National health and social care workforce planning: discussion document

4 - Who Now Needs To Do What?

1. The matters raised for shared discussion in this document will need close involvement and careful consideration from individuals and organisations. This Discussion Document is the first step, rather than an end point.

2. The Plan in Spring 2017 will identify potential solutions to the challenges we face. To help inform its contents, your views are invited on the following questions:

Governance

We need to improve the current system so that each layer takes responsibility for actions that are appropriate to it. We propose to put in place governance arrangements which will help stakeholders set the direction of the workforce plan; to check and advise on progress; and to resolve contentious issues. The following table sets out broad proposals for workforce planning roles at national, regional and local levels.

Question 1. Are these roles the right ones, or do you have an alternative model? What steps will be needed to ensure these proposals are fully effective?

Strategic Level	Workforce Planning role/activity: (these are suggestions for consideration. The Plan in Spring will set out more definitive proposals based on feedback to this discussion document.)
National - these actions are done in partnership with relevant stakeholders from across the health and social care sectors. Where possible existing groups will be used, perhaps revitalised with a new action orientated remit. Where required, new groupings will be formed to undertake specific tasks (for example, a new monitoring and scrutiny body may be required to inject challenge into the workforce planning system).	The role we propose for this level is the following: preparation and publication of the National Workforce Plan, which will set the vision and principles collating and sharing evidence of best practice developing and agreeing policy/strategy/guidance identifying national priorities, including professions and geographical areas where national action is required coordinating ongoing monitoring and scrutiny agreeing remedial action required at a national level.
Regional - The current system does allow for regional planning, but feedback we have received is that the system needs to improve so that required actions are taken forward in a coordinated and effective way that has definite impact. We need to consider how best to create a regional planning structure for the health and social care sector that is effective and has appropriate authority for decisions to be implemented once agreed. This may ask organisations such as NHS Boards, Local Authorities and IJBs to work together to determine workforce requirements across health and social care, rather than decisions being taken independently of each other.	The role we propose for this level is: identification of regional priorities agreeing and implementing actions to ensure health and social care needs are met as effectively as possible across geographical regions and priority professions (for instance ensuring that remote rural areas are served effectively, and that resources within fragile professions are deployed to most effective use) regular monitoring to ensure delivery is effective.
Local - This level of the health and social care sector is where most of the day to day operational decision-making will take place, and there are a wide range of organisations working independently of each other to ensure health and social care needs are met. If a more effective national and regional planning process is put in place it could significantly reduce the burden on those planning front line delivery by ensuring they only need to tackle the issue which they can have best impact on. This does not mean a one size fits all approach as at the local level we will see a range of ideas and approaches being implemented that are appropriate to that area,. This needs to be encouraged and catered for so that informed, relevant, effective and prompt decision making can continue.	The individual organisational roles for this area may vary in terms of the detail but broadly fit within the following criteria: IJB local workforce planning in partnership with Local Authorities and NHS Boards, setting out workforce requirements across the agreed responsibilities that each IJB has. Any health and social care needs for local areas that remain the responsibility of Local Authorities , working with the third and independent sectors. NHS Board Planning for local secondary and primary care sector, ensuring local needs are met effectively.

Workforce Planning Roles

"Silo" approaches to workforce planning can prevent effective delivery of integrated services, following systems rather than persons.

Question 2. How can organisational and individual collaborative working be improved, and barriers removed, so that workforce planning can be effectively co-ordinated to ensure people get the care they need where and when they need it:

- Nationally?

- Regionally?

- Locally?

Workforce Data

Intelligent and insightful data is crucial to workforce planning, but data capture and analysis varies in scope and quality both within the NHS and between NHS and wider care systems. In order to improve our understanding of the challenges the health and social care sectors face, we need to ensure we have the most accurate and relevant data possible, and that this data is used effectively to undertake workforce planning across and between organisations.

Question 3. How should workforce data be best collated and used to undertake workforce planning in an integrated context based on current approaches of a nationally-led NHS system and a locally-led care system?

Recruiting and Retaining Staff

Employers are often in competition with each other to recruit staff from the same market, and for a variety of reasons can find posts difficult to fill - causing pressure on services and people who need and use them. A more collaborative approach to recruitment at a regional, and in some cases national level may help us to address recruitment pressures more effectively and efficiently.

Question 4a). How might employers and other relevant interests in the Health and Social Care sector work, jointly and individually, to identify and tackle recruitment and retention issues, ensuring priority gaps are identified and addressed:

- Nationally?

- Regionally?

- Locally?

Question 4b). Are there any process or structural changes that would support collaborative working on recruitment?

Clear and Consistent Guidance

There is considerable variation in workforce planning practice across the Health and Social Care sector. National guidance for the NHS has helped put in place a standard system, but this needs to be refreshed and its implementation improved. This guidance sets out an approach that is recognised internationally as the most effective way to undertake workforce planning. In essence it asks those planning workforce requirements to answer the following questions:

• What is to be delivered?
• What do you have to deliver it?
• What do you need to deliver it?
• If there is a gap, how will you close it?

Woven through this is regular monitoring and evaluation to ensure approaches taken are having an effective impact.

Public and private sector organisations utilise this approach all over the world, and Health Boards have used it to progress workforce planning in the NHS. We believe it would be appropriate to use the same approach for other organisations within the health and Social Care sector where that is required, taking care to ensure its use is appropriate to each. This is not about rolling out an NHS approach for others to use, this is rolling out an internationally recognised process that allows an organisation to efficiently map out their workforce requirements as best they can using the data to hand. It may not require every organisation to undertake the process, as long as those planning have accurate and relevant data which would allow them to assess workforce requirements in the short, medium and longer term.

Question 5. Based on what is said above, would it be helpful at national level to have an overarching process (or principles, or framework) for workforce planning across the Health and Social Care sectors?

Student Intakes

Labour markets for doctors, dentists, nurses and midwives are complex and subject to uncertain future supply factors. Absolute certainty that estimates will be correct is not possible given the range of factors in play, and overly precise approaches provide little flexibility. Successful workforce planning relies on the creation of a surplus supply of an appropriately skilled and deployed workforce, meaning we need to strike the correct balance between ensuring a sufficient supply whilst at the same time doing our best to provide those coming out of training with an opportunity of employment. Vacancies in some professions remain persistent and capacity pressures continue for some clinical and nursing specialties. Student intake planning for "controlled" professions - doctors, nurses and midwives and dentists - is carried out by separate planning groups, each committed to ensuring all qualified professionals secure employment. Decisions on intakes are informed by statistical analysis and professional judgement, but also influenced by this commitment and on available funds. There is scope for the training process to align more effectively with workforce planning objectives, predicting supply needs against a more comprehensive set of demand factors, and making better connections across professions.

Question 6a). How can a more coordinated and collaborative approach be taken to assessing student intake requirements across all relevant professions, and what other issues should be addressed to remove barriers to successful workforce planning?

Question 6b). What other issues should be addressed to remove barriers to successful workforce planning in both health and social care?