The Calderdale Framework A Facilitation Tool for a

The Calderdale Framework A Facilitation Tool for a Flexible and Competent Workforce Developed by: Rachael Smith & Jayne Duffy

The right person, doing the right thing at the right time, RIGHT!

The Calderdale Framework: “a transformational tool for a competent & flexible workforce” • • CF is the result of evaluation & further development of Saunders original Functional Model of Delegation. Developing a competent & flexible workforce using the Calderdale Framework R Smith & J Duffy, IJTR 2010; 17(5): 254 -262

Why Bother …. ! ? The National Challenges n Demographic challenges –workforce and patients n Fiscal challenges n Safety and quality challenges –Francis, Keogh, Berwick, Cavendish n Modernising medical careers = early specialisation. GAPS in less ‘sexy’ areas n 2 year Foundation Programme = shifting focus to community

Why Bother…. ! ? Local Challenges: Longstanding medical staffing recruitment difficulties n Reduction in numbers of junior doctors n Changing demands of the service n Ability to offer career development opportunities n Regular rotation of junior doctors impacts on continuity of care n

What does this mean to us? n INCREASING DEMANDS ON OUR SERVICES n PATIENT DRIVEN SERVICE PROVISION n MAINTAIN QUALITY & PRODUCTIVITY WHILST CONTROLLING OR REDUCING COST n ENSURE REGISTERED PRACTITIONERS ARE FREE TO UNDERTAKE TASKS ONLY THEY MUST DO n IMPROVE SKILLS BASE OF THE WORKFORCE TO PROVIDE FLEXIBILITY & CONTINUITY

HEYH response: n Development of both Assistant Practitioners and Advanced Practitioners is a regional priority. n Regional steering group being formed to ensure consistency and rigour. n Investment in Calderdale Framework methodology to support this.

Bid for HEYH for support DIRECTORATE NO. SPECIALITY Elective Care 4 Acute & Cancer Care 6 Surgical Care Practitioner 1 x Post Trauma & Orthopaedic 1 x General Surgery 2 x Peri-Operative Care for Older Patients Undergoing Surgery To be used flexibly across Urgent Care Services Integrated Care 5 2 x Acute Care 2 x Elderly Care 1 x Dermatology

So how can we do this? n Service Improvement Initiatives n Workforce development and new ways of working using The Calderdale Framework.

The Calderdale Framework 1 Awareness Raising 7 2 Service Analysis Sustaining 7 Stages to Successful Implementation 6 Training 5 Supporting Systems 3 Task Analysis 4 Competency Identification

2 Service Analysis Captures ‘as is’ in detail Captures ideas to improve What is the service? When & where delivered? Staffing How well are patients needs met ? What could be different? What functions and tasks are carried out? Who does what now?

3 Task Analysis KNOWLEDGE BASED RISK ANALYSIS RULE BASED SKILL BASED FREQUENCY TRAINING IMPLICATIONS

Stages 2 & 3 - ‘New Ways of Working’ Tasks mainly knowledge & rule based & highly specialist Tasks mainly knowledge & rule based Tasks rule & knowledge based with protocols available Tasks mainly skill & rule based Remain with current profession Registered Practitioners consider Skill Sharing/Advanced Practice Allocate to Assistant Practitioner Delegate to support worker

Assistant Practitioner Definition: n ‘An assistant practitioner is a worker who competently delivers health & social care to & for people. They have a required level of knowledge & skill beyond that of a traditional healthcare assistant or support worker. The Assistant Practitioner would be able to deliver elements of care and undertake clinical work in domains that have previously only been within the remit of registered professionals. They may transcend professional boundaries. They are accountable to themselves, their employer and more importantly the people they serve’. Skills for Health 2009

Advanced Practitioner definition (a): n ‘The advanced practitioner has highly specialised or highly developed knowledge & skills, beyond those required for registration, encompassing the breadth & depth of current and future professional practice. Advanced practice forms the continuum from practitioner to emergent consultant’ (Shared Framework, DOH , developed by University of Salford 2004)

Advanced Practitioner definition (b): n ‘Experienced non-medical registered professional who has developed his or her knowledge to a very high standard in a specific and often high level of practice. This high standard is such that not only is the individual the expert in the base domain: - but can also accept the full responsibilities for providing those services hitherto undertaken by others, in defined circumstances’ (J Sargent, Chair WDC national forum 2003)

Advanced Practitioner definition (c): n ‘Advanced (Nurse) Practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your healthcare needs or refer you to an appropriate specialist if needed’. (NMC Proposed Framework for the standard for post registration nursing 2006)

Benefits of The Calderdale Framework For Organisations § § § § Consistency & Safety Reduction in Risk Efficient & Effective Improved Productivity Flexible Competent Workforce Improved Patient Experience Employer of Choice Provider of Choice For Teams & Individuals • Builds Effective Teams around the Patient • Personal & Team development needs. Links to KSF (in UK) and PDP • Clear Roles & Responsibilities • Safe Skill Sharing • Transferable Skills • Job Satisfaction

Hybrid Support Worker Jack’s wife , Margaret said, “ Under the direction of therapists, Cath the rehab assistant undertook speech and language therapy exercises and movement exercises. To the relief of both of us Jack’s speech returned and his walking has improved, giving him more independence. Thank you to all. ” Margaret

Assistant Practitioner (New type of worker) Nicky Byrne, team leader (Mac. Millan Rehab) said: n “ Michelle is now competent to take her own non complex caseload, including elements of assessment (to protocol) previously done by Health Professionals. This means patients are seen quickly by one person and complex cases have access to the specialist skills they need”

Health Professional Skill Sharing (level 7) Nicky Hill, Emergency Department Occupational Therapist said n “ Competency training was completed around tasks that are traditionally uni-professional, to allow Health Professionals to share skills in order to complete all aspects of the assessment & treatment. This enhances the patient experience and journey by reducing the number of disciplines involved, subsequently speeding up the assessment & discharge planning process” n OT News May 2010; 18(5): 25

Health Professional Advanced Practice (level 8) Physiotherapy led outpatient orthopaedic clinic: First assess Order X rays and scans & tests –read & interpret these. Prescribe Inject List for surgery, Refer on Give advice

NEW WAYS of WORKING: STAFF VIEWS ” “ Confidence and skills increased” ” ensuring “Still quality services” “Allay fears of role erosion” “Enables health professionals to focus on more complex interventions” “ Beneficial for patients - they don’t have to wait for another “ Able to apply assessment” new knowledge and skills “ Increase knowledge of wider with real benefit initiatives and policies” to patients”

The Combinations are Limitless …… ‘alternative approaches are needed to develop a sustainable workforce that is flexible enough in its work practices to manage the complex changes facing the NHS’. Gita Milhora, Kings Fund UK