Cheshire & Merseyside Cancer Screening Programme
Bowel/Breast Screening
Improvement Project
Project Initiation Document
Project name:
Bowel/Breast Screening Non-Responder Project
Date of current
version:
04/10/19
Version:
2.6
Gemma Hockenhull
David McKinlay
Author(s)
Louise Vernon
Marie Coughlin
Note:
Document
location:
The version-controlled copy of this document is available at:
1
Cheshire & Merseyside Cancer Screening Programme
Revision History
Revision
Date
25/07/2019
25/07/2019
02/08/19
20/08/19
13/09/19
04/10/19
04/10/19
Previous
Revision Date
Summary of Changes
Changes
Marked
Updated approvals list
Update to project rationale
Update to milestones/approvals/project aim
Overall update and removal of acronyms
Updated NHSE milestones
Updated project roles and resources
Addition of logo’s
Approvals
This document requires the following approvals:
Group
Cheshire and
Merseyside Cancer
Alliance SMT Group
Champs Public Health
Collaborative
Cheshire & Merseyside
Directors of Public
Health
Public Health England
Screening &
Immunisation Team
NHSE/I North West
Name (on behalf
of group)
David McKinlay
Signature
Date of
Issue
Version
Helen Cartwright
Sandra Davies
Hayley
Mercer/Marie
Coughlin
Julie Kelly
2
Cheshire & Merseyside Cancer Screening Programme
Table of Contents
1.
PURPOSE OF DOCUMENT............................................................................. 4
2.
PROJECT BACKGROUND .............................................................................. 4
Strategic context .................................................................................... 4
Project rationale ..................................................................................... 5
3.
PROJECT AIM, BENEFITS AND DELIVERABLES ......................................... 8
Project aim and objectives ..................................................................... 8
Project timescales .................................................................................. 9
Project benefits and evaluation framework .......................................... 10
4.
PROJECT PLANNING .................................................................................... 10
High level project milestones ............................................................... 10
Project scope ....................................................................................... 11
5.
RISK AND ISSUES MANAGEMENT .............................................................. 11
6.
PROJECT INTERFACES ............................................................................... 12
7.
PROJECT ORGANISATION AND GOVERNANCE ....................................... 13
Organisation ......................................................................................... 13
8.
PROJECT ROLES / RESPONSIBILITIES ...................................................... 14
9.
PROJECT RESOURCES ............................................................................... 14
3
Cheshire & Merseyside Cancer Screening Programme
1. Purpose of document
The purpose of this document is to define the bowel and breast screening non-responder project, to form
the basis for its management and to help with the assessment of the project’s overall success. This
document gives the direction and scope of the project, defining the main aim, objectives and deliverables
to be achieved.
In terms of definitions used:
Uptake, is the percentage of women who, having been sent an invitation for screening, attend a screening
unit and undergo mammography in response to that invitation.
Coverage is defined as the percentage of women in the population who are eligible for screening at a
particular point in time, who have had a test with a recorded result within the last 3 years.
The three primary uses of the document are:



To ensure that the project has a sound basis before full initiation of the project activities.
To provide a baseline document against which progress, issues and on-going viability can be
assessed.
To provide a single source of reference for the project, enabling stakeholders to quickly understand
the details of the project and how it is being managed.
This document will be monitored and updated following each phase of the project to reflect the current
status. It therefore reflects the status of the project at the point of phase completion. Each Version of the
document will be preserved so that progress of the project can be monitored and the original Project
initiation document (PID) will be used as a baseline against which to measure success at the end of the
project. The PID addresses the following fundamental aspects of the project:






What the project is aiming to achieve.
Why it is important to achieve the stated aims.
Project scope, budget and stakeholder information.
Who will be involved in managing the project, and what are their roles and responsibilities.
Methods of risk and quality management.
How and when the arrangements discussed will be put into effect.
2. Project Background
Strategic context
The NHS long term plan (2019) sets out ambitious aims for cancer, with cancer alliances playing a key
role in delivery. The plan highlights that by 2028:
•
•
An extra 55,000 people each year will survive for five years or more following their cancer
diagnosis; and,
Three in four cancers (75%) will be diagnosed at an early stage.
4
Cheshire & Merseyside Cancer Screening Programme
In February 2019, the National Cancer Director wrote to Cancer Alliances confirming cancer
transformation funding for 2019/20. The funding allocation for Cheshire & Merseyside Cancer Alliance this
year has been confirmed as £5.9m, subject to an agreed delivery plan. The National Cancer Team
identified transformation funding priorities for the following with clear associated ‘must-do’ deliverables:
•
Sustainable operational performance including delivery of the 28 and 62 day standards.
•
Screening and early diagnosis.
•
Personalised care.
Development of Cheshire and Merseyside priorities for transformation funding was led by Cheshire &
Merseyside Cancer Alliance through engagement with key partners and stakeholders. This included
establishment of a number of priority project working groups, a region wide engagement event and a call
for proposals. Over 100 proposals were received and tested against the national funding criteria. From this
a programme of transformation work for 2019/20 was developed and submitted for approval to the
national team. This project represents one of those key priorities for Cheshire and Merseyside. A
summary of the Cheshire & Merseyside Cancer Alliance programme can be found below.
Cancer Alliance
Delivery Plan 19 20.docx
Project rationale
Cheshire and Merseyside Cancer Prevention Steering Group identified improvement in cancer screening
performance as a key priority for Cheshire and Merseyside. In December 2018 the Screening and
Immunisation Team and Cheshire and Merseyside Cancer Alliance supported collaborative stakeholder
workshops to discuss screening programmes and identify initiatives to improve screening uptake and
coverage. These workshops identified initiatives to improve bowel, breast and cervical uptake and coverage.
Improvement in screening uptake and coverage was identified as a priority due to the significant impact of
late detection on mortality from cancer. Deaths from bowel, breast and cervical cancer are shown in table
1. It was identified that the current commissioning and delivery landscape for cancer screening is complex.
It was therefore felt that there would be benefit in a series of focused projects working with all key
stakeholders to influence and directly contribute to improvements in screening uptake and coverage. This
is further highlighted in the interim report of the Independent Review of Cancer Screening Programmes in
England (Sir Professor Mike Richards, 2019).
Workshop attendees identified a number of opportunities to improve uptake and coverage. In particular the
role of screening support workers was highlighted with evidence presented from a number of sites including
Halton Council, Beating Bowel Cancer and Liverpool Public Health volunteer model.
5
Cheshire & Merseyside Cancer Screening Programme
Table 1 Mortality from Cervical Cancer, Breast Cancer and Colorectal Cancer1
Bowel screening
Bowel screening is offered to men and women aged 60- 74 with another one off screening test offered to
men and women aged 55. Bowel cancer screening saves approximately 2400 lives per year in England.
The current position for bowel cancer screening is as follows:
•
•
•
•
•
•
1Source
The national bowel screening coverage target is 60%.
Coverage across Cheshire & Merseyside varies from 52.8% to 64.3%.
Numbers need to reach target - additional 7,752 men and women in Merseyside should have
been screened (Q3 17/18).
There is a very strong relationship between bowel screening coverage rates and deprivation:
deprivation explains 91% of the variation in coverage rates.
Between 2012 and 2016, there have been 3,248 deaths from bowel cancer in C&M.
Bowel cancer mortality appears to be associated with both screening coverage and
deprivation, with mortality reducing as coverage increases and deprivation decreases.
PHE Fingertips
6
Cheshire & Merseyside Cancer Screening Programme
Table 2 highlights the current position across Clinical Commissioning Groups in Cheshire and Merseyside.
Table 2 % Population Aged 60-74 Screened within the last 2.5 Yrs 2
Breast Screening
Breast cancer screening is offered to woman aged 50-70 with women over 70 able to self-refer. Breast
screening saves 1 life for every 2000 women screened and approximately 1300 lives per year. The current
position for bowel cancer screening is as follows:
•
•
•
•
•
•
2Source
The national breast screening coverage target is 70%.
In C&M, 9/12 CCGs are above the 70% threshold, with coverage varying from 65.0% to 79.2%.
Numbers need to reach target - an additional 3,272 women in Merseyside should have been
screened (Q3 17/18).
There is a strong relationship between breast screening coverage rates and deprivation:
deprivation explains 63% of the variation in coverage rates.
In the past five years there have been 2,358 deaths from breast cancer in Cheshire &
Merseyside.
There is no association between breast cancer mortality rates and either screening coverage
or deprivation.
PHE Fingertips
7
Cheshire & Merseyside Cancer Screening Programme
Table 3 highlights the current position across Clinical Commissioning groups in Cheshire and Merseyside.
Table 3 % Women aged 50-70 Screened within the last 3 Yrs 3
3. Project aim, benefits and deliverables
Project aim and objectives
To develop and begin implementation of a model to improve uptake and coverage of bowel and breast
cancer screening.
The model will target those who are due to attend/ complete their first screening, non-responders to
screening appointments/ reminders and people who do not progress to endoscopy for colonoscopy
following a positive Faecal immunochemical Test (FIT) test.
FIT (Faecal Immunochemical Test) is a stool test designed to identify possible signs of bowel disease. It
detects minute amounts of blood in faeces (faecal occult blood).
The model will utilise support workers who will engage directly with patients and support them to
participate in screening.
Delivery of this project will support the ambitions to:
3Source
PHE Fingertips
8
Cheshire & Merseyside Cancer Screening Programme

