Blue Box - Agenda Item 10.3(i)(D)

Annual Report from Research, Education and Training (RET) Committee 2018/19

Audit Committee

7 March 2019

Presented for: Information and assurance

Presented by: Yvette Oade, Chief Medical Officer

Author Donna Johnstone, Research & Innovation Manager

Previous Committees

Research, Education & Training Committee February 2019

Key points

1. The annual report of the Research, Education and Training (RET) Committee for 2018/19 is presented for information and assurance.

Information and assurance.

Trust Goals

The best for patient safety, quality and experience ✓

The best place to work ✓

A centre for excellence for research, education and innovation ✓

Seamless integrated care across organisational boundaries ✓

Financial sustainability ✓

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1. Summary The purpose of this report is to provide assurance to the Trust Board that the Research, Education and Training (RET) Committee has carried out its obligations in accordance with its terms of reference and work plan for 2018/19.

This report describes the RET activities from 1 April 2018 to 31 March 2019.

2. Background This is the fifth full year of the RET Committee work cycle. The RET Committee reports directly to the Trust Board and through its work focuses on: -

• positioning LTHT, alongside its partners, particularly the University of Leeds as a national centre of excellence and global research and innovation powerhouse;

• education and training excellence;

• in partnership with others, or individually, compete for and win research grants or funds that underpin the Board’s long-term clinical aspirations;

• patient benefit from research participation and utilisation;

• linking research participation to quality and service improvement;

• the replenishment of trainee pipelines in sufficient numbers to meet the Trust’s anticipated operational need;

Dr Yvette Oade is the appointed Chair of the Committee. This work cycle has seen new members and a number of changes to the representatives and the Committee members are set out below:

• Yvette Oade, Chief Medical Officer (Chair)

• Jenny Lewis, Director of Human Resources (HR) & Organisational Development (Vice Chair) replaced Dean Royles

• Dawn Marshall, Interim Chief Nurse replaced Suzanne Hinchliffe

• Paul Stewart, Non-Executive Director

• Jacqueline Andrews, Director for Research & Innovation (R&I)

• Chris Herbert, Director of Operations for R&I

• Karen Vella, Deputy Director of HR

• Heather Iles-Smith, Head of Nursing for R&I

• Katie Robinson, Head of Nursing, Education and Workforce, replaced Heather McClelland

• Jon Cooper, Director of Postgraduate Medical & Dental Education

• Andrew Lewington, Director of Undergraduate Medical Education

• Rosalind Roden, Guardian of Safe Working

• Mark Wright, Guardian of Safe Working

• Claire Gaunt, Senior Finance Business Partner, R&I/ Education & Training (E&T)

• Wayne Hamer, Associate Medical Director for Education, stepped down in May 2018

• Clinical Service Unit (CSU) representation: Adam Glaser & Alan Anthoney

• Rory O’Connor, Pro-Dean for Research, University of Leeds replaced Pam Jones

• Laura Treadgold, Pro-Dean for Education, University of Leeds, replaced Mitch Waterman

• Stuart Haines, General Manager Corporate Medical CSU/Medical Education Leeds

• Sheree Axon – Project Manager Leeds Health and Social Care Academy (new)

• Ceri Williams, Director of R&I, University of Leeds (new)

• Tom Keeney, Associate Non-Executive Director (new)

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In routine attendance:

• Donna Johnstone, R&I Manager

• Navjeet Suryavansi, Minutes Secretary

Where possible where members are unable to attend, Deputies are sent to the meeting. The Trust Chair, other Directors and Managers have attended meetings to observe or to discuss particular items as requested.

Minor amendments have been made to the RET Committee Terms of Reference (TOR) reflecting changes to the membership, which can be seen in Appendix 1.

3. Meetings The Committee has met 4 times during this financial year, with meetings scheduled quarterly and all have been well attended. The Chair’s report and minutes of the RET Committee meetings are presented to the subsequent Trust Board for information.

4. Work Programme The RET Committees work programme for 18/19 is set out in Appendix 2 and the work programme for 2019/20 was agreed by the Committee members is available in Appendix 3. The work programme is underpinned by the outcomes of two Committees, the Research & Innovation Committee and the Medical Education Sub-Committee. The minutes from those meetings are presented to the RET Committee for information purposes.

5. Reporting to the Committee

The main agenda items alternate to ensure each theme is given priority for discussion and updates.

5.1 R&I Reports

National Institute for Health Research (NIHR) awards. The Trust hosts a number of major NIHR infrastructure awards:

• Leeds Clinical Research Facility (CRF)

• Leeds Bioresource

• Leeds Musculoskeletal Biomedical Research Centre (BRC)

• Leeds Invitro Diagnostics Co-operative (Leeds MIC)

• Leeds Medical Technology Co-operative (Surgical MIC)

Progress and annual reports for these awards are reported to the RET Committee and the following reports have been submitted for review and information:

• Annual and finance returns to the NIHR

Professor Paul Emery, Director of Leeds BRC and Professor Anne-Maree Keenan, Assistant Director at the Leeds BRC were both awarded an OBE in the Queen's birthday honours for services to rheumatology and podiatry respectively.

An agreement was reached regarding funding (approx £2m) to replace the NIHR BRC MR Scanner enabling the centre to stay at the forefront of musculoskeletal imaging research.

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The expansion of the Leeds CRF in the Bexley Wing remains a priority for the Trust and work started in January 2019 and is due for completion in summer 2019.

