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CHAPTER SEVENTEEN: WORKFORCE

This section of the consultation document suggested 3 key milestones for the planning and commissioning of services and listed 3 action points.

17.1 TARGETS AND MILESTONES

Key targets

There were two specific targets that related to workforce.

Consultees were first asked whether they agreed with the key target to achieve a sickness absence rate of 4% by 31 March 2008. As seen in table 17.1 below, around two thirds of (63%) of those responding to this question agreed.

Table 17.1
42: Sickness Absence Rate: 4% by 31 March 2008

Base: All those responding in each category

Consultees also offered a number of comments regarding this target.

Four consultees stated their belief that achieving this target would prove challenging or indeed, be unachievable, particulalrly if it were to be achieved by the target date. An NHS Board stated "Achieving this target will be challenging. We need to look at the reasons why staff are off sick and put in place better support mechanisms, including support for them and their colleagues."

Four consultees indicated that in order to achieve this target, structural and organisational factors that contribute to staff sickness need to be addressed e.g. pressures on service, stress, staff susceptability to childhood illness.

A NHS Service Provider stated "Sickness absence management must consider the pressures and stress staff are under and will continue to face, as described on P63 of the Action Framework, Point 188 "pressures being faced currently will increase".

A NHS Service Provider also mentioned the need to improve the morale of the workforce if the sickness absence rate target were to be achieved.

A Professional Body expressed the opinion that they were dubious about setting targets related to sickness absence rates and their interpretation and suggested that this might require further consultation.

Consultees were then asked whether they agreed with the key target to increase consultant productivity by 1% over the next three years. As seen in table 17.2 below, around two in five consultees (43%) of those responding to this question agreed.

Table 17.2
43: Productivity: increase in consultant productivity by 1% over the next 3 years

Base: All those responding in each category

Consultees offered a number of comments regarding this target.

Eight consultees expressed concern over the definition of 'productivity' and requested clarification on what aspects of consultant activity this referred to. An Education Body stated "It is not clear whether the productivity referred to is throughput of patients, quality of direct clinical care, quantity and quality of supervision and teaching, or quantity and quality of communications, consultation and multidisciplinary working. With the changes in practice suggested throughout this document, it is unlikely that throughput of patients per consultant will increase within child health."

Four consultees stated that the HEAT targets on workforce appear to be at variance with other legislation i.e. increasing consultant activity conflicts with the European Working Time Directive.

Three consultees queried why the focus is on consultant productivity as opposed to service productivity.

An Education Body stated "Any increase is positive and beneficial to help reduce waiting lists and increase productivity and care".

An Individual consultee said "Consultants already exceed planned activity workloads. Further increased activity needs resourcing!"

An NHS Management and Strategy group felt that "these are ambitious target dates and we have concerns over their achievability".

Milestones

Consultees were then asked whether they agreed with 3 milestones listed in the Action Framework. In each case a large majority of those responding at each question expressed agreement.

Clear action plans for the development of consultant AHP and nurse specialist roles for community and specialist children's services by 2007

15 consultees expressed general agreement with this milestone target. However there were some additional comments made regarding the nature of the national planning arrangements. Two consultees queried whether there will be supportive resources for recruiting and training these specialist staff. An Education Body expressed the concern that there were too many plans - and the need for adequate implementation. A NHS Board stated that there "is potential for generic nurses with additional skills on specific diseases rather than moving to highly specialist nurses with limited roles. The plan must not focus on Consultant numbers as the driving factor in paediatric workforce. There needs to be planned expansion across a range of specialist roles, clinical psychology, nursing, AHP and medical."

A Professional Body asked whether psychologists would be involved within this milestone, as they are not covered under the grouping of Allied Health Professionals. At a seminar, one group of respondents highlighted the fact that there is no clear pathway for career progression towards consultant AHP or nurse roles.

Table 17.3
44: Clear action plans for the development of consultant AHP and nurse specialist roles for community and specialist children's services by 2007

Base: All those responding in each category

Regional and national workforce plans that specifically address the requirements for children and young people's health services by 2006 and annually thereafter

16 consultees expressed general agreement with this milestone target. However there were some additional comments made regarding the nature of the national planning arrangements.

Two consultees stated that it is essential that workforce planning begins now to respond to fast moving changes and developments in children's services, and that it may take a number of years to establish these changes in workforce planning.

