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Health Education England NCEL LETB Gateway 2 Submission

NCEL LETB Operating Model

Gateway 2 Submission

29 June 2012

Doc Reference: NCEL1227 Version: 1.8

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Gateway 2 - Operating Model

Contents

1. Purpose..........................................................................................................................................5

1.1 Introduction...........................................................................................................................5

1.1.1 The LETBs Role...............................................................................................................5

1.1.2 Developing the London LETBs........................................................................................5

1.1.3 The North Central East London LETB.............................................................................5

1.2 Opportunity...........................................................................................................................7

1.2.1 Overview........................................................................................................................7

1.2.2 The London Opportunities.............................................................................................7

1.2.3 NCEL LETB – Local Opportunities...................................................................................8

1.3 Vision/Rationale...................................................................................................................11

1.3.1 A Shared Vision for London..........................................................................................11

1.3.2 NCEL LETB - Operational Vision....................................................................................11

1.3.3 NCEL LETB - Mission.....................................................................................................11

1.3.4 NCEL LETB - Desired Delivery Outcomes......................................................................12

1.3.5 NCEL LETB - Immediate Priorities.................................................................................12

1.4 Design Principles and Planning Assumptions.......................................................................13

1.4.1 DH / HEE - Primary Design Principles...........................................................................13

1.4.2 London LETB’s - Collaborative Design Principles..........................................................13

1.4.3 NCEL LETB - Localised Design Principles.......................................................................14

1.4.4 Implementation Approach...........................................................................................15

1.5 Values and Culture...............................................................................................................16

1.5.1 Shared Values and Culture – DH / HEE / London LETBs...............................................16

1.5.2 NCEL LETB - Values and Culture - Delivery Methodology.............................................16

1.5.3 NCEL LETB – Values and Culture - Delivery Principles and Behaviours.........................16

2. Our Governance and Relationships.............................................................................................18

2.1 Governance..........................................................................................................................18

2.1.1 NCEL LETB – Engagement, Representation and Accountability...................................18

2.1.2 NCEL LETB Governance – Roles and Responsibilities...................................................19

2.1.3 LETB Shared Services...................................................................................................24

2.2 Stakeholder Relationships...................................................................................................25

2.2.1 The Evolving National Healthcare Infrastructure.........................................................25

2.2.1 Building Stakeholder Relationship - Overview.............................................................27

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2.2.2 Geographical Scope.....................................................................................................27

2.2.3 Stakeholders Groupings...............................................................................................28

2.2.4 Engagement and Communications Framework...........................................................29

2.2.5 Rational for the Framework.........................................................................................29

2.2.6 Targeted Engagement..................................................................................................30

2.2.7 Engagement and Communication Strategy..................................................................31

2.2.8 Stakeholder Engagement and Communications..........................................................32

3. Our Organisation.........................................................................................................................34

3.1 Functions, Structure and Ways of Working..........................................................................34

3.1.1 Organisational Architecture Design Overview.............................................................34

3.1.2 Lead Provider and Local Education Provider Model – Overview and Rational.............35

3.2 Functions.............................................................................................................................37

3.2.1 Overview......................................................................................................................37

3.2.2 LETB Functions.............................................................................................................37

3.2.3 The Lead Provider - Functions......................................................................................37

3.3 Structures............................................................................................................................38

3.3.1 LETB Structure..............................................................................................................38

3.3.2 Shared Service Structure..............................................................................................39

3.4 Ways of Working..................................................................................................................40

3.4.1 Workflows....................................................................................................................40

3.4.2 Annual Business Planning Cycle...................................................................................40

3.5 Running Costs and Affordability...........................................................................................41

3.5.1 Financial Envelope.......................................................................................................41

3.5.2 NCEL LETB Running Costs.............................................................................................41

3.5.3 Organisational Costs....................................................................................................42

3.5.4 Projected Cost Savings.................................................................................................42

4. Transition and Continuing Operation..........................................................................................44

4.1 Transition Approach............................................................................................................44

4.1.1 Rational for Transition.................................................................................................44

4.1.2 Phases of Transition.....................................................................................................44

4.2 Risk and Issues.....................................................................................................................49

4.2.1 Risks and Issues............................................................................................................49

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1. Purpose

1.1 Introduction

The government announced its intention to transfer responsibility for commissioning education and training to local partnerships, or Local Education and Training Boards (LETBs) in Liberating the NHS Workforce. Formal guidance on implementation of these changes was published on 10th January (Liberating the NHS: Developing the Healthcare Workforce - From Design to Delivery). LETBs will take on much NHS Education and Training commissioning, including control of the Multi Professional Education and Training levy (MPET) budget allocation, when the Strategic Health Authorities (SHAs) cease to exist on 1st April 2013.

1.1.1 The LETBs Role

The role of the LETBs will be to:

Work in partnership with the local health community to identify and agree local priorities for education and training to ensure the supply of compassionate, knowledgeable and highly skilled people providing health and public health services well connect to social care provision;

Plan and commission excellence in education and training on behalf of the local health community in the interests of sustainable, high quality service provision and health improvement;

Be a forum for developing excellence across the whole health and public health workforce.

1.1.2 Developing the London LETBs

NHS London has been working towards the creation of three LETBs for London based broadly upon the geographic areas covered by the Academic Health Sciences Centres and Heath Innovation and Education Clusters – NC and NE London; South London and North West London (Please refer to supporting Document Reference NCEL1213).

The design teams supporting the three emerging LETBs have been working collaboratively - supported by the expertise of NHSLondon - to develop target operating models for their individual LETBs and also to create a joined up vision and approach to the delivery of LETB services across London.

These new LETB arrangements will deliver benefit to patients, employers, the workforce, students and trainees through excellence in education and training, tailored to local need while recognising national priorities.

The three London LETBs will become fully operational in April 2013 when NHS London is disbanded

1.1.3 The North Central East London LETB

The North Central and East London Local Education Training Board (hereafter known as NCEL LETB) is the largest of the three LETBs being set up to provide control and management of workforce planning, education commissioning and provision across London.

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http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_132087.pdf

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf


A representative NCEL LETB Transition Board chaired by David Fish CEO of UCLPartners (UCLP) has been put in place to oversee the organisational design of the NCEL LETB from April to October 2012 prior to authorisation by Health Education England (HEE) and establishment of an end-state board, with independent chair in October 2012.

The operational and organisational design process has to date been managed by the NCEL LETB Design and Delivery Project Team that has drawn extensively on inputs resulting from comprehensive stakeholder engagement, collaboration with the other two London LETBs and NHSLondon subject matter expertise.

This documents sets out the proposed high level operating model that is to be adopted by the NCEL LETB in order to provide excellence in service to all its key stakeholders.

The NCEL LETB has engaged with local stakeholders to gain support for the proposed leadership, vision, governance, operating model and high level intentions as set out in this document and the direction of travel as outlined in this document was been endorsed by the NCEL LETB Transition Board at the meeting held on the 13 June 2012

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1.2 Opportunity

1.2.1 Overview

The immediate challenge facing the NCEL LETB - and the other London LETB’s - is the safe transition to operational delivery of services of an excellent quality which meet the local, London and National agendas within the reducing and non-negotiable financial envelope for the provision of such services in the future. In delivering these services the NCEL LETB will need to address and deliver against the following opportunities.

1.2.2 The London Opportunities

The future education and training commissioning system must ensure sustainable supply of the right healthcare professionals and provide solutions to service problems – both local, pan-London and recognise its impact nationally – while enabling enhanced innovation that will create professional flexibility and organisational behaviour that the future NHS needs.

1. Intra and Inter London workforce movements – The NCEL LETB must recognise the reality that London is a net exporter of our health and social care workforce – to other parts of the country, to private healthcare providers and internationally. The complex dynamics of intra-London movements of staff and the relationship between education and training provision need to be understood and managed in order to co-ordinate commissioning across LETBs in London. NCEL LETB must be able to respond to national workforce development imperatives such as the significant expansion of the Health Visiting workforce to 2015/16.

2. Changing care settings – In future patients will expect excellent integrated care structured around their needs rather than traditional professional boundaries. The focus of care must shift to settings in the Community that are easier for patients to access and potentially better value for money for the health service. In addition, and equally importantly, there must be a substantial emphasis on cross-agency partnership to promote health and wellbeing. These changes, which are now needed urgently, will need a transformed workforce in appropriate numbers equipped with the knowledge, skills and behaviours to deliver them. Education and training play a central role enabling safe and effective workforce change supporting developments planned to improve patient experience and population wellbeing. NCEL LETB will be a locally-focussed platform for partnership between service and education providers to commission and provide effective and safe education and training to support this service transformation.

3. Utilising our collective abilities –The NCEL LETB believes that effective and carefully planned multiprofessional education and training are a key means to bring together the disparate parts of our healthcare system – e.g. primary care, secondary care, mental health, public health, social care. Health outcomes improve when patients are cared for by integrated teams aligned to pathways of care. While health service educational programmes must continue to support the development of excellence in individual professional groups, more can be done to commission education and training across professional boundaries. In particular, the NCEL LETB will seek to sponsor education and training that fosters increased generalism, integration and team-working. As a comprehensive network partnership of health care and social care employers, six Universities, two Medical Schools and a successful

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Academic Health Sciences Centre, NCEL LETB is uniquely equipped to manage this new skills, behaviour and competency approach to workforce change.

4. Offering staff careers that are fulfilling and incentivising longevity – If the NCEL LETB is to ensure its stakeholders keep the best staff, they must be supported through the changes in skills, competence and behaviours that they will need to deploy in a fulfilling career. Education, training and development have a crucial role in incentivising staff to remain within the service and to provide excellent care to patients and people. It is an ambition of the NCEL LETB to make NCEL a brand for excellence in education, Training and continuing professional development across all professional groups.

5. Improving health outcomes – London’s NHS needs services that are patient-centred; population-focused; holistically designed; and orientated to prevention of long term conditions. This can only be achieved by a healthcare workforce equipped to balance and prioritise population and individual needs. Professionals will need increasing knowledge and expertise to intervene with the best and most appropriate care, cognisant of the breadth of solutions and available resources. Our experience with the NE NC London and Essex (NECLES) Health Innovation and Education Cluster (HIEC) has demonstrated that properly trained and motivated clinical leaders can be catalyse effective change for the good across large populations. The NCEL LETB will work to equip more of the workforce to be agents for health and well-being working in partnership with people, patients and providers.

