National health and social care workforce planning: discussion document

2 - What Workforce Planning Is Currently Done?

1. Workforce planning is a complex activity taking place at different levels, over different timescales, with the involvement of a multiplicity of stakeholders. It may be useful to provide a general understanding of what people view as workforce planning. Audit Scotland ^[3] has provided a helpful definition (though it does not directly address the fundamental changes taking place to health and social care).

Workforce planning is the process that organisations use to make sure they have the right people with the right skills in the right place at the right time. To manage their workforces effectively, organisations need to have up-to-date information on:

• the numbers of people they employ to carry out different tasks
• what skills the workforce has and where there are gaps
• what skills and staff will be needed to deliver future services and priorities.

They must then plan and manage their workforces, and make any necessary changes, to meet their organisational objectives.

Within the health and social care sector, the importance of having people with the right values is embedded in national approaches to safer recruitment.

2. In brief, workforce plans currently apply across health and social care as follows:

• IJBs, though not employers themselves, have to produce workforce development/organisational development plans; and must also produce strategic commissioning plans which identify local needs and show how these will be met;
• Local Authorities and other social care services employers operate various approaches to workforce planning for their workforce - as recognised in a 2016 research project supported by the Social Work Services Strategic
  Forum ^[4] ;
• NHS Boards are required to produce and submit annual workforce plans and there is also a requirement on them to ensure the full range of services are provided, including working with independent contractors in primary care;
• Third and independent sector employers are likely to do local workforce planning to enable adequate staffing resources, but scale and scope of this varies from employer to employer. Much of this provision is commissioned by the IJB or Local Authority.

3. Several organisations also provide support for, and input to, workforce planning in Scotland:

• IJBs are required to complete integrated workforce development plans.
• IJBs are tasked with managing integrated budgets to deliver or commission integrated health and community care services. This requires a planned approach to the workforce which provides these services.
• The Scottish Social Services Council ( SSSC), working with the Care Inspectorate, collects and publishes a range of workforce related data intended to assist social services providers in planning their workforces.
• Local Authorities and other providers of social care services use a range of means to ensure that they have in place the workforce capacity to deliver those services.
• For NHS Scotland, Scottish Government sets the policy direction, guides and monitors. Everyone Matters: 2020 Workforce Vision launched in June 2013 makes a commitment to strengthening workforce planning to ensure that we have people with the right skills, in the right numbers, in the right jobs.
• Scottish Government leads and manages, through the Scottish Shape of Training Transition Group, detailed medical specialty supply and demand profiles.
• The Scottish Government's Nursing and Midwifery Workload and Workforce Planning Programme provides a validated framework and suite of tools enabling NHS Boards to make sustainable, evidence-based decisions on nursing and midwifery workforce requirements - mandated in Local Delivery Plans ( LDPs) since 2013. Scottish Ministers have committed to enshrine safe staffing in law, placing the tools on a statutory footing in future.
• Workforce planning is a statutory requirement for all NHS Boards: each NHS Board must plan its workforce according to local needs and circumstances.
• NHS Boards are required to complete and submit Local Delivery Plans ( LDPs) and must demonstrate the actions they are taking to ensure workforce planning takes place.
• NES holds core data on the numbers and progression status through training of key sectors of the healthcare workforce, particularly nurses and midwives, doctors and dentists. This data is critical to understanding the short, medium and long term supply pipelines for these workforce groups into NHS Scotland. NES provides a comprehensive report every 2 years on workforce planning in dentistry and have built up a valuable data base over the years.

4. While many of these working arrangements are close, they do not always work strategically and in some cases compete directly with each other to recruit the right staff. Each of the major organisations maintains distinct objectives with regard to workforce planning, and there is no fully integrated workforce planning system that addresses challenges collaboratively. There are opportunities to examine how a "whole system" approach to workforce planning can look at challenges and resources across health and social care and address these effectively. This will help the shift from hospitals towards communities, taking into account that some parts of the health and social care workforce are highly mobile, both within the UK and internationally.

5. For NHS Scotland, workforce planning is a statutory requirement established in 2005. The current guidance contained in CEL 32 (2011) was issued on 19 December 2011 ^[5] . This revised guidance was developed to include an internationally recognised "Six Step Methodology to Integrated Workforce Planning" for use by the NHS workforce planning community across Scotland. It also established that this methodology could be used for other areas of planning, most notably financial and service planning. In essence, the six steps are:

Step 1 - Defining the plan

Step 2 - Service Change - what you want to do?

Step 3 - Defining the Required Workforce - what you need to achieve this?

Step 4 - Workforce Capability - what do you have at present?

Step 5 - Action Plan - what needs to happen to deliver the change required?

Step 6 - Implementation and Monitoring

There are strong similarities in approach between this methodology, the 8-stage guidelines set out by the Scottish Social Services Council, and a 4-stage process used within the third sector.

