1. HETV Partnership Council Thursday 3 July 9. 30am – 2
HETV Partnership Council Thursday 3 July 9.30am – 2.30pm Milton Hill House Hotel Wifi network: ConferenceWiFi password: venues Fill in all fields DeVeres screen

2. Welcome Sandra Hatton Managing Director HETV

3. New Independent Chair and HETV Business Plan:
We welcome Professor John Caldwell as the new HETV Independent Chair
HETV Delivery Plan 2014/5 – sets out our priorities for delivery over 2014/15 in response deliver the HETV Workforce Strategy Tomorrow’s People, Today - circulated shortly

4. Strengthening HETV capacity:
Pauline Brown
Deputy Dir. Education & Quality
Quality
Performance
Juliet Anderson
Deputy Dir. Education
& Quality
Workforce strategy implementation
ECAT Plan
Programme Management
Agnes Hibbert
Programme Manager

5. Beyond Transition Realising our potential Health Education England

6. HEE Case for change: We must create One HEE
Our operating model must allow HEE to focus on the whole workforce and transformation, increase efficient working and reduce duplication nationally
Increase governance expected of a Non-Departmental Public Body with greater alignment with the rest of the system
We must deliver the DoH requirements to reduce running costs by 20% (-£17m nationally) and the number of senior posts paid over £100k by at least the same amount
We must continue to be as efficient as possible in non-staff running costs to help meet our challenges

7. What does it mean for HETV?
Committed to maintaining the HETV Board and local delivery model, built on close stakeholder engagement and involvement
Opportunities for local providers to shape the workforce in support of patient needs
Better governance, better connections and efficiencies
New structures and management aligned across four regions, including new National Directors (Geography)
HETV Managing Director, Head of Finance and Director of Education & Quality roles cease to exist
Replaced by one Local Director role
Appointment of a Vice Chair to the HETV Board
What we need to address
Keep what's working....and make it more efficient and effective
Change what's not working.....and fix the problems
Secure 'best of breed' governance across the whole of HEE
Secure a management structure that's affordable, appropriate and 'Lean'
Secure a 'Tax Payer Dividend' by reducing overall operating cost by 20%
Retain sustainability
Retain localism
What doesn't change
LETBs as the LOCAL delivery vehicle for HEE
Local multi stakeholder LETB Boards with an independent Chair
Local Providers taking decisions that shape the local workforce 
Local workforce decisions supporting the needs of local patients 
LETB clinical leadership
LETB Executive leadership
LETB budgets for local deployment
LETB responsibility for quality of training
What will change
Greater Patient and Carer influence to frame our work...their NHS, their service - designed for their needs
Administration that flows from LOCAL decisions will be streamlined 
Economies of scale must be achieved
Common administration, procurement and contracting done at scale 
Management and staffing structures aligned to what we do - not what we used to do and not how we used to do it
We will take 20% out of our operating cost
A widening of HEEs advisory network to operate with us to "make it better for patients"
Fine tune HEE advisory structures to fulfil the requirements of the Act
Please excuse the shorthand as I'm travelling but I want to put right the misconceptions.  LETBs have a legal status which was fully described in the Care Bill (now the Act), local bodies, serving local people....that doesn't change....why should it?  What we are looking to achieve is better governance, underpinning greater efficiency.  
I'm at a loss to understand how your stakeholders could have reach the assumptions they have done.

8. Timetable
Engagement with staff/Boards now complete – final decisions made at HEE Board on 7 August
Statutory consultation of staff:
phase 1 (senior): July 2014 onwards
phase 2 (functions): October 2014 onwards
New senior team in place: September 2014
Complete and review: March 2015

9. Questions?

10. Partnership Council review:
Final Partnership Council for 2014, ahead of Autumn Conference – Tuesday 14 October, The Oxford Hotel
This represents our sixth Partnership Council event – increasing audience, increasing representation and increasing influence on HETV

11. You said, we listened, we did
Partnership Council:
You said, we listened, we did
November 2013: Our organisational effectiveness and Board composition.
We addressed your feedback – widening out Partnership Council to include more representation
We changed the composition of our Board – including local commissioners
We’ve increased regular communications to you and we want more feedback and involvement on Twitter and our website

12. Partnership Council – February: You said, we listened, we did
February 2014: We discussed the refreshed HEE Mandate and how to meet it
We consulted on development of HETV Support Worker Strategy
Latest version approved by HETV Board in June
We responded to calls to ensure comprehensive approach to all roles
End-to-end approach across system
Develop a ‘Skills Partnership’ - get involved via
Reference that the latest verison of the strategy is available via the link highlighted
Stress that we want to gather those interested in the Skills Partnership – to contact Richard Griffin at Bucks New Uni

13. Partnership Council – May: You said, we listened, we did
May 2014: Discussed development of HETV’s Dementia Strategy and how we meet HEE Mandate target to roll-out Dementia Awareness Training
Your feedback has informed the training outcome framework
We responded to calls to build on existing work and to aid collaborations - Dementia Academic Action Group (DAAG) is now scoping all current provision of Dementia Training (reporting Sept 2014)
We will respond to calls for ‘blended approach’ in the second phase – development of new training materials for all staff
Our lead: and
HEE Mandate includes a challenging target relating to the delivery of
Dementia Awareness Training; 250,000 NHS patient-facing staff to have received
the training by end of March Of which, 15,000 are to be staff from across the
Thames Valley. We are currently at around 6,000, which while ahead of schedule
represents a significant challenge.
Reference Prof. Jackie Parkes, University of Northampton – the Chair of the DAAG and encourage those interested to speak with her
Reference Zoe and Jacqueline

14. Partnership Council – July: Out of Hospital Care
Today, we discuss the need to move towards increased Care Closer to Home, with new out of hospital models
What are the impacts on our workforce?
How can HETV support you to ensure we have the right skills, right staff in the right place at the right time?
Introduce Emeritus Professor David Sines, who has kindly agreed to assist HETV as we develop this workstream

15. County Consultation Groups
Workforce Planning
County Consultation Groups
Share service commissioning plans – CCGs, Local Authorities
HETV will share latest workforce demand statistics and will report on 2015/16 education commissions - review and challenge
An opportunity to be involved in the development of the Education Commissioning & Training Plan 2015/16
Buckinghamshire/Milton Keynes:
9.00am –1pm: Thursday 24 July
Clare Foundation Centre
Oxfordshire:
9.00am – 1pm: Tuesday 29 July (note date/venue change)
Marston Rd Campus, Oxford Brookes University
Berkshire:
9.00am – 1pm: Thursday 31 July
Easthampstead Park, Bracknell He

16. HETV Autumn Conference Tuesday 14 October The Oxford Hotel

17. Purpose of Partnership Council and our ways of working Professor Peter Hawkins Lead Facilitator

18. Role of Partnership Council as an advisory body to HETV:
Government
HEE
HETV Board
1) Commissioning of high quality, well defined strategic questions
2) The design process detailing the right route through which to gain the required information
3) The right cycle of timing to this process
Board members and their own organisations
Local partnerships between HEIs/providers
HETV Exec
Partnership Council
HETV Task & Finish Groups
Expert stakeholder groups
T&F specific stakeholder groups

19. The UK health challenge between now and 2032
Population growth of 8 million
Half the population over 50
Over 65s: 10.6 million – 16.1 million
Over 85s: million – 2.6 million
Obesity: 26% - 40%
Arthritis: 8 million - 17 million
Dementia: 800, million
Dementia cost of care - £40 billion
Source Kings Fund:
30th April 2014
Renewal Associates

20. Objectives:
Hear from our keynote speakers perspectives on both the strategic drivers to a move towards Out of Hospital Care
Share good practice and hear from some of our local leaders in Out of Hospital Care delivery
Consider the workforce challenges and priorities
Discuss and inform how HETV and all local partners can work together to drive improvements