6. Improving clinical excellence – The NCEL LETB headline priorities include: reducing the variations in care, reducing errors, increasing the right response to health needs with the right skills at the right time to reduce

duplication of effort, clear communications with patients, between professionals and between components of the

system.

In Medicine and Dentistry the NCEL LETB acknowledges the imperative to implement the recommendations of the Temple Report so that care delivered by Consultants is the default and service delivery becomes an effective learning methodology for trainees.

7. Promoting healthy lifestyles – There is a growing role for health professionals to be able to intervene in health outcomes not just through direct care, but also using their skills to influence patients and the public’s lifestyle. Supporting the development of professionals able to care for the population at large as well as individuals will greatly support longer term, population wide improvements in health.

1.2.3 NCEL LETB – Local Opportunities

The area to be served by the NCEL LETB shares some of the wider national and pan London workforce issues, but also has unique characteristics and associated problems. The workforce implications for the service of the current NHS North Central London, NHS East London and the City and NHS Outer North East London strategic commissioning plans are significant:

1. Primary Care strategies - The implementation of the North Central London and North East London Primary Care strategies and integrated care programmes in North Central and North

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East London will have a direct impact on primary, secondary and community care in terms of ways of working, education and training. It is expected that the provision of care will shift from acute to community and primary care settings and that therefore the how and where of educating and training the workforce will change significantly. The NCEL LETB will need to understand the implications for training provision, pre-registration and continuing professional development across all clinical professions and the wider workforce. How the NCEL LETB provides for training and education will change to reflect the provision of care across pathways of care and networks of providers rather than by organisational boundary.

2. Organisational changes – Providers face significant organisation change. For example, the Barnet, Enfield, Haringey Clinical strategy, the Health 4 North East London programme along with significant organisational change associated with Barts Health and BHRUT, which all will affect the provision of training and education across employers. The NCEL LETB will need to collaborate and support its members responding to the education commissioning implications of these organisational changes and ensuring the benefits possible from the investment into infrastructure and restructuring are maximised.

3. Local demography – The geographical area that the NCEL LETB covers encompasses London boroughs with considerable wealth and other areas where all the local wards in a borough are within the top 10 per cent of the most deprived in the country. The NCEL LETB will need to develop new partnership working relationships with providers and HEIs to maximise local recruitment to professional, academic and other development programmes to reduce existing inequalities of access and opportunity.

4. Productivity – Service providers are faced with significant productivity challenges which will have an impact on ways of working, shape and size of provider workforce and education and training.

5. Workforce planning development – The development of workforce planning to inform both long and short term education commissioning investment is in its infancy. The NCEL LETB will need to continue the development in particular assuring integrated workforce, finance and service planning.

6. Health Visitors – It is expected that the NCEL LETB will need to respond to national workforce development initiatives such as the significant expansion of the Health Visiting workforce to 2015.

While NCEL does have excellent examples of educational practice, there are places where the quality of education and training remains sub-optimal. The NCEL LETB recognises the opportunity to drive up quality and performance through partnership, supportive development and where necessary in making tough commissioning decisions.

The North Central and North East London area that the NCEL LETB will serve has excellent potential to address these challenges.

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1.3 Vision/Rationale

1.3.1 A Shared Vision for London

The three London LETBs have agreed on the common design principles for the delivery and management of Workforce, Education and Training for London. The approach of local and shared functional services and the governance arrangements outlined in this document will ensure that the three LETBs have a shared vision - and can speak with one voice - for London.

1.3.2 NCEL LETB - Operational Vision

The following operational ideals underpin the NCEL LETB and its vision of service delivery:

Working in partnership to deliver a service that meets local workforce reconfiguration, education and training needs and ensures highest quality service to patients

Providing a lean, effective, responsive and transparent mechanism for decision making Providing a lean, effective, responsive and transparent mechanism for commissioning and

funding education and training activities that drives delivery of excellence Providing assurance that commissioning decisions and priority-setting reflect the needs of

patients, students and trainees and the health system as whole

1.3.3 NCEL LETB - Mission

The mission of the NCEL LETB is to optimise health outcomes and experience in the NE/NC locality through delivery of excellence in multi-professional education, training and workforce development that is aligned to current and future healthcare service needs.

The NCEL LETB will focus on ensuring that education commissioning and workforce development is based on excellence of content and output through intelligent and challenging partnership working across all healthcare service providers and education providers in the NE/NC locality: a Partnership for Excellence. The NCEL LETB will build upon the values and partnership ethos of UCLPartners (UCLP) and will maintain an uncompromising focus on excellence, quality and patient safety.

The NECL LETB will work closely with healthcare service providers to strengthen integrated workforce planning and workforce development, including promoting leadership excellence. The LETB will help enable service improvements and the re-design of services along care pathways, particularly supporting the movement of services closer to homes and the development of integrated care to meet the changing needs of the population. The evolving Academic Health Sciences Network (AHSN) will provide the infrastructure for provider side partnership.

The NCEL LETB will operate to ensure that education and training are rooted in what really matters to patients and what service providers need while striving to exceed quality standards in clinical excellence. The LETB will be steered and informed through clear and open interactions with a full representation of local service providers and Universities while responding to HEE and the requirements of the national Education Outcomes Framework.

The NCEL LETB will work in partnership with local stakeholders, including patients, students and trainees, local authorities, the independent and third sector providers and other LETBs. The LETB will take a national leadership role in enabling the design and delivery of distinctive education and

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training that maximises service, educational and placement resources in the most efficient and cost effective way for patient benefit.

1.3.4 NCEL LETB - Desired Delivery Outcomes

The NCEL LETB will deliver the following outcomes:

Provide a sustainable workforce responsive to the changing needs of the population and equipped to provide excellent care for patient’s both now and in the future.

Be accountable and representative of the needs of local employers and other key stakeholders through fair, transparent and evidence based decision making.

Ensure the local healthcare workforce consistently demonstrate the capabilities and values needed to meet local health community needs and health improvement goals.

Commission relevant education and training in partnership with Universities with a focus on quality outcomes and clinical excellence to ensure delivery of high quality, multi-professional education and training in NE and NC London.

Ensure that education and training meets regulatory professional and assurance standards that also aligns with the Education Outcomes Framework.

Establish appropriate roles and responsibilities between the NCEL LETB and the providers of education and training services, including NHS placement providers.

Increase value for money from allocated Multi Professional Education and Training levy (MPET) funding.

Have financial control of operational costs, including determining the scope and scale of internal LETB operations and outsourced services.

Be responsive to future healthcare needs by supporting integration of health, public health and social care and the movement of health services into community settings.

Establish appropriate roles and responsibilities between the LETB (‘the commissioner’) and the providers of education and training services, including NHS placement providers.

Meet and where possible exceed expectations of Health Education England (HEE).

Model behaviours and values consistent the NHS Constitution

1.3.5 NCEL LETB - Immediate Priorities

While the capacity and capability to affect real change in education and training during ‘shadow’ operations will be limited and safety in transition remains a high priority, the NCEL LETB is eager to prioritise the following improvements, amongst other outcomes:

Enhancing the quality of postgraduate medical and dental education through increased collaboration between placement providers and Universities

Local Education Provider development to enhance undergraduate pre-qualification training in nursing, midwifery and allied health professions

Multiprofessional post registration training to supply excellence in clinical professionals to provide integrated care across patient pathways

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1.4 Design Principles and Planning Assumptions

1.4.1 DH / HEE - Primary Design Principles

The primary design principles are those set out in Liberating the NHS: Developing the Healthcare Workforce from Design to Delivery and the advice given by the Future Forum:

1. Greater accountability for all providers to plan and develop their workforce, whilst being professionally informed and underpinned by strong academic links

2. Aspiring to excellence in training and a better experience for patients, students and trainees3. Supporting NHS values and behaviours to provide person-centred care4. Supporting the development of the whole workforce, within a multi-professional and UK-

wide context5. Widening participation6. Supporting innovation, research and quality improvement7. Providing greater transparency, fairness and efficiency to the investment made in education

and training8. Reflecting the proposed, explicit duty of the Secretary of State to secure an effective system

for education and training9. Sustainability and value for money10. Facilitate best use of local education and training resources

1.4.2 London LETB’s - Collaborative Design Principles

NHS London has been and will be responsible for healthcare workforce planning, education commissioning and quality management until LETBs take full operational responsibility in April 2013. This system has undergone significant development over recent years, developing capacity and capability that has informed the design of the three London LETBs. To this end the three London LETBs supported by NHSLondon have identified the following high-level collaborative design principles:

Three LETBs for London, led by employers in partnership with key stakeholders o Allocations made from HEE to individual LETBso Local accountable bodies for education, training & workforce planningo Constituted to exercise authority invested in them, o Employer-led with input from key stakeholders

Complete the roll-out of the MDECS processo Fewer direct commissions for individual placements – all medical and dental

commissioning through Lead Providerso Lead Providers take up QA responsibilities in relation to individual placements/rotationso Potential development of LP model to

i. multi-specialty, ii. integrated primary & secondary care,iii. multi-professional education

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Setting a direction of travelo Local where possible, centralised where necessaryo Move to planning and commissioning education and training on a multi-professional

basis which is across a care pathway and patient focused

Focus on efficiencyo Establish a shared service working to the LETBs to deliver functions that are most

effectively done together across Londono Requirement to meet challenging reductions in running costso Commissioning support from other agencies as well, e.g. CfWI to provide certain

workforce analysis

Safe transition o The LETBs are committed to safe transitiono The model proposed allows for certain current NHSL/PGD functions to be integrated in

a single shared support serviceo Some functions will transfer to individual LETBs and LPs at the outset, others can follow

and those elements that are best delivered once for all three LETBs have a sustainable basis for the future.

These high-level operating model design principles are further underpinned by a number of more specific shared design principles – please refer to Appendix 1 LETB Shared Design Principles for further details.

