Transforming Care Delivery - Conference Update

Transforming Care Delivery was the theme of Skills for Health - Workforce Projects Team's first Working Time Directive 2009 conference. The day longevent at the QE II conference centre in London in April brought together a capacity audience of 300 delegates, with the majority of NHS acutetrusts represented along with other key stakeholders.

The conference was about re-energising the work towards 2009 and updating people on the national and local initiatives going on at the moment and what they can expect to see in the future. It aimed to give an honest appraisal of the challenges that need tobe faced around implementing the Working Time Directive and provide some clarification of the current situation. A range of nationalspeakers and people closely involved in WTD work lined up to emphasise the message that 2009 is fast approaching and must already be on the agenda of NHS organisations.

Here’s a run through of the days events – and pointers to the resources that are available:

Professor Judy Hargadon, former chiefexecutive of the NHS ModernisationAgency opened the day with areminder of the basic facts aboutWTD 2009, the rules on breaks andcompensatory rest and the latest onthe SiMAP and Jaeger rulings from theEuropean Court of Justice.

Lord Warner, Minister of State for Reform,addressed the audience and set WTDinto context with other policies andinitiatives such as Modernising MedicalCareers and highlighted that the daywas also about patients, planning and productivity.

The progress that the NHS has madein improving the working lives of staffand strengthening patient care overthe last few years was emphasisedand delegates urged to use WTD2009 as an opportunity to further this.Resources: Lord Warner’s full speech is available on the healthcareworkforce portal.

Outside the main conference hall,delegates were able to visit an exhibition area run by the WorkingTime Directive partners, each ofwhich described their role in andcontribution to the support available for NHS organisations to achievecompliance. NHS National WorkforceProjects gave an overview of thesupport and pilot work, theWorkforce Review Team were able toshow delegates their currentcompliance rates and national data andEssex Workforce DevelopmentConfederation presented the findingsof their diagnostic work –highlighting key issues common tomany trusts and possible solutions.Also on display were posters submittedby delegates which highlighted areasof best practice in solutions to WTD. Resources: Conference posters are available on the healthcare workforceportal.

Back in the main hall, Danielle Procter, stakeholder manager for Integrated Service Improvement Programme (ISIP)gave an overview of the programmewhich aims to help the NHS in a varietyof ways such as supporting the processof integrating people, processes,technology and infrastructure toachieve change. Delegates were alsochallenged to consider how WTD canbe linked into their integrated serviceimprovement plans.Resources: Danielle Procter’spresentation is available on thehealthcare workforce portal.

The Workshop sessions The workshops took place in the morningand afternoon and aimed to build onsome of the key messages with practicalexamples of work and the opportunity tohear from some key speakers.

Direction – WTD and the broader policy agenda
This workshop highlighted some of the broader policy initiatives which complement the WTDagenda. Professor Shelly Heard from Modernising Medical Careersgave an overview of their role andremit. David Wells, WTD lead formaternity & paediatrics and Susanne Cox, children’s & maternity servicesnetwork development lead, fromthe Care Services Improvement Partnership, gave presentations ontheir work. This was accompaniedby a working example of CSIP inaction by Matthew Bluck and Dr Yasmin Ahmed-Little from Greater Manchester Strategic Health Authority.Resources: The directionpresentations are available on thehealthcare workforceportal.

Practice – Making WTD work for your organisation
The aim of the practice workshop wasto highlight how Hospital at Night(H@N) had been effective in a numberof different NHS organisations. It alsoarticulated how H@N is a key enabler toachieving WTD 2009, as demonstratedwith the 2004 directive. Contributorsto the session included: Wendy Reid,national clinical lead for the H@Nteam and also Postgraduate Dean,London Deanery; Dr John Coakley,consultant in intensive care medicine,and medical director, HomertonUniversity Hospital Foundation Trust;Alison Cole, WTD changing workforce project manager, University Hospitalsof Morecambe Bay Trust and lastly, Dr Patrick Chu, H@N lead, Royal Liverpool and Broadgreen University Hospital Trust.Resources: The practice presentationsare available on the healthcare workforceportal.

