decision handbook: liverpool ccg · hen h ow w hat w ho w hen h ow w hat w ho w hen h ow w hat w ho...

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent

Decision Handbook: Liverpool CCG

June 2015

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 2150619 Decision Handbook Liver ...LON

How to read the pages in this section

“WHAT”

CHARTER, ARCHITECTURE, METRICS

“WHO”

DECISION ROLES

“WHEN”

TIMELINE

“HOW”

DECISION COMPONENTS

What Who

HowWhen

What Who

HowWhen

What Who

HowWhen

What Who

HowWhen

Context, objectives

and constraints set

up the decision for

success

This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd party without Bain's prior written consent 8150618 Decision Handbook ... l v.01LON

Stakeholders

CC

G G

overn

ing B

ody

CC

G S

RO

CC

G P

atient

Engagem

ent G

roup

HLP

Board

Cancer

Pro

gra

mm

e

Gro

up

Cancer

Part

ners

hip

G

roup

Fin

ance, P

rocure

ment

and C

ontr

acting

Health a

nd W

ellbein

g

Board

NW

SC

G*

Local A

rea T

eam

Local M

edic

al

Com

mitte

e

Pri

mary

Care

C

om

mitte

e

Pro

vid

ers

(Phase 1

, P

rim

ary

, S

econdary

and

Tert

iary

care

)LocalA

ware

ness a

nd

Earl

y D

iagnosis

Gro

up (

LA

ED

I)

Cancer

Netw

ork

Patient O

rganis

ations**

Public H

ealth (

LA

)

AC

E a

nd C

LA

HR

C

Healthy L

ung S

teeri

ng

Gro

up

Pro

gra

mm

e M

anager

Contr

acting

Team

s

Fin

ance

Team

Decide whether to improve lung cancer in Liverpool

D A R I I I I I I

Decide on lead org / governance

A D R I I I I

Decide value criteria and metrics

A D R I I I I I I I

Decide on set of available options

A D R I I A

Decide on preferred option to work up into full business case

D R I A I I I I

Decide on whether to invest in the preferred option

D R A

Decide on service spec

D I I I I I R

Decide how to procure

I D P P

RAPIDs: Liverpool

R Recommend A Agree P Perform I Input D Decide

What Who

HowWhen

Should HLP make an additional investment to improve lung health in Liverpool,

and if so how can it do so in a way that delivers best value?

1

2

3

4

5

6

7

8

R

Note: *NWSCG = North West Specialised Commissioning Group; **Patient Organisations = Roy Castle Foundation, British Lung Foundation


Constraints

Key

outcomes

Context

• Liverpool CCG needs to make a decision on a potential investment in a pilot which aims to improve lung health across

Liverpool. The pilot will be split into two phases:

1. Delivery of a programme to raise awareness of respiratory health, focused on areas with higher incidence of lung disease

2. Delivery of a primary & secondary care partnership intervention, offering a clinically targeted higher risk group the opportunity to

engage with primary care for a ‘lung health check’. A proportion of participants will meet the criteria for low dose CT and be offered this test

• Cancer is Liverpool’s biggest killer

• There is significant fear and fatalism surrounding the disease, which stops people seeking professional help

• The proposed pilot is controversial/untested and lacks support from Public Health

DecisionShould HLP make an additional investment to improve lung health in Liverpool,


• Clinical – directly patient-focused:

- Earlier interventions / earlier diagnosis (cancer & COPD)

- Improved cancer survival rate / healthy life expectancy

• Clinical – broader outcomes:

- Improved reputation of health system in Liverpool

- Addition to evidence base

• Patient experience:

- Lower level of fear and fatalism

- Access in targeted areas to reduce inequality

- Greater patient awareness / education around options

available (driving shared decision making)

- Timely access to high quality services

• Safety:

- Minimised level of avoidable clinical harm

- Minimised level of false positives

• Resources:

- Staff & support services

resources

- Financial resources

- Diagnostic capacity

• Strategic constraints:

- Fit within HLP strategy

- Time - to demonstrate value

within two years (though

challenge that statistical

validity may require 3+ years)

What Who

HowWhenFOR DISCUSSION

PRELIMINARY

Decision charter: Liverpool

• Stakeholder

engagement:

