flexible learning for workforce modernisation: building a ... · pdf filejayne duffy / rachael...

Flexible Learning For Workforce Modernisation:

Building A Framework for Learning and Development of Assistant Practitioners in Yorkshire and the Humber

By Alison Hedley, Judy Smith & Jane Kettle on behalf of West Yorkshire Lifelong Learning Network

This publication presents three demonstrator case studies arising from a project led by West Yorkshire Lifelong Learning Network and Escalate at the University of Bradford. The aim was to work with HE providers and Y&H employers in health and social care to develop a flexible framework for learning and development of higher level skills for support workers, building opportunities for progression and credit transfer across institutions and supporting the development of a flexible, multi-disciplinary workforce for integrated service delivery.

Steering GroupChair: Celia Moran University of Bradford (Escalate) Alison Hedley WYLLN Ian Wragg NHS Y&HJoanne Beaumont WYLLNVal Rhodes / Rosie Hawley Bradford District Care Trust (BDCT)Jan Tallett Bradford & Airedale Community Health Services (BACHS), now part of BDCTJayne Duffy Calderdale & Huddersfield Foundation Trust (CHFT)Rachael Smith Calderdale & Huddersfield Foundation Trust (CHFT)Sandra Rowan Skills for HealthJeanette Cookson Skills for CareVal Ely University of HuddersfieldJane Priestley / Lynda Gatecliffe University of BradfordCarol Wood Bradford College

Workshop ParticipantsAlison Hedley WYLLNJan Tallett / Tahzim Ahmed / Dr Alison Pighills BACHSJune Copeman Leeds Met UniversityNicky Hughes Open UniversitySue Beacock University of HullJane Priestley / Lynda Gatecliffe University of BradfordJan Firth / Martin Smith / Moira Tyas University of HuddersfieldVal Rhodes / Rosie Hawley BDCTJayne Duffy / Rachael Smith CHFTSandra Rowan Skills for HealthJayne Marran / Amanda Hudson Bradford Hospitals Foundation Trust (BHFT)Carol Wood Bradford College

With the support of Escalate Associates:

Jane Kettle & Judy Smith

Working Together

Project Partners:

OPEN UNIVERSITY

SKILLS FOR CARE

LEEDS MET

BDCTPsychology/

Physical Health

SKILLS FOR HEALTH

(NTR’s)BRADFORD COLLEGE

BHFTTheatreRenal

BACHSBlurred

Boundary

UNIVERSITY OF BRADFORD

UNIVERSITY OF HUDDERSFIELD

NHS Y&HStrategic Health

Authority

C & HFTRehabilitation

UNIVERSITYOF HULL

Contents

Acknowledgements:

With thanks to the following for their contributions to this publication:

Jayne Duffy & Rachael Smith (Calderdale & Huddersfield Foundation Trust)Jan Tallet - (Bradford & Airedale Community Health Services, now part of Bradford District Care Trust)Val Rhodes (Bradford District Care Trust)Jane Priestley (University of Bradford)

And for examples from:

Humberside Mental Health NHS Trust and University of HullBradford District Care TrustCalderdale & Huddersfield NHS Foundation TrustLeeds Metropolitan UniversityBradford Hospitals Foundation TrustAssistant Practitioners for their stories

Forward 2Section One: Introduction 3

Section Two: Developing Assistant Practitioners in local NHS Trusts 4

The AP Role 4

The WYLLN Project 6

The Demonstrator Case Studies 7

The Demonstrator Organisations 7

Drivers to developing the AP role 7

Support implications for developing the AP role 8

Service analysis and scoping the AP role 10

Developing the learning and working with Higher Education 15

Work Based Learning 15

Higher Education Involvement 16

Section Three: Partner reflections 19

2

West Yorkshire Lifelong Learning Network (WYLLN) is an inclusive partnership involving higher education and further education, work-based learning providers, Sector Skills Councils, employers and their representatives, and community based organisations. All of these partners have a shared goal which is to improve the progression of vocational and work based learners into and through higher education for the benefit of the individuals and the region’s economy.

The WYLLN Health, Social Care and Early Years Sector Group has focused on developing a “Flexible Framework” which aims to meet the emerging education and training needs within the health sector resulting from the introduction of the new Assistant Practitioner role. This includes new learning opportunities to develop the skills and knowledge support workers may require to carry out these new roles as well as the means to gain recognition for skills they have already developed. As a result, a number of West Yorkshire NHS Trusts, Skills for Health, Skills for Care, the Strategic Health Authority, and local universities and colleges have worked to develop a range of new courses, new modules, new opportunities for APEL, and new employer/institution relationships which directly address local workforce development needs.

The success of the “Flexible Framework” clearly demonstrates the excellent outcomes that can be achieved when employers, education and sector lead organisations work together effectively. WYLLN is pleased to have been able to lead and support the delivery of the project.

Steve Challenger

Executive Director, West Yorkshire Lifelong Learning NetworkMay 2011

There are a number of drivers for the need to develop Assistant Practitioners in the Yorkshire and Humber region. Whilst originally interest may have been generated by work in other parts of the country, this has now translated into an increasing demand from local NHS Trusts.

Not least in the factors that have fuelled this interest are the financial pressures than many Trusts now face. This is leading them to look to improve productivity and reduce costs in line with the Department of Health’s drive around the QIPP programme (Quality, Innovation, Productivity and Prevention).

The development of Assistant Practitioners in the region (largely at Agenda for Change band 4) forms part of a wider strategy to improve training of support staff generally. The NVQ Framework and Apprenticeship programmes available through Train to Gain have been central within this, and will continue to play a key role through the recently launched Qualifications and Credit Framework (QCF). However, our aim regionally is not only to have high quality support staff that provide excellent patient care, but to have an effective ‘skills escalator’ enabling progression for staff within the service to develop higher level skills. This should lead to the employment of support staff that will have the opportunity to become our Assistant Practitioners and registered staff of the future.

The work that West Yorkshire Lifelong Learning Network has done on bringing partners together to develop flexible learning within higher education for these emerging roles has, and is, helping to define a benchmark within the region for Assistant Practitioners. It is hoped that this will result in greater consistency and ‘portability’ of skills, including recognition of those developed in the workplace or by other education providers in the region, and a reduction in the need to repeat learning when taking up new roles or programmes of development. I commend WYLLN on the work they have done.

Ian Wragg

Workforce Modernisation ManagerNHS Yorkshire and the HumberMay 2011

Foreword: WYLLN

Foreword:Strategic Health Authority

3

The West Yorkshire Lifelong Learning Network (WYLLN) has supported a number of projects aimed at developing a more employer-responsive curriculum and enhancing progression opportunities for vocational learners. One such project is the development of a Flexible Framework for Learning and Development in Health and Social Care. It originated from open forum discussions in April 2009 with employers across health, social care and early years sectors as part of the work of the Health, Social Care and Early Years Sector Group, which consists of FE and HE partners, Sector Skills Councils and employers in West Yorkshire.

Research carried out during this project confirmed that employers had a perception that the flexible provision they needed was not currently on offer from HE providers.i (The immediate need was primarily from the health sector, looking to develop learning for emerging Assistant Practitioner roles.) Finding a solution to this problem has increased in urgency as public spending constraints have begun to take effect. Employers are only able to fund learning that has direct relevance to the role and are unwilling to support what they see as duplication or superfluous learning in some established programmes.

The project began with a review of the existing landscape through a detailed audit of flexible learning provision in West Yorkshire for higher level skills in Health and Social Care, and of the needs of NHS employers in the region for learning for Assistant Practitioner roles.

