HEE ADVISORY GROUP FRIDAY 8 TH NOVEMBER 2013, 14:00 16:30 PRESENT 1. Helen Langton (HL) (Co Chair), Pro Vice Chancellor and Executive Dean, Faculty of Health and Life Sciences, University of the West of England 2. Lisa Bayliss-Pratt (LBP) (Co Chair), Director of Nursing, Health Education England 3. David Foster (DF), Deputy Director of Nursing, Department of Health 4. Lynne Hall, Clinical Advisor, Health Education England (by telecon) 5. Lizze Jelfs (LJ), Head of Policy, Council of Deans for Health 6. Obi Omadi (OO), Lead Professional Officer, UNITE 7. Louise Silverton, Director for Midwifery, Nursing and Midwifery Council (deputising for Jacque Gerard) 8. Andy Tilden, Head of Sector Development - Skills, Skills for Care 9. Angelo Varetto, Head of NOS, Qualifications and Apprenticeships, Skills for Health 10. Colette Ferguson, Director of Nursing, Midwifery and Allied Health Professions, NHS Education for Scotland IN ATTENDANCE 11. Sue Beacock (SB), Associate Dean, External Engagement, Senior Lecturer Learning Disabilities, Faculty of Health and Social Care, University of Hull 12. Kellie Espie-Whitburn (KEW), Advisory Groups Manager, Health Education England 13. Angela Himsworth (AH), Network Nurse Lead & Chair Critical Care Networks National Nurse Leads (CC3N) 14. Katerina Kolyva (KK), Director of Continued Practice, Nursing and Midwifery Council (by telecon) 15. Jo Lenaghan (JL), Director of Strategy and Planning, Health Education England (by telecon) 16. Annette Richardson (AR), Chair, The British Association of Critical Care Nurses (BACCN) 17. Sally Rodgers (SR), Registered Nurse Governing Body Member, NHS Eastern Cheshire CCG 18. Andy Smith (AS),Strategy Lead, Health Education England (by telecon) 19. Rob Smith (RS), Head of Planning and Workforce, Health Education England 20. Judi Thorley (JT), Executive Nurse, NHS South Cheshire CCG and NHS Vale Royal CCG APOLOGIES 21. Elaine Readhead, Managing Director, HEE North East 22. Howard Catton, Head of Policy and International, Royal College of Nursing 23. Pauline Watts, Professional Officer for Health Visiting, Department of Health 24. Joanne Bosanquet, Deputy Director of Nursing, Public Health England 25. Jacque Gerard, RCM Director for England, Royal College of Midwives SECRETARIAT 26. Tom Clayton, Advisory Groups Coordinator, Health Education England 1
INTRODUCTIONS AND APOLOGIES 1. Helen Langton (HL) welcomed attendees to the inaugural meeting of the HEE Advisory Group for Nursing and Midwifery. Apologies were accepted on behalf of Elaine Readhead, Joanne Bosanquet, Howard Catton and Pauline Watts. TERMS OF REFERENCE AND MEMBERSHIP 2. HL acknowledged that the Advisory Group's membership had been transitory and that there could be further change before the next meeting. It was also noted that terms of reference for each of the HEE Advisory Groups had been developed along a single framework, in order that the means by which both the Strategic Advisory Forum (SAF) and HEE Board are advised, remains consistent. HL asked members whether they proposed any further changes to either the draft Terms of Reference or membership of the group. 3. David Foster (DF) enquired as to the relationship between the HEEAGs and the SAF. Jo Lenaghan (JL) explained that the HEEAGs are a uni-professional source of advice, and that such meetings present an opportunity for HEE to gather expertise on the potential short-term impact of proposed strategy or policy. The SAF, on the other hand, is intended to bring together representatives from each HEEAG in addition to external partners from the Department of Health (DH) and other Arm's-Length Bodies (ALBs) in order that multiprofessional strategies over the medium to long term might better be given appropriate consideration. It was noted that the HEEAGs and SAF do not exist in a hierarchical relationship, and that the two are to be considered of equal importance. It was also noted that HL is the representative at the SAF for the Nursing and Midwifery HEEAG. 4. Lizze Jelfs (LJ) enquired as to the expected role of the Patient Advisory Forum (PAF) going forward. JL noted that the PAF was founded as a consequence of historical trends in workforce planning being primarily driven by supply-side forces. The PAF, co-chaired by Sir Keith Pearson, Chair of HEE and Mary Aldford, Non-Executive Director, is intended to ensure appropriate information as to both current and future patient needs. It was noted that each HEEAG ought also to have patient or lay representation. 5. The following action was agreed: JL to issue HEE Board paper to the membership explaining the relationship between the HEEAGs, SAF and PAF. WORKFORCE PLANNING 6. JL reported that it remains HEE's responsibility to co-operatively develop and ultimately certify LETB workforce plans. Rob Smith (RS) and the HEE Planning and Workforce Team in recent months considered each LETB's planned education commissions, both in furtherance of their individual ratification, and also in order that as required by the HEE Mandate a national workforce plan might best be developed for agreement at the December 5 th meeting of the HEE Board. JL invited 2
