Cheshire and Merseyside Planners Updates Mike Burgess Workforce Strategy

Topics NHS operating plan and triangulation Workforce planning feedback Workforce Assurance Frameworks Health Visitors Data Quality

Cheshire and Merseyside Planners Operating Plans

Each cluster submitted: Detailed Narratives 9 KLOES Workforce numbers and costs 3 Key workforce questions Health visitor plans Other priority areas Activity, finance and workforce information for triangulation 3 lots of analysis and triangulation were undertaken by the SHA OPERATING PLANS TRIANGULATION

Cheshire, Wirral and Warrington NHS Cluster

NHS Mersey Cluster

Cheshire and Merseyside Planners Workforce Plans

Workforce Plan Feedback On eWIN Resources  Workforce Planning Process: Initial Feedback Workforce Planning Process: Initial Feedback  Workforce Planning Process: Detailed FeedbackWorkforce Planning Process: Detailed Feedback  Slide pack for the Cheshire and Merseyside NLG on Workforce Plans Slide pack for the Cheshire and Merseyside NLG on Workforce Plans  Slide pack for the Cumbria and Lancashire NLG on Workforce Plans Slide pack for the Cumbria and Lancashire NLG on Workforce Plans  Slide pack for the Greater Manchester NLG on Workforce Plans Slide pack for the Greater Manchester NLG on Workforce Plans Informing process for this year via  NLGs – Network Leadership Group  LETBs – Local Education Training Boards  HEE – Health Education England  DH – Department of Health

Coverage COVERAGE in the Plans Nursing and Midwifery Submissions: Good Allied Health Professionals: Good Modernisation and new roles: Good Healthcare Scientists: Average Medical and Dental demand: Good Narrative submissions: Good

Challenges – Health Economy Liverpool area at a glance The health of people in Liverpool is generally worse than the England average. Deprivation is higher than average and 32,400 children live in poverty. Life expectancy for both men and women is lower than the England average. Life expectancy is 11.5 years lower for men and 7.8 years lower for women in the most deprived areas of Liverpool than in the least deprived areas (based on the Slope Index of Inequality published on 5th January 2011). Over the last 10 years, all cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen but remain worse than the England average. obese. A lower percentage than average of pupils About 21.1% of Year 6 children are classified as obese. A lower percentage than average of pupils spend at least three hours each week on school sport. Levels of teenage pregnancy, GCSE attainment and tooth decay in children are worse than the England average. Estimated levels of adult 'healthy eating' and smoking are worse than the England average. Rates of hip fractures, smoking related deaths and hospital stays for alcohol related harm are higher than average. Priorities in Liverpool include smoking, alcohol misuse and obesity Includes: Liverpool Other profiles include: St. Helen’s, Knowsley, and Sefton as part of Merseyside The above facts are priorities in Liverpool and overall for Merseyside will challenge NHS Providers in ensuring that the workforce of today are equipped and have the skill set to deal with tackling health inequalities particular among females, heart disease, cancer and reducing alcohol related harm as key priorities.

Challenges – Health Economy Cheshire West and Chester at a glance The health of people in Cheshire West and Chester is mixed compared to the England average. Deprivation is lower than average, however 10,810 children live in poverty. Life expectancy for men is higher than the England average. Life expectancy is 10 years lower for men and 7.5 years lower for women in the most deprived areas of Cheshire West and Chester than in the least deprived areas (based on the Slope Index of Inequality published on 5th January 2011). Over the last 10 years, all cause mortality rates have fallen. Early death rates from cancer and from heart disease and stroke have fallen and are similar to the England average. About 19.4% of Year 6 children are classified as obese. A higher percentage than average of pupils spend at least three hours each week on school sport. 68.4% of mothers initiate breast feeding and 14.0% of expectant mothers smoke during pregnancy. An estimated 20.5% of adults smoke and 22.7% are obese. Rates of road injuries and deaths and hospital stays for alcohol related harm are higher than average. Priorities in Cheshire West and Chester include tackling smoking, reducing inequalities in heart disease and childhood obesity. Includes: Cheshire West and Chester Other areas include: Cheshire East, Wirral, and Warrington,

Challenges for Providers Cash Improvement Plans (CIPs) Cash Releasing Efficiency Savings (CRES) Cost avoidance service reform plans 1.5% Tariff reduction QIPP savings and level 3 adoption and implementation Rationalisation of services across economies Meeting Monitor Authorisation Assessments and Criteria Delivering against CQC Assessments Changes to the commissioning and provider landscape Demanding health populations Governance and regulations High concentration of specialised trusts and services

Medical Workforce EWTD and Other Availability of Junior Doctors in general and to cover wards Availability of Junior Doctors with limited hours to support outpatients / endoscopy lists Compliant rotas, but non-compliant services because of gaps Medical revalidation Looking at Consultant job plans and Pas Immigration restrictions causing issues Service reconfigurations Managing transition and New service models Engagement and consultation using precious FTE and PAs Insufficient consultant numbers for sustainable out of hours rota Vacancies at: A & E Consultants & Middle Grades Haematology and Dermatology Consultants & Middle Grades Consultant obstetrics and Gynaecology Clinical Psychologists, Consultant Neurophysiologists and Consultant Radiologists Locums (medicine, emergency medicine, A&E, Respitory and T&O) Radiography and Radiology

