Health and social care: national workforce strategy

Health and Social Care Recovery

As part of our tripartite ambition, the Scottish Government's NHS Recovery Plan^[3] sets out principles for the safe and effective recovery of the NHS, while taking a wider whole system approach.

Backed by £1 billion of targeted investment over the next five years, it sets out ambitions that rely on growing and transforming the workforce.

Address backlogs in healthcare and increase capacity by at least 10%.

• We will grow our NHS workforce over the next five years by 1% -unmitigated this would be the equivalent of 1,800 WTE. This will be in addition to projected required growth, ensuring there is workforce capacity to address backlogs and increase capacity in the NHS. We must also innovate and streamline our service to support productivity as well as support self-care as we increase our capacity capabilities.

Bolster the NHS Pharmacy First scheme to enhance the range of services patients can access from community pharmacists without having to go to their GP.

• There are approximately 240 students each year who graduate from the two Schools of Pharmacy in Scotland. In 2018, to support the pipeline of new pharmacists, we extended the number of NHS pre-registration pharmacists places we funded nationally from 170 to 200.
• In 2019, we committed to increasing pharmacy pre-registration places in the Integrated Health and Social Care Workforce Plan, and since 20/21 we have increased places by a further 31. By 2024/25 this will have increased by a further 89 places to bring the total to 320 pharmacist trainees over 5 years staying in Scotland to complete their pre-registration training.

In acute care, increase capacity across multi-disciplinary teams and continue to expand the range of skills and roles available within practice teams to support the ambition to increase NHS capacity substantially beyond pre-pandemic levels.

Increase investment in National Treatment Centres (NTCs) to more than £400 million, contributing to delivery of over 40,000 additional elective surgeries and procedures per year

• We will recruit an additional 1,500 staff to deliver the additional capacity in elective surgeries and procedures, which will be created by the National Treatment Centres, through domestic and international recruitment.

Invest £29 million to target diagnostic backlogs, providing 78,000 additional procedures in 2021/22 rising to 90,000 per year from 2025/26

Provide £12 million to support the mental health and wellbeing of the Health and Social Care workforce

• Via NHS Education for Scotland (NES) we are delivering a workforce development programme to increase capacity and capability to provide psychological therapies and interventions for the Health and Social Care workforce. This programme includes national and local delivery of training and supervision in psychological therapy and interventions.
• Up to 16 Whole Time Equivalent (WTE) posts will be created to support the mental health and wellbeing of our workforce over the next two financial years, including Clinical Psychologists, Counsellors, Project Coordinators, Community Navigators, and Assistant Psychologists.
• At September 2021, 13.25 WTE posts are in place, with the remaining posts in recruitment.

Investing £155 million in 2021/2022 rising to £170 million in 2022/2023 through the Primary Care Improvement Fund to provide General Practice and their patients with support from a range of healthcare professionals in the community.

This supports the implementation of the new GP contract, creating more capacity for GPs to deal with complex medical care in the community through working as part of an expanded multidisciplinary team.

• Significant recruitment has taken place within Primary Care.
• We have seen a large increase in our Pharmacotherapy workforce with WTE numbers of pharmacists in general practice rising from 132 in 2018 to 543 by March 2021 and pharmacy technicians growing from 38 in 2018 to 248 over the same period.
• The workforce of healthcare assistants and nurses supporting the delivery of vaccination and community based treatment and care services has increased from 38 in 2018 to 707 in March 2021.
• The period 2018 to 2021 has also seen increases in the WTE number of Advanced Nurse Practitioners from 18 to 202, MSK Physios from 11 to 169 and Community Links Workers from 51 to 189.
• Overall the WTE MDT workforce in Primary Care has risen from 313 in 2018 to 2,463 in March 2021
• This is in addition to our existing commitment to deliver 800 additional GPs by 2028 which has seen total GP numbers working in Scotland increase to a record number of 5,195 in September 2021.

Boost paramedic numbers through the £10,000 Paramedic Bursary.

• This is the first year of the Paramedic Bursary. We know that paramedic science already had a high student application rate and the introduction of this bursary confirms our commitment to ensure we attract and support the next generation of these vital workers.

Create a network of 1,000 additional dedicated staff who can help grow community mental health resilience and help direct social prescribing, by 2026.

