Everyone Matters: 2020 Workforce Vision Summary of engagement and consultation responses

Engagement

Early Engagement

Since publication of 'A Force for Improvement' (2009), the context within which the workforce is operating has changed significantly, with a different political, economic and cultural focus. Following a period of initial scoping in early 2012, which established the need to develop a 2020 Workforce Vision, early engagement thereafter took place with a range of stakeholders around the impact of the changing strategic context on the workforce, the changes needed to equip the workforce to respond to the 2020 Vision for Healthcare in Scotland and how a national approach might support this. Stakeholders in this early engagement included NHS Board Chairs, Chief Executives, Directors of Human Resources and Employee Directors, representatives of recognised trades unions/professional organisations and representatives from Scottish Government, and, importantly, around 100 people who participated in a session at the 2012 NHSScotland Event on the development of a 2020 Workforce Vision, as well as many more who shared their personal values to generate a 'Value Wordle', most of whom would have been members of the NHSScotland workforce.

From the outputs of this early engagement, a series of key themes emerged which were used to shape the direction of subsequent work, particularly in relation to an identified need for a 2020 Workforce Vision to focus on the areas of 'governance, engagement and empowerment', 'capability and leadership' and 'modernisation and capacity' and cross-cutting work in relation to 'culture, values and behaviours' and 'integration'.

Initial Phase of Communication & Engagement with NHSScotland Staff

An initial phase of communication and engagement with NHSScotland staff took place between 13^th December 2012 and 28^th February 2013.

In determining the approach to be taken, a working group was formed, comprising representation from NHSScotland Human Resource Directors, Employee Directors and Strategic Communications Leads, as well as representatives from Scottish Government.

Key objectives, to support the overriding goal of supporting buy-in to an appropriately informed 2020 Workforce Vision were identified as follows:

• We wanted as many staff as possible to be aware of work to develop a 2020 Workforce Vision and why; and of the genuine commitment to seeking their engagement to inform its development.
• We wanted as many staff as possible to know how to and be able to contribute their feedback as part of the development of a 2020 Workforce Vision and whilst, ideally, we hoped to capture the views of a minimum of 5% of the NHSScotland workforce as part of this process, it was equally important to us that such views came from a representative cross-section of the workforce
• Ultimately, we wanted staff to have a clear line of sight between this initial phase through to the launch of the 2020 Workforce Vision and its subsequent implementation, and for staff to be able to clearly see how their input had helped to inform this work.
• We wanted to encourage local Board ownership of the communications and engagement process, to support their subsequent ownership of the resulting 2020 Workforce Vision, and therefore wished this work in the main to be undertaken at local Board level and enabling local flexibility of approach. That said we equally recognised the need for broad consistency of approach in relation to both communication and engagement.
• We also recognised challenges in relation to geography, staff working bases, working patterns, the variety of different staff groups that exist and the fact that not all staff have access to IT or are IT-literate. As such, we recognised that a combination of more than one approach would be required if we were to maximise coverage of communications and engagement participation levels.

A Communications and Engagement Toolkit was subsequently developed and issued to NHS Boards on 13^th December 2013, which contained guidance and resources for use as part of the initial communications and engagement phase of the 2020 Workforce Vision development process. Boards were asked to use local channels of communication and the set of resources provided, in order to maximise coverage, impact and clarity of understanding amongst staff about the key messages provided on the 2020 Workforce Vision and development process, giving particular consideration to any local issues of staff accessibility. Boards were also asked to undertake facilitated discussions with a view to maximising participation and ensuring involvement of a representative cross-section of their workforce. Given recognition of the need for local flexibility and whilst guidance on the approach to be followed was provided, Boards were asked to provide a copy of their local communications and engagement plans in order to provide assurance at the approach being taken within their respective organisations.

A 2020 Workforce Vision website was also developed (which was launched on 7^th January 2013) to supplement to supplement work at local Board level, providing an additional means of communication and engagement with staff in the development of a 2020 Workforce Vision, whilst at the same time creating a platform for cross-organisational discussion. Site users were able to participate through the online discussions or, alternatively, submit their thoughts directly to the project team, and were able to do so anonymously if they chose.

Engagement participants were asked to consider the following questions:

What will the NHSScotland workforce need to look like in order to achieve the aims/address the challenges as set out within the Quality Strategy, 2020 Vision and the Scottish Government response to the Christie Commission Report? In particular, we would like your views on:

• The nature of job roles and the makeup of the workforce;
• The skills and behaviours required;
• Use of technology and new ways of working;
• The way we manage and lead; and
• The way teams work.

Against each of the above areas, consider:

• What will need to be improved or changed?
• How these improvements or changes might be made?
• What the potential barriers are to making these improvements/changes, and how these might be overcome?
• How a national 2020 Workforce Vision might support this?

How can we make sure that the NHSScotland workforce understands and is motivated to achieve the 2020 Workforce Vision, once developed, as well as the wider future context as described in the Quality Strategy, 2020 Vision and the Scottish Government response to the Christie Commission Report?