A NHS Board stated that "The structured development of the Children's Services workforce requires to be undertaken at all levels and not overwhelmed by the needs of the Specialist Children's National Delivery Plan. It is essential that all the elements - locally, regionally and nationally - are all developed in a complementary fashion which reduces competition for limited numbers of suitably qualified and experienced staff".

A NHS Management and Strategy Group suggested that workforce plans must reflect issues of remote and rural localities.

Another NHS Management and Strategy Group noted concern over the timings to achieve this milestone, stating that the dates appeared ambitious and that there may be some difficulties in achieving these.

A Professional Body stated that it is essential that the development of the workforce plans is adequately supported and strengthened by resources.

Another Professional Body noted that " GP numbers are not mentioned in Paragraph 191 about NHS Workforce. If GPs are to be involved in delivering the aims of the Action Framework then workforce planning needs to reflect their involvement and consideration needs to be given to whether an increase in GP numbers will be required".

Table 17.4
45: Regional and national workforce plans that specifically address the requirements for children and young people's health services by 2006 and annually thereafter

Base: All those responding in each category

Development of workforce plans as part of the specialist children's national delivery plan by 2007

Eight consultees expressed general agreement with this milestone target. Some additional comments were provided by individual consultees.

Two consultees indicated that there needs to be a clear view on service configuration before workforce planning begins

Two consultees expressed the opinion that in order for this milestone to work, a comprehensive multidisciplinary approach must be undertaken when developing workforce plans.

Table 17.5
46: Development of workforce plans as part of the specialist children's national delivery plan by 2007

Base: All those responding in each category

General comments on targets and milestones

Of the more general comments on the milestones for workforce, one independent professional commented that "there appears little development in role of consultant children's nurses which would help drive through some of these changes. No national strategy for ensuring there are enough community children's nurses being trained."

A NHS Board stated that the Scottish Intercollegiate Guidelines Network ( SIGN) guidelines should be discussed in this action framework, but that these haven't been addressed.

A Professional Body expressed the concern that "whilst the document acknowledges that it is essential to double the CAMHS workforce, this has been left out of both Milestones and Action points. We consider this to be an oversight. We would reiterate our comment about the potential benefit to services and service users, of integrating counsellors into the workforce as they are a distinct profession, and who can, and do, work within many sectors including health, education and social work".

17.2 ACTIONS

Further comments were invited on the actions listed in the Action Framework in relation to planning and commissioning of Children's and Young People's Services and 22 consultees included a response to this section.

Regions and Boards produce workforce plans which address the needs of children's and young people's nursing.

Seven consultees were in general agreement with the suggested action, however a few additional comments were made. Two consultees expressed the concern that in order to implement this action and to ensure future demands can be met, adequate resources must be made available. Two consultees indicated concerns over the timescale for implementing this action and an Education Body also expressed some concern that workforce planning must take a multi-disciplinary focus.

A nursing workforce tool should be developed to influence the development of work force plans for children and young people's nursing.

Ten consultees were in general agreement with the suggested action, however a few additional comments were made. Three consultees suggested that a workforce toolkit should be developed for Allied Health Professionals as well. One NHS Board stated that the workforce toolkit will need to be supported by sufficient resources.

An action plan for the development of community and children's nursing will be developed by SEHD, Regional Planning Groups and NHS Boards using senior professional paediatric nursing advice, working collaboratively in an all-Scotland basis.

Twelve consultees were in general agreement with the suggested action, however a few additional comments were made.

Five consultees highlighted the need for adequate, comprehensive nursing education. In particular, community children's nursing education requires support which appears so far to have been seriously under resourced. A Professional Body stated "Scotland needs to review the provision of nurse education in particular relating to the lack of community children's nurse courses. They need to be clear about what the status and remit of this action plan will be".

An Independent Professional suggested that the different requirements of workforce planning for young people's services should be assessed, such as the use of multi disciplinary teams and multi agency collaboration. An NHS Board stated that there needs to be sufficient financial and human resources to fulfil this action plan.

General comments on actions

Of the more general comments on the actions for national and regional planning, a number of consultees felt additional factors should be included.

An Independent Professional commented that there is a high level of stress in the NHS. They queried what systems, structures and training will be put in place to try and reduce this.

An NHS Board also commented that there is some feeling that young people are being put off applying for nursing courses, as they feel that the routes of entry are becoming too demanding in terms of required qualifications. Whilst this may push up standards within the profession, this may impact on the number of new staff entering the profession and thus causing a workforce shortage.

A Professional Body also stated that it was important to develop sustainable services. Often there is insufficient funding and/ or only time-limited funding to support services.

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