Health and social care: national workforce strategy

Part 3: Action

Effective recovery is essential to creating the stability through which we can then accelerate further growth and transformation over the medium and longer term. As set out in the NHS Recovery Plan, we will increase NHS capacity by at least 10% as quickly as is possible in order to address the backlog in care and meet ongoing healthcare needs for people across the country, with new investment supporting targeted intervention across all the integral parts of our Health and Care Services. In growing this workforce, we must avoid unintended consequences in terms of affecting workforce supply for Social Care. We acknowledge that workforce projections and assumptions are highly variable. The Feeley Review also noted that more specific Scottish projections will be vital in the future.

Plan

The following outlines action for recovery over short-term (next 24 months) within each of the 5 pillars of workforce. These actions are summarised, in the annex to this Strategy, alongside medium term (3-5 years) and longer term (5+ years) actions.

To improve the quality and effectiveness of strategic workforce planning, over the next 24 months we will directly support planning capacity for recovery by:

• Improving workforce planning capability across health boards and HSCPs, local authorities and Social Care providers, specifically focussing on shared learning and better alignment of national and local planning, modelling the needs/growth projections, and improved understanding of workforce planning skills, methodologies and approaches, and a greater understanding of the barriers and solutions that reflect the diversity of employers.
• Taking steps to improve the quality of the workforce data, including the demographic data we collect, and to progressively improve the quality of analysis we undertake from data collected, at different geographic levels.
• Improving the accuracy of capacity planning and use workforce planning to more readily spot emerging gaps and pressure points.

These objectives will allow health boards and HSCPs to proactively plan for service growth, in line with our intention to increase capacity across inpatient, day patient and outpatient services by at least 10% by 2026.

To ensure optimal career progression and retention, planning of local and national recruitment should remain focussed on workforce demographics, aiming to have a workforce that is representative of the communities we serve.

Taking these steps now will lay effective foundations for realising more robust whole system planning in the future and create an active culture of continuous improvement.

Current activity and next steps

Recruitment Data

We have already taken steps to improve the whole system approach to workforce data collation and assessment. Posts across Health and Social Care are currently advertised via MyJobScotland and Jobtrain respectively.

These national recruitment portals provide valuable back-office data sets that allow key partners and other employers to assess any cyclical or seasonal issues with vacancy rates across job roles and professions, regional differences in response rates to national recruitment campaigns, the overall attractiveness of Health and Social Care roles advertised, and the relative attractiveness of Health and Social Care employers in the context of the wider job market and economy.

Wider labour market analysis such as that commissioned through Skills Development Scotland also has a vital role. Management information can be routinely accessed by some employers and is provided by agreement to the Scottish Government. We are using this additional information to inform trend analysis and plan future recruitment activity. We have already used this information to inform recent approaches to a Public Health Consultant recruitment campaign, and forthcoming national Nursing and Midwifery campaigns.

Modelling Projected Growth for Doctors in Training

Projecting supply and demand for doctors in training is particularly difficult given the typical length of the training pathway from undergraduate to consultant/GP, and the changes that can take place in relation to population health needs during that timeframe.

Nevertheless, the Scottish Government has developed an analytical model for assessing the impact of projected increases in controlled intake for undergraduate medicine, on the anticipated future supply of graduates into foundation and specialty training.

This allows us to assess whether planned growth will be sufficient and use this information to inform annual intake setting processes.

It has informed our decision to increase the number of medical school places over the course of this parliament by 100 per annum. The first year of this commitment has been delivered in 2021/22 bringing medical undergraduate intake to 1,210 and is in addition to planned increases in annual undergraduate intakes up to 2020.

Whilst this modelling will require further continuous improvement, we can currently use it to provide projections using assumed growth rates in postgraduate and specialty training, and compare this with historical growth, year-on-year, across medical specialties.

This modelling has allowed us to begin to more accurately plan for expansion, which is demonstrated by improved fill rates in postgraduate specialty training since 2016.

In 2020, we achieved an overall fill rate of 95%, and a 94% fill rate in 2021.

These improved fill rates are in the context of expansion in Foundation and Specialty postgraduate medical training places of over 600 since 2014.

Furthermore, this modelling will allow us to project the future medical capacity we will achieve from the planned expansion in undergraduate medicine over the lifetime of this parliament. Further detail on this expansion is set out in section III below "Train".

