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Scottish Health Workforce Plan - 2004 Baseline

5 Taking action

It is clear that there will have to be fundamental changes to the way we staff the service. This chapter summarises the action in hand to answer the longer-term questions identified in earlier sections.

Determining the Long-Term Service Vision

Workforce issues and redesign of services are fundamentally connected. The Health White Paper Partnership for Care¹⁴ set out a commitment to safe, high quality, sustainable and patient-centred care delivered close to the patient where possible and in appropriate specialist facilities where necessary. Nevertheless, there is currently no clear shared model of how future service delivery will be organised across NHSScotland to ensure this. This hampers workforce planning and the redesign required to respond to workforce needs.

Against this backdrop the Executive has established an expert group to develop a national framework for service change that emphasises both sustainability and integration in NHSScotland. Professor David Kerr, Rhodes Professor of Cancer Therapeutics and Clinical Pharmacology at the University of Oxford, will lead this work and report to the Minister for Health and Community Care within a year with recommendations for the future development of the NHS in Scotland. It will promote opportunities for local access to services but will balance that with the need to have centres of excellence providing high quality, modern specialist care. The work will run in tandem with work already underway at local level, providing guidance and examples of good practice to NHS Boards as they develop new configurations of service and redefine the various roles and responsibilities of the various players.

The workforce pressures on NHSScotland are clear. A full understanding of the implications of these, and other pressures - demographic trends, epidemiological trends, public expectations, quality standards - is central to our effort to put the NHS in Scotland on a sustainable footing for the long term. The group will therefore take these and the other issues into account in during its deliberations and will consider recent developments in the delivery of health services in Scotland and elsewhere in response to these pressures

Roles and Responsibilities

Working for Health set out for the first time the vision for workforce development in NHSScotland. To deliver this vision, Working for Health described a new infrastructure which placed significant roles and responsibilities on NHS Boards, Regional Groups, the Health Department, and others. Much of this is well under way and described below. Significant new resources are being distributed to support the building of this capacity.

The NHS Reform bill currently going through the Scottish Parliament requires NHS employers to have in place arrangements for workforce planning. For the first time, this requirement, which is part of wider staff governance responsibilities, will have statutory force.

Locally, each NHS Board will have its own workforce development capacity, with workforce officers leading on local workforce development while liaising with the regional groups. Many staff in place at local level already fulfil a workforce role though they may not be dedicated solely to that function at present.

Regionally, three regional workforce groups supported by Workforce Champions at Chief Executive level - in north, west and south-east Scotland - have been developing. The necessity for links with existing regional service planning structures was recognised at an early stage and the Workforce Co-ordinators for each region will work to develop a coherent regional approach on core services which addresses local circumstances as well as informing more strategic work.

It is acknowledged that the size and shape of these regional networks is bound to vary from region to region. Despite the need for a flexible approach, it will be important to ensure some consistency, and further guidance will be available in summer 2004 from the National Workforce Unit about how best regions and NHS Boards should co-ordinate and integrate their workforce plans cyclically with existing requirements for contributions to local health plans and accountability reviews. The guidance will also set this in context with other milestones such as the publication of ISD statistics as well as the requirements and timetable of the National Workforce Committee and its sub-groups.

At national level, the National Workforce Committee (NWC) provides leadership and direction to NHSScotland on workforce development, with its actions and guidance not only taking account of evidence provided regionally and locally by the service itself, but also of workforce issues emerging from within priority clinical - or "care group" - areas, or from a UK context. This evidence enables the NWC to gauge risks to service provision presented by workforce supply and demand issues, to manage the capacity of the NHS to respond to these risks and to ensure that the workforce is in a position to deliver real benefits to the service and to patients.

Reporting to the Health Department Board, the NWC takes a wide view of emerging and current workforce issues and will work through an extended network of expertise pulled together for specific programmes or clusters of work, each producing identified outputs essential to take forward workforce development in Scotland.

