Brenda Wraight Director

1. Brenda Wraight Director Nga Ara Tohungatanga O Te Hauora: defining professional Pathways in Health Promotion 8 July 2011

2. HWNZ • National oversight for workforce planning, training and development • A whole of education continuum, whole of health system view • Monitor and respond to national and regional workforce pressures • Focus on inter-professional, connected workforces and services

3. Our objectives are • Improved recruitment and retention • a workforce with more generic skills • new roles & extension of existing roles • strengthened workforce relationships across health & education • ensuring high quality, integrated and best value training

4. Improved recruitment and retention of key workforces to meet current and future service needs particularly in aged care, mental health and rehabilitation Activities and projects • Voluntary Bonding scheme • Advanced Trainee Fellowship • Reform of GP training • Regional training hubs • Career planning • Advanced competency modules • NZREX Preparation Placement Programme for IMGs • Modular and integrated training programmes …..

5. Development of a workforce with more generic skills to ensure maximum flexibility and integration between institutional and community settings Activities include: • Mental health credentialing of nurses working in primary care settings • Reforming training so GPs can work in community and hospital settings • Integrating components of training programmes for allied health • Interprofessional learning and practice eg for pharmacy and general practice

6. Development of new health workforce roles and extension of existing roles to make best use of all available skills, free up expensive clinician time, provide better access to health care for patients and provide services closer to home Projects include developing roles for • Nurse endoscopists • Trainee Rehabilitation Associate role in home and community support services • Gerontology nurse in primary care • Diabetes nurse specialist prescribing • Pharmacist management of anti-coagulant medications (wafrarin) • Physician Assistants • Upskilling ED workers to better respond to the needs of Maori

7. Building and strengthening of workforce relationships across the health and education systems to ensure economies of scale, integrated training and sharing good practice Includes • Tertiary Education Commission & HWNZ aligning investment plans • Careerforce & HWNZ on the unregulated workforce in aged care • Universities, Institutes of Technology & HWNZ connecting learning across the education continuum • Integration of HWNZ priorities into curriculum, eg leadership, aged care, mental health, rehabilitation, prevention, public health • Centre of Excellence in Health Care Leadership • Alignment with existing workforce development strategies and plans - egTe Uru Kahikatea – Public Health workforce development

8. Ensuring high quality and best value clinical training to contribute to improved satisfaction for trainees and better outcomes for patients. Activities include • Career planning • Regional training hubs • Advanced competency modules • Public / private partnerships • Integrated training – multidisciplinary approaches

9. Workforce Service Reviews - iterative planning model Aims: a2020 vision for the health workforce informed by changing models of care, IT and service delivery to inform planning and purchasing (investment and disinvestment) Parameters 100% increase in demand and little or no additional funding no loss of access or quality, reduce inequalities regional or national service configurations multi-disciplinary teams, and the public and private sectors Prevention, self-care, community settings WSR to date anaesthesia, palliative care, eye health, aged care, muscular skeletal, gastroenterology, mental health, youth health, diabetes care, mother and baby,rehabilitation

10. Common themes across workforce service reviews: • More hub and spoke service configurations – regional planning and delivery • More community-based models of care • Better use and upskilling of existing workforces • Expanded scopes of practice for some workforces • More focus on improving teamwork, interprofessional training and practice • Smart use of managed clinical networks • Better IT to improve information flows • Legislation changes – eg to Medicines Act to enable prescribing by more clinical groups

11. Workforce Service Review areas recommendations include Anaesthesia– expanded scope anaesthetic technician Palliative Care – managed clinical network, expand allied health role in the multidisciplinary team Eye health – undergrad degree in orthoptics, rationalisation and standardisation of screening services and vision and hearing testers, Aged Care – home and community based prevention and rehab services, support and ‘career path’ for formal and informal carers, especially in dementia care Musculoskeletal – advanced scopes for physiotherapists, better integration of DHB-funded community physio and clinician services, targeted access to rehabilitation, focus on prevention and public health Mental health – whole of system, person centric, life course approach……………………

12. Increased access to ‘organised MH&A responses’. • A rebalanced mix of responses across a life course continuum with a focus on: • Intervening earlier • Integration across primary/secondary MH&A working with CYF, Education and Justice • Proactively managing the impact of mental health on care for the elderly. • A renewed focus on the drivers of inequalities in MH&A burden and outcomes that affect Maori in particular • An active engagement of mental health within wider general health services and across sectors • A commitment to an integrated primary/community based response • Increase mix of e-therapies, supported self care, brief interventions and integration • Early intervention reducing downstream intensive service demand. • An investment in workforce, roles, capability and capacity including • in general health, particularly within primary care teams. • across the spectrum of self-care support • primary MH&A workforce as part of an integrated MH&A system with community and specialist services. • Building capacity in specialist clinical workforces; psychiatrists, psychologist and mental health nursing

13. Regional training hubs 4 regional hubs to co-ordinate and integrate health workforce planning, education and training Underway July 2011 Initial focus on medical training from PGY1 to vocational registration; other groups to follow Professional colleges and registration authorities responsible for content and accreditation of training programmes Integrates career planning, and administers Voluntary Bonding scheme and HWNZ Advanced Trainee Fellowship HWNZ provides strategic direction on health workforce priorities, and continue monitoring and oversight role links with Centre of Excellence in Health Care Leadership

14. Career planning HWNZ requires career plans to be in place for all trainees it funds from January 2012 Resources (guidelines, tools, enhanced workforce information) to assist trainees, mentors and employers developed Many organisations already do career planning in whole or in part - intention is to build on existing processes Intention is for a supportive process, with involvement of senior clinicians, owned by the trainee HWNZ is not prescriptive about the process used, however recommends that it should not to be linked to assessment or selection processes Career planning for older and retiring clinicians is recommended

15. HWNZ and Te Uru Kahikatea Public Health Workforce development plan • Te Uru Kahikatea vision is that inequalities will be reduced and the health of all peoples in New Zealand will be improved through public health and societal strategies that are: • delivered by a properly configured, responsive, well-trained and competent workforce (including culturally competent) • strengthened with core public health skills and knowledge • supported by infrastructure and workplaces that actively encourage and develop the public health workforce.

16. In summary • public health principles integrated into generic health worker qualifications • Health promotion integrated into practice across the continuum of health care – opportunities for secondments, internships • Regional planning and workforce development • Evidence on outcomes and effectiveness • Clinical leadership and professional development