the membership to comment upon the plan, and assert whether such a plan provides a credible platform upon which high-quality patient care might best be maintained. It was explained that such data are to remain strictly confidential. 7. RS noted that, as a consequence of the Quality, Innovation, Productivity and Prevention (QIPP) agenda, 2012 forecasts on behalf of service providers had indicated that the size of the nursing workforce was expected to decrease in coming years. However, data collated from between 2012 and 2013 have indicated that actual staffing levels have increased during this period, and the aggregate of 2013 forecasting would appear to indicate that a further increase of nursing staffing levels will be required in order to appropriately meet service need. Furthermore, current predictions have suggested that there will likely be a shortfall in service provision in 2014, though this will likely have diminished by 2015. 8. RS explained the limitations of central modelling, noting that any model will necessarily require the acceptance of assumptions, and as such may not be entirely accurate. Furthermore, supply forecasting also remains poorly developed, and given the three-year lag period between education commissioning and the graduation of a nurse, any present decision-making would not affect staffing levels until 2017. 9. Andy Tilden (AT) enquired as to the extent to which the community nursing workforce had been considered in the development of workforce models. RS noted that, as it remains necessary to fully transition to a system in which multi-professional modelling is conducted proactively, a call for evidence across all LETBs was issued prior to model development. JL noted that it would be necessary to transition to a more flexible workforce in which staff will be appropriately equipped to work in any care setting. 10. JL noted that high attrition rates remain a significant concern going forward, and suggested that there may be merit in commissioning additional nursing placements in order that this effect might be suitably mitigated. She also noted that, if indeed additional nursing placements are commissioned, it remains to be seen whether it can be reasonably expected that such trainees will be sufficiently trained for them to work in both community and hospital settings. LBP expressed confidence at the presented opportunity for the HEEAG to further develop the role of community placements in order to combat attrition and resolve the existing compartmentalisation of care. 11. LJ proposed that data pertaining to attrition ought to be fully understood prior to the development of strategic direction. JL explained that this issue remains complex, and that there remain several definitions of attrition. She suggested that John Stock, Workforce Planning/Information Analysis Lead,is working to develop a single definition and that this would be discussed at a subsequent meeting. 12. Although there remain concerns pertaining to training capacity, regional variation, and the extent and veracity of supporting data, the Advisory Group expressed broad support for plans to mitigate the effect of attrition. 13. Louise Silverton (LS) expressed concern that as the Nursing and Midwifery Council (NMC) intend to introduce protocols which would require the revalidation of nurses 3
and midwives from 2015, the potential exists for those nurses or midwives who have taken career breaks to be dissuaded from returning to practice by difficult revalidation processes. HL also noted that although the quality of continuing professional development (CPD) provided nationally is somewhat variable, this presents a significant opportunity to conduct further professional development throughout the nursing and midwifery workforces. Katerina Kolyva (KK) noted that NMC guidance on CPD would be issued to the Advisory Group. 14. JL explained that as there is likely to be an employment gap until 2014, HEE intends to work alongside partners including inter alia, the NMC, NHS Employers and the Royal College of Nursing (RCN) to promote a return-to-work programme in order that the value of investment in historical training might be suitably realised. Furthermore, the numbers of education commissions for Core Surgical Training (CST) are to be conservatively reduced in order to avoid a potential boom and bust effect. 