NES Item 8e October 2012 NES/12/93 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Annual Stakeholder Engagement Report - 2012 2. Author(s) of Paper Donald Cameron (Head of Planning and Performance Management) and Karen Howe (Partnership Development Officer) 3. Purpose of Paper To outline the engagement intelligence gathered from NES s stakeholders during 2012. 4. Key Issues Our engagement report for 2012 contains a summary of the feedback gathered through board engagement leads; regional networks; professional leads in directorates; the Chief Executive and Chair and social care. This work is the result of face to face engagement at a range of levels which is part of a wider picture of how we engage with our stakeholders, in particular through established educational networks within each directorate. Therefore while it is possible to identify key themes, the report is not designed to provide an exhaustive list. In addition further research and analyse would be needed to produce a detailed diagnostic of the additional educational support required for some of these themes, in particular support for health and social care integration. In summary the report has identified the following key themes to help inform our future planning; A key priority for almost all of our stakeholders is educational support for health and social care integration. Key themes which are relevant for many stakeholders are: - support for medical workforce planning (particularly in relation to paediatrics) - e-learning (increasingly mobile/app technology) - support for service redesign and reshaping the workforce (particularly healthcare support workers, paediatrics and reshaping the medical workforce) Key themes which are a priority for several stakeholders are: - older people and dementia services - rural general hospitals and rural fragility - leadership to support quality improvement and managing change - literacy: encompassing reading, writing, arithmetic and information technology skills Key national priority themes which feature across the range of our stakeholder feedback are: - the quality strategy and quality improvement - early years 1
5. Educational Implications Once approved, the themes outlined above will be incorporated into the operational planning guidance to help ensure that there is a focus on these priority areas. 6. Financial Implications All activities to address the key themes identified will be planned within existing financial allocations and budgets. 7. Which NES Strategic Objective(s) does this align to? Delivering our aims through a connected organisation. 8. Impact on the Quality Ambitions These themes support the quality ambitions and the 20:20 vision. 9. Key Risks and Proposals to Mitigate the Risks The key risk is that the priorities identified are not truly representative of our stakeholder s needs. This is managed through sense checking the key themes within our Executive Team and triangulating it with other feedback. We will also further research and analyse the results of the engagement process to produce a detailed diagnostic of the educational support required for some of the emerging priority areas, in particular health and social care integration. 10. Equality and Diversity Impact Assessment No major issues. 11. Communications Plan A Communications Plan has been produced and a copy sent to the Head of Communications for information and retention: Yes No X A Communications Plan format template is available in the Meetings and Communications sections of the NES Intranet. 12. Recommendation(s) for Decision The Board are asked to discuss and endorse the key themes that have been identified through our engagement and intelligence gathering process. 2
Annual Stakeholder Engagement Report - 2012 3
Contents 1. Executive Summary 2. Board Engagement Territorial Boards Regional engagement Special health boards 3. Engagement by NES Directorates 4. Engagement by NES Chair and Chief Executive 5. Engagement with social care 6. Summary of common engagement themes Page 5 6 11 12 15 22 23 25 4
1. Executive Summary This report contains a summary of the engagement intelligence gathered from NES s stakeholders during 2012. The intelligence has been gathered from the following sources: - board engagement leads - regional networks - engagement by NES Directorates - engagement by NES Chief Executive and Chair - engagement with social care This report will be used to inform NES operational planning process and ensure that NES is meeting the needs of those who use its products and services. Whilst every effort has been made to ensure this report is as thorough as possible, it is designed to reflect only key stakeholder priorities and an indication of corresponding NES activities, rather than provide an exhaustive list. In summary the report has identified the following key themes to help inform our future planning; A key priority for almost all of our stakeholders is educational support for health and social care integration. Key themes which are relevant for many stakeholders are: - support for medical workforce planning (particularly in relation to paediatrics) - e-learning (increasingly mobile/app technology) - support for service redesign and reshaping the workforce (particularly healthcare support workers, paediatrics and reshaping the medical workforce) Key themes which are a priority for several stakeholders are: - older people and dementia services - rural general hospitals and rural fragility - leadership to support quality improvement and managing change - literacy: encompassing reading, writing, arithmetic and information technology skills Key national priority themes which feature across the range of our stakeholder feedback are: - the quality strategy and quality improvement - early years Acknowledgement Many thanks to all the staff involved in engaging with NES stakeholders for taking the time to contribute to this report. Those who have contributed are acknowledged within each section, as appropriate. 5
