Agenda Item: 5.2
Ref: W06-07/063
The Future of Networks in Cheshire and Merseyside post October 2006
Introduction
1. The purpose of this paper is to seek Board sign up across Cheshire and
Merseyside to the continuation of a range of networks funded by and
accountable to Cheshire and Merseyside PCTs.
Background
2. Since 2002 when all the former Cheshire and Merseyside PCTs were
established, a number of networks have been set up to support their
activities (some of the networks pre-dated the PCTs).Networks have been
encouraged nationally in a number of policy documents such as the
Cancer Plan, Shifting the Balance of Power, Standards for Better Health,
Our Health, Our Care, Our Say, and most recently in the Commissioning
Framework. Networks were conceived in the late 1990’s as connections
across disciplines that provide integrated care across institutional and
organisational boundaries raising clinical quality and improving the patient’s
experience.
3. Since the publication of “Commissioning a Patient led NHS” there has
been much debate about the role of networks in a post Foundation Trust,
post new PCT world. However, it is clear that PCTs are responsible for:

Strategic service development, including
specification, target setting and quality monitoring

Care pathway management to ensure high quality service provision to
patients particularly when a patient’s journey spans more than one
health sector

Provider development

Monitoring of health care outcomes
service
planning,
This is confirmed in the Fit for Purpose diagnostic. All Cheshire and
Merseyside PCTs thus far assessed have been identified as needing at
least some improvement in one or more of these areas.
Networks have a key role to play in ensuring that PCTs meet the Fit
for Purpose requirements, particularly in respect of those services
which span more than one PCT and/or more than one provider.
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
The proposal for Cheshire and Merseyside
4. There are currently 12 networks in Cheshire and Merseyside – Cancer,
Cardiac, Child Health, Champs(public health), Critical Care, Diabetes, Neonatal
Intensive Care, Maternity and Perinatal, Sexual Health, Teaching PCT, Renal,
Urgent care/Emergency Services Action Team. It is proposed that all of these
should continue – with the exception of ESAT which it is proposed should cease
to function as a separate network from April 2007. PCTs in Cheshire and
Merseyside remain committed to collaborating in respect of the planning of
emergency services but Chief executives are of the view that they do not need a
separate organisation to take this forward. Brief details of the work priorities of
each of the remaining networks is attached at Appendix One.
5. Following a review of the Networks, and in particular accountability
arrangements, it is proposed that a Network Board should be established
which will be the key method of accountability between the networks and
PCTs in Cheshire and Merseyside. The remit of the Board will be:
 To oversee the work of all networks in Cheshire and Merseyside
which are established and funded by PCTs
 To ensure that the annual programmes of networks are consistent
with the commissioning programmes of PCTs
 To sign off a business plan from each network
 To agree the annual budget for each network
 To promote synergies and encourage joint working between
networks; to seek value for money and scope for greater efficiency
at all times
 To consider requests for the establishment of new networks and the
decommissioning of existing networks where appropriate
It is proposed that the Network Board should meet twice a year in January
and July. Membership would be all PCT C/Es in Cheshire and Merseyside.
It has been proposed that the C/E of Wirral PCT should chair the Board.
Decisions of the Board will be binding on all PCTs. If a Chief Executive
cannot attend a Board meeting then they should field a Deputy who is able
to commit to agreements in the Chief Executive’s absence. In between the
two annual meetings of the Network Board, the Cheshire and Merseyside
collective commissioning group/group of Commissioning Directors should
ensure that network programmes continue to support PCTs’
commissioning intentions.
