D04/ODN/a NHS STANDARD CONTRACT FOR NEUROMUSCULAR OPERATIONAL DELIVERY NETWORKS SCHEDULE 2- THE SERVICES A. SERVICE SPECIFICATIONS Service Specification No. Service Commissioner Lead Provider Lead Period 2014-2015 Date of Review December 2014 Version Control 2.0 D04/ODN/a Neuromuscular Operational Delivery Network Specification 1. Population Needs 1.1 National/local context and evidence base Operational Delivery Networks The NHS England has recognised that clinical networks are an NHS success story and have been responsible for some significant sustained improvements in the quality of patient care and the outcomes of their treatment. The Way Forward: Strategic Clinical Networks (July 2012) outlined the range and role of clinical networks in the new health system. There will be a range of networks performing different functions which include: a small number of Strategic Clinical Networks (SCNs) that are established and supported by NHS England to advise commissioners, support strategic change projects and improve outcomes Operational Delivery Networks (ODNs) that are focused on coordinating patient pathways between providers over a wide area to ensure access to specialist resources and expertise. ODNs will focus on operational delivery. ODNs will ensure outcomes and quality standards are improved and evidence based networked patient pathways are agreed. They will focus on an operational role, supporting the activity of Provider Trusts in service delivery, improvement and delivery of a commissioned pathway, with a key focus on the quality and equity of access to service provision. This will allow for more local determination, innovation and efficiency across the pathway. ODNs support the delivery of Right Care principles by incentivising a system to manage the right patient in the right place. Neuromuscular networks will operate as ODNs defined in this specification. ODNs are focussed on coordinating patient pathways between providers over a wide area to ensure access to specialist resources and expertise.
Neuromuscular Networks Neuromuscular Networks exist to deliver a comprehensive, equitable, integrated and safe service, local where possible, for adults and children with neuromuscular conditions. Neuromuscular Networks will comprise all services providing Neuromuscular Care, as outlined in the NHS Commissioning Board Service Specifications for neurosciences. The development of a Neuromuscular Operational Delivery Network will ensure there are effective pathways of care across a network of providers and provide professional and clinical leadership. A multidisciplinary network team will include neuromuscular consultants, specialist nurses, allied health professionals (e.g. Physiotherapists), Psychology support and neuromuscular care advisors working across a network of primary care, community, secondary and tertiary providers. The network should encompass both adult and paediatric neuromuscular care. [For insertion by Area Teams (AT)- local Network membership (organisations)] Key Publications NICE Clinical Guidelines on Epilepsy NICE Clinical Guidelines for MS NICE Guidelines for Parkinson s Disease Long term conditions NSF and new Long Term Conditions Outcomes Strategy National Strategy for Stroke RCP Guidelines and Reports including Local Adult Neurology Services for the next decade Everyone Counts: Planning for Patients 2014/15 to 2018/19 http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf Department of Health Guidance on Strategic Clinical Networks http://www.england.nhs.uk/ourwork/part-rel/scn/ NHS England: The Way Forward: Strategic Clinical Senates July 12 NHS England: The Way Forward: Strategic Clinical Networks: Single Operating Framework November 12 http://www.england.nhs.uk/wp-content/uploads/2012/07/way-forward-scn.pdf http://www.england.nhs.uk/wp-content/uploads/2012/11/scn-sof.pdf NHS England: The Way Forward: Developing Operational Delivery Networks July 2012. http://www.england.nhs.uk/wp-content/uploads/2012/12/develop-odns.pdf 2
2. Scope 2.1 Aims and objectives of service Neuromuscular ODNs will deliver a whole system work programme for a service across a defined geographical area and within a specific area of care. They will align and work with established and evolving NHS organisations such as Senates and Clinical Reference Groups (CRGs). The ODN model will be reviewed and developed through the regional specialised commissioning bodies, coordinated through national Programmes of Care as the delivery mechanism of the four regions, linked to CRGs, then out into the networks with delivery of the aligned pathways through the provider landscape. To improve joined up working to achieve better outcomes and service access, ODNs will collaborate with regional level Programme of Care (commissioning) leads, as well as commissioning quality teams and national outcomes leads. Area Teams will performance manages the ODNs through the contractual relationship. Operational Delivery Networks will respond to need through national, regional and local determination, depending on the identified challenge for example, a local critical care bed crisis or a large scale mass incident. An ODN will: Ensure effective clinical flows through the provider system through clinical collaboration for networked provision of services. Take a whole system collaborative provision approach to ensuring the delivery of safe and effective services across the patient pathway, adding value for all its stakeholders. Improve cross-organisational multi-professional clinical engagement to improve pathways of care. Enable the development of