Spring In-Brief 2019 - Flipbook - Page 2
Continued from previous page.
It’s unlikely that there will be placard waving fracking
protesters turning up at the doors of the new
neighbourhood teams complaining about the resource
push into their integrated neighbourhood hubs. However
will the benefits be realised? The Nuffield Trust recently
noted that they have reviewed over 40 evaluations of
‘integration’ projects and none delivered the intended
benefits.
However, assuming the fracking process goes well it will
directly lead to financial winners too. Primary Care
Networks will have their ‘shared savings scheme’ and
acute hospitals will also receive a fracking ‘dividend’ as
their future funding will not be offset by assumptions
about reduced system demand.
So all the new integrated systems have to do is:
• propose and develop new integrated models of
working;
• assess the pathway interdependencies across
systems;
• allow for variability in performance in setting new care
delivery thresholds and standards;
• ensure patients can be tracked as they flow through
the new pathways of care;
• model the workforce needed with the right skills and
competencies;
• ensure the governance systems are in place to
mitigate the turbulence of major change;
• keep a look out for any untoward outcomes of change;
• set up proper evaluation frameworks to see if what we
are doing is actually making a difference; and
• model the funding flows to ensure systems are
delivering better VFM, and of course measuring the
fracking ‘dividends’ to be paid out.
This requires a whole new skill set for Integrated Care
Systems (ICSs) and within that, NHS managers and
leaders. Capacity, patient flow and demand planning
skills (as well as reliable models and analytic systems)
have traditionally been hard to source within the NHS
workforce. Complex analytical and data science
professionals are as rare as hen’s teeth and the
requirement for this capability is now more urgent than
ever if we are to unlock the potential of the long-term
plan.
Simulating a single provider’s supply and demand
interactions has been hard enough for most organisations
to achieve. Now add to this the need to model how care is
delivered, and actual patients treated, across multiple
providers within an integrated and seamless new system
and the complexity ‘tends towards infinity’. But this is the
task, this is the challenge, this is the agenda and a ‘future
proofed NHS’ is the prize.
Tom McCarthy
Managing Partner at Niche
Tom.McCarthy@nicheconsult.co.uk
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The long-term workforce
Workforce really is the critical factor in how the Long
Term Plan will be delivered; everyone acknowledges the
risks and challenges currently faced by the NHS in
securing and retaining a future-fit workforce.
Some of the workforce spending debate was postponed
to the 2019 spending review but the bottom-line on
spending is that we simply are not making nursing and
medical careers attractive to people. Even if we do
manage to entice people through the front doors of some
of our outstanding colleges and universities, we are
failing to keep them for a number of key reasons:
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long hours and a lack of flexibility;
pay is not commensurate with levels of responsibility;
training opportunities leading to clear promotion
pathways are not always accessible; and
the NHS sense of ‘pride’ so touted, only goes so far
when you are being bullied/open your pay packet/
make a mistake.
Of course, some nurses, doctors and other healthcare
professionals absolutely love their roles and it cannot be
denied that this is still an immensely rewarding career on
both a personal and professional level. Yet the numbers
of qualified and trained professionals leaving the service
are at an all time high. The challenge of how to stem and
reverse this flow is crucial in the next ten years.
Perhaps the challenge is that we are far too traditional
about how we design these roles. For years the NHS has
been talking about role redesign and lining up human
resource to deliver strategic change – but what in reality
does this mean? What it doesn’t mean (but a response
which is often translated) is to add new responsibilities to
someone's already creaking portfolio. Ten years ago a
Director of Nursing was a Director of Nursing, now they
are the Director of Nursing, Governance,
Communications, Strategy, Estates and Quality
Improvement (this is not altogether too far from the
truth…).
Whilst Agenda for Change (AFC) unfortunately hindered
creativity, there have been areas where great strides
have been made in role redesign, for example Nurse
Practitioners. However, we are still constantly adding
supplemental (and often fixed-term) roles to respond to a
gap (getting the most from the AFC banding), rather than
designing roles to plan for a bold strategy.
Perhaps the long term Plan and integration agenda will
finally force us to look at how we can change current
roles. We should finally start to look across the ICS
(particularly) and integrate our thinking on career design,
particularly between health and social care. Perhaps
once again these jobs will be manageable, attractive and
rewarding; ultimately helping the NHS to deliver the aims
of the Long Term Plan.
Ruth Laird, Consultant, Niche