"Beyond Boundaries A Guide to Diabetes Networks"
Beyond Boundaries: A Guide to Diabetes Networks June 2006 Beyond Boundaries: A Guide to Diabetes Networks Contents Page Foreword 3 1 Introduction 4 What is a network and why do we need them? 4 What is a clinical network? 4 Why do we need networks? 5 2 Network Essentials 7 What Can Networks Do? 7 Networks and their role in Policy and Guidance Implementation 8 What this means for diabetes 8 What Networks Look Like 9 Leadership in networks 10 The key leadership roles within a network 12 Network Chair 12 Network Manager 12 Network Clinical Lead(s) 13 User Champion 13 3 What Networks Need 14 Accountability and Governance Arrangements for Networks 14 Measuring outcomes 15 4 Patient and Public Involvement 18 A patient-led NHS 18 How diabetes networks should encourage patient and public involvement 19 Key actions for Diabetes Networks to make user involvement a reality 19 Service users and networks 20 5 Workforce Planning, Design and Development 21 Workforce planning and design 21 How workforce planning and design is carried out 21 Competences and how can they be used 22 Available support 23 6 Communications for Diabetes Networks 24 7 Diabetes Clinical Network – Getting Started 27 Stage 1- Need for a network is identified 27 Stage 2- Development 27 Stage 3- Leadership 27 Stage 4- Identify Stakeholders 27 Stage 5- Identify someone to co-ordinate the network 28 Stage 6- Network Launch Event 28 External Drive 28 Ongoing Development of the Network 28 Key stages in setting up a network 29 8 Conclusion 30 9 References 31 Page 2 of 31 Beyond Boundaries: A Guide to Diabetes Networks Foreword Dear Colleagues, The important contribution that effective clinical networks can bring to improving the care of people with diabetes is recognised in the Diabetes National Service Framework (NSF) Delivery Strategy (DH, 2003). By developing commissioning links between healthcare professionals and managers working across health and social care, as well as people with diabetes, beneficial synergies in identifying priorities and targeting resources can emerge. However, effective networks do not necessarily appear by themselves. They need the commitment, drive, enthusiasm and practical support of all those responsible for delivering diabetes care and users of the services they provide. This often means that tensions between the different components of the health and social care community have to be overcome, recognising that personal and parochial interests have to be put aside in the interests of improving diabetes care for all patients. This is not always easy, as people often hold strong views about the importance of their own particular aspect of the service and can resist what is often perceived as “giving up” any autonomy or individual decision making. It is here that the role of the Diabetes Network Manager is crucial in promoting the benefits that effective networks can produce and influencing decision makers to become positively engaged with new ways of delivering diabetes care. Their job is not an easy one, although support is offered by the National Diabetes Support Team (NDST). The team has been instrumental in providing both start-up resources to local organisations to employ network managers and continuing support provided by the network of Regional Programme Managers. There is still some confusion over the role of networks – how they should operate, what they should do and how they should do it. To provide some clarity to all of those questions the NDST has produced this easy to use Guide to Diabetes Networks. It contains simple guidelines on the role of networks and practical examples of how they have worked and what they have achieved. It aims to be a valuable resource to those working in established diabetes networks and people setting one up. I believe that the lessons it contains can also be relevant to people working in other clinical networks. Ultimately, improved care for people with diabetes will only be achieved with the commitment, energy and imagination of all health and social care professionals in the diabetes community working in partnership with service users. Bev Bookless National Diabetes Support Team Programme Director Page 3 of 31 Beyond Boundaries: A Guide to Diabetes Networks 1 Introduction What is a network and why do we need them? Networks within the NHS are not new and have existed informally in different formats for some time. Over the last five to ten years there has been an attempt to develop and formalise clinical networks. The aim is to try and deliver more integrated care across organisational boundaries that reflect the whole spectrum of patient needs. This has been made more explicit in some disease areas than others. For example, there are a number of cancer networks that have been mandated and given funding for their development and maintenance. Their role is to implement the NHS Cancer Plan: A plan for investment, a plan for reform (Department of Health (DH), 2000). What is a clinical network? The DH defines a clinical network as: “Connections across disciplines which provide integrated care across institutional and professional boundaries, raising clinical quality and improving the patient experience” (DH 2004) This highlights that clinical networks need to be at the centre of planning, commissioning and delivery of clinical care, whilst putting the patient at the focus of it all. Involving the service user in the process will shape and improve services around patient experience. Clinical networks tend to be non-hierarchical and involve many stakeholders; their function is reliant on relationships which take time to develop. Their function is reliant on relationships which take time to develop. There is a need for a trusting environment with a common purpose. This is expanded upon by the World Health Organisation (WHO): “A network is a grouping of individuals, organisations and agencies organised on a non - hierarchical basis around common concerns or issues, which are pursued proactively and systematically, based upon commitment and trust.” (WHO 1998) Page 4 of 31 Beyond Boundaries: A Guide to Diabetes Networks In Scotland diabetes clinical networks were mandated by the Scottish Health Department. They define clinical networks as: “linked groups of health professionals and organisations from primary, secondary and tertiary care working together in a co-ordinated manner , unconstrained