2014 … and what about the workforce? -Patrick Mitchell Director of National Programmes

HEE exists: To improve the quality of care delivered to patients. Through our Local Education and Training Boards (LETBs), we ensure that our workforce has the right skills, values and behaviours, in the right numbers, at the right time and in the right place. HEE promises: to oversee that education contracts include consultant availability to provide adequate supervision of doctors in training 7 days a week. Health Education England

Our business

Beyond transition Building on a successful first year: continuing to focus on Mandate and quality, focus on the whole workforce, effective workforce strategies, partnership and engagement and workforce transformation locally and nationally Reducing our running cost by 20% and the number of very senior leaders by at least the same amount whilst delivering for patients, student and trainees Reducing duplication and silos by creating teams which support the whole of HEE, locally and nationally. Making the best use of staff skills and knowledge in a more cost-effective and efficient manner. One HEE Preparing HEE for non-departmental body status, addressing the governance and audit issues in the current structure.

How it all fits together – our key documents Informed by local plans 15 year strategic framework (F-15) Mandate 2014/15 Mandate 2014/15 Business Plan 14/15 Workforce Planning Guidance Workforce Plan for England 15/16

Local Planning National Planning Provider Forecasts LETB Aggregate provider Forecasts LETB Investment Plans England Wide Forecasts Workforce Investment Plan for England LETB 5 Years Skills Strategies Call for Evidence Local Challenge, triangulation and moderation HEE Workforce Planning Process 2013 ALBs, HEEAGs, and PAF National Challenge, triangulation and moderation Commissioners HEIs, and Other Partners Strategic Intent Document and Mandate

Workforce plan for England extract

Predicted % medical workforce growth 2012 to 2020 (CfWI)

The shape of training Medical training needs for next 30 years UK-wide 5 themes: 1.Patient needs 2.Workforce needs 3.Breadth and scope of training 4.Training and service needs 5.Flexibility of training o Undergraduate to postgraduate transition o Clinical/Academic training interface

Workforce delivery – Physician Associates About 200 physician associates working across England Work in many areas of secondary and primary care Barrier to their employment – not able to prescribe medication/request x-rays HEE supporting Royal College of Physicians to create a Faculty for PAs. Faculty will manage voluntary register, re-accreditation examinations and CPD HEE and RCP Faculty will lobby for form of statutory registration This will lead to work to enable prescribing for PAs. Only 1 programme in England - at least 5 more opening in 14/15

Workforce delivery – Paramedics The Paramedic Education and Training Steering Group to make recommendations with respect to the conclusions from the Paramedic Evidence-Based Education Project (PEEP) Review of scope of practice and education entry level, careers structure, financing education and training Close work with College of Paramedics and Ambulance services in UK The Urgent and Emergency Care Review recommends using paramedics and ambulance services as mobile treatment centres The group will also consider the use of paramedics within ED for instance triage posts, and in primary care.

Workforce delivery – Pharmacists There is a likely surplus of pharmacists in the system The role of community pharmacists is emphasised within the Urgent and Emergency Care review How pharmacists can fit in with Emergency Department staffing is being considered, with a sub-group about to be convened. Managing minor ailments at front door of ED As a specialist pharmacist supporting the wider clinical team and reducing poly-pharmacy

Workforce delivery – Advanced clinical practitioners Advanced clinical practitioners - development group have defined a core minimum set of competences for ACPs based on the Membership examination for the College of Emergency Medicine - first time there is a national minimum standard for ACPs. Next steps are to o Describe and agree educational preparation o Define the assessment framework o Develop a national growth plan by geography o Disseminate the work

Workforce support – Better Training Better Care Aims to improve the quality of training and learning for the benefit of patient care Professor Sir John Temple: Time for Training ‘ Making every moment count’ ‘Appropriate supervision’ and/or ‘Consultant present service’ ‘Service delivery must explicitly support training’

Mid-Cheshire Hospitals NHS Foundation Trust – Enhanced Training & Education in Handover & Supporting Electronic Solution Demonstrated an 82.6% improvement in ‘out of hours’ tasks being handed over and completed after the interventions Statistically significant 10% increase in ‘out of hours’ discharge rates, without any negative effects on length of stay Video observation results revealed that 60% of handovers adhered to the ‘Think FIRST’ technique Estimated £156,200 savings over 3 months 1.Provide training to develop key handover skills such as leadership, task prioritisation and time management 2.Support handover 3.Modify the structure, standardise the handover process and utilise the good practice guidelines. Pilot project

Enabling 7 day Care & Hospital at Night Supports 7 day care Rota redesign and out of hours care Provision of dedicated learning time at weekends Improvement in out of hours tasks being completed There has been a statistically significant increase in out of hours discharges and reduction in length of patient stay. Supports Hospital at Night Pilots have encouraged managers to look at what happens in their hospital night Supports HaN as the vehicle to raise awareness of patient safety and maximise efficiency of staff at night Puts patient at the centre.

