The RRHEAL collaboration with Orkney Partnership - What happened next

Research Proposal Exploration of the remote and rural generic healthcare worker from three perspectives in Orkney. Wilma Bichan (Orkney College UHI), Judy Sinclair (NHS Orkney) and Rachel Erskine (Lews Castle College UHI)

Context Integration of health & social care Scottish Government initiative In remote & rural areas a significant shift in skill mix is anticipated Recruitment and retention may increasingly become an issue Training generic health and social care support workers in local areas is believed to be essential

Background March 2009 NES & SSSC began to consider joint training for health & social care workers December 2009 NHS Highland commissioned a report to provide an overview of Health Care Support Workers (HCSW’s) role (RRHEAL) engaged with (SQA), NES and SSSC to establish the education needs that would match the role of the Rural Generic Support Worker (RGSW) NHS Orkney and Orkney Islands Council (OIC) agreed to develop the first remote and rural programme and pilot June 2011 partners from UHI, RRHEAL and OIC created an action plan to agree an education programme to meet the RGSW job description

Background (continued) 2012 It was initially agreed that 7 posts would be created in Orkney – this met with challenges due largely to differences in terms & conditions between health and social care agencies 2013 A workshop was held in Orkney the aims of which were to: Take a person-centred approach to consider how the role might support service improvement Use the Skills Maximisation Toolkit (NES) to support the role within the context and challenges of remote and rural areas Examine the patient/client journey to identify opportunities for change Consider the potential of the RGSW role in supporting any potential to improve patient journeys

Mapping Exercise A mapping exercise was commissioned by RRHEAL and undertaken by Mary Richardson (MER Consultants) and Wilma Bichan (UHI) identified clear guidelines matching the Knowledge and Skills Framework to the National Occupational standards Enabled identification of key modules and other training needs that would be required by the RGSW to practice safely As a result of this, Orkney Health and Care (OHAC) were ready (2014) to appoint to the role of RGSW

Rationale of study to evaluate the effectiveness of the educational mapping to the RGSW role NHS Orkney’s job description requires the RGSW to work without direct supervision and exercise initiative when providing care and enablement. Use person centred, outcomes focused principles, participate and work in collaboration with the multiagency team to implement and evaluate interventions that improve outcomes for service users in their home or homely environment. Review and reflect on own practice and performance through formal/informal participation in professional supervision, appraisal and peer support, in line with Orkney Health and Care guidelines.

Rationale (continued) Fits well with the four pillars of reform & seven outcomes of successful public service reform Skills for Care (2013) emphasised the importance of training as a ‘key success factor for integrated working’ as well as suggesting that ‘existing training and education needs to change to better promote integrated working’. These two key elements have driven the mapping of education and training to the RGSW post in Orkney. It is hoped that ultimately the outcome of the educational mapping and results of the evaluation will lead to establishing clear registerable qualifications for this post

Proposal Wilma Bichan(UHI), Dr Rachel Erskine (UHI) and Judy Sinclair (NHS Orkney) are evaluating the effectiveness of the training offered to a RGSW based in Orkney. The research questions is: ‘Is the training and are the competencies developed for the role of the remote and rural generic health worker acceptable?’ METHODS The intention is to explore the role of the RGSW from three perspectives, that of (a) the worker themselves, (b) the users of the service and (c) NHS Orkney a qualitative approach is best suited with the use of semi-structured interviews. Themes emerging can then be discussed and recommendations made for continuation of the role and improvements if necessary.

