User Foundation Training Day

Session 1 Welcome and Introductions

Aims of Today

Learning Outcomes By the end of the training session participants should be able to: Understand aspects of cancer care/treatment that relate to user involvement in Cancer Peer Review (CPR) Outline the key principles of CPR Describe the role and responsibilities of user reviewers Understand how CPR relates to the patient/carer experience/user involvement Understand how to review evidence Define the essential elements of effective communication, assertiveness and teamwork that enhance CPR Gain insight into appropriate questioning techniques Seek further advice/support/help for this role

Group agreement Valuing everyone’s contributions – We may not always agree with what everyone says but we can at least acknowledge their point of view and value their contribution Taking responsibility for own learning - No question is a silly question- all you are doing is asking for clarification Time keeping - Everyone to share responsibility for this. Confidentiality - Tips, hints or general factual information feel free to share with others, BUT anything personal or attributable to individuals, places or settings please keep confidential. Confidentiality re peer review process is addressed during the full day’s reviewer training Equal opportunity for all- only one person speaking at any one time in the large group Mobile phones- switched off or to vibrate mode please

Peer Review and the New Political Environment Session 2

The White Paper

The key players

NHS commissioning board –Will be held accountable for NHS Outcomes Framework –Delivering high quality outcomes for patients NICE Quality Standards –Commissioned by NHS Commissioning Board –150 Quality Standard in 5 years CQC – Quality regulator - Essential Standards Monitor – Economic regulator

Key points of the white paper Equity and excellence: Liberating the NHS (July 2010) Putting patients and the public first –No decision about me, without me –Choice and voice –The Information Revolution Improving healthcare outcomes –“To reduce mortality and morbidity, increase safety and improve patient experience and outcomes for all” –Outcome measures not process targets (Outcomes Framework) –Quality standards (NICE) –Cancer Drug Fund –Payments for quality

NHS Outcomes Framework

A new NHS Commissioning Board would be held to account for the NHS Outcomes Framework - Delivering high quality outcomes for patients The NHS define quality as: the effectiveness of the treatment and care provided to patients; the safety of the treatment and care provided to patients; and the broader experience patients and their carers have of the treatment and care they receive.

NHS Outcomes Framework In terms of measuring these three areas, it is legitimate to look at: the structures of care – based on robust evidence, how should treatment and care be structured in order to maximise the chance of a good outcome for the patient? the processes of care – based on robust evidence, what are the things that should be done to maximise the chance of a good outcome for the patient? and the outcomes of care – what actually happens to the health of the patient - the outcome - as a result of the treatment and care they receive?

NICE Quality Standards The NHS Commissioning Board will commission NICE to produce the Quality Standards. 150 over 5 years. NICE Quality Standard for Breast Cancer

Aims of Cancer Reform Strategy Refresh To align cancer strategy with the White Paper To set the direction for the next 5 years –Taking account of progress since December 2007 To show how outcomes can be improved despite the cold financial climate

The New Healthcare Environment

Ensuring Effective Levers Ensuring Peer Review outcomes are fed into the Care Quality Commission legal registration requirements Embedding Peer Review outcomes into the Commissioning process Providing evidence that services are meeting the NICE Quality Standards

Commissioning Ensuring the reports go to named individual commissioners, SCG, GP Consortia Providing commissioners with a summary and recommended actions Updating the Cancer Commissioning Toolkit

Care Quality Commission Mapping of measures to CQC registration outcomes 2009/2010 data incorporated into CQC Quality and Risk Profiles (QRPS) in October 2010 Immediate Risks and Serious Concerns reported to CQC regional assessors Partnership working on CQC visits

NICE Quality Standards Peer review measures will map onto NICE Quality Standards. Initial work has started with breast cancer Peer review outcomes will demonstrate where a MDT is a high quality service and this can be used in the quality accounts

Session 3 Who's Who and What’s What in the NHS

Structure of the NHS The Card Game Challenge

Session 4 Using Cancer Policy to Improve Care and Treatment

Cancer policy

Improving Outcomes Guidance

The Patient Experience Clinical Pathways versus Patient Journeys – is there a difference?

Pathways

Refreshments Please return in 15 mins

Session 5 What is National Cancer Peer Review?

