The impact of workforce on patient safety and experience has increased in priority since the issues at Mid-Staffordshire.

The Francis Report due for release in early January 2013 and will examine why such failures in the system happen.

It is imperative processes are in place to act as an early warning system.

Huge system change resulting in the move towards an NHS Operating Model for quality and outcomes

Work to develop this tool began in June 2011 and the tool is scheduled to go live in December 2012 in the North West.

The tool will be available for use across all 3 SHAs and at both a system management level (SHA, PCT Cluster) and at Provider organisational level in the North Cluster

Role of the Quality Surveillance Groups (QSGs)

Workforce Assurance

The Assurance Framework

Workforce Assurance is the process of managing risk and assuring that the composition of the workforce delivers safe, effective and high quality care

What is different?

• A systematic approach enabling rigorous, structured evaluation

• A statistically robust underpinning for assurance analysis

• Analysis of correlation and relationships between triggers

• Thresholds for triggering

• Escalation routines to enable consideration of escalation in a structured manner

This enables you to

• Create and drive top table discussions

• Changes the nature of assurance engagement with Trust Boards and Management Teams

• Call on robust evidence and analysis as support for key decision making

• Take a more integrated approach to assurance activities

• Justify decisions

Work to develop this tool began in June 2011 and the tool went live in February 2012 for a number of providers

The project team had representatives from SHAs and the Department of Health, each SHA formed their own internal project teams to engage locally with clinicians and managers

The tool will be available for use across all SHAs at Region, Commissioner/Cluster and Provider levels

A web-based application to triangulate organisational performance via selected metrics – highlighting potential risks

A platform for a standardised approach linking workforce to quality and safety drawing on 205 metrics from a single repository

A mechanism for considering potential workforce risks in a structured, logical and data driven manner

A single reference point and process for assessing workforce variables - enabling proactive assessment of the current workforce and the likely impact on quality and safety of planned changes

Process itself can be performed manually but is incredibly labour intensive. Non-workforce metrics in the Tool give a more rounded picture and highlight potential risks impacting on WFA.

Removes some of the subjectivity by building stated thresholds into each metric and enables correlation between metrics

Enables challenge to accepted wisdom by supplementing expert opinion with robust statistical analysis

Provider Commissioners/ Clusters

SHAs / DH

• Improve workforce monitoring and planning systems

• Analyse impacts of increased productivity efforts.

• Fundamentally assess their workforce changes and the impact on quality and safety.

• Benchmarking allows trusts to compare themselves to other trusts in their Cluster or specialty.

• Undertake assurance with respect to quality and safety of providers.

• Provides an evidence base for WFA.

• Exercise appropriate judgement on assurance responsibilities given the system pressures.

How it will be used by different organisations

DH has stated that the WFA tool could support  the delivery of 5 of the 9 Key Lines of Enquiry for workforce

Automated to reduce manual data manipulation and handling burden

Data: Utilising existing national data sources

A hierarchical structure consisting of a number of categories and levels:

Assurance categories: There are four assurance categories which group together trigger groups that show:

High level

Low level

Trigger groups: a collection of similar assurance triggers e.g. workforce or finance

Triggers: a collection of similar metrics / indicators that can be seen as a natural group e.g. Staff Turnover or Cost Improvement Metrics: individual, national, local and bespoke metrics on workforce, quality, safety, finance, activity, etc.

Assurance of plan

quality of the plan

Assurance against

plan

variance analysis

Organisational workforce

profile

general organisational

indicators

Qualitative Indicators

not metric based but a prompt for areas to look for in an assurance

process

Analysis of Metrics

• Comparison against safety activity, finance and quality

Integrated Dashboard

Metric rating risk assessment and action

Metric rating

Assuredno further action

Trigger flaggedfurther assessment and

validation

Action takencommunication and

intervention as appropriate

Levelof Input

BenefitsReceived

The tool has been designed to require zero / minimal input from Trusts, and can operate with or without forward workforce plans. However, with these plans the value delivered from the tool with be far greater.

Adding workforce plans, with summary finance and activity information

Without any workforce plans, the tool will provide triangulation, comparisons, and projection using national data sets covering workforce, quality, safety, activity and finance.