6. Each network will have a Chief Executive Chair/Sponsor who will
represent the network at the Board meetings, as follows:
Network
Named Director/Lead
Cancer
Cardiac
ChaMPs
Child Health
Critical Care
Pat Higgins
Margaret Leid
Dawn Leicester
Jonathan Smith
Sarah Brookfield
Chair/sponsor
from October 2006
Kathy Doran
Rebecca Burke-Sharples
Allison Cooke
Anita Marsland
Kathy Doran
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
Diabetes
Neonatal Intensive Care
Maternity and Perinatal
Sexual Health
Teaching PCT
Renal
Nina Birt
Maria Howard
Jonathan Smith
Simon Henning
Cindy Freeman
Jenny Scott
Rebecca Burke-Sharples
Anita Marsland
Anita Marsland
Leigh Griffin
Derek Campbell
Helen Bellairs
The Funding of Networks from April 2007
7. Funding for 2006/7 is agreed and secured. There is £1.796m funding
available recurrently for networks; expenditure is currently running at
£2.312m, but will reduce following the winding up of ESAT. Current
funding will then cover current expenditure It should be noted that
some efficiencies have already been achieved. Three networks
(cancer, Champs and sexual health) are now co-located; critical care is
now sharing a network manager with the Cumbria and Lancashire
network, has agreed data analyst support from the specialised services
commissioning team and has released c£50k of unallocated resource
back to specialised commissioning; the cancer network has had a 15%
cut to its central allocation imposed by the Office of the SHAs and has
made further savings in the region of £135k; cardiac networks have
had a cut to their central allocation imposed by the Office of the SHAs.
This will not affect the C&M network this year. There will need to be a
discussion with the SHA regarding next year.
8. Given the need to ensure co-ordination across commissioning PCTs, to
develop care pathways and provider collaboration for services which
span more than one PCT and/or provider, and to develop quality
measures for such services, it is proposed that PCTs give a
commitment to continue to fund the networks as described above,
incorporating the efficiencies which have already been achieved and
charging the Network Board with the responsibility to seek further
opportunities for efficiencies which would reduce the commitment for all
PCTs.
Conclusion and recommendation
9. The Board is invited to give its support to the continuation of a
range of networks, to support key commissioning objectives,
subject to the establishment of enhanced accountability
arrangements through the establishment of a Network Board across
Cheshire and Merseyside
Kathy Doran
Network Project Lead
November 2006
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
Appendix 1:
Summary of work priorities for 2006/2007
The key work priorities for 2006/2007 as identified by the networks and collective
working arrangements in Cheshire and Merseyside can be summarised as follows:
Cardiac network
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NICU
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Policy advice for commissioners.
Supporting the implementation of NSF Chapter 8 Cardiac
Arrhythmias.
Stable angina.
Primary prevention.
Facilitate the sharing of best practice.
Promote compliance with DoH guidelines.
Provide robust transport services within Cheshire and Merseyside.
Increase nurse staffing levels.
Education and ongoing continuing professional development.
Development of protocols guidelines and audit.
Support the ongoing development of the human milk donor bank.
Sexual Health
 Delivery of LDP targets.
 Developing care pathways.
 Improving access to abortions.
 Increasing the uptake of Chlamydia screening.
 Tackling workforce issues.
 Prevention of sexually transmitted diseases.
 Improving communication.
Child Health/Maternity and Perinatal
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Support and inform the development of new commissioning
‘footprints’.
Lead a strategy to develop and expand the child health provider-side.
Put in place a ‘fit for purpose’ performance management system
Establish the first phase of a Peer Trainer/Mentor Scheme across
C&M schools and communities.
Develop the role of the Parent Carer Network as the custodians of
best practice in relation to the planning and case management of
services for children and young people with disability.
Support Health in becoming a core leader in the establishing of
Children’s Trusts.
Engage Health in commissioning services, with partner agencies,
which are discreetly designed for young people, to transform the
“Transitions” experience.
Implement the recommendations from the Risk Review, and
strengthening the clinical safeguarding network.
Create a strategy and capacity for working on the issues relating to
children’s Unplanned Care.
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
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Support the implementation of recommendations from the HCC
Improvement Review of Children’s Hospital Care.
Establish a new, inter-agency Network for the planning and delivery of
services to young people with the most complex mental health
needs (Tiers 3b & 4, or =).
Establish a children’s Prescribing/Pharmacy Network.
Establish an effective “Maternity Services” Network.
Lead the strategic thinking about new approaches to an
“Intermediate Community Child Health” service or pathway.
Conclude the development work on a comprehensive children’s SARC
service.
Launch a new stream of work relating to excluded children and
young people.
