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WORKING FOR HEALTH
WORKING FOR HEALTH - PART 2
THE ACTION PLAN
2 The Action Plan
The Action Plan sets out how the vision for workforce development will be achieved, in five sections:
This Action Plan is designed to work as a whole with specific actions pulled together in groups by target dates for delivery, and based on four key prerequisites for delivery:
it needs to be effective at local, regional and national levels through a strong sense of ownership within NHSScotland and purposeful leadership from the Health Department;
it relies on workforce issues being integrally linked from the earliest stages, to service planning, to service developments and to changing clinical practice;
it requires workforce development to be factored into the planning and policy development business cycles within NHSScotland and SEHD from the earliest stages, to the extent that it becomes as routine and central as, for instance, the consideration of financial implications;
it rests upon the development of robust and comprehensive HR information systems which can provide the evidence base required to allow well-informed decisions to be made.
The Scottish Executive Health Department (SEHD) is putting considerable financial resource and dedicated human resource behind this Action Plan's delivery. The commitment of a wide range of individuals and organisations, working together with a common purpose, will be needed to move the plan forward.
The Action Plan is not a rigid blueprint. But it does place significant responsibilities on the Health Department, NHS Boards and other partners to act together promptly, positively and proactively in setting up practical and sensible arrangements for workforce development, a key cornerstone in building a reformed health service.
There are a number of detailed issues which will need to be worked through relating to the operation of these regional arrangements and their relationships with individual Boards and with the Department. These will be addressed through a managed process of regional conventions facilitated by SEHD to be held in autumn 2002.
A Health Department Letter (HDL) will be issued this Autumn to confirm and explain further what is expected of local health systems in implementing this plan over the medium-term.
3 Action Plan - Immediate Actions
3.1 Key Issues
A number of urgent workforce pressures have become apparent recently and need to be tackled as soon as possible. This is the focus for the Immediate Action, although real solutions will depend on longer-term action on workforce development.
Many recruitment and retention problems are already being tackled by Trusts and Boards across Scotland. Some however need more co-ordination and national leadership. Some of these will be addressed by a new short-life working group on NHS careers, recruitment and retention. Others are issues that will need to go to the National Workforce Committee as it develops in 2002.
3.2 Action on NHS Careers, Recruitment and Retention - Short-life Working Group
This group will be set up immediately.
It will oversee priority regional and national initiatives on recruitment and retention across the healthcare team, pioneering solutions. It will drive forward the development of careers initiatives and will identify flexible employment packages that can be rolled out locally.
Specifically, it will co-ordinate actions in the following priority areas to set, create and disseminate exemplar practice:
Careers: development of a co-ordinated national approach to NHS and health careers, including creating generic materials that promote and attract professionals to work in Scotland. This will include taking forward the recommendations relating to medical careers set out in the recently published report,
Future Practice, written by Professor John Temple;
Educational priorities: working with NHS Education for Scotland - work will include: the development of a fast-track graduate entry programme for therapeutic radiographers; establishment of a national project to support skill mix development for radiographers; and service redesign and work to support the development in Scotland of a new BSc course in Audiology;
Overseas recruitment: develop and bring together short-term strategies for recruiting experienced healthcare professionals from abroad, targeted to national priorities. A clear objective will be to make best use of the recently acquired National Waiting Times Centre;
Identity of staff groups: work will seek to create definite identities for staff groups that are attractive to potential employees from school age. This includes supporting the launch phase of
Building on Success
3 and organisation of a conference this autumn to define workforce strategies for NHSScotland in relation to Healthcare Scientists;
Employment and Retention: accelerate the development of packages to extend the working lives of key healthcare workers and respond to pressure points in current services.
The Short Life Working Group will be chaired by SEHD's Director of Human Resources and will include a core membership drawn from NHSScotland, together with other agencies including NHS Education for Scotland, Careers Scotland, and specialist recruiters. It will seek to draw in further expertise as required for specific initiatives.
3.3 Strategic Leadership - National Workforce Committee
The creation of a National Workforce Committee is an immediate priority. Its full remit is set out in Section 4 below.
Among its first tasks the National Workforce Committee will as a matter of urgency:
establish processes to assess and address gaps in shortage specialties across the whole healthcare team. These will provide effective short-term assessments of requirements on a case-by-case basis. The Committee will use these processes to assess the number of trained specialists required for the future, set targets for consultant numbers, and gear the numbers of doctors in training accordingly;
address pressures on the number of medical training-grade posts required to deliver the service and comply with the New Deal for junior doctors;
prioritise the current recruitment and retention pressures among the Allied Health Professions, in particular in physiotherapy, occupational therapy, radiography and speech and language therapy;
consider the recruitment and retention issues for nursing staff highlighted by
Facing the Future
4 in the context of the whole healthcare team;
develop robust processes to respond to sudden shortages in specific services.