by existing professional and health board boundaries to ensure equitable provision of high quality clinically effective services throughout Scotland” (Scottish Health Department, 2002) Why do we need networks? Single and multi-professional clinical groups have existed for some time because they have a common interest. They are a means of being able to share and learn as well as producing evidence based practice. The National Service Framework (NSF) Diabetes: Delivery Strategy (DH, 2003) states that in developing integrated services PCTs should consider putting robust mechanisms in place to reach standards and deliver targets which will: • engage all stakeholders, including clinical staff, managers and people with diabetes • work across traditional service boundaries • have clear lines of accountability • demonstrate excellence in leadership and management Clinically-led, managed diabetes networks, involving people with diabetes, provide one means of embedding these principles in practice. A network of this type provides structure for service planning and delivery, promotes seamless care and supports staff by targeting resources where they are most needed. This results in: • integrated care • improved clinical outcomes • cost-effective services • improved patient experience • equity of service provision Experience has shown that the most effective networks are those which are inclusive and bring together all necessary stakeholders. Since the publication of the NHS Plan in 2000 (DH, 2000) a common theme has emerged from the DH through subsequent documents up to the recent White Paper Our Health, Our Care, Our Say (DH, 2006). Priority has been given to the patient experience, listening, shaping and delivering services around users and involving them in the process. This, linked to promoting and Page 5 of 31 Beyond Boundaries: A Guide to Diabetes Networks providing the environment for self care and choice, underpins the fundamental philosophy of the Diabetes NSF (DH, 2001) and Delivery Strategy (DH, 2003). Care for people with diabetes is complex with many interconnecting pathways. People with diabetes want their care streamlined. Models of care need to be determined locally as a region’s history, geography and culture all need to be considered. Diabetes Clinical Networks will be crucial to the successful implementation of the recommendations in Our Health, Our Care, Our Say (DH, 2006). They will ensure that all aspects of care delivery, from specialist care to primary care together with local authorities and social care are engaged in partnership working and have an active part to play in commissioning. North Cheshire Diabetes Network Structured education: A six week patient education programme facilitating self management skills has been introduced for people with diabetes. It uses the Xpert programme devised in Burnley. Lesley Mills said: “Our programme is unique in the fact that we implement physical activity using the Reach for Health Team rather than just talking about it.” The dietetic service also has input into the programme and a weight referral scheme is being set up to link with other lifestyle agencies. Drop in clinics: Two community drop in clinics are run by secondary care services covered by the network. There are also two community booked clinics, which are held at a local rugby ground. A clinic is also held there for central access in the evenings and there are educational and social evenings, covering aspects of drug and alcohol use and sex. Communication: Monthly link meetings are held jointly with both primary care staff and ward nurses, helping with communication and discharges. Young people: The network has a designated young persons’ Diabetes Specialist Nurse, working with 17-to-25-year-olds. She has a mobile for direct contact, including text message clinics and email support. Page 6 of 31 Beyond Boundaries: A Guide to Diabetes Networks 2 Network Essentials What Networks Can Do Networks can provide many benefits and are central to the delivery of developing reforms to healthcare that have been described in health policy since 2000. Networks have the potential to improve services by promoting a whole system approach across all organisations and professions involved. They aim to bring all partners together with a common sense of purpose i.e. improving services for people with diabetes. Gloucestershire Managed Network Group Network achievements include: Collaborative work associated with the development of policies and guidelines such as glucose monitoring and self-testing, microalbuminuria testing, prescribing of diabetes medication in primary care and design of patient information leaflets. Collaborative working around finding a solution for safe collection and disposal of clinical sharps waste. Successful identification of recurring funds to match the capital investment in the Retinal Screening Programme in order to deliver the March 2006 target of 80% of people with diabetes offered screening. Duncan Thomas, Service Development Programme Manager, West Gloucestershire Primary Care Trust: “The group tends to work very well together and generally speaking the dynamics are good; the primary and secondary care axis is now well established and there is much more of a collaborative approach to new developments. As we pick off the various standards in the NSF, our next big challenge will undoubtedly be around the identification and management of those, as yet, undiagnosed with diabetes.” Page 7 of 31 Beyond Boundaries: A Guide to Diabetes Networks This example demonstrates some of the benefits associated with networks, identified by Wall D. and Boggust M., in 2003 as: • Potential for seamless patient care • Integrated care across existing professional and health-care boundaries • Agreed care protocols and pathways across the network area • Diversity of professional contributions • More equitable services for patients • Prevention of duplication of effort and resources • Multi-professional and multi-site working • Teamwork and collaboration • Flexibility and dynamism • Evolution and change Networks and their role in Policy and Guidance Implementation The NHS Improvement Plan (DH, 2004) sets out the way the NHS needs to change to become patient led. It emphasises supporting personal care, providing choice, making it happen through providing the introduction of Foundation Trusts and the Independent Sector. It also emphasises the move