National health and social care workforce plan: part one

Chapter 1 - Executive summary

1. This Chapter summarises the recommendations needed to take forward changes and improvements to workforce planning for the NHS Scotland workforce, as a step to facilitating workforce planning across the integrated health and social care sectors. The key driver for this is the Health and Social Care Delivery Plan published in December 2016, which sets out an ambitious programme of change for the NHS and wider health and social care services in Scotland.

2. The Discussion Document published by the Scottish Government in February 2017 set out a number of suggested approaches to workforce planning issues. In total, 79 responses to the questions asked in the Discussion Document, reflecting the broad range of stakeholders with whom positive discussions were held, were received. ^[1]

Approach

3. This document is Part 1 of the 2017/18 National Health and Social Care Workforce Plan, covering NHS Scotland and:

• Aims to support NHS Scotland organisations, including independent NHS contractors in the community, to identify, develop, retain and support the workforce they need to deliver safe and sustainable services to Scotland's people;
• Will enable NHS Scotland organisations to work together over time to broaden this aim in order to help deliver a whole system approach to health and social care;
• Provides an overview of the current NHS Scotland workforce and an assessment of what it could look like in the future;
• Sets out how improved workforce planning can benefit NHS Scotland services at national, regional and local levels.

Key recommendations

4. The following key recommendations arise from each of the six main consultation questions (Questions 1 to 6a) set out in the Discussion Document. Many state clearly who will be responsible for acting on them. For some, further discussion will be required as appropriate between the Scottish Government and stakeholders, or as covered by the remit for the new National Workforce Planning Group. Recognising that this Group has yet to be set up, a more detailed implementation timetable covering the recommendations will follow.

Governance - a clearer authorising environment which supports NHS Boards to plan for the workforce they will need in future, and resolve capacity issues nationally, regionally and locally.

• Nationally, a new National Workforce Planning Group will be established with broad representation from across health and social care - including NHS Scotland, local authorities, IJBs and third and independent sector and their staff side and trade union representatives.
• Terms of reference for the National Workforce Planning Group, including its membership, role and remit, will be finalised in discussion with stakeholders following the publication of this Plan. We expect that the Group will work across boundaries to support implementation of the Plan by health and social care providers; and to act collectively to advocate the Plan, raising its profile and promoting the understanding of its requirements within respective workplaces.
• The National Workforce Planning Group will meet from Summer 2017 to review the Plan's recommendations and proposals for future work. Initially the Group will focus on the NHS workforce, but will take on a broader role which reflects Parts 2 and 3 of the Plan published later this year. The Group will strengthen a "Once For Scotland" approach, improving consistency and use of workload tools across Scotland.
• Regionally, Health Board Regional Delivery Plans arising from the Delivery Plan for Health and Social Care will include workforce planning from September 2017. Successful regional workforce planning will depend upon the further development of a clear and sustainable workforce planning infrastructure to progress regional issues.
• Locally, work will begin to share development of existing workforce tools and resources with employers, reflecting governance arrangements as they develop, by end 2017. This work, including the roles expected for NHS Boards, IJBs, local authorities and third and independent sector employers, will flow from the establishment of the National Workforce Planning Group.

Roles - Greater clarity about who does what in terms of aligned, co-ordinated responsibility for workforce policy and planning nationally, regionally and locally.

• Nationally: The National Workforce Planning Group will support implementation of this Plan, helping to define where workforce planning sits within the strategic direction and vision for NHS Scotland, and with strategic priorities for social care. It will identify good practice in national workforce planning - for example, how this should apply to the new elective centres - in line with main Delivery Plan and National Clinical Strategy themes.
• Work will begin to reconstitute the National Forum for NHS Workforce Planners from Summer 2017 with a new, clearer remit and reporting structure to ensure Board level links are visible nationally, and to further develop links with IJBs using practical approaches to workforce planning which can apply in an integrated context.
• Regionally: Linking to NHS Board Regional Delivery Plans, NHS Boards will undertake joint regional workforce planning (also through the refocused National Forum for NHS Workforce Planners), to ensure patients' needs are met and resources allocated effectively, responding to and meeting the needs of IJBs and others as required.
• Locally: This will be determined over Summer 2017 in partnership with COSLA and other relevant stakeholders.

Data - integrating statistical, demographic and labour market information on the NHS Scotland workforce to build the evidence Boards will require in future.

• NHS Education for Scotland ( NES) will provide proposals to bring together existing data sources in a new supply side "platform" by Autumn this year. This will consider the NHS Scotland workforce and how this fits wider social care and local authority needs in the context of integration.
• NES will work alongside stakeholders to bring together relevant data sources; analyse and align them to better inform workforce planning; and work to determine the data required for effective decisions on workforce and improving analysis of future demand and supply and the "pipeline" between education and employment. This work will be delivered in Autumn 2017, while being responsive to Parts 2 and 3 of this Plan and the wider, whole system approach required for the future.
• NES will lead development of a minimum standardised dataset with potential to use across different sectors, with agreed data collection and collation parameters. It is important that this work aligns with the rollout of e: ESS across NHS Boards, where much work has already been undertaken to ensure a consistent dataset on the NHS workforce. This will require a phased approach.

