Public Health Review: Analysis of responses to the engagement paper

8 Providing opportunities for professional development and workforce succession planning (Q5)

8.1 Question 5 in the Engagement Paper asked: ‘How can we provide opportunities for professional development and workforce succession planning for the core public health workforce?’ Ninety-one (91) respondents made comments in relation this question.

8.2 There was substantial overlap between the comments made at Question 5 as compared with Question 4. In fact, in their responses to Question 5, several respondents simply referred back their responses to Question 4, making statements such as, ‘Please see the response to Question 4 above’ or ‘I have mostly answered this in Question 4’. However, comments at Question 5 in relation to workforce development and training were often more detailed than comments made in Question 4.

8.3 It was also notable that comments made at Question 5 were not limited to the issue of professional development and workforce succession planning for the core public health workforce. Many respondents also made comments (particularly in relation to professional development) that related to the wider public health workforce as well.

8.4 Respondents’ comments are discussed in relation to 5 main themes: workforce planning; importance of developing the wider workforce; career progression and career pathways; registration of the public health workforce; and training opportunities and programmes, including resourcing. The issue of leadership was also raised in relation to Question 5, but these comments have been analysed with the other material on leadership (see Chapter 5).

Workforce planning

8.5 Within the general theme of workforce planning, there were three sub-themes namely: identification of the ‘core’ workforce, the need for a workforce development plan, and the need for succession planning. The context for much of this discussion was that the current workforce was ageing, and there were decreasing numbers of experienced staff.

Identification of the ‘core’ workforce

8.6 Respondents thought that there needed to be clarity about who the core public workforce are, and the skills and capacities required by this group to deliver their functions. It was noted that a mapping of the core public health workforce in Scotland is currently being carried out by the Scottish Public Health Workforce Development Group, and it is anticipated that this will give a useful basis on which to agree continuing professional development and succession planning.

More clarity around what is core would inform the debate about succession planning and development. (Partnership, 24)

Need for a workforce development plan

8.7 There were calls for both a national workforce development plan – not only for the core workforce, but also for the wider workforce, and local workforce planning strategies. It was thought that these documents needed to be regularly reviewed to ensure they kept pace with developments.

We believe that there should be a national public health workforce development plan which is owned by the relevant professional bodies representing the wider public health workforce and resourced centrally. (Third sector, 95)

Need for succession planning

8.8 Respondents’ comments about workforce planning were closely related to comments on succession planning. Respondents believed that succession planning was needed, not only at senior levels, but also junior levels – which is made difficult by specialist staff being largely funded on short-term contracts.

8.9 It was pointed out that the small number of public health specialists across Scotland makes it difficult to predict the number of trainees required each year in order to ensure adequate replacement. It was noted that there are now vacancies available, but insufficient specialists to fill them, and a particular challenge was noted around recruitment of specialists in the central belt. There was concern that failure to fill senior level posts over time may result in the posts being removed.

8.10 A further challenge to succession planning (and to the professional development of the workforce) identified is the number and diversity of education and training routes, and the wide variety of agencies involved.

Importance of developing the wider workforce

8.11 Respondents thought that the robust development of the wider public health workforce was essential to deliver public health outcomes, both in terms of health behaviour change, but also in terms of reducing health inequalities. Respondents again emphasised the need for better career pathways from the wider public health workforce into the specialised public health function.

Part of this work would implicitly promote, recognise and respect the wider workforce, and contributions to public health from many sources. (National NHS Organisation, 79)

8.12 Specific suggestions included:

• Reviewing the roles of NHS Education for Scotland, Health Scotland and Education Scotland in delivering training across the whole of the public health workforce.
• Reaffirm (and build on) the work of the UK Faculty of Public Health, and People in Public Health, in relation to identifying core competencies for the public health workforce at different levels.
• Developing of specific types of training for the wider workforce – examples from Fife were highlighted in relation to “Reducing health inequalities training”, “Welfare reform training” and “Health literacy”.

Career progression and career pathways

8.13 This was a major theme in relation to Question 5. However, comments often repeated views expressed in response to Question 4 about the need to widen opportunities for career development and leadership and specifically, the importance of better – and more clearly defined - career progression for non-medical public health staff.