Each of these actions depends in the longer-term on the creation of the rest of the workforce development infrastructure at local and regional levels.
3.4 Better HR and Workforce Information
Improving the quality and relevance of key information at all levels of NHSScotland is essential if workforce development is to be effective and to be set up on a sound basis. We will be therefore be taking immediate action to improve the supply of workforce information by:
appointing a workforce information team to service the Workforce Development Unit and the National Workforce Committee, as well as support the regional co-ordinators;
systematically reviewing data collection systems at national and local levels to build a new credibility for HR information at the centre of development, planning and delivery;
commissioning specialist expertise to scope what needs to happen to make NHSScotland's workforce information fit for purpose. This will identify the options for new information and information technology strategies to support workforce development. The work will start immediately and will incorporate existing best practice drawn from outside the healthcare sector as well as within NHSScotland;
prioritising investment in information management and technology to support workforce development as a core implementation target in local and national strategies;
developing a best practice database for workforce development and human resources.
4 ACTION PLAN - NATIONAL WORKFORCE DEVELOPMENT
4.1 National Workforce Committee
The National Workforce Committee will provide direction and leadership for the workforce development agenda across NHSScotland, basing its actions and guidance on evidence gleaned from NHSScotland through the Regional Workforce activity.
It will work closely with the Regional Workforce Co-ordinators, NHS Education for Scotland, the Scottish Partnership Forum, the UK Sector Skills Council, the Centre for Change and Innovation, and other key interests.
The National Workforce Committee will also oversee work to develop the capacity for Scotland to take the 'long view', scoping future workforce trends 15-20 years into the future. It is essential to focus on future scenarios to take the right decisions now on building a workforce fit for the next generation.
More specifically, the Committee will:
oversee the planning of numbers for all the professional staff groups - including those in general practice - agreeing national targets where necessary (for example for consultant numbers) and clearly setting out objectives for training, recruitment and retention across the professional workforce. The Committee will carry out these tasks with a view to managing supply and demand effectively, and in so doing it will be advised by expert groups;
oversee and promote workforce strategies for all staff groups, taking in careers and recruitment and retention;
respond to 'hot' issues over staff shortages;
commission and refresh at regular intervals long-range strategic workforce scenarios, looking at service change 10-15 years ahead;
help to develop national strategic responses to major external developments that have impact across the whole NHS workforce, such as the Working Time Regulations;
promote workforce development as a core component of the Performance Assessment Framework and the accountability process;
maintain a wider interest in the development of workforce issues in Scotland, the UK and internationally, including taking evidence as necessary from key interests so that it can inform its decisions by a thorough examination of the Scottish scene and the context in which it operates.
A key relationship will be between the Committee and NHS Education for Scotland, which will provide the Committee with the necessary supply-side intelligence and information across the NHS workforce.
The Committee will also have a key role to play in overseeing the implementation of a number of recommendations contained in
Future Practice and will advise the Department on the outcome of the working groups on basic medical education and medical career structures being established in the wake of that report. An important element of this work will be to consider how any future changes to the operation of the SHO grade should be addressed in Scotland, and what knock-on effects these might have on other parts of the healthcare team.
The Committee will be a small group drawn from the following sectors and stakeholders:
NHSScotland;
Scottish Enterprise;
Careers Scotland;
NHS Education for Scotland;
Higher and Further Education;
Scottish Partnership Forum;
Other UK Health Departments.
4.2 National Leadership - Scottish Executive
Overall responsibility for workforce development will rest with the Health Department Board to whom the National Workforce Committee will report through the Director of Human Resources. The Board will have responsibility for the risk management and benefits realisation relating to workforce development for NHSScotland.
All Directors at national level recognise they have a key role to play in workforce development on a collective and an individual basis, and that this requires a new focus on workforce development and its integration into the mainstream of reform.
In addition, the Human Resources Directorate within the Scottish Executive is also being restructured to reflect the challenges of reform, including creating capacity to support workforce development and fitness for purpose of health staff.
The core workforce development function will lie within the Directorate's
Workforce and Policy Division, which will house the National Workforce Unit. The National Unit will ensure the approach to workforce planning and development is driven at a national level.
The
Learning, Development and Careers Division will link closely with aspects of career development, fitness for purpose and recruitment and retention. It will also sponsor NHS Education for Scotland and the development of models for continuous professional development, appraisal and mentoring.