21. Keep the debate going:
Keep the debate going via the HETV Twitter – follow us
#hetvpartnershipcouncil
And so – from today, what will happen? Well this is the very first step – working with you all as local partners to understand the priorities which we can work towards.
As with eveyr Partnership Council – a paper summarisng all discussions will be drafted and will go to the HETV Board on 17 July. There is likely to be a further submission to the Board following their discussion, setting out more detailed project outlines and deliverables
HETV will respond to your feedback in developing a programme of activity – which will require the involvement and support of all local partners
Today is the opportunity to shape that workstream and highlight the prioriteis for the system, the local economy and for your organisation

22. Out of Hospital Care - Responding to the Workforce Challenges Emeritus Professor David Sines

23. Rationale:
For staff across the health and social care system in the Thames Valley, the shift of care to the community will enable skills to be used more appropriately and deliver the highest quality care more effectively across organisational and professional boundaries.
Particular focus is required on the skills, competencies and enhanced roles to be embedded in the community in order to successfully deliver the vision for out of hospital care.
An overview to the rationale

24. Strategic workforce drivers:
‘We are moving away from a 20th century model with its outdated divisions of hospital-based practice and of ‘health’ and ‘social’ care…
‘....towards a 21st century system of
integrated care, where clinicians work closely together in flexible teams, formed around the needs of patients and not driven by professional convenience or historic location’.
RCGP – 2022 GP
HEE 15-Year Strategic Framework
Making it clear – these are the drivers of note to the WORKFORCE for health and social care –
The publication of the Health Education England 15-Year Strategic Framework provides a vision and a model of care, and the workforce required to deliver it. This document provides a framework for discussions as to what is needed from our future workforce

25. Rational and drivers:
HEE Mandate from Government – setting national priorities
‘The health and care system will require a greater emphasis on community, primary and multi-integrated health and care. Working in multi-disciplinary teams and work to break down barriers between primary and secondary care is required. HEE will train and develop a workforce with skills that are transferable between these different care settings.’
There are specific national priorities and a Mandate from government to the Health Education England, and to HETV itself.
With over 100 deliverables within the mandate itself – which HETV must respond to – it is clear that shifting the focus of care will only be enabled by developing the right workforce
HEE Mandate

26. Rational and drivers:
Built around six Strategic Themes – including Care Closer to Home theme and Integrated Person-Centred Care
‘90% of patient interactions take place in primary care, community settings and people’s own homes. We need to build skills and competencies in preventative care, to support
home-based care and to enable patients in self-care.’
HETV Workforce Strategy – Tomorrow’s People, Today
And specifically here for the Thames Valley – HETV’s Workforce Strategy. Developed last year, it responds both to the national drivers within teh HEE Mandate, but it is also built upon the priorities of local partners.
There are six strategic themes – two of which can be clearly seen to deliver the Out of Hospital Care Workforce – that being Care Closer to Home and the Integrated Person Centre Care themes.
The challenge to HETV – and to all members of Partnership Council is how to we develop a new workstream which meets all these strategic drivers and ensures that we deliver against those strategic themes?

27. What could this mean for our workforce – both existing and for the future?
Need more diverse multiprofessional roles underpinned by excellent clinical skills
Even with greater productivity, primary care workforce needs to expand
Patients and carers recognised as part of workforce and provided with support
....this will have to be supported by better collaboration between primary and community nursing
GPs will continue to play the generalist role yet spend more time overseeing delivery of care by multi-disciplinary teams...
Enhancing skills of the administrative staff to incorporate basic clinical tasks and more general advice and support for patients
... and some may also choose to augment additional clinical and leadership specialisations.
Building on those strategic documents – so what does this mean for our workforce – both those already employed and the future health workforce?
We can suggest what we are likely to need –
What else is there – what other considerations?
Take some suggestions from the floor – let’s capture them on the flip chart up at the front

28. Developing the HETV Out of Hospital workstream – what is needed?
Understanding what innovative initiatives are there - identifying the workforce-specific considerations and sharing the good practice
Identifying the skills and competencies required to deliver these new services effectively
Identifying new roles, laying foundations for better succession planning and career development to attract, recruit and retain staff to the community setting
HETV to work closely local partners to ensure that education commissioning responds to local priorities to meet the shift
Building new partnerships – with social care, with Public Health, with private/voluntary/independent sectors
What else does HETV need to be doing to support and develop?
And so it is clear our workforce needs to change and develop to meet the response. HETV was advised by members of this Partnership Council back in November that this is an area for our consideration.
In response, and to those other drivers, HETV is launching a new workstream focused on how we develop the Out of Hospital Care Workforce.
But in setting up this new project – what is that HETV needs to do? Some possible examples of what that HETV project needs – but what else is there? How can that project make best effect?