consistent provider guidance and improved service standards, ensuring a consistent patient and family experience. Focus on quality and effectiveness through facilitation of comparative benchmarking and auditing of services, with implementation of required improvements. Fulfil a key role in assuring providers and commissioners of all aspects of quality as well as coordinating provider resources to secure the best outcomes for patients across wide geographic areas. Support capacity planning and activity monitoring with collaborative forecasting of demand, and matching of demand and supply. The benefits of this will be improving outcomes, productivity and increasing efficiency through: Stronger collaborative networked provision of services. Maintained and/or improved patient outcomes and quality of care and, where appropriate, to standardise care. New approaches associated with new hosts. Increased opportunities for risk sharing between providers. Opportunities to more accurately cost out the pathways of care and the utilisation of resources more efficiently. Sharing the benefit of Quality, Innovation, Productivity, Prevention (QIPP) opportunities. Opportunity to move to a prime contracting focus (i.e. a single contract for a pathway of care over several providers). More effective utilisation of contract levers for commissioners. 3
Increased speed of adoption of innovation. Rapid learning and development. Improved system resilience, including major incident planning. Members of the ODN will work collaboratively to share learning, experiences, knowledge, skills and best practice for the benefit of all within that specialist environment. The ODN will need to function based on a compact between all parties which defines professional behaviour. To promote providers to do a good job, a network competency assessment would allow qualification to establish an inter-provider contract model. The outcomes and indicators in the NHS Outcomes Framework were chosen with a view to measuring the outcomes resulting from treatment activity for which the NHS is largely responsible. Providers will be held to account for delivering improved outcomes. Providers will be supported by ODNs in achieving their critical contribution to the indicators within the NHS Outcomes Framework. The Neuromuscular Networks consist of the providers of Neuromuscular Care, collaborating in the provision of that care and cooperating in quality improvement activities. Much of the activity in the network will be around the development of pathways and protocols to ensure effective care delivery. Providers will work towards professionally agreed standards and protocols for care and movement of patients across the Network (in line with national services specifications for neurosciences), in order to ensure consistent and coherent practice and provide assurance of care quality. Quality standards should be enforced in protocols that can be derived from the System Performance Framework and should be narrow, measureable goals. Protocols should have a wider remit, seeking full implementation of relevant national (National Institute of Clinical Excellence; NICE) guidance or local standards of care. The aim of the Neuromuscular network is to improve the coordination of care across a regional network or across networks; to integrate both service strategy and clinical pathways. The Neuromuscular will be responsible for the development of a local strategy to implement national imperatives and in response to relevant national standards and service specifications. A Neuromuscular Operational Delivery Network will specifically: Ensure patients receive high quality care within an appropriate setting across a network of providers. Ensure patients receive closer to home through shared care and outreach services across a network. Ensure that patients have a voice and their views considered. Fully support the future development of neuromuscular services by enabling clinical expertise to be shared. Commissioners have clearly defined the Neuromuscular Care pathway standards through a service specification, articulating the requirement for a networked provision of services, and delivered through the contract delivery mechanism. For the directly commissioned services of Neuromuscular services, the pathway standards are outlined in service specifications for Neurosciences. The ODNs outputs will be to deliver the work programme and operational model to enable the delivery of the services specification standards, national programme of care outcomes and outcomes framework targets. Neuromuscular Care Network The Neuromuscular network will advise on the commissioning and development of services to provide high quality, effective Neuromuscular Care services in line with national priorities and local imperatives. The network will also foster partnership working and collaboration across all of the organisations providing Neuromuscular Care within its geographical area. 4
