Healthcare Science National Delivery Plan for Healthcare Science Professionals in Scotland 2014-2017

1. INTRODUCTION

The Scottish Government published Safe, Accurate and Effective; an Action Plan for Healthcare Science in NHSScotland in November 2007. This important document, developed through an inclusive process involving the Scottish Forum for Healthcare Science, healthcare scientists and workforce colleagues from across NHSScotland, was the first to set a strategic direction for this staff group.

The then Cabinet Secretary for Health and Wellbeing described in the foreword that the purposes of the document were to:

• maximise the contribution of healthcare science to improving the health and well-being of the people of Scotland through safe, accurate and effective healthcare science interventions;
• ensure that healthcare science expertise contributes to the development of sustainable clinical teams that will underpin the implementation of the new health policy agenda in Scotland; and
• ensure that the clinical leadership, research capacity and capability of the healthcare science workforce is harnessed to contribute to national and local priorities that improve the quality of care and outcomes for patients.

The action plan made recommendations for developments in 12 areas, including visibility and engagement, community-centred healthcare, leadership capacity, improvement, role development, diagnostic waits, and research, development and innovation. The recommendations have largely been implemented. Most NHS boards now have healthcare science (HCS) advisory committees reporting through the local area clinical forum and many also have lead HCSs in post, bringing the HCS voice to board-level planning and delivery issues. Investment has been made in HCS leadership development, focusing on succession planning and building a cadre of leadership talent capable of leading improvements beyond traditional working practices. HCS networks have become increasingly important in sharing best practice across NHSScotland.

NHS Education for Scotland (NES) has played a vital role in delivering education solutions to service and workforce challenges. Work to address educational development and sustainability issues for some key professions and small occupational groups is ongoing, in partnership with the Health Workforce & Performance Directorate of the Scottish Government.

Despite progress in these areas, HCS faces a considerable task in shifting the focus of professionals 'upstream' towards a greater emphasis on prevention, early detection and treatment and interventions that support people to live well in their community, with pathways of care that mitigate the need for hospital referral or admission and support self-management of long-term conditions and multiple co-morbidities. More of the same cannot be the answer: new solutions need to emerge, with new and more flexible ways of working to enable capacity to be realised and utilised in new ways.

The challenges facing NHSScotland have never been more pressing. For instance:

• the population is expected to increase by up to 10% over the next 25 years;
• the percentage of the population over 65 will increase by around 63% over the next 25 years;
• the NHS is committed to reducing the time people wait for healthcare, including a guaranteed 'referral-to-treatment' time of 18 weeks; and
• the NHS aims to improve the quality of safe, effective and person-centred healthcare, including reducing healthcare-associated infections.

These pressing issues must be faced at a time of financial challenges, making new ways of working a strategic imperative.

The National Healthcare Science Delivery Plan provides a unique opportunity to align the contribution of HCSs to the principles set out in the Healthcare Quality Strategy for NHSScotland (Scottish Government, 2010), the 20:20 Vision for Sustainable Quality in Scotland's Healthcare (Scottish Government, September 2011) and the 20:20 Route Map (2013). In particular, it seeks to maximise the contribution of HCS to a healthy organisational culture and help to create a sustainable, capable and integrated workforce with effective leadership and management.

This includes efforts to integrate primary and secondary care. HCSs have a key role to play in redesigning patient pathways by providing responsive advice and services to underpin integrated care and diagnostic tests in primary care. Some of this work is already underway in NHS boards across the country. Where this is the case and good evidence of improvement and benefits has been collected, consideration needs to be given on how spread and sustainability can be delivered at scale.

1.1 Healthcare scientists' roles

Many HCS roles have a history longer than the NHS. They have evolved significantly over recent decades in response to changing pressures on services. This evolutionary process has created an array of career structures, roles and responsibilities, prompting the desire to reconfigure scientific career pathways to equip staff for the changing demands of the 21^st century.

A new approach to workforce planning that looks at how best to deploy HCS staff as part of integrated professional teams is required. There is a need not only to describe traditional HCS roles, but also to articulate how they may be more effectively positioned to fully utilise HCS skills and expertise.

Numerous examples exist of HCS staff extending their practice into areas previously only undertaken by medical staff as part of integrated multi-disciplinary team approaches to supporting effective and sustainable care. This has the potential to support ambitions for delivery of NHSScotland's seven-day services.

Cytology services have led the way in deploying HCSs in interpretive roles, with great benefit to clinical outcome measures and cost-effectiveness. Similarly, histopathology dissection has been developed as an extended-practice role in a number of NHS boards, freeing up consultant histopathologist time. Many more examples of diagnostic departments being appropriately led by HCSs can be seen around the country. This has particularly obvious benefits in disciplines such as haematology, in which medical consultants spend a large proportion of their time in direct clinical contact with patients, designing and delivering their treatment.