2. Board Engagement 2.1 Territorial Boards 2.1.1 NHS Ayrshire & Arran (Board Engagement Lead: RoseMarie Parr) - copyright issues - learnpro versus ess NES Response: Both issues being supported by the Educational Development Directorate (EDD). 2.1.2 NHS Borders (Board Engagement Lead: formerly Robert Parry & Fiona Gailey; currently Stuart Cable) - Healthcare support workers (HCSW) - Collaboration with social work - Dementia - E-learning - Paediatric and neonatal advanced practitioner development - Additional learning needs around dyslexia and dyscalculia Both EDD and NMAHP are supporting work with HCSW. Robert Parry and NMAHP lead work with the Scottish Social Services Council to support the National Dementia Strategy. EDD are leading inter-disciplinary work on all forms of literacy. Many directorates are involved in the support and development of e-learning packages, from both a technological and educational perspective. Robert Parry is leading work which supports integration of health and social care, including action learning sets. 2.1.3 NHS Dumfries & Galloway (Board Engagement Lead: RoseMarie Parr) - Integration of health and social care - Paediatrics - Reshaping Care & Dementia Strategy - Community Hospitals and Remote & Rural Healthcare Educational Alliance (RRHEAL) - Telehealth / Telecare - IT Literacy See response for NHS Borders. Also, RRHEAL are supporting Rural General Hospital workforce redesign and education and training for generic rural health & social care support workers. 6
2.1.4 NHS Fife (Board Engagement Lead: Robert Parry) - Leadership and Management Development - Healthcare Support Workers - e-learning Whilst the above have been identified as a priority, there are a number of local issues that NHS Fife has had to address throughout the year with the support of their Board Engagement Lead, including: the challenges of mandatory and statutory training and health and social care integration. Board Engagement Leads from the south east (NHS Borders, Fife and Lothian) regularly meet with SWEDAG, the regional forum whereby the three territorial boards discuss priority issues. Various NES staff have supported the group over the year e.g. Liz Jamieson on HCSW, Stuart Cable on statutory and mandatory training, Simon Williams on Return on Investment. NES has financially supported NHS Fife in two projects last year (Heart Disease Competency Framework and a project between NHS Fife and Fife Council, Fife Constabulary et al to develop a Public Sector Leadership Programme). NHS Fife is actively engaged in the elearning activity at NES and has welcomed opportunities to pilot and be involved in developments with EDD. During the year a number of queries from NHS Fife were referred to NES leads, including information about education and training of pharmacy and healthcare scientist staff. 2.1.5 NHS Forth Valley (Board Engagement Lead: Robert Farley) - trainer preparation, particularly for non-clinical groups - seeking a national approach to skills for working with the public/public engagement - leadership development which includes a focus on partnership working, particularly the integration agenda with social care - statutory and mandatory training - leadership development for genuine leadership cohorts, rather than those who self-select See response for NHS Borders. EDD are offering guidance on core areas of mandatory training and benchmarking work across Boards. 2.1.6 NHS Grampian (Board Engagement Lead: Gillian Needham) Key themes (also applicable to North region, excluding Tayside): - Impact of Reshaping the Medical Workforce: planning for fewer middle grade trainee doctors available for rotas. - Impact of ScotMT (medical trainee selection and recruitment) on post fill: high number of Speciality Training and Locum Appointment for Training vacancies in some programmes with disproportionate effect on North placements/programmes. - Planning for the potential new supply of Physician Assistants from the University of Aberdeen PG Diploma course first cohort graduate summer 2013. 7
There is a Regional (including Tayside) Reshaping Group that meets regularly to share practise. We have provided data for the NES Annual Report over several years that has demonstrated the differential impact of ScotMT on post fill, including application score analysis. Grampian, Highland, Orkney, Shetland and Western Isles have all been affected by disproportionate fill and quality of post-holder compared to Scottish norms and central-belt. Single rota systems such as the Island Boards are especially vulnerable to these effects (poor fill, poor quality fill) and this is rapidly becoming system critical. Scrutinising closely, since this is one example of how innovation could have a potentially negative effect on some parts of the Scottish NHS. 2.1.7 NHS Highland (Board Engagement Lead: Ronald MacVicar) - major focus on the integration of Health and Social Care with NHS Highland being the lead agency for Adult Services and Highland Council for Children s services. - Rural general hospitals - Rural fragility, especially in relation to general practitioners - Rural-track training and recruitment: recruitment to consultant positions and rural-track training posts is a challenge - Service redesign and the challenges of ensuring the supporting education meets needs in a timely manner Much of RRHEAL s work is helping to address these issues, including: NES Education Action Plan to support Rural General Hospital workforce redesign Education and training to support Generic/Rural Health & Social Care Support Workers A map of Rural Nurse Practitioner core competencies for acute and community rural settings. Further accessible Child Health emergency care learning materials Community Wheelchair Prescribing accessible training programme Community of Practice for senior Island Leadership group Midwifery training programmes accessible at distance Evidence Based Practice Remote Participation Seminars. NES/SSSC hosted a workshop with Learning & Development Leads from NHS Highland and Highland Council to identify current learning needs and resources (as stated on p.20) 2.1.8 NHS Lanarkshire (Board Engagement Lead: formerly Andrew Forgie, currently Janice Turner) - Integration agenda between health and social care - The transition of services from acute to community care settings to reflect the increased focus on care in the community - Service redesign - including reducing the number of beds in acute care, and reducing older people's services from 3 down to 2 sites 8