The network will advise on the local commissioning and development of services to provide high quality, effective Neuromuscular care in line with both nationally commissioned priorities and local imperatives. Advice may be provided to CCGs, ATs, and through the CRG, to the national commissioning board. The ODN will provide an environment where clinicians work together to do once where possible, to share best practice and promote best quality care to continually improve services. A Neuromuscular Operational Delivery Network will include: A managed clinical network to support multi-disciplinary and cross organisational working to provide effective and efficient treatment, care and support to patients and their families; Shared care with services delivered as close to home as possible, as well as access to a specialist centre when appropriate, supported by multi-disciplinary team working across primary, secondary and tertiary services. Individualised care supported by ongoing care co-ordination from he point of diagnosis; Close working between paediatric and adult services to ensure smooth transition between services Support to patients and their families will be delivered through Neuromuscular Care Advisors or Clinical Nurse Specialists. A Neuromuscular Operational Delivery Network will ensure: A managed clinical network to support multi-disciplinary and cross organisational working to provide effective and efficient treatment, care and support to patients and their families; Shared care with services delivered as close to home as possible as well as access to a specialist centre when appropriate supported by multi-disciplinary team working across primary, secondary and tertiary services. Individualised care supported by ongoing care co-ordination from he point of diagnosis; Close working between paediatric and adult services to ensure smooth transition between services Support to patients and their families will be delivered through Neuromuscular Care Advisors or Clinical Nurse Specialists based within the network. 2.2 Service description/care pathway Specialised neuromuscular services will be provided to NMD patients of all ages and via a managed clinical pathway that supports multi-disciplinary and cross organisational working. This will facilitate effective and efficient treatment, care and support to patients, their families and carers. Neuromuscular Operational Delivery Networks Neuromuscular care ODNs will be hosted in a named provider from within the network. This lead provider will be responsible for ensuring the effective functioning of the network working in conjunction with the lead commissioner from the NHS England. The lead provider hosting the network will be responsible for ensuring effective pathways of care between providers in network. The host provider will be responsible for the delivery of following areas of work; Strategic Planning Providing professional and clinical leadership across the network. Developing an annual work programme for the ODN to deliver the national strategy and outcomes. Hosting a risk register and undertaking risk management across the network. Effective linkages into the Programme of Care lead in NHS England. Effective linkage into local Clinical Commissioning Groups (CCGs). 5
Involvement with disaster/surge planning Operational Delivery To ensure patient care is coordinated and follows agreed pathways of care. To ensure improved access and equity of access to Neuromuscular services as defined in section 2.2) Support capacity planning and activity monitoring with collaborative forecasting of demand, and matching of demand and supply. To ensure equity and access to specialised Neuromuscular services in line with national policy Support capacity planning and activity monitoring with collaborative forecasting of demand, and matching of demand and supply both within the ODN and across other ODNs. To work with commissioners to implement service convergence plans To work collaboratively with all other Neuromuscular Networks to agree and achieve national goals. The Network will agree how it identifies, manages and escalates key risks in relation to the delivery of Neuromuscular services across its area. Local Advice and Support to Commissioners Providing local information, data and intelligence to support performance monitoring of the network i.e. process measures, key performance and quality indicators, audit outcomes, workforce data To undertake Peer review and assurance of providers with programme of care leads and AT commissioners of services. Supplement local work of Clinical Reference Group by receiving national products for local implementation. Improved Quality and Standards of Care Developing and Implementing network protocols for Neuromuscular Care On-going service improvements, ensuring best practice models are embedded and contribute to improved quality performance (i.e. dashboard measures Collaborating to undertake investigation into Serious Untoward Incidents and Sitrep reporting (SUIs). Education and Continued Professional Development (CPD) support to network learning. Assurance of the training and maintenance of competencies for all staff in o Recognition of critical illness o Stabilisation and short term management of critically ill children High dependency care in line with each unit s capacity and capability Delivery of an annual audit programme agreed with members, outcomes will be reported the annual report. Undertaking Self-assessment and peer review against national standards. Using clinical process and clinical outcome measures to compare and benchmark providers. Reviewing work-load within neuromuscular services. Measuring improvement in clinical outcomes. The network must have a robust governance structure in place to ensure that all providers of Neuromuscular within the network support o delivery of care and access to treatment in line with locally agreed network protocols and guidelines and national service specifications, o all operational training, governance and audit requirements of network. o Critical incident reporting across the network o Sharing of best practice Partnership Development 6
