Provision of community care: who, what, how much?

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

A large proportion (39%) of the contracts for community provision are held by private providers, with a further proportion held by charities. Library provision to these groups is likely to be difficult to arrange due to the effort required to prepare SLAs with each provider, with many of these providers holding just one contract.

Source: The Health Foundation

Link to main document

Publication format: PDF

Date of publication: May 2017

Summary of driver:

This paper analyses the community care contracts held by clinical commissioning groups (CCGs) in England. NHS providers held more than half of the total annual value of contracts in the sample, while private providers held 5% of the total annual value, but 39% of the total number of contracts issued. Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most held just one contract.

Key features of driver:

  • Successive governments have wanted to increase the use of community care relative to acute care
  • BUT community care still only accounts for one in every 10 pounds spent by commissioners
  • Recently spending on community care delivered by non-NHS providers has increased substantially
  • BUT not many people know who are providing these contracts or what size they are
  • Investment in community provision is central to the Five year forward view, leading to 14 multispecialty community provider (MCP) vanguards testing new ways of delivering community care.
  • NHS providers hold over half (53%) of the total annual value of contracts awarded for community services
  • Other contracts are provided by:
    • GPs
    • Local Authorities
    • Charities
    • Private Companies
  • Of the contracts studied by the Health Foundation private providers held 39% by number but only 5% by value
  • Private providers tend to hold much smaller contracts – most held just one
  • The majority of very large contracts were held by the NHS

Primary audience: Commissioners, community healthcare providers

Date last updated: August 2017

Due for review: August 2018

Group member responsible: JC

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Shining a light: the future of public libraries across the UK and Ireland

Impact on library policy/practice: NHS libraries are being encouraged to partner with local library services; this report will give NHS librarians an understanding of the current public library landscape.  Central to the report is the theme of wellbeing (see page 9) which may be a useful way for NHS libraries to open a conversation with their local public library colleagues.  The report also encourages partnership working and clearly there is an opportunity for NHS and local authority libraries to work together to work towards the five recommendations laid out in the report.

An accompanying data booklet summarises ‘how people in the UK and Ireland use public libraries and what they think of them’ which could be of use for business cases, impact reports or understanding how to target local services.

Source: Carnegie UK Trust

Link to main document

Publication format: PDF

Date of publication: April 2017

Summary of driver: This report outlines how public libraries can continue to contribute to government policy goals and improve people’s wellbeing for many years in the future. The report presents recommendations drawn from research conducted by Carnegie into library use and attitudes towards library across the UK and Ireland.

Public libraries have the ability to contribute to individual and community wellbeing and to many of the priorities of local and national government.  Moving forward, library services and their advocates need to be future focused and outward looking, and resist the temptation to embrace a backwards-looking ethos.

Key features of driver: This report seeks to contribute to the debate by sharing the ‘state of play’ for public libraries in the UK and Ireland revealed by our research.  The reports sets our five recommendations (‘lessons’) for how libraries can continue to improve people’s wellbeing both in today’s political, economic and social context and into the future.

These lessons are as follows:

  1. Demonstrate value to policy makers, decision makers and funders to maximise public and other investment
  2. Increase focus on tailored, personalised services whilst maintaining a focus on delivering a universal service
  3. Accelerate the development of a user-centred, data rich service with a strong online presence
  4. Invest in innovation, leadership and outcomes-based partnerships (one point is ‘Local and national governments and voluntary organisations to explore the value of partnering with public libraries to deliver services and outcomes’)
  5. Enhance learning between libraries and across jurisdictions

Primary audience: Members of the public and public library stakeholders.

Date last updated: August 2017

Due for review: August 2018

Group member responsible: VT

 

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King’s Fund report – Caring to Change: how compassionate leadership can stimulate innovation in health care

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice:

  • Knowledge Management opportunities
  • Promote research and innovation opportunities to support the culture of learning and providing evidence based research in the relevant areas
  • Working with managers, commissioners, transformation teams to support the organisation and staff whilst undergoing this change
  • Current awareness / linking into other organisations and disseminating that information- condensing the amount of information available/ do once and share
  • Cross boundary work/promotion with public libraries to engage staff with health and wellbeing
  • Listening in action/coaching – opportunities for LKS to branch out into other areas of the organisation and showcase transferable skills