- The development of the NHS Lanarkshire Learning Strategy - Improving the quality of the learning environment - Streamlining access to education and training across the Board - Benefits of learning networks See NHS Borders response for NES support for integrating health and social care. 2.1.9 NHS Lothian (also applicable to South East & medical) (Board Engagement Lead: Bill Reid) - Medical staffing, especially paediatrics - Reshaping workforce issues - Induction issues The Postgraduate Dean for the South East has worked closely with the Health Board and Scottish Government regarding the medical staffing of paediatrics across Lothian. The Postgraduate Deanery in the south east has been encouraging students and foundation doctors to produce Quality Improvement projects in joint working with the 3 Boards (NHS Lothian, NHS Fife and NHS Borders), by introducing a Dean s QI Day at which prizes were awarded for the best projects. 2.1.10 NHS Shetland (Board Engagement Lead: Gillian Needham) - Medical staffing challenges - Integration with social work at management level The Postgraduate Dean for the North region is working closely with NHS Shetland regarding medical staffing. Support for integration with social care is outlined under NHS Borders. 2.1.11 NHS Tayside (Board Engagement Lead: Philip Cachia) - Workforce plans: indicate challenges with: medical workforce; retraction of smaller hospitals; recruitment of nurses for learning disabilities; and expansion of roles for Grades 1-4. - Use of Knowledge Network: There needs to be clear alignment of the needs of practitioners and other NHS employees, the methods used to deliver information and education, and access to appropriate educational resources. - Local / national programmes of training: In postgraduate medical and AHP training, consideration needs to be given to the balance of local / national training programme in terms of numbers and distribution of trainees across Health Board areas. 9
- Workforce development: Review of team structures, skill mix and educational requirements to support future service needs is necessary. This process will require educational support across professional groups and grades of staff. In May 2012 a Quality Improvement (QI) workshop, was run jointly by NHS Tayside and Knowledge Network. This provided practitioners involved in QI in the clinical setting with an opportunity to share their experiences of QI and discuss their educational needs with staff from the Knowledge Network. The reshaping medical workforce programme board has agreed to a pause in the reduction of numbers in some specialties. There are continuing concerns about the sustainability of small programmes in the North of Scotland as trainee numbers decrease. 2.1.12 NHS Orkney (Board Engagement Lead: Jane Cantrell) - Ongoing education and training needs: Affordable and accessible education required; distance learning /blended programmes work well e.g. Telebasics course. Need education that supports /enables Boards to ensure their workforce is fit for the future. Need access to high quality refresher training to sustain skills. Would value distance mentoring & supervision guidelines. - Supporting staff and structure changes integration of health & social care - New build in the future for general hospital - Support for transforming clinical services project.- whole systems approach to ensuring organisation continues to meet changing needs and is fit for purpose. - Sustainability of workforce with specialist skills-significant issues with existing education and training formats. Specific challenges discussed: costs, attendance formats backfill issues. - BASICS- Cost of course too high, 150 per person. Difficult for board to maintain /support numbers required. - Island/Remote Nurse Education- Need to review educational needs and improve access and affordability. NHS Orkney have an established list of key training requirements but: current format expensive; issues with backfill; not remote and rural specific. Need for an adapted, tailored remote and rural training programme to meet Island/Remote Nursing workforce needs. RRHEAL and NMAHP are working with remote and rural boards in the North to agree core Rural Nurse Practitioner competencies and have an agreed objective to identify the competencies for a Rural Practitioner as part of Scottish Government Remote & rural Implementation Group (RRIG) Action Plan and Rural General Hospital workforce redesign priorities. RRHEAL will explore development of competences for a combined hospital rural nurse practitioner with rural acute and community care skill set. This will ensure education in the future will offer remote & rural/island Boards greater flexibility in relation to future workforce / role development. RRHEAL have worked with remote & rural Boards in north to agree core Rural Nurse Practitioner competencies and have completed similar work in developing an adapted GP Acute Care Competency framework and education programme. 10
2.1.13 NHS Western Isles (Board Engagement Lead: Pam Nicoll) - Supporting workforce development and redesign activity re: modernising the rural workforce. - Education to support development of Support Workers - Affordable Education to support Advanced Nurse Practitioners - Education support for GPs See RRHEAL activity outlined under NHS Highland. 2.2 Regional Engagement 2.2.1 North (Grampian, Highland, Orkney, Shetland, Western Isles, Tayside) (Key NES contacts: Gillian Needham, Pam Nicoll or Karen Howe) - North of Scotland paediatric review. There are 22 recommendations under wider headings of: improved quality leadership; safe & accessible care; sustainable workforce. - North of Scotland neonatal network: a gap analysis has been undertaken against the quality framework for neonatal care in Scotland. Key themes were: staffing, communication, education & training, transport and facilities. - Physician s assistants: the Grampian and Aberdeen University course is recruiting its second cohort. - Remote & rural practitioners: a common unmet need across remote and rural areas - pressures to reduce supplementary staff costs i.e. bank and locum staff across the region RRHEAL is developing a competence list and looking at educational requirements. EDD is working with NHS Grampian and Health Professions Council on possible state registration for the Physician s Assistant role. NMAHP is working with the North of Scotland neonatal network. 2.2.2 South East (Borders, Fife, Lothian) (Key NES contacts: Stuart Cable, Robert Parry and Bill Reid) - Medical workforce issues (particularly in paediatrics, but potentially also in obstetrics & gynaecology, accident & emergency and mental health). - Working on linking the various local workforce plans (and the associated education & training) with the ongoing review of nursing education. Looking to integrate these 2 agendas regionally - Adopting a regional approach to continuing professional development funding from higher education institutions - Integration of HCSW between health and social care - E-learning The Postgraduate Dean for the south east works closely with all Boards across the south east regarding medical staffing. Representatives from NES Nursing & Midwifery are working with the south east regarding nursing education. Support for integrating health and social care is outlined under NHS Borders. Various staff from EDD have supported the region in the area of e-learning. 11