• These additional roles will be created through the implementation of Mental Health and Wellbeing in Primary Care Services. This could include Occupational Therapists, Mental Health Nurses, Psychologists and Link Workers. The intention is for these teams to be designed according to local need, based on a set of national principles underpinning service delivery.
• Recruitment for these multi-disciplinary services will commence early in the 2022/23 financial year. Local plans will be developed by local planning groups led by Integration Authorities. Recruitment will be incremental to 2026 to meet the 1,000 additional roles.

Deliver £23 million to redesign urgent care – with rapid access to a senior clinician via a telephone or video consultation where possible, in order to support people to be cared for in the right place by the right person.

• As part of the work to transform our services and workforce this programme will reduce A&E attendances by providing 24/7 access to NHS 24 for those who think they need to go to A&E but their illness is not life threatening and community alternatives will be strengthened. If A&E is the most appropriate service to provide that care, NHS 24 will make a referral to A&E where a telephone or video consultation may be offered by A&E staff.

Devote £130 million to deliver our National Cancer Plan and Detect Cancer Early Programme

• This investment will contribute towards both growth and reform of the workforce required to deliver cancer care.

Refreshing the Mental Health Strategy, recruiting 320 additional Child and Adolescent Mental Health Services (CAMHS) workers and ensuring that by the end of parliament at least 10% of frontline NHS spend will be dedicated to mental health. Wider community based support for mental health will remain a priority.

Scotland has faced a growing number of drug-related deaths in recent years (including during the pandemic), in response, the First Minister announced a new National Mission to tackle drug deaths. This Strategy seeks to enable the development of a workforce that is equipped to deliver the National Mission, both saving and improving lives.

We must ensure that this Workforce Strategy supports commitments in the Recovery Plan such as increasing capacity to support procedures, and additional appointments. These commitments are reliant on ensuring we have the workforce required to deliver this increase in activity. We must shape our workforce to deliver these commitments by transforming the way we manage our workforce and services.

Other commitments, for example the additional recruitment required to ensure we have 1,500 people to work in the National Treatment Centres (NTCs), are solely reliant on developing new and innovative ways to recruit skilled and experienced staff directly into our NHS workforce.

Significant investment has been committed via the NHS Recovery Plan. Social Care recovery is equally needed. A whole system approach to workforce planning is required at national and local levels, understanding the interconnected nature of the sectors and reflecting issues including the contribution of carers and the role of preventative services beyond Health and Social Care.

With some difference from the NHS, the Social Care sector in Scotland is hugely diverse in terms of its size, ownership, role in local areas and in the type of support it delivers. It is a major employer operating at the heart of communities, working in often innovative and creative ways with and for people in receipt of Social Care support. It is central to the care, wellbeing and in the achievement of human rights, for many thousands of citizens and their families.

Social Care support is as essential as Health Care and must be recognised for its unique and vital role. The Independent Review of Adult Social Care (the Feeley Review) heard much about the dedication and commitment of Social Care workers but also learned about a workforce that has in part been undervalued and poorly paid for vital and skilled work.

Social Care workers have continued to deliver person-centred care throughout the pandemic, while undoubtedly under extreme pressure. This dedicated workforce has carried an immense responsibility, in common with Health colleagues and carers, and this has been both prolonged and often traumatic. It is critical that this workforce has parity of esteem and that the profession is seen as offering highly-regarded work, opportunities to develop a career and also providing opportunities for learning and development.

The Feeley Review, called for a 'new narrative' for Social Care support, moving away from one often based on crisis, unsustainability, vulnerability, staffing shortages and funding pressures. To help retain our Social Care workforce and to help attract new workers into the sector, a positive narrative about the sector is critical and must emphasise opportunities, values, fulfilment and respect. This Strategy's implementation must reinforce that message.

The proposals for a National Care Service (NCS) will be debated in the Scottish Parliament from 2022, with a view to establishing the NCS by the end of this parliamentary term in 2026. However, with current and recent pressures in Social Care, recovery of Adult Social Care must be taken forward now and over the coming years to 2026 to help meet the needs of our citizens, build resilience, increase the workforce and further develop the delivery of Fair Work across the sector.