The NIHR Leeds CRF successfully hosted the 14th Annual Clinical Research Facilities Conference, on the 12th-13th July 2018 at the Royal Armouries. The theme of the conference “Imaging and Digital Technologies in the 21st Century” arose from and showcasing key research strengths in Leeds. Excellent feedback from both the NIHR and attendees was received. Workforce Following a presentation to the Trust Executive team, R&I are now starting on the implementation of a new operational model by moving the management of research from CSUs to R&I. The anticipated benefits from creating an integrated function include the ability to utilise research income more strategically, look at the skill-mix across the organisation as a whole. This process will hopefully bring some efficiencies to enable movement of the workforce where needed. Chapel Allerton have moved across and the Cardiology team are currently being transferred. The cost centre relating to Chapel Allerton moved to R&I in November 2018, aligning financial responsibility with the management changes. Research Academy The LTHT Research Academy opened in October 2018, driven by the requirement of a highly trained and experienced research workforce to ensure the research we deliver is of the highest quality. The Research Academy will:

• Ensure we use resources efficiently & provide assurance to partners that patient safety is our highest priority

• Ensure staff involved in delivering, overseeing or leading research are valued and can easily identify the numerous opportunities to further their research career at LTHT.

• Offer a broad range of topics to be delivered: - Research Delivery: GCP, Consent, Investigator training, learning bursts

(research ethics, consent and eligibility, clinical research protocols, source data, AE reporting)

- Personal Research: Identify funding opportunities, professional bid writing support, regular calls for funding opportunities

Karl Ward, Lead Nurse for Education and Training was appointed in January 2019 to provide strategic development and leadership for the Research Academy. R&I Performance Reports A report is provided to the Department of Health and Social Care on a quarterly basis to monitor the performance of Initiation and Delivery for research. The measurements for initiation metrics were revised in April 2018 for the Q1 submission. The Committee received regular updates relating to R&I performance across the Trust relating to national metrics of:

▪ Number of patients recruited to portfolio studies ▪ Number of open portfolio studies

• Initiation - 70 days or less from receipt of a valid application to first patient visit for Q3 & Q4, target >80%. From Q1 a new measure was introduced; the mean days to first patient recruited following selection as a site.

• Delivery - recruit the agreed target number of patients within the agreed recruitment period (applies to all sponsored commercial trials)

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Table 1 below shows the Trust’s performance in the Initiation and Delivery metrics and Table 2 the Trusts national ranking for number of patients recruited and number of studies in the NIHR Portfolio.

PID submission Quarter

Initiation (70 day) % Trials meeting

benchmark Q3 & 4/ Q1 & Q2 mean days to first

patient recruited following site selection.

Delivery - % of trials recruiting to time and

target

Q3 86% 55

Q4 79% 67

Q1 72 days 82

Q2 61 days 86

Table 1 Performance in the Initiation and Delivery metrics

2017/18 2018/19 (data cut 7 Feb 2019)

National ranking for number of patients recruited, and number of studies in NIHR Clinical Research Network Portfolio.

Patients 19,179 (2nd) Studies 451 (4th)

Patients 15,348 (4th) Studies 396 (8th)

Table 2 National ranking for number of patients recruited and number of studies in the NIHR Portfolio

The Medicines and Healthcare Products Regulatory Agency (MHRA), Good Clinical Practice (GCP) systems inspection of the Trust and University. A successful inspection took place in December 2018 and the formal report is yet to be received. However verbal feedback from the inspection team noted significant improvements to systems and processes and on this basis LTHT and the University are no longer on quarterly reporting to the regulator and no critical findings were identified. The inspection has resulted in 4 ‘major’ findings (source data, protocol compliance, record keeping & essential documents, adverse event reporting) and a number of ‘other’ findings which will be addressed as part of a formal corrective action preventative action (CAPA) plan once the formal inspection report is received. A potentially critical finding was raised around compliance of LTHT electronic health record systems with the clinical trials regulations. However, following discussions with the senior informatics team about existing functionality and plans to ensure full compliance, the inspector was satisfied for this to be logged as only a major finding (source data).

Planning for Brexit The major short-term risks associated with a no-deal Brexit for research at LTHT would be:

• Customs delays affecting the delivery of therapeutics for use in clinical trials (particularly those with a short shelf-life)

• Availability of “standard equipment” required for research projects purchased through LTHT procurement or NHS Supply Chain

• Continuing involvement of Leeds researchers in Europe-wide networks

• Ability of UK sites to continue participating in rare disease trials and subsequent impact on patients with rare diseases.

• Continued availability of European funding for research

• Rights of LTHT employees who were born within the EU and outside the UK

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The continuing uncertainty around Brexit has meant we have had to carry out a full assessment of risks to them associated with Brexit. From our portfolio of 700 studies, 15 studies required further assessment and of these only 1 was identified where the supply of the drug needed to be checked and working with Pharmacy have ensured that there are sufficient stocks in place. The contingency measures being put in place centrally for supply of “standard equipment” for the NHS minimise the risk of such items not being available for research - and many projects come with necessary equipment for drug delivery supplied. LTHT receives a small proportion of funding for research (<1%) from the EU and the government has already pledged to honour committed funding in the likelihood of a no-deal Brexit. Longer-term challenges associated with a no-deal Brexit would include the UK becoming less attractive to multinationals for commercial clinical trials due to any future non-regulatory harmonisation with the EU for clinical trials, pharmaceuticals and medical devices. We are working closely with our CRO partners to understand how the international market responds to Brexit and to ensure that we have sight of any downturn in the attractiveness of the UK for carrying out clinical trials and can plan accordingly.