6. The need to improve and harmonise current NHS Scotland workforce planning practice is specific. It involves ensuring NHS Boards use the existing workforce planning methodology more consistently, and requiring them to do this in a regional context. And it will involve looking at how workforce planning for doctors, dentists, nurses and midwives is carried out nationally and how it might operate more effectively at regional and local levels than is currently the case. Though workforce planning arrangements differ for Allied Health Professionals, Healthcare Scientists and other key groups of NHS staff, those groups will also play an important part in addressing this need.

7. At the same time, there are also opportunities to examine how a "whole system" approach to workforce planning can look at challenges and resources across health and social care and address these effectively. This will only succeed if there is agreement about how a joint approach to workforce planning might work. That might imply a "framework" approach allowing for some variation between employers. It is encouraging that there is some similarity between methodologies referred to above, though there is further scope for common ground to be reached on roles and their definitions - where for example the term "Healthcare Assistant", and the associated education and training requirements for that role - is perceived differently within health and social care systems.

8. Making the most of these opportunities (within NHSS, as a priority; and across wider health and social care, in the longer term) will help achieve the best results possible from:

• Public Sector reform to enable NHS Boards, Local Authorities and IJBs to collaboratively deliver the health and care services that Scotland now needs;
• Programme for Government commitments on health and social care;
• The need to achieve integrated services delivered by multi-disciplinary teams.
• National Clinical Strategy objectives, including those on Cancer, Primary Care and developing plans for Elective Centres;
• The forthcoming (early 2017) Mental Health Strategy, which will deliver the Scottish Government's commitment to achieve parity of mental and physical health. This will require more emphasis on shaping the workforce via IJBs because the majority of health contacts with the population will fall outside acute settings.

National workforce planning

9. Workforce planning at a national level is currently carried out to support Scottish Ministers' decisions on the NHS Scotland workforce. The Scottish Government co-ordinates action and funding to:

• control student intake numbers to medicine, dentistry and nursing, and in the medical and dental supply chain beyond undergraduate education;
• support Scottish Ministers on NHS workforce planning policy;
• monitor and report on trends in the workforce arising from the publication of official statistics on workforce numbers and workforce projections;
• enhance workforce planning in NHS Scotland through improved data quality, better workforce intelligence, and application of a consistent methodology to assess and mitigate workforce risk;
• advance NHS Scotland workforce issues in a service context.

10. In NHS Scotland, student intake planning for the "controlled" professions - Doctors, Nursing, and Dentists - is carried out by separate groups convened for those purposes. These groups model and forecast numbers of students required in future training intakes which best meet the needs of future services, assessing demand and reflecting professional judgement and statistical analysis. Those needs must also take into account the conditions under which public funds are allocated by the Scottish Government for training, enabling educational institutions to provide training to the required level from within allocated resources. The main groups are:

a) Medical - Undergraduate medical numbers are set annually under the principles of "controlled" student numbers by Scottish Government on the advice of the Medical Undergraduate Group. The Shape of Training Transitions Group takes decisions on postgraduate medical training intakes with input from NHS Education for Scotland ( NES) about medical supply and demand, and professional judgement input from Royal Colleges, BMA Scotland and others.

b) Dental - The Dental Student Intake Reference Group takes account of NES and other projections in deciding how many trainees are needed in future. This group communicates its recommendations to Ministers for approval. The Scottish Funding Council ( SFC) is then responsible for allocating places across Scotland's Dental Schools, within available Scottish Government ( SG) funding.

c) Nursing and Midwifery - The Student Nursing and Midwifery Intake Group triangulates statistical input from NES and ISD with SG analysis and professional judgement from the main representative bodies. This group makes recommendations to Ministers about numbers of funded student places across the main categories of nursing and midwifery. SFC is then responsible for allocating the places across HEIs from within SG funding.

11. For social care services, the national Scottish Government role involves:

• providing resources to ensure the supply of degree-qualified social workers in Scotland.

• funding the Scottish Social Services Council ( SSSC) to undertake the role of provider of Official Statistics on the social services workforce in order to provide workforce intelligence, monitor and report on trends in the workforce
• requiring the SSSC to set the qualifications required by certain categories of workers across the workforce and assess the quality of the qualifications.

12. Also at national level, SSSC works on a range of issues affecting the social care workforce, including demand for social workers, Mental Health Officer ( MHO) provision and on data, qualifications and registration.

Regional Workforce Planning

13. Currently, regional workforce planning within NHS Scotland varies. Differing regional structures vary in how they respond to cross-board capacity problems as they affect particular services and professions. As a strategic priority for "scheduled care" provided in hospitals, the Health and Social Care Delivery Plan sets out arrangements for strengthening regional planning for services, with NHS Boards working together through three regional groups. That Scottish Ministers have committed to strengthen regional workforce planning is therefore a logical step. While regional workforce planning to date has enabled positive outcomes to be reached involving co-ordination of staff resource between Boards, a fully developed regional workforce planning capability across the NHS in Scotland - able to operate proactively and co-operatively across its territorial boundaries - now needs to be realised.

