Newham Community Education Provider Network Annual Report April 2015 March 2016

Transcription

1 1 Newham Community Education Provider Network Annual Report April 2015 March 2016

2 EXECUTIVE SUMMARY 2015/16 marks the second year of operation for Newham Together, the Newham Community Education Provider Network (CEPN). The CEPN is a multi-organisational network focusing on improving the health outcomes of the local population and the service user experience by strategically investing in and shaping education and training for health and social care professionals. The aim is to systematically improve services through professions learning with and from each other. With 14 statutory and community organisations as members, Newham Together has become an essential coordinating partner in developing and delivering the borough s education, training and workforce planning. Key achievements in 2015/16 include: coordinating 73 educational programmes with 2,182 participants (compared with 45 events for 700 staff in 2014/15) managing 15 different projects, with 11 being fully completed delivering education to professionals and groups who would not normally be trained together, including patient representatives, optometrists, pharmacists, dental workers and housing officers launching an online multiprofessional resource pack portal to support GP practices in North and East London recruiting 10 new practice nurse trainees who have commenced in post, attracting 380, to primary care securing 35,000 to implement apprenticeships in general practice, with apprentices growing from 3 to 12 and a further 12 being recruited being one of two CEPNs to bid successfully to be a pilot site for the 3 rd Sector Working Project, aimed at increasing the number and variety of placements for pre-registration student nurses increasing nurse mentors in community and primary care by 77% through the Community Nursing SuperHub, which has been replicated in other areas as a model of excellence increasing membership from 12 to 14 organisations and working with patient and voluntary sector representatives to promote an independent and person-centred perspective strengthening the network s identity, including developing the name Newham Together Newham Together has strengthened interprofessional learning and working and is now recognised as a vehicle for delivering local priorities through workforce planning and development. The network is a member of the strategic Transforming Services Together programme for East London, leading key sub-groups looking at recruitment and retention. Thinking ahead, Newham Together is planning for sustainability and has drawn together partners to consider next steps. System leaders in Newham and beyond have acknowledged that a network of organisations working together can achieve a great deal more than any single organisation working alone. 2

3 CONTENTS 1. DEVELOPING NEWHAM TOGETHER 4 Newham in context 4 What is a CEPN? 6 Data collection 6 Newham Together 7 Objectives of Newham Together 7 Structure 8 2. ACTIVITIES 9 Overview of activities 9 Core functions 9 3. NETWORK IMPACTS 15 Achievement of CEPN objectives 15 Core workforce indicators 16 Feedback from the workforce 17 Feedback from close stakeholders LOCALITY FUND IMPACTS 21 Care certificate project 23 Chronic disease upskilling project 24 Future generations project 25 Health coaching project 27 Management of asthma project 28 Visual impairment awareness project 29 Multicompartmental compliance aids 30 LGBT project REFLECTIONS 32 Lessons learnt 32 Challenges faced 33 Areas for development LEGACY AND SUSTAINABILITY 39 Resources and products developed 39 Sustainability 44 APPENDIX 46 3

4 1. DEVELOPING NEWHAM TOGETHER This section describes Newham Together, the objectives and membership of the CEPN and the context in which it works. NEWHAM IN CONTEXT Newham is an amazing place. It is the most populous borough in outer London, with around 314,000 residents, and an additional 60,000 registered for NHS services in the borough. Understanding the characteristics of the population is important for recognising the priorities for health and care workforce planning and education. With the highest birth rate in the country, Newham has one of the youngest populations anywhere in England. It is estimated that Newham, together with Tower Hamlets and Greenwich, will account for 30% of London s population growth in the future, with many of these people being of working age. Newham is one of the most diverse areas in the country with over 100 languages spoken and 70% of people coming from Black, Asian and ethnic minority communities. Transport links are good and there has been a great deal of regeneration, with Newham being the host borough for major sporting events. But Newham faces challenges too. The borough is the 2nd most deprived local authority area in England with around 32% (22,700) of children living in poverty, and the unemployment rate in the borough is the highest in the capital. Newham residents have poorer health outcomes than their peers in other parts of the capital or the country. Figure 1 Areas within Newham 4

5 Some key health and social care challenges in Newham include: 10,850 people aged 65 and over are thought to have a life limiting long-term illness. The levels of new cases of people diagnosed with diabetes are the highest in England. Newham has the highest under 75 s mortality rate for women, and Public Health England says that general life expectancy is 7.4 years lower for men and 6.6 years lower for women in the most deprived areas of the borough. 27% (1,014) of children and 20% of adults are classified as obese, with estimated levels of adult physical activity being the lowest in London. Newham is estimated to have some of the highest rates of tuberculosis in the western world, with rates eight times higher than the national average, and three times higher than the London average. Tooth decay in children at age five is worse than the England average. 3,052 people have a serious mental illness, with an estimated 37,000 with common mental illnesses. Heart disease, cancer and circulatory disease are the biggest causes of death in Newham, which has the second worst one-year survival rate for cancer in England. The rate of sexually transmitted infections is worse than average, with a historically low uptake of interventions. Many of these poor outcomes are preventable and have the potential for good outcomes if prevention is tackled at an early stage and in an integrated way. In response to these challenges health, social care and community organisations have collaborated to develop a Health and Wellbeing Strategy which aims to drive change by building personal, economic and community resilience to improve health outcomes and narrow health inequalities, and to support the people of Newham to make positive choices to improve their health and wellbeing. Across Newham therefore, health services, the council and partner agencies are working together to build on the good practice that already exists and to transform local services. These efforts are in line with key Government policy drivers including the NHS Five Year Forward View and local strategies such as Transforming Services Together. NHS Newham Clinical Commissioning Group (CCG), and the London Borough of Newham are the main commissioners of health and care services. Newham has a network of 58 general practices, 105 pharmacy contractors, 37 optometrists and 29 dental surgeries, 8 nursing and residential care homes for older people, 5 mental health residential care homes and 12 learning disability residential care homes. NHS Barts Health provides hospital services. East London Foundation Trust provides mental health and community services. There are also a range of private, voluntary and independent organisations. This context is important because it sets the scene for the development of Newham Together, a network of organisations working jointly to improve the quality and quantity of health and care workers in primary care and the community. The Newham Joint Strategic Needs Assessment 2012 (JSNA) highlighted how poor health outcomes in Newham reflects disadvantage and risk exposure throughout the life course, culminating in a pattern whereby many people present to the NHS late and with advanced stages of potentially preventable conditions. The JSNA highlighted the cost and unsustainability of this pattern and noted that turning around health inequalities in Newham would require coordinated partnership work between health, the local authority and community sectors. 5

6 WHAT IS A CEPN? Community Education Provider Networks (CEPNs) are groups of organisations working together within a specified geography in order to develop the community-based workforce to meet the health needs of the local population. CEPNs are a model of health and care education which brings together health and social care service providers, community groups, patients and education providers focused around assessing workforce training needs, and expanding capacity for training, enabling the development of dynamic communities learning with and from each other. The model was developed to deliver Health Education England s strategic aspiration of improving population health through the development of the current and future primary and community care workforce in line with the vision set out in the NHS Five Year Forward View The key elements of CEPNs are: They are multi-professional provider-led cross-organisational networks whose work is explicitly linked to local population needs. Their work is closely aligned with the aspirations of key policy initiatives such as the 5 Year Forward View, London s Primary Care Transformation Standards and Health Education England s general practice 10-point plan. They are designed to support: o a shift in education to community and primary care communities where greater integrated health and social care services will be delivered; o enhanced experiences for sections of the workforce traditionally not exposed to community healthcare e.g. undergraduate students; o overcoming the difficulties of engaging a dispersed provider landscape and doing this at scale; o primary and community services having a voice in the allocation of limited educational resources and contributing to primary care workforce planning. DATA COLLECTION This annual report describes the progress of Newham Together, the CEPN for Newham, in 2015/16. Material for this report was sourced from: Local strategic documents including the CCG Commissioning Strategy, the Health and Wellbeing Board Strategy, the Transforming Services Together (TST) Investment case, Public Health reports and national policy such as the Five Year Forward View; Activity logs and monthly reporting outcomes from educational providers and project leads; Data monitoring reports used for quarterly submissions to Health Education England North Central and East London; Evaluation reports from educational providers based on the pre-and postfeedback forms from attendees to educational events; The outcomes of a deep dive evaluation on one of the projects delivered; Feedback from interviews with 20 key stakeholders including members of the CEPN Board, project leads and educationalists involved in developing and delivering training programmes. The interviews were undertaken by an independent organisation, and those interviewed included representatives from the CCG, local authority, local universities, general practitioners, pharmacists, optometrists, dentists, voluntary and patient and public groups; The results of an online survey disseminated to staff within organisations represented on the CEPN board; Analysis of training needs surveys; Reflections recorded at monthly CEPN meetings on the activity levels achieved and added value; Notes of member discussions at Developmental Events and Away Day sessions. 6

