Review Body on Doctors' and Dentists' Remuneration 2023 to 2024: Scottish evidence

I. Employee Experience, Morale and Motivation

Health Workforce Experience

368. To support improvements for all protected characteristics we included demographics questions, including on ethnicity, in the 2021 iMatter Health and Social Care Staff Experience Continuous Improvement Model questionnaire for the first time. We will analyse responses to iMatter survey by demographics to better understand the experience of staff from the view of protected characteristics – including race, gender, sexual orientation and age. We have demographics data from 2021 and 2022 so will be able to track any trends from the past two years. This will provide invaluable staff data to further inform future equality policy and initiatives at national and health board level, based on staff feedback. This analysis will be completed by the end of the 2022/23 financial year.

Race/ethnicity

369. We facilitated the creation of the National NHS Ethnic Minority Forum (EMF) in 2021. This forum is designed to amplify the voices of ethnic minority staff across the health service and tackle issues of systemic racism. The main membership of the Forum consists of representatives from individual Health Board's Race Equality or Equality staff networks and provides opportunity for them to share resources and support one another. We continue to working with the EMF to deliver on their work plans and ambitions. Planned work includes the development of a "how to talk about race in the workplace " guide, developing proposals and how to improve reporting of racist incidents.

370. Improved training around equalities will help staff better meet the needs of our diverse work force and the diverse communities they work with. To support this we have commissioned the Coalition for Racial Equality and Rights (CRER) to develop anti-racist staff resources to be developed in partnership over the next two years. This will cover identifying structural racism, impact racism has on mental and physical health, racialised health inequalities, intersectional racism, and reporting structures and support. The first year will be information gathering, working with H&SC partnerships to identify training objectives and parameters.

371. The Scottish Government commissioned CRER to conduct research on what meaningful anti-racist objectives look like. Based on this we have successfully drafted an Equality, Diversity and Inclusion objective for NHS Board Chairs. This is because SG is only able to set targets for Board Chair. The objective directly references the need to support anti-racist work within Boards.

372. Caroline Lamb, Chief Executive NHS Scotland, has begun working these anti-racist objectives into her performance reviews and discussions with Board Chairs. We will continue to work with Chairs and the Office of the Chief Executive to ensure this objective is delivered in a meaningful way across all health boards.

Disability

373. We continue to fund the Business Disability Forum to provide resources for Health Boards to support disabled staff in the workplace. We also fund the Careers Development Programme, a two-year paid work placement scheme for disabled graduates in health boards.

Gender

Menopause and Menstrual Health

374. A menopause and menstrual health workplace policy for NHS Scotland is in development. A nationwide survey University of Glasgow in collaboration with the Scottish Government and The Health and Social Care Alliance was launched in October to hear about NHS Scotland employees' experiences of menstrual health and menopause in the workplace. The analysis from nearly 7000 responses, and focus groups which will be happening in the new year, will inform the development of the policy. This is intended to serve as an example of best practice, starting with NHSScotland, and promote across the public, private and third sector employers.

Equally Safe at Work

375. Four Health Boards are taking part in the year-long NHS pilot of Equally Safe at Work which commenced in July. Equally Safe at Work is an innovative employer accreditation programme developed by Close the Gap, Scotland's policy advocacy organisation working on women's labour market equality. It supports employers to improve their employment practice to advance gender equality at work and prevent violence against women. This pilot stage has the potential to link with work a number of areas including violence and aggression, other areas of women's health and retention.

Safety of Staff

376. NHSScotland have joined the multi-agency Your Safety Matters (YSM) initiative, led by Police Scotland, that launched on the 15th November. This will help to develop an integrated approach to tackling violence and aggression towards staff across public facing organisations. Other partners include the Fire Service, British Transport Police, SERCO and the Federation of Grocers. The initiative compromises of a pledge, communication materials and the opportunity to share best practice and resources.

Improving Medical Retention Advisory Group (consultants - latter stage careers)

377. In order to improve the retention of consultants at the latter stages of their careers, across the peri-retirement phase, an advisory group was formed. The group consisted of individuals who were invited both for their knowledge and for experience in relation to the subject matter, and as representatives of their respective organisations who had a contribution to make in the development and implementation of the report and recommendations. These included the BMS, GMC, NHS Education Scotland, an NHS Chief Executive and Human Resource Director.

378. The group consolidated and analysed quantitative and qualitative evidence and identified gaps in evidence on retention. This evidence informed a report, drafted and agreed by the advisory group with recommendations for Health Boards and Scottish Government to consider. This includes interventions at Health Board and Scottish Government level that can be implemented quickly, with the aim of alleviating winter pressures.

379. This advisory group report to the Scottish Shape of Training Transition Group (SSoTTG) in SG Health Workforce Directorate. The National Workforce Forum will provide an established governance structure for this and other expert advisory groups on retention. On the 27/09/22 the advisory group's report and recommendations were formally submitted to the SSoTTG.

