Agenda for ChangeHow Does it Work in Practice?

Chris Plant: Agenda for Change Regional Lead, North Wales

Steve Sloan: National Officer, AMICUS

UK Update

How are we doing?How are we doing?

England: 94% matched, 88% assimilated 94% matched, 88% assimilated

Scotland: 60% matched, 0 assimilated 60% matched, 0 assimilated

NI: 45% matched, 3% assimilated 45% matched, 3% assimilated

Wales: 66% matched, 21% being paid 66% matched, 21% being paid under AfC (but 56% assimilated)under AfC (but 56% assimilated)

UK Update (Cont’d)UK Update (Cont’d)

Unsocial Hours – now put back to 1 Oct 2006 for new arrangements to start

Xmas guidance will be out shortly Profiles still coming out – but not many,

and tending towards generic profiles now Pay Review Bodies now considering

evidence for next year’s pay awards

Objectives of the session: Understand the impact of AfC on how Understand the impact of AfC on how

managers recruit, manage and deploy managers recruit, manage and deploy staffstaff

Consider where support and information Consider where support and information is available from is available from

Understand the opportunities delivered Understand the opportunities delivered through enhanced partnership workingthrough enhanced partnership working

Understand how AfC can drive and Understand how AfC can drive and enable the modernisation of services enable the modernisation of services and processesand processes

Pay Modernisation - Why?

Government Government commits commits sustained sustained investment in investment in NHSNHS

• Better services for patients

• Better staff development

• Fairer rewards for staff

NHS Plan

Twin objectivesTwin objectives More capacity = more staffMore capacity = more staff Modernised jobs = working differentlyModernised jobs = working differently

Three great workforce leversThree great workforce levers Management and LeadershipManagement and Leadership Education and LearningEducation and Learning Pay and RewardPay and Reward

Annex E – Success Criteria

More patients being treated more quickly More patients being treated more quickly Higher quality care Higher quality care Better recruitment and retention Better recruitment and retention Better teamwork/breaking down barriers Better teamwork/breaking down barriers Greater innovation in deployment of staffGreater innovation in deployment of staff Fair pay Fair pay Improve all aspects of equal opportunity & diversity Improve all aspects of equal opportunity & diversity Better pay Better pay Better Career Development Better Career Development Better moraleBetter morale

Partnership

New language for the NHS that is differentNew language for the NHS that is different

Staff engagement, involvement and participationStaff engagement, involvement and participation

Decision making is more robustDecision making is more robust

Increased transparencyIncreased transparency

Staff feel valued, and share workloadStaff feel valued, and share workload

Beyond staff involvementBeyond staff involvement

AFC designed to enable:

Redesign of services around patients Redesign of services around patients Design of the right jobsDesign of the right jobs Higher quality care Higher quality care The NHS to become more effective at The NHS to become more effective at

what it does what it does The NHS to become a more attractive The NHS to become a more attractive

employer employer

Moving forward Line manager and local staff representative Line manager and local staff representative

understanding of how AfC will operate in understanding of how AfC will operate in practice is essentialpractice is essential

This session is designed to help you start to This session is designed to help you start to “operationalise” AfC “operationalise” AfC

Start to move away from seeing AfC as Start to move away from seeing AfC as “project” to understanding how we can “project” to understanding how we can change the way we manage, deploy etc change the way we manage, deploy etc staff in the longer termstaff in the longer term

Intention is that these will be rolled out for Intention is that these will be rolled out for all managers across organisationsall managers across organisations

Life cycle of an employee: Want to look at key stages in the employment Want to look at key stages in the employment

history of a member of staff identifying the history of a member of staff identifying the impact of AfCimpact of AfC

Not exhaustive and not going into the detail of Not exhaustive and not going into the detail of your local agreementsyour local agreements

The new pay agreement left a great deal for The new pay agreement left a great deal for local agreement and work on this is still going onlocal agreement and work on this is still going on

The key aspects addressed are:The key aspects addressed are: JE SchemeJE Scheme KSFKSF Terms and ConditionsTerms and Conditions

Life Cycle (cont.)Life Cycle (cont.)

Support available from your AfC Teams, Support available from your AfC Teams, HR Directorate, Service Improvement HR Directorate, Service Improvement Teams, Staff Representatives …..Teams, Staff Representatives …..

Purpose is to stimulate discussion and Purpose is to stimulate discussion and encourage you to start planning how AfC encourage you to start planning how AfC can help you work smartercan help you work smarter

Effort now will pay dividendsEffort now will pay dividends

Workforce PlanningRecruitment

Induction

Performance ReviewCompetent Practitioner

Promotion

PATIENT/SERVICE

NEEDS

AppointingDeveloping

Roles

Patient or Service Life Cycle

Workforce Planning

Consider changes/development in service Consider changes/development in service provisionprovision

Changes to working weekChanges to working week Increase in annual leaveIncrease in annual leave Consider skills/knowledge neededConsider skills/knowledge needed Replace like with like/change role/new roleReplace like with like/change role/new role

Recruitment Develop Job Description and Person Develop Job Description and Person

Specification based around skills and Specification based around skills and acquired knowledge neededacquired knowledge needed

Develop KSF outline which will be sent out Develop KSF outline which will be sent out with packwith pack

Job “pay banded” through JM/JE processJob “pay banded” through JM/JE process Is a Recruitment and Retention Premium Is a Recruitment and Retention Premium

applicable or necessary?applicable or necessary? Advert should identify the skills and Advert should identify the skills and

experience required as per KSF outlineexperience required as per KSF outline Do transitional points apply to the post?Do transitional points apply to the post?

