Evidence to the Health and Social Care Workforce
Inquiry from Macmillan Cancer Support, Wales.
Prepared by Andrea Phillips, Learning and Development Manager.
Purpose
This paper provides information to support the Health, Wellbeing and Local Government Committee of the Welsh Assembly Government with its inquiry into Health and Social Care Workforce Planning.
It responds to the Terms of reference set by the Committee and includes specific commentary from Macmillan and from a number of self help and support Groups comprising carers and people affected by Cancer in Wales.
Context
Macmillan exists to improve the lives of people affected by cancer. Its Primary objective is to reach every person affected by cancer by 2010.
Across the UK, it will do this by developing and investing in cancer services that are relevant to local need taking into account existing patterns of Health and Social care services. This approach is underpinned through Macmillan’s engagement with established networks of self help and support groups to ensure that the views of people affected by cancer are heard and acted upon.
In Wales Macmillan has also hosted a number of conferences aimed at gathering the views of people affected by cancer on their experiences of having received treatment, care and support. A number of priorities have emerged including;
The need for improved health services
Equality in service provision across Wales
Better co-ordination of existing health and social care services
Greater prominence of Primary care Practitioners in the planning and delivery of services.
Demographic Data
Each year approximately 15,000 people are diagnosed with cancer in Wales (1). In Wales the overall incidence of cancer is 7% above the UK average and accounts for 27% of deaths in Men and 23% of women’s deaths.
Data from the Welsh Cancer Intelligence and Surveillance Unit (WCISU) for the period 1993-2002 highlighted a slight drop in overall cancer deaths and an Improvement in rates of survival for patients diagnosed between 1995 and 1999 compared with those diagnosed between 1990 and 1994.
However, there is evidence that for some cancers, the survival rate for patients in Wales is poorer than many other countries in Europe. There is evidence that cancer is being detected and diagnosed later in Wales and that this is a significant factor in the poor survival rates.
Macmillan’s research in Wales to date has highlighted the need for us to work more effectively with our partners to:
Find more effective ways of detecting cancer at a much earlier stage to maximise the effect of treatment and improve survival rates.
Reduce workforce shortages across the NHS and Social Care
Increase the provision and sustainability of palliative care in-patient beds and development of 24/7 services.
Improve support for patients associated with Discharge arrangements and out of hour’s services.
Achieve Trusts waiting times target for Urgent Suspected Cancers (USC) in Wales.
Macmillan wishes to invest in innovative and effective service delivery initiatives including pump priming the development of new Health and Social Care posts.
Specific Terms of Reference.
1. The division of responsibility amongst organisations charged with workforce planning and the mechanisms they use.
For the NHS in Wales, this function is discharged by the National leadership and Innovation Agency for Healthcare (NLIAH). It collates workforce plans submitted by NHS Trusts and Local Health Boards and submits one overall plan to the Welsh Assembly Government. This plan informs the number of academic places commissioned in Wales the following year. The process has come under scrutiny for some years amidst concerns of its robustness, accuracy and affordability. It relies heavily on the intelligence at individual Trust level and LHB level on their workforce needs in the future which may not be entirely accurate. It also fails to encapsulate any forecasts by other providers (such as Macmillan) and potential wastage from the statutory sector.
For Social Care in Wales, responsibility for workforce planning lies with local Authorities as employers and commissioners of social care staff and the Care Council for Wales. Local authorities are supported by a network of local and regional workforce development partnerships. Whilst theses partnerships have attempted to engage a number of sectoral interests it has not fully succeeded in engaging all potential commissioners and providers of specialist social care functions.
It is recommended that both NHS and Social care workforce planning functions adopt a wider perspective and engage more comprehensively with the independent, voluntary and charitable sectors in order to produce more robust workforce plans in future.
2. The availability and quality of intelligence to inform workforce planning.
As stated above, there are significant gaps in intelligence and plans are produced based on often ill conceived estimates. Forecasts for academic places need to be based on an accurate picture of what is taking place across Wales that recognises changing plurality in terms of non statutory service providers and commissioners, likely reconfigurations at NHS Trust Level and role re-design more universally across Wales and indeed the UK.
3 The involvement of all relevant stakeholders in the planning process
A more inclusive process will need to be established than at present that will provide a more accurate synopsis of the Welsh workforce requirements.
4. Changing patterns of demand and service provision in the health and social care sectors, use of new technology, new public service delivery arrangements.