2.2.3 West (Glasgow & Clyde, Lanarkshire, Forth Valley, Ayrshire & Arran, Dumfries & Galloway) (Key NES contacts: Alastair McLellan, RoseMarie Parr and Karen Howe) - Regional Medical Workforce Group: two of the regional speciality sub groups are planning to meet. Emergency medicine is meeting to discuss pressures on middle grade level and paediatrics is meeting to understand Board retirement and replacement plans for the community child health workforce. - Regional Oral-maxillofacial Surgery (OMFS) group: an exercise is underway to refresh the current workforce and staffing information. Planning is underway to transfer the service from NHS Ayrshire & Arran to NHS Greater Glasgow & Clyde. - Regional Child & Adolescent Mental Health Services (CAMHS) Network: supporting the national change agenda around CAMHS inpatient and community service provision for adolescents. West region are bidding for additional funds from Scottish Government to extend the work to 2015. - Regional child health group & regional paediatric clinical network: work focussing on the impact of Modernising Medical Careers and European Working Time Directive on paediatric workforce & future community paediatrics workforce - Regional neonatal managed clinical network: a workforce model has been developed to reflect each Board s current workforce against the indicators contained within Neonatal Care in Scotland The Postgraduate Dean for the West region works closely with all Boards across the West region regarding medical staffing issues. 2.3 Special Health Boards 2.3.1 NHS Golden Jubilee National Hospital (Board Engagement Lead: Colette Ferguson) The only issue identified from this hospital related to literacy issues. EDD worked with the hospital to find a solution to this specific issue. 2.3.2 NHS Health Scotland (Board Engagement Lead: Jane Cantrell) - Tackling health inequalities - Better collaboration with other agencies - Evidence-informed decision making - Better designed programmes and services - Improved workforce capacity - Organisational excellence and innovation NES works closely with colleagues from NHS Health Scotland on a range of overlapping issues, including: health behaviour change, equality & diversity, foetal alcohol spectrum disorder and maternal & infant nutrition. NES is participating in a 12
mapping exercise that is being carried out to identify any other areas of potential overlap. 2.3.3 NHS Healthcare Improvement Scotland (NHS HIS) (Annual meetings are held between each Board s Executive Team) - supporting delivery of the quality strategy - contributing to the integration of health and social care - embedding patient centred care within the existing infrastructure Various NES staff are working closely with NHS HIS on all of these issues. There is also work ongoing to share intelligence regarding the integration of health and social care. 2.3.4 NHS National Services Scotland (NSS) (Board Engagement Lead: Donald Cameron) The current priority areas from engagement with NSS focus around Health Protection Scotland (HPS) and the NSS Information Systems Division (ISD). HPS an NSS priority is health protection education which will; define local and national workforce education needs implement European, UK and Scottish knowledge, skills and competencies requirements develop and roll out educational packages ISD another priority area is joint working between the NSS newly structured ISD function and the NES AIM for workforce programme. NES and HPS - have a Memorandum of Understanding and have a joint Health Protection Programme Director/Manager. Together our organisations are supporting workforce development through the following; a National Health Protection Education Advisory Group health protection training for Specialist Registrars training and educational resources for epidemiology and incident management a career framework for health protection nurses advice on health protection workforce development Healthcare Acquired Infection (HAI) and Antimicrobial Resistance (AMR) advice and educational resources HIV educational advice and resources pandemic flu workforce development advice NES and ISD - NES have contacted ISD to identify their new workforce contacts under their new structure with the aim of developing close relationships between the key people in both organisations and to focus on quality. ISD have undergone significant change (to integrate horizontally) and in addition to working with key workforce contacts our Analysis, Intelligence & Modelling (AIM) team will engage with the ISD Head of Service for Data Management and also with the new 'Bespoke 13
Specialist Services' unit who are tasked with supporting new projects and innovation in the service. 2.3.5 State Hospitals Board for Scotland (Board Engagement Lead: Susanne Forrest) The School of Forensic Mental Health was established 5 years ago to address the specific educational needs of staff working at the State Hospital and the wider Forensic Network. The School offers a range of educational programmes including the New to Forensic Programme which was established with support from NES. It will launch a new MSc in Forensic mental Health in 2013. NES Response NES continues as a member of the School of Forensic Mental Health Board. 2.3.6 NHS 24 (Board Engagement Lead: Karen Adams) - Telehealth - Areas of joint working with NES - The key priority re learning and development at present is linked to the changeover to a new software system which will be more sensitive to user needs. Once active, all NHS24 staff involved in using the patient pathway system will need to be trained to use this new software. - Recruitment of adequately experienced nursing staff is a major challenge, which is being managed by service redesign RRHEAL and EDD are in discussion with NHS 24 around the potential of a national video conferencing network to support remote and rural education. There are also discussion about the use of telehealth and telecare in medical, nursing and pharmacy curricula. 2.3.7 Scottish Ambulance Service (SAS) (Board Engagement Lead: Brian Durward) - Statutory and Mandatory Training - Areas of joint working with NES - Service redesign and training implications for the SAS - Patterns of recruitment for SAS grades of staff - QI for SAS staff Discussion with SAS around the potential for a bespoke QI programme. Creating links to Statutory and Mandatory developments in EDD. Creating links between the NES clinical skills programme and the SAS. Liaison with new senior staff appointments in the SAS. 14