The
Partnership and Employment Practice Division will cover issues such as the further development of partnership in NHSScotland, the
Joint Future initiative and will develop core employment strategies that support flexibility and new ways of working.
All of these divisions will be headed by Assistant Directors and they will ensure that workforce development is embedded into the business cycles that operate within SEHD and NHSScotland. This will mirror the integration of service planning and workforce development at local level by ensuring that workforce issues are factored in to the preparation of all planning and guidance produced across the Department.
Action Plan - National Workforce Development
By end September 2002 |
SEHD to have appointed the Head of the National Workforce Unit and his or her immediate team. SEHD to have agreed an initial work programme for the National Workforce Unit. SEHD to have agreed with NHSScotland draft terms of reference for the National Workforce Committee. SEHD to have co-located with the National Workforce Unit workforce information specialists from ISD to help provide the information base to support the new arrangements. SEHD to have appointed Assistant Directors to head the Learning, Development and Careers Division and the Partnership and Employment Practice Division. SEHD to have appointed the members of the National Workforce Committee and first meeting to be held. National Workforce Committee to have agreed its terms of reference, working methods and how it will link to the National Workforce Unit, Regional Workforce Co-ordinators, NHS Boards, NHS Education for Scotland and the Scottish Partnership Forum.
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By end October 2002 |
The National Workforce Committee to have devised an initial work programme, to include: Deciding on numbers and allocation of posts of doctors-in-training Deciding on numbers and allocation of medical staff-grade posts Overseeing arrangements for distribution of GPs and wider workforce planning for primary care services, following the abolition of the Scottish Medical Practices Committee Overseeing the implementation of remitted aspects of
Future Practice and any changes in the operation of the SHO grade Overseeing the development of Student Nurse Intake Planning (SNIP), workforce planning for nurses and midwives, and other aspects of recruitment and retention for nurses and midwives identified as Committee priorities by the
Facing the Future Group Overseeing the development of workforce strategies for Allied Health Professionals and other staff Giving a strong strategic lead to developing new HR information systems Overseeing the development of a robust capacity to take the 'long view', and reviewing regularly Developing procedures for addressing 'hot' workforce issues Giving a strategic lead to policies on recruitment and retention and career development Linking the items listed above with closely related areas such as: the impact of the working time regulations; the New Deal for junior doctors; new pay systems; service redesign; and new ways of working
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By end December 2002 |
The National Workforce Committee to have agreed its methods of working and its working relationship with other relevant bodies. The National Workforce Committee to have agreed its priorities for 2003 and identified how it will tackle these through the year.
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5 Action Plan - Local and Regional Workforce
Development
5.1 Key Issues
The main focus in the medium-term (the next nine months) will be to establish the local, regional and national workforce development infrastructures - the Regional Workforce arrangements, the National Workforce Committee and the National Workforce Unit.
The key relationships and roles within the new structures are set out in Appendix 4. This focus on the importance of workforce development places particular responsibilities on those in leadership positions at Trust and NHS Board levels and within SEHD. This extends beyond the Chief Executives to all Directors and the detail of the infrastructure that follows assumes that commitment will be made, given the clear priority now being placed on workforce development at local and national levels.
5.2 Regional Workforce Arrangements
The Regional Groups are crucial in providing a direct link to service planning, which is already being undertaken at regional level on core services such as cancer, and also in creating cross-employer links into local employment markets.
They will be developed incrementally, allowing the partners to ensure they add value in the way they are set up and operate. Crucial to this process will be regional conventions to be held in the autumn where the integration of service and workforce planning and the detail of implementation can be worked through and refined for each part of Scotland.
The role of the Regional Groups is not to perform the workforce planning or development functions for the NHS Boards in their areas; each Board will continue to lead workforce development for their workforce and will produce their own workforce plans.
These will take a regional perspective, ensuring that where required - for example, in relation to regional-level Managed Clinical Networks and the delivery of new service frameworks - a coherent regional approach to planning the workforce is taken forward.
Each NHS Board will need its own workforce development capacity to look beyond the pressures of everyday fire-fighting and to provide a strategic workforce development function. The Boards will also be able to use this capacity to contribute to the work of the Regional Groups.
Setting-up
NHS Boards will receive core funding from the Health Department (to be topped up by the Boards) to appoint personnel to lead on workforce development for the Trusts/units in their areas. These are referred to as Workforce Officers.
Funding will also be available to fund essential infrastructure costs, for example to cover information technology in each regional group.
The central recurrent funding will vary according to the size and complexity of the health system in each Board area. Monies will be released upon approval by the National Workforce Unit of each Board's proposals on how they intend to invest the funds available to them.
