Projects 2011 - 2012

• Supporting relevant and topical education

• Training benefits both staff and older people

• Fostering closer links with academics

Home-grown training for new support role

The four acute NHS trusts in south west London have banded together to commission a new foundation degree that will train ‘associate practitioners’ to offer practical support to both patients and qualified staff. The job titles of the ‘associate practitioners’ will vary between trusts and specialities, but all will work in services that experience recruitment difficulties – maternity services and perioperative care, for example. The SW London System has financed a part-time project manager for six months to get the associate practitioner posts and accompanying training off the ground.

Each trust will appoint their own associate practitioners (some existing staff have been encouraged to apply for the posts) and then send them to university to train while working: between them, the four trusts are recruiting about 40 trainee associate practitioners (APs) to start in January 2012.

The four NHS trusts – St George’s Healthcare, Epsom and St Helier University Hospitals, Kingston Hospital and Croydon Health Services – have tasked the Faculty of Health and Social Care Sciences (run jointly by Kingston University and St George’s, University of London) to create the two-year Healthcare Practice Foundation Degree. NHS London is providing funding for the course fees and cover for the trainee APs while they are at university. The emphasis of both the training and the work is on practical care in collaboration with qualified staff: the AP posts are band 4 (healthcare assistant posts are bands 2 and 3 while a registered nurse post is band 5). Initially, the APs will be trained to work in one of three specialities: maternity care, perioperative care and general nursing.

Those in maternity care will be called ‘midwifery support workers’ and will work with midwives on postnatal wards and in the community, helping new mothers learn to breast-feed and care for their babies, for example. Other APs will be trained to offer support in perioperative services, working in theatres or day surgery units as scrub staff and runners, and with patients during recovery; or to work with nurses on hospital wards and in the community in different services, depending on where they are needed.

A curriculum steering group means there has been input from all four trusts into the design of the foundation degree.

·  The setting up of the new role and specialist training has been a collaborative venture involving Di Morgan from St George’s Healthcare NHS Trust; Jackie O’Neill, head of education at Epsom and St Helier University Hospitals NHS Trust; Sarah Connor, professional development lead at Kingston Hospital NHS Trust; and Ann Bell, clinical nurse trainer at Croydon Health Services NHS Trust.

Helping GPs in new commissioning role

GPs are soon to have more responsibility for spending and investing public money. As a result of the NHS reforms detailed in the Health and Social Care Bill 2011, they will in future play a pivotal role in new clinical commissioning groups charged with buying hospital-based and community health services to meet the needs of people living in local neighbourhoods. Many GPs however, have little expertise in methodologies that can inform spending decisions – or knowledge of the concepts, language and terms used in the world of health finance and health economics, says Professor Giampiero Favato, head of the Department of Accounting and Finance at Kingston University. With the support of the SW London System, he is designing a short training course that will help GPs in their new commissioning role. The aim, he says, is to give them a broad understanding of modern methods that can help them evaluate both cost and value – and then reach informed decisions about which are the best services to purchase on behalf of their patients.

Not all methodologies used for economic evaluation are relevant to taking ‘real life’ decisions, he says. QALYs (quality adjusted life years), for example, are a standard tool used by health economists when assessing cost-effectiveness of a particular treatment, but may not be relevant for commissioning decisions. Maths and statistical calculations won’t feature in the training: the new commissioning groups will employ accountants and financial advisors, he says. However, GPs and other health professionals will need to understand financial ‘language’ used to express advantages and disadvantages of different treatments and services.  The training will be piloted at the beginning of 2012 and then developed as the structures of the new clinical commissioning groups in south west London are finalised during the countdown to the formal abolition of primary care trusts in 2013.

The idea is to offer the training to everyone new to the commissioning process – GPs and other health care professionals who will advise on which treatments and services are available. The training will be fully customisable to meet the needs of different groups.

Supporting collaborative leadership

A Leadership Development Programme commissioned by the SW London System will help senior managers focus on working together to plan and provide services that address all the needs of both an individual and a local area.

‘In the past, organisations have developed stand-alone solutions to problems that were particular to their individual remit,’ says SW London System director Laurence Benson. ‘There is now an acknowledgment that the best way to improve people’s health and wellbeing is for health and social care organisations to work together – and also to work with organisations concerned with housing, leisure and sport, for example. Strategies to prevent ill health and promote good health within a local neighbourhood also need to be taken into consideration.’

Senior managers from all the organisations that are part of the SW London System are being offered a place on the new Programme that will emphasise the skills needed to collaborate imaginatively and productively with both existing and new organisations, and inspire their teams to think creatively. Kingston Business School (at Kingston University London) is organising the year-long Programme that will start in January 2012 with a first intake of 40 service managers and senior academics working in a range of different departments, with varied backgrounds and fields of expertise.

They will come together for three modules to be staggered throughout the year. Between times, each participant will be offered the support of a mentor, appointed by their employing organisation, and work on their own project, focusing on improving services by collaboration.

The Programme will run for a second time throughout 2013, recruiting another 40 participants. To find out more, click here.

