary prevention led by stroke specialist therapist and nurses. Demonstrate how consultant led specialist stroke care can be provided during the working week covering annual leave and study leave. Options may include cover across several sites to deliver consistent, high quality 24/7 stroke care. 2.6 An Integrated Stroke Service All of the 3 elements together with the ambulance service are crucial to the success of `Greater Manchester Integrated Stroke Service. The Comprehensive (CSC), Primary (PSC) and District (DSC) stroke centres must work together if we are to deliver the anticipated gains in improving outcomes and services for patients in Greater Manchester who experience a stroke. By sharing protocols and guidelines, developing pan-city training programmes and outreach to the wider community, and sharing a commitment to a comprehensive quality improvement process we have the opportunity to be world leaders in stroke care. The successful delivery of the new service will be heavily dependent on the understanding of how to integrate services amongst acute trusts and with the ambulance trust. This understanding will evolve through effective knowing sharing within the stroke network. 7
3.0 LEADING & MANAGING THE SYSTEM 3.1 In support of the achievement of the service aims it is necessary to clarify the components of the system and assign appropriate roles according to the tasks to be undertaken to oversee and assure the integrated service. The nature of the tasks to be undertaken to support delivery and management of the service will require clear engagement and reporting lines to key groups in addition to clinicians and Chief Executives, including PCT Directors of Commissioning and acute Directors of Operations. The picture of key stakeholder groups which we can identify as immediately critical to the further work is complex and extensive. ROLE LEAD PCT CEOs BODY/GROUP ASSURE PCT CEOs Acute CEOs DELIVER All Stroke provider Organisations N WAS OVERSEE Stroke Network Board Lead Commissioner Clinical Commissioning Governance ACCOUNTA Reference BLE Group Group CHECK/ CHALLENGE Directors of Commissioning Directors of Finance Directors of Public Health PEC Chairs/ Directors of Fig. PBC 4 Key RolesOperations SUPPORT/ ENABLE Stroke Network Team/CBS Stroke Network Board Stroke Network Sub-groups BE AWARE NHS NW The Public Figure 2 Stakeholder Roles 3.2 Across these elements of the system we should seek to identify: Who is accountable? Who, ultimately is answerable and required to provide assurance? Who is responsible? for the delivery of specified tasks and the fulfilment of commitments Who needs to be consulted? before key decisions are taken and actions agreed Who needs to be informed? to maintain engagement as the work progresses 3.3 As more specific roles are ascribed, the work begins to highlight the nature of the relationship between clinicians, managers, commissioning organisations, provider organisations and supporting/enabling organisations. It also identifies the points at which co-operation and joint working become essential and the scale of the work simply to ensure key groups are kept engaged. 8
4.0 CRITICAL GROUPS 4.1 PCT Chief Executives The PCT Chief Executives meeting provides the accountable forum for system wide decision making as the decision-making body of the Association of Greater Manchester PCTs. PCT Chief Executives recognise the interdependencies of the proposed integrated service and the need to ensure that commissioners across GM protect the integrity of the model. The PCT Chief Executives will be responsible for leading communications on progress against the implementation plan. 4.2 PCT Chief Executive & Acute Trust Chief Executive Joint Meeting The joint Chief Executives meeting will provide a forum for ensuring all Chief Executives are briefed on progress, risks and issues as the service is implemented. It will provide a forum to secure and record system wide engagement, communication and support for the project as it progresses. It is not a decision making forum. 4.3 Greater Manchester and Cheshire Stroke Network Board The Network Board will provide oversight of the service and expert challenge to the achievement of key milestones. The Board provides a source of clinical sponsorship and advice to commissioners. It will provide advice o the system in support of the strategic development of stroke services in line with recommendations contained within the National Stroke Strategy, RCP and NICE guidance and local priorities by developing, coordinating and supporting the clinical advisory groups, workstream/project groups and local implementation teams. The Network Board is required to provide advice and recommendations to the Commissioners, and advice on service delivery to providers by bringing together clinicians, managers and commissioners to establish needs and determine best practice. The Network Board is responsible for leading the design and delivery of the project. The Board will review all aspects of implementation and report progress to the system and to PCT Chief Executives. The Board will provide an escalation point for barriers to effective implementation. The Board is responsible for supporting organisational delivery across the whole pathway and for defining and driving quality to provide assurance to the system. The membership of the Board is designed to facilitate effective organisational links to sustain understanding and engagement across the system with a focus on continuous service improvement. It will identify opportunities for economies of scale and increase opportunities for education and learning. The Board will direct the work (or elements of the work) of key groups which will include the Clinical Governance Group, Workforce and Training group and other clinical advisory groups. The Network Board might also sponsor Peer Review processes to establish a system of mutual assistance across the network in service of the individual organisations. This might utilise learning and expertise from within and beyond the network. 4.3.1 Greater Manchester & Cheshire Cardiac and Stroke Network Team The Network Team will lead and facilitate the effective delivery and co-ordination of the project. The Team will provide day-to-day direction to the Programme Management Office. The team will facilitate the contributions of the working groups and clinical workstreams reporting through the network structures. The Network will support effective patient and public involvement in the service redesign and lead the development and 9
