Everyone Matters: 2020 Workforce Vision - Implementation Framework and Plan 2014-15

6. Priorities for action

Healthy organisational culture - creating a healthy organisational culture in which NHSScotland values are embedded in everything we do, enabling a healthy, engaged and empowered workforce.

Why this matters

There is a compelling case in support of a healthy organisational culture and we know from evidence^[5] that staff who are valued and treated well improve patient care and overall performance. We also know from the engagement feedback^[6] with NHS staff that this as an area of concern to them. Recent reports^[7] on service failures have also focused on culture, values and behaviours. However, culture change is complex, difficult and unlikely to be achieved quickly or easily, and the challenges will differ within and between organisations.

A healthy organisational culture is not about what we do, it's about how we do it. By developing and sustaining a healthy organisational culture Boards will create the conditions for high quality health and social care. The focus this year is on embedding the shared values in everything we do.

What we are doing

In recent years considerable work has been carried out within Boards to develop local values and a healthy organisational culture. Boards are expected to continue to take appropriate local action to support culture change as it provides a robust foundation for the developments set out below.

Actions for 2014-15

Scottish Government and others will:
Develop guidance on the core NHSScotland values and the process of embedding values
Encourage the use of NHSScotland core values to support selection onto relevant further and higher education programmes
Develop a plan for the roll-out of the iMatter Staff Experience continuous improvement model
Develop guidance on creating a healthy organisational culture and improving well-being.

NHS Boards will:
Take action to ensure that everyone is clear about the values and behaviours expected of them
Incorporate behavioural competencies (which reflect our core values) within recruitment and development reviews/appraisal processes
Roll out the iMatter Staff Experience continuous improvement model
Ensure that local feedback and monitoring arrangements (from patients, staff, service users etc) inform how well the core values are embedded
Engage and involve staff in decisions that affect them.

Sustainable workforce - ensuring that the right people are available to deliver the right care, in the right place, at the right time.

Why this matters

Our health service is facing many challenges: growing demand, health inequalities, increasing public expectations, an ageing workforce, recruitment challenges, budget pressures and the integration of health and social care. To meet these challenges NHSScotland is changing how services are delivered. The health workforce will need to change to match these new ways of delivering services and new ways of working. We need to ensure that people with the right skills, in the right numbers, are in the right jobs. We need to promote the health and well-being of the existing workforce and prepare them to meet future service needs. Strengthening workforce planning is identified as one of the early actions.

What we are doing

Work is progressing to develop new service models and enhance roles in the priority areas identified in the 2020 Route Map. These include early years, unscheduled and emergency care, and care for people with multiple and chronic illnesses. Shared services are being developed locally, regionally and at a national level to increase efficiency and ensure that resources are being invested in front-line services.

Progress is also being made in supporting healthy working lives and providing employment opportunities for young people.

Actions for 2014-15

Scottish Government and others will:
Identify and agree high impact workforce actions to support new and emerging service delivery models and ensure a more joined-up approach
Implement a national programme of work to ensure that the quality of regional and local workforce data is of the highest standard
Extend the risk assessment model of workforce planning to ensure risks are identified and mitigating actions are taken
Develop a Scottish Investment Plan to set the strategic direction for investing in the health care workforce now and in the future.

NHS Boards will:
Review their workforce planning arrangements to ensure a joined-up, consistent approach so that all services are included and benefit from the process
Demonstrate that workforce planning includes a long-term perspective and supports new and emerging service delivery models
Identify workforce risks and use this information to inform local workforce plans
Put in place measures to provide high quality workforce data and identify a lead officer with responsibility for workforce data
Ensure that workforce plans include an analysis of future education and training needs and that this is reflected in local learning and development strategies
Implement the Good Practice principles recommended by Audit Scotland in their Early Departures report[8] to ensure that early release schemes are driven by the needs of the Board and their workforce plans.

Capable workforce - ensuring that all staff have the skills needed to deliver safe, effective, person-centred care.

Why this matters

Over 150,000 people work for NHSScotland and the majority of the 2020 workforce already work here or are in training. All staff need to be appropriately trained and have access to learning and development to support our Quality Ambitions and 2020 Vision for Health and Social Care. The focus this year is on meaningful development reviews/appraisals, providing fair access to learning and development for support staff, and building capacity and capability to improve the quality of what we do.

Systems and processes are already in place locally to support staff development and people management, and there is much good practice. Development review/appraisal is one of the tools available. The engagement feedback shows that not all development review/appraisal discussions are meaningful, difficult issues are often avoided and that staff want this to change. The challenge is for all appraisals to be carried out effectively and reach the standard of the best.

Although support staff^[9] make up over one-third of the NHSScotland workforce, their development needs are not always recognised and supported. Recent high profile events and reports highlight the important role of support staff in providing safe, effective, person-centred care. The staff engagement feedback shows that not all staff have fair and appropriate access to learning and development. This needs to change.

Going forward, more people with the right skills and knowledge will be needed to spread good practice and support service improvements across NHSScotland. We need to build capacity and capability to continually improve and meet current and future challenges. Leadership and management capabilities are dealt with later in this plan.

