PPMA Seminar 2016 - Aspirations for integration and the workforce challenges
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Aspirations for integration and the workforce
challenges Guy Daly
and David Holmes
Introduction
• Context/drive for integration• Evidence• Projects
– Older adults workforce integration– HEE LET B transformational theme
• Lessons learned• Challenges and opportunities
Context and Drivers• £ challenges
– Health inflation (c4%)– Current efficiencies (0.5-1%)– Most acute Trusts in deficit
• FYFV– Need £30M– Got £10bn - CHECK
• Local government – 46% austerity reductions• Need/demand/demographic challenges
‘Crisis’ in health and social care
• NHS – funding & budgets– workforce– challenges: mid-staffs/Francis– expectations
• Social care funding (means and need)• Workforce challenges in both health and
social care
Yet health care (and public health) a great success
• Commonwealth Fund 2014 research• improvements in mortality and morbidity • BUT inequalities in health persist
– Service area– Geographically– Demographically
• Age• Ethnicity• Class
Social care less so …?
• increasingly only the most needy • Winterbourne View• Market failure – Southern Cross• 10 fold difference in use of residential care
across UK • no residential care in London because no
one can afford it • See Professor John Bolton
… social care less so?• LA social care – 1/3rd of LAs have seen increases,
1/3rd a cut • even with 2% c tax increase (if all local authorities
increased by 2% over next 4years, still £4bn short;• residential care for older people (nursing and res
care) – many / most die within 0.5-2 years;– 0.25 recover and leave the nursing home to go
home– so, getting it wrong for 0.75??
Health and Social Care Policy
• 1946 NHS Act & 1948 National Assistance Act
• Crisis of funding in the 1980s– ‘perverse incentives’
• 1990 NHS and Community Care Act – empowering community care users
Health and Social Care – the Coalition and Conservative Governments
Health and Social Care Act 2012 CCGs and AWP
Continued roll out of IBs, PBs, DPs in social care
Crisis of funding Dilnott Review (2011-12)
Commission on Funding on Care and Support
• White Paper (HMG, 2012) - Caring for our future: reforming care and support and Care Act 2014– promote independence & wellbeing– greater national consistency in access to care– provide better information to help choices – more control– improve support for carers– improve the quality of care and support– improve integration
• Care Act 2014• Postponement to 2020• Cap on individuals’ expenditure• Overall (individual and LA) expenditure
capped at £72,000 – subject to inflationary increases
• Better Care Fund• 2% Council Tax for social care• 5YFV, Vanguards,
State of Social Care now (1)
social care markets mixed economy of providers has occurred substantial shift to independent sector little LA/public sector provision
shift to home care numbers of LA funded users decreases year on year only those most in need receive LA funded support
paradoxically, these individuals have received more hours of care and more bespoke care
Non publically funded users increasingly resorting to self funding
The solutions?
• Integration• Social movements & asset based
approaches • Choice and personalisation• Socially insured health and social care
Integration the answer? • Very complicated health and
social care system currently• Tackle bedblocking• Various examples - NI, Torbay,
etc.
…integration the answer?
• Work of Jon Glasby• Unhelpful disruption of reorganisizations• Have to deal with health and social care
divide – the 1944/46/48 legislation• More efficient, effective, efficacious?• It certainly would help….• Governance
– role for local authorities or combined authorities
Integration – the answer?