discharge of an effective communications and information strategies. The Network Team will support the system wide activity, leading on the management of change and identifying and reporting on opportunities for service improvement. It is important to note that whilst the network team hosts a commissioner operating on behalf of the Co-ordinating Commissioner, the network and the network team itself IS NOT a commissioning organisation. 4.3.2 Clinical Governance Group Stroke presents a specific challenge to individual organizational clinical governance arrangements as it involves the initial care of the patient usually being delivered at a either CSC or PSC many patients will bypass their local acute trust in the emergency phase. Regular clinical governance information on key indicators will be required in order that local DGHs are assured that their patients are, for example, treated within the agreed time limits. It is proposed that a network wide Clinical Governance Group is established, building on the commitment and expertise contained to date in the Networks Emergency Response Group. To maintain effectiveness this may be organised according to equivalent arrangements on a sector basis (North, West and South East) with periodic joint meetings. The Group(s) would seek to secure connectivity of care pathways through regular joint audit and review of activity data, clinical data and outcome metrics. It would work closely with the Commissioning Reference Group to develop proposals for joint service improvement. The group(s) will aim to be as accessible to as many people as possible (eg through video conferencing arrangements) and will meet every 2 months to support near real time reporting. The group would ensure an appropriate fit with proposals for a new national data set. In the first instance the group would seek to address challenges to ensure the patient s journey is able to be tracked across organisations. The Stroke clinical governance group should be multi disciplinary and contain representation from: CSC PSC DSC NWAS Network Support Team (to facilitate) Its role is to Request, receive and consider up to date data on the preceding month s workload; highlight and address issues which prevent the smooth flow of the patient through the pathway form a system wide view which reflects the intentions of the networked service ( whole system approach ) rather than that of the individual trusts which make up the network Work according to the ethos of continuous quality improvement Present the data, together with any relevant issues identified and related actions, to the bi-monthly Stroke Network Board meetings 10
Stroke Clinical Governance Structure Stroke Board Commissioning Projects Committee (involvement when/if necessary) Service/ quality Improvement Stroke Clinical Governance Groups (Sector Based) Service/ quality Improvement CSC PSC DSC NWAS Figure 3 CGG Relationships RG. Draft 2, Jan 2009 4.4 Co-ordinating Commissioner The Lead Commissioning PCT for the Collaboratively Commissioned element of the service, in conjunction with the CBS Collaborative Commissioning Team and the Network Team, will ensure that specifications for the service reflect the agreed guidelines and protocols developed through the Network. The Co-ordinating Commissioner will ensure performance management arrangements are robust; clinical and financial risks are assessed and managed; and robust and transparent arrangements are in place for the consideration of service developments against agreed priorities. Specifically the Co-ordinating Commissioner will: Agree contract with provider AND associates Set thresholds for performance consequences with associates Agree with the provider the appropriate range of standards and care pathways which must be catered for to meet associates needs Lead negotiations and solutions Contract monitoring and review Manage contract control mechanisms and communicate with associates on required actions Manage information flows between provider and associates The Co-ordinating Commissioner will be responsible for supporting the proper engagement and participation of the key Director Level groups. 4.4.1 Commissioning Projects Committee The Cardiac & Stroke Commissioning Projects Committee will support the Co-ordinating Commissioner, associate commissioners, individual organisations and network board 11
through the development and maintenance of a strategic and operational overview of contracting and performance across stroke (and cardiac) services. It will make recommendations to the PCT Directors of Commissioning, Finance and Public Health and to the CEO NHS Bury, as lead for cardiac and stroke collaborative commissioning arrangements. It will provide regular reports to the Stroke Network board in support of the implementation of the National Stroke Strategy and oversight of the GM Integrated Acute Stroke Service. It will provide regular updates on potential and planned investments through the Greater Manchester Process for Investment and Reform. Core members will include: Cardiac and Stroke Networks Boards Chair Co-ordinating Commissioner CEO AD Collaborative Commissioning Lead Director of Public Health Lead Director of Commissioning Lead Director of Finance Network Director AGMPCTs Associate Director Project Management Lead CBS Strategic Finance Manager Its role is to: Provide