Project Initiation
Document
Reducing variability
in patient outcome
and experience Multiple Sclerosis
within the Midlands
(MSiM) Pathway
West Midlands
Strategic Clinical
Network and Clinical
Senate
Version 0.2
(Ref:1a/T1C1)
1
Project Initiation Document
Reducing variability in patient outcome and
experience – Multiple Sclerosis within the
Midlands (MSiM) Pathway
Planning Phase : Project Initiation Document (PID)
The PID builds on the Project Brief to fully define the project and form the contract
between the Project Board and Project Manager. It provides a baseline against which
the Board can assess progress, issues and ask on-going viability questions.
The PID also provides a useful single source of reference for others to quickly and
easily find out what the project is about. It answers the following questions:




What is the project aiming to achieve?
Why it is important to achieve it?
Who will be involved and what are their responsibilities?
How and when will it happen?
Issue Date: 23 May 2014
Document Number: v0.2
Prepared by: Bernie County
2
Amendment History:
Version
Date
Amendment History
0.1
23/05/14
First draft for comment
0.2
04/06/14
Revisions
Reviewers
This document must be reviewed by the following:
Name
Signature
Title / Responsibility
Date
Version
Mary Passant
Theme 1 Lead
v.0.1
Sarah Freeman
Service Specialist
v.0.1
Prof Adrian Williams
Neurology Clinical Lead
v.0.2
Approvals
This document must be approved by the following:
Name
Signature
Title / Responsibility
Kiran Patel
Area Team Medical Director
Anna Morton
Associate Director
Date
Version
Related Documents
This document should be read and approved in conjunction with the following:
Name
Owner
Location
Risk and Issue Register
Ben Knight
Shared Drive
Plan
Bernie County
Shared Drive
Stakeholder Engagement Bernie County
Strategy /
Communications Plan
Appendix 1&2
Business Case
Ben Parfitt
Shared Drive
Equality Analysis
NA
3
Executive Summary
A key strategic aim within the Strategic Clinical Network is to reduce unwarranted
variation in outcomes and experience for patients. Operating within the boundaries of
the four-condition and disease areas, which jointly account for approximately 70% of
all NHS service expenditure, the SCN has developed a programme of work aimed at
improving the consistency of quality outcomes and value for a number of key care
pathways. The Multiple Sclerosis pathway across the West Midlands is one of the
initial pathways to be examined.
The objectives for the project are
1. To identify where and what services are provided across the West Midlands
for MS patients
2. To map the current MS pathway including information and data flows.
3. To identify gaps or variation in provision and any impact this has
4. To articulate the commissioning flows through the system
5. To understand the impact of new drugs and potential changes to service
provision in the future
6. To determine the validity of the specialist commissioning service specification
in light of the findings
The work will commence with formation of a short life working group which will map
the pathway utilising the three West midlands neuroscience centres as the hub along
with their respective satellite services. This professionals’ view will be underpinned
with the experience of patients which will be captured via focus groups. The final
tenet will be the use of data to quantify the experiential evidence. The group will also
model future impacts of NICE accredited pharmacological treatments. The final
element will be review of the CRG service specification in light of the learning from
the earlier work.
The main deliverables are a report on the learning from these processes for the
specialist commissioners which will incorporate best practice. A paper on likely
impact and potential changes to pathways and costs created by new drugs and a
review of the specialist commissioned service specification. These will be the tangible
elements but equally there will also be the experience of the shared learning and
collaboration which is also multifaceted.
The projected costs are: £6350
£1350 is to fund the focus groups and £5000 is for data (this may not be required
once the NCS report is back)
4
Contents
1
2
Background ..........................................................................................................6
Definition ..............................................................................................................6
Aims and Objectives ................................................................................................6
2.3 Scope and Exclusions ........................................................................................6
2.4 Dependencies ....................................................................................................6
2.5 Constraints .........................................................................................................6
2.6 Interfaces ...........................................................................................................7
3
Approach ..............................................................................................................7
3.1 Assumptions ......................................................................................................8
3.2 Plan ....................................................................................................................9
3.3 Deliverables ..................................................................................................10
3.5 Stakeholder Engagement & Communications ..................................................11
4
Business Case ...................................................................................................11
4.1 Cost..................................................................................................................12
4.3
5
6
Benefits Realisation Plan....................................................................................13
Organisation and Capability ...............................................................................13
6.1 Governance ..................................................................................................13
6.1
6.2
7
Equality.........................................................................................................12
[Insert title e.g. Programme Board] ...........................................................14
Resource ......................................................................................................14
Management Controls ........................................................................................15
7.1 Reporting ......................................................................................................15
7.2
Change Control ............................................................................................15
7.3
Risks and Issues ..........................................................................................15
7.4
Quality Management ....................................................................................16
5
1 Background
A key strategic aim within the Strategic Clinical Network is to reduce unwarranted
variation in outcomes and experience for patients. The SCN has developed a
programme of work aimed at improving the consistency of quality outcomes and
value for a number of key care pathways. The Multiple Sclerosis pathway across the
West Midlands is one of the initial pathways to be examined.