Source:  The King’s Fund

Link to main web site

Link to report

Publication format:  Web site and pdf

Date of publication: 4th May 2017

Summary of driver: This paper looks at compassion – which involves attending, understanding, empathising and helping – as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things. It also describes four key elements of a culture for innovative, high-quality and continually improving care and what they mean for patients, staff and the wider organisation:

Key features of driver:

  • More money on its own is not enough to transform the NHS – transformative changes are needed
  • BUT examples of radical and sustained innovation are exceptions
  • The best examples have triumphed over adversity by:
    • Re-designing whole systems
    • Radically rethinking organisational roles
    • Giving teams the power to be innovative
    • Persistently nurturing continuous improvement
  • Leadership – and a culture – that makes change possible are essential to spread innovation and make it a cultural norm in the NHS
  • Compassionate leadership makes a culture of improvement and radical innovation possible
  • Compassionate leadership motivates NHS staff and reinforces their fundamental altruism
  • Compassionate leadership promotes learning and encourages people to take risks
  • Compassionate leadership helps people feel safe to raise concerns and develop new ideas
  • Compassion is the core cultural value of the NHS
  • There are four elements to a culture conductive to innovative and high-quality care
    • An inspiring vision and strategy
    • Deliberate attempts to include people and get them to participate
    • Enthusiastic team and cross-boundary working
    • Support and autonomy for staff to innovate
  • Most leadership development occurs by experience – it’s vital leaders are good role models
  • All staff should get timely feedback to make sure that they are behaving compassionately, consistently
  • People should be allowed to respond autonomously to challenges by innovating
  • Shared leadership results in significantly higher levels of innovation and better team performance
  • Leadership has to be consistent with all leaders being authentic, open, transparent, curious, appreciative and compassionate
  • NHS organisations do not generally have quality improvement and radical innovation as parts of their strategies but this might change as the National Improvement and Leadership Development Board takes effect promoting compassionate and inclusive leadership

Primary audience: All NHS staff

Date last updated: 4th May 2017

Due for review:  4th May 2019

Group member responsible: LK

British Medical Association (BMA) evaluation of the General Practice Forward View – One Year On : Policy Briefing

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice:
Offer support with LKS resources and expertise
Concentrating on building relationships with VTS in order to maintain links once people move into General Practice
Link in with Medical Education to strengthen GP training.

Source: British Medical Association

Link to main website

Link to report

Publication format: Website and pdf

Date of publication: April 2017

Summary of driver:
The General Practice Forward View (GP Forward View) was published in April 2016. The paper commits to an extra £2.4 billion a year to support general practice services by 2020/21. This will improve patient care and access, and invest in new ways of providing primary care. This is an update of the last 12 months from the BMA.

Key features of driver:
• An extra £220m was added to the GP funding pot for 2016/2017. CCGs added £102m to cover population growth and for local investment. Together this represents an immediate increase in funding of 4.4%
• £40m has been committed over four years to reduced workload of which £16m was committed for 2016/2017. By the end of March 2017 £17.2m had been spent reducing workload in 1,279 practices
• £10m was committed for supporting struggling practices of greatest concern. By the end of March 2017 £10.1m had been spent on 714 practices
• £30m was committed to a 9-12 month programme of workshops and learning sessions as part of the Time for Care programme. To date 86 schemes covering 107 CCGs are being supported by national resources and expertise
• 18 transformation areas have received £1.50 per patient to accelerate increased opening hours
• 653 schemes have been completed under The Estates and Technology Transformation Fund but the BMA are worried about the delay in the provision of this money leading to slow progress of the delivery of some projects
• There has been an increase in GPs in training but between September and December 2016 there was a decrease in the total of GPs of 390 (headcount) and 445 (FTE). The BMA is very worried that progress is not enough for the 2020/21 workforce targets to be achieved
• 370 GPs are now on the Induction and Refresher Scheme, 76 have completed so far and have now re-entered the GP workforce
• £112m was committed to fund clinical-pharmacist posts in General Practice on top of £31m for a pilot project already announced by NHS England. So far 491 clinical pharmacists have been funded by this scheme
• CCGs should plan to spend £3 per person as a one-off non-recurrent investment starting in 2017/2018 either as £1.50 per person over two years or £3 per person in one year. The money should be used for:
o Stimulating development of at-scale providers for improved access
o Stimulate implementation of the 10 high-impact actions to free up GP time and secure the sustainability of general practice
• BUT some CCGs have said they won’t be able to come up with the money or that it might come from other budgets. The BMA have raised this with NHS England at the highest levels
• £30m will be spent to tackle the rising costs of GP indemnity and the BMA, NHS England and the Department for Health are discussing this further

Primary audience: GPs CCG staff local government NHS organisations

Date last updated: April 2017

Due for review: April 2019

Group member responsible: LK

NHS England Research Plan

Impact on library policy/practice:

Library and Knowledge Services are specifically mentioned in the Research Plan. Firstly, NHS England will work in a supporting role with NHS LKS in the development of communities of practice and enabling the translation of evidence into practice (p. 17).

