Health and social care: national workforce strategy

The Centre for Sustainable Delivery and NHS Academy

The Scottish Government commissioned NHS Golden Jubilee to establish the Centre for Sustainable Delivery (CfSD) to support the Care and Wellbeing Programmes and enable NHS Boards to achieve the required transformation to support the recovery of services adversely impacted by the COVID-19 pandemic.

This will design and drive the priority programmes to enable the Remobilise, Recover and Redesign approach through sustainable transformation programmes across the Health and Social Care arena.

The Centre for Sustainable Delivery (CfSD) brings together high impact, mature programmes including Early Cancer Diagnosis, Scottish Access Collaborative, Modernising Patient Pathways and Planned Care Redesign.

The CfSD will be key in developing new workforce capabilities and programmes, including the Accelerated National Innovation Adoption Pathway (ANAIP) and moving towards whole system working, thus crucial to our ambition of transformation. The diagram below provides an explanation of the ANAIP.

The CfSD brings together teams with a track record in innovation to support role transformation through the Scottish Access Collaborative and will proactively share learning and the corresponding impact of initiatives to support uptake. It will work with organisations engaged in transforming roles to ensure service readiness for adoption in relation to optimising pathways.

The CfSD are also working in partnership with the Scottish Government and the Royal College of General Practitioners (RCGP) to improve interface working by scoping potential areas of patient centred pathway redesign work relevant to Primary / Secondary Care Interface working.

This involves collaborative working across RCGP, CfSD, Scottish Government, Health Board Interface Groups and other relevant stakeholders to identify new opportunities for redesign of ways of working that can be applied nationally to challenges across the interface. Potential examples for scoping may include referral guidelines, IT, Community Treatment and Care services and unscheduled care. This work will also explore systems for shared learning and develop case studies of patient-centred redesign within the continuum of care.

Overall the Centre will support the Scottish Government's whole system approach to workforce planning and data analysis will be used to support the work of the Centre in developing innovative new approaches to the delivery of services.

In addition to this, the CfSD will carry a leadership role in the adoption of innovation which may require upskilling of staff to be able to integrate new technology and ways of working into services. The Centre will work with key partners to ensure service and workforce readiness for adoption of new innovations. This will be supported by measures such as the NHS Scotland Academy as part of a hub and spoke national academy model for NHS Scotland. The NHS Scotland Academy is a partnership between NES and NHS Golden Jubilee and is responsible for the planning and delivery of a significant level of accelerated innovative clinical and non-clinical education programmes across NHS Scotland Health and Social Care sectors to respond to workforce needs. Aligned to NHS Scotland Remobilisation Plans, this will attract, train and develop people into the Health and Social Care workforce as part of a 'Once for Scotland' solution.

To achieve our outcomes, underpinned by a tripartite ambition of Recovery, Growth and Transformation, we must do this through the 5 pillars of the workforce journey.

The Five Pillars of Workforce

• Plan
• Attract
• Train
• Employ
• Nurture

The key to this Strategy and achieving our ambitions, vision, outcomes and values for the workforce is understanding the workforce journey. As demonstrated by the five pillars of workforce, the actions we take can have the maximum impact in terms of recovery, growth and transformation in our services and workforce. Planning is the first step.

Plan

Evidence Based Planning

Data about our workforce is key to understanding where and how that workforce delivers health and care services to the people of Scotland.

With partners, we already gather data that helps plan the workforce needed to deliver services and identify the demographics and geographical spread of our workforce. However, we must strive to continually improve the quality and granularity of the data we collect, especially on the unregistered workforce, and adapt our planning accordingly.

Linked to this, we will improve the analysis and reporting of this data, while working to ensure coherence across the relevant national and local systems used by partners.

Throughout the pandemic, we have relied heavily on management information from employers to understand amongst other things staff movement and where they are delivering services. This has provided the opportunity to identify and test new roles and new ways of working, embedding these into workforce planning processes and modelling.

The data needs to tell us more than numbers – it must tell us about the employee e.g. the career paths they take, how they enter our workforce, the skills they develop and the reasons they leave our workforce.

Core partners including Scottish Government, Local Government, NHS employers, Social Care providers, SSSC, the Care Inspectorate and NES all have a role in defining, collating and analysing Social Care data and will work to make improvements over the life of this plan.