• FYFV• Care Act 2014• Framework 15 – HEE Strategic Framework
2014 - 2029• New Care Models - Better Care Fund,
Vanguards, STPs• Devolution
Integrated care map: examples of new models of care in practice
• See Kings Fund• http://www.kingsfund.org.uk/topics/integ
rated-care/integrated-care-map
• England – 34• Europe – 4• Rest of World - 11
Defining Integration
• Mix or join• Combine• Desegregate
Integrated Care - DefinitionsIntegrated care is person centred co-ordinated care: “I can plan my care with people who work together to understand me and my carer(s), allow me control and bring together services to achieve the outcomes important to me.” (TLAP/National Voices, 2013)
“Care which is intended to improve the quality of care for individual patients, service users and carers by ensuring that services are well co-ordinated around their needs”. (Kings Fund)
Varieties of Integration
• Health and social care• Primary and secondary• Patient/care pathways
Examples from the West Midlands
• Older adults workforce integration• HEE LET B Integrated Care
Transformation Theme
Learning from the Older Adults Workforce Integration (OAWIP)
Programme
David HolmesHR Director
Context• Increasing numbers of
older adults/increased longevity
• Increasing numbers with complex co-morbidities / LTCs
• Need to reduce emergency admissions, length of stay and facilitate effective discharge from hospital
• Improving the experience of people who use services
• Develop a fit for purpose workforce delivering appropriate care in the right setting
• NHS Five Year Forward View • Care Act 2014• Framework 15 – HEE Strategic
Framework 2014 - 2029• New Care Models - Better Care Fund,
System Transformation Plans, Vanguards
Delivering Integrated Care
From an approach based on: To an approach based on:
Patients Population health management
NHS workforce Health and social care workforce - statutory, private and voluntary sectors ….and wider!
Organisations Places
Workforce plans primarily focused on the NHS workforce
Integrated system-wide workforce planning
Programme Board – bringing partners together
Acute Trusts
Patient & Practitioner reference groups
Community Health Trust
Local Authorities
(Social Care)
Mental Health Trust
Better Care
Boards
CCGs
Crucial role of care co-ordinator
Consider the wider workforce, including: independent sector
providers, social care, informal carers
ICT is an enabler but don’t over rely on it - process and interpersonal communication are more important
BEST PRACTICE
RESEARCH Multi-disciplinary teams should be built around models of continuous learningTake care with
recruitment to new roles – use value based approaches and ensure buy-in from the team
Knowledge of local population and services is very important
Service redesign and workforce development need to go hand in hand
Co-location helpful - more important for team members to align their goals and work together
Patient engagement is important to sustain integrated services, that are responsive
Learning about Integrated Working
Older Adults Workforce Integration Programme - Pilots
Project Theme Lead Organisation
Integrated Care Model Pathfinder Healthcare Developments CIC
Falls and Fractures - Care Homes University Hospitals Birmingham NHSFT
Falls Prevention – Health and Social Care
Walsall Council
Complete Care Programme (community)
Birmingham Community Healthcare NHS Trust
Integrated Care and Support (GPs) Solihull CCG
Competency Based Education and Training Programme – Care Homes
Shropshire CCG
HEE LET B Integrated Care Transformation Theme (ICTT)
Aims• implement workforce development interventions that
enable new models of care to be delivered• vehicle for expanding and applying work previously
undertaken on integrated working, including from OAWIP
• scale and spread products and tools already developed – Identifying best practice and pilot projects, – e.g. principles and framework for integrated working,
care coordination and development of care home workforce and volunteers
Acute Care
Diagnostics
Self Care
Specialist Treatment
Primary Care
More Investment In Workforce Here
Prin
cipl
es A
nd F
ram
ewor
ks F
or In
tegr
ated
Wor
king
(Wor
kstre
am 3
)
Workforce C
ompetencies And D
evelopment Program
mes
(Workstream
4)
Support Self Care And Digital Innovations (Workstream 1)
Kais
er P
yram
id M
odel
Mindset And Culture ShiftINTEGRAT
ED CARE THEME
Long Term System Vision And Workforce Profile (Workstream
2)
Integrated Care Transformation Theme: Workstreams and Relationship with other
Transformation Themes
Lead
ersh
ip T
hem
e
Mental Health Theme
Acute, Urgent &
Emergency Care Theme
Primary & Communit
y Care Theme
ICTT
