National health and social care workforce plan: part two

Chapter 4: Planning The Workforce

30. This chapter describes the complex landscape within which workforce planning for social care takes place. It outlines some of the varied roles and responsibilities of employers, Integration Authorities and national bodies in workforce planning. It identifies three priorities for action to support these responsibilities:

• improved information about the surrounding labour market;
• workforce planning tools that will support the changes needed in services and the workforce to deliver these; and
• guidance to support partnership working in workforce planning at multiple levels.

Complexities of workforce planning for social care

31. Workforce planning for social care is a complex activity taking place at different levels, over different time horizons, and involving a multiplicity of stakeholders. It takes place in a varied context provided by the surrounding labour market within which over 2,500 public, independent and third sector employers provide social services and use many different approaches for their own organisational workforce planning. Along with service commissioners, these employers also have interests in and/or responsibilities for workforce planning that come into play to varying degrees at regional and local levels. This complexity means that considerable benefit can be gained from a clearer and more consistent approach to workforce planning at multiple levels that involves appropriate engagement between service commissioners and employers.

32. To manage and plan their workforces effectively, organisations need to have up-to-date information in regard to:

• The numbers of people they employ and what they do;
• Current deployment of staff, past trends and anticipated changes;
• What skills the workforce has and where there are gaps;
• What skills and staff will be needed to deliver future services and priorities.

33. In addition to this kind of data, workforce planning in the social care and social work sectors must also take account of complex factors such as:

• Demand – the needs of the populations they serve, the intensity of care needed and the demand for different kinds of services;
• The financial resources available;
• Availability, productivity and skill level of staff;
• Technology and local factors such as the physical premises where services are delivered, or geographic remoteness;
• The current and future policy landscape;
• The aims and objectives of the social service being provided, and the purpose for which it is being, or could be, commissioned.

34. Given the market arrangements prevalent in social care, there are strong interconnections between strategic commissioning and service procurement, workforce planning and pay, recruitment and retention and a range of other factors that influence the wider labour market, such as the departure of the UK from the European Union. In addition, workforce requirements shift over time as new policies and approaches to best practice come into play – for example implementation of Self-directed Support, shifting the balance of care to care at home, the expansion of free personal care to under 65s and increased up-take of new technologies.

35. Understanding the influence of these dynamic forces is critical in planning and redesigning care services and therefore the workforce locally and nationally. The Local Government Improvement Service is currently undertaking work to assist in a better understanding of workforce dynamics within the broader labour market. This work is examining past trends and developing projections at sectoral level, considering the likely future competition for labour in Scotland. It is also looking at international practice in making the care sector more competitive. Analysis emerging from this work and other relevant data, such as the regional skills assessments and other reports ^[13] published by Skills Development Scotland, will help in providing that understanding and the evidence base needed for workforce planning.

36. Recommendation 2 below sets out the need to build on this work to improve understanding of how local and national labour markets interact, how different parts of the sector interact and what these interactions mean for workforce planning locally and regionally. Part 1 of this Plan identified a need to integrate statistical, demographic and labour market information on the NHS Scotland workforce to build the evidence NHS Boards will require in the future. In order to meet the evidence needs of IJBs and others involved in commissioning and delivering integrated health and social care services, Recommendation 2 in this document seeks to deliver similar work for the social care sector that links to and aligns with the work being developed for the NHS Scotland workforce. This will aim to help in predicting recruitment and retention challenges, in understanding how they may be affected by service, policy and wider changes, and in identifying approaches to tackle them at appropriate levels.

Recommendation 2: National and local labour market and workforce analysis

• To develop our understanding and provide evidence of the interactions between the national and local labour market pressures, the interactions between different parts of the sector and the specific challenges presented by the configuration and location of the current social care workforce.

Current workforce planning activity

37. Workforce planning responsibilities rest primarily with employers and with commissioners of services, and there is a range of organisations with interest in this area including Integration Authorities, health boards, local authorities, employers and employer representative bodies such as COSLA, Scottish Care, the Coalition of Care and Support Providers in Scotland ( CCPS) and the Scottish Council for Voluntary Organisations ( SCVO).

Employers

38. In the social care sector, workforce planning activity is primarily undertaken at individual employer level (local authority and other statutory providers, independent and third sector providers). Each employer will undertake their own workforce planning linked to local demand and their service delivery plans. In registered services, detailed staffing arrangements are considered and agreed by the Care Inspectorate prior to a service being registered to operate; such staffing schedules may form part of the conditions of a service’s registration. Providers of care services are required by law to ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users, and that suitable training is provided ^[14] .

39. Research undertaken by Why?Research in 2016 as part of a wider project ^[15] indicated that almost all of the 73 respondents involved in workforce planning reported that their organisation discusses workforce planning at senior levels and collects a variety of workforce data. Most collect data on current staff numbers and costs, current vacancies and current training activity. Most organisations used this information for budget setting, day to day management and planning for a 1-2 year time frame. A significant, though smaller, proportion used workforce data for medium term (3-5 year) planning and for service delivery planning and the strategic commissioning of services.

