Workforce challenges
Adam Wickings
9 th July 2014 www.england.nhs.uk

• Hello: My roles
• Overview: Commissioning and Planning in Surrey & Sussex
• Call to Action the national challenge
• Two “Units of Planning” and what they’ve planned
• Primary Care & “Out of Hospital” Strategy
• “Enablers”: Ring-fenced pots of money
• Better Care Funds
• Urgent Care and RTT “resilience” funds
• Change in the Air co-commissioning, specialised commissioning
• Big themes with workforce implications www.england.nhs.uk
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www.england.nhs.uk
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Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex are :
•
12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
•
Primary Care
•
Specialised services
• Prison services
• Armed Forces
•
4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)
Provider landscape is as follows:-
• 6 Acute Trusts
•
2 Healthcare (Acute & Community)
•
3 Community Trusts
• 354 GP Practices
• 2 Mental health Trusts www.england.nhs.uk
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Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex are :
•
12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
•
Primary Care
•
Specialised services
• Prison services
• Armed Forces
•
4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)
 2 Year “Operational Plans”
 2 x 5 yr Strategies
Provider landscape is as follows:-
• 6 Acute Trusts
•
2 Healthcare (Acute & Community)
•
3 Community Trusts
• 354 GP Practices
• 2 Mental health Trusts www.england.nhs.uk
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2 “Units of Planning”
2 NHS 5 Year
Strategies www.england.nhs.uk
6

Commissioning & Planning responsibilities in
Surrey & Sussex
Commissioning organisations in Surrey and Sussex are :
•
12 CCGs (5 in Surrey, 7 in Sussex)
• NHSE Area Team commissions:
•
Primary Care
•
Specialised services
• Prison services
• Armed Forces
•
4 Local Authorities (East Sussex, West Sussex,
Surrey and Brighton)

4 x Health &
Wellbeing Strategies
Provider landscape is as follows:-
• 6 Acute Trusts
•
2 Healthcare (Acute & Community)
•
3 Community Trusts
• 354 GP Practices
• 2 Mental health Trusts www.england.nhs.uk
7

4 Health & Wellbeing
Boards
4 Health & Wellbeing
Strategies www.england.nhs.uk
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www.england.nhs.uk

The NHS faces a range of whopping challenges
•
We have limited financial resources, no longer growing
• An ageing population and growing LTC, and so
• A greater and growing demand on services
•
Workforce that in key areas is not growing at even a similar rate
A
‘
Call to Action
’ tells us that if we are to preserve key values of the NHS, it must change to survive. More of the same won’t do it. It means transforming services, to put patients at the centre and to better meet the health needs of the future.
• Improving efficiency (£20bn)
• Lowering financial costs
•
Providing more care outside of hospitals :-
 INTEGRATION, FEDERATION,… polysystem?
 TRANSFORMATION
 SELF MANAGEMENT www.england.nhs.uk
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How does providing care “out of hospital” not save money?
• Staff in the community are not cheaper than hospital staff ( and they have to travel)
•
Buildings in the community are not cheaper than hospitals
(they’re more expensive)
•
Episodes of care, e.g. appointments, are not cheaper than hospital OP appts moving appointments from hospitals to clinics, health-centres or surgeries is not cheaper
•
The point of a hospital is to lump staff and services together to make them efficient and cheap
How can providing care “out of hospital” save money?
•
Fewer, more-expensive episodes are much cheaper overall
•
People pay for their own homes
•
30% of a GP Practice list use 80% of the appointments
• They’re the same patients having hospital appointments and admissions etc.
• Money is saved when we reduce the fixed assets: hospital buildings www.england.nhs.uk
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Surrey and Sussex need to provide a better landscape of health and social care services for our communities and must be committed to:-
• Increasing the Potential years of life lost from causes considered amenable to Healthcare
• Improve the quality of life for people with Long term conditions
• Increase the proportion of older people living at home
• Decrease the number of people having a negative experience of care outside Hospital, in primary care and in the community
• Decrease the number of people having a negative experience of hospital care
• Making a significant progress towards eliminating avoidable deaths in our hospitals www.england.nhs.uk
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www.england.nhs.uk

Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Acute Hospital Urgent and
Emergency Care
• Stroke
•
Complex Invasive Cardiology
• Elective productivity
•
Mental Health
• Cancer
• Burns
•
Plastic
Sussex Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Maternity and paediatrics
• Acute Hospital Urgent and
Emergency Care
•
Stroke
• Complex Invasive Cardiology
•
Elective productivity
• Renal
• Cancer
•
Burns/Plastic
• Provider Landscape
Enabling Workstreams

Workforce
 Commissioning developments and levers
 Others, e.g. BI, IT, premises www.england.nhs.uk
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Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Acute Hospital Urgent and
Emergency Care
• Stroke
•
Complex Invasive Cardiology
• Elective productivity
•
Mental Health
• Cancer
• Burns
•
Plastic
Sussex Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Maternity and paediatrics
• Acute Hospital Urgent and
Emergency Care
•
Stroke
• Complex Invasive Cardiology
•
Elective productivity
• Renal
• Cancer
•
Burns/Plastic
• Provider Landscape
Enabling Workstreams

Workforce
 Commissioning developments and levers
 Others, e.g. BI, IT, premises www.england.nhs.uk
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Wider area transformation strategy Call to Action
CCG Commissioning
/ transformation strategy
Out of Hospital
Strategy
Primary &
Community
Strategy
Primary Care
Strategy www.england.nhs.uk
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Provider changes – integration?, federation?, reorganisation?, workforce?
Incentives, contracts, new commissioning
Strategy, aims, values, commissioning intentions, messages
PLAN www.england.nhs.uk
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www.england.nhs.uk
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• Prime Provider models
• “Outcome based commissioning”
• Commissioning from “federations”
• New procurement approaches
• Less commissioner specification
• More co-design www.england.nhs.uk
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Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Acute Hospital Urgent and
Emergency Care
• Stroke
•
Complex Invasive Cardiology
• Elective productivity
•
Mental Health
• Cancer
• Burns
•
Plastic
Sussex Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Maternity and paediatrics
• Acute Hospital Urgent and
Emergency Care
•
Stroke
• Complex Invasive Cardiology
•
Elective productivity
• Renal
• Cancer
•
Burns/Plastic
• Provider Landscape
Enabling Workstreams

Workforce
 Commissioning developments and levers
 Others, e.g. BI, IT, premises www.england.nhs.uk
20

Main Workstreams in Surrey & Sussex
Surrey Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Acute Hospital Urgent and
Emergency Care
• Stroke
•
Complex Invasive Cardiology
• Elective productivity
•
Mental Health
• Cancer
• Burns
•
Plastic
Sussex Strategic Plan
• Out of hospital (primary care, Better
Care Fund, urgent care
•
Maternity and paediatrics
• Acute Hospital Urgent and
Emergency Care
•
Stroke
• Complex Invasive Cardiology
•
Elective productivity
• Renal
• Cancer
•
Burns/Plastic
• Provider Landscape
Enabling Workstreams

Workforce
 Commissioning developments and levers
 Others, e.g. BI, IT, premises www.england.nhs.uk
21

www.england.nhs.uk

• £18 M Surrey 14-15 BCF
• £65 M Surrey 15-16 BCF
£47 M Sussex 14-15 BCFs
£120 M Surrey 15-16 BCFs
• Not new money: CCG allocations ring-fenced for use as agreed with HWBs, technically non-recurrent
• Not a “bung” for Local Authorities: NHS money for use on integration, transformation, out-of-hospital
• 1415 plans a plethora of “schemes” and “initiatives”
Other Funds in CCGs Control
• Local Contracts ( Local Enhanced Services )
• DES contracts www.england.nhs.uk

£17 Million
£xyz Million resilience funds (winter)
RTT funding
• “New” money: non-recurrent allocations (via CCGs, not straight to Trusts) for delivery of constitution standards (4 hrs in A&E, 18 wks RTT)
• Non-recurrent and short timescales, short notice so very difficult to use well
• 1415 plans a plethora of “schemes” and “initiatives” www.england.nhs.uk

www.england.nhs.uk
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• Moving control from NHSE (back) to CCGs
• Expressions of Interest so far
• Can be about budgets or just co-design
• A journey: back to unified budgets?
• A unified budget allows investment (investment in primary & community care) www.england.nhs.uk
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• Moving control from NHSE (back) to CCGs
• Re-designation - what is designated as specialised
• Population commissioning - away from contracts
•
A journey: back to unified budgets?
• A unified budget allows investment (investment in primary
& community care) or disinvestment… www.england.nhs.uk
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• Redesign, initiatives, federations…
• Get involved with planners
• Integration and federation have to be instead of increases in workforce
• We can move nurses and doctors from place to place but we can’t often get more
• Reduce episodes and reduce hand-overs
• Lots of new schemes and initiatives can’t be delivered if they all mean more nurses or doctors
• What workforce can we recruit successfully?
• Pharmacy?
• Physician assistants?
• Who should do innovation and workforce planning?
• Commissioners?
• Providers?
www.england.nhs.uk
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“Every child deserves to be given the very best start in life, and healthcare staff working with children and young people must have the right knowledge and skills to meet their specific needs and ensure that children receive joined up health and care across both hospitals and the community” . (CMO 2013)
SCN WORKS JOINTLY WITH HEE CYP
PROGRAMME BOARD
Sort- Coding and Counting of Staff on ESR is required to have robust
Health and Social Care
Information Centre Data
Make a plan-
Training & governance wider children’s workforce e.g. PA’s and school staffpersonal health budgets and the DfE statutory guidance which takes effect from 1st Sept 14
HEE Mandate P11-13
Other issues
Health Visiting – Role of minor
Illness
School Nursing role in Long term
Conditions
HEE Mandate https://www.gov.uk/government/uploads/system/uploads
/attachment_data/file/306967/HEE_mandate_2014-
15.pdf?utm_medium=email&utm_source=The+King%27s+
Fund+newsletters&utm_campaign=4043517_HMP+2014-
05-02&dm_i=21A8,2ENZX,FLWRM1,8RQGI,1
How do we work with
Social
Care
Education to join up our workforce strategies
Nursing
Significant national shortage of registered children’s nurses
Need for a review of Need for more community and advanced roles in the community
Need for more
Practice Educators
Medical
Shortage of paediatricians to cover RCPCH standards in acute care
Role of Community
Paediatrican and recruitment issues
Primary Care workforce role &
Skills for CYP with
Acute and LTC
How do we get the right balance?
Health
DEPARTMENT OF HEALTH COMMUNITY NURSING STRATEGY
The SCN are engaged in scoping of CYP community nursing

www.england.nhs.uk
9 th July 2014