The audit of HE provision revealed that there was:

little or no collaboration between HE providers in terms of provision

no clarity about which specialisms HE providers could support

no common learning outcomes agreed for AP’s

no consistency about credit transfer to be awarded between institutions

limited opportunity for Accreditation of Prior Experience and Learning or accreditation of in-house training

a mis-match between provision and the range

of sub-regional development needs identified. i

Three demonstrator projects were chosen to become exemplars of collaborative and responsive working to address local and regional needs. This report explains the work carried out by the demonstrators and explores what has been learned about flexible learning and employer-responsive provision to enhance the delivery of health care.

The project has been developed with reference to national developments undertaken by Skills for Health (the Sector Skills Council for Health) in developing Nationally Transferable Roles (NTR) including those of Assistant Practitioners. As well as one of the demonstrator sites contributing a specific NTR role (Calderdale & Huddersfield NHS Foundation Trust), Skills for Health (SfH) has developed a West Yorkshire NTR for AP roles based on the outcomes of this project and previous work as stated. This West Yorkshire NTR is available on the WYLLN and Skills for Health websites (www.wylln.ac.uk or www.skillsforhealth.org.uk).

As interest in these developments have grown, other NHS Trusts across Yorkshire and Humberside who have been working with the Y&H Strategic Health Authority, or who have been involved in national developments, have also contributed to this local collaborative development, such as the work that has been undertaken in Humberside to develop Assistant Practitioner roles in mental health.

EMPLOYERCONSULTATION

PROJECT PROPOSAL

STEERING GROUP

(NHS Y&H, Empoyers, HEIs,

FECs, SSCs)

AUDIT OF PROVISION &

EMPLOYER NEED

DEMONSTRATOR PROJECTS & WORKSHOPS

JOb DESCRIPTION

MAPPING & DEANS PAPER

FLEXIbLE LEARNING

PROGRAMMES & AP TOOLKIT

Section 1:

Introduction

4

The Assistant Practitioner role

The Assistant Practitioner (AP) role is seen as increasingly significant in terms of developing the future workforce in health and social care. Throughout this report, reference is made to the AP role as defined by Skills for Health.

Section 2:Developing Assistant Practitioners in local NHS Trusts

An assistant practitioner is a worker who competently delivers health and/or social care to and for people. They have a required level of knowledge and skill beyond that of the traditional healthcare assistant or support worker. The assistant practitioner would be able to deliver elements of health and social care and undertake clinical work in domains that have previously only been within the remit of registered professionals. The assistant practitioner may transcend professional boundaries. They are accountable to themselves, their employer, and more importantly, the people they serve. The job description of the assistant practitioner should equate to Level 4 on the career framework iii www.skillsforhealth.org.uk, 2010

The Assistant Practitioner role was introduced as part of the NHS modernisation programme to complement the work of registered professionals in hospital and community based care. There is substantial evidence nationally that the role of Assistant Practitioners is seen as a key development opportunity within Trusts to fulfil a range of objectives including to:

introduce more flexible roles to provide changing service demands

improve the quality of services by developing a client led service with personalised care provision and responding to new care pathways

provide more productive service delivery

manage the impact of demographic changes and on recruitment and retention of staff

provide a financially effective service in time of economic pressures and financial cuts.

encourage greater satisfaction and enhanced motivation of existing workforce, enhanced recruitment and retention and reductions in sickness

enable a refocusing of education provision to reduce duplication in training including the use of APEL which enables stepping on and off the training pathway

However, a national research exercise in 2009 identified that the role varies across different regions and between employersIV

5

The audit demonstrated that there was a need for the WYLLN partners to work together across and beyond the region. A vision emerged of a core of shared higher level learning outcomes being delivered across learning providers supplemented by specialist units which could be delivered by institutions with relevant expertise. This would mean that APs develop the same core skills which are then supplemented by additional specialist skills according to role, but which can easily be modified as and when service needs change. Learning would take place in the workplace supported by mentors and supervisors, so that it is accessible, flexible, and tailored to individual needs and so they only learn what they need to do the job. Ultimately this would develop staff with portable core skills which are transferable across units and services. It would offer both vertical and lateral progression, so learners can broaden skills to support blurred boundary working, for example, or they can become more highly specialised in one particular area.

Following early discussions with employers and WYLLN partners which resulted in the project proposal, key stakeholders were invited to form a steering group for the project. This consisted of representatives from local NHS Trusts, universities and further education colleges, sector skills councils, the Yorkshire and Humber Strategic Health Authority and WYLLN. Firstly the employers shared their plans for developing new roles and the national and regional picture around AP developments was discussed. It became evident that the local picture of learning needs and of available learning provision for these roles was still quite unclear so the group commissioned an audit of employers, to assess their interest in the development, and of education providers, to identify existing flexible educational provision that could help with the new role developments. The progress of the Calderdale framework, a locally developed tool for service analysis and skill mix review, was also shared and dialogue between different Trusts and the education providers began.

Alison Hedley, WYLLN Sector Officer for Health Social Care and Early Years, comments:WYLLN project partners wanted to address some of these anomalies locally by providing for a more aligned approach while recognising individual service needs. The project aimed to support the development of learning outcomes to meet the learning and development needs of a range of APs through a common role and competence framework, underpinned by a “Flexible Framework” of learning and development at Higher Education Levels 4-5.

6

Project DevelopmentIn June 2010, WYLLN launched the project with a regional conference that invited NHS commissioners and clinical leads from across the region, along with HE learning providers to provide a forum for discussion around the AP role and education and training needs.

The project has involved identifying which Y&H NHS Trusts are engaged in workforce development around AP roles and mapping commonality across the roles. Nineteen job descriptions of the roles were scrutinised to identify the competences required for AP roles in a variety of health care settings. These competences were then compared to determine the common core required of all APs, against which shared learning outcomes could be developed, as well as those requiring specialist learning.v

The WYLLN NHS Trust partners are at different stages in their recruitment of Assistant Practitioners working in different health care settings. However the WYLLN project has provided the space and resources to identify three demonstrator sites for enhancing knowledge and understanding of the issues for these NHS Band 3-4 roles and the subsequent Level 4 learning required to improve the effectiveness and impact of these new staff. The demonstrators have identified key learning from their individual projects which are shared below and include details of :

The national, regional and local drivers;

Support implications for the AP role;

How tasks and competences required for the role were identified and job descriptions written;

The identification of education and learning required for the role and how higher education providers have become engaged in;

Reflections on the lessons learnt and benefits of collaboration.

The steering group were keen to develop demonstrator projects that would identify some of the good practice in Trusts for

developing roles and also to address the issues of developing relevant education and training provision for AP roles. Some Trusts themselves indicated that there were internal issues about demonstrating the cost-benefits of developing AP roles. There was evidence of progress for individual Trusts in working with universities but there were concerns about funding and learner numbers that were taxing HE providers. With this in mind a ‘position’ report was commissioned which presented the case for the AP role in the context of national and regional policy, practice and research, and which identified sources of evidence of the requirement for, and potential benefits of, the role particularly in terms of relevance to the local QIPP programme.vi

QIPP The Department of Health has

established quality, innovation, productivity and prevention (QIPP) as the guiding principles to help the NHS deliver its quality and efficiency commitments, building on the progress made in implementing Lord Darzi’s Next Stage Review. Achieving these commitments has become known as the ‘quality and productivity challenge’. The national and locally delivered programme will aim to improve staff productivity and support key changes in the way services are delivered and local health services are encouraged to review their workforces and consider redesigning and streamlining the way they manage and work. This may help achieve significant and lasting improvements – predominately in the extra time that staff give to patients, as well as improving the quality of care delivered whilst reducing costs. The work of local WY Trusts in redesigning their workforces e.g. AP role development, meets the QIPP agenda and throughout this project employer partners have had this initiative in mind when developing the AP roles.

