Health and social care: integrated workforce plan

What does demand look like?

Workforce planning is shaped by the increasing demand for health and social care services as we live longer lives, often with more complex and intensive needs.

A number of studies have attempted to quantify this demand based on forward projections of need including analysis carried out by the Health Foundation, the Fraser of Allander Institute, the International Monetary Fund and the Organisation for Economic Co-operation and Development. Most conclude that demand for health and social care will increase faster than the rate of growth of the wider economy and that, over time, expenditure on these services will gradually increase in three main areas:

• Price Effects: general price inflation within health and social services;
• Demographic Change: this includes the effect of population growth on the demand for health and social care services, the impact of a population living longer, and demographic change in the workforce itself;
• Non-Demographic Growth: demand-led growth, generated by increased public expectations and advances in new technology or service developments, for example expenditure on new drugs.

We have drawn on these national and international analyses in defining an approach to assessing future demand in Scotland's health and social care services. The Scottish Government MTFF^[6] provided additional funding for the health portfolio of £3.3 billion by 2023-24. That sits alongside a rigorous reform agenda as set out in the Health and Social Care Delivery Plan.^[7] An example of Scottish Government's commitment to the reform agenda was announced in the Programme for Government 2019/2020: Scottish Government will support Social Work Scotland to work with local authorities and others to design and test a framework of practice for self-directed support across Scotland, including approaches to assessment and resource allocation. This will result in more consistent experiences, making it easier for supported people to move from one area of Scotland to another. Local flexibility will ensure authorities can work with their communities to develop systems that suit local strengths and needs, particularly in remote, island and rural areas.

This twin approach of investment and reform is essential to create sustainable health and social care services for the future.

We recognise there is a plethora of published material expressing varying views on the rates of growth in the Scottish Economy, the Health and Social Care sector being no exception. For the purposes of this Plan we have used the growth assumptions outlined within the MTFF. The Framework projects that over the next five years future demand would rise by 3.5% per annum for health and 4% for social care, based on inflation, demographic pressures, non-demographic growth and the dampening of growth created by efficiency and reforms. In reflecting the impact of the NHS pay deal and similar expected impact for social care (2.2%-2.4% per annum), we have assumed an non-pay average annual growth of around 1.3% for health and around 1.7% for social care.

In this Plan we use these figures as the starting point to assess future workforce planning needs. However we cannot simply apply them across the health and social care workforce. For example, the overall number of care at home and housing support workers increased by 12% between 2009-2018, while the number of care home for adults staff decreased by 1% over the same period.^[8] To make our workforce planning as robust as possible we must adjust the figures to take account of particular demand and supply issues which affect all or individual staffing groups.

In assessing how demand will be met we need to take account of new forms of provision such as the creation of Elective Centres, the Waiting Times Improvement Plan, The Health and Care (Staffing) (Scotland) Act and technology enabled care.

Elective Centres

Projections indicate that our elderly population will be 25-30% higher by 2035 than it is now. This will mean a substantial increase in demand for treatments such as cataract surgery and hip and knee replacement operations.

The elective centres aim to provide additional capacity to accommodate the increasing demand for age related treatments, such as those mentioned above, as a result of an increasingly elderly population. The new centres will separate emergency and non-urgent services, resulting in shorter waiting times and improved outcomes which result in an overall improvement in the population's health as well as better value and financial sustainability.

Elective centres are being created in Highland, Grampian, Tayside and Lothian with an expansion of facilities at the Golden Jubilee Foundation and Forth Valley and will start to come on stream from this year. These centres will create additional capacity and provide a more efficient way of delivering services to meet the increasing demand for these treatments.

The creation of the centres will have particular impact on workforce demand in specialties such as Orthopaedics, Ophthalmology, General Surgery and Dermatology. The impact on these specialties will be as a result of the increasing demand for the age related treatments as detailed above and skill mix and roles will need to evolve to support this increase in demand.