1. Development of education packages for carers, volunteers and to support self-care 2. Delivery of a shared longterm system vision with clear workforce recommendations and multi-organisation signup (tested in Birmingham & Solihull) 3. Production of a directory of principles and best practice to support integrated care 4. Produce an agreed shared competency framework for key roles in delivering integrated care.5. Develop and deliver education to support healthy ageing 6. Development of Data Sets for Evaluation
Learning from elsewhere
• Skills for Care• Skills for Health
Skills for Care – Creating new roles
• Care Navigators/Co-ordinators • Physician Associates supporting doctors in
the diagnosis and management of patients • Associate Nurses (Nursing Associates)
widening access to the profession and supporting the requirements for nurses within Social Care settings
• Joint Health and Social Care Apprentices
Skills for Health’s Six Steps Methodology to Integrated Workforce
Planning
1. Defining the plan2. Mapping service change3. Defining the workfoce requres4. Understanding workforce availability5. Developing and action plan6. Implement, monitor and refresh
Overall key Messages1. Alignment of leadership and OD with workforce development initiatives2. The definition of the workforce3. The need for integrated system workforce planning4. Workforce redesign – roles and competencies5. Approaches to learning and development
1. Leadership and OD
• Workforce development in isolation?• The importance of OD and systems
leadership in promoting integrated working
• Sustaining integrated working• Experience of pilot projects• The “Leading Integrated Workforce
Solutions” Programme
2. Defining the WorkforceEveryone, including paid and unpaid/informal carers, working in health and social care settings, including people’s own homes.
Workforce integration v integrated working • Relationships• Understanding each others perspectives• Good communications• Trust
3. Integrated System Workforce Planning
• Across health and social care economies• To reflect new models of care• HEE North Central and East London• Aligned with local commissioning priorities
and plans• The offer: helping commissioners to identify
and address workforce implications• HEE North West – Devolution, Workforce
Planning and development of tools
Integrated System Workforce Planning Challenges
• Definitions: the system, the workforce, the plan?
• Timescales• System leadership• Intelligence gathering –
demographics/long term conditions, trends and projections,
• Workforce intelligence: health, social care, PIV
Integrated System Workforce Planning Challenges
• Definitions: the system, the workforce, the plan?
• Timescales• System leadership• Intelligence gathering –
demographics/long term conditions, trends and projections,
• Workforce intelligence: health, social care, PIV
4. Workforce Redesign Options
New (alternative) worker
New work
Old worker
Old work
increasing the numbers of nurses, doctors, and other health professionals
expanding the job descriptions of existing workers, such as community matrons, to include work previously not done by anyone
handing off existing tasks to other workers, such as nurse practitioners and general practitioners with specialist interests
creating new jobs for work previously not done by anyone, such as genetic counselors, and lay providers to support self-care
Redistribution Creation
Capacity expansion Retraining
Source: Bohmer, Imison. Health Affairs 2013
Skills, Competencies, Roles• Common principles, values, behaviours
based on outcomes for patients/service users
• Competencies, skills and knowledge for the wider team
• Care Co-ordination and Navigation • Supporting workforce transition, eg
acute to community settings• Apprenticeships
5. Learning and Development
• Emphasis on learning together, training, networking, job rotation
• Expand Multi Professional Learning opportunities
• Common foundation and part of CPD• Role of HEIs and other training
providers
Conclusion
• HR Practitioners • HR Business
Partners• Learning and
Development Specialists
• Terms and Conditions?• New Organisational Structures?• Changing the way we work √• Change management/OD √• Systems Leadership √• Integrated workforce planning √• Creating shared opportunities for
learning √
ConclusionsChallenges and opportunities
• Challenges– Funding– Workforce demography– Levels of education and training of social
care workforce– Changes to funding of NMAHP pre-
registration education
• Opportunities– Integrate(!) into the STPs– Devolution/Combined Authorities
Discussion
• Thoughts from other experiences• Other examples• Key challenges• Key opportunities
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