Whole-system Planning

Planning for the workforce at a local level is critical to achieving the right workforce with the right skills in the right place at the right time. Our workforce is made up of registered and unregistered roles, the people who fill these roles are employed in a variety of ways and by a number of employers. Some of this workforce, known as Personal Assistants (PAs), are employed using individual budgets through Self-Directed Support.

Recent surveys undertaken by NHS Education for Scotland and separately by councils to understand workforce planning capacity identified that there are various professions contributing to workforce planning, but a relatively small number of formally qualified workforce planning practitioners.

The 2019 National Integrated Workforce Plan committed to progress work to better understand workforce planning capacity and capability issues across Social Care providers and this will be taken forward. In 2021, a selection of workforce planning resources was collated by the Improvement Service, primarily for use by councils.

Whole system planning requires further development to better understand the needs and demands of communities including their public health challenges, the types of roles needed to support different Health and Social Care needs, and the availability of different types of workers over time and geographically, as well as the relationships and influences between all parts of the system.

There are, of course, extensive contributions made by other workforces to health and wellbeing, including carer centre staff and those operating in early intervention and prevention, such as local government and the voluntary sector. The formal Health and Social Care system has always relied heavily on the vital contribution of Scotland's unpaid carers, who outnumber the paid Health and Social Care workforce.

We must increasingly recognise and value these individuals, working with them as partners in supporting Health and Social Care and helping people to live well locally.

Attract

The education system is one key aspect to providing the right educational pathways and creating an interest in working in Health and Social Care.

We are investing in our pipeline of health and Social Care graduates today in order to meet the demand of tomorrow. For example, we have committed to increasing the number of medical graduates by 100 per annum.

Education is only one route, given the size of the workforce we have a real opportunity, through better outreach, to make a difference to communities and life chances across Scotland. We must consider how we can recruit people through alternative routes and where we put resources to maximise and attract the pool of talent we need for our workforce. The labour market has changed significantly over the last two years and labour market pressure poses an increasing challenge across the Health and Social Care system. Our workforce plans will be taken forward in light of these demographic and economic factors.

Our ambition is for our workforce to reflect the diversity of our population. Continuing to improve equality, diversity and inclusion in our workforce, ensures we benefit from different lived experiences, perspectives, ideas and skills, and are better able to serve the people of Scotland. Championing visible diversity at all levels has been proven to have a positive influence on attracting and retaining staff, career progression and enhancing organisational reputation. This will ensure Health and Social Care employers are seen as employers of choice.

Domestic Recruitment

In light of our existing and future workforce challenges, we must prioritise the attraction, recruitment and retention of young people, amongst others. Like the population, our workforce profile is ageing and if we are to create a sustainable Health and Social Care workforce for the future we must attract young people by emphasising the opportunities within the Health and Social Care professions.

Youth employability programmes, including apprenticeships, can provide career opportunities for young people in Scotland and help secure the workforce we need for Health and Social Care services. Positive communications about the sector, which improve public understanding and help to dispel any myths, will be critical in attracting people of all ages into the workforce.

The COVID-19 pandemic has had a significant impact on the Scottish economy and labour pool, with many individuals losing jobs and facing redundancy. We must support those individuals who may consider a career transition to Health and Social Care. Employability programmes have a core role here, including opportunities for training.

We also know that COVID-19 has exacerbated the existing inequalities in our society, with particular adverse impacts on women, unpaid carers, people with disabilities or long-term health conditions, and black and minority ethnic households. Our commitment to a diverse workforce provides an opportunity to contribute to the Good Green Jobs and Fair Work strand of the COVID Recovery Strategy. This in recognition of our role collectively as major employers but also our fundamental interest in helping to address the inequalities in our society.

Ethical International Recruitment

Scotland is a welcoming and inclusive nation and we value everyone, no matter where they were born, who has chosen to make Scotland their home; to live, work, study, raise their families and build their lives here. Migration supports economic growth and the delivery of public services and helps address demographic change. It is clear that migration plays its part in supporting the largest public sector workforce in Scotland.

We must attract Health and Social Care staff from abroad. Recent changes in UK Migration policy open up a new opportunity for Social Care workers to work in the UK.

Our ambitions to deliver amongst other services, the National Treatment Centres at an accelerated pace means that we must identify a pool of qualified staff to fill the additionality required to deliver these centres which will support the recovery of services by addressing the backlog of elective care which has increased during COVID-19.