7

Calderdale and Huddersfield NHS Foundation Trust (C&HFT)Calderdale and Huddersfield NHS Foundation Trust is an acute Trust serving the population of Calderdale and Huddersfield. It is currently “ Acute Trust of The Year” HSJ Awards 2010

The Clinical Therapy and Rehabilitation Directorate delivers rehabilitation services to adults and children in both acute and community settings.

It is comprised of Allied Health Professionals (AHPs) i.e. Physiotherapy, Occupational Therapy, Speech and Language Therapy, Dietetics and Podiatry who work as part of multi disciplinary teams to deliver high quality, cost effective care.

Bradford and Airedale Community Health Services: Practice Development (BACHS)Bradford and Airedale Community Health Services (BACHS) is the healthcare provider arm of NHS Bradford and Airedale. Its vision is to be the provider of choice for the delivery of high quality community based services that deliver positive outcomes for those people who access its care. From health visitors and district nurses, to speech and language therapists and children’s services BACHS delivers an extensive range of services for the people of Bradford and Airedale District.

As part of the Transforming Community Services initiative and in line with the NHS Operating Framework 2010/11, BACHS would experience significant organizational change over the next 12 to 18 months

The significant financial challenges and the organizational changes must not detract from continuing to deliver high quality community based services and driving innovation.

Bradford District Care Trust: Low Secure Service (BDCT)

Established in 2002, Bradford District Care Trust provides care for people of all ages who have community health and mental health, learning disabilities and social care needs. The Trust covers the Bradford District of West Yorkshire and the Craven District of North Yorkshire and offers services in hospitals, the community, and in people’s own homes. Mental health services are divided into adult mental health, older people’s mental health, child and adolescent mental health, substance abuse and forensics. The low secure service delivers intensive, comprehensive, multidisciplinary treatment and care by a MDT (Multi Disciplinary Team) for service users who require the provision of a low secure facility. The service is for those whose care and treatment cannot be safely or successfully delivered in local mental health services and whose behaviour presents at a level of risk greater than general mental health services could safely address. The unit provides 32 male beds and is divided into three wards that provide assessment and treatment, rehabilitation and longer term care.

The Demonstrator organisationsThree local employers and partners on the WYLLN Project Steering group agreed to put themselves forward as demonstrators.

8

C&HFT identified national drivers, one of which was the need to develop a skilled, flexible and productive workforce. This linked directly to recommendations from the Leitch report (2006), which identified concerns with skills shortages and more recently the Quality, Innovation, Productivity and Prevention (QIPP) programme. Skills for Health was sponsored by Department of Health (DoH) to develop a competence based career framework for the Allied Health Professionals as one mechanism to address national workforce challenges.vii The Framework was designed to reflect all functions at all levels and grades across the Allied Health Professions. C&HFT was approached by SfH in 2008 to act as an early implementer of the Career Framework, using The Calderdale Frameworkviii to distil out the Assistant Practitioner role in two different teams.

Locally, since 2001, the Clinical Therapy and Rehabilitation Directorate of Calderdale and Huddersfield NHS Foundation Trust has been working on The Calderdale Frameworkix. This provides a clear and systematic approach for analysing and transforming services leading to skill mix review, role redesign and management of the risks associated with new ways of working, all of which ensure high quality, productive services for patients. The recognition within the directorate of the value of a competent support workforce and the potential to explore and maximise their capabilities was another positive influence on this piece of work. At a local level the QIPP agenda, along with increasing demand and expectations of services users, influenced the organisation’s engagement with this work.

BACHS had also identified a national operating context that required a more flexible workforce that is responsive to changing demand. Staff need the skills and knowledge to deliver high quality safe care, in new clinical settings, closer to home. Increasingly multi-professional support worker posts are emerging and replacing uni-professional support staff. Following the C&HFT approach, BACHS initiated the development of a competency framework in October 2008. Demographic trends, the economic context, and the need to provide more effective, flexible, quality driven services, based on local health needs precipitated this initiative.

In 2008 the BDCT Low Secure service embarked on a work force redesign project to review the roles of the staff within the unit to ensure that they were meeting the changing needs of the service users. The workforce data showed a high labour turnover rate and above-average levels of sickness especially amongst the non registered workforce. The non registered workforce was mainly made up by band 2 staff and there was a lack of clear career progression. There were equality and diversity issues to consider as the Health Care Assistants made up a significant proportion of the BME staff in the service and were predominantly a young workforce with no one aged over 50 years. The low secure client population was changing and the unit needed to ensure that services it provided met and balanced the needs of service users and that of the newly developed regional Low Secure commissioning team.

Key drivers for redesigning the workforce aligned closely with the other demonstrators and included:

Improved outcomes for service users

A regional key performance indicator to deliver 25 hours meaningful activities per week for service users

The need to deliver a service that was culturally and spiritually sensitive with a social inclusion focus

Development of career progression pathways for non-registered staff

Retention and sickness issues

Drivers for developing the AP RoleThe first part of the journey for demonstrator projects was identifying the drivers to make this a viable project and determining what sort of support would be needed to make it happen.

9

The bACHS development aligned with the established organisational vision and so practical measures were required to support it. This demonstrator illustrates the practical operational measures required to ensure effectiveness. The Practice Development Team (PDT) led on the project to roll out the competency development throughout BACHS services. A database of all existing and newly produced BACHS competencies is maintained by the team as well as supporting the training elements. This database forms a repository for competencies that have been written in the new BACHS format and existing competencies written in a variety of other styles. The competency database will be accessible to all staff via the Practice Development Team web page. The aim of this database is to maximise organisational efficiency through avoiding duplication in writing competencies, by providing examples for staff writing new competencies to use, and highlighting when competencies are due to be reviewed for their applicability to current practice. This will ensure that they remain embedded in the most up to date clinical evidence and clearly identify named people who are responsible for ensuring that competencies are up to date.

For C&HFT, two teams were selected for the project:

The MacMillan Community Rehabilitation Team (newly formed) were looking to address the survivorship needs of cancer patients and;

The Rehabilitation at Home Team-Early Orthopaedic Discharge Team (well established) who have a challenge in meeting the outcomes of increased surgical efficiency as well as plurality of surgical providers out of area.

The early implementer project needed executive support and commitment, team engagement as well as a robust governance structure which captured patient, staff side and HR views in order to shape an acceptable outcome for all stakeholders. This was achieved by the formation of a project board, steering group and reference group. Funding of £50,000 had been made available from Skills for Health to fund 2 part-time project leads for 12 months (November 2008- October 2009).

Support implications for developing the AP roleEach demonstrator committed resources to developing their AP roles. There are common demands, but the individual situation of each employer meant that emphasis was placed on different elements. To summarise, C&HFT piloted the role using two teams to develop a new policy, BACHS focused on developing appropriate systems, while BDCT used a workforce planning tool to engage staf and service users in identifying needs.