7 NEWHAM TOGETHER Newham Together was one of the first implementer sites for the CEPN model in East London and was established in April The network was developed to build on the educational systems that were already in place, and that were quite well developed within the established health and social care organisations, but which were traditionally delivered within organisational boundaries. Prior to the establishment of Newham Together, Newham CCG had invested significantly in the development of general practice education, with the founding of the Newham Education and Training Academy (NETA). General practitioners had access to centrally organised training on clinical and governance topics. Practice nurses and HCAs benefited from clinical training commissioned via Health Education England funding. Other established organisations including Barts Health, East London Foundation Trust and London Borough of Newham all had their own internal budgets and often comprehensive programmes of training for staff, both internally and externally delivered. However, the fragmented systems of delivery meant that often there was: OBJECTIVES OF NEWHAM TOGETHER Newham Together has set itself some key objectives to make a strong contribution to workforce planning and development via a coordinating role. These are: 1. Supporting workforce planning processes to identify and develop the Newham workforce to ensure that it has the right numbers, skills, values and behaviours that contribute to collaborative working and delivery of person centred care. 2. Developing an educational and learning faculty. 3. Coordinating the delivery of education and training for the health and social care workforce. This includes: a) Developing learning experiences that promote and ensure the delivery of high quality education and training programmes that address population needs. b) Coordinating and implementing multiprofessional and interprofessional training and learning opportunities. duplication of effort and delivery of training; no overarching organisational training and development plans informed by workforce or training needs analysis; a non-alignment of health and social care training needs in programmes delivered, and; ad-hoc and limited multidisciplinary training. c) Developing a sustainable programme of education and development programmes in line with the public health and commissioning priorities of Newham and the integration agenda. There was a recognition that new ways of working mean moving away from traditional professional boundaries and ensuring that staff are able to take on different roles where it benefits patients. Training is a key success factor in integrated and interprofessional working, so Newham Together was developed as a vehicle to plan and provide easily accessible education programmes and resources to help the new and existing workforce enhance their integration skills. 7

8 STRUCTURE Newham Together is hosted by Newham CCG which oversees the CEPN budget and funds a part-time project manager, two part-time GP Education Leads and administration of the CEPN Board. CEPN Board membership includes the CCG, social care, general practice, mental health and community services, acute care, pharmacists, optometrists, dentists, three higher educational institutions, voluntary organisations, public health and patient and public representation. All members were recruited via their employing organisations and were in roles which had an interest in managing and developing the workforce that they represent. The CEPN Board is accountable to the Newham CCG Board through the Clinical Commissioning Committee. The GP Education Steering Group, previously known as NETA, was developed by the CCG to deliver education and training to local practices. This became a formal subgroup of the Board and oversees a range of projects relevant to delivery in primary care. Figure 2 - Members of the CEPN Board Amongst others, Newham Together s Board comprises representatives from: Barts Health NHS Trust City University London East London and City Local Dental Committee East London and City Local Optical Committee East London NHS Foundation Trust London Borough of Newham Newham CCG North East London Pharmaceutical Committee The Forum for Health and Wellbeing University of East London The CEPN Board reviewed its structures to strengthen its governance arrangements, with a structure chart, project plan and with revised Terms of Reference which were adopted in September A copy is available in the appendix. During this process the Board increased its membership from 12 to 14 members, with appointments representing London South Bank University (LSBU) and the Patient and Public Forum. The Board is chaired by a GP, closely aligned with the CCG. 8

9 2. ACTIVITIES This section provides an overview of activities undertaken by the network in 2015/16. OVERVIEW OF ACTIVITIES Table 1 lists key activities undertaken by Newham Together over the past year. CORE FUNCTIONS Table 2 shows how Newham Together is has matured as a group, achieving the six core functions of CEPNs. Table 1 Activities and achievements of Newham Together in 2015/16 ACTIVITIES Network development Board development to support members to discharge their responsibilities towards achieving the objectives Clarifying roles and responsibilities and ask members to nominate deputies Engagement with patient/service users DETAILS Board members kept informed of opportunities to attend Health Education England and other development events. Board meetings scheduled to allow for bi-monthly development sessions. Training offered to the Patient and Public Board representative to increase understanding of issues. Revised the Terms of Reference. Recruited a patient and public member and a representative from London South Bank University. Governance discussed at an Away Day session, with a facilitated Development Event scheduled for April Independent interviews with Board members reflected their views on roles and responsibilities. Membership includes Voluntary organisations and a Patient and Public representative. Project Leads are encouraged to involve service users in the design and delivery of educational programmes where possible and this is monitored by the Board. Six of the eight Locality Fund projects engaged service users. The Board is represented at CCG Public and AGM events with a stall to inform interested public members on its function. 9

10 ACTIVITIES DETAILS Communication with stakeholders and promotion of the CEPN Launch of Newham Together brand and development of marketing materials such as a logo, banners and presentation slides. Monthly reports to the CCG Clinical Commissioning Committee with reports provided to CEPN members for circulation to their organisation; weekly mailshots to GP practices on training and development events; updates to CCG staff on CEPN progress; inviting stakeholders to CEPN events such as the bi-monthly Developmental discussions and facilitated events; presentations to groups including the Practice Council, GP Cluster Leads, practice managers and practice nurses forums; presentations to the Integrated Care Board and discussions with the NIPP on Integrated workforce planning; monthly reports to the TST Workforce Group; utilising newsletters of other organisations for circulation of information; working jointly with London Borough of Newham on Council led activities; manning stalls at events such as the CCG AGM and CEPN celebratory activities. Evaluation of the CEPN The Board took steps to evaluate its outcomes through minutes of reflection at the end of each meeting and through the monitoring of the progress of all projects. Workforce planning and development Integrated workforce planning aligned to strategic initiatives Private, voluntary and independent Project (PVI) previously called The Third Sector Working Pilot one of two pilots across London Resources Production of a Multiprofessional Resource Pack for General Practice Collaborating in the development of an Integrated Care Action Plan following the Skills for Health Integrated LTC project with the Integrated Care Programme Board and NIPP Collaboration with the NHSE Better Care Support Team to develop case studies looking at issues relating to workforce development Leading TST sub-groups on recruitment and retention of health and social care staff in East London Successful bidding process to be awarded the pilot Establishment of appropriate governance with Steering Group members from two educational establishments, ELFT, Barts Health, voluntary organisations, CCG; Terms of Reference; Risk Register; and project plan Project Co-ordinator appointed It is expected that the pilot will be completed in October 2016 Development of an online Multiprofessional Resource Pack launched to all GP practices in North Central and East London to support practices to become learning organisations Ongoing development of an online Learning Management System (LMS) for general practices in Newham. It is hope that this will be developed as an LMS across all CEPN organisations, with the potential to be shared across neighbouring CEPNs 10

11 ACTIVITIES Training delivery Coordination and delivery of clinical, corporate and statutory / mandatory training programmes for general practice staff, which has been widened to include other primary care contractors and CEPN member organisations. Effective commissioning and monitoring of training uptake for practice nurses and health care assistants Nurse recruitment into primary care Implementing apprenticeships in primary care Management of asthma in children and young people programme (Locality Fund) DETAILS Training Needs Analysis (TNA) undertaken for all GP practice staff, with educational programmes commissioned accordingly 1,507 GPs, nurses, HCAs, practice managers, pharmacists and consultants from the acute sector attended 22 training sessions 105 General practitioners and practice nurses attended a bespoke Level 1,2 and 3 accredited Child and Adult Safeguarding training programme 48 practice nurses and HCAs trained in flu vaccinations and immunisations 20 GPs being trained in cervical cytology to improve the quality of smears Events calendar accessible by CEPN trainers developed 65 practice nurses completed clinical and developmental programmes 5 practice nurses are in their 2 nd year of completing an MSc programme as Advanced Nurse practitioners 5 practice nurses are qualified as Non-Medical Prescribers 15 HCAs undertaking Foundation degree/diploma courses Bespoke NMC Revalidation programme developed with a local university for a cohort of 15 practice and CCG nurses from underutilised course funding to support revalidation and retention of nurses Training commissioned on cervical cytology, immunisation and motivational interviewing in collaboration with the Nursing SuperHub Skills audit database developed for practice nurses which includes Mentors, Sign-Off mentors, NMPs, cervical cytology and lists NMC revalidation dates 10 practice nurse trainees recruited to address workforce gap and development of associated induction and monitoring processes Recruitment process and documentation in place with development of Memorandum of Understanding and contractual documents Increased apprenticeships from 3 to 12 in GP practices, with a further 8 practices expressing an interest and recruiting 12 more apprentices Working to implement the apprenticeship programme within the CCG Increase in educational faculty with the training of 57 health visitors and schools nurses who cascaded Asthma management training to 125 school teachers and teaching assistants in two schools Interprofessional working and engagement across school nursing, health visiting, community children s nursing, GPs, pharmacy, service users and local authority education staff Development of an Asthma Management Policy and Register in schools DVD produced on asthma management in schools to be launched in April 2016 Interactive training video coproduced with children, young people, families and professionals 11

