Doctors' and dentists' remuneration (DDRB) review body - 2022-2023 pay round: evidence

I. Employee Experience, Morale and Motivation

Staff Experience and Wellbeing

300. The Staff Governance Monitoring Exercise for 2020 was placed on pause in March 2020 in response to the prioritisation of work during the emerging pandemic. We continue to liaise with NHS Boards on how HR Practice has changed in order to appropriately support its employees during this time; however we are taking steps to explore formal Staff Governance Monitoring arrangements and look to develop and agree, in partnership, a more agile approach going forward.

Specific measures

301. The National iMatter Staff Experience Programme was paused for 2020 in light of the changing priorities in responding to the Covid-19 pandemic. Whilst it was acknowledged that Health and Social Care should continue to focus on response, remobilisation and recovery, it was also recognised that now more than ever it is vital that we hear from staff about their experiences. To enable this, we introduced an 'Everyone Matters' Pulse Survey for the 2020 staff experience measure.

302. The Pulse Survey was undertaken from 1-23 September 2020 and designed, in partnership, to capture and focus on key measurements of staff experience during the Covid period.

303. The Everyone Matters Pulse Survey National Report was published on the 4 December 2020 which saw responses from across all of Scotland's 22 Health Boards and 30 Health and Social Care Partnerships, with more than 83,000 staff members taking part (43% of the Health and Social Care Workforce). The following key themes were identified in analysing this work:

• Health and Social Care staff feel a strong sense of pride in their work
• Despite concerns about challenges in both their work and personal lives, staff expressed satisfaction with their lives and the majority of health and care staff continue to say that they would recommend their place of work to others
• The survey found the impact of the Covid-19 pandemic on staff and their loved ones, with one in four stating they were supporting a vulnerable relative and, prior to the schools going back, one in four had school aged children at home. One in six had a family member who had been furloughed.
• The survey also heard accounts of a range of measures for wellbeing support put in place around the country and staff's appreciation of this. This included comfort zones and wellbeing packs, e-cycles so staff could travel to work without using public transport and online huddles and blogs.

304. The survey outputs have allowed us to capture the very real changes and impacts presented by Covid-19, including analysis of how/whether staff across the service have been differentially impacted by Covid-19.

305. We will continue to at staff experience and the Pulse Survey will be linked to wider pieces of work, including the full National iMatter Staff Experience Programme recommencing from January 2021, the Ministerial Short Life Working Group for Culture, Dignity at Work development, Equality, Diversity and Inclusion work and Staff Governance Monitoring.

306. The Scottish Government remain absolutely clear that everyone who works in our Health Service must have the confidence to raise any concerns they may have, particularly in these unprecedented and challenging times. When a whistleblower raises a concern, this must be treated with the upmost seriousness and thoroughly investigated.

307. On 1 April 2021 the role of Independent National Whistleblowing Officer (INWO) will be introduced to further support staff to speak up. The INWO that has a statutory footing and is provided by the Scottish Public Services Ombudsman (SPSO), 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.

308. The underpinning legislation (The Public Services Reform (The Scottish Public Services Ombudsman) (Healthcare Whistleblowing) Order 2020)) extends the powers of the SPSO, to not only take on the role of the INWO but to allow the SPSO to set a 'model procedure' for handling whistleblowing concerns raised by staff and others delivering NHS services. The Whistleblowing Standards apply to anyone working to deliver an NHS service, whether directly or indirectly. This includes current (and former) employees, bank and agency workers, contractors (including third sector providers), trainees and students, volunteers, non-executive directors, and anyone working alongside NHS staff, such as those in health and social care partnerships.

309. This transparent, consistent, understandable and accessible process offers staff assurance about board responsibility and accountability when they raise a concern. By being supported to speak up, staff are likely to feel more engaged and able to contribute to continuous improvement of service delivery.

310. The Health Secretary has also appointed dedicated non-executive Whistleblowing Champions in each health board. These scrutiny and governance roles help to ensure: that boards comply with the new Whistleblowing Standards; there is organisational support and training for staff and managers; and that sound governance arrangements are in place. The Whistleblowing Champions have a direct escalation route to the Health Secretary.

311. We continue to offer an advice and information line. This is now delivered by the Scottish Public Services Ombudsmen (SPSO) who provide independent, confidential advice and information from trained staff in a safe space. This service is not only for staff but for managers who can also contact the advice and information line for support handling whistleblowing concerns within an organisation, or preparing for / implementing the National Whistleblowing Standards.

Health and Wellbeing

312. The First Minister and Health Secretary have both been clear in their assessment that this will be the most difficult winter that our health and social care services have ever faced. The wellbeing of the workforce, wherever they work, remains a key priority and we are working to ensure that the right level of support is offered across the system. This year we have made £12 million available to support the wellbeing of the workforce. This includes £8 million from the NHS Recovery Plan to provide ongoing wellbeing support for the workforce alongside an additional £4 million to provide further support to address winter pressures.

