2014 … and what about the workforce? -Patrick Mitchell Director of National Programmes

2014

… and what about the

workforce?- Patrick Mitchell

Director of National Programmes

www.hee.nhs.ukwww.hee.nhs.uk

HEE exists:To improve the quality of care delivered to patients. Through our Local Education and Training Boards (LETBs), we ensure that our workforce has the right skills, values and behaviours, in the right numbers, at the right time and in the right place.

HEE promises:to oversee that education contracts include consultant availability to provide adequate supervision of doctors in training 7 days a week.

Health Education England


Our business


Beyond transition• Building on a successful first year: continuing to focus on Mandate and

quality, focus on the whole workforce, effective workforce strategies, partnership and engagement and workforce transformation locally and nationally

• Reducing our running cost by 20% and the number of very senior leaders by at least the same amount whilst delivering for patients, student and trainees

• Reducing duplication and silos by creating teams which support the whole of HEE, locally and nationally. Making the best use of staff skills and knowledge in a more cost-effective and efficient manner. One HEE

• Preparing HEE for non-departmental body status, addressing the governance and audit issues in the current structure.


How it all fits together – our key documents

Informed by local plans

15 year strategic framework (F-15)

Mandate2014/15

Business Plan 14/15

Workforce Planning Guidance

Workforce Plan for England 15/16


LocalPlanning

NationalPlanning

Provider Forecasts

LETB Aggregate provider Forecasts

LETB Investment

Plans

England Wide

Forecasts

Workforce Investment

Plan for England

LETB 5 Years Skills Strategies

Call for Evidence

Local Challenge,

triangulation and

moderation

HEE Workforce Planning Process 2013

ALBs, HEEAGs, and

PAF

National Challenge,

triangulation and

moderation

Commissioners HEIs, and Other

Partners

Strategic Intent Document and

Mandate


Workforce plan for England extract


Predicted % medical workforce growth 2012 to 2020 (CfWI)


The shape of training

• Medical training needs for next 30 years

• UK-wide

• 5 themes:

1. Patient needs

2. Workforce needs

3. Breadth and scope of training

4. Training and service needs

5. Flexibility of training

o Undergraduate to postgraduate transition

o Clinical/Academic training interface


Workforce delivery – Physician Associates

• About 200 physician associates working across England

• Work in many areas of secondary and primary care

• Barrier to their employment – not able to prescribe medication/request x-rays

• HEE supporting Royal College of Physicians to create a Faculty for PAs.

• Faculty will manage voluntary register, re-accreditation examinations and CPD

• HEE and RCP Faculty will lobby for form of statutory registration

• This will lead to work to enable prescribing for PAs.

• Only 1 programme in England - at least 5 more opening in 14/15


Workforce delivery –Paramedics

• The Paramedic Education and Training Steering Group to make

recommendations with respect to the conclusions from the Paramedic

Evidence-Based Education Project (PEEP)

• Review of scope of practice and education entry level, careers structure,

financing education and training

• Close work with College of Paramedics and Ambulance services in UK

• The Urgent and Emergency Care Review recommends using paramedics

and ambulance services as mobile treatment centres

• The group will also consider the use of paramedics within ED for instance

triage posts, and in primary care.


Workforce delivery – Pharmacists • There is a likely surplus of pharmacists in the system

• The role of community pharmacists is emphasised within the Urgent and

Emergency Care review

• How pharmacists can fit in with Emergency Department staffing is being

considered, with a sub-group about to be convened.

• Managing minor ailments at front door of ED

• As a specialist pharmacist supporting the wider clinical team and

reducing poly-pharmacy


Workforce delivery – Advanced clinical practitioners

• Advanced clinical practitioners - development group have defined a core

minimum set of competences for ACPs based on the Membership

examination for the College of Emergency Medicine - first time there is a

national minimum standard for ACPs.