Achieving the goal of improving services within a challenging financial environment requires deployment of the highly skilled HCS workforce in more advanced and extended roles. This is a very challenging ambition: ever-increasing demands on services can make it difficult for staff to fully consider the scope of the HCS contribution to health and social care. HCSs are busy delivering the service, with limited capacity to explore creative solutions and challenge accepted or unproductive practices.

Opportunities for advanced practice were nevertheless recognised in the Report of the Diagnostic Workforce Short-life Working Group, July 2013. It set out 10 recommendations, the second of which was:

Building on achievements to date, redesign, skill mix and roll extension appropriate to task should be applied across all specialties, while ensuring cost effective, efficient, high quality and safe service delivery.

Like the rest of the UK, Scotland is moving towards a four-tier HCS workforce structure with assistant/associate grades, practitioners, scientists and consultant scientists. Greater use of assistant/associate grades has significant potential to release greater numbers of highly trained colleagues to take on advanced roles. The driver is the development of sustainable multi-professional diagnostic teams to underpin the delivery of unscheduled and scheduled care.

All scientists and practitioners need to be working in the upper quartile of their clinical expertise. Now more than ever, it is essential that the most experienced, expert and expensive staff resource is not preoccupied with routine tasks and service provision, but realises its full potential in service delivery.

1.2 The National HCS Delivery Plan

The Delivery Plan focuses on the period 2014-2017 and aims to provide a strategic platform for future HCS activity, with a deliberate shift from introspection towards the delivery of high-impact changes for the people and organisations HCSs serve. It demonstrates the contribution HCSs can make and the impact they can have on the delivery of national policy, patient experience and outcomes.

The Delivery Plan is fundamentally about making explicit the alignment of HCS leadership and practice to the delivery of the Quality Strategy and 2020 Workforce Vision. It shows how better value can be extracted from HCS expertise from strategic to frontline levels and demonstrate the impact for patients and NHS service users. It defines the future vision for HCSs and the services they deliver, focusing specifically on a number of high-level outcomes that HCS services will effect and setting out key recommendations for change.

NHS boards will develop local plans identifying how they intend to implement and evidence the outcomes of the Delivery Plan by a proposed target of the 2015 year-end. Annual reviews of progress against local implementation plans will be led by the Chief Health Professions Officer (CHPO) for Scotland.

1.3 This consultation

This consultation document has been developed in partnership with leaders and HCSs from across the country. The process of engagement will continue and extend to a broad range of key stakeholders and groups during the consultation period, which will run until September 2014 (three months from publication).

General consensus has been reached among key professional leaders that the broad direction of the plan is right, but we want to consult further on:

• the overall structure and approach of the National HCS Delivery Plan;
• the key proposals (are they sufficiently ambitious, are they achievable, and are there any significant gaps that need to be addressed?); and
• prioritisation to support local implementation.

1.4 Responding to the consultation

We are inviting written responses to this consultation by 30 September 2014.

Please send your response with the completed Respondent Information Form (see "Handling your response" below) to:

CNOPPPAdmin@scotland.gsi.gov.uk

Or by post to:

Julie Townsend

Scottish Government Health Directorate

Directorate for Chief Nursing Officer, Patients, Public and Health

Professions

GE19, St Andrew's House

Regent Road

Edinburgh

EH1 3DG

If you have any queries please contact Julie Townsend on 0131 244 3739.

This consultation, and all other Scottish Government consultation exercises, can be viewed online on the consultation web pages of the Scottish Government website at
http://www.scotland.gov.uk/consultations

1.5 Handling your response

We need to know how you wish your response to be handled, and, in particular, whether you are happy for your response to be made public. Please complete and return the Respondent Information Form attached as an annex to this paper as this will ensure that we treat your response appropriately. If you ask for your response not to be published, we will regard it as confidential and treat it accordingly.

All respondents should be aware that the Scottish Government is subject to the provisions of the Freedom of Information (Scotland) Act 2002 and would have to consider any request made to it under the Act for information relating to responses made to this consultation.

Where respondents have given permission for their responses to be made public and after we have checked that they contain no potentially defamatory material, responses will be made available to the public in the Scottish Government Library (see attached Respondent Information Form). These will be made available to the public in the Scottish Government Library. You can make arrangements to view responses by contacting the library on 0131 244 4556. Responses can be copied and sent to you, but a charge may be made for this service.

1.6 What happens next?

Following the closing date, all responses will be analysed and considered along with any other available evidence to help us to reach a decision on the content of the final Delivery Plan which will be published in Autumn 2014.