Healthcare Workforce Deanery Balanced Scorecard

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Healthcare Workforce DeaneryBalanced Scorecard

December 2008
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How does the Balanced Scorecard work?
Level 1 Overview. This outlines the 5 high
level areas of focus in line with the SLA with
the DH. It shows the overall SLA line scores to
give an at a glance summary.
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Level 2 High level performance assessment for
each of the standards / targets within the 5 key
areas. RAG rating based upon actual
performance against target or SHA interpretation
of progress to date (where no performance measure
available)
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Level 3 Evidence to support Level 2 comments
and wider information on Deanery actuals,
including those issues that require detailed
discussion.
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Overview Areas of Focus for the Review (Level
1)
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1. Undergraduate medical and dental education
placements (Level 2)
1 .1 Sufficient Medical and Dental placements
available for local Medical and Dental Students
SLA 5 Heidi Breed
University of Leicester 2008 Graduates - 268
University of Nottingham 2008 Graduates - 327.
Graduates from local Universities exceed places
with local foundation schools. Under the national
recruitment system graduates can apply to any
foundation school across the country. No known
unplaced graduates for 2008/9.
G
1.2 Learning and development agreement/contract
specifies support required by students on
clinical placements





SLA 6
J Wallsgrove
SIFT support and clinical placements for
undergraduate medical student contracts are
agreed annually. SIFT contract with GP exists to
specify the support required with GP practices.
The SIFT contract with medical schools forms the
basis of 3 way agreements between service
provider organisations, university medical
schools and NHS East Midlands. The LDA contains
schedules to support post-graduate medical
trainees and non-medical trainees. Monitoring of
the LDA will be aligned wherever possible with
the Quality Management and Regulation Team PMETB
accreditation visits (SIFT student numbers -Graph
1 2).
G
1.3 Dental placements funded based on the
nationally agreed dental placement rate
SLA 7
Dental Dean located in Sheffield There are no
undergraduate dental trainees supported by EM
deanery as we received no SIFT funding for this
purpose.
1.4 Arrangements in place with medical schools
to monitor the quality of training against QAA
and GMC/GDC standards, improve student
satisfaction with clinical training and fitness
for purpose of trainees completing programmes


SLA 8 Peter
Rolland
G
Joint visit to service environment undertaken
with University of Leicester to review UoL
Quality Control process in practice. Revision
of University of Nottingham Quality Control
Framework Taking place in conjunction with the
north East Midlands SIFT Steering Group.
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1. Undergraduate medical and dental education
placements (Level 3)
Graph 1 SIFT student weeks University of
Leicester Medical School (2008/09) Graph 2 SIFT
student weeks University of Nottingham Medical
School
Explanation of Graph 1 2
Graph 1 Illustrates the placements for
University of Leicester Medical School for
2008/2009. Graph 2 Illustrates the placements
for University of Nottingham Medical School for
2008/2009.
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2. Post Graduate Medical Education (Level 2)
SLA 9 Dr S Carney / Dr B L Langham
2.1 Numbers of F1 and F2 placements available
match medical school output with nationally
agreed headroom
G
Headroom does not relate to local medical school
output. Posts are allocated to the region on a
per capita basis. F1 Placements (North) - 294.
F1 Placements (South) - 174.
G
F2 Placements (North) - 267. F2 Placements
(South) - 166.
2.2 Evidence that quality management arrangements
are in place to meet PMTEB standards for local
quality control and to ensure that all PMETB
mandatory conditions can be met
SLA 12 Kate
Caulfield
G
New focussed approach piloted at Chesterfield.
Initial self-assessment against PMETB domains
completed by specialty schools. (Graph 4 - 6)
2.3 Additional GP Training Program capacity to
enable NHS EM Share of new trainees in GP
training program Year 1 to be Delivered.


SLA 10 Simon Gregory
Proposals have been received. Further details are
being sought. The crucial next step is ensuring
that the money is spent in this financial year.
A

2.4 Report on Number and type of Specialty
School established, showing Multi deanery schools
separately



SLA 11 Nathan
Jones
A
15 specialty schools up and running. 1 school is
currently without a HoS. Plans in place to
address this by the end of December.
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2. Post Graduate Medical Education (Level 2)
2.5 Plans in place to ensure that Supervisors of
Trainees have received appropriate trainer
training SLA 13 Gordon French /
David Williams
Deanery menu for training. Scheduling for
training sessions being arranged.
A
2.6 Funding for NCCG Career Support and training
and CPD for SAS Grades should be used to support
SAS doctors pursuing their careers



