Better Health, Better Care: Planning Tomorrow's Workforce Today

CHAPTER 1:
THE CHALLENGE FOR
WORKFORCE PLANNING

Introduction

The challenge for workforce planning is to enable NHSScotland to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to healthcare and services. Workforce planning plays a key role in enabling the health service to work together with its partners, provide services that are both accessible and which meet the needs of patients, and realise efficiencies and improve productivity. With around 70% of the NHSScotland budget allocated to the workforce, the importance of workforce planning to ensuring sustainable services across Scotland cannot be overestimated.

Over recent years the workforce planning function has become more firmly established within NHS Boards and Regional Planning Groups and the value of considering the current and future use of the workforce in terms of how services are planned and delivered is widely appreciated. The time is now right to further develop the value of this function and ensure it becomes more fully integrated with service delivery and financial plans.

Better Health, Better Care: Planning Tomorrow's Workforce Today sets out the direction of travel for workforce planning. It outlines the challenges in supporting delivery of the Better Health, Better Care: Action Plan through a selection of case study examples. It also emphasises the importance of investment in education and training, both in relation to the existing workforce and new supply flows. This includes outlining the supply training numbers for controlled groups for 2008. However, this document does not attempt to be a national workforce plan, nor summarise the demand outlined in local workforce plans.

There are four main sections within the document: this first section outlines our vision for the future. The second section considers some of the core workforce messages arising from the Better Health, Better Care: Action Plan, which will impact on our ability to deliver our strategic
vision for Scotland. The third section describes the role that education and training plays in moving towards tomorrow's workforce, and the fourth considers the changing nature of the workforce planning function and how NHS Boards can be supported to plan in a more dynamic way.

Vision

The Scottish Government vision for a healthier Scotland will enable us to live longer, healthier lives; tackle the significant inequalities in Scottish society; ensure our children have the best start in life and get support when they need it; and ensure public services are high quality, continually improving, efficient and responsive to local people's needs.

Workforce planning ensures NHSScotland has the right staff in the right place with the right skills at the right time in order to deliver high quality care and services to the people of Scotland. To achieve this outcome, workforce planning should feature as an integral element of NHS Board and Region strategic planning processes to ensure that the workforce is fully aligned behind service delivery needs in a way that is both affordable and sustainable.

Better Health, Better Care: Planning Tomorrow's Workforce Today signals the direction of travel for workforce planning over the immediate future and thereafter. A phased approach is planned over the next 2-3 years enabling a move towards the potential development of integrated capacity and delivery plans. The finer points of this phased approach are detailed in Chapter 4.

Challenges and Opportunities

Given the robust workforce planning processes and systems that are now well established across NHSScotland, there is a real opportunity to aim for excellence in this role. There is also plethora of work underway at local, regional and national level to support the development of dynamic workforce planning. The level of skills and competences at all levels is better than ever before, allowing a well-placed NHS to take advantage of opportunities arising across Scotland to achieve greater synergy around the development of our workforce.

There are, however, a number of challenges that will need to be taken into account and considered carefully to ensure full integration across planning functions, such as the need to align planning timetables, the provision of consistent and quality information, and the need to move towards more sophisticated and dynamic workforce planning. Action is underway to tackle each of these issues. There is also a need to ensure the fiscal position is given due consideration, and, in the short term, we also need to balance the desire to workforce plan around the strategic priorities with the need to have accurate information across the whole workforce for planning purposes. Last, but certainly not least, we need to encourage and sustain the further development of the workforce planning function without depreciating the significant progress made by NHS Boards to date.

In addition to the specific challenges around the workforce planning function, NHS Boards and Regional Planning Groups are well versed on the range of issues that impact on the development of their workforce plans. Both challenges and opportunities arise from demographic changes, national priorities and policy, and legislation and regulatory frameworks. We do not intend to review each of these topics here in any detail, but will simply highlight some of the national factors that are likely to be of greatest impact over the coming period.

