1. Implementing the Calderdale Framework
Created &Developed by:
Rachael Smith Grad Dip Phys BA MSc
&
Jayne Duffy Grad Dip Phys MSc

2. Track Record Trust Competency trained therapy assistant workforce
Development of Nursing HCA competency pack
Development of Assistant Practitioner role (AHP)
Skill Sharing (AHP)
Locally Kirklees Local Authority - Accessible Homes Team .
Calderdale Social Services – Modernising Home Care
Tameside Local Authority. Bradford University
Regionally Implementation in neighbouring Trusts
Working with SHA - commissioned to work across region
Training methodology accredited by SHA Skills Network 2011
Nationally Highly Commended in HSJ Awards 2008 & finalists 2011&2013
Skills for Health Early Implementer Project
Queensland Health Board (AHPOQ) 2011
SARRAH conference, Tasmania 2012, NAHC Brisbane 2013

3. Benefits Across Therapy Directorate 2006-2008
Risk Score Reduced risk rating
Patient Satisfaction Reduction in Complaints
Skill Mix Ratio Qualified to non qualified staff
Activity % increase
Reduction in sickness absence

4. The Calderdale Framework
‘Developing the Assistant Practitioner role using the Calderdale Framework’ NHS Employers briefing 75 (2010) (
R Smith & J Duffy ‘Developing a competent & flexible workforce using the Calderdale Framework’ IJTR 2010; 17(5):
Nancarrow S ‘Assessing the implementation process and outcomes of newly introduced assistant roles: a qualitative study to examine the utility of the Calderdale Framework as an appraisal tool’
Journal of Multidisciplinary Healthcare 2012:5 307–317

5. Risks = WASTE: Some Stories!
Variation in: training/skill to fulfil task
what is delegated/shared
how task is to be delivered
documentation & feedback
Lack of clarity when to escalate.
Role boundary not clear

6. Aims of the Workshop
Understanding of & how to implement The Calderdale Framework
Understanding of Service Analysis based on patient needs.
Understanding of how to analyse tasks in order to delegate or share these safely.
Awareness of Skills for Health National Occupational Standards

7. Aims - continued
An understanding of how to transform suitable tasks into written competencies.
An understanding of how to set up the workplace to support new ways of working.
An understanding of how to create a training programme for all staff involved.
An understanding of how to monitor, evaluate & sustain new ways of working.

8. Background – ‘The Age Wave’
SUPPLY
Current workforce is ageing
Population is ageing leading to a shrinking workforce.
Competition for skills across all sectors will increase
Current workforce in post now will still be here in 10yrs.
DEMAND
People are living longer
Health costs are age dependent –increase after age 50 yrs (cost for over 85yr is 3x that of yrs)
Technological and medical advances mean people are surviving with complex long term conditions.
58% people over 65yrs have at least one long term condition
Leitch report national document looking at our position in the global market place and despite our nations history the report highlighted skills deficits across the country

9. UK Ageing Population Proportion of Add to this: population > 65yr
Over 85 years to increase by 106%
Dementia cases to rise from 570,000 to 1.4 million by 2043.
Number of people with 3 or more LTC
2.9 million by 2018
Older people needing care
2.1 million(2010)
4.5 million(2030)
2011
17%
2032
37%

10. WORKFORCE IMPACTS: CHALLENGES Slowing rate of labour force growth.
Slowing rate of economic growth
Slowing rate of growth of living standards
SOLUTIONS
Develop CURRENT workforce
Adult re-skilling to increase adaptability & number of workforce (30-49 yr olds)
Shift in retirement age
increase productivity of workforce

11. Improving Productivity & Quality in Health
Lean processes
Workforce development :
Delegation
New roles (focus at levels 3/4 and level 7/8)
Skill sharing (cross discipline practice and CPD) (UK Sector Skill Assessment ,Skills for Health 2011)

12. UK solution includes A Competence Based Career Framework
More senior staff 9
Consultant practitioners 8
Advanced practitioners 7
Senior practitioners 6
Practitioners 5
Assistant practitioners 4
Senior assistants/technicians 3
Support workers 2
Initial entry – level jobs 1

