Shape of Caring Event
22nd July 2014
Kathy Branson
Director – Special Projects
Health Education East of England
Agenda
Timing
Item
09.30 – 09.35
Introduction and Welcome
09.35 – 10.20
HEE Shape of Caring Review and Q&A
10.20 - 10.50
Overview of HEEoE Review of Pre-Registration Nurse Education
10.50 – 11.00
Refreshment break
11.00 – 11.15
Evidence Base for Practice Education
11.15 – 11.30
New Models for Practice Education
11.30 – 11.45
Dual Qualifications: Moving Up and Sideways
11.45 – 12.00
Community Preceptorship and Pathways
12.00 – 12.15
Grow Your Own
12.15 – 12.30
Plenary discussion/Q&A
12.30
Close and Lunch
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Shape of Caring review:
Education for tomorrow’s nurses
Lord Willis of Knaresborough
East of England LETB
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Context for change
• Growing population – 3 million by 2020
• Challenge of Aging population
• Challenges of long term chronic disease management
Diabetes
25%
Kidney Disease
45%
Dementia
25%
Obesity: 48% Men and 43% Women by 2030
• Chronic care management: 70 - 75% of costs of NHS
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Context for change continued…
• Changes in technology – personalized
medicine
• Changes in patient demand
• Changes in Commissioning
• Changes in care delivery
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Context for Change
• Funding Uncertainty:
•
•
•
Continued growth over past 50 years
NHS spend now larger than education and defence
1 in 16 people in England are employed by NHS
• Future Funding
• Demands will rise but budget will not keep pace
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Constant factors
• Patients, families and communities
• ‘Caring’ workforce
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A vision for the future…
•
The majority of healthcare will be managed out of the hospital setting, with more care
being provided in the community. Patients will be encouraged to self-care as much as
possible:
•
•
•
•
•
Patients will be better supported to manage their own health, with better outcomes
for individuals and better value for money
Patients will receive high quality care wherever they are and at the time of their
choosing, reducing inequalities and outcomes
Patients will have higher quality relationships with healthcare professionals, reducing
unnecessary visits to different specialists, leading to satisfaction for patients
Patients will benefit from the latest research and technology, whilst being treated with
care and compassion
(Framework 15: HEE’s Strategic Framework 2014-2029)
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Care support and nurses in England
• HCSWs in healthcare – 270,000
• HCSWs in social care – 1.2 million
• Registered nurses – 500,000
• These staff deliver most hands-on patient care
• Their access to education and training vary
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Shaping tomorrows workforce…
• Prime Minister’s Commission on the Future of Nursing and Midwifery
(2010): 20 recommendations relating to nursing/midwifery
• Willis (2012): 29 recommendations relating to nursing
•
Francis (2013): 29 recommendations for nursing/HCSW
•
Cavendish (2013): 18 recommendations for HCSWs
Currently we lack a coordinated response
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•
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Shape of Caring review
• Patient centered
• Evidence based
• Build on existing best practice
• Output focused
• Career focused
• Skill focused
Solution and evidence based!
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The Shape of Caring review
• Commissioned by HEE
• Sponsoring Board jointly chaired by HEE/ NMC and includes:
•
Council of Deans; NHS England, Public Health England;
LETB’s; NHS Trust Development
Authority (TDA);
LETB’s; RCN; Unison
•
In attendance: Chief Nursing Officers: Wales, Scotland and
Northern Ireland; Researcher from Kings College, London.