12 ACTIVITIES DETAILS Care certificate programme (Locality Fund) 70 Assessors across health and social care organisations (primary care, ELFT, London Borough of Newham) trained over 4 sessions 70 health and social care support workers completed an integrated Care Certificate programme over 16 training sessions Development of a common assessment document for use across all sectors based on the Care Certificate Standards and Skills for Health literature Chronic disease upskilling programme (Locality Fund) 197 health care professionals from GP practices, pharmacists and hospital based services trained in CVD, COPD, Pre-diabetes and Cancer over 17 training sessions RCGP accreditation gained for programmes Futures generation programme - previously known as the Children s Academy (Locality Fund) 92 participants from health, social care, education services and children, young people and their families trained in a Solutions Focused programme which will directly support the transformation of children community services Health coaching programme (Locality Fund) 176 health, social care and voluntary sector professionals trained as Health Coaches 65 previously trained Health Coaches provided with a masterclass experience using Expert Patients Independent Deep Dive evaluation commissioned and completed LGBT programme (Locality Fund) Programme recommissioned for delivery in 2016/17: sessions booked in May/June 2016 to accommodate 60 LGBT champions Multi-compartmental compliance aids programme (Locality Fund) Development of an Integrated Medicines Management Policy between health and local authority Visual impairment programme (Locality Fund) Training programme commissioned for delivery in 2016/17 64 health, social care, and voluntary professionals trained to improve care to services users with a visual impairment 12

13 Table 2 How Newham Together has achieved the six core functions of CEPNs in 2015/16 Core function Activities Outputs Supporting workforce planning Attendance at the Integrated Care Programme Board to progress the recommendations of the Skills for Health (SfH) LTC workforce assessment and skills modelling project Workforce baseline is available across health and social care Targeted recruitment strategy Rotational training model for Contributions to. NIPP in the development of an Integrated Care Strategy and Action Plan. apprenticeships (in progress) Integrated Care Strategy, Working with the NHS Englan s Better Care Support Team in the development of case studies in Newham related to workforce development Vision and Workforce model (in progress) Contributions to the Transforming Services Together (TST) programme, including submission of baseline workforce data and facilitating access to general practice staff for data collection Chairing of TST recruitment and retention Task and Finish Group Membership of the TST Physicians Associates Steering Group and Apprenticeship Workgroup Supporting and testing the development of a Responding to local workforce needs Education programme coordination Workforce Modelling Toolkit Design of an online Multiprofessional Resource Pack Design and development of a Learning Management System Recruiting practice nurses to primary care Developed bespoke Safeguarding training for GP practices Commissioning of training for general practice staff Widening participation with the recruitment of apprenticeships in general practice Working with the Medicines Management team to develop a Non-Medical Prescribing Policy Undertaking annual Training Needs Analysis across the general practice workforce Undertaking a Practice Nurse Skills Audit Co-ordinating the commissioning and monitoring of integrated educational programmes for professionals based on population needs Working with UCLP to deliver a local Train the Trainers End of Life Care programme See also Responding to local workforce needs section above New learning materials including online multiprofessional resource pack, Management of Asthma DVD, two EoL training videos and a Care Certificate Assessment toolkit 13

14 Core function Activities Outputs Developing educational Supporting the development of nurse mentors through training and updates 5 new practice nurse mentors trained faculty Recruitment of a second GP Education Lead 147 staff have undertaken a Appointment of five Quality Improvement Fellows in collaboration with UCLP to improve the quality of primary care whilst developing leadership capacity. The group spends a day a week working on individual quality improvement projects Train the Trainer or Assessor programme Monitoring educational quality Developing existing workforce Train the Trainer and Assessor programmes Developing quality assurance systems including: o Monitoring activity forms o Pre and post feedback processes for all training o Evaluation requirement for all educational programmes Ensuring the accreditation and quality assurance of training programmes where possible with universities and other providers Commissioning an independent deep dive evaluation into a Locality Fund project to assess the added value and transfer of knowledge to service delivery Developing training and assessment tools that meet CQC and other policy standards such as the Integrated Care Certificate Assessment toolkit Commissioned an independent organisation to gain feedback from CEPN members about progress and areas for development Running a programme of clinical, corporate and mandatory training programmes Developed bespoke Nursing and Midwifery Council (NMC) Revalidation Training programme with London South Bank University Commissioned bespoke training for practice nurses and GPs in cervical cytology and immunisations Evaluation Guide Feedback datasets from training programmes. 73 integrated educational programmes attended by more than 2,000 participants 14

15 3. NETWORK IMPACTS This section outlines the progress made in achieving the CEPN objectives for 2015/16, noting outcomes that would not have occurred without the network. ACHIEVEMENT OF CEPN OBJECTIVES Newham Together has made substantial progress towards achieving its objectives in 2015/16 (see Table 3). The network has matured and is working well together, with a more focused and refined approach on workforce planning and the development of faculty than was the case in the past. Newham Together was always strong on educational delivery, but is now taking a more strategic role. Support workforce planning processes Table 3 - Progress towards Newham Together objectives in 2015/16 Objective Progress Impact Substantial progress The network has supported the recruitment of 10 additional practice nurses and 10 pharmacists in primary care. See Tables 1 and 2 for The network has increased the number of apprentices in activities undertaken primary care from 3 to 12, with a further 12 in the process of regarding workforce recruitment. planning Develop an educational and learning faculty Coordinate the delivery of education and training for the health and social care workforce Substantial progress See Tables 1 and 2 for activities undertaken regarding developing faculty Substantial progress See Tables 1 and 2 for training delivery undertaken Workforce baseline data will allow for more accurate planning and modelling of the workforce, as well as meeting training needs. Two GP educational leads have been recruited for Newham Together. The network has collaborated with UCLP to recruit 5 Quality Improvement Fellows with the aims of improving quality across primary care. Co-funding of 2 GPs in undertaking their MScs. Funding 5 practice nurses to become Advanced Nurse Practitioners. Increased capability of the workforce with staff trainers in dementia awareness (20 trainers), management of asthma in children and young people (80 trainers), and Care Certificate Assessing (70 trainers). Training delivered to 2,182 health, social care and voluntary and community staff with 73 training programmes. This compares to 45 programmes for 700 staff in 2014/15. Integrated training opportunities are a priority to support integrated care. 15

16 CORE WORKFORCE INDICATORS The work of Newham Together has helped Newham achieve improvement in core workforce indicators over time (see Table 4). There has been a substantial improvement in reach of the educational and development programmes and the activity of the CEPN over the past two years. The number of trained nurse mentors has increased by 25%, the number of student and postgraduate nurse placements has increased from being nonexistent and the number of places on learning events and in CPPD courses has doubled. Table 4 - Progress towards core workforce indicators in Newham 2014/ /16 % change Total population 371, , % increase Total number of trained nurse mentors in general practice % increase Number of pre-registration nurse placements in the geographic 0 1 Increase area now covered by the CEPN Number of postgraduate nursing placements in the geographic 0 10 increase area now covered by the CEPN Number of apprenticeships in the geographic area now covered % increase by the CEPN Number of CPPD training sessions run in the geographic area % increase now covered by the CEPN Number of CPPD training places offered in the geographic area 1,021 2, % increase now covered by the CEPN Total number of places in learning events organised or funded 1,052 2, % increase as a result of the CEPN Total number of multiprofessional learning events / training sessions run that were organised or funded as a result of the CEPN % increase 16

17 FEEDBACK FROM THE WORKFORCE In the final quarter of 2015/16, Board members from Newham together circulated an online survey to all members of the workforce. The aim was to gain feedback about training needs and to gauge awareness of Newham Together and its impacts on joint learning and working. The response rate was low, with 30 people responding, predominantly health visitors, nurses and social workers. It is likely that the survey was not prioritised or well promoted. The survey will be repeated annually and will form a key indicator of the network s success in future years. If Board members can be shown to be engaging with promoting the survey to the workforce and the workforce are motivated to describe their learning needs, this will be evidence that Newham Together has moved to the next phase of maturity. The 2015/16 findings provide a baseline for future years (see Figure 3). Whilst people felt Newham was a good place to work and felt confident working with colleagues in other organisations, they felt there was scope for more multiprofessional training and more training tailored to the needed of local communities. Half of those who completed the online survey said they had never heard of Newham Together / the CEPN (50%). 17% had heard of it, but said they did not know much about it, 30% said they knew quite a bit about it and 3% said they felt fully informed about the CEPN. In a way this is positive because it shows that the workforce survey did not solely target those who were already part of the CEPN community. This result also gives Newham Together a baseline to improve from in future years, especially as a priority in 2015/16 is for the network to raise awareness about its role and impact. The survey also contained useful information about the types of training that people valued and ways that they thought training and workforce development could be improved in Newham. A recurring suggestion was having a single website that provided access to all training opportunities available. Figure 3 Feedback from 30 workers to annual survey Newham is a good place to work Communication between colleagues from different organisations has improved in the past year I feel as though I have all the skills I need to provide person-centred care I feel confident about working with colleagues in organisations from different sectors I have attended some type of multiprofessional training in Newham in the past year Newham CEPN is a good source of information about education and training The training available in Newham links well to local and national priorities It is easy to find out what training is available in Newham Over the past year, I have worked in a more joined up way I am more aware of the training available in Newham than I was last year The training available in Newham is tailored to the needs of local communities I feel as though I have all the skills I need to work with other roles and organisations %

