National health and social care workforce plan: part one

Appendix: - Programme for Government (PfG) and other strategic commitments

PfG Commitments relating to planning:

• To make sure our NHS has the right skills mix, we will introduce national and regional workforce planning. This will include an increase in the number of consultants and greater use of clinical generalists;
• We will enshrine the proposal for safe staffing in law - we will put our innovative nursing and midwifery planning tools on a statutory footing, and explore how this model can be extended to cover other parts of the health and social care workforce.

PfG Commitments to maintain/increase/improve staffing capacity:

• We will continue the policy of no compulsory redundancies in the NHS;

• Increase number of GPs and Nurses working in Communities;
• We will invest £3 million to train an additional 500 advanced nurse practitioners;
• Commitment to create 1000 additional training places for nurses and midwives;
• We will recruit an extra 500 health visitors by 2018 so that every child benefits from a health development check at 30 months;
• We will increase the number of GP training places from 300 to 400 a year;
• We will invest over £23 million to increase the number of medical school places;
• We will work to improve recruitment and retention;
• Scotland's most deprived communities need additional support, so we will recruit at least 250 Community Link Workers to work in GP surgeries and direct people to local services and support;
• Over the next five years another 1,000 paramedics will be trained to work in the community, helping to reduce pressure on A&E services.

PfG Commitments that will impact on the workforce:

• The number, structure and regulation of health boards - and their relationships with local councils - will be reviewed, with a view to reducing unnecessary backroom duplication and removing structural impediments to better care;
• Thirty-one new local integration bodies have been created to deliver adult health and social care. Scotland also has 22 health boards - 14 territorial and 8 special boards. In implementing the National Clinical Strategy, we will make sure the existing boundaries between health and integration bodies do not act as barriers to planning local services effectively;
• We will put in place a new ten year plan to transform mental health and invest an additional £150 million to improve mental health services (part of this will mean we recruit mental health link workers in GP practices);
• We will invest £100 million to improve the prevention, early diagnosis and treatment of cancer (part of this will be recruitment of more radiographers);
• Our reforms will bring together a range of professionals in GP surgeries, including practice nurses, district nurses, mental health professionals, pharmacists, and allied health professionals. All GP practices will have access to an enhanced pharmacist, allowing GPs to focus more on the patients who require their assessment;
• We will implement the recommendations from The Best Start Review of Maternity and Neonatal Services which describes a new model of care which puts mothers and babies at the centre of safe and high quality care.

Strategic Commitments

1. Employers in health and social care are being asked to deliver on a number of fronts, linked to the Programme for Government commitments set out above, and to the Health and Social Care Delivery Plan published in December 2016, which set out an ambitious programme of change for the NHS and wider health and social care services in Scotland. The Delivery Plan's key components are health and social care integration; the National Clinical Strategy (including Realistic Medicine, the Cancer Strategy and the investment in Elective Centres); public health improvement (including the mental health strategy); and NHS Board reform. These will be supported by cross-cutting activity including the review of health and social care targets and innovation and digital health, as well as this Plan.

2. Health and Social Care Integration requires whole system planning. IJBs are required to deliver workforce plans but cannot do this in isolation. A national framework will help to draw out whole system planning and also identify which elements are for local resolution. There is an opportunity for joint planning between Integration Authorities, NHS Boards and local authorities as authorities (at the end of their first year of operation) are clearer about their strategic plans and delivery objectives and the workforce needed to deliver on it.

3. The National Clinical Strategy is the framework for a range of activity to create more high quality sustainable health care. Within that framework is included strengthened primary and community care, improvements to secondary and acute care and a focus on realistic medicine. It sets the direction of travel within which Boards can work effectively with Integration Joint Boards and others. This will require workforce models and scenarios that are more generalist, and flexible enough to cope with the uncertainty of future demands.

4. Realistic Medicine describes how the workforce can provide care and treatment more innovatively, intuitively and flexibly. For example, hospital-based clinicians are now operating in the community along with other health and social care professionals to provide more tailored care to people in their homes.

5. The Cancer Strategy ^[24] takes a wide look at the range of services provided and considers how the vital roles that staff play in delivering high quality services can be clearer, more targeted and better prepared for and planned.

6. The Elective Strategy aims to deliver an integrated approach to the effective delivery of elective care. A key objective of this work is to deliver the commitment of £200 million of new investment in Diagnostic and Treatment Centres capacity within the timeframe of the current Parliament.

7. The Mental Health Strategy 2017-2027 ^[25] underlines the principle of "ask once, get help fast‟ by ensuring the right workforce is in place at local and national levels, As well as increasing the supply of the mental health workforce with different skill mixes across different services, the Strategy emphasises the need to make careers in mental health more attractive with clearer career pathways. It includes the following actions: "Increase the workforce to give access to dedicated mental health professionals to all A&Es, all GP practices, every police station custody suite, and to our prisons. Over the next five years increasing additional investment to £35 million for 800 additional mental health workers in those key settings."

8. The Active and Independent Living Improvement Programme in Scotland ( AILP) focuses on wellbeing, prevention and targeted early interventions for children, young people and adults of all ages and abilities, supporting them to live well; be physically active; self-manage their health conditions; remain in, or return to employment; and live independently at home or in a homely setting. Through AILP, the Allied Health Professional ( AHP) workforce will support the delivery of key elements of the Health and Social Care Delivery Plan.

Technology

9. Technology is already being used differently to monitor care, with effects on the roles played by different workforces and changes in the patterns of demand and supply. Those effects will continue to expand, with an increasing impact on the demand for and supply of care. In some circumstances, this may mean less direct care is needed, with training and education ensuring staff are fully able to use what technology can deliver, while being fully aware of its limitations. An integrated Digital Health and Social Care Strategy ^[26] is being developed which can aid staff in using data and evidence as a routine part of decision-making - particularly in the community and in primary care settings. This will give health and social care staff access to data and evidence to inform safe and effective decisions about the services they provide. Workforce development in digital skills is already captured in the Everyone Matters 2020 Workforce Vision actions.