There are clear routes into Consultant in Public Health roles, including leadership positions. However the career progression for other staff working in Public Health is less clear and is often banded at a much lower level. Enabling multiple routes into leadership positions may be of benefit. (Royal college or other professional grouping, 70)

8.14 The point was made that, although career pathways are slowly opening up for non-medical staff in the UK, this is happening more quickly in England and Wales than it is in Scotland. A training programme delivered by Public Heath Wales, which is open for both qualified medical doctors and individuals from other disciplines related to public health, was cited as a positive example of how to speed up this process. The point was also made that as long as public health specialists continued to come primarily from medical backgrounds, the perception that the most important determinant of health is health care would continue. This risked undermining efforts to involve other agencies in addressing the wider determinants of health.

8.15 The issue about lack of career progression was also mentioned in relation to specific roles within the public health workforce. For example, it was noted that there is no established career path for health protection nurses or public health officers.

8.16 There was a call for more flexible career pathways, more flexible opportunities to develop careers outside formal training programmes, and the strengthening of links between the public health workforce and academia.

Registration of the public health workforce

8.17 The issue of public health practitioner registration was frequently raised again in response to Question 5. This was described as ‘a significant concern’, and some respondents argued for mandatory registration of this group within the public health workforce. The benefit of this was that it would result in a recognition of the experience and expertise, and greater development of the wider public health workforce.

Mandatory registration might help to identify specialist public health professionals and ensure maintenance of core competencies. (Royal colleges or other professional grouping, 83)

8.18 However, the point was also made that many health and social care professionals are already required to maintain a professional registration, and sometimes a dual registration with a second regulatory body, which could act as a barrier to their willingness to identify as a public health practitioner. Indeed, it was suggested that mandatory registration ‘may stifle entry to the profession’; as had reportedly been the case with the mandatory registration for health improvement staff in Wales. It was suggested that one way of avoiding multiple registrations might be to ask existing regulators to establish public health registers within other professions, as currently happens with non-medical prescribing.

8.19 It was noted that there may be opportunities to learn from the operation of other UKPHR schemes elsewhere in the UK, particularly in Wales.

We might also learn from other local UKPHR practitioner schemes, e.g. Wales and consider supporting an advanced practice registration process. (NHS Board, 85)

Training opportunities and programmes, including resourcing

8.20 Within the wider theme of training, there were several sub-themes. Each of these is described briefly. It should be noted again, that training was often discussed not only in relation to the core / specialist workforce, but also in relation to the wider workforce.

Resource / funding available for training

8.21 Respondents thought that personal development review and planning was important to enable staff to develop. However, respondents frequently highlighted the difficulties for staff to take advantage of CPD opportunities and other forms of training, due to lack of funding. The point was also made that the lack of capacity in the workforce in some areas made it difficult to give staff the time out from their jobs to take advantage of training opportunities. Training provision was described as ‘fragmented and sporadic’ and variable across disciplines / organisations.

Relevant CPD opportunities from professional societies and other organisations are plentiful within the UK; however, Health Boards in Scotland often lack the resources to allow their staff to attend these. (Individual, 87)

We note that training/CPD budgets are not consistent within disciplines in public health. The budget is a soft target for savings and would need to be allowed for in professional development support. There are few opportunities for secondments in or out – resilience is low due to annual cost savings (NHS Board, 74).

Suggested types of training

8.22 Respondents suggested a range of mechanisms (including in-house or local mechanisms) for supporting workforce development within existing budgets. These included:

• Joint training of staff: on a peer basis, or through professional trainers
• Peer audit processes: to improve practice and standardise approaches to service delivery
• Shadowing and peer mentoring opportunities: both within and across services
• Staff supervision: including making use of annual reviews and feedback to staff
• The use of attachments and secondments: including rotations into national agencies to refresh and extend expertise.
• The use of staff recognition awards and rewards: to recognise achievements.

8.23 Respondents also wanted to see enhanced CPD programmes that included ‘place-based approaches’, co-production methodologies, collaborative leadership, and service user involvement. It was suggested that NHS Health Scotland and the Scottish Public Health Practitioners Network could play a role in the development and / or delivery of such programmes.

8.24 Some suggested that community planning partners (including partners in the third sector) could be involved in the development and delivery of training at a local levels, and that specialist training programmes could be delivered in partnership with professional bodies.

Training programmes

8.25 There was also generally positive comment about current training programmes, including those delivered by NES, STRADA, and the programme for health protection staff developed jointly by NES and Health Protection Scotland.

A similar model to the STRADA training could be adopted to help with professional development within Public Health. This would ensure that it was easily accessible, affordable and providing the same messages and information from a national perspective. (Partnership, 13)

Any programme should be aligned with a broader and agreed strategy, for public health overall and with an integrated professional development plan, and with milestones that record and ensure progress. The health protection workforce has the best developed arrangements in this regard. (National NHS Organisation, 79).