1. SWAG Cancer Alliance Board
Organisation Development project
September 2019

2. Key themes from OD Diagnostic (March-April)
What’s working well
Identity and purpose
Governance
Systems Leadership
Planning and processes
Engagement including clinical

3. Overview of progress on OD action plan
ACTIONS
PROGRESS
Refresh purpose and why
Done
Clarify roles and responsibilities with key partners
Design principles agreed
3 of 4 STPs/ICS bilaterals held
Region & others O/S
Board Governance review TBC
LTP planning process aligned
SB proposed collaborative process
Improve SWAG communications
Awaiting NHSE/I change process
Improve clinical engagement
Establishment of Clinical cabinet In progress
Ensure patient centric
No further work
Build systems leadership capacity
Interim MD pending permanent recruitment process post NHSE/I change process
Develop annual planning and funding cycle
In progress: need to refine existing planning cycle and funding approach to make it more collective & aligned
Review financial flows and assurance processes
Recognised in bliaterals: need for strong PM to track investments and link to impact in changing context
Review progress
June & Sept reports but not yet complete

4. Key context & common themes from OD work
Continued development of local systems (STPs/ICS) and own OD processes
Change in SWAG leadership: Sunita as p/t Alliance Manager/interim MD
LTP implementation planning process
National guidance and requirements including single alliance cancer plan
SWAG approach
General support for draft roles & responsibilities for SWAG/STPs but request to simplify
Recognition of inherent tension in STPs with local financial pressures and wider strategic remit and nationally mandated Alliance with focus on national cancer priorities
Recognition of need for continued strong SWAG programme management tracking investment & impact – demanding in complex evolving local systems
Need for great senior strategic alignment across STPs/ICS with SWAG - how to reflect this in overall governance?
Support for enhanced clinical engagement
Local pick up of national priorities with transformational funding attached increasingly challenging where tight local funding & unrealisable savings.
PCNs in early stages of development and very variable

5. Proposed SWAG CA revised vision
NB Red = added since draft presented to Board
Current
“The Alliance is committed to taking the recommendations of Achieving World-Class Cancer Outcomes and making them a reality to the people of the Alliance. This will build on the many examples of excellence and innovation and a history of collaborative working. “ From SWAG Delivery Plan Jan 2017
Proposed
The Alliance vision is to improve outcomes and experience of care for the cancer patients and populations of SWAG.
The Alliance is a membership network and vehicle whose purpose is to ensure patients are at the heart of the system and to add value to and support Integrated Care Systems and STPs in the delivery of the National Cancer Programme and NHS Long Term Plan.
The Alliance works collaboratively to plan and deliver improvements locally and across the wider system, sharing learning, good practice and resources across organisations.

6. Transformational objectives Transactional objectives
SWAG CA Purpose
Transformational objectives
Facilitate collaboration between multiple partners to improve cancer outcomes and access across SWAG
Across STP systems
Pan-STPs
Facilitate clinical collaboration and pathway mgmt.:
Co-ordinate and encourage collaboration to overcome system constraints to deliver quality services
Facilitating clinical groups, to develop pathways, protocols, patient guidelines, keeping up to date with national guidance/clinical guidelines
Searching out good practice, peer learning opportunities
Facilitate more joined-up services and sustainability, e.g. services for rarer cancer sites where multiple providers operate but lack population critical mass & struggle with workforce.
Ensure that pathways reflect patient and public feedback
Facilitate system wide intelligence on Cancer to inform STP/ICS decision-making (including workforce challenges)
Transactional objectives
Agree the strategy for cancer across an area in collaboration with providers and commissioners
Lead service transformation:
Oversee a programme of transformation and investment
Co-ordinate Cancer Fund bids and create momentum for change/driving improvements
A conduit to :
Primary Care Networks (where early detection of Cancer is one of 7 priorities by 2022/23]
NHSE/I – Funding streams for initiatives
Influence Spec Commissioning and National programme
Link and coordinate with Radiotherapy Network
Supporting delivery of National Cancer Plan, including 28 day and 62 day standard.
The CA should NOT act as a regulator or, commentator or performance manager

7. Organisation design principles for the Alliance
Organisational arrangements in the Alliance must:
Focus on Cancer outcomes and experience of care for patients and the wider population, with an emphasis on reducing inequalities
Organise the Alliance as a collaborative network with distributed leadership
Align with the configuration of emerging ICS and current STPs
Design for subsidiarity (decisions are made as close to the patient as possible) based on roles and responsibilities at each level of the CA system
Issues are dealt with at the most immediate (or local) level consistent with their resolution
The Alliance acts where the objectives of the proposed action cannot be sufficiently achieved by or within STPs, by reason of the scale or where the effects of the proposed action are better achieved at Alliance level
Allow for local differences between ICS/STPs
Be strategically consistent with the National Cancer Programme, NHS Long Term Plan, and locally flexible for ICS/STPs in its delivery
Be co-designed with clinicians, patients and key stakeholders as our default way of working

