FOCUS ON THE FUTURE – THE STRATEGIC REFORM AGENDA AND IMPLICATIONS

1. THE MODERNISATION AGENDA 2015–2025 What are the implications for workforce development? Friday 14th February 2014 Dr Patricia Oakley Director, Practices made Perfect Ltd. Teaching and Research Fellow Public Policy and Management King’s College, London FOCUS ON THE FUTURE – THE STRATEGIC REFORM AGENDA AND IMPLICATIONS

2. FINANCIAL ADJUSTMENTS New Reality – Tight Fiscal Regime; Real Incomes; Size of State

3. The Next 30 Years • Care of the Elderly – physically well and mobile, socially engaged and psychologically content. • Chronic Disease Management including Mental Health and Carer Support. • Specialist Surgical and Therapeutic Interventions. • New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics. • Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

4. BIG SCIENCE COMING TO YOU SOONRCTs, Cash Flow, Research  New Ways of Working • Genetic Profiling and Therapeutic Targeting. • Proton Beam Therapy and Novel Treatments. • High-speed informatics and cooling technology. • Stem-cell based research and new science. • Prosthetics, regeneration and bio-engineering developments.

5. Supporting Getting Old and Managing Long Term Conditions Build a fabric of dense social networks within which good quality health and social care interventions are delivered in a timely and sensitive way. The Goals of Integrated Care Programmes

6. Supporting Getting Old and Managing Long Term Conditions • Support for family, friends and community self-help groups. • Support for collectivising events and activities. • Support for patient-focused charities and enabling groups. Reducing Social Isolation ?What is the Role of the State?

7. New Service Design Assumptions • Assertive Public Health Strategies and Public Engagement. • Technology-supported Homes and Communities. • Early Health Risk Screening, Diagnostics and Interventions. • Advanced Pharmaco-therapeutics and Genetic Profiling. • Technology-supported Clinical Decision-making and Work Designs.

8. New Service Design Principles Hospital @ Home Service Hospice@ Home Service Single-people enabledHomes and Campuses “High Street” Screeningand Diagnostic Centres (high science and technology) Community Activity Centresand The Gym Re-enablement, Rehabilitation and Resettlement Centres GP Well-being PracticesandManaged Care Centres (Cancer, Stroke/Cardio, Mental Health) Trauma Centres Urgent Care Centres Planned Care Centres Nursing and Care Homes Step-down/Convalescent Homes

9. “The Place in the Middle” Regional TraumaServices High Street (including children’strauma service) Paramedic/Blue Light Service Services Local Care Services (including mental health and planned care services) Social Care Services UrgentCare Services • Convalescent, Observation and Place of Safety Beds and Services. • Minor Injuries and “Off-legs” Front Door Services. • Planned Care and Rehabilitation Services. • Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes. • End of Life Services. Hospice and Hospital at Home Services (including children’surgent care service) Maternity & Neonatology Care Services Community Pharmacy and Medicines Services Social & Probation and Police Services Genetics Services GP Surgeries and Out of Hours Services Cancer, Cardiac, StrokeCare Services Community Nursing and Midwifery and Therapy Services Mental Health Care Services (inpatients) (includes current A&E “minors” service) • The Home Tests? • The Gym Tests? • Point of Testing Services? • Local Diagnostic Services? • Local Imaging Services? • Local Genomics Services? • Regional Diagnostic Services? • Regional Imaging Services? • Regional Genomics Centres and Predictive Analytics Services?

10. Supporting Getting Old and Managing Long Term Conditions • Service commissioning development. • Tariff and rewards payment development. • Service reviews and development of service networks. • Policies to reduce integrated service delivery hurdles. • Policies to build robust QA and inspectorate processes. The Role of the State – Progress Report

11. Focus on the Future – The Wheel Turns AgainPossible Streamlined Public Service Architecture* • Dept. of Health and Social Care Permanent Secretary andChief Medical Officer. £ Independent NHS Board and its Regional Directorates Workforce Regulators Pay Review Bodies Independent Reconfiguration Panel CareQuality Commission Monitor-Market Regulator Service Commissioning Agencies • Chief Executive. £ • £ Controller. £ Service Providers Network • Commissioning Director. • Local Authority and Primary Care Trust Service Commissioning Agency: • economies of scale service commissioning; • Public Health Programmes; • “residual” services commissioning. • Clinical Commissioning Groups – Managed Agencies for majority of local people’s needs. • GP-Patients Commissioning Partners: • Individual Choice; • Co-Payment Choice; • Means-Tested Services. • National Specialist Commissioning Group e.g. Transplant Programmes, Proton Beam Therapy and “Orphan”Drugs. • Foundation Trusts and Academic Health Science Centres. • Social Enterprises. • Companies. • Partnerships. • Medical Director • Nursing Director • Chief Officers £ £ • WorkforceDirector. • R&DDirector. • Clinical Senates’ Guidelines and Advice. • New “NICE”.

12. Professionalism in Healthcare Staff “Professionalism” Goals: Good, Safe, and Accurate Patient Care Good, Safe and Accurate Patient Care • Who sets them? Practice Standardsand Quality Assurance • Who develops metrics and QA methodology? • Who inspects? • Who builds E&T specification and Curriculum? Education and Trainingand Supervision • Who validates teaching programmes? • Who develops teachers and supervisors? Staff’s Behaviours, Attitudes, Aptitudes,Skills and Knowledge ? Who develops and QAs the clinical placements?