Going forward, we will continue to refine the model we have developed, and consider how it might be replicated across the other controlled intake subjects for Health and Social Care.

Understanding Our Workforce

The National Staff Experience Report for 2021 "iMatter", will include for the first time an in-depth breakdown of survey results across protected characteristics. Going forward, this additional information will allow us to tailor measures to improve staff experience and career outcomes for underrepresented groups.

Additionally, we are taking forward a review of NHS recruitment processes. This review is adopting an intersectional approach and will develop anti-racist guidance and other national resources to support recruitment, retention and career progression of staff from minority ethnic groups.

In addition to collecting data on workforce composition, we need to consider service user experience to inform planning for how staff are trained, and developed in the workplace, to improve service user outcomes.

The Scottish Government has commissioned the ALLIANCE to undertake research into the Health and Social Care experience of people living in Scotland during the pandemic^[9]. We will act upon the findings and use them to inform the commissioning of new training via NHS NES and through the NHS Academy.

We are committed to a person-centred approach that puts the individual at the heart of services.

Attract

Over the next 24 months we will:

• Increase domestic workforce supply routes into Health and Social Care with a specific focus on embedding Fair Work principles across Health and Social Care, taking place-based approaches to workforce employability and providing significantly improved access to work experience opportunities where practical.
• Increase international workforce supply routes into Health and Social Care through establishing a robust infrastructure in every health board that offers world-class support to incoming international staff, and through increasing recognition of the NHS Scotland brand in markets across the globe.

These objectives directly support current service recruitment priorities to support our recovery agenda, and put in place infrastructure that will facilitate longer term workforce growth through enhancing the attractiveness of Health and Social Care services to prospective employees.

Current activity and next steps

Domestic Recruitment

The National Transition Training Fund (NTTF) was announced in the Programme for Government 20/21. Now in its second year, the NTTF continues to support upskilling and retraining for individuals and sectors affected by COVID-19, but also sectors affected by the EU Exit and those in areas which require skills transitions, including the transition to net zero.

The training aims to help individuals develop the skills required to move into sectors with the greatest potential for future growth, which includes Social Care. Up to 1,800 training places will be supported through £929,060 of NTTF support for those interested in roles in Adult Social Care, which will respond directly to current recruitment challenges and increase knowledge and understanding about the variety of skilled roles available in Adult Social Care.

Additionally, through the College Development Network and supported by NTTF funding, a bespoke 6-week course has been developed and is being run in colleges across Scotland to introduce participants to a career in Social Care. These will be linked with virtual recruitment events for completing cohorts to bring providers with vacancies in the local area together with those who have completed the programme.

We also are working with SSSC and 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.

We are also working with DWP to support them to make appropriate, informed referrals to the Social Care sector and to make use of any employability routes available as appropriate, to assist retention.

Across the NHS, candidates are already able to start their career in NHS Scotland through a variety of routes, including through employability programmes and partnerships at a locality level, through apprenticeships in frontline healthcare and in support services, administrative services and facilities. Individuals are then supported in their role to participate in further qualifications and development opportunities to progress their career in healthcare.

Going forward, we will expand the reach of these programmes, and consider the introduction of new national target measures to promote the recruitment through apprenticeships and new employability programmes in every health board area, with a particular focus on Health and Care roles in acute services, community based multidisciplinary care teams and in public health teams.

In line with our Recovery Plan ambitions, this will create both new opportunities and new workforce pipelines for sustainable employment in communities across Scotland, and it will increase workforce resilience in key services.

Recruitment campaigns in Social Care will emphasise the wide range of roles across the sector, the skills and values of those working in these roles and the potential to gain recognised qualifications on the job.

We will ensure the interconnected nature of Health and Social Care is to the fore when making recruitment decisions.

Ethical International Recruitment

We know that successful, sustainable and ethical international recruitment relies on quality infrastructure. International recruits enrich our Health and Care Services, adding diversity and a rich quality of experience gathered from systems across the globe.

However, international recruits also require bespoke support with settling into a new role in a new country. We have provided £1 million in-year funding to territorial health boards to allow each board to host an international recruitment lead and going forward this will be supported with recurring funding of £1 million per annum.