8. The Strategic roles of the Cancer Alliance and ICS/STP:
Supra-STP/ICS
Oversight of whole cancer population
Facilitate system level transformation to improve outcomes and access
Sponsor proof of concept and innovation projects on behalf of the system
Facilitate system wide intelligence on Cancer to inform STP/ICS decision-making
Assess impact for service provision of national guidance and standards for Cancer services provision
Impact assessments for proposed cancer pathway changes
Work in partnership with ICS/STP and Primary Care Networks to achieve ambitions detailed in the Long Term Plan
Local: ICS/STP
Facilitate collaboration between multiple partners
Lead service transformation across the ICS/STP in partnership with the CA and service providers
Oversee the ICS/STP programme of transformation and investment
Co-ordinate Cancer plans at ICS/STP level and create momentum for improvement and transformation in outcomes and access
Identify and escalate issues needing CA support
Work in partnership with CA to achieve ambitions detailed in the Long Term Plan
Shared Functions
Co-ordinate and encourage clinical collaboration to deliver quality cancer services
Facilitate clinical groups, to develop pathways, protocols, patient guidelines, in line with national guidance
Develop and support peer review for compliance in standards of cancer service provision and clinical variation.
Facilitate learning opportunities and sharing of good practice
Two way reporting

9. Strategic roles of Cancer Alliance and ICS/STP: (v2 based on STP-SWAG bilaterals)
Supra-STP/ICS
Oversight of whole cancer population
Identify & initiate CA system wide level transformation to improve outcomes and access
Sponsor proof of concept and innovation projects
Provide system wide intelligence on Cancer to inform local decision-making
Assess impact of national guidance and standards for Cancer services provision
Undertake Impact assessments for proposed cancer pathway changes
Local: ICS/STP
Facilitate collaboration between multiple local partners
Lead service transformation across the ICS/STP in partnership with the CA and service providers
Oversee the ICS/STP programme of transformation and investment
Co-ordinate Cancer plans at ICS/STP level and create momentum for improvement and transformation in outcomes and access
Identify and escalate issues needing CA support
Shared Functions
Co-ordinate and encourage clinical collaboration to deliver quality cancer services
Facilitate clinical groups, to develop pathways, protocols, patient guidelines, in line with national guidance
Develop and support peer review for compliance in standards of cancer service provision and clinical variation.
Facilitate learning opportunities and sharing of good practice
Partner to deliver Long Term Plan ambitions
Two way reporting

10. The Operational roles of the Cancer Alliance and ICS/STP:
Supra-STP/ICS
Work with partners to agree the system strategy for cancer
Oversee local planning and implementation of the National Cancer Plan objectives
Provide guidance and advice on population-wide performance within SWAG
Co-ordinate Cancer Transformation Fund allocations and hold ICS/STP systems to account for agreed delivery of plans against the funding.
Broker flexibility and resources across the Alliance system to support SWAG-wide operational delivery of National Cancer Planning guidance
Local: ICS/STP
Oversee the local delivery of the National Cancer Strategy across the ICS/STP
Agree the local plan for cancer across the ICS/STP
Collective responsibility for operational delivery and performance against the National Cancer Plan, including all Cancer Standards
Oversee the planning and management of CA Transformation Funding to ensure proper application and accountability within the ICS/STP
Ensure ICS/STP co-ordination of all cancer investment to contribute to the local delivery of the National Cancer Plan.
Shared Functions
Ensure robust system-wide governance and foster collective accountability
Ensure transparent and open communications
Two way reporting

11. Operational roles of Cancer Alliance and ICS/STP:
(v2 based on STP-SWAG bilaterals)
Cancer Alliance:
Supra-STP/ICS
Lead work with partners to agree the SWAG wide cancer strategy and planning and implementation of the National Cancer Plan objectives
Provide performance improvement support and advice on SWAG-wide and local system performance
Co-ordinate Cancer Transformation Fund allocations and hold ICS/STP systems to account for agreed delivery of plans against the funding.
Broker flexibility and resources across the Alliance system to support SWAG-wide operational delivery of National Cancer Planning guidance
Lead delivery of SWAG wide initiatives where appropriate and agreed
Local: ICS/STP
Contribute to development of SWAG cancer strategy and develop aligned local delivery plans
Accountable for operational delivery and performance against the National Cancer Plan, including all Cancer Standards
Ensure planning and management of devolved CA Transformation Funding to ensure proper application and accountability within the ICS/STP
Ensure ICS/STP co-ordination of all cancer investment to contribute to the local delivery of the National Cancer Plan.
Lead delivery of wider network initiatives as agreed
Shared Functions
Ensure robust system-wide governance and foster collective accountability
Ensure transparent and open communications
Two way reporting