15. The following actions were agreed A map showing the geographical definitions of each LETB is to be issued to the membership KK to issue NMC guidance on CPD to the membership. MINUTES OF THE LAST MEETING 16. It was noted that the minutes of the last meeting are to be edited to reflect that Gail Johnson was in attendance, whilst Jackie Gerrard had given her apologies. The minutes were otherwise accepted as factual. MATTERS ARISING NHS Blood and Transplant (NHSBT) TRANSFUSION TRAINING 17. HL noted that Paper 1-B was issued for information, but was not to be discussed at this meeting of the advisory group. UPDATE ON MANDATE DELIVERABLES DEMENTIA 18. LBP explained that in light of the requirement laid out in the HEE Mandate, it had been expected that a minimum of 100,000 NHS employees would undergo dementia awareness training. It was noted that in excess of 108,000 staff have at present undergone such training, and it is now intended to ensure that there is consistence across the system. The ultimate aim is to ensure that all NHS staff have dementia training. 19. LBP noted that HEE aims to develop a three-tiered approach to dementia, and that consideration is being given to the potential role of clinical academic pathways in the research and management of dementia. Furthermore, it was noted that a pilot project considering the management of dementia is being led by Health Education South West, and that a report from this project was to be issued to the membership. 4
20. LBP noted that a dementia lead has been nominated in each LETB; such staff are to consider the products that ought to be promoted as part of the future management of dementia. 21. The following action was agreed: HF to issue a report on a pilot project conducted by Health Education South West to the membership. UPDATE ON MANDATE DELIVERABLES PRE-DEGREE WORK EXPERIENCE 22. LBP explained that HEE has successfully exceeded the required target of having 170 students conduct a year of pre-degree work experience. It was noted that Mary Lovegrove is currently working to develop a robust evaluation strategy and corollary survey. 23. HF enquired as to whether this project is likely to undergo further iteration in coming months. LBP explained that a second wave of candidates will undergo training in February for a further six month period. However, it was noted that the extent to which there is capacity for this to be delivered remains broadly unclear. UPDATE ON HEE MANDATE DELIVERABLES CAVENDISH 24. LBP noted that the recommendations proposed in the Cavendish Report have yet to be agreed by the Department of Health, and although significant work has been undertaken to consider minimum training standards, these have yet to be embedded into training provision. It was noted that enquiries have been made with both the NHS Trust Development Authority and Nurse Leaders Forum to determine how best these standards might be introduced, but that there remains consternation on behalf of both Trusts and Directors of Nursing. 25. It was noted that a further event considering the implications of such recommendations is to be held on the 29 th of November, and that this matter would be discussed further at a future meeting. UPDATE ON HEE MANDATE DELIVERABLES POSTGRADUATE NURSE TRAINING FOR OLDER PEOPLE WITH COMPLEX NEEDS 26. LBP noted that the following points have become apparent during the progression of Elaine Readhead's project considering postgraduate nurse training for older people with complex needs: A definition of what it means to be 'older' has yet to be agreed upon. It is expected that this definition should be predicated upon need rather than age. A definition of a 'complex need' is yet to be agreed upon. It has been suggested that there exist many needs, which span both health and social care. These matters amongst others are to be agreed upon at the accelerated learning event due to take place between the 14 th and 15 th of November. 5
27. LBP noted that the working group has been convened to discuss this at national level, is due to report its findings in December. Subsequently, a tender will be issued to Higher Education Institutes (HEIs) in furtherance of the development of a range of programmes intended to improve care for older people with complex needs. It was agreed that a further update on progress made by these groups will be given at the next meeting of the Advisory Group. COMMUNITY NURSE STRATEGY FRAMEWORK UPDATE 28. LBP noted that the following projects have been agreed in promotion of community nursing: Workforce planning Pre-registration nurse training CPD provision Lack of career progression for community nurses 29. DF noted that it may be difficult to develop an overarching view vis-à-vis community nursing without the input of the SAF and other stakeholder groups. NURSE EDUCATION PRACTICE NURSING 30. Judi Thorley (JT) stressed the need for further and integration within the practice nursing workforce. Although significant investment has been made to further develop leadership roles, it remains the case that such nurses often suggest that they do not feel empowered or that they have been appropriately invested in. As such, the following changes were introduced: A practice nurse membership council has been established in order that influence might be exerted upon commissioning intention; and This membership council is in concert with Clinical Commissioning Groups (CCGs) and NHS England developing a six-day programme focusing upon the improvement of leadership skills and promotion of an appropriate leadership style in order that the 6 Cs might better be delivered. 