“The benefit of the demonstrator pilots coming together was that they could share their different approaches to how they were developing the roles internally. It was obvious that they were using different models and tools to determine their service and client needs. The partners from Calderdale were ahead of the game

and they were in a position to share their approach to other local partners. WYLLN funded a number of workshops for the partners to focus on particular issues. The outcomes of the audit and the position statement provided stimulus for discussion and the project was well supported by Skills for Health who were keen to use the developments within their own project for Nationally Transferable Roles . They were also very helpful in developing the partners’ understanding of the Skills for health work around competences and National Occupational Standards (NOS) and introduced the web-based tools to help people to identify their own needs. A number of the partners also participated in regional workshops and have helped place the project developments within the national context and research on APs. In particular HE colleagues from Hull and Leeds had been very actively developing learning for APs and the work they had undertaken was shared with the partnership. Membership of the collaboration was growing too as other practitioners involved in AP role development in other Trusts came forward to share their developing practice and learn from the other partners.

The demonstrator roles are in Forensic Mental Health (Low Secure), Rehabilitation Health Care provision and blurred-boundary team working. The SfH Nationally Transferable Role developed through this project provides a template based on two roles within specific care settings: Cancer Rehabilitation and Low Secure Mental Health. The nature of the roles varies in relation to responsibilities and patient contact but they demonstrate that there are common requirements to both. The purpose of the NTR was to provide a starting point for other organisations in developing new AP roles and/or learning provision as the need emerges.

10

Humber Mental Health NHS Trust has been developing a specialist personality disorder service. They are recruiting band 4 associate practitioners. The development is designed for a practitioner who works to a prescribed care plan and across professional boundaries. The development formed part of the YELLN (the former Yorkshire East Lifelong learning network) project. In negotiation with the University of Hull a pathway has been designed linked to the KUF (Knowledge and Understanding Framework for personality disorder) outcomes ensuring that all learning is either applied or specifically designed to meet user need.

Beacock. S, Report of the Workforce Development Project, June 2010

ODS Population CentricTM approach to workforce planning

For bDCT, a management tool – the ‘Population CentricTM’ workforce planning tool – was the starting point for the work-force redesign. This planning model starts with consideration of population needs before developing the workforce plan. This approach allowed the low secure service to identify service priorities, address health inequality issues and importantly encouraged a participative approach to workforce planning. A steering group consisting of service managers, human resources personnel, non registered staff and clinicians was established to steer and plan the work. A number of facilitated sessions took place over 10 months which focused on defining the wider population and the strategic/political environment of the client group i.e. the criminal justice field. Time was given to defining the local needs of the service users and the elements of the service which are essential to meet their needs e.g. mental health assessments and substance misuse work. Individual service users were asked what they wanted from staff and substantial development took place to define skills, knowledge and competence required to meet service and user needs. This resulted in the identification of a list of basic, intermediate or specialist skills and competencies required and defined roles and future workforce need based on the identified competencies.

Complementary partner initiative:

11

Service analysis and scoping the AP role

Once the Trust frameworks for AP role requirements were established, the demonstrators then needed to explore the specifics relating to the development of the AP role.

The employers have followed internal and national protocols for developing job descriptions for the AP roles. They have each been innovative in their approach and in developing a role that adds to their service productivity and quality. Each of the demonstrator sites have approached the task of role development in different ways but mainly they have been led by identifying tasks APs can carry out to meet the needs of service users and improve the user experience. The competences of the staff to carry out those tasks have been matched against national and regional standards. Role development has followed internal procedures following Agenda for Change requirements.

At bACHS a framework was established to ensure that rehabilitation health care support workers (RHCSWs) in intermediate care were competent to carry out nursing and rehabilitation tasks which crossed professional boundaries, delegated by nurses and allied health professionals i.e. occupational therapists, physiotherapists, speech and language therapists, dieticians and podiatrists. The development of competencies in BACHS was also done using the Calderdale Framework and training was delivered by the authors of the Framework (Smith and Duffy). After following the stages of the Framework a database of relevant competences was developed. Some of the competencies required for the RHCSW roles were purchased from the authors as they had already produced them.

The RHCSWs already possessed an NVQ3 in health care. There was a requirement that the post holders would undertake the competency training in nursing and rehabilitation skills which were linked to the Knowledge and Skills Framework (KSF). Once appropriately trained, the RHCSWs could implement individualised patient treatment programmes developed by nurses and allied health professionals (AHPs).

Future developments will be to create competency based job descriptions linked to Nationally Transferable Roles currently being developed by Skills for Health, which provide common templates and a methodology for developing a more flexible workforce. This is underpinned by the NOS which cover the key activities undertaken within the occupation in question under all the circumstances the job holder is likely to encounter.

There has been practice guidance written and ratified by BACHS to ensure consistency and quality of the writing of the competencies and roles and responsibilities identified and how these are approved and reviewed by the organization. The competencies are linked to the Knowledge and Skills Framework and to the National Occupational Standards. The roll out of the competency development has been completed across the business units in two other services since the pilot and is currently being evaluated.

BACHS have since merged with BDCT in April 2011 and, once priorities have been identified by the senior manager team, the project will be continued. The Assistant Practitioner (Band 4) is under review as part of these developments.

12

The Calderdale Framework was developed by Smith & Duffy to assure quality and safety for patients through development of a competent and flexible workforce. The Seven Stages of The Calderdale Framework (CF) were implemented over 12 months to develop the AP role x. This is described in some detail here as it is pivotal to the WYLLN project.

1. Awareness Raising This stage is vital to ensure managers and clinical staff are fully informed and aware of the process, rational and benefits of the Calderdale Framework and potential new roles. Champions were identified at this stage.

2. Service Analysis This is a facilitated stage (using CF methodology), which requires front line staff to identify the purpose and all the functions of their service. They must also consider who currently undertakes these and identify whether patient need is being met. At this point, potential service changes which would improve efficiency and patient experience can be suggested and explored.

3. Task Analysis This stage involves front line clinical staff and clinical leads analysing the sub-tasks for suitability to delegate and /or skill share, based on whether and how the risks of doing so are manageable. Part of this process also involves considering the cost- benefit of training another person to undertake a given task.

4. Competency Generation/ Mapping to NOS Having agreed on the tasks to delegate, allocate and share, the next stage was for clinicians to agree on how these should be performed. This involved them agreeing best practice, based on evidence, where available, or peer consensus. Tasks were then written into local competencies and cross-referenced with Skills for Health National Occupational Standard (NOS) database.

5.Supporting Systems Systems within the workplace are set up to enable the management of the risks associated with new ways of working. At an organisational level this means setting up clinical supervision & reflective practice for all staff. This ensures an explicit understanding of scope of practice for each role within the service, and provides quality assurance, risk management and on going staff development. At a team level it is vital to ensure communication networks are clear & robust. In the case of delegated work it is expected that any deviation from the plan is fed back to the qualified Practitioner. In the case of allocated work or skill sharing, staff should seek advice and support if the task is going beyond the protocol.

6.Training This is a key element of this publication and is discussed in Phase Three.

7. Sustaining The Calderdale Framework has become part of organisational and team induction to ensure that all staff (new starters and rotational staff) understand and are trained in their role. This is underpinned within the Trusts Personal Development and Review processes and links closely to the organisation’s Knowledge and Skills Framework (KSF).

7Sustaining(Focus on

Embedding & Evaluating)

1Awareness

Raising (Focus on Staff Engagement)

2 Service Analysis (Focus on Potential

to Change)

3Task

Analysis (Focus on Risk)

4Competency Identification(Focus on Best

Practice)

5Supporting

Systems (Focus on

Governance)

6Training

(Focus on Staff Development)

Calderdale Framework

R Smith, J Duffy 2009 (report to Skills for Health)R Smith, J Duffy 2010 ‘Developing a Competent and Flexible Workforce using ‘The Calderdale Framework’ International Journal of Therapy & Rehabilitation 17(5)254-262.