SLA 14 Rashbal Ghattaora
APD in post. Funding being allocated to Trusts
for 08/09. Plan being developed. Project plan
being developed within a project mandate agreed
at OMT (See Pages 27 Project Reports).
A
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2. Post Graduate Medical Education (Level 3)
Graph 3 Shortage specialties vacancies for 2009
Explanation of Graph 3
Graph 3 Illustrates the shortage specialties
vacancies.
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2. Post Graduate Medical Education (Level 3)
Graph 4 Issues and Risks in each PMETB Domain
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2. Post Graduate Medical Education (Level 3)
Graph 5 Issues and Risks in each PMETB Domain
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2. Post Graduate Medical Education (Level 3)
Graph 6 Issues and Risks in Domain 6 (Support
and Development of Trainees and Trainers)
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2. Post Graduate Medical Education (Level 3)
Table 1- Accreditation Visit Dates
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2. Post Graduate Medical Education (Level 3)
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2. Post Graduate Medical Education (Level 3)
As defined in A Guide to Postgraduate Specialty
Training in the UK The Gold Guide  there are
three key elements that will allow GPStRs to
progress as a GP Specialty Registrar (GPStR). 
These are annual planning, appraisal and
assessment.  These three elements join together
to form the basis of the Annual Review of
Competence Progression (ARCP).   All GPStRs are
required to undertake this process in order to
progress through the training and gain their CCT.

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2. Post Graduate Medical Education (Level 3)
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3. Non medical education (Level 2)
3.1 Long term Commissioning Plans Agreed with HEI
Partners
SLA 15 P Rolland
G
Commissioning Plan revised for implementation
2009-10 and consulted with service
representatives. Currently negotiating financial
implications.
3.2 Achievement of sufficient numbers of trained
non-medical prescribers to deliver local service
improvements



SLA 19 P Rolland
Prescribing course for non medical staff covering
AHPs, Nurses and pharmacist are run at a number
of our partner HEIs, these include Lincoln
University, Nottingham University, Derby
University, De Montfort University, and the
University of Northampton. Currently, DMU and
Northampton courses are delivered through the LBR
contracts and are demand driven, that is, if
there is sufficient demand from the service, a
course will be put on as necessary to meet that
demand within the overall commissioned LBR module
numbers. The other 3 universities have contracts
for this year only and have trained to their
capacity with Derby University being
offered additional funding to meet that local
health communities need. (See Table 2).
G
3.3 Staff survey results on staff undertaking
training showing satisfaction levels
SLA 20 P Rolland
The staff survey of NHS employees demonstrates
that taught courses is the main access for
on-going education for NHS staff. There is good
up-take of these opportunities across the East
Midlands.
G
3.4 SHAs to have in place joint strategies with
their Higher Education Providers for the
management of attrition and attrition rates for
each pre registration profession are reduced to
contribute to the delivery of nationally agreed
targets. Benchmark is 13

SLA18 P
Rolland
G
Monthly monitoring continues with HEIs engaged in
setting action plans for improvement. (Graph 9)
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3. Non medical education (Level 2)
3.5 Plans in place with Ambulance Service for
transition of Paramedic pre - reg education to
Higher education



SLA 24
Peter Rolland
Responses to respecification has been received by
two (existing provider) HEIs. Responses being
consulted with service to ensure this meets
service requirements.
G
3.6 Staff Survey results showing on the job
training shows year on year increase
SLA 22 Trish Knight
G
As the staff survey is only completed once a year
there will be no further update till June
09. East Midlands performance in composite
indicators in the 2007 survey in relation to
appraisal, learning and development continues to
require improvement, particularly in Acute Trusts
where 58 of indicators in relation to this theme
were below national average (45 mental health
and 44 PCTs). Review of action plans and trends
with employers will highlight risks and follow up
required. For SHA/Deanery statutory training is
over 95 compliance.
3.7 Plan for the development of the wider
workforce updated and published on the SHA
website by June 2008 Plan includes
review of investment through the JIF and report
on implementing the Skills Pledge







SLA 23
Trish Knight
Changes in LSC funding policy are resulting in an
increase in the number of qualifications not
requiring an employer contribution therefore
concern was highlighted that the in year
investment target would be met. Contingency
strategies are in place.
R

3. 8 Year on Year Variations in commissioning
justified against workforce need e.g. Health
Visitors, Neonatal nurses and School Nurses


SLA 16 Peter Rolland
Training for Public Health Specialist
Practitioners, School Nurses and Neonatal Nurses
is available within the Learning Beyond
Registration education portfolio at a range of
universities across NHS East Midlands. Access to
education is in response to demand by the service
and all requests for training by NHS
organisations / GP practices is met and funded
through this route.
G
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3. Non medical education (Level 3)
Midwifery, School Nursing and Public Health
Specialist Practitioner figures (left)
demonstrate a commitment to increase these
students within East Midlands. This has been
reviewed with service colleagues at the workforce
planning event in September. This will influence
the commission numbers for 2009 -10.
Neonatal nurse training is not commissioned as a
discrete course within the NHS East Midlands.
Rather, to facilitate flexible development of
capacity and capability within service provider
organisations a range of modules / programmes are
purchased from HEIs for fee-free access by
service provider organisations. This has
increased from three programmes in 2007-08 to a
range of modules / programmes in 2008-09
available as whole programmes or stand-alone
modules ( as demonstrated in the table below).
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3. Non medical education (Level 3)
Graph 7-Contract value for the new commissions
08/09
Graph 8-WTE for the new commissions 08/09
Explanation of Graph 8
Explanation of Graph 7
Graph 8 Illustrates the numbers of new
commissions for non-medical professional
healthcare programmes by WTE count for year 08/09.
Graph 7 Illustrates the value of tuition, salary
support and Learning beyond registration
contracts for the new commissions.
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3. Non medical education (Level 3)
Graph 9Attrition rate for Midwifery and Nursing
(Dec 2008)
Table 2 Non-medical prescribing figures
Explanation of Graph 9
Graph 9 Illustrates the attrition rate (December
2008) for Midwifery and Nursing Diploma/Degree in
various HEIs.
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4. Efficiency (Level 2)
4.1 Activity funded in line with Service Level
Agreement/ Contract/Business Plan and ensure
outputs delivered
SLA 25 Belinda Hales

