The new landscape of care: responding to the challenge challenge Paul Stanton Adviser on Standards...

The new landscape of care:The new landscape of care:responding to theresponding to the

challengechallenge

Paul StantonAdviser on StandardsDepartment of Health

The new landscape of care The new landscape of care

• TurbulenceTurbulence• Reform as process, not eventReform as process, not event• ““We are transferring some of the risk and We are transferring some of the risk and

anxiety from the patients lives into the anxiety from the patients lives into the system”system” Corrigan 2006

• New professional identitiesNew professional identities• New employing bodiesNew employing bodies• New non-linear career trajectoriesNew non-linear career trajectories

Unconsciouslyincompetent

Novice

After Pat Benner

Consciouslyincompetent


TraineeProfessional

Novice

After Pat Benner

Consciouslycompetent



TraineeProfessional

NewlyQualifiedEntrant

Novice

After Pat Benner

Unconsciously competent




TraineeProfessional


Expert

Novice

After Pat Benner

Unconsciously competent




TraineeProfessional


Expert

Novice

Professional Education & Training

Values

KnowledgeSkills

Developing a ‘fit for purpose’ and professionally competent workforce

“In a constant internal iterative dialogue with each other and with external reality” Winter 1996

Professional Education & Training

Values

KnowledgeSkills

Developing a ‘fit for purpose’ and professionally competent workforce

““a new common foundation curriculum … a new common foundation curriculum … will enable students and staff to switch careers will enable students and staff to switch careers and training paths more easily”and training paths more easily” NHS Plan 2000NHS Plan 2000

Reflective & reflexive

life long learning

Clinging to currentmodels, patterns & locations of care

Change for change’s sake

Clin

gin

g t

ocu

rren

t ro

les

Loss o

f p

rofe

ssi o

nal

iden

tity

Zone ofComplexity

Chaos &Helplessness

Stasis & Denial

After Dr James Price

Key challengesKey challenges for the for the academic communityacademic community

• “What are the major threats and the opportunities that are likely to arise as a result of the system reform agenda”

• Pink hexagons = key threatsPink hexagons = key threats• Blue hexagons = key opportunitiesBlue hexagons = key opportunities

Key challenges

• ““Let the good of the people be the highest Let the good of the people be the highest law” law” CiceroCicero

• What needs to be done and what can be done What needs to be done and what can be done further to develop effective partnerships further to develop effective partnerships between the academic community and the between the academic community and the health and social care community so that the health and social care community so that the best sustainable value is delivered to best sustainable value is delivered to communities and service users?communities and service users?

Underpinning Questions

• Does the overall health and social care education and training spend deliver ‘value for money’ from the perspective of service users, patients and local communities?

• Does qualifying training deliver a workforce that is ‘fit for current purpose’?

• New entrants who can thrive in the ‘marketplace’

• Is ‘learning’ still a ‘hostage’Is ‘learning’ still a ‘hostage’

A learning rich environment?A learning rich environment?

An unstable environment

• MoraleMorale• ““Coping with the unchanging nature of human Coping with the unchanging nature of human

need at the same time as coping with constant need at the same time as coping with constant organisational change can leave professional organisational change can leave professional staff feeling ‘lost in familiar places’ staff feeling ‘lost in familiar places’ Shapiro & Shapiro & Carr 2002Carr 2002

• Sustainable competence in an Sustainable competence in an ‘incompetent context’‘incompetent context’

• Learning from the lowest common Learning from the lowest common denominatordenominator

Patient Voices

• This was where Jimmy’s fall story was inserted

• All of the digital stories that were used in this presentation can be found at www.patientvoices.org.uk

• They are available free of charge and can be used in education, training and organisational development

http://www.patientvoices.org.uk/

Underpinning Questions• Does CME, CPD and PQSW expenditure deliver evidenced Does CME, CPD and PQSW expenditure deliver evidenced

value for money in improved patient experience or value for money in improved patient experience or outcomes?outcomes?– ““A recent review [by the Standing Committee on A recent review [by the Standing Committee on

