Making the most of partnerships with universities Prof Steve Tee Associate Dean Education, Florence Nightingale School of Nursing & Midwifery, King’s College London Prof Alison Robertson Chief Nurse and Director of Operations, St George’s Healthcare NHS Trust

Session objectives: Potential for partnerships between health service providers and universities The education commissioning environment Types of partnership activity on offer The service provider context Some worked examples

Partnership – How can we work together? Mutual benefit

Some formal partnerships Academic Health Sciences Centres (AHSC) Academic Health Sciences Networks (HIN) Collaborations for Leadership in Applied Health Research and Care (CLARHCs) AHSC: a partnership between one or more universities and healthcare providers focusing on research, clinical services, education and training. AHSCs are intended to ensure that medical research breakthroughs lead to direct clinical benefits for patients. The centres speed up the time it takes the NHS to access new and better quality treatments and approaches to improving health because of the unique partnerships between researchers and NHS staff working at the front line delivering patient care. There are 6 in UK Cambridge University Health Partners Academic Health Science Centre Imperial College Academic Health Science Centre King’s Health Partners Academic Health Science Centre Manchester Academic Health Science Centre Oxford Academic Health Science Centre University College London Partners Academic Health Science Centre AHSNs 15 in UK to pull together the adoption and spread of innovation with clinical research and trials, informatics, education, and healthcare delivery. They will develop solutions to healthcare problems and get existing solutions spread more quickly by building strong relationships with their regional scientific and academic communities and industry. East Midlands Eastern Greater Manchester North East and North Cumbria North West Coast Imperial College Health Partners Oxford South London South West Peninsula Kent, Surrey and Sussex UCL Partners Wessex West Midlands West of England Yorkshire and Humber CLARHCs Following on from the initial nine NIHR CLAHRCs, the number has been expanded to 13 and there has been research into how the organisations work. Ministers see CLAHRCs as a success, and to varying degrees they have fulfilled their initial aim of encouraging staff in the NHS to adopt research-informed practices. In a paper published this month in the Journal of Health Services Research and Policy some of the key success factors arising from the rich experience of the first wave are highlighted.

Prospective Academic Health Sciences Networks Produced by East Midlands AHSN

How does education get commissioned? Financial allocation from Health Education England to Local Education & Training Boards (13 LETBs in UK) Pre-registration Commission pre-reg numbers based on work-force projections CPPD Providers of NHS funded care Distributed according to needs of local population and services Including primary care, third sector providers Health Education England has 13 Local Education and Training Boards (LETBs) that are responsible for the training and education of NHS staff, both clinical and non-clinical, within their area. The LETB boards, are committees of HEE, and are made up of representatives from local providers of NHS services and cover the whole of England. Health Education England exists to improve the quality of care delivered to patients by focusing on the education, training and development of current and future healthcare staff. With employers and professionals as part of their governing bodies, the 3 LETBs in London are tasked with improving the quality of education and training outcomes to meet the needs of patients, the public and service providers in their areas.

The Healthcare Education Offer 1. Preparatory pre-registration programmes 2. Research and Development 3. Continuous Professional Development

Red queen effect in higher education …the need for Universities to adapt and evolve to survive opposing threats in an ever-changing environment… “It takes all the running you can do, to keep in the same place.”

What does this mean? “Changes to the basic building blocks of the 21st century university” (PA Consulting 2013): the nature and presentation of HE offers and services - diversity of tailored provision the ways that different needs for those services are met - student-centred, employer-led learning, research-based how institutions organise themselves and secure the capabilities they need - patchwork of provider partnerships how quality is interpreted and assured - accreditation

Agreeing the strategy / mission To improve the health outcomes for individuals and populations To co-design services around the needs of service users/patients Translating great ideas inc: health policy, technologies and processes into embedded everyday practice and health systems

Building consensus Begin conversations early - strategic Set common goals - operational Develop partnerships – who? Agree and set mutual expectations – what, when and how? Sustain and review

The focus of partnership working Interventions, health systems, leadership, technology, staff development, team development Knowledge transfer, dissemination and translation Consultancy Work-based learning

Knowledge Translation Application of knowledge Promoting research-led care models that foster inter-relational practice Integrated models of leadership and management of research activity Clinical Academics/Joint appointments Knowledge translation (KT) is a relatively new term coined by the Canadian Institutes of Health Research (CIHR) in 2000. CIHR defined KT as "the exchange, synthesis and ethically-sound application of knowledge—within a complex system of interactions among researchers and users—to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system" (CIHR, 2005, para. 2). Since then, a few other definitions of KT have been developed. Adapted from the CIHR definition, the Knowledge Translation Program, Faculty of Medicine, University of Toronto (2004), stated its definition of knowledge translation as "the effective and timely incorporation of evidence-based information into the practices of health professionals in such a way as to effect optimal health care outcomes and maximize the potential of the health system." The World Health Organization (WHO) (2005) also adapted the CIHR’s definition and defined KT as "the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health." At around the same time, the National Institute on Disability and Rehabilitation Research (NIDRR) developed a working definition of KT in its long-range plan for 2005–2009. NIDRR refers to KT as "the multidimensional, active process of ensuring that new knowledge gained through the course of research ultimately improves the lives of people with disabilities, and furthers their participation in society" (NIDRR, 2005). Most recently, the National Center for the Dissemination of Disability Research (NCDDR) proposed another working definition of KT as "the collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders (i.e., consumers, researchers, practitioners, and policymakers) for the purpose of improving the lives of individuals with disabilities" (NCDDR, 2005).