MPET budgets have been set to meet the
requirements of the DH SLA through LDA/contracts
with NHS trusts and PCTs, GP practices and health
education institutes - annual budget total is
343m compared to annual DH allocation total of
344m. Latest forecast for the year shows a
6.9m under spend against allocation mainly due
to lower than planned take up of non-medical
education course places at the universities,
confirmation that our DH MPET allocation will not
be reduced this year to finance training fund
payments to trusts/PCTs, lower than expected GP
trainee salary costs and a surplus on the MMC
Transition Plan allocation. An additional
spending plan of 4.5m has been agreed by the
Deanery Management team and this is included in
the latest forecast expenditure figures leading
to the overall 6.9m forecast surplus.
G
4.2 Account to other SHAs for use of Allocated
Funding SLA 26 Belinda
Hales
G
SHA Corporate Finance working with DH MMC SRO
have drawn up the national financial plan for the
30m MMC transition reserve. This financial plan
was discussed and agreed at the National
Workforce Finance Leads meeting on 22 July 08
and allocations have been made to each SHA based
on this plan.
4.3 Funding passed to student grants unit on 1st
working day of each month based on share of
national costs


SLA 17 Peter
Rolland
G
Funding passed to Student Grants unit on the 1st
working day of each month based on the share of
national costs.
4.4 All contracts to be at benchmark price by
31st March 2009
SLA 21 Peter Rolland
G
Only those contracts which are not able to be
amended (due to existing commitments) or do not
carry BMP are not currently at BMP.
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4. Efficiency (Level 3)
Graph 10-South MADEL Contracts Junior Doctors
WTE 2008/09
Graph 11-North MADEL Contracts Junior Doctors
WTE 2008/09
Explanation of Graph 10
Explanation of Graph 11
Graph 10 Illustrates the South MADEL contract
change in placements as of Dec 2008
Graph 11 Illustrates the North MADEL contract
change in placements as of Dec 2008.
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5. General (Level 2)
5.1 Annual investment plan published by 31 May
2008
SLA 1 Paul Timperley Peter Rolland

Business Plan published May, and return made to
DH. Work has commenced on Business Plan 2009/10,
with a view to March 2009 sign-off.
G
5.2 Contracts and Learning Development
Agreements are in place with service and
education providers.



SLA 2
Peter Rolland
G

All LDA contracts have been signed and returned,
and entered onto the contract register.
5.3 Arrangements are in place (either directly
or via higher education partners and others) to
monitor the quality of training including the
satisfaction of students and trainees and the
satisfaction of employers with outputs from
training.

SLA 3 K
Caulfield / P Rolland

Programme of visits with provider trusts is
established including on-going quarterly
monitoring alignment with HEIs, will be achieved
through integration or these processes and LDA
review process Feb 09 onwards. (Tables on page
12 - 13).
G
5.4 SHA working with NHS Partners to maximise
the information from the ESR
SLA 4 Trish Knight
A
Work continues with all organisations
particularly with the regard to the introduction
of OLM and self-service.
.
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5. General (cont.) (Level 2)
5.5 Investment / Business Plan Reporting (See
page 28)
Owner Paul
Timperley
The following algorithm has been
used Green over 75 of lines
reporting green, no reds Yellow
less than 50 of lines reporting yellow, max of
one red Red Over 50 of lines
reporting yellow, more than one red
G
Overall, the reports on the Business Plan
delivery show an improved position, with over 81
of the lines reporting delivery by 31-03-2009.
Objective 1 Contracting Three out of
seven work streams are reporting significant
levels of risk of delivery.
A
Objective 2 Quality No significant
changes to the trajectory reported.
G
G
Objective 3 Delivery. One line (3.6)
academic exposure for trainees has reported a
significant deterioration
and will not be achieved.
G
Objective 4 Staff Development All lines
on track.
G
Objective 5 Multi-professional Ethos All
lines on track.
G
Objective 6 Partnership All lines on track.
A
Objective 7 Corporate Efficiency
Increased risk in the reported position of
delivery of PDPs report given to DMT.
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5. General (Level 3)
Graph 12 Staff management indicators (October
December 08)
Explanation of Graph 12
Graph 12 Illustrates staff management indicators
for the period of Oct 08-Dec 08 for
NHS/University employees in EMHWD.
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5. General (Level 3)
Table 3 Organisational Development stages
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5. General (cont.) (Level 3)
Table 4 Projects
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)
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5. General (cont.) (Level 3)