Presentation on theme: "HETV Partnership Council Thursday 3 July 9. 30am – 2"— Presentation transcript:
1HETV 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
3New Independent Chair and HETV Business Plan: We welcome Professor John Caldwell as the new HETV Independent ChairHETV 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
4Strengthening HETV capacity: Pauline BrownDeputy Dir. Education & QualityQualityPerformanceJuliet AndersonDeputy Dir. Education& QualityWorkforce strategy implementationECAT PlanProgramme ManagementAgnes HibbertProgramme Manager
5Beyond Transition Realising our potential Health Education England
6HEE 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 nationallyIncrease governance expected of a Non-Departmental Public Body with greater alignment with the rest of the systemWe 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 amountWe must continue to be as efficient as possible in non-staff running costs to help meet our challenges
7What does it mean for HETV? Committed to maintaining the HETV Board and local delivery model, built on close stakeholder engagement and involvementOpportunities for local providers to shape the workforce in support of patient needsBetter governance, better connections and efficienciesNew 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 existReplaced by one Local Director roleAppointment of a Vice Chair to the HETV BoardWhat we need to addressKeep what's working....and make it more efficient and effectiveChange what's not working.....and fix the problemsSecure 'best of breed' governance across the whole of HEESecure a management structure that's affordable, appropriate and 'Lean'Secure a 'Tax Payer Dividend' by reducing overall operating cost by 20%Retain sustainabilityRetain localismWhat doesn't changeLETBs as the LOCAL delivery vehicle for HEELocal multi stakeholder LETB Boards with an independent ChairLocal Providers taking decisions that shape the local workforce Local workforce decisions supporting the needs of local patients LETB clinical leadershipLETB Executive leadershipLETB budgets for local deploymentLETB responsibility for quality of trainingWhat will changeGreater Patient and Carer influence to frame our work...their NHS, their service - designed for their needsAdministration that flows from LOCAL decisions will be streamlined Economies of scale must be achievedCommon 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 itWe will take 20% out of our operating costA 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 ActPlease 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.
8TimetableEngagement with staff/Boards now complete – final decisions made at HEE Board on 7 AugustStatutory consultation of staff:phase 1 (senior): July 2014 onwardsphase 2 (functions): October 2014 onwardsNew senior team in place: September 2014Complete and review: March 2015
10Partnership Council review: Final Partnership Council for 2014, ahead of Autumn Conference – Tuesday 14 October, The Oxford HotelThis represents our sixth Partnership Council event – increasing audience, increasing representation and increasing influence on HETV
11You said, we listened, we did Partnership Council:You said, we listened, we didNovember 2013: Our organisational effectiveness and Board composition.We addressed your feedback – widening out Partnership Council to include more representationWe changed the composition of our Board – including local commissionersWe’ve increased regular communications to you and we want more feedback and involvement on Twitter and our website
12Partnership Council – February: You said, we listened, we did February 2014: We discussed the refreshed HEE Mandate and how to meet itWe consulted on development of HETV Support Worker StrategyLatest version approved by HETV Board in JuneWe responded to calls to ensure comprehensive approach to all rolesEnd-to-end approach across systemDevelop a ‘Skills Partnership’ - get involved viaReference that the latest verison of the strategy is available via the link highlightedStress that we want to gather those interested in the Skills Partnership – to contact Richard Griffin at Bucks New Uni
13Partnership 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 TrainingYour feedback has informed the training outcome frameworkWe 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 staffOur lead: andHEE Mandate includes a challenging target relating to the delivery ofDementia Awareness Training; 250,000 NHS patient-facing staff to have receivedthe training by end of March Of which, 15,000 are to be staff from across theThames Valley. We are currently at around 6,000, which while ahead of schedulerepresents a significant challenge.Reference Prof. Jackie Parkes, University of Northampton – the Chair of the DAAG and encourage those interested to speak with herReference Zoe and Jacqueline
14Partnership Council – July: Out of Hospital Care Today, we discuss the need to move towards increased Care Closer to Home, with new out of hospital modelsWhat 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
15County Consultation Groups Workforce PlanningCounty Consultation GroupsShare service commissioning plans – CCGs, Local AuthoritiesHETV will share latest workforce demand statistics and will report on 2015/16 education commissions - review and challengeAn opportunity to be involved in the development of the Education Commissioning & Training Plan 2015/16Buckinghamshire/Milton Keynes:9.00am –1pm: Thursday 24 JulyClare Foundation CentreOxfordshire:9.00am – 1pm: Tuesday 29 July (note date/venue change)Marston Rd Campus, Oxford Brookes UniversityBerkshire:9.00am – 1pm: Thursday 31 JulyEasthampstead Park, BracknellHe
16HETV Autumn Conference Tuesday 14 October The Oxford Hotel
17Purpose of Partnership Council and our ways of working Professor Peter Hawkins Lead Facilitator