- Need for recognised

evaluation framework

- Need for stakeholder

input

• Opportunity Costs:

- Cannot impact other NHS services

beyond certain level (e.g. # CT scans

required by pilot)

- Cost bulges on rest of system

(specialised commissioning; smoking

cessation; wider health economy)


Decision architecture: Liverpool

Key sub-decisions









1

2

4

5

6

3



Main decision:

7

8

What Who

HowWhen

FOR DISCUSSION

PRELIMINARY


Outcomes & metrics: Liverpool

Outcomes

Clinical

outcome

• Earlier interventions / earlier

diagnosis (cancer & COPD)

• Improved cancer survival rate /

healthy life expectancy

• Phase 1- # of people engaged in Phase 1 events

- # referred onwards to different services

• Phase 2- # of lung health checks out of eligible population

- # of people diagnosed with COPD (including severity level)

- % people aware of Healthy Lung marketing in target areas (also P1)

- # who consent to CT scans as % of eligible population (and % DNA)

- # cancer diagnoses

• Additional- Under-75 lung cancer mortality rate by neighbourhood (long term)

- Increased 1-year survival rate

- Stage of cancer diagnosis

- % offered surgery of those diagnosed with cancer in this process

Patient

experience

• Positive patient view on participation

• Lower fear and fatalism

• Reduced inequality

• Increased patient awareness

• Patient feedback (qualitative interviews):- Decision regret score

- Other feedback

Safety

• Reduction of:- Over-diagnosis

- Over-treatment

• Incidental findings (largely nodules)

• Negative biopsy rate

• Benign resection rate

• % quality assurance radiology double reporting

Resources

Revenue

costs

• Staff costs

• Project management

• Travel costs

• Evaluation costs

• Scan costs

• Phase 1- GP costs

• Phase 2- Staff costs (locum radiologist and

radiographer; other clinical; nurses)

- Admin costs

- Travel costs

- Machine costs (imaging & surveillance)

- Cost of letters

- Management costs

- Interpreter costs

- Materials for providers

- Costs of (external) evaluator

- Practice costs

Capital

costs

• Training costs

• Material costs

• Supply / product costs

• Training costs

• Materials for promotional activity for Phase 1 providers

• Spirometry tubes

COMPONENTS OF VALUE CRITERIA/OBJECTIVES METRICS

What Who

HowWhen

Key metric

FOR DISCUSSION

PRELIMINARY

Decision roles

(R-A-P-I-D) of all

key players for

each sub-decision


Decide whether to

improve lung

cancer in Liverpool

Decide on lead

org/governance

Decide value

criteria and metrics

Decide on set of

available options

Decide on

preferred option to

work up into full

business case

Decide on whether

to invest in the

preferred option

Decide on

service spec

Decide how

to procure

Critical Steps: Liverpool

1

2

3

4

5

6

7

8

SUB-DECISION CRITICAL STEPS

Design strategy for data

gathering within

context of strategic

organisational priorities

Gather data

(current and projected)

Synthesise data -

key insights

Determine key

opportunities for

improvement

Prepare strategic outline

case to go to

governing body

Map out decision &

governance pathway

Map out potential

scope of providers and

commissioners

Agree decision making

process within CPG

Seek key

stakeholder input

Gather

evidence

Decide on weighting

for each component

(value and other)

Appraisal options1 Obtain agreement

from appropriate group2



Note: 1Appraisal options = evidence; value prioritisation; risks; ethical concerns; strategic fit; affordability / feasibility; time to implement. 2In accordance with gov. pathway defined in sub-decision 2

1

5

What Who

HowWhen

Assess funding

availability (current &

potential)

Stress test business

case (costs, savings,

etc.)

Assess opportunity costs

(including impact on

other services)

Conduct Equality

Impact Assessment

Pull relevant data and

content from business

case

Do further work

(beyond BC) to gather

detail for contract form

Check metrics are

practical / tangible

Build metrics for

evaluation

Validate service spec

with SRO

Note: May be one service

spec for each part of project

6

7

Review Guidance

Decide route of

procurement (e.g. full,

pilot, etc.)

Decide model of

procurement (lead

provider, AQP, etc.)