29. HETV next steps:
Today represents the launch by HETV of a new Out of Hospital Care Workforce workstream
17 July – HETV Board will consider feedback and proposals developed from today’s meeting
A programme of activity will be developed within HETV, working closely with local and national partners
Take the opportunity today to help shape the development of this workstream
And so – from today, what will happen? Well this is the very first step – working with you all as local partners to understand the priorities which we can work towards.
As with eveyr Partnership Council – a paper summarisng all discussions will be drafted and will go to the HETV Board on 17 July. There is likely to be a further submission to the Board following their discussion, setting out more detailed project outlines and deliverables
HETV will respond to your feedback in developing a programme of activity – which will require the involvement and support of all local partners
Today is the opportunity to shape that workstream and highlight the prioriteis for the system, the local economy and for your organisation

30. The strengths in the region:
The Thames Valley is well placed to deliver through:
A strong track record of integrated care initiatives across our designated localities and at every level of the system
Plans to shift care from acute to community settings, which will ensure financially sustainable delivery
The partnerships that have been established, working together to develop trust and consensus about what needs to change
Experience and understanding of the technical systemic changes that need to happen to make the difference to patients, service users and staff.
We have great strengths – and we work best together

31. Making it happen: There are: “Those who make things happen;
“Those who think they make things happen;
“Those who watch things happen;
“Those who wondered what happened;
“Those who did not know anything had happened at all!”

32. Out of Hospital care clinical network – a critical area for success
Dr Dan Lasserson MA MD FRCP Edin MRCGP
Out of Hospital Care Clinical Network Lead, Oxford AHSN
Senior Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford
Senior Trust General Practitioner, Oxford University Hospitals NHS Trust

33. Focus of the Out of Hospital Care network
Acute illness in patients who live with frailty
Challenge of recognition and response
Timely
Assessment
Intervention
Monitoring
Patients at the centre of design of care

35. Development of alternative care pathways for acutely unwell adults
Emergency Multidisciplinary Unit (EMU) concept
Accessible, rapid, multidisciplinary diagnosis and treatment from a community setting
Medical – interface capability, drawn from 2°and 1°care clinicians
Nursing
Physiotherapy
Occupational therapy
Social work
Transport
Credible alternative to acute hospital admission

36. EMU operation Catchment: 140k at 11 practices
Weekday working: 8am – 8pm
Weekend working: 10am – 4pm
Vertical integration:
Integration with Home’
Patient capture (111, 999)
Referrals outside the hyperacute pathways – Chest Pain, Stroke, Fractured NOF

37. Investigations Interventions Care pathways Ambulatory care
Point of care bloods
Na, K, urea, creatinine, calcium, glucose, bicarbonate, gases,
INR, haemoglobin, troponin, CRP
ECG
Plain X-Ray (no cross-sectional imaging)
Interventions
‘Interface MDT care’: delivers enabling care alongside interventions traditionally delivered in an acute hospital, in settings close to home
Intravenous fluid, antibiotics, diuresis, blood products
Care pathways
Ambulatory care
Bed based care (community or acute)

38. Primary Care Paramedic Community team EMU referral
Acutely unwell frail co-morbid adult living at home/care home
Primary Care
Paramedic
Community team
EMU referral

39. EMU assessment and treatment
Acutely unwell frail co-morbid adult living at home/care home
Primary Care
Paramedic
Community team
EMU referral
Dedicated transport
EMU assessment and treatment

