How many more staff do you need to improve the quality of care? - hosted by McKesson
Mike Davidge, Author 1000 Lives, plus panel members
- are we resorting to a default position of simply hiring more staff and increasing our reliance on temporary workforce to respond to the need to improve quality in healthcare?
- is there a better way to make use of whole teams which will improve engagement, patient outcomes and be more affordable in the longer term?
Session one: Driving the case for change
Welcome and introduction
Chair: Candace Imison, Deputy Director of Policy, The King's Fund
National overview: The future workforce
Professor Ian Cumming OBE, Chief Executive, Health Education England
- Implementing 'Framework 15' and delivering the characteristics of the future workforce
- Aligning the national long-term workforce strategic framework with the anticipated needs of future patients, the demands of new models of care and advances in technology.
The changing workforce: meeting the needs of patients across the system
Dr Harriet Gordon, Director of the Medical Workforce Unit, Royal College of Physicians, and Workforce Lead on the RCP's Future Hospital Commission
- Ensuring continuity of care and moving towards integration of hospital and community health care provision 7 days a week.
- Integrating acute and specialist care beyond the hospital walls.
- Achieving a balance of holistic and specialist care: the importance of team working and leadership.
Specialists working in out-of-hospital settings
Ruth Robertson, Fellow, Health Policy, The King’s Fund
- How are hospital consultants working with colleagues in primary and community to deliver more specialist care outside of hospital?
- The consultant’s role as an educator, helping to upskill GPs and other primary care staff.
- Barriers and enablers to this new way of working.
Questions and discussion
Session two: Streams
Delegates had the choice of attending one of the following streams:
A. Bridging the gap between primary and secondary care
Chair: Ruth Robertson, Fellow, Health Policy, The King’s Fund
Case Study - Community Geriatrician Project
Dr Caroline Ruaux, GP and Clinical Lead for Long-term Conditions, NHS Ashford Clinical Commissioning Group Winner of the Efficiency in Community Service Redesign Award (HSJ Awards 2013) for its work to help frail older peple receive better care and avoid unnecessary trips to hospital
- Providing support to care homes from a full-time consultant (geriatrician) and a community matron working extended hours
- Promoting independence and providing access to a specialist opinion or treatment without the upheaval of care home residents having to go into hospital
Case Study - Providing integrated care for respiratory patients
Dr Louise Restrick, Integrated Respiratory Physician, Whittington Health and London Respiratory Network Lead
Dr Myra Stern, Integrated Respiratory Physician, Whittington Health
- Developing new roles that span primary, community and secondary care settings.
- Assessing the challenges and lessons associated with implementation of the new model of service provision.
Questions and discussion
B. Integrated care
Chair: Nicola Walsh, Assistant Director of Leadership, The King's Fund
Bridging the gap between community and acute care
Julian Emms, Chief Executive, Berkshire Healthcare NHS Foundation Trust
- Outlining the role of the rapid assessment community clinic (based within a local community clinic) in supporting people who have complex health and social care needs and need urgent medical attention
- Giving support to the acute hospitals, GPs and the local ambulance trust by providing a real alternative to secondary care assessment and admission
Integrating the health and social care workforce to deliver effective joint working
Dr Bernie Gregory, Clinical Lead for the Well Connected Programme, Worcesthershire Health and Care NHS Trust and Vicky Preece, Deputy Director of Nursing, Worcestershire Health and Care NHS Trust
- Redesigning existing roles and developing new positions spanning health and social care to facilitate greater integration.
C. Primary care
Chair: Dr Steve Feast, Executive Medical Director, North East London NHS Foundation Trust
Nursing in primary care settings
Howard Catton, Head of Policy and International Affairs, Royal College of Nursing (RCN)
- Ensuring a supply of community nurses with the right skills to deliver more proactive care out of hospital settings and into primary and community settings.
- Supporting and enabling both student nurses and those working in hospitals in the transition to primary care.
The deployment and role of physician assistants in practices
Dr Simon de Lusignan, General Practitioner and Professor of Primary Care and Clinical Informatics at the University of Surrey
- Work diaries – balancing clinical and non-clinical activities
- Evaluating the extent to which PAs are involved in the ongoing management of patients with chronic diseases
- Developing the role of PAs to include income generating work
Questions and discussion
Session three: Panel discussion
Bev Fitzsimons, Programme Manager, The Point of Care, The King's Fund
Community health care as ‘part of the DNA’ of NHS
Matthew Winn, Chief Executive, Cambridgeshire Community Services NHS Trust and Chair, NHS Confederation Community Health Services Forum
- Promoting joined up working between NHS Trusts (community, acute and mental health), social enterprises and the private and voluntary sectors, to deliver high quality care in or close to patients’ homes, seven days a week.
