Where’s the evidence? The Hub’s approach to capturing the benefits and impact of skill mix change

1. Where’s the evidence? The Hub’s approach to capturing the benefits and impact of skill mix change Liz Hedgecock Knowledge Development Manager North West Workforce Modernisation Hub

2. Overview • The background to our evidence base work • Our aims • Overview of the evidence workstream • Partners and projects • Products and resources

3. The QIPP challenge: bridging the £15-20bn QIPP gap Quality Innovation Productivity Prevention Our evidence base work in context What is the evidence that skill mix change helps to bridge the QIPP gap?

4. A clear ROI Potential Role Substitution Return On Investment (ROI) Baseline: Cost of qualified registered professional Band 5 mid point £23,345 Cost of qualified Assistant Practitioner Band 4 mid point £19,495 ROI calculation ROI = Basic Grade Radiographer cost – AP cost x 100 AP cost 23,345 – 19,495 x 100 = 0.20 19,495 0.20 x 100 =20% cost saving

5. Some national findings re: skill mix change… • There is a dearth of research (Sibbald 2004) • Cost-effectiveness not evaluated (Sibbald 2004) • Nurse/doctor substitution (Laurant et al, 2009) • Role revision has no detrimental effect & in some cases a positive effect on the quality of care (Health Foundation, 2010) • Labour Substitution report (CfWI, 2011) Service developments are some way ahead of the research-based evidence in this area

6. Substitution: the Centre for Workforce Intelligence’s view Quality • An appropriately trained substitute can deliver as high quality care as the original worker Workforce shortages • Demand for the original worker can be reduced but not eliminated Cost savings • Salary savings are often offset by lower productivity of substitute Efficiency • Efficiency gains are possible only if the original worker stops carrying out tasks now delegated to the substitute ‘Labour Substitution…’ CfWI 2011

7. NW evaluations of impact and process include Assistant Practitioners, Advanced Practitioners, Non Medical Consultants and Non Medical Prescribing NW evaluations show improved access, reduced waiting times and care closer to home Evaluations also highlight the importance of organisational readiness and culture (lessons learned) Some North West evidence re: skill mix change

8. Our aims for the evidence base workstream • To lead the development of the evidence base in relation to the impact of skill mix change, in particular the links to QIPP • To influence the national development of the evidence base in relation to skill mix change Objective 1: In order to influence skill mix changes and commissioning, contribute to new evidence, identifying priority areas for investment and development Objective 2: Review and summarise existing evidence relating to skill mix change and produce guidance on how to apply the evidence Objective 3: Ensure organisations have access to sound evidence about skill mix changes

9. Overview of the evidence base workstream

10. Programme: the impact and benefits of skill mix change ‘The North West Workforce Modernisation Hub invites expressions of interest from health and social care organizations, to undertake a detailed analysis of their own skill mix change in order to provide evidence of the impact and benefits of skill mix changes within their workforce.’ • Expressions of interest (EOIs) invited from NW organisations via Workforce Modernisation and Planning Networks • Partnership approach • ‘Launch’ meeting with each organisational lead to explore and define the project scope • Backfill funding for each organisation, equivalent to c. 35 days at midpoint band 8a • Project length: usually 1-2 years • Planned overall outcomes: • Develop a benefits framework for workforce • Develop organisational capability in planning and evaluating benefits and impact of skill mix change • Produce and share adaptable, reusable resources to enable wider learning and practice

11. Partners and projects – impact and benefits Wave 1: commenced mid-2012: • 5 Boroughs Partnership – Assistant Practitioners, Community Health Services • Mersey Care – Advanced Practitioners, Mental Health • Royal Liverpool & Broadgreen University Hospitals – skill mix change for non-clinical support staff • Wirral University Hospitals Trust – Advanced Practitioners Wave 2: commenced early 2013: • Cumbria Partnership – Assistant Practitioners • East Lancashire Hospitals Trust – Assistant Practitioners, community stroke rehab • Greater Manchester West Mental Health Trust – Advanced Practitioners, Mental Health • Lancashire Teaching Hospitals – skill mix change in pharmacy teams

12. Products and resources • Benefits tracker template • Project highlight report template • Project plan template • Online resource area planned as part of evidence base area of Hub website – including resources which our partners have agreed to share, e.g. presentations, questionnaires, project documentation, terms of reference, focus group questions…

13. Benefits tracker template

14. Using the tracker in practice SKILL MIX SUMMARY FOR NEW ASSISTANT PRACTITIONER ROLES

15. Using the tracker in practice SKILL MIX BENEFITS PROJECT: OUTCOMES AND MEASURES

17. Some local evidence sources • Formal evaluation studies: • Non Medical Consultants (Gavin-Daley and Mullen 2010) • Advanced Practitioners (Acton Shapiro 2006-2009, Holbourne 2006) • Non medical prescribing (UCLAN 2010) • Assistant Practitioners (University of Manchester2004-2007, UCLAN 2008) • Journal articles on NW skill mix changes • Case studies • Posters • Presentations • Business cases • Award nominations

18. Learning to date/key messages • Build benefits and measurement in from the beginning • Set boundaries • Get help! • Allow plenty of time to establish metrics and baselines – and obtain data! • ‘And so what?’ • Some learning may be unexpected – but valuable

19. Any questions? liz.hedgecock@5bp.nhs.uk 07785 528696 wmhub@5bp.nhs.uk http://www.nwwmhub.nhs.uk Attribution: Salazar210 at en.wikipedia