Participation

Based on the information provided from NHS Board returns received, from participation in the 2020 Workforce Vision website online discussion and from feedback received directly via a dedicated 2020 Workforce Vision email address, participation levels were as follows:

• 9234 participants
  • 9108 through engagement within Boards (either specific to the 2020 Workforce Vision or specific to relevant local work already undertaken)
  • 117 staff registered with the online discussion forum
  • 9 staff who submitted feedback via the dedicated email address

We are still waiting for final details of participant numbers from a small number of Boards. As such, this overall total may be considerably higher.

Breakdown by staff group was available for 71.75% of participants. Of that group, the breakdown was as follows.

Nursing & Midwifery	37.07%	(42.7%)
Administrative Services	28.58%	(18.3%)
Support Services	11.29%	(10.3%)
Medical (Hospital, Community & Public Health Services)	4.80%	(8.5%)
Allied Health Professions	9.99%	(7.2%)
Healthcare Science	3.59%	(4.0%)
Emergency Services	0.13%	(2.8%)
Other Therapeutic Services	3.32%	(2.7%)
Medical & Dental Support	0.36%	(1.4%)
Personal & Social Care	0.29%	(0.7%)
Dental (Hospital, Community & Public Health Services)	0.58%	(0.5%)

Figures in brackets show the equivalent breakdown of the NHSScotland workforce as at 31^st December 2012 (source, ISD). Whilst there is slight negative variance against some staff groups, staff participation within the initial engagement phase is shown to be broadly representative of the wider NHSScotland workforce when broken down by staff group.

Breakdown of participants was also sought by pay band/grade. However, as this information was only available for 21.75% of participants, an accurate comparison could not be made due to the absence of pay band/grade data for the majority of participants.

Engagement Feedback

The following key themes emerged from initial engagement with NHSScotland staff:

The 2020 Workforce Vision needs to be more than 'rhetoric'. It needs to be fit for purpose, setting out clear goals and expected benefits, and staff need to be able to easily relate it back to their individual roles. People need to believe that early engagement has genuinely helped to inform the Vision and there must be an ongoing commitment to its achievement by all.

We need to embed a healthy organisational culture. In particular:

• Staff need to be able to speak out and challenge without fear
• We need to tackle historical power bases
• We need to ensure greater fairness and equity in the treatment of staff
• We need to effectively manage change
• We need to acknowledge and address pressures experienced by staff and ensure that our staff feel appropriately supported
• We need to communicate openly and honestly
• We need to effectively recognise the achievements and efforts of our staff
• We need to empower staff with greater influence over the way they work and give them a greater voice in decisions.
• We need to move away from a target-driven culture
• We need effective managers and leaders
• We need to focus on continuous improvement and shared learning

We need to support the achievement of this type of culture by embedding our values in everything we do (including our recruitment and performance management processes) and ensure that we embed our Staff Governance Standard.

We need clear, effective and stable management structures and we need effective leaders and managers, who are appropriately selected, given the tools and authority to lead and manage, and held to account, in relation to both achievement of outcomes as well as application of the necessary skills and behaviours.

We need to develop effective teams, and support an approach of multi-disciplinary teams coming together around patients/service users, and across the wider health and social care spectrum as necessary, with a focus on effective collaboration and communication.

We need to ensure that regular, effective PDPR/appraisal discussions become the norm, and form part of a wider talent management process. We need to ensure that there is clear accountability for performance, and that we do not avoid 'difficult conversations', although this needs to be balanced against clear, achievable performance objectives.

We need to develop the necessary skills in relation to the changing nature and needs of patients/service users. These include skills required for delivering care in the community, promoting health, supporting patient self-management, providing care for patients with dementia and enabling co-production. There is also a wider need for a focus on development of communication and interpersonal skills, as well as skills in quality improvement. Whilst this approach needs to be reflected within further and higher education courses, there is also a need for a focus on these areas within learning and development programmes for existing staff, if the majority of our 2020 workforce are already employed within NHSScotland.

We need effective workforce planning across the health and social care spectrum, with the workforce designed to meet service need, and with a long-term focus (to support effective succession planning) as well as flexibility to meet short-term challenges. We need to consider and respond to the challenges of an aging workforce, particularly in terms of career development opportunities for the wider workforce given the likelihood of reduced turnover. Where possible, we should seek to grow talent from within NHSScotland. We need an increase in generalist versus specialist roles, as well as an increase in community versus hospital-based roles. There should be a move away from traditional role divisions, with a greater skills mix across and between both registered and unregistered staff and between different professional groups. In general terms, we need to support a more flexible workforce, within and between Boards, and where possible across the wider health and social care spectrum. We also need to give particular consideration in terms of issues of recruiting, developing and retaining staff within more remote and rural locations.

We need NHSScotland opening hours and locations for service provision which meet patient needs. This will require changes in the location and working hours of our staff. However, in reviewing working hours and staff locations, we need also to consider how to meet staff needs in terms of improved work-life balance.

We need to provide health facilities and equipment which are conducive to providing effective care and satisfactory working conditions for staff.

We need to make better use of technology, in order to meet patient needs (particularly in relation to improving access and communication), and to enable staff to carry out their roles more effectively and efficiently. However, we need to ensure that such technology is introduced appropriately, particularly in terms of training, if it is to be used to maximum effect. There is a particular need to improve levels of IT access and literacy for staff.

We need to remove processes which do not add value and introduce increased standardisation across the health and social care spectrum, including the alignment of IT systems. We should move towards paper-light organisations, thereby reducing duplication of recording and removing room for error.