Developing A Strategic Approach to Managing Supply & Demand

1. Developing A Strategic Approach to Managing Supply & Demand Dr. Patricia Oakley Director, Practices made Perfect Ltd. Teaching & Research FellowOrganisational Psychology & HRM Birkbeck & King’s Colleges, London University

2. TheModernisationAgenda • Wanless’s Recommendations - Service and Workforce. • The Crucible of Modernisation – Primary Care and Community Developments. • Complex Inter-Agency Networks – Care of the Elderly. • Complex Public Service Partnerships – Care of Children. • Managing Change – Technical, Cultural & Political Agendas.

3. Managing Complex Change The Wales Wanless Report Issues • Expertise is too thinly spread • Institutional care > Community Care • Burdens on acute care are too great • Performance varies widely • The workforce needs developing

4. Primary Focused – Community Based Care SPECIALIST SUPPORT SOCIAL & VOLUNTARY SERVICES • Finance • Personnel • Estates • Pathology • Support Staff • Education and Training • Social Services • Legal and statutory duties • Advice and information • Inspections • Carer support networks • Education and Training ACUTE HOSPITAL AIDED LIVING CENTRE (non-medical model) • Integrated Care Group in and outpatient services • Day Surgery and Treatment Centres • Specialist Centres • Intensive Care • Therapists led care • Rehabilitation and alternative therapies • Equipment Store • Carer support PRIMARY CARE • GP’s and practice based care • Aided Self Care • Advisory Services • Self Care COMMUNITY HOSPITALS/ HEALTH CENTRES NURSING HOMES & HOME • Maternity and Child Care Services • Overseeing medical discharge and MOT centre • Investigations and minor surgery • Mental health Care • Nursing support and night sitting services • Home based treatments • Home based therapies • Respite services and carer support

5. Elderly Trauma Centre • Parkinson’s • ALC • Dementia Specialist Medical • Dermatology • Oncology • Diabetes M.I.U. Pain Clinic Carer Support • Acupuncture • Osteopathy • Chiropractice GPs Specialist Mental Health Day Surgery • CPN • Psychology • Psychotherapy • Counselling X-ray & Imaging Primary Care Led NHS

6. Complex Case Management Programmewith a Case Manager who coordinates care from several groups of experts joining up care for patients and carers. c. 20% of chronic Care Management (but c.80% of resources). Level 3:Highly complex patients who need case management. Disease Care Management Programmeand Proactive support from Multi-disciplinary Teams using Care Protocols & shared information. Level 2: High risk patients who need disease management support e.g. diabetes. 70-80% of Chronic Care Management. Level 1: right support, many people can look after themselves, living with and managing their condition(s). “Expert Patient” Programmesand Carer Support involving Voluntary Groups eg. BDA, Age Concern etc. Health Promotion Health Promotion Programmeseg. Diet, exercise, and education. Primary Care Led NHS

7. Gwent Health Authority & Healthcare NHS Trust Strategic Development Framework Policy Very Local Goal: “Go Solo” @ Home – individual (& carer) well and independent Keep as much clinical and care support as possible very local and accessible. Local Reactive and Proactive Support for individual (& carer) @ Home - Specialists helping Local Services • GP • District Nurses • Social Workers • Care Assistants Reactive # Support @ Home & in Homes - • Medical & Surgical Adm. Units • Diagnostic & Treatment Centres • Rapid Reaction Teams • Intermediate Care Packages Local Specialist Service Centres - Proposed Plan • Cancer • Renal • Rheumatology • Diabetes • Urology • Trauma • Build-up Clinical Strategy to support local services. • Develop underpinning HRM Strategy to support Clinical Strategy. • Develop underpinning Informatics and IT Strategy. Regional / National Specialist Service Centres - Issues • What processes need to be employed to build-up work programmes? • Where are the ring holders to hold it all together? • Who will manage the work programmes? • Transplant Centres • Genetics Services • Super-Specialist Centres

8. Children’s Services Trusts Education Authority (Accounting Officer) • Sure start & Mum’s support • Skills for Life & Education • Exclusions & Referral Units PARTNERSHIP AGENDA • Integrated Legal Trust? • Group Commissioner of Children’s Services? • Information and Informatics Network? • Talking Shop? • Discrete focus eg. CAMHS? Health Services Police Authority • Primary Services • Secondary Services • Tertiary Services • Child Protection • Custody & CJD • Links with HMPS & NPS for Children being resettled Social Services • Child Protection & Adoption • Families & Children @ Risk & in Care • Young Adults Support