2 Definition
Aims and Objectives
2.1 Aim
To identify unwarranted variation in outcomes, quality, and experience for patients
who go through the multiple sclerosis (MS) pathway in the West Midlands
2.2 Objectives
1. To identify where and what services are provided across the West
Midlands for MS patients
2. To map the current MS pathway including information and data flows.
3. To identify gaps or variation in provision and any impact this has
4. To articulate the commissioning flows through the system
5. To understand the impact of new drugs and potential changes to service
provision in the future
6. To determine the validity of the specialist commissioning service
specification in light of the findings
2.3 Scope and Exclusions
The scope includes the three neuroscience centres from across the West Midlands
and there relevant satellite services.
2.4 Dependencies
There are no dependencies as this is the first pathway to be tested
2.5 Constraints
The project has the following constraints:
There are no constraints at the moment but this could change dependant on whether
the MS pathway is part of the revised specialist commissioning aligned work stream
or that the resource is allocated elsewhere.
6
2.6 Interfaces
The project has the following interfaces:


Interfaces will be fully determined once clarity is provided about the
proposed changes to theme 1.
The project also interfaces with Specialist Commissioning and Area Team
plans.
3 Approach
A short life working group has been convened which is composed of:
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Bernie County WM Strategic Clinical Network
Brad White – CNS SWBH and CRG representative
Sam Colhoun – CNS UHB
Sylvia Lyons – CNS UHCW
Nikki Embrey – CNS UHNS
Nicky Ward-Able – Birmingham City University/ UHB
Jo Scott - MS Society
Mahira Jabeen – Biogenidec
Additional oversight and expertise is also provided by:
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Dr David Nicholls MS Consultant City Hospital and member of CRG
John Woolmore MS Consultant University Hospital Birmingham and Chair of
MS EAG
Sarah Freeman – WM Specialised Commissioning Team
Mandy Matthews - Pharmacist Support Specialised Commissioning Team
The service will be mapped via six half day mapping events. The first three will focus
on the acute sector elements of the pathway and will be taking place in June and July.
The remaining three will focus on the rehabilitation elements and it is proposed that
these will take place in September. The events will be arranged by utilising each
neuroscience centre (Birmingham, Coventry and Stoke) as the hub and the relevant
satellite services to each hub will also be included.
Birmingham event is taking place on the 16 June 2014 and it will involve
representatives from the following Trusts.
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University Hospital Birmingham FT
Sandwell and West Birmingham Hospitals
Walsall Healthcare Trust
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Worcester Acute Hospitals Trust
Hereford Hospital NHS Trust
Dudley Group of Hospitals
Sir Robert Peel Community Hospital
Coventry date is 1 July 2014 there are no satellites to this service
Stoke date yet to be confirmed (proposed 2 July 2014)
A pre event questionnaire is being sent to all attendees to enable some pre work to
be undertaken. This will involve identification of common issues as well as the
formation of a skeleton map prior to the event. It is hoped that this will significantly
reduce the time taken to map, it will also guide facilitation
There will also be three patient focus groups held on the same footprint. The focus
groups are being delivered in partnership with the MS Society and their Neurological
Champions. It is planned that these will be delivered in July 2014.
The core working group (supplemented by others from the additional list as required)
will review the outputs from the mapping events and the patient focus groups to
determine the impact of any identified gaps or unwarranted variation. The group will
also examine the available data to add weight to any arguments, issues or solutions
that are that are raised.
Commissioning flows through the system will also be identified. This work will be
achieved through discussions with specialist commissioners, CCG commissioners
and contracting personal in the providers. We will also be exploring ways of tracking
the information through data.
The core working group and additional members will horizon scan new drugs and
produce a report which will look to answer the following questions.