Improve screening uptake and coverage across Cheshire and Merseyside

Reduce variation in cancer screening programmes across Cheshire and Merseyside, focused on
population groups who are particularly vulnerable to screening inequalities identified in national
PHE Screening Inequalities Strategy (2019) including;
People living in poorer areas
 People with a learning or physical disability
 Black, Asian or people from other ethnic minority groups
 Lesbian or bisexual women
 Men – who are less likely to be screened than women
The project will do this by:










Working with provider organisations to define and recruit patient navigators
Developing a training and support package for patient navigators
Ensuring an appropriate governance mechanism is in place to enable access to patient information
by the patient navigators
Reviewing current data to identify inequalities of uptake and coverage of access across Cheshire
and Merseyside and developing approaches to improve this
Designing a patient engagement approach for example targeting patients from practices with lower
uptake and coverage, focussing geographically etc.
Working with provider organisations, Screening and Immunisation Team, the hub and patient
navigators and other stakeholders to identify structural barriers to access and plan work with
partners to improve this
Working to establish improvement trajectories
Working with provider organisations to manage capacity and demand as the result of increased
cervical screening
Establishing a robust evaluation and monitoring approach across all sites participating
Working with partner organisations to develop cases for sustainability of roles if shown to be
effective.
Project timescales
Early work has taken place from December 2018 including stakeholder engagement and establishing
project leadership in anticipation of national funding. The project is due to be formally mobilised in July
2019. The project milestones run until March 2020 however it is expected that some aspects of the project
will run beyond the formal lifecycle of the project, for example where timescales for recruitment for 12
month fixed term posts results in a contract running beyond March 2020 and evaluation activities need to
continue.
3Source
PHE Fingertips
9
Cheshire & Merseyside Cancer Screening Programme
Project benefits and evaluation framework
Evaluation support will go out to procurement
4. Project planning
High level project milestones
The project will deliver the following high level milestones:
Key Project milestone
Associated NHSE milestone (if
relevant)

Establish governance, clinical
leadership
and
project
management resource. Engage
secondary care, primary care, local
authority
and
commissioning
organisations in project. Develop
PIDs.
Prioritise
project
workstreams. Develop patient
navigator
role
and
initiate
recruitment.














Project initiation activities completed,
including draft milestones, project
initiation document approved, risks
identified, project plan and risk log
established.
Stakeholder engagement plan
developed and stakeholders engaged
Role description for patient
navigators developed
Host organisations identified and
engaged in recruitment process
Outline training and support package
development initiated
Review data to identify inequalities of
uptake and coverage
Develop draft evaluation plan
Fully define patient navigators role
Initiate recruitment for patient
navigator role
Work with local stakeholders to
define plan for patient navigator
activity (which patients are engaged
first)
Establish governance framework to
ensure access to patient information
by patient navigator
Finalise evaluation plan and delivery
mechanism
Support on-boarding of patient
navigators and deliver training
Go-live- mobilise patient engagement
activities
Initiate evaluation data capture
3Source
Expected delivery
date
Q2 2019
Q3 2019
Patient navigators in post. Evaluate
implementation
progress
and
impact.
Q4 2019/2020
PHE Fingertips
10
Cheshire & Merseyside Cancer Screening Programme


Q1 20/2021
Interim evaluation
Initiate development of case for
sustainability
Project scope
This project will involve the following stakeholders:








All local authorities/ public health in Cheshire and Merseyside
Clinical Commissioning Groups in Cheshire and Merseyside
Cancer Research UK
Screening and Immunisation Team
CHAMPS Public Health Collaborative
Cheshire & Merseyside Cancer Alliance
Directors of Public Health
Primary Care via Clinical Commissioning Groups and Primary Care Clinical, Quality and
Governance
Public Health England
Cancer screening providers of endoscopy, cytology and breast services
Provider trusts for bowel and breast screening services
Primary Care Network leads




This project encompasses all services provided in Cheshire and Merseyside.
5. Risk and issues management
Risks have been scored in line with Clatterbridge Cancer Centre policy as illustrated below in Figure 3:
Figure 6; Risk scoring through application of a. Impact chart; b. Likelihood chart; c. Risk matrix
a. Impact chart
b. Likelihood chart
c. Risk score matrix
The following risks have been identified at the time of writing:
3Source
PHE Fingertips
11
Cheshire & Merseyside Cancer Screening Programme
Post mitigation scores
Risk type
Quality
Quality
Quality
Identified Risk
There is a risk that
endoscopy, pathology and
radiology cannot meet the
demand that may be created
by the project
There is a risk organisations
are not prepared/ in a
position to receive funding
There is a risk that primary
care will not engage with the
project uniformly
Mitigating Factors
Likelihood
Impact
Overall
Project manager to engage with services to
model impact and mitigating actions with
providers
3
3
9
Project manager to engage early with
organisations. PM to seek support from
DsPH and CMCA if required
3
3
9
PM to begin engagement activities early and
seek support from PCCQG and CCG leads
3
2
6
6. Project interfaces
Other projects/programmes which it is known will interface with the project (i.e. will need to factor into local
project plans) are:
 Screening & Immunisation team activities
 Cheshire & Merseyside MECC programme
 Cheshire & Merseyside Health & Care Partnership Prevention Programme
 Endoscopy programme
 Radiology Programme
 Cancer Research UK delivery plan
 Cheshire & Merseyside Cancer Alliance programme
 Local area cancer action team plans
It is acknowledged that further interfaces may be identified throughout the course of the project.
3Source
PHE Fingertips
12
Cheshire & Merseyside Cancer Screening Programme
7. Project organisation and governance
Organisation
The project team structure and governance are outlined below in figure 1. The Project Manager will
ensure coordination of the project with regards to work streams and with other interdependent Cancer
Alliance Projects. All relevant project documentation will be produced for the project.
Figure 1; Project team overview and governance structure.
3Source
PHE Fingertips
13
Cheshire & Merseyside Cancer Screening Programme
8. Project roles / responsibilities
Title
Name
Organisation
Role
Senior
Responsible
Officer
Sandra Davies
Liverpool City Council
DPH for Liverpool City Council and Chair
of Cheshire & Merseyside Cancer Alliance
Board
Champs
Accountable
Lead
Helen
Cartwright
Champs Public health
Collaborative
Head of Commissioning and Mobilisation
Programme Lead
Marie Coughlin
NHS
Screening & Immunisation Manager
England/Improvement NHS England and NHS Improvement –
North West
Programme
Manager
Louise Vernon
Champs Public
Health Collaborative
Cheshire & Merseyside Cancer Screening
Programme Manager
Project Support
Officer
Rosie Murphy
Champs Public
Health Collaborative
Cheshire & Merseyside Cancer Screening
Project Support Officer
9. Project resources
A detailed budget statement for each project is to follow
3Source
PHE Fingertips
14
Cheshire & Merseyside Cancer Screening Programme
Reference List
NATIONAL HEALTH SERVICE, 2019. The NHS Long Term Plan. Available from:
https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf [Accessed 8
November 2019].
SIR PROFESSOR MIKE RICHARDS, 2019. Independent Review of National Cancer Screening Programmes in
England. Available from: https://www.england.nhs.uk/wp-content/uploads/2019/02/independent-review-ofcancer-screening-programmes-interim-report.pdf [Accessed 8 November 2019].
PUBLIC HEALTH ENGLAND, 2019. Supporting the Health System to reduce inequalities in screening. Available
from:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/816245/PHE
_Screening_inequalities_strategy_2018__1_.pdf [Accessed 8 November 2019].
3Source
PHE Fingertips
15
Cheshire & Merseyside Cancer Screening Programme
16
Cheshire & Merseyside Cancer Screening Programme
17