 The impact of workforce on patient safety and experience has increased in priority since the issues at Mid-Staffordshire.  The Francis Report due for release in early January 2013 will examine why such failures in the system happen.  It is imperative processes are in place to act as an early warning system.  Huge system change resulting in the move towards an NHS Operating Model for quality and outcomes  Work to develop this tool began back in June 2011 and the tool is scheduled to go live in January 2013 in the North West.  The tool will be available for use at Provider organisational level in wave 1.  Important for the new Health Watch and Role of the Quality Surveillance Groups (QSGs)

Workforce Assurance

The Assurance Framework Workforce Assurance is the process of managing risk and assuring that the composition of the workforce delivers safe, effective and high quality care Assurance of plan quality of the plan Assurance against plan variance analysis Organisational workforce profile general organisational indicators Qualitative Indicators not metric based but a prompt for areas to look for in an assurance process

What is different? A systematic approach enabling rigorous, structured evaluation A statistically robust underpinning for assurance analysis Analysis of correlation and relationships between triggers Thresholds for triggering Escalation routines to enable consideration of escalation in a structured manner This enables you to Create and drive top table discussions Changes the nature of assurance engagement with Trust Boards and Management Teams Call on robust evidence and analysis as support for key decision making Take a more integrated approach to assurance activities Justify decisions

 A web-based application to triangulate organisational performance via selected metrics – highlighting potential risks  A platform for a standardised approach linking workforce to quality and safety drawing on 205 metrics from a single repository  A mechanism for considering potential workforce risks in a structured, logical and data driven manner  A single reference point and process for assessing workforce variables - enabling proactive assessment of the current workforce and the likely impact on quality and safety of planned changes  Process itself can be performed manually but is incredibly labour intensive. Non-workforce metrics in the Tool give a more rounded picture and highlight potential risks impacting on WFA.  Removes some of the subjectivity by building stated thresholds into each metric and enables correlation between metrics  Enables challenge to accepted wisdom by supplementing expert opinion with robust statistical analysis

Automated to reduce manual data manipulation and handling burden Activity: Health Episode Statistics Quality Outcomes Framework Unify, Forward looking activity plans Information Centre Workforce: ESR Census Workforce plans Quality/Safety: STEIS, Unify NHS Patient and Staff Survey, IC Complaints data base, NPSA Incident and CAS systems, HPA, Monitor Finance: FIMS, Forward looking finance plans Monitor Data: Utilising existing national data sources

Plans / scenarios can be “reviewed” in private by the Trust before being shared with commissioners and assurers Benchmarking against peers is anonymous – you will see your position and the distribution, but not who the other data points relate to Access to the tool can be granted to multiple users - HR, CEO, medical and nursing directorates Providers (PENDING) Commissioners will be able to view data related to the providers from whom they commission Commissioners (PENDING) Will have a complete view of the data for those organisations they are responsible for assuring and not those of other regions/areas (NB this may be flexed dependent on changes to the NCB regions in future) System Assurers

A hierarchical structure consisting of a number of categories and levels: Assurance categories: There are four assurance categories which group together trigger groups that show: High level Low level Trigger groups: a collection of similar assurance triggers e.g. workforce or finance Triggers: a collection of similar metrics / indicators that can be seen as a natural group e.g. Staff Turnover or Cost Improvement Metrics: individual, national, local and bespoke metrics on workforce, quality, safety, finance, activity, etc. Assurance of plan quality of the plan Assurance against plan variance analysis Organisational workforce profile general organisational indicators Qualitative Indicators not metric based but a prompt for areas to look for in an assurance process

Metrics have individual thresholds set – RAG rated Comparison against peer mean Change from previous month(s) Performance against national clinical guidance Analysis of Metrics Comparison against safety activity, finance and quality Integrated Dashboard Metric rating risk assessment and action Metric rating Assured no further action Trigger flagged further assessment and validation Action taken communication and intervention as appropriate

Level of Input Benefits Received The tool has been designed to require zero / minimal input from Trusts, and can operate with or without forward workforce plans. However, with these plans the value delivered from the tool with be far greater. Adding workforce plans, with summary finance and activity information Without any workforce plans, the tool will provide triangulation, comparisons, and projection using national data sets covering workforce, quality, safety, activity and finance. By adding a forward plan using a basic template the tool will provide additional functionality. This will include comparison against plan functionality and the ability to use trend projections to test the quality and safety implications of the plan. The scenario modelling element of the tool can be done without providing visibility of the plan to assurers. Do Trusts have to input data to the tool? All data will be provided centrally with two potential exceptions: If Trusts wish to upload a workforce plan / scenario into a private part of the tool for review (i.e. Before I submit my plan, can I check if it will flag up any major areas of concern at the LETB), then this will be possible at the users discretion; and Where a regional collection process does not exist, then approved plans may be uploaded by Trusts.

My Analysis My Resources My Actions Regional Dashboard Organisation Dashboard Metric Dashboard Help Workforce Assurance Portal My Flags My Qualitative Indicators My Plans My Threads My Notes My Assurance Logs Supporting Materials Community Data Sources FAQ Workforce Dictionary

The Tool IS intended to provide: The workforce element that will link with wider system level assurance Triangulation between workforce, activity and finance data A national platform to workforce assurance that can be adapted as appropriate for each SHA / LETB Best practice approach that is built on existing published literature An approach which recognises that assurance criteria will change and be refined over time The Tool IS NOT intended to be: A tool to publish information A performance management tool A data collection tool; existing data is used A directorate and divisional assurance tool; Trusts can use their own granular and often more recent data to explore potential areas for concern.

Workforce assurance will take place in the proposed new structure for the NHS. With the challenges facing the NHS, There is a strong rationale for this being done by an overall assurer. This is, of course, to be decided and could be the remit of the National Commissioning Board, Health Education England or Local NHS Education and Training Boards. The tool will provide a robust way of assuring the workforce for commissioners and providers alike. The tool will provide Commissioning groups/Commissioning Clusters confidence in current workforce performance and workforce plans, in relation to quality, safety and patient experience. It would also simplify negotiations around workforce plans and assurance which would condense timescales and potential tensions.

Productive Workforce Metrics Dashboard Supports ad hoc enquiries and regular assessment focused on direct workforce data 15 high level metrics Data is un-weighted, is primarily direct workforce information, can be extracted as raw data for reporting, supports Cluster and Trust ‘type’ benchmarking Wider range of users – HR, Service Managers, Workforce Analysts The focus and outcome of reviewing the dashboard is driven by the user Workforce Assurance Tool Supports an assurance process at local, regional and national level 200 metrics Data covers workforce, activity, finance, and qualitative information. Uses an evidence based approach to weight these, provides RAGs and scores for different levels and sets of data Smaller range of users, more strategic – Directors, CEOs, OD Leads The outcome of an assessment is more standardised - focusing on rating four ‘domains’ with an overall RAG

Ongoing Evaluation Following on from the Pilot Evaluation in May, a further evaluation session will be held towards the end of September Feedback is being captured on a continuous basis, (please see contact details in final slide). Enhancements Sandboxing: trusts will be able to submit various plans to compare against various scenarios, currently uploaded plans and actual data. This will enable trusts to analyse plans before they are viewed by their reviewers. Metric dashboard in pop-up window: this will enable metrics to be viewed without affecting the organisational dashboard. Custom dashboards Metrics National metric review WebEx's for each specialty (Acute, Community, Mental Health, Orthopaedic, Women’s, Children’s and Ambulance) took place in June. These were very successful and process will be repeated for future metric reviews (dates TBC). Changes to activity and finance metrics Changes to sickness absence and turnover.