National health and social care workforce planning: discussion document

3 - Areas for Improvement

1. There are a number of practical issues to consider in improving workforce planning, to give an accurate assessment of the work needing to be undertaken now and over the next 5, 10 and 15 years.

Updated Guidance/Structural Framework

2. Each NHS Board is currently required to produce an annual workforce plan, and IJBs are required to ensure they have developed one. These plans often acknowledge the changes required to deliver national strategies, but are either unable to articulate this fully, or choose not to address this - for example, in the absence of financial certainty. This works against effective long-term workforce planning (more than five years) and workforce plans tend only to outline fairly superficial responses to problems with recruitment and retention or succession planning.

3. This is not an issue for NHS Boards alone; it also involves Scottish Government. One way Scottish Government might address this is by setting out requirements within a clearer context for NHS Boards, using a more structured framework. In developing new guidance and setting out a framework for NHS Boards, the SG could take the opportunity to develop guidance which would be of wider use to IJBs and local authorities as well. This might offer more explicit guidance about the need to address particular constraints. Other areas where Scottish Government might work with NHS Boards and IJBs to improve the methodology of workforce planning are:

• Refining the processes around workforce plans, projections and LDPs.
• Seek ways to use the 6-step methodology more consistently and insightfully, so that NHS Boards and IJBs can predict workforce supply and demand trends with greater accuracy and sensitivity, and align these with service needs and priorities.
• Provide structured opportunities to look at recruitment - eg improved targeting and advertising - influencing NHS Boards' approach to locum and private sector use.

Workforce Data

4. One area that must improve if workforce planning is to be more effective is the quality and availability of data across all sectors. We need confidence in this to:

• take forward policies in pursuit of better health and social care

• improve outcomes for the people of Scotland

• ensure we have enough people with the right skills, doing the right thing in the right place at the right time.

5. Health and social care services are pressed on many fronts and need confidence that they are collecting, collating and using the right information, proportionately and intelligently, to plan for and deliver the services they provide. An important part of the Plan will therefore involve reviewing data requirements - assessing how to streamline them and improving workforce data collection. This will focus on:

• reducing data "demand" where appropriate by focussing on what is needed;
• harnessing available insight, research and analysis to enable workforce planning to relate much more closely to delivery of successful clinical and patient outcomes as people experience them; and
• identifying and filling gaps where necessary.

6. There are some practical opportunities to refine the collection and use of data. These might include:

• examining how official statistics produced on a quarterly basis might cross-refer more helpfully with known management information held from day to day by NHS Boards.
• further work to compare, understand and analyse data respectively held for the NHS Scotland workforce (by ISD Scotland) ^[9] and for the social care services workforce (by SSSC) ^[10] ;
• reducing the demands of the currently quarterly statistical reporting cycle to free up analytical capacity within ISD Scotland and within NHS Boards themselves.

• Streamlining the projections process which will mean NHS Boards report only essential elements - and cut out unnecessary effort.
• Committing further time and resource to researching and analysing need and demand, and combining that information intelligently to factor in age, geography, training demands, career attractiveness and other factors.
• Committing resource to assessing gaps and identifying options for filling them, particularly in the area of primary care.

7. Improving workforce planning will require a better understanding of the numbers and contribution of non- UK EU citizens to NHS and social services in Scotland. While it is estimated that non- UK citizens account for approximately 5% of the total NHS workforce in Scotland, and around 6.8% of Scotland's doctors, the sensitivity of this data on the NHS Scotland workforce is being improved; and to achieve a better understanding of this within social care, COSLA, the Coalition of Care and Support Providers Scotland ( CCPS) and Scottish Care are working at national level with the Office of the Chief Social Work Adviser. More refined data covering all health and social care sectors should help to inform workforce planning developments and will contribute significantly to our understanding of the challenges outlined in this document. Better information on the vital contribution made by EU citizens will also play an important part in designing and implementing effective recruitment strategies in future.

Co-ordinating student intakes across professions

8. Each national group dealing with the control of student intakes deals with its own set of complex issues and takes advice combining statistical analysis with professional judgement. While improvements are being made to these processes, this is an area where, rather than continue to plan student intakes in professional silos, there is scope to make better connections across the professions, in line with the clinical priorities envisaged by the National Clinical Strategy. More detailed discussion will also be needed with further and higher education institutions and others about aligning these priorities with the education sector's capacity to meet ongoing need for trained staff across health and social care.

9. For the longer term, a more strategic approach is needed to encourage younger people to make positive choices about careers in health and social care. More work on career opportunities, labour markets and how these influence recruitment and retention will help to build evidence to support further action.

Strengthening demand dimensions in workforce planning

10. Current workforce planning models are largely predicated on supply factors. The 6 step methodology does makes provision for demand-led factors but how Boards interpret and observe the guidance needs to be considered carefully. Assumptions which are currently factored into workforce plans tend to be supply-based and service-related ones relating to perceived difficulties in securing sufficient capacity. It is critical that we understand planned future models of care and likely demand and articulate this as part of more intelligent, evidence-based workforce planning. We need to develop our understanding of demand factors and their effects on recruiting and retaining staff across all service areas.

11. In the longer term, the Plan will need to develop a series of actions, perhaps set within a framework of tools accessible by different employers, allowing them to use these to build sufficient numbers of appropriately trained and qualified staff. This will involve exploring how to develop better intelligence through workforce analysis - being clear how a range of demand factors impact on supply. This will be covered in more detail in the Plan.

Strengthening Workforce Planning Networks

12. While structural changes will not solve workforce planning issues on their own, there are opportunities to examine how we might improve and extend workforce planning structures to include social care and other sectoral interests, regionally and nationally rather than locally. Broadly, a workforce planning network might be configured as follows:

• Nationally - the establishment of a National Workforce Planning Group, to be taken forward in partnership between Scottish Government and key health and social care stakeholders, to ensure there is clarity of responsibility, governance and expectation. Dialogue to facilitate and establish this would include membership from the wider medical and non-medical professions. This group will also involve IJBs, primary care and social care representatives. It will require a work programme that is solutions-driven with an active and dynamic agenda that prioritises workforce planning challenges and links them clearly to national clinical and other strategic priorities. Its work programme would recognise the need to bring in a range of contributions from providers within a timescale appropriate to them.
• Regionally - Regional workforce planning already takes place in the NHS, but is variable in scope. A more inclusive and mandated regional approach across Scotland might allow solutions to be identified, designed and delivered across boundaries. Regional workforce planning would need to be backed by clear governance, and the ability to reach balanced conclusions taking full account of differences in employment markets and economic drivers within regions.
• Locally - with guidance from Scottish Government, NES, Scottish Social Services Council, the Care Inspectorate, Social Work Scotland and other key organisations, and input from trade unions, there are opportunities for NHS Boards, Local Authorities and IJBs to work together constructively using a framework approach to share workforce planning data, solutions and good practice - building on what works best in differing situations and locations.

13. The process for all three levels of planning will need to fit together and have clear timescales and expected outputs.