By adding a forward plan using a basic template the tool will provide additional functionality.

This will include comparison against plan functionality and the ability to use trend projections to test the quality and safety implications of the plan.

The scenario modelling element of the tool can be done without providing visibility of the plan to assurers.

Do Trusts have to input data to the tool?All data will be provided centrally with two potential exceptions:•If Trusts wish to upload a workforce plan / scenario into a private part of the tool for review (i.e. Before I submit my plan, can I check if it will flag up any major areas of concern at the SHA?), then this will be possible at the users discretion; and•Where a regional collection process does not exist, then approved plans may be uploaded by Trusts.

My Analysis My ResourcesMy Actions

RegionalDashboard

OrganisationDashboard

MetricDashboard

Help

Workforce Assurance Portal

My Flags

My QualitativeIndicators

My Plans

My Threads

My Notes

My Assurance Logs

Supporting Materials

Community

Data Sources

FAQ

Workforce Dictionary

The Tool IS intended to provide:

• The workforce element that will link with wider system level assurance

• Triangulation between workforce, activity and finance data

• A national platform to workforce assurance that can be adapted as appropriate for each SHA

• Best practice approach that is built on existing published literature

• An approach which recognises that assurance criteria will change and be refined over time

The Tool IS NOT intended to be:

• A tool to publish information• A performance management tool• A data collection tool; existing

data is used• A directorate and divisional

assurance tool; Trusts can use their own granular and often more recent data to explore potential areas for concern.

• Workforce assurance will take place in the proposed new structure for the NHS. With the challenges facing the NHS, There is a strong rationale for this being done by an overall assurer. This is, of course, to be decided and could be the remit of the National Commissioning Board, Health Education England or Local NHS Education and Training Boards.

• The tool will provide a robust way of assuring the workforce for commissioners and providers alike.

• The tool will provide Commissioning groups/Commissioning Clusters or GP Consortia confidence in current workforce performance and workforce plans, in relation to quality, safety and patient experience.

• It would also simplify negotiations around workforce plans and assurance which would condense timescales and potential tensions.

Continued Investment for the Tool to ensure the Tool remains contemporary is subject to continued evaluation. The Tool continues to be developed and funding has been approved by WLG for 2012/13.

There will be ongoing costs associated with accessing the data feeds e.g. the Information Centre costs. There is an associated need to understand if the LETBs will have access in the same way as the SHA to e.g. the data warehouse.

FT Compliance: there is a debate around performance vs. benchmarking vs. surveillance.

FOI Considerations: Any risks need to be managed and a clear steer around the role and function of the Tool to include absolute clarity about how data is used.

Productive Workforce Metrics Dashboard

• Supports ad hoc enquiries and regular assessment focused on direct workforce data

• 15 high level metrics

• Data is un-weighted, is primarily direct workforce information, can be extracted as raw data for reporting, supports Cluster and Trust ‘type’ benchmarking

• Wider range of users – HR, Service Managers, Workforce Analysts

• The focus and outcome of reviewing the dashboard is driven by the user

Workforce Assurance Tool

• Supports an assurance process at local, regional and national level

• 200 metrics

• Data covers workforce, activity, finance, and qualitative information.

• Uses an evidence based approach to weight these, provides RAGs and scores for different levels and sets of data

• Smaller range of users, more strategic – Directors, CEOs, OD Leads

• The outcome of an assessment is more standardised - focusing on rating four ‘domains’ with an overall RAG

Ongoing Evaluation

•Following on from the Pilot Evaluation in May, a further evaluation session will be held towards the end of September 2012.

•Feedback is being captured on a continuous basis, (please see contact details in final slide).

Enhancements

•Sandboxing: trusts will be able to submit various plans to compare against various scenarios, currently uploaded plans and actual data. This will enable trusts to analyse plans before they are viewed by their reviewers.

•Metric dashboard in pop-up window: this will enable metrics to be viewed without affecting the organisational dashboard.

•Custom dashboards

Metrics• National metric review WebExes for each specialty (Acute, Community, Mental

Health, Orthopaedic, Women’s, Children’s and Ambulance) took place in June. These were very successful and process will be repeated for future metric reviews (dates TBC).

•Changes to activity and finance metrics

•Changes to sickness absence and turnover.