7 Stages to Successful

Implementation



1Awareness



to Change)

3Task



Practice)

5Supporting

Systems (Focus on

Governance)

6Training





Implementation



1Awareness



to Change)

3Task



Practice)

5Supporting

Systems (Focus on

Governance)

6Training





Implementation



1Awareness



to Change)

3Task



Practice)

5Supporting

Systems (Focus on

Governance)

6Training





Implementation



1Awareness



to Change)

3Task



Practice)

5Supporting

Systems (Focus on

Governance)

6Training





Implementation

reproduced with permission of Calderdale & Huddersfield NHS Foundation Trust

The Calderdale Framework

13

For bDCT the outcome of their internal work-force redesign review was the identification of a number of new non-registered roles which included generic Band 3 workers, a physical health worker, a community worker with a social inclusion focus, a therapy practitioner, a service user post and a knowledge and training worker. The Calderdale Framework was not utilised but a process followed to develop the long lists of competencies required for each of these roles into a format which could be incorporated into job descriptions and training standards. These were matched and identified against the national competencies set out by Skills for Health: the result was three levels of competencies against the key elements of the service.

The competencies being developed within the low secure services mapped against the SfH national standards for the AP role, which provided a clearer remit for planning. In the low secure service the specialist element focused on the therapy aspect so a specialist Psychology AP role was developed. The development of these posts along with the Band 3 posts has created an improved career pathway for non registered staff and work is taking place to link roles to a learning and development programme delivered both internally and with local education providers.

The aims of this project were in tune with the regional strategy of the Strategic Health Authority who had already

funded some AP developments in the region which had stimulated new learning in HE. These were supporting particular job roles, for example, audiology, theatres, dietetics, and midwifery support, so the steering group suggested that a review of all the related job descriptions that were out in the field could identify some of the common tasks and competences AP are required to have. This was undertaken and a mapping of the competences provided a frameworkv to guide AP development in Trusts prior to the development of the SfH NTR. The discussion also gave rise to the importance of demonstrating the benefits of the role and several partners have participated in Return on Investment (ROI) workshops funded by the SHA to help shape the business case for sustaining these developments.

14

Assistant Practitioner 1: Psychology

I am currently working as a health care assistant. The main reason I was attracted to the post was because of the idea of having a new model of working within the forensic service: a new psychological framework which will give the AP the opportunities to deliver new information and a new system to deal with mental and psychological behaviours. The attraction of this post was the idea of delivering psychological interventions on a daily basis, undertaking protocol based psychological assessments and psychological procedures with clients. Having the opportunity to work closely with family members and others who are involved in the clients care, developing care plans which are formulated involving the psychological treatments and/or management of the service users problems makes the role more attractive.

I applied apply for the AP post to broaden my horizons, to explore and enhance my knowledge further and deeper in mental health and because of the chance to develop my own knowledge and practice to the highest level. I think the service will benefit from the new AP roles because they will have an AP based on the ward who can carry out other tasks that health care assistants and nurses do not always have the chance to do because of time etc. They will work more closely with the psychologist and be able to discuss any matters which are not being resolved regarding service user care: they will bring a different model of care into place. The APs will be able to work more closely with service users on a one to one basis and have the chance to implement the interventions and change things for service user benefit. Service users will also get the chance to understand the new framework of care.

I hope to see a big difference within the forensic service in the next year, which is something I cannot predict but hopefully a positive change is happening. I would like to see the AP -

being able to undertake care activities to meet the health and well being of the individuals with a greater degree of dependency

making judgments around what may or may not be significant changes in a service users condition involving observation and engagement skills and being able to report these changes to the appropriate healthcare professional

assist in the design and implementation of service development projects within the service as required

work effectively with other colleagues

listen and be open to the views of others

being able to take responsibilities for psychometric assessments, self report measures, direct and indirect structured observations

carry out semi-structured interviews with clients

delegate with the supervision of the clinical psychologist

contribute to research/projects/audits/surveys

provide learning opportunities for other colleagues

have up and running group activities for service users and colleagues

to have an effective working way between the clinical psychologist and the AP

to undertake further studies/training

These are only a few changes that hopefully I would like to see in myself and changes within our service.

15

In bACHS a formal process has been developed to implement the training programme for the support workers. It was clear that although an initial focus should be on developing learning that builds on the existing qualifications of staff, there was a need to ensure learning pathways were developed that support individual progression pathways. It was also recognised that staff varied in their prior educational achievements and some were well qualified. Much of the learning is provided in-house as the organisation is an accredited training provider with a long history of providing rigorous training and development for its staff. The Practice Development Team delivers Calderdale Competency awareness training to the pilot areas on a monthly basis for all staff to access. The process is closely coordinated. A grid is sent to Team Leaders and Modern Matrons with the names of HCSWs and mentors and this determines the composition of each cohort of learners. There is dedicated training for mentors on the process.

A programme of classroom-based training, devised, developed and delivered in house, to provide underpinning knowledge is supplemented with “hands-on” practice using models. This training has been accredited at NVQ 3 level by Shipley College. The training has a comprehensive workbook which is in three areas; Nursing, Physiotherapy and Occupational Therapy competencies. There is then a programme of formal work-based assessment associated with each unit. This involves engaging Community Hospitals Therapy staff in formal work based assessments and arranging a mechanism for Community Support Team staff to undertake the formal work-based assessments. The process is agreed with team leaders and modern matrons to ensure appropriate delegation is taking place within the work place. The RHCSWs already possessed a minimum of an NVQ 2 in health care. There was a requirement that the post holders would undertake the competency training in nursing and rehabilitation skills which were linked to the Knowledge and Skills Framework (KSF) and undertake an NVQ 3 in general health (AHP support). Once appropriately trained, the RHCSWs could implement individualized patient treatment programmes developed by nurses and allied health professionals (AHPs).

Developing the learning and working with Higher EducationEmployers can provide much of the learning and development required for the AP roles through their well established in-house work-based training provision. The national standard for the AP role however identifies that learning should be at Level 4 of the Higher Education Qualification Framework (HEQF) and therefore the underpinning knowledge for APs may require additional HE learning. The WYLLN project has provided the space and resources to explore the learning and development needs of the APs with a number of Further and Higher Education providers across the West Yorkshire region. Dialogue for what is required to support AP competence development is still ongoing. Some of the employers involved in the project have been successful in developing appropriate HE learning to support learner progression but because the demonstrator sites are at different stages of AP development the learning elements are still under review.

Work Based LearningThe C&HFT AP roles require work-based training which includes competencies derived from implementing the Calderdale Framework and this is facilitated by appropriate training of all staff. Registered staff are not taught about delegation at undergraduate level as delegation skills are picked up once working, which leads to a variation in practice. All registered staff require training to ensure they understand how the AP competencies have been derived and what the AP’s are competent to do. Work-based training is done using Calderdale Framework methodology. All staff need training to understand the communication systems regarding what, when and how to feedback and when a task is to be halted. The supporting systems described earlier are an integral part of making these new ways of working safe and effective.

