A Time to Pause

1. A Time to Pause Royal College of Speech and Language Therapists Managers’ Conference Wednesday 13th April 2005 The Moat House, Stratford upon Avon Dr. Patricia Oakley Director, Practices made Perfect Ltd., Teaching & Research Fellow Organisational Psychology & HRM King’s College, London Tel: 0870 241 9937 Tel: 0870 241 9938 Email: office@practices.co.uk

2. A Time to Pause The Policy and Professional Development Agendas • Care of the Elderly Integrated Service Networks • Community-based Long Term Care • Children’s Services Trusts • Service Accreditation and Development in the Contested Market of Foundation Trusts • Professional Accreditation and Development in the post-Shipman NHS and Social Services *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

3. Developing Contestability in Public Services Political context: “small government”; “regionalisation”; “going local”; “public involvement”; “value for money”; Regional/Intermediate Tier Central/National Tier Local/Provider • Contestability & Commissioning Care Management Programmes: • Accredited supplier of programmes. • children’s programmes. • women’s programmes. • elderly care programmes (inc. EMI). • Delivers contract/pathway clinical & care outcomes. • Meets Public Service Specification (HMT) for good financial management and controls. • Meets Public Service Specification for good Human Resource Management Practices (inc. EO and CRE requirements). • Meets Public Services Specification for local representation and involvement. • Meets Public Service Specification for Good Governance. • Performance Management Framework. • Metrics. • Methodology. • Informatics. • Change Management & Service Modernisation inc. Financial Allocations & Controls Governance. • National Standards of Service. • Service Objectives to deliver Public Services: • seamless pathway. • silo mentality. • Patient focused. • Inspectorate vs. Service Standards & Performance Management Framework. • Managed Market/Public Services Contestability Regulatory Framework. • Ombudsman & Citizen’s “voice & amplification”. *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

4. The National Planning Guidance Priorities National Standards, Local Action – Planning Framework 2005-2008 – Priority I: • Reduce mortality from heart disease. • Reduce mortality from cancer. • Reduce inequalities in health outcomes (ref. children and elder people). • Reduce mortality from suicide. • Reduce smoking, obesity and teenage pregnancy rates. Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

5. The National Planning Guidance Priorities National Standards, Local Action –Planning Framework 2005-2008 – Priority II/III/IV: • Supporting people with long-term conditions esp. expert patients, primary care developments & community matrons. • Access to Services esp. diagnostic services capacity and diversity of provision, and drug users. • Patient/User experience esp. ethnic and minority groups, patient choice, care based @ home, and MRSA infections. • Plus existing commitments!!! Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

6. Developing Commissioning Practices • Rules: • Fixed price by tariff. • Drive operational gearing ratios. • Service dumping and Minimum Operating Standard Pain Clinic • Commissioning: • Case by Case Programmes? • Bundle of Cases? • Mixed Bundle of Cases/Block Contract? • Trauma & Emergency/Urgent Care Networks. • Intensive Care Networks. • Diagnostic and Backup Services. • Elective/Planned Care Procedures. • Rehabilitation/Aftercare Programmes. • Diagnostic and Backup Services. • Chronic Disease Management Programmes. • Diagnostic and Backup Services. • End-stage Care Services. *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

7. Future NHS Structure and Career Pathways* Financial Flows Service Infrastructure Clinical Services • Long term investment programmes in capital stock through private sector (PFI, PPP, LIFT). • Long term leases for major equipment (replacement/ upgrade) & partnership arrangements to run at full operational gearing for the NHS. • Manage and staff infrastructure to support clinical services & administrative functions, eg. HRM, IT, Finance. • Develop Clinical and Care networked services and partnerships involving public, private and voluntary sectors. • Develop Education and Training syndicated services in partnerships involving Universities, FE colleges, private voluntary sectors. • Develop Research and Development knowledge domains in partnerships involving Universities, Pharmaceutical and Biotechnical Companies and commercial research organisations. • National and Regional Group Commissioning Schemes; financial allocations, reconciliation and audit vs. planning priorities eg. transplant and genetics services. • Group Commissioning Schemes as above involving GPs, Clinical Networks and Specialist groups eg. NCT, MIND, MENCAP and Children’s services. • Patients’ Choice (via GPs and Community matrons) involving direct and co-payments. *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

8. Primary Care Led NHS Elderly Trauma Centre • Parkinson’s • ALC • Dementia Specialist Medical • Dermatology • Oncology • Diabetes M.I.U. Pain Clinic Carer Support • Acupuncture • Osteopathy • Chiropractice GPs Specialist Mental Health Day Surgery • CPN • Psychology • Psychotherapy • Counselling X-ray & Imaging *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

9. Care Planning & Management InvolvingPatients & Carers Complex Case Management Programmewith a Case Manager who coordinates care from several groups of experts joining up care for patients and carers. c. 20% of chronic Care Management (but c.80% of resources). Level 3:Highly complex patients who need case management. Disease Care Management Programmeand Proactive support from Multi-disciplinary Teams using Care Protocols & shared information. Level 2: High risk patients who need disease management support e.g. diabetes. 70-80% of Chronic Care Management. Level 1: right support, many people can look after themselves, living with and managing their condition(s). “Expert Patient” Programmesand Carer Support involving Voluntary Groups eg. BDA, Age Concern etc. Health Promotion Health Promotion Programmeseg. Diet, exercise, and education. *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

10. Children’s Services Trusts Education Authority (Accounting Officer) Police Authority Social Services • Sure start & Mum’s support • Skills for Life & Education • Exclusions & Referral Units PARTNERSHIP AGENDA • Integrated Legal Trust? • Group Commissioner of Children’s Services? • Information and Informatics Network? • Talking Shop? • Discrete focus eg. CAMHS? Health Services • Primary Services • Secondary Services • Tertiary Services • Child Protection • Custody & CJD • Links with HMPS & NPS for Children being resettled • Child Protection & Adoption • Families & Children @ Risk & in Care • Young Adults Support *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

11. Professional Accreditation & Validation Post-Shipman Review-December 2005 • What does “fitness to practice” mean? • How do you assess “competence”? • What is the correct periodicity? • What is the future of professional bodies? • Where does Professor Kennedy’s Health & Social Care Commission Fit? *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

12. Fitness to Practice • Knowledge • Skills • Aptitude • Attitude • Experiences • Motivation profile • Psychological contract • Kinsmanship • Organisational citizenship • Voice & Amplification CompetentIndividuals • Community of Practitioners • Knowledge Management • Learning Modalities & Mentorship *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

13. The Service Inspection & Quality Assurance Programme Trust-based Inspection system • £ Management & Contract Assurance • Human Resource Management & Development Policies • Individual Performance Management & Accreditation Care of the Elderly Network Cardiac Care Network Children’s Services Network Cancer Care Network Jones’s Surgical Care Enterprise PLCSystem Smith’s Scan in a Van PLC System Blogg’s Nursing Care Agency System Social Services Inspection System Accessible & Responsive Care Care Environment & Amenities Public Health Clinical & Cost Effectiveness Patient Focus Safety Governance *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk

14. Speech & Language Therapy Services Quo Vadis? • All together in an Agency or Segmented into Specialist Service Networks? • Public vs. Private Sector? • State-driven standards vs. Royal College’s? • Developing Practitioners & Managers for What Future? • Career & Professional Development Pathways for which service stream? *Practices made Perfect Ltd., Alpha House, 100 Borough High Street, London SE1 1LB Tel: 0870 241 9937; Fax: 0870 241 9938; email: office@practices.co.uk