Our NHS Recovery Plan includes a commitment to provide £11 million for new nationally coordinated and international recruitment campaigns and to establish a national Centre for Workforce Supply (CWS).

Scottish Government along with key partners continue to engage with the UK Government to highlight why Scotland's Health and Social Care sector must have access to workers from outwith the UK, to help meet the existing and anticipated shortfall in workforce capacity and avoid the subsequent impact on our most vulnerable citizens.

We also must work with the UK Government to ensure that immigration policies that are intended to attract and recruit overseas Social Care workers are fit for purpose and result in desired outcomes – including the need to retain staff longer-term.

All international recruitment will be in line with the Scottish Code of Practice for international recruitment to protect the healthcare systems of developing countries, and to ensure the ethical recruitment of Health and Social Care personnel.

Fair Work

Employment law is reserved to the UK Government but we are doing all we can with the powers available to us to promote fair working practices which attract and retain the best candidates into Health and Social Care.

We will continue to work with partners to address the issues highlighted by the Fair Work Convention, regarding fair work in Social Care and further supporting our ambitions to reduce childhood poverty.

Scottish Government, COSLA, councils and other partners continue to progress work jointly through the Fair Work in Social Care Group and sub-groups.

Work is underway to review the opportunities around terms and conditions that affect the workforce, agreed in partnership. We wish to recruit staff in ways that meets their personal needs and aspirations around career progression, and the evolving service needs as well as the expectations of those who require Social Care support.

Many of our staff have invested time and money before they come into our Health and Social Care services. Many come through courses at University or College, this investment is built on when they join the workforce as support is in place, for those that seek a career path, to develop further and adapt to new ways of working and digital opportunities.

Train

We must support our staff with the skills and education to deliver Health and Social Care services.

Training our staff ensures that they have the skills to continue to develop in their roles as well as developing career paths which will aid retention of our workforce. This, in turn, supports the people of Scotland to achieve the best health and care outcomes and experience possible.

One of the factors that has been identified as important for retention is that career pathways, with opportunities for career progression, are perceived to be limited in both Health and Social Care and we must address this.

We must also focus on succession planning for key leadership roles, such as NHS and third sector Chief Executives.

Education Pipeline and Pathways

The supply of newly qualified doctors and nurses into our Health and Social Care Workforce is enabled by Scottish Government's investment in training places which are delivered by educational institutes across Scotland.

In specific student groups such as undergraduate medical students, nursing and midwifery and paramedic students, Scottish Government sets national intakes which account for turnover and growth in these groups. We will continue to do this, responding to our workforce and population needs and supporting our ambitions for recovery, growth and transformation.

We also are working with SSSC, local government, Social Care providers and other key partners to promote career opportunities in Social Care and deliver policies on upskilling and developing the workforce, in order to address recruitment and retention issues and attract new people to the sector to ensure the sustainability of services in the future. This links closely with the Fair Work in Social Care agenda.

We will ensure that the ecosystem of care is supported by enabling existing roles such as Allied Health Professionals (AHPs) and Healthcare Scientists (HCSs) are better understood and supported to maximise their development along with emerging roles such as Physician Assistants and Advanced Nurse and AHP Practitioners that also have a valuable contribution to the delivery of care.

Allied Health Professionals (AHPs) play a pivotal role in supporting the health and wellbeing of the people of Scotland.

During the pandemic, a rapid test of change produced AHP safety huddle and professional judgement templates which gathered real-time workforce data and the impact on people of staff movement, these tools will be used going forward to ensure we maximise our understanding of the contributions of AHPs.

Healthcare Scientists (HCSs) and the clinical services that they lead comprise over fifty areas of scientific and clinical expertise and are the fourth largest professional grouping within the NHS. These areas span pathology and laboratory services, physiological sciences, medical physics and clinical engineering, and data science.

We know that the work this component part of the workforce does impacts 75% of clinical decisions in the patient journey and contributes to over 80% of all diagnostics. During the pandemic, laboratory staff were critical in supporting Scotland's response to testing.

To ensure a sustainable workforce for the future, we are seeking to recruit more HCSs and enhance career pathways.

The pandemic led many in our workforce to adapt, at pace, to using new technologies and digital platforms such as the video consulting service 'Near Me'. The impact and benefits of Near Me have been evaluated across Health, Social Work and Social Care as an enabler to enhancing the practice and skills of the workforce, improving patient and service user experience and supporting service redesign.

