Highland NHS Board 14 August 2012 Item 5.2(d) NHS HIGHLAND WORKFORCE DEVELOPMENT PLAN 2012/13

Transcription

1 Highland NHS Board 14 August 2012 Item 5.2(d) NHS HIGHLAND WORKFORCE DEVELOPMENT PLAN 2012/13 Report by Pamela Cremin, Workforce Planning and Development Manager and Judith McKelvie, Head of Learning and Development, on behalf of Anne Gent, Director of Human Resources The Board is asked to: Note the NHS Highland Workforce Development and Action Plan 2012/13 Note the key workforce risks and challenges for NHS Highland. 1 BACKGROUND This Workforce Development Plan for NHS Highland 2012/13 incorporates Learning and Development. This integrated approach has been underpinned by close working with Partnership Forum through relevant sub groups. Key workforce risks and challenges are highlighted in the Local Delivery Plan for 2012/13 including remote and rural issues which are impacting on hospital services, community services and GP practices. The sustainability of Rural General Hospitals continues to be a key issue evidenced by significant challenges for recruitment and succession planning for medical staffing. Recruitment to new roles (for example nurse practitioners) and succession planning (for example, AHP specialist roles) are also becoming more of a challenge in rural areas. There are also a number of current and impending vacancies across rural GP practices. More generally the workforce is ageing. Over and above these issues the move towards integrated services and the Highland Quality Approach also sets out new challenges for the shape and development of the workforce. In a time when the Board is facing reduced staff turnover and new ways of working having an explicit approach about how we plan and develop our current and future workforce is important to support service redesign and future service sustainability. 2 KEY COMPONENTS OF THE PLAN The Plan is set out in three sections, as follows: Section 1: Workforce, set out in the format required by CEL 23 (2011) revised Workforce Planning Guidance 2011 Section 2: Rolling Action Plan Section 3: Learning and Development.

2 Section 1: Workforce Plan This describes the purpose and scope of the plan. Progress against NHS Highland Workforce Plan Action Plan is outlined from page nine. Strategic drivers for workforce change are picked up from page 13. This includes specific workforce challenges and the need to develop the staff we already have to respond to service redesign and integrated health and social care delivery. Highland population and health care needs are outlined from page 15, taking into account findings from the NHS Highland Annual Report of the Director of Public Health. This clarified the health demands that our workforce will need to respond to. NHS Highland Strategy is outlined from page 21, focussing on the Board Vision, Strategic Framework and Quality Objectives. Workforce Analysis is outlined from page 25. The next steps to examining Workforce Risks and Challenges, are covered from page 37, making these explicit and explaining how these are articulated as part of NHS Highland Corporate Risk Register. Workforce risks are outlined specifically on page 41. Finally, the Workforce Requirements arising from NHS Highland Service Plans for 2012/13 and beyond, are considered from page 43 Section 2: Rolling Action Plan This section (from page 54) identifies 11 workforce actions to be taken forward in the Short (1 year) Medium (1-3 years) and Longer term (3-5 years). Some are specific to Board delivery; others are part of regional and national work streams and development strategies. Section 3: Learning and Development Plan This year it has been a conscious effort to integrate the Learning and Development Plan into the Workforce Plan. This is described from page 63 onwards. This is seen as one of the key enablers is support effective alignment to the Highland Quality Approach. 2.1 Working with partners to deliver workforce solutions The Board recognises and values that partnership working is key to effective workforce planning. Our partners include: - Staff Side Organisations Scottish Government Local Authorities (Integrating Care in the Highlands) Voluntary Sector Scottish Ambulance Service Regional Planning Groups Neighbouring Health Boards National Shared Services NHS Education for Scotland Skills for Health Remote and Rural Implementation Group; and Remote and Rural Healthcare Education Alliance (RRHEAL). 2

3 Patients, carers, communities and public representatives are also vital partners in informing and implementing new roles and models of working. 2.2 Workforce Projections for 2012/13 In line with the requirements of CEL 23 (2011) Revised Workforce Planning Guidance 2011, a workforce projection template has been completed and forward to Scottish Government on 29 th June All NHS Scotland workforce projections will be published by Scottish Government in August 2012 (publication date not yet confirmed). This will be in the form of a national document that will inform future intake numbers for commissioned training programmes in medical, dental, nursing and midwifery. This will then drive a partnership approach with education institutions to meet workforce demand, to ensure that NHS Scotland and in turn NHS Highland has future workforce capacity matched to health and social care demands. 2.3 Monitoring Systems are in place for quarterly monitoring of workforce projections and Workforce Plan Rolling Action Plan 2012/13. This monitoring will be overseen by the Workforce Planning and Development Sub Group, reporting to Highland Partnership Forum. Adherence to the process for integrated workforce planning will provide a mechanism to ensure that quality, patient safety, engagement, consultation and risk management, have all been considered and addressed. This will be delivered by implementing a monitoring process around workforce plans with the Operations Directors. 3 CONTRIBUTION TO BOARD OBJECTIVES The plan is aligned to Quality Objectives and has been developed in partnership to support the delivery of the Highland Quality Approach. 4 GOVERNANCE IMPLICATIONS.Staff Governance workforce planning and development are key components of the staff governance standard and staff engagement is integral to the workforce planning process and the agreement of workforce plans. Clinical Governance The planning function ensures recruitment and development of a workforce that has the right skills and competencies to deliver high quality, safe and effective health care services that underpins the Board s successful delivery of Highland Quality Approach. Financial Impact Through an integrated approach to financial, workforce and service planning, there are in place a number of workforce plans that respond to service redesign and service improvement programmes. In addition, specific workforce efficiency measures have been developed to scope and monitor workforce expenditure in terms of 1) reducing whole time equivalents; 2) skill mix review; and 3) reducing workforce cost base in line with the current PIN policy framework. 3