Secondly, NHS England will work with HEE to support NHS LKS to ensure best evidence underpins research, and that researchers can freely access LKS, including training in advanced search and information handling skills (p. 17).

Information skills training is something that NHS libraries are already offering, though it may be necessary to promote our ability to provide more advanced training to researchers, or to review what other training we can offer to researchers. Whilst researchers in many NHS trusts will have access to LKS, there may be other organisations such as CCGs where there is limited access, and it may be necessary to put an SLA in place; this driver could be used as an argument that organisations need to ensure their researchers have access to libraries and the necessary information skills training.

The development of communities of practice is a new area for libraries, especially across organisational boundaries, but there are initiatives such as the KnowledgeShare service that are already enabling this where organisations subscribe, and NHS Education for Scotland have national systems in place such as People Connect. At a local level, there is an example in the KfH Knowledge Management Toolkit of the development of communities of practice using the Intranet within Pennine Care NHS Foundation Trust. Part of our role may also be to signpost to existing communities of practice.

There may also be a role for libraries as part of the PPI agenda to promote recruitment into local research, and the Research Plan specifically mentions improving public access to research opportunities and recruitment (p. 15).

There are some more ideas on how libraries can support research on a blog post on the KfH blog.

Overall, this document makes clear the importance of research and its use in the NHS and could be used by NHS LKS to push to be more fully involved in the research agenda in the NHS.

Source: NHS England

Link to main document

Publication format: PDF

Date of publication: April 2017

Summary of driver:

NHS England is mandated by the Department of Health to promote and support research in NHS organisations, whether funded commercially or non-commercially. This plan sets out NHS England’s strategic approach to research and how it links with work across Government, including the Industrial Strategy.

It recognises that research is vital to provide the evidence to transform care and improve outcomes.

There are three main areas of focus:

  • Driving the direction of research by ensuring commissioned research addresses the needs of the NHS. Part of this will include defining what research is needed. A Research Needs Panel has already been created.
  • Contributing to creating an environment that fosters research and innovation by supporting commissioners, CSUs, AHSNs, and national programmes to facilitate research in the NHS. It will also include supporting the recruitment of patients into trials, and the allocation of funding for Genomic Medicine Centres.
  • Supporting the use of evidence in decision making, and translating research into practice by using a range of ways to share good practice such as partnership working, networks and guidance. A ‘research and use of evidence self-assessment’ tool for CCGs has already been produced.

Key features of driver:

The document lists all of the partners that NHS England will work with to promote and support research, and in some cases gives a brief description of the role they play in research.

A part of the strategy is to develop the genomic medicines service, with the aim of sequencing 100,000 human genomes by the end of 2018, and developing a genomic medicine laboratory infrastructure. Initially the focus is on cancers and rare inherited diseases.

There will be work to promote patient and public participation in research, such as recruitment to clinical trials, by contributing to NHS Choices and the UK Clinical Trials Gateway.

Primary audience: Chief executives and accountable officers of NHS organisations, national bodies with an interest in healthcare research, higher education institutions.

Date last updated: July 2017

Due for review: July 2018

Group member responsible: JC

Dismantling the silos: Poster Exhibition to share and celebrate good practice

Project team:

  • Lis Edwards, Library Services Manager
  • Library Services Team
  • Medical Illustration Team

Resources required: Poster template, Library staff time, Medical Illustration team time

Timeframe: Two months

The story: In September 2016 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust began a culture change programme throughout the organisation.  This was in response to reports from Deloitte and the CQC which found that there were issues within the Trust around leadership and culture.  As part of the culture change programme two ‘big conversations’ have taken place where members of the executive team and Non-executive directors have visited every department in the hospital  to talk and listen to staff about their concerns.  One of the overwhelming issues raised by staff throughout the Trust was that they wanted other staff to recognise the work that was going on within their departments, and also to know more about what other wards and departments were doing.