18 FEEDBACK FROM CLOSE STAKEHOLDERS Twenty members of the Newham Together Board and training leads and facilitators were also interviewed about the impact of the CEPN by an independent group. Box 1 summarises stakeholder s perceptions of the impacts of Newham Together. Stakeholders noted that in 2015/16 Newham Together has been instrumental in: providing integrated and diverse training relevant to the needs of Newham providing a coordinated approach extending the reach of education and training improving collegiate working relationships supporting personal professional development for those involved increasing a number of key posts which have been difficult to recruit to in the past changing the practice of individuals to improve on performance Each of these aspects is described in turn. PROVIDING A CO-ORDINATED APPROACH A key perceived benefit of Newham Together was supporting organisations to work together to plan workforce development and training. There was a sense that everything was now more joined up and connected two words that were most commonly used to describe Newham Together work over the past year. Stakeholders noted that the coordinating role of the CEPN had made a difference to delivery of training in a way that had not taken place before. The quotes below exemplify those views: The CEPN has provided a focus on education and workforce across a wide range of organisations. Without the CEPN education would not be so high on the agenda. Projects would not have happened or happened so quickly without CEPN. Also when recruiting people for roles, CEPN members want to take part so we have more multidisciplinary recruitment to key posts. It is as thought people feel more ownership of the primary care roles now. The knock on effect is good take up of projects as a result. What has never happened in Newham before is that a range of groups are meeting and discussing their needs for education of the workforce. In the past there has been a lot of duplication of education so it has been enlightening for those of us sitting around the table. What is different is the shared conversations to make education more streamlined and cost effective. It is not all just talk like it was in the past. We are achieving things now. Our reports show that progress has been made in delivering particular education initiatives to a wide range of people. There was a view from some stakeholders that they were now being recognised as members of the CEPN rather than members of the CCG, trusts or similar, which pointed to a higher degree of visibility and perhaps respect for Newham Together because of this coordinating function. 18

19 EXTENDING THE REACH OF EDUCATION There was a feeling that working through Newham Together helped to promote the training available to a wide range of people. The training we are delivering has benefits. For example the locality funded projects are offered to a wide range of people. There are more opportunities for multidisciplinary training now and we are tailoring education guided by priorities for the borough itself. An often cited example related to general practice training, which was said to have previously been isolated with little input from other organisations. Now Friday afternoon general practice training sessions are open to other organisations, with up to 15 extra places each week available for professionals outside primary care. In addition to GPs, these sessions have now been attended by a patient representative, healthcare assistants, practice nurses, practice managers, pharmacists, hospital consultants, allied health professionals and others. The topics have also broadened to include non-clinical topics to accommodate non-clinical staff. IMPROVING COLLEGIATE WORKING Newham Together believes that creating a sustainable network is dependent on having a strong, collaborative structure and vision and one of the critical impacts of the CEPN is to have built a firm foundation of partnerships. Stakeholders pointed to the collegiate working relationships between members and the increased networking in 2015/16, and said they were impressed by the level of attendance at Board meetings and the passion of discussions. There is more communication now having people around the table who can cut through political boundaries. It is less about people all trying to fight their corner, and more about joint working now. We are seeing things from other points of view. Service user involvement was also seen as a benefit. The Futures Generation Programme was one of many programmes where service users helped to shape delivery. Figure 5 Building collegiate relationships Similarly, participants on training programmes funded via the Locality Fund were from a range of health, social care, education, housing and voluntary organisations. Stakeholders also provided examples of the local authority and NHS trusts supporting the delivery of training for primary care, rather than this being seen as the remit of the CCG. Figure 4 Widening the reach of education 19

20 PERSONAL PROFESSIONAL DEVELOPMENT Some CEPN Board members said that being part of the Board had helped to alter their mindset and perspective as they were more aware of the roles of others and the challenges other organisations faced. They also said that this helped them to think of how other organisations and professionals might feel about things. I can see things from different angles we have so many members on the CEPN Board and can see all their views. I often think about that when I m planning now. What would [organisation] say about that or how will this impact on [specific professionals]. Being part of the CEPN has developed my own understanding that (training) can be multidisciplinary. We make training more open now, whereas this was not the case in the past. A number of Board members said that being part of Newham Together had helped with their own professional development in that they felt more competent in planning training or had developed stronger leadership, liaison or negotiation skills. This is seen as an important in achieving one of the CEPN s objectives for faculty development, but also in recognising that improving leadership on the Board can support overall performance and in being visionary. Box 1 Summary of perceived impacts of Newham Together according to close stakeholders Providing a coordinated approach Reduced duplication of training Increasing opportunities for multidisciplinary training guided by population needs Tailoring training programmes to meet a transforming landscape Developing training materials such as the multiprofessional online tool, DVD and videos to aid sustainability of training programmes Undertaking integrated workforce projects Extending the reach of education and training Multiprofessional learning is now a reality rather than an aspiration Training is offered on a much broader range of subjects, both from educational institutions and new providers Developing multiprofessional facilitators to cascade training across and within organisational boundaries Offering opportunities for groups who would have limited opportunity for training such as primary care and voluntary services Improving collegiate working relationships Co-delivery of training with service users Offering an opportunity for partner organisations to reflect on what is needed Involvement in work programmes of other partner organisations Increased awareness of the challenges that organisations face Personal professional development Increasing understanding of other organisations and their training and workforce priorities Increased competence in planning training and developing stronger leadership, liaison and negotiation skills 20

21 4. LOCALITY FUND IMPACTS In 2015/16 Newham Together applied for Health Education England Locality Fund resources. The CEPN gained funding for eight projects. This section provides an overview of the Locality Fund projects coordinated by the CEPN including key activities undertaken and the extent to which project objectives were achieved. Table 5 provides a summary of the projects and their costs, then each of the projects are described in more detail overleaf. Table 5 Summary of eight Locality Fund projects Project Purpose Progress Cost per person Care certificate programme Designed to meet the requirements of Cavendish Review and to equip health and social care support workers with the knowledge and skills needed to provide safe, compassionate care. Progressing well 20 training sessions completed for 70 Assessors and 70 support workers across health and social care. Competency assessments of support workers are in progress. Training delivered by ELFT. 254 Chronic disease upskilling programme Futures generation programme Health coaching programme Designed to upskill professionals in four high prevalence long-term conditions(cancer, COPD, CVD and anticoagulation and prediabetes), linked to the enhanced primary and community contracts in Newham. Designed to use a solution focused approach with stakeholder groups to create an integrated child health model. Developed to use a process that facilitates healthy, sustainable behaviour change related to the management of long-term conditions through transforming goals into action. Progressing well 197 primary care and hospital based health care professions trained across 17 sessions to date. Training programme to be repeated in 2016/17. Training delivered in collaboration with CCG subject experts. Completed 92 stakeholders attended across four sessions. Interviewees have endorsed the programme delivered in collaboration between the CCG and UCLP. Progressing well 176 professionals attended the starting health coaching course, with 82 trained health coaches having attended or booked to attend a Masterclass before the 30 th April 2016 to hone their skills. Patient involvement was a central component in the delivery of the masterclasses

22 Project Purpose Progress Cost per person Lesbian, gay, bisexual, and transgender (LGBT) programme Designed to build confidence in professionals to address LGBT issues and raise awareness of equality and diversity within services and service delivery. Delayed New providers were commissioned in February The project is now progressing with a training programme developed, dates of training in circulation, with a plan to 275 Management of asthma in children and young people Multicompartmental compliance aids programme Visual impairment programme Developed to support the implementation of 2014 Department of Health guidance on the use of emergency salbutamol inhalers in schools using health visitors and school nurses to train educational staff in primary and secondary schools. Designed to train social care support workers in safe administration of medicines for patients who require additional support. Developed to train professionals to meet the needs of service users with a visual impairment. train 60 LGBT champions. Progressing well 57 health visitors and schools have been trained on the management of asthma and have cascaded the programme to 125 school staff. An Asthma Management Policy has been developed. A DVD and Asthma Register are in development for launch in the first quarter of 2016/17. Delayed Training will be delivered to 299 staff in 2016/17. Completed This programme attracted a varied range of attendees of 64 from health, social care and voluntary and community groups. The sessions were well evaluated, with requests received from expert patient groups for more similarly run sessions

23 CARE CERTIFICATE PROJECT OBJECTIVES Following the Francis Enquiry (Francis 2012) and identification of serious challenges in other health and social care settings in 2013, the Secretary of State commissioned an independent review on the recruitment, learning and development, management and support of healthcare support workers (HCSW) and adult support care workers (ASCW), to ensure that this workforce provides safe and compassionate care. The resulting report - An Independent Review into Healthcare Assistants and support workers in the NHS and Social Care Settings (July 2013) recommended the development of a Certificate of Fundamental Care. This programme aimed to implement the Care Certificate. The objectives were: To ensure that health and social care support workers are developed to meet national minimum training standards To equip healthcare support workers with the skills and knowledge to be able to provide effective, compassionate, high quality care and quality care ACTIVITIES UNDERTAKEN Activities in this programme included: Development of an integrated programme between ELFT and the local authority Development of Care Certificate literature, training materials, workshops to support learning, a competency workbook in electronic and hard copy format and evaluation documents 4 half day workshops to 70 Assessors across health and social care 4 education one day workshops to 70 support workers across health, social care and primary care Two half day evaluation sessions to elicit feedback from Assessors on their experiences which would be considered in any future planning A celebration event is to be held for all support workers successfully completing the Care Certificate assessment on the 29th April 2016 EXTENT TO WHICH OBJECTIVES WERE MET To build capacity into the workforce with the training of Assessors who could undertake the ongoing assessment of newly recruited support workers and test their capacity to be caring and developed through supervised practice, mentorship and assessment To ensure health and social care organisations are compliant with the standards of the Care Quality Commission Feedback on 4 day training and content All participants reported that the training was relevant to their work, that they had learned new information which they would use often. They believed their practice would improve as a result of the training and they would recommend the course to others. Prior to the training participants had rated themselves as 2 or 3. All rated their knowledge and understanding as a 5 post training. 23