The new Workforce Numbers Group (WoNuG) is one important constituent of this network - a sub-group set up to advise on workforce numbers and modelling across all staff groups, on an annual cycle co-ordinated with commissioning processes for education and training. Lack of this co-ordination in previous years has resulted in an incomplete picture of workforce and services alike, resulting in an unsighted and piecemeal approach to planning. As job redesign moves forward, difficulties persist in striking a balance between directing resources for education and training efficiently and in ensuring sufficient numbers to provide a viable and effective service. From its inception in June 2004 and thereafter meeting regularly throughout the year, advice from WoNuG will give the NWC the means to surmount these anomalies and make recommendations on workforce size and shape in a sensible and pragmatic way which recognises provider and service roles alike, and aligns supply with demand. (Further details on WoNuG are in Appendix C.)

Work strands taken on by other NWC sub-groups will enable the Committee itself to provide national leadership on the development of an approach to Careers for Health
in a strategic way which transcends local boundaries; on realising the benefits of
pay modernisation; on workforce design, new roles and new ways of working, and workload across the health workforce; and to ensure a comprehensive, visible, framework of occupational and regulatory standards is in place, covering all staff engaged in providing services in the name of NHSScotland. The NWC will also draw much more systematically upon advice provided by care group workforce planning structures across clinical specialist areas, especially those covering national priorities such as cancer, mental health, coronary heart disease and stroke and maternity services. Taken together these work strands are a step-change in the move away from "silo" planning restricted to specific staff groups, to fully integrated workforce planning covering clinical care groups. This approach will need to be replicated at both regional and local level to ensure planning continuity.

The National Workforce Unit within the Scottish Executive Health Department will continue to co-ordinate and facilitate this activity nationally, not only through the support it already provides to the NWC but also by developing links with other UK countries to ensure robust and realistic planning which takes account of wider trends and cross-border issues such as workforce mobility. It will also work with NHS employers to develop and implement training and development programmes for those working in workforce planning and development.

The diagram below represents a snapshot of some of the main influences on workforce issues over a yearly cycle. The development and synchronisation of the planning cycle is at an early stage: for example it need to be expanded to include staff groups other than doctors and nurses.

In the next phase of work we will focus on the requirements for specific care groups, and on how a more structured approach to predicting requirements across such groups as the Allied Health Professions and the professions within Healthcare Science, can be put in place.

The diagram sets out some of the timescales for:

• Workforce planning - at local, regional and national level. The National Workforce Plan will be produced by the Workforce Numbers Group (WoNuG) in April each year, taking account of Regional and Local workforce plans produced by March, which have key targets themselves informed by Local Health Plans (see below).

• Service Planning - NHS Boards prepare Local Health Plans annually. The Plans set out actions the Boards intend to take to address each of the national priorities identified by SEHD and their own local priorities in the year ahead and beyond. Boards generally prepare and update their Local Health Plans over the first 3 months of the year in consultation with their local planning partners and the wider communities they serve. NHS Boards are also subject to an annual Accountability Review process - the key formal mechanism through which the Scottish Executive Health Department holds NHS Boards to account for their past performance, and probes their plans for the coming year.

• ISD - ISD Scotland publishes national workforce statistics at 6-monthly intervals at the end of February and at the end of September. These statistics provide a snapshot of workforce numbers within NHS organisations, vacancies and a range of other workforce characteristics. They cover all staff groups including the nine Allied Health Professions and the group of professions known collectively as Healthcare Scientists.

• WoNuG - is a formal sub-group of the National Workforce Committee which comprises representatives from NHS Boards, Regional Workforce networks, the HR Forum, NES, ISD Scotland, Higher and Further Education, Joint Future and other stakeholders. This group will improve strategic planning of workforce needs by providing an evidence base which takes account of workforce numbers, characteristics and trends at all levels of the service. WoNuG will be established by June 2004 and will meet quarterly thereafter.

