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2014. … and what about the workforce? Patrick Mitchell Director of National Programmes. Health Education England. HEE exists:
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2014 … and what about the workforce? Patrick Mitchell Director of National Programmes
Health Education England 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.
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 15 year strategic framework (F-15) Mandate 2014/15 Informed by local plans Business Plan 14/15 Workforce Planning Guidance Workforce Plan for England 15/16
HEE Workforce Planning Process 2013 LETB 5 Years Skills Strategies Local Planning Commissioners HEIs, and Other Partners LETB Investment Plans Provider Forecasts LETB Aggregate provider Forecasts Local Challenge, triangulation and moderation Workforce Investment Plan for England England Wide Forecasts ALBs, HEEAGs, and PAF Call for Evidence National Challenge, triangulation and moderation National Planning Strategic Intent Document and Mandate
The shape of training • Medical training needs for next 30 years • UK-wide • 5 themes: • Patient needs • Workforce needs • Breadth and scope of training • Training and service needs • Flexibility of training • Undergraduate to postgraduate transition • 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 • Describe and agree educational preparation • Define the assessment framework • Develop a national growth plan by geography • Disseminate the work
Workforce support – Better Training Better Care • Aims to improve the quality of training and learning for the benefit of • patient 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’
Pilot project Mid-Cheshire Hospitals NHS Foundation Trust – Enhanced Training & Education in Handover & Supporting Electronic Solution Provide training to develop key handover skills such as leadership, task prioritisation and time management Support handover Modify the structure, standardise the handover process and utilise the good practice guidelines. Estimated £156,200 savings over 3 months 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
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.
Pilot project East Kent Hospitals University NHS Foundation Trust Hot & Cold Teams – Enhancing trainee experience, improving patient care Provide enhanced support/training for trainees, especially at weekends To improve the care and safety of patients Hot and cold rotas provided the necessary support and improved training opportunities for trainees during the weekends 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
Trainees as change agents Trainees demonstrated outstanding leadership skills championing their pilot projects during implementation and outside of the pilot environment. East Kent – EM rota Trainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers. Mid Cheshire – Handover Trainees moved to other trusts and requested the pilot initiative to be implemented in their new roles. Leeds and York – Decision making in psychiatry Trainees 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 care Trainees 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. Dudley – Prescribing Better working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines. Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence. 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 Several of the pilots have had a positive impact on culture, efficiency and effectiveness in the implementation of their pilots. 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 12.7% increase in supervised operative training Increases of 37.7% weekday, 29.1% weekend and 22.1% night shift activity 82.6% improvement in ‘out of hours’ handover and 10% increase ‘out of hours’ discharge
Integrated Technology Enhanced Learning (TEL) • 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 Simulation • Share and spread of good practice and innovation across higher and postgraduate education • Underpinned by the DH TEL framework. E-learning M-learning
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: • Individual capabilities • learning styles • behaviours and values • Leadership • team working • training and curricula • the design of equipment • 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