away from a target driven performance management framework. Creating a patient-led NHS – Delivering the NHS Improvement Plan (DH 2005) describes the profound organisational changes needed to achieve this vision. It outlined that the aspect of every healthcare system is to create a service that is designed to be patient led, incorporating choice and information, standards and safeguards. Our Health, Our Care, Our Say (DH 2006) has strategic aims of better prevention with more care in the community, more choice, fewer inequalities and more support for people with long term conditions. What this means for diabetes These policies fundamentally support the underlying principles of the Diabetes NSF (DH 2001) by supporting self care, being organised and systematic, being joined up and delivering care where it is most appropriate. However, the move of care from hospital to the community may be seen to be threatening to diabetes specialist services although it is not. Diabetes Networks have a real opportunity to take forward new policies in reforming health care and shaping their local services. They are the mechanisms for creating joined up care that involves everyone, including people with diabetes, parents and carers. The advantage of working in an integrated, collaborative manner will ensure Page 8 of 31 Beyond Boundaries: A Guide to Diabetes Networks that diabetes services meet the specific local population need and reduce inequalities. In addition, the model of care that is developed needs to incorporate people who have a specific remit which includes managing complex care situations, training, education, research and implementation of evidence. What Networks Look Like The Diabetes NSF Delivery Strategy (DH 2003) proposes that an effective network should cover a natural population. For diabetes, this will usually be determined by the population served by a specialist diabetes service based within an NHS Trust. Where the network covers the population of two or more PCTs, it is good practice to design accountability arrangements to ensure that decisions are implemented. The network may be considered to be all of the stakeholders within a diabetes community. This could include health and social care, people with diabetes and parents/carers. Networks need to be inclusive and this requires robust communication mechanisms between core team members and other stakeholders across the network. Careful consideration needs to be given to the core team membership. It is essential that organisations’ representatives are senior enough, or have delegated authority, to make decisions on behalf of their organisation. Because of the expertise in diabetes networks and their collaborative approach to working they should be involved with the commissioning of high quality, efficient diabetes services. “Firstly, we need to see commissioning as a positive experience: not just specifying services and buying them; but how we use this process to develop and deliver better services. not just, as occasionally with GP fundholding, a “gun fight”; but as far as possible a collaborative process. Think COPD services, diabetes – crossing boundaries, led by clinicians – a process of working together – not of one group being “done to” by another.” Sir Nigel Crisp speech to NHS Confederation 1 November 2005 Page 9 of 31 Beyond Boundaries: A Guide to Diabetes Networks East Berkshire Partnership Board The East Berkshire Diabetes Network works in partnership with the local Long Term Conditions Sub Group. It covers three PCTs –Windsor, Ascot and Maidenhead (WAM), Slough and Bracknell: Collaborative Projects across East Berkshire PCTs East Berks Partnership Board COPD Diabetes East Berks Long Term Conditions East Berks Sub Group East Berks Diabetes Strategic level COPD Group network Bracknell Slough WAM Diabetes Diabetes Diabetes No PCT level COPD groups group steering steering Tactical level group group WAM Phase III COPD subgroup to become: No Bracknell No Slough WAM Phase Contracting Phase III III Diabetes Implementation East Berkshire Collaborative Projects Collaborative Collaborative subgroup level COPD Group from February 2005 Diabetes group Diabetes group Leadership in networks Effective leadership is one of the key requirements for any network. The essential skills around influencing and negotiating are crucial when attempting to work within a virtual organisation in a position with little direct authority over others. The key leadership roles identified in the network are manager, clinical lead, patient champion and network chair. However, in order to ensure the sustainability of the network there will be a need to develop others; this assists in succession planning and also helps drive forward the agenda. This may be achieved through assigning key tasks or small projects for others to lead on. This not only helps individuals within the network to develop, thereby ensuring the sustainability of the network, but also fosters a greater degree of accountability and responsibility that compels action. The success of the network is dependent upon the engagement of each of the network partners in taking forward the network strategy. Page 10 of 31 Beyond Boundaries: A Guide to Diabetes Networks Network leaders will need to demonstrate three types of role: • As the architect to facilitate the emergence of the network and to support its overall design • As lead operator to connect the various individuals and pieces of the network • As caretaker to enable monitoring, helping, engaging, learning, supporting within and without the network (Snow and Miles (1992) cited in NHS Confederation 2001) A shared leadership approach is one way of ensuring sustainability of the network group. One way of approaching this is to delegate leadership to task specific groups which provides others within the network the opportunity to share in the leadership role. It is clear that there will need to be a co-ordinating leadership role which in most situations will be the network manager. The network manager will therefore need to have a high level of interpersonal skills because of the number and complexity of partnerships within a network which need to be sustained. The table below illustrates one example of a network structure which aims to achieve a shared leadership approach by appointing others into the chairing of the various project groups. An example of a network structure which can enable shared leadership