16

Assistant Practitioner 2: Re-ablement Support

When applying for the post of assistant practitioner I saw it as a career development move, to broaden my knowledge and develop my skills to enable me to carry out the role of ‘the blurred boundary therapist.’This new concept of both disciplines working across boundaries seems innovative and exciting in the field of therapies having worked alongside physiotherapists and occupational therapists for a number of years experiencing the need for interactive working to ensure a smooth and safe episode of care for the patient and team involved.My job is a little different to the ‘normal therapy role’ given the nature of the illness that our patients have which is cancer of all types and brain tumours. Each individual’s mobility and function can change on a daily basis thus ensuring prompt interventions from the team members. It also involves psychological and emotional support for the patient and their families. During my time with the team I have developed an extended knowledge of the medical background of the patients and its implications. This has been achieved through formal and informal training; I have the ability to carry out initial assessments of patients and can manage a caseload under the supervision of a registered practitioner. I also carry out specific treatment related assessments on my own behalf and on behalf of the registered practitioner. I have the ability to progress more complex treatment programmes on behalf of the registered practitioner and of my own caseload. I have an understanding of the clinical reasoning behind my decisions based on experience, knowledge and completed competencies. I have informed liaison with other professionals, I am embedded within the team therefore enabling me to co-ordinate the workload of all other team members.Throughout my practice I am aware of medical changes in the patient’s condition and how treatments impact on their daily living, this requires me to be observant and intervene accordingly taking into consideration the complexity of each individual’s personal need. When practicing I am able to assess holistically therefore reducing the number of health professionals involved during an extremely anxious time for the patient. I feel this approach is beneficial to the patient and their relatives, whilst also demonstrating effective use of resources within the team. The Assistant Practitioner role is a more challenging and responsible role than the Band 3 role I previously worked at as demonstrated above.Having completed my NVQ 3 in Physiotherapy and Occupational Therapy Support, and my competencies, I feel that The HE Certificate will acknowledge and recognize the qualities, skills and knowledge I have to carry out my Band 4 role successfully, thus enabling me to reflect and further develop my practice.

Within the early Skills for Health implementer project at C&HFT a key outcome was to identify the educational needs for the Assistant Practitioner role and how the employer and HEI would work together to make this successful, including an emphasis on accrediting the work-based learning and competencies needed to do the job.

The University of Bradford used SfH design principles to develop a new course to support the level 4 worker. This uses a “shell” model to create a Certificate in Higher Education Award (120 credits), as a full Foundation Degree was not considered appropriate.

The outcome has surpassed expectations, producing a bespoke Certificate in Higher Education for Assistant Practitioners. During the meetings with the University it became apparent that a Certificate in Higher Education for Assistant Practitioners would allow wider participation across Health and Social Care, thereby maximising flexibility of the workforce. The award recognises and accredits work based learning with APEL of work based learning being available to the value of 50 credits. The ‘shell’ structure allows the content to be tailored to the learner and the service. This development fitted well with the aims of the WYLLN project by providing flexible learning for developing the skills for Assistant Practitioners.

In bDCT each of the competencies developed for the AP role are being linked to training requirements in terms of the knowledge required and the source of training and development required. It is expected that much of the training will be provided in-house via available training courses e.g. access to e-learning, NVQ and the Low Secure service training which is aimed at the specialist nature of the service area. It is also expected that much of the development on the psychological specialty will come from input by the psychologist within the Low Secure service or from other local psychological services. The prior learning and experiences within the service will also be identified and supported by APEL where appropriate.

It has been made clear in the appointing information given to APs that there is a service commitment to the learning aspect of the role and that some training time will be allocated to the role but that the practitioner is also responsible for self development and learning and will be expected to commit personal time to study when necessary.

Higher Education Involvement

17

The local HEIs have been actively involved in steering the project, participating in workshops and sharing information about learning developments within their own institutions. We were offered the opportunity to present what had been achieved so far to the Yorkshire and Humber Deans of Health meeting convened by the Strategic Health Authority to raise their awareness of the demand for the new role in the Trusts and the learning and development required. It was hoped that we would gain commitment from Deans to build a truly collaborative framework across Y&H institutions to fulfil the vision of shared learning outcomes linked to recognised core common competences.

However, this was a very big step and we were in the hands of a new government which was having a massive impact on health service strategy and higher education. The meeting took place in the weeks following the Browne Report and the Comprehensive Spending Review when HE departments found themselves facing reductions in staff, HEFCE income and NHS education commissioning contract funding, notwithstanding the fact that NHS organisations were also facing major reform as a result of the health white paper ‘Liberating the NHS’ released in the summer.

The resulting political turbulence and economic pressure across the sector, meant that the Deans were unable to resource a collaborative learning framework at this point in time. It was clear that the vision of a region-wide flexible framework offering truly portable skills would only be considered in a far more stable environment.

In the meantime, however, the project has produced some excellent examples of flexible curriculum within individual institutions, which has responded to the notion of developing a flexible workforce by recognising skills developed in-house or in the workplace; new partnerships have developed between employers and educators, and employers have valued the opportunity to share their learning and experiences amongst themselves.

For bDCT knowledge and skills which cannot be accessed internally will be supported by further and higher education providers within the region. WYLLN has supported health organisations to access a range of courses which are either in existence or which will be developed to more closely meet the needs of employers. Work on developing appropriate programmes is still underway.

bACHS have been working on developing new roles that cross boundaries between staff who are working at different levels. They are just beginning to address the needs of the service for staff working across Bands 3 and 4 but already have a model of HE learning developed with the University of Huddersfield for their staff working in post-registration roles, including a quality framework for clinical supervision and clinical supervisor training, so a similar model may be developed for those working at lower Bands. The intention is to use this framework to have all the clinical in-house training awarded by HEIs as a ‘quality training session’. The clinical skills training as a whole is due to be stamped with the clinical skills network SHA award in the near future.

The blurred boundary working is currently being externally evaluated by the University of Huddersfield and, once this has been completed, the PDT is hoping to develop a research project to identify measurable outcomes at the outset for the further development of staff which can be used to demonstrate ‘return on investment’ on completion. The PDT have presented at conference and prompted discussions on the future development of the workforce with local Higher Education Institutions. Being part of a demonstrator site has enabled the organization to link with national and local developments and influence direction and focus of the network as government policy has changed.

18

Complementary partner initiative:

Cert/Cert HE Nutritional Health, Leeds Metropolitan University The Certificate in Nutritional Health commenced in September 2009 with its first intake of 30 students from across the Yorkshire and Humber region and within the pre-registration dietetic placement cluster for Leeds Metropolitan University. The course was developed after a scoping report which was carried out in September – December 2008 identifying the requirements and needs of the support workers within the nutrition and dietetic workforce and funding approved from the Strategic Health Authority.

The CourseThe current students attend on a monthly basis, with the exception of October and March where they attend bi-monthly, the face to face teaching sessions delivered at Leeds Metropolitan University and different sites further North. The sessions run from 10 am until 4 pm and cover all the modules that the students are taking at different points in the day.

Between the days they attend the students have specific tasks and activities that they complete and that are related to the course content and the specific subjects that are being delivered at the following sessions. These tasks are set through the university virtual learning environment X-stream to which all the students are linked and can access either from work, home or the university campuses if they wish.

So far we have only had 4 students absent since September and all have followed university procedure for informing us of their absence. We are currently at session number 6 of 12 face to face sessions of the course and are due to finish at the end of July 2010.

Feedback Since the start of the course the students have fed back verbally at different points on many aspects pertaining to distance learning the venue and timings of the sessions and their enjoyment of the course. More recent feedback has been centred around the relevance of the course to their working lives and how they value this course over the other options that are available to them e.g. NVQ. The cohort has reported that they are really enjoying the course and feel it is relevant to their specific profession.