Integration Authorities

40. Integration Authorities have responsibility for managing services covering adult social care, adult primary health care and unscheduled adult hospital care; some are also responsible for children’s care and criminal justice social work. Integration Authorities will increasingly become a key link in the workforce planning landscape. The Public Bodies (Scotland) Act 2014 places a duty on each Integration Authority to produce a Strategic Commissioning Plan which sets out how the Integration Authority will plan and deliver services for its area over the medium term, using the integrated budgets under its control. In general these plans include a high-level summary of workforce issues.

41. In advance of developing the Strategic Commissioning plan, the Integration Authority should oversee the production of Joint Strategic Needs Assessments ( JSNAs). JSNAs analyse the care needs of local populations and inform and guide the commissioning of health, wellbeing and social care services within its area in order to improve the physical and mental health and wellbeing of individuals and communities. Within the Strategic Commissioning Plan process, a Market Facilitation Plan (which is a summary of the key requirements to meet current and future demand) should be developed, clearly stating the level and type of services required. Based on a good understanding of need and demand, market facilitation is the process by which strategic commissioners ensure there is sufficient, appropriate range of provision, available at the right price to meet needs and deliver effective outcomes.

42. Taking into account their Strategic Commissioning Plans, Integration Authorities are also required to have in place plans for workforce development that include, at a minimum, a list of the plans that the relevant health board and local authority have undertaken to put in place, (a) for developing and supporting the staff employed in integrated services and (b) for organisational development ( OD) of the NHS board, local authority and (if relevant) the IJB in relation to integrated services. In the majority of cases, where the Integration Authority also has responsibility for service delivery, it will take responsibility for the workforce development and OD plans that cover integrated services. In practice, all three parties share in the responsibility for ensuring that appropriate staffing is in place. In doing this, they will be working to:

• Consider anticipated changes in the demography of their populations;
• Develop new ways of working and redesigning services; and
• Ensure an appropriate skill mix, including development of multidisciplinary teams.

43. An assessment of 12 Integration Authority workforce development plans available at the end of 2016 indicated that all plans provided an overview of existing staff employed by statutory partners, while most considered the policy context and included some assessment of local demographics and future demand. Some had done initial work on future workforce needs, and some had started to consider the workforce contributions from the third and independent sectors.

44. As outlined in Chapter 2, nearly two thirds of the social care workforce is employed by the third and independent sectors, which make an essential contribution to the delivery of integrated services in most parts of Scotland. It is therefore important that workforce planning takes account of this wider workforce in considering how services will be delivered. As indicated above, it is apparent that this is currently occurring to varying degrees across Scotland.

45. One of the priorities for action identified in developing this plan and addressed in Recommendation 3 below is thus the need for development of guidance to support Integration Authorities and their commissioning partners to include consideration of third and independent sector employers and their representative bodies in workforce planning at multiple levels, to enable greater consistency in approaches. This work should consider how workforce planning can further be aligned with financial and commissioning plans that involve third and independent sectors. It should also take account of work delivered under Recommendation 2 on local labour market conditions and operation.

Recommendation 3: Workforce planning guidance for partnership working

• To develop guidance for Integration Joint Boards and their commissioning partners in local authorities and NHS boards that supports partnership working for the formulation of workforce plans at regional and local level which include consideration of the third and independent sector workforce. This work will aim to:
  • engage with third and independent sector employers and/or their representative organisations, and trade unions;
  • support and facilitate alignment of local workforce plans with associated commissioning and financial plans;
  • make use of the work delivered under recommendation 2 above, to develop improved understanding and awareness of the impact of market mechanisms in social care; and
  • develop approaches through which workforce planning can take these mechanisms into account in contributing to the delivery of improved outcomes for those who use services.

National bodies

46. The Scottish Government funds two Non-Departmental Public Bodies with relevant responsibilities: the Scottish Social Services Council ( SSSC) and the Care Inspectorate.

47. The SSSC registers many groups of social services workers, sets standards for their practice, conduct, training and education and supports their professional development. Where registered workers fall below the required standards of practice and conduct, the SSSC can investigate and take action. As part of their work, the SSSC publishes Codes of Practice that place requirements on employers in the sector with regard to provision of learning and development opportunities for their staff, including those needed for registration. The Codes of Practice also place obligations on all employees in the sector with regard to their ongoing learning. As outlined in Chapter 2, the SSSC also produces official workforce statistics that aim to support workforce planning by relevant organisations.

48. The Care Inspectorate authorises care services to operate; it is an offence to operate a care service that is not so registered. As part of the detailed registration process, the Care Inspectorate considers the staffing arrangements to be provided for the particular service seeking registration and may, where necessary, require (or vary) mandatory conditions in relation to the numbers and skill of staff to be employed.