To consider if any

procurement actions required

before sub-decision 88

Seek evidence / ideas

on option set

Document long list of

options

Assess options against

criteria, metrics and

constraints

Condense to create

short list

Communication of

shortlist outcome4

Identify clinical leadDecide other roles and

responsibilities

Communicate roles

and responsibilities2

Describe objectives,

define value and

constraints

Review evidence within

organisational strategy /

definition of value

Produce summary

document

Define metrics to

support assessment of

value

Sense check of

evidence & studies

Final document

issued3

Submit paper to FPC


CCG Governing Body CPG HLP Board

Cancer Ptn Grp, H&W Board,

Providers, LAEDI, Patient Org,

Public Health

Criteria Critical Steps Choices Considered Committees

• The chosen issue (e.g. lung

cancer) must address top

priority health concern for

Liverpool

• There should be sufficient data

to assess value and potential

outcomes

• Design strategy for data

gathering within context of

strategic org. priorities

• Gather data (now and projected)

• Synthesise data - key insights

• Determine key opportunities for

improvement

• Prepare strategic outline case to

go to governing body

• What constitutes evidence

• Which cancer outcomes to

prioritise

• How to rank evidence

• What goes into final paper

• Governing Body

• Healthy Liverpool

• Cancer Partnership Group

• CPG

• Public Health

• H&W Board

Communication Closure

• Press, Public, University, Cancer Network

• Social Media, Minutes of Governing Body

• Evidence of decision: paper and minutes issued; agreement in

principle

• Immediate next steps: mapping out decision and governance

pathway

What Who

HowWhen

Sub-Decision: Decide whether to improve lung cancer in Liverpool

6Cs: Liverpool

DECISION

RAPID Roles

3 41 2 3 4

AR ID

3 4

A high-level

summary of

critical steps and

issues to consider

in the decision

process


What Who

HowWhenWorkplanning: Liverpool

2014 2015 2016

Decision Calendar (calendar year not financial year) Q

1

Q2

Q3

Q4

Ja

n

Fe

b

Ma

r

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oct

No

v

De

c

Ja

n

Fe

b

Ma

r

Ap

r

Ma

y

Ju

n

Decide whether to improve

lung cancer in Liverpool

Decide on lead org /

governance

Decide value criteria and

metrics

Decide on set of available

options

Decide on preferred option

to work up into full

business case

Decide on whether to invest

in the preferred option


Decide how to deliver

1

2

4

5

6

7

3



Main decision:

8Today

Started July

2013

Ideal state =

6 months

Not consistent effort throughout;

only elements of value considered

(no clear definition of “value”)

Ideal state =

3 months

Ideal state =

3 months

Ideal state =

3 months

Ideal state =

2 months

“Decided” on basis

of high level metrics

Preliminary, but not

full option set

identified

A reasonable

timeline for the

decision process

with key

milestones


• Define the decision

• Frame the decision

• Define value criteria & metrics

• Split into sub-decisions

What• Identify stakeholder

• Clarify decision roles (RAPIDs) for each sub-decision

Who

• Install structured decision approach

- Interactions- Critical meetings / committees- Closure and commitment- Feedback loops

HowWhen• Clarify timelines & milestones

1 2

4 3

Decision roadmap: “What-Who-How-When”


Constraints

Key

outcomes

Context

• Liverpool CCG needs to make a decision on a potential investment in a pilot which aims to improve lung health across

Liverpool. The pilot will be split into two phases:

1. Delivery of a programme to raise awareness of respiratory health, focused on areas with higher incidence of lung disease

2. Delivery of a primary & secondary care partnership intervention, offering a clinically targeted higher risk group the opportunity to

engage with primary care for a ‘lung health check’. A proportion of participants will meet the criteria for low dose CT and be offered this test

• Cancer is Liverpool’s biggest killer

• There is significant fear and fatalism surrounding the disease, which stops people seeking professional help

• The proposed pilot is controversial/untested and lacks support from Public Health

DecisionShould HLP make an additional investment to improve lung health in Liverpool,


• Clinical – directly patient-focused:

- Earlier interventions / earlier diagnosis (cancer & COPD)

- Improved cancer survival rate / healthy life expectancy

• Clinical – broader outcomes:

- Improved reputation of health system in Liverpool

- Addition to evidence base

• Patient experience:

- Lower level of fear and fatalism

- Access in targeted areas to reduce inequality

- Greater patient awareness / education around options

available (driving shared decision making)

- Timely access to high quality services

• Safety:

- Minimised level of avoidable clinical harm

- Minimised level of false positives

• Resources:

- Staff & support services

resources

- Financial resources

- Diagnostic capacity

• Strategic constraints:

- Fit within HLP strategy

- Time - to demonstrate value

within two years (though

challenge that statistical

validity may require 3+ years)

What Who

HowWhenDecision charter: Liverpool

• Stakeholder

engagement:

- Need for recognised

evaluation framework

- Need for stakeholder

input

• Opportunity Costs:

- Cannot impact other NHS services

beyond certain level (e.g. # CT scans

required by pilot)

- Cost bulges on rest of system

(specialised commissioning; smoking

cessation; wider health economy)


Decision architecture: Liverpool

Key sub-decisions









1

2

4

5

6

3



Main decision:

7

8

What Who

HowWhen


Outcomes & metrics: Liverpool

Outcomes

Clinical

outcome

• Earlier interventions / earlier

diagnosis (cancer & COPD)

• Improved cancer survival rate /

healthy life expectancy

• Phase 1- # of people engaged in Phase 1 events

- # referred onwards to different services

• Phase 2- # of lung health checks out of eligible population

- # of people diagnosed with COPD (including severity level)

- % people aware of Healthy Lung marketing in target areas (also P1)

- # who consent to CT scans as % of eligible population (and % DNA)

- # cancer diagnoses

• Additional- Under-75 lung cancer mortality rate by neighbourhood (long term)

- Increased 1-year survival rate

- Stage of cancer diagnosis

- % offered surgery of those diagnosed with cancer in this process

Patient

experience

• Positive patient view on participation

• Lower fear and fatalism

• Reduced inequality

• Increased patient awareness

• Patient feedback (qualitative interviews):- Decision regret score

- Other feedback

Safety

• Reduction of:- Over-diagnosis

- Over-treatment

• Incidental findings (largely nodules)

• Negative biopsy rate

• Benign resection rate

• % quality assurance radiology double reporting

Resources

Revenue

costs

• Staff costs

• Project management

• Travel costs

• Evaluation costs

• Scan costs

• Phase 1- GP costs

• Phase 2- Staff costs (locum radiologist and

radiographer; other clinical; nurses)

- Admin costs

- Travel costs

- Machine costs (imaging & surveillance)

- Cost of letters

- Management costs

- Interpreter costs

- Materials for providers

- Costs of (external) evaluator

- Practice costs

Capital

costs

• Training costs

• Material costs

• Supply / product costs

• Training costs

• Materials for promotional activity for Phase 1 providers

• Spirometry tubes

COMPONENTS OF VALUE CRITERIA/OBJECTIVES METRICS

What Who

HowWhen

Key metric








• Clarify decision roles (RAPIDs)for each sub-decision

Who




1 2

4 3


Stakeholders

CC

G G

overn

ing B

ody

CC

G S

RO

CC

G P

atient

Engagem

ent G

roup

HLP

Board

Cancer

Pro

gra

mm

e

Gro

up

Cancer

Part

ners

hip

G

roup

Fin

ance, P

rocure

ment

and C

ontr

acting

Health a

nd W

ellb

ein

g

Board

NW

SC

G*

Local A

rea T

eam

Local M

edic

al

Com

mitte

e

Prim

ary

Care

C

om

mitte

e

Pro

vid

ers

(Phase 1

, P

rim

ary

, S

econdary

and

Tert

iary

care

)

LocalA

ware

ness a

nd

Early

Dia

gnosis

Gro

up (

LA

ED

I)

Cancer

Netw

ork

Patient O

rganis

ations**

Public

Health (

LA

)