3. Engagement by NES Directorates 3.1 Allied Health Professions (AHP) Theme 1: Supporting the changing needs of the AHP workforce - Making the most of the skills that AHP staff have by providing educational support that connects practice and policy - Take account of the wider health agenda by supporting learning between health and other sectors e.g. social care, education, third sector - Enable AHPs to access and use learning and development opportunities to support change, improvement and innovation - Provide opportunities that help AHPs to make the most of work-based learning opportunities - Develop AHP capacity and capability in leadership and quality improvement methodologies to improve the quality of care within agreed priority areas. Theme 2: Make communication even better - Work with service users and carers to develop education that supports the principles of inclusive communication and helps the AHP workforce to build on their communication and interpersonal skills. Theme 3: Support AHPs to use educational solutions in their work - Reduce duplication of effort by supporting AHPs across the country to share their own educational solutions - Demonstrate best practice by making sure all our educational solutions are based on evidence, impact assessment, evaluation and review. NES AHP operational plans have been addressing these priority areas since 2011. The directorate are also taking a different approach to engagement with the territorial health boards to ensure a more tailored response to their needs. NES is working with Board AHP directors and the NHSScotland Quality Improvement Hub to address leadership and support for quality improvement. 3.2 Dental - Approval to advertise posts is very slow, but recruitment is very healthy once posts are advertised. NHS Boards do not appear keen to develop new work-streams at present. - NHS Boards are keen to develop intermediate levels of dental care - Organising meetings with key stakeholders is very challenging due to competing pressures on already, very busy staff. This has repercussions on NES staff time and leads to delays in work, due to the length of time between meetings Support local staff and emphasise that not recruiting to NES funded posts has no financial benefit for territorial Boards. The directorate already offers Remote and Rural fellowships and is investigating if this can be rolled out to other areas. Also investigating how training at this level could be delivered i.e. NES, Royal Colleges, Universities, etc. Organising meetings on a fixed schedule, but remaining as flexible as possible. 15
3.3 Education Development Directorate 3.3.1 ACS Programme - administrative services and non-clinical support services (estates & facilities). - A number of Boards have undertaken, or plan to undertake, a review of administrative services with an aim of making services more efficient. - The age of the estates workforce in most NHS Boards continues to cause concern as large numbers are approaching retirement and little or no succession planning has been undertaken. - Many staff in these groups are not being released to undertake training. There is therefore growing pressure to identify learning which can take place through work as opposed to at work. - There are still complaints that facilities and estates staff have little or no access to IT. Members of the ACS team have: Met with representatives from a range of Boards and networks to discuss how the administrative core skills map and The Admin Centre can support administrative services. Launched three demonstrator projects designed to test the core skills map for estates and facilities staff. These projects will help to create development pathways for staff in these service areas. The projects are being carried out in NHS Borders, NHS GG&C and NHS Tayside. Started work on co-ordinating support at a national level for the use of Modern Apprenticeships (MAs) in NHS Scotland. Although MAs apply to a wide range of areas in the service, they are often seen as particularly relevant to estates and facilities services. Ensured that the learning sections of both The Admin Centre and the new portal for support services staff (currently in development) highlight different approaches to learning through work. These sections are highlighted in presentations to/discussions with different staff boards. Raised the issue of IT access with a number of groups (IM&T Network; Quality Strategy Co-ordinating Group; E-Health team at Scottish Government Health Department (SCHD)). Visited a number of Boards to promote the resources and support provided by the ACS programme and gather information about what else is required. 3.3.2 Knowledge Services - Systems: Need for clear direction of travel from NES around Learning Management Systems and elearning Content Creation tools, standards and processes. Growing interest in mobile/app development and use of social media for knowledge support and learning. 16