12. Current SWAG structures

13. Agreed Terms of Reference
SWAG Cancer Network Site Specific Groups:
Brain
Breast
CUP
Colorectal
Gynae
Haem
Head & Neck
Lung
Sarcoma
Skin
Urology
Upper GI/HPB
Regional/National
Bath, Wiltshire and Swindon Cancer Steering Group
Agreed Terms of Reference
Executive Lead:
James Rimmer
CEO WAHT
Clinical Lead:
Amelia Randle
Somerset CCG
Macmillan GP
Somerset Cancer Steering Group
SWAG Cancer Alliance Board Interim Managing Director: Sunita Berry
SWAG Programme Manager: Patricia McLarnon
Bristol, North Somerset, South Gloucestershire (BNSSG) Cancer Steering Group
Gloucestershire Cancer Steering Group
Transformation Steering Groups
LWBC Group
Prevention & Early Diagnosis
The Alliance consists of 7 CCGs and 8 Acute Trusts and covers a population of 2.7 million
User and charity involvement with SSGs as well as the Cancer Alliance is essential to assist with identifying service developments that are practical for clinical teams to implement.
STP abbreviation: Sustainability and Transformation Partnerships
All Cancer Steering Groups map to the local STP geography
SWAG Operational Group
Taunton &Somerset NHS FT also looks to the Peninsula Alliance

14. Interim Managing Director: Sunita Berry Clinical Lead: Amelia Randle
Somerset CCG
SSGs/Clinical Leads
SWAG Programme Manager: Patricia McLarnon
Prevention & Early Diagnosis Dr Sadaf Haque
LWBC Dr Dorothy Goddard
1 WTE Prevention & Early Diagnosis Project manager
1 WTE Pathway Project Manager
.6 Mac PPE Lead
.8 Mac LWBC Evaluation/Commissioning
Prof Raj Persad – Prostate Pathway
Mr Mike Thomas – Colorectal Pathway
Dr Henry Steer – Lung Pathway
User and charity involvement with SSGs as well as the Cancer Alliance is essential to assist with identifying service developments that are practical for clinical teams to implement.
STP abbreviation: Sustainability and Transformation Partnerships
Project Support: Emma Derrick
Amin Support: Harriet Munday
Communications Lead to be appointed

15. STP/ICSs: Bristol, North Somerset and South Gloucestershire
STP Cancer Working Group reporting to STP in place
Chaired by SRO with system engagement
SRO, Peter Brindle, Medical Director of Clinical Effectiveness
BNSSG CCG.
Co-lead Gemma Artz, Head Of Performance Improvement (Planned Care) NHS Bristol, North Somerset & South Gloucestershire CCG
Telephone: / ,
Co –lead Andy Newton, Head of Planned Care
NHS Bristol, North Somerset & South Gloucestershire CCG
Tel: , Mobile:
Clinical Lead, Dr Alison Wint
Specialised Care Clinical Lead & Macmillan GP at BNSSG CCG

16. STP/ICSs: Bath, Swindon and Wiltshire
STP Cancer Working Group. Andy and Jon co-chair an information sharing based cross BSW group. Not functioning as a governance group.
SRO, tbc by Nikki Millin, Interim STP Director of Strategy by end October 2019
Lead Andy Jennings
Senior Commissioning Manager
NHS Wiltshire Clinical Commissioning Group
Tel:
Mob:
Clinical Lead, Dr Jon Cullis, Consultant Haematologist, Salisbury DH

17. STP/ICSs: Somerset
STP Cancer Working Group: under review by David Freeman
SRO, David Freeman, Chief Operating Officer, Somerset CCG
Lead: Rachel Rowe, Head of Long Term Conditions, Operations Directorate
Somerset Clinical Commissioning Group.
Wynford House | Lufton Way | Lufton | Yeovil | Somerset | BA22 8HR
  | Telephone: |
Clinical Lead,

18. ICSs: Gloucestershire
One Gloucestershire Cancer Clinical Programme Group. Chaired by Dr Hein le Roux.
Works on cross-system priorities and projects with range of stakeholders incl lay reps within overall Clinical Programme.
SRO, Ellen Rule, Director of Transformation and Service Redesign at Gloucestershire Clinical Commissioning Group, Interim Programme Director ICS
Lead, Kathryn Hall, Associate Director, Service Improvement and Redesign
Mobile: Desk:
 NHS Gloucestershire Clinical Commissioning Group, Sanger House, Valiant Way, Gloucester Business Park, Brockworth, Gloucester, GL3 4FE
Clinical Lead, Dr Hein Le Roux , Deputy Chair CCG