• Profession-specific - Some structured workforce planning at national level is undertaken for the medical and nursing professions: other groups (e.g. dentists, clinical psychologists) have also developed national workforce plans. NES is closely involved in medical workforce planning, and in addition an annual Scottish Medical and Scientific Advisory Committee (SMASAC) Specialty Adviser report is produced in May or June each year, highlighting service and workforce planning issues particular to medical specialties.

Workforce Planning Arrangements

WORKFORCE MODELLING: APPROACH, PRIORITIES AND OUTPUTS

Introduction

As we have seen, demand and supply for healthcare services are not independent variables and are influenced by many factors including: change in technology, demographic trends, medical trends, public expectations, different patterns of disease, and workforce factors. Decisions about the workforce at all levels (local, regional, national) and on all timescales (short, medium and long) are likely to be better made if they are based on authoritative analysis. The Workforce Numbers Group will provide the NWC with that analysis and this section describes the approach, priorities and outputs from that group.

Approach

The development of comprehensive, authoritative workforce planning models that encompass all staff groups and examine the potential for integration of the groups is new to NHSScotland. There is a great deal of information to draw on - for example the Scottish Integrated Workforce Planning Group's second report (January 2002) provides a platform for developing the modelling required, and there are lessons to be learned from modelling work across the globe. However, workforce planning is a complex area and one that must be developed in Scotland in parallel with the range of NHS reforms that are already underway - whilst ensuring delivery of key results by the end of 2004 to input effectively into the planning cycle. The modelling approach aims to be one that:

• is inclusive and transparent - allowing collaboration and the pooling of resources

• is evolutionary, with repeated iterations to support inclusion of new information/ assumptions

• uses scenarios to minimise risk

• involves multiple models that are developed through a consistent method and planned to be complementary

• uses estimates and expert opinion to bridge current data gaps - but applies sensitivity testing to all assumptions

• feeds back new data quality and coverage requirements to the development of workforce information systems

• provides a mechanism for developing expertise in modelling at national, regional and local level.

Given the need to develop the modelling in parallel with service developments the analysis will take a twin-track approach, with the trajectory looking like this:

With this approach we can address immediate issues using more simplistic but practical analytical techniques and, through a structured programme of work on models, build in complexity and sophistication over time. So we will be continually refining our approach as our knowledge base improves - moving from left to right across this maturity spectrum.

Workforce Planning Maturity Spectrum

We have a number of initiatives in place to reflect the NHS priority areas. Implementation of these initiatives and this National Workforce Plan will enhance our maturity in workforce planning. The following briefly describes some of these activities and their focus in moving us along the workforce planning maturity spectrum.

Priorities

The draft work plan for 2004 shown below identifies five priority work streams at the national level with suggested focus and outcomes. Priorities have been identified on the basis of:

• Practicalities of the requirement to deliver (e.g. on Partnership Agreement targets)

• Policy priorities, e.g. Pay Modernisation Implications

• Legislation implementation timescales and their impact (e.g. European Working Time Directive)

The following plan will be taken forward by a group including ISD and the Health Economics Research Unit, under SEHD leadership.

Modelling work plan 2004

Where we want to go - "The Workforce Information Vision"

This first Scottish Health Workforce Plan has shown the vital importance of collecting the data and information necessary to inform the direction of travel.

The current scope and coverage of our existing infrastructure is unable to provide an accurate picture of what skills and knowledge each staff member holds and what each post requires. As a result, traditional professional definitions or grades are used as a surrogate measure of skill mix. Furthermore, current information falls short of providing a good understanding of worked hours and how that time is deployed in terms of services provided. This information is needed to support the care group focus and service linkage required for workforce planning.

In addition, the data are largely focused on NHSScotland directly employed staff. There is limited information on, for example, GP practice staff, locums, and agency staff. Given the Joint Future agenda and future direction of health care and social care demand, it is only sensible for the scope of data used to include social work.

