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Speech by Lord Warner, Parliamentary Under-Secretary of State in the Lords, 8 September 2004: New Ways of Working in Surgery

  • Last modified date:
    8 February 2007

Good afternoon, ladies and gentlemen, I'm glad to have this opportunity to say a few words about the New Ways of Working in Surgery Project.

We all recognise that things are changing. Patients are tending to see themselves more as 'consumers', and they want services to fit more readily around their lives. At the same time, people working in the health service have a legitimate desire to pursue rewarding and stimulating careers, which are also flexible enough to meet their family commitments and other commitments.

In the case of surgery, the physical location of services is changing quite singnificantly. Nowadays, more surgery is being done in community settings, or in dedicated facilities such as the independent sector or NHS treatment centres. I think this reflects patients' demands for speedier, more convenient and accessible services, but I think it also highlights the importance of looking at what skills and competencies staff really need if we are to optimise the benefits of delivering care in new environments and in new ways.

As a result, working practices, attitudes and cultures are undergoing substantial change. Traditional boundaries and hierarchies that work against the development of sufficiently flexible and responsive services are being challenged. The focus now is very much on providing services designed around the needs of patients, and on promoting good working relationships across all professions and between all members of the health care team.

And one of the keys to success is role redesign - taking a fresh look at ways of working differently to improve patient care, and how best to make good use of the skills that staff have already developed and create new opportunities for them to acquire new skills and competencies. This is the reason that the Government set up the Changing Workforce Programme - to help the health service, and linked organisations, revisit the way that services are organised, and look at how health care professionals can be supported and encouraged to make the best use of their skills.

It has now been about eighteen months or so since the Changing Workforce Programme set up its New Ways of Working in Surgery Project. You have already heard from previous speakers, and seen from the various displays and presentations, that the project is having an impressive impact. You only have to look at the improvements in services evident on the posters and reported by several hospitals, to understand that real and tangible benefits for patients have been realised. These benefits include reductions in the number of cancelled operations and in length of stay; reductions in waiting times at clinics and waiting times for operations; and helping services to meet cancer targets.

We know that by redesigning roles and matching them against staff skills and competencies we can offer safe, patient-centred services and reduce waits. We also know that we can improve staff retention rates, and thereby reduce agency spend and recruitment costs and drive things down more, meaning money for patient services. And we know that new and amended ways of working can help achieve compliance with the Working Time Directive, another major consideration for the health service.

Evidence from the project also demonstrates that introducing new surgical roles helps free up consultants' time, so allowing them to focus on the more complex cases, and that by freeing up junior doctors' time, they are able to get maximum exposure to training opportunities during their surgical experience. Role redesign is clearly an important building block in developing services that are accessible, responsive, and that use staff time far more productively.

Role redesign, however, is only part of the jigsaw we're trying to assemble. Other Modernisation Agency programmes, such as the Improvement Partnership for Hospitals, are highlighting the central importance of planning and scheduling surgery. Traditional patterns of working may no longer serve the needs of patients or, indeed, of staff themselves. Work within the Partnership is uncovering how surgery needs to be planned and scheduled within the wider context of hospital activity.

Indeed, a range of initiatives arising from the NHS Plan have started to impact on the provision of NHS elective care, and particularly on waiting times, and this allows renewed focus on the overall objective of shaping and supporting the implementation of high quality, productive, and efficient short-stay elective care in the NHS, with several aims :

  • Firstly, laying the foundations for a sustained contribution from short-stay elective care to support delivery of improved access in the 3 years from 2005 - 2008 and beyond;
  • Secondly shaping and promoting a vision of short-stay elective care;
  • Thirdly optimising patients' outcomes and experience; and
  • Lastly developing and embedding leading edge practice.

There is, of course, still huge potential for progress, which can be unlocked.

  • The scope for even better use of staff skills;
  • Fully realising the potential of moving elective activity to a short-stay or day case basis, or of streaming it effectively, is still a goal to be achieved.
  • There are many technological advances - including minimally invasive surgery - these will continue to drive changes in clinical practice;
  • Increasing NHS productivity and efficiency is also possible so that it is on a level with the best in the world;
  • And we still need to work away at decreasing the big differences in performance between different NHS providers

Last week on a ministerial visit to Yorkshire, I learnt about pioneering gynaecological surgery project where Ashwini Trehan and his team at Dewsbury District Hospital use keyhole surgery to carry out hysterectiomies so that women return home the day after this major procedure. Dewsbury is thought to be the only hospital in the country where patients can leave hospital following a hysterectomy after just one night rather than staying in hospital for up to five days. Now this team there - and I'm keen to emphasise that it is a team effort - have encountered scepticism and they still have a long way to go to ensure that proven good practice is used everywhere.

Over the next 18 to 24 months, it will be important for us to maintain the impetus towards improved access in 2005, and to shape a compelling vision of short-stay elective care for the later period.

A key element of this programme of work is that the Department of Health will provide initial support for a number of Centres of Innovation and Training in Short-stay Elective Care. These will be units where innovation can be pushed further and where "on the job" learning can be provided to others. And they will cover areas such as incentives and productivity, new workforce models, innovative surgical practice (in particular pushing the boundaries of day surgery), and new approaches to surgical training.

These and the other initiatives that you have been hearing about today, demonstrate that, although there is a way to go, significant progress is being made and can be made.

These new approaches to care delivery have highlighted the fact that it is skills and competencies that should determine job design as a means of delivering the best possible care, and the development of new roles has been a driver in work to establish an overarching "Career Framework", so that skills, competence and educational qualifications become much more transferable across the NHS. The framework, which reads across to Agenda for Change, is being developed as a guide for the health service and its partner organisations on the implementation of flexible careers and a kind of escalator for skill development. It will enable members of staff with transferable, competency-based skills to progress and develop careers that not only meet their professional needs, but also the needs of the service and the organisations that they work for.

As you may be aware, the framework is out for discussion with the NHS and wider health and social care community and, subject to the views received, the next stage will be to map roles, including surgical roles, onto it. Alongside this, work will shortly get underway to develop the academic, vocational, education and regulatory frameworks that will be crucial to ensuring national consistency and the local flexibility essential if roles are to be designed to meet the needs of patients and to take account of the local labour market conditions.

I was pleased to see that both role redesign and new thinking around surgery feature prominently in the new definitive guide to modernising clinical and managerial practice on the NHS frontline - The 10 High Impact Changes for Service Improvement and Delivery - which has been launched by the Modernisation Agency. This is a very significant document that Sir Nigel Crisp has called it a 'ready reckoner' for NHS innovation and improvement.

The 10 High Impact Changes distil the work the Modernisation Agency has done with hundreds of frontline organisations and thousands of NHS staff over nearly four years into a series of key principles, backed by practical examples. These cover areas of critical importance in service delivery such as the role of day surgery, the management of admissions and discharges, long term conditions and the reduction of queues and bottlenecks. Each principle is backed by practical examples, and supported by resources and contacts to help support local implementation.

Already some frontline organisations are putting the changes into practice and reaping the benefits. If implemented systematically across the NHS, the experience of millions of patients would be transformed, hundreds of thousands of clinician hours, appointments and hospital bed days would be saved, patient waiting would be virtually eliminated, staff satisfaction would be enhanced and clinical quality significantly improved.

I do commend The 10 High Impact Changes to you as a vital addition to your leadership portfolio. It is a key element in delivering the promises in the NHS Improvement Plan which sets the agenda for the NHS over the next 4 years.

In conclusion, I would like to say that I am heartened by the enthusiasm for developing a modern NHS workforce, with NHS staff themselves as leaders in innovation and that has been evident today.

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