24 Assessor training Attendees reported that prior to the training they had limited or no knowledge of the Care Certificate. Following the training they felt equipped to assess care support workers and were keen to share the knowledge in their respective organisations so that they could build internal assessor capacity. Some attendees felt that assessor preparation should be extended to two days to allow for better exploration and discussion around the care booklet itself. Completion of booklet Competence in the Care Certificate domains needs to be achieved within 12 weeks, and the process of assessment will be completed by the end April Five Care Support Workers have been assessed and achieved the competencies. RETURN ON INVESTMENT The cost per participant was 254 ( 35,500/140). As start-up costs can be removed from the equation, in future the price per participant would be reduced. A significant amount of expenditure can be attributed to initial start-up costs. Future delivery will require organisations to provide speakers/trainers free of charge and to cover costs in respect of learning materials, administration and venue hire. LEGACY CHRONIC DISEASE UPSKILLING PROJECT OBJECTIVES It is known that 65,000 of people (17% of the population) currently has one or more long-term conditions, with Newham having one of the highest rates of diabetes in the UK. Newham health profiles indicate low recorded prevalence for COPD, cancer and CVD related conditions, with high admission and readmission within these patient cohorts and poor outcomes. The Chronic Disease Upskilling project was designed to build on the CCG s strategic ambition to improve patient care and experience, better manage demand, and work to achieve the integration of care delivery to improve health outcomes for those patients through a comprehensive training programme to develop the competencies and skills of primary care professionals in cardiovascular disease, COPD and asthma, diabetes and cancer. ACTIVITIES UNDERTAKEN Activities in this programme included: Collaboration with a range of partner organisations in developing the programme including the CCG specialists, Barts Health, CVD Lead in east Midlands, TST, ELFT, UCLP and Intelligent Health A programme is in place which allows health and social care organisations to be compliant with CQC standards and the National Minimum Training Standards. There are common standards and quality of training across health and social care for the induction of both existing and newly recruited support workers. Educational capacity has been built into the system with 70 trained assessors and Assessors, and a foundation for educational capability is established with 70 support workers trained and assessed as competent. Programme materials are available for future use. This work is being shared with neighbouring CEPNs as an option for further roll out. Gaining RCGP accreditation for programmes Delivering training programmes which included theoretical, practice and follow up assessment visits to GPs, practice nurses, practice pharmacist and community pharmacists working in areas of CVD, reception and administrative staff Evaluation 24

25 EXTENT TO WHICH OBJECTIVES WERE MET For CVD, five three-hour workshops were delivered on heart failure, atrial fibrillation, ECG/echo, angina and prevention and examination to 43 health professionals including 20 GPs, 6 Practice Nurses, 3 GP based pharmacists, 3 CCG and 6 community pharmacists. For COPD and asthma two half day sessions were delivered followed by assessment sessions including site visits and a check on spirometry results undertaken to quality assure to 42 participants including 3 GPs, 20 practice nurses, 18 HCAs, 1 pharmacist, 1 physiotherapist. There was an improvement in defining lung function parameters and recognising types of graphs produced from 10% to 84%, greater understanding of contraindications to performing spirometry from 45% to 95%, greater recognition of common problems encountered that affect technical quality of spirometry tests from 25% to 100% and understanding of the number of blows required for a technically acceptable test improved from 70% to 100%. For pre-diabetes three sessions were delivered to 48 clinical staff as above, and three to 27 non-clinical administrative staff. There was a 17% change in knowledge, 18% change in applying current knowledge, and 12% change in confidence with working with other team members for clinical staff. There was a 31% change in knowledge, 34% change in applying current knowledge and 18% change in confidence with working with other team members for non-clinical staff. For cancer two half day sessions were to be delivered focussed on the four most common cancers. Attendance from first event included 15 non-clinical staff and 30 clinical staff comprising 25 GPs, 3 practice nurses, 2 hospital consultants. The second session is due to be delivered in May RETURN ON INVESTMENT The Locality Fund investment was 51, ,737 was used for training 197 staff across primary and secondary care. Training programmes are still in progress however based on attendance and funds used to date the cost is 110 per person. In addition, the team are in the process of developing learning materials which will provide an added legacy. LEGACY There is now a quality assured and RCGP accredited training programme. There are increased competencies and knowledge in primary and hospital based staff groups, with demonstrated improvement in the quality of assessments for COPD. FUTURE GENERATIONS PROJECT OBJECTIVES Future Generations is a collaborative programme using a solutions-focused approach to co-design health services where all stakeholders in child health, including children, young people and families, have an equal voice. Objectives included: Changing the way children s services in Newham are commissioned, bringing patient engagement to the centre of the process. Shifting the focus away from disease, illness and healthcare to wellbeing, prevention of ill health and self-care. Reducing the pressure on acute care, enabling more children and young people to access the services they need in the community Further evaluation details are available in the appendix. 25

26 ACTIVITIES Activities included: Stakeholder engagement and participant recruitment programme Communications plan and promotional materials designed to target specific audiences Four workshops designed to capture diverse stakeholder views about local healthcare needs by creating create a space for ongoing dialogue and service reform in Newham o Session 1 - Child services professionals, child nurses, midwives and other stakeholders o Session 2 - Paediatricians and doctors in general practice o Session 3 - Children, Young People, members of the youth council, parents and other stakeholders o Session 4 - The final session all three groups were integrated and encouraged to engage with each other Evaluation of each session Figure 6 Future Generations workshop EXTENT TO WHICH OBJECTIVES WERE MET The solution-focused approach was well received. Participants reported consistently high usefulness and enjoyment with respect to the workshops. Most attendees endorsed the concept of bringing people together in order to effect change. It was a really nice mix, I liked how they had a variety of people. I think the vision is absolutely fantastic [ ] it could be a prototype across the whole of England. RETURN ON INVESTMENT The Locality Fund investment was 30,366. This was for four facilitated sessions attended by 96 stakeholders across health and social care, and including children, young people and their families. Based upon actual attendance the cost was 316 per person over the four sessions. LEGACY There is a cohort of young people who have been empowered to participate in deciding future services. A significant amount of data on priority health topics has been collated which will be used to influence the transformation of children s services. Stronger partnerships have been developed between health, social care, voluntary and charitable sectors. The experience and reflections on delivery of the project have generated some lessons learnt which we can share with others, and be used to strengthen the co-design process. 26

27 HEALTH COACHING PROJECT OBJECTIVES The health coaching programme was designed to: Develop the knowledge and competencies of health and social care staff in supporting service users in Self-care of their long term condition Develop workforce skills in focussed coaching and motivational interviewing that can be applied within a range of clinical settings Develop staff expertise in helping patients set goals, understand their lifestyle choices and navigate an increasingly complex healthcare system ACTIVITIES UNDERTAKEN In 2015/16 the activities undertaken included: Liaising with Tower Hamlets CEPN and Newham CEPN to agree a joint strategy Developing an enhanced health coaching curriculum Developing promotional materials to support a mixed audience Recruiting a good mix of participants to attend the training Recruiting attendees for two day programme Collecting feedback before the training, after day 1 and after day 2 3 month follow up feedback to be completed from May 2016 onwards Health coaching training was carried out for a range of health professionals across Newham and Tower Hamlets between July 2015 and 2nd February EXTENT TO WHICH OBJECTIVES WERE MET The programme continues until mid-2016 so a summative outcomes assessment is not yet available. Newham CEPN commissioned an external evaluation of the health coaching programme from City University. This report is available in the appendix. Feedback from participants has been positive: I did change my approach when giving health advice to people. I am more positive about them, their knowledge and their ability to change. I see them as capable of working out their own solutions, I often ask more powerful questions, let them come up with their own ideas and giving them value It was interesting to get feedback from other people where the doctors were not in the majority so it was useful to get different perspectives from other people (GP) I have adjusted my consultations to get patients more involved. So for example we create a plan with the patient and ask them what they can achieve, what they want to achieve and what transformation is possible (Pharmacist) RETURN ON INVESTMENT The Locality Fund investment was 32,600. Funds utilised for the two day coaching programme totalled 19, people attended the day 1 session and 62 attended the day 2 session. Based upon actual attendance the cost was 319 per person. An evening masterclass and two-session masterclasses were run on Sundays and further masterclass is scheduled for April 216. Initial attendance figures show 82 attendees booked to attend. This amounts to 156 per session per attendee. LEGACY There is an increased capacity and capability of the workforce with skills to support increased patient self-care. 27

