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Response to the Nursing and Midwifery Workload and Workforce Planning Project
Contents
Foreword
Introduction
Policy Context
Key Principles
How the project's recommendations will be taken forward
Implementation, Monitoring and Review
National Template
Conclusion
Appendix 1: Response to Recommendations - Template
Foreword by Minister for Health and Community CareThe NHS workforce in Scotland is both large and diverse. It is central to the delivery of first class health services today as well as those services demanded of tomorrow. It is essential, therefore, that in recognising this, our key asset, we are able to support the needs of the workforce in an ever changing environment.
2003 heralded the first piece of major work to be undertaken on nursing and midwifery workload and workforce planning across NHSScotland. Through the
Facing the Future group, which I chair, nursing and midwifery workload had been identified as an area of concern on which further analysis and understanding was required.
I welcome this report. In an increasingly demanding working environment, it is important that resources are deployed in an efficient manner. This report allows for the workload agenda to be developed in a way that will make a meaningful difference to the working lives of all NHS staff as well as to deliver improved services to patients. However,
Facing the Future will have a key role to play in implementing the recommendations for nursing and midwifery staff.
This response to the Nursing and Midwifery Workload and Workforce Planning Project endorses, in principle, the recommendations made to the benefit of nursing and midwifery staff.
But it does more. It recognises the wider context in which workload and workforce planning sits and sets the first steps to ensuring that this research benefits all those working within NHSScotland. Workload is an issue that cannot be seen in isolation.
Teamworking is an essential commodity in any successful organisation. NHSScotland is no different. While professional boundaries are acknowledged, it is essential that services are delivered across multi-disciplinary teams that meet patient needs. In doing so, the important roles that
ALL NHS staff have to offer in delivering the health agenda in Scotland are recognised.
From the project's recommendations, it is clear that further scoping work will be required. This may identify resource implications which must be fully understood in addition to any cost benefits they may afford. Nevertheless, I would wish to see action plans that further build on the recommendations made.
I extend my gratitude to those within the workload sub-group and in particular to the sterling efforts of the Project Manager, Pauline Milne, for delivering this report. This has brought workload and workforce planning to the forefront of service delivery and needs to reflect whole workforce issues at both strategic and operational levels. By developing an integrated approach we are able to learn valuable lessons to the benefit of everyone associated with the NHS in Scotland
This is an important first step and I look forward to witnessing the benefits to staff and patients as it is developed across the service.
Malcolm Chisholm, MSP
Minister for Health and Community Care
IntroductionThe
Facing the Future group was established to lead on a number of key themes that would ultimately lead to improved recruitment and retention within the nursing and midwifery workforce. As part of this, the
Facing the Future group commissioned research into nursing and midwifery workload and workforce planning under the theme of Research and Evaluation.
Working in partnership with NHSScotland, RCN, RCM, UNISON, Higher Educational Institutions and other external agencies, this workload report has produced twenty recommendations on how workload and workforce planning should be improved within the nursing and midwifery workforce.
It is important to realise both the need and the potential to develop this across all staff groups within the NHS. After all, the delivery of a first class health service in Scotland is dependent on the whole workforce working in teams to deliver quality care to patients.
In understanding this, it is important to consider a number of policy documents that allow this subject to be considered in a wider context.
Policy Context
A number of policy documents provide a context for the workload report:
Facing the Future - Following the national
Facing the Future event held in November 2001, an Action Plan was developed and approved for use at both national and local levels. The Action plan highlighted 8 key themes that required to be developed in order to improve the recruitment and retention of nurse and midwives in Scotland. The key themes that were identified were:
1. Careers
2. Leadership
3. Flexibility
4. Education and Training
5. Working conditions and tools for the job
6. Employment packages
7. Research and Evaluation
8. New Roles
This, as well as the development of local action plans, has allowed nursing and midwifery developments to be highlighted and monitored that support the building of capacity within these professions.