49. As part of its scrutiny responsibilities, the Care Inspectorate collects and considers other information on workforce matters such as vacancy information and issues arising in terms of staff availability and capacity. Regulated care services are inspected to ensure that people using the service experience high quality care which is consistent with the national care standards. Inspections may, where considered necessary, include detailed scrutiny of staffing arrangements, including skill mix, quality of staffing, staffing levels, and approaches to recruitment and induction. The Scottish Government have worked with COSLA and other stakeholders to develop Health and Social Care Standards that apply across all health and social care. These will be rolled out from April 2018 onwards, forming the basis of the Care Inspectorate’s scrutiny model. The standards set out how a person should experience care and are relevant across service planning, assessment, commissioning and delivery. Where people wish to make a complaint about the quality of care, including staffing levels, the Care Inspectorate can investigate this.

50. Some of the information identified above is published annually (e.g. SSSC workforce data reports), while some is published in individual Care Inspectorate inspection reports and aggregated thematic reports. Both of these sources can provide information to national and local government, regulators and commissioners about workforce capacity across the sector and help to identify where action may need to be taken locally or nationally.

51. The Scottish Government publishes annual official statistics across the range of social care services that provide information on current service provision, demand and outcomes and on trends, largely at national level. The publications cover care homes, Children’s Social Work, Adult Social Care Services and Criminal Justice Social Work, amongst other topics. A summary of these statistics was published in Jan 2016, with an updated summary due for publication in early 2018 ^[16] .

Improving approaches to workforce planning

52. The Why?Research study referred to above suggested that employers across different sectors used a variety of approaches in undertaking their workforce planning, including case management tools, IORN (Indicator of Relative Need), the NHS Scotland 6-step methodology and guidance such as that provided by the SSSC. The study suggested that these are used particularly for training and skills needs; however, relatively few of the respondents’ organisations use formal planning tools for workforce planning purposes. There was some support from this study for the development of suitable, robust tools, alongside acknowledgement of the inherent difficulties in developing tools for the complex landscape of social care.

53. This complexity includes the diversity of employers in the sector, both in terms of size and service area, and the different roles of, and interactions between, commissioners and service providers. As indicated in the Why?Research study, budgetary considerations and workforce planning are intertwined in this sector. Independent and third sector social care service providers may be commissioned to deliver a service for a fixed period of time (e.g. one or more years) before the contract is put out for tender again. Uncertainty regarding contract renewal can make proactive workforce development and planning difficult.

54. This issue is linked to underpinning annual budgetary cycles at national government level, and the Scottish Government is working to develop a medium term financial framework, within the context of the budget settlement that it receives. This will be to outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services. In the longer term, providers will need the strategic commissioning plans to be clear about what kind of care and support will be commissioned in the future, so that they are better able to plan and develop their workforce appropriately in order to respond.

55. The planned “Safe and Effective Staffing” legislation in health and social care was consulted on earlier in 2017. Scottish Government is considering ongoing feedback on legislative proposals and will publish its response to the consultation exercise by end of 2017. These considerations will take into account how the legislation can support and enable the recommendations of this plan.

56. Acknowledging the complexity highlighted above, one of the priorities for action identified in the development of this plan is the development of improved workforce planning tools for the social care sector that can be applied in the context of integration, changing models of care and an increasingly multidisciplinary workforce. This priority is addressed through Recommendation 4 below, which seeks the development and co-production of improved workforce planning tools for the sector for use, where appropriate, by partners in workforce planning at different levels in order to support the delivery of high quality care.

57. Workforce planning tools developed for the sector should aim to:

• Be built on robust information;
• Accommodate the third and independent sectors, as major employers;
• Complement existing practices and be adaptable for local needs;
• Be flexible enough to be used in settings of different size and type;
• Add value to workforce planning activity, for example by supporting joint role development or co-ordinated approaches to recruitment, training and development;
• Be accompanied by training on the tool being made available; and
• Support alignment with associated financial and commissioning plans.

58. The identification of resource needs for this work and how these can be addressed will be an early priority. This will include exploring how existing expertise and practices can inform the work and whether/which existing workforce planning resources can form a base to build on. The SSSC will be publishing an online resource in spring 2018, which aims to bring a range of resources together in one location to support workforce planning in the social services sector. The online resource has been developed with nput from local authorities and third and independent sector providers, and will contribute to the early stages of this work.

Recommendation 4: Workforce planning tools

• To progress and co-produce social care and multi-disciplinary workforce planning tools that support the delivery of high quality care that reflects the new health and social care standards, and enable service redesign and new models of care. In developing this work, we will take account of progress with planned Scottish Government legislation that includes a focus on tools and methodology to inform and support workforce planning, starting with nursing and midwifery in the NHS.