Medical Workforce Vacancies Continued:  Consultant Otolaryngologist  Consultant General Surgery  Cellular Pathology Consultants (potentially linked to uncertainty over provision due to regional QIPP scheme Consultants in haematology, radiology and emergency medicine Speciality doctors in emergency medicine and ophthalmology Recruitment to specialist Consultant posts: Histopathology Microbiology Radiology Chemical Pathology Cardiology- Imaging Acute Physicians Anaesthesia Ophthalmology Elderly Medicine

Non-Medical Workforce General  Reduced demand for nursing newly qualified across providers  Initiatives in place to split posts to recruit, but expensive on headcounts  Over supply of physiotherapists but on limited band 5 posts due low turnover in higher bands  Very weak on health care scientist demand from the plans. Very little data submitted by providers with a health care scientific workforce  Recruiting the out-turn of qualified health visitors but no additional supply in the system to further boost supply  The implementation of new technology will undoubtedly present challenges and will include training in use of programmes and equipment, provision of correct equipment in order to undertake role and the constant need to ensure programmes are updated as required. Vacancies  Clinical Coders  Clinical Audit Managers  Optometrists  Specialist practitioners in District Nursing and School Nursing  Therapy staff, Specialist Nurses and OPD (Operating department practitioner)  Vascular surgery scientists  Occupational health specialists  Clinical Scientists / Medical Physicists

Non-Medical Workforce Vacancies Continued: Clinical Scientists (potentially linked to uncertainty over provision due to regional QIPP scheme) Biomedical Scientists within blood sciences (due to multi-disciplinary nature of the laboratory and uncertainty over QIPP changes) District Nursing out of hours Diabetes Specialist Nurses Sonographers (potentially due to no direct access degree course) Chaplaincy (particularly relevant following the removal of national recruitment and retention premia RRP) Ophthalmological nurse ENT specialist nurse Specialist ENT nurse practitioner Microbiologist Senior ECG Technicians

Cheshire and Merseyside Planners Data Quality

Data Quality update – north west score NW retained first place Dec ‘11 to Apr ‘12 Error count reduced by 5.1% (-1,039 errors) Mar to Apr 2012

Data Quality update – priority areas

Data Quality update – HIGH IMPACT priority areas 40.1 Recruitment Source is Blank: 20.6% of total errors 19.1 Sexual Orientation is Blank: 12.8% of total errors 31.1 Disability is Blank: 17.4% of total errors 16.1 Religious Belief is Blank: 12.9% of total errors 30.1 Destination on Leaving is Blank: 19.4% of total errors 2.1 Area of Work is Blank: 6.5% of total errors

Data Quality update – TEN HIGH IMPACT TRUSTS BY ERROR COUNT The error counts from these organisations account for 70.5% of NW errors We want to work with organisations to improve their error count Please contact if you need assistance in resourcing data quality improvement projects

Data Quality update – TRUST ANALYSIS by FINAL SCORE INCREASE Five organisations in the North West in April 2012 had maximum scores of 10,000 Congratulations to:  Warrington PCT  Central And Eastern Cheshire PCT  Halton And St Helens PCT  Bolton PCT  Knowsley PCT

ACCESSING EWIN REPORTS QIPP Dashboard

ACCESSING EWIN REPORTS Navigate to the Woven Data Quality Reporting “speed-o-meter” and select graph

ACCESSING EWIN REPORTS 4 data reports are available and a data guidance page All reports can be exported to PDF Free WebEx demonstrating reports on 15th May pm (1 hour) For more information on events visit

Data Quality update – priority areas KEY

Cheshire and Merseyside Planners Health Visitors

NORTH WEST PERFORMANCE – 2011/12 The North West target for Mar-12 health visitors was FTE The Feb-12 ESR downloads show the current North West performance.

NHS Operating plans The NHS Operating Framework plan for Health Visitors was submitted on the 19 th April. To ensure our plans are robust and achievable, NHS NW carried out extensive modelling to predict the achievable outputs from the system. As a result, new targets for 2012/13 and 2012/14 have been formulated. End of March 2013 target has changed from to is the absolute minimum we have to achieve by the end of 2012/13

NHS Operating plans: NEW TARGETS

CLUSTER LEVEL MODELLING Modelling for 2012/13 has also been carried out on a PCT Cluster basis. End result is a modelled year end position of 1450 (without any other action in the system to support improvement). Sum of all 5 PCT cluster targets is FTE The additional 23.2 FTE is the contingency to ensure delivery (achievable through ‘system stretch’) Cluster level models have been shared with HV cluster leads and we are awaiting comments before they can be shared further.

HOW WILL WE ACHIEVE OUR ‘SYSTEM STRETCH’? Increasing participation rates (increasing the hours of part time staff) Decreasing leaver rates Retirements and the age profile of current workforce Training capacity (Clinical Practice Teachers) Retention of trainee student numbers Return to Practice Conversion of staff registered as Health Visitors but not working in a HV service

FURTHER READING Briefing 81 - Retaining your health visitor workforce Contains valuable information on: Flexible Working Preceptorship Recruitment, selection and induction Flexible retirement options Staff Engagement And many more