1. Agenda for Change How Does it Work in Practice? Chris Plant: Agenda for Change Regional Lead, North Wales Steve Sloan: National Officer, AMICUS

2. UK Update How are we doing? How are we doing? 94% matched, 88% assimilated England: 94% matched, 88% assimilated 60% matched, 0 assimilated Scotland: 60% matched, 0 assimilated 45% matched, 3% assimilated NI: 45% matched, 3% assimilated 66% matched, 21% being paid under AfC (but 56% assimilated) Wales: 66% matched, 21% being paid under AfC (but 56% assimilated)

3. UK Update (Cont’d) Unsocial Hours – now put back to 1 Oct 2006 for new arrangements to start Xmas guidance will be out shortly Profiles still coming out – but not many, and tending towards generic profiles now Pay Review Bodies now considering evidence for next year’s pay awards

4. Objectives of the session:  Understand the impact of AfC on how managers recruit, manage and deploy staff  Consider where support and information is available from  Understand the opportunities delivered through enhanced partnership working  Understand how AfC can drive and enable the modernisation of services and processes

5. Pay Modernisation - Why? Government commits sustained investment in NHS Government commits sustained investment in NHS Better services for patients Better staff development Fairer rewards for staff

6. NHS Plan Twin objectives More capacity = more staff More capacity = more staff Modernised jobs = working differently Modernised jobs = working differently Three great workforce levers Management and Leadership Management and Leadership Education and Learning Education and Learning Pay and Reward Pay and Reward

7. Annex E – Success Criteria  More patients being treated more quickly  Higher quality care  Better recruitment and retention  Better teamwork/breaking down barriers  Greater innovation in deployment of staff  Fair pay  Improve all aspects of equal opportunity & diversity  Better pay  Better Career Development  Better morale

8. Partnership  New language for the NHS that is different  Staff engagement, involvement and participation  Decision making is more robust  Increased transparency  Staff feel valued, and share workload  Beyond staff involvement

9. AFC designed to enable:  Redesign of services around patients  Design of the right jobs  Higher quality care  The NHS to become more effective at what it does  The NHS to become a more attractive employer

10. Moving forward  Line manager and local staff representative understanding of how AfC will operate in practice is essential  This session is designed to help you start to “operationalise” AfC  Start to move away from seeing AfC as “project” to understanding how we can change the way we manage, deploy etc staff in the longer term  Intention is that these will be rolled out for all managers across organisations

11. Life cycle of an employee:  Want to look at key stages in the employment history of a member of staff identifying the impact of AfC  Not exhaustive and not going into the detail of your local agreements  The new pay agreement left a great deal for local agreement and work on this is still going on  The key aspects addressed are:  JE Scheme  KSF  Terms and Conditions

12. Life Cycle (cont.)  Support available from your AfC Teams, HR Directorate, Service Improvement Teams, Staff Representatives …..  Purpose is to stimulate discussion and encourage you to start planning how AfC can help you work smarter  Effort now will pay dividends

13. Workforce Planning Recruitment Induction Performance Review Competent Practitioner Promotion PATIENT/SERVICE NEEDS Appointing Developing Roles Patient or Service Life Cycle

15. Workforce Planning  Consider changes/development in service provision  Changes to working week  Increase in annual leave  Consider skills/knowledge needed  Replace like with like/change role/new role

16. Recruitment  Develop Job Description and Person Specification based around skills and acquired knowledge needed  Develop KSF outline which will be sent out with pack  Job “pay banded” through JM/JE process  Is a Recruitment and Retention Premium applicable or necessary?  Advert should identify the skills and experience required as per KSF outline  Do transitional points apply to the post?

17. Appointing  Need to consider how to assess candidates against skills and applied knowledge needed  Determine previous experience and reckonable service  Identify appropriate starting salary  Identify annual leave entitlement  Unsocial hours and on-call entitlements  Identify working hours i.e. are they protected or not?

18. Inducting  Initial assessment of new appointee against KSF outline  Arrangements for preceptorship period, where applicable, in place  Induction plan developed based around KSF outline  Processes for first gateway review – at least two reviews during the first year

19. Competent Practitioner/ Performance Review  Process for annual performance review for all staff against KSF outline  Developing and implementing PDPs for all staff  Appropriate release and support for staff to fulfil PDP  Planning career progression  Those who have passed through the - 'Final Gateway - maintaining enthusiasm and motivation to develop'  Secondment/acting up arrangements  Supporting and managing staff who are struggling with gateways  Will assist with clinical governance

20. Developing Roles  Skills gaps identified through PRP/PDP processes  Roles changing and developing to address service needs  Job descriptions and KSF outline reviewed  JE rebanding reviews available:however additional responsibilities do not necessarily mean higher grade!  New roles developed

21. Promotion  Careers escalators developed  PDPs assist in preparing for promotion  Salary on promotion CYCLE STARTS AGAIN

22. Patient Pathway- Coronary episode ( Patient Pathway- Coronary episode (How will it look in the future)  Attended by emergency care practitioners (nurses & paramedics)  Admitted to coronary care where cared for by advanced specialist practitioners, and consultant nurse  Informing Healthcare will assist with the prompt reporting of blood and x- ray results - and path lab may have different working arrangements.  Choose & book will allow the pt. to discuss treatment options with a specialist nurse who will arrange transfer to the chosen unit for surgery.  On discharge, care will be followed up by community cardiac rehab team in liaison with the practice nurse with enhanced skills.

