Current challenges : Future

opportunities

Professor Mark Radford

Director of Nursing – Improvement, NHS Improvement

#nursingnhsi

System Challenges

Workforce

Supply constraints

Fiscal Pressures> Activity growth

> Quality

> Performance

#nursingnhsi

The next quarter

Keep the focus on patients/clients and

their families

Real challenge operationally

• Emergency care standard

• RTT

• Cancer

Real challenge on finance

Shared Planning guidance

• 2years to get ahead and plan

Francis

Report

Keogh 14

July 14

CIH Program

Aug 14

Workforce & Staffing

Current reliance on EAA nationals in the NHSData from NHS Digital indicates the different reliance on EEA national across the country. Broadly

speaking, London tends to rely most heavily on EEA nationals, followed by regions in the South East. The

South West, Midlands and the North tend to rely least on EEA nationals.

NW London

South London

NC&E London

South West

Thames

Valley

East

Midlands

Yorkshire

& the Humber

North

East

North

West

West

Midlands

Wessex

Kent, Surrey

and Sussex

East of

England

North,

Midlands &

South West

South and

EastLondon England

Total EU

staff

All staff 2% - 3% 6% - 7% 10% - 11% 5% 57,604

Doctors 7% - 8% 9% - 11% 12% - 14% 9% 10,175

of which:

Consultants 6% - 8% 6% - 9% 11% - 13% 8% 3,873

Doctors in training 6% - 8% 9% - 12% 13% - 14% 10% 4,925

Nurses and midwives 1% - 4% 8% - 11% 13% - 14% 6% 22,361

Scientific, therapeutic & technical staff 2% - 3% 4% - 5% 9% - 10% 4% 6,536

Ambulance staff 0% - 1% 1% - 3% 0% - 2% 1% 212

Support to doctors, nurses & midwives 1% - 2% 4% - 6% 6% - 8% 3% 9,446

Managers and senior managers 0.5% - 1% 2% - 3% 4% - 5% 2% 646

The heatmap presents the proportions of all staff who are EEA nationals

across England. Darker colours represent higher proportions and lighter

colours lower proportions. The table indicates that the greatest reliance on

EEA staff appears to be for the regulated professions (doctors, nurses and

ST&T staff). However, the is also reasonably significant reliance on EEA

staff in the support to doctors, nurses & midwives group.

#nursingnhsi

Retention

• Working alongside NHS

Employers

• We will support trusts on

their improvement journey

• Key elements –

• Knowing your workforce

• Engagement

• Talent development

• Health and well being

programme

Milton Keynes University Hospital

NHS Trust

‘We know that our highest turnover

point for newly qualified nurses is

1year/18months. In response to this,

we have extended our preceptorship

programme. The nurses feel more

settled and supported. Our staff

survey highlighted that we needed to

focus on staff in theatres. NHS

Improvement is working with us to

retain staff here’

Lisa Knight

Chief nurse & Director of Patient Care

Nursing Associate

St. George’s University Hospitals

NHS Foundation Trust

Whittington Health NHS Trust

Barts Health NHS Trust

Nottingham University Hospitals NHS

Trust

Central Manchester University

Hospitals NHS Trust

Cheshire and Wirral Partnership NHS FT

Walsall Healthcare NHS Trust

Great Ormond Street Hospital for

Children Foundation Trust

Leeds Teaching Hospitals NHS

Trust

Cambridgeshire and

Peterborough NJS Foundation

Trust

Royal Devon and Exeter NHS

Foundation Trust

#nursingnhsi

Developing our workforce

University Hospitals of North

Midlands NHS Trust

Developing a generic therapy role and

training staff in both PT and OT skills so

they can carry out an integrated

assessment and treatment plan,

supported by senior practitioners.

• We have an already supportive

and developed HCSW workforce

• Do we do enough to maximise

their skills and passion ?

• Examples of outstanding practice

supporting patients in their existing

roles

• Developing new roles to support

patients in different ways

• Developing new skills to support

patients in innovative environments

• Maternity

• Mental Health

• Community settings

University Hospitals Coventry and

Warwickshire NHS Trust

Staff set up an internal specialling team

to provide the right number of enhanced

care shifts per day by employing band 2

and 3 healthcare support staff trained

for the specific role.