Planning Together was published in January 2002 and built upon the initiatives first identified in
Our National Health. This identified the need to take an integrated approach to workforce planning. It also set clear recommendations for creating a dynamic and effective workforce planning function at national, regional and local levels. In doing so, it laid the foundation for workforce planning to become an integral part of delivering an effective NHS in Scotland. This was to be further developed within
Working for Health.
Working for Health - Published in August 2002,
Working for Health identifies that in order to support reform and improvement within NHSScotland, workforce planning and development has a key role to play. This document provides a vision for workforce planning and development and identifies the role this will play now and in the future. This is set within a wider context of developing a workforce in NHSScotland which is fit for purpose.
Working for Health also sets out an action plan and identifies some of the practical steps required to be taken to achieve this vision from a local, regional and national perspective.
Partnership for Care: Scotland's White Paper - In February 2003,
Partnership for Care was launched. This identifies the need for new measures to be taken to improve services and to improve the health of the nation. This includes service re-design and the need to place greater emphasis on better integration and partnership arrangements.
Partnership for Care sets down a framework for a modernised NHS in Scotland and acknowledges the need for service improvement and innovation. In addition, it recognises the need to build capacity within the service to deliver a modern, first class health service to the people of Scotland.
A Partnership for a Better Scotland: Partnership Agreement - In May 2003, the Labour/ Liberal Coalition produced the Partnership Agreement as part of its programme to deliver excellent public services in Scotland. This commits the Scottish Executive Health Department to step up action on health improvement, to improve the quality and consistency of care through national standards, inspection and support as well as in the delivery of services. It also commits the Scottish Executive Health Department to deliver improvements to NHSScotland through the empowerment of its workforce.
Caring for Scotland: The Strategy for Nursing and Midwifery in Scotland was published in March 2001 and outlines how the capabilities of nurses and midwives will be enhanced in order to provide the flexible, responsive, needs-driven services demanded by the public. It acknowledges the challenges that individuals face in becoming a nurse or midwife, but at the same time demonstrates the educational and career opportunities available in these fields. However, above all, it emphasises the importance of the 'caring' roles played by both professions.
Report of the Expert Group on Acute Maternity Services - EGAMS (2002) acknowledged the challenging workforce pressures faced within maternity services in Scotland. It concluded that the current configuration of acute maternity services was no longer viable. It confirmed a need to review critically how resources could be made more efficient and effective, advocating flexible, collaborative and innovative models of working as a way forward.
Audit Scotland's Report: 'Planning Ward Nursing - Legacy or Design?' looked at numbers of nurses, costs and quality indicators in 6 ward types in all Primary and Acute NHS Trusts in Scotland. The ward types were: Acute Medical Receiving, Gynaecology, Continuing Care of the Elderly, Orthopaedics, Paediatrics and Old Age Psychiatry. Its key findings included:
The need for improvements in workforce planning.
Unexplained variations in the number and costs for nurses at ward level.
The need to develop and agree quality of care measures, which focus on continuing improvement rather than service failures.
Key Principles
In acknowledging the need to develop the workload agenda across NHSScotland's workforce, a number of key principles can be applied. These are:
Continued partnership working at local and national levels
Links to service modernisation at local and regional levels
An integrated approach to workforce planning that supports service planning.
Building workforce planning and development capacity at national, regional and local levels.
Strategic approach to further research and analysis on workload and workforce planning.
How will the project's recommendations be taken forward?
The project provides details of the mapping exercise taken across Scotland and on the findings made. It also highlights 20 recommendations that have been accepted in principle by the
Facing the Future group which originally commissioned the work. It is essential, therefore, that these recommendations are acted upon appropriately and in a timely fashion. Further pieces of work will require to be commissioned to gain clarity, particularly in relation to outcomes, impact and benefits for patients.
It is important that further developments continue in partnership at a national level but more importantly with local NHS systems that hold the responsibility for the planning of services and for the workforce to deliver these effectively.
Implementation, Monitoring and Review
The Nursing and Midwifery Workload and Workforce Planning Project is the first of its kind for NHSScotland and provides baseline information on which to move ahead. The recommendations will be developed, monitored and reviewed over a period of 12 months (unless stated).