It is unclear how Trusts, LHB’s and Local Authorities currently "make sense” of the changing demand for services and translate this into a meaningful workforce plan.
There are a number of Policy Drivers which are likely to bring about significant changes to the way services are commissioned and provided in future but the full impact is yet to be realised e.g. Regional commissioning, Local Service Boards, Locality plans for strengthening Community Services, the emergence of new roles (Practitioners with Special Interests, Consultant Nurses), Telecare, NICE guidance on supportive and palliative care.
It is evident however that demand for services will continue to be a challenge for all sectors unless there is a plan for how that demand will be met, for example by early intervention to improve outcomes and/or focussing on prevention.
The need for new skills and competences across the entire health and social care pathway will be necessary in future as will more meaningful (to service users) integration between Health and Social Care Services and their partners.
An increased reliance upon caring by family and friends will bring with it a requirement for support for people in this role. This will include basic care skills but also training and information relating to symptom control and pain management. Macmillan’s Cancer Support Certificate may play a role here.
There is evidence that more formal training for carers has the effect of de-skilling them in what they previously felt confident in doing.
Other key challenges include;
The need to attract younger people into direct care roles and for these to be seen as attractive career options.
The need for retention strategies that focus on maintaining and developing a skilled and qualified workforce.
5. Changing professional roles and training programmes
The need to influence changes to the core curricula will be paramount if Wales is to derive the maximum benefit from changing professional roles and to increase the pace of implementing generic Health and Social care workers. It is unclear (to us at least) who is responsible in Wales for applying this leverage with Higher Academic institutions and Universities across the UK.
We believe there are far more collaborative efforts that can be made in developing training programmes, particularly those that are aimed at developing more specialist skills and knowledge for certain staff groups and programmes that cut across traditional professional roles. There is untapped potential for NHS Trusts and local authorities to commission specific training programmes from Charities and the voluntary sector.
Self Help Training is also necessary for patients that utilises the ethos of the Expert Patient Programme in Wales and delivers more specialist content and support.
There is significant scope to reduce bottlenecks in hospital services by investing in the Primary care Workforce and allied technology. The pace of change in this area in England has been much quicker with obvious advantages to patients being able to access local care in a timelier manner.
6. Joint working between health and social care agencies
Whilst there is evidence that new Welsh Assembly Government funding has created some innovative and integrated models of Health and Social Care, there is less evidence that core statutory services are similarly being integrated to improve outcomes for Welsh service users. Many Welsh Strategies make reference to the need for more streamlined first contact services that are easier for the general public to access and which respond quickly and effectively. Macmillan supports this policy direction in Wales and is able to provide examples of integrated and innovative practice in section 8 below.
7. The workforce needs of the public, voluntary and private sectors
Fulfilled lives, Supportive Communities, the Strategy for Social Services in Wales over the next decade, points out that major changes have already taken place in the past 10 years that has changed the traditional model of Social Services. It comments that;
"Almost 90% of adult care homes, a growing volume of domiciliary care, two thirds of places in children’s homes and an increasing proportion of foster care is now provided by the private sector”.
This would suggest that the workforce requirements of the non statutory sectors must be included in National workforce plans. The issue of capacity building in the voluntary sector must also be addressed alongside workforce development.
8. Examples of good and innovative practice.
Macmillan has contributed to the development of cancer services in Wales by investing in a number of posts which reflect a move towards meeting the holistic needs of people affected by Cancer. Accordingly a number of new posts such as Social Workers, Welfare benefits advisors and Allied Health Professionals have been provided across Wales in addition to Clinical Professional roles.
Uniquely, Specialist Social Workers and Welfare Benefit Advisors (employed by local authorities and funded by Macmillan) work as part of the Palliative care teams in North Wales. Similarly, the Hospice at Home Service established in North East Wales, involves Macmillan Nurses, A specialist social worker and an end of life co-ordinator working as one team.
Macmillan is interested in investing in services that provide added value and quality both at a Strategic and service delivery level. These include expanding investment in GP facilitators; Welfare benefits advisors, Information and support services (working in partnership with Local Authorities and the voluntary sector) and posts which support the reconfiguration of health services in Wales. We also would like to work with the Welsh Assembly Government in developing the cancer nursing profession.
Andrea Phillips
Learning and Development Manager
Macmillan Cancer Support
Bocam Park, 1 Oldfield Road
Pencoed, Bridgend CF35 5LJ
Tel: 01656 867960
Email: aphillips@macmillan.org.uk