Non-Medical Clinical Research Careers Strategy

During 2018/19 significant progress has been made in achieving the Clinical Research Careers for the Non-Medical Professionals strategy deliverables. Most notably, with the support of the UoL, a range of successful fellowship applications totalling over £2.7M (see Table 3) have been achieved with a range of professional groups being awarded including podiatrists, clinical scientists, dietician, physiotherapist, pharmacists, psychologist, radiographer, dental technician, operating department practitioner, nurse and midwife.

Type of award HEI Collaboration

Number of awards

Total Amount Awarded

NIHR Senior Clinical Lectureship UoL 1 £560,000

NIHR Clinical Lectureship UoL 2 £1,048,749

NIHR Clinical Doctoral Research Fellowship (CDRF)

UoL 2 £532,368

HEE/NIHR MRes/CDRF Bridging N/A 2 £20,000

HEE Masters Bridging N/A 2 £20,000

HEE/NIHR Pre-doctoral Clinical Academic Fellowship (PCAF)

UoL 5 £300,569

Well Women Early research career fellowship UoL 1 £50,000

HEE Internship N/A 4 £40,000

HEE ERIC Funding for PGCert Health Research course

UoL 1 £3,167

Florence Nightingale Foundation/HEE Windrush Research Leadership Program

N/A 4 £6,000

NIHR Clinical Research Network (CRN) 70@70 Senior Nurse/Midwife Research Leader Programme

N/A 2 *£130,000

Total £2,710,853.00 *estimate awaiting intelligence regarding exact amount

Table 3: Fellowships and awards received by non-medical staff during 2018/19

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General Updates The Committee has received updates providing progress on the R&I Strategic objectives including:

• The formal launch of the paediatric Clinical Research Facility (CRF) in Clarendon Wing in May 2018 as part of the Leeds CRF/Leeds Children’s Hospital on-going. developments. This is a significant milestone in R&I estate and capacity building plans, and will provide the infrastructure to support new work including studies in Cystic Fibrosis, diabetology and neurodegenerative disorders.

• The Yorkshire Lung Screening Trial was formally opened at the White Rose Centre, Leeds on the 6th November 2018 and was attended by Yvette Oade, Dr Kathryn Scott, Chief Executive at Yorkshire Cancer Research, Jacqueline Andrews and Matthew Callister, the Chief Investigator for the research study.

• A successful £10.1m bid to Innovate UK of the “Northern Pathology Imaging Co-operative” led by Darren Treanor was announced in November 2018. The bid brought together 10 industry partners, 9 NHS Trusts and 8 Universities to develop region-wide service models to enable development and testing of Artificial Intelligence (AI) technologies in Pathology. This will build on the current partnership with Leica. The Trust was also a partner is a successful bid to Innovate UK, led by Oxford University for a “National Consortium of Intelligent Medical Imaging”, integrating the expertise to accelerate the potential impact of AI in enhancing the utility and efficacy of clinical imaging for the benefit of patients.

• The Trust entered into a formal transatlantic research partnership with a Canadian innovation company called Densitas in July 2018. Dr Nisha Sharma clinical lead for breast imaging is pioneering the use of world-leading software that analyses screening and diagnostic images and helps identify women who may be at higher risk of developing cancer.

• LTHT are partnering with IQVIA (one of the largest Clinical Research Organisations in the world) to utilise “real world” patient data to improve clinical outcomes through novel ways of working. Industry and LTHT colleagues in the fields of data extraction, data analytics, project management and clinical medicine are working together under the R&I leadership. The first Research Data Extraction Manager started in November 2018.

5.2 E&T Reports

Nursing, Midwifery & AHP Education & Training

Pre-registration Education The Registered Nurse Degree Apprenticeship was been validated by the Nursing and Midwifery Council (NMC) and the UoL and there are now 55 employees on the programme. .

Work-Based Learning In September/October 2018 24 trainee Nursing Associates were successfully recruited across the UoL and Leeds Beckett University. In December 2018 an additional cohort of 41 trainees commenced with the UoL. Learning is supported by a Clinical Educator working closely with the Practice Learning Facilitators, CSU Clinical Educators and Organisational Learning Tutors to ensuring all learners are supported within operational areas. Post-Registration Education 21 Advanced Clinical Practice (ACP) trainees have been recruited across the Trust starting in September 2018 The Health Education England (HEE) Programme Review was attended by a number of ACP/Physician Associates where the LTHT programme was commended by the trainees and supervisors.

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Best Start One of the Trust commitments is to ensure every member of healthcare staff has the best start to their career in Leeds. Feedback has been positive in that the Best Start ensures that new starters complete the majority of the priority training in a very short period of time with timely access to passwords and accounts to use clinical systems. A lot of the data is input manually for Best Start and there are plans to move this into on-boarding so that managers will have more choice over the dates selected for new starters to attend. Additional Best Start programmes are added in at peak times of recruitment in the Autumn. There are plans to reduce the programme length of Best Start to 4 days as corporate induction is moving to one day a week in April 2019.

Health Education England (HEE), Self-Assessment Introduction The HEE Education and Training Self-Assessment Report (SAR) is a new, annual, multi-professional report which is submitted to HEE in October each year and its purpose is to report on how the Trust meets the HEE Quality Framework and the 6 quality domains, which mirror GMC standards for training. An overview of the responses can be found in Table 4

Table 4 HEE Self-Assessment responses.