Bursaries

• Understand the controversy but …..

• Understanding the challenges:

– Future student demand for training

– Understanding student characteristics

– Clinical placements

– Use of apprenticeships

• HEIs potential of up to 10,000 additional

training places

• CNO and senior ALB nurses working

together to monitor and assess

#nursingnhsi

Advanced Practice

13

Advanced Practice has been

developing for 30 years in UK

• Lack of clarity/definition

• Scope and education challenges

NHS I leading with HEE a national

steering Group to deliver a national

standard on ACP

• Agree definitions

• Curriculum requirements

• Competency

• Deployment

As a Nurse Consultant myself I directly

saw the patient and organisational

benefits of ACP delivered care. This

programme of work with HEE

develops a common understanding

across professions and agreed

education and competency

arrangements is the ideal platform to

deliver an innovative NHS Workforce

solution.

Professor Mark Radford, Director of Nursing

Improvement

Joint Chair of National ACP steering group

National Quality Board Guidance Refresh

Care Setting Chair

Inpatient wards for Adult

Acute Hospitals

Professor Hilary Chapman, Chief Nurse, Sheffield

Teaching Hospital

Urgent and Emergency Care Pauline Philip, CEO, Luton and Dunstable NHS Trust

Maternity Services Professor Mark Radford, Chief Nurse, University

Hospitals Coventry and Warwickshire NHS Trust

Children’s Services Michelle McLoughlin, Chief Nurse at Birmingham

Children's Hospital

Community Services Dr Crystal Oldman, CEO The Queens Nurse Institute

Learning Disability Services Professor Oliver Shanley, Director of Quality and Safety

and Deputy Chief Executive Officer; Hertfordshire

Partnership, University NHS Foundation Trust.

Alison Bussey, Director of Nursing/Chief Operating

Officer South Staffordshire and Shropshire NHS

Foundation Trust

Mental Health Ray Walker, Executive Director of Nursing Merseycare

NHS Trust

Setting-Specific Safe Staffing

Improvement Resources

Quality

Efficiency

What good looks like: the Model Hospital

17

• Model Hospital concept: A nationally available information system that will support trusts to develop a greater understanding of their comparative productivity, quality and responsiveness, supporting a clearer view of improvement opportunities

• Trusts can compare themselves to the national average or to trusts considered peers and they can identify which areas they need to improve across different metrics in the hospital

• Iterative approach - prototype portal

• All 136 acute non-specialists trusts have assigned users to check the metrics, give us feedback and start to learn how they can use the metrics to improve hospital productivity and efficiency

• New sets of metrics are going live each month

Full Model Hospital to be developed by April 2017

November 2016 key stats

Total number of users: 1,911

Average weekly page hits: 5,019

Average weekly

logins: 360

Total number of metrics: 542

Total data points: 192,699

18

Model Hospital

A prototype product rapidly gaining traction

Trusts can view at a glance how they

compare to peers and the national picture

19

Nursing time variation

Variation in Ward CHPPD Rates by Trust - August

21

Analysis Prepared by Analytics & Informatics - NHSI : Data Source – Unify2 – Safe Staffing Monthly Returns

CHPPD by Specialty – August

22

Analysis Prepared by Analytics & Informatics - NHSI : Data Source – Unify2 – Safe Staffing Monthly Returns

#nursingnhsi

Workforce transformation

What does the patient see ?

GP

Practic

e

Nurse

Paramedi

cNurse

Junior

Doctor

Consulta

nt

What the professionals see ?

GP

Practic

e

Nurse

Paramedi

cNurse

Junior

Doctor

Consulta

nt

PA

Pharmacist

ACP

Technicia

n

HCSW

CNS

ACP

PA

AHP

HCSCommunit

y NurseHV

Social

care

Finance

management

HR

What matters to patients ?

• Accessibility

• Convenience

• Time spent

• Decision making/Diagnosis

• Gateway knowledge to specialist

• Navigation

• Caring

• Continuity

Band 2 Band 3

Band 5 -

RN

Band 6

Band 8

ACP

Junior Doc

Unwarranted variation in scope and

competence

28

#nursingnhsi

#nursingnhsi