Innovation – New ways of working to meet WTD
New roles and new technology wereshowcased in this workshop;providing another example of how toachieve WTD compliance. Dr James Gray, community medical advisor,South Yorkshire Ambulance Servicegave a presentation on emergency care practitioners and the impact theyhave made on A&E admissions. Dr Brendon McCarron, consultant in infectious disease and senior projectleader, James Cook University Hospital, Middlesbrough gave a presentation onthe PDAs (personal digital assistants)software in use in their trust which have replaced the traditional bleepsystem. The new innovative technologyhas transformed communication for the on-call teams by allowinginformation to be available that ensuresstaff with the right skills can get to patients quickly. Resources: The innovationpresentations are available on the healthcare workforceportal.

Safety – Putting the patient at the centre of WTD
This workshop looked at WTD fromthe perspective of the patient and the staff. It was delivered in an interactiverole-playing format, by drama groupSteps. Some real life scenarios wereplayed out and delegates were asked for their views at key points.

Diagnosis – Giving you the tools to assess the WTD challenge
This workshop was delivered by the Working Time Directive partners,which comprises of Skills for Health - Workforce Projects Team, Workforce Review Team (WRT) and Essex Workforce Development Confederation (WDC). Each partnerarticulated their unique role insupporting NHS organisations achieveWTD 2009. Nigel Burgess, portfolio project manager at the Workforce Projects Team describedthe overarching ‘lead’ role they offer;Ian Weller, business manager, from WRT, described the vital WTD analysis work they have undertaken, whichfocused on the current WTD 2009compliance rates by speciality andSHA area. Steve Buggle, director of workforce development, Essex WDCdescribed the diagnostic tools andenabling strategies project they have been leading on (described in the lastissue of Calling Time). Other team members from all three organisations were on hand to answer the manyquestions delegates had at a marketplace style event afterwards.Resources: The diagnosispresentations along with data and tools showcased are available onthe healthcare workforceportal.

WTD is a must do says panel
The opportunities that WTD presents tothe NHS should not be overlooked, a panel of workforce and WTD experts stated during a question and answer session,facilitated by professor Judy Hargadon. Introduce a ‘copying award’ to help sharegood practice was some of the advicefrom Julie Dent, chair of WTD stakeholder board and chief executive of South West London Strategic Health Authority. Chief nursing officer Christine Beasley,emphasised that WTD should be seen as an opportunity for the health service ratherthan just a directive.Andrew Foster, then director ofworkforce at the Department of Healthnoted his anticipation as he returns to the NHS, in using and sharing all the goodpractice and tools that are becomingavailable in the run up to WTD 2009.Wendy Reid, postgraduate dean at the London Deanery and also clinical lead for Hospital at Night explained that hospitalat night teams do improve patient care, and that they’re popular, they’re whatpeople want to work on.

On training
Q“Everything we hear about is that the training budgets are being cut and ifwe’re really going to have new roles andnew skills and going to deliver servicesdifferently then we need to start trainingthese people nowcome this September ifthey are going be fit for purpose for August 2009, where’s the money goingto come from and is it going to come?

”A“ I agree that training is absolutely at theheart of this, but I must correct theimpression that training budgets arebeing cut. Training budgets haveincreased for each of the last three yearsI think the total increase for the last threeyears is 30%. Whereas we may belooking at some pressure on thepreviously hoped for growth in thetraining budgets for 06/07 it is still thecase that the training budgets areexpected to increase, so its not a cut it’sa lower level of increase than we hadhoped for. If you’re prepared to use the WTD is an opportunity to rethink all yourclinical services, there’s an opportunitynot just to achieve compliance but also to improve the patient experience, tohave better training for juniors and to doso in a way that doesn’t add cost to the system.”
Andrew Foster

