The new landscape of care:

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The new landscape of care responding to the
challenge
Paul Stanton Adviser on Standards Department of
Health
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The new landscape of care

• Turbulence
• Reform as process, not event
• We are transferring some of the risk and anxiety
  from the patients lives into the system
  Corrigan 2006
• New professional identities
• New employing bodies
• New non-linear career trajectories

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After Pat Benner
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After Pat Benner
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After Pat Benner
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After Pat Benner
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(No Transcript)
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Professional Education Training
Developing a fit for purpose and
professionally competent workforce
Values
Knowledge
Skills
In a constant internal iterative dialogue with
each other and with external reality Winter 1996
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Professional Education Training
Developing a fit for purpose and
professionally competent workforce
Values
Reflective reflexive life long learning
Knowledge
Skills
a new common foundation curriculum will
enable students and staff to switch careers and
training paths more easily NHS Plan 2000
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Loss of professional identity
Chaos Helplessness
Displacement activity
Zone of Complexity
Flexibility engagement
Clinging to current roles
Defensive manoevering
Stasis Denial
Clinging to current models, patterns locations
of care
Change for changes sake
After Dr James Price
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Key challenges for the academic 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 threats
• Blue hexagons key opportunities

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Key challenges

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

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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

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A learning rich environment?
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An unstable environment

• Morale
• Coping with the unchanging nature of human need
  at the same time as coping with constant
  organisational change can leave professional
  staff feeling lost in familiar places Shapiro
  Carr 2002
• Sustainable competence in an incompetent
  context
• Learning from the lowest common denominator

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Patient Voices

• This was where Jimmys 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

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Underpinning Questions

• Does CME, CPD and PQSW expenditure deliver
  evidenced value for money in improved patient
  experience or outcomes?
• A recent review by the Standing Committee on
  Postgraduate Medical and Dental Education of
  random control trials of CME concluded that it
  was undermined by difficulties in its delivery,
  that it seemed unable to respond to the urgent
  demands of healthcare reform and that there was
  little evidence of its own effectiveness and
  efficacy Headrick, Wilcock, Bataldan BMJ 2005
• Is the scale of the budget justified?
• NHS spending on CPD in 1999-2000 was about 1bn.
  Brown, Belfield, Field 2002 currently
  estimated at circa 1.3 bn
• Is the individual focus always appropriate?

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A new focus for post-qualifyingeducation and
training

• The complexity of health care systems and the
  multiple variables which impact upon team working
  at a clinical level may affect the translation of
  policy into improvements in the quality of
  patient care West
• Dissemination of information as a passive
  process does not appear to produce behaviour
  change in clinical teams an awareness of the
  barriers to change is an important factor in
  initiating a process that translates policy into
  practice Kaner et al
• Cf NICE Guidance
• Active processes where teams themselves seek out
  new information increase the likelihood of the
  successful adoption of innovation Fitzgerald
• A new definition of team
• Communities of practice

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From intra-organisational silos
W O R K F O R C E
REFORM
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Pathways as mediums for integrating the policy
agenda
Patient Engagement Choice
Service Integration
Commissioning
Clinical Pathway Focused Management Systems
Capital Renewal
Information Technology
Workforce Development
Standards, CG Performance Management
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Pathways as mediums for integrating the policy
agenda
Patient Engagement Choice
Service Integration
Commissioning
Clinical Pathway Focused Management Systems
Capital Renewal
Information Technology
Workforce Development
Standards, CG Performance Management
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Interfaces

• Relative under-representation of the University
  sector at the level of
• policy formulation
• system leadership
• operational development
• Not one University Sector representative on the
  twenty person LSWC Programme Board
• Getting on to the radar screen of DH reform,
  Local Government, SHAs, Local Strategic
  Partnerships, PCTs and care providers

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Ranking of Organisational Goals across the Health
Economy
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Overall Strategy?

• No one over-arching strategy to align education
  and training to public sector reform
• Nor to co-ordinate discrete strategies

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Responses to the challenge
An excellent workforce that gives the best
possible care 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
staff to help them in new ways
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Responses to the challenge
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.
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Responses to the challenge
Integrated Care Network Care Services
Improvement Programme
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Responses to the challenge
Summary ! 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 action 37 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
across undergraduate and postgraduate curricula
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Responses to the challenge
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.
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Responses to the challenge
MMC will deliver a modern training scheme and
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 careMMC has
created two-year foundation schools that will,
for the first time, 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
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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.
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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
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Responses to the challenge
The NHS Institute current priorities are No
Delays (18 Week Wait) Healthcare Associated
Infections Primary Care / Long Term Conditions
Delivering Quality and Value
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Responses to the challenge
The Large Scale Workforce Change (LSWC) team
designs and delivers service improvements and
workforce developments 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 that are measurably better for
staff and, as a result, better for patients
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Responses to the challenge
Agenda for Change Integrated Service Improvement
Programmes (ISIP) National Service
Framework Implementation Teams
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Responses to the challenge
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.
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Alignment?

• The whole may be less than the sum of the parts
• Opportunity for a radical re-appraisal of the
  education and training interface with the new
  landscape of care

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Underpinning Questions

• In an increasingly competitive education and
  training market place do Universities capitalise
  on their unique market advantage?
• The scale of the marketplace
• Is there a coherent market?

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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

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Perhaps we could be a little more explicit here
in step two.
Reflective debate on the need for profound reform
New fit for purpose Education and training
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There are more things in heaven and earth,
Horatio, than are dreamed of in our philosophies

• This was where Rizias 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