AC

E a

nd C

LA

HR

C

Healthy

Lung S

teering

Gro

up

Pro

gra

mm

e M

anager

Contr

acting

Team

s

Fin

ance

Team


D A R I I I I I I


A D R I I I I


A D R I I I I I I I


A D R I I A


D R I A I I I I


D R A


D I I I I I R


I D P P

RAPIDs: Liverpool

R Recommend A Agree P Perform I Input D Decide

What Who

HowWhen



1

2

3

4

5

6

7

8

R

Note: *NWSCG = North West Specialised Commissioning Group; **Patient Organisations = Roy Castle Foundation, British Lung Foundation









Who




1 2

4 3


Decide whether to

improve lung

cancer in Liverpool

Decide on lead

org/governance

Decide value

criteria and metrics

Decide on set of

available options

Decide on

preferred option to

work up into full

business case

Decide on whether

to invest in the

preferred option

Decide on

service spec

Decide how

to procure

Critical Steps: Liverpool

1

2

3

4

5

6

7

8

SUB-DECISION CRITICAL STEPS

Design strategy for data

gathering within

context of strategic

organisational priorities

Gather data


Synthesise data -

key insights

Determine key

opportunities for

improvement

Prepare strategic outline

case to go to

governing body

Map out decision &

governance pathway

Map out potential

scope of providers and

commissioners

Agree decision making

process within CPG

Seek key

stakeholder input

Gather

evidence

Decide on weighting

for each component

(value and other)

Appraisal options1 Obtain agreement

from appropriate group2



Note: 1Appraisal options = evidence; value prioritisation; risks; ethical concerns; strategic fit; affordability / feasibility; time to implement. 2In accordance with gov. pathway defined in sub-decision 2

1

5

What Who

HowWhen

Assess funding

availability (current &

potential)

Stress test business

case (costs, savings,

etc.)

Assess opportunity costs

(including impact on

other services)

Conduct Equality

Impact Assessment

Pull relevant data and

content from business

case

Detail the contract

documentation

Check metrics are

practical / tangible

Build metrics for

evaluation

Validate service spec

with SRO

Note: May be one service

spec for each part of project

6

7

Review Guidance

Decide route of

procurement (e.g. full,

pilot, etc.)

Decide model of

procurement (lead

provider, AQP, etc.)

To consider if any

procurement actions required

before sub-decision 88

Seek evidence / ideas

on option set

Document long list of

options

Assess options against

criteria, metrics and

constraints

Condense to create

short list

Communication of

shortlist outcome4

Identify clinical leadDecide other roles and

responsibilities

Communicate roles

and responsibilities2

Describe objectives,

define value and

constraints

Review evidence within

organisational strategy /

definition of value

Produce summary

document

Define metrics to

support assessment of

value

Sense check of

evidence & studies

Final document

issued3

Submit paper to FPC


CCG Governing Body CPG HLP BoardCancer Ptn Grp, H&W Board,

Providers, LAEDI, Patient Org,

Public Health


• The chosen issue (e.g. lung

cancer) must address top

priority health concern for

Liverpool

• There should be sufficient data

to assess value and potential

outcomes

• Design strategy for data

gathering within context of

strategic org. priorities

• Gather data (now and projected)

• Synthesise data - key insights

• Determine key opportunities for

improvement

• Prepare strategic outline case to

go to governing body

• What constitutes evidence

• Which cancer outcomes to

prioritise

• How to rank evidence

• What goes into final paper

• Governing Body

• Healthy Liverpool


• CPG

• Public Health

• H&W Board


• Press, Public, University, Cancer Network

• Social Media, Minutes of Governing Body

• Evidence of decision: paper and minutes issued; agreement in

principle

• Immediate next steps: mapping out decision and governance

pathway

What Who

HowWhen

Sub-Decision: Decide whether to improve lung cancer in Liverpool

6Cs: Liverpool

DECISION

RAPID Roles

3 41 2 3 4

AR ID

3 4


HLP Board CPG CCG SROProviders, LAEDI, Public

Health, Patient Organisations


• There should be clearly defined

governance and workstreams

• Lead org should have sufficient

resources and expertise

• There should be adequate

clinical input

• Map out decision and

governance pathway

• Map out potential scope of

providers and commissioners

• Identify clinical lead

• Decide other roles and

responsibilities

• Communicate roles and

responsibilities

• Who involved / not involved

(external & internal)