“I feel more confident in the information I pass on to clients and also in my ability. I think a lot more about how I approach things and this course confirms that nutrition assistants have an important role to play within the dietetic service”

Ann Coleman, Gateshead Health NHS foundation Trust

“I am finding the course very interesting and useful. As I am a renal dietetic assistant all my knowledge and training has been renal oriented. By attending this course I am gaining some good general dietetic knowledge. I have completed a NVQ 3 in health with a specialised dietetic section but felt I learned nothing from this as I was just documenting my day to day duties. This course is far superior. “

Catharine Noble, Northern General, Sheffield

“ I feel that it is full of information and I’m enjoying learning from someone who has practical experience as both a dietitian and a tutor. The face to face sessions each month keep us in contact with each other and the information we are learning is valuable in my day to day work role. It is much more comprehensive than I had anticipated which is great and I’m very much hoping to pass this year and put my new knowledge to use, both at work and in the second year of the course”.

Catherine Atkinson, Middlesbrough, Redcar & Cleveland Community Services

The current cohort has already prompted discussions around their advancement to the second year of the course. They appear very optimistic about the future having now settled into the course and many are relishing the opportunity that the next year will offer as well as enquiring how they go about progressing. As a result they have been enquiring about the next intake of students and when information will be available for colleagues who are also interested in starting the course.

19

Section 3:Partner reflections: impact and outcomes

Rachael Smith and Jayne Duffy The Calderdale Framework Team: C&HFT

The Assistant Practitioner (level 4) roles have emerged and have been recruited to in both of the identified services, exceeding the original aims. The project has now been rolled out across the directorate, with the identification of potential future AP roles. There have been a number of successes and challenges in the project to date. For example we have designed and adopted a standardised portfolio in partnership with the University of Bradford which includes protocols and training competencies and completion of this can provide 50 credits of a Certificate of Higher Education. There is still further work to do in the work-based learning and assessment area to take account of increasing numbers of participants and a training programme for mentors needs to be implemented as part of this, again in partnership with our HEI provider.

A frustration from our perspective has been around funding for the HE programme which has delayed recruitment to the programme. This sort of new way of working raises questions about who funds such developments and any solution needs to be easy in order to engage employers. There is need for a regional consensus around what an Assistant Practitioner is and the level of learning required i.e. level 4 on the career framework, and to evidence the Skills for Health standards.

We believe that the Calderdale Framework approach has really engaged the workforce in its own modernisation and real changes have happened. In our opinion, a top down, fragmented approach to the introduction of AP roles into services should be avoided. A future evaluation is being planned to explore the Return on Investment of this approach, and comparative studies, locally and internationally are also in the pipeline.

Each of the demonstrators has been asked to provide a reflective comment on their experiences and achievements on being involved in the AP role development :

20

Jan Tallet, Practice Development Lead, from the bACHS team looks back on some of the achievements to date

This project benefitted from having a tight project brief which kept a clear focus. It was crucial to get managers and team leaders on board because modern matrons and senior managers needed to agree systems for embedding this initiative. A range of issues had to be dealt with such as how to accommodate time not included in the roster for working with therapists, mechanisms to delegate tasks, managing induction and supporting systems including supervision, Joint Performance and Development Review and the development of reflective practice.

Identifying ‘Calderdale Framework’ champions, mentors and other professionals in other disciplines who will sign off competencies was crucial. We consider that mentoring is key - there was a need to train mentors and those signing off competencies and to undertake awareness raising and delegation skills development. Identifying key stakeholders and establishing a stakeholder engagement strategy, alongside a communications strategy was important, along with considering service-user involvement in the development of the programme

A project such as this should only be implemented in services which can deliver the training and sign off of competence, and piloting on one small team minimizes disruption. Clearly defined outcomes at the beginning of the project should be measured using a “Return on Investment” (Kirkpatrick’s model) analysis plan - it is important to be able to use existing sources of information collected, including baseline measures at the outset of the project. A focus on the decision analysis stage was necessary. Rigorous administration and project management tools have been invaluable, for example, create templates for service analysis and task analysis and, more importantly, for monitoring those trained and their progress to competence sign off and change in service delivery.

21

The BDCT BDCT Low Secure service is in the process of appointing the first three AP roles all of which will have a psychological focus and will be based on each of the three wards providing the service.

Val Rhodes , Service Improvement and Innovation Manager, notes:

The elements of the process that have worked well in this project are the linked parts involving staff and the use of the Population CentricTM approach. Involving staff, in particular the non-registered staff, has been beneficial in terms of the quality of the work produced. The outcome has meant that the competencies developed came from those who knew the most about this more specialist area of work. Healthy debate and challenge arose between the non - registered and qualified staff on the delivery of competencies and skills required to deliver them.

The Population CentricTM approach meant that the service took a service-user centered approach and the wider needs of the low secure population were considered before focusing on local needs. Service users were involved indirectly in small focus groups to ask what they wanted from staff time and in future projects the service user aspect will be developed more robustly.

Another positive aspect of the work has been that of partnership working with other health colleagues. This has provided a richness and diversity to the development and has resulted in joined up working and links across Trusts and localities.

BDCT has also worked closely with the SHA on their ‘Every Contact Counts’ competenciesxii which support healthy lifestyles. These competencies have been incorporated into the AP job descriptions as a means of ensuring that staff are able to support service user health on issues such as smoking, alcohol, diet and exercise.

22

Partners also reflect here on the WYLLN collaboration

C&HFT had been earlier participants in a National Skills for Health Project- with a

focus on Assistant Practitioners/ level 4 support workers (Early Implementer - Allied Health Professionals Career Framework) and wanted to share learning from this with regional partners. A significant outcome of the collaborative work was the development of the Certificate of Higher Education from an idea into reality, through a series of stakeholder events, which not only added to the rigor of the process but the credibility of this approach across the region. The WYLLN project enabled this to take place and develop our local network of interested/influential partners, especially at a strategic level. We have since been invited to work on other regional pieces of work as a result of this (University of Hull) and the Calderdale Framework methodology is becoming more widely adopted.

For BACHS , working with other employers and learning from their initiatives prevents duplication of effort and

helps to influence local and national direction. It is really important not to try to reinvent the wheel, especially in the current economic context. One of the benefits of partnership working with the universities is to change perceptions about what learning and development should look like. It generates creative thinking and the chance to develop real accountability. It also facilitates links between the national, regional and organisation policy and practice agenda. The BACHS team has been able to influence the direction of the network. This has been achieved by illuminating the challenges in clinical practice and the difficulties of future workforce planning in a constantly changing climate. As an employer BACHS is able to innovate and supports the need for a well educated, competent and flexible workforce that can meet patients’ needs in the future. This also helps to retain staff by providing a career pathway and, by highlighting the need for a mix of skills in the team, all staff feel valued.

For BDCT the WYLLN connection has formed an important element in the workforce redesign. It has provided links with other health organisations enabling a joint approach to take place, which has speeded up processes by building on existing work. This collaborative approach has also resulted in a closer relationship between

employers and education providers with training and courses being developed which match the need of employers and the changing face of the NHS.

23

The benefits of collaborative workingThe region benefited from having access to the learning which

had emerged from the development of the Calderdale Framework, a robust, innovative and pioneering tool which is at the heart of the project.

The development of the competencies in BACHS for example was done using the Calderdale Framework and training to do this was delivered by the authors of the framework. As BACHS developed their own database of competences they also purchased some that the Calderdale team had already written. These inter-Trust developments have meant that partnership working has not only benefited the regional collaboration as a whole but they have also helped individual trusts to progress with development of AP’s within their own services. Work is ongoing to seek sustainability options so some of this collaborative activity can be continued.

This document and the outcomes it describes is the culmination of a highly productive 18 month collaboration between higher and further education, sector skills councils and employers. As outlined by Stephen Challenger and Ian Wragg in their forewords, it demonstrates what can be achieved when committed partners come together to work towards a shared goal: in this case vocational progression and flexible learning opportunities that align with the changing workforce development needs of the health and social care sectors.

