Taking forward 2009 diagnostic work

The latest information from the diagnostic work carried out as part of the WTD 2009 work programme has been released. The work has been carried out for Skills for Health - Workforce Projects Team by East of England SHA.

Following last year’s initial diagnostic work, the programme has continued with work using the national diagnostic framework produced to look at key issues and work underway in NHS trusts. 11 trusts have been visited by the team to look in detail at the work underway and key issues and solutions to give a snapshot across the NHS.

As well as using their diagnostic framework, rotas have been analysed, key staff were interviewed and information triangulated from across the organisations. The work found that levels of compliance with the 48 hour week ranged from 9 percent to 54 percent and that, whilst it was recognised that it won’t be achieved by adding more doctors, there were still areas where it is seen as just a ‘doctors’ issue rather than a whole systems issue. WTD is also still relatively low on many trust’s priorities with MMC taking a priority - although there were many examples of good practice and innovation in finding solutions.

The findings showed that when WTD work is done well it is part of a larger change in an organisation with good partnership working between clinicians and management that benefits both patients and staff. This has been backed by the successful WTD 2009 pilot sites where staff have led change.

The reports and diagnostic tools are available at www.healthcareworkforce.nhs.uk/wtd

For further information about this project, its findings and how they can be applied to challenged specialties or to support your trust in complying with the WTD 2009 target, please contact Deborah Wodhams, Workforce Project Manager (Workforce Programmes), East of England Strategic Health Authority at deborah.wodhams@eoe.nhs.uk

Key themes from the work

These key themes are explored in more detail in the latest publications from this work.

Vision

• Need an agreed vision, shared by leaders
• Service and process re-design can be the catalyst for change
• Jumping straight to solutions can be dangerous.

Governance

• Clear leadership and accountabilities at all levels
• Requires doctors, nurses and managers working together on the issues, not separately on different issues
• Build structural links between WTD and MMC
• Options appraisals can generate the strongest possible solution.

Engagement

• Doctors, nurses and managers working together on the issues, not separately on different issues
• Hospital at Night thrives in a strongly collaborative environment
• Availability of specialist skills around rota design, change and project management is crucial
• Clinician involvement and engagement is essential.

Solutions

• Over-confidence in solutions based on rota design and increasing doctor numbers is a danger
• Service and process re-design needs a stronger emphasis
• Specialty reviews can focus effort on the key problem areas
• Training models can change to accommodate both MMC and WTD.

Trusts visited in phase II of the work were:

• Basildon and Thurrock University Hospitals NHS Foundation Trust
• Essex Rivers Healthcare NHS Trust
• Frimley Park Hospital NHS Foundation Trust
• North Middlesex University Hospital NHS Trust
• Northumbria Healthcare NHS Foundation Trust
• Royal Berkshire Hospitals NHS Foundation Trust
• Royal United Hospital Bath NHS Trust
• Salford Royal NHS Foundation Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• University Hospital of North Staffordshire NHS Trust
• West Suffolk Hospital NHS Trust.