Organisational Overview

Top three successes

- Multi-professional Student Forum

- Professional Support team

- Multi-Professional Simulation

Challenges/Important Issues

- Funding for undergraduate medical

placements

- Recruitment and retention in the medical

workforce

- Introduction of a new internal medicine

programme.

Undergraduate Medical Education

Good practice items

- Multi-professional student forum

- Inter-professional learning

- Student Access to Electronic systems

Challenges

- Undergraduate funding.

Nursing, Midwifery & AHP Education Top three successes - Multi-professional Student Forum - Placement expansion - Coaching Empowered Learning in Leeds Challenges/Important Issues - Post-registration education for educators to create the workforce of the future - Mentor numbers – in a small number of areas, due to staff vacancies, limiting the number of learners in the environment. - Opportunities to participate in quality improvement, R&I and evidence-based medicine.

Postgraduate Medical Education Good practice items: - Junior Doctor Forum and Junior Doctor Body - Participation of trainees in the Leeds Improvement Method and other QI projects - Professional Support Team - Improving working lives of trainee doctors. Challenges/Important Issues - Developing the non-medical workforce, recruitment and retention of physician associates as a new and evolving role. - Winter pressures – on-going challenge of balancing service pressures with education and training - HEE Programme support, inaccurate/late transfers of information from HEE to resourcing/medical education teams in LTHT.

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Postgraduate Medical Education Urgent Risk Review - Medical Education An urgent risk review was carried out in October 2018 by HEE working across Yorkshire & the Humber (HEEYH). It was conducted following repeated poor results in the GMC National Training Survey (NTS) and covered foundation year trainees in:

• Trauma & Orthopaedics, including Orthogeriatrics

• Vascular Surgery

• Neurosurgery

The main findings of the review panel were the foundation training in Trauma & Orthopaedics fell below the required standard and trainees felt unsupervised and found it difficult to contact more senior doctors for support and access to training. HEEYH gave notice that the specialty is elevated to GMC ‘Category 3’ concerns, which means unless demonstrable and sustainable improvements are put in place quickly, foundation training will be suspended in Trauma & Orthopaedics. This is a major risk to the Trust and a task and finish group was established and a plan devised of which a number of actions have been implemented. An interim review meeting took place on 31st January 2019 with HEE and the team was invited to visit two of the orthopaedic wards, L34/35 to ‘drop in’ on trainees on duty. Those trainees reported noticeable improvements and said they were positive about their jobs and would recommend T&O posts.

In light of the significant progress that has been made in such a short time and following the visit on the 31st January 2019, HEE and the GMC advised that the enhanced monitoring conditions in T&O will not be escalated at this time. This means that the matter will be monitored as part of the regular Monitoring the Learning Environment (MLE) process and the immediate threat of trainee removal has receded, but in the longer term should the situation slip trainees could still be removed.

Conditions Update The term ‘conditions’ was used by Health Education England Yorkshire and the Humber (HEEYH) to denote improvement actions required of the Trust following adverse feedback in the GMC National Training Survey (NTS) and also from quality reviews. There are currently 20 open (‘red’ and ‘amber’) conditions, 10 of which relate to the Urgent Risk Review. The 10 remaining conditions cover concerns relating to curriculum delivery, workload and undermining in:

• Trauma and Orthopaedics (x2)

• Paediatric Medical Specialties (x2)

• Paediatric Surgery (x2)

• Neurosurgery (x1)

• Medical Microbiology (x1)

• General Surgery (x1)

• Cardiac Surgery (x1) The Medical Education team continue to support the CSU management teams in delivering action plans to address training concerns. HEE have indicated that they will look to close older conditions that are not linked to the October 2018 Urgent Risk Review should feedback improve in this year’s HEE National Education and Training Survey (NETS) and GMC NTS.

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Undergraduate Medical Education Clinical placement evaluation During the last academic year, LTHT delivered 1,850 individual undergraduate placements. The placements are delivered by a faculty comprising some 75 consultants, supported by a wide cohort of trainee doctors, nurses, allied health professionals and scientists who each contribute towards improving the quality of education delivered. In addition, our Undergraduate Clinical Teachers provide highly rated teaching in the Undergraduate Hub. Medical Student feedback is collected by the University of Leeds at the end of each placement and at the half way point in the academic year feedback continues to be strong as demonstrated in Table 5 which shows scores for the seven key factors. The top of table shows a combined score based on 548 student responses, whilst the lower section provides a breakdown into main year and programme groups. Scores are RAG rated according to the NTS banding: Green >= 80% responding ‘strongly agree’ or ‘agree’ Amber <80% and >65% responding ‘strongly agree’ or ‘agree’ Red <= 65% responding ‘strongly agree’ or ‘agree’