With respect to the depth of information sought, the distinction between "Posts" and "Staff in Posts" in our systems as well as our thinking is an important next step. Agenda for Change, National Occupational Standards and competency frameworks will support descriptions of staff in terms of the skills they offer rather than the profession that they represent. Again, the breadth of information and the systems that collect the information must be extended.

To increase quality - that is completeness, accuracy and timeliness - will require an infrastructure of systems, standards, quality assurance, and continuous development in order to ensure data that are fit for purpose.

Finally, we must expand our analysis from the current snap-shot at a point in time to an understanding of the career path and history. This will allow us to gain a better understanding of patterns of recruitment, retention, mobility, promotion, flexible working and retirement.

Workforce Information, Modelling and Forecasting

Defining the Focus Area

Benefits to be achieved are:

• Improved Efficiency, Reduced Collection Burden

• Streamlined data collection; management information by product of operational processes

• Safeguards and assurances data use as prescribed

• Better Decision Making

• Timeliness of management information

• Understand both Scotland and UK dimensions

• Multiple Management Information Views supported over multiple dimensions

• Transparency of decision-making, intelligent application of information

• Better understand and manage workforce demand as well as supply

• Better Use of Valuable Resource

• Linkage of patient, workforce, cost data for productivity and outcome measurement

• Full career coverage for the employee

• Support Shared Purpose

• Single source of management information for all

• Focus on 'Scotland Health Sector' staff (in/directly employed)

• Reflect Joint Future Agenda in our data collection, analysis and decision making

How we will get there

The tactical operational plans for delivering this vision are being developed through the Scottish Workforce Information Systems Strategy Group. This group is developing a national approach for workforce information, including defining standards, definitions and short-term, medium-term and long-term system options.

To date, the group has established the following:

Short/Medium-Term Solutions

• Development, with Service involvement, of Core Data Standards (CDS) required for Workforce Planning Information

• Based on the CDS, development and implementation of field extension to Scottish Standard Payroll System to capture the new standards. The intention is to provide access to additional and better quality workforce information

• Appointment of a SWISS project manager to plan the implementation of short-term and longer-term system developments, preparing NHSScotland to deal with the organisational development, education and training, and cultural changes required to support effective collection and use of new information.

Long-Term Solution

• Evaluation of three long term options for feasibility with the support of Atos KPMG Consulting. Three options were evaluated: the English/Welsh Electronic Staff Record (ESR), development of a fully integrated bespoke system, and an off-the-shelf integrated HR/Payroll package

• Based on the consultant's report, a further option was identified: a modernised and updated SPSS interfaced with an off-the-shelf HR package solution

• Development of an HR operational systems requirements specification. To date, a high level specification has been developed and will be further developed into a functional specification through the SWISS project manager in partnership with the service

Membership of SWISS includes representation from:

• Scottish Executive Health Department

• HR Directors

• Scottish Standard Payroll System Steering Group

• Staff Side Representation

• ISD Scotland

• Atos Origin

• Shared Services Steering Group

Next Steps

We are committed to building on this first National Workforce Plan so that future editions will enable NHSScotland to have more certainty about near term and future requirements for the shape and size of its workforce. Many individuals and organisations have a part to play: the roles and responsibilities have been set out above.

Within the framework provided by the Workforce Strategy, and this baseline plan, the key actions are:

• SEHD to establish the Workforce Numbers Group (WoNuG), involving the full range of those who are directly and indirectly involved in workforce issues

• National Workforce Unit to develop guidelines to support the design of local and regional workforce plans and linkages (e.g. service planning), refining the planning cycle

• SEHD and partners to implement the modelling action plan

• SEHD and partners to develop care group workforce modelling to inform regional and national workforce planning

• Regional workforce champions and coordinators to create and develop further suitable structure and resources to support workforce planning development

• Regions to liaise closely with NHS Boards and agency partners to agree and publish a regional workforce plan

• Workforce Officers in NHS Boards to develop local workforce plans together with service planning counterparts

• National Workforce Committee will publish the Scottish Workforce Plan 2005 outlining future expectations to inform planning at all levels

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