It would be great if we could transform things by will power alone.  If we added the power of positive energy to a well-coordinated, fully engaged plan it would be lovely to think we had every chance of success.  If we have good leadership (at every level), positive energy and a good plan – and then combined it with a fabulous tool-kit of tried and trusted techniques to change and improve things, wouldn’t we succeed?  Well, maybe.  But there is another big bit of the change jig-saw we have to put in place.  Training (and real, workplace learning) to do the work differently. 

Better Care Together is a detailed plan supported by a strong partnership and a lot of positive energy.  It depends, however, not on being ‘a good plan’ but upon significant changes to the way patients are managed by our system.  Fundamentally there needs to be less dependence on hospital care – and when hospital care does happen, it needs to be ‘short and sweet’ with significantly shorter lengths of stay / more early discharge.  For these things to happen, everybody needs to change.  We will need a different engagement with patients themselves, a different primary care, different community services, different A&E, different hospital services and different social care.  Quite a challenge.   

So, as the popular saying goes: how do you eat an elephant?  Not by chewing on the tusks and toenails all day long, that is for sure!  Together with the Better Care Together partners, CLIC has been supported by Health Education England (North West) to do some practical workplace training.  Clinical skills training.  Helping nurses to see their changing role and prepare for it. If we are going to see more dependent patients cared for more pro-actively in the community (and indeed some nurses who currently work in hospitals working in the community), we need to support them in building the right set of clinical skills.  The Forerunner Fund initiative is a toe in that water, a digestible mouthful of the elephant of change.  Six clinical skills educators and project facilitator are soon to start work – based in CLIC and in partnership with the University of Cumbria – to support the changes needed across all of Cumbria. The University of Cumbria will deliver the training and the clinical educators will work with clinicians to embed learning in practice. It’s a welcome practical step. 

It isn’t ground breaking; it isn’t massive in scale; it is experimental (think PDSA cycles – there isn’t anything that cannot be improved!) and it cannot yet support everyone who needs to change.  But it is a good place to start and well done to everyone involved it getting the initiative going.  We know the population of patients that we serve is ageing; many are more ill and more dependent than we have been used to serving in a primary and community setting and yet we cannot afford a bigger and bigger hospital service.  With a good plan, positive energy, consistent leadership and a continuous improvement ethos we should do well.  Add in systematic workplace learning and we cannot fail!

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