28 MANAGEMENT OF ASTHMA PROJECT OBJECTIVE A study by Asthma UK identified 86% children with asthma have at some point been without an inhaler at school, either because it was forgotten, lost, broken or the inhaler had run out. From October 2014 new regulations were put in place to allow schools to purchase and store an emergency inhaler within the school without a prescription for use in an emergency (Department of Health, 2014). This project was designed to: Support the implementation of non-statutory Guidance on the use of emergency salbutamol inhalers in schools (Department of Health, 2014) in local schools Deliver an integrated programme of training for the management of asthma in children and young people for staff within the health and education sectors Develop educational materials for schools as part of the managing medical conditions policy Build capacity and capability within the workforce in managing asthma Support schools in developing their own Asthma policy and Register to improve care to children and young people ACTIVITIES UNDERTAKEN EXTENT TO WHICH OBJECTIVES WERE MET 80 health visitors and schools nurses undertook a train the trainer programme on the management of asthma of children and young people in schools. 125 school staff have been trained in four schools. Interactive training materials have been co-produced with children, young people, families and professionals which includes a video in which children talk about how they feel about having asthma. A training DVD has been produced which includes a live demonstration on the technique of administering an emergency inhaler and recognising signs and symptoms of asthma. Figures 7 and 8 show before and after self-rated knowledge and confidence Figure 7 Change in self-reported knowledge % 8 None / very little 12 Neutral Good / very good 4 12 Excellent Activities included: Knowledge before Knowledge after Identification and involvement of experts by experience Schools were recruited through the dissemination of letters to head teachers to establish implementation of guidelines for the use of emergency inhalers in schools and where indicated invite expression of interest to be involved in the pilot to receive training and education to support on-going implementation Multiprofessional trainers were identified and commissioned to deliver a train the trainer programme for health visitors and school nurses Figure 8 Change in self-reported confidence % 8 12 None / very little Neutral Confidence before Good / very good 4 12 Excellent Confidence afterwards 28

29 RETURN ON INVESTMENT The Locality Fund investment was 26,000. This was used for the training of 125 health professionals and cascade training to 205 school teachers and teacher assistants over 12 training sessions. Based upon actual attendance the cost was 126 per person. LEGACY 80 nurses are trained thus increasing capacity and capability in the workforce and will be a resource for a rolling teaching programme to ensure all relevant new staff entering into the education settings are trained. A DVD and training video are available for roll out to schools across Newham. Health promotion and prevention messages have been collated from the perspective of a young person and can be shared with other schools in a roll out of the programme The development of an Asthma Management Policy and Register will support improved identification of children and overall management of their condition. VISUAL IMPAIRMENT AWARENESS PROJECT OBJECTIVES Consultations carried out amongst blind and partially sighted people in Newham have demonstrated that, if engagement with the health sector is made difficult due to their sight loss, then they are less likely to access and revisit a service. For example, visiting a GP surgery where the clinical support staff or GP themselves do not know how to interact with a slight impaired or blind person in a non-stigmatising way can cause the individual to feel awkward, embarrassed and uncomfortable within that environment. It is therefore vital that health professionals are trained to overcome such situations and ensure that the needs of this specific sector of the population are met. The visual impairment awareness project was developed to address these needs. The objectives were: Develop the eye health knowledge of all clinical staff and ensure education and training supports all staff to deliver improvements in ophthalmic public health. Ensure education and training contributes to a positive experience of healthcare consistent with the values and behaviours identified in the NHS Constitution. Contribute to continued improvements in scores from patient surveys on questions relating to staff behaviours and compassion in care. ACTIVITIES UNDERTAKEN Activities included: Programme development with Vision Impaired service users Marketing of programme across the CEPN stakeholder organisations Six workshops delivered including 2 full day events, 2 evening events, and 2 lunchtime events to increase the accessibility of the programme to the health and social care workforce EXTENT TO WHICH OBJECTIVES WERE MET A diverse range of 64 staff attended the six workshops. Interprofessional working and engagement was achieved across health, social care and voluntary and community groups. Attendees included staff from the primary, community, hospital based, social care, public health, education departments and the voluntary and private sectors. Before and after surveys show a marked improvement in learning and awareness in supporting those with a visual impairment (see Table 6). Three month post training evaluations are in the process of being carried out in which delegates are asked to assess the impact of the workshops on their day to day work. 29

30 Table 6 % that rated their confidence at 6 or above out of 10 before and after visual impairment training Confidence in communication Guiding a vision impaired person Knowledge of the NHS England Accessible Information Standard Knowledge application to role RETURN ON INVESTMENT Pre training Post training 55% 97% 45% 97% 35% 86% 54.8% 82.7% The Locality Fund investment was 8,500 with training delivered to 64 health, social care professionals and workers from voluntary and community groups over six sessions. Based upon actual attendance the cost was 133 per person. LEGACY 64 health, social care and voluntary organisations staff have been trained to empower visually impaired service users in taking more control and responsibility of their health by the removal of obstacles to care. Training materials are available for a future roll out of the programme. A request has been received from expert patient groups for more similarly run sessions. MULTICOMPARTMENTAL COMPLIANCE AIDS OBJECTIVES Across East London, GPs, hospital and community pharmacists and district nurses have reported a significant increase in use of MCAs mostly at the request of care workers and carers/family. It takes 8-10 times longer to dispense medicines into an MCA compared to dispensing of original packs. This is resulting in unmanageable workload for pharmacists and GPs and in some instances delayed discharge from hospital. In an attempt to resolve and to identify right solution, a multi-disciplinary group of health and social care professionals from organisations across health and social care was convened. The group comprised of doctors, pharmacists, nurses, social services, service managers and care workers. The objectives of this programme were to: Improve safe appropriate use of Multi- Compartment Compliance Aid (MCA) by upskilling health care workers and domiciliary care workers to support safe administration of medicines to people (adults) who need support to take their medicines Support individual resilience through selfmedication, where appropriate Reducing the reliance on inappropriate use of multi-compartment compliance aids and the associated workload for community and hospital pharmacists Optimise the use of medicines so that people can get the best health outcomes Streamline the delivery of care especially where district nurses are undertaking home visits for the sole purpose of medicine administration 30

31 ACTIVITIES LGBT PROJECT Development of a draft medicines policy OBJECTIVES Development of a draft medicines administration assessment tool Successful Road testing of three workshops to 49 care workers, informal carers, community mental health practitioners, Allied Health Professionals and community learning disability workers to test the draft policy Consultation undertaken with GPs Development of training programme with London Southbank University RETURN ON INVESTMENT The Locality Fund investment was 50,000 of which 40,000 has been used for the pilot training programme and the commissioned LSBU programme for 299 social care professionals and patient and public groups over 15 sessions. Based upon actual and planned attendance the anticipated cost is 134 per person. The balance of funds will be used for the development of an online assessment tool and ongoing training. Nationally, research indicates that LGBT people suffer poor health outcomes and inequality, have higher rates of mental health problems, with gay men six times more likely to commit suicide, and lesbians twice as likely to commit suicide as their straight counterparts. LGBT people are also more likely to smoke, drink alcohol above recommended limits and misuse drugs. Newham CCG commissioned East London Out Project (ELOP) to undertake focus group work with LGBT people to ascertain their experiences of NHS care. Their report highlighted examples of negative staff behaviours and attitudes that demonstrated a need for education around delivering services to LGBT people in an approachable and nondiscriminatory way. This project is intended to provide that training, and to identify 60 LGBT champions across health, social care and third sector services to support their organisations to make the necessary policy and practical changes to deliver nonstigmatised services. This training is being delivered in partnership with Pride in Practice and ELOP. The objectives are: Raise awareness in the health and social care workforce of the disparities in access to health and social care services and poor health outcomes for LGBT people Equip health, social care and third sector staff with the skills and attitudes to effectively tackle health inequalities Improve the experience of services for LGBT people Develop a cohort of leaders to influence change in services through the use of LGBT champions RETURN ON INVESTMENT The training has not been completed but sessions have been booked. The Locality Fund investment was 16,500 for the training of 60 health, social and PVI workers. Based upon planned attendance the anticipated cost is 275 per person. 31

32 5. REFLECTIONS This section outlines: The lessons learnt from network development, workforce planning and training provision The challenges that were faced by Newham Together in 2015/16 and how these were overcome The areas identified for development Proposed activities that will be undertaken to strengthen the network. LESSONS LEARNT A defining condition of learning and being in a position to improve is that we have to understand the meaning of our experience. To support development, Newham Together compiled feedback from member organisations during reflection sessions at Board meetings and through independent interviews with 20 stakeholders. Feedback from stakeholders indicates that the significantly increased momentum in 2015/16 was linked to four main areas: Greater time for organisations to build relationships and embed a culture of joint working The diversity of a committed membership A competent project manager Being held to account by Health Education England, so the CEPN grew stronger and focused on recognising its value. The following quotes exemplify these views: It feels like we re a lot more organised. Some of this is down to maturity and people knowing each other better. We ve also taken the time to stop and reflect more formally. The CEPN brings diverse organisations and diverse roles within the organisations together So now we are all talking and identifying gaps in service delivery or training options. Coming together is quite significant and would not have happened without CEPN existing. [Project manager] has been a key person. She came in with the right skill set and approach. CEPNs need good project management and relationship management. The role of the project manager is crucial. It helps us feel on track so we know what we re doing. Everything isn t last minute now; we have plenty of opportunity to contribute now. What has never happened in Newham before is that a range of groups are meeting and discussing their needs for education of the workforce. In the past there has been a lot of duplication of education so it has been enlightening for those of us sitting around the table. There are more opportunities for multidisciplinary training now and we are tailoring education guided by priorities for the borough itself. 32