9. Managing Complex Change Bear Traps and Death Knells: • Goodwill and “elasticity” only gets you so far before they, and energy, run out. • No-one owns the change issue/plan – staff are “done to”, and anyway Christmas is coming. • Psychological contract is breached and not reset between both parties. • Complex long term change programmes not thought through or staged correctly, and component parts not closed off as progress is made. • We have a “run away” in progress and it’s splattering messy stuff on everyone who can’t get out of the way fast enough.

10. Complex Change Management Programmes Anti-Fog : Anti-Displacement Activity : Anti-Can’t Do Brigade Project Management Architecture • Strategic Steering Group. • Executive Group. • Project Manager & Change Team. • Technical Support Team. • Administration Support Team. ?Who Benefits? Technical Cultural • Clarity in service needs and model’s design and how it fits in the local context and current service provision. • Clarity in scope of work programme and who needs to be involved. • Clarity in timescales and budget required for the change and the estimated value added of the change. • Clarity in legal and regulatory constraints and delegated power of authority. • Clarity in what the end point is and the exit and closedown procedures. • Clarity in constituents involved and their beliefs about the service and themselves. • Clarity in the role of pilot projects as tasters/samplers and adjusters to the original ideas. Political • Clarity in diagnostic mapping of the political groupings and their agendas. • Clarity in the differences between those for and those against the changes and what their respective “prices” are. • Clarity in the scope of resources and leverage available to manage the rebalancing of “for’s” and “antis”. • Clarity in how the key opinion formers will be supported to mobilise positive forces (the 67%). • Clarity in how the “entrenched never going to change” group of individuals are going to be managed and bifurcated from the main group (the 3%). • Clarity in the role of experiential learning and developing a “Community of Practitioners” which is underpinned with a common belief system. • Clarity in staff involvement and communication mechanisms and facilitation techniques. • Clarity in the use of policy instruments to underpin shifts in culture, language and beliefs 5 Work Programmes • Scoping Work. • Technical Programme. • Cultural Programme. • Political Programme. • Evaluation Work.

11. Building-up locally facilitated by 3 Regional Offices. • Incorporate New Ways of Working Agenda & Agenda for Change. • Incorporate Primary & Community Care Developments & Joint Partnership Working with Social Services Clinical Service Strategy to deliver Wanless • Pre-registration Workforce Strategy incorporating Agenda for Change issues. • Post-basic Workforce Strategy incorporating new regulations & New Ways of Working. • Care Assistants’ Strategy to complement above. Nurses, Midwives & Care Assistants Workforce Strategy • Medical Workforce Agenda – EWTD, new Consultants Contract & Modernising Medical Careers. • GPs Workforce Agenda – GPs/Special Interests, new GMS Contract & primary Care Teaching Organisations. • Medical and Dental Undergraduates Strategy & Clinical Placements Programme. Medical & Dental Workforce Workgroups Strategy • Therapists & Assistants Workforce Strategy – pre & post basic streams. • Pharmacists, Dentists, Ophthalmic & Optometrists – Post-graduate Workforce Strategy. • Scientists, Physicists & Psychologists – Post-graduate Workforce Strategy. Programmes. Professions & Scientists Workforce Strategy NHS Wales – Delivering the Wanless Report Building Capacity & Capability in Workforce Planning Education & Training Contracting unit/Service Policy Objective • Education & Training Contract negotiations, financial planning & sign-off. • Contract Performance Management & budget/out-turn reconciliation procedures. • Relationship & long-term agenda (HESP) developments & management. Deliver The Wanless ReportforWales • Workforce Planning data collection management. • Workforce Planning data analysis synthesis & modelling/forecasting. • Workforce Planning proposals, budget reconciliation & risk management. Workforce PlanningUnit/Service

12. The Modernisation Agenda Big Issues– CUI BONO? • Is there enough political will to see through the changes required? • Is the management infrastructure good enough to support the changes? • Who is explaining this to and working on managing the expectations of the public? • How are we going to address the inequalities building-up on the border? • How are we going to take the staff, especially doctors, with us?