business skills: Children's services 8 th December 2014 - - PowerPoint PPT Presentation

Welcome to the RCSLT’s webinar:

Introduction to clinical business skills: Children's services

8th December 2014

#ClinicalBusiness

Chair of webinar: Presenters: Kamini Gadhok MBE

CEO, RCSLT

Maria Luscombe

Chair RCSLT’s Board of Trustees

David Amos

RCSLT Workforce Planning and Development Adviser

Welcome

Kamini Gadhok MBE

CEO RCSLT

Maria Luscombe

Chair RCSLT’s Board of Trustees

Data is one of the keys to influencing and building your case!

Understanding needs of children and young people with SLCN

“Assessing and understanding the needs of individuals as well as of the population as a whole is integral to helping them achieve good outcomes” Bercow 2008

Share the knowledge !

Develop a shared understanding of the needs of children and young people with SLCN Engage and influence local decision makers within and external to your own

• rganisation

Population and demographic data - know your local area!

 Local demographics  Population trends  Ethnicity / language profiles  Deprivation indices –children in poverty  Health inequalities – infant mortality  Educational outcomes

JSNA and commissioning priorities

Local Trends -

 Children and young people

 with complex difficulties at birth  with ASD  with behavioural difficulties  excluded from school  accessing youth offending teams

 Survival rates of pre-mature /low birth babies  Foundation stage results for communication , language

and literacy

 Attainment of students with SEN  SEN and school census data sets

Link to - ‘At risk factors’ SLCN

 Gender -Boys over represented relative to girls 2.5:1 for

SLCN and 6:1 for ASD.

 Birth season strong indicator for SLCN in school  Socio-economic disadvantage  Poor sensory or linguistic environment  Family history  Survival rates of pre-term / low birth weight babies  Co-morbidities (ASD, learning difficulties, physical and

sensory difficulties, hearing loss )

Communication is crucial and at the core of all social interaction.’ (Bercow 2008) Link the impact of having a SLCN with outcomes –

 often have difficulties forming friendships  are at risk of poor attainment academically.  commonly have difficulties with reading and writing

and accessing the curriculum.

 often have poor behaviour - may find it hard to

socialise with their peers.

 more likely to be bullied than other children.  more likely to be excluded

A high proportion of young offenders have SLCN.

11

Prevalence and incidence SLCN

 1% of five year olds entering school in England - have

the most severe and complex SLCN.

 7% of children at school entry will have significant

speech, language or communication needs which will not improve without specialist interventions as part of the team working with the child, including the parents

 Up to 50% of CYP in some socio-economically

disadvantaged populations have speech and language skills that are significantly lower than their peers.

 10% of all children with SLCN which may be complex

and long-term.

Specialist

Targeted

Universal

7% of school entry age have been found to have significant SLCN

Prevalence of SLCN – The balanced System ( M Gascoigne 2012)

1% most severe and pervasive at school entry Up to 50% of children entering school in most socio-economically deprived areas will have impoverished language skills ? of all CYP in your Local Authority ? of those entering reception each year in your school ? of all CYP in your Local Authority ? of those entering reception each year in your school Figure unknown but there will be significant variability correlated to the demographic variation. This can be estimated. In areas of high deprivation may be as high as 50+%

Impact on commissioning and service provision

 Support for children and young people and their families  Communication and language friendly environments  Need for early and appropriate interventions  Workforce with appropriate knowledge and skills  A system wide approach  Continuum of universal, targeted and specialist services

should be commissioned for children’s speech, language and communication.

Speech and Language Therapy

SLT service data sets

 Referral rates and trends  Links with areas of social deprivation, schools  Hard to reach groups  Age, gender, ethnicity, language  Waiting times referral to treatment  Activity data  Non attendance rates  Gaps in service provision  Service and user feedback

Speech and Language Therapy

SLT Staffing -

 Number  What are SLT’s delivering? What is being

commissioned

 Clinical hours available  Skill mix, competencies required  Clinical leadership  Management  Administrative support, IT systems

Sources

1.

