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Coronary Heart Disease and Stroke in Scotland

4 Workforce Issues

Strategy Recommendation

A substantial increase in the number of training posts so that by December 2003 there are an additional 10 SpR posts in cardiology and a total of 8 SpR posts in stroke medicine.

4.1 The 2001 Task Force Report had recommended the appointment of an additional 30 consultant cardiologists throughout Scotland. The 2002 CHD and Stroke Strategy recognized that the effective implementation of the Task Force recommendations would require a substantial increase in the numbers of specialist nurses, Allied Health Professions, technicians, pharmacists, intermediate specialists, cardiologists and cardiac surgeons. But the Strategy also recognized the difficulties in recruiting and retaining consultants given that there were few people in Scotland with the appropriate training to fill these posts. It acknowledged that the target of 30 new consultants was unrealistic and focused instead on a substantial increase in the number of training posts. There has been real progress made.

Source: ISD Scotland. NHS Scotland Workforce Survey: 2001; 2003.

4.2 Between 2001 and 2003 there has been a slight increase in the number of consultant cardiologists and the number of staff in training grades has almost doubled. The figures for nurses and Allied Health Professionals represent numbers working across the health service and not just those working exclusively on CHD and stroke, but the overall increase is positive.

4.3 Because stroke services have not been provided by a specific stroke specialty, it is not possible to show the numbers of stroke clinicians. Stroke patients are sometimes treated by clinicians from the general medicine, geriatrics and neurology specialties, and these clinicians may not work exclusively on stroke services. The Scottish Executive is aware that the absence of data on stroke clinicians is an obstacle to planning for stroke services and has commissioned a survey of stroke workforce in Scotland. In the longer term, the recent approval of Stroke Medicine as a sub-specialty will help to clarify the number of stroke clinicians, and allow closer monitoring of the workforce.

Recruitment and Retention Challenges

4.4 Whilst the 2003 figures show a slight increase in the number of consultants in cardiac services, they clearly fall well short of the increase envisaged by the Task Force. Challenges continue to exist around recruitment and retention of consultant staff, particularly for cardiology and substantial investment has been provided to support additional nurses, AHPs and training posts. The aim is to establish specialist multi-disciplinary teams to deliver local and regional services for both stroke and CHD. MCNs are starting to explore ways of working together at a regional level to share and make best use of their resources. There is considerable interest and merit in exploring the potential for newly appointed cardiologists at local hospitals to have sessions at the tertiary centres as part of their job plans.

Workforce Planning and Development

4.5 Following a lack of historic workforce planning in NHSScotland, "Working for Health", the first ever Workforce Development Action Plan for NHSScotland was launched in August 2002. It heralded new regional and national teams to support workforce development and dedicated personnel to take this forward. It set out plans to drive forward better information, planning and employment data and also the production of an annual Scottish Workforce Plan.

4.6 Implementation of the Workforce Development Plan is continuing with new structures, processes and personnel in place and the Scottish Health Workforce Plan 2004 Baseline was published in April 2004. In addition, the NHS Reform Act imposed a new duty on NHS Boards to have arrangements in place for workforce planning from September 2004.

4.7 Workforce development is being led at national level by the National Workforce Committee through 8 strands of work:

• model of supply and demand

• workforce planning

• commissioning plan for education

• workforce design and workload

• careers recruitment and retention

• workforce performance and effectiveness

• occupational professional and regulatory standards

• workforce observatory

4.8 The Workforce Numbers Group (WoNuG) has been established to determine the number and shape of the workforce for the future. A subgroup of WoNuG is focusing on immediate priorities including medical staff pressure areas and numbers in training.

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