In tandem with this we have established a Centre for Workforce Supply (CWS) in NHS NES to provide labour market intelligence and to develop links with the UK Government and partner agencies.

These developments will allow boards to coordinate recruitment efforts and act on current labour market intelligence to increase response rates to new international recruitment efforts.

The Centre for Workforce Supply is tasked with the proactive promotion of the NHS Scotland brand identity and will work with partner agencies, including Visit Scotland to successfully advertise opportunities to build a career in Health and Social Care, and a home in Scotland.

As stated earlier we are committed to ethical international recruitment through aligning our practices with the Scottish Code of Practice for international recruitment.

To support Health Board recruitment efforts, we established national relationships with the Yeovil District Hospital NHS Foundation Trust and NHS Professionals to create longer term supply pipelines of international medics and nurses who wish to work in Scotland. However, Boards can use any other recruitment agency that operates in accordance with the Code of Practice for ethical recruitment of Health and Social Care personnel in Scotland.

Going forward, we will set new international recruitment targets annually and coordinate recruitment, through CWS national campaigns, focusing on key areas of shortage and directly supporting key commitments set out in our NHS Recovery Plan.

This will include further targets to recruit nurses and medics to meet our commitment to recruit 1,500 new staff for National Treatment Centres in the period up to and including 2027 and support new recruitment campaigns annually to deliver the 1% net growth in workforce that we have modelled for 2022-2026 to support the NHS Recovery Plan, in addition to our anticipated compound annual growth rates of 1.3% for health services and 1.8% for Social Care.

To support these recruitment efforts, we are providing a record investment of £11 million in this parliament to fund the establishment of the CWS and directly underwrite recruitment campaign activity.

We welcome the addition of Social Care roles to the UK Shortage Occupation List (SOL), however the earnings threshold of £20.4k per annum means that many Social Care roles will still not qualify. We continue to push for a migration system tailored to Scotland's needs, including a Scottish Visa, and support our Social Care employers by highlighting to and engaging with UK Government key issues with the current position.

Train

Over the next 24 months we will:

• Continue to grow controlled healthcare subjects intake in line with evolving demand projections, and in line with the commitments made in the Programme for Government.
• Support new entrants to Social Care through induction programmes and new skills development.
• Progressively expand the role of the NHS Academy and locality based training programmes to support pathways into Health and Social Care services, enable existing registered staff to work flexibly across their practitioner licenses to improve service outputs, and increase the pace of role-redesign to facilitate longer-term service reform.

These objectives will ensure that we have a comprehensive approach to training for roles at all levels, with new programmes directly aligned to developments in service design and delivery across acute and community settings.

Current activity and next steps

Increasing training places in Medicine, Nursing & Midwifery and the Allied Health Professions

The Scottish Government has already committed to increasing the number of undergraduate medical school places by around 100 per annum in each year of this parliament and to double the number of widening access places.

Significant progress has already been achieved. Actual intake in undergraduate medicine in 2021 is 1,210, a significant increase on the previously planned undergraduate baseline for 2021 of 1,048. Further planned increases will boost the annual intake in medicine to around 1,550 places by 2025. These increases build on planned expansion that took place between 2016 and 2020; by 2025 controlled intake for medicine will have increased by 84% on 2016 levels.

To support this planned expansion, the Scottish Government will invest an additional £47.5 million in undergraduate medical training over the lifetime of this parliament.

Further investment will be brought forward to support planned growth in the number of postgraduate foundation and specialty training places.

This level of planned growth in undergraduate medicine will allow for significant further expansion in foundation medical training and postgraduate specialty training in the years to come.

On current modelling, Foundation Training places in medicine could grow from around the current 1,015 to almost 1,400 by 2025-26. In 2022, we will introduce an additional 139 specialty training places, nearly doubling the typical average annual rate of specialty training expansion and building on the 435 additional places that have already been created since 2014.

This planned expansion will be supported by new investment of £5.3 million in 2022/23, rising to £8.4 million per annum by 2024/25.

Similarly, in 2021 the Scottish Government increased funded places in nursing and midwifery degree programmes for the ninth successive year. The student intake for 2021/22 grew by 5.8% to 4,449 students across nursing and midwifery.