Retinal screening Sub Group Chair: Manager PCT LIT Director Information and Audit Chair: Manager Children and Young Adults South of Tees Chair: Consultant PCT LIT Diabetes Director Network Board Workforce Chair: Manager Patient education PCT LIT Chair: DSN GPwSI Pregnancy Chair: DSN Page 11 of 31 Beyond Boundaries: A Guide to Diabetes Networks Leaders can contribute to the effectiveness of the network in a number of ways by: • articulating a clear vision • ensuring the network has a clear sense of purpose • ensuring things get done • ensuring sustainability of the network through shared leadership • negotiation and influence • encouraging active service user involvement • ensuring services are developed around the patient pathway • listening, communicating and valuing the contribution of others • undertaking self evaluation of their role as leader and of the network The key leadership roles within a network The Diabetes NSF suggests the following key leadership roles within the network: • Network manager • Network chair • Clinical champion(s) • User champion(s) The NSF Delivery Strategy states that ”clinical leadership will be crucial in building and sustaining professional ownership for the NSF. A clinical champion will be an important voice in the diabetes network to ensure that priorities and obstacles identified by frontline staff inform its priorities” (DH 2003). Examples of role descriptions for each of these roles is included in the tool kit. Network Chair The appointment of a Chair at Chief Executive level can help to ensure that organisations provide appropriate representation. It also ensures that the Chief Executive community has someone who understands the workings of the network, and is able to represent its views to the network, and vice versa. Appointments should be time limited with clear accountability. Network Manager To provide managerial leadership to the network and management team and to lead in coordinating the work of network team members and constituent organisations involved in planning, developing and providing diabetes services and improving care. Page 12 of 31 Beyond Boundaries: A Guide to Diabetes Networks Network Clinical Lead(s) To provide clinical leadership and advice to the Network Board. The clinical lead should work closely with the network manager to lead the implementation of service reconfiguration arising from service improvement, NICE Guidance etc. The lead clinician may also: • Provide clinical leadership to the network team • Collaborate with diabetes information leads improving the quality, collection and use of diabetes services data User Champion To champion involvement at all levels and to support culture change. The User Champion will promote and facilitate wider involvement of people living with diabetes in the planning and monitoring of services. “I wanted to become involved in my local Diabetes Network because I want to help make things better for everyone with diabetes. I have never done anything like this before, as a user of the services. I thought that it was time to give something back” Sarah, Patient Champion “I think user champions help ground the board. Sometimes networks can get tied up in jargon. They say: ‘what does that mean?’ It’s quite powerful. “They also bring a very human element. In networks it’s all about relationships. Without a non-powerful relationship with the patient we are not going anywhere.” Bernie Stribling, Diabetes Programme Board Manager for Leicester, Leicestershire and Rutland Page 13 of 31 Beyond Boundaries: A Guide to Diabetes Networks 3 What Networks Need Networks must be able to demonstrate they are adding value to diabetes care that they would not be able to do if all the stakeholders did not work collaboratively together. Accountability and Governance Arrangements for Networks Monitoring Effectiveness Monitoring the effectiveness of the network is crucial, there is a need to safeguard value for money, to ensure most efficient use of resources and to ensure the network is outcomes focussed. How a network can monitor its effectiveness The National Diabetes Support Team (NDST) network self assessment framework can be used by networks to help them identify the stage of development of their network, identify gaps and develop action plans. Further developmental assessment may include assessing whether all the partners involved in the network are fully engaged with it. There are a number of tools which can be used to monitor the effectiveness of the partnership/network. The Strategic Partnership Assessment Tool provides a simple, quick and cost-effective way of assessing the effectiveness of partnership working. It enables a rapid appraisal, a quick health check, which identifies problem areas. This allows partners to focus remedial action and resources commensurate with the seriousness and urgency of the problems. http://www.integratedcarenetwork.gov.uk/docs/resources/134/53.doc Network assessment should be an iterative process. Things may change either due to organisational change or individuals within the organisation. To be really effective the network needs to evaluate and re-evaluate through a process that involves each of its partners. “Successful alliances go through a sequence of interactive cycles of learning, re- evaluation and readjustment” Pedlar M. (2001) Page 14 of 31 Beyond Boundaries: A Guide to Diabetes Networks Measuring outcomes There are a number of tools available for this purpose, however, none of the tools are network specific, tending to focus on PCT/Practice level data. Information can be collated and used for setting local targets with constituent PCTs of network. • Better Metrics This joint initiative between Strategic Health Authorities and National Clinical Directors set out to develop a small set of indicators in each NSF area which were evidence based and could be used by local services for assessment. The aim was to define indicators which were important rather than easy to measure. For Diabetes thirteen indicators have been developed covering all the NSF Standards and mapping to National Standards used by the Healthcare Commission. Workshops on the use of metrics and pilots of them in a number of conditions are currently under development. They will be useful to diabetes networks setting local targets with their SHA, or who want to audit a specific part of their diabetes service and compare it with others. More information on the