Postgraduate Medical and Dental Education] of random Postgraduate Medical and Dental Education] of random control trials of CME concluded that it was undermined control trials of CME concluded that it was undermined by difficulties in its delivery, that it seemed unable to by difficulties in its delivery, that it seemed unable to respond to the urgent demands of healthcare reform respond to the urgent demands of healthcare reform and that there was little evidence of its own and that there was little evidence of its own effectiveness and efficacy” effectiveness and efficacy” Headrick, Wilcock, Bataldan BMJ 2005 …

• Is the scale of the budget justified?Is the scale of the budget justified?NHS spending on CPD in 1999-2000 was about £1bn. Brown, Belfield, NHS spending on CPD in 1999-2000 was about £1bn. Brown, Belfield, Field 2002Field 2002 – currently estimated at circa £1.3 bn – currently estimated at circa £1.3 bn

• Is the individual focus always appropriate?Is the individual focus always appropriate?

A new focus for post-qualifyingeducation and training

• ‘‘The complexity of health care systems and the multiple The complexity of health care systems and the multiple variables which impact upon team working at a clinical variables which impact upon team working at a clinical level may affect the translation of policy into improvements level may affect the translation of policy into improvements in the quality of patient care’in the quality of patient care’ WestWest

• ‘‘Dissemination of information as a passive process does Dissemination of information as a passive process does not appear to produce behaviour change in clinical teams not appear to produce behaviour change in clinical teams … an awareness of the barriers to change is an important … an awareness of the barriers to change is an important factor in initiating a process that translates policy into factor in initiating a process that translates policy into practice’practice’ Kaner et alKaner et al– Cf: NICE GuidanceCf: NICE Guidance

• ‘‘Active processes where teams themselves seek out new Active processes where teams themselves seek out new information increase the likelihood of the successful information increase the likelihood of the successful adoption of innovation’adoption of innovation’ FitzgeraldFitzgerald

• A new definition of ‘team’A new definition of ‘team’– Communities of practiceCommunities of practice

From intra-organisational silos…

CHOICE

FINANCE

CLIN

GOV

INFO

TECH

PERFORMANCE

STANDARDS

WORKFORCE

REFORM

Pathways as mediums for integrating the policy agenda

ServiceIntegration

Commissioning

Information

Technology

PatientEngagement

& Choice

Capital Renewal

Standards,CG &

Performance Management

Workforce Developme

nt

Clinical Pathway Focused

Management Systems

Interfaces• Relative under-representation of the Relative under-representation of the

University sector at the level of University sector at the level of • policy formulation policy formulation • system leadershipsystem leadership• operational developmentoperational development• Not one University Sector representative on

the twenty person+ LSWC Programme Board

• Getting on to the radar screen of DH Getting on to the radar screen of DH reform, Local Government, SHAs, Local reform, Local Government, SHAs, Local Strategic Partnerships, PCTs and care Strategic Partnerships, PCTs and care providersproviders

Acute Care Trusts

PCTs General Practice

1 Financial viability Financial viability Quality

2 Quality Equal access Equal access

3Organisational

stabilityOrganisational

stabilityOrganisational

stability

4 Productivity Quality Staff welfare

5 Equal access Staff welfare Financial viability

6 Service innovation Service innovation Productivity

7 Staff welfare Productivity Service innovation

8 Training teaching and research

Training teaching

and researchTraining teaching

and research

Ranking of Organisational Goals across the Health Economy

Overall Strategy?

• No one over-arching strategy to No one over-arching strategy to align education and training to align education and training to public sector reform …public sector reform …

• Nor to co-ordinate discrete Nor to co-ordinate discrete strategiesstrategies

Responses to the challenge

“An excellent workforce that gives the best possiblecare must be able to change. Social care needs to change,…..people want different types of care that they can access closer to their own homes, and people who use services expect staffto help them in new ways”

“SCIE's aim is to improve the experience of people who use social care by developing and promoting knowledge about good practice in the sector. Using knowledge gathered from diverse sources and a broad range of people and organisations, we develop resources which we share freely, supporting those working in social care and empowering service users.”



