The Scottish Government

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Section 1

1 Introduction and Background

1.1 Introduction

In April 2004 the Scottish Health Workforce Plan 2004 Baseline¹ was published by the Scottish Executive. This described the healthcare workforce in Scotland and our plans for developing strategic workforce planning in NHS Scotland and the Scottish Executive Health Department.

Building on the 2004 Baseline Plan this year's report looks ahead to the healthcare workforce that Scotland will need between now and 2015. It is not a recruitment and retention plan for the immediate workforce pressures facing the NHS. Rather it outlines the framework within which NHS Boards and regions will, from this year onwards, plan for their workforce needs and it explains actions at national, regional and Board level to deliver those plans. It also flags the actions required to align staff resources more effectively with NHS' objectives in the years to come.

1.2 Context

Since the publication of the 2004 Baseline Plan, three important publications and new legislation have provided a fresh context within which to plan the future workforce needs of NHS Scotland:

• Fair to All, Personal to Each - The Next Steps for NHS Scotland² builds on existing commitments to improve patients' access to healthcare by setting new targets to further reduce waiting times across NHS Scotland. These new standards have workforce implications which are addressed in this report.

• In January 2005 the Health Committee of the Scottish Parliament reported on its inquiry into workforce planning in NHS Scotland with the publication Reshaping the NHS? - Workforce Planning in the National Health Service in Scotland. ³ This noted that while encouraging initial work had been undertaken to develop workforce planning in NHS Scotland there were still barriers to be overcome to ensure effective planning. It also noted the impact that workforce issues have on the design of services. The Committee subsequently held a public debate on these issues which reflected the high degree of public interest in these matters.

• In May 2005 the Scottish Executive published Building a Health Service Fit for the Future⁴ on the shape of Scotland's health services over the next 20 years. The direction of travel provides the overall vision for the future shape of NHS Scotland in years to come. A key aspect is planning the workforce required to deliver the services envisaged over the next twenty years. The workforce planning framework outlined here gives an all-Scotland overview by painting potential future scenarios at national level. It provides a context for Board and workforce regions to forecast their future staffing needs based on their operational knowledge of the healthcare requirements for their populations. These forecasts will then be developed and refined for the next edition of national, regional and Board workforce projections, and so on year-on-year.

• From 30 September 2004 the NHS Reform (Scotland) Act 2004 made it a statutory duty for all NHS Boards to have in place arrangements for workforce planning. That duty underscores the fact that workforce planning cannot be done at national level alone. The Act also obliged NHS Boards to collaborate across boundaries where appropriate. Regional workforce planning arrangements are now well established, with workforce planning capacity in place and working in each Board. Baseline workforce profiles have already been produced for each Board. Regional and Board workforce plans will follow by the end of this financial year.

1.3 Objectives

This report provides an overview of the main factors impacting on the supply and demand of the workforce. It identifies the actions that need to be taken at national, regional and local levels to maintain and grow the healthcare workforce that will be required by the NHS in Scotland.

It is a complex and challenging remit. Predicting at national level at this time the future workforce needs for an organisation with 150,000 staff against a constantly changing set of dynamics affecting supply and demand, from individuals' career choices to advances in medical technology, is inherently uncertain, particularly when looking beyond the immediate horizon. For that reason this report does not attempt a precise national prediction of the number of staff required in each staff group for each year to 2015. Such predictions, made on a top down basis, would become outdated the day after publication and would not be directly relevant to the staffing requirements of each individual Board, where the decisions and planning of specific requirements for staff must be focused.

This report, therefore, offers a strategic overview which informs and supports the regional and Board-level elements of the planning framework outlined here. Underpinning this approach is a recognition that the constantly changing dynamics of service provision and a mobile labour market make it aspirational to achieve perfect alignment of supply and demand across Scotland at all times for all aspects of the NHS. The aim of this report, therefore, is to build mechanisms that allow services to anticipate and respond effectively and nimbly to the changes in supply and demand that inevitably arise.

On this basis the report:

• provides a strategic overview of the various factors influencing the NHS Scotland workforce and the dynamics which are shaping it now and into the future

• identifies the actions required at national, regional and local levels to ensure that our objectives for improved patient care are met through sustainable and affordable changes in the healthcare workforce

• gives a clear picture of how national, regional and Board plans interact with each other and with service and financial planning to form a robust and sustainable planning framework

• looks ahead at developing workforce planning to better anticipate the changes we can expect in the way services are delivered

The primary audience for this report is the NHS, and specifically those whose responsibility it is to manage and plan its staffing. We have therefore striven to make this a useful and practical document for this group. In so doing we hope it has not made the report inaccessible to the 'lay' reader. A glossary of terms is provided at Annex A to aid understanding.

1.4 Overall approach

Workforce planning offers the opportunity to strategically anticipate workforce changes. It should be:

• integrated - with all other planning systems, but particularly with service planning and resource/finance planning;

• consistent and evidence-based - to ensure that decisions are informed by sufficiently reliable information and robust methodologies

• on-going - to build expertise and refinement year on year through evaluating previous projections, monitoring trends and learning from others.

