NHS Tayside Transformation Support Team: report

4. AAG Recommendation 4 – Workforce

" NHS Tayside should undertake an early and comprehensive review of staffing

levels across all services and sites, including those delegated to or utilised by

HSCPs [Health and Social Care Partnerships]. This review should aim to clarify key drivers of NHS Tayside's workforce levels compared to peer Boards and to identify safe options for bringing redesigned services and sites within available resources."

4.1 NHS Tayside's Assessment – Rating = Red

"Our staff are our greatest asset and we have developed the means to produce a detailed analysis of our workforce. We will use this to build a full workforce profile, enabling the service to determine revised workforce trajectories to the financial year end and to inform recruitment planning and effective use of staff turnover to reshape the workforce. We continue to undertake a wider workforce efficiency programme and benchmarking exercise to re-profile our workforce within available manpower and affordable resourcing, by the end of December 2017. We now need to build this workforce profiling and benchmarking analysis into our forward service planning and budgeting process and into our day to day business management to ensure the most efficient and effective utilisation of available staffing.

A refreshed and revised Vacancy Management Group has been established to review all requests to fill current and future vacancies for all job families to ensure that only critical and essential vacancies are filled. Work on effective rostering, operation of standardised shifts and implementation of a workforce toolkit across our Nursing and Midwifery workforce will enable a safe switch-off of premium cost agency staffing. The next stage, through to the end of December 2017, will evidence that steps are being taken to bring staffing levels within agreed establishments for all our services and, where appropriate, to identify and implement plans to reduce our workforce costs by reference to workforce plans, benchmarks and service redesign. At all times our actions will be predicated on ensuring safety for care and practice within the context of clinical and care governance. At this stage, given the importance of workforce as a major cost driver and with the plans still to have impact, the status of this recommendation is assessed as 'Red'."

4.2 TST Comment - Rating = Red

The TST agrees that this recommendation should be rated Red. This is a challenging and complex recommendation with both short and longer term actions to be planned and managed in parallel.

In the immediate term, a range of actions is required to improve the efficient use of existing resources – which also requires better information about cost drivers and the impact of current models of service delivery. A number of those are described above and further detail is available in NHS Tayside's self-assessment document (available on their website.)

NHS Tayside has developed improved workforce reporting which enables monitoring of actual workforce levels against establishment. More work remains to be done to analyse benchmark information and to grasp the opportunities for bringing establishment levels more into line with relevant benchmarks.

However, many of the outputs of these immediate actions will also be essential to properly inform the longer term development and assessment of scenarios for redesigned services which will emerge through the Integrated Clinical Strategy.

NHS Tayside has provided evidence of how they can deliver in-year savings but the impact is yet to be felt. Going forward, timescales and benefits associated with these savings require further clarification.

Between now and December, the TST would expect to see evidence that establishment control is being strictly maintained with all business areas operating within establishment – the Vacancy Management Group will no doubt play a key role in this process. We would also expect to see plans to reduce the establishment developed and being implemented, and clear arrangements for modelling and assessing the workforce requirements in relation to redesigned services. We would also expect to see robust proposals, developed in partnership, to respond to the results of benchmarking and clear arrangements for feeding in robust workforce information to inform the further development of any service reconfiguration proposals arising from the next stage of the ICS work.