• What the roles are / are not

• What governance is / is not

• What is the decision pathway

• CCG SRO

• HLP Board

• CPG

• LAEDI

• Public Health


• No additional stakeholders beyond RAPID roles • Evidence of decision: Project Initiation Document (PID) issued along

with Terms of Reference

• Immediate next steps: define objectives, value criteria and

constraints

What Who

HowWhen

Sub-Decision: Decide on lead org / governance

6Cs: Liverpool

DECISION

RAPID Roles

3 4 2 3 4

AR ID

23 4


HLP Board CPG CCG SRONWSCG, Loc. Med. Com, PCC,

Providers, LAEDI, PH & Patient org


• Value criteria / metrics should be

segmented by priority to

maximise value

• There should be access to

sufficient data to assess each

metric

• It should be practical /

straightforward to collect data

• Criteria / metrics are sufficient to

enable robust evaluation

• Describe objectives, define

value and constraints

• Review evidence within

organisational strategy &

definition of value

• Produce summary document

• Define metrics to support

assessment of value

• Sense check of evidence &

studies

• Final document issued

• Which are the most important

metrics

• Who to involve

• What is included as evidence

• How to apply value, constraints

and metrics to the decision

• CCG SRO

• HLP Board

• CPG

• NWSCG

• Local Medical Committee

• LAEDI

• Public Health

• ACE & CLAHRIC


• No additional stakeholders beyond RAPID roles • Evidence of decision: final summary paper

• Immediate next steps: seek evidence on option set

What Who

HowWhen

Sub-Decision: Decide value criteria and metrics

6Cs: Liverpool

DECISION

RAPID Roles

3 4 2 3 4

AR ID

3 4


HLP Board CPG CCG SRO, Public HealthProviders, LAEDI, HLP, CCG

SRO


• Option set should maximise

value (as defined in the ‘What’):

- Clinical outcomes (e.g. # cancer

diagnoses)

- Patient experience (e.g. Decision

regret score)

- Safety (e.g. negative biopsy rate)

- Cost (e.g. practice costs)

• Seek evidence / ideas on full

option set

• Document long list of options

• Assess options against criteria,

metrics and constraints

• Condense to create shortlist

• Communication of shortlist

outcome

• What classification of evidence

to use

• Who prioritises options and how

• Which procedural groups to

involve; refer option set to

• What level of financial scrutiny

of the options is required

• CCG SRO

• HLP Board

• CPG

• LAEDI


• No additional stakeholders beyond RAPID roles • Evidence of decision: issue / agree Final Paper

• Immediate next steps: agree decision making process within CPG

What Who

HowWhen

Sub-Decision: Decide on set of available options

6Cs: Liverpool

DECISION

RAPID Roles

3 4 3 4

AR ID

3 3 3 4


HLP Board CPG H&W BoardCancer Ptn Grp, NWSCG,

Local Med Comm, Patient

Orgs, Public Health


• Preferred option should

maximise value as defined in the

‘What’

• Preferred option must be

deliverable within required time

horizon and resources

• Preferred option should be

evaluated relative to alternatives

• Agree decision making process

within CPG

• Seek key stakeholder input

• Gather evidence

• Decide on weighting for each

component (value and other)

• Appraisal options1

• Obtain agreement from

appropriate group in accordance

with governance pathway

defined in sub-decision 2

• Set of options defined in

decision 4 (including do nothing)

• HLP Board

• CPG

• NWSCG

• H&W Board


• LMC


• Informal CCG Governing Body, SMT • Evidence of decision: minutes of HLP Board

• Immediate next steps: assess wider budget availability

What Who

HowWhen

Sub-Decision: Decide on preferred option to work up into full business case

6Cs: Liverpool

DECISION

RAPID Roles

3 4 5 3 4

AR ID

3 3 4

Note: 1Appraisal options = evidence, value prioritisation, risks, ethical concerns, strategic fit, affordability, time to implement


CCG Governing Body HLP Board Finance Team N/A


• Preferred option should

maximise value as defined in the

‘What’

• Sufficient budget must exist for

required investment

• Assess funding availability


• Stress test business case

(costs, savings, etc.)

