1. FOCUS ON THE FUTURE – THE STRATEGIC REFORM AGENDA AND IMPLICATIONS Friday 14 th February 2014 Dr Patricia Oakley Director, Practices made Perfect Ltd. Teaching and Research Fellow Public Policy and Management King’s College, London THE MODERNISATION AGENDA 2015–2025 What are the implications for workforce development? THE MODERNISATION AGENDA 2015–2025 What are the implications for workforce development?

2. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk FINANCIAL ADJUSTMENTS 1.The Depression – 30/34:c. 50 months 2.1 st Oil Shock – 73/76:c. 40 months 3.2 nd Oil Shock – 79/83:c. 48 months 4.DotCom Bust – 90/93:c. 36 months 4.Banking Bust – 08/?:Projected c. 120+ months New Reality – Tight Fiscal Regime; Real Incomes; Size of State

3. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk Care of the Elderly – physically well and mobile, socially engaged and psychologically content. Chronic Disease Management including Mental Health and Carer Support. Specialist Surgical and Therapeutic Interventions. New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics. Building technologies and flexible designs underpinned with real- time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes. The Next 30 Years

4. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk  Genetic Profiling and Therapeutic Targeting.  Proton Beam Therapy and Novel Treatments.  High-speed informatics and cooling technology.  Stem-cell based research and new science.  Prosthetics, regeneration and bio-engineering developments. BIG SCIENCE COMING TO YOU SOON RCTs, Cash Flow, Research  New Ways of Working

5. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk Build a fabric of dense social networks within which good quality health and social care interventions are delivered in a timely and sensitive way. Supporting Getting Old and Managing Long Term Conditions

6. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk  Support for family, friends and community self- help groups.  Support for collectivising events and activities.  Support for patient-focused charities and enabling groups. Supporting Getting Old and Managing Long Term Conditions

7. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk  Assertive Public Health Strategies and Public Engagement.  Technology-supported Homes and Communities.  Early Health Risk Screening, Diagnostics and Interventions.  Advanced Pharmaco-therapeutics and Genetic Profiling.  Technology-supported Clinical Decision-making and Work Designs. New Service Design Assumptions

8. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk New Service Design Principles GP Well-being Practices and Managed Care Centres (Cancer, Stroke/Cardio, Mental Health) Community Activity Centres and The Gym Re-enablement, Rehabilitation and Resettlement Centres “High Street” Screening and Diagnostic Centres (high science and technology) Single-people enabled Homes and Campuses Trauma Centres Urgent Care Centres Planned Care Centres Nursing and Care Homes Step-down/Convalescent Homes Hospice @ Home Service Hospital @ Home Service

9. 13h21321aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk ?Local Diagnostic Services? ?Local Imaging Services? ?Local Genomics Services? “The Place in the Middle” High Street Social Care Services Hospice and Hospital at Home Services Community Pharmacy and Medicines Services GP Surgeries and Out of Hours Services Community Nursing and Midwifery and Therapy Services ?Regional Diagnostic Services? ?Regional Imaging Services? ?Regional Genomics Centres and Predictive Analytics Services? ?The Home Tests? ?The Gym Tests? ?Point of Testing Services? Maternity & Neonatology Care Services (including children’s trauma service) (includes current A&E “minors” service) Regional Trauma Services Urgent Care Services Cancer, Cardiac, Stroke Care Services Mental Health Care Services (inpatients) Convalescent, Observation and Place of Safety Beds and Services. Minor Injuries and “Off-legs” Front Door Services. Planned Care and Rehabilitation Services. Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes. End of Life Services. Local Care Services (including mental health and planned care services) Genetics Services Social & Probation and Police Services (including children’s urgent care service) Paramedic/Blue Light Service Services

10. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk  Service commissioning development.  Tariff and rewards payment development.  Service reviews and development of service networks.  Policies to reduce integrated service delivery hurdles.  Policies to build robust QA and inspectorate processes. Supporting Getting Old and Managing Long Term Conditions

11. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk Independent Reconfiguration Panel Care Quality Commission Monitor-Market Regulator Workforce Regulators Pay Review Bodies Local Authority and Primary Care Trust Service Commissioning Agency: − economies of scale service commissioning; − Public Health Programmes; − “residual” services commissioning. Clinical Commissioning Groups – Managed Agencies for majority of local people’s needs. GP-Patients Commissioning Partners: − Individual Choice; − Co-Payment Choice; − Means-Tested Services. Foundation Trusts and Academic Health Science Centres. Social Enterprises. Companies. Partnerships. ££ Service Providers Network Dept. of Health and Social Care Permanent Secretary and Chief Medical Officer. £ Independent NHS Board and its Regional Directorates Service Commissioning Agencies £ £ Chief Executive. Commissioning Director. Medical Director ? Chief Officers Nursing Director ? Workforce Director. ? R&D Director. £ Controller. Clinical Senates’ Guidelines and Advice. New “NICE”. National Specialist Commissioning Group e.g. Transplant Programmes, Proton Beam Therapy and “Orphan” Drugs. Local Education Training Boards Workforce – Human Resources Development Workforce – Strategic Planning and E&T Investment Deanery Schools, HIECs and All SCs. Assessment Centres. Leadership and Organisational Development Consortia. Recruitment and Payroll Agencies. Workforce Planning and Information Consortium. Education and Training Commissioning Consortium. Health Education England Focus on the Future – The Wheel Turns Again Possible Streamlined Public Service Architecture*

12. 14b07479aso1 © Practices Made Perfect Ltd. *Prepared by Dr. Patricia Oakley, Director, Practices made Perfect Ltd., 131-133 Cannon Street, London EC4N 5AX. Tel: 0845 862 0372. Fax: 0845 862 0373. E-mail: office@practices.co.uk “Professionalism” Goals: Good, Safe, and Accurate Patient Care Good, Safe and Accurate Patient Care Practice Standards and Quality Assurance Education and Training and Supervision Staff’s Behaviours, Attitudes, Aptitudes, Skills and Knowledge Professionalism in Healthcare Staff ? Who builds E&T specification and Curriculum? ? Who validates teaching programmes? ? Who develops teachers and supervisors? ? Who sets them? ? Who develops metrics and QA methodology? ? Who inspects? ? Who develops and QAs the clinical placements?