Recruitment and Retention - tackling persistent recruitment challenges to provide sustainable national, regional and local solutions. Building the right conditions for better retention, to ensure an NHS workforce fully fit for purpose, in the right place, with the right numbers now and in future.

• The Scottish Government will work with NHS Boards and NES on a strategic approach to recruitment and retention, including GP recruitment and retention challenges. Actions developed over Summer 2017 will be reported to the new National Workforce Planning Group, with clear recommendations for action by NHS Boards to be drawn up by early 2018. Consideration will be given to:
  • existing work (for example work being taken forward in a Shared Services context within NHS Boards);
  • testing out new approaches, focussing on promoting and attracting applicants and making health and social care careers more attractive to young people through improved marketing and advertising;
  • exploring the interface between health and social care and further and higher education to maximise opportunities to recruit and retain staff;
  • exploring whether the regionalisation of colleges and the development of regional curricula may provide further opportunities to collaborate on recruiting and retaining the future NHS Scotland workforce; and
  • promoting better retention, ensuring the workforce has access to CPD support and structured, transparent career progression opportunities.
• This work will involve reviewing current learner and student support across the health and social care workforce to maximise the attractiveness of careers in health and social care, and work to promote them in schools; assessing how access to training and developmental opportunities can promote better retention of existing staff; and how this can help ensure the future sustainability of the remote and rural workforce.

• This work will also consider international flows, including the impact of Brexit, on recruitment and retention, and how to make more effective use of international recruitment opportunities. These will take account of developing research across the wider public sector in Scotland of the potential effects of Brexit on international recruitment.

• Recruitment also needs to be considered as part of regional service and workforce plans, including the development of further ways to fill vacancies and address recruitment issues. We expect regional workforce plans to give consideration to regional and national recruitment initiatives. These may include the following:
  • Examine extension of bursary approach, other training/developmental incentives to retain staff; increased roles working across regions; co-ordinated regional recruitment activity;
  • Work with employers on careers, liaison with FE/ HE, campaigns, social media, including youth groups eg Young Scot etc;
  • Youth employment initiatives to increase supply across the NHS workforce - recognising that work with NES should help to identify new frameworks and approaches;
  • Work to consider retention initiatives, including potential for employers to outline Regional Retention Strategies including e.g. "bonding", and increasing returners.
• Progress made in this area must take account of contributions already being made by COSLA and local authorities, the Improvement Service, Scottish Care, Scottish Social Services Council, Care Inspectorate, CCPS and others. Further discussion on recruitment and retention issues between all relevant health and social care stakeholders will be required following publication of this document, and in advance of the publication of Part 2 of the Plan later this year.

Guidance - providing high quality workforce planning support to NHS Boards throughout a period of change, building on clear principles to provide and further develop better data, intelligence and tools to predict future needs.

• Scottish Government will work with NHS Scotland stakeholders to refresh workforce planning guidance for NHS Scotland by end of 2017, with potential to link to other sectors as appropriate, taking account of Part 2 of this Plan, to be published later this year.
• The refreshed guidance will need to fully reflect the post-integration environment, complementing and supporting workforce planning undertaken within Primary Care, Integrated Joint Boards, local authorities and other health and social care providers.
• NHS Education for Scotland will work together with other organisations to develop training resources to assist adoption of the workforce planning guidance in NHS Boards.

Student and Post-Graduate Training Intakes - designing and developing an improved process so that national decisions on student intakes are more closely linked to addressing future demand, with closer ties to NHS Board workforce planning priorities.

• Nationally, NES will work together with other organisations to use specialty profiles and other data sources across professions to design a "pipeline" approach demonstrating how supply via training and recruitment numbers will meet estimated demand. This work will help to achieve better alignment between training providers and services and will begin in Summer 2017, leading to a shadow process in 2018 and then full implementation in 2019. These timescales recognise that many organisations are involved, with long training lead-in times and resource implications.
• The current workforce projections process in NHS Scotland is limited in its ability to project forward nursing and medical staff intakes in the longer term. The impact of local demographics - for example retirements in 3 years due to an ageing workforce - should be more consistently factored in to national intake projections. The new National Workforce Planning Group will consider, in consultation with other organisations, how this process should be adjusted.
• NES should also assess how the nationally controlled student intake process might extend to other professions beyond nursing, medical and dental staff. This will be beneficial if it is closely linked to recruitment, retention, youth employment and potentially bonding, taking account of current trends in supply and demand. This work should also link to career paths and opportunities across the health and social care sector.