Welcome to the RCSLT’s webinar: Professionalism: The Big Conversation continues 22 nd November 2013 #Professionalism

Chair of webinar: Presenters: Kamini Gadhok MBE, CEO, RCSLT Karen Middleton, Chief Health Professions officer for England Andy Burman, CEO of the British Dietetic Association

Professionalism webinar for AHPs Karen Middleton CBE Chief Allied Health Professions Officer November 2013

A patient’s story ‘In the next room you could hear the buzzers sounding. After about 20 minutes you could hear the men shouting for the nurse, ‘nurse, nurse’ and it just went on and on. And then very often you would hear them crying, like shouting ‘nurse’ louder, and then you would hear them crying, just sobbing, they would just sob and you presumed that they had had to wet the bed. And then after they would sob, they seemed to then shout again for the nurse, and then it would go quiet…’ 4

Background to the Francis Inquiry Damning investigation report Independent inquiry chaired by Robert Francis QC First inquiry: catalogue of failures and the impact on patients Recommendation for a second inquiry on the wider system Francis 2 launched as full Public Inquiry

Francis report – in numbers 3 volumes and an executive summary; 1782 pages 290 recommendations The recommendations have been grouped according to themes. The report allocates recommendations to organisations to take forward, with any remaining falling to DH to ensure they are taken forward. The report is structured around: Warning signs that existed and could have revealed the issues earlier Governance and culture Roles of different organisations and agencies Present and future

Francis report: reprise Culture change  An overall theme; important we don’t lose sight as we focus on the specific recommendations Fundamental standards  The standards themselves, and what Francis means  Criminal sanctions  The regulatory machinery: “a single regulator”, a new Chief Inspector of hospitals Openness, transparency and candour  Statutory duty of candour, backed up with criminal sanctions  Complaints and feedback as an engine of change  Transparency

Francis report: reprise Leadership  New leadership college  Manager regulation/fit and proper person test Compassionate care  Nursing: entry, education and training, revalidation, RCN, “specialist older person’s nurse”  Healthcare assistants: minimum training, mandatory register  Professional regulators: NMC/GMC/HSE Information  Clear metrics on quality  Publication of data, inc in quality accounts

PM response Acknowledged dreadful events Apologised Patient care Single failure regime Friends and family test Don Berwick safety review Nurses hired and promoted on the basis of compassion, and pay for quality of care

PM response Accountability SofS written to GMC and NMC Law Commission advise on NMC process Consider HSE criminal prosecutions powers to CQC Defeating complacency Chief Inspector of Hospitals Quality of care inspections start in autumn Bruce Keogh investigation into hospitals with high mortality rates Ann Clywd complaints review

Have you had the conversation yet?

The 6Cs Care Compassion Competence Communication Courage Commitment 12

Other work and lessons learnt Review into the quality of care and treatment provided by 14 trusts in England: Overview report Sir Bruce Keogh KBE Improving the safety of patients in England National Advisory Group on the safety of patients in England 13

The health system needs to: Recognise with clarity and courage, the need for system-wide change Abandon blame as a tool and trust the goodwill and good intentions of staff Reassert the primacy of working with patients and carers to achieve health goals Use quantitative targets with caution Recognise that transparency is essential and expect and insist on it Ensure that responsibility for functions related to safety and improvement are established clearly and simply Give NHS staff career-long help to learn, master and apply modern methods for quality control, improvement and planning Make sure pride and joy in work, not fear, infuse the NHS 14

The role of clinical leadership A relentless focus on quality (safety, effectiveness, experience) Data and information Transparency Notice, notice, notice Do the right thing!

Thank you 16

Andy Burman Chief Executive The British Dietetic Association

 To improve services and influence change, this must come from top/down and bottom/up  Where do the opportunities exist for AHPs to create that change?

 Increasing opportunity/responsibility to take a leadership role  Professionals in health and social care should not simply ‘stand by’ and be told what to do  Increasing emphasis on taking responsibility and learning from Francis, Colchester Hospital, etc.  Is it just in the workplace, can more be done by AHPs outside of it?

Some ideas for AHPs to exert influence:  Through the professional body by way of involvement and activity – pushing the boundaries (e.g. scope of practice)  Through Membership of Trusts (England) – even as employees  Through strategic roles – lay roles – e.g. Healthwatch in neighbouring areas – avoiding conflicts with employment

 Local networks of profession specific/AHP peer support groups  AHP Research Network  Commissioning Groups – open meetings and keeping up to date  Health and Wellbeing Boards – the democratic approach!  Representing the AHP on Boards, Working Groups, etc. within other Colleges or organisations (good CPD)

 We have affinities which we seek between like minded people with the same interests  We seek support, affirmation and a sharing of minds  With changing work locations, fragmentation of traditional ‘teams’, this becomes increasingly important for AHPs to maintain and develop professionalisation  What other national frameworks provide a comprehensive structure?

 Professional Bodies/Associations own the curriculum or body of knowledge that defines the profession  Develop the profession - pushing boundaries of practice - responding to member needs – help to ensure safe practice  Offer regional networks or branches for local networking, CPD, etc.  Offer individual or collective support to members  Advocate and represent locally or nationally

 Professionalism is often: ◦ directed by others,  facilitated by some,  but the responsibility of the individual  Professional identity requires the professional to strive for professionalism within their own practice, within others’ practice and elsewhere  If there is the opportunity to influence and improve outcomes generally, should the professional not be using their expertise and skills?

If you care about leadership as an AHP? Influence + Outcomes = Leadership

 Transdisciplinary Professionalism  Different to ‘patient centred’ approaches  Patient is not just the main focus, the patient is part of the discussion, the solution and the delivery  The focus is not on Multi Professional approaches but on the issue itself – what is the best approach to a positive outcome  Provides the sole focus for M-P approach  Examples – ◦ Uganda, 1960’s, health of the newborn ◦ Rehabilitation?

 Positive aspects of Transdisciplinary Professionalism ◦ Education of the patient, greater involvement and more chance of a positive outcome, reduced costs, reduced errors  Negative aspects of Transdisciplinary Professionalism ◦ More time intensive, requires collaboration across professional teams and is a challenging model, compliance is not a ‘given’

 ‘Patients see ‘professionalism’ as behaviours’  ‘Patients want to make decisions about their own care’  ‘Patients want a transdisciplinary team that empowers them and allows them autonomy’  ‘They want health care providers to listen to them’  ‘The bottom line is that individuals, whom the medical model refers to as “patients,” are not bystanders in their care’ Kornblau (2013) Institute of Medicine – Transdisciplinary Professionalism Workshop

 Establishing Transdisciplinary Professionalism for Improving Health Outcomes: Workshop Summary (National Academies Press)      (clinical senates) update.pdfhttp:// update.pdf  AHP Research Network union/research/networking/allied-health-professions-research-networkhttp:// union/research/networking/allied-health-professions-research-network     Framework of Excellence for CCGs content/uploads/2013/11/frmwrk-exc-cc.pdfhttp:// content/uploads/2013/11/frmwrk-exc-cc.pdf   

@BDAAndyBurman

ANY QUESTIONS?