Within this setting the Library Services Manager was asked to look at how a culture of innovation could be created within the Trust, by facilitating an event to celebrate and share good practice.  All staff were invited to submit a poster which would go on display as part of a poster exhibition to take place in the main entrance of the hospital, giving both staff and patients an opportunity to see the diversity of work which goes on within the organisation.  The Medical Illustration team based in the hospital agreed to create a template for the posters, and issued guidance for designing a poster.  The library team offered help to all staff in the design and layout of the poster.

The Library Services Manager met with managers and team leaders across the Trust, both clinical and non-clinical to ask for their support for this event.  An Invitation was sent to all staff, and the template and guidance was made available on the Trust intranet.  A deadline of two weeks prior to the event was set for the submission of posters, and regular reminders to staff were communicated via the Trust electronic noticeboard and Facebook and Twitter.  The Chief Executive Officer also lent his support to the event at his monthly staff forum.

Our expectation for support for this event had been around 30 to 40 posters at the most.  The response that we had was totally overwhelming; as the deadline approached it was becoming clear that we had really struck a chord with staff.  The final number of posters submitted was over 100, way beyond our most optimistic expectations.  Because of the number of submissions it was decided to reduce the size of the posters when printed to enable us to make better use of the display space we had available.  This worked well as some departments had submitted several posters in order to tell their ‘story’ and we were able to group them together on the display.

Prior to the day, all senior managers in the Trust were asked to ensure as many staff as possible were given time to view the posters, and be able to be part of the event.

Colleagues from other departments within the hospital helped the library team to display the posters the day before, also affording more staff the opportunity to view the posters.  Initially we had planned for the posters to be on display for one day only, but because of the enthusiasm for the event and the huge amount of information on display it was decided to extend the display over the weekend.

We also supplied all departments throughout the Trust with stickers (small dots) to put on the posters which they found of most interest.  The 3 teams whose posters had the largest number of dots were presented with chocolates by the Chief Executive Officer.

Support and interest from both staff and patients for the event was immense, and the energy and enthusiasm as people viewed the posters was amazing.  The event was organised in response to a view expressed by many staff that no-one knew or valued what they did, and what their contribution was to the organisation.   This exhibition, by showcasing the huge variety of work which goes on, gave us a chance to share what we do; to break out of our individual silos and engage in meaningful and thought-provoking conversations with our colleagues.

Staff from across the Trust really embraced the concept of this event, and have shared learning and good practice from their area of work.  It offered a unique opportunity for us all to learn from each other and about the work which goes on.  By learning from each other and finding out if others have a better way of doing things; we can find the ‘how’ and not just the ‘what’ of bringing about change.
Alignment to local, regional and national drivers: 

Organisational Drivers:

Caring for patients:

·         By sharing good practice and learning from each other

·         Patients given the opportunity to see and understand the work that goes on within the Trust.

Caring for Staff:

·         Giving staff the opportunity to share learning and good practice from their area of work

·         Breaking down silos and giving staff the opportunity to network and learn about what other teams do, and how they may be able to work together.

·         Enabling change in practice.

Caring for Finances:

·         Sharing good practice, enabling other teams to use more efficient ways of carrying out their work.

 

Impact of this project/service: This event was symbolic of what the library service brings to the organisation:

·         Bringing people together

·         Sharing knowledge

It also raised the profile of the library service and our accessibility to staff.
Lessons learned: The response to this project far outweighed our expectations.  The amount of posters submitted made it difficult to keep track of numbers.  In addition several iterations of the same poster were submitted which again made it difficult to ensure the final version was displayed.

Sustainability / next steps? 

  • We will be displaying the posters again as part of the information fair which will be held prior to the Trust AGM.  The posters will be on display as before in the main entrance, and also in the conference suite, giving us another opportunity to showcase our work.
  • We are creating a PDF booklet of all the posters which will be available on the Trust Intranet, enabling all staff to view or revisit the posters.
  • We are exploring how we can use the posters to showcase the work of the Trust going forward.
  • We are planning to make this an annual event

Contact details: Lis Edwards, Library Services Manager, Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Trust, Lis.edwards@rjah.nhs.uk, 01691 404287

Date case study completed: 2nd June 2017