Consultancy To solve organisational problems One-off advice through to undertaking a study Provision of a researcher or student to support a project Developing bespoke packages of training

Workforce development - Work-based learning “a partnership approach ....to learning which accredits or extends the workplace skills and abilities of employees” The Higher Education Academy Student- and employer-led negotiated learning work-based service & practice development Accredit “in house” education programmes

St George’s Healthcare NHS Trust Our mission, vision and values all have a strong focus on excellence across clinical care, education and research. This can be further seen when looking at the key components of our vision set out on the following pages. To provide excellent clinical care, education and research to improve the health of the populations we serve MISSION An excellent integrated care provider and a comprehensive specialist centre for south west London, Surrey and beyond with thriving programmes of education and research VISION VALUES Mission Our purpose Vision What we want to be Values These guide the way in which we work and the behaviours we would expect to see kind excellent respectful responsible

Why is research part of the Trust’s mission and vision? As a teaching/university hospital it is important that as well as provide services for patients we provide education and carry out research (tripartite role). Research is important because: Improved clinical services It improves health related outcomes for patients Research active organisations provide better healthcare It enables us to grow and consolidate referral networks Government / DH priority It is required by NHS Constitution and NHS Operating Frameworks “Increasing research and innovation in health and social care” – government policy

Education : Driver for Change (include) Restructuring of the systems for the commissioning and provision of Education. Changes to the numbers of medical students in training – development of the new roles, expand the scope of practice for others. New ways of training – more flexibility enables where and when training takes place (on-line , simulation, practice based learning, multiprofessional) Care closer to home – curricula and practice placements need to keep place with national strategy.

How our Workforce Needs to Change Set out below is a summary of the key characteristics of the workforce that will need to change over the next 10 years Workforce now Workforce 2022 All staff aware of trust values Services at times and places that suit staff Hospital based Reactive workforce planning Less efficient Less engaged All staff proud to deliver trust values Services at times and places that suit our patients Care in a range of settings Clinically agreed short and long term workforce plans More efficient More engaged

St George’s Education Strategy Patients and service users at the heart of everything we do 1. Ensure the development of a competent, caring and capable workforce 2. Be a national leader in multi-professional training 3. Become a recognised field leader in patient safety training 4. Play a leading role in the Education and Training Board, Health Education South London 5. Ensure the development of high quality learning environments 6. Develop new training pathways

Partnership Working The development of the Associate Practitioner role (a sector approach) Consortium of SW London trusts agree to take a common approach to development of a Band 4 associate practitioner role to support Registered workforce. Collaborative working with Faculty of Health, Social Care and Education (Kingston University and St George’s University of London) Development of a Foundation Degree in Health Care Practice with agreed curriculum to prepare associate practitioner / support worker to deliver safe and contemporary patient care. Three pathways: General; Maternity support; Perioperative Care First cohort commenced January 2012, completed January 2014

Partnership Working Meeting patient need (Mental Health) Increasing need for nurses to ‘special’ patients with mental health problems who may be vulnerable and / or displaying aggressive and challenging behaviour Limited availability of RMNs as bank nurses leading to excessive agency costs or care provision by untrained HCAs Potential solution to develop a training programme for RNs Adult to develop competence and confidence to care for these patients Project scoping King’s College London to develop 4 x 15 credit modules as stand alone modules or Postgraduate certificate Successful bid for funding to Health Education South London Working with mental health trust to provide practice placements

Partnership Working Maintaining the quality of the learning environment (placements) Joint working with both Universities to undertake educational audits Joint approach to delivery of mentor updates Link Lecturers from both Universities Collaborative approach to planning of placements with equitable division of placement capacity Trust led student safety forum to enable all students to raise issues of concern re placements and quality of care provision Development of Preceptorship programme with Faculty of Health, Social Care and Education (KU / SGUL)

Partnership Working 4. Workforce and CPD development Development of Physician Associate placements and roles to meet changes in workforce requirements e.g. decommissioning of junior doctor posts, reduction in EWTD hours, increasing service provision (SGUL) Design and delivery of bespoke provision of Dementia training to meet national and CQUIN requirements (SGH, KU/SGUL/KCL) Flexibility on CPPD education contract use

Partnership Working 5. Towards Visible Leadership Trust recognition that senior ward leader role increasingly challenging within NHS Trust desire to identify the development that would help the Band 7s to meet those challenges to the best of their ability KCL commissioned to undertake a scoping project with the senior ward leaders to identify key areas for development – focus groups and a report produced. Report used to develop in-house development programme for senior ward leaders and team leaders working in other areas (SGH) Development programme very well received with positive impact evaluation.