Better Metrics Project and worked examples can be found at: www.osha.nhs.uk and on a factsheet produced by the NDST at: http://www.diabetes.nhs.uk/downloads/Factsheet_better_metrics.pdf • DiabetesE This offers a fast, effective assessment and continuous quality improvement solution to monitor the development of diabetes services within PCTs across clinical networks. The system provides organisations with quick, easy and comprehensive baseline assessments. Answers are automatically analysed and results are instantly available giving an overall PCT assessment score. At the same time, the system generates priority recommendations together with an action plan. Networks can set their own achievable timescales for addressing these recommendations. On completion a new assessment is undertaken and new action plan can be generated. As a result it simultaneously supports continuous assessment over a rapid timescale and drives forward the quality improvement process. A demo of the tool can be found on the following site: http://www.diabetese.net/demo/demosite/index.jsp Page 15 of 31 Beyond Boundaries: A Guide to Diabetes Networks North Staffordshire Diabetes Network has found using DiabetesE very useful: North Staffordshire Diabetes Network North Staffordshire Diabetes Network covers Newcastle-under-Lyme, Staffordshire Moorlands, North Stoke and South Stoke PCTs. Since the appointment of a network manager in April 2005 a great deal of progress has been made, including: • Contribution to the development of Staffordshire Diabetic Retinopathy Screening Service. • Completion of Diabetes E self assessment and used the recommendations to form the basis of an action plan for the district. • All organisations in the Network are now in the process of participation with the National Diabetes Audit. • A multi-disciplinary sub-group has been established with representatives from primary and secondary care to look at a care pathway for the district. • The structure of the network and its sub-groups has been reviewed to improve accountability, communication and to make best use of people’s time. • National Diabetes Audit The National Diabetes Audit (NDA) aims to establish a national system for routine data collation, analysis and feedback of diabetes related data that can be collated for population based analysis, to cover all people, children and adults, with diabetes in England. The Healthcare Commission, along with the DH, commissioned the NDA and have been deeply involved in its development. They endorse the contribution it makes to improving diabetes care and recommend contributing to it. Following extensive piloting the programme has been live since July 2004 and health care organisations are already submitting valuable information on the services they provide. More information about NDA including signing up to the programme, a working example of the analysis provided and workshops on what the NDA can deliver can be seen at http://www.nhsia.nhs.uk/ncasp/pages/aud Page 16 of 31 Beyond Boundaries: A Guide to Diabetes Networks • PBS Diabetes Prevalence Model Public Health Observatory Brent PCT School of Health and Related Research, Sheffield University. PBS is a spreadsheet model that generates estimates of expected total numbers of cases of diabetes ,both diagnosed and undiagnosed, at SHA, Local Authority and PCT level. The model applies age/sex/ethnic group-specific estimates of diabetes prevalence rates, derived from epidemiological population studies, to resident populations based on the 2001 Census. The model can be used to compare expected prevalence between populations and over time. More information is available at: http://www.yhpho.org.uk Page 17 of 31 Beyond Boundaries: A Guide to Diabetes Networks 4 Patient and Public Involvement Section 11 of the Health and Social Care Act (HMSO 2001) places a duty on NHS trusts, Primary Care Trusts and Strategic Health Authorities - to make arrangements to involve and consult patients and the public in service planning and operation, and in the development of proposals for changes. Creating a patient led NHS (DH 2005) states that patient and public involvement (PPI) should be part of everyday practice in the NHS and must lead to action for improvement. Patient and Public Involvement is reflected in the core national standards which the Healthcare Commission will take into account when they assess all NHS healthcare providers. A patient-led NHS Better quality, and more capacity, stimulated by More insight into financial incentives People offered local communities, services to maintain to improve how health, not just treat effectively we help sickness them A patient-led NHS Applying learning – builds on the Locally driven from around the best from the past service, operating to world in a new a national institute for skills framework and and innovation standards A joined-up service A choice for patients which enables of when and where integrated care for they are treated patients Page 18 of 31 Beyond Boundaries: A Guide to Diabetes Networks How diabetes networks should encourage patient and public involvement Networks will need to explore how they can involve people with diabetes, parents/carers in the planning and development of local services. They will also need to consider how they can engage with the “hard to reach communities” by adopting a range of methods for consultation. Diabetes UK has produced a toolkit for networks and PCTs: Key actions for PCTs and Diabetes Networks to make user involvement a reality. Further information on service user involvement in diabetes and examples of good practice can be found on the Diabetes UK at www.diabetes.org.uk Key actions for Diabetes Networks to make user involvement a reality: Stage 1 Networks will need to develop a user involvement strategy ensuring people living with diabetes are involved at all levels of planning, including setting priorities, monitoring and evaluation. This strategy should build upon the PPI strategies, where these exist in the PCTs that are in the diabetes network . PPI leads may be able to help and advise on this. Stage 2 People with diabetes and/or carers should be included on the core network groups and each of the planning groups as service user representatives. A minimum of two service user representatives should be included on each group. There will be a need to provide support and training for service user representatives and others who are involved