Supporting relevant and topical education

An MSc in Public Health is being planned at St George’s, University of London. The SW London System is supporting the creation of the new postgraduate programme, which could be up and running in September 2013. Public health is not just the domain of specialist professionals, says Peter Brambleby, director of public health in Croydon. An MSc will appeal to people who want to carve a career in the field and go on to study for public health qualifications, but it will also have relevance for all health and social care professionals.

‘Public health can be described as population medicine,’ he says. ‘Anyone who takes an interest in the welfare of the population is a public health practitioner. In future, doctors and other health professionals will need a population perspective. For example, commissioners of health services will be commissioning diabetic health, not diabetic care – a diabetic expert would be asked to improve the glucose control of the population, not just treat people with diabetes.’

The public health perspective will be high on the agenda of new health and wellbeing boards led by local authorities and working with the new clinical commissioning groups charged with purchasing health services post 2013. Local authorities, responsible for planning and running a wide range of services that contribute to the wellbeing of people living within their boundaries, are to take on board leadership for the public health of their residents from the same date. (Public health expert teams are currently employed by primary care trusts and other NHS organisations.)

A new MSc may also be attractive to international students and help generate an income in times when public funding for higher education is being reduced and universities are being encouraged to become more entrepreneurial.

Training benefits both staff and older people

A training scheme designed by a team working for Wandsworth Council helps care workers better support the growing numbers of people with dementia who live in residential homes.

‘Working with people with dementia can be overwhelming,’ says Iris Jackson who works in Wandsworth social services’ specialist Transformation, Quality and Review team: one of the team’s roles is to review the quality of care in residential homes for older people. ‘Some care workers say they are quite frightened about approaching residents who have dementia because they don’t know how to talk to them and respond to them.’ The training – ‘Person-centred care for people with dementia’ – consists of eight weekly half-day sessions and aims to help care workers understand more about dementia and the reasons for residents’ behaviour, give them confidence, and teach them practical ways of supporting their clients. ‘People say the training has helped them re-engage with the job, improved their work day and given them more job satisfaction because they see improvements in their clients,’ says Iris. Now a formal evaluation is to be undertaken to provide evidence to show this sort of training is beneficial for people with dementia, and for the care workers who support them. The evaluation is to be carried out by researchers at St George’s, University of London with the financial backing of the NHS London Dementia Strategy and the Department of Health (social care), secured with the help of the SW London System.

As well as measuring improvements in residents’ quality of life, the evaluation will seek to find out if there has been a decreased use of medication to control agitated and aggressive behaviour in homes where care workers have been trained. The course was developed in collaboration with the Development and Learning team in social services and is now delivered three times a year to groups of about 30. The training takes place in one of the care homes – run by private sector organisations or charities – rather than in a classroom. There is optional ‘homework’ – preparing a case study about supporting a particular resident, for example – and workplace assessment, which can be carried out by a senior member of staff or a peer. Care workers are encouraged to share what they have learned on the course with colleagues. The results of the evaluation will help the Wandsworth social services teams develop the training. If the evidence proves the benefits, other boroughs in south west London might want to commission the course, says Iris.

Fostering closer links with academics

How can health and social care professionals working in services run by NHS trusts and local authorities in south west London work more closely with researchers and teachers employed by St George’s, University of London and the Faculty of Health and Social Care Sciences (run jointly by St George’s and Kingston University)?

The SW London System is supporting a project that will gather the views of staff working for the trusts, borough councils and the universities about the best way to introduce some kind of cross-organisational arrangement to support and encourage teamwork and greater alliances. ‘We want to look at ways of working together across traditional organisational boundaries to bring service excellence and academic strength together for the benefit of both,’ says SW London System director Laurence Benson. ‘Postgraduate medical education in particular would benefit from a mechanism that emphasises clinical research and allows the swift adoption of evidence-based service improvements from across the UK and internationally.’ One idea would be to set up an ‘academic care group’ (ACG) for some of the hospital and community-based services run by member NHS trusts to facilitate closer working between health professionals, social care professionals and academics.

‘NHS trusts and university researchers and teachers have always worked closely together: by creating ACGs, these collaborations would become more formalised. Bringing social care professionals into these groups would make sure all the health and care needs of an individual are considered,’ says Laurence. ‘There is evidence from both the US and the UK that this type of structure – aligning the academic, health and social care systems toward common goals by breaking down silos, encouraging collaboration and creating transparency across organisations – can be very successful.’

Other NHS trusts and universities involved in academic health science centres have set up more formal partnerships in the shape of ‘clinical academic groups’ to deliver specific National Institute for Health Research-funded ‘bench to bedside’ research programmes. This project is not about implementing that sort of prescribed change, says Professor Paul Jones, head of the Division of Clinical Sciences at St George’s, who is leading the project and is working with a steering group made up of representatives from SW London System member organisations.  The objective is to find an arrangement that best supports the collaborations already occurring, makes them more widespread, makes it easier for health professionals to get involved in research and for patients to participate in trials and studies – and fosters ‘the provision of a high quality learning environment for teaching and training.’ Paul says: ‘This is about facilitating partnerships rather than imposing new ways of working or service reconfiguration.’