14. A National Workforce Planning Forum, with membership drawn from the principal workforce planners from all 22 NHS Boards - has sought to reduce variability in regional workforce planning practice, to encourage the use of cross-boundary solutions by sharing data and to bring more consistency to workforce planning across Scotland. The Forum has had to work with a diverse agenda in complex and difficult territory where workforce data is often variable and where Boards have different, and sometime conflicting, priorities. Consequently it has not always been able to access the input and intelligence it needs around changes in service models and associated capacity constraints. As such, the Forum has had limited capacity to wield sufficient influence at national, or even regional level.

15. There is limited regional planning for social service services, and indeed limited demand. There may be an opportunity to look at how a regional approach to workforce planning might be evolved in light of IJB roles and responsibilities.

Local workforce planning

16. Local workforce planning takes place in a variety of levels and within a variety of contexts - at NHS Board level, within Local Authority areas and IJB boundaries. Different challenges affect each of these systems.

17. For individual NHS Boards, it is essential to make accurate predictions over a number of future years to plan services properly. Boards estimate their future staff requirements in their workforce plans and workforce demand projections. In doing so, Boards need to ensure that these plans are driven by - and reflect - the design of their services in order to maintain quality of care and ensure efficiency. They must take into account factors such as changing models of care and where people live, advances in medicine and new technologies and drug treatments. As the majority of the future workforce will be drawn from the current workforce, Boards also need to take account of factors influencing the development of the existing workforce in order to meet future need.

18. This is an exacting process, and NHS Boards can experience difficulty in predicting accurate numerical projections of the number of staff needed, particularly in the medium to long term. Boards' ability to project anticipated staffing needs can be subject to shorter-term financial challenges: funding for workforce initiatives may be too short term in nature; there may be restrictions in how funds can be utilised, or difficulties in prioritising spend; funding may not be easily identifiable and difficult to plan for and monitor; or funding may not be targeted carefully enough to bring about intended change.

19. There is scope to reduce the level of detail NHS Boards are required to provide in workforce plans and projections, and for Scottish Government and NHS Boards to work more closely together to forecast more effectively - for example by using medical profiles to support local workforce planning. Closer and clearer working relationships should also help in wider considerations on how local workforce planning can be aggregated most effectively at regional level.

20. In the Scottish social care services sectors, it is understood that most, if not all, employer organisations take decisions at local level (that is, at employer or establishment level) about workforce planning and collect data on:

• Services provided/used and current staff numbers and costs
• Current vacancies
• Current training activity

Most organisations use this data for budget setting, day to day management and planning for short term needs, with a recent study indicating that some do use data for longer-term workforce planning. Local Authorities do workforce planning for their own workforce, but there is, as yet, no clear picture of the extent to which employers in the independent and third sectors use formal workforce planning tools - though resources such as the SSSC Workforce Planning Guide ^[6] are generally available.

21. Though IJBs are not employers themselves, they are accountable for planning staffing needs for the services delegated to them by local authorities and NHS Boards. They play a key role in shaping workforce demand and in supporting 'intelligent forecasting'. A legislative requirement operates on IJBs to produce a workforce development plan and an organisational development plan. How IJBs choose to action this is left to local decision-making. As they have only been fully up and running since April 2016, workforce planning is currently a live issue.

22. Some of the complexities of integration, and the scale in which it is taking place, extend to workforce planning. The social services sector comprises a wide range of areas and service types and employs over 200,000 social services staff across approximately 2,600 third, independent and public sector employers ^[7] . ^[8] These service providers run just over 8,000 separate registered care services. Differing governance structures and responsibilities are in place across different sectors, although Local Authorities remain responsible for procuring social care services. Recognising these challenges, and the variety of methodologies in place will be important to ensuring workforce planning has full relevance in an integrated context.

23. 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. One question is how beneficial a systematic approach to workforce planning can be for parts of the social care system. Independent and third sector social care service providers may be commissioned, primarily by Local Authorities or IJBs, to deliver a service for a fixed period of time (eg 3 years) before the contract is put out for tender again. Any uncertainty regarding renewal of contract can therefore make proactive workforce development and planning difficult. In the longer term, these providers will need strategic commissioning plans to be clear about what kind of care and support will be commissioned in the future, so that they can plan and develop their workforce appropriately in order to respond.

24. As a large number of social care service employers have a workforce of fewer than 30 people, and some are sole employees, there are also questions about the kind of workforce planning input that might reasonably be expected of those employers; and what kind of planning the commissioning bodies should be involved in. There are already examples of effective working between independent employers and local authorities around workforce training and development, but agreeing clearer and wider arrangements which can bring about more systematic approaches to workforce planning should help reduce some of the uncertainty experienced by providers.

25. The Plan will need to address these challenges and opportunities, which will require further discussion with IJBs, Local Authorities, independent and third sector interests.