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Presentation on theme: " HETV Partnership Council Thursday 3 July 9.30am – 2.30pm Milton Hill House Hotel Wifi network: ConferenceWiFi."— Presentation transcript:

1 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 shortlyTomorrow’s People, Today

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

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: 30 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 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 - @hethamesvalley 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 itHEE Mandate We consulted on development of HETV Support Worker Strategy Latest version approved by HETV Board in June Latest version We responded to calls to ensure comprehensive approach to all roles End-to-end approach across system Develop a ‘Skills Partnership’ - get involved via

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

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?

15 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 ParkEasthampstead Park, Bracknell Workforce Planning County Consultation Groups

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

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: 1.26 million – 2.6 million Obesity: 26% - 40% Arthritis: 8 million - 17 million Dementia: 800,000 - 1.3 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 feed @hethamesvalley – follow us #hetvpartnershipcouncil

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.

24 Strategic workforce drivers: HEE 15-Year Strategic Framework ‘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

25 Rational and drivers: HEE Mandate 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.’

26 Rational and drivers: HETV Workforce Strategy – Tomorrow’s People, TodayTomorrow’s People, Today 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.’

27 Even with greater productivity, primary care workforce needs to expand Need more diverse multiprofessional roles underpinned by excellent clinical skills GPs will continue to play the generalist role yet spend more time overseeing delivery of care by multi-disciplinary teams...... and some may also choose to augment additional clinical and leadership specialisations.....this will have to be supported by better collaboration between primary and community nursing What could this mean for our workforce – both existing and for the future? Enhancing skills of the administrative staff to incorporate basic clinical tasks and more general advice and support for patients Patients and carers recognised as part of workforce and provided with support

28 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? Developing the HETV Out of Hospital workstream – what is needed?

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

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.

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

37 Investigations 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 EMU referral Paramedic Community team Acutely unwell frail co-morbid adult living at home/care home

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

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

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

42 Presentations 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 Diagnoses

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 The axes of generalism Older ageMiddle age Children and young people newborn Vertical generalism of traditional community practice

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

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 Presentation title here Why is integrated working important for Reading?  Rising admissions  Increasing complexity  Right person, right place, right time 52

53 Presentation title here What is service navigation? 53

54 Presentation title here MAISIE  Fell at home  Referred to community hospital near to her home via HUB 54

55 Presentation title here FRED  Lives alone  Taken home by Red Cross  3 nights sitting service from BHFT 55

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

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

58 Presentation title here 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 MedicalGPDentalEducation Commissioning Quality, Innovation & Workforce Planning CorporateLeadershipProjectsTotal £000's 2014/15 Budgets: Future Workforce: Postgraduate Medical45,36513,54058,905 Undergraduate Medical16,077 Non Medical4,36056,2235,46595567,003 Future Workforce Total61,44213,5404,36056,2235,465955141,985 Workforce Development3191743,9791,1751051,0453,68310,480 Education Support3,3291,4051752615292833086,290 Running Costs42994431371,6492,352 National Activities134117251 Grand Total65,51914,9464,93660,6247,3052,0371,0454,946161,357 HETV 2014/15 budgets

62 DescriptionCategory£000s Practice nursing – increase number of GPNsFuture workforce500 Increase adult nursing commissionsFuture workforce850 GP expansion – 6 x ST1 postsFuture workforce350 4 additional ST1 ACCS postsFuture workforce240 2 Pre Hospital Emergency Medicine posts at ST4Future workforce100 12 x GPST4 postsFuture workforce535 Recognition of additional postgraduate medical posts above 11/12 baseline at tariff Future workforce1,500 Investment Prospectus – commitments carried forward from 2013/14Workforce development1,267 Investment Prospectus – commitments carried forward from 2013/14Education Support208 Emergency Medicine ProjectFuture workforce250 Midwifery ProjectFuture workforce120 Adult Nursing ProjectFuture workforce250 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 Future workforce200 Contribution to AHSN for continuous learningWorkforce development400 PreceptorshipFuture workforce100 Values based recruitmentFuture workforce50 Dementia strategyWorkforce development300 Junior doctor feedback mechanism – Bucks HealthcareFuture workforce25 Development of education information systemEducation Support100 Frail elderly strategyWorkforce development284 Total7,629 Additional budgets for 2014/15 – contributing to Out of Hospital Care Workforce

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 £000s Supporting Return to GP Practice225 A patient-centred approach to improving the care of people with dementia495 Scientist workforce development and redesign105 Thames Valley Skills set105 Supporting 24/7 working in unscheduled care: GP clinical fellows in Out of Hours General Practice225 Supporting Physicians Personal Assistants (PPAs) = GPs321 Introduction of the Physicians Associate Role177 Physician Associates; supporting workforce redesign100 Developing pre-registration practice placements to support research and innovation in practice75 Developing an Infrastructure to support Pharmacy Technician Training in NHS Trusts across HETV71 In-Trust Workforce planners development programme55 Using Learner Feedback to improve educational experience and patient/client safety80 Developing resources to support and promote out of hospital care learning experiences95 Sustainable Healthcare Fellowships in Dementia, Out of Hospital Care and Diabetes375 Developing Specialist Paramedics in the Ambulance Service174 Advanced Clinical Practitioner: Addressing the shortage of Doctors in Emergency Medicine and advancing the skills of the non-medical workforce 720 Clinical Simulation Training100 Introduction of the House of Care Model to Support People with Long Term Conditions101 Value based organisations198 HETV Multi Professional Service Improvement Fellowships140 Redesign of learning disability health services in Oxfordshire and Buckinghamshire114 End of life care advanced communication skills71 4,122 Bids approved under Transformation Funding

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?

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