Health and social care: integrated workforce plan

Supply: the skills and people we need

Meeting demand requires us to look at both the types of skills and numbers of people we need, taking into account any additional supply factors.

Skills

We need a workforce that is flexible and adaptable to the demands of a changing health and care environment, digitally confident and able to work effectively in multi-disciplinary teams. As an illustration of what this might mean for the skills required, we will have particular need for:

• Team working skills to work well in multi-disciplinary teams delivering joined up services that focus on anticipatory and preventative care, respond to people's needs and ensure vulnerable people's rights are supported and protected;
• Skills to provide more complex support and care to people living with frailty, disabilities, multiple morbidities and long term conditions, particularly in community settings, in a way that ensures a meaningful continuity of care and support for the person receiving it. For example, many care home workers are taking on a wider range of tasks such as the administration of medication, delivering end of life and palliative care and specialist dementia care;
• Working with health and care service users and their families. In a community setting this will focus on promoting self-care, prevention and shared decision making;^[10]
• Understanding of mental health issues and how to support people - across the workforce;
• An understanding of how digital solutions can improve care and how to effectively implement and use these solutions in delivering care.

The actions we take to improve training, create and develop career pathways and support continuous professional development need to reflect these developing skills requirements.

People

Using an assumed average annual growth, where no mitigating actions have been taken, of around 1.3% for the healthcare workforce and around 1.7% for the social care workforce (from the MTFF, referred to earlier in this Plan), we can estimate what this means for the overall numbers that may be required in key staffing groups over the next 10 years.

Over 8,800 more Nursing & Midwifery staff

Over 1,100 more Medical Consultants

Over 1,500 more Allied Health Professionals

Over 700 more Healthcare Scientists

Over 8,800 more Care Home staff

Over 14,400 more Home Care & Housing Support staff

Over 900 more Practicing Social Workers

However these need to take account of the particular supply issues as well as the demand factors identified earlier. Significant current factors which need to be taken account of in considering supply are the impact of potential EU withdrawal, the changing shape of our workforce and particular supply issues in certain job families and areas of Scotland.

Impact of potential EU withdrawal on workforce supply

Potential EU withdrawal poses a significant risk to the recruitment and retention of staff in the health and social care workforce. These sectors employ considerable numbers of EU citizens, with particular concentrations of EU staff in some regions and specialties. Based on the best information available we estimate that in Scotland non-UK EU nationals make up:

• 7.3% of registered nurses employed in adult social care;
• 5.9% of Scotland's doctors;
• 5.9% of people employed in care homes for adults;
• 4.1% of people employed within housing support and care at home services;
• 1.5% of (band 5) nurses and midwives.^[11]

The vote to leave the EU had an immediate impact, with the number of EEA-qualified nurses and midwives practising in the UK decreasing by 5.9% between March 2018 and March 2019. Extrapolating variations at UK level gives an estimated total of just over 1% of nurses, midwives and dual qualified professionals practising in Scotland with a non-UK EEA qualification.^[12]

Changing shape of our workforce

We also have to take into account the changing shape of our workforce. Many staff now have different expectations of their career and are looking for greater flexibility from their employers to accommodate different, more flexible work patterns, career breaks and less linear careers.

Vacancies and Turnover

While there has been an upward trend in the numbers of staff working in health and social care,^[13],[14] turnover and vacancy rates are generally above the Scottish average.

• In medicine, more than half the long term vacancies are at consultant level, with particular pressures in Clinical Radiology, General Practice and Psychiatry;
• In nursing and midwifery turnover and vacancy rates have also been rising in part due to the number of leavers;
• In the allied health professions, turnover remains steady but increasing numbers of workers are nearing retirement and there has been an increase in vacancies with the highest rate and numbers in physiotherapy;
• There are also particular issues in parts of the health and social care workforce, where the age profile of staff suggests high levels of retirals in the next 10 years. One area where this could have a significant impact is nursing and midwifery, where 19.2 % of the workforce is expected to retire in that period;
• There are similar challenges in social care, which has an overall vacancy rate almost twice the Scottish average.^[15] The care home and care at home workforce is experiencing high vacancy levels with many services reporting problems filling jobs. Nursing posts in care homes also have relatively high levels of vacancies;
• Many Local Authorities are also reporting a shortfall around their ability to provide sufficient numbers of Mental Health Officers to deliver key statutory services.^[16] For social workers, recent trends have seen a small decrease in numbers and relatively steady vacancy rates. However, there is evidence that a significant number of Mental Health Officers are approaching retirement and this, aligned to a forecast increase in demand for social workers, may impact on vacancy rates.

Remote, Rural and Island Sustainability

There are distinct recruitment issues across health and social care in remote, rural and Island areas driven by specific patterns of demographic change.^[17] For example, parts of the west of Scotland and all the island council areas are expected to have smaller working age populations by 2026.^[18] Work to explore these issues and develop actions to address them has commenced under Part 2 of the Workforce Plan and we will learn from actions already in progress to address recruitment challenges in remote and rural areas in primary care.

We must do all that we can to ensure equity and sustainability of health and care services and delivery across the geographic landscape of Scotland. The actions we are taking, and will take, aim to address the specific challenges in delivering health and care services in remote, rural and island settings.

All of this must be taken in the context of employment forecasts for Scotland being generally cautious. Scotland is already at a near record high for employment. The Scottish Fiscal Commission, in its May 2019 Economic and Fiscal forecast^[19], projected an average increase in employment in Scotland of around 0.1% per year over the next 5 years. Labour market forecasts produced by Oxford Economics indicate that over the next 10 years there could be significant churn in our labour market - although this is not a new feature of our labour market.

Scenario Planning

We are creating an increasingly robust evidence base for workforce planning decisions through a greater understanding of these complex demand and supply issues. This is informing the decisions and actions we take and is enabling us to plan ahead, rather than 'firefighting' at the point when a workforce issue is identified.

This can be done through scenario planning, which uses evidence-based assumptions that can be revised annually and triangulated with workforce data.

It is also an important tool for workforce planning at national, regional and local levels, where it can help employers to visualise the workforce they need and informs the decisions they take in the future. Workforce planning is a statutory responsibility for the NHS. Local government and other sectors are generally at an earlier stage of developing workforce planning approaches.

The annex published alongside this Plan sets out scenarios illustrating potential workforce changes. Alongside core staffing groups we have produced scenarios on some key groups which can make a significant contribution in our three priority areas - building the community based workforce, mental health and waiting times performance:

• Care Home for Adults;
• Care at Home and Housing Support;
• Practicing Social Workers;
• Social Work - Mental Health Officers;
• Primary Care Advanced Musculo-Skeletal Practitioners;
• Pharmacists;
• Dentists;
• Nursing and Midwifery;
• Clinical Radiology;
• Reporting Radiographers;
• Cardiac Physiologists;
• Clinical Psychology.

As well as overall increase in demand, the scenarios take into account current vacancies, age profiles and assumed retiral ages, outflow (leavers) and inflow (joiner) trends and student numbers and assumed education course completion rates.

The use of high level scenario planning starts to offer a way of workforce planning across health and social care. However, in the social care sector, with 32 local authorities and thousands of providers, workforce planning is extremely complex and will take some time to mature.

These are only a selection of the scenarios which could be developed. This Plan signals a commitment to developing workforce planning beyond the NHS, by offering support and guidance for integration bodies and others to develop their local approaches to workforce planning. We will work closely in partnership with stakeholders to further develop the scenarios, outlined in the annex to this document, and to develop scenarios for additional staffing groups. The scenarios form part of the evidence base for the actions we will take, set out in the next section.