Workforce development in digital skills, leadership and capabilities across the whole health and care sector underpins the successful uptake and use of digital technologies.

That is why we must continue to work with partners to ensure our entire workforce has the necessary skills and confidence to embrace the new ways of working that digital brings. The success of our ambitions for transformation is entirely reliant on people's ability to know when, why and crucially how to use digital. Our Digital Health and Care Strategy^[4] sets out our existing commitments, including for our leadership and for growing and enhancing our specialist Digital, Data & Technology Professions.

Developing new skills and capabilities

Whilst digital skills and capabilities are critical to all staff, training we deliver must extend to ensure that we understand the skills and capabilities our workforce will need to deliver world class Health and Social Care services.

We have already developed innovative new roles such as Associate Physicians and Advanced Nursing Practitioners. We must now work with our partners, stakeholders, professional bodies and educational institutes to identify where new and innovative roles in our workforce will enhance the capacity and capabilities of our workforce and support delivery of our key priorities, not only those identified in the Recovery Plan but those which emerge as we learn from the pandemic, look towards renewal of services and grow and transform our workforce.

Key to delivering this will be the Centre for Sustainable Delivery and the NHS Academy as outlined earlier in this Strategy.

In recognition of the increasing number and complexity of health conditions of those living in care homes, we are developing a Healthcare Framework for Adult and Older People's Care Homes. One of the main enablers for realising the vision of a multi-disciplinary team ethos, that puts the person at the centre of the framework, will be ensuring we have a sustainable workforce in place.

To enable this, the framework will examine the transformation of nursing, Allied Health Professionals (AHP) and Social Care roles in primary and community care, setting out plans to invest in Social Care leaders/managers and ensuring that staff, regardless of role, have access to continuous training and development.

The framework is an important first step to achieving our vision of person-centred care and aligns in full to the findings of the Independent Review of Adult Social Care and creation of a National Care Service.

Employ

It is vital that our staff feel valued and rewarded for the work they do, and that NHS Scotland and Social Care employers are employers of choice.

How staff are paid is a significant factor in the value they feel. That is why NHS staff in Scotland are the best paid in the UK and it is why Scottish Government recently increased pay for frontline adult Social Care workers in the third and independent sectors, as part of our commitment to Fair Work in the sector.

In addition to our commitment to Fair Work, the Scottish Government has set out its intention to establish a National Care Service to oversee the delivery of care, improve standards, ensure enhanced pay and conditions for Social Care workers and provide better support for unpaid carers.

The National Care Service will require legislation to be set up, but the intention is to establish it by the end of this Parliamentary term (2026). A fully realised National Care Service would allow Scottish Government to further address issues around pay and Fair Work for social care staff.

In the interim, it is recognised that the critical pressures in Social Care mean that these issues must continue to be addressed urgently, by all partners across the sector.

Fair and Meaningful Work

It is important that staff are well rewarded for the work that they do, and that terms and conditions continue to modernise to suit the needs of a large and dynamic workforce, a 24/7 modern Health and Social Care service, and ensure that we can continue to recruit and retain the staff we need for NHS Scotland and Social Care. We will ensure that the pay, terms and conditions are competitive, and that a Health and Social Care career is one of choice.

The Social Care workforce is split across a mixed economy of providers in the public, private/independent and third sectors. Providers are finding it increasingly harder to fill vacancies and retain staff once they join. With employers being responsible for setting their own pay, terms, and conditions, there is inconsistency across the country. COSLA and Scottish Government are committed to working together in partnership to address the long term challenges in the Social Care and Social Work workforce.

Stability of staff and continuity of care is important for people who access support, and progression and professional development for Social Care workers will result in better quality services and more rewarding careers.

Social Care workers do a critical and invaluable job and there requires to be greater consistency in recognition of this across the workforce.

To develop a resilient and stable workforce, more of those who work in the sector must choose to remain in the sector.

Therefore, it is key that the importance of providing better working conditions for the existing workforce is not lost, especially where this is often cited as the reason for leaving. As noted elsewhere, one way of achieving this is through the consistent progression of Fair Work practice in the sector.