Literature Search Methodology: An initial search was undertaken using the University’s search engine called ‘multi-search’ which scans across all databases available in UHI. Using this process the number of potential papers was found to be 123. These 123 papers were printed and scanned for relevance. Many were discarded leaving 37 papers requiring further interrogation. In-depth critical analysis is currently being undertaken of these remaining papers with the aim of producing an overall literature review for publication. This review is now underway 10

Stage one: Employees perspective Stage a: Initial meeting/questionnaire to establish worker’s views after 3 months employed Stage b: Meet with research team to analyse the responses and discuss any issues that can be addressed/liaise with multi-disciplinary team/identify gaps in education/training Stage c: Second meeting/questionnaire to review development since first meeting after 6 months employed Stage d: Meet with research team to analyse the responses and discuss any issues that can be addressed/liaise with multi-disciplinary team/identify gaps in education/training Stage e: Third meeting/questionnaire after 9 months employed Stage f: Meet with research team to analyse the responses and discuss any issues that can be addressed/liaise with multi-disciplinary team/identify gaps in education/training Stage g: Review programme after one year and write report

What has happened so far The first of three interviews with the employee has taken place and key themes emerging from initial analysis are as follows: The significance of the previous experience of the employee from either a health or social care background in influencing individual perception of the role. The significance of prior learning, in particular the qualification(s) held. The importance of a clear understanding of the role of the RGSW for all members of the multidisciplinary team. The importance of a clear understanding of the roles of all members of the multi-disciplinary team for the RGSW. The need for focussed contact with the MDT in understanding the holistic needs of the people in their care The need for time to share outcomes of each intervention with the MDT to enable reflection and development of practice. The need to have a regular appraisal and review to ensure that each RGSW has development opportunities to meet their own specific learning and service needs.

Next Steps The next interviews with employees will take place in August This is an ongoing evaluation: the next stage will evaluate the attitudes of the employers and the stage three, the service users Ongoing funding will be sought to support the continuation of this project

References Braun, V. Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology. 3, pp. 77-101. Hart, C. (1998) Doing a Literature Review. London, Sage Publications. MacVicar, R & Nicoll, P. (2013) NHS Education for Scotland : Supporting Remote and Rural Healthcare, NES Board Paper Morrison, Helen, Cremin, Pamela, Gent, Anne (2009) Health Care Support Workers Position Paper Highland NHS Board [online] http://www.nhshighland.scot.nhs.uk/meetings/boardsmeetings/documents/board%20meeting%201%20december%202009/5.7%20healthcare%20support%20workers.pdf Orkney Health and Care, (2012) Joint Commissioning Strategy 2012-2022 [online] http://www.orkney.gov.uk/Files/Council/Consultations/2013/Appendix_1_-_JCS.pdf {accessed 9/10/15} RRHEAL (2013) The Rural Generic (Health & Social Care) Support Worker Projects. RRHEAL http://www.rrheal.scot.nhs.uk/media/212372/merc.rhheal%20rgsw%20final%20shared%20report%20may%202014%20with%20nes%20logo.pdf (accessed 28/6/2016) RRHEAL (2014) Options for new and existing Rural Generic (Health and Social Care) Support Worker Roles. RRHEAL http://www.rrheal.scot.nhs.uk/media/212375/merc.rrheal%20options%20for%20educational%20devt%20rgsw%20final%20with%20nes%20logo.pdf (accessed 28/6/2016) Scottish Government. (2014) Integration of Health and Social Care [online] http://www.scotland.gov.uk/Topics/Health/Policy/Adult-Health-SocialCare-Integration [accessed 9/10/15] Scottish Government. (2010) The Healthcare Quality Strategy for NHSScotland [online] www.scotland.gov.uk/Resource/0039/00398674.pdf [accessed 9/10/15] Scottish Government. (2011). The Government's response to the Christie Commission. [online] http://www.scotland.gov.uk/Publications/2011/09/21104740/0 {accessed 9/10/15} Scottish Government (2014). National Health and Wellbeing Outcomes [online] http://www.scotland.gov.uk/Topics/Health/Policy/Adult-Health-SocialCare-Integration/Outcomes {accessed 9/10/15} Skills for Care. (2011) Evidence review - integrated health and social care- A Skills for Care discussion paper Institute of Public Care, Oxford Brookes University