Building a productive workforce
“Five Year Forward View into Action”
and Better Care Support
Dr Simon Plint, Postgraduate Dean
www.wessex.hee.nhs.uk
www.wessex.hee.nhs.uk
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Multispecialty Community Providers
What they are
• Greater scale and scope of services that
dissolve traditional boundaries between
primary and secondary care
• Targeted services for registered patients
with complex ongoing needs (e.g. the frail
elderly or those with chronic conditions)
How they could work
• Larger GP practices could bring in a wider
range of skills – including hospital
consultants, nurses and therapists,
employed or as partners
• Shifting outpatient consultations and
ambulatory care out of hospital
• Expanded primary care leadership and new
ways of offering care
• Potential to own or run local community
hospitals
• Making the most of digital technologies,
new skills and roles
• Delegated capitated budgets – including
for health and social care
• Greater convenience for patients
• By addressing the barriers to change,
enabling access to funding and
maximising use of technology
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Primary and Acute Care Systems
What they are
• A new way of ‘vertically’ integrating
services
• Single organisations providing NHS listbased GP and hospital services, together
with mental health and community care
services
• In certain circumstances, an opportunity
for hospitals to open their own GP
surgeries with registered lists
• Could be combined with ‘horizontal’
integration of social and care
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How they could work
• Increased flexibility for Foundation Trusts
to utilise their surpluses and investment
to kick-start the expansion of primary care
• Contractual changes to enable hospitals
to provide primary care services in some
circumstances
• At their most radical they could take
accountability for all health needs for a
register list – similar to Accountable Care
Organisations
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Other new care models (1)
Urgent and emergency care
Specialised care
Simpler and better organised systems,
achieved by:
• Consolidating services where there is good
evidence that greater patient volumes lead
to greater quality
 Developing networks of linked
hospitals to ensure access to
specialist care
 Ensuring seven day access to care
where it make a clinical difference to
outcomes
 Proper funding and integration of
mental health crisis services
• Working with a smaller group of lead
providers willing to take responsibility for
developing geographical networks of
specialised and non-specialised care
• Moving towards specialised centres of
excellence for rare diseases
 Strengthening clinical triage and
advice
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Other new care models (2)
Viable smaller hospitals
• Help sustain local hospital services where:
• They are the best clinical solutions
• They are affordable
• They have commissioner support
• They have local community support
• Consider adjustments to payment
mechanisms
• Explore new staffing models
• New organisational models including:
 Sharing management across sites
 Satellite provision on smaller sites
 Primary and acute care systems
Modern maternity services
Enhanced health in care homes
• Explore how to improve our current
services and increase choice by:
• Developing new models of in-reach
support and services by:
 Commissioning a review of future
maternity units for Summer 2015
 Working in partnership with social
services and care homes
 Ensure funding supports choice
 Building on existing success
 Make it easier for midwives to set up
services
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Forward View into Action
• NHSE expects providers and commissioners to
engage with their LETBs to work together to
identify their current and future workforce needs
• Planning assumptions must be shared between
commissioners, providers, LETBS and other
partners to ensure alignment, with LETBs
triangulating their plans with local
commissioners and providers before submitting
them to HEE
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HEW Board – 27 Jan
Challenges to deliver
1. Train more healthcare workers, particularly nurses, increase
the commissions, look to innovative education models
(Lancashire)
“We want choice, so that we can choose the best people, to give
the best care and develop the service.”
2. Improve access to nursing, BTEC in health and social care
needs better access route (118 students at FE, 2 people
accepted on nursing degree)
“We need to recruit and train a local workforce.” “We still make it
too hard for people who want to care, to care at the level they
can.”
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HEW Board - Challenges
3. IT literate staff and students, Prepare students for step
changes in healthcare delivery and continuous developments
in IT and genomics
“The minute we start seriously sequencing people we won’t treat
cancer patients as we do now.”
4. Leadership and skills development for commissioners so they
can develop new models of care
“CCGs are clinical leadership in action. We need people coming up
through the ranks”
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HEW Board – Challenges
5. Improve training and support for End of Life Care working
with nursing homes and third sector
“We have about 50 people at any one time in the hospital whose
home is a nursing home.”
6. Address GP Career Plans and recognise the change to
workforce models, it’s not just about recruitment to the
same.
“GPs of the future will have different career models, perhaps two
days in a practice, one day as a commissioner, then as a
specialist or an educator.”
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HEW Board – More challenges
• New models of care: Develop roles that work
across settings and that train staff to be able to
put patients at the centre of their care and of
service development (eg AHPS taking self
referrals)
• Support cultural changes so that staff work as
one team not two teams working in parallel eg
community nurses and district nurses
• Look after the health of NHS staff – biggest
employer in the county
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HEW Board – More challenges
• Cultural change and a new NHS/Patient
Contract: training for independent living (even
if people are in hospital)
• Links to preventative healthcare
• Improve links with Health and Wellbeing
Boards (who are now maturing)
• Extend investment and development in
advanced practice roles
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HEW Better Care support
• £2.5m investment as catalyst for changing
behaviour and developing new skills
• £1.7m SHIP and £0.8m Dorset
• Support for education, training and workplace
development
• Promote integrated working across the health
and social care system and working beyond
traditional professional boundaries
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Delivering integrated care
through Better Care Reviews what has already worked – case
studies (nationally and internationally),
evaluation of specific approaches, theoretical
perspectives
Recommends inter-professional learning (IPE)
to deliver Better Care that is:
-Transformational,
-Sustainable,
-Value for Money.
-Gives us evidence for agreeing spending on
our “bottom up” approach
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HEW Better Care support
Supporting 9 projects in SHIP
Lead organisations
1.
2.
3.
4.
5.
6.
7.
8.
9.
Portsmouth City Council
SE Hants, Fareham, Gosport and Portsmouth CCG (AvOCET)
IOW NHS Trust
Hampshire Hospitals Foundation Trust
Southampton City Council
West Hants CCG
Hants County Council
North Hants CCG
Hants County Council on behalf of all organisations
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HEW Better Care support
• Project Management Support
• Support inter-professional learning
• Evaluation of Impact
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Five Year Forward View
Discussion...
The Board answered the question “What does the
LETB need to do to support the development of
new models of care for the Wessex health (and
social) care economy?”
Our role today to respond to the challenge(s)
•
•
•
e.g. PEST analysis
e.g. SWOT analysis
e.g. develop specific plans
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SHIP feedback
Themes 1&2
How do we help students to find their right step off
point (career climbing frame), so we don’t lose
BTECs we enable them to work at the level they
want
LETB Action – broker conversations across
stakeholders, use existing funding to support 3-4
people in a new type of programme
For existing workforce – community re-skilling
(address gaps from retirement in nursing workforce)
Ensure that we track along the way to support
evaluation
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SHIP feedback
Theme 1:
A sufficient supply is important – but keep staff we
have as well
“recruitment, retention, rotation”
As people develop through their careers look at new
opportunities with new MSPs (so don’t even have to
change organisations)
Mental Health – improve new and existing staff’s
awareness and skills, supported by interprofessional learning – take what has happened
with dementia – and people with mental health
issues coming into acute settings or below level of
clinical intervention – link with new Mental Health
Taskforce
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SHIP feedback
Theme 2:
LETB to give a framework on funding pots/stream eg
foundation degree – is that entry to nursing? And
other funding streams to get into nursing
Developing assistant practitioner role in GP practices
Support from LETB to deliver academic component of
nursing programmes
Problem of placements for foundation degree students
in GP – not financial support but also shift of culture
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SHIP feedback
Theme: Partnership working for support workers
Share open access to study days and what would
unblock that, we have started to look at cross
health and social care opportunities – shared
curriculum and lesson plan, benefit from shared
learning and networking. Barriers – how do we
do that when say, NHS gets funding, but social
care or LA don’t? Looking to HEW (collectively)
unblock that.
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SHIP feedback
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