in committees or groups. The user representatives should have a clear remit and the “term of office” should be agreed. The network may consider establishing a patient/carer reference group as a way of providing peer support and of improving communication/consultation. Stage 3 The network will need to establish mechanisms for ensuring involvement of the wider diabetes community. This may include people from Black and Minority Ethnic (BME) backgrounds and socially disadvantaged etc. It is advisable to use existing networks and to work with others such as link workers, local community leads etc. A variety of strategies will need to be utilised. Stage 4 Networks should feedback and take action on the results of wider research and consultation with people with diabetes to ensure the delivery of a responsive service. Feedback should be to individuals and communities through a variety of methods. This may include attendance at local meetings, newsletters, local press, radio etc. Page 19 of 31 Beyond Boundaries: A Guide to Diabetes Networks Service users and networks “I would like to see patients and carers welcomed as equal partners in making decisions about how we provide care for people with diabetes in this area” John, person with diabetes “I hope not only to be able to give something back by being a User Champion but also to learn about how the patients can have a role in improving services in the NHS. In particular I hope to use my professional experience to help NHS professionals to listen more effectively to the patient’s point of view” Anne, User Champion Page 20 of 31 Beyond Boundaries: A Guide to Diabetes Networks 5 Workforce Planning, Design and Development Workforce planning and design Workforce planning is about making sure there are the right number of staff in place, with the right skills and competences, doing the right job at the right time. It is a continuous process of shaping the workforce to ensure that it is capable of meeting the objectives for the service. How workforce planning and design is carried out To be effective workforce planning needs to be competence based and integrated fully into the development of models for service delivery. It is not difficult but it does require time and the right skills. Skills for Health has developed a competence framework for workforce planning which can be a useful reference. This can be found on the Skills for Health website www.skillsforhealth.org.uk Stage 1 Before undertaking any workforce planning it is important to have in place an agreed model of care. This will ensure that workforce planning is integrated into the design of services. Stage 2 Undertake an analysis of the current workforce. This can range from identifying the numbers of staff you have in each role through to carrying out a detailed assessment of the range of competences available across the workforce. This can form the basis of a training needs assessment, which should also be undertaken as part of the analysis. This stage is about comparing what is available now with what is needed to deliver the model of care. The output from this should be a gap analysis. Stage 3 Develop a Workforce Strategy. To be robust all key stakeholders need to be identified and included in its development. Some examples of questions that might be asked when developing the strategy are: • How will any gaps in competences be addressed? This could be through role redesign or the development of new roles • What training and development will be needed? This should be based on the training needs assessment • What is the workforce demand now and in the future? This will be driven by service need and activity If there are a number of possible options for how the workforce requirements might be met, an options appraisal should be carried out at this stage. It is important that a clear Page 21 of 31 Beyond Boundaries: A Guide to Diabetes Networks mechanism exists for feeding the Workforce Strategy into Local Delivery Plans (LDP) and other local planning processes. Stage 4 Implementation of the Workforce Strategy. This needs to include agreed milestones and timescales. It is also important to clearly identify who is responsible for doing what and how implementation will be monitored. Stage 5 Evaluate and revise the plan. Workforce planning is a continuous process and the Workforce Strategy needs to be reviewed at agreed intervals to ensure it is still meeting the needs of the service. Competences and how can they be used National Workforce Competences are statements of competence describing good practice and are written to measure performance outcomes. A single competence will describe the required standard to which a particular activity or function should be undertaken. They describe what needs to happen in the workplace - not what people are like. Competences are tools which can be used in a variety of ways including: • Workforce planning • Design of job roles and profiles • Role and service redesign • Recruitment and selection • Continuing Professional Development • Training and development Through Phase I of the Diabetes Competence Framework Skills for Health has developed a range of competences covering diagnosis, the management of Type 2 diabetes, retinal screening and screening for other complications. The competences cover the whole range of functions from patient presentation and assessment and through to treatment. They cover all staff groups, working in all staff grades, in all healthcare environments across the UK. Phase II of the project, which is currently underway will develop competences for Type 1 diabetes, including paediatrics, transitional care, pregnancy, psychological support and management of the ‘at risk’ foot. The development of National Workforce Competences/National Occupational Standards for Patient Educators/Facilitators will compliment the diabetes competence framework and support professionals working in the delivery of education to people with diabetes. Page 22 of 31 Beyond Boundaries: A Guide to Diabetes Networks Greater Peterborough Primary Care Trust NSF Steering Committee has been creative in role design: Greater Peterborough Primary Care Trust NSF Steering Committee This network involves North and South Peterborough PCTs, commonly known as the Greater Peterborough Care Partnership. Network Manager Kay Hircock said: “We work as one team. There’s no defining line between us. We are very much a cohesive team.” Network