National health and social care workforce plan: part one

Chapter 2 - Setting the context

Purpose of this Plan

1. The main purpose of Part 1 of this Plan (and Parts 2 and 3 issuing later this year), is to support organisations which provide health and social care services to identify, develop and put in place the workforce they need to deliver safe and sustainable services to Scotland's people. This will enable them work together over time to help deliver a whole system approach to health and social care.

2. Putting in place improved arrangements for workforce planning has multiple benefits and should be seen as an investment, not a cost. Insightful and intelligent workforce planning plays an important part in improving population health, which in turn benefits economic growth and encourages employment opportunities. ^[2] The Plan's recommendations are therefore directly relevant to employers in health and social care, independent contractors in the community, professional groups and organisations, trade unions and individual employees. Their effects will directly benefit services, people in Scotland who receive them, and the staff who provide them.

3. The overall aim can be summarised as follows:

Getting the right people into the right place, at the right time, to deliver sustainable and high quality health and social care services for Scotland's people.

4. This aim has many active components. It must make practical sense within different working environments, and apply across different systems and professions - nationally, regionally and locally. ^[3] It must:

• describe the type of workforce planning that needs to happen nationally (for example projecting anticipated demand or determining final training numbers); regionally (allowing locally integrated health and social care services to work in a wider context); and locally (at the point of contact between health and social care systems and people);
• be relevant to all people who work across health and social care to provide care, support and treatment;
• provide the focal point for staff to develop their skills and to continuously improve within the context of reform set out in the Health and Social Care Delivery Plan, and of other strategic priorities across health and social care.

5. Workforce planning Is a dynamic and evolving work programme that needs to be robust, but also able to adapt over time. The Discussion Document published on 1 February was clear that health and social care is extremely diverse and consists of many staff, engaged by different employers, operating in different environments. This document - Part 1 of the Plan - makes workforce planning recommendations specific to NHS Scotland. Part 2, to be published jointly with COSLA later this year, will also develop over time, and its progress - and how it links to Part 1 - will be determined through further dialogue with and between different organisations across health and social care.

Scope

6. It is important that the overall scope of this Plan is clear. The Discussion Document said that the Plan would aim to cover the workforce engaged in providing all health and social care services in Scotland - provided by public sector, third and independent sector employers - including:

• NHS Scotland services;
• Adult social care services;
• Children's social care services;
• Mental health services;
• Primary care services, including General Practice and independent contractors.

7. Parts 1 ( NHS Scotland), 2 (Social Care) and 3 ( GP supplement) of this Plan recommend actions for different parts of the system and will beundertaken using a phased approach, reflecting on-going discussions between NHS Scotland, local authorities, primary care, professional and regulatory bodies, trade unions, Integration Joint Boards and the third and independent sector. Each Part needs to give due regard to service developments, the pace of change and the different timescales and priorities which operate across health and social care. Though published at different times, the intention is for all three Parts cumulatively to demonstrate a "whole system" approach. From 2018, future editions of the Plan, merged to reflect this, will have greater capacity to address the size and diversity of the health and social care workforce, and workforce planning needs across the whole system.

8. Workforce planning can be influenced by, but remains separate from decision-making around terms and conditions of employment. Employers in different sectors must be able to manage their workforces proactively and with agility to meet local demands. There are challenges, for example, in minimising barriers to effective workforce planning that may potentially arise out of different terms and conditions of employment across the health and social care landscape. It is recognised that this can have an impact on getting the right people into the right place at the right time.

9. Many workforce planning decisions are already taken so that resources are better targeted, aligning demand and supply. A better understanding about how this can work, particularly at a regional level, needs to be developed to meet future health and care needs. Current challenges are persistent: difficulties in filling vacancies; agency use; using workforce data intelligently; or striking the right balance in achieving organisational priorities. Developing a longer term horizon for workforce planning will also involve planning and modelling sustainable, affordable multi-disciplinary teams to support health and social care integration. This should also recognise that many financial and budget setting processes in NHS Boards are undertaken annually, and resource allocation decisions should be informed by the need to enable and support integrated workforce planning.

Responding to changing demand

10. Health and social care in Scotland is shifting away from hospital and residential care toward community based services. These services are supporting people to live well and die well, independently in their own homes and on their own terms, wherever possible. While Scotland's ageing population and workforce poses continued challenges for the longer term, there are also opportunities because the workforce is at the forefront of the shift to the community, directly involved in improving patient care and outcomes.

11. The NHS was set up for medical, episodic care and when it was created in 1948, only 10% of the population were aged 65 or over. The current (2016) figure is 18%, reflecting advances in treatment and care, improvements in overall health and standards of living and a number of other societal changes. Health and social care services are dealing with more older people than ever before, but it is the increase in numbers of the very elderly, and of older people with long-term conditions that will have most effect. ^[4] Their more complex and long-term health care needs will require further changes in the approach to workforce planning.

12. In the near future, continuing growth in demand for health and social care services is expected to arise from:

• management of multiple long-term conditions;
• care and enablement in the community;
• mental health support;
• specialist elderly care.

13. As new services are developed in response to changing demand, they must also keep pace with further change. Though many people are now living longer lives, they often do so with multiple long-term conditions which require long-term reactive treatment and care. That in turn requires adjustments to the supply of our health and care workforce, and requires staff to develop new skills, combining them in different ways. For GPs, that may mean a significantly enhanced role in caring for people with undifferentiated or complex conditions, with support from multi-disciplinary teams. For medical and nursing staff, it may mean providing much more flexible and complex care outside hospital settings. The focus is already shifting towards health improvement measures which can prevent these conditions from occurring in the first instance.

14. It is mainly in the areas above where workforce demand will increase in the future. In response to these challenges, a range of strategic commitments operate on employers in different sectors. The main strategic commitments as they apply to NHS Scotland are set out at Appendix A. These address changing demand for health and social care and in turn influence the training, development and deployment of the NHS Scotland workforce. Although these commitments do not apply uniformly across different sectors and services, they can influence the care and treatment people receive in social care settings. Part 2 of this Plan, when it is published later this year, will say more about this.

15. The time is now right to begin working together in more consistent, targeted and effective ways to alleviate the rising pressures on our workforce caused by increasing and changing demand - nationally, regionally and locally. In supporting a whole system approach to workforce planning across health and social care, this Plan recognises that improvements made in one part of the system can benefit others. It recognises that better, more convincing evidence is needed about the impact on individual staff who experience daily pressures and challenges. And it sets out how on-going improvements to workforce planning can help sustain the delivery of high quality, integrated services to those people who need them.