R D1 D2 D3 D4 D5 D6 D7

All LTHT 548 84% 83% 86% 87% 87% 81% 88%

Yr 2 C2C 53 78% 83% 85% 92% 89% 87% 85%

Yr 3 C2C 61 90% 93% 90% 94% 92% 88% 94%

Yr 3 Special Senses 68 91% 90% 93% 87% 90% 80% 88%

Yr 3 Radiology 29 93% 91% 93% 92% 86% 95%

Yr 4 Integrated 178 79% 81% 86% 91% 89% 90% 91%

Yr 5 Integrated 159 96% 87% 91% 87% 89% 91% 92%

Table 5. Clinical placement scores

OSCE Examinations The annual OSCE season has been completed and feedback was positive from those involved. The loss of J32 as a venue created problems but the temporary location in J16 worked well but there were some drawbacks including staff challenges in running OSCEs in three different locations and securing J16 for the assessment duration was problematic. As the OSCEs are a critical component in the University’s assessment of medical students, preparations are under way for the 2019 examinations and assurances have been given that J32 will temporarily return to the education team at the end of April ensuring the exams take place in a tried and tested environment. Guardians of Safe Working It is now 2 years since the new junior doctor contract was implemented, it remains under review including the use of exception reports. Supervisor engagement is improving but still variable and this may have an effect on a trainee’s decision on whether or not to submit an exception report. Improved trainee engagement remains a priority and reaching out to new starters to have their say has helped through the recruitment of new trainees to join the Junior Doctor’s Forum. A meeting with Junior Doctors Forum took place on the 22nd October 2018 and some points raised were:

D1: Orientation and induction

D2: Facilities

D3: Learning environment and support

D4: Delivery of scheduled teaching

D5: Opportunities for learning and clinical

experience

D6: Feedback and assessment

D7: Overall rating of the attachment

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• Difficulties in taking breaks during night shifts on the acute medical floor, compounded by the distance to the canteen and mess area.

• Interest was expressed in doing local shifts they were not often included in email/text requests. One way of advertising local shifts is to have a table published and made available on notice boards.

• All the foundation trainees fed back that they are struggling with receiving late information about placements and rotas, which is particularly relevant to the December to April placements as trainees are unable to plan ahead with regard to Christmas and New Year.

A recent publication in the Health Service Journal (REF: https://www.hsj.co.uk/workforce/exclusive-tens-of-thousands-of-junior-doctors-working-beyond-contract/7023993.article) has provided an opportunity for focus on exception reporting nationally.

Whilst the interpretation of the data is the work of the writer, the hard data does suggest that LTHT ranks 6th nationally for exception reporting. Whilst national engagement with exception reporting is poor (10% of all trainees currently) it is helpful to know that we are one of the trusts with higher awareness.

Clinical Teaching Awards The Leeds Institute of Medical Education (LIME) encourages and rewards excellence in undergraduate clinical teaching across West Yorkshire and Harrogate. This year’s winners from LTHT are:

• Dr Ian Craven, Consultant Radiologist

• MSK Education Group

• Maxillofacial Team

• Mr Mark Lansdown, Consultant Breast and Endocrine Surgeon (retired) received this year’s long standing service award.

General E&T Update Medical Education Accommodation There are a number of concerns around two important parts of the medical education estate which, unless addressed, could significantly impact on the department. The Clinical Practice Centre (CPC), located in Ashley Wing is showing significant signs of its age. In 2018 the Clinical Skills Education Team (CSET), who are employees of the UoL based in the CPC formally complained about the poor general state of repair of the building and whilst several issues have been addressed, some will require significant investment. A programme of work has been agreed with the LTHT Estates and Facilities team, namely:

• Heating has been fixed

• Broken windows are to be repaired

• Interior walls where there is damp damage are to be re-plastered and repainted.

Beckett Wing is the home of the LIMIT suite which attracts learners from across the Y&H region as well as the UK and abroad. It has been proposed that MEL be re-located permanently from J32 and J34 so that these wards can both become decant clinical facilities to enable refurbishment of wards elsewhere in the Trust. This is likely to take more than a year to complete and could which could significantly curtail MEL’s ability to deliver its curriculum demands - unless alternative facilities of the same size and quality can be found. There is a risk that the annual OSCE exams will leave the Trust, and it is highly likely that ‘Urology Boot Camp’ will be moved to another hospital, from which it is unlikely to return. Both would impact on both income and reputation. Education programmes are planned 12-24 months in advance, and this lack of certainty around available facilities is proving problematic.

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Apprenticeship Activity LTHT is using Apprenticeships to secure a talent pipeline for a range of roles, including Clinical Support Worker/Nursing, Administration and Biomedical Scientists. Leeds Beckett University have been commissioned to undertake a small research project which aims to identify the barriers to apprenticeship growth in health and care across West Yorkshire. As the host of both the Leeds Health & Care Academy (LCHA) and the West Yorkshire and Harrogate Excellence Centre (WYHEC), LTHT is taking a lead in engaging with organisations across the city and region to expand the use of Apprenticeships. Trust Induction All permanent members of staff and Junior Doctors are required to attend Trust induction which is designed to prepare them for their role, learn about the Leeds Way and receive the majority of their mandatory training requirements. Staff are also provided with for example staff identification badges and IT login details. All Junior Doctors are required to attend Doctors face to face induction and complete the Clinical e-induction package. All permanent staff and Junior Doctors are required to complete Local induction which provides staff with an orientation to their ward or department and the basic awareness and knowledge of local processes and procedures. Table 6 indicates the current performance (as of November 2018) for Corporate and Local induction.

Table 6. Current Induction performance

There have been significant improvements in the completion of local inductions however Medical Education Leeds (MEL) continues to work with the CSU’s and Trainees to ensure that evidence of local inductions are monitored and recorded which has led to an 11% increase in performance. Revisions have been made to the Trust Corporate Induction Programme to enable additional speaking slots for the Trust Freedom to Speak Up Guardian and the Leeds Cares charity. Work is also been undertaken with the Research and Innovation department to use induction to improve staff member’s engagement with research. Corporate Induction is also being used to educate staff about system working in Leeds with a short educational film developed collaboratively by the Trust and partners in the city to explain how the system works and what the benefits are to the people of Leeds in us working in this way.