Appointing

Need to consider how to assess candidates Need to consider how to assess candidates against skills and applied knowledge neededagainst skills and applied knowledge needed

Determine previous experience and reckonable Determine previous experience and reckonable service service

Identify appropriate starting salaryIdentify appropriate starting salary Identify annual leave entitlementIdentify annual leave entitlement Unsocial hours and on-call entitlementsUnsocial hours and on-call entitlements Identify working hours i.e. are they protected or Identify working hours i.e. are they protected or

not?not?

Inducting

Initial assessment of new appointee Initial assessment of new appointee against KSF outlineagainst KSF outline

Arrangements for preceptorship period, Arrangements for preceptorship period, where applicable, in placewhere applicable, in place

Induction plan developed based around Induction plan developed based around KSF outlineKSF outline

Processes for first gateway review – at Processes for first gateway review – at least two reviews during the first yearleast two reviews during the first year

Competent Practitioner/ Performance Review

Process for annual performance review for all staff Process for annual performance review for all staff against KSF outlineagainst KSF outline

Developing and implementing PDPs for all staffDeveloping and implementing PDPs for all staff Appropriate release and support for staff to fulfil PDPAppropriate release and support for staff to fulfil PDP Planning career progressionPlanning career progression Those who have passed through the - 'Final Gateway Those who have passed through the - 'Final Gateway

- maintaining enthusiasm and motivation to develop' - maintaining enthusiasm and motivation to develop' Secondment/acting up arrangementsSecondment/acting up arrangements Supporting and managing staff who are struggling Supporting and managing staff who are struggling

with gatewayswith gateways Will assist with clinical governanceWill assist with clinical governance

Developing RolesDeveloping Roles Skills gaps identified through PRP/PDP Skills gaps identified through PRP/PDP

processesprocesses Roles changing and developing to address Roles changing and developing to address

service needsservice needs Job descriptions and KSF outline reviewedJob descriptions and KSF outline reviewed JE rebanding reviews available:however JE rebanding reviews available:however

additional responsibilities do not necessarily additional responsibilities do not necessarily mean higher grade!mean higher grade!

New roles developed New roles developed

PromotionPromotion Careers escalators developedCareers escalators developed PDPs assist in preparing for promotionPDPs assist in preparing for promotion Salary on promotionSalary on promotion

CYCLE STARTS AGAINCYCLE STARTS AGAIN

Patient Pathway- Coronary Patient Pathway- Coronary episodeepisode ((How will it look in the future)

Attended by emergency care practitioners (nurses & paramedics)Attended by emergency care practitioners (nurses & paramedics)

Admitted to coronary care where cared for by advanced specialist Admitted to coronary care where cared for by advanced specialist practitioners, and consultant nurse practitioners, and consultant nurse

Informing Healthcare will assist with the prompt reporting of blood and x-Informing Healthcare will assist with the prompt reporting of blood and x-ray results - and path lab may have different working arrangements.ray results - and path lab may have different working arrangements.

Choose & book Choose & book will allow the pt. to discuss treatment options with a will allow the pt. to discuss treatment options with a specialist nurse who will arrange transfer to the chosen unit for surgery.specialist nurse who will arrange transfer to the chosen unit for surgery.

On discharge, care will be followed up by community cardiac rehab On discharge, care will be followed up by community cardiac rehab team in liaison with the practice nurse with enhanced skills.team in liaison with the practice nurse with enhanced skills.

AfC and Service ImprovementAfC and Service Improvement

All Organisations will have a Service All Organisations will have a Service Development Plan, linked to AfCDevelopment Plan, linked to AfC

Delivery structures in organisations for Delivery structures in organisations for service improvement, linked to AfCservice improvement, linked to AfC

Modernisation Group/Team must be part Modernisation Group/Team must be part of this!of this!

How do you as line managers How do you as line managers realise benefit from AfC?realise benefit from AfC?

Understand existing terms and conditions in Understand existing terms and conditions in department department what is happening and whywhat is happening and why how will new terms and conditions affect thishow will new terms and conditions affect this

Existing service improvement initiatives – Trust Existing service improvement initiatives – Trust and departmentaland departmental

What seems different pre- and post AfC (and What seems different pre- and post AfC (and more specifically, after assimilation?)more specifically, after assimilation?)