achievements: Development of the role of diabetes care technicians. This is helping with annual reviews, and bringing diabetes care into the community. The role is growing and now encompasses retinal photography, freeing up specialist nurses. They can also refer people on to specialist services, for example podiatry. Available support The National Diabetes Workforce Strategy, which is due to be completed in summer 2006 will support diabetes networks with all aspects of workforce planning, design and development. Locally Workforce Development Directorates will be able to provide advice, support and expertise. Page 23 of 31 Beyond Boundaries: A Guide to Diabetes Networks 6 Communications for Diabetes Networks Communications should be a key part in the activities of diabetes networks. It is essential to keep both network members and other stakeholders informed of what is happening and what the network is doing. Good communication strategies are an effective way of raising the profile of diabetes amongst local influencers and decision makers. This section of the Network Guide provides some simple recommendations to develop and improve network communications. The support and advice of local communication officers will also be an invaluable resource and allow you to connect with all the local communications channels and initiatives. Stage 1 - Get Someone To Do It As a starter it is recommended that someone in the network be given specific responsibility for communications. This could be a local communications officer from a PCT or Hospital Trust, which would be the best solution, or someone from the network who is prepared to take on the role. Whether they are directly involved or not local communications professionals will be a valuable resource in terms of advice and support. Stage 2 - Identify What You Want to Tell People You will need to identify a number of key messages that you want to communicate about what the network is doing and has achieved. The NDST has compiled a list of key messages, ways of promoting them and potential audiences. These might act as a useful guide to local networks in thinking about their own particular messages. Stage 3 - Identify Who You need to Communicate With It is obviously important to find out who needs to be kept informed and what they need to be informed of. Because different people will be interested in different things it is important that key messages match the needs of the audience. Members of the network will obviously fall into that category but there may be others that are not so obvious. These could include: • Chief Executives of SHAs, PCTs and Hospital Trusts • Local diabetes leads • Long Term Conditions leads • Local Communications Officers • Professional Executive Committee (PEC) Chairs • Diabetes UK and other local service user groups Page 24 of 31 Beyond Boundaries: A Guide to Diabetes Networks • Local media - any communication with local media should always be cleared by local communication officers. A simple aid to this is to compile a contact list containing names, titles, addresses and email addresses. Stage 4 - What Sort of Things Should You Be Telling People You should adopt a proactive approach to communicating your network activities and achievements and ensure that people know what you are doing. Different people will be interested in different things and so by using your key messages and audiences you should match message to audience. Examples of the type of things people will be interested in are: • Service improvements • Conferences • Seminars • Workshops • Policies • Initiatives Chief Executives will be interested in benefits realisation. If a national or senior local figure is involved then it is even more important that people are told about it. How You Can Tell People There are a number of very simple ways that you can use both printed and electronic methods to let people know what you are doing. These include: • Meeting minutes • Network Updates in printed and electronic form • Local NHS Newsletters • Emails • Web Sites • News releases – always cleared through local communications teams • Posters It is useful when writing anything to consider plain English principles and also design. The clearer the language the easier it will be to read and reach wider audiences whilst adding some simple design techniques, such as using two columns of text, will also help. The use of pictures, graphics and colour also enhances the appearance and usability of both electronic and printed material. Page 25 of 31 Beyond Boundaries: A Guide to Diabetes Networks By following some of these simple principles the valuable work of Diabetes Networks can be given wider recognition and the profile of diabetes raised throughout the locality. Good communications are vital to alerting key influencers and decision makers as to how effective networks can be in improving diabetes care and the importance of supporting them. It may be a good start to discuss this with your local communications officer, they are often able to advise on the most appropriate mechanisms and increase your opportunities for publicity. Page 26 of 31 Beyond Boundaries: A Guide to Diabetes Networks 7 Diabetes Clinical Network – Getting Started Stage 1- Need for a network is identified Networks develop through a common interest or purpose with people that are passionate about what they do and how they do it. They tend to be built on existing relationships or a common purpose of different stakeholders with a common aim. Drivers – • Diabetes NSF (DH 2001) and Delivery Strategy (DH 2003) • The requirement of organisations across a pathway to work together • Health Policy - patient led and centred care Stage 2- Development The diabetes network may emerge from an informal clinical group, or a more formalised commissioning group. It is unlikely that there is not an existing forum that can develop into a more effective clinical network. So identify what currently exists and build upon it. If not identify key influencers through existing relationships and interests. Stage 3- Leadership Someone has already demonstrated the drive and determination to start the process of network development. But leadership in the early stages is critical. The engagement of senior level staff in the development of a network is essential to ensuring its success. So these key influencers need to be on board, eg Chief Executives, PEC chairs of PCTs. Stage 4- Identify Stakeholders