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Partnership for Care: Scotland's Health White Paper
CHAPTER SIX EMPOWERING AND EQUIPPING STAFF
Strengthened partnership between NHSScotland and its workforce
Support for local leadership in service redesign
More resource for workforce planning and development
New support for continuing professional development and training
Better reward systems for staff at all levels
Major investment in information services to achieve an Integrated Care Record
1. If we are serious about improving health and healthcare, then we have to be serious about supporting, valuing and empowering the staff who deliver care. The key to change is giving healthcare teams support to solve old problems in new ways. This means giving staff the opportunity and incentive to design and deliver integrated services around the needs of their patients. It also means investing in staff, freeing them to do things better and equipping them with the tools they need to do the job.
2. Evidence suggests that staff initiate and lead service improvement if they are fully involved and understand the context for change. Where staff have to work differently they will be directly involved in driving the change process. We must get the size and shape of the workforce right, promote flexibility and team working and encourage new ways of working, with appropriate training and development support.
Workforce Planning and Development
3. Failure to get the shape of the workforce right in the past has resulted in shortages in certain specialities today. We are already developing a more strategic and coherent approach to workforce planning for NHSScotland, making sure we have the right people with the right skills in the right place at the right time. This means taking a holistic approach which integrates workforce planning, service planning, redesign, education and training, recruitment and retention, role development, modernised pay systems and the impact of applying safe limits to working hours.
4. Our approach to workforce planning and development, outlined in
Working for Health: The Workforce Development Action Plan for NHSScotland23 will enable us to plan how many doctors, nurses, pharmacists, Allied Health Professionals and ancillary staff are required to deliver responsive and sustainable services 3, 5 and 10 years into the future.
5. Young people with mental health problems will be the first to benefit from our new national approach to integrated workforce development. Our first priority will be mental health workers for child and adolescent services. This initiative will identify core competencies for staff, provide new opportunities for joint training and enable staff in partner organisations to combine more effectively in multi-disciplinary teams to provide improved, sustainable services.
6. To build capacity to develop the workforce at
local, regional and national level we will:
support the development of expertise in workforce planning and development in each
NHS Board area, making it a central strand of redesign;
appoint
Regional Workforce Co-ordinators for the North, East and West of Scotland to work closely with those responsible for regional service planning; and
provide overall direction and leadership for workforce development through a
National Workforce Committee.
7. These initiatives build on the measures we are already taking to improve recruitment and retention for nurses and midwives, through the Facing the Future initiative, and for Allied Health Professionals and the medical workforce. We are:
providing extra investment to provide new posts;
funding schemes that encourage skilled professionals to return to NHSScotland;
making careers more attractive and engaging with staff to develop initiatives which will motivate and reward them and encourage them to stay;
supporting local recruitment with regional and national campaigns; and
promoting diversity in employment.
8. It is critical that we get the shape of the medical workforce right in the future. We are committed to developing a new structure for postgraduate medical training, geared to meet current pressures and changing demands.
Learning, Development and Careers
9. We are committed to creating a culture of lifelong learning within the NHS and to the promotion of learning organisations across the NHS. NHS Education for Scotland will work in partnership with NHS Boards and staff organisations to bring together strategies for learning and development for all staff groups, delivering multi-disciplinary and team-based development programmes.
10. We will build on the success of our
Learning Together24 strategy by:
establishing NHSScotland as an exemplary employer for workplace learning;
confirming the role of appraisal and personal development plans in supporting quality improvement and change;
developing an entitlement for all staff to continuous professional development; and
reviewing arrangements for health-related educational and development funding.
11. We are taking a co-ordinated look at skills, careers and recruitment through a multi-agency group, looking at:
new methods of providing career support for the personal and professional development of staff;
setting up a register of skills for staff which will provide them with greater access to learning and development and an electronic means of recording their development; and
increasing access to learning activities through the development of a co-ordinated database.
12. We will co-ordinate the activities of responsible agencies including NHS Education for Scotland, NHS Quality Improvement Scotland and regulatory and professional bodies to ensure that the people who provide services are appropriately trained and skilled. NHS Quality Improvement Scotland and NHS Education for Scotland will also ensure that new ways of working and emerging new roles will promote the highest standards of care.
Flexibility
13. Care in the 21st century will depend on flexible teams providing services that patients need, irrespective of organisational boundaries. Staff are the best people to develop these new roles and there is already much good practice to build on. Diagnostic testing and extended prescribing roles for pharmacists and nurses, technician-led pre-admission clinics, clinical decision-making by paramedics and other clinical staff are just the beginning.