On spreading good practice
“If any of us go through an academic career, plagiarism is knocked out of you. I just sat on a student disciplinary, andthe student has just been chucked outfor plagiarism, suddenly you come outand we want you to be a plagiarist, soit’s something about how do we leavesome of that behind and how do wereward it. I always wanted to introduceinto the NHS a copying award, alwayshad a fantasy it would be done by somephotocopying company and you wouldactually get a reward for something you have copied from someone andimplemented, but also if you had a goodidea that 10 other people had copied itand implemented it.”Julie Dent“I once asked a very wise old medicaldirector who had a very good record ofachieving change ‘how do you spreadbest practice?’ and he said ‘well I nevercall it that, I talk about best outcomesand that appeals to the scientists and clinicians”
Andrew Foster

On working at night

Q“ To equate nurses and doctors working the same shifts when the nurses areworking less than 40 hours a week anddoctors are working up to 56 is not thesame. Doctors are not based in that hospital for the rest of their working lifethat they can foresee and they’re tryingto undertake postgraduate exams whichare quite difficult. So I do feel there isa difference between giving doctorsrest on 14 hours shifts when they’reworking 56 or even 48 hours a week.”A“I’d challenge some of that, as whatwe’ve found is that nurses tend to doquite long hours and they also doovertime in a way that doctors don’t andactually some of the evidence is not asclean cut as you say and lots of nursesare doing lots of training andqualifications, so its not as simple as whatyou pose. Our duty as employers is tomake sure all of our staff are safe to workpatterns that disrupt their sleep and weshould be educating all of our workforceabout what is good practice.”
Julie Dent

On SiMAP & Jaeger judgementsQ“Interested to hear you are still trying tooverturn these judgements because I fail to see how it can possibly be deemed that someone isn’t working when they are required to be in a place overnight whatever they’re doing, you are away from home, you have to be there, youhave to be able to work at a moments notice, how can it be that you aren’t at work? I’m speaking from experience ofbeing a doctor but also regularlyspending nights in the hospital as aconsultant. I’m still working when I’m there. To base any strategy on trying tooverturn a judgement which reallywould be a retrograde step for many working peoples lives. I fail to see it being a sensible approach. ”A“Whilst I understand your point that ifyou are resident on call then to some extent you are more working than if you are home doing what you want. It is alsothe case that if you are asleep at night,but resident in a hospital you are doingless work than if you were walkinground the wards. There’s somewhere in the middle really, and that’s where the resolution to the SiMAP/Jaeger discussions have centred, not aboutsaying there is absolutely no weight at all to being resident at night, but to say there is some common sensible groundto go for.”
Andrew Foster

Q “If you introduce hospital at night thenon call rotas disappear anyway, you’re never going to need these doctors back.The ones that are there are the ones thatare needed, they are working all night.So SiMAP and Jaeger, once you’ve done hospital at night become irrelevant.”

A “I agree that once you’ve got a good hospital at night, you’re calling people in less frequently. I think there is an issue with your surgeons at home and maybeorthopaedic for those rare occasions that they’re called back in, but I think there is an issue around compensatory rest.”
Wendy Reid

Summary
With the aim of this conference being to raise awareness of WTD 2009 and to highlight the supportand resources available, that will help NHS organisations meet the directive; the Workforce Projects Team were delighted tohave achieved this aim and also received so much positive feedback. Discussions are already underway for the 2007 conference; you can let usknow what you’d like a national or regional event by emailing wtd@skillsforhealth.org.uk.

Feedback

• 92% of delegates rated the conference was 'good' or 'very good'
• 85% of delegates rated the conference as a good use of their time
• Workshops were very well received overall and were by far the most helpful element of the conference. 83% of delegates rated the workshops were 'good' or 'very good'.

Note: All presentations from the day and postersdisplayed in the exhibition are available on the healthcare workforce portal.