AfC as a LEVERAfC as a LEVER

Opportunistic Benefits that fall naturally outOpportunistic Benefits that fall naturally out

of effective implementationof effective implementation Review of job descriptions Review of job descriptions Changes to working week - Changes to working week -

increased/decreased capacity?increased/decreased capacity? Rewarded for responsibilitiesRewarded for responsibilities Harmonised terms and conditions – team Harmonised terms and conditions – team

working/cross boundary workingworking/cross boundary working Partnership WorkingPartnership Working

AfC as part of PAY AND AfC as part of PAY AND CONTRACT MODERNISATIONCONTRACT MODERNISATION

Consultant Contract, EWTD, GMSConsultant Contract, EWTD, GMSPharmacists/Dentists/Optometrists,Pharmacists/Dentists/Optometrists, Modernising Pathology & Imaging ServicesModernising Pathology & Imaging Services

Need to understand impact of these on Need to understand impact of these on department and servicesdepartment and services

What are the links?What are the links? How can AfC be harnessed to support How can AfC be harnessed to support

implementation of these?implementation of these?

AfC as an EnablerAfC as an Enabler Workforce ModernisationWorkforce Modernisation

Does the existing skill mix in the team meet Does the existing skill mix in the team meet needs of department/service?needs of department/service?

What new roles are planned in the department What new roles are planned in the department but have yet to be “priced” properly?but have yet to be “priced” properly?

Are there procedures in place to capture staff Are there procedures in place to capture staff suggestions for service improvement arising suggestions for service improvement arising through AfC activity?through AfC activity?

Pay Protection – opportunity for role redesign?Pay Protection – opportunity for role redesign?

Key Lessons from EI Sites: Key Lessons from EI Sites: Benefits RealisationBenefits Realisation

System change not a service changeSystem change not a service change Establish your own specific gains from the new Establish your own specific gains from the new

system - be aspirationalsystem - be aspirational Leadership is crucial - at all levelsLeadership is crucial - at all levels Change in staff perception and culture will Change in staff perception and culture will

facilitate future changes in patterns of service facilitate future changes in patterns of service deliverydelivery

Opportunity to develop an organisation wide Opportunity to develop an organisation wide process for service improvement process for service improvement

Human resources practices will change - Human resources practices will change - partnership working will drive thispartnership working will drive this

Early OD issues and possible Early OD issues and possible solutionssolutions

Staff in the same band as their managerStaff in the same band as their manager- Develop the manager’s role and reband using - Develop the manager’s role and reband using NHSJES?NHSJES?

““Grade compression” (e.g. Whitley D and E grade Grade compression” (e.g. Whitley D and E grade nurses)nurses)- establish and develop careers escalators, develop - establish and develop careers escalators, develop the staff.the staff.… … but E grade competence becomes the norm for but E grade competence becomes the norm for fully competent Band 5 nurses.fully competent Band 5 nurses.

Pay protectionPay protection- get the value out of the staff by redesigning the job- get the value out of the staff by redesigning the job

OD issues and possible OD issues and possible solutions (cont’d)solutions (cont’d)

Departments in “Organisational Space” – Departments in “Organisational Space” – don’t seem to report to anyonedon’t seem to report to anyone

- give them a Directorate/ management - give them a Directorate/ management structurestructure

Other structures not workable – e.g. 1 Other structures not workable – e.g. 1 manager, 50 staffmanager, 50 staff

- review the structure- review the structure

Questions to take away:Questions to take away: How will I engage with my Trust’s Benefits

Realisation work? Do I know what work is currently ongoing in my

organisation to change HR processes? What are the issues I need to take into account

now when developing my/our service/workforce plans? and

How will our service planning/workforce planning process change?

How will I involve staff and develop greater partnership working in my area?

Costing/ MoneyCosting/ Money

Service modernisation may actually save money Service modernisation may actually save money e.g. reduction in overtime, fewer steps in a e.g. reduction in overtime, fewer steps in a process deceases error rateprocess deceases error rate

Organisations may “pump prime” changes where Organisations may “pump prime” changes where benefits are defined and expected at the outsetbenefits are defined and expected at the outset

No specific increases in training budgets…No specific increases in training budgets…

Development is not just courses, however!Development is not just courses, however! The investment in staff is expected to bring The investment in staff is expected to bring

about changeabout change

Useful WebsitesUseful Websites

www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAwww.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/ModernisingPay/AgendaForChangendTraining/ModernisingPay/AgendaForChange

www.e-ksf.orgwww.e-ksf.org

www.modern.nhswww.modern.nhs

www.nhsemployers.nhswww.nhsemployers.nhs

http://www.wales.nhs.uk/sites3/home.cfm?OrgID=433http://www.wales.nhs.uk/sites3/home.cfm?OrgID=433

Further information is also available from Trade Union Further information is also available from Trade Union and Professional Organisation websites.and Professional Organisation websites.

WorkshopsWorkshops

What changes am I going to consider to What changes am I going to consider to modernise the service using Agenda for Change modernise the service using Agenda for Change – and how am I going to use AfC to achieve – and how am I going to use AfC to achieve these?these? (i) In the short term ( next 12 months)? (ii)(ii) In the medium term (next 1-3 years)? (iii)(iii) In the long term (over 3 years)?

45 minutes 1 person to give feedback from flip charts (5 minutes)