The
Facing the Future group will continue to oversee and monitor implementation of the recommendations made in relation to nursing and midwifery staff. It is anticipated that the National Workforce Committee will be responsible for ensuring how these are then developed across a wider context that relates to all staff groups.
National Template
To assist with the implementation, monitoring and review process, a national template is attached. The template reflects the key themes under which the recommendations were produced. These are:
General
Principles
Education and Training
Systems
Allowances
Research
Conclusion
This paper proposes that the workload and workforce planning agenda is developed in a systematic way to the mutual benefit of all NHS staff, recognising the wider context within which it sits. Recommendations need to be fully understood and may require further scoping work to be undertaken prior to any implementation being agreed. This needs to be developed in partnership at all levels reflecting the wide networks of interest in delivering meaningful change across NHSScotland.
Finally, by taking a 'whole systems' approach, we can make a real and significant difference to the working lives of all NHS staff that ultimately delivers better services to patients.
National Workforce Unit
Directorate of Human Resources
Scottish Executive Health Department
April 2004
RESPONSE TO RECOMMENDATIONS - TEMPLATE
Appendix 1
General |
Recommendation 1. NHS Boards should have in place no later than 4 months after publication of this report, an agreed action plan for taking forward the recommendations. The plan should include a timetable with costings backed by adequate resource and appropriate workforce planning capacity and must be signed off by the relevant Partnership Forum. The Nurse Director will be the executive sponsor of the plan at Board level, and the action plan will form part of the formal accountability review process. Timeframes for review of systems should be made explicit in the plan. | Response: Accept - NHS employers to implement Comments:NHS Board Nurse Directors should take responsibility for the development of Action Plans for nursing and Midwifery staff. This should be undertaken within a four month period of publication. NHS Boards should consider the development of action plans that account for the wider workforce. |
Principles |
Recommendation 2. The NHS Board action plan should demonstrate the balance between use of permanent, bank and agency staff. This must include savings targets on use of agency staff and details of how this money (or a proportion) will be re-invested in permanent nursing and midwifery staff. | Response: Accept - NHS employers to implement Comments:Action plans should be developed demonstrating methods to reduce costs associated with agency nurses and where this is being re-invested. These should build upon the recommendations of Audit Scotland's report Planning Ward Nursing - Legacy or Design? In addition, action plans should take into consideration the forthcoming recommendations on the Partnership Agreement's commitment to develop nationally co-ordinated nurse bank arrangements. |
Recommendation 3. ISD, in partnership with representatives from NHS Boards and other relevant stakeholders, should progress a process to further develop appropriate indicators that allow accurate national comparisons of workload and workforce planning data. Progress towards any new or developed indicators should be reflected through the Performance Assessment Framework, accountability review and staff governance mechanisms. | Response: Accept - further scoping work required and will be commissioned at a national level |
Recommendation 4. NHS organisations should have in place systems to demonstrate how flexible working practices are contributing to effective use of nursing and midwifery resources, increasing recruitment and retention rates and maximising benefits for patients. Quality indicators could include measures of workforce stability and turnover. | Response: Accept - NHS employers to implement. |
Recommendation 5. The Scottish Executive Health Department should ensure that systematic approaches should be applied to nursing and midwifery workload and workforce planning across NHSScotland. | Response: Accept - Workforce planning and development arrangements should be aligned to national, regional and local systems. |
Recommendation 6. Tools/ systems need to be adapted at national level to take account of emerging patient acuity and workload issues, using a systematic process to ensure valid and reliable outcomes. | Response: Accept - further scoping work required and will be commissioned at a national level. |
Recommendation 7. A balance needs to be achieved between resource intensity related to nursing and midwifery workload and workforce planning systems and the outputs of these systems. | Response: Accept - further scoping work required (linked to recommendation 6) Comment:option to explore through pilot site in NHSScotland. |
Education and Training |