The Network will work collaboratively with the other Neuromuscular ODNs. Monitoring and performance management of active engagement by members in the network to improve performance against agreed outputs. Fostering a culture of collaboration across the network. Linkage and reporting into the clinical senate. Engagement with patients and third sector organisations. Linking into local Education and Training Boards (LETBs) to ensure Neuromuscular education provision is supported. Forming effective partnerships with academic health science network (AHSNs). Co-ordination of Neuromuscular research. Participation in relevant national such as NICE for development of Neuromuscular clinical guidelines. Linkage with adjacent ODNs and other ODNs. Linkage into the Neurosciences Clinical Reference Group. Accountability ODN hosted by and accountable to a lead provider. ODN to deliver service in line with operation network governance model. ODN to produce annual report highlighting quality outcomes and work programme outputs and objectives delivered. The Network will agree formal mechanisms for gaining the support and commitment of all Neuromuscular providers, including agreed communication flows between organisations. This should include a commitment to the collection and analysis of data within relevant national databases and the sharing of analysed data (e.g. agreed performance indicators). The above outputs will be further directed, performance managed by Area Teams ODN Service Model and Structure [For local insertion based on structures already established prior to April 13 but now hosted by a lead provider.] 2.3 Population covered Service user groups covered There are more than 60 different types of muscular dystrophy and related neuromuscular disorders (NMD). Neuromuscular disorders can be genetic or acquired: Inherited neuromuscular disorders include: Muscular dystrophies Spinal muscular atrophy (SMA) Congenital and syndromal neuropathies Inherited neuropathies Congenital myopathies Metabolic myopathies Genetic myasthenic syndromes Mitochondrial disorders Channelopathies Myotonias Acquired disorders include: 7
Myasthenia gravis Autoimmune neuropathies Inflammatory myopathies. The configuration of Neuromuscular services within a given Network is to be agreed by the NHS Commissioning Board. 2.4 Any acceptance and exclusion criteria Excludes development of national commissioning products and policies. 2.5 Interdependencies with other services Local resilience for a SCNs for Maternity and Children, Local Education and Training Boards, Health & Wellbeing Boards, Patient Groups & Representatives, Public Health England, Academic Health Service Networks, Health watch, Professional Colleges and Societies, Clinical Commissioning Groups, NHS England, Area Teams, AT Clinical Senates, relevant National Clinical Reference Groups, NHS Acute Trusts, Regional & Area teams, Ambulance providers, Independent sector, Institutes of Higher Education, Local Education and Training Boards, Royal Colleges and specialist professional organisations. Related Services -services involved in the patient journey The following services are integral to the care of people with neurological conditions and the commissioning of specialised neurology services should integrate with the commissioning arrangements for neurology / neurosurgery intensive care. neurology paediatric neurology cardiac respiratory specialist orthopaedic specialised equipment services specialist physiotherapy dietetics end of life care 3. Applicable Service Standards 3.1 Applicable national standards e.g.: NICE, Royal College Applicable national standards A number of protocols and standards will be developed and used, including a (locally defined) Neuromuscular and Neurosciences protocols and pathways for implementation across the network. The Neuromuscular ODNs will deliver the agreed work programme outputs as defined by the regional programme of care leads aligned to the delivery of the national strategy for women s and Children.. 8
3.2 Applicable local standards Not applicable 4. Key Service Outcomes The Neuromuscular ODNs will be a key element in enabling improved performance in the quality Dashboard Indicators. The Neuromuscular ODNs will be a key element in the delivery of locally defined Key Performance Indicators The Neuromuscular ODN will be responsible for improvement in the outcomes measures within the Neuromuscular Critical Care Quality Dashboard. The ODNs will be a key element in the delivery of Improved outcomes, experience and quality of care for patients. Improved equity of access to Neuromuscular services. Accessible clinical expertise that delivers analytical capabilities to enhance the debate and credibility of decision making for stakeholders. Improved productivity and increasing efficiencies across a geographical area. Strategic resilience and capacity management Identification and drive of systemic service improvement. Provision of safer service delivery Increased opportunity for risk sharing between and across provider and commissioner organisations. Stronger collaborative networked design and delivery of services. Evidence of public and patient engagement in the design of services. Clearly identified links to regional and national bodies (see 2.2 below). Evidence of consistent application of standards which improve access to and egress from services at the right time. Evidence of joint working with Higher Educational Providers and Professional bodies to deliver new ways of working. part of delivering the 9
The Provider s Premises hosting the ODN are located at: [Name and address of the Provider s Premises OR details of the Provider s Premises OR state Not Applicable ] 10