Implementing the Calderdale Framework Created &Developed by: Rachael Smith Grad Dip Phys BA MSc & Jayne Duffy Grad Dip Phys MSc

Track Record Trust Competency trained therapy assistant workforce Development of Nursing HCA competency pack Development of Assistant Practitioner role (AHP) Skill Sharing (AHP) Locally Kirklees Local Authority - Accessible Homes Team . Calderdale Social Services – Modernising Home Care Tameside Local Authority. Bradford University Regionally Implementation in neighbouring Trusts Working with SHA - commissioned to work across region Training methodology accredited by SHA Skills Network 2011 Nationally Highly Commended in HSJ Awards 2008 & finalists 2011&2013 Skills for Health Early Implementer Project Queensland Health Board (AHPOQ) 2011 SARRAH conference, Tasmania 2012, NAHC Brisbane 2013

Benefits Across Therapy Directorate 2006-2008 Risk Score Reduced risk rating Patient Satisfaction Reduction in Complaints Skill Mix Ratio Qualified to non qualified staff Activity 13% increase Reduction in sickness absence

The Calderdale Framework www.calderdaleframework.com ‘Developing the Assistant Practitioner role using the Calderdale Framework’ NHS Employers briefing 75 (2010) (http://www.nhsemployers.org/SharedLearning/Pages/DevelopmentofAssistantPractitionerRoleusingtheCalderdaleFramework.aspx) R Smith & J Duffy ‘Developing a competent & flexible workforce using the Calderdale Framework’ IJTR 2010; 17(5):254-262 Nancarrow S ‘Assessing the implementation process and outcomes of newly introduced assistant roles: a qualitative study to examine the utility of the Calderdale Framework as an appraisal tool’ Journal of Multidisciplinary Healthcare 2012:5 307–317

Risks = WASTE: Some Stories! Variation in: training/skill to fulfil task what is delegated/shared how task is to be delivered documentation & feedback Lack of clarity when to escalate. Role boundary not clear

Aims of the Workshop Understanding of & how to implement The Calderdale Framework Understanding of Service Analysis based on patient needs. Understanding of how to analyse tasks in order to delegate or share these safely. Awareness of Skills for Health National Occupational Standards

Aims - continued An understanding of how to transform suitable tasks into written competencies. An understanding of how to set up the workplace to support new ways of working. An understanding of how to create a training programme for all staff involved. An understanding of how to monitor, evaluate & sustain new ways of working.

Background – ‘The Age Wave’ SUPPLY Current workforce is ageing Population is ageing leading to a shrinking workforce. Competition for skills across all sectors will increase Current workforce in post now will still be here in 10yrs. DEMAND People are living longer Health costs are age dependent –increase after age 50 yrs (cost for over 85yr is 3x that of 65-74 yrs) Technological and medical advances mean people are surviving with complex long term conditions. 58% people over 65yrs have at least one long term condition Leitch report national document looking at our position in the global market place and despite our nations history the report highlighted skills deficits across the country

UK Ageing Population Proportion of Add to this: population > 65yr Over 85 years to increase by 106% Dementia cases to rise from 570,000 to 1.4 million by 2043. Number of people with 3 or more LTC 2.9 million by 2018 Older people needing care 2.1 million(2010) 4.5 million(2030) 2011 17% 2032 37%

WORKFORCE IMPACTS: CHALLENGES Slowing rate of labour force growth. Slowing rate of economic growth Slowing rate of growth of living standards SOLUTIONS Develop CURRENT workforce Adult re-skilling to increase adaptability & number of workforce (30-49 yr olds) Shift in retirement age increase productivity of workforce

Improving Productivity & Quality in Health Lean processes Workforce development : Delegation New roles (focus at levels 3/4 and level 7/8) Skill sharing (cross discipline practice and CPD) (UK Sector Skill Assessment ,Skills for Health 2011)

UK solution includes A Competence Based Career Framework More senior staff 9 Consultant practitioners 8 Advanced practitioners 7 Senior practitioners 6 Practitioners 5 Assistant practitioners 4 Senior assistants/technicians 3 Support workers 2 Initial entry – level jobs 1

Assistant Practitioner Definition ‘A worker who competently delivers health and/or social care to and for people. They have a required level of knowledge & skill beyond that of the traditional health care assistant or support worker. The Assistant Practitioner would be able to deliver elements of health & social care and undertake clinical work in domains that have previously only been within the remit of registered professionals. The Assistant Practitioner may transcend professional boundaries. They are accountable to themselves, their employer and more importantly, the people they serve.’ (Skills for health 2008)

Advanced Practitioner definition (a): ‘Advanced (Nurse) Practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed’. (NMC Proposed Framework for the standard for post registration nursing 2006)

Advanced Practitioner definition (b): ‘An Advanced Clinical Practitioner is a professional who has acquired the expert knowledge base, complex decision making skills and clinical competencies for expanded practice the characteristics of which are shaped by the context and/or country in which s/he is accredited to practice.’ (HEYH Advancing Clinical Practice task & Finish Group 2014)

Calderdale Framework: 7 stages Focus on Engagement Focus on Potential to Change Focus on Embedding Focus on Risk Focus on Staff Development Focus on Best Practice Focus on Governance

For Patients,Teams & Individuals For Organisations Advantages of Competency Approach Using The Calderdale Framework For Patients,Teams & Individuals Builds Effective Teams around the Patient Personal & Team development needs-Links to KSF Clear Roles & Responsibilities Safe Skill Sharing Transferable Skills Job Satisfaction For Organisations Consistency & Safety Reduction in Risk Efficient & Effective Improved Productivity Flexible Competent Workforce Improved Patient Experience Employer of Choice Provider of Choice

Awareness Raising – Stage 1 Identify desired impact of change Top down + bottom up = Successful Change No surprises! Champions Clinicians Involved from the outset in redesign process Ohno 1980,Benson 2009, 2010. Cooper & Gavin-Daly 2006

Service Analysis – Stage 2 What does the service do When and Where is the service delivered What functions/tasks are carried out Who currently delivers these functions/tasks Does this meet your patients needs

Task Analysis – Stage 3 Increasing Demands on cognitive processing

Allows analysis of risk for task delegation Decision Table 1 Allows analysis of risk for task delegation Aids decisions re skill ,rule, or knowledge based task.

