Evidence submitted by Institute of Healthcare
Management (WP 77A)
1. GENERAL COMMENTS
The Institute's comments are broadly divided
into three areas. Firstly, a general response to the points raised
by the Committee. Secondly, and in view of the emerging issues
in the need for high quality Primary Care and Commissioning arrangements,
a Primary Care perspective. And thirdly some brief comments on
how the Institute of Healthcare Management may be able to assist
in developing more robust workforce planning through its professional
management development programmes.
— Workforce planning in the NHS is
a skill that is evolving and dependant on a comprehensive understanding
of the complexities and changes at both a national and local level
There are a plethora of tools available which need to be used
in a more collaborative and focussed way.
— Over the last decade current workforce
planning at individual organisation level has relied heavily on
local judgements. Some consistency was achieved through Workforce
Development Confederations, but subsequent re-organisations has
diluted the expertise and talent in this area. The submissions
to SHAs have very much been reliant on the local resource and
expertise which has differed widely across the country.
— The NHS has been supported by the
centralised planning of workforce who have attempted to keep abreast
of the ever changing NHS landscape, but as a consequence of a
combination of planning rules, College rules and individual Trust's
ability to poach or procure internationally for shortage specialities
the process has not been transparent or seamless.
— There is a confusion between DH general
policy to achieve an increase in employment in health disciplines
and the economic reality at individual organisation level. There
is a case for workforce modelling to be scrutinised be health
economists for a "reality check". It is likely that
health economists could have predicted the current mismatch between
DH planned level of manpower and the economic development of the
NHS.
— The NHS can take advantage of the
flexibilities that the consultant contract and agenda for change
offer. However, there will be constraints with the demands of
individual professional bodies (including nurses, doctors and
therapists) with continued protection of areas and ways of working.
— Little has been achieved on retention
rates. The highest turnover occurs in the lowest paid groups,
(eg auxiliaries, domestics, porters) where absence from work is
also greater. There is little evidence that retention can be improved
to a significant degree. Turnover amongst professionals is seen
as desirable as career ladders are climbed and/or professional
development is sought.
— Achievements in diversity are being
made. The Birmingham and the Black Country Black and Ethnic Minority
programme is an example of good practice.
— Modelling of workforce needs requires
a combination of centralised and devolved working; neither, (in
isolation) have proven to be consistently successful.
2. COMMENTS FROM
A PRIMARY
CARE PERSPECTIVE
2.1 Workforce planning and development
Workforce planning and development is a dynamic
process. Service redesign, new models of care and new ways of
working require a flexible and creative response and the strategy
will have to respond to new initiatives developed by the NHS nationally
and locally, and with its partners.
The NHS and each local health economy and NHS
organisation needs a vision for the future delivery of services.
This requires the PCT to look at its current and future staffing
requirements and to assess what new roles and skills are needed
for the future. An integrated approach to service planning will
facilitate the creative interaction between new care pathways
across the healthcare system and known and projected staff resources.
For primary care this requires a strategy which
increases capacity in primary and community services, enabling
a wider variety of services to be delivered in these settings
in order to improve access and increase flexibility for patients.
The aim is also to reduce the demand on acute and secondary services.
This is reinforced by the recently published White Paper "Our
Health, our care, our say: a new direction for community services".
PCTs need to work in partnership with Acute
Trusts and Local Authority Social Care to deliver on this strategy
and develop an integrated approach to service delivery.
New models of work are being developed which
will mean that staff will require skills to enable them to work
across primary, community and secondary interfaces as well as
social care.
More patients will be cared for in community
and primary care settings so requiring new and additional skills
to manage care effectively. The clinical staff will also need
an infrastructure to support them in their new roles, thus requiring
non clinical staff to learn new skills such as commissioning services
at local level in primary care and also across the health and
social care sector.
The development of National Occupational Standards
should help organisations to develop hybrid roles that need a
newly defined set of competencies to meet patient needs.
2.2 Drivers for Change
— Integrated Teams
In order to be able to deliver services which
reflect local need the NHS needs to develop models of multi-disciplinary
integrated teams through a singly managed structure. These teams
deliver a range of primary care services at local level within
a specific geographical area while working closely with local
GP's.
Health needs assessments should be undertaken
in each local area and a local service plans developed in order
to ensure service delivery reflects local need. This needs the
involvement of local people and other stakeholders as part of
a community engagement strategy as well as GP's and other independent
contractors.
Staff within these teams need new skills to
enable them to work in this multi-disciplinary environment and
over time will be required to inform the Commissioning Agenda
at local level once practice based commissioning is implemented
(see below).
— Practice Based Commissioning
PCTs are developing strategies to implement
Practice Based Commissioning with full coverage by December 2006.
The aim is enable local GP's and community health staff to commission
services for their own population.
This will result in a wider range of services
being delivered at local level and commissioned differently for
the local populations so requiring staff to develop new skills
and expertise in both clinical and organisational development
arenas.
— Integrated Multi Agency Children's
Teams
As a result of the recommendations in the Laming
Report on Victoria Climbie, PCTs are working in partnership with
Local Authorities to develop integrated multi agency teams across
health, social care and education to deliver on children's services
at local level. It is envisaged that these teams will be linked
closely into the Primary Care teams as above in order to be able
to be responsive to local need. There will also be models of locally
based commissioning on a multi agency basis which will inform
a commissioning strategy for the delivery of children's services.
— Reforming Emergency Care
The Reforming Emergency Care Agenda has three
main planks; Unscheduled Care, Active case management and Scheduled
care. These models will require staff to have the ability to work
in differing care settings as key elements of the move to services
delivered in more appropriate settings.
— Mental Health
Major cities have highest incidence of people
suffering with mental health problems. PCTs in inner city areas
should be developing models to provide services which can help
prevent mental health problems but also support people in Primary
Care and Community settings for those with common mental health
problems and less complex needs. Primary Care Mental Health (PCMHT)
teams are required to support people with a range of common mental
health problems but all staff require a grounding in care of people
with mental health problems and mental health should be a core
element to training for all staff in order for them to be able
to undertake more prevention work.
— Joint Appointments
PCTs, Acute Trusts and Social care should work
together to develop joint appointments in certain areas of work
in order to support the models of care outlined above. Public
Health is an area where the Local Authority and PCTs have worked
closely. Manchester's Joint Health Unit is a good example.
Joint appointment require staff to have continuing
professional development and ad hoc training in the different
skills that will enable them to work across these different care
settings.
2.3 Equality and Diversity
Embedding equality and diversity is essential
if NHS organisations are to deliver services that meet the needs
of local people. This requires successful recruitment from all
local communities. Patient and Public Involvement initiatives
can contribute to improving recruitment from local people, (eg
the new health trainers need to be part of and therefore drawn
from local communities to be successful). The NHS needs to meet
its obligations under legislation.
2.4 Current Workforce
A good picture of the existing workforce in
any organisation is a prerequisite for understanding the development
needs of the workforce. Significant issues include:
— % of staff are aged 50 or over and
as 90% are female are likely to retire in next 10 years or less;
— gender differences in job roles reflecting
NHS patterns of employment;
— high turnover rates in certain occupational
groups which will affect continuity of care and service to patients
and support for staff;
— under-provision of GPs in inner cities;
and
— recruitment and retention problems
with particular staff groups; health visitors, practice nurses
and administrative and clerical staff.
2.5 Key Barriers
Key Barriers to successful Implementation of
the organisational vision should be identified: an example is
attached which identifies issues which then need to be reflected
in the Workforce Action Plan. The complexities of the issue are
clear from this analysis which drew on a survey of general and
clinical managers.
2.6 Categories of Training Required
A clear strategy for education and training
is required. This has various elements:
A—ad hoc training, for example study days
and other learning opportunities that deliver organisation focused
updating, such as might be required for health and safety purposes
associated with, for example, moving and manual handling and with
risk reduction such as infection control or techniques for control
and restraint;
B—continuing professional development,
which we take to mean learning and development intended to update
and refresh professional knowledge and skills and to maintain
professional competence which is focussed mainly on the current
sphere of practice (a minimum of which is mandatory for all registrants
and exists independently of employment status or organisational
context);
C—more formalised education and training
associated with the acquisition of additional knowledge, skills
and professional competencies of a specialist and or advanced
nature, intended to enable the practitioner to move from their
current sphere and scope of practice to more specialist and or
advanced professional activity;
D—education, training and development
of a more generic nature that is nevertheless of relevance to
the practitioner's professional practice such as, for example,
a leadership development programme or a Masters degree in healthcare
ethics.
3. HOW THE
IHM CAN HELP
As the leading professional body for individual
healthcare managers, the IHM already provides a range of development
programmes, requires its members to undertake CPD, and requires
its members to abide by a code of professional practice, (on which
the dh's own management code is based).
The IHM recognises that from its experience
in working with managers across the NHS that:
— There are good training schemes in
place.
— There is a shortage of appropriately
trained and experienced general managers at the middle/senior
level.
— There is a key skill and knowledge
deficit in moving from public service model to a market led model.
(Developing commercial skills now forms a key part of the IHM's
new programmes).
— There remains a shortage of quality
development programmes aimed at producing first class CEOs.
The IHM is willing to assist in the development
of programmes to support a more robust Workforce Planning regime
for the NHS.
Should the Committee require further information,
or clarification of any part of this response please contact us.
Sue Hodgetts
Chief Executive, Institute of Healthcare Management
21 December 2006
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