Across the NHS workforce we will continue to reward staff for their experience as their career progresses. Alongside a pay progression system that acknowledges the clear link between staff experience and patient outcomes, we will continue to explore and develop policies that seek to create a modern and flexible workplace that is fit for the future, and recognises the needs of our valued NHS staff.

A central pillar of this work will be ensuring that NHS staff have a system around them that is responsive to their personal circumstance, provides opportunities for career progression and ultimately helps to deliver more care and quality outcomes for the people of Scotland.

Registration

Registration of the workforce has been a driver to increase the skills and qualification levels across the Social Care sector. The way services are delivered, in job roles, and in the complexity of tasks, all reinforce the need to continuously update and further develop qualifications to ensure their relevance and enable a flexible, confident and competent workforce.

We need to create more enablement, empowerment and freedom for our Health and Social Care workforce to make more decisions.

We should be much more flexible around how we register component parts of the workforce and how those different individuals can move between the different sectors.

We will design a system that allows flexibility and focuses on outcomes, which is more focused on human rights and person-led experiences. We can learn lessons from the start of the pandemic here, where there was a need to be innovative and have less of a focus on regulation. Staff feedback told us that this was empowering and rewarding.

Nurture

Once we have employed our workers, it is important that we support and nurture them.

The wellbeing of our Health and Social Care workforce, wherever they work, remains an essential priority and this is why we have invested £12 million to support the mental health and wellbeing of the Health and Social Care workforce.

We are working to ensure that the right level of support is offered across the system. We are actively listening to colleagues to understand where the pressures are, and what actions can be taken to mitigate their impact on staff, across both and Health and Social Care, where the issues can differ. These factors are key to ensuring we understand how to further develop the work we do in terms of retention, and ensuring that we can retain the excellent workforce we already have whilst growing that workforce.

Culture and Leadership

Organisational culture defines how people feel about working for an organisation. There is clear evidence that workforce cultures that consider wellbeing and are positive workplaces lead to better outcomes. Kind and compassionate leadership that listens and fosters diverse, inclusive and positive workplace cultures is crucial to improving staff wellbeing and as a result, helps to deliver high quality care.

There is evidence that more positive cultures lead to better outcomes clinically, and there is emerging evidence that positive cultures can result in financial savings to healthcare organisations. Conversely, poor workplace culture is commonly reported as a reason for staff leaving organisations.

We want everyone in the Health and Social Care workforce to have the best experience at work - focusing on values based recruitment, compassionate leadership and increasing the diversity and inclusivity of the most senior roles in the workforce.

It is therefore imperative that we consider this as services recover, remobilise and redesign, and in light of the continuing pressures faced by our workforce.

It is vital that when those working for us have concerns that these can be raised in a manner that is consistent with our values. To support this, we introduced the role of the Independent National Whistleblowing Officer (INWO) for NHS Scotland in April 2021. This is the first role of its kind in the UK, which provides an avenue for the independent external review of the handling of whistleblowing cases, including the treatment of the whistle-blower.

The INWO also has a national leadership role, providing direction, support and guidance with the focus on continuous improvement, early resolution, recording and reporting. Furthermore, each Board now has a dedicated non-executive Whistleblowing Champion.

This role offers an approach to scrutiny ensuring: that the Board complies with the whistleblowing standards; there is organisational support and training for staff and managers; and that sound governance arrangements are in place. Whistleblowing Champions also have a means of escalation directly to the Health Secretary should they have concerns about internal processes.

Our work must extend beyond supporting those in the public sector and include adult Social Care providers in the third, independent and private sector. We must also focus on succession planning for key leadership roles (such as NHS Chief Executives), and aim to further develop the diversity of our values driven senior workforce, by supporting existing and aspiring senior leaders, and developing and implementing a consistent national approach to succession planning that ensures a pipeline of candidates for future senior roles, who are equipped to realise our ambitions set out in the Health and Social Care Delivery Plan^[5], and the NHS Recovery Plan.

To improve understanding of different care needs and lived experience, we must ensure we have more diversity in our future leaders.

The pandemic has provided additional opportunities for learning. For example, we have seen a shared sense of common purpose, higher trust for devolved decision making and permission to stop some activity, collaboration and flexibility. We must continue to learn from the most recent wave of the pandemic.