- Content: Need for easy and quick access to subscription journals. Need for easy to use and comprehensive point of care knowledge services. - Strategy (Knowledge into Action review and strategic framework): Need for clinical engagement and leadership. Endorsement of aligning our knowledge services with Quality Strategy and quality improvement. Importance of flexible support framework that enables Boards to implement at their own pace and in a way that supports local priorities. Staff within Knowledge Services are working closely with stakeholders to address these issues. 3.3.3 National Leadership Unit (NLU) - Clinical leadership / engagement - Boards and stakeholders are continuing to emphasise the need to support clinical leadership (all clinicians) and ensure that they are involved in leading quality improvement and transformational change - Cross sector development - Our stakeholders are emphasising the need for more development to take place across sectors particularly in support of the health and social care agenda. - Board development - our stakeholders are looking to the NLU to support Board development. This includes both the development of individual groups i.e non executives as well as the whole Board as a functional unit. The latter is a particular challenge for small Boards who have very limited organisational development resource. Stakeholders are keen for the NLU to support work with strategic teams and Boards as there is a gap in this provision. - Complexity and transformation - our stakeholders highlight the increasing complexity of the environment in which they are working. The challenges that organisations now face are complex / 'wicked' in nature and there is a commonly held view that they will not be resolved by taking a traditional approach. There is a need to encourage a much more innovative and creative approach to how we think about some of the healthcare quality challenges and how we work within our organisations to support a culture of improvement and innovation - Culture and values - In the wake of the reports from NHS Lothian and Ayrshire and Arran, our stakeholders regard the embedding of an agreed set of values and behaviours that promote a culture in our organisations that has people (patients carers AND staff) at its heart. There is a strong view that we must now not only focus the service of what is delivered but the way in which it has been delivered. In reviewing the leadership strategy as part of the 2020 workforce vision, this needs to be embedded and interventions identified that will support this shift in emphasis The NLU continues to run its succession planning programme (Delivering the Future) to ensure that there is capacity in the system. The Scottish Clinical Leadership Network will be developed as part of the Leading Quality Network as a way of increasing the pace and spread of quality improvement. The NLU supports work that is cross sector e.g. Chief executive / Chief Officer action learning sets. The NLU is working closely with colleagues across the sectors to look at opportunities to share resources and work together on areas of mutual interest / concern i.e. succession planning 17
The NLU provides development support to Chairs, Chief Executive Officers, executive directors and Chairs of Area Clinical Fora. The leadership strategy is currently being reviewed to address the most recent needs of Boards and stakeholders. 3.3.4 WEDG (Workforce & Education Development Group) Over the past 12 months, most external enquiries (n=58) have come from local health boards, special health boards and higher education institutions. Key topics are: return on investment training, equality & diversity issues, e-learning and designing educational solutions. The WEDG team (in collaboration with colleagues) responds to each enquiry as it comes in. The team are also analysing each Health Board s workforce plans, which will help to strengthen the intelligence gained from the engagement process. 3.4 General Practice - As one of the contracted services in Primary Care (along with dentistry, pharmacy and optometry) general practice has a major interest in, and commitment to, progressing a multi-professional primary care agenda. - The Royal College of General Practitioners has successfully made the educational case for enhanced GP training to the Medical Programme Board in England and the Scottish Medical Training Board. This enhancement involves an extra year in training (to a standard four year programme) with two years in General Practice (currently 18 months), 18 months in hospital specialties and a six month community post. - Recruitment to GP Specialty Training. Training Numbers are set to remain static for 2013 in General Practice with no reductions, as is the case in many other specialties. However, recruitment to training opportunities in Scotland has shown a worrying pattern in recent years where Scotland is not as popular as other parts of the UK, especially programmes and rotations that are distant to the urban centres. The National GP Director is working with Director of Pharmacy to take forward a NES Primary Care Network with a new Primary Care cross directorate initiative based on integrating Human Factors principles and learning from Patient Safety Incidents. Enhanced GP training has major funding and practical implications in Scotland, including funding an extra six months experience in general practice and in decommissioning a tranche of six month hospital posts that are currently used to populate our four year programmes. The Director of GP Education in the West of Scotland is leading a group to consider how these new programmes could be implemented in Scotland. Difficulties in recruiting are not unique to General Practice and efforts to understand and address this are ongoing. 18
3.5 Healthcare Science Clearer identity of Healthcare Science across the career grades Risks regarding the availability of recurrent funding to support the many professional groups within the Healthcare Science workstreams. At present this primarily depends on attrition from current schemes, unless additional Scottish Government or other resource is obtained Reduction in employment opportunities for all grades of Healthcare Science staff Preparation of Healthcare Science trainers for work-based learning Support for more junior staff at the initial stage of their career NES Response: NES has introduced a common core list for Postgraduate Scientist trainees (scientist level), regardless of specialty or profession. These we define as our training grades. We have pioneered a register of post-graduate trainees all of whom have National Training Numbers and we have, in 2012, surveyed both trainees and supervisors 1% uplift on trainee salaries will be made available for Healthcare Science trainees, and further non-recurrent funding may be made available from SG to support trainees in 13-14 NES will produce the equivalent of 17-20 pre-registration clinical scientists moving from supernumerary training posts to frontline posts from a total cohort of 65-70 over the training cycle. NES will also support up to 45 Healthcare scientists to work towards a postgraduate