14. For example, radiography teams are using their expertise more effectively and flexibly to ensure patients receive care as quickly as possible with more job satisfaction for practitioners. Radiographers undertake ultrasound and barium investigations in many areas and therapy radiographers in some cancer centres provide and monitor treatment for patients receiving palliative radiotherapy.
15. Flexibility is about the NHS providing the care that patients need, at the time and in the place that they need it. It is also about staff finding work they want to do while maintaining a fair work life balance. The Centre for Change and Innovation is already leading new work on providing flexible working conditions for nurses. The principles underpinning this work will provide a platform for initiatives for all staff groups. Every NHS Board will, as part of their programme of change and innovation, set out their plans for staff flexibility and the development of new roles.
Partnership and Employment Practice
16. High quality services and good employment practice go hand in hand. So partnership between staff and employers, involving Trade Unions and professional organisations, is essential to the continual improvement of public service. This partnership commitment will be driven forward at national level through the Scottish Partnership Forum and Human Resources Forum, launched earlier this year to make sure staff have a voice at the highest level.
17. We will also strengthen partnership working by investing further in a national Partnership Support Unit. This brings together expertise from the unions and professional organisations, NHSScotland and other partners. It will help local health systems work more effectively and support staff governance in practice.
18. We will build on the Partnership Information Network Guidelines, which are a good example of staff partnership at work, producing guidance on good practice in the workplace, from family-friendly policies to safety at work.
19. We will also actively support collaboration between NHS employers, trade unions and professional organisations to forge a consistent set of national employment, learning and careers standards for everyone in NHSScotland.
Staff Health
20. Staff need to feel that their own health at work is protected. Under the leadership of the Human Resources Forum we will invest in a network of one-stop centres at NHS workplaces, develop a fast-track rehabilitation service for health workers and encourage a campaign to reduce work-related ill-health. The existing
Staff Governance Standard25 will be extended to include a commitment to improving the wellbeing of all staff providing NHS health services whether permanent, temporary, agency or from the private sector.
Leadership and Management
21. Leadership is not the preserve of a small group of people in senior positions but needs to be nurtured at all levels of the service. Delivery of improved services depends on effective leadership at all levels of the NHS. In particular, clinicians, working as part of multi-professional teams, are at the heart of service development. We recognise that clinical leaders require the support and time to be fully involved in service redesign and we are committed to finding better ways of recognising the key leadership role of clinicians from all professional backgrounds. This includes investment in development programmes that cross clinical boundaries and consideration of supplementary financial rewards for clinicians who play a lead role in service redesign. In particular we will give priority to the support needs of clinicians leading the development of Community Health Partnerships, Managed Clinical Networks and Care Networks.
22. Leadership more generally will be strengthened by the creation of a National Framework for Leadership Standards to support staff and a supporting Code of Practice, which will clearly set out the leadership standards and behaviours.
Pay, Reward and Motivation
23. We are working to introduce major new systems of remuneration covering most of the 136,000 health workforce. If agreed by staff, these will amount to the most comprehensive change ever in NHS pay.
24. We are in discussion with the profession on the terms and conditions of a new
contract for consultants which, if agreed, will build better relationships between managers and clinicians and allow consultants to plan their work in a way which recognises their own needs and makes best use of their contribution to clinical care.
25. We have played a full part in negotiations on a UK-wide contract for the delivery of
general medical services by GP practices. If agreed by the profession, this will transform the way in which services are delivered in the community by focusing on the practice team rather than the individual GP, and supporting more effective care pathways between primary and secondary care. It will also deliver more effective management of GP workloads and provide a clearer focus on the achievement of outcomes through the provision of quality care to patients.
26. There are also plans to introduce a new pay system,
Agenda for Change, for the majority of NHS staff including nurses, Allied Health Professionals, healthcare scientists, ancillary, clerical, administrative and managerial staff. If agreed, for the first time life-long learning will be embedded in pay arrangements for these staff, rewarding them for the development of knowledge and skills, allowing them the flexibility and freedom to design jobs that are more rewarding, and providing them with the opportunity to develop new roles that can respond more effectively to patients' needs.
27. We are in the initial stages of negotiating a new contract for
community pharmacists. The focus will be on the contribution pharmacists make to health improvement, chronic disease management and community pharmacy-led treatment of minor illness. This will be underpinned by a quality framework and will ensure community pharmacy is recognised as an integral part of the wider primary care team.
