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5 A Framework for Workforce Planning
5.1 A framework for workforce planning at national, regional and Board level
The 2004 Baseline Workforce Plan emphasised the importance of an integrated framework for workforce planning at national, regional and Board level. This has since been reinforced by Building a Health Service Fit for the Future, which flags the importance of planning for services at these three levels. This provides a common framework for integrated service and workforce planning across Scotland.
Workforce leads have now been appointed in all three planning regions. In one case (the North) the regional workforce planning director also has the regional service planning role, while the other two leads are working closely with their service planning counterparts. These individuals and their teams are working with the NHS Boards in their regions, all of which have now prepared workforce baselines from which to develop their workforce plans.
This report is only one element in a workforce planning cycle that will see regional workforce plans produced in January 2006, followed by Board workforce plans produced as an integrated part of each local health plan, by April 2006. These plans will then inform the production of the National Workforce Plan in December of each year.
Figure 66: Current workforce planning timeline 2005/06
Figure 67: Future aligned workforce & service planning timeline 2006/07 onwards
5.2 Gathering a bottom-up evidence base to inform future decisions on workforce supply
Scotland has lacked a complete picture of the future demands on health services, how they will impact on the workforce and how they should influence the decisions we take on supply. This planning framework, operating in the context of Building a Health Service Fit for the Future, will provide that bottom-up evidence base about demand which has not previously been captured. This will allow us to make decisions on training numbers which effectively align supply with future demand.
This evidence base will be at regional and Board level. Both regional and Board workforce plans will provide projections of the workforce numbers across the different staff groups required to deliver the future shape of services they envisage over the next 10 years. They will also provide proposals for any fresh training packages which need to be commissioned to deliver this workforce, or any new roles which might need to be designed and/or piloted.
These plans will in addition identify actions to address any misalignment between their workforce projections and the available supply. These actions may for example be one or a combination of:
redesign of services and/or roles;
recruitment from sources beyond Scotland;
retention initiatives;
improving productivity;
mechanisms by which they can grow their own supply through development of their existing staff.
This last option is of particular interest as a tool which enables NHS Boards to ease pressure points in the workforce by investing in a skills pathway for their own staff, while also helping to tackle problems of social exclusion in the local labour market through recruitment of the unskilled and unemployed to replace - and emulate - those who have extended their skills and taken on new roles.
Regional workforce plans will not be an aggregation of Board workforce plans. Instead they will concentrate on planning the workforce for those services which serve populations beyond individual Board areas and therefore go beyond Board boundaries.
We are asking each planning region to work with the NHS Boards in their regions to produce their regional workforce plan by January 2006. This process will enable regions and their constituent NHS Boards to identify those aspects of the workforce which need to be planned at regional rather than Board level, ensuring that regional planning takes place where it needs to and clarifying what remains for NHS Boards to plan for within their own workforce plans.
Board workforce plans will form part of their local health plans and will provide projections of the workforce requirements to underpin their strategic service planning, aligning these with the relevant regional workforce plan and with their financial plans. Detailed guidance will be issued to NHS Boards this summer on the preparation of their workforce plans.
5.3 The development of workforce planning
These are still early days for integrated strategic workforce planning in NHS Scotland, but we have embarked on a journey to develop this function as a core element of service planning. The maturity spectrum set out in the diagram below takes the approach to workforce planning from simple and practical work based on immediate issues through to greater complexity and more sophistication over time. We are committed to moving along this spectrum and have begun to do so through initial work on patient pathways and care groups. This report has outlined how we will take this further with regions and NHS Boards by beginning to line up the workforce in their plans with the key themes identified by Building a Health Service Fit for the Future.
The key areas which are crucial to the next steps in this work are:
Planning increasingly organised along the lines of the themes outlined in Building a Health Service Fit for the Future and on patient pathways;
Planning undertaken increasingly across organisations and sectors - for example between health and social services;
A joined-up approach to workforce planning at national, regional and Board level, incorporating a two-way flow between bottom-up evidence and top down strategic direction.
These developments are already beginning to happen. The initial steps that have been taken to planning along patient pathways in relation to maternity services, mental health and radiotherapy services are described here.