the link between the Stroke Network, Co-ordinating Commissioner and PCT Directors of Commissioning Ensure comprehensive organisational involvement in the management of cardiac and stroke pathways ensuring the links between primary and secondary and specialist care are maintained; Support the planning, delivery and performance management of agreed investments; Review recommendations of the cardiac and stroke network boards; Sharing knowledge and best practice to ensure consistent implementation of agreed models of care; Ensure engagement on future investment intentions as part of the GM Process for Investment & Reform resource allocation process; Track progress against key indicators; investments and workstreams identified as priorities to deliver: Intended system reform Improved and sustained clinical outcomes Value for money Evidence based pathway reform Performance management and review Commissioning advice to the network and constituents 4.5 NHS Directors The key director level groups (Commissioning, Finance, Operations and Public Health) will support the oversight and assurance arrangements and will be responsible for checking, challenging and directing the work as well as leading and driving local implementation and management. 12
4.6 Commissioning Business Service (CBS) The CBS will support the development of the financial arrangements underpinning the service at all levels. The CBS will also provide informatics expertise to support service modelling to inform management, monitoring and redesign. 5.0 FUNCTIONAL GOVERNANCE ARCHITECTURE 5.1 Clarity of accountability and responsibility for the commissioning of services needs to be understood in relation to the functional elements of commissioning, which includes, strategic management, performance management, risk management, change management, resource allocation and procurement. Each of these elements are related and interdependent see below for a model designed to support partnership governance. Mechanisms that allow for effective linkage of these elements will constitute an important assurance function at the system wide level. Models of partnership governance to support an ecosystem of independent commissioners and providers are required and this report seeks to propose the principle elements of that model. Figure 4 relationships between Commissioning management Functions 5.2 The configuration of the system in relation to stroke seeks to ensure the following key elements are able to be progressed simultaneously: Clinical leadership, expertise and advice; Commissioning leadership to network wide priorities; Clear decision making capability; and Clear means of communicating progress and issues across the whole system. Key roles and relationships are illustrated in figure 5 below. 13
Figure 5 Governance Map 5.3 The consolidation and organisation of these functional elements, described in detail above, presents an operating system capturing, analysing and reporting on service activity, quality and outcomes. Those elements support effective clinical governance and performance management as well as service improvement, review and redesign. The reality of the interdependencies existing across provider and commissioner functions is such that we have described the governance of the system in the context of an ecosystem. 14
Done By Network Team For Commissioning Reference Group Clinical Governance Group Done By Commissioning Reference Group Clinical Governance Group For Stroke Network Board Reporting to Directors Done By For Clinical Local Governance Organisations Group Done By On advice from Chief Stroke Executives Network Board Directors Integrated Commissioning Eco-System Technological advance Public Awareness Technological advance Public Awareness Assurance, Decision Oversight, Performance, Quality Information Management & Monitoring Field Work, Service Improvement Integrated Acute Stroke Service Information Management & Monitoring Done By Network Team For Commissioning Projects Committee Clinical Governance Group Assurance, Decision Oversight, Performance, Quality Done By Commissioning Projects Committee Clinical Governance Group For Stroke Network Board Reporting to Directors Done By Chief Executives Field Work, Service Improvement Done By Clinical Governance Group Clinical Audit Nurse For Local Organisations Integrated Acute Stroke Service On advice from Stroke Network Board Directors 6.0 CONCLUSION 6.1 The priority for this paper is to clarify who, or what arrangement, is responsible for key tasks, on whose authority they act and with which groups they are expected to engage. As the service moves to full implementation, it is recognised that these arrangements will be tested and are likely to be further refreshed and refined to describe fully the management and monitoring arrangements for whole system delivery (performance management and monitoring, clinical governance, clinical audit etc). The current phase will directly inform those arrangements but it is important to recognise that this phase remains one of detailed design and the system needs to be supported in that context. Warren Heppolette 21.05.09 15