The Role of the Regional Co-ordinators
The Health Department will fund and appoint directors drawn from senior NHS management to head up each Regional Workforce Group as Regional Co-ordinator. They will be accountable to the National Workforce Committee, both financially and in terms of delivering on the strategies agreed by the Committee. They will also have a key role in liaising with the NHS Boards in their regions and ensuring that workforce officers function effectively as a team, to the mutual benefit of the region and their own Boards.
The Role of the Workforce Officers
Workforce Officers will have a dual role. In addition to their local responsibilities within their NHS Board area, they will also help to build workforce development at regional level for their relevant regional group. They will therefore be accountable to a nominated senior Trust manager in their employing NHS Board and, for their regional input, to the director of their regional workforce group.
Workforce Officers are likely to be supported by teams in Trusts drawn from a number of quarters:
those already working on aspects of workforce development (work on SNIP,
Facing the Future and HR information systems, for example);
fresh resource provided by Boards and Trusts to ensure they have sufficient capacity to deliver on workforce development;
existing service planning staff, who should work increasingly in harness with workforce development personnel to bring together the demand and supply side of the workforce equation.
Regional boundaries for services planned and delivered above NHS Board-level may be different for each service however. Workforce Officers, while being attached to a 'lead' region, may therefore operate in more than one group.
Service Planning and Workforce Planning
The integration of service planning with workforce planning at all levels is a pivotal message from
Planning Together and must be achieved if this Action Plan is to be effective.
Effective service planning must involve appropriate workforce planning at an early stage - across NHSScotland we need an integrated service planning and workforce development function.
Key to this is the creation of integrated teams with complementary skills and objectives so that the service and workforce remits can be combined and staff are not partitioned into silos. The workforce officers themselves might well combine their workforce role with a wider regional service planning role.
We will drive this process by combining the regional workforce groups with the regional service planning arrangements outlined in HDL(2002)10. We will also put in place a process to facilitate the integration of service planning with workforce development at local level, which we recognise may be a real change management challenge.
Development and Support
In setting up new structures and new roles, development and support will play a crucial role to create a new workforce development capacity that goes beyond the Workforce Co-ordinators and Officers. The National Workforce Unit will ensure that appropriate development programmes and activities are created and delivered.
Remote and Rural Issues
Remote and rural issues arise in all parts of Scotland and straddle the workforce development regions. This suggests an approach that secures a national focus for remote and rural workforce development issues, but also ensures remote and rural issues are articulated effectively through the regional arrangements. This might be done by nominating one or more lead remote and rural workforce officers in each region. These officers could then network through a national co-ordinator, based in the National Workforce Unit, and link back to both the Remote and Rural Areas Resource Initiative (RARARI) programme and the relevant NHS Boards.
Because of their size and geographical constraints it may be that Island NHS Boards will wish to share a dedicated Workforce Officer between them. The Island Boards would, however, need to be fully involved in any regional workforce considerations which touch directly or indirectly on what they do.
Action Plan- Regional Workforce Development
By end August 2002 |
NHSScotland to agree on the exact configuration of the three Regional Workforce Groups, tied to Regional Service Planning arrangements. This will be finalised through regional planning conventions. SEHD to draw up job descriptions for Regional Workforce Co-ordinators and to agree, in conjunction with NHS Boards, job descriptions for Workforce Officers. NHS Boards to be invited to submit proposals for the release of core funding for the appointment of workforce development personnel. NHS Board Chief Executives to agree collectively, in conjunction with SEHD, general modes of operation for workforce development in Regional Planning Groups.
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By end November 2002 |
NHS Boards to have submitted and agreed with the National Workforce Unit their proposals for the appointment of workforce development personnel. All regions to have appointed Workforce Officers and Regional Workforce Co-ordinators. NHS Boards, in consultation with Workforce Officers, to identify supporting workforce development teams. The teams will be drawn from and shared with existing planning, data, HR or administrative functions within their Trusts. HDL to issue clarifying what is required of local health systems to implement the required medium-term actions for workforce development. NHS Boards, with facilitation from SEHD, to work through the integration of their service planning and workforce development resource, prior to the 3 regional conventions referred to below. NHSScotland, with support from SEHD, to hold three conventions - one in each workforce region. The conventions will aim to define modes of working and initial work programmes for each Regional Planning Group. Local chief executives, HR Directors and other senior managers should participate. National Workforce Unit to agree necessary start-up costs and running costs with each Regional Workforce Co-ordinator within the Regional Planning Groups, and to resource accordingly. National Workforce Unit to issue guidance to NHS Boards on the operation of workforce development at regional and local levels. The guidance will include advice on integrating with regional planning groups and developing relationships with: NHS Boards The National Workforce Unit The National Workforce Committee The Scottish Partnership Forum and local and area partnership forums NHS Education for Scotland
Regional Planning Groups, Regional Workforce Groups and the National Workforce Unit to link with the Payroll Steering Group and Information and Statistics Division of NHSScotland to take forward the development of HR information systems for the near and longer-term future. Will also take account of the findings of the Department of Health's Review of Workforce Information Needs (RoWIN).