Health and Social Care Staff Experience Report:

380. The 2022 Health and Social Care Staff Experience Survey was conducted between 16 May and 8 August 2022 and had over 110,250 responses from health and social care staff across all 22 NHSScotland Boards and 29 participating Health and Social Care Partnership's. The National Report was published on 16th November 2022.

381. At national level, key themes include an overall response rate of 55%, down 1% from 2021 but a generally positive growth in staff experience compared to 2021.

Medical and Dental Staff

382. Within the overall total, there were 6206 survey responses for 'medical and dental' staff. Results for this staff group, with comparisons to 2021 and the wider NHSScotland staff average are detailed in the following table:

Doctors and Dentists in Training

383. Doctors and Dentists in training do not fall within the scope of the wider health and social care staff experience programme due to the nature of their rotational placements. A short pulse survey for this group was undertaken in 2021 as a test for change, using 6 key questions from the wider health and social care survey, and repeated for 2022, between 26 October and 21 November. The results are currently being analysed and due to be published in early 2023.

Wellbeing

384. As we move away from a reactive response to Covid-19 and consider the long-term, sustainable offers in place at both a national and local level to support staff, we need to ensure that they are aligned to the existing and emerging needs – such as those posed by additional winter pressures – of the workforce.

385. To complement the help available at a local level, we are continuing to provide a range of resources including the National Wellbeing Hub, a 24/7 National Wellbeing Helpline, confidential mental health treatment through the Workforce Specialist Service, Coaching for Wellbeing and funding for additional local psychological support.

386. Our ongoing response will be informed by a new strategy that will be launched in early 2023. The Improving Wellbeing and Workforce Cultures Strategy has been collaboratively developed, building on the ambitions set out in the Workforce Strategy, published on 11th March 2022. This strategy is a commitment from the Scottish Government to drive a supportive and enabling culture for people working in health, social care and social work across wellbeing, leadership and equalities.

387. We are working on a range of initiatives designed to meet the basic and practical needs of Doctors in Training, and their teams, including access to dedicated quiet spaces to support their health and wellbeing. Boards will be approached directly about involvement as these are developed.

Workforce Practice (Staff Experience and Wellbeing)

388. All staff are encouraged to raise concerns and Boards are expected to investigate concerns fairly and appropriately and ensure that the individual raising the concern does not suffer any detriment for doing so. There are a number of policy measures are in place to support this, including the NHSScotland Whistleblowing Policy set against the National Whistleblowing Standards and the Independent National Whistleblowing Officer (INWO) role delivered by the Scottish Public Services Ombudsman.

389. The Public Services Reform (The Scottish Public Services Ombudsman) (Healthcare Whistleblowing) Order 2020 created the role of Independent National Whistleblowing Officer for the NHS in Scotland. The INWO role is the first of its kind in the UK. It provides a mechanism for external review of how a Health Board, primary care or independent provider has handled a whistleblowing case. The INWO also has a national leadership role, providing direction, support and guidance to the relevant bodies with the focus on continuous improvement, early resolution, recording and reporting.

390. In addition, Health Boards have a dedicated non-executive Whistleblowing Champion, to seek assurance that staff are encouraged and supported to speak up. The Whistleblowing Champions have a direct escalation route to the Health Secretary.

Staff governance monitoring

391. In view of continued service pressures faced within the Boards a more streamlined approach was taken for 2020-2021 and also the 2021/2022 exercise that is currently underway.

392. The Scottish Government provided succinct, tailored feedback to the 2020-2021 Board Returns. These:

• recognised areas of good practice that Boards may wish to share
• identified progress areas that we would expect to see included in their 2021-2022 Staff Governance plans
• provided key iMatter data to be considered when developing the Staff Governance Plan.

393. Boards were offered the opportunity to discuss the feedback with Scottish Government officials. Whilst no Board took this opportunity it is acknowledged that the feedback was issued some time after the returns were provided due to the pandemic and ongoing pressures at both Board and Scottish Government level.

394. Board Returns indicated that many Boards actions in response to the pandemic had shown positive outcomes that support achievement of the Staff Governance Standard. Key Themes from Staff Governance Monitoring Exercise 2020-2021:

395. Improved communications and an appetite to continue to use digitally enabled communications. Progress and planned work indicates continued focus on communications and engagement

396. Leadership Development to demonstrate kindness and compassion Progress and planned work indicates focus on development, training and appraisals in view of lower than usual levels of appraisals undertaken

397. Co-production of remobilisation plans and Boards iterating that partnership is at the heart of delivery outcomes Progress and planned work indicates focus on stakeholder engagement and involvement to improve outcomes

398. Improving behaviours through awareness, support and involvement Progress and planned work indicates focus on equalities, reporting unfair treatment and coaching

399. Improved staff wellbeing and support mechanisms Progress and planned work indicates a continued focus on wellbeing and support

400. Given the timeliness of the last exercise, the 2020/2021 Staff Governance Monitoring Exercise commenced slightly later than in previous years. To afford Boards the usual 4 month period to consider, draft and sign off Returns for submission to Scottish Government, time lines were adjusted. The exercise for 2021/2022 commenced in July 2022 with Board returns being submitted by November 2022.