1.4.3 NCEL LETB - Localised Design Principles

The NCEL LETB has identified opportunities to maximise the benefits of partnership working to further elaborate existing improvements for the benefit of patients, trainees, employers and the wider health service, particularly for individual localities. In order to achieve this, the NCEL LETB’s design has and will continue to based on the following principles centred upon Partnership for Excellence:

1. Contribute to an excellent patient, student and trainee experience 2. Sustain delivery during transition3. Be provider/employer driven to meet current and future workforce needs4. Have a fair, transparent and accountable governance structure that averts and manages

potential conflicts of interest5. Promote innovation, multi-professional training and research excellence with University

partners based on care pathways.6. Drive maximum return on investment within a defined financial envelope7. Champion multi-professional development working with experts in the field8. Ensure the highest possible quality and safety standards and promote clinical excellence9. Promote challenging partnership working and collaboration10. Facilitate input across all healthcare professionals and workforce groups11. Encourages partner organisations to oo-ordinate non-MPET funded education and training

(e.g. Bands 1-4 and social care workforce) to leverage mutual benefit and benefit for the system as whole.

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1.4.4 Implementation Approach

Using the design principles and planning assumptions as set out above, the current operational system will be re-designed and reconfigured by the three London LETBs and NHS London - working collaboratively and with full consultation with stakeholders - to best meet individual LETB, London wide, National and International service needs.

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1.5 Values and Culture

1.5.1 Shared Values and Culture – DH / HEE / London LETBs

The NCEL LETB endorses the following statement on shared values and culture

‘London has a leading role both nationally and internationally in training and education of healthcare professionals. We take this responsibility seriously and will work together as three LETBs to ensure that this position of national and international leadership is enhanced. We have agreed to work together to represent London when appropriate and to that end will meet regularly to discuss issues that affect London as a whole. Throughout the year we will seek to align our planning processes so that we are proactive in our awareness of each other’s plans. We will be collaborative and transparent in our dealings as individual LETBs and also when we work together. We have agreed that there are a number of areas where it will be sensible and more efficient if we were to do them just once for London. This could include commissioning smaller specialities.

We are all committed to driving up patient care and improving people’s experience of working in the healthcare system. We must attract the best people to come and work in our health system. We see high quality education and training as a key that will lead to excellent high quality research which in turn we want to see leading to improvements in quality and innovation in our patient delivery systems. Through this cycle we will enable improvements in the health and wealth of London’

1.5.2 NCEL LETB - Values and Culture - Delivery Methodology

The NCEL LETB will fulfil its vision by ensuring the following are integral to its delivery methodology:

• Care pathway specific• Patient facing• Continuity between undergraduate and postgraduate• Pedagogic research• Identifying and creating innovative solutions to long term problems • Collaboration with other LETBs, particularly the two in London, to share good practice,

make the best use of resources and avoid unnecessary duplication• Innovation resources• Involvement of the private and voluntary sectors• Ensure education of the whole workforce, including bands 1-4 • Maximise opportunities for working with the AHSN to avoid duplication of effort and

expense

1.5.3 NCEL LETB – Values and Culture - Delivery Principles and Behaviours

The NCEL LETB will fulfil its vision by ensuring the following principles and behaviours are embedded within its operations and our manifested in people’s behaviours and the ways things get done:

Effective leadership with a shared vision and agreed outcomes Collective responsibility, working together in a transparent, inclusive and accountable

way Well articulated ways of working within the NCEL LETB Explicit links to planning for workforce transformation, e.g. better services better value Collaboration with other LETBs within and without the bonds of London.

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Takes difficult decisions Takes cross-sector decisions that support commissioning consortia and system-wide

leadership

Learning organisation Learn from the past and experiences of others Resolve disputes Develop the capability to undertake workforce modelling Aim for the best Model high values and attitudes (to probity, fairness, widening participation,

compassion, equality and diversity)

Demonstrate professional and clinical legitimacy for joint decisions Commission and decommission through robust processes Support a pan-London voice on education and training

Make the best use of resources to ensure a trained workforce to meet patients’ needs Demonstrate effective governance Accountability for resources Promote best value with due regard for impact on partner organisations

Robust workforce planning at employer level Assess workforce design, skills and behaviours not just workforce numbers High level multi-professional dialogue to define key workforce issues Education and workforce development to support strategic service changes and

innovation not just business as usual Working with the Better service, better value workforce transformation and change

planning boards Accurate and consistent intelligence that can be used to inform planning and modelling

across the sectors. Develop a consistent approach to understanding requirements so that we can plan in an integrated way for the medium and long term. This will include understanding the local labour market and ensuring that the workforce analysis is sufficiently robust to translate into an education change programme.

Essential to include all the workforce in the workforce planning process, including the independent/third/private sector and the GP practice workforce

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2. Our Governance and Relationships

2.1 Governance

This section covers the governance arrangements for the NCEL LETB including details of the formation of the Board, the relationships between the LETB and the Academic Health & Sciences Networks (AHSN) and the governance arrangements for shared (once for London) services.

2.1.1 NCEL LETB – Engagement, Representation and Accountability

The constitution of the LETBs is designed to give employers a strong voice in the development of Education and Training tuned to local workforce need across acute, mental health and community health services, primary care and local government. LETBs will need to link with a comprehensive partnership of service and training providers, including Universities, Local Authorities and non-NHS healthcare providers, forming a partnership for excellence, innovative and value for money.

To this end the NCEL LETB operating framework has been designed to maximise engagement whilst streamlining representation so as to enable delivery, effective governance and direct lines of accountability.

The streamlining of representation from stakeholder to member, from member to constituency, from constituency to Advisory Council representation, and from Advisory Council representation to LETB Board representation provides an operating framework whereby the Board can provide an appropriate degree of representation in line with HEE requirements and attain the required skills mix, whilst remaining small enough to enable effective governance and decision making.

The proposed operating framework not only serves to maximise engagement and representation in the planning and decision making process but also serves to provide a structure whereby there is only one layer of separation between the Board and the operational delivery for which it is accountable - as shown in Figure 1 below.

Figure 1: Target Operating Model – Organisational Structure Overview

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2.1.2 NCEL LETB Governance – Roles and Responsibilities

HEE - the NCEL LETB is represented by the Independent Chair who is a member of the HEE National Governing Body – working to agree Local, National and International priorities. The NCEL LETB will submit reports via its Independent Chair into HEE - reports will cover financial and performance management and quality assurance and by exception any escalated risks and issues.

NCEL LETB Board – the Independent Chair and the mandated executive and non-executive members will collectively form the Board responsible for discharging LETB duties. The proposed mix of membership – as shown in Figure 2 below - will serve to maintain an appropriate balance of skills and experience within the LETB.

Figure 2: Target Operating Model – NCEL LETB Board Membership

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Seat

s

Votin

g ‘Constituency’Skills / Role Comments Appointment

Rem

uner

ation

Non Exec 1 No Independent Chair Nationally appointed Day Allowance

Exec 1 No Managing Director Via recruitment process Employee

Exec 1 NoDirector of Finance (and Commercial Lead)

Via recruitment process Employee

Exec 1 No Director of Education & Quality (and Performance Lead)

Via recruitment process Employee

Non Exec 1 Yes Systems Representative

Member to be the Chair of Advisory Council - who will initially be the Chair of the ASHN Board (or another NED from the AHSN Board as the organisations mature)

Appointment nominated by the NED of the AHSN Day Allowance

Non Exec 1 Yes Provider 1 Nominations from constituencies appointed via simple majority of the Advisory Council Members

Day Allowance


Day Allowance


Day Allowance

Non Exec 1 Yes HEI Provider Nominations from constituencies appointed via simple majority of the Advisory Council Members

Day Allowance

Non Exec 1 Yes Student / Trainee Nominations from constituencies appointed via simple majority of the Advisory Council Members

Day Allowance

Non Exec 1 Yes Patient Representation Nominations from constituencies appointed via simple majority of the Advisory Council Members

Day Allowance

Members will be representing the Provider perspective - bringing a mix of skills and knowledge of Primary and Secondary Care Provision

Total: 11 (including Chair)

2/3

Prov

ider

1/3

Oth

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Stru

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Man

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The Board will act as the governance body that is directly accountable for the activities of the LETB Delivery Unit. The Board will be responsible for:

Co-designing and overseeing a strategy to implement HEE requirements - setting the strategic direction of multi-professional, education, learning and development within NCEL by agreeing an annually updated Strategic Plan (five year).

Providing oversight of multi-professional integration and activity with and within providers; Providing assurance over the operational delivery of the LETB ‘business’ - undertaking a

NCEL wide quality assurance function with regards to workforce reconfiguration delivery and education and training provision (including performance, competition, value for money, quality and local failure regime management).

Ensuring stakeholder engagement and being responsible for open and transparent consideration of views presented through the Advisory Council.

Overseeing an executive with responsibility for the LETB ‘business’, including the governance of any shared services.

Co-operating with other London and national LETBs to present a ‘London Voice’ and equally with other LETBs on national issues.

Managing significant risks and issues, and reporting on progress against agreed quality and performance measures on a regular basis (and by exception on patient safety and quality risk and issues) to HEE.

The Board will receive regular dashboard/scorecard reports that will encompass the KPIs and Benchmarks as outlined in this document and also cover key risk and issues. This Dashboard report and escalated risk and issues will be presented to the Board and HEE in line with agreed corporate

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governance reporting requirements. Risk and Issues escalated to the Board will be reviewed and the Independent chair will ensure that appropriate responses are made.

The proposed draft terms of reference of the Board as outlined above and any supporting reporting framework will be fully aligned with HEE governance structures and requirements as and when they are known.

Non-Executive Membership of the Board will be endorsed by a simple majority of the Advisory Council - should the Advisory Council be unable to agree their representation for a specific seat on the Board the final appointment decision would fall to the Independent Chair of the Board.

LETB Board meetings would initially be monthly – moving to bi-monthly or quarterly as agreed by the Independent Chair

Development Process – the Independent Chair and Executive Board members will be recruited / appointed in line with HEE timelines with the expectation the executive would in post July / August with the Chair following in September / October. Other non-executive members would then be nominated by and or agreed with the Chair with these nominations being endorsed by an majority vote of the LETB Transition Board / Advisory Council – with an expectation that all members of the Board would be recruited by the end of November. The initial term of the non-executive members will be for 24 months after which their re-election staged over a 12 month period as constituencies mature and develop appropriate processes to agree representation. Appointments will be overseen by and Appointments Committee / Panel.