40. EMU assessment and treatment
Acutely unwell frail co-morbid adult living at home/care home
Primary Care
Paramedic
Community team
EMU referral
Dedicated transport
EMU assessment and treatment
Home
Community hospital
Acute hospital

41. Presentations Breathlessness Leg swelling Global decline in function
Reduced mobility
Confusion
Collapse
Fall
Weight loss
Fever
Fatigue

42. Presentations Diagnoses Cardiac failure PE Respiratory tract infection
Breathlessness
Leg swelling
Global decline in function
Reduced mobility
Confusion
Collapse
Fall
Weight loss
Fever
Fatigue
Cardiac failure PE
Respiratory tract infection
Cellulitis
Urinary tract infection
COPD exacerbation
Fast AF
Dehydration
Electrolyte disturbance
Pleural effusion
Acute kidney injury
Decompensated liver disease
Upper GI bleed
Medication side effects

43. Activity – 30 months of operation

44. Development into a population service

45. Implementing the Silver Book
Respect for autonomy and dignity
Access to health and social care based on need
Integrated health and social care services delivered by interdisciplinary working
Rapid comprehensive geriatric assessment in response to frailty syndromes
Ambulatory emergency care pathways for those who do not require admission

46. Future care models at the interface of primary and secondary care

47. Children and young people
The axes of generalism
Older age
Middle age
Children and young people
newborn
Vertical generalism of traditional community practice

48. Children and young people
The axes of generalism
Older age
Middle age
Children and young people
newborn
Horizontal generalism -optimised care to an increasingly prevalent complex patient population

49. Network Partners Care providers and commissioners
Academic partners – reflect breadth of acute care provision
Patients and the public
Third sector organisations

50. Out of Hospital care clinical network – a critical area for success
Dr Dan Lasserson MA MD FRCP Edin MRCGP
Out of Hospital Care Clinical Network Lead, Oxford AHSN
Senior Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford
Senior Trust General Practitioner, Oxford University Hospitals NHS Trust

51. Service Navigation Integrated working in action
Sue Wright
Manager, Service Navigation Team.

52. Why is integrated working important for Reading?
Rising admissions
Increasing complexity
Right person, right place, right time

53. What is service navigation?

54. MAISIE
Fell at home
Referred to community hospital near to her home via HUB

55. FRED Lives alone Taken home by Red Cross
3 nights sitting service from BHFT

56. BILL Bill’s wife needs nursing home care SNT work with Social
Services to identify Continuing
Healthcare entitlement

57. Lily Waiting for community hospital Seen by Integrated Discharge Team
Plan changed to CRT and taken home the same day

58. Thank you

59. Workshop 1:
When considering the delivery of care closer to home, in out of hospital settings:
Question 1: For the system as a whole - what are the overarching workforce specific priorities or challenges to be addressed and how can HETV support?
Question 2: For your organisation locally – what are the key workforce specific priorities or challenges to be addressed and how can HETV support?
Question 3: What do patients and care-givers require from our workforce in the delivery of excellent out of hospital care?
Question 4: HETV is developing a Thames Valley Skills Set. What are the values, qualities and specific skills our workforce needs to deliver great care closer to home? - Consider Values – Qualities – Specific Skills separately on your flip-chart

60. HETV investment 2014/15 and how you can influence future budget setting Andrew Hall Head of Finance Health Education Thames Valley

61. Education Commissioning Quality, Innovation & Workforce Planning
HETV 2014/15 budgets
Medical GP
Dental
Education Commissioning
Quality, Innovation & Workforce Planning
Corporate
Leadership
Projects
Total
£000's
2014/15 Budgets:
Future Workforce:
Postgraduate Medical
45,365
13,540
58,905
Undergraduate Medical
16,077
Non Medical
4,360
56,223
5,465
955
67,003
Future Workforce Total
61,442
141,985
Workforce Development
319
174
3,979
1,175
105
1,045
3,683
10,480
Education Support
3,329
1,405
175
261
529
283
308
6,290
Running Costs
429 94 43
137
1,649
2,352
National Activities
134
117
251
Grand Total
65,519
14,946
4,936
60,624
7,305
2,037
4,946
161,357