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What MS drugs are likely to be approved in the next 12 – 24 months?
How does this change the pathways?
What opportunities are there to move care closer to home? Is shared care an
option?
How many patients are likely to be affected
What are the cost implications for commissioners?
The final piece of work for the core working group will be to review the specialist
commissioning specification in light of all the information and intelligence that has
been gathered via the other pieces of work that the group and its members have
undertaken. Clarity around an appropriate approach will be informed by the earlier
work.
3.1 Assumptions
The project approach has been defined with the following assumptions in mind:
8



That this work will be taken forward under the alignment to specialist
commissioners work planned for theme 1
In the event that this is not the case that the working group will be able
to continue without the SCN support
That the data and information commissioned from NCS in 2013/14 will
fulfil the requirements for this project
3.2 Plan
o Half day x 3 for specialist aspects of pathway based around the
neuroscience centre including their hubs - Facilitation of events by
Bernie County
 Proposed dates Birmingham 16 June 2014, Coventry 1 July
2014, Stoke 2 July 2014
 Pre event questionnaire to be developed – Working group
 Pre event questionnaire to be circulated to attendees for return
by 6 June – Bernie County
 Invites to be sent – Bernie County
 Replies to be evaluated to create a skeleton map Bernie County
and Shared with Working Group
o Half day x3 mapping for the rehabilitation aspects of pathway - Sept
 Approach yet to be confirmed likely to have similar footprint to
specialist aspect
 Invites to be sent
 Pre event questionnaire to be circulated
 Replies to be evaluated to create a skeleton map

Patient Focus Groups to gather experience - July
o Three events across the West Midlands – Facilitated by Jo Scott and
Neurological Champions +/- support from SCN
 Dates to be confirmed
o Questions to be aligned to the pre mapping questionnaire

To review maps and outputs from patient focus groups – Aug/ Sept 2014
o Identify of gaps and unwarranted variation – Working group
o Determination of impact – Working Group plus additional support
o Supporting data for any identified unwarranted variation
o Compilation report of finding to Specialist Commissioners– Bernie
County

Identification of commissioning flows through the system July/ Aug 2014
9
o This will be determined through working with contracting departments at
provider Trusts and commissioners both Specialist and CCG

Horizon scan for new drugs Sept /Oct 2014
o What is coming? Names etc. Brad White and Mandy Matthews
o How does this change pathway? Are there opportunities to move care
closer to home? Shared care? Working Group plus Dr John Woolmore,
Dr David Nicholls, Janine Barnes. All three neuroscience centres will
have medical and nursing representation
o How many patients are likely to be affect? Working Group plus Dr John
Woolmore, Dr David Nicholls, Mandy Matthews. All three neuroscience
centres will have medical and nursing representation
o What are the cost impacts of this for commissioners? Working Group
plus Dr John Woolmore, Dr David Nicholls and Mandy Matthews plus
some finance support (yet to be identified)
o Paper on modelled impact for specialist commissioners to be produced.
Will also include data around population and potential patient numbers
(unmet need) against actual activity - Working Group plus Dr John
Woolmore, Dr David Nicholls and Mandy Matthews

Validity of service spec Oct 2014
o Report on the review of the specialist commissioning specification in
light of findings from all the previous work - Working group
3.3 Deliverables
.
Deliverable or product
Owner
Start date
End date
Establishment of task and finish groups
for MS pathway, which is multi
professional and representative the
West Midlands
Bernie County
19/05/14
Close of
project
Production of PID
Bernie County
23/05/14
30/06/14
Map of Birmingham pathway
Bernie County
16/06/14
31/07/14
Map of Coventry pathway
Bernie County
01/07/14
31/07/14
Map of Stoke pathway
Bernie County
02/07/14
31/07/14
3 x patient focus groups report on
experience of MS services in the WM
Jo Scott
tbc
tbc
Report on the learning from these
processes for the specialist
commissioners which incorporates best
practice
Bernie County
01/08/14
30/09/14
10
Paper on likely impact and potential
changes to pathways and costs created
by new drugs
Bernie County
01/09/14
31/10/14
Report on the review of the specialist
commissioned service specification
Bernie County
01/10/14
31/10/14
3.4 Outcomes
Outcome
Better informed
commissioning of MS
pathway including the
identification of the causes of
unwarranted variation within
it.