Advisory Council – (shared with the AHSN). The Council will act as a Clinical and expert leadership forum that is collectively responsible for

Enabling stakeholder engagement between the LETB and their respective constituencies ensuring that there are appropriate methods and mechanisms to support their representation.

Actively engaging with all existing and any prospective providers (education and training and service providers).

Collating views and feedback from representatives on all matters relating to healthcare education and training and workforce issues

Openly and clearly presenting views of members to the LETB Board for due consideration.

Reviewing, endorsing and making recommendations to the Board regarding the annual and five year planning process.

Reviewing key decisions taken by the Board Reviewing, endorsing and making recommendations regarding Board membership

and reappointments Reviewing reports on the financial and operational performance of the LETB. Supporting the development of Advisory Groups

o reviewing, endorsing and making recommendations regarding the make-up of the Advisory Groups

o reviewing, endorsing and making recommendations regarding the chair of the Advisory Groups

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o reviewing, endorsing and making recommendations regarding Board sponsorship of Advisory Groups

The proposed draft terms of reference of the Advisory Council as outlined above and any supporting reporting framework will be finalised and agreed formally with the AHSN and appropriately aligned with HEE governance structures.

The Chair of the Advisory Council will be a NED of the AHSN Board – initially this will be the Chair of the AHSN Board with the potential to be another NED of the AHSN Board as the system matures. Members of the Council will be nominated as representatives from within their constituencies.

Advisory Council meetings would initially be bi-monthly – moving to quarterly as agreed between the Chair of the Advisory Council and the Independent Chair of the LETB Board.

Development Process - The current members of the NCEL LETB Transition Board will migrate to form the initial membership of the Advisory Council. The initial term of members will be staggered for re-election over 24 months as constituencies mature and develop appropriate processes to agree representation. In the event that a Constituency was unable to agree representation then the Chair of the Council would hold the deciding vote. Please refer to Appendix 2 NCEL LETB Transition Board Membership – for proposed representation.

LETB Delivery Unit – consisting of the Executive Directors and a number of Portfolio Managers and Administrative support. In short the role of the unit is to manage and coordinate all activity required to facilitate, support and empower the LETB Board, Advisory Council and Advisory Groups to (1) make commissioning recommendations and (2) oversee commissioning activity quickly and efficiently; and (3) ensure such recommendations are implemented (e.g. by the Joint Support Services).

The LETB Delivery Unit will be tasked with implementing the plan within tolerances as set by the Board and will report to the Board on progress, key decisions/actions taken, the finances of the LETB and the education and training commissions and funding flows within NCEL, and the quality of delivery by providers - reporting any material request for change/deviations to the Board or conversely to implement the same as directed by the Board.

The Unit will be led by the Managing Director who will coordinate activities across all areas of workforce reconfiguration and associated education and training commissions supported by a Director of Quality Assurance and a Director of Finance (collectively forming the LETB Executive) as well as a number of Portfolio Managers all of whom will have clear roles and responsibilities to deliver the following as a collaborating team:

First-rate support to the LETB Board, its Advisory Council, Advisory Groups, Constituencies and Membership

Integrated and Endorsed Workforce Reconfiguration Plans, Integrated and Endorsed Education and Training Commissioning Excellent support to Advisory Groups to enable

o The identification of planning priorities o Integrated workforce responses to service reconfigurationso Excellence in Workforce Reconfiguration and Education and Training Needs Assessment o Portfolio Management of Commissioned Activities

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o Efficient use of the LETB Joint Support Services

Development Process – the Executive will be recruited in line with HEE timelines with the expectation that the executive would in post July / August. The Portfolio Managers will be recruited to post following the NHSLondon timeline and processes with the expectation that these would be in place prior to full authorisation currently targeted for January/February 2013. Appointments to the LETB Delivery Unit will be overseen by an Appointments panel – consisting of LETB (Transition) Board Members supported by HR expertise from NHSL London with input from HEE where mandated

Advisory Groups - the LETB Delivery Unit will work with the Advisory Council to facilitate the setting up a number of Advisory Groups in order to deliver the mandate of the LETB Board. It is expected that such Advisory Groups would fall under two main categories

Long-Term - professional groups that would take on a sub-committee role to the Board with regards to specific areas of LETB Business / expertise – with an understanding that these could move to become more automatous bodies within the LETBs constituency

Shorter-Term - task and finish groups established by the LETB to address specific issues with a cross-professional emphasis and time limited existence.

The LETB Board will be able to assign members as sponsor/s to specific advisory groups (depending on how contentious the issue being addressed). Each Advisory Group will have a Chair nominated by the Advisory Council - either from the within the Council itself (or from the Council’s pool of alternate representatives) or if desired an external expert - with the Chair being endorsed by the Board and reporting informally to the Board member sponsor/s. Advisory Group members would not be substantive appointments but practicing clinicians and experts. The development and work of the Advisory Group will be supported by a Portfolio Manager assigned by the LETB Delivery Unit.

This approach ensures that Advisory Groups have the right leadership, integrity, gravitas and the ability to galvanise stakeholder buy-in and agreement on the proposed direction of travel as it is developed prior to ratification (or otherwise at Board level) – i.e. it ensures there are no surprises from within the LETB family.

Advisory Group meetings would be expected to be held at a frequency contingent with its mandate.

Membership – In addition to the Constituencies that nominate to the Advisory Council, the LETB and AHSN (as a separate entity to the founding membership arrangements for UCLP) will invite individuals to become Members. Members will be supported by a virtual forum whereby they can detail and express their interest in specific LETB/AHSN business areas. This would enable the LETB/AHSN/Constituencies to send out targeted information pertinent to member’s interests and conversely receive and act on feedback from members.

The membership would meet for an annual open meeting - chaired by the Independent Chair – that will act as the forum whereby members can

hold the board to account with regards to I. attendance and performance

II. the quality of the services provided III. delivery against plan

explore and scrutinise the five year and annual plan

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LETB Joint Support Services – works to support LETB Delivery Unit to discharge the LETB responsibilities (more information provided below).

2.1.3 LETB Shared Services

The LETB Shared Service Governance Group (SSGG) will govern LETB Joint Support Services (shared services).

Purpose - The SSGG’s terms of reference will be to:

Assure the design of the shared service operating model and it’s fit with the required cost envelope

Oversee the safe and effective implementation of the shared service operating model Agree key handover dates between NHSL/Deanery and LETBs Ensure shared services is delivering ‘business as usual’ support to LETBs, enabling them to

function effectively

Remit - The SSGG’s remit and responsibilities will develop over the phases of transition, details of this may be found in section 4.1. The intention is that the LETBs will start to take more decisions and take more of a leading role balanced within the constraints of the duties of the SHA while it still exists.

Membership - The SSGG will comprise representatives from each of the three London LETBs. The Managing Directors, Finance Directors and Directors of Quality & Education from each of the London LETBs will form the membership of the group. In attendance members of the current operation to advise on issues as needed.

The SSGG will be chaired by the Independent Chairman of one of the three London LETBs. The Independent Chairman from the host-LETB will not be permitted to chair the SSGG.

Meeting Cycle - The SSGG will commence meeting monthly during the Phase 2, and every 2 months thereafter.

Working Sub-Groups - In phase 1 (summer 2012) a Whole System Transition Group will oversee the design of the shared service operating model with input and advice from a Medical Workforce Group. Aspects of the shared service provided by NHS London will also be included in this redesign. A combined model of shared services will be designed by September 2012 end of Phase 1. Going forwards to implementation the Shared Services Governance Group may want to continue with working groups as appropriate.

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2.2 Stakeholder Relationships

2.2.1 The Evolving National Healthcare Infrastructure

The Health and Social Care Bill will disestablish SHAs and ‘Developing the Healthcare Workforce’ and ‘From Design to Delivery’ establishes devolution of decision-making power from regional to local levels and employer ownership of the system via LETBs. HEE will be have national oversight and will be accountable to the Secretary of State for ensuring that the health workforce has the right skills, behaviours and training, in the right numbers, to support the delivery of excellent healthcare and health improvement.

Figure 3: Target Operating Model – the Evolving Healthcare Infrastructure

These NHS reforms are introducing a number of new sub-national structures to co-ordinate the work of, and relationships between, different bodies in defined geographical areas - refer to Figure 3 above. These include LETBs as well as Clinical Senates and AHSNs amongst others – which in turn sit alongside current structures (some of which are also under review) – these structures include but are not limited to

Clinical Senates Networks Specialised commissioning hubs Academic Health Science Networks (AHSNs)(and AHSCs) Comprehensive Clinical Research Networks (CCRNs) Collaboratives for Leadership in Applied Health Research & Care (CLARHCs) Health Innovation and Education Clusters (HIECs) Quality Observatories (QOs) and Public Health Observatories

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Local Authorities

A key issue which has arisen in the design of the new system is that the numbers and geographical boundaries of both the new and existing structures vary significantly. In some cases this lack of consistency will not matter, but in others it could lead to problems in maintaining effective working relationships and partnerships.

The NCEL LETB believes there are significant benefits from closer alignment between structures as it will be easier to develop and maintain effective partnerships between structures and member organisations if arrangements are consistent. The NCEL LETB believes this will contribute to greater efficiency (including support arrangements); to closer links between the research, innovation education and clinical communities; and ultimately to improved outcomes.

Achieving close alignment between the NCEL LETB, the AHSN, Health and Well-being Boards and Clinical Senates and other parts of this emerging architecture provides a real opportunity to b ring together clinicians with NHS providers (inclusive of third sector and independent)and commissioners, academia and industry to drive the adoption and spread of innovative care and treatment that improves patient outcomes and population health. The NCEL LETB will take a leading role alongside the AHSN in bringing these component structures and organisations together across our geographical area and beyond.

The NCEL LETB is aware of and supportive of the healthcare infrastructure alignment review being undertaken by the NHS Commissioning Board that is based on the following principles:

Where possible boundaries of sub-national structures should be based on communities which have coherence in terms of work patterns. The foundation of this should be links to local authorities and CCGs, and patient flows.

There should be alignment of structural boundaries wherever relationships between structures are important.

Where one-to-one alignment is not possible there should be a principle of ‘nesting’ of boundaries within overall common footprints (i.e. co-terminous, but not necessarily at a one-to-one level).

The nesting approach should recognise, and build up from CCG and local authority boundaries, and should normally align within the four NHSCB regional boundaries.