313. As you will be aware we have made available the National Wellbeing Hub, a 24/7 National Wellbeing Helpline, confidential mental health treatment through the Workforce Specialist Service and funding for additional local psychological support. We are also providing further support for practical measures to aid rest and recuperation alongside additional resources such as Coaching for Wellbeing and grief and bereavement support.

314. Throughout the pandemic, we have emphasised to Boards, Health and Social Care Partners and Local Authorities the on-going need to promote both the physical and the psychological wellbeing of everyone working in health and social care. Kind and compassionate leadership that listens and fosters diverse, inclusive and positive workplace cultures is crucial to improving staff wellbeing and as a result it helps to deliver high quality care.

Equality and Diversity

315. Fostering an inclusive culture in the NHS is the corner stone to improving everyone's experience within NHS Scotland. Supporting individuals – both patients and staff - from all backgrounds is paramount in ensuring we deliver the best care for the people of Scotland.

316. Groups like the Expert Reference Group on Covid and Ethnicity (Aug 2020) and Mental Welfare Commission report titled Racial Inequality and Mental Health in Scotland (Sept 2021) have all concluded that there are four key areas for improvement to support a more inclusive culture:

• Data collection, processing and reporting;
• Recruitment, retention and progression;
• Staff representation and voice; and
• Equality and Diversity training.

317. To support improvements for all protected characteristics we have included demographics questions, including on ethnicity, in the 2021 iMatter Health and Social Care Staff Experience Continuous Improvement Model questionnaire for the first time. iMatter provides a team-based tool for measuring employee engagement levels, and putting in place an action plan to deliver improvements in Health and Social Care. The iMatter questionnaire is run annually.

318. Analysis by ethnicity and other protected characteristics of responses to the 2020 Health and Social Care Staff Wellbeing Survey is also underway. Our provisional examination of the data revealed that a number of demographic groups have a significantly lower sense of well-being, in particular those who are non-binary and staff who identify as trans. Staff who consider themselves disabled also have lower well-being scores.

319. We have facilitated the creation of the National NHS Ethnic Minority Forum (EMF). 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.

320. Accountability and governance for the EMF is provided by the Director General of Health and Social Care in her role as the Senior Sponsor. The Forum is currently considering its priorities for the next 18 months, under the themes of employment, workplace culture and mental health. Resources for Health Boards in these areas, flowing from the Forum's work plan, will be agreed and developed over the next 18 months.

321. Across protected characteristics we are developing a new national online platform that will bring equality, diversity and staff networks together and allow colleagues across the health and social care sector to share resources, information, lessons learned and best practices. We will also develop a menopause and menstrual health workplace policy as an example of best practice, starting with NHS Scotland and further promoting across the public, private and third sector. This policy will be owned jointly with the Women's Health Plan colleagues.

322. 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 are working to improve mandatory Equality, Diversity and Inclusion training for Health and Social Care staff and ensure that it incorporates up to date messaging and relevant information on equality including anti-racism, sexual harassment, islamophobia, ageism, LGBTI+ equality, and identifying/reporting incidences of equality based harassment.

International Recruitment

323. The Scottish Government provided £1m funding to NHS Boards in September 2021 to increase in-house recruitment capacity by building support structures and post-recruitment support for international recruits. Funding has also been provided to enable each Health Board to establish an International Recruitment Lead post. This will allow boards to maximise the benefits from international recruitment opportunities and enhance their ability to recruit at pace and scale.

324. The Scottish Government commissioned NES to set up a Centre for Workforce Supply which became operational as of November 2021. This replaced the previous International Recruitment Unit which was decommissioned in March 2021. The Centre for Workforce Supply will provide labour market intelligence, work with the UK Government to access new and existing bilateral agreements for workforce supply, and provide practical advice and support to health boards with the on-boarding of overseas staff. The Centre will develop expert support on immigration processes and regulatory requirements to work in Scotland.

325. Although we are encouraging clinicians from other countries to come and work in Scotland, we are clear that this must not be to the detriment of health systems in lower income countries. All international recruitment must be carried out in accordance with the Code of Practice on the International Recruitment of Health and Social Care Personnel (published on 26 February 2021). The Code demonstrates Scotland's commitment to ethical recruitment and protecting the healthcare systems of developing countries, and sets out updated principles and practices for the ethical recruitment of health and social care personnel.

Impact of Covid-19 on Consultant Recruitment

326. Under the National Health Service (Appointment of Consultants) (Scotland) Regulations 2009, External Advisers (EAs) are required for all consultant interview panels held by Health Boards (HBs) in Scotland. The Scottish Academy is contracted by the Scottish Government Health Workforce Directorate to compile and maintain a list of EAs for this purpose and to run a service to assign one EA per consultant panel in Scotland.

327. The most recent report^[52] from the External Adviser Service contains data from January to December 2020 and provides an overview of some of the challenges posed by Covid-19 to the recruitment process. These included holding panels virtually, an increased reliance on digital systems and a quicker process, with a shorter notice period agreed for requesting an EA. The very positive news is that despite all of the disruption 530 consultants were appointed in 2020, 25 more than in 2019.