Meeting 18 week wait times through strategic workforce development plans improves patient care at Children’s Hospital, using national competences and enhancing the patient experience

Central Manchester and Manchester Children’s University Hospitals NHS Trust (now Manchester University NHS Foundation Trust) uses Skills for Health competences. The aim was to see how workforce analysis and process mapping could contribute to better-delivered services and so improve patient experiences, reduce waiting times and support workforce development.

The Trust discovered that by reshaping the workforce, in particular Allied Health Professionals (AHPs) and Health Care Scientists (HCS), the result would be more flexible and responsive team configuration for improved service delivery. The work centred around three clinical areas:

• Computed Tomographic Colonography (Virtual Colonography)
• Magnetic Resonance Imaging of the Internal Auditory Meatus
• Radionuclide Myocardial Perfusion Imaging

An important element of the NDS work is to support a patient-focused approach, central to the ‘Line of Sight’ model, so a competence-based approach to patient pathway analysis and service enhancement was deemed a good fit. Working with the Skills for Health Demonstrator Project Team, Trust managers looked across the three areas at:

• Patient pathways
• Blockages
• Competences to unblock pathways

Before long, it was clear that new and enhanced roles would become part of the answer to supporting the Trust’s existing good record around the 18-week target and its Early Achiever agenda, which aims to deliver the target 12 months ahead of the national schedule.

“The workforce analysis and processes carried out using Skills for Health tools and products have been an invaluable starting point to redesigning services and influential in driving the change process. We intend to continue the work started by this project to reduce waiting times for our service users and will work towards implementing a competence-based approach to future workforce development and service delivery.”

Anne-Marie Varney, Project Manager, Central Manchester and Manchester Children’s University Hospitals NHS Trust

Having a suitably skilled workforce to deliver diagnostics services is one way to tackle the Department of Health 18 week waiting target. Managers at Central Manchester and Manchester Children’s University Hospitals NHS Trust (CMMC) set out to achieve an ambitious programme as part of their work as a National Demonstrator Site (NDS) testing Skills for Health competences and tools. Although the Trust had made much progress towards achieving the 18-week waiting target, there were still improvements to be made in the area of diagnostics. Waiting times ranged from 2 to 35 weeks. Building on existing work to scope demand and capacity, the Trust decided to use the existing Skills for Health competences for HCS and developing competences for AHPs.

By reviewing the patient pathway and resources and roles involved across each area, managers were able to scope the potential for service redesign, supported by the development
of new and/or different roles based on competences. They mapped the entire process, beginning with a referral through to testing, scans and reporting:

• Adult-cardiac surgery and cardiology
• Complex obstetrics and fetal medicine
• Genetics
• Complex general surgery
• Clinical haematology
• Renal transplantation and nephrology
• Complex gynaecology and gynaecological oncology
• Vascular surgery
• Ophthalmology
• Children’s-comprehensive specialist children’s and neonatal, medicine and surgical services including intensive care

The key aims of the three work areas were identified:

• Radionuclide Myocardial Perfusion Imaging (MPI)
• Reduce the waiting times for routine scans
• Increase capacity and improve efficiency in cardiac stress testing
• Develop the role of the senior technical staff in order to perform cardiac stressing
• Release medical staff and increase reporting slots to reduce delays in reporting
• Computed Tomographic (CT) Colonography (Virtual Colonography)
• Investigate the viability of introducing CT Colonography reporting as an additional role for the GI trained Radiographers.
• Reduce the turn around time for reporting Magnetic Resonance Imaging of the Internal Auditory Meatus (MR IAM) Scanning
• Reduce the time for MR Scan reporting.
• Investigate the possibility of introducing Radiographer reporting within the speciality of Neuro-Radiology

By breaking down the process mapping of the services into individual components, managers were able to see how services could be reconfigured. Skills gaps were identified, and it became apparent that upskilling senior technicians to carry out certain procedures, such as stress and rest testing, could release medical staff to reduce delays in triaging referrals and reporting. Example competences identified and used:

• Perform intravenous cannulation
• Carry out the intravenous infusion
• Produce a clinical interpretation of acquired images
• Acquire Magnetic Resonance images for diagnostic purposes
• Introduce and remove a rectal catheter for the introduction of contrast agents for imaging procedures

Skills for Health competences were matched against skills gaps, and job profiles created. To develop knowledge and skill acquisition across the three clinical areas, managers scoped suitable learning programme providers. This underlines the advantage of taking a competence-based approach to role redesign, where education and training gaps can be identified based on competences, and plans then put in place to address gaps in training and education.

Benefits

• Services have been redesigned and competences mix changed
• Waiting times in certain diagnostic areas have been reduced from 35 to 19 weeks
• New roles will lead to further reductions in waiting times
• Increase in available appointments in MPI
• Job roles based on competences and designed around procedures and patient need
• Training needs and skills gaps identified for future developments and recruitment
• Future education commissioning will be evidence-based on competences

Central Manchester and Manchester Children’s University Hospitals NHS Trust provided general acute services for the local community of Central Manchester (and for children’s services to North Manchester and Salford), and specialist services for both children and adults in Greater Manchester.

Skills for Health continues to support the development of competence-based approaches to the design and redesign of roles and services. As part of this we are helping health care organisations strengthen their professional development programmes.

Competences describe what individuals need to know and do, whoever is performing the task, which means they have many and varied uses. During the life of the project it was recognised that this ambitious remit was more of a challenge than first realised and that the areas were probably too complex within a single project. However, valuable lessons have been learned, and the Skills for Health competences and resources have been of great assistance to the Trust in bringing real, measurable improvements to service delivery and in workforce development.

A close working partnership between the Trust, the AHP and HSC Leads, members of the Clinical Radiology and Nuclear Medicine Department and Skills for Health, meant that despite the challenges, issues could be addressed and revisions made. This included the development of a new workforce competence around reconstructing images for MR, and reconfiguration of competences organised in career frameworks leading to greater accessibility and easier searching.

The application of Skills for Health competence and application tools has enabled the Trust to articulate its training needs and revise it accordingly. By upskilling technicians and releasing medical staff, it has been able to provide more timely services and reduce patient waiting times. CMMC anticipates continued involvement in the development of Skills for Health AHP and HSC Career Frameworks and workforce competences, and greater partnership with local HEIs to commission demand led programmes based on service need.

As the Sector Skills Council for Health, we’ve developed a bank of national workforce competences (NWCs) and National Occupational Standards (NOS) which describe the skills and knowledge required to carry out a task or function effectively. Competences are designed to underpin and be integral to accredited and non-accredited education and training programmes. A range of electronic tools, interactive guides and a database of competences are available on the Skills for Health website, which can help managers design roles, services, education and training. They are a powerful resource for those who want to structure their teams’ and individuals’ learning and development around service user needs and they can all be linked to the Knowledge and Skills Framework.