Metric: November 2017:

November 2018:

Variance:

% new recruits are compliant with the Trust Induction Policy.

99% 99% <0>%

% new recruits completing Local Induction within 28 days of joining the Trust.

87% 97% >10%

% Junior Doctors completing Trust Induction within specified timescale.

91% 92.5% >1.5%

% Junior Doctors completing Clinical e-Induction package - 2 year passport.

74% 67% <7%

% Junior Doctors completing a Local induction within specified timescale.

86% 97% >11%

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The Leeds Health and Care Academy Regular updates have been provided on the Academy including a presentation in June 2018 explaining more about the Academy:

• Vision: To create one Leeds workforce with the best skills founded upon the best research and evidence, to care for and empower the people of Leeds

• Ambition: To improve system sustainability through collaboration on learning and development to deliver “one workforce”. Accelerate learning transfer from universities and research and innovation into care delivery and to engage with citizens to expand career and employment opportunities and enhance social mobility

• Values: Value and support our one Leeds workforce; work with people to improve the health and wellbeing of our citizens, patients and workforce; embrace digital solutions and be a beacon of excellence in learning and development

The Academy Portfolio Delivery Group (PDG) role is to ensure delivery of the Academy’s products and services on behalf of partners is on time and in line with the agreed plan and budget. For a soft launch in April 2019 the PDG has committed to establishing a different delivery model, with a blended model of centrally funded resource and resource assigned from partners. The aim is to deliver a small number of tangible products and progress headlines which include:

• Improving systems working: The one workforce induction video rollout has started across the city; the system leadership module has been developed and is being piloted with positive feedback; the Working in Leeds two-day programme for health and care staff will start in May with 150 staff taking part across the first three cohorts

• Improving working lives: The Leeds Mental Health First Aider network has made significant progress with firm plans to train more staff as first aiders and a citywide event; we are currently working to bring the leaders of the city’s women’s networks together to discuss the benefits of working more closely in the future and opening up their networks to more women across the city

• Improving working partnerships: We have engaged many of our Trade Union partners as part of the work towards a new city health and care partnership forum in April/May

• Attracting our future workforce: Our one Leeds workforce ambassadors are being recruited with three from each organisation and existing ambassadors are attending the Leeds Apprenticeship Recruitment Fair in March.

5.3 Finance Reports

Reports on the financial aspects of Research, Education and Training have been presented at meetings, clearly reporting progress against development objectives. In particular risks and opportunities relating to E&T finances are:

• Participation in national working groups looking at defining the scope and responsibility for undergraduate medical education has taken place; these groups include the DHSC, HEE and representatives from education and healthcare providers. Current provision varies significantly across the country.

• There is a lack of clarity over future funding levels in E&T with potential further funding reductions, through national changes to funding methodologies and through standardisation by HEE of the inconsistencies across the country.

• There have been a series of meetings to further scope potential opportunities around the provision of dental education particularly dental nursing/technology.

• Work is on-going to improve the level of understanding of CSUs around their education and training income and to ensure that appropriate income levels are received from HEE and other stakeholders.

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Highlights on R&I finances are:

• All research staff received the pay award and some of the funding was included in the Trusts overall pay award.

• Training sessions have been delivered to research staff in conjunction with the NIHR CRN Yorkshire and the Humber and to date 60 research staff have received training on the use of the NIHR Industry Commercial Costing Template.

• Participation in various aspects of the national agenda is continuing and there are many national changes which are in train and being assessed in terms of potential impact; one such being the recent changes to the funding of excess treatment costs (ETCs).

5.4 Guest Speakers During the course of the year, a number of guest speakers have been invited to present to the Committee, with representation from the Leeds Health & Care Academy, Director of the NIHR Biomedical Research Centre, Director of Postgraduate Medical & Dental Education regarding HEE, Education & Training Self-Assessment Report and Guardian of Safe Working Hours explaining about SuppoRTT, a national initiative to provide a supported return to work and training for trainee doctors who have had a period of absence.

6. Publication under Freedom of Information Act This paper has been made available under the Freedom of Information Act

7. Recommendations The Audit Committee is asked to receive and note this report. Donna Johnstone Research & Innovation Manager February 2019

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Appendix 1

Terms of Reference Research Education & Training Committee

1. Main Authority / Limitations

1.1 The Board hereby resolves to establish a management committee to be known as the Research and Education & Training Committee (‘the Committee’). The Committee is an executive-led management committee accountable to the Trust Board and shall have executive responsibilities, powers, authorities and discretion as set out in these terms of reference.

1.2 The Committee is authorised by the Board to oversee the development, implementation and performance management of the research, innovation, education and training strategies, and to monitor, investigate and address any activity within its terms of reference. It is authorised to seek a range of views, expertise, transparency and openness in meeting its objective. The Committee is authorised to request the attendance of individuals and advisors with relevant experience and expertise where necessary.

1.3 The Committee Chair provides the Trust Board with a brief summary of the Committee’s work at the first available Trust Board meeting opportunity after each Committee meeting. Approved minutes of the Committee are circulated to the Trust Board for information at the first formal meeting of the Trust Board after approval. The minutes are also circulated to those regularly in attendance. The Chair of the Committee will escalate matters in the first instance to the Chief Executive and Executive Management Team, and thereafter to the Trust Board as deemed appropriate.

