1. 2013 BTBC – Evidence linking improvements in training to patient safety. Patrick Mitchell – Director of National Programmes Heather Murray – Assistant Programme Manager- National Programmes

2. www.hee.nhs.uk HEE exists for one reason: 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. £5billion budget. Workforce planning. Commission all under/postgraduate education and training for healthcare staff. Health Education England

3. www.hee.nhs.uk 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’ Professor John Collins: Foundation for Excellence Appropriate supervision for trainees Concerns that trainees are working beyond their level of competence Redistribution of posts and community experience

4. www.hee.nhs.uk Local implementation and pilots The objective 16 projects piloted across different settings and disciplines Aim to improve training and education Aim to improve patient care Demonstrate value for money Next steps Evaluation of the pilot projects Identify early adopters National spread and adoption Pilot Themes Hand over / care transition Out of hours 24/7 Communication Front door (A&E) Patient & rota scheduling Multidisciplinary working

5. www.hee.nhs.uk The NHS Trust Business Model Governance and communication Finance, commissioning and business Strategy and innovation Clinical 70–90% Research 2–15% Commercial 3–15% Education 5-20%

6. www.hee.nhs.uk Pilot evaluation findings Trainees express positivity about the pilot experience Mid Cheshire: trainees moved to other Trusts and requested the pilot initiative be implemented into their new roles East Kent: trainees displayed strong leadership and enthusiasm for the pilots Training initiatives showed marked improvements- Workplace Based Assessments North Bristol: video-feedback for consultations improved consultation styles and increased the number of WBAs in an outpatient area East Kent: significant increase in opportunities for trainees to complete WBAs while on ward duty and on shift.

7. www.hee.nhs.uk Pilot evaluation findings Trainees are becoming more integrated in the care delivery systems Mid Cheshire: greater consultant input at handover meetings, registrars taking leadership roles in their absence Dudley: demonstrated better working relations and understanding between pharmacist and trainees Positive impact on culture, efficiency and effectiveness- pilot design & delivery Leeds and York: changing rotas allowed trainees time to access greater exposure to training and support South Man: reconfiguring theatre lists exposed trainees to concentrated training allowing them to develop skills and confidence.

8. www.hee.nhs.uk Impact For trainees Improvement in productivity, efficiency and ability to complete WBAs Improvement in trainee skills, competency and knowledge due to training sessions providing sufficient clinical exposure Increase confidence in performing technical skills, prescribing, performing consultations and working as part of a team For trainers Increased opportunity to supervise and provide feedback Pilots allowed better management- better ability to identify areas in which trainees need more support Increased confidence in trainees

9. www.hee.nhs.uk Impact For patients In data found from 9/16 pilot sites: 5 pilots found a significant increase in patient safety 6 pilots found increased quality of care 6 pilots found a large increase in ‘time to treat’ 2 pilots found strong evidence of decreased morality 1 pilot found reduced length of stay 2 pilots found an increase in weekend discharges

10. www.hee.nhs.uk £96K approx. East Kent Hospitals University NHS Foundation Trust Hot & Cold Teams – Enhancing trainee experience, improving patient care Improved handovers leading to better weekend management Increased patient safety at weekends. Improved response time on emergency floor Vastly improved weekend service. Reduced length of stay, waiting times, higher quality of care & lower mortality Establishing hot ‘emergency-based’ and cold ‘ward based’ teams to enhance the trainee experience, improving patient care at weekends.

11. www.hee.nhs.uk Rationale, drivers and clarity of objectives: huge variety and not necessarily driven by ‘BTBC’ Leadership and governance: project management, clinical champion, Trust support, communication and relationships with key stakeholders Engagement: trainee buy-in, clinical buy-in, Trust/ Academic, IT support Ease of implementation: range and complexity of projects, organisational readiness, building on organisational structures and processes of working Programme support: important in helping shared learning and problem solving. Adoptability- current thinking

12. www.hee.nhs.uk Workshop: What are the enablers to other Trusts adopting these projects? What are the barriers to other Trusts adopting these projects? How could we approach this nationally? How can you influence the adoption of these pilots in your local organisations? National spread and adoption

13. www.hee.nhs.uk Questions Patrick Mitchell & Heather Murray