31. LBP noted the importance of not duplicating existing work, and enquired as to whether JT and Sally Rodgers (SR) had consulted the Leadership Academy prior to initiating this project. 32. Sally noted that there is at present no such project being conducted by the RCN, Royal College of General Practitioners (RCGP) or National Association of Primary Care (NAPC), and invited further input from the Leadership Academy wherever possible. 33. LBP noted that it would first be necessary to have developed a project plan, and that she would talk to Carol Jollie (CJ) in order to conduct appropriate liaison with LETBs with a view to developing a project plan. 6
34. The following action was agreed: LBP to correspond with CJ to develop a project plan around practice nursing. NURSE EDUCATION CRITICAL CARE NURSING 35. Annette Richardson (AR) noted that, following the conclusion of work conducted over a series of pilot sites, the Department of Health published a framework in 2006 which proposed a two-year programme with a minimum of 90 weeks integrated theory. Subsequently, large cohorts of nurses typically those from existing critical care roles were trained between 2007 and 2008. 36. However, given that many existing curricula are locally determined, and that there remain few members of junior medical staff, a further Education and Competency Framework was published in 2008 which proposed that further training would be conducted as part of a Level 4 NVQ. AR noted that, despite a large turnover (as is to be expected for a city centre hospital), recruitment numbers have been promising. 37. Angela Himsworth (AH) noted that the Critical Care Education Review Forum was formed in 2008 to identify and articulate concerns about critical care education. Consequentially, the National Standards for Critical Care Nurse Education; a Framework to Improve Educational Outcomes and Quality of Care (CC3N 2012), were developed with a view to resolving such concerns. 38. LBP enquired as to whether this framework takes appropriate consideration of the needs of patients with dementia. AH explained that the management of dementia is addressed throughout the framework. DF stressed the importance of developing a suitable, quality assured learning environment around the issue of dementia, and noted that the DH have been working closely on these pieces of work, and is in the process of formalising it. 39. AR requested advice as to whether Critical Care Network-National Nurse Leads (CC3N) ought to seek to have the quality framework quality assured. LBP proposed that it would be necessary to first consolidate workforce information especially that pertaining to retention in order that these protocols might be used concomitantly with the broader attrition agenda. NURSE EDUCATION LEARNING DISABILITY NURSING 40. Sue Beacock (SB) explained that the UK Learning and Intellectual Disabilities Framework was developed as a consequence of work conducted by the Nursing and Midwifery Professional Advisory Board. SB noted that this work directly affects health and social care, and that as a group; a key objective is to map current learning disability provision across the UK. She noted that a list of universities which are being commissioned for learning disability training would be issued to the Advisory Group. 7
41. HL enquired as to how they might best support the social care agenda given that the impact of learning disability nursing provision can be clearly linked to health outcomes for those with a learning disability. 42. LBP proposed that a half-day workshop be scheduled in order to give sufficient time to such issues. It was noted that a call would take place between SB, LBP and HL as to the planning and scheduling of such a meeting. 43. The following actions were agreed: SB to issue a report on the UK Learning and Intellectual Disabilities Framework to the membership SB to issue a list of universities commissioned to provide learning disability training A meeting to be scheduled between SB, LBP and HL in order to plan and schedule a half-day meeting to address learning disability provision. ANY OTHER BUSINESS 44. LS requested that the Advisory Group address issues concerning clinical academic training and clinical academic careers at a future meeting. 45. It was noted that the next meeting is due to take place on 10 January 2014, 14.00 16.30. 46. The following action was agreed: Clinical academic training and careers to be discussed at a future meeting of the Advisory Group. 8