Integrated Care Network

Care Services Improvement Programme

Responses to the challengeSummary! ensure a stronger interface between complaints about clinical services and complaints about doctors;! give educational and standard-setting bodies a more formal role in medical regulation.Recommended action37 There are 44 recommendations in the report …! the creation of a clear, unambiguous and operationalised standard to define a good doctor,and adoption into the contracts of all doctors;! steps to further the consistency with which medical education is managed acrossundergraduate and postgraduate curricula;


“Good Medical Practice sets out the principles and values on which good practice is founded;these principles together describe medical professionalism in action. We have provided on line links to other guidance and information which illustrate how the principles in Good Medical Practice apply in practice, and how they may be interpreted in other contexts; for example, in undergraduate education, in revalidation, or in our consideration of a doctor's conduct, performance or health through our fitness to practise procedures”.

Responses to the challenge“MMC will deliver a modern training schemeand career structure … to improve patient care by delivering a modernised and focused career structure for doctors through a major reform of postgraduate medical education. … As training and education are central to the work of doctors and their role in delivering patient care…MMC has created two-year foundation schools that will, for the firsttime, require doctors to demonstrate their abilities and competence .. and to develop experience in a range of specialties. Post-foundation, specialist/GP training will be streamlined”

Responses to the challenge“The Centres for Excellence in Teaching and Learning (CETL) initiative has two main aims: to reward excellent teaching practice, and to further invest in that practice so that CETLs funding delivers substantial benefits to students, teachers and institutions.74 project based initiatives –19 collaboratives”

CETL Networks The Academy is facilitating and supporting the creation of CETL Networks. All CETL delegates are invited to join a general network CETL Support.

Responses to the challenge“Creating an Interprofessional Workforce (CIPW) is funded by the Department of Health and hosted by the SWP SHA. We aim to produce a strategic framework to bridge the gap between service modernisation and education in health and social care.The programme covers all aspects of Inter-professional learning and development,which make up a substantial strand of the overall work being done to modernise nursing, allied health professions and medical undergraduate (and post graduate) education. The framework will cover: All levels of education within health and social care including pre-registration and post-registration education”


The NHS Institute current priorities are:• No Delays (18 Week Wait) • Healthcare Associated Infections • Primary Care / Long Term Conditions • Delivering Quality and Value


The Large Scale Workforce Change (LSWC) team designs and delivers service improvements and workforcedevelopments through a series of nationally-led programmes.The LSWC team's work focuses on developing an adaptable and flexible workforce, reducing unnecessary boundaries, and enabling the effective use of staff skills to deliver benefits thatare measurably better for staff and,as a result, better for patients”


Agenda for Change

Integrated Service Improvement Programmes (ISIP)

National Service FrameworkImplementation Teams


“The Children's Workforce Development Council (CWDC) aims to improve the lives of children and young people. It does this by ensuring that the people working with children have the best possible training, qualifications, support and advice.”

Alignment?• The whole may be less than the sum of The whole may be less than the sum of

the partsthe parts• Opportunity for a radical re-appraisal of Opportunity for a radical re-appraisal of

the education and training interface with the education and training interface with the new landscape of carethe new landscape of care

Underpinning Questions

• In an increasingly ‘competitive’ In an increasingly ‘competitive’ education and training market place education and training market place do Universities capitalise on their do Universities capitalise on their unique market advantage?unique market advantage?

• The scale of the marketplaceThe scale of the marketplace

• Is there a coherent market?Is there a coherent market?

Raising the University Profile

• Willingness pro-actively to raise and address challenging issues…

• to embrace rather than resist profound change …

• to make the most of brand and market advantage …

• to invest in (sometimes frustrating) partnerships with the service …

• and with private sector consultancies, training and organisational development providers

New ‘fit for purpose’

Education and training

Reflective debate on the need for

profound reform

Perhaps we could be a little more explicit here in step two.

“There are more things in heaven and earth, Horatio, than are dreamed of in our

philosophies”• This was where Rizia’s post stroke ‘meditation’ story was inserted

• All of the digital stories that were used in this presentation can be found at www.patientvoices.org.uk

• They are available free of charge and can be used in education, training and organisational development

http://www.patientvoices.org.uk/

The new landscape of care: responding to the challenge challenge Paul Stanton Adviser on Standards...

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