23. AfC and Service Improvement  All Organisations will have a Service Development Plan, linked to AfC  Delivery structures in organisations for service improvement, linked to AfC  Modernisation Group/Team must be part of this!

24. How do you as line managers realise benefit from AfC?  Understand existing terms and conditions in department  what is happening and why  how will new terms and conditions affect this  Existing service improvement initiatives – Trust and departmental  What seems different pre- and post AfC (and more specifically, after assimilation?)

25. AfC as a LEVER Opportunistic Benefits that fall naturally out of effective implementation  Review of job descriptions  Changes to working week - increased/decreased capacity?  Rewarded for responsibilities  Harmonised terms and conditions – team working/cross boundary working  Partnership Working

26. AfC as part of PAY AND CONTRACT MODERNISATION Consultant Contract, EWTD, GMS Pharmacists/Dentists/Optometrists, Modernising Pathology & Imaging Services Modernising Pathology & Imaging Services  Need to understand impact of these on department and services  What are the links?  How can AfC be harnessed to support implementation of these?

27. AfC as an Enabler  Workforce Modernisation  Does the existing skill mix in the team meet needs of department/service?  What new roles are planned in the department but have yet to be “priced” properly?  Are there procedures in place to capture staff suggestions for service improvement arising through AfC activity?  Pay Protection – opportunity for role redesign?

28. Key Lessons from EI Sites: Benefits Realisation  System change not a service change  Establish your own specific gains from the new system - be aspirational  Leadership is crucial - at all levels  Change in staff perception and culture will facilitate future changes in patterns of service delivery  Opportunity to develop an organisation wide process for service improvement  Human resources practices will change - partnership working will drive this

29. Early OD issues and possible solutions Staff in the same band as their manager Staff in the same band as their manager - Develop the manager’s role and reband using NHSJES? “Grade compression” (e.g. Whitley D and E grade nurses) “Grade compression” (e.g. Whitley D and E grade nurses) - establish and develop careers escalators, develop the staff. … but E grade competence becomes the norm for fully competent Band 5 nurses. Pay protection Pay protection - get the value out of the staff by redesigning the job

30. OD issues and possible solutions (cont’d) Departments in “Organisational Space” – don’t seem to report to anyone Departments in “Organisational Space” – don’t seem to report to anyone - give them a Directorate/ management structure Other structures not workable – e.g. 1 manager, 50 staff Other structures not workable – e.g. 1 manager, 50 staff - review the structure

31. Questions to take away:   How will I engage with my Trust’s Benefits Realisation work?   Do I know what work is currently ongoing in my organisation to change HR processes?   What are the issues I need to take into account now when developing my/our service/workforce plans?   and   How will our service planning/workforce planning process change?   How will I involve staff and develop greater partnership working in my area?

32. Costing/ Money Service modernisation may actually save money e.g. reduction in overtime, fewer steps in a process deceases error rate Service modernisation may actually save money e.g. reduction in overtime, fewer steps in a process deceases error rate Organisations may “pump prime” changes where benefits are defined and expected at the outset Organisations may “pump prime” changes where benefits are defined and expected at the outset No specific increases in training budgets… No specific increases in training budgets… Development is not just courses, however! The investment in staff is expected to bring about change The investment in staff is expected to bring about change

33. Useful Websites  www.dh.gov.uk/PolicyAndGuidance/HumanResourcesA ndTraining/ModernisingPay/AgendaForChange www.dh.gov.uk/PolicyAndGuidance/HumanResourcesA ndTraining/ModernisingPay/AgendaForChange www.dh.gov.uk/PolicyAndGuidance/HumanResourcesA ndTraining/ModernisingPay/AgendaForChange  www.e-ksf.org www.e-ksf.org  www.modern.nhs www.modern.nhs  www.nhsemployers.nhs www.nhsemployers.nhs  http://www.wales.nhs.uk/sites3/home.cfm?OrgID=433  Further information is also available from Trade Union and Professional Organisation websites.

34. Workshops What changes am I going to consider to modernise the service using Agenda for Change – and how am I going to use AfC to achieve these? What changes am I going to consider to modernise the service using Agenda for Change – and how am I going to use AfC to achieve these? (i)In the short term ( next 12 months)? (ii) (ii)In the medium term (next 1-3 years)? (iii) (iii)In the long term (over 3 years)? 45 minutes 1 person to give feedback from flip charts (5 minutes)