Panel - Realising the full potential of community services to transform care
Panellists include: Pete McGrane, Clinical Director of Community Services Division, Oxford Health NHS Foundation Trust; Colin Scales, Chief Operating Officer, Bridgewater Community Healthcare NHS Trust; Sam German, Director, Healthy Villages Programme, Birmingham Community Healthcare Trust; Dr Crystal Oldman, Chief Executive, The Queen's Nursing Institute
- Building the information infrastructure, workforce, and ways of working and commissioning that are required to create services that offer an alternative to hospital stay
- Establishing news ways to contract and pay for community services are needed, which will require changes in primary care and hospital contractual arrangements
- Reducing unnecessary complexity of community services
- Forging closer relationships with groups of general practices
3.10pm: Refreshment break, exhibition and networking
Session four: Closing plenary
Professor Chris Ham, Chief Executive, The King's Fund
Developing and enhancing teamwork and collective leadership
Vijaya Nath, Assistant Director, Leadership Development, The King's Fund
Designing a high-level workforce model to support the spread and adoption of seven day services
Raj Bhamber, Director at PricewaterhouseCoopers LLP Services Limited and previous Chair, NHS Services, Seven Days a Week Forum Workforce and Organisational Development (OD) Workstream
Lessons from England's health care workforce redesign: No quick fixes
Candace Imison, Deputy Director of Policy, The King’s Fund
Richard Bohmer, International Visiting Fellow, The King's Fund
Professor Ian Cumming OBE
Chief Executive, Health Education England
Ian is the Chief Executive of Health Education England - organisation that is responsible for the education, training and development of the health and healthcare workforce for England.
Ian started his career in the NHS as a health care scientist specialising in the diagnosis and monitoring of coagulation disorders. Ian moved into his first general management role in 1990. Ian held a series of NHS Senior Management roles including Assistant Chief Executive at the North West Regional Health Authority before being appointed to his first chief executive job of an NHS Hospitals Trust in 1995 when, at the age of 30, he became the youngest ever chief executive in the NHS. Since 1995 Ian has also been the Chief Executive of a University Teaching Hospitals Trust and an NHS Commissioning organisation before being appointed as the Chief Executive of the West Midlands Strategic Health Authority in 2009. On taking up this role, Ian also became a member of the national Management Board for the NHS in England.
In 2012 Ian was appointed as the first Chief Executive of Health Education England. Ian was awarded an OBE by Her Majesty the Queen for services to the NHS in 2003. Ian also holds an honorary chair in Leadership and Management at Lancaster University and honorary degrees from the Lancaster, Wolverhampton, Birmingham City and Manchester Metropolitan Universities. Ian is also an honorary Fellow of the Royal College of General Practitioners.
Dr Harriet Gordon
Director of the Medical Workforce Unit, Royal College of Physicians
Harriet is Director of the Medical Workforce unit at the Royal College of Physicians. Work there includes involvement in the unit's annual census work for both trainee and consultants and currently utilising this in liaison with agencies such as Health Education England to achieve the RCP workforce goals.
She previously represented the British Society of Gastroenterology for Workforce and is otherwise a consultant gastroenterologist in Winchester.
Professor Chris Ham
Chief Executive, The King's Fund
Fellow, Health Policy, The King’s Fund
Integrated Respiratory Consultant, Whittington Hospital
Dr Louise Restrick works as an integrated consultant respiratory physician at Whittington Health and in Islington, North London. She co-leads the Whittington Health multi-disciplinary COPD Team with Dr Myra Stern and leads the London Respiratory Network with Dr Chris Cooper, a London GP. She has a long-standing commitment to developing effective shared pathways that better meet the needs of people with respiratory illnesses, in particular disabling breathlessness, using a right care and best value framework and working collaboratively with patients and their families and carers and with physical health, mental health and social care colleagues.
International Visiting Fellow, The King's Fund
Integrated Respiratory Consultant, Whittington Hospital
Myra is an integrated consultant physician working for Whittington Health and Islington CCG. She has a long term interest in chronic respiratory conditions, having previously worked in the cystic fibrosis unit at the Royal Brompton before joining the Whittington Health team in 2002. Since then, she has co-lead the COPD service together with Dr Louise Restrick, focusing on the development of a community multidisciplinary service to support management and self-management of respiratory patients in their homes. She has worked with GPs and public health to innovate and evaluate pathways of care across primary and secondary care and other services for respiratory patients and has piloted the first two training posts for Respiratory SpRs in integrated respiratory medicine. She has also been the clinical lead for Stop Smoking at Whittington Health since 2003 and National lead for the British Thoracic Society Stop Smoking Champions 2011-2014.
