NBT Cardiac Physiology Review Healthcare Consultant Advisor December 2015

Objectives Clinical Governance and Patient Safety Cardiac Physiology Management Review Cardiac Physiology Skill mix Review Finance and activity Agreed objectives with the management team, physiology lead and shared with the consultants

Opportunities Reduce Clinical risks Develop the Cardiac Physiology lead role to work in a more strategic way and band 7 working at operational level Develop structures for the department to maintain standards Agree a skill mix structure that will deliver the required activity and maintain a developed workforce Reduce and replace High locum use – financial risk and quality issues Improve the activity data and income to the speciality

Documents and Tools NBT Cardiac Physiology paper NBT catheter lab paper Summary and Actions Deactivation of devices Implementation Plan Responsibility charts Equipment Register NBT Non invasive Activity NBT Cath Lab procedure level costing

Additional Documents Developed by the senior CP team Job descriptions KSF and Job Plan – B8 to B2 SOP – for each procedure and test SOP – for clinical quality standards Equipment Training schedule CP strategy IQIPS check -Improving Quality In Physiological diagnostic Services (IQIPS) Standards and Evidence Patient Experience Facilities, Resources and Workforce Safety Clinical

Standards Domain 1: Patient Experience The purpose of the Patient Experience Domain is to ensure that service delivery is patient- focused and respectful of the individual patient and their specific requirements. This is achieved through provision of appropriate information and support for patients and carers with due regard to differences in culture, religion, age and other factors. Effective feedback systems for patients and carers are necessary. Domain 2: Facilities, Resources and Workforce The purpose of the Facilities, Resource and Workforce Domain is to ensure that adequate resources are provided and used effectively to provide a safe, efficient, comfortable and accessible service. This is achieved through appropriate and adequate facilities (rooms and equipment); motivated and competent staffing; and the integration of sound business planning principles within the service Domain 3: Safety The purpose of the Safety Domain is to ensure that services provide the highest level of safety for patients, staff and others who come into contact with the service. This is achieved through assessment and management of the risks associated with delivery of the service. Domain 4: Clinical The purpose of the Clinical domain is to promote the service’s role in rapid and accurate diagnosis and treatment. This is achieved through administrative and clinical practices appropriate to the patient population including children; effective management of risk and emergencies; and the review of existing and new clinical practice to develop and improve the service.

NB : 7 day service may additional adjustment Skill mix change Clinical role/activity against grade Maximising skill from each grade and introducing new grades at B4 and B2 in line with national roles Activity numbers and agreed job plans Rostering to the agreed staffing levels Clinical managerial ratio for B8 role 40:60 Reviewed the use and locum within budget line NB : 7 day service may additional adjustment

Skill Mix Skill mix working towards August 2015 skill mix This new skill mix consists of trained staff band 5 and above 62% of which 26% are of band 7 and above and 38% of staff of grades less than band 5 August 2015 skill mix The ratio mix of staff are 67% of band 5 and above of which 28% are band 7 and above and 33% are less than band 5 grade

Financial position

Service Risks Strengths Challenge to CP leadership team Device Service Financial Balance MPI Heart Failure Service Echo Service Community Services Catheter Lab capacity

Opportunities Integrated care model – strengthen community links Stop HF project – increase Heart failure referrals Increase Device implant – CRT and ICD CP – service being IQIPS accredited Financial optimisation including income generation

Questions