Equality, Diversity and Inclusion

Equality, diversity and inclusion must form part of all organisations' culture. The pandemic and the Black Lives Matter movement have highlighted racial, health and other inequalities, as well as a lack of diversity and inclusion, across public sector workforces. Based on the Expert Reference Group on COVID-19^[6] and Ethnicity recommendations^[7], the Scottish Government is leading on cross-cutting work to drive change and deliver long-term meaningful outcomes for everyone with protected characteristics with a particular focus on race, gender, disability, age and LGBTQI+.

Our aim is that staff with protected characteristics are heard, supported, valued and engaged in the development of policies and initiatives that recognise our diverse population and their needs. We are also working with colleagues in recruitment and leadership to ensure that barriers to attract, retain and progress staff from a diverse range of backgrounds are removed. We work with diverse communities and our workforces should be fully reflective of the communities they serve, including at senior level.

Safety

The wellbeing of staff is not only about supportive measures, but also linked to the environments in which staff work, including safe working, safe staffing levels and workloads.

We have put stringent protocols in place to ensure that infection prevention and control measures within health and care settings are robust. This includes the appropriate use of PPE, extended use of face masks, physical distancing, outbreak management and admission testing for patients.

The Scottish Government is committed to the implementation of the Health and Care (Staffing) (Scotland) Act 2019 and its contribution to ensuring the safety and wellbeing of both patients and staff. Fundamental to the Act's success will be the process of co-production required from the Scottish Government and stakeholders. This will ensure the development and uptake of statutory guidance, reporting structures, application of workload tools and that Health Board and other appropriate governance is in place.

The effect of implementing the Act during the recovery and post recovery period will be more reactive in its application to staff numbers and deployment. Particularly as the situation has changed with the pandemic. As the tools are used and updated to meet the new normal, together with staff's professional judgement we expect the Act to have a greater proactive effect on staff planning and deployment

A National Care Service

The Scottish Government committed to an Independent Review of Adult Social Care in Scotland. COSLA and the Scottish Government agreed a joint statement of intent in March 2021, in relation to the Review's key pillars findings, to allow selected areas of work to progress to help improve Adult Social Care.

While the partners acknowledged the need for significant discussion around governance issues, both agreed that empowering people, valuing the workforce, and embedding a human-rights based approach, are essential.

A central recommendation of the Review was the creation of a National Care Service, with Scottish Ministers being accountable for Adult Social Care and support.

The Scottish Government has consulted on proposals to create a National Care Service that will include a national approach to workforce planning and data, improving access to care, regulation, and embedding ethical commissioning and procurement. The responses to the consultation have been analysed and an independent report was published in February 2020.

The analysis of the National Care Service Consultation was published on 10 February 2020. The Scottish Government will be working and engaging with people and partners, in particular people with lived and living experience of community Health and Social Care, and the workforce across the sector, on the development of the National Care Service.

As noted elsewhere in this Strategy, the current acute pressures on the Social Care system must be addressed now and the Scottish Government, COSLA and partners continue to work together in an effort to identify creative and sustainable solutions to address unmet needs.

The development of a National Care Service is proposed to have a key role in delivering the workforce needed in Social Care and understanding the interactions and dependencies across the whole Health and Social Care workforce.

An important factor in this will be any actions required to connect governance structures and actively collaborating across organisational boundaries across Health and Social Care providers and the workforce.

A Carers Strategy

The Scottish Government has committed to the publication of a stand-alone Carers Strategy in late spring, with an immediate focus on COVID-19 recovery and a longer-term purpose of improving carer support in a meaningful and sustainable way.

The strategy will focus on carers and their needs, setting out how policies across the Scottish Government can work together with other public bodies to support carers as we recover from the pandemic and beyond.

We will engage with unpaid carers about the strategy's scope and purpose in the coming months, and this will inform its development. Our approach to the development of the strategy will be both a collaborative and an iterative one which will draw on the knowledge and lived experience of unpaid carers so that the strategy is shaped by those who best understand the many challenges faced.

We will seek to publish the strategy by late spring to provide a clear vision for how we will respond to the challenges faced by so many carers.

Partnership Working

We are committed to working in partnership with NHS Employers, Local Government, Social Care Employers, Trade Unions Professional Organisations and our regulators.

Partnership structures are integral to understanding the needs within our Health and Social Care system, and how changes are likely to impact on the experiences of Health and Social Care staff.

In keeping with the development of other plans and strategies we have engaged and worked in partnership extensively in developing this workforce strategy and will continue to do so when reporting on progress and evaluating success.