Dr Bernie Gregory
Clinical Lead for the Well Connected Programme, Worcestershire Health and Care NHS Trust
Dr Bernie Gregory is the Clinical Lead for Well Connected, the Integrated Care Programme for Worcestershire and one of 14 national integration pioneers. The Well Connected programme oversees 6 major transformation programmes in the county across health and social care, aiming to improve the experience of individuals by providing better coordinated person centred care and to take a whole system approach to meet our demographic and financial challenges. Within the Well Connected programme she is taking a particular lead on workforce issues and integrated IT.
Deputy Director of Nursing, Worcestershire Health and Care NHS Trust
Vicky qualified as a nurse in 1975 and after gaining experience in renal medicine and trauma, decided to progress her career in community nursing. She practised for many years as a District Nurse in South Wales and in Worcestershire. From this she gained valuable experience of caring for patients and their families in rural and urban areas.
In 1997 she set up and ran a nurse–led community clinic and then took up positions in Primary Care Groups and Primary Care Trusts, at the same time maintaining both a clinical and corporate role. As Deputy Director of Nursing she maintains a strong link to nursing practice and is passionate about promoting pride in the nursing profession.
Assistant Director, Leadership, The King's Fund
Read Nicola's biography
Chief Executive, Berkshire Healthcare NHS Foundation Trust
Julian is Chief Executive of Berkshire Healthcare, a combined Mental Health and Community Health NHS Foundation Trust. Julian started his career in the probation service as a support worker and went on to undertake a variety of roles in the service over a 10-year period before joining the NHS in 1997.
Julian's senior management roles prior to becoming an Executive Director in 2004 were all joint posts with social care and focused on providing better integrated care for local people. His early years as Director of Operations at the Trust were spent overseeing the development of out-of-hospital care in mental health services which resulted in a 50 per cent reduction in the use of hospital beds, underpinned by the establishment of highly skilled multi–disciplinary teams in the community. Working with partners in the local system in order to replicate a similar level of transformational change with regard to physical health care is currently an area of priority focus for his organisation.
Head of Policy and Internal Affairs, Royal College of Nursing
Howard has held a variety of posts at the RCN, including regional officer and worked as a national policy adviser in workforce research and health policy. He became a registered nurse in 1988 and held a variety of nursing posts in England and the United States. He has also worked for the New Zealand Nursing Organisation and the International Council of Nurses in Geneva.
Howard also served as a local Government Councillor for seven years, for five of which he was Cabinet member with lead responsibility for corporate and customer services.
In 2005, he was appointed Head of Policy at the RCN and Head of Policy & International in 2010. His department works with a wide range of stakeholders, including government and think tanks, on the development and implementation of policy at home and overseas to ensure nursing influence and voice. The department also leads on supporting the RCN's sister nursing associations and alliances internationally.
Howard has a bachelor's degree in social policy from Cardiff University and a master's in industrial relations from the University of Warwick.
Programme Manager, The Point of Care, The King's Fund
Read Bev's biography
Chief Executive, Cambridgeshire Community Services NHS Trust and Chair, NHS Confederation Community Health Services Forum
Matthew Winn is the Chief Executive of the Trust and has worked in Cambridgeshire since 2007. Previously he worked in London in roles in acute care, local government and Primary Care Trusts. He is a Board member of the East of England Collaborative Procurement Hub, Chair of the Cambridgeshire/Peterborough Workforce Partnership and a member of the East of England Health Education England LETB Board. He has an MSc in Public policy and public management, focusing on how organisations can work together. He is Trustee of a charitable Trust working within the educational field in Northern Uganda and Chair of the Community Foundation trust CEO group
Clinical Director of Community Services Division, Oxford Health NHS Foundation Trust
Pete, a registered general nurse, has worked in a variety of different positions in the NHS since 1989. He has worked in community services since 2004, having previously been involved in emergency care with a number of acute trusts. Pete was appointed Clinical Director of Community Services with Oxford Health NHS Foundation Trust in 2010 in the Older People's Directorate. The emergency multidisciplinary unit development is a key service in the directorate’s portfolio. Pete is passionate about the integration of physical and mental health care, workforce development and care personalisation. Pete works clinically in unscheduled care in GP out-of-hours and minor injuries care.