5.3.1 Maternity Services
A Framework for Maternity Services in Scotland48 set out how the principles for achieving a step change in the quality, access and responsiveness of healthcare would be applied to the provision of maternity services across Scotland. This was followed in 2002 by the reports of the Expert Group on Acute Maternity Services ( EGAMS) 49 which identified education, training and workforce issues as key areas for action in order to sustain high quality acute maternity services.
Oversight of this workforce and service planning work was assumed by the National Maternity Services Workforce Planning Group in February 2004. This Group which includes membership from NHS Scotland, the Scottish Executive Health Department and professional organisations, was tasked with reviewing the maternity workforce profile, advising on the supply of relevant staff, establishing links with the regional workforce networks, and monitoring/ reviewing training and competencies in line with changing workforce needs and demands.
The Group's philosophy has been to support the three workforce planning regions in implementing the principles of both the Maternity Services Framework and EGAMS with a focus on regional solutions with national support and co-ordination where appropriate.
Work to date includes:
overseeing the establishment and development of the regional EGAMS groups;
undertaking a review of current activity and staffing levels across each of the maternity units in Scotland;
holding an event in October 2004 open to those involved in planning and delivering maternity services across Scotland to consider different models of care and future direction. This provided an opportunity to consider how maternity services had changed over the previous 60 years, what the current drivers for change are and the challenges in sustaining services and planning the future workforce;
contributing to the Advisory Group on the National Framework for Service Change;
consideration of the assumptions included within Modernising Medical Careers and the impact that they might have on service delivery;
drafting an interim maternity services workforce plan. This plan, which will be published later in 2005, will provide further detail of the Group's work so far, set out the current service and workforce baseline, and describe potential models of care for the future.
The next steps are:
clarification of the different levels of service delivery across Scotland;
description of potential models appropriate to these levels of care;
establishing the workforce and training needs for each model;
consideration of new roles needed to deliver these models including enhanced roles for midwives, maternity care assistants, neonatal nurses, GPs, general surgeons and allied health professionals;
support of regional groups in using models within an integrated regional configuration of services;
ongoing consideration of developing models to maximise the role and potential of midwives to provide the bulk of care for normal pregnancies and births.
5.3.2 Mental Health
Mental Health was identified as a Pathfinder group for new efforts on workforce development in October 2002, and the White Paper Partnership for Care50 identified child and adolescent mental health services ( CAMHS) as a priority within that effort. In June 2003 the Minister for Health and Community Care announced the appointment of a National Mental Health Workforce Group, ( NMHWG).
The activities supported by the NMHWG currently fall into four main categories:
developing a better understanding of the dynamics driving demand and supply to ensure that the future workforce is fit for purpose;
in the immediate short term, to develop the workforce to meet the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003:
specific development projects on CAMHS to address immediate workforce pressures and to improve future supply;
specific activities to stimulate and promote service redesign and workforce development.
Establishing links with other related portfolios will also be of benefit in developing better integrated workforce planning, including, for example, the impact of the Cosgrove Report 51 and the requirement for forensic psychologist and forensic psychiatrist capacity.
Mental Health (Care and Treatment) (Scotland) Act 2003
This new piece of legislation heralds new responsibilities for staff of both NHS Scotland and local authorities. It will also impact on the voluntary sector workforce. In this regard, the NMHWG is giving attention in the first instance to the workforce needs for Mental Health Officer ( MHO) and Consultant Psychiatrist services. This activity will inform next steps on linked workforce issues. The focus is on identifying the workforce implications for the new activities and the time demands required to deliver the new legislation and the associated planning processes. Work is in hand to agree current and future estimates for both staff groups - these will inform and be informed by the implementation process and workforce planning process for the new legislation.
Child and Adolescent Mental Health Services
One of the first tasks of the NMHWG was to give shape to the undertakings made in Partnership for Care to prioritise work on child and adolescent mental health services. The Group therefore established, in collaboration with the Child Health Support Group and the National Workforce Unit, the Child and Adolescent Mental Health Workforce Group ( CAMHWG). The group's work programme has primarily addressed three areas:
the workforce associated with in-patient and intensive mental health services for children and young people;
the workforce requirements of community-based specialist mental health services for children and young people;
how to build the "mental health capacity" of the broader network of children's services in Scotland.