33 Other key success factors include: Dedication of Board members to strive for overall success. Commitment of members who have integrated the work of the CEPN into their roles. Strong clinical leadership for Board and projects. Financial, budgeting and resource support from the CCG. Support from Health Education England through CEPN meetings. Careful planning, attention to detail and effective communication. Having accountability and monitoring frameworks to maintain an overview on the progress and quality of delivery of projects. Building on the successes and good work in the previous year. Increased multiprofessional working within the Board. Delivering multi-organisational training programmes. Co-delivery and planning with patient and public involvement. Newham Together has learnt that successful projects start with the end in mind, and require that the team allows itself sufficient time to clarify its short to long term objectives, rather than be reactive, as this will determine the quality of the strategy and the outcomes. It takes time for members of diverse organisations and diverse roles to build relationships and embed a culture of joint working to be an effective team. Appropriate governance with a sound infrastructure, and having key decision makers on board as well as a comprehensive marketing plan is critical for sustainability. Shared ownership by all member organisations is also critical to ensure appropriate CEPN capacity and resources in delivering transformational change. CHALLENGES FACED CAPACITY It was recognised that whilst the CCG very instrumental in funding the core staff to manage the CEPN, capacity remained a significant issue with the project manager being interim and part-time, with one full time Coordinator and limited time for the GP Educational Lead. The lack of administrative support impacted on planning, organisation and undertaking essential activities such as marketing the CEPN to the wider organisational networks. Development funds were utilised for establishing the identity of the CEPN, developing the Board, and systems such as the Learning Management System, rather than core staffing. Newham Together managed this process through the use of independent consultants to support specific programmes whilst recognising that this had to be an interim measure. Newham Together requires a full time Project Manager to undertake the breadth of work that is required, as well as administrative support. In addition, it is important that the CEPN limits its work programme to no more than five key projects aligned to public health and commissioning priorities to support sustainability and not be stretched too thinly. TIMING OF FUNDING The requirement to spend funding and complete the delivery of projects within a short period of six months meant that that there were dependency and resource conflicts, with the same people having to deliver across a range of projects in the same limited time scale. In addition the timing was too short to be able to comprehensively evaluate the added value and impacts of training. We undertook to deliver as many training sessions as was feasible, however, to gain good attendance and effective partnerships with educational providers, we made the decision where necessary to spread training programmes into the next financial year. We are also of the view that building in funding for longer term follow up of some seminal programmes will be essential. 33

34 SUSTAINABILITY Clarity on the future of the CEPN is critical to maintaining motivation and interest of Board members and stakeholders to ensure that impacts can be sustained. The CEPN is currently reliant on CCG and Health Education England for funding and these funding amounts are decreasing. Newham Together is taking steps to engage with a wider network of stakeholders both within and external to Newham in developing proposals of sustainable models (see Section 6). SCOPE Bi-monthly development sessions provided an opportunity for Board members to consider a range of issues pertaining to the purpose of the CEPN. One area which lacked consensus was in regards to the role of the CEPN for workforce planning. Some members felt that the focus should be on the delivery of high quality integrated training. There was clear view from others however that workforce planning should be a focus as this is one of the original six pillars that the CEPN was set up to address. Newham Together recognised the conflicting views and worked to address this by taking a more strategic focus and aligning the training needs identified and delivery of training with the TST programme Workforce Workstreams so that members understood the benefit of bringing the both streams of work together. Linked to this, the network also wants to engage more with Public Health in using public health data to consider workforce needs over a longer period of time, rather than focusing on annual planning and one year projects. We need to do more needs analysis and mapping against quality data. We should get the right people to help look at the data and help it make sense to us so that we can plan longer term. MANAGING CONFLICTS OF INTEREST The process of submitting bids for Locality Funding has been open to all partner organisations and it has been recognised that there may be potential conflicts of interest, especially for Board members. Newham Together has addressed this through establishing a declaration of interest at Board meetings, and future bidding processes will include that the directors / owners of all providers offering training under CEPN auspices will be declared. MAXIMISING TRAINING ATTENDANCE The release of staff to attend training has been an ongoing issue both in regards to backfill to release staff, as well as the difficulty in accessing training. Newham Together managed this through supporting limited groups of staff with backfill funds where feasible. To aid accessibility, a significant amount of training was provided in venues locally, sometimes within GP surgeries, central sites such as the CCG offices and at different times of the day and week. Some training such as health coaching was run on weekends and in collaboration with other CEPNs to aid flexibility of attendance. AREAS FOR DEVELOPMENT Stakeholder comments and Board reflections provided valuable insight into areas for further development of the CEPN. Newham Together has a strong Chair and committed members; however the governance of the CEPN could be strengthened further with the engagement of senior decision makers (the executives and assistant directors) of stakeholder organisations, whilst retaining the hands on members of the current Board. This structure would support both strategic and operational delivery, and be critical to the sustainability of the CEPN. We need to invite more senior directors, but we also need the doers around the table too. Add more senior people, but don t get rid of people that are there already as they are doing good work. 34

35 We see this as central to the future of the CEPN and have proactively arranged an extended stakeholder group discussion to affirm the case for retention and development of the CEPN, to explore issues of sustainability including future membership, and to agree the actions necessary to build a sustainable proposition. There is an agreement that the development of shared ownership will be a supporting element to the sustainability discussions, with member organisations taking responsibility for supporting administration and contributing funding and personnel to the work of the CEPN. When actions are agreed we need to follow things up as a CEPN team, not just one organisation all the time. All of us need to get more involved. People need to commit their skills, not just turning up for the meetings and that s it. Some organisations still see the CEPN as a way to get funds rather than all working together. We need to iron out what it means to be a member and what resources all need to put in. We need to be clear what are the responsibilities of being a member and have more resources put in by all. To assist with developing a greater sense of shared ownership we are considering a range of options which relates to sharing the hosting of Board meetings, having a Deputy Chair from an organisation other than the CCG, or rotational chairing and hosting of CEPN development sessions. We have made great strides in partnership, but recognise that we need to continue working to maintain that ethos, and be active in challenging siloed or professional specific thinking. CEPN-run developmental sessions have proved to be useful in allowing for effective reflections and we plan to develop that concept further to allow for more creative thinking and planning with an annual celebration with a wider network of stakeholders at the end of each financial year. There are a number of avenues that we have already identified where we need to increase our educational reach and these include strengthening our links with nursing and care homes, extending multidisciplinary training to professionals allied to medicine, as well as to Expert Patients who have contributed to coproduction of some of our training programmes. Ultimately, Newham Together aims to ensure a more sustainable, upskilled and relevant workforce, working together to improve outcomes for the local population. These are long-term aims, which are sometimes challenging to measure and therefore we want to ensure that we have systems that allows the measuring our impact not only on professional learning but importantly on the services received by service users. Evaluation is not as evidenced as it could be and this needs to improve. We need to get better at showing impacts. Even with the short time period we could still use a more standardised approach and upskill ourselves more in how to show the impact of the training. We will therefore be updating the Evaluation Guide with templates and a Worker Classification Tool and Report Template to ensure a standardised approach. Increasing the evaluation and report writing capability in project leads will be considered as another developmental area. People need to think more broadly; think from other people s perspectives. We need to think of education as a whole and have a more together approach not just their own agendas. It takes time to develop this culture and we need senior people in the room that will spread this thinking across their organisations. 35

36 We have made great strides in developing the network and establishing an identity for Newham Together was a significant step forward in its evolution. We are now seen by partner organisations as the vehicle to support delivery of local priorities. We now want to spend time promoting the work of the CEPN to raise awareness of how it can support workers as well as organisations. We want to move to a place where not only face to face training programmes are integrated, but that training needs analysis, the use of e-learning, clinical and professional supervision systems can also be integrated where is makes sense, and the developing Learning Management System is a centralised hub across the network. Newham Together believes the network has evolved substantially over the past year in bringing organisations together in the joint pursuit of an improved workforce. We have strong individual champions leading the way and recognise that there are opportunities to do much more, to embed CEPN processes and mindsets more widely within organisations, to be a vehicle for transformational change and to ultimately impact positively on patient care and satisfaction. Members can see advantages. There is a commitment for pushing things forward. We have a clear vision for where we are going now and recognise that without the CEPN things would be more fragmented. Jointly we have more power than ad hoc individual work. Box 2 lists key developmental actions planned. 36

37 Box 2 Developmental priorities for Newham Together Strengthen strategic approach Develop and implement a sustainable proposition for Newham Together which includes a review of structure and composition of the Board which will allow for a more strategic approach Maintain collaborations with strategic programmes such as TST, commissioning priorities and developments across WEL area to ensure that the work of the CEPN is aligned to workforce priorities Undertake work to look at capturing and making more effective use of workforce data to inform decision making Proactively take forward the recommendations of the Skills for Health workforce modelling project with the NIPP and ensure full alignment with TST programme Pursue collaborative ventures across CEPN boundaries on education and workforce planning Develop business and project plan to support more structured and longer term planning Consider and implement leadership programme opportunities for Newham Together Board members to support individual development to meet changing agendas Undertake joint needs analysis across CEPN organisations to build a more comprehensive picture of the workforce and training needed Develop a risk register Build capacity Consider structure required by Newham Together to maximise effectiveness, bid /identify funding and secure appointments as necessary Clarify the activities that the organisations must deliver to achieve its aim and the named lead(s) and be clear on the focus for the year Undertake skills audit of Board members to use current skills effectively and identify training needs Work and plan collaboratively with partner organisations within and external to Newham, including the developing GP Federations and neighbouring CEPNs Further develop the Learning Management System to support more efficient planning, administration and undertaking of training and development programmes Work collaboratively with the education and workforce leads of stakeholder organisations to utilise current capability and capacity more effectively Extend the engagement of the CEPN Finalise the communication plan and toolkit for Newham Together for consistency of use across Board members Promote the function, vision, and role of Newham Together to a wider audience within stakeholder organisations as well as to organisations and groups where engagement has been limited Consider the messages that may need to be targeted to different professional and workforce groups Develop a prospectus of training programmes so that the receiving audience can identify the relevance to themselves, ensuring that information is clear 37