Stages 2 & 3 - ‘New Ways of Working’ Tasks mainly knowledge & rule based & highly specialist Remain with current profession Registered practitioners consider Skill Sharing/ACP Tasks mainly knowledge & rule based Allocate to Assistant Practitioner (UK) Tasks rule & knowledge based with protocols available Delegate to support worker Tasks mainly skill & rule based

Underpins accountability & responsibility issue. Decision Table 2 Formalises delegators / delegatees approach to delegation in terms of appropriacy each time a task is carried out. Underpins accountability & responsibility issue.

At the point of delegation/allocation the clinician must consider the following statements: GO STOP & Consider RISK Identified 1. Is the presentation of the patient’s condition complex? NO YES 2. Is the patient’s situation likely to be unpredictable? 3. Is the patient’s condition common? 4. Is the patient’s condition stable? 5. Is the patient able to participate as expected? 6. Is the patient highly emotional/ anxious? 7. Has the staff member demonstrated competence? 8. Are communication networks & boundaries established and understood? 9. Is the environment organised to support working partnerships? Smith & Duffy 2009 Adapted from Saunders 1996

Turning Tasks into Competencies – Stage 4 Frequency of delegation/skill sharing (time investment) Consensus among peers Skills and knowledge required

Competence Term Basic Meaning Competence General, overall capacity; holistic ; rests on consensus view of what forms good practice. Competency Specific ability that makes up competence. Competencies Abilities to undertake specific tasks that relate to specific ability (competency). Capability Potential competence. Performance Competence in action. (CSP 2005)

Competence Competence incorporates values and philosophy of the person and the profession as well as knowledge, skills and abilities. Competence changes and is dependent on the context in which you work and your role. Competence is dependent upon ability to self-evaluate and learn from experience, whether this is formal or informal learning & its application in practice.

Calderdale Framework & Skills for Health NOS Patient Needs Analysis Task Analysis Service analysis Refine search criteria for Skills for Health National Occupational Standards Local competencies evidence and contextualise National Occupational Standards

Assures ‘fitness for purpose’ of staff Value of work based training Assures ‘fitness for purpose’ of staff Improves consistency of care for trainers and trainees Link with your educational providers to explore potential for recognition of prior learning (APL) on the CQF

Writing a Competency Standardisation (Format) Procedure (Best Practice) Clarity Variations (Flexibility) Feedback (Role Boundary)

Show & Tell Competencies for delegation (support worker) Competencies with clinical reasoning records for allocated work (Level 4) Competencies with clinical reasoning records for skill sharing

Support Systems – Stage 5 Organisational Level Personal development review CPD activity Clinical supervision including reflection

Support System – Stage 5 Service Level Caseload allocation Caseload management When to stop/feedback understood Communication systems established Availability of registered practitioner is essential to communication Explicit care plans- who does what

Supporting Systems Activity Complete the checklist : What have you already in place? Where are your gaps? How can you address these ?

Training - Stage 6 The cost of clinical negligence claims in UK was £787 million in 2009/2010 (NHSLA, 2010) This included 6652 successful claims of clinical negligence (NHSLA, 2010) Appropriate training and development of competent practice is one means of reducing clinical negligence www.NHSLA.com

Underpinned by Education Providers Training (Locally Designed) - Stage 6 Registered Practitioners – level 5 and above Non Registered Practitioners –level 2/3 & level 4 2 TRAINING STRANDS How to use CF (theory) Work based training (competencies) Underpinned by Education Providers

Training: Work Based Strand All Support Staff are given a training record. The Training has 3 Stages: T= Taught -class room setting +/- self directed underpinning theory M= Modelled - this is achieved by assistants watching other competent workers doing the activity They then practice on each other until competent (SIMULATION) C= Competent- this is achieved by assistants undertaking supervised practice until the assessor signs them off as competent The training record is signed off by an occupationally competent assessor at each stage of the training.

APEL in Practice (UK example) Level 4 competencies with clinical reasoning records Portfolio of reflection of application of competencies and learning from other work based training in practice Rigorous external validation day Mapped to learning outcomes of modules of existing provision of University of Bradford 40 credits to 120 credit award

Benefits in Practice Service Specific HEI input Learner Specific HEI input Reduces time out of work place and duplication of learning Recognised transferable academic credit Quality assured internal training and governance practice Staff valued Better for patients

Sustaining – Stage 7 Have you achieved what you set out to do?. Measure the impact of implementing The Calderdale Framework. Use systems already in place e.g. Induction process. Develop standards for delegation/new competencies. Develop means of easy access to competencies Audit delegation/allocation practice and monitor supporting systems. Mechanism for diffusion and capacity building

Points to Consider to Aid Success Involve front line staff at all stages – these are your change makers (CHAMPIONS) Involve service managers Form a steering group to oversee the implementation Be open about your aims & set deadlines Use project management methodology to help keep on target and mitigate issues & risks.

To Recap Awareness Raise Service Analysis Task Analysis Competencies Supporting Systems Train staff Sustain

What are your next steps in using this knowledge in your service? Spend 5 mins reflecting what you have learnt about The Calderdale Framework What are your next steps in using this knowledge in your service?