13. Assistant Practitioner Definition
‘A worker who competently delivers health and/or social care to and for people. They have a required level of knowledge & skill beyond that of the traditional health care assistant or support worker. The Assistant Practitioner would be able to deliver elements of health & social care and undertake clinical work in domains that have previously only been within the remit of registered professionals. The Assistant Practitioner may transcend professional boundaries. They are accountable to themselves, their employer and more importantly, the people they serve.’ (Skills for health 2008)

14. Advanced Practitioner definition (a):
‘Advanced (Nurse) Practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed’.
(NMC Proposed Framework for the standard for post registration nursing 2006)

15. Advanced Practitioner definition (b):
‘An Advanced Clinical Practitioner is a professional who has acquired the expert knowledge base, complex decision making skills and clinical competencies for expanded practice the characteristics of which are shaped by the context and/or country in which s/he is accredited to practice.’
(HEYH Advancing Clinical Practice task & Finish Group 2014)

16. Calderdale Framework: 7 stages
Focus on Engagement
Focus on Potential to Change
Focus on Embedding
Focus on Risk
Focus on Staff Development
Focus on Best Practice
Focus on Governance

17. For Patients,Teams & Individuals For Organisations
Advantages of Competency Approach Using The Calderdale Framework
For Patients,Teams & Individuals
Builds Effective Teams around the Patient
Personal & Team development needs-Links to KSF
Clear Roles & Responsibilities
Safe Skill Sharing
Transferable Skills
Job Satisfaction
For Organisations
Consistency & Safety
Reduction in Risk
Efficient & Effective
Improved Productivity
Flexible Competent Workforce
Improved Patient Experience
Employer of Choice
Provider of Choice

18. Awareness Raising – Stage 1
Identify desired impact of change
Top down + bottom up = Successful Change
No surprises!
Champions
Clinicians Involved from the outset in redesign process
Ohno 1980,Benson 2009, Cooper & Gavin-Daly 2006

19. Service Analysis – Stage 2
What does the service do
When and Where is the service delivered
What functions/tasks are carried out
Who currently delivers these functions/tasks
Does this meet your patients needs

20. Task Analysis – Stage 3
Increasing Demands on cognitive processing

21. Allows analysis of risk for task delegation
Decision Table 1
Allows analysis of risk for task delegation
Aids decisions re skill ,rule, or knowledge based task.

22. Stages 2 & 3 - ‘New Ways of Working’
Tasks mainly knowledge &
rule based & highly specialist
Remain with current profession
Registered practitioners consider
Skill Sharing/ACP
Tasks mainly knowledge &
rule based
Allocate to
Assistant Practitioner (UK)
Tasks rule & knowledge
based with protocols
available
Delegate to
support worker
Tasks mainly skill & rule based

23. Underpins accountability & responsibility issue.
Decision Table 2
Formalises delegators / delegatees approach to delegation in terms of appropriacy each time a task is carried out.
Underpins accountability & responsibility issue.

24. At the point of delegation/allocation the clinician must consider the following statements:GO
STOP & Consider
RISK Identified
1. Is the presentation of the patient’s condition complex? NO
YES
2. Is the patient’s situation likely to be unpredictable?
3. Is the patient’s condition common?
4. Is the patient’s condition stable?
5. Is the patient able to participate as expected?
6. Is the patient highly emotional/ anxious?
7. Has the staff member demonstrated competence?
8. Are communication networks & boundaries established and understood?
9. Is the environment organised to support working partnerships?
Smith & Duffy 2009
Adapted from Saunders 1996

25. Turning Tasks into Competencies – Stage 4
Frequency of delegation/skill sharing (time investment)
Consensus among peers
Skills and knowledge required

26. Competence Term Basic Meaning
Competence General, overall capacity; holistic ; rests on consensus view of what forms good practice.
Competency Specific ability that makes up competence.
Competencies Abilities to undertake specific tasks that relate to specific ability (competency).
Capability
Potential competence.
Performance Competence in action.
(CSP 2005)

27. Competence
Competence incorporates values and philosophy of the person and the profession as well as knowledge, skills and abilities.
Competence changes and is dependent on the context in which you work and your role.
Competence is dependent upon ability to self-evaluate and learn from experience, whether this is formal or informal learning & its application in practice.