Scope of Peer Review

Purpose of Peer Review

How CPR is Organised Nationally National Cancer Action Team National Steering Groups Zonal Advisory Groups 4 Zonal Teams :- –North –Central –London –South

The Peer Review Programme

Handbook for the National Cancer Peer Review Process Contains details of the process from start to finish including: 1.The Peer Review Programme 2.Annual Self Assessment 3.Internal Validation 4.External Verification 5.National Schedule for Peer Review Visits & Conducting the Review 6.Outcomes of the Peer Review Process 7.Identification of Concerns 8.CQuINS

Session 6 The Role of the Reviewer

Who are Reviewers?

The Reviewer Role

Session 7 Becoming a reviewer A patient/carer perspective

User Peer Reviewer

A bit about my cancer journey

Why I got involved with Peer Review Because I was asked! Service improvement Patient experience Self development

Peer Review experience - the first time Scary! but Excellent team leader Lots of support Rapport and respect

Tips for a successful review Preparation! Teamwork Tight timing Don’t be afraid to ask questions …. and keep asking Use the zonal team

What I’ve got out of it Worthwhile Stretching Good practice Enjoyment!

The Unique Role of the User Reviewers

Lunch Please come back at 13.30

Session 8 Reviewing as a Team

Reviewing as a Team A team is a group of people who share and are aware that they share a common goal

Benefits of Team Working Combines collective knowledge/skills/attributes Creates cooperative action Makes best use of individual strengths Mutual support & learning on difficult problems Common ownership of actions/decisions Increases individual contribution & overcomes domination Creates momentum Achieves consensus Increases significance of findings/conclusions

What Makes a Team Tick? Keeping focused on real issues Encouraging participation from everyone Managing competitive activity/conflict Encouraging positive attitudes Avoiding compromise Pacing & keeping to time/deadlines Achieving the required result Ensuring conducive environment

Making a Team Tick Team Members’ Responsibilities Taking a lead Listening Making suggestions Asking for information Posing/answering questions Recapping /summarising Initiating solutions/ideas Testing for consensus

Formulating Questions ‘It’s not what you say it’s the way that you say it’

Session 9 Reviewing the evidence A focus on patient issues

Group Work Spend 20 minutes reading the documentation on your table and recording on this proforma whether you think the measure is met where you found the evidence. identify any outstanding queries

Key points from group work What conclusions did you reach after looking at the evidence ? Where was the Evidence? What questions do you have that you need to ask the team. 2C-102 2C-105, 2C-109, 2C-117, 2C-121

Session 10 Using Effective Communication During the Review

Formulating Questions From the information you gathered earlier formulate some questions that you would want to ask the team being reviewed.

Question types OpenEncourage people to talk What, where, when, why, how? ClosedChecking factsHow many? do you? HypotheticalTest contingenciesWhat if? ProbingGreater depthIn what way? Tell me more.. LeadingPacifying Use with care You do, don’t you? MultipleAvoidWho sends it, what do you do and how?

Funneling questions Open - to explore Probing - to clarify Hypothetical - to test contingencies Closed - to confirm

Listening Listen before deciding response –Be active summarise regularly ask confirmatory questions –Let the Reviewees talk –Encourage contributions from everyone –What if they won’t stop talking?

Refreshments Please return in 15 mins

Session 11 The Three G’s

The Three G’s 1) Gains- What you hope to gain from the becoming a reviewer 2) Gives- What you’ll bring to the process 3) Groans- Any concerns you have

Session 12 Next steps

Next steps This may not be for everybody, but we are happy if you want to give it a go!

Learning Outcomes By the end of the training session participants should be able to: Understand aspects of cancer care/treatment that relate to user involvement in Cancer Peer Review (CPR) Outline the key principles of CPR Describe the role and responsibilities of user reviewers Understand how CPR relates to the patient/carer experience/user involvement Understand how to review evidence Define the essential elements of effective communication, assertiveness and teamwork that enhance CPR Gain insight into appropriate questioning techniques Seek further advice/support/help for this role

Acknowledgements User Reviewer members of the National User Steering Group for NCPR Derek Stewart O.B.E. RIME & Reason Consultancy Cancer Patient Advocate and Trainer for the use of the patient and clinical pathway exercise Gillian Fletcher – Lead Trainer for Cancer Voices for the use of her National Health Jigsaw

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