Workforce planning in health needs consideration of the health of the population and what healthcare services will be required in 10+ years time. The size and configuration of the workforce needed to deliver such services then needs to be determined, anticipating future working practices, productivity and technological advances. That vision should then be compared with the picture of the workforce today to identify what must be done to move from the current workforce to the workforce of the future. Action to align future supply with predicted future demand will need to include education and development plans, as well as plans for recruitment and retention and redesign of roles.

Unfortunately, it is not possible at this time to accurately predict ten years into the future, given the pace of continual change in the NHS. For this reason projections need to be refined and developed year on year, as experience and knowledge of a highly dynamic workforce are built up, and as the longer-term becomes the medium and immediate term.

1.5 Roles and the planning cycle in year one

NHS Boards have responsibility for delivering healthcare services and they employ or contract the workforce required to deliver those services. (Throughout this report, independent contractors, such as GPs and dentists and their staff, are included in any reference to the NHS workforce.) NHS Boards are therefore best placed to assess future demand for workforce on the basis of services required, including changes to those services. This information will inform what is required at regional level, where NHS Boards must work together across their boundaries to staff and deliver regional services.

Workforce planning at Board and regional levels will provide the Scottish Executive with the information on workforce demand that will inform national assessments for supply of trainees. It is the role of the Health Department to set the numbers of undergraduate medical and dental students and of postgraduate medical and dental trainees and to determine the number of pre-registration training places for nursing and midwifery. The Department can also facilitate increased supply of other professional staff, for example by funding fast track training schemes or supporting the development of training programmes, with NHS Education for Scotland ( NES), for new roles. In this way any adjustments to the supply flow will be based on considered evidence from the Service on workforce demand.

In the first year of this planning framework, the national picture is coming before the Board and regional level inputs to provide direction for workforce planning. Thereafter it will take a bottom up approach to ensure patient needs drive the design of services and the workforce required to deliver those services. This is explained in more detail in Chapter 5.

1.6 Guiding principles

This report is underpinned by the following eight guiding principles:

The first three principles are clearly key components which shape the demand for the future healthcare workforce. These are described in the next chapter and have been applied to the workforce considerations in Chapter 3.

Chapter 5 outlines how we are meeting the fourth and fifth principles by developing workforce planning in a way which takes it from a static snapshot based upon uni-professional staff groups to a more dynamic approach aligned with patient pathways and service outcomes.

The final three principles are an essential challenge against which we need to test all our judgements on the workforce:

• Affordability: We need to ensure that our workforce planning projections are affordable and offer value for money.

• Availability: We need to ensure adequate sources of supply for the planned workforce, taking account of the overall labour market, competition for scarce skills and opportunities for inward recruitment; careers and posts must seem sufficiently attractive to people with the skills we require.

• Adaptability: We must ensure the planned workforce is trained and supported and that our workforce plans fit with those for service redesign.

1.7 Overview of the NHS workforce

As at 30 September 2004, NHS Scotland employed (or contracted) 149,896 people (headcount) or 125,996.7 whole time equivalent ( WTE).

These include staff directly involved in clinical care (doctors, dentists, nurses, midwives, allied health professionals, scientific and technical staff) and those who provide infrastructural support (senior managers, administrative and clerical staff, ancillary, trades and works staff). Figure 1 gives an overview of the NHS Scotland workforce.

Figure 1: Staff groups employed (or contracted) by NHS Scotland at 30 September 2004 ( WTE)

• Nursing and midwifery remains the largest single staff group with 54,522.9 WTE staff (43.3%).

• A further 12.4% of the workforce are medical and dental staff. This includes hospital and community doctors as well as GPs and general dental practitioners.

• In total, 20,015.5 WTE work in the other clinical staff groups: allied health professionals ( AHPs), scientific and professional, technical and ambulance staff.

• A total of 35,810.2 WTE non clinical staff are employed by NHS Scotland. The largest group are administrative and clerical staff, numbering 19,747.1 WTE or 15.7% of the total workforce.

• There are 12,246.0 WTE staff in the works, trades and ancillary groups.

Figure 2 shows the proportion of each staff group working full and part time. Within the clinical group, nursing and midwifery staff have the highest proportion working part time. Within the non clinical group, ancillary staff have the highest proportion working part time.

Figure 2: Contract type by staff group as at 30 September 2004

Over three-quarters of the workforce are female (78.1%). This is largely accounted for by the high proportion of females in the nursing and midwifery (90%), AHP (91%) and administrative and clerical staff groups (87.8%).

As Figure 3 shows, the percentage of each staff group that is female ranges from under 1% for trades staff to 91% of AHPs.

Figure 3: Gender split by staff group (headcount) as at 30 September 2004

Just over one quarter (25.4%) of NHS Scotland staff are aged 50 or over and there is significant variation in the age profile by staff group. Figure 4 shows these profiles.

Figure 4: Age profile of all staff groups (headcount) as at 30 September 2004

Information on the ethnicity of the NHS workforce is derived from the annual medical and dental census and the equivalent non-medical census. (These figures only relate to those staff who provided data on their ethnicity so should be interpreted with caution.)

Figure 5: Ethnic origin distribution (based on staff replying to survey) at 30 September 2004

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