62. Additional budgets for 2014/15 – contributing to Out of Hospital Care Workforce
Description
Category
£000s
Practice nursing – increase number of GPNs
Future workforce
500
Increase adult nursing commissions
850
GP expansion – 6 x ST1 posts
350
4 additional ST1 ACCS posts
240
2 Pre Hospital Emergency Medicine posts at ST4
100
12 x GPST4 posts
535
Recognition of additional postgraduate medical posts above 11/12 baseline at tariff
1,500
Investment Prospectus – commitments carried forward from 2013/14
Workforce development
1,267
Education Support
208
Emergency Medicine Project
250
Midwifery Project
120
Adult Nursing Project
Workforce Projects – this is the funding we give out to Trusts to support workforce planning. We will increase it by £200k so that each Trust can employ a member of staff to work with LETB and Trust
200
Contribution to AHSN for continuous learning
400
Preceptorship
Values based recruitment 50
Dementia strategy
300
Junior doctor feedback mechanism – Bucks Healthcare 25
Development of education information system
Frail elderly strategy
284
Total
7,629
Oxford Healthcare NHS Trust Education programme for interface working: multi-disciplinary team development and up-skilling the workforce to deliver care closer to home
Oxfordshire CCG initiative to enhance nursing skills of the workforce in care home settings
Berkshire local pharmaceutical committee’s initiative in carer identification and support to improve health outcomes and support for carers in the community – across the Thames Valley
There is also the work of SCAS and reducing inappropriate use of emergency services and up-skilling paramedics for improvements in directing transfers appropriately.

63. Funded workforce development projects in support of integrated and out of hospital care
Live Well with Better Care. Buckinghamshire CCGs and Local Authority to integrate health and social care provision using a preventative approach to support self-care and includes mental health and tailored approaches for high risk groups.
Oxfordshire County Council and Oxfordshire CCG - the adult social care workforce capability to support independent healthy living in order to provide timely, best health and social care services that offer values for money across Oxfordshire. Focus on dementia and up-skilling the integrated workforce
Windsor, Ascot and Maidenhead CCG and local authority - a wide ranging community project which will develop staff to achieve person-centred outcomes, enablement and prevention.
The ten organisations in the Berkshire West health and social care economy are working together to develop a Whole System Integrated Workforce Development and Training Strategy which will plan across health and care, looking at skills, ratios, roles development and the use of the voluntary workforce.

64. Bids approved under Transformation Funding
Supporting Return to GP Practice
225
A patient-centred approach to improving the care of people with dementia
495
Scientist workforce development and redesign
105
Thames Valley Skills set
Supporting 24/7 working in unscheduled care: GP clinical fellows in Out of Hours General Practice
Supporting Physicians Personal Assistants (PPAs) = GPs
321
Introduction of the Physicians Associate Role
177
Physician Associates; supporting workforce redesign
100
Developing pre-registration practice placements to support research and innovation in practice 75
Developing an Infrastructure to support Pharmacy Technician Training in NHS Trusts across HETV 71
In-Trust Workforce planners development programme 55
Using Learner Feedback to improve educational experience and patient/client safety 80
Developing resources to support and promote out of hospital care learning experiences 95
Sustainable Healthcare Fellowships in Dementia, Out of Hospital Care and Diabetes
375
Developing Specialist Paramedics in the Ambulance Service
174
Advanced Clinical Practitioner: Addressing the shortage of Doctors in Emergency Medicine and advancing the skills of the non-medical workforce
720
Clinical Simulation Training
Introduction of the House of Care Model to Support People with Long Term Conditions
101
Value based organisations
198
HETV Multi Professional Service Improvement Fellowships
140
Redesign of learning disability health services in Oxfordshire and Buckinghamshire
114
End of life care advanced communication skills
4,122

65. Workshop 2: Your opportunity to influence HETV investment for 2015/16
How can we invest for the development of the existing workforce in support of out of hospital care?
Do we need to invest, and in what areas, to meet the future workforce needs?