Six national demonstrator sites are leading the way in using a powerful new set of tools from Skills for Health to redesign jobs and services, says Stuart Shepherd

Defining the skills needed for a job in the NHS is getting a lot easier. Rather than sitting down with a blank page and writing a job profile from scratch, you can now build it by selecting from a vast bank of competencies created by Skills for Health.

The Line of Sight project began in September 2006, assessing the need for new workforce roles and identifying the appropriate competencies. Phase two, providing training and implementing roles, is getting under way. Six national demonstrator sites across a range of healthcare trusts are leading the way in putting these Skills for Health competencies and tools into practice – and showing how they can be used in workforce development.

At Central Manchester and Manchester Children’s University Hospitals trust the focus has been adapting roles to help reduce waits for diagnostics and support the delivery of the 18-week target. Waiting times for some of these services had been reaching as long as 35 weeks.

The demonstrator project is working on three distinct areas – myocardial perfusion imaging, CT colonography and MRI scanning of the internal auditory meatus – using a similar approach in each.
Detailed mapping of the patient pathway, resources and roles allowed managers to identify skills gaps and opportunities for service redesign. It became clear, for example, that some senior technicians could carry out procedures such as stress and rest testing, freeing up medical staff time for specialist referral and reporting duties.

Competencies have since been used to define the new roles and identify training needs for putting them into action, along with future development and recruitment needs. Training courses will now be designed to plug gaps in the competencies required.

Formal project evaluation is yet to begin, but with, for example, radiographers already moving to take on a number of the reporting tasks previously done by radiologists, waiting times in some areas have already come down by as much as 16 weeks.

Emotional intelligence
At South Birmingham primary care trust, the national demonstrator project has sought to describe the competencies for the role of community support nurse within the school nursing service. Comparing the qualities historically demanded for the role with the current requirements of a range of stakeholders helped to identify areas for skills development to deliver support to vulnerable families and their children, often in hard to reach communities.

One particular point of interest stands out from the South Birmingham experience so far – as the trust tried to define the qualities of a successful community support nurse, the need for nurses to have emotional intelligence became clear. This led the project team to look long and hard at the personal qualities, communication skills and empathy nurses need in their work with families. They then redefined the community support nurse role, basing their approach on the work of author and psychologist Daniel Goleman, and went on to capture those skills in some of the 18 Skills for Health competencies identified as central to the post.

Berkshire Mental Health foundation trust is running not one but three national demonstrator site projects. One of these has been designed to look at how the Hospital at Night plans – to staff hospitals out of hours without falling foul of EU working-time rules – can be applied in acute mental healthcare. The competencies needed for a role to cover the clinical and managerial duties arising from running hospitals out of hours were compared with the existing workforce roles, qualifications and experience. The project identified and defined the post of advanced practitioner, a role that could be done by nurses and allied health professionals working at consultant level. Training and planning requirements are now being considered.

Berkshire’s psychological therapies project reflects the trust’s desire to strengthen its training in this area and particularly to develop skills of workers in bands 1 to 4.
Berkshire picked out Skills for Health competencies relevant to its foundation-level psychological therapies training programme. Students participating in the project used the competencies to support their learning and self-assessment and their feedback was positive.

The competencies will be used to drive future curriculum development and the trust’s efforts to get Thames Valley University accreditation for its foundation psychological therapies course.
The third Berkshire project will use competencies to help reconfiguration of mental health services in the West of Berkshire.

Better care
Work at Whittington Hospital trust in north London has helped to define a therapy assistant role that supports the responsibilities and functions of the occupational therapy and physiotherapy teams. To enhance the credibility of the initiative, it is being linked to the Whittington’s own Making Best Use of Beds scheme, aimed at reducing length of stay.

The exercise determined competencies for the role and two candidates – both healthcare assistants at the trusts – were recruited. One is now working on a care of the elderly ward and the other is based in a stroke ward within the hospital’s Jeffrey Kelson unit. The therapists provide support for nursing staff, allowing nurses to continue uninterrupted with their duties.

It is when the therapist moves on, however, that the real difference is felt because the therapy assistants can continue to deliver the programmes in a way that has not been possible up to now.
According to patient surveys the new assistants have met with a very positive response and much improved the hospital experience.

Figures show that patients are also making quicker recoveries and as a consequence either spending less time as an inpatient or, importantly to those who need to move on to a specialist rehabilitation unit, more readily reaching the levels of independent functioning required for transfer.

Certainly it is early days, but the rigorous approach pioneered in these six demonstrator trusts could be a huge help in putting the right people in the redesigned jobs now being created throughout the NHS.