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By end January 2003 |
Regional Planning Groups and the National Workforce Unit to agree initial work programmes, which should include: Mapping existing workforce development activity and resource; Identifying local stakeholder forums and establishing mechanisms for engaging with them in each region; Determining national, regional and local approaches to developing workforce strategies across different staff groups; Supporting
Facing the Future and responding to priorities identified in the Scottish Executive Response to
Future Practice
5; Taking forward actions from the report
Building on Success; Taking forward actions from
Caring for Scotland
6, the nursing and midwifery strategy for NHSScotland.
The National Workforce Unit, working in partnership with regional teams and consultancy support where necessary, and sharing learning and experience with the Department of Health, to begin work on defining competency frameworks and common skill-sets for workforce development. This should lead to a development programme being rolled out to workforce development teams, Chief Executives and other senior managers from February 2003. Regional Workforce Co-ordinators to consult with the National Workforce Unit on particular workforce skills or needs identified. Regional Workforce Co-ordinators and the National Workforce Unit to agree timing, format and participation in an initial joint planning event or events to: Build a corporate identity between Workforce Officers and their teams; Share common concerns and successes; Achieve joint agreement on the development of effective and integrated regional and Board-level approaches to workforce development; Determine the focus and priorities for subsequent action across Scotland.
Similar events would be held on a regular basis. |
By end February 2003 |
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By end May 2003 |
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6 Workforce Development Links
Workforce development is central to initiatives designed to deliver many of the commitments outlined in
Our National Health. This demands a clear, co-ordinated approach across Scottish Executive and NHSScotland to ensure workforce development links fully into ongoing initiatives now and in future.
A description of some of the existing workforce development initiatives already underway in NHSScotland is listed in Appendix 3.
A selection of some of the key links are also set out as follows:
Workforce development links to key NHSScotland initiatives |
Supporting and tracking delivery of Partnership Information Network (PIN) guidelines, and ensuring they are being utilised to maximum effect in developing recruitment and retention, family-friendly and flexible working environments, and health and safety in the workplace; Working with RARARI, and others, to follow up initiatives (such as the new consultant and GP contracts and the report for Allied Health Professions
Building on Success) to develop responses to recruitment and retention pressures in remote and rural areas; Linking with those involved in following up the Primary Care Modernisation Group's report,
Making the Connections, to ensure that workforce development aspects, such as the development of clear positions on 'intermediate care', are addressed; Exploring approaches to the training and workforce planning of Allied Health Professionals, developed in the light of the establishment of NHS Education for Scotland and the workforce development arrangements outlined in this Action Plan; Co-ordinating action with those involved in taking forward
Caring for Scotland, the nursing and midwifery strategy for Scotland; Supporting policies on redesign and reconfiguration of NHSScotland and on service-wide issues working with, for example, the Chief Executives' Working Time Regulations Solutions Group and the Junior Doctors' New Deal Implementation Support Group; Actions to put in place a co-ordinated approach to ensuring all staff in NHSScotland are fit for purpose.
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7 Action Plan Outputs
The Action Plan will need to be led and delivered jointly between NHSScotland and SEHD, and will involve many others. All these partners will need to achieve the right balance between 'top down' and 'bottom up' approaches to ensure that the benefits of workforce development are realised.
Partnership lies at the heart of the approach, with the
Joint Future agenda and the Scottish Partnership Forum and its counterparts at local and area levels playing a key role in ensuring workforce development works. The outputs are clear.
The future of NHSScotland and the future of the health workforce in its broadest sense are therefore profoundly intertwined. Ultimately, it is not structures but the people who work in those structures who will be the engines of reform. Real and effective change springs from shifts in the culture and behaviour of staff, flowing from a willingness to embrace new ways of working and more flexible approaches to service delivery. That brings workforce development centre-stage in the reform of NHSScotland, because it demands that we invest in a workforce that can - and will - deliver change.
This Action Plan puts in place a systematic approach to workforce development. At a minimum, it will help NHSScotland to make effective, timely decisions on investing in its workforce and thus assist in the improvement of healthcare services. At most, it promises to be a pivotal engine of change which will be at the heart of driving the creation of an NHSScotland fit for the 21st Century, meeting the health and care needs of all the people in Scotland.
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