Published: 02/06/2005, Volume II5, No. 5958 Page 6 7 8

The Skills for Health standards ensure a well-qualified workforce but can also help managers anticipate future recruitment needs, reports Stuart Shepherd

Part of Skills for Health's work is to establish sets of national occupational standards for staff in all areas of the health service. These standards of competence describe what is required of an individual to achieve what is expected of them in their work.

Here we look at how Skills for Health has helped to implement some of the standards around the health service, in a variety of disciplines, and find out how organisations have benefited as a result.

Community health partnerships in Scotland

As part of a 2004 initiative to help the new community health partnerships mark out their function in health improvement, the Scottish Executive commissioned Skills for Health to develop a pilot programme. The work focused on UKwide occupational standards for the practice of public health.

Earlier the same year the executive had published statutory guidance on establishing community health partnerships as 'a key building block in the modernisation of NHS and joint services, with a vital role in partnership, integration and service design'.

Three principal fields of work have been designated as falling within the remit of the emerging community health partnerships (CHPs) - planning, service delivery and redesign, and health improvement. It was on the latter that the focal point of this pilot scheme concentrated.

The West Fife Local Healthcare Co-operative was chosen from a number of LHCCs that had already expressed an interest in being involved in the pilot.

West Fife joined forces with Skills for Health to test out, evaluate and improve the pilot programme for development as a resource pack for other emerging CHPs in Scotland. They had initial planning meetings, a 24-hour residential workshop and an outcomes group.

The workshop activities aimed to raise awareness of the culture and styles of working that facilitate health improvement. They also examined who the key partners in the new structures would be and how health improvement work might change.

West Fife public health consultant Margaret Hannah says: 'The Skills for Health framework provided a great opportunity for people from a wide range of agencies to develop a common understanding of what public health work is all about. People were really encouraged when they saw that the work they were doing was already making a contribution to the public's health.' Following the work, the pilot documents were modified into a resource pack that was distributed to all health board areas.

'The national occupational standards gave us an excellent framework on which to base our discussions, ' says Lyn Campbell, a West Fife public health practitioner. 'It meant that we were not floundering around with a blank sheet wondering where to start.'

Flexible, skilled and versatile support staff

In Alison McCree's opinion the Skills for Health national occupational standards not only ensure a highly competent and well-qualified workforce but can also help managers to anticipate future recruitment and training needs.

County Durham and Darlington Acute Hospitals trust, where Ms McCree works as associate director of estates and facilities, was one of seven Skills for Health pathfinder pilot sites for the support services national occupational standards implementation project.

At the start of the scheme, the directorate was looking to develop and support good practice in an ancillary services team composed, among others, of chefs, porters, domestics, maintenance operatives and telephonists.

'Our aim was to provide and sustain an improved service delivery to patients through a flexible, skilled, knowledgeable and versatile workforce. We had never had competences defined like this before, ' says Ms McCree.

The occupational standards available for incorporation consisted of catering, health record and patient administration, housekeeping and laundry, portering and security, and postal duties.

'We held an open forum with estates and facilities staff at which the Skills for Health team presented an overview of the project and its potential, and sought the staff's co-operation. It was important to us that they wanted to buy in from day one.' An implementation steering group was then established with representation from the workforce development confederation, the NHSU, service providers from the local private finance initiative hospitals, training and development and estates and facilities.

Three subcommittees each concentrated on work with defined groups - catering and housekeeping, domestic and laundry, and portering, transport, post room and switchboard.

The steering group set out to map the composition of the support services staff. To achieve this skill, employment status and age were all profiled through audit.

The skills audit included an exercise in which every post-holder described a typical working day, identifying key activities and responsibilities and existing qualifications. It also affected the opportunity to look at expanding development opportunities for staff, helping recruitment and retention and developing a more flexible workforce through the scope for horizontal and vertical movement.

The age profiling, says Ms McCree, was very illuminating. 'We found that the team had an average age of 51, with 15 employees near retirement age and only one under 36.' This brought home the importance of succession planning, vacancy monitoring and a good recruitment strategy.

So the directorate took part in a business ambassadors scheme to raise awareness of NHS career opportunities with representatives going to local schools.

The culmination of this data collection was the drawing up of job descriptions with the national occupational standards written into them. The integration of NVQs at level 2 and 3 into a career structure means that each post now has a pathway and offers everyone the chance to progress to a post with a supervisory element.

And those new recruits who do not have NVQs on joining the trust will be given a time frame and the resource support to get them.

The contact with the workforce development confederation and other training organisations also led to 40 current support services staff starting the national occupational standards, equivalent to an NVQ level 2, in January 2005.

Cancer collaborations point the way forward

More than 500 multi-disciplinary team co-ordinator posts have been created since the launch of the NHS Cancer Plan in 2000, with more still anticipated. The goal has always been to improve resource delivery to the patient but the position has never been defined nationally by competences or standards. Until now.

Collaboration between Skills for Health and the national cancer action team has led to the design of a generic job description, an outline knowledge and skills framework and core competencies for the post of multi-disciplinary team co-ordinator for cancer. The Modernisation Agency's 'new ways of working' team has helped design the job description.

