Safe and effective staffing in health and social care: discussion document

Background

The ‘Safe Staffing’ Bill will deliver on the Scottish Government commitment to enshrine in law the principles of safe staffing in the NHS, starting with the nursing and midwifery workforce planning tools. A Nation With Ambition: The Government's Programme for Scotland 2017-18 indicated that the Bill would ensure that nationally agreed, evidence-based workload and workforce planning tools are applied in nursing and midwifery settings, and ensure key principles relating to professional judgement, local context and quality measures underpin workload and workforce planning.

On 11 April 2017 the Scottish Government launched a consultation on ‘Safe and Effective Staffing in Health and Social Care’. The consultation ran for 12 weeks, closing on 5 July 2017. A series of consultation events was also held across Scotland.

That consultation paper invited views on proposals to introduce legislation requiring organisations providing health and/or social care to:

• Apply nationally agreed, evidence based workload and workforce planning methodologies and tools where they exist and are validated.
• Ensure consideration of professional judgement, local context and quality measures underpin workload and workforce planning and inform staffing decisions.
• Monitor and report on how they have done this and provide assurance regarding safe and effective staffing.

The paper made clear that the proposals were intended to:

• Strengthen and enhance arrangements already in place to support continuous improvements and transparency in workforce planning and employment practice across Scotland.
• Support consideration of service delivery models and service redesign to ensure Scotland’s health and social care services continue to meet the needs of the people they serve, both now and in the future.
• Ensure consideration of professional judgement, local context and quality measures inform workload and workforce planning decisions.
• Provide assurance – including for service users and staff – that safe and effective staffing is in place to enable the provision of high quality care.
• Actively foster an open and honest culture where all staff feel safe to raise concerns regarding safe and effective staffing.

The proposals for legislation set out in the 2017 consultation document focused intentionally on the application of evidence based approaches to nursing and midwifery workload and workforce planning as there is already a validated framework, methodology and suite of 12 workforce planning tools mandated for use in NHS Scotland as part of the Local Delivery Planning process. Additionally the consultation proposed that the legislation could contain provisions to enable this approach to be widened to include organisations providing health and social care services and to other staff groups if other relevant tools were developed in future. It asked for views on whether the legislation should apply to health and social care organisations, and on extension to other settings and staff groups (beyond the existing nursing and midwifery tools for NHS settings) in the future.

Consultation findings

A summary of consultation findings can be found here link to consultation response report and the Scottish Government published our response here link to response. In brief, over 80% of the respondents agreed that:

• a statutory requirement to apply evidence based workload and workforce planning methodology and tools will help support consistent application;
• the requirement should apply to organisations providing health and/or social care services;
• consideration should be given to extending the requirement to apply a similar approach to other settings and/or staff groups in the future.

Responses highlighted that a focus on achieving better outcomes for service users should be at the heart of the legislation; that workload and workforce planning tools are only one of the components required to achieve high quality care and improved outcomes; and suggested setting out further guiding principles on safe and effective staffing in the Bill.

There was significant divergence in responses over whether legislation should span social care, given existing statutory frameworks for these settings. In particular, Health and Social Care Partnerships and some public bodies did not support the inclusion of social care. Respondents emphasised the importance of ensuring that legislation reflects the context of health and social care integration, while also highlighting the specific context, requirements and current assurance framework in social care. Respondents also identified the risk of resources being drawn from one service to another if a whole-systems approach is not taken; while the need to extend beyond nursing and midwifery to the wider multi-disciplinary or multi-agency team was a frequently raised theme.

The purpose of this engagement

We recognise that some stakeholders may not have been aware of the proposal to include social care in the Bill and therefore did not engage with the initial consultation on the legislation. As part of overall proposals, the consultation proposed that the Bill would be able to extend requirements to apply workload and workforce planning tools and methodologies to social care organisations when tools and methodologies were developed in the future. It is important that stakeholders across health and social care are involved in the development of this legislation to ensure it delivers the intended aims.

We also recognise that there have also been important wider developments since the initial consultation was undertaken, notably the publication of Part 2 of the National Health and Social Care Workforce Plan, co-produced by the Scottish Government and COSLA. The recommendations aim to begin a process to improve national and workforce planning for health and social care in Scotland, in keeping with the principles of ensuring the right people, in the right place at the right time to deliver sustainable and high quality services with improved outcomes for service users. One of the recommendations is to progress and co-produce social care and multi-disciplinary workforce planning tools that support the deliver high quality care that reflects the new health and social care standards, and enable service redesign and new models of care.

The details of the legislation are still to be defined and are a focus for a Bill Reference Group; however, this paper sets out intentions for the legislation at this stage, taking account of themes from the initial consultation and subsequent engagement with stakeholders. It is important that stakeholders across health and social care are involved in the development of this legislation to ensure it delivers the intended aims. Therefore, we are undertaking further focussed engagement in early 2018 on refreshed proposals to ensure the legislation and underpinning policy are effective and proportionate. As this discussion paper builds on the initial consultation and will run alongside further engagement with stakeholders the response period will be limited to four weeks.

Feedback

Views are particularly sought on the following areas where provisions in the legislation may apply:

Sections 1-2 invite your views on refreshed proposals that cover health and social care sectors and aim to create a cohesive legislative framework for workforce planning across health and social care.

Section 3 invites your views on proposed requirements applicable to health boards.

Sections 4-6 invite your views on proposals on how the legislation could apply to the social care sector.

Section 7 invites your views on any risks or unintended consequences of the proposals.