• Assess opportunity costs

(including impact on other

services)

• Conduct Equality Impact

Assessment

• Invest / don’t invest • CCG Governing Body


• Inform CPG (informal and official minutes) • Evidence of decision: minutes of CCG Governing Body

• Immediate next steps: set up Healthy Lung Steering Group, referral

to Finance, Procurement & Contracting Committee

What Who

HowWhen

Sub-Decision: Decide whether to invest in preferred option

6Cs: Liverpool

DECISION

RAPID Roles

3 4 6 4

AR ID

3 3 4 4


CPGHealthy Lung Steering

GroupN/A

Cancer Ptn Grp, NWSCG,

Public Health, Patient

Organisations


• Service Spec can be delivered

within a realistic timeframe

• It is sufficiently detailed and

content is understandable to all

relevant stakeholders

• Metrics are practical to measure

and tangible

• Making decision within

parameters of legal framework

• Pull relevant data and content

from business case

• Detail the contract

documentation

• Check metrics are practical /

tangible

• Build metrics for evaluation

• Validate service spec with SRO

• Deliverables

• Timescales

• Measurements

• Scope

• Payment Mechanism


• NWSCG

• Patient Organisations

• CPG

• Healthy Lung Steering Group


• No additional stakeholders beyond RAPID roles • Evidence of decision: minutes of Cancer Programme Group

• Immediate next steps: review guidance

Sub-Decision: Decide on Service Spec

6Cs: Liverpool

DECISION

RAPID Roles

3 4 7

AR ID

3 3 4 4

What Who

HowWhen 4


Finance, Procure &

ContractingContracting Teams N/A CCG Gov. Body

Programme Mgr,

Contracting Teams


• Agreed routes and models of

procurement set foundation for

rigorously costed contracts with

reliable providers

• Review Guidance

• Submit paper to FPC

• Decide route of procurement

(e.g. full, pilot, etc.)

• Decide model of procurement

(lead provider, AQP, etc.)

• Route to procurement

• Model of procurement

• Finance & Procurement

Committee (FPC)


• No additional stakeholders beyond RAPID roles • Evidence of decision: minutes of FPC sent to CCG Governing Body

Sub-Decision: Decide how to procure

6Cs: Liverpool

DECISION

RAPID Roles

3 4

AR ID

3 3 4 4 84

P

What Who

HowWhen









Who




1 2

4 3


What Who

HowWhenWorkplanning: Liverpool

2014 2015 2016

Decision Calendar (calendar year not financial year) Q

1

Q2

Q3

Q4

Ja

n

Fe

b

Ma

r

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oct

Nov

Dec

Ja

n

Fe

b

Ma

r

Ap

r

Ma

y

Ju

n

Decide whether to improve

lung cancer in Liverpool

Decide on lead org /

governance

Decide value criteria and

metrics

Decide on set of available

options

Decide on preferred option

to work up into full

business case

Decide on whether to invest

in the preferred option


Decide how to deliver

1

2

4

5

6

7

3



Main decision:

8Today

Started July

2013

Ideal state =

6 months

Not consistent effort throughout;

only elements of value considered

(no clear definition of “value”)

Ideal state =

3 months

Ideal state =

3 months

Ideal state =

3 months

Ideal state =

2 months

“Decided” on basis

of high level metrics

Preliminary, but full

option set not

identified


Glossary

•CCG – Clinical Commissioning Group

•COPD – Chronic obstructive pulmonary disease

•CPG – Cancer Programme Group

•FPC – Finance & Procurement Committee

•H&W – Health & Wellbeing

•HLP – Healthy Liverpool Program

•LAEDI – Local Awareness and Early Diagnosis Group

•NWSCG – North West Specialised Commissioning Group

•SRO – Senior Responsible Owner


Project Management: Liverpool

Lead and responsibilities Key support group Meeting cadence

Immediate next steps post kick-off Bain support

• Lead = Michelle Timoney

• Key responsibilities:

- Articulate value in business

case process and documents

- Ensure access to the right

inputs into the business case

• Progress sub-decision 6:

- Work towards refining the business case

Pro

jec

t m

an

ag

em

en

tN

ex

t s

tep

s

• FPC (in conjunction with CPG) • Fortnightly

• Support on refining and improving the business

case

decision handbook: liverpool ccg · hen h ow w hat w ho w hen h ow w hat w ho w hen h ow w hat w ho...

Documents