'The local development of the posts has created issues around job description/role content, pay scales and responsibilities, ' says Sue Bates, national cancer programme manager, Cancer Action Team. 'multi-disciplinary team coordinators are not 'one size fits all'. Lots of people are doing the job in different ways - some are clinical but many are not. For some It is a bolt-on, while for others It is full-time. Any approach to future development has to be flexible enough to take these variations into consideration.' The consultative phase with Skills for Health prompted a collaboration between 10 cancer networks to work on the generic job description, core role competencies and a knowledge and skills framework.

All the documentation is being put out to testing at a range of meetings.

'The whole package is to be supplied as a CD and folder. All the component parts can be adapted to meet local needs, ' says Ms Bates.

Complementary to this process will be NVQ/ SVQ training, development of which is due to begin very soon. This will be of value to those who had little training prior to coming to post.

Nan Latta, patient pathway co-ordinator for urology at The Ipswich Hospital trust, exemplifies the type of post-holder whose initiative and dedication has been translated into meaningful outcomes despite the lack of nationally defined role standards.

'Collecting data on patient journeys from GP referral onward has helped the team identify bottlenecks, ' says Ms Latta. 'As a result, we have devised strategies to significantly reduce the time between preliminary investigations and the start of treatment.

'Now when casemanagement options are decided at the multidisciplinary team the consultant completes a pro forma which doubles up as an instant referral letter to colleagues in other departments. At this stage we can also pre-book appointments and offer them to patients when we see them later, ' she says.

'Nothing about the job was set in concrete when I took it on. The NVQs will give crucial recognition to a role that is actually pivotal to the work of the multi-disciplinary team. To be credible, our work has to be measurable, and a skills framework allows for this. I, for one, am really pleased.'

A new way of thinking An in-use evaluation of practice of public health competencies for multi-agency children's teams provided the inspiration for an entirely new locality-based lead practitioner role.

Multi-disciplinary clinical staff from East Elmbridge and Mid Surrey primary care trust public health services took part in the pilot scheme after consultation between Skills for Health, trust head of professional development Paul Chapman and Surrey University.

As many as 50 staff participated in an awayday to test how the public health and other Skills for Health standards could be incorporated into a service reconfiguration. This workshop was a high-profile event in the trust's activities and was attended by director of nursing Jo Pritchard. And what started as an exercise in redesigning a team became the catalyst for a new way of thinking about the resourcing and delivery of a key community service.

The occupational standards that the school nurses, nursery nurses and health visitors studied were successfully integrated into a new vision of public health family teams for 10-19-year-olds.

'But further to this, ' says health visitor Caroline Wilkinson, 'and also motivated by the chief nursing officer's review of nursing, midwifery and health, we identified a number of structural difficulties in responding to the wider public health agenda. The natural progression in this service development was to identify a new role - lead practitioner in public health.' The standards for the practice of public health have been central to further developmental thinking about this position and its contribution to the service.

They have informed how the practitioner interactively responds to and directs the work of multi-agency public health team. Profiling of local needs, inequalities and at-risk groups, health promotion programmes and advocacy for community groups have all been included using a framework of competences to describe activities.

It is anticipated that to fulfil responsibilities to the trust's population, several lead practitioners will be attached to geographical or social communities. A specialist would oversee the work of this small team.

The implementation phase is anticipated for the summer. Job descriptions, core duties and outline knowledge and skills frameworks are being developed for each role in the broader public and family team.

As an innovative enterprise Ms Wilkinson is currently testing the lead practitioner public health role informally in an evaluative phase.

'The away-day gave us all the chance of getting under way a process that was already waiting to happen, ' says Ms Wilkinson. 'That momentum is being maintained and wider consultation is now taking place among the different disciplines.'

Positive future for drugs and alcohol

The unique personal qualities that allow Positive Futures project workers to engage with service users are being enhanced through training based on Skills for Health drug and alcohol national occupational standards.

The challenge facing the national sports-based social inclusion programme for 10-19 year-olds is to develop staff teams at its 107 projects capable of providing services to meet local need. Through the workforce quality initiative that challenge is being met.

Drug and alcohol occupational standards, recognised by Positive Futures as benchmarks of good practice, have been incorporated into this core training programme alongside other standards considered appropriate to the work.

These include sport, youth work and youth justice.

'The work with the sector skills councils is intended to help our staff be more effective, ' says Positive Futures national director Neil Watson.

Staff are introduced to the training at a half-day workshop during which they identify the national occupational standards appropriate to their role profile. They then prioritise a shortlist showing areas where they lack confidence.

Among this they must include a unit entitled 'Recognise indications of substance misuse and refer individuals to specialists.' A regional core training programme complements the workshop and further ensures the competency of workers. It covers the following drug and alcohol national occupational standards units:

recognise indications of substance misuse and refer individuals to specialists;

contribute to the prevention and management of abusive and aggressive behaviour;

support individuals who are users;

assess and act upon immediate risk of danger to users;

raise awareness about substances and their effects.

At a subsequent half-day meeting, workers go on to reassess their performance.

Sue Carter is a Positive Futures project manager in Keighley, West Yorkshire, and has first-hand experience of the difference this input can make to a team.

'The biggest change in workers with drug and alcohol national occupational standards training is the way they give health messages. After they complete the units they appreciate the distinction between just dishing out information and discriminately 'drip-feeding' it.

'They recognise when service users are receptive to messages and seek out appropriate opportunities. They take a calmer, more sensitive approach and choose moments spontaneously to initiate conversations and issues.' .