specialist qualification NES will continue to develop its well-regarded Train the Trainer / Assessor programme for Healthcare Science with support from the NES Training and Development Support Unit (TDSU). During 2012-13 we will deliver a generic train the trainer programme to 5 cohorts of HCS trainers NES will support NHS Boards to develop HCS support workers and assistant practitioners. During 2012-13 NES will provide posts to complete the first intake of a clinical physiology assistant practitioner programme, will develop a national career framework and associated job descriptions for life sciences support workers, will hold a professional forum to identify training pathways that enable HCS support worker and assistant practitioner development NES continues to offer support to practitioner level (undergraduate trainee) physiologists we are encouraging the development of a common approach to physiology pre-registration training in Scotland NES will continue to develop its Early Career programme for junior Healthcare Science staff. We are now in the second round of support using this model NES remains closely sighted on developments concerning Healthcare Science career modernisation. Our strategy is to ensure that Scottish training arrangements are compatible with these developments. 3.6 Medicine - Medical workforce planning - Medical undergraduate numbers - Foundation programme: oversupply - Speciality training in General Practice - GMC Approval & recognition of trainers - GMC review of Quality Assurance & Standards - UK Medical & Dental selection and recruitment 19
- UK shape of training review NES is part of the Scottish Government s National Reshaping Medical Workforce Project Board, which recently agreed that instead of a blanket approach to devising training numbers, each medical speciality would be considered individually and different approaches used as necessary. In addition, it was also agreed that there would be a move away from the Scottish Government setting detailed intake numbers annually, to a process which will allow NES to manage the agreed overall numbers of whole time equivalent trainees in programmes across Scotland over time. A number of key specialities, including: acute medicine; emergency medicine; anaesthetics; and paediatrics have been identified as requiring further detailed work. NES continues to be involved in the annual Scottish Government process for recommending intake numbers for undergraduate medicine in 2013. For the 2012 intake, a reduction of 50 was made and the recommendation is that no further reduction be made in 2013. As a consequence of decisions made in the past regarding intakes to medical Schools across the UK, it is anticipated that, over the next several years, there will be an excess of graduates from UK Schools, over available funded foundation training places. A range of short, medium and long term solutions are being considered. The RGCP has made proposals for extending and enhancing GP training. The NES GP Directors set up a short-life working group to scope (i) how changes to current Scottish programmes could be configured to be attractive to trainees, GP practices and the service, (ii) an economic assessment of potential costs for a range of new 4 year programmes, (iii) what the new programme content might be and how the 4th year - which will comprise a mix of community placements and work in GP practices, could work, (iv) an incremental approach to the introduction of 4 year programmes. The GMC Council has agreed a phased process for implementing new arrangements for recognising trainers. The GMC have published a detailed implementation plan with timelines. This work will be challenging for NES and the service. The GMC has embarked upon a wide-ranging review of its approach to Quality Assurance of Medical Education and training. The review should conclude by the end of 2013. Health Education England have been leading a UK programme of work to develop a nationally coordinated system of selection and recruitment into medical speciality training. The Scottish Medical Training Board has approved Scotland making use of the existing UK (Deanery and College based) speciality recruitment systems for 2013, on a pilot basis. NES is one of the joint sponsors for the UK shape of training review, which is currently taking evidence and a final report is anticipated late 2013. 3.7 Nursing & Midwifery Strategically - sustainability of educational resources - enhancing educational partnerships (NHS Boards, Higher Education Institutions (HEI) and NES) - impact on quality (education & practice) 20
Operationally Healthcare Support Workers Older People in Acute Care Community Nursing Modernisation Health and Social Care Integration Midwifery Education Provision Dementia/Cognitive Impairment Senior nursing & midwifery staff from NES are working with stakeholders to address the strategic issues, while there are small teams within nursing & midwifery addressing each operational issue. 3.8 Optometry - development of an Educational Institute within NHS Lothian - staff secondment from the Edinburgh Eye Pavilion to provide medical cover for Teach and Treat clinics within the Institute - development of a new Stobhill Teach and Treat Clinic for NHS Greater Glasgow & Clyde The Programme Director for Optometry is working closely with both Health Boards to progress these developments. 3.9 Pharmacy - The SGHD Review of NHS Pharmaceutical Care in the Community - Health Education England and Modernising Pharmacy Careers proposals for an Integrated 5 Year Undergraduate Programme in England - The General Pharmaceutical Council registration requirement for mandatory Continuing Professional Development and the forthcoming Revalidation for pharmacists and pharmacy technicians NES Pharmacy team are working with colleagues and stakeholders on these issues. 3.10 Psychology - Meeting HEAT target requirement for Psychological Therapies and CAMHS. - Gaps in Older People s services (psychological capacity across whole workforce). - Gaps in Physical Health services (psychological capacity across whole workforce). Education and training developed/planned to support Boards with HEAT targets. 21