Help ensure that Joint Investment Statements can be established in
each C&YPP area, in time for the start of the 07/08 financial year.
Implement a proactive Health contribution to an ambitious, children’s
workforce plan.
Establish a sound, joint information strategy, and make and effective
implementation of its first phase.
Bring the child health research community together into a more
coherent network, which begins to respond to locally-identified
priorities and needs.
Advocate, in the NW and nationally, for the establishing of a common
public health dataset for children, and the creation of a “Child Health
Observatory” capacity.
Critical Care
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Develop service improvement champions.
Promote patient and public involvement.
Develop care bundles.
Provide commissioners and providers with information on changing
acuity of illness.
Promote accurate prescribing and administration of medication.
Reduce the number of critical care transfers and delayed discharges.
Ensure hospital wide systems are in place for the early identification of
patients whose condition is deteriorating (outreach).
Analysis of critical care transfers and bed capacity.
ChaMPs Public Health Network
•
Support the delivery of PCTs’ and local authorities’ public health
priorities and targets
•
Promote collaboration and cooperation between the NHS, local
authorities and other organisations e.g. development of guidelines to
make effective joint public health appointments, and reduce
smoking prevalence and exposure to second-hand smoke
•
Facilitate an effective and accredited CPD programme for the public
health workforce and hold the second ChaMPs conference
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
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•
Collaborate effectively with other networks by developing joint
programmes and working groups (e.g. Cancer Network, Sexual
Health Network, CHD through Heart of Mersey and the Children’s
Network)
•
Develop and disseminate practice-based commissioning guidance to
enable commissioners to effectively commission for health gain
•
Develop novel approaches in tackling health inequalities e.g. using
social marketing to address childhood obesity and awareness of
COPD
•
Develop public health workforce capacity and capability to deliver
improvements in the health of the population and address
inequalities e.g. implement a Health Trainers programme
•
Submit a joint bid to win DH funding to establish a regional Public
Health Teaching Network to strengthen links between PCTs and
academia
•
Engage health protection partner agencies in setting out a strategic
direction and promoting opportunities for joint work and sharing
good practice to protect the health of the population
•
Jointly organise with the Healthcare Commission a North West event
for provider trusts and commissioners around achieving world class
standards in public health
•
Implement a best practice procurement project through ChaMPs’
partnership in the EU Healthclusternet programme
•
Establish a joint working group on alcohol to develop effective
strategies
Teaching PCT
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Support business continuity during the organisational instability whilst
functions, systems and structures are being established.
Hold the ring on organisational intelligence around community and
primary care education, helping to avoid “re-invention of wheels”.
Work on educational development programmes that help
organisations achieve performance targets.
Provide education leads with a forum to challenge, be creative, share
knowledge, special skills and information
Work with and at the interface with other partner organisations
including Higher Education, Social Services and the SHA.
Facilitate the best use of educational resource so that economies of
scale are achieved.
Focus on embedding the ethos of learning and sharing between
organisations.
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
Cancer Network
Summary of key functions and anticipated outputs for 2006-2008 for the
Cancer Network
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Strategic Direction and Leadership
Engagement with all stakeholder organisations
Clinical Engagement (and other professionals)
Service Planning and Commissioning advice to PCTs
Patient Pathway Development and Service Improvement
Patient & Public Involvement
Quality Assurance, accreditation and governance e.g. pathways, IOGs
Information Dissemination and Communication
Implementing national policy
Workforce Development and planning
Performance management e.g. Peer Review, CWT
Through the Taskforce, (board) a number of key strategic objectives were agreed
as part of the Network’s Service Delivery Strategy 2005-8. This included a
number of overarching objectives e.g. reducing mortality, improving outcomes
and delivering national targets. The following objectives have been approved and
for the next 18 months the key areas will be :
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Continue implementation of action plans for NICE Improving Outcomes
Guidance (IOG) in all cancers with full implementation in gynaecological,
urological, upper gastro-intestinal, haematological cancers and supportive
and palliative care.
Prepare for peer review in haematological, urological and upper gastrointestinal cancers (November 2006), colorectal and head & neck cancers
(May 2007).