28. Calderdale Framework & Skills for Health NOS
Patient Needs Analysis
Task Analysis
Service analysis
Refine search criteria for
Skills for Health
National Occupational
Standards
Local competencies evidence and contextualise
National Occupational Standards

29. Assures ‘fitness for purpose’ of staff
Value of work based training
Assures ‘fitness for purpose’ of staff
Improves consistency of care for trainers and trainees
Link with your educational providers to explore potential for recognition of prior learning (APL) on the CQF

30. Writing a Competency Standardisation (Format)
Procedure (Best Practice)
Clarity
Variations (Flexibility)
Feedback (Role Boundary)

31. Show & Tell Competencies for delegation (support worker)
Competencies with clinical reasoning records for allocated work (Level 4)
Competencies with clinical reasoning records for skill sharing

32. Support Systems – Stage 5
Organisational Level
Personal development review
CPD activity
Clinical supervision including reflection

33. Support System – Stage 5 Service Level Caseload allocation
Caseload management
When to stop/feedback understood
Communication systems established
Availability of registered practitioner is essential to communication
Explicit care plans- who does what

34. Supporting Systems Activity
Complete the checklist :
What have you already in place?
Where are your gaps?
How can you address these ?

35. Training - Stage 6
The cost of clinical negligence claims in UK was £787 million in 2009/2010 (NHSLA, 2010)
This included 6652 successful claims of clinical negligence (NHSLA, 2010)
Appropriate training and development of competent practice is one means of reducing clinical negligence

36. Underpinned by Education Providers
Training (Locally Designed) - Stage 6
Registered Practitioners – level 5 and above
Non Registered Practitioners –level 2/3 & level 4
2 TRAINING STRANDS
How to use CF (theory)
Work based training
(competencies)
Underpinned by Education Providers

37. Training: Work Based Strand
All Support Staff are given a training record. The Training has 3 Stages:
T= Taught -class room setting +/- self directed underpinning theory
M= Modelled - this is achieved by assistants watching other
competent workers doing the activity They then
practice on each other until competent (SIMULATION)
C= Competent- this is achieved by assistants undertaking supervised
practice until the assessor signs them off as competent
The training record is signed off by an occupationally competent assessor at each
stage of the training.

38. APEL in Practice (UK example)
Level 4 competencies with clinical reasoning records
Portfolio of reflection of application of competencies and learning from other work based training in practice
Rigorous external validation day
Mapped to learning outcomes of modules of existing provision of University of Bradford
40 credits to 120 credit award

39. Benefits in Practice
Service Specific HEI input
Learner Specific HEI input
Reduces time out of work place and duplication of learning
Recognised transferable academic credit
Quality assured internal training and governance practice
Staff valued
Better for patients

40. Sustaining – Stage 7 Have you achieved what you set out to do?.
Measure the impact of implementing The Calderdale Framework.
Use systems already in place e.g. Induction process.
Develop standards for delegation/new competencies.
Develop means of easy access to competencies
Audit delegation/allocation practice and monitor supporting systems.
Mechanism for diffusion and capacity building

41. Points to Consider to Aid Success
Involve front line staff at all stages – these are your change makers (CHAMPIONS)
Involve service managers
Form a steering group to oversee the implementation
Be open about your aims & set deadlines
Use project management methodology to help keep on target and mitigate issues & risks.

42. To Recap Awareness Raise Service Analysis Task Analysis Competencies
Supporting Systems
Train staff
Sustain

43. What are your next steps in using this knowledge in your service?
Spend 5 mins reflecting what you have learnt about The Calderdale Framework
What are your next steps in using this knowledge in your service?