Chief Operating Officer, Bridgewater Community Healthcare NHS Trust
Colin is Chief Operating Officer at Bridgewater Community Healthcare Trust. He is an experienced NHS Director having held board level posts in the acute sector, a PCT and now in the community sector where he is leading the development of out of hospital services in partnership with commissioners and hospital colleagues. He is passionate about health and care reform, the health and wellbeing contribution of community providers and in particular the role that empowered community-based clinicians can play in delivering high-quality alternatives to hospital.
Director, Healthy Villages Programme, Birmingham Community Healthcare Trust
Director at PricewaterhouseCoopers LLP Services Limited and previous Chair, NHS Services, Seven Days a Week Forum Workforce and Organisational Development (OD) Workstream
Raj has a developed a wide appreciation of both the private and public sectors through roles in banking, pharmacy, cable television, the Manpower Services Commission, the Hotel and Catering Training Board, the NHS (primary care, acute, health authority, Department of Health) and further education.
She is a Fellow of the Chartered Institute of Personnel and Development, the Law and Business Faculties at Kingston University and the Royal Holloway University of London.
Amongst her other roles, Raj has been the Chair of the Workforce & Organisational Development workstream of the Seven Day Services Forum, Co-Chair of the Medical Workforce Forum (NHS Employers), a member of the national Joint Consultative Committee Seniors (negotiating committee for consultant medical staff in England, including the devolved administrations) and a member of the national Staff Partnership Forum (chaired by the Minister of Health) for employer and trade union representatives.
Raj joined PricewaterhouseCoopers LLP Services Limited (PWC) as a Director in October 2014. She holds a Bachelor of Arts Degree from the University of British Columbia, Vancouver, Canada and an MSc in Human Resources Leadership from the University of Manchester, England.
Deputy Director of Policy, The King's Fund
Dr Caroline Ruaux
GP and Clinical Lead for Long-term Conditions, NHS Ashford Clinical Commissioning Group
Caroline is Ashford's elected representative on the Local Medical Committee. She is also clinical lead for long-term conditions on the governing body of the NHS Ashford Clinical Commissioning Group. She trained at St George's Hospital Medical School and has been a partner at the New Hayesbank Surgery, Bybank, Kennington since 1994.
Caroline is passionate about improving services for patients and has been involved in commissioning since 2004 in Ashford's former Practice-Based Commissioning Group, a forerunner to the CCG.
Dr Steve Feast
Executive Medical Director, North East London NHS Foundation Trust
Professor Steve Feast is Executive Medical Director at North East London NHS Foundation Trust (NELFT), a large mental and community health provider operating with 6000 staff across north east London and south west Essex. Steve also has key roles in the CLAHRC and AHSN within UCL Partners. Previous roles include Deputy CEO and Director of Transformation - NHS Bedfordshire and Luton PCT Cluster; UK Cabinet Office on issues relating to primary care and social exclusion, setting the Inclusion Health agenda; Senior Advisor in Health and Wellbeing at the Department of Health advising DH and other government departments on projects relating to health inequalities, commissioning and incentives. For 16 years, Steve was a partner in general practice, a Police Surgeon and for 5 years the Professional Executive Committee Chair of a Primary Care Trust in Bedfordshire.
Dr Crystal Oldman
Chief Executive, The Queen's Nursing Institute
Crystal is Chief Executive of The Queen's Nursing Institute, the national charity which was founded in 1887 by William Rathbone and Florence Nightingale to develop training for District Nurses. The QNI remains focussed on supporting all community and primary care nurses to improve the care of people in their own homes and communities.
Crystal joined the QNI from Buckinghamshire New University where she was Dean of Enterprise and Business Management, working with a range of health and social care providers to develop the primary and community nursing and social care workforce. Her role included the support of research and innovation in practice and the establishment of the Institute of Diversity Research. Crystal is a registered nurse and Health Visitor and has worked in some of the most deprived communities in west London. She is also the governing body nurse of Aylesbury Vale CCG.
Dr Simon de Lusignan
General Practitioner and Professor of Primary Care and Clinical Informatics, University of Surrey
Simon is a Senior Academic General Practitioner and Head of the Department of Health Care Management and Policy at University of Surrey. He is also the Director of the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). Simon is a visiting professor at St. George’s University of London and Brighton and Sussex Medical School.
Simon’s research focuses on how routinely collected data can be used to measure health outcomes and how IT is best used at the point of care. Further information about his research and projects can be found here. Simon has carried out research studies in a wide range of disease areas. These include: chronic kidney disease (CKD), diabetes, psychological therapies, child safeguarding, heart disease, osteoporosis, chronic obstructive pulmonary disease (COPD), and vaccine benefits and risk. Simon has also developed video methods for observing the impact of technology on clinical workflow.
Assistant Director, Leadership Development, The King's Fund
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