28. We will also take forward, in discussion with the
dentistry profession, proposals for changes to the system for rewarding primary care dentistry in order to promote prevention, improve access to services and improve recruitment and retention.
29. These new pay systems will of course only be implemented with the agreement of staff.
Equipping Staff
30. Staff need to have the tools to do their job. So we are investing heavily, not only in NHS staff themselves, but also in modernising the infrastructure of NHSScotland and above all in the information systems and communications technology necessary to deliver redesigned healthcare.
31. NHS staff need access to the right information at the right time, if they are to meet patients' needs. We urgently require an e-Health culture to be established, driven by clinical leaders.
32. This means both getting the foundations in place, and systematically building sophisticated information and communication systems. By the foundations, we mean personal computers, network connections and training for staff to use these tools as part of their job. Steadily increasing investment in these basics has been made over the past three years and this will continue.
33. Our goal is to deliver an Integrated Care Record jointly managed by patients and professional NHS staff with in-built security of access governed by patient consent. Integrated Care Records will take time to reach, but each step in their development will bring immediate benefits to patients, carers and healthcare professionals by enabling:
greater patient involvement in their own care;
service redesign and the shift in the balance of care provided in different settings;
quicker exchange of information between professionals;
quicker access to patient records (with built-in patient confidentiality); and
continuous improvement by providing routine monitoring of quality standards.
Clinical Information Systems
34. When people move within or between care settings, we must ensure that the right information such as clinical letters and laboratory test results are transferred quickly and securely. Our priority is to speed up this process by establishing agreed data sets and codes to be used in all exchanges so that information is correctly interpreted by everyone who shares it. Standardisation of definitions and integration between data sets will be clinically-driven in future to ensure that NHSScotland's information systems support national clinical priorities. Scotland's diabetes specialists are already working closely on the Scottish Clinical Information Diabetes Collaboration, an initiative which has already defined shared information for diabetes care and is now starting to roll out electronic patient record systems across NHSScotland GP and hospital diabetes services.
35. We will improve the co-ordination of children's care services, through an electronic Integrated Children's Services Record, developed in partnership with Local Authority and other relevant agencies. The benefit for children will come from better communication between professionals involved in their care. This key project will be Scottish Executive-wide. In due course, it should be possible to issue a 'smartcard' containing key health information in easily accessible electronic form which patients could use to unlock their information rapidly and securely when required. We plan to explore the possible use of such 'care cards' in consultation with patient groups and professionals, and we will explore the use of the Citizen's Smartcard under development through Scottish Executive 21st Century Government as the secure key to enable safe access to this record.
36. Information and communication systems must also be used to reduce pressures on staff who waste time looking for information. NHSScotland information systems must offer support for:
Accident & Emergency departments;
online access to laboratory tests;
electronic prescribing systems integrated with other clinical information systems;
on-line instant retrieval and transmission of clinical images such as X-rays and ultrasound across Scotland;
primary care and shared communication with other parts of the NHS; and
community pharmacy systems linked to other NHS practitioners (e-Pharmacy).
37. National procurement is already under way to establish electronic patient record systems for Accident & Emergency departments which will be linked to existing hospital systems and to partner services such as GP Out of Hours, NHS 24 and Scottish Ambulance Services. We have also established a secure way of linking NHS and Local Authority telecommunications networks and three local NHS and Social Work partnerships use this, with patient consent, to share the patient/client record with practitioners in each agency.
38. To achieve this, clinicians will take a lead role in the selection and use of systems. NHS Boards will be required to appoint a clinician as Director of Clinical Information to drive forward this e-Health culture.
39. A Ministerially chaired e-Health Programme Board will draw together clinicians and other stakeholders to co-ordinate this work. A Clinical Information Steering Group, led by the Chief Medical Officer, will be responsible for agreeing common definitions and standards across NHSScotland in partnership with NHS Quality Improvement Scotland and other relevant organisations. Consideration will be given at every stage to clinical coding and UK data sharing requirements.
40. These actions will support the redesign of health services:
patients, carers and staff will find consistent information systems across NHSScotland;
patients will benefit from consistent interpretation of shared information as a result of agreed data sets and coding systems;
patients will be involved in decisions about the use of their personal health information;
clinical communications will use a single broadband telecommunications network, with a common e-mail directory and access to the Internet wherever it is needed; and
e-Health funds and information support staff will be organised in a way that supports operational systems critical to the care process.
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