18Role of Partnership Council as an advisory body to HETV: GovernmentHEEHETV Board1) Commissioning of high quality, well defined strategic questions2) The design process detailing the right route through which to gain the required information3) The right cycle of timing to this processBoard members and their own organisationsLocal partnerships between HEIs/providersHETV ExecPartnership CouncilHETV Task & Finish GroupsExpert stakeholder groupsT&F specific stakeholder groups
19The UK health challenge between now and 2032 Population growth of 8 millionHalf the population over 50Over 65s: 10.6 million – 16.1 millionOver 85s: million – 2.6 millionObesity: 26% - 40%Arthritis: 8 million - 17 millionDementia: 800, millionDementia cost of care - £40 billionSource Kings Fund:30th April 2014Renewal Associates
20Objectives:Hear from our keynote speakers perspectives on both the strategic drivers to a move towards Out of Hospital CareShare good practice and hear from some of our local leaders in Out of Hospital Care deliveryConsider the workforce challenges and prioritiesDiscuss and inform how HETV and all local partners can work together to drive improvements
21Keep the debate going:Keep the debate going via the HETV Twitter – follow us#hetvpartnershipcouncilAnd 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 deliverablesHETV will respond to your feedback in developing a programme of activity – which will require the involvement and support of all local partnersToday is the opportunity to shape that workstream and highlight the prioriteis for the system, the local economy and for your organisation
22Out of Hospital Care - Responding to the Workforce Challenges Emeritus Professor David Sines
23Rationale: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
24Strategic 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 ofintegrated 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 GPHEE 15-Year Strategic FrameworkMaking 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
25Rational 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 workforceHEE Mandate
26Rational 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 supporthome-based care and to enable patients in self-care.’HETV Workforce Strategy – Tomorrow’s People, TodayAnd 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?
27What could this mean for our workforce – both existing and for the future? Need more diverse multiprofessional roles underpinned by excellent clinical skillsEven with greater productivity, primary care workforce needs to expandPatients and carers recognised as part of workforce and provided with support....this will have to be supported by better collaboration between primary and community nursingGPs 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
28Developing the HETV Out of Hospital workstream – what is needed? Understanding what innovative initiatives are there - identifying the workforce-specific considerations and sharing the good practiceIdentifying the skills and competencies required to deliver these new services effectivelyIdentifying new roles, laying foundations for better succession planning and career development to attract, recruit and retain staff to the community settingHETV to work closely local partners to ensure that education commissioning responds to local priorities to meet the shiftBuilding new partnerships – with social care, with Public Health, with private/voluntary/independent sectorsWhat 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?
29HETV next steps:Today represents the launch by HETV of a new Out of Hospital Care Workforce workstream17 July – HETV Board will consider feedback and proposals developed from today’s meetingA programme of activity will be developed within HETV, working closely with local and national partnersTake the opportunity today to help shape the development of this workstreamAnd 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 deliverablesHETV will respond to your feedback in developing a programme of activity – which will require the involvement and support of all local partnersToday is the opportunity to shape that workstream and highlight the prioriteis for the system, the local economy and for your organisation
30The 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 systemPlans to shift care from acute to community settings, which will ensure financially sustainable deliveryThe partnerships that have been established, working together to develop trust and consensus about what needs to changeExperience 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
31Making 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!”
32Out of Hospital care clinical network – a critical area for success Dr Dan Lasserson MA MD FRCP Edin MRCGPOut of Hospital Care Clinical Network Lead, Oxford AHSNSenior Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of OxfordSenior Trust General Practitioner, Oxford University Hospitals NHS Trust
33Focus of the Out of Hospital Care network Acute illness in patients who live with frailtyChallenge of recognition and responseTimelyAssessmentInterventionMonitoringPatients at the centre of design of care
35Development of alternative care pathways for acutely unwell adults Emergency Multidisciplinary Unit (EMU) conceptAccessible, rapid, multidisciplinary diagnosis and treatment from a community settingMedical – interface capability, drawn from 2°and 1°care cliniciansNursingPhysiotherapyOccupational therapySocial workTransportCredible alternative to acute hospital admission
37Investigations Interventions Care pathways Ambulatory care Point of care bloodsNa, K, urea, creatinine, calcium, glucose, bicarbonate, gases,INR, haemoglobin, troponin, CRPECGPlain 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 homeIntravenous fluid, antibiotics, diuresis, blood productsCare pathwaysAmbulatory careBed based care (community or acute)
38Primary Care Paramedic Community team EMU referral Acutely unwell frail co-morbid adult living at home/care homePrimary CareParamedicCommunity teamEMU referral