Implement remedial action plans resulting from peer review 2005.
Develop action plans for NICE IOG in skin, brain, sarcoma and children’s and
young people’s cancers.
Achieve and sustain waiting time targets for all cancers.
Develop plans to achieve two week access for all breast and colorectal
referrals.
Implement commissioning and governance frameworks for cancer.
Implement the Bowel Cancer Screening Programme for C&M PCTs.
Responding to the challenges re Commissioning patient led NHS – reshaping
the portfolio of the network team to support the new organisations and
demonstrate VFM whilst contributing to corporate savings targets.
Supporting providers and commissioner on financial reforms for cancer
services by strengthening links to host commissioners and host cancer
centres
Developing the Primary care cancer agenda – emphasis on health
inequalities, early detection and prevention strategies linking with PBC
Examine and audit care pathways focusing on in patient episodes of care in
line with national direction (further guidance is expected from the National
Cancer Action Team – Going Further on Cancer Waits)
Develop plans to achieve two week access for all breast and colorectal
referrals (a manifesto commitment and likely to be a part of above)
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
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Implementing a comprehensive strategy on Patient information (part of
Supportive and Palliative Care IOG for which Macmillan funding has been
secured)
Strategic development of patient involvement linking with other networks and
PPI fora across Cheshire and Merseyside
Workforce Development – supporting staff through changing roles,
particularly nursing roles learning from the Integrated Cancer Care Pilots
End of Life – mainstreaming this to all disease groups.
Renal network
 Progress initiatives to address the need for additional capacity within
renal services
 Inpatient bed requirements
 Central Cheshire / University of North Staffordshire Hospital HD
expansion
 East Cheshire / Central Manchester HD expansion
 ISTC Haemodialysis expansion programme
 Nephrology Outpatient Demand and Capacity Plan
 Workforce Planning in renal services
 Implementation of the Cheshire and Merseyside Renal Transport
Learning Set recommendations
 Address renal service priorities in implementation of the renal NSF
 Collate and analyse NSF baseline assessments
 Establish a detailed work programme for the Renal Strategy Group
 Update Cheshire and Merseyside Strategic Framework for 20082014
 Paediatric Nephrology issues
 Development of an effective renal IT system
 Establish a network-wide IT system in order to submit national
data to the Renal Registry UK and manage local clinical care.
 Formalise policies and guidelines for the Cheshire and Merseyside
Renal Network
 Blood borne viruses / Hep B Vaccination Programme
 Transplantation including Immunosuppression and Organ Donor
Marketing Plan
 Acute Renal Failure Management
 Conservative Management
 Home Haemodialysis
 Temporary Away From Home Dialysis
 Anaemia Management
 Cinacalcet prescribing
 Peritoneal Dialysis Development
 Early Referral of Chronic Kidney Disease

Strengthening Communication with Patient Groups and Service
Users
 Website
 Quarterly newsletter
 Strengthening links with Cardiac and Diabetes colleagues
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006
Agenda Item: 5.2
Ref: W06-07/063
 Annual patient conference
 Meetings with directorate managers
 Engagement with PCT renal commissioners
 Regular contact with patient groups
 Sharing good practice events for clinicians and commissioners
Renal SpRs education / training in commissioning
Diabetes network
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Facilitate review and development of structured education in
accordance with NICE Guidelines
Facilitate and support local networks in achievement of Diabetic
Retinopathy Screening Target
Share learning and outcomes from Health Care Commission Review
and National Diabetes Survey
Communication Strategy – Provide regular information to local
networks via web site and newsletters
Facilitate forum for clinical engagement and sharing of good practice
Develop consistent guidelines and protocols across the Region to
support equity of service provision (ie Insulin Pumps)
Develop strategy to support implementation of Children and Young
People with Diabetes guidance
Provide education and learning opportunities for local diabetes
networks as identified
Represent colleagues at the National Diabetes Support Team
Meetings
Facilitate participation in National Diabetes Audit and share outcomes
to help improve service provision
The Future of Networks in Cheshire & Merseyside post October 2006:
Board Meeting: 12 December 2006