Roadmap to Integration Developing a workforce for Wyn

Helen Watkins: Head of Workforce and OD, Primary, Community Intermediate Care Clinical Board, Cardiff and

Vale UHB

Lance Carver: Head of Adult Social Services, Vale of Glamorgan Council / Locality Manager Cardiff and Vale

UHB

Our aim today is to:

• Explain the Wyn Campaign and nature of the transformational change

• Outline the workforce response to deliver a sustainable, productive workforce to deliver the change

• Demonstrate the benefits: quantitative and qualitative

Why Wyn?

• Wyn can be a man or a woman, is typically 86, frail with cognitive impairment.

• Health Board, two Local Authorities and Third Sector working in partnership

• Transforming whole scale service and cultural change across the whole health and social care system

What Wyn tells us he/she wants:• Old-fashioned values• Understand & treat me as

an individual• Talk to me and involve

me in decisions about me – work with me don’t ‘do to’ me

• Inform but don’t intrude• If I’m sick, fix me up and

get me back on feet as quickly as possible; I don’t have time to hang around!

Wyn Campaign principles

• Everything we do will be focussed on supporting Wyn to regain & retain independence,

• We will provide timely, tailored & co-ordinated responses in the community to meet Wyn’s needs in the context of his/her life and community

• We will work collaboratively together across health, social care and the voluntary sector to meet Wyn’s needs;

The ‘Team Around Wyn’ Model

Team Around WynRegaining and Retaining Independence

Co-ordination

Primary CareRisk Stratification

Healthy Ageing

SignpostingComms Hub

Medicines Management

Facilitated Early Discharge, Case Management

Falls Prevention/Management Support Carers

Recovery & Re-ablement, Targeted monitoring,

Support to Care Homes Step up/admission avoidance

Joint Commissioning Framework/Unit

Focused improvement in Advance Care Planning and End of Life Care

Targeted Interventions“Needing a bit of support for a

while”

Universal

Services – “doing

ok

thanks”

Longer-term Care

“Needing regular help”

Three Pronged Approach

• To deliver a productive workforce to care for Wyn we needed to:– Plan for the workforce of the future:– Develop the multi agency teams– Work across boundaries

• Key principle – work together and develop joint solutions by engaging across Health, Local Authorities and Third Sector

• Workforce Workstream Lead

Roadmap to Integration

• Provide time to think differently and identify the workforce, service and financial issues

• Think big picture – look at the whole system• Consider what our workforce look like in 3/5

years and how we get there• Protected time to share ideas and think together• Transformational – longer term gains and need

for planning

Defining the case for change

• Service and finance presentations

• SWOT analysis

• Use of Public Health / demographic information

• Pathway development and workforce barriers and enablers

• Stakeholder Analysis

• Action Planning around emerging themes

Workforce Planning Process

• Three workshops

• Six Step Processo Define future service provision and planso Analysis of current service and workforceo Forecasted workforce requirementso Planning for Deliveryo Proposals for Implementation, Performance

Management and Reviewo Working in Partnerships

Key Themes Emerging

• Team working & Development

• Communication, Engagement & Partnership

• Shared Roles and Skills,

• Education and Training

• Culture and Leadership

• Infrastructure and Service issues

Workforce Roadmap Around Wyn

Workforce Around WynRight Staff, Right Time, Right Place

Working together to make every contact

count

Skilled, willing Professionals

Duplication

Tribalism & Silos

Co-Location

Different priorities

Risk aversion

Hospital focus

Clarity of role & team working Joint Vision & Values

Stakeholder Clarity & established relations across 3 organisations

Shared bases Common Procedures Good communication

Shared Training Third Sector contribution

Shift from acute to community Fully integrated teams

Transferable skills and generic roles

Culture Change and strong embedded leadership

Joined up IT and systems Wyn Friendly working Hours

Where we are now

2013/14

Short term2012

Long Term

2014/15

Vision

Commitment

Brave New World

Team Development

• Official launch of Community Resource Teams – October 2012 (earlier in the Vale)

• Teams had experienced change to working arrangements and expectations

• Time was right to invest in them

• Interagency / multidisciplinary approach

• 100+ staff participated

Areas covered

• Team identity – how does it feel now?

• Team purpose – what will we have achieved in 12 months

• Operating Principles – key values and behaviours for the teams

• Team Interdependencies – identify the main teams they interact with

• Team Objectives

Hopes for the future

• WYNNING COMBINATION : Dynamic, innovative team enabling patient – centred care = Independence and reduced admissions

• WYN-ING Team Improve Care and Support In Patients’ Own Homes.

• WYN WIN For Patients And Budgets! CRTs Unite For Success!!

• CRT Provides Holistic Patient Centred Hospital At Home WYN WINS!!!

• New Ways of Working, Keep Local People Safe and Independent

Values and Teams

Key Values• respectfully, competently,

professionally, valued equally, honesty, dignity, welcoming, as one – not us and them, fairly, acknowledged, praised, trusted, equipped

Key Behaviours• role model, team player,

mentor, listening, sharing, enthusiastic, as a champion of the service, proactive, approachable, humour, appreciative, dynamic, motivated, courteously

Key working relationships to improve are:• Mental Health, Inpatient

Wards, GPs, Social services, Welsh Ambulance

Potential Solutions include:• Better communication,

Scheduled meetings, joint education, rotation, awareness raising, access to notes, link roles, better referral process, understanding of roles (role clarity)

Cross Boundary Working

• Every opportunity to remove silo working

• Examples include– Care Pathway Development: staff involved to

ensure user friendly language and engage in redesign process

– Newsletter: Enthusiastic group of communication champions pull together this regular document

– Induction: Specific Wyn Induction developed.

What have we achieved so far?

• Aiming for long term transformational change across whole system.

• Planning for long term improvements

• However, we can identify both– Qualitative benefits– Quantative benefits

Benefits - Qualitative

• Strategic Workforce Plan developed

• Co-location of multi agency CRTs

• Clinical Governance Programme

• Core operating Principles for CRTs

• Regular Patient stories• Operational Policy• Engagement across

sectors

• Network of Communication champions

• Care Pathway developed• New roles introduced (eg

FallsTechnician)• Roll out programme- IT:

agile working• Participation in All Wales

Research Collaborative• Enthusiasm for change

Benefits - Quantitative

• Emergency Admissions and Re-admission rates

• Long Term Care Placements reducing• Percentage of Discharges to Usual Place

of Residence increased• Delayed Transfers of Care (DTOCs)• Faster Re-ablement response times

(reduction on 1/3) & greater capacity from existing resources

What We Have Learned• Providing the space, time and opportunity for

shared thinking is crucial • Development work is not delivered overnight – it

is essential to be committed to a shared vision and passion to deliver the required change

• Don’t overlook the constant need for clear communication with staff

• Keep the patient (WYN) care central –this enable colleagues to work towards common goals and not focus on organisational differences.

Awards

• Healthcare People Management Association (HPMA) National Awards - this work won the category for workforce productivity to support service transformation.

“ The judges instantly connected with Wyn, keeping the patient rather than the organisations at the centre of the programme from beginning to end.”

Highly commended in the category “Developing a Flexible and Sustainable Workforce” – NHS Wales awards

Final Words

“ We thought we’d been abandoned until they referred us to this team. We’re very, very grateful for their support…..the team has been invaluable to us … it’s meant that we can cope at home – if we hadn’t had that help I think he would have had to go into care and that wouldn’t be good for either of us.”

Mr and Mrs Donohughe

Thank you

Any Questions?