APPENDIX ONE Greater Manchester & Cheshire Network Stroke Board Terms of Reference and Membership Background The Greater Manchester & Cheshire Network Stroke Board takes an overarching strategic view of the development of Stroke and TIA services in Greater Manchester and Cheshire. Accountability The Greater Manchester & Cheshire Stroke Network is accountable through the Chair to the Association of Greater Manchester PCTs. Purpose of Board THE OVERALL AIM OF THE BOARD IS TO ENSURE THE STRATEGIC DEVELOPMENT OF STROKE SERVICES IN LINE WITH RECOMMENDATIONS CONTAINED WITHIN THE NATIONAL STROKE STRATEGY, RCP AND NICE GUIDANCE AND LOCAL PRIORITIES BY DEVELOPING, CO-ORDINATING AND SUPPORTING THE CLINICAL ADVISORY GROUPS, WORK STREAM/PROJECT GROUPS AND LOCAL IMPLEMENTATION TEAMS. THE BOARD SEEKS TO BE AUTHORITATIVE AS OPPOSED TO EXECUTIVE. Expected Outcomes To ensure that all people living in Greater Manchester who have had a Stroke have access to high quality Stroke Services at all stages in the pathway. To develop a Network for Stroke Services across Greater Manchester and share good practice. Ensure the delivery of a Strategic Network Delivery Plan. Set the direction and parameters for Clinical/Advisory/Project Groups and validate recommendations. Ensure equitable provision of services and a seamless transition in care across the whole patient journey. Identify and share common risks to our Strategic Objectives (and Escalation Plans). Consider and prioritise development proposals in areas of Stroke Services. Support the development of a Network-wide Clinical Governance Strategy, Quality Assurance and Peer Review Mechanism for Stroke Services. To make links at Strategic Level and local level with other Professional Groups and Voluntary Organisations involved in the delivery of care for people who have had a Stroke. Facilitate and support links with Greater Manchester & Cheshire Cardiac Network and other Managed Clinical Networks to ensure impact of services and developments are considered in Stroke development/services. Ensure effective integration of the Service Improvement Programme with a mechanism for sharing good practice. 16
Ensure an effective Workforce Development Strategy is developed in line with the delivery of the National Stroke Strategy and service requirements that it is aligned with the local and National Workforce Strategies. To support local Stroke Services in improving their performance (particularly with reference to the indicators in the National Sentinel Audit for Stroke). To make links with local Stroke Development /Project Groups. Ensure an effective Communication and Information Strategy is established across the Network. To provide a Strategic Direction for Stroke Prevention Services and make links with Prevention Strategies for other Cerebral Vascular Diseases. To support Commissioning and the development of Business Cases for Specialist Stroke Services across Greater Manchester. To develop and support Patient & Public Involvement and user involvement in the development and usage of Stroke Services. To develop and support the implementation of a public awareness and education programme around presentation of Acute Stroke and prevention of Stroke. Facilitate effective links with, and contribution from Primary Care. Develop information systems to inform Stroke Service developments and decisions on Service Developments. Membership Chair PCT Chief Executive Network Director Network Leads Quality Improvement Managers Primary Care 2 General Practitioner Leads Public Health Lead Director of Public Health Acute Trust Chief Executive Representative Director of Operations PEC / PBC Representative Patient/Carer/Voluntary Sector Representatives Stroke Association Different Strokes Commissioning Commissioning Leads Strategic Finance Strategic Finance Lead NWAS NWAS Representatives CLAHRC CLAHRC Leads Neurosciences Network Network Lead Communications Support Communications Leads Clinical Advisory/ Work Stream Leads Allied Health Professionals Emergency Response Group Patient and Public Involvement Workforce Development Post Hospital Care Others TBC as groups form Clinical and Managerial Leads: Comprehensive Centres Primary Centres District Centres Local Authority/Social Care Frequency - Bi-monthly NW Local Research Network Representative 17
Appendix Two 18
APPENDIX THREE CARDIAC & STROKE COMMISSIONING PROJECTS COMMITTEE TERMS OF REFERENCE 1. Role of the Committee The Committee will operate on behalf of the Association of Greater Manchester PCTs (the Association) to ensure that PCTs proactively and collectively commission those cardiac and stroke services that serve the population of Greater Manchester and C&E Cheshire as a whole or where delivery models are in place that require a Greater Manchester and C&E Cheshire-wide commissioning perspective, focusing on the clinical, economic and organisational consequences of services delivered or to be delivered. 2. Specific responsibilities a. To ensure join up between the cardiac and stroke commissioning strategies of PCTs, sectors, the AGMPCTs and NWSSCT, ensuring the links between primary and secondary and specialist care are maintained. b. To ensure commissioning leadership is applied to the delivery of the cardiac and stroke Network Boards programmes of work. c. To provide commissioning leadership to the delivery of cardiac and stroke performance targets, in support of providers, where those targets relate to the Greater Manchester and C&E Cheshire health economy. d. To support the planning, delivery and performance management of agreed investments e. To review recommendations of the cardiac and stroke network boards, ensuring engagement on future investment intentions as part of the GM Process for Investment & Reform resource allocation process f. To ensure that the consequences to other services of service improvement or change to cardiac and stroke services within or between providers, are understood and proactively managed by commissioners. g. To ensure that commissioning leadership is applied to Greater Manchester and C&E Cheshire-wide cardiac and stroke prevention or protection programmes. 3. Membership Chair: Vice Chair: Core Members: Attendees: Chief Executive, NHS Stockport Chief Executive, NHS Bury Network Director, Co-ordinating Commissioner, Lead Directors of Finance & Public Health Associate Director Cardiac & Stroke Commissioning, Strategic Finance Manager, Network Support Team Programme Manager 19
4. Frequency of meetings The Committee will meet monthly. 5. Tenure The Committee will meet for one year before formal review by the Association (and the C&E Cheshire CE). 6. Accountability The Committee will be accountable to the Association through their monthly meetings and to the CE of C&E Cheshire PCT. 20