• Next steps are to

o Describe and agree educational preparation

o Define the assessment framework

o Develop a national growth plan by geography

o Disseminate the work


Workforce support – Better Training Better Care

Aims to improve the quality of training and learning for the benefit ofpatient care

Professor Sir John Temple: Time for Training

• ‘Making every moment count’

• ‘Appropriate supervision’ and/or ‘Consultant present service’

• ‘Service delivery must explicitly support training’


Mid-Cheshire Hospitals NHS Foundation Trust – Enhanced Training & Education in Handover & Supporting Electronic Solution

Demonstrated an

82.6% improvement

in ‘out of hours’ tasks

being handed over

and completed after

the interventions

Statistically

significant 10%

increase in ‘out of

hours’ discharge

rates, without any

negative effects on

length of stay

Video observation

results revealed that

60% of handovers

adhered to the ‘Think

FIRST’ technique

Estimated £156,200

savings over 3

months

1. Provide training to develop key handover

skills such as leadership, task prioritisation

and time management

2. Support handover

3. Modify the structure, standardise the

handover process and utilise the good

practice guidelines.

Pilot project


Enabling 7 day Care & Hospital at Night Supports 7 day care

• Rota redesign and out of hours care

• Provision of dedicated learning time at weekends

• Improvement in out of hours tasks being completed

• There has been a statistically significant increase in out of hours discharges and

reduction in length of patient stay.

Supports Hospital at Night

• Pilots have encouraged managers to look at what happens in their hospital night

• Supports HaN as the vehicle to raise awareness of patient safety and maximise

efficiency of staff at night

• Puts patient at the centre.


East Kent Hospitals University NHS Foundation Trust Hot & Cold Teams – Enhancing trainee experience, improving patient care

12% increase

in discharges per

week day. Plus 20%

increase in Saturday

and 6% increase in

Sunday discharges

Handover process

improved and

patients were being

seen quicker

Cost savings were

estimated at

£663,912.

Net monetary

benefit in 1 year of

over £0.5 million

Hot and cold rotas

provided the

necessary support

and improved

training opportunities

for trainees during

the weekends

1. Provide enhanced support/training for

trainees, especially at weekends

2. To improve the care and safety of

patients

Pilot project


Trainees as change agentsTrainees demonstrated outstanding leadership skills championing their pilot projects during implementation and outside of the pilot environment.

Mid Cheshire – HandoverTrainees moved to other trusts and requested the pilot initiative to be implemented in their new roles.

East Kent – EM rotaTrainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers.

Leeds and York – Decision making in psychiatryTrainees championed the system and took on a strong leadership role from the outset.

Trainees felt better supervision and support allowing them further

development

Clear leadership in the handover process was

clear in 100% of meetings

100% trainees higher confidence, 83% felt

benefitted by the change


Integration of training in careTrainees became more integrated in the delivery of care and in the wider multi-disciplinary team. This has had a positive effect on patient care and improved communications and multi-disciplinary team working.

King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop.

Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence.

Dudley – PrescribingBetter working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines.

82.6% improvement in ‘out of hours’ tasks

handed over and increase in staff satisfaction

Significant improvements in time to treatment and

time to referral

Improved relationships in pharmacy department


Impacting on culture, efficiency and effectiveness

Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working

Mid Cheshire – Handover Greater degree of efficiency in performing handovers , better quality information recorded and an increase in the number of tasks completed.

South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities

Several of the pilots have had a positive impact on culture, efficiency and effectiveness in the implementation of their pilots.

82.6% improvement in ‘out of hours’ handover and 10%

increase ‘out of hours’ discharge

Increases of 37.7% weekday, 29.1% weekend

and 22.1% night shift activity

12.7% increase in supervised operative

training


Integrated Technology Enhanced Learning (TEL)

• Share and spread of good practice and innovation

across higher and postgraduate education

• Underpinned by the DH TEL framework.E-learning

Simulation

M-learning

• Development of a hub to provide a national picture of where TEL is

happening and provided

• Access to examples and TEL resources that are delivering major benefits

in health education and training


Human Factors‘Human factors’ is concerned with the ‘fit’ between an employee, their equipment and the surrounding environment.

• HEE, LETBs and partner organisations: exploring how we can ensure that the practices and principles of human factors are integrated into all training and education

• It draws upon characteristics and potential issues that can influence behaviour at work and can affect patient health and safety. Including:o Individual capabilities o learning styleso behaviours and valueso Leadershipo team workingo training and curriculao the design of equipment o organisational culture.


Health Careers

• Developing a new integrated Health Careers Service to bring together the work of:

– NHS Careers– Medical Careers – PHORECaST (public health)

• Will encourage flexibility in settings and working practices


Questions?- Patrick Mitchell

Documents

2014 … and what about the workforce? -Patrick Mitchell Director of National Programmes