Health profiles in England, Scotland, Wales and Northern Ireland (links on RCSLT – support for services web page)

2.

Public health England datagateway@phe.org.uk

3.

Local authority and Department for education websites

4.

Better Communication Research Programme ( BCRP) http://www2.warwick.ac.uk/fac/soc/cedar/better/

5.

The Communication Trust web site https://www.thecommunicationtrust.org.uk

• What Works. The Communication Trust working with BCRP

to develop the What Works database.

• Commissioning support tools
• Implementation of SEND reforms conference report Feb 14 .

RCSLT on line resources and tools

 Commissioning support tools  Matrix reports  Support for services  Leadership series  SEND reforms and guidelines

David Amos

RCSLT Workforce Planning and Development Adviser

Understand, influence and control

• 1. To have a far greater understanding of the

principal drivers and nature of change facing SLT services.

• 2. To be capable and confident enough to be

able to influence action plans for achieving greater influence and control.

• 3. To build personal and team resilience during

times of continuous change.

Clinical business skills development

The challenges ahead Dealing with change Making the clinical business case Building personal and team resilience

Public sector spend trend and forecast

NHS Funding profile: Nuffield Trust

• 1. Funding pressure on the NHS
• 2. Increase in allocation in line with NHS

long-term average

• 3. Increase in allocation in line with GDP
• 4. Real-terms freeze in allocation

NHS productivity: 1995-2010 [ONS

survey]

England NHS

Understanding a changing world

• Less revenue to run existing services
• Lack of clarity about how services will be commissioned
• Potential increase in the use of personal budgets
• Increase in privately funded SLT
• Changes affecting the SLT team themselves and the rest of the
• rganisation within which it fits
• Growing demand for services driven by demographic change and

new ways of meeting patient and client need

• Merger at either employer or department level
• Dramatic changes at the top of the employer facing insolvency
• Opportunity to introduce new patient/client pathways and ways of

working which are more efficient and better for those in need

• New professional development requirements and limited time to

undertake

What could my organisation be planning?

• 1. Making cost improvement and efficiency savings

each year

• 2. Merging with another provider organisation
• 3. Merging the clinical service with another one
• 4. Placing the SLT service under the leadership of

another profession

• 5. Introducing a service level agreement
• 6. Undertaking a job evaluation exercise
• 7. Implementing advanced job planning
• 8. Being involved in a procurement exercise

Dealing with change: how employees react

• “Not me!”
• “What will this do to my job security?”
• Anger
• Gossip
• “Who’s in charge here?”
• Panic!
• “I quit!”
• “This is a challenge!”
• Enthusiasm
• “Maybe I could adjust to this change . . . .”
• Positive Vision

Peter Barron Stark 2010 “Common Manifestations of Employees’ Anticipation of the Unknown”

How employers react to change

• Often feel that something is being done to them

by the system

• Consult early without details or later with details
• Spend time checking that a major change (eg

financial challenge) is as great as originally quantified

• Consider first all options which do not affect the

staff

• Try and take advantage of the need for change to

achieve the best for patients – why waste a crisis?

Clinical business language dictionary

Acquisition Budgetary management Consultation Co-production Cost avoidance Cost reduction Efficiency Heads of terms Merger Procurement Productivity Privatisation Public-private joint venture Redeployment Service level agreement Tendering

Creating extra workforce capacity and capability

Capacity used to generate additional revenue Capacity used to reduce spend elsewhere Capacity used to enhance service elsewhere Capacity removed as redundant

Workforce cost reduction productivity improvement opportunities

: reducing backfill costs

: training and

deploying lower levels of staff

: commercial

solutions and working in partnership with other organisations

: diverse, effective

teams, well-led and rewarding careers

: using advanced technology and new working

environments and arrangements

Key indicators: SLT workforce and budget profiling

• Number of whole time equivalents
• Number of headcount
• % of bands 1-4;5-6; 7; 8+
• Contract targets (volume/quality) – 2014/15
• Contract performance 2013/14
• Year to date performance (2014/15)
• Access targets
• Skills audit
• Diversity and equality profile
• Recruitment and retention trends
• Financial targets
• Sickness absence % (compared with organisation as a whole)
• Pay budget – 2014/15
• Non-pay budget – 2014/15
• Training and development expenditure and plans
• Month 8 income and expenditure position
• Market analysis – other providers

Right staff, right place, right skills

• “What do I do, that only I can do?”
• “What do I do, that someone else can do?”
• “What do others do, that I could do?”