• Independent Chair – Lord Willis of Knaresborough
• Reports: February 2015
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How we are doing it
Call for evidence/engagement
•
Review of the literature
•
Engagement events:
– HCA’s, nurses, educationalists and the public
•
Involving a cross section of staff:
– Independent sector, prison health, community, acute, voluntary
sector
• Commissioning Groups
• Social media
• Surveys and questionnaires
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The Shape of Caring - Emergent themes:
•
Increasing patient/carer voice & service user involvement
•
Valuing the role of the Care Assistant
•
Widening opportunities for Care Assistant career progression
•
Assuring flexibility in the model of education and training for the future
•
Assuring & maintaining high quality learning environments for the future
•
Assuring Registered Nurses continuous learning and development
•
Enabling research, innovation and evidence-based practice
•
Reviewing the use of funding and commissioning levers to drive up quality
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Thank you
• Contact details: willisg@parliament.uk
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Overview of HEEoE Review
of Pre-Registration Nurse
Education – Kathy Branson
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HEEoE Review-Overview
•
•
•
•
•
23 pre-registration nursing programmes commissioned per year
by HEEoE
£100m + per annum
The Francis Report identified need for us to ensure programmes
meet existing healthcare requirements now and in the future.
The review will align planning for future provision with the
emerging implementation of the National Standard Contract
Framework
Safer staffing standard/National shortage of nurses
”
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Design Principles
The study design will be built upon the principles of Health
Education East of England:
• Patient-focused
• Provider-led
• People-centred
With quality at the heart of everything we do:
• Quality of patient care
• Quality of education provision
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Key Lines of Enquiry
The following 4 KLoEs, underpinned by a number of detailed
questions, will be considered in the review:
1. How do we determine what excellent nursing
education should look like and how it should be
delivered?
2. How do we ensure the right learning environment?
3. What is the optimum commissioning pattern for nurse
education?
4. How do we ensure that we have the right applicants
on our nursing programmes?
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Who did we ask?
•
•
•
•
•
8 workshops for nurses (n=191)
3 workshops for service users (n=42)
1 HEI workshop (n=19)
4 workshops for students (n=86)
Collected data (taped and written), analysed by key
themes
• Carried out a Preliminary Literature Review – setting the
context
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Mentorship
NHS Staff
Student
Service User
Education Staff
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Partnership HEI/
Practice
NHS Staff
Student
Service User
Education Staff
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Core Skills and
Knowledge
NHS Staff
Student
Service User
Education Staff
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Values: Care, Compassion
& Resilience
NHS Staff
Student
Service User
Education Staff
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Values: Care,
Compassion & Resilience
The little things
which
count………..
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Service user & patient
involvement
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Preparation for working in a
range of settings
NHS Staff
Student
Service User
Education Staff
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Selection of Future
Nurses
NHS Staff
Student
Service user
Education Staff
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Future Commissioning
Patterns
NHS Staff
Student
Service user
Education Staff
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Next steps
•
•
•
•
Interviews with key stakeholders
Online surveys
Testing & implementation
Website on HEEoE: http://eoe.hee.nhs.uk/ourwork/fundamental-nursing-review/
• Twitter: @HEEoENurse
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Tea & Coffee Break
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Evidence Base for
Practice Education –
Anne Devlin
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Developing professional
practice and expertise
requires being ‘in practice’
and ‘doing practice’
Repeated
exposure to
practice
situations
Seeing
theory/policy/
evidence role
modelled in
the real -world
context of the
healthcare
workplace
Personal
engagement
Engaging with
practical
situation i.e.
trying out and
assimilating
what works
well
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A Model of Effective
Practice Learning
in Nursing
An enabling
community
A systematic
organised and
progressive
learning
experience
within an
unpredictable
world
Continuity and
proximity with
an individual(s)
who has clinical
expertise
A shared
positive culture
and
commitment to
common
patient-centred
values
Doing practice
& reflection on
practice
Mentors with
an interest in
and passion for
practice
education
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Barriers to Effective Practice Learning in Nursing and Suggested
Solutions
Barriers to Effective Practice Learning in Nursing and Suggested
Solutions (continued)
New Models of Practice
Education – Chris Sykes
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Collaborative Learning In
Practice (CLIP) Project
Improve
Quality
• Student-led learning
• Supported mentorship
• Reducing Failure to Fail
Increase
Capacity
• Able to support more learners
• In-patient area from 6 to 16
• Variable
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Situational Leadership
Clinical Educator
Maximum of 2 areas
Grow Coaching Model
(Whitmore, 2009)
Mentor
Student leads care –
delegates to day coach
Clinical Educator supports
challenging conversations
and failing to fail issues
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Maximum of 3
students
Day Coach
Patients allocated:
Student
2
3
3+
Year 1
Year 2
Year 3
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“……a license
to step back
and push the
student”
“Allows students to
work as nurses - not
be followers
(spoon-fed)”
“Students
more involved,
gained more
insight, more
enquiring”
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“Better awareness
and understanding
of what’s expected
of a ward nurse”
“Ensures we
consider the
rationale behind
decisions”
“I felt as though
I could really
concentrate
(my care) on
those patients”
Dual Qualifications:
Moving Up and Sideways
– Carol Edwards
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Dual Qualifications Moving
Up and Sideways
Service users, nurses and students told us
nurses should recognize / have knowledge of:
LD – Death by
indifference
Physical
conditions
Children
with
learning
disabilities
Children
with mental
health issues
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Mental
health
conditions
Learning
disabilities
People with LD are
living longer with
complex physical
conditions
CN – early mental
health problems in
children are missed
Acute A&E miss
mental health
problems / LD
MH patients are
diabetic / need
would care / have
physical conditions
Options
Generalist preregistration
programme
Continuing
professional
development
modules
2nd/3rd
qualifications in
another branch
Make it easier to
move between
fields of nursing
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Steps That Have Been Taken
and Work to Consider
NMC on the
Reference Group
Considering the
need to commission
further work
Working with HEIs
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Information from
users, nurses and
students
Feeding into NHS
workforce to
identify needs
Community
Preceptorship and
Pathways – Julia Whiting
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Preceptorship into community
and community pathways
A programme for newly
qualified nurses
Preceptorship
Programmes
Do you have
in place, or
are currently
developing?
The NMC recommendation
that newly qualified nurses
undergo a post qualification
‘preceptorship’ period of
consolidation must be fully
implemented.
A programme for newly
qualified health visitors
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A programme for newly
qualified district nurses
A programme for registered
nurses transferring from
hospital based services to
community teams
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Do you have
an induction
programme
for HCA’s ?
For nurses already in
specialist or advanced
roles.
To consolidate learning for
newly qualified nurses
building on their
preceptorship programme
DEVELOPMENT
PROGRAMMES –
what is out there
and what do we
need to build on?
For nurses that wish to
stay in staff nurse roles
Do you have a
District Nurse
Training
Programme ?
To prepare registered
nurses moving from an
acute to community
setting
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For nurses that wish to
progress to specialist or
advanced roles
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Grow Your Own – Kathy
Branson
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Why grow your own?
•
•
•
•
•
Valuing effective delivery of essential care
Person centred & integrated care
Skills gap and youth unemployment
Representation & inclusivity
Cost benefits
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What we have already
Band 2
&3
Band 1 &
Pre-employed
Band 4 inc
Assistant
Practitioners
Band 5+
Registered
professions &
Pre-degree
careroles
experience
specialist
pilot; part-time undergraduate
courses (OU)
Foundation degrees;
Higher apprenticeships
Minimum standards; Certification;
Apprenticeships and Advanced Apprenticeships
Prince’s Trust; Job Centre Plus;
NHS Careers and Schools;
Traineeships; Project Search
Incorporating the NHS Constitution and Values
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What we need to do next
• Develop a clear pathway to inform staff and education
providers
• Develop a commissioning model that specifies quality, cost
(for practice and education) and practice support standards
• Build on potential for improved patient care with flexible roles
• Clarify APEL arrangements
• Develop a way of workforce planning for Band 1-4
development
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Plenary Discussion / Q&A
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Lunch and Close
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