What we are doing

All Boards are required to have a learning and development strategy which is developed in partnership, includes mandatory training, reflects the outcomes of development reviews/appraisal discussions, and identifies actions for implementation, monitoring and evaluation. NHS Education for Scotland supports Boards with their education, training and development needs. The Scottish Government is working with partners and stakeholders to agree the future shape of the medical workforce.

Actions for 2014-15

Scottish Government and others will:
Review guidance on development reviews/appraisals to ensure they are effective and meaningful
Develop a quality improvement capacity and capability plan
Agree and develop education pathways for support workers to increase capability and support career progression
Develop guidance and provide support to help Boards make best use of national educational systems and learning resources that are available for support workers.
NHS Boards will:
Ensure that appraisers and those being appraised understand the purpose of development reviews/appraisals, their individual and mutual responsibility for ensuring it is meaningful and that conversations review whether behaviours, decisions and actions reflect our shared values
Improve the confidence, capability and capacity of everyone involved in leading and practising quality improvement
Provide fair and appropriate access to learning and development for support staff
Ensure that their Learning and Development Strategy is developed in partnership and addresses longer-term learning and development needs up to 2020.

Integrated workforce - developing an integrated health and social care workforce across NHS Boards, local authorities and third party providers

Why this matters

The integration of health and social care is a key part of the Scottish Government's commitment to public service reform. The goals are to: improve the quality and consistency of services; provide seamless, joined-up, quality health and social care services; and ensure resources and staff are used effectively and efficiently to deliver services. To provide integrated services, there is a need for an integrated workforce, and joined-up working within and across primary and secondary care, across NHS Boards, local authorities and third party providers.

This implementation plan focuses only on the health service in Scotland and creating the conditions for an integrated workforce. Once legislation for health and social care integration has been enacted, the focus will extend beyond health and include social care. The focus this year is on developing the right conditions for an integrated health and social care workforce.

What we are doing

The Public Bodies (Joint Working) (Scotland) Bill^[10] provides the framework that will improve the quality and consistency of health and social care services through integration. It is likely to be enacted around spring 2014. Work is going on to support the integration of primary and secondary care through the Primary Care Modernisation Programme.

Actions for 2014-15

Scottish Government and others will:
Develop practical guidance to support the creation of effective governance arrangements for an integrated workforce
Identify HR/workforce issues for integration to anticipate challenges and risks, and ensure that appropriate action is taken.
NHS Boards will:
Use the guidance provided to inform the appointment of Chief Officers and other joint appointments
Continue local actions and development work to support integration of primary and secondary care
Make better use of existing mechanisms, such as community planning partnerships, to identify opportunities to share resources, including workforces[11].
Effective leadership and management - leaders and managers lead by example and empower teams and individuals to deliver the 2020 Vision.

Why this matters

We know from recent events and reports^[12] that the quality and kind of leadership and management we have affects how services are delivered, how staff feel about their work, and how organisations perform. The Staff Governance Standard^[13] sets out the rights and responsibilities of staff and NHS employers to ensure fair and effective management of staff.

Delivering services that are fit for the future requires leaders and managers, at all levels across the public sector, who are visionary, work seamlessly with partners who deliver care, can make change happen, empower teams and individuals to innovate and make things better, and lead by example. They also play a key role in creating a culture of organisational learning and ensuring compliance with regulation and legislation.

Managers and leaders are part of the workforce and have a key role to play in driving service and culture change. They need to be valued, supported and developed. As we move towards 2020, investment is needed in leadership and management at all levels. This includes investing in emerging managers and leaders, as well as NHS Board Chairs and Non-Executive Directors who have a role in leading by example and demonstrating the shared values. This year, the focus is on supporting and developing line managers, particularly their people skills.

What we are doing

Work is ongoing locally and nationally to support leadership and management development though high quality programmes, management training schemes, toolkits, resources, expert advice, and consultancy support. This work is being taken forward in partnership with trades unions and professional organisations. Work is also planned to support the development of NHS Chairs and Non-Executive Directors.

Actions for 2014-15

Scottish Government and others will:
Develop a policy statement setting out the kind of leadership and management needed to deliver the 2020 Vision
Ensure that guidance and development support for NHS Board Chairs and Non-Executive Directors aligns with the leadership and management statement
Create a portal for information about leadership and management support, tools and resources
Ensure that national development programmes relating to leadership, management, leading quality improvement and so on reflect the leadership and management statement
Develop guidance and support for leaders and managers at all levels on people management skills
NHS Boards will:
Plan to build local leadership and management capacity and capability as part of their workforce plan to deliver the 2020 Vision
Ensure that line managers at all levels are clear about their people management responsibilities and are held to account for how they carry out these responsibilities
Identify the development, training and support needs of line managers at all levels, particularly in relation to people management, and ensure these needs are met
Ensure that leaders and managers at all levels understand and demonstrate the values and behaviours expected of them as well as their responsibilities in relation to the Staff Governance Standard and Quality Ambitions
Ensure that leaders and managers are aware of and abide by national governance arrangements/structures
Ensure that the approach to ongoing leadership and management development supports Everyone Matters: 2020 Workforce Vision and the Quality Ambitions, and reflects the leadership and management policy statement
Ensure that managers and leaders identify and focus on the strategic workforce actions needed to deliver Everyone Matters: 2020 Workforce Vision.