Education and training developed/planned to meet capacity groups on Older People s and Physical Health services. 3.11 Remote & rural healthcare educational alliance (RRHEAL) - Need for education to support Rural Hospital workforce redesign - Need for education to support Rural Fragility issues across community workforce - Need for new and adapted education and training to support development of Rural /Generic Health & Social Care Support Worker role Action or response: RRHEAL 2012/13 Objectives designed to deliver a response in each of these key areas. RRHEAL are lead partners in international Northern Periphery Programme Recruit& Retain project NES Education Action Plan to support Rural General Hospital workforce redesign Education and training to support Generic/Rural Health & Social Care Support Workers A map of Rural Nurse Practitioner core competencies for acute and community rural settings (in partnership with NMAHP). Further accessible Child Health emergency care learning materials Community Wheelchair Prescribing accessible training programme Community of Practice for senior Island Leadership group Midwifery training programmes accessible at distance Evidence Based Practice Remote Participation Seminars. 4.0 Engagement by NES Chair and Chief Executive 4.1 NHS Greater Glasgow & Clyde (NHS GG&C) - a positive evaluation report of the NHS GG&C demonstrator sites working with HCSW and a redesigned skill mix. - Seek a national approach to medical workforce planning groups to negotiate reductions in training post numbers - Adopting new approaches to youth unemployment and introducing a modern apprenticeships (MA) programme - Application for funding to support a recognition of prior learning (RPL) project with Estates & Facilities staff NES will build the findings from the NHS GG&C HCSW report into the NES national review of the HCSW role to help establish a consistent national approach to role development for this group of staff. Medical workforce issues are being addressed by the NES Director of Medicine. NES is exploring taking on a national co-ordinating role for MAs across NHSScotland, possibly working with Skills Development Scotland. NES will take this forward through a national workshop to explore how we could best achieve this. NES has funded the NHS GG&C RPL project and is receiving support from EDD. 22
4.2 NHS Highland - Challenges associated with rural general hospitals - Education to support the role of the generic/rural health & social care support worker To ensure this issue was on the agenda at the Educational Leaders Group Facilitate engagement with appropriate colleagues to ensure that this is raised with Scottish Government Provide additional funding to support the development of an education programme for rural/generic support worker in NHS Highland and Orkney NES and SSSC have met with key contacts within NHS Highland to explore educational needs and competencies around the role of rural/ generic workers 5.0 Engagement with Social Care 5.1 Social Care Integration Key theme: Facilitating health and social care integration. Work with NHS Highland and Highland Council revealed a need for the following: - Leadership development with senior staff - Team leaders supported in managing change - Outcome focused care (Sliding Doors) approaches - Commissioning processes - Communication skills - Understanding differences between different regulatory boards - Health and Social paradigm information - Education and training applicable across both sectors A review of the draft Highland Change Fund Plan revealed that transformational change is considerable and the requirement for staff to work in new / different ways is significant e.g. telecare /health, equal partnerships to develop competency, capability and capacity in commissioning practice across all sectors. Admirably, the Highland Joint Community Care Plan 2012/13 sets outcomes to be achieved in these areas. Where training and education are identified, it is in health behaviour change, self management champions, nutritional care, falls prevention and dementia support, clinical skills development/mentoring and Carers (services commissioned for older people will support carers and training around carer awareness and carer identification). Through commissioning it acknowledges Leadership and Culture and the need to develop in this area. NES has worked with the Scottish Social Services Council (SSSC) to develop and deliver Action Learning Sets to support health and social care integration. These action learning sets have been used by NHS Highland and Highland Council and 23
they will be offered to all NHS Boards who have highlighted this, via the engagement process, as a priority. To date, the action learning sets have also been used by the following Community Health Partnerships: Highland mental health and Highland Reablement; Perth & Kinross (Shifting Balance); North East Fife and Glenrothes; Aberdeen City and Aberdeenshire; East Dunbarton; East Renfrewshire; and Shetland. Many of these issues have also been identified by the National Leadership Unit as requiring support and action. 5.2 The Institute for Research & Innovation in Social Services (IRISS) IRISS is a charitable company and this is a strategic partnership underpinned by a Memorandum of Understanding. Bob Parry, Associate Director sits on IRISS Strategic Board as an Observer. IRISS vision is for a high quality, continually improving social services sector renowned for its effective use of knowledge and research based innovation whose work is organised into three interrelated programmes: - Evidence Informed Practice - Innovation and Improvement - Knowledge Media In 2011-12 NES has worked in partnership with IRISS to support both health and social care workforces. Knowledge Services has set up the Social Services Knowledge Services portal. The NES Child Health Team, NHS Greater Glasgow and Clyde and IRISS developed scenario based video resource to support practitioners through the use of routine enquiry to help families seek financial support from debt. 5.3 Scottish Social Services Council (SSSC) This is a strategic partnership underpinned by a Memorandum of Understanding. - Integration of Adult Health and Social Care NES and SSSC are seen has national partnership leads in education and workforce. - Supporting the delivery of key Scottish Government priorities for the health and social care workforce including Dementia Strategy Carers Strategy Reshaping Care for Older People Health and Social Care Support Workers Early Years Leadership All the above work-streams have outputs and have produced a range of educational and workforce development solutions including: 24