38 Operational priorities Complete the evaluation of all projects which required further delivery into 2016/17 including the Apprenticeships and PVI (3 rd Sector Working) projects Develop Probity Plan to achieve a successful Locality Fund submission bidding process with clear criteria of assessment which accords to HEE NCEL rules and with the appointment an independent panel Achieve apprenticeship target of 47 by March 2017 Work with the CCG and the wider primary care workforce such as optometrists and dentists to identify apprenticeship opportunities Develop Learning set for newly Recruited Practice Nurse trainees Commission training based on analysis of Training Needs across the CEPN organisations, aligning plans for Commissioning and joint delivery where possible e.g. End of Life Care Undertake joint commissioning of training for practice nurses and HCAs with the Nursing SuperHub and neighbouring CEPNs to maximise funds effectively and develop joint quality standards for programmes Collaborate with the CCG, London Borough of Newham and Public Health to support achievement of commissioning priorities Develop clear assessment procedures for providers of training to ensure that they can provide high quality accessible training programmes Maintain the focus on the implementation of integrated training, co-produced with patient and public involvement where feasible Increase number of GP training practices Maintain programme to practice nurses for NMC revalidation to support retention Maintain support to TST Workstreams to achieve workforce planning priority targets such as recruitment of GPs, Social workers, HCAs Undertake annual survey with an aim to achieve 20% increase in staff awareness of the CEPN Establish a database of trainers and consider opportunities for their continuing competency development Work with local educational institutions to get an accurate picture of the medical and nursing student placements within the Borough 38

39 6. LEGACY AND SUSTAINABILITY This section describes the list of resources and products developed from projects delivered by Newham Together in 2015/16 the way that learning has or will be shared, and how as a CEPN we link to wider system initiatives. This section also outlines plans related to the sustainability of the network. RESOURCES AND PRODUCTS DEVELOPED During 2015/16, Newham Together developed a range of resources relating to: Human Resources which were critical to ensuring appropriate capacity to deliver our planned benefits Board Assurance documents which were developed to support the business of the CEPN Material resources developed as an output of educational projects Financial resources This section describes each in turn. HUMAN RESOURCES Within its second year of existence, Newham Together has sought to capitalise on its capacity through collaboration between members of the Board as well as effective collaboration with partner organisations. Resources developed include: A Board whose commitment must be recognised in driving forward a challenging but exciting agenda, and which comprises: o A strong Chair o Clinical and senior leadership representing medics, nurses, pharmacists, optometrists, and dentists from primary, community, mental health and hospital services o Strategic workforce expertise from London Borough of Newham o Three partner Universities o Voluntary organisations and Patient and Public representative o Dedicated project management and training coordination roles Senior level sponsorship from the CCG which strengthens the accountability of the CEPN to maintain transparent systems of probity Finance manager support from the CCG Interim Project managers for specific projects Stakeholder networks, including the Newham and Tower Hamlets Nursing SuperHub, HEE NCEL, UCLP, the NIPP, TST, Skills for Care and neighbouring CEPNs 39

40 BOARD ASSURANCE RESOURCES Newham Together has implemented a framework and key assurance documents with the aim of developing stronger governance processes. These include: Revised Terms of Reference for the Board Terms of reference for the subgroups including the GP Education Training Steering Group and the PVI project (previously the 3 rd Sector Working Pilot) Declarations of Conflict of Interest process implemented A Project Plan which utilises the Prince Project Management methodology CEPN objectives and planned activity for Structure charts which map accountability structures and key workstreams Marketing materials which incorporate the Newham Together name and logo such as banners, headed paper, presentation slide template Evaluation Guide Monitoring reporting templates and forms for project leads Memorandum of Agreement and contractual documents utilised in the recruitment of Practice Nurse trainees Training Needs Analysis templates CEPN Staff Survey Online templates Locality Bid Submission Independent Assessment criteria scoring template and process Business case for the implementation of apprentices MATERIAL RESOURCES Establishing a legacy to support ongoing workforce learning and development has been a priority of Newham Together, and as a result a number of learning materials have been developed which can be accessed or shared beyond the CEPN network. These include: The Multiprofessional Training Online Resource The online portal is a Health Education England North Central and East London initiative developed and hosted by Newham Together to support GP practices across North Central and East London to become multiprofessional learning organisations. The portal was launched in February The portal is structured to provide information on training pathways for each profession and includes written case studies, video interviews and testimonies from trainers, mentors and students in general practice; links to web resources and organisations for further information, as well as examples of good practice emerging around workforce development in general practice within North Central and East London. The online training resource portal can be accessed at: Newham Together has been in discussions with colleagues in Health Education England Kent Surrey and Sussex and Health Education England South London and has agreed to support the development of a similar resource for those areas. There is a process to ensure that where necessary, the above documents will be revised on an annual basis. Copies of selected material are available in the appendix. 40

41 Management of Asthma in Schools Materials A legacy from the asthma educational project has been the production of A person centred audio visual programme (DVD) co-designed with children and young people, their families, health and educational professionals. The short version of the script is 4 minutes long and will be used as a podcast in all training in schools. A 6 minute training video enacted by a school child will be used for educational programmes in all schools and will be uploaded onto the interactive electronic bill boards in schools, the ELFT Trust and London Borough of Newham websites and via YouTube. The video will also be uploaded on the CEPN Learning Management System as it develops. The video features a live demonstration of the technique for administering the emergency inhaler and also recognising the signs and symptoms. An Asthma Management Policy and Asthma Register has been developed within the four schools recruited for the pilot, and will support the identification of children who require support and intervention and ultimately improve the management of Asthma in schools. The DVD and Video will be launched on World Asthma Day with the support of the communications teams at ELFT, London Borough of Newham and the CCG to maximise the marketing and sharing of the resource. It is anticipated that all resources will be shared with other schools and colleges as part of the roll out of training. The DVD and video will be available for educational purposes worldwide. Care Certificate Competency Workbook This project was a collaboration of ELFT, London Borough of Newham and general practices in Newham to develop and implement a common approach to training and assessment in the Care Certificate for support workers. This approach was chosen to ensure a consistent standard of training and assessment across the organisations. An outcome of the project was the design of an Assessment Workbook based on the Care Certificate Standards and Skills for Health/Care literature, and which met the required competencies of care workers in adult health and social care. The workbook allows for sign-off against specific competencies by both the support worker and their assessor. The Workbook has been produced in hard copy and electronic copy for ease of accessibility and supports the completion of competencies and assessment of support workers within a 12 week period. Electronic copies will be made available on the ELFT, London Borough of Newham and CCG websites and via the Multiprofessional Training Resource portal which is open to GP practices across North Central and East London. The workbooks will be used during the ongoing delivery of training across other sectors of staff within Newham, for example within care homes. Discussions have commenced with neighbouring CEPNs on joint working opportunities and the sharing of such resources will be considered. 41

42 Learning Management System (LMS) Newham Together has procured and is developing an online LMS platform which will be developed to provide a range of learning and development resources including: E-learning material, learning records and appraisal evidence Webinar and virtual classroom learning opportunities A platform for forums and social learning interactions Access to a range of learning materials and resources for healthcare professionals Management of bookings and attendance at face-to-face training events Revalidation information and e-portfolios for professionals to record and track their CPD information The LMS was initially intended to be for use by GP practices; however, consideration is being given to the potential for its use across the CEPN organisational network. This development will be considered as part of the wider discussion on sustainability of Newham Together. FINANCIAL RESOURCES Table 7 lists how Newham Together has used funds provided by Health Education England for the 2015/ 2016 financial year. The network received a total of 785,000 from Health Education England across North Central and East London for the delivery of the Locality Fund projects, training of practice nurses and support workers via indirect funding streams, management of specific projects, Development funds for the CEPN and the recruitment of Practice Nurses. A proportion of funds will be carried across into the 2016/2017 financial year for continuing project and training delivery. This was either due to projects being delayed but with training programmes already committed to be delivered during the new financial year; or funds having been received for projects which would span the two year period in delivery; or where project leads were able to negotiate more efficient use of funds in regards to activities such as room bookings. The projects which will be continued into 2016/17 include: Locality Fund Projects: Figure 9 Online portal for LMS system LGBT which will be delivered between May to September 2016 Multi-Compartmental Aids with training commissioned for delivery May to October 2016 Chronic Disease Upskilling Project for the roll out of a further integrated programme Workforce Projects: The Apprenticeship project will continued for delivery of 2016/17 targets PVI project which is scheduled to be completed in October 2016 Recruitment of 10 Practice Nurse trainees whose BSC / MCS programmes will be completed in February