Demographic changes

It is widely known that changes in demography present some of the most significant challenges for workforce planning. In 2006, it was estimated that Scotland's population stood at 5,116,900 ¹, an increase of 22,100 on the previous year. The age structure of the population is also changing towards an older profile. The latest projections predict that the population of Scotland will continue to rise over the next 12 years to 5.13 million, before falling to around 5.07 million by 2031. Demographics will affect NHSScotland in two main ways. We will be challenged by not only an ageing population with multiple long term conditions posing more complex care needs, but also by an ageing workforce. Opportunities for the workforce lie in retaining quality, knowledgeable, highly-skilled and motivated staff who are very able to deliver high-level services, but who can also further improve those services, develop their own personal knowledge and skill base, and allow for better succession planning.

Increases in life expectancy, medical advances that widen the range of conditions that can be treated, and increasing expectations from the public regarding access to services will impact on the pattern of demand in the health sector. It is likely, as the population ages, that there will be increases in demand for elective surgery, i.e. non-emergency demand, such as cataract and hip replacement surgery. There will be higher levels of long term conditions such as diabetes which will require a more focused approach towards early intervention, rehabilitation and enablement. Major health problems such as cancer and coronary heart disease are more common in later life and there will be a move to more anticipatory care as well as potentially more unscheduled care needs.

National priorities and policy

Our aim for Scotland is to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to healthcare. Over the next five years, NHSScotland will continue to be challenged to put patients at the heart of the service, tackle health inequalities in everything it does and demonstrate its commitment to continuous improvement across the six dimensions of quality (safety, effectiveness, patient centredness, timeliness, efficiency and equity). Our workforce will need to respond to these challenges, with team based approaches and ways of working which embrace the views of patients and their carers in designing and delivering care. This gives us the opportunity to redesign our services to meet these challenges and in doing so identify which roles are best suited to deliver the various elements within, and along, the patient journey.

Other specific legal, regulatory and policy influences that impact on the workforce include:

• Working Time Regulations ( WTR) legislation: Reduction in junior doctors' working hours to
  48 hours per week by 2009.
• Trust, Assurance and Safety legislation: The Regulation of Health professionals in the 21st Century, confirms changes to be made to current regulatory systems through the UK Health and Social Care Bill; a number of orders under section 60 of the Health Act 1999 and associated guidance.
• Public Health legislation: Clarification of the roles and responsibilities of organisations involved in protecting public health; assigns the lead responsibility for the public health protection of people to NHS Boards.
• Mental Health (Care and Treatment) (Scotland) Act 2003 and Adults with Incapacity legislation: This framework helps to promote best care and treatment options for those who are mentally ill and unable to make informed choices.
• Clinical practice under continuous and rapid change policy: Development of academically talented individuals, who are likely to be highly influential in the future development and delivery of clinical services within Scotland.
• 18 week referral to treatment target: A whole journey waiting time target of 18 weeks from general practitioner referral to treatment, by December 2011.
• Pay and reward systems: Assumptions about workforce are changing or need to change to make best use of these opportunities, including improvements to efficiency, effectiveness and quality through implementation of the Knowledge and Skills Framework and making best use of the opportunities that the Career Framework can offer.
• New ways of working and of using the workforce: Scottish and UK drivers are influencing new and hybrid role developments to meet the needs of service provision, often across traditional sector boundaries.

Our approach

To ensure NHSScotland has the right staff in the right place with the right skills at the right time, the workforce needs to be fully aligned with service delivery in a way that enables the delivery of high quality services that are both affordable and sustainable over the longer term. To deliver this vision for workforce planning, we need to:

• Ensure the workforce supports affordable and sustainable delivery which places people at the heart of services;
• Work with partners across and outwith NHSScotland to ensure workforce planning delivers accessible services across organisational and professional group boundaries;
• Develop new roles, redesign services and review models of delivery to enable a shift in the balance of care towards more local, community focused care;
• Improve knowledge and intelligence of the workforce, particularly across primary and social care, in liaison with Local Authorities and the voluntary sector as appropriate;
• Ensure education and training of the workforce enables quality standards to be met across services;
• Implement and support pay modernisation and new frameworks to enable changing practices, improved productivity and benefits realisation;
• Attract and retain the best talent in a shrinking labour market to ensure today's workforce is well placed to meet tomorrow's requirements; and
• Work with educational partners, such as NHS Education for Scotland ( NES) and Higher Education Institutes ( HEIs) to ensure education and training supports a confident, competent, flexible and adaptive workforce.