1.4 Trust Standing Orders and Standing Financial Instructions apply to the operation of this Committee.

2. Objective

2.1 The Committee shall be accountable to the Trust Board and through its work focus on: (i) positioning LTHT in partnership with the University of Leeds and other academic organisations, as a global research and innovation powerhouse; (ii) working in partnership across Leeds/WestYorkshire to lead the delivery of cutting edge education and training; (iii) in partnership with others, or individually, compete for and win research grants or funds that underpin the Board’s long-term clinical aspirations; (iv) patient benefit from research participation and utilisation; (v) linking research participation to quality and service improvement; (vi) replenishment of trainee pipelines for all groups in sufficient numbers to meet the Trust’s anticipated operational need; (vii) Offering first class education and training programmes

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3. Primary Duties and Responsibilities

3.1 Oversee the development and implementation of strategies to promote LTHT as a global hub for research, innovation, education and training and to establish conditions for increasing participation in research, education and continuing development opportunities.

3.2 Oversee the establishment of partnerships with higher education institutes, industry, NHS organisations, and charities across the UK and internationally to increase participation in research, innovation, education and continuing development opportunities.

3.3 Keep under review the performance management for the delivery of the research, innovation, education and training strategies.

3.4 Provide assurance that opportunities to develop the research, innovation, training and education portfolio are aligned with the Trust Board’s strategy and that high quality bids are submitted.

3.5 Provide assurance that LTHT delivers an outstanding learning experience for all trainees, ensuring whatever steps necessary are taken to exceed the expectations of trainees, the Deanery, universities and other partners commissioning placements from the Trust.

3.6 Provide assurance that the trainee pipeline for all groups is replenished in sufficient numbers to meet LTHT’s long-term strategic and clinical aspirations

3.7 Oversee the development and implementation of highly-effective controls for

research and educational governance. 3.8 Oversee the rapid resolution of any significant weaknesses found in the

Trust’s research, innovation, education or training endeavors by reviewing decisions to halt research and education activity and apply whatever learning is necessary to: (i) ensure safe, high-quality and compliance research, education and training practices at all times; and (ii) the success fulfillment of research obligations to which the Trust is committed. Ensure material concerns are addressed to the satisfaction of all concerned and properly declared to the Trust Board of Directors.

3.9 Provide assurance to the Chair of Audit Committee confirming the effectiveness of the Committee and fulfillment of its objective, and to the effect that the Committee has disclosed to the Audit Chair all significant deficiencies and material weaknesses in the design or operation of internal controls which could adversely affect the Trust’s ability to achieve research, innovation, education or training objectives.

3.10 To undertake or consider on behalf of the Trust Chair or the Trust Board such other related tasks or topics as the Trust Chair or the Board may from to time entrust to the Committee.

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4. Duties and Behaviours

4.1 The duties of the Chairperson of the Committee shall be to:

• keep the Board informed regularly of any material matters which have come to the Committee’s attention;

• ensure that minutes of the Committee are an accurate reflection of discussion;

• attend or designate another member of the Committee to attend public meetings of the Trust to answer any questions related to the work of the Committee;

• submit an annual report on the work of the Committee to the Audit Committee;

• and ensure that all significant risks are discussed and escalated in line with LTHT’s Risk Management Policy.

4.2 The duties of members and attendees shall be to:

• attend and contribute

• have read the papers and materials in advance and be ready to work with them

• actively participate in discussions pertaining to Committee business ensuring that solutions and action plans have multidisciplinary perspectives and have considered the impact Trust-wide;

• disseminate the learning and actions from the meetings; and

• to attend at least 75% of meetings of the RET Committee.

5. Constitution 5.1 The Committee shall meet as often as required but not less than four times

each year. 5.2 The quorum for meetings shall be two Members, one of whom should be the

Committee Chair, unless he or she is unable to attend due to exceptional circumstances. In the absence of both the Committee Chair and Vice Chair a decision will be taken in advance of the meeting as to which member of the committee shall chair that particular meeting.

6. Membership and attendance 6.1 Members of the Committee shall be appointed at the discretion of the Chief

Medical Officer and Director of Human Resources/Organisational Development. The Trust Chair and Non-Executive Directors shall have the right of attendance but not as members of the Committee. Inextremis, any member of the Committee who is able to speak and be heard by each of the other members shall be deemed to be present in person and shall count towards the quorum. The core membership shall be:

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(i) Chief Medical Officer (Chair) (ii) Director of Human Resources & Organisational Development (Vice

Chair) (iii) Chief Nurse (iv) Director of Research & Innovation (v) Head of Nursing for Research & Innovation (vi) Director of Operations for Research & Innovation (vii) University of Leeds representative(s) (viii) Director of Undergraduate Medical Education (ix) Director of Postgraduate Medical & Dental Education (x) Representative from the composition of Clinical Service Units (xi) Senior Finance Business Partner Research, Education & Training (xii) Deputy Director of HR (Organisational Learning) (xiii) Guardian of Safeworking (Junior Doctor Contract) (xiv) General Manager Medical Directorate (xv) Head of Nursing for Education & Training (xvi) Project Director, Leeds Health & Care Academy (xvii) Non-Executive Director (xviii) Associate Non-Executive Director

In routine attendance:

(i) Research & Innovation Manager (Serving Officer) (ii) Minutes Secretary

6.2 Where ever possible members must send deputies to represent them in their

absence. The Chair may invite specific colleagues to address the Committee where appropriate.