Reduction in variation in the
MS pathway (identified
through outcomes, quality
standards and patient and
carer reported experience)
within the West Midlands
More consistent and
sustainable commissioning of
services against these
defined pathways.
Work will give view of whole
system, and opportunity to
identify where the system
might be under stress, or
demonstrating
capability/capacity issues.
Indicator it has been
delivered
Production of West Midland
wide pathway map that is
supported by patient insight
and experience as well as
relevant data
Target date
Consistent adherence to the
CRG service specification
Post project closure
See above
Post project closure
Project report to
commissioners
November 2014
October 2014
3.5 Stakeholder Engagement & Communications
Please see appendices 1 and 2
4 Business Case
See SCN Business Case on shared drive
11
4.1 Cost
Costs £
Revenue costs
Patient focus groups x3
Venue costs
3 x £300 = £900
Travel costs (taxi) for attendees
3 x £150 = £450
Data (this may not be required due to NCS
report)
£5000
Mapping venues are NHS
£0
Capital
£0
Total project costs
£6,350
4.2 Project income
Income source
Income £
none
£0
Total Project Income
4.3 Equality
The project will highlight areas of unwarranted variation across the West Midlands for
MS patients. It will also identify the implications of new NICE approved treatments
and where issues exist in the system which restrict access.
12
5 Benefits Realisation Plan
Benefit
description
and link to
which
objective
How will this
be realised
How will this
be measured
Baseline
measure
Key date for
benefit
realisation
Understanding
by
commissioners
and providers
of the West
Midlands
landscape of
MS services
(obj. 1, 2 and 3)
By an analysis
of the
professional
map, the
outputs from
the experience
of care focus
groups and the
validation by
data
Through patient
and
professional
evaluation
Zero no
measure of a
West Midlands
exists
November 14
Understanding
of the impact of
New NICE
approved
disease
modifying
treatments
By working
with clinicians
and
pharmacists to
determine
what drugs are
in the pipeline
and what the
impact of their
introduction
will be on the
service
Incorporation in
to specialised
commissioning
plans
No WM
November14
pathways for
DMT are held
by the
specialist
commissioners
6 Organisation and Capability
6.1 Governance
Reporting to Theme 1 Lead and reporting fortnightly to the AD via PMO and
subsequently to oversight group and Area Teams
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Oversight Group
Speciality Lead Manager - BP
Project Manager-BC
Programme
Management
Office
Working Group
6.1 [Insert title e.g. Programme Board]
TBC
6.2 Resource
Resource
Time
Role
Core Project Management
5 days
Senior Responsible
Owner
[04/14 –
11/14]
Project Manager –
35 Days
0.4 FTE
[04/14 –
11/14]
The SRO is accountable for the success of
the project and for enabling the organisation
to exploit the benefits. They also maintain the
interface with senior stakeholders, keeping
them engaged and informed.
The Project Manager has the overall
responsibility for the successful planning and
execution of the project. He/she will manage
the overall schedule to ensure work is
assigned and completed on time, within
budget and that all deliverables adhere to
acceptable quality levels. He/she must
identify, track, manage and resolve project
issues risks and lessons learned and ensure
that mitigating actions are implemented. The
Project
Manager
will
have
project
management responsibility for the technical
and business change team members and will
14
report to the IMG on a monthly basis and at
key decision points in the lifecycle.
Project Support –
0.2 FTE
20 Days
[04/14 –
11/14]
The project support is responsible for the
administration of the project which will involve
the arrangement of venues for mapping
events and the maintenance of relevant
contact lists for stakeholders. Along with
support in the manipulation of the data.
7 Management Controls
7.1 Reporting
Report
Frequency
Audience
Highlight / Status Report
Fortnightly
Anna Morton
Exception Report
As needed
Anna Morton
Risk / Issues
Fortnightly
Over Sight Group
Lessons Learnt
Project close
Programme Board
End of project Report
Project close
Programme Board
7.2 Change Control
Changes to the content of this PID following approval can only be authorised by the
Project Board.
7.3 Risks and Issues
Risk
Mitigation
That the MS pathway is not part of
the SCN and SCT joint working
once Theme 1 is re-launched
Plan is being set up so that group will be able to
continue without the SCN support but this will
significantly delay the time to delivery of results.
End products and outputs are not
utilised or integrated into the
commissioning process.
Ensure early engagement with commissioners
particularly around co-design of commissioning
resources.