The work that has been done by the Health & Social Care Sector Group complements very closely that of the University of Bradford’s Escalate employer engagement programme, particularly in the way that it has innovated in the development of flexible curriculum models, accreditation and delivery. In linking its work to current agendas, specific organisational needs and to identified roles, the project has the potential to influence developments in these sectors and to achieve in the longer term some very practical and beneficial outcomes.

The landscape for the Health, Social Care and Early Years Sector Groups has changed dramatically during its relatively short life, and has created uncertainty and challenge for this project in particular. In light of this, I congratulate the Group, and especially the Sector Officer, Alison Hedley for this very successful outcome.

I would also like to thank WYLLN for the funding and support that made the project possible, the two associates Jane Kettle and Judy Smith for their perseverance and professionalism, and the employer representatives who have rightly kept us focussed on the needs of their organisations.

Celia Moran, Director, Escalate Programme May 2011


The main reason I wanted to apply for the AP role was to gain experience to further my career and to be successful in gaining a place on a doctorate course in Clinical Psychology. As I will be working under the supervision of a Clinical Psychologist, this opportunity will help me a great deal in being successful at the interview stage. I also applied so that my skills and knowledge which I studied on my Undergraduate degree of Psychology, could be used at a higher level.

I think the service will benefit from the AP’s as the qualified nurses workload will be shared between themselves and the AP’s where possible. I think the benefits for the service users will involve them having extended time in 1:1 sessions therefore allowing the service user to communicate more effectively, having therapy services at weekends and having the continuity of care through a reduction in numbers of staff caring for a the service user.

I think in the next 12 months I will have strengthened my interpersonal skills, established competencies in practice and developed more effective inter-professional working through both academic and work mediums. Also, the role will have a clearer structure and I will have gained more confidence working in the role as an AP.

24


I am currently a health care assistant working in BDCT.

I was attracted to the AP post as I was already looking for a job that would help me progress in my career and as the position was a developmental role I felt it would be a really good opportunity for me. I have studied psychology at masters level and wanted an opportunity to apply my training and knowledge to my work. I felt the AP post would allow me to gain further experience of working with service users and delivering psychological interventions.

I decided to apply for the post as I felt I had the relevant experience required for the position and felt it was a good opportunity to develop my skills. I believe working as an AP will also give me more opportunities for me to use my existing knowledge and training in the workplace than I have in my current role as a health care assistant.

I think the benefits of the AP post to the service and service users will be that there will be more opportunities for service users to benefit from psychological interventions, which will mean that service users are offered a wider range of interventions and therefore will result in a better quality of service. There will also be more opportunities to address specific problems service users commonly face such as substance or alcohol misuse.

In 12 months time I feel that psychological interventions and approaches will be used a lot more and more effectively and will play a larger part in service users recovery programs. I also think the AP position will generate greater awareness in staff and service users of how psychology can assist recovery.

Assistant Practitioner 4: TheatresLesley was a health care assistant (HCA) in theatre for 17 years before beginning her journey as an Assistant Theatre Practitioner (ATP). Prior to that, Lesley worked in the hospital kitchens as a supervisor, but had wanted for some time to be involved in patient care. She undertook the Operating Department Support NVQ level 2 training and was one of the first Bradford theatre HCAs to achieve this award.

Lesley has always provided excellent support to the surgical team in the operating theatre. Having achieved the NVQ award, she felt that she was then limited as to where and how she could progress. Lesley had the desire to develop her skills in the operating department, but did not want to undertake professional education such as nursing or operating department practitioner (ODP) training.

In 2008, the opportunity arose for the theatre training team to become involved with Leeds Teaching Hospitals, in the development of an ATP role as a pilot. Only two places were available on the NVQ training course run by Leeds NVQ centre and Lesley successfully secured one of those places through a local selection process. As the Leeds course was a level 3 NVQ, she also had to complete ‘bridging units’ before the additional scrub units were undertaken. Both Bradford candidates undertook this training whilst being paid their HCA banding with an uncertain direction as to what roles and pay bands such training would lead to.

Lesley successfully completed her Perioperative award in 2009. She has since continued to develop her scrub skills within the defined ATP role description and scope of practice and locally determined band for this particular assistant practitioner role. The surgeons she works with are relaxed and confident when working with her, in the knowledge that Lesley has the right skills in the right place at the time they are needed. Lesley feels more satisfied in her role and now has the opportunity to demonstrate a clearly defined extension to her previously determined skill set as a HCA and directly contribute to the surgical care of the patient in the operating theatre.

25

Endnotesi & ii Smith, J, Kettle, J & Stapleford, J (2010) Building a flexible framework for health and social care, for WYLLN

iii Skills for Health (website) Proven role templates for skilled and flexible workforce: Assistant Practitioner http://www.skillsforhealth.org.uk/rethinking-roles-and-services/proven-role-templates-for-a-skilled-and-flexible/(accessed 09.04.2011)

iv Spilsbury K. , Stuttard L. , Adamson J . , Atkin K., Borglin G., Mccaughan D. , Mckenna H. , Wakefield A. & Carr-Hill R. (2009) Mapping The Introduction Of Assistant Practitioner Roles In Acute NHS (Hospital) Trusts In England,

Journal Of Nursing Management 17, 615–626

v Smith, J & Kettle, J (2010) Mapping of Assistant Practitioner role competences for the Flexible Framework in Health and Social Care, for WYLLN

vi Smith, J (2010) Making the business case for the development of Assistant Practitioner Roles and the development of a Flexible Framework for Learning and Development in Health and Social Care, WYLLN

vii Department of Health and skills for Health(2008) Modernising allied health professions (AHP) careers: a competence-based career framework, DOH, Gateway reference 10108 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086264 (accessed 09.04.2011)

viii Smith R , Duffy J (2008) The Calderdale Framework, Skills for Health Healthcare workforce portal http://www.healthcareworkforce.nhs.uk/ffc/aboutus.php (accessed 09.04.2011)

ix Smith R, Duffy J (2010) Developing a Competent and flexible workforce using the Calderdale Framework IJTR 17(5): 254-262

x NHS Yorkshire and Humber(2010) Prevention and Lifestyle Behaviour Change A Competence Framework http://www.yorksandhumber.nhs.uk/document.php?o=6189 accessed 25.03.2011

xi Smith R , Duffy J (2010) The Calderdale Framework, Skills for Health Healthcare workforce portal http://www.healthcareworkforce.nhs.uk/ffc/aboutus.php (accessed 09.04.2011)

xii NHS Yorkshire and Humber(2010) Prevention and Lifestyle Behaviour Change: A Competence Framework http://www.yorksandhumber.nhs.uk/document.php?o=6189 accessed 25.03.2011

Besides the strong relationships with and between partners involved in the project, and flexible programmes resulting from work with HE providers, such as those at Bradford, Leeds Met and Hull universities, the project leaves as a legacy a number of reports and documents which will be downloadable from the WYLLN website until June 2012:

Audit of WY flexible learning provision and employer needs for AP roles (Mar 10)

Position paper to support workforce / education planning for APs (Aug 10)

Job description mapping across AP roles developed in Y&H to date (Oct 10)

WY Nationally Transferable Role (NTR) for AP based on cancer rehab care and psychology assistant (low secure settings) developed with Skills for Health (also available on SfH website) (April 11)

AP toolkit to support employers and education providers in developing AP roles and relevant learning provision (May 11)

May 2011 | Designed and Printed by www.inprintdesign.com FSC paper

flexible learning for workforce modernisation: building a ... · pdf filejayne duffy / rachael...

Documents