East Kent Hospitals University NHS Foundation Trust Hot & Cold Teams – Enhancing trainee experience, improving patient care 12% increase in discharges per week day. Plus 20% increase in Saturday and 6% increase in Sunday discharges 12% increase in discharges per week day. Plus 20% increase in Saturday and 6% increase in Sunday discharges Handover process improved and patients were being seen quicker Handover process improved and patients were being seen quicker Cost savings were estimated at £663,912. Net monetary benefit in 1 year of over £0.5 million Cost savings were estimated at £663,912. Net monetary benefit in 1 year of over £0.5 million Hot and cold rotas provided the necessary support and improved training opportunities for trainees during the weekends Hot and cold rotas provided the necessary support and improved training opportunities for trainees during the weekends 1.Provide enhanced support/training for trainees, especially at weekends 2.To improve the care and safety of patients Pilot project

Trainees as change agents Trainees demonstrated outstanding leadership skills championing their pilot projects during implementation and outside of the pilot environment. Mid Cheshire – Handover Trainees moved to other trusts and requested the pilot initiative to be implemented in their new roles. Mid Cheshire – Handover Trainees moved to other trusts and requested the pilot initiative to be implemented in their new roles. East Kent – EM rota Trainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers. East Kent – EM rota Trainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers. Leeds and York – Decision making in psychiatry Trainees championed the system and took on a strong leadership role from the outset. Leeds and York – Decision making in psychiatry Trainees championed the system and took on a strong leadership role from the outset. Trainees felt better supervision and support allowing them further development Clear leadership in the handover process was clear in 100% of meetings 100% trainees higher confidence, 83% felt benefitted by the change

Integration of training in care Trainees became more integrated in the delivery of care and in the wider multi- disciplinary team. This has had a positive effect on patient care and improved communications and multi-disciplinary team working. King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop. King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop. Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence. Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence. Dudley – Prescribing Better working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines. Dudley – Prescribing Better working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines. 82.6% improvement in ‘out of hours’ tasks handed over and increase in staff satisfaction Significant improvements in time to treatment and time to referral Improved relationships in pharmacy department

Impacting on culture, efficiency and effectiveness Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working Mid Cheshire – Handover Greater degree of efficiency in performing handovers, better quality information recorded and an increase in the number of tasks completed. Mid Cheshire – Handover Greater degree of efficiency in performing handovers, better quality information recorded and an increase in the number of tasks completed. South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities Several of the pilots have had a positive impact on culture, efficiency and effectiveness in the implementation of their pilots. 82.6% improvement in ‘out of hours’ handover and 10% increase ‘out of hours’ discharge Increases of 37.7% weekday, 29.1% weekend and 22.1% night shift activity 12.7% increase in supervised operative training

Integrated Technology Enhanced Learning (TEL) Share and spread of good practice and innovation across higher and postgraduate education Underpinned by the DH TEL framework. E-learning Simulation M-learning Development of a hub to provide a national picture of where TEL is happening and provided Access to examples and TEL resources that are delivering major benefits in health education and training

Human Factors ‘Human factors’ is concerned with the ‘fit’ between an employee, their equipment and the surrounding environment. HEE, LETBs and partner organisations: exploring how we can ensure that the practices and principles of human factors are integrated into all training and education It draws upon characteristics and potential issues that can influence behaviour at work and can affect patient health and safety. Including: o Individual capabilities o learning styles o behaviours and values o Leadership o team working o training and curricula o the design of equipment o organisational culture.

Health Careers Developing a new integrated Health Careers Service to bring together the work of: –NHS Careers –Medical Careers –PHORECaST (public health) Will encourage flexibility in settings and working practices

Questions? - Patrick Mitchell