6.3 The Committee is serviced by the Trust’s Research & Innovation Manager

who shall organise meetings, prepare the annual work plan and record proceedings. Papers shall be available at least five clear days before each meeting. Papers shall not be tabled unless it is essential and only with the Committee Chair’s prior agreement.

6.4 Terms of reference are reviewed annually or in the light of changes in practice

or national/local guidance. The Board will initiate the mechanism to review performance, which shall include the extent to which the Committee has operated in satisfaction of its terms of reference, and in particular compliance with reporting arrangements to the Board.

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7. Version Control

Version Control

Date Comments

V0.6 20/04/2015 Final comments from Executive Team

• Remove reference to governors in para 4.1

V0.7 08/05/2015 Minor changes to membership captured

V.08 25/05/2016 Approved by public Board

V.09 20/06/2017 Updated primary duties and responsibilities following consultation with RET committee members

V.10 12/02/2018 Minor changes to membership captured

V.11 19/02/2019 Minor changes to membership captured

Document Owner

The Trust Board Secretary is the owner of this document and of any Board minute authorising any amendment.

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Appendix 2

RESEARCH, EDUCATION & TRAINING (RET) COMMITTEE FORWARD WORK PROGRAMME 2018/19

Agenda Item 1

May 2018 2

Aug 2018 3

Nov 2018 4

Feb 2019

Strategy/Update

• Research & Innovation ⧫ ⧫ ⧫ ⧫

• Medical Education & Training ⧫ ⧫ ⧫ ⧫

• Non-medical Workforce, Development of Clinical Academic Careers

⧫

Performance/Metrics

• Clinical Education Report

- Postgraduate - Undergraduate - Nursing, Midwifery & AHPs

⧫ ⧫ ⧫ ⧫

• Induction Metrics - Medical & Non-Medical

⧫

• Apprenticeship Programme ⧫

• Research & Innovation ⧫ ⧫ ⧫ ⧫

• Mandatory/Priority Training ⧫

• Student Experience ⧫

• Guardians of Safe Working Exception Report ⧫ ⧫ ⧫ ⧫

Governance

• Research & Innovation ⧫ ⧫ ⧫ ⧫

• Education & Training ⧫

⧫

Presentations

• Research & Innovation ⧫

⧫

• Clinical Education & Training ⧫

⧫

Charitable Foundation

• Priorities planning ⧫

Education & Training Academy

• Workstream Update ⧫ ⧫ ⧫ ⧫

Finance Report ⧫ ⧫ ⧫ ⧫

Chair’s Items ⧫ ⧫ ⧫ ⧫

Items for Information

• Research & Innovation Committee minutes ⧫ ⧫ ⧫ ⧫

• Medical Education Sub Committee minutes ⧫ ⧫ ⧫ ⧫

• Applied Health Cooperative/Clinical Trials Unit Activity

⧫ ⧫ ⧫ ⧫

• NIHR Annual Reports ⧫ ⧫

• Health Education Yorkshire and the Humber Multi-professional Review report

⧫

⧫

• Learning & Development Group Annual Report

⧫

Board/Assurance Reports

• Annual Report & Work Programme ⧫

• Audit Committee Assurance ⧫

• Terms of Reference review

⧫

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Appendix 3

RESEARCH, EDUCATION & TRAINING (RET) COMMITTEE FORWARD WORK PROGRAMME 2019/20

Agenda Item 1

May 2019

2 Aug 2019

3 Nov 2019

4 Feb 2020

Strategy/Governance Update

• Research & Innovation ⧫ ⧫ ⧫ ⧫

• Medical Education & Training ⧫ ⧫ ⧫ ⧫

• Non-medical Workforce, Development of Clinical Academic Careers

⧫

Performance/Metrics

• Clinical Education Report

- Postgraduate - Undergraduate - Nursing, Midwifery & AHPs

⧫ ⧫ ⧫ ⧫

• Induction Metrics - Medical & Non-Medical

⧫

• Apprenticeship Programme ⧫

• Research & Innovation ⧫ ⧫ ⧫ ⧫

• Mandatory/Priority Training ⧫

• Student Experience ⧫

• Guardians of Safe Working Exception Report

⧫ ⧫ ⧫ ⧫

Presentations

• Research & Innovation ⧫ Mat Callister

YLST

⧫ Leeds

Children’s Hospital

• Clinical Education & Training ⧫ Undergraduate

Quality

⧫ Student Forum

Charitable Foundation

• Priorities planning ⧫

Education & Training Academy

• Workstream Update ⧫ ⧫ ⧫ ⧫

Finance Report ⧫ ⧫ ⧫ ⧫

Chair’s Items ⧫ ⧫ ⧫ ⧫

Items for Information

• Research & Innovation Committee minutes

⧫ ⧫ ⧫ ⧫

• Medical Education Sub Committee minutes

⧫ ⧫ ⧫ ⧫

• NIHR Annual Reports & Feedback ⧫ ⧫

• Health Education Yorkshire and the Humber Multi-professional Review report

⧫

⧫

• Learning & Development Group Annual Report

⧫

Board/Assurance Reports

• Annual Report & Work Programme ⧫

• Audit Committee Assurance ⧫

• Terms of Reference review

⧫