The network will consist of a number of stakeholders involved with planning, commissioning and delivering a diabetes service. There should be representatives from local authority, social care and the ambulance service as well as those directly involved in delivering diabetes care . The stakeholders should represent the diversity and individual needs of the network population. If there is more than one PCT involved then one should be identified through discussion and agreement of taking a lead role across the network for diabetes services. Page 27 of 31 Beyond Boundaries: A Guide to Diabetes Networks Stage 5- Identify someone to co-ordinate the network Co-ordination or management is critical to the success of a clinical network. This role needs to be identified early on in the process of development. Stage 6- Network Launch Event Ideally a whole day or half day event where the core team of Chair, clinical and user champions can be ‘elected’. Network purpose and terms of reference agreed and some early priorities for the network identified. This event will need to include some identification of development needs. External Drive The drive for the development of a clinical network may come from an external source. The National Diabetes Support Team (NDST) is promoting and supporting the development of clinical networks. The Regional Programme Manager (RPM) may be the instigator and can in the first instance support the initial set up phase of a network. Ongoing Development of the Network Clinical networks need to be continually reviewed for usefulness if they are to endure (Goodwin et al, 2004). In order for networks to become increasingly effective they need to understand what stage of network development they are at. All networks will be continually evolving and the stage of development of each network will vary. The developmental stage of the network may also be subject to change if any of the key personnel in the network move on. This emphasises the need for succession planning within the network in order to ensure sustainability. The National Diabetes Support Team (NDST) has developed a Network Self Assessment Tool. Completion of the tool will assist networks in undertaking a gap analysis and the production of an action plan which should assist the network in identifying areas for further development. It will also allow networks to clearly see where they are making progress and can provide opportunities for shared learning. This process can be facilitated by the RPM. Page 28 of 31 Beyond Boundaries: A Guide to Diabetes Networks Key stages in setting up a network Consider structure of Need for network identified and constituent the network: Ideally organisations agreed based around the population served by a single acute trust Seek “Buy in” from senior level in organisations eg CEOs Define terms of reference: give careful consideration Identify stakeholders to network partners at this stage Appoint dedicated network manager Identify other key roles and agree role descriptions Network launch to raise awareness of network and involve stakeholders Define network strategy and agree communication mechanisms Page 29 of 31 Beyond Boundaries: A Guide to Diabetes Networks 8 Conclusion There has never been a better time to be involved in a diabetes clinical network in the “new world” of planning, commissioning and delivery of high quality health care with the diversity of providers now available. Clinical networks are key in ensuring patient safety by crossing boundaries and by involving clinical teams and people with diabetes and their carers. This guide will be supplemented by an ongoing series of supporting documents which will be informed by emerging NHS policy. Further guidance will focus on the specific aspects of developing effective networks and the potential impact of policy on diabetes services. The toolkit accompanying this guide contains a round up from networks of key documents etc which networks may find useful. There are also links to other resources and websites and suggested further reading which some may find useful. Further information and discussion on how networks can deliver specific aspects of the NSF can be posted on the National Diabetes Support Team web site: www.diabetes.nhs.uk. Items can be posted on the general forum which encourages the sharing of information and good practice. Our thanks are due to everybody who has contributed to this guide. We are confident that it will inform the development and progress of effective diabetes networks. They will make a significant contribution to the improved care of people with diabetes and support local health economies deliver the NSF standards. Bev Bookless Anne Greenley National Diabetes Support Team Network Development Manager Programme Director Page 30 of 31 Beyond Boundaries: A Guide to Diabetes Networks 9 References Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform Department of Health (2000) The NHS Cancer Plan: a plan for investment, a plan for reform Department of Health (2003) National Service Framework Diabetes: Delivery Strategy. DH, London Department of Health (2004) The NHS Improvement Plan: Putting people at the heart of public services Department of Health (2005) Creating a patient-led NHS: delivering the NHS improvement plan. DH, London Department of Health (2006) Our health, our care, our say: a new direction for community services Goodwin, N., 6 Perri, Peck E., Freeman T., Posaner R. (2004) Managing across diverse networks of care: lessons from other sectors. Policy report to the NHS SDO R&D Programme, Health Services Management Centre, Birmingham HMSO (2001) Health and Social Care Act Pedlar M. (2001) Issues in health development. Networked organisations-an overview Edwards N., Fraser SW. (2001) Clinical networks: a discussion paper. London: The NHS Confederation Scottish Executive Health Department, (2001) Promoting the development of managed clinical networks in NHS Scotland Snow and Miles (1992) cited in Edwards N. and Fraser S. (2001) Clinical Networks: a discussion paper. NHS Confederation. London Wall, D., Boggust, M., (2003) Developing Managed Clinical Networks, Clinical Governance Bulletin March 2003 Further copies of this document can be ordered by emailing NDST@prolog.uk.com or tel: 08701 555455 quoting NDST026 Designed and produced by: NHS Clinical Governance Support Team Page 31 of 31 email: firstname.lastname@example.org website: www.cgsupport.nhs.uk