4 5 RISK ASSESSMENT Risk Assessment is an integral part of the workforce planning process. Specifically, workforce risks are identified on NHS Highland Risk Register: Explicit approaches to mitigate against these risks are outlined on page of the Workforce Development Plan 2012/13. 6 IMPACT ASSESSMENT The NHS Highland Workforce Development Plan 2011/13 has undergone Planning for Fairness assessment throughout and in conclusion of its development. 7 PLANNING FOR FAIRNESS This is a status report summarising the Plan, risks and key issues. As such, this report does not require impact assessment. 8 ENGAGEMENT AND COMMUNICATION Having effective engagement and communications is integral to the workforce planning process and delivery. This is necessary in terms of understanding the need for a changing workforce, as well as how the change will be managed and what this means for people (staff, patients, communities). This is clearly an ongoing process and needs to be happening at a strategic level as well as at operational unit level in work place settings and in local groups. Through the Highland Quality Approach, close working is in place to make sure there is alignment across the key elements such as: Improvement plans, Service Re-design, Values and Behaviours, Public Relations and Engagement. Pamela Cremin Workforce Planning & Development Manager Corporate Services Judith McKelvie Head of Learning & Development Corporate Services 26 July

5 Workforce Development Plan 2012/13

6 Table of Contents Page(s) Glossary of Key Terms 4 SECTION 1: Workforce Plan Introduction and Purpose 6 Scope 8 Progress Made Against NHS Highland Workforce Plan Action Plan 2011/12 9 Strategic Drivers for Workforce Change 13 Highland Population and Health Care Needs 15 NHS Highland Strategy 21 NHS Highland Workforce Analysis 25 Workforce Risks and Challenges 37 Workforce Requirements arising from NHS Highland Service Plans for 2012/13 42 SECTION 2: Workforce Plan Rolling Action Plan 2012/13 53 SECTION 3: Learning & Development Plan 2012/13 63 List of Figures and Tables Figure 1: Workforce Planning Approach 6 Figure 2: NHS Highland Workforce Planning Cycle 8 Figure 3: Figure Components of population change by administrative area NHS Highland: Figure 4: Projected Population Change Numbers by Age Group and Gender, NHS Highland Area, 2008, 2023 and NHS Highland Workforce Development Plan 2012/13 2

7 Figure 5: Projected Population Change Percentage Change by Age Group, NHS Highland Area, 2008 to 2033 Figure 6: NHS Highland Workforce Staff Group Pie Chart (staff in post by staff group Headcount %) Figure 7: NHS Highland Age Profile (Headcount) 29 Figure 8: NHS Highland Workforce Equality & Diversity Distribution 30 Figure 9: NHS Highland Workforce Establishment Trend 31 Figure 10: NHS Highland Use of Fixed Term Contracts (WTE) 31 Figure 11: NHS Highland Turnover and Stability Trend 32 Figure 12: NHS Highland Vacancy Data 33 Figure 13: NHS Highland Use of Flexible Workforce (Replacement) (WTE) 34 Figure 14: NHS Highland Annual Sickness Trend and Breakdown 34 Figure 15: Social Care Staff as at 1 st April 2012v by Job Family (Source Highland Council) 36 Table 1: NHS Highland Staff in Post as at 31 st March 2012 by WTE 25 Table 2: Workforce Trend for NHS Highland 2011/12 Staff in Post SWISS Extract Published by ISD 29 th May Table: 3 Social Care Staff as at 1 st April 2012 (Source Highland Council) Table 4: Components of NHS Highland Corporate Risk Register Table 5: NHS Highland Workforce Risk Register Table 6: Workforce Productivity and Efficiency Contribution to Quality 2012/ NHS Highland Workforce Development Plan 2012/13 3

8 Glossary of Key Terms AfC AFFI AHP AT-L BC BH BV CEL CHP CPC CPD CRES DGH DoH DRRH EFM EPA eess eksf EWTD GPhC GOS GP GRO(S) HAI HC HCHS HCS HCSW HEAT HDL HPF HR ICH IPG IRF ISD IT KPI KSF LDP LTC MH MMC NRRP Agenda for Change A Force for Improvement Allied Health Professional AT Learning System Better Care Better Health Better Value Chief Executive s Letter Community Health Partnership Community Pharmacy Contract Continuing Professional Development Cash Releasing Efficiency Savings District General Hospital Department of Health (England) Delivering for Remote and Rural Health Estates and Facilities Management Extra Programme Activity (in the Consultant Contract) (electronic) Employee Support System Electronic Knowledge and Skills Framework European Working Time Directive General Pharmaceutical Council General Ophthalmic Services General Practitioner General Register Office for Scotland Healthcare Associated Infection Headcount Hospital and Community Health Service Healthcare Science Healthcare Support Worker Health Efficiency Access and Treatment Targets Health Department Letter Highland Partnership Forum Human Resources Integrating Care in the Highlands Integrated Planning Group Integrated Resource Framework Information and Statistics Division (NHS Scotland) Information Technology Key Performance Indicator Knowledge and Skills Framework Local Delivery Plan Long Term Condition Mental Health Modernising Medical Careers (now SMT) National Recruitment and Retention Premia NHS Highland Workforce Development Plan 2012/13 4

9 NES NHS Education for Scotland NHS National Health Service NHSH NHS Highland N&M Nursing and Midwifery NMC Nursing and Midwifery Council NoSPG North of Scