HETV Partnership Council
Thursday 3 July
9.30am – 2.30pm
Milton Hill House Hotel
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www.thamesvalley.hee.nhs.uk
Welcome
Sandra Hatton
Managing Director
HETV
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
New Independent Chair and
HETV Business Plan:
• We welcome Professor John Caldwell as the
new HETV Independent Chair
• HETV Delivery Plan 2014/5 – sets out our
priorities for delivery over 2014/15 in
response deliver the HETV Workforce
Strategy Tomorrow’s People, Today circulated shortly
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Strengthening HETV capacity:
Pauline Brown
Deputy Dir. Education &
Quality
• Quality
• Performance
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www.thamesvalley.hee.nhs.uk
Juliet Anderson
Agnes Hibbert
Deputy Dir. Education
Programme Manager
& Quality
• Workforce strategy
implementation
• ECAT Plan
• Programme Management
Beyond Transition
Realising our potential
Health Education England
HEE Case for change:
• We must create One HEE
• Our operating model must allow HEE to focus on the whole
workforce and transformation, increase efficient working and
reduce duplication nationally
• Increase governance expected of a Non-Departmental Public
Body with greater alignment with the rest of the system
• We must deliver the DoH requirements to reduce running costs by
20% (-£17m nationally) and the number of senior posts paid over
£100k by at least the same amount
• We must continue to be as efficient as possible in non-staff
running costs to help meet our challenges
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What does it mean for HETV?
• Committed to maintaining the HETV Board and local delivery
model, built on close stakeholder engagement and
involvement
• Opportunities for local providers to shape the workforce in
support of patient needs
• Better governance, better connections and efficiencies
• New structures and management aligned across four regions,
including new National Directors (Geography)
• HETV Managing Director, Head of Finance and Director of
Education & Quality roles cease to exist
• Replaced by one Local Director role
• Appointment of a Vice Chair to the HETV Board
www.hee.nhs.uk
Timetable
•
Engagement with staff/Boards now complete – final decisions
made at HEE Board on 7 August
•
Statutory consultation of staff:
•
phase 1 (senior):
July 2014 onwards
•
phase 2 (functions):
October 2014 onwards
•
New senior team in place:
•
Complete and review:
www.hee.nhs.uk
30 September 2014
March 2015
Questions?
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Partnership Council review:
• Final Partnership Council for 2014, ahead of
Autumn Conference – Tuesday 14 October,
The Oxford Hotel
• This represents our sixth Partnership
Council event – increasing audience,
increasing representation and increasing
influence on HETV
www.hee.nhs.uk
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Partnership Council:
You said, we listened, we did
• November 2013: Our organisational
effectiveness and Board composition.
• We addressed your feedback – widening out
Partnership Council to include more
representation
• We changed the composition of our Board –
including local commissioners
• We’ve increased regular communications to you
and we want more feedback and involvement @hethamesvalley on Twitter and our website
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Partnership Council – February:
You said, we listened, we did
• February 2014: We discussed the refreshed HEE
Mandate and how to meet it
• We consulted on development of HETV Support
Worker Strategy
• Latest version approved by HETV Board in
June
• We responded to calls to ensure
comprehensive approach to all roles
• End-to-end approach across system
• Develop a ‘Skills Partnership’ - get involved
via Richard.Griffin@bucks.ac.uk
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Partnership Council – May:
You said, we listened, we did
•
May 2014: Discussed development of HETV’s Dementia Strategy
and how we meet HEE Mandate target to roll-out Dementia
Awareness Training
•
Your feedback has informed the training outcome framework
•
We responded to calls to build on existing work and to aid
collaborations - Dementia Academic Action Group (DAAG) is now
scoping all current provision of Dementia Training (reporting
Sept 2014)
•
We will respond to calls for ‘blended approach’ in the second
phase – development of new training materials for all staff
•
Our lead: zoe.scullard@thamesvalley.hee.nhs.uk and
jacqueline.fairbairnplatt@thamesvalley.hee.nhs.uk
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www.thamesvalley.hee.nhs.uk
Partnership Council – July:
Out of Hospital Care
• Today, we discuss the need to move towards
increased Care Closer to Home, with new out of
hospital models
• What are the impacts on our workforce?
• How can HETV support you to ensure we have the
right skills, right staff in the right place at the right
time?
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Workforce Planning
County Consultation Groups
• Share service commissioning plans – CCGs, Local Authorities
• HETV will share latest workforce demand statistics and will report
on 2015/16 education commissions - review and challenge
• An opportunity to be involved in the development of the
Education Commissioning & Training Plan 2015/16
•
Buckinghamshire/Milton Keynes:
9.00am –1pm: Thursday 24 July
Clare Foundation Centre
•
Oxfordshire:
9.00am – 1pm: Tuesday 29 July (note date/venue change)
Marston Rd Campus, Oxford Brookes University
•
Berkshire:
9.00am – 1pm: Thursday 31 July
Easthampstead Park, Bracknell
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HETV Autumn Conference
Tuesday 14 October
The Oxford Hotel
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www.thamesvalley.hee.nhs.uk
Purpose of Partnership Council
and our ways of working
Professor Peter Hawkins
Lead Facilitator
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Role of Partnership Council as an advisory body to HETV:
Government
HEE
HETV Board
1) Commissioning of high quality, well defined strategic questions
2) The design process detailing the right route through which to gain
the required information
3) The right cycle of timing to this process
Board
members and
their own
organisations
Local
partnerships
between
HEIs/providers
HETV Exec
Partnership
Council
HETV Task &
Finish Groups
T&F specific
stakeholder
groups
Expert
stakeholder
groups
The UK health challenge between now and
2032
•
•
•
•
•
•
•
•
Population growth of 8 million
Half the population over 50
Over 65s: 10.6 million – 16.1 million
Over 85s: 1.26 million – 2.6 million
Obesity: 26% - 40%
Arthritis: 8 million - 17 million
Dementia: 800,000 - 1.3 million
Dementia cost of care - £40 billion
• Source Kings Fund:
30th April 2014
Renewal Associates
Objectives:
• Hear from our keynote speakers perspectives on both the
strategic drivers to a move towards Out of Hospital Care
• Share good practice and hear from some of our local
leaders in Out of Hospital Care delivery
• Consider the workforce challenges and priorities
• Discuss and inform how HETV and all local partners can
work together to drive improvements
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www.thamesvalley.hee.nhs.uk
Keep the debate going:
• Keep the debate going via the HETV Twitter feed
@hethamesvalley – follow us
• #hetvpartnershipcouncil
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www.thamesvalley.hee.nhs.uk
Out of Hospital Care Responding to the Workforce
Challenges
Emeritus Professor David Sines
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www.thamesvalley.hee.nhs.uk
Rationale:
For staff across the health and social care system in the Thames Valley,
the shift of care to the community will enable skills to be used more
appropriately and deliver the highest quality care more effectively
across organisational and professional boundaries.
Particular focus is required on the skills, competencies and enhanced
roles to be embedded in the community in order to successfully deliver
the vision for out of hospital care.
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www.thamesvalley.hee.nhs.uk
Strategic workforce drivers:
‘We are moving away from a 20th
century model with its outdated divisions
of hospital-based practice and of ‘health’
and ‘social’ care…
‘....towards a 21st century system of
integrated care, where clinicians work
closely together in flexible teams, formed
around the needs of patients and not
driven by professional convenience or
HEE 15-Year Strategic Framework
historic location’.
RCGP – 2022 GP
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www.thamesvalley.hee.nhs.uk
Rational and drivers:
• HEE Mandate from Government –
setting national priorities
‘The health and care system will require a
greater emphasis on community, primary
and multi-integrated health and care.
Working in multi-disciplinary teams and
work to break down barriers between
primary and secondary care is required.
HEE will train and develop a workforce
with skills that are transferable between
these different care settings.’
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HEE Mandate
Rational and drivers:
• Built around six Strategic Themes –
including Care Closer to Home theme and
Integrated Person-Centred Care
‘90% of patient interactions take place
in primary care, community settings
and people’s own homes. We need to
build skills and competencies in
preventative care, to support
home-based care and to enable
patients in self-care.’
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HETV Workforce
Strategy – Tomorrow’s
People, Today
What could this mean for our workforce –
both existing and for the future?
Even with greater
productivity, primary
care workforce needs to
expand
Need more diverse
multiprofessional
roles underpinned by
excellent clinical skills
Patients and carers recognised as
part of workforce and provided
with support
....this will have to be
supported by better
collaboration between
primary and community
nursing
GPs will continue to play
the generalist role yet
spend more time
overseeing delivery of care
by multi-disciplinary
teams...
... and some may also
choose to augment
additional clinical and
leadership
specialisations.
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Enhancing skills of the
administrative staff to
incorporate basic clinical
tasks and more general
advice and support for
patients
Developing the HETV Out of Hospital
workstream – what is needed?
•
Understanding what innovative initiatives are there - identifying the workforcespecific considerations and sharing the good practice
•
Identifying the skills and competencies required to deliver these new services
effectively
•
Identifying new roles, laying foundations for better succession planning and career
development to attract, recruit and retain staff to the community setting
•
HETV to work closely local partners to ensure that education commissioning
responds to local priorities to meet the shift
•
Building new partnerships – with social care, with Public Health, with
private/voluntary/independent sectors
• What else does HETV need to be doing to support and
develop?
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HETV next steps:
• Today represents the launch by HETV of a new Out of Hospital Care
Workforce workstream
• 17 July – HETV Board will consider feedback and proposals
developed from today’s meeting
• A programme of activity will be developed within HETV, working
closely with local and national partners
• Take the opportunity today to help shape the development of this
workstream
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
The strengths in the region:
The Thames Valley is well placed to deliver through:
• A strong track record of integrated care initiatives across our
designated localities and at every level of the system
• Plans to shift care from acute to community settings, which
will ensure financially sustainable delivery
• The partnerships that have been established, working
together to develop trust and consensus about what needs to
change
• Experience and understanding of the technical systemic
changes that need to happen to make the difference to
patients, service users and staff.
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www.thamesvalley.hee.nhs.uk
Making it happen:
There are:
“Those who make things happen;
“Those who think they make things happen;
“Those who watch things happen;
“Those who wondered what happened;
“Those who did not know anything had happened at all!”
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Out of Hospital care clinical network –
a critical area for success
Dr Dan Lasserson MA MD FRCP Edin MRCGP
Out of Hospital Care Clinical Network Lead, Oxford AHSN
Senior Clinical Researcher, Nuffield Department of Primary Care Health
Sciences, University of Oxford
Senior Trust General Practitioner, Oxford University Hospitals NHS Trust
Focus of the Out of Hospital Care network
• Acute illness in patients who live with frailty
• Challenge of recognition and response
•
•
•
•
Timely
Assessment
Intervention
Monitoring
• Patients at the centre of design of care
Development of alternative care pathways for
acutely unwell adults
• Emergency Multidisciplinary Unit (EMU) concept
• Accessible, rapid, multidisciplinary diagnosis and treatment from a
community setting
• Medical – interface capability, drawn from 2°and 1°care clinicians
• Nursing
• Physiotherapy
• Occupational therapy
• Social work
• Transport
• Credible alternative to acute hospital admission
EMU operation
• Catchment: 140k at 11 practices
• Weekday working: 8am – 8pm
• Weekend working: 10am – 4pm
• Vertical integration:
• Integration with ‘Hospital @ Home’
• Patient capture (111, 999)
Referrals outside the hyperacute pathways –
Chest Pain, Stroke, Fractured NOF
Investigations
• Point of care bloods
• Na, K, urea, creatinine, calcium, glucose, bicarbonate, gases,
INR, haemoglobin, troponin, CRP
• ECG
• Plain X-Ray (no cross-sectional imaging)
Interventions

‘Interface MDT care’: delivers enabling care alongside interventions
traditionally delivered in an acute hospital, in settings close to home

Intravenous fluid, antibiotics, diuresis, blood products
Care pathways


Ambulatory care
Bed based care (community or acute)
Acutely unwell frail co-morbid adult living at home/care home
Primary Care
Paramedic
EMU referral
Community team
Acutely unwell frail co-morbid adult living at home/care home
Paramedic
Primary Care
Community team
EMU referral
Dedicated transport
EMU assessment and treatment
Acutely unwell frail co-morbid adult living at home/care home
Paramedic
Primary Care
Community team
EMU referral
Dedicated transport
EMU assessment and treatment
Home
Community hospital
Acute hospital
Presentations
•
•
•
•
•
•
•
•
•
•
Breathlessness
Leg swelling
Global decline in function
Reduced mobility
Confusion
Collapse
Fall
Weight loss
Fever
Fatigue
Presentations
•
•
•
•
•
•
•
•
•
•
Breathlessness
Leg swelling
Global decline in function
Reduced mobility
Confusion
Collapse
Fall
Weight loss
Fever
Fatigue
Diagnoses














Cardiac failure
PE
Respiratory tract infection
Cellulitis
Urinary tract infection
COPD exacerbation
Fast AF
Dehydration
Electrolyte disturbance
Pleural effusion
Acute kidney injury
Decompensated liver disease
Upper GI bleed
Medication side effects
Activity – 30 months of operation
Development into a population service
Implementing the Silver Book
• Respect for autonomy and dignity
• Access to health and social care based on need
• Integrated health and social care services delivered by
interdisciplinary working
• Rapid comprehensive geriatric assessment in
response to frailty syndromes
• Ambulatory emergency care pathways for those who
do not require admission
Future care models at the interface of primary and
secondary care
The axes of generalism
Older age
Middle age
Children and
young people
newborn
Vertical generalism of
traditional community
practice
The axes of generalism
Older age
Middle age
Children and
young people
newborn
Horizontal generalism optimised care to an
increasingly prevalent
complex patient
population
Network Partners
• Care providers and commissioners
• Academic partners – reflect breadth of acute
care provision
• Patients and the public
• Third sector organisations
Out of Hospital care clinical network –
a critical area for success
Dr Dan Lasserson MA MD FRCP Edin MRCGP
Out of Hospital Care Clinical Network Lead, Oxford AHSN
Senior Clinical Researcher, Nuffield Department of Primary Care Health
Sciences, University of Oxford
Senior Trust General Practitioner, Oxford University Hospitals NHS Trust
Service Navigation
Integrated working in action
Sue Wright
Manager, Service Navigation Team.
Presentation title here
Why is integrated working important for Reading?
 Rising admissions
 Increasing complexity
 Right person, right place, right time
52
Presentation title here
What is service navigation?
53
Presentation title here
MAISIE
 Fell at home
 Referred to
community hospital
near to her home
via HUB
54
Presentation title here
FRED
 Lives alone
 Taken home by Red
Cross
 3 nights sitting service
from BHFT
55
Presentation title here
BILL
 Bill’s wife needs nursing
home care
 SNT work with Social
Services to identify Continuing
Healthcare entitlement
56
Presentation title here
Lily
 Waiting for
community hospital
 Seen by Integrated
Discharge Team
 Plan changed to
CRT and taken
home the same day
Presentation title here
Thank you
Workshop 1:
When considering the delivery of care closer to home, in out of hospital settings:
Question 1: For the system as a whole - what are the overarching workforce
specific priorities or challenges to be addressed and how can HETV support?
Question 2: For your organisation locally – what are the key workforce specific
priorities or challenges to be addressed and how can HETV support?
Question 3: What do patients and care-givers require from our workforce in the
delivery of excellent out of hospital care?
Question 4: HETV is developing a Thames Valley Skills Set. What are the values,
qualities and specific skills our workforce needs to deliver great care closer to
home? - Consider Values – Qualities – Specific Skills separately on your flip-chart
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HETV investment 2014/15 and
how you can influence future
budget setting
Andrew Hall
Head of Finance
Health Education Thames Valley
andrew.hall@thamesvalley.hee.nhs.uk
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
HETV 2014/15 budgets
Medical
GP
Dental
Education
Commissioning
£000's
£000's
£000's
£000's
Quality, Innovation & Corporate Leadership Projects
Workforce Planning
£000's
£000's
£000's
£000's
Total
£000's
2014/15 Budgets:
Future Workforce:
Postgraduate Medical
45,365
Undergraduate Medical
16,077
13,540
16,077
Non Medical
Future Workforce Total
Workforce Development
Education Support
Running Costs
61,442
58,905
13,540
4,360
56,223
5,465
955
67,003
4,360
56,223
5,465
955
141,985
174
3,979
1,175
105
3,683
10,480
175
261
529
283
308
6,290
94
43
137
1,649
134
117
4,936
60,624
319
3,329
1,405
429
National Activities
Grand Total
65,519
14,946
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
1,045
2,352
251
7,305
2,037
1,045
4,946
161,357
Additional budgets for 2014/15 – contributing to
Out of Hospital Care Workforce
Description
Practice nursing – increase number of GPNs
Increase adult nursing commissions
GP expansion – 6 x ST1 posts
4 additional ST1 ACCS posts
2 Pre Hospital Emergency Medicine posts at ST4
12 x GPST4 posts
Recognition of additional postgraduate medical posts above 11/12
baseline at tariff
Investment Prospectus – commitments carried forward from 2013/14
Workforce development
Investment Prospectus – commitments carried forward from 2013/14
Education Support
Emergency Medicine Project
Midwifery Project
Adult Nursing Project
Workforce Projects – this is the funding we give out to Trusts to support
workforce planning. We will increase it by £200k so that each Trust can
employ a member of staff to work with LETB and Trust
Category
Future workforce
Future workforce
Future workforce
Future workforce
Future workforce
Future workforce
Future workforce
£000s
500
850
350
240
100
535
1,500
1,267
208
Future workforce
Future workforce
Future workforce
Future workforce
250
120
250
200
Contribution to AHSN for continuous learning
Preceptorship
Values based recruitment
Dementia strategy
Junior doctor feedback mechanism – Bucks Healthcare
Workforce development
Future workforce
Future workforce
Workforce development
Future workforce
400
100
50
300
25
Development of education information system
Frail elderly strategy
Total
Education Support
Workforce development
100
284
7,629
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Funded workforce development projects
in support of integrated and out of
hospital care
• Live Well with Better Care. Buckinghamshire CCGs and Local Authority to integrate health and social
care provision using a preventative approach to support self-care and includes mental health and tailored
approaches for high risk groups.
• Oxfordshire County Council and Oxfordshire CCG - the adult social care workforce capability to
support independent healthy living in order to provide timely, best health and social care services that
offer values for money across Oxfordshire. Focus on dementia and up-skilling the integrated workforce
• Windsor, Ascot and Maidenhead CCG and local authority - a wide ranging community project which
will develop staff to achieve person-centred outcomes, enablement and prevention.
• The ten organisations in the Berkshire West health and social care economy are working together to
develop a Whole System Integrated Workforce Development and Training Strategy which will plan
across health and care, looking at skills, ratios, roles development and the use of the voluntary
workforce.
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk
Bids approved under Transformation Funding
£000s
Supporting Return to GP Practice
A patient-centred approach to improving the care of people with dementia
Scientist workforce development and redesign
Thames Valley Skills set
Supporting 24/7 working in unscheduled care: GP clinical fellows in Out of Hours General Practice
225
495
105
105
225
Supporting Physicians Personal Assistants (PPAs) = GPs
Introduction of the Physicians Associate Role
Physician Associates; supporting workforce redesign
Developing pre-registration practice placements to support research and innovation in practice
321
177
100
75
Developing an Infrastructure to support Pharmacy Technician Training in NHS Trusts across HETV
71
In-Trust Workforce planners development programme
Using Learner Feedback to improve educational experience and patient/client safety
55
80
Developing resources to support and promote out of hospital care learning experiences
95
Sustainable Healthcare Fellowships in Dementia, Out of Hospital Care and Diabetes
375
Developing Specialist Paramedics in the Ambulance Service
Advanced Clinical Practitioner: Addressing the shortage of Doctors in Emergency Medicine and advancing
the skills of the non-medical workforce
Clinical Simulation Training
Introduction of the House of Care Model to Support People with Long Term Conditions
174
720
Value based organisations
HETV Multi Professional Service Improvement Fellowships
Redesign of learning disability health services in Oxfordshire and Buckinghamshire
198
140
114
End of life care advanced communication skills
100
101
71
4,122
Workshop 2:
Your opportunity to influence
HETV investment for 2015/16
• How can we invest for the development of the existing
workforce in support of out of hospital care?
• Do we need to invest, and in what areas, to meet the
future workforce needs?
www.hee.nhs.uk
www.thamesvalley.hee.nhs.uk