39EMU assessment and treatment Acutely unwell frail co-morbid adult living at home/care homePrimary CareParamedicCommunity teamEMU referralDedicated transportEMU assessment and treatment
40EMU assessment and treatment Acutely unwell frail co-morbid adult living at home/care homePrimary CareParamedicCommunity teamEMU referralDedicated transportEMU assessment and treatmentHomeCommunity hospitalAcute hospital
41Presentations Breathlessness Leg swelling Global decline in function Reduced mobilityConfusionCollapseFallWeight lossFeverFatigue
42Presentations Diagnoses Cardiac failure PE Respiratory tract infection BreathlessnessLeg swellingGlobal decline in functionReduced mobilityConfusionCollapseFallWeight lossFeverFatigueCardiac failurePERespiratory tract infectionCellulitisUrinary tract infectionCOPD exacerbationFast AFDehydrationElectrolyte disturbancePleural effusionAcute kidney injuryDecompensated liver diseaseUpper GI bleedMedication side effects
45Implementing the Silver Book Respect for autonomy and dignityAccess to health and social care based on needIntegrated health and social care services delivered by interdisciplinary workingRapid comprehensive geriatric assessment in response to frailty syndromesAmbulatory emergency care pathways for those who do not require admission
46Future care models at the interface of primary and secondary care
47Children and young people The axes of generalismOlder ageMiddle ageChildren and young peoplenewbornVertical generalism of traditional community practice
48Children and young people The axes of generalismOlder ageMiddle ageChildren and young peoplenewbornHorizontal generalism -optimised care to an increasingly prevalent complex patient population
49Network Partners Care providers and commissioners Academic partners – reflect breadth of acute care provisionPatients and the publicThird sector organisations
50Out of Hospital care clinical network – a critical area for success Dr Dan Lasserson MA MD FRCP Edin MRCGPOut of Hospital Care Clinical Network Lead, Oxford AHSNSenior Clinical Researcher, Nuffield Department of Primary Care Health Sciences, University of OxfordSenior Trust General Practitioner, Oxford University Hospitals NHS Trust
51Service Navigation Integrated working in action Sue WrightManager, Service Navigation Team.
52Why is integrated working important for Reading? Rising admissionsIncreasing complexityRight person, right place, right time
59Workshop 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
60HETV investment 2014/15 and how you can influence future budget setting Andrew Hall Head of Finance Health Education Thames Valley
62Additional budgets for 2014/15 – contributing to Out of Hospital Care Workforce DescriptionCategory£000sPractice nursing – increase number of GPNsFuture workforce500Increase adult nursing commissions850GP expansion – 6 x ST1 posts3504 additional ST1 ACCS posts2402 Pre Hospital Emergency Medicine posts at ST410012 x GPST4 posts535Recognition of additional postgraduate medical posts above 11/12 baseline at tariff1,500Investment Prospectus – commitments carried forward from 2013/14Workforce development1,267Education Support208Emergency Medicine Project250Midwifery Project120Adult Nursing ProjectWorkforce 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 Trust200Contribution to AHSN for continuous learning400PreceptorshipValues based recruitment50Dementia strategy300Junior doctor feedback mechanism – Bucks Healthcare25Development of education information systemFrail elderly strategy284Total7,629Oxford Healthcare NHS Trust Education programme for interface working: multi-disciplinary team development and up-skilling the workforce to deliver care closer to homeOxfordshire CCG initiative to enhance nursing skills of the workforce in care home settingsBerkshire local pharmaceutical committee’s initiative in carer identification and support to improve health outcomes and support for carers in the community – across the Thames ValleyThere is also the work of SCAS and reducing inappropriate use of emergency services and up-skilling paramedics for improvements in directing transfers appropriately.
63Funded 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 workforceWindsor, 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.
64Bids approved under Transformation Funding Supporting Return to GP Practice225A patient-centred approach to improving the care of people with dementia495Scientist workforce development and redesign105Thames Valley Skills setSupporting 24/7 working in unscheduled care: GP clinical fellows in Out of Hours General PracticeSupporting Physicians Personal Assistants (PPAs) = GPs321Introduction of the Physicians Associate Role177Physician Associates; supporting workforce redesign100Developing pre-registration practice placements to support research and innovation in practice75Developing an Infrastructure to support Pharmacy Technician Training in NHS Trusts across HETV71In-Trust Workforce planners development programme55Using Learner Feedback to improve educational experience and patient/client safety80Developing resources to support and promote out of hospital care learning experiences95Sustainable Healthcare Fellowships in Dementia, Out of Hospital Care and Diabetes375Developing Specialist Paramedics in the Ambulance Service174Advanced Clinical Practitioner: Addressing the shortage of Doctors in Emergency Medicine and advancing the skills of the non-medical workforce720Clinical Simulation TrainingIntroduction of the House of Care Model to Support People with Long Term Conditions101Value based organisations198HETV Multi Professional Service Improvement Fellowships140Redesign of learning disability health services in Oxfordshire and Buckinghamshire114End of life care advanced communication skills4,122
65Workshop 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?