That we lose the engagement of
Promoting the benefits of understanding the West
15
clinicians as the outputs are for the Midlands landscape which may help with internal
benefit of commissioners not in
Trust discussions around resource allocation.
improving clinical interaction
7.4 Quality Management
None specific
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Appendix 1
CITIZEN PARTICIPATION
Type of citizen participation needed: Identify the role required by individual
members of the public and/or patients e.g. attend meetings / review documentation /
surveys / research / focus group / other etc.
The MS Society is representing the patient perspective on the core group.
Patients and carers (who have been diagnosed with MS within the last 12-24
months) will be invited to take part in three geographically located ‘experience
of care’ focus groups.
Reason for citizen participation: Why is citizen participation required?
This is the second tenet of the work following on from the mapping of the
pathway which is being completed by the professionals. This will provide us
with a real life experience of utilisation of the services and identification of
where there are gaps, long waits or inconsistencies of the service.
Does the person(s) you are seeking need any specific skills and/or interests:
e.g. interviewing / minute taking / experience of a particular service area (mental
health etc?)
Experience of receiving an MS diagnosis within the last 12-24 months and
subsequent use of services.
Time commitment required: e.g. number of meetings to attend over a period of
time
1 session per experience of care focus group
17
Supporting Documents and Links: How does this contribute to existing priorities
and policy – local / regional / national)
NHS Outcomes Framework
NHS Business Plan - putting patients first
NHS Constitution
Outcomes: How will this work benefit patients / carers / staff / organisations /
Network & Senate
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Better informed commissioning of MS pathway including the
identification of the causes of unwarranted variation within it.
Reduction in variation in the MS pathway (identified through outcomes,
quality standards and patient and carer reported experience) within the
West Midlands
More consistent and sustainable commissioning of services against
these defined pathways.
Work will give view of whole system, and opportunity to identify where
the system might be under stress, or demonstrating capability/capacity
issues.
18
Appendix 2
Communication Plan
This communication plan describes the approach for communicating and collaborating on the
Multiple sclerosis pathway project. The plan identifies the audiences for the project, the
information to communicate, and the communication methods to use. This plan can help
facilitate effective and coordinated communication between all project audiences.
Project Audiences
List here the project audiences
 The Project team includes the stakeholders and all people assigned to work on the
project.
 CCG’s
 Acute Trusts
 Community Trusts
 Specialist Commissioners
For this project, we have created six categories of information to simplify project
communication:
 Approval information represents documents, change requests, budget requests, or
project deliverables that require stakeholder approval.
 Stakeholder project status includes high-level summaries of completed milestones, major
accomplishments, current schedule and budget performance, and any issues or risks that
have occurred.
 Detailed project status includes completed and in progress work packages, team
accomplishments, issues that need resolution, and lessons learned.
 Project reference represents all project documents and document-based deliverables.
 Collaboration information includes change requests, issues, risks, and lessons learned.
 Publicity represents high-level overviews and status.
Communication Methods
We will use the following methods of communication:
 Email is the preferred method for sending information that people are supposed to act on,
whether they are to approve documents or begin work on an assignment.
 Voice mail is a secondary method for requesting action.
 Meetings will be kept to a minimum.
 The SharePoint Web site contains project reference information.
The Communication Matrix
The communication matrix shows how we plan to communicate information to the project
audiences. The matrix also includes the frequency of communication for different types of
information and the method of communication.
19
Given the small size of the team on this project, communication is relatively simple. Team
members will copy all e-mail to the entire team. The project manager will document
telephone calls and meetings and post notes to a shared workspace. The project manager
will maintain a folder in Microsoft Office Outlook® for all e-mail correspondence. In addition
to the project deliverables, Project Manager will distribute biweekly status reports to the
project team. The status reports will cover the previous two weeks and include tasks
completed, tasks in progress with percent completed, upcoming tasks, and copies of the
current issues list, assignment list, defect list, and report of earned value against the project
baseline.
Audience
Information
Method
Frequency
Who Is
Responsible
Project team
Detailed project status
Email
Weekly
Team leads
Project team
Collaboration
Email
As required
Team leads
Project team
Collaboration
Meeting
Every other
week
Project
manager
Area Team
Approval
Email/voice mail
As required
Project
manager
MS pathways
stakeholders
Stakeholder project status
Meeting
Monthly
Project
manager
Internal
Publicity
Email
Weekly
Project
sponsor
Internal
Publicity
Meeting
Quarterly
Project
sponsor
20