A fourth strand of work has been added: NHS Scotland's Information Services Division ( ISD) will soon be mapping the workforce in NHS specialist CAMHS. Raw data was gathered in May 2005 and will provide an important way of measuring the effectiveness of this and any subsequent CAMH workforce planning. Because of the additional data which will emerge from the mapping exercise, the CAMHWG aim to produce a comprehensive workforce report on Child and Adolescent Mental Health Services later in 2005.
5.3.3 Radiotherapy
Radiotherapy is a key component of modern cancer treatment and is likely to remain so for the foreseeable future. The need for an increased workforce to meet the requirement for additional activity is unavoidable. This workforce can either operate more linear accelerator machines running less hours or operate fewer machines running longer hours; and in both scenarios there may be opportunities to develop new ways of working.
Future Service Demand
Cancer Incidence Projections for Scotland52 projected an 18.9% increase in cancer incidence from 2004 to 2015. In addition increased demand on radiotherapy services will result from:
an ageing population, who may present with coincident medical conditions making radiotherapy a safer and more attractive treatment option than surgery
increased cancer prevalence and therefore higher likelihood of re-treatment
improved diagnostic techniques and technologies
growing indications for the use of radiotherapy
increased fractionation (increased number of treatments per patient)
increased complexity of treatment planning and delivery
additional quality assurance requirements
This is expected to result in a projected 51% increase in demand for radiotherapy between 2004 and 2015. Some steps to increase radiotherapy service capacity are already underway and by 2008 there will be 25 modern linear accelerators in operation across Scotland, compared with 15 in 1997.
Future Service Capacity
In order to meet the required capacity for linear accelerator operation, the Radiotherapy Activity Planning Group has considered the possibility of increasing the core clinical service day, week and year. It is estimated that this could deliver a 34% increase in service capacity, and 68% of the total projected increase in service capacity required between 2011 and 2015. A further 3 to 4 linear accelerators may be required by 2011/2012.
Workforce Demand
The key professional groups essential to the delivery of radiotherapy services are:
Having carried out the preparatory service planning, work is now underway to take into account the recommendations on workload and workforce establishment from the Royal College of Radiologists, the Institute of Physics and Engineering in Medicine and the Royal College of Radiographers to determine the required workforce capacity for future radiotherapy services.
5.4 Workforce Planning Skills Capacity
In order to make effective, strategic planning decisions the NHS and the four UK Health Departments require high quality, timely and integrated workforce, service and financial information. To support regions and NHS Boards in effective decision-making there needs to be more investment in the development of workforce planning expertise.
5.4.1 Development of a UK Wide Workforce Planning Competency Framework Development
All four UK countries have identified a need to invest in, train and develop everyone involved in the workforce planning and development function. A starting point for this is the development of a competency framework, which has now been completed. Skills for Health (the UK-wide sector skills council for the healthcare sector) has been working in partnership with the National Workforce Project Team in England and the four UK Health Departments to develop a UK-wide competency framework for all staff engaged in workforce planning, covering healthcare wherever it may be delivered. The project was completed in February 2005.
The Competency Framework encompasses the skills and competencies required by operational managers, strategic managers and specialists working in workforce planning and development. Competency frameworks have a broad range of uses, including the development of job descriptions for workforce planners, and identification of individuals' training and development needs.
The Competency Framework 53 was developed through engagement of workforce planning practitioners and key stakeholders. The consultation process has included UK wide development sites, workshops and a reference group. There have been five workshops throughout the UK, including a Scottish workshop in Glasgow and involving participants from all three Scottish workforce planning regions. Details of the project can be found on www.healthcareworkforce.org.uk.
The launch of the Competency Framework was on the 11 May 2005 and further testing and fieldwork of the competencies is now being undertaken. It can be accessed on the above website.
In Scotland work is now beginning to map existing training and development provision and identify any gaps when this is matched against the competencies highlighted in the Competency Framework. In the short term a UK-wide approach will be taken to learn, share and benefit from economies of scale, paving the way for each country to develop its own workforce planning skills and expertise.
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