Waiting Times Improvement Plan

Timely access to care is a critical aspect of delivering better health and care, and we recognise that performance in key areas such as waiting times must improve substantially and sustainably.

The Waiting Times Improvement Plan, which is a key Scottish Government commitment published in October 2018, directs more than £850 million of investment to substantially and sustainably improve waiting times by spring 2021. This investment focusses on the future shape of services, capital planning and workforce sustainability. While this Plan is predominantly set in the context of NHS waiting times, there is a recognition that a whole-system approach to tackling long waiters is required if the ambitions set out in the Plan are to be achieved. In our workforce planning, we need to reflect the fact that delivery of the Improvement Plan will have particular impact upon workforce demand in specialties such as Urology, Dermatology and General Surgery, as well as Diagnostics. We set out in this Plan the steps we are taking to build the workforce which will improve our waiting times. This includes targeted actions on diagnostic capacity and efficiency and plans in the medium term for a recruitment campaign targeting the medical specialties which support our waiting times priorities.

The Health and Care (Staffing) (Scotland) Act

The Health and Care (Staffing) (Scotland) Act 2019 introduces into legislation guiding principles for those who commission and deliver health and care, which explicitly state that staffing is to provide safe and high quality services and to ensure the best health care or care outcomes for service users. While this is the main purpose, health and care services should promote an efficient, effective and multi-disciplinary approach which is open with and supportive of staff.

The 2019 Act places a duty on Health Boards to ensure appropriate numbers of suitably qualified and competent staff are in place for the health, wellbeing and safety of patients. It enables rigorous, consistent assessment of workload, based on assessment of acuity, patient need and the delivery of patient outcomes. The Act also requires that Health Boards ensure clinical team leaders have adequate time to fulfil their leadership role. In some areas this may require additional clinical or administrative staff.

For Care Service providers, the 2019 Act places a statutory duty to ensure that at all times suitably qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of service users, and the provision of high-quality care. Providers are also required by the Act to ensure staff are appropriately trained for the work they perform.

Implementation of the legislation will generate a significant amount of data on the staffing needed across services based on the needs of people who use services and will therefore inform workforce planning at local and national level.

Technology

Technology is playing an increasing role in the services we deliver, providing better online services and helping people to manage their health at home through initiatives such as video clinics, digital access to records, test results, outpatient booking and online services for triage and repeat prescriptions. SSSC, NES and others continue to make long term commitments to develop resources that support the workforce to use and embrace technology. Technology - when used appropriately and innovatively - offers the opportunity to automate some tasks and to use artificial intelligence to free up the time of healthcare and social care professionals, enabling them to focus on high value activities, leading to better and improved outcomes for everyone. Technology can also have a positive impact on staffing demand, as recognised in the Topol Review.^[9]

An example of the use of technology to deliver the best care is the introduction of the Attend Anywhere service, a web-based platform, which gives patients the opportunity to video call their healthcare provider. In the past year, the Attend Anywhere Scale-up Challenge has seen increased usage and reports of significant savings in both patient and clinician travel. As announced in Scottish Government's Programme for Government, this will now roll out to primary care and social care services so more services can be delivered closer to people's homes. The Blood Pressure service for remote diagnosis and management of hypertension will also be scaled up.

Another example of technology playing an increasing role in the delivery of care is the telecare services provided by local authorities and providers. Telecare is the provision of technology enabled solutions which can support daily living activities such as cooking or prompting and dispensing medication. These services allow individuals to continue to live at home by supporting their independence and enhancing their wellbeing and safety. Utilising telecare means that services can be delivered more efficiently by freeing up the workforce who have traditionally been involved in delivering some of these daily living activities to focus on the more complex areas of holistic care and support.

However, to take full advantage of these opportunities our workforce must have the necessary digital skills. In this Plan we set out how we are addressing this through the workforce development aspect of our Digital Health and Care Strategy.