Adult Safeguarding: Roles and Competencies for Health Care Staff

Adult Safeguarding: Roles and Competencies for Health Care Staff
RCN 20 August 2018

• This intercollegiate document has been designed to guide professionals and the teams they work with to identify the competencies they need in order to support individuals to receive personalised and culturally sensitive safeguarding. It sets out minimum training requirements along with education and training principles.

NHS Leadership Review

Better leadership for tomorrow: NHS leadership review

Lord Rose,  June 2015

• This review, initiated by the Secretary of State, examines what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS. It also asked how strong leadership in hospital trusts might help transform the way things get done and how best to equip CCGs to deliver the NHS five year forward view. 
• Lord Rose concludes that "the NHS, as a whole, lacks a clear, consistent, view of what ‘good’ or ‘best’ leadership look like" (p20). He found "that there was no consistant clear picture for CCGs of what ‘good’ commissioning performance looks like." (p22)

Highlights for CCGs:

• When considering the importance of leadership to support large scale change within CCGs Lord Rose says: 
•  "The current level of support given to CCG Chairs and other senior individuals such as Accountable Officers and Chief Clinical Officers is woefully inadequate. There is no ‘step up’ for these individuals: either they have the necessary leadership skills or they don’t. A systematic way to identify and develop this group is needed."
• The review also considers the place of cross-functional training of CCG Chairs to support their relationships with other CCGs and local providers.
• When considering the training which is available, Rose concludes that more can be done to encourage those working in CCGs to take part in courses offered by the NHSLA and the NHS Staff College, and that this provision needs to be supplemented by a new training programme for the specific needs of those working in commissioning.
• The review acknowledges the concerns of CCG Chairs around balancing their role as Chair and their responsibilities as practicing GPs. 
• Greater collaboration and integration of working between CCGs and providers to reduce the fragmented nature of commissioning would reduce tensions between the different organisations.
• The lack of performance management and talent management is discussed, in particular the inadequate support for CCG lay members and NEDs.
• " the NHS is drowning in bureaucracy" (p40)

The review makes 19 recommendations:

What does a great CCG look like? - CCG Development Framework 2013/14

CCG Development Framework 2013/14: Working together to achieve excellence in clinically led commissioning
Prepared by John Bewick, Director of CCG Development, NHS England, 28 August 2013

• The CCG Development Framework identifies the most important areas for future CCG development. The aim is to develop a clear understanding of what excellent practice looks like across the range of domains that underpin a CCG’s ability to deliver transformational change.
• It is intended to support CCGs and Area Teams in identifying where to prioritise development efforts. It will guide NHS England in its leverage of development resources with national partners; and it will signal to suppliers of development where they can most effectively add value. One of the outputs is a Directory of CCG Development Support Offers (draft Sept 2013)
• The most significant challenges identified as priorities by CCGs include:
• Service challenges
• addressing unwarranted variations in quality and safety of present services;
• reducing health inequalities, including variations in access to services and health outcomes;
• delivering whole care delivery system change, promoting health, wellbeing and independence and avoiding unnecessary use of urgent and emergency services; and
• redesigning services to bring them closer to home, wrapped around the complex needs of individuals, including the redesign of primary care.
• System challenges
• leading local communities in embracing new service offers;
• achieving collaborative agreement across several commissioners to shared priorities; and
• releasing resources trapped in familiar but outdated services for reinvestment.
• Development Challenges
• Striving to engage and exploit the talents of clinicians and managers within the CCG;
• Strengthening the new relationships between general practices as the membership of the CCG;
• Exploring the new potentials of commissioning support services provided from outside the CCG to complement their own strengths, improving their access to expertise, value for money and resilience in commissioning functions;
• Establishing new collaborative commissioning arrangements with other local commissioners including local government, NHS England and other CCGs; and 
• Establishing good and productive relationships with NHS England nationally and locally, including receiving useful support, commissioning together locally, and assurance and oversight.
• The CCG development framework will be reviewed annually

What do commissioners actually do? - a research study

Commissioning high-quality care for people with long-term conditions
NIHR Service Delivery and Organisation programme, March 2013

• Researchers examined the ‘nitty-gritty’ of what commissioners do on a day-to-day basis, focusing on how they sought to develop and improve care for people with diabetes, dementia, and stroke.
• An in-depth two year study of commissioning practice in three high-performing primary care trust areas (Calderdale, Somerset and the Wirral).
• The most striking finding was the sheer scale of the ‘labour of commissioning’ – the amount of meetings, discussions, planning, and analysis that goes into the review and commissioning of often small-scale service changes.
• Several themes emerged from the study of commissioning across the sites-
• The question of money
• The scale and pace of change
• External drivers of commissioning 
• The report concludes with a discussion of the observed activities most closely associated with effective commissioning, and suggestions for practical indicators that could be developed to assess their overall effectiveness.

Competencies for local Healthwatch

Knowledge and skills and competencies for an effective local Healthwatch
Local Government Association, January 2013

• An initial view of what the key knowledge, skills and competencies of an effective local Healthwatch would include.

CCG authorisation process

The Authorisation Process,
BMA General Practitioners Committee, November 2011

• A outline of the process by which CCGs are deemed ready and able to take on responsibility for the commissioning process and budget .  The document:
• discusses the six domains of competence for CCGs that the Government has identified;
• highlights issues for general practitioners (GPs) and Local Medical Committees (LMCs) to consider and
• provides examples of how a competent and successful CCG should operate.
• One of a series of documents designed help doctors understand commissioning in a changing NHS.