Future Practice: A Review of the Scottish Medical Workforce
4. PLANNING THE WORKFORCE - IMPROVING THE PROCESS
Coherent systems for planning the workforce are required supported by valid and reliable information.
SEHD proposals for new regional and national workforce systems in response to Planning Together provide the means.
121. The previous chapters have set out what we believe workforce planning for doctors in Scotland needs to achieve. It is clear from the evidence we have received and from the Report Planning Together that the current processes in SEHD and NHSScotland have not been adequate. Medical workforce planning needs to be the subject of a continuing, managed process which is complete in itself and is integrated with other planning processes both for other staff groups and for service delivery. It cannot be done by an occasional 'snapshot' review.
122. We welcome arrangements to support workforce development proposed by SEHD in response to Planning Together. They promise to make a step-change improvement in the structure and capacity for integrated planning of the workforce and its development. We anticipate a clearer lead from the centre than has previously been the case in medical workforce planning with decisions taken in partnership between centre, region and trust/board. But we believe there is a case to go further. We consider that there is a place for much larger managed regional health economies for Scotland than exist at present. An option could be three economies - one each based:
in the north with centres in Aberdeen and Dundee;
in the south east with the major centre Edinburgh; and
in the west with the major centre Glasgow.
These would manage services comprehensively, with the exception only of those highly specialised services such as liver transplantation which need to be managed at a national level. Each would provide specifically for remote and rural participation.
123. These proposals raise the possibility that the employment of medical staff should rest with the region. From our perspective, the importance of this scale in the integrated planning of services and the workforce means that regional management should be considered seriously.
Managing workforce planning for doctors
124. Systems for workforce planning:
need to be clearly defined and understood, so that planners ask the right questions and decisions are soundly based;
need to be backed up by suitable levers and accountability for action, so that workforce planning for doctors and for other professionals is accepted by service leaders as a priority for the health service in Scotland;
should ensure that decisions are taken in the right way and at the right time on the right issues, supported by the best information that can be obtained;
must accommodate longer planning horizons - a five-year NHSScotland horizon is not sufficient particularly for doctors, whose training period is much longer than five years and where the labour market is international; and
must take account of "horizon-scanning" for related issues such as likely changes to the nature of services and medical advances.
125. Local decisions on individual appointments to the medical establishment must be set clearly in a framework of larger-scale decisions which take into account the needs of effective workforce development.
126. The information required to support this decision framework is of various types and should normally be collected and validated in-year but to a shorter timescale if required. Delays in the system of data provision and aggregation should be minimised. This information might not necessarily be renewed annually but should be on a recognised cycle to ensure that the data are refreshed sufficiently often.
127. It is clear that there is an urgent need to "professionalise" planning and to improve the quality and timeliness of data and information. These points were well recognised in Planning Together and the SEHD response to it. The proposals they contain should improve and increase the capacity to carry out the workforce planning function. Our experience in reviewing medical workforce planning reinforces the essential and urgent need to establish a radically improved method of generating, collecting and validating workforce data, making full use of the potential of information technology.
Recommendations (planning the workforce - improving the process)
35 Establish much larger managed health economies than exist at the moment covering all services and workforce planning except those highly specialised services which have to be managed at a national level.
36 Take action to ensure that workforce data and information is generated, collected and validated in a timely way. This is urgent
37 Develop a coherent, nationally-led medical workforce planning system as a part of the workforce development arrangements in the SEHD response to Planning Together.