Convergence of Senates, AHSNs and LETBs around a core pattern of geographical footprints should be considered carefully so that strong local linkages can be established, building on existing patterns and relationships.

The core pattern of geographical footprints should provide the most affordable and cost-effective working arrangement within the range of numbers being considered for each structure.

Given the complexities associated with this transition the NCEL LETB is aware that relationships with this evolving architecture will have to be managed flexibly and proactively so that the current one time opportunities - to achieve benefits through closer alignment where possible and desirable to achieve an architecture which will support improved partnerships and improved outcomes for NCEL - are achieved. Existing partnership development expertise within UCLPartners will inform this activity.

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2.2.1 Building Stakeholder Relationship - Overview

The NCEL LETB will ensure that education and training is rooted in what really matters to patients and what service providers and commissioners need - while striving to exceed quality standards in clinical and educational excellence. In order to achieve this - the NCEL LETB will develop and maintain close working relationships with a comprehensive range of stakeholders as represented in Figure 4 below.

Figure 4: Target Operating Model – Developing the Five Year Plan

As outlined above the NCEL LETB will be steered and informed through clear and open interactions with a full representation of local service providers and Universities while responding to HEE and the requirements of the national Education Outcomes Framework.

A number of these stakeholders will be internal to the proposed operational constituencies and processes as outlined in the previous section – other important interested parties will be on the periphery of a LETBs business and will have to be engaged with on a targeted basis.

The following sections aim to provide an overview of how the NCEL LETB intends to develop and maintain working operational relationships with its stakeholders in order to effectively discharge its duties.

2.2.2 Geographical Scope

Stakeholder identification is the critical first step to developing successful targeted communications to, and the involvement and engagement of, interested parties in the development of relationships that support the continuous improvement LETB internal operations and the services it supports.

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NHS London has undertaken a mapping exercise in order to ensure that the geographical boundaries of the London LETB’s are appropriately aligned and that engagement relationship with key stakeholders within these areas and across these boundaries are articulated and understood (Please refer to Supporting Document reference number: NCEL1213 for further information) – the LETB geographies will be agreed by HEE prior to full authorisation.

Stakeholder engagement is at the heart of NCEL LETB’s operating model. Full engagement with members is critical to ensuring the successful delivery of an operational service that meets local workforce reconfiguration, education and training needs in order to deliver the highest quality of service to patients.

2.2.3 Stakeholders Groupings

The high level stakeholders with which the NCEL LETB will engage include but are not necessarily limited to:

Providers of NHS services Local authorities Education providers Professional regulation/registration bodies Clinical Commissioning Groups NHS Commissioning Board Health Education England Academic Health Science Networks Clinical Senates

The NCEL LETBs will work to develop transparent and substantial arrangements for the engagement of key stakeholders locally, including:

Patients, service users and the public Education providers Primary care Local government (public health and social care) Staff representatives e.g. through the Social Partnership Forum Other representatives as locally determined

The NCEL LETBs will engage with key partner organisational groupings including:

Clinical Networks Academic Health Science Networks (AHSNs) Commissioning Groups NHS Commissioning Board sectors Local Government Commissioning Support Units Health and Wellbeing Boards Local Healthwatch Regional Social Partnership Forums

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2.2.4 Engagement and Communications Framework

The LETB will work with its stakeholders to develop an appropriate engagement and communications framework (building on existing groups and for a where ever possible) that best facilitates their involvement – elements of the framework might include (but not necessarily be limited to):

Membership - creating a broad membership based LETB with a virtual presence shared with the AHSN.

Website - developing a website providing information about LETB services and how to become involved in LETB activities and, register interest or become a member.

Register of Interests – developing a web-based register of interests to enable direct email alerts to members pertinent to their specific areas of interest with potential to invite members to take part in and inform LETB/AHSN activities and projects.

Social media – setting up a site on Twitter/Facebook to communicate service updates and general health news to members.

Virtual Student Union/Trainee Forum - creation of a virtual student union / trainee forum to enable direct access to LETB business.

Patients Forum – creation of a patients forum to enable direct access and feedback to LETB business – this can be based upon existing patient action groups

PR/You Tube Campaigns - focussed on high-lighting the education and career opportunities within the LETB geography.

Targeted Outreach - attendance at events in conjunction with local community/patient groups and bodies – to gain participation of hard to reach groups.

Direct Mail/Email Campaigns – to the membership and local residences, encouraging participation in specific activities / forums / groups / research / health initiatives etc.

Board Membership – to develop skills based membership via executive and non-executive representation.

Advisory Council Membership – to create an advisory body (Council) that represents LETB constituencies.

Provider Partnership Groups – to set up and facilitate groups that enable subject matter experts from the LETB membership and constituencies to become directly involved in work of the LETB.

2.2.5 Rational for the Framework

The development of a comprehensive engagement and communications framework will serve to provide the vehicle by which the LETB can develop:

Student and Trainee Insight and Endorsement – by continuously reviewing education and training programmes, satisfaction and feedback to ensure that new developments are focused on participants needs. For example a dedicated student/trainee insight forum / framework– supported by a range of collaborative research techniques to understand user and their priorities for change and improvement – would enable the LETB to prioritise programme improvements to ensure they meet participant needs.

Patient Insight and Endorsement – by continuously reviewing patient pathways and patient satisfaction and feedback to ensure that new developments are focused on patient needs. For example a dedicated patient insight forum / framework – supported by a range of collaborative

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research techniques to understand usage and why people are not satisfied with current service provision – would enable the LETB to prioritise a programme of improvements to ensure that workforce reconfiguration, training and education is targeted to address patient concerns in order to better meet their needs and expectations. This links into activities in hand by clinical networks – e.g. London Cancer

Professional Insight and Endorsement – by working closely with professional groups to develop and maintain excellent collaborative relationships with professionals and facilitating these professional groups to challenge, advocate and provide the service information required to improve workforce design, educational and training opportunities and programmes. The NCEL LETB will to develop systems to inform decision-making by feedback from patients, students, trainees and members.

2.2.6 Targeted Engagement

The NCEL LETB is aware that it must target resources and activities to identify and engage stakeholders at the margins – i.e. those that have historically been hard to reach, those currently on the periphery of existing engagement arrangements, or those without a satisfactory engagement portal. The LETB will work to develop and maintain interactive and integrated working relationship with such stakeholders.

Proposed Approach to targeted engagementThe (urrent LETB Transition Board) Stakeholder Working Group will regularly review the stakeholder mapping outputs and current engagement activities in order to identify groups that may require targeted engagement activities – and to monitor the success of any such activities. This activity will be shared with the AHSN. The LETB has to date identified the following groups that require targeted engagement activities:

Third Sector Local Authorities Students Patients

Stakeholder Relationships Development resources will be engaged to work with the Design Lead, Project Manager, and LETB Transition Board members and stakeholders to identify and develop key relationship contacts with such groups and to define and implement / facilitate an engagement strategy of networking events, and workshops to ensure their involvement in LETB business.

The following have been identified as key tasks that will need to be undertaken to support this approach

Identifying stakeholder groupings requiring targeted engagement activities Identifying initial contacts within these stakeholder groups Identifying Engagement Leaders for these groups Working with the Engagement Leaders and these Groups - help to define and implement a

strategy for their engagement Supporting the Engagement Leaders to build sustainable working relationships and

engagement vehicles (forums, groups, committees) to facilitate successfully engagement with the LETB

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2.2.7 Engagement and Communication Strategy

The NCEL LETB will undertake specific engagement and communication activities during design, transition and operational delivery as outlined below:

Design StageDuring the design stage the LETB will undertake the following activities

Use opportunities when LETB Transition Board representatives and LETB staff (when in post) are engaging with stakeholders to promote the LETB approach and ethos, and seek feedback

Hold local open sessions in partnership with stakeholders to canvass views on the LETB operating model and how best to ensure their engagement in its design, development and delivery

Actively test the LETB design and any proposed developments with these stakeholders Develop a web presence to publicise and direct people to the LETB information – which

could also serve to provide a feedback forum Develop a newsletter to communicate progress to stakeholders Identify ‘Engagement Leaders’ to represent and facilitate the engagement of specific

stakeholder groups/constituencies Develop a communications strategy to utilise IT to best advantage – i.e. emails, You Tube

videos etc. in order to maintain communications with stakeholders

Transition StageDuring the Transition stage the LETB will undertake the following activities

Maintain regular communication on developments with Stakeholders via website and newsletter

Undertake outreach to stakeholder constituencies and support ‘Engagement Leaders’ to develop an inclusive engagement framework for the LETB

Target engagement activities with periphery and historically hard to reach groups that need proactive engagement; developing avenues for regular information exchange as well as opportunities for their on-going involvement.

Engage and appoint appropriate executive and non-executive LETB Board members to deliver a skills based board in line with HEE guidance and stakeholder expectations

Develop an interim Advisory Council that demonstrates fair representation of constituencies in line with HEE guidance and stakeholder expectations

Ensure involvement of appropriate stakeholders in the shadow activities of the NCEL LETB such as the commissioning planning cycle and the development of investment plans and workforce strategies

Continue to develop a stakeholder relationship framework that demonstrates fair representation of patient, professional, managerial, organisational and sectorial stakeholders across the LETB area

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Operational Stage During operational delivery the LETB will undertake the following activities

Mobilise engagement with stakeholders to o gain nominations for LETB and Advisory Council membership

o hold the LETB to account regarding

• value for money

• the quality of service being provided

• individual board member performance

o to establish appropriate engagement portals and mechanisms (Advisory Groups) that will enable stakeholders to come together to

• investigate ways to improve education and training opportunities

• define workforce and education and training strategic plans

• define service quality, implementation targets and associated key performance indicators (KPIs) and reporting requirements

• hold Service Providers to account regarding service quality, delivery of targets and performance against KPI's

• drive value and reduce the cost of the service provision.

Raise awareness throughout the constituency of the benefits of LETB and how it can be utilised to promote positive change.

Ensure consistent and appropriate communications are maintained with all stakeholders. Build local cross-boundary, national and international relationships to the benefit of NCEL.