In 2022/23 we will increase funded places for nursing and midwifery by over 8.7% to 4,837, a net increase of 388 places. Importantly, there will be increases across all nursing training pathways including adult nursing, mental health, learning disability etc. Additional investment of over £27 million over the next 3 years will support this expansion.

We will invest over £230 million per annum in nursing and midwifery training costs, including our commitment to maintain a student bursary.

Going forward we will consider the need for further planned increases, alongside improving access to pre-registration nursing training through additional routes to the degree programme and considering the possibility of more than one intake per annum.

Following the establishment of a new degree level course in Paramedic Science in 2020, the Scottish Government will fund an increased intake for 2022/23 of 335 places, supported by workforce projections of anticipated need undertaken by the Scottish Ambulance Service.

This planned increase will bring the number of places to 941, and will be supported by investment over the next 3 years, building further on the steps already taken to increase sustainability of routes into para-medicine.

Supporting new entrants into Social Care

As outlined in Programme for Government, we are working with SSSC and NES to deliver a national induction framework to support new entrants into adult Social Care. This includes SSSC working with NES to develop Infection Prevention Control (IPC) induction resources which includes the development of a professional support tool.

Scottish Government partners in SSSC and NES are helping us to deliver the digitally enabled workforce programme to support the delivery of the Digital Health and Care Strategy.^[10]

The Social Work Education Partnership (SWEP) is a national strategic group comprised of key stakeholders across social work education. Its focus is to facilitate the delivery of Social Work qualifying programmes and provide infrastructure support to ensure Newly Qualified Social Workers enter the workforce in sufficient numbers. SWEP is also concerned with the development of an Advanced Practice Framework to support social workers progress through different career phases.

The NHS Academy

The Academy is a partnership between NHS Golden Jubilee and NHS Education for Scotland. Established in 2021, it provides accelerated training to address current workforce needs, focussing specifically on increasing capacity, enhancing skills and improving productivity. Over the next 24 months, the Academy will deliver the following priority work programmes:

• A national endoscopy training programme to increase the number of trained endoscopists in Scotland, supporting improved endoscopy and cancer waiting times. The programme will be flexed to allow workforce growth in line with service demand, and initial projections show that the programme will provide endoscopy capacity for an additional 5,600 patients per annum.
• A national workforce development programme to support the induction and on-boarding of staff recruited to work in National Treatment Centres.
• A national clinical skills for pharmacists programme to support community pharmacists across Scotland to become independent prescribers.
• A national induction programme to support on-boarding of new staff in Health and Social Care in response to on-going recruitment efforts: preparation for work in Health and Social Care in Scotland.

The work of the Academy has been supported by £2.5 million investment in set-up costs and future funding will be provided in line with the Academy's forthcoming work programmes for future years.

Going forward we will expand the role of the Academy in providing enhanced skills training to nurse practitioners and allied health professionals as part of our progressive transformation of professional roles across our NHS.

We will also work with the Academy to introduce specific programmes in Social Care.

Employ

Over the next 24 months we will:

• Continue to invest in and monitor progress against recruitment commitments set out in our NHS Winter Overview and NHS Recovery Plan.
• Finalise the Once for Scotland Workforce Policies Programme, as a significant step in embedding a Fair Work culture.

Current activity and next steps

New Recruitment

Through record investment of over £300 million in Winter Planning and Preparedness we will fund the recruitment of 1,000 new Health Care Support Workers by the end of March 2022.

As part of our commitment to recruit over 1,500 new staff to National Treatment Centres in the period up to and including 2027, we have been working directly with recruitment teams in NHS Highland, NHS Fife, NHS Forth Valley and the Golden Jubilee National Hospital, who have so far collectively recruited over 166 whole time equivalent staff (WTE) to posts in their centres. Overall, around 11% of posts for the centres are already recruited to and we will continue our support with new campaign and marketing activity in 2022.

Across pandemic resilience and public health functions including our COVID19 Vaccinations Programme and Contact Tracing, extensive rolling-recruitment has taken place throughout 2021.

To support permanent recruitment allowing NHS boards to collectively meet the programme demands in 2022/23, we plan to invest around £100 million in our vaccinations workforce to promote long-term sustainability.