In recognition of the need to increase and upskill the workforce and also support retention, a number of recent initiatives have been taken forward in partnership with Scottish Government funding. Their impact will be seen over the life of this Strategy. These initiatives include a new Induction Programme for Health and Social Care Workers, launched in February 2022 and a new Introduction to a Career in Social Care course available in Scottish colleges which launched in October 2021.

Recruitment Campaigns continue to have a key role in attracting people into Social Care and the third wave of the national 'There's More to Care than Caring' campaign recently concluded. Local campaigns have also operated, often in line with the national campaign but with the ability to focus on local dynamics.

Labour market changes over the last two years are however challenging and Social Care has a number of competitor sectors.

There is an increasing need to support a 'pipeline' of workers coming into the profession, for example through highlighting the sector in schools, through other opportunities in developing the young workforce, through wider employability routes, or from career-changers. This must be coupled with a focus on supporting workers' wellbeing, ensuring opportunities for effective voice and influence, and through availability of career pathways.

Opportunities for recruitment through international routes are also being explored.

Councils working with Health and Social Care Partnerships continue to develop new ways of working and modernising Social Care roles, including through the use of multi-disciplinary teams and approaches, which appear promising. Initiatives such as Home First support discharge from hospital in an integrated way taking a whole system approach, based on continuity of care and helping to prevent failure demand in acute settings. This approach will be key to NHS recovery.

Integrated approaches to recruitment are also being used to help break down any perceived barriers across Health and Social Care and integrated training and leadership approaches are in place. There are successful examples of Modern Apprenticeships in some areas of Social Care.

The scale of the challenge to support Social Care and to address the unmet needs of citizens remains significant. The Campaign Advisory Group for the National Adult Social Care recruitment campaign is assessing a range of enablers to further support recruitment into the sector, including employability; positive messaging; flexibility in job roles; the role of registration; apprenticeships; and reaching out to groups currently less represented in the workforce.

We are clear that Health and Social Care are interdependent. In all our action to grow the workforce, we will carefully consider the implications of recruitment in one part of the Health and Social Care system on the remainder of that system, recognising finite people resources.

The Scottish Government and partners will continue to take a person-centred approach to transforming the Health and Social Care systems and workforce and enable a healthier population in line with the COVID Recovery Strategy's aims. This aligns with our National Performance Outcomes and the Scotland in which we wish to live. This Workforce Strategy provides the overarching framework for enabling a workforce to deliver these outcomes.

Workforce and Community

Our Health and Social Care employers play a role as 'anchor institutions', contributing to community wealth building, by choosing how and where they spend their budget, how they approach employment and how they manage the land and buildings within their local communities – and in doing so – help to address some of the causes of health inequalities within those communities.

The Scottish Government and COSLA have a shared ambition to remove barriers, support innovation and share learning. This will enable us to support local level actions and align national policy and legislation behind such approaches; accepting that further macro-level change is also needed to address the root causes of health and wider inequalities.

As socially responsible employers, NHS Scotland and Social Care providers are currently considering additional ways of providing support and opportunities for lifting families out of poverty.

Public Health

Alongside these factors, we will ensure that a world class public health system is at the heart of ensuring Scotland's future health and wellbeing. This is essential to our communities, economy, public services and society as a whole. To achieve this we need a coordinated approach to public health workforce planning and development.

We will improve workforce planning to respond to issues including staff retention, succession planning, recruitment pressures and the level of vacancies in public health. To maintain an adaptable public health workforce will also require flexibility in training and skills development of some existing staff groups, to enable them to undertake work in priority areas, enhancing the skills mix and strengthening multi-disciplinary ways of working.

This Strategy supports these crucial programmes of work by putting our workforce at the heart of innovation and system and workforce transformation.

Trauma Informed Workforce

The Scottish Government and COSLA have a shared ambition that services and the workforce across Scotland are 'trauma informed'. The 2017 Transforming Psychological Trauma: A knowledge and skills framework for the Scottish workforce details the specific range of knowledge and skills required across the workforce, depending on their and their organisation's role and remit in relation to people who have experienced trauma.

NHS Education Scotland continue to develop a suite of training and learning resources to support local delivery, commissioned by Scottish Government for use by the wider Scottish workforce.

We recognise that training staff to enable change in the way we work is key to delivering excellent services