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Committee/Meeting Report


Future Healthcare workforce – The National Project – The Third Report


17th April 2002

Attended by:

Frankie Dearling - Chair CPHVA Speicial Interest Group for Older Peple


Summary/Key Points:

Prof. Michael Schofield, Dr David Cochrane, Margaret Conroy, Judy Hardigan, John Rogers and Andrew Foster .

The third report focuses on services for older people.

Prof. Schofield outlined the purpose of the project, which was to design a workforce today, for tomorrow’s health service; an attempt to find a solution to the crisis of resources within the NHS, the prime resource being staff, at all levels.

The project started seven years ago, since when there has been a lot of detailed research to support the proposals. People have been encouraged to think imaginatively about how a workforce should be designed and trained. The results have formed a major part of the policy report and Consultation Document, ‘ Health Service of all Talents’,( DOH April 2000, responses published DOH February 2001).

The core purpose is to provide improved services to patients through the provision of care by fewer more relevantly trained staff. The workforce has never been planned from a multi-disciplinary viewpoint The biggest single issue facing the NHS is to meet the staffing needs. It is well known that the problems facing the NHS are the demands both acute and chronic, in both primary and secondary care settings. A number of tracer conditions, (Stroke, Fractures, Chronic Heart Failure, Chronic Obstructive Pulmonary Disease, Upper Respiratory Tract Infections, and Urinary Tract Infections) that constituted 60% of all cases, were used to detail the patient experience.

Intermediate care and hospital service units, offered treatment where appropriate.

Primary Care offered support, monitoring, screening, and Treatment. The high risk categories in the >75’s. The main problem is that people do not fit neatly into categories, the needs are complex, and care requires co-ordination, and should be delivered by a practitioner competent in all aspects of assessment. This leads to ‘Case Management of the At Risk Elderly’. Research from the USA shows that 6.5% of over 65’s use 60% of resources. In an American ‘Case Management’ pilot study, great quality of life gains for the older person were the result, reducing periods of care required from an average of 19 days to 6. This was a total quality management approach to mainly over 65’s, offering a pro-active community based service. Currently the emphasis for resources in the acute sector, should move to support greater emphasis on community based intermediate care, case management and disease management.


Margaret Conroy went on to describe how the project set out to design roles from the patients perspective in the light of the worst recruitment and retention crisis right across the Health and Social Services labour force.

The project initially looked at the patients experience, what the needs were, and to avoid the incessant procession of faces, to design a role for practitioner and assistant, who would care for the patient across the care-pathway. Continuity is the key across Health and Social Care. The current focus was not on the needs of the patient, but on the services that were provided. The new role, the Community Practitioner for Older People, had a knowledge base across heath and social care, across acute, chronic, and functional problems, incorporating the theory of ageing, disease prevention and an understanding of mental health problems of old age.

The assistant practitioner role would implement the care plan, including investigations and monitoring, offering advice and support on daily activities. This role would have a function also of health education and health promotion.

This would be a 24 hour service, budgeted across Health and Social Services, accessed through a central call centre

Appropriate clerical support would be available so tat 80% of the practitioners time would be spent with clients, while 60% of care would come from assistant practitioners. In the American project the case managers assessed and planned the packages of care, ensuring resources were available rather than delivered the care themselves.

In the pilot stage, the implication for education and training would be an expansion of the roles of existing health care staff, (District Nurses and Health Visitors are well placed to develop their roles). The Future plan would be the development of a common initial training with National Occupational Standards. There would be a portfolio of achievement. There would be flexible skills and qualification framework with credit accumulative transfer schemes.

There would be better training provision for assistant practitioners, who would initially come from the pool of health care assistants and auxiliaries.

From a Human Resources perspective, workforce planning would support creativity, to build capacity and enable innovative practice. Locally developing new courses to meet local needs. There should be a mix and match programme to help deliver the National Occupational Standards, with continued support for learning across professions.

Andrew Foster, Director of Human Resources for the Department of Health, posed how we could improve the patients experience, using the NHS Plan as a base. The NHS Plan has headline objectives of increasing staff numbers and the re-engineering of jobs around the patient pathways, these came together in what is described as the four pillars of delivery. This looks across the NHS, as an employer, NHS career structures, what is called the psychological contract, between NHS staff and employers, between NHS staff and government, between NHS staff and patients, and the human resource element, building capacity, quality and attitude. These four pillars relate to the Workforce taskforce to oversee formulation and delivery, and this all supported by evidence base. This would then cascade across managers, health authorities, councils, staff and unions. In turn this would then be translated by the work of the frontline teams and so to the patient experience.


The process to develop new roles would be supported by the new NHS University, for multi-professional education and lifelong learning

Information to be placed on the committee's web pages:

Ref: The Future Healthcare Workforce. The third report.

ISBN: 0-9542689-0-3

Further information re the project: Conrane Consulting 0208417450

Action required/


to be considered




Signed: Frankie Dearling Chair SIGOP


(The presentations were all couched in terms of ‘the patient’. The Publication refers to ‘the client’ in most non-clinical contexts)