Across primary care, in addition to the £155 million already provided to Health and Social Care Partnerships to recruit multi-disciplinary teams for Primary Care improvement, we have provided additional funding through the Winter Overview^[11] to accelerate these recruitment plans. This is directly supporting the recruitment of additional pharmacists to support patients with repeat prescriptions and medicine reviews, and new community nurses to support diagnostic testing and chronic disease management, as well as new physiotherapists to support musculoskeletal conditions in the community.

Through this investment, we aim to have health board delivered pharmacy and nursing support to every one of Scotland's 925 General Practices.

Expansion of the Social Work Workforce is required to support the increasing demand for Adult Social Care Services, some of which have resulted from the pandemic. As stated in the recent budget, the Scottish Government has provided £22m for local authorities for the next financial year (2022/23), and recurring thereafter, to provide additional Social Work Workforce capacity within local authorities. Funding is being provided to specifically add capacity to the Social Work Workforce.

Official statistics have revealed that the shortfall in Mental Health Officers (MHO) capacity has continued to grow, exacerbated by COVID-19. The latest report from the SSSC found that at the end of 2020, the shortfall sat at 53 full time equivalent MHOs.

Responding to this, Scottish Government developed with COSLA a Mental Health Officer Capacity Building (Training) Grant Scheme to help local authorities train additional MHOs.

From 2019 to 2021, we have awarded £1.17m to local authorities to train an additional 47 MHOs, and this year, we will award another £0.72m. We are providing extra funding to build additional MHO capacity and increase resilience across local authorities by supporting the equivalent of 53 additional full time equivalent MHO posts across Scotland. £2.78 million was allocated in 2021-22, and a further £3.71 million will be awarded in 2022-23 and 2023-24, subject to the Scottish Parliament's approval of the Scottish budget.

Once for Scotland

Once for Scotland Workforce policies promote NHS Scotland as a modern, exemplar employer; showcasing our core values, and promoting consistent employment policy and practice that supports recruitment and retention. This is work in partnership between Scottish Government, NHS Employers and staff side and aims to create single, standardised policies that will be used consistently and seamlessly across NHS Scotland. Prior to the onset of the pandemic, we completed phase one of this programme and aim to finalise phase two in the medium term, where circumstances permit.

Fair Work

The Fair Work in Social Care Group's work, will continue to support the improvement of Fair Work terms and conditions throughout Social Care, in line with the recommendations of the Fair Work Convention.

Nurture

Over the next 24 months we will:

• Take forward work to enhance the diversity of our workforce through increasing the number and visibility of minority ethnic staff in senior roles.
• Take forward work to tackle systemic racism in our Health and Care Services.
• Promote Carer Friendly Employment Policies.
• Bring forward proposals for the implementation of the Health and Care Staffing (Scotland) Act 2019.

Current activity and next steps

Culture and Leadership

A new proposed accelerated development programme for minority ethnic staff working in the NHS and Social Care will help to ensure we can have more diversity in future leaders. This will improve understanding of the different care needs and lived experience, supporting values-based leadership in hybrid working environments.

Equality, Diversity and Inclusion

This includes establishing the new National Minority Ethnic Forum for the NHS to work with Scottish Government and Health Boards to tackle systemic racism in the workplace and improve workforce data on ethnicity.

Developing accountability and governance around the monitoring and progression of equality, diversity and inclusion work is also key to ensuring this work is embedded into workforce practice in a progressive and meaningful way. This will require improved training and support for staff at all levels, an inclusive culture where staff feel comfortable disclosing personal information so that we have robust demographics data, and ensuring there is a clear reporting process so any incidents of discrimination or violence and aggression, regardless of protected characteristics, is dealt with appropriately.

Staff who are also unpaid carers

We recognise that a significant proportion of Health and Social Care staff, particularly women, are balancing work with looking after family members or friends. We will continue to promote the Carer Positive scheme to employers in the sector to help them establish and maintain carer-friendly employment policies to attract and retain staff in that situation.

Safety (Health and Care (Staffing) (Scotland) Act 2019)

The Government will redevelop the implementation and transition timetable to take account of NHS recovery and remobilisation, the effective deployment of new innovations and, if necessary, any changes that a National Care Service may bring to the legislative landscape.

Pending implementation, the Government has already notified its expectation to Boards that they will engage with the spirit and intent of the Act, particularly ensuring staff continue to be enabled to report and escalate any safety concerns relating to staffing so that relevant actions are taken and recorded when required.