Recommendation 8. Education and training on the use of recommended nursing and midwifery workload and workforce planning systems should be mandatory prior to implementation of any system, with regular updates made available. | Response: Accept - co-ordinate at national level to ensure consistent approach to the use of tools. |
Recommendation 9. Directors of Nursing should lead an education and training needs analysis (E&TNA) of staff contributing to workforce planning locally to identify education and training requirements in relation to establishment setting, budget control and resource allocation. This will help to ensure consistent understanding of concepts and approaches. | Response: Accept - NHS employers to implement. |
Recommendation 10. Continuing support should be provided for appropriate clinical leadership development initiatives at sister/team leader level. | Response: Accept - Support for continued clinical leadership development should be led by local NHS Boards. For nursing & midwifery staff, this will be monitored and supported via the Facing the Future Group. This should 'fit' within a national leadership framework which is presently being developed for all staff. |
Systems |
Recommendation 11. A combination of tools should be used, with all services using a nationally agreed Telford-type approach as a minimum. | Response: Accept - further scoping work required and will be commissioned at a national level. |
Recommendation 12. The combination adopted should include a patient dependency
1 measure standardised for each of the areas for which questionnaires were developed and sufficiently sensitive to detect significant changes in patient acuity. | Response: Accept - see recommendation 11. |
Recommendation 13. NHSScotland should adopt a standardised approach to determining patient dependency and quality of care. To avoid duplication, outcomes of the work being undertaken nationally by NHS QIS should inform actions on quality tools. Until that project produces its conclusions, a nationally agreed quality tool should be used in conjunction with a workforce planning tool and patient dependency measure. | Response: Accept - NHSQIS are commencing work to scope, develop and pilot agreed clinical quality indicators for nursing for use across NHSScotland. SEHD have funded and commissioned this project recognising that the clinical quality indicators have the potential to benefit a number of areas including workforce planning and service re-design. |
Recommendation 14. To satisfy the expressed wish for standardisation, systems for workforce planning currently being used should be tested to identify which best meet the needs of NHSScotland. | Response: Accept - further scoping work required and will be commissioned at a national level. |
Recommendation 15. A standardised approach to Telford, supported by IT, should be developed and applied consistently across NHSScotland. | Response: Accept - further scoping work required and will be commissioned at a national level. |
Recommendation 16. A national process for validating National Recommendations should be developed and implemented. | Response: Accept - further scoping work required and will be commissioned at a national level. (Link to recommendations 14 and 15.) |
Allowances |
Recommendation 17. Establishments should ensure that nurses and midwives who have overall team leadership responsibility in the direct care area have a minimum 7.5 hours per week of protected time to enable them to focus on leadership, managerial, education and clinical governance-related aspects of their role. | Response: Accept - further scoping work required and will be taken forward across a pilot site within NHSScotland. Comment:
Currently the situation varies across NHS Boards. As part of effective management of resources, all NHS Boards Nursing Workforce Plans should reflect the principle of protected time for nurses in this leadership role. This should be managed within the total resource envelope that is available for nursing establishments and should be part of the effective management of predictable absence allowance. |
Recommendation 18. The predictable absence allowance should be a minimum of 21%
2, with a proportion (recommended as 1 of 21%) defined to support systematic management of maternity leave. The calculations on which predictable absence is based and the funding sources to support it should be clearly demonstrated in each nursing and midwifery establishment and NHS Board action plan. | Response Accept - further scoping work required and will be commissioned at a national level. Comments:
Recognising the situation is currently variable, each NHS Board, as part of their Action Plan, will need to specify how they will reach this target, all within a timescale. |
Research |
Recommendation 19. Further research on nursing and midwifery workload and workforce planning is required in the specialty areas of paediatrics, psychiatry, and primary care teams. | Response: Accept - further scoping work required and will be commissioned at a national level. |
Recommendation 20. Although any tool used needs to take account of these patients, additional work in relation to Level 1 patients (and equivalents in non-adult acute areas)
3 should be commissioned and undertaken. | Response: See recommendation 19 |
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