Health and social care: integrated workforce plan

Executive Summary and Summary of Commitments

This Plan puts effective workforce planning at the forefront of achieving safe, integrated, high quality and affordable health and social care services for the people of Scotland. It underlines the need for better evidence which can support the many national actions we are taking to address the challenges our services face. Crucially this Plan reflects our approach to effective workforce planning in an integrated environment - essential to delivering and sustaining the world-class services we all rely on.

How services and support are planned, designed, developed, commissioned and delivered is also a key part of the reform of adult social care. As part of that, we are reviewing national data for social care support, to put in place measures and evidence that better reflect policy intentions to support independent living and promote sustainability.

With key partners, we recognised in Parts 1, 2 and 3 of the National Workforce Plan that delivering integrated services where people in Scotland need them depends on shared understanding and trust. It also requires robust data and intelligence about the highly skilled and committed workforce who deliver them. Building, sharing and using that intelligence effectively, in integrated ways across different systems, is essential.

Better planning and intelligence can also help decision-making where pressures are most immediate and where skilled staff are most needed. That applies across the health and social care workforce operating in very distinct landscapes of service commissioning, provision and employment. Scottish Government has already delivered on ambitious commitments to expand and strengthen the health and social care workforce - for example, delivering 100 more GP specialist training places and 500 more health visitors in the workforce. The Scottish Government has also supported the introduction of the real Living Wage for adult social care workers, while the registration and regulation of the social services workforce will complete its final phase of implementation in 2020, resulting in regulation of around 80% of the social care workforce.

We have also seen recent successes in medical trainee recruitment, such as:

• an increase in the overall fill rate to medical training places to 92% in 2019, from 85% in 2018;
• 37 specialities achieved a 100% fill rate (out of a possible 60);
• 33 more GP Speciality Training places were filled in 2019 compared to 2018;
• a 100% fill rate in ST1 Clinical Radiology training places.

And we remain on track to deliver:

• access to Pharmacist support for all GP practices by the end of 2021;
• 250 community link workers working in GP surgeries by 2021;
• 2,600 more nursing and midwifery training places by 2021;
• 500 additional Advanced Nurse Practitioners trained by 2021;
• 1000 more paramedics training in the community;
• 800 additional Mental Health Workers in A&E departments, GP practices, police custody suites and a range of other settings;
• 250 additional School Nurses by 2022;
• 80 additional counsellors in Further and Higher Education over the next four years;
• all children and young people (over the age of 10) will be able to access counselling services in every secondary school by September 2020;
• an increase to the GP workforce of 800 by 2027.

To ensure these commitments have maximum effect a strengthened workforce planning base has been put in place through:

• developing strong national governance structures for workforce planning, via the National Workforce Planning Group and National Workforce Planning Programme Board;
• delivering the TURAS Data Intelligence Platform, bringing together workforce data in one place;
• commissioning a new Labour Market Survey research to give us a better understanding of the national and local challenges;
• delivering a new GP Contract which clarifies and strengthens the roles of GPs as Expert Medical Generalists working as leaders within the primary care system; and of Health and Social Care Partnerships in planning and delivering a far broader multi-disciplinary team to support GPs. The contract and improvements to IT systems are also significantly improving the data available on activity and workforce in general practice.

Initiatives to enhance staff numbers have been particularly successful with record numbers of staff now working in NHS Scotland and in Scottish Social Services. National workforce statistics from September 2019 show that:

• NHS Scotland's staffing levels are at a record high, up by over 14,300 WTE - an 11.3% increase between September 2006 and September 2019;
• numbers of Consultants working in our NHS are at a record high, up 51.4%;
• numbers of Qualified Nurses & Midwives have increased 6.7%;
• numbers of Nursing & Midwifery support staff are at a record high, up 2.8%;
• AHP numbers are at a record high, up 17.5%, or by 1,547.9 WTE (8,842.1 WTE to 10,390.0 WTE);
• numbers of staff in the social care workforce have risen by 1.2% since 2017, the highest level recorded since reports began.

We must consider this in the wider UK context, where:

• NHS staffing per head in Scotland is higher than NHS England - there are 26 staff per 1,000 people in Scotland (Sept 2019), while in England the figure is 19.7 (August 2019);
• there are also more Qualified Nurses and Midwives per 1,000 population in Scotland than in England: 8.1 WTE in Scotland (Sept 2019) compared to 5.5 WTE in England (August 2019).

We must continue to ensure our efforts are targeted, and support delivery of integrated services in Scotland. Some of the challenges we face are not unique to Scotland, as recognised in a report by the Health Foundation in March 2019 which reported that "most high income countries are facing the social, health and economic challenges of an ageing population". The report identified that, unless the supply of health workers was addressed there would be "a global needs based shortage of more than 14 million health workers in 2030". International challenges are particularly acute in developed countries in nursing, where it is estimated up to 40% of nurses will leave the profession in the next decade. In other, less developed, countries there are significant challenges linked to the appropriate training and skills mix of consultants and their migration.

This Plan focusses on national challenges including further embedding integration, improving waiting times and improving mental health support. The recommendations we are making below will significantly augment our capacity to address these challenges. The steps we can take to further improve workforce planning in Scotland, will also equip our staff with the right skills to meet them.

The key commitments in this Plan are:

Create 225 more Advanced Musculo-Skeletal (MSK) Practitioners in Primary Care, by increasing MSc training places for the Physiotherapy workforce.

Support the shift in balance of care into community settings, by delivering more care at home and reducing rates of admission to acute hospital services. Train and introduce into the workforce an additional 375 nurses within the district nursing service based upon the current skills mix, over the next 5 years.

Increase the Cardiac Physiologist workforce thereby increasing capacity to carry out diagnostic testing by supporting an additional 30 training places on the 4 year BSc course in Clinical Physiology.

Over the next 3-5 years we will also focus on increasing the workforce by promoting recruitment into Scientist Training Programmes and Practitioner BSc. Programmes.

Create up to 120 more Pharmacists to work in primary care settings, increasing Pharmacy pre-registration training places by 40 each year over the next 3 years.

Support an additional 60 Clinical Psychologists in training by:

• Increasing the training programme intake by 10 students per year for the next three years.
• Maintain the current intake level (30 per annum) for the two existing Masters training programmes. This will continue the additional 10 places which have been available in recent years.

Support additional Mental Health Officer (MHO) capacity in local authorities by providing funding to help address the current shortfall in capacity of 55 WTE by 2022-23.

In the medium term, modelling work will take place to assess the impact of reforms to adults with incapacity requirements, particularly around guardianship applications on mental health services workload and demand for MHOs.

Increase Reporting Radiography training places by 30 (10 in each of the next 3 years).

In partnership with NHS Tayside the Scottish Government will develop a bespoke training programme to upskill Interventional Radiologists (and others with appropriate skills) to perform Mechanical Thrombectomy (MT) procedures to improve treatment of stroke patients across Scotland, and ensure these skills are approved as credentials by the GMC.

Scottish Government , working with COSLA, will design and oversee work to obtain a national picture of workforce planning capacity, methodology and capability in Local Authorities/ Health and Social Care Partnerships for planning social care services. We will respond by considering how best to support effective collaborative and strategic workforce planning in light of the findings.

Over the next 12 months Scottish Government and COSLA will work with the Scottish University and College sectors to examine, develop and build a workforce planning educational qualification - building a strategic approach to developing workforce planning education and skills for the health and social care workforce.

Provide additional support in 2019/21 to the third and independent social care sectors to enable their contributions to the developments in workforce planning to be supported through this Workforce Plan.