The full team

2 4 6 8 10 12 14 16 Volunteer Parental/guardian support Band 1 Band 2 Band 3 Band 4 Band 5 Other professional staff Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9 SLT professional staff Non-qualilfied staff and support Support staff (not exclusive to SLT service)

Team-based advanced job planning: matching capacity with demand

Clinical specialists:  Senior and specialist staff  Work autonomously or within a specialist field  Contribute to and highly influential on the clinical performance research and development  Skilled in building partnerships and project management  Skilled in knowing how to engage hard to reach families and deal with the complexities of social disadvantage  Have the authority to command respect of their knowledge and its application to Sure Start from early years practitioners and parents  Primary responsibilities for the delivery of patient care in their own right and as members

• f multi-disciplinary teams

Clinical impact features:

• Improving life chances
• Risk avoidance -safeguarding
• Enhancing the productivity and efficiency of others
• Developing the skills of others -optimising communication environments
• Service development
• Identifying new opportunities – horizon scanning

Quantifying the specialist contribution

(Direct) Direct Clinical Care [dDCC] (Indirect) Direct Clinical Care [iDCC] Supporting Professional Activity (personal) Supporting Professional Activity (others) To work as an autonomous, advanced practitioner, with an extended scope of SLT practice

• To use advanced clinical

reasoning, evidence based practice, understanding f the diagnosis, previous experience and wide-ranging knowledge of treatment options across all SLT specialisms to plan and implement individual therapy programmes using extended skills and specialist therapy techniques.

• To use an extended depth and

breadth of experience across all specialisms to manage a highly complex caseload

• Direct delivery of face-to-face

therapy programmes including parent education programmes

• Education and training of the

wider workforce to deliver specific SLT interventions

• To provide emergency cover for
• ther staff within the team
• Advanced diagnostic skills
• To act as an expert resource for

consultants, GPs, schools and education authorities SLT voice for clinical development within the multi- disciplinary team arena

• To provide professional

representation of SLT service

• Support best practice

through appraisal and competency frameworks

• Lead the development of

service improvement

• Oversee clinical policy
• Lead in clinical

governance within area

• f specialism
• To demonstrate continuous

professional development

• To lead audit
• To ensure that the service complies

with clinical governance

• To ensure that all clinical practice is

benchmarked against all relevant national programmes and national standards

• Statutory and mandatory training
• To support the development and

implementation of outcome measures

• Ensure that all new research is

disseminated and implemented

• Face for speech therapy

Divisional/departmental and external meetings

• Forging relevant partnerships with

key stakeholders

• General training, education and

formal teaching

• Advise on improving the

efficiency, effectiveness and productivity of other staff through job planning

• To use an extended depth and

breadth of experience across all specialisms to provide a high level clinical supervision

• Monitor the effective use of all

resources across SLT

• Support all local SLT

developments

• Training the wider workforce to

understand and support the needs of children with SLCN

45% of role 25% of role 20% of role 10% of role

Developing personal capability

Building team resilience in challenging times

Succeeding as a manager: five ways to build a resilient team” by WFC Consulting (2006). It provides a useful checklist for staff in their roles a both managers and employees:

• 1. Build your own personal resilience.
• 2. Encourage autonomy and flexibility.
• 3. Help employees manage change.
• 4. Provide opportunities for ongoing learning.
• 5. Help employees find a sense of meaning in their work.

Building resilience

Characteristics A resilient individual… Positive …sees opportunities for success not failure Focused …sets and achieves goals and stays centred on ultimate objectives in light of setbacks Flexible …finds new and creative ways to approach situations Organised …manages ambiguity in an orderly way Proactive …takes initiative and gets involved

Any questions?