2.2.8 Stakeholder Engagement and Communications

Stakeholder Engagement ActivitiesTo date the following key targeted engagement activities have been undertaken:

NCEL LETB Transition Board - set up with a wide representation with members acting as Engagement Leaders

NCEL LETB Working Groups - set up to support design and development in following areaso Governanceo Target Operating Model (TOM)o Stakeholder Engagement

NCEL Design Lead (Chris Fowler) - appointed and working with ‘Engagement Leaders’ focusing on LETB design and development and the engagement of their constituencies. To date targeted engagement discussion have been initiated with:

o Primary Care / GP’s - focus: creating a forum for engagemento Nursing and Midwifery - focus: developing future operational

delivery modelso Independent Sector - focus: developing an improved route to

engagement

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o Patient representation - focus: developing a patient forum / network

o Trainee representation - focus: gaining representation and developing a network

o Student - focus: gaining representation and developing a virtual forum

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Engagement Events

o The following events have been held 1st NCEL LETB Stakeholder Event – held 10 April 2012 GP Engagement Event – held 13 March 2012 NCEL LETB Transition Board meeting – held monthly Governance, TOM and Stakeholder Engagement Working

Groups meetings NHS London LETB Stakeholder Event – 14 June 2012 HEE Engagement Event – 15 June 2012

o The following events are planned 2nd NCEL LETB Stakeholder Event – 18 July 2012 and follow

on events with a Commissioning Cycle Focus NCEL LETB Transition Board meeting - monthly Governance, TOM and Stakeholder Engagement Working

Groups meetings

Stakeholder Communication ActivitiesTo date the following key communications channels have been put in place

NCEL LETB Website - set up providing access to key papers and updates

NCEL LETB Bulletin - issued monthly to circulation list and uploaded onto website

NCEL LETB Project Update - issued weekly to project team NCEL LETB Stakeholder Events and Meetings - as noted above

Communications have been supported by

Question and Answers - developed and shared via the website Stakeholder Circulation List - developed and maintained by the

project team

The following communications channels are planned to be developed

You Tube Video - the creation and sharing of a you tube video Social Media Outputs - the development of a Twitter/Facebook feeds Specific Stakeholder Forums - to be put in place Web Based Membership - database of interest supported by targeted

email communications

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3. Our Organisation

3.1 Functions, Structure and Ways of Working

3.1.1 Organisational Architecture Design Overview

The future education and training environment across London will comprise the following functional entities:

LETBs – will act as commissioners in the new system and will be responsible for the following activities

o Workforce planning and reconfigurationo Planning commissioning strategieso Contracting with Lead Providers and setting statement of requirements (SoRs)o Managing the quality and relationships with the regulatorso Working with providers to improve the quality of education and trainingo Developing Providers

I. LETB Operational Delivery (Localised) – that will drive local workforce strategy and develop local workforce reconfiguration and education and training plans with due consideration of the London and broader national and international environment

II. LETB Joint Service(s) Office - that will support the London LETBs and the Lead Providers by executing functions where there is merit in doing so once for all London LETBs (Shared Services)

Lead Providers - who will be responsible for the delivery of education and training, as commissioned by the LETB – and undertake the following activities

o Quality managing the education delivered by Local Education Providers (LEPs) through leadership and management of LEPs and trainees and students to achieve the NCEL LETB vision for education and training

o Recruitment (shared service element)o Managing trainee rotations/student placements(shared service element)o Reviews of trainee/student progress(shared service element)o Construction and oversight of training programmes

Local Education Providers (LEPs) - will deliver education and training and will be responsible for local quality control (Lead Providers can also be LEPs)

The document “LETB Development Briefing Document: Function-based Outline of Activity; January 2012” described function taxonomy as provided by London’s education and training system. The analysis below is based on that taxonomy and a summary document is included – please refer to the Supporting Document reference NCEL1287 LETB Capabilities Statement.

A full analysis of all of the activities carried out by NHS London and the Deanery (including PSSO) has taken place. The three LETBs have reached consensus on which activities should be local, which should fall to the lead providers (further subdivided by those which will be shared) and which services should be shared.

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Transition of these services will be managed in a staged process as outlined in section 4.

The Figure 5 below shows the breakdown of these functions into their respective areas. Costings for these areas can be found in section 4.

Figure 5: Target Operating Model – Functional Infrastructure

3.1.2 Lead Provider and Local Education Provider Model – Overview and Rational

OverviewWithin London the Lead Provider (LP) model was developed to transform and to promote significant improvements in PGMDE in order to enable it to keep pace with changes in healthcare delivery. The LP model enables a clear distinction between the roles of education commissioners and providers.

This change in approach to the commissioning of education and training is built upon a series of national policy developments, from Sir John Tooke’s independent inquiry into Modernising Medical Careers through to the Department of Health’s report on Educational Commissioning for Quality.

The model offers - through appropriate collaboration between LETBs (as commissioners in the new architecture) and LPs – the opportunity for educational investment in training to be better aligned to service need, thereby improving patient care.

Adoption of the model offers a way to implement a commissioning system designed to ensure a high quality and appropriate healthcare workforce for now and for the future.

Excellence and innovation in education would be encouraged through contestability and clear statements of requirements (SoR) from the LETBs that will be developed in partnership with interested constituencies and that will be published so that everyone – including trainees, students and patients can be actively engaged in supporting the move to make training programmes in NCEL the best nationally and internationally.

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The success of LP/LETB system can and will be measured using agreed and streamlined targeted metrics against the SORs.

Rational for AdoptionThe driving forces behind the adoption of the LP by PGMDE are, at the high-level, the same as those being experienced by the wider heathcare system – i.e. to ensure that

the workforce is better prepared for tomorrow’s health care needs education and training are improved significantly unique health care resources are more wisely used to support education and training where-

ever possible

In order to achieve these changes the leadership and management of the provision of PGME training was devolved to organisations (LPs) – that

were better positioned to make timely changes to education and training so as to deliver the quality improvements required to meet the changing needs of the ever-evolving healthcare system

served to bring together Local Education Providers (LEPs) to make local decisions about the provision of training and manage the service training relationship

could involve LEPs in a process of co-creation and peer oversight of education and training with increased buy-in and mutual support for innovation and improvement

The LP model has been designed to focus all providers on the end point of better training for better care maintain a clinically lead approach enable better engagement and ownership of training programmes and trainees bring service and education planning together innovate to improve training target improvement to trainee experience in service delivery so as to attain excellent

performance across all departments in LEPs

Within the model, efficiency of delivery is enhanced by the fact that LP’s are supported in their role by a shared service of “Provider Support” that provides common back-office functions - inclusive of London’s role in National recruitment – and the LPs manage and govern these function in partnership.

To LP model is relatively new but tangible benefits are already beginning to be released that include

More frequent and localised training events o better for trainees as more accessible o better value for money

Improved liaison and direct communication with trainees Review and leverage of existing resources that historically just flowed into the system

o e.g. study leave funding

Approach SummaryThe NCEL LETB will adopt the LP model for managing all contracts (not just medical and dental). The LETB will manage the relationships, determine statements of requirements and perform contract performance management activities with LPs only. LPs will be responsible for the contract

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management activities with LEPs, rather than the LETB. The LETB will only get involved in exceptional circumstances with LEPS.

3.2 Functions

3.2.1 Overview

A comprehensive review of the current delivery infrastructure has been undertaken - full details of these functions can be found in Supporting Document reference number NCEL 1287 (LETB Capacity Statements). The following section uses this taxonomy to outline where these functions will be performed within the new architecture.

3.2.2 LETB Functions

Within the new architecture the NCEL LETB will be responsible for:

LETB Operational Delivery - Localised FunctionsFunctions are currently performed by NHS London.

Workforce strategy Workforce planning Education planning Education quality Education Commissioning Decisions (including LCMDE - Deanery)

LETB Joint Services Office - Support FunctionsThe NCEL LETB will be responsible for ensuring that the following functions done once for all LETBs (shared) provide an appropriate quality and level of support to the business activities of the NCEL LETB

Functions currently performed by NHS London:

Procurement and Contract Management Finance Informatics

Functions currently performed by PSSO / Deanery

Programme Intake and Recruitment Library Lead Provider Support Services Functions HR and Finance are expected to be provided as a shared service by HEE via a subcontract

with NHSBSA

3.2.3 The Lead Provider - Functions

The NCEL LETB will be responsible for ensuring the quality of the following functions that will be commissioned from and provided by LPs: (inclusive of DILP)

Programme Design Programme Delivery Placement Management Assessment

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3.3 Structures

Each LETB has developed its own organisational structure to meet local needs and to interact with the Shared Services. Details of the other two London LETB structures can be located within their individual Gateway 2 submission documents – the current proposed NCEL LETB structure is outlined below.

3.3.1 LETB Structure

The NCEL LETB organisation is shown in Figure 6 below. All roles are graded using the NHS Agenda for Change scheme (these will be reviewed in line with DH Guidance).

Figure 6: Target Operating Model – Organisational Structure

LETB Chair - The LETB chair must be an independent chair. This will be a part time role (the current assumption is 4-5 days per week). The job description for the LETB chair can be found in Supporting Document reference NCEL1240 (Annex B). Appointments for the role of chair are expected to complete by the end of July 2012.

Managing Director - The job description for the Managing Director can be found in Supporting Documents reference NCEL1240 (Annex C). Appointments for the role of Managing Director are expected to complete by August 2012. This is a Band 9 role.

Director of Finance - The job description for this role has been prescribed by HEE can be found in Supporting Document reference NCEL1240 (Annex D). Appointments for the role of Director of Finance are expected to complete by August 2012. This is a VSM role.

Director of Education & Quality

The NCEL Director of Education & Quality is a clinical grade role. The job description for this role has been written locally and can be found in Appendix 3 – NCEL LETB Non Mandated Job Descriptions.

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Appointments for the role of Director of Education & Quality are expected to complete by August 2012. (cross check)

Portfolio Managers X3

The NCEL Portfolio Managers will pull together teams of people from various stakeholder groups and the specialist resource pool to create business case for change for new LETB activities as well as managing business as usual activity. The job description for this role is attached in Appendix 3. Portfolio Manager appointments will be made from August 2012 onwards. This is a band 9 role.

Engagement Manager - costs to be shared with AHSN – to support governance, constituencies and membership and maintaining and enhancing the engagement framework and supporting processes and communications. The job description for this role is attached in Appendix 3.

Administrative Support x3

There will be three Administrative Support resources for the NCEL LETB. One Administrator will support the executive and non-executive directors and act as Secretariat to the LETB Board and Two further Administrators will act as project support the work of the Portfolio Managers. The job description for these roles is attached in Appendix 3 respectively. These are all band 6 roles.

Specialist Resource Pool

The NCEL LETB will have a pool of specialist resources which they can mobilise to work on specialist projects as and when required. The size of the resource pool will be dependent upon the cost envelope available for the NCEL LETB.

3.3.2 Shared Service Structure

The organisational structure of the LETB Shared Service Organisation (LETB SSO) will be determined as part of the detailed design process to be carried out during Phase 1 (Please refer to Figure 5 , and Section 4.1).

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3.4 Ways of Working

3.4.1 Workflows

The NCEL LETB high-level organisation work-flow is shown in Figure 7 below.

Figure 7: Target Operating Model – High-Level Workflow

From this high-level workflow a number of scenarios have been developed by the NCEL LETB and these have been explored and tested with interested stakeholders. Feedback from this engagement has enabled the NCEL LETB to stream-line this process and an example business as usual scenario is included at Appendix 4 – NCEL LETB Workflow Example, which provide an overview of the workflow through this new architecture.

3.4.2 Annual Business Planning Cycle

The Planning CycleA business cycle has been constructed by NHSLondon to provide an overview of the critical business undertaken within the scope of education and workforce commissioning system within any given year. The NCEL LETB will begin to integrate its operations with this cycle and prioritise its shadow operations and functions to this plan and participate in the retrospectively-focused and in year key activities and Lead the future facing activities as a priority on receiving shadow operating status. To this end the NCEL LETB has a half day event scheduled for the 18 July that will start to focus engagement with stakeholders with regards to this planning cycle and will begin to work with stakeholders to put in place the Advisory Groups needed to develop and support this commissioning cycle going forward.

Please refer to the Supporting Document NCEL1288 – LETB Proposed Commissioning Cycle – which illustrates two different perspectives of the business cycle required for workforce and education commissioning system. The first cycle provides a high level overview of the medical and non-medical education planning and commissioning cycle. The second cycle details key operational milestones associated with the wider education and workforce commissioning system.

Scope of the business cycle

The following work-streams have been highlighted within the business cycle: Strategic workforce planning Non-medical education planning and commissioning Medical education planning and commissioning Medical recruitment and rotation Contract management: Learning Development Agreement and Lead Provider Continuing Professional and Personal Development (CPPD) Simulation and Technology-enhanced Learning Initiative (STeLI) MPET statutory functions

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The business cycle includes information from three separate financial/ academic years, with theassociated business activities run in parallel. This requires the following to be simultaneouslymaintained throughout any given year:

Backward view - to ensure activity is taking place to agree activity outturn and final reporting/ evaluation, etc,

In year focus -to ensure activity taking place to deliver contract management and performance, mid-year reviews, uptake reports, statutory reporting to DH, etc,

Forward planning - activity to plan for future academic/ financial years such as strategic workforce planning, stakeholder review sessions to plan future requirements, allocations and budgets set, etc.

Supporting narrative providing further detail against each business cycle activity is also provided in the Supporting Document reference NCEL1288 which corresponds directly to the business cycle.

3.5 Running Costs and Affordability

3.5.1 Financial Envelope

Current guidance from DH suggests LETBs will be required to operate with between 1.3 and 1.6 percent of the overall MPET allocation (with 1.3 percent being the most likely). For London this equates to between £15-19m, and for the NCEL LETB between £6-7m (based on a differential allocation methodology). It is approximately 40 percent less that NHS London currently manages the MPET budget with (£26m 2012/13).

3.5.2 NCEL LETB Running Costs

The running costs for the NCEL LETB organisation are shown in Figure 8 below. An uplift of 25% has been applied to salary costs to account for other costs such as pension and accommodation costs

Figure 8: Target Operating Model – Running Costs

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In addition to the above, NCEL LETB will have a pool of specialist resources available to call off to be able to provide support on projects as and when required. The size of the specialist resource pool is dependent upon the funding available for the NCEL LETB, which is expected to be between £1.2-£1.8M.

It should be noted that the organisation above is the minimum requirement to be able to operate.

3.5.3 Organisational Costs

Please refer to Appendix 5 - London LETB As-Is Financial Breakdown 2012/13, which provides an overview of the available budget by key functions

3.5.4 Projected Cost Savings

Efficiency DriversThe whole approach to the design and development of the NCEL LETBs emerging target operating model has effectively served to embed efficiency drivers in all areas of service delivery for which LETBs will be responsible – these efficiency drivers and their potential efficiency benefits are outlined below

Collaborative / Lean Operating Model (Localised Functions) – as has been demonstrated in this submission the NCEL LETB has been designed to be extremely lean with a working ethos based on collaboration and partnerships working approach that will utilise the emerging AHSN to mobilise expertise from within the system via its Advisory Council and a number of Advisory Groups. This new symbiotic working relationship - of collaborative working for the benefit of the whole system – has the potential to reduce costs by leading to

o more effective and efficient access to and utilisation of existing expert resource by LETBs

o LETBs being closer to the “customers” (providers/employers) enabling a refocusing on activity that they value, removing the costs of activities that they do not value

o Removal of some costs inherent in running a hard commissioner-provider split

• Lead Provider Approach – rolling out the LP approach has the potential to reduce cost byo Introducing a different contractual relationship with a smaller number of providers –

leading to a reduced undertaking of expensive procurement / contracting activities as well as a simplified quality management relationship based on the statement of requirements and targeted indicators that focus on ensuring and enhancing quality and excellence in the system.

o LPs managing local providers more efficiently due to being closer to them o An appropriate move to different mix of skills focused on achieving and maintaining

quality in a collaborative environment based on building mature and effective relationships with providers – improving the quality and value for money of the whole system.

Shared Service Reconfiguration – has the potential to reduce costs byo bringing together LETB support services under a one governance and management

structure to enable efficiencies of scale to be identified and current areas of over resourcing / under resourcing to be identified and addressed.

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Efficiency OpportunitiesThe LETBs are working with NHSL and London Deanery to identify areas for potential cost reduction to support the above efficiency drivers to release savings in the short to medium term - and a number of early efficiency opportunities have already been identified for consideration these include:

Co-located Estate - vacating current premises to a better value location and co-locating staff could release in the region of £1m p.a. of estate savings

Professional Advisor / Interims Contractual Review – a comprehensive review of such contracts could potentially release signification savings (£tbc)

Special Projects – termination of special projects would be expected to release in the region of £2.5m of savings

Information Technology – investment in appropriate information technology to support the business of the LETBs could potentially release circa £3million per annum by 2017

Efficiency Activities - A number of efficiency activities are currently being implemented by NHSLondon and the London Deanery in order to reduce running costs to 01 April 2013 as part of their existing annual CIPs – for example The London Deanery has initially identified a range of savings which may total £600k in 2013/14. These will increase as functions are redesigned.

SummaryFurther work will be undertaken during the transition stage to

Develop the detail around the cost benefits of the above efficiency drivers Design and deliver the shared services and contracting model to support implementation Identify, quantify and agree which efficiency opportunities and existing efficiency activities

LETBs would wish to prioritise and take forward from now to 2014.

These high-level efficiency drivers, emerging efficiency opportunities and the on-going programme of efficiency activities as outlined above provide a high-level of confidence that the required costs saving can be released by this emerging education and training system for healthcare in London by 2014/15.

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4. Transition and Continuing Operation

4.1 Transition Approach

4.1.1 Rational for Transition

The NCEL LETB is aware of the scope, scale and complexity of the changes that are required to effect a system change that can deliver the required efficiency saving. As such it supports the proposed interim transition of these services as a way to afford the London LETBs the time required to review and re-configure service delivery while at the same time ensuring their safety in transition.

The NCEL LETB will thus seek and promote close collaboration with each of the two other LETBs in London to ensure safe transition of functions from NHS London as well as to maximise opportunities for efficiencies and outcomes across London. This collaboration would also serve to enhance relationships with LETBs across England and provide a cohesive London voice to HEE during this transition period.

The NCEL LETB will work to ensure a safe transition of operations from NHS London by:

Developing a robust NCEL LETB Transition and Authorisation plan Close collaboration with NHS London and the other two LETBs in London Robust design principles A staggered operational transition Maximising the utilisation of and input from current expertise and resources both in NHS

London and across the stakeholder groups

4.1.2 Phases of Transition

Overview of ApproachThe three LETBs in London have decided to work together through the transition period to develop the final operating model for the whole education system by April 2014. The intention is that the LETBs will start to take more decisions and take more of a leading role balanced within the constraints of the duties of the SHA while it still exists.

The LETBs have identified four phases of transition and have mapped the proposed governance arrangements for each. These are:

Phase 1: July 2012 to October 2012 Phase 2: November 2012 to March 2013 Phase 3: April 2013 to March 2014 Phase 4: April 2014 onwards

Working with colleagues at NHSL the LETBs have identified three main areas of transition with clear lines of accountability and responsibility throughout the transition phases. In particular the overall responsibility for the safe transition will remain with NHS London until it ceases operation on the 31 March 2013. It will oversee the work through the LETC (Local Education and Training Committee), this will also be called the LETB Transition Group which reflects the growing sense that the LETBs are taking more decisions.

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The Working GroupsThe working groups that will initially report to the LETC are as follows:

1) Business as usual (2012/13 annual plan) group (LET Management Group) – ensuring safe and effective operational functioning with clear accountability for decision making on this year’s current plan. LETBs will be expected to take more decisions as they become established in shadow form.Membership: LETB DLs/MDs, NHSL and Deanery

2) Whole System Transition Management Group – responsible for development of the new operating model for the whole NHS education and training system in London and the safe transition from the current system. To oversee the three areas of:

Shared Service development and cost efficiency Local LETB development People and talent management so people in the current system are managed and

communicated with effectively and closure of the SHA is completedMembership: LETB DLs/ MDs to lead, advice and input from NHSL and Deanery - Chaired by a LETB lead

3) LETB Shared Services Governance – responsible for oversight of the shared service elements and ensuring effective interface with the local LETBs over the transition phases. Established by Phase 2.Membership: LETB MDs with managers from the delivery system - Chaired by a LETB

AccountabilityFigure 9 below outlines the accountability for each of the three main groups through phases 1 and 2.

Figure 9 – Target Operating Model - Transition Management and Governance in Phase 1 and 2

NHS London Board

London Education & Training Committee (LETC)

LETC Management Group Business as usualWhole System Transition

Management Group

Shared Services Operating Model

Local LETB Operating Model

Medical Workforce Group Finance Group HR/People Group Handover Closure

Operating Model

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In Phase 2 - as per Figure 10 below - there will be a gradual transition from the LETC to the LETBsFigure 10 – Target Operating Model - Phase 2 Transition Governance Arrangements in Phase 2

NHS London Board

LETC(LETB Transition Group)

Business as usual

Whole System Transition Management

Group

South London LETB

North Central & East London

LETB

North West London LETB

Health Education England (HEE)

Shared Services Governance Group

HR/People Receiving

Shared Services Operating Model

LEGACY NEW

ResponsibilitiesDetails of each group are listed in the Table 1 below:

Table 1 – Working Group ResponsibilitiesBusiness As Usual Working Group (LETC Management Group)Business As Usual 2012/13 annual operating plan and on-going responsibility will be discharged through the existing NHS London governance arrangements. This will ensure that the day to day functioning of the system continues during transition. Initially the LETC will continue to be the main governance and oversight group with a BAU working group. It is expected that the LETC will continue through to early 2013 and will meet to fulfil the oversight of business as usual making key decisions as required with a gradual handover of responsibilities to the shadow LETBs until they are authorised and commence full operation by April 2013. This group will have active LETB engagement and leadership and it is expected that the LETBs will start to take a much more active role in decision making during this period.The Whole System Transition Group Oversight and assurance that the whole NHS education and training system in London will safely transition into the new operating models for the three LETBs will be held by the LETC and the development of this Whole System Transition Group. The group will meet fortnightly to keep track of transition progress and make key decisions as required led by the LETBs. This group will continue to meet to fulfil the oversight of the whole system transition until the HEE LETB authorisation process is completed. There will be a number of working groups established:

Shared Services Operating Model Local LETB Operating Model Medical Workforce Group Finance, Estates, Facilities and Infrastructure working group People and HR working group Closure of NHSL and handover

LETB Shared Services Governance GroupThe LETB Shared Services Governance group will take on responsibility from the LETC as the LETBs become established and authorised for the shared service oversight. Transition Note - The Whole System Transition Group will ensure that the shared services operating model will be redesigned over the summer 2012. Gradually throughout Phase 2 this group will handover responsibilities to the LETBs through the Shared Service Governance Group.

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Transition RoadmapThe following road map, Figure 11, outlines the key activities to be carried out during each phase of the transition process.

Figure 11 – Target Operating Model - Phase 2 Transition Governance Arrangements in Phase 2

PeopleMove Recruit local LETB

executive team (incl. people transition)

LETB Future Design

Transition Governance

Select LETB to manage shared

services

Design activity for shared services to meet the

efficiency (spec, design & sign-off)

Transitional Management

‘Voice for London’

LETB Shared Service Governance Group

Authorisation Preparation (Gateway 3) Local LETBs operational (shadow form)

Implement cost efficiency designImplement

Shared ServiceAgree

detailed design

LETB Shared Service Governance Group Mtgs

Shared Services Interim Management Arrangements

LETB Business As Usual

Develop LETB IT &

accomm rqmts

Define local LETB roles

Self assessment of LETBsAgainst authorisation criteria

LETBs established

LETB chairsappointed

Recruit LETB MDs

2012 2013 (Q1) 2013-2014 2014-2015

Phase 0 Phase 1 Phase 2 Phase 3 Phase 4

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr ’13 – Mar ’14 Apr ’14 – Mar ‘15

Transition Period Business As Usual

Gateway 2 submission

Gateway 3 submission

Communicate with staff and Stakeholders

TUPE of Staff complete where required

Selection and Recruitment of Local LETB and shared services staff

LETC – Whole System Transition

LETC – Business as usual 2012/13 cycle LETC – Business as usual 2012/13 cycleLETC – Whole System Transition Local LETBs

authorised

X3 LETBs (HEE)Business as usual/ Whole System Transition

Lead Provider Development

LETB authorisation process

Transition functions from shared service to LETBs/ LPs

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Transition PlanDetails of the Transition Plan to be managed through the Whole System Transition Management Group are detailed in Table 2 below

TABLE 2 – Transition Plan

Phase 1 - July to Sept’12 Phase 2- Oct to Mar’13 Phase 3 – Arp to Mar ‘14Key Decisions

Select interim shared services transition lead

Agree scope of shared services cost efficiency project

Agree interim working arrangements with the Deanery & NHS London

Select the shared services LETB host

Sign off cost efficiency & design proposals

Agree staff communications strategy

Communicate transition plan to staff and stakeholders

Agree shared services location and infrastructure

Sign off Annual Business Plan (2013-14)

Sign off end state plan (2014 onwards)

Organisation, People & Structures

As-is Deanery to remain in current

form NHS London to remain in

current form

Interim structures & working arrangements (TBD)

TUPE transfer of staff (where appropriate); all staff employed by HEE

Staff move as required to new location completed

Management As-is As above

Interim arrangements Organisation formally hosted by one LETB

Governance Shared services to still be governed through NHS London structures and through to the single LETC

Shared service governance group formed in shadow form

Shared services governance group to be accountable to the three LETBs in shadow and once authorised

Final state governance arrangements in place for 2014 onwards

Shared services governance group

Key Activities Produce detailed transition plan

Appoint interim shared services transition leader

Define scope of shared services & interfaces with local LETBs

Complete LETB shared service host selection

Produce detailed operating design of shared services for transition (including job descriptions)

Define interim structures and working arrangements for phase 2

Assure continuity of service (BAU)

Commence development of Annual Business Plan (2013-14)

Convene first shared services governance group and agree LETB chair

Implement design (to deliver shared services as agreed in phase 1)

Assure continuity of service (BAU)

Plan TUPE process (as appropriate)

Prepare staff communications and key messaging

Commence staff selection & recruitment process

Determine staff location for new organisation

Support LETB authorisation Develop infrastructure

arrangements for new organisation (e.g. IT and locations)

Develop shared services business plan (including SLAs, KPIs , reporting & budget)

Commence development of end state plan (2014 onwards)

Year one/BAU activities operational

Performance management procedures operational for shared service (including resolution procedures for performance management issues which cannot be resolved locally by each LETB) through Shared Services Governance Group

Develop end state plan (2014 onwards)


4.2 Risk and Issues

4.2.1 Risks and Issues

The following table provides an overview of the high-level risks and

The following tables list the operational/clinical, reputational and financial risks, as well as associated mitigating actions, issues associated with the design and transition to full operational delivery of the proposed Target Operating Model as described in this document. A NCEL LETB risk and issue log providing a more detailed analysis is attached at Appendix 6 – NCEL LETB Risk and Issues Log.

Operational

Key Risk/Issue MitigationTalent

The LETB model cannot be designed quickly enough to allow coordination with the wide system transition

Key current staff are lost to the system leading to a loss of corporate memory and instability in continuing operations

Co-ordinated with wider system HR timetable to support staff retention as appropriate

Swift identification of high-level positions and job descriptions, with support from HEE where required for nominations

Ensure roles are designed to be attractive to the desired profile of a candidate

Ensure the HR process is well planned, implemented and communicated to staff in the wider system so as to secure staff retention where appropriate

Consensus Agreement cannot be reached between

the three London LETBs on which services should be shared and how

Build on good relationships between three Design Leads, and engagement with HEE as established, to manage agreed process

Agree process for resolution on any outstanding issue

Regular design sessions held between LETBs, supported by operating model team

Planning & Quality Insufficiently robust workforce planning Non-achievement or shortfalls of the

education outcomes framework

Need robust shadow and transition period prior to April 2013

Need support and transparency of current operating process in development

Maintain engagement and provision of information from local service providers

Conflicts of interest Perception that conflicts of interest will

not be appropriately managed by the new structure

LETBs operating model to be explicit about roles and responsibilities of the board and the different parts of the system


Explicit governance statements to address conflicts of interest

Create and maintain transparency in the decision-making process overseen by HEE appointed Chair

Reputational

Key Risk/Issue MitigationLondon reputation

Risk of losing London’s inter/national reputation in education & training

Managed through joint-governance between the three London LETBs; enables them to collaborate and provide / maintain one voice for London where this adds value

LETBs Lead Provider delivery and commissioning approach will ensure and enhance quality of delivery and local reputations and thus reinforce London wide reputations

Buy in Failure to effectively engage and

communicate with key stakeholders. Securing buy-in is challenging –

recognise the need to reach out to diverse networks – e.g. CCGs, public health and social care, private sector

Continue stakeholder mapping and strategy

Build on strong relationships, existing networks and forums

Continue engagement to date with key stakeholder groups

Announce/post direction publically and transparently

Develop and utilise full suite of communication channels and outreach tools to engage and inform stakeholders

Financial

Key Risk/Issues MitigationCost envelope

The cost envelope does not allow for sufficient delivery of responsibilities

Local LETB has been designed to be very lean - and to utilise expertise from within the system via Advisory Groups

Manage transition period with other London LETBs to ensure best value for money solutions are delivered, and what should be done to maximise efficiencies and reduce costs (e.g. Shared Service).

The LETB will mitigate against the proposed model being outside the costing envelop by the LETB finance working group developing several operating models with the central NHSL


finance group NHSL / Deanery providing financial

information and costs per functional areas

Allocation This is further complicated by a potential

introduction of tariffs and allocations methodology which might reduce the amount of funds available

Request DH/ HEE providing more clarity on methodology and outcome

Finance Group surveillance and advocacy of allocation methodology; LETBs to lobby HEE on this area

Transition There is insufficient resource to manage

the transition/ transformation to separate LETB operations resulting in a decline in quality

Difficulty of achieving and delivering cost reduction and organisational reconfiguration simultaneously.

Prioritisation of LETB responsibilities (e.g. statutory vs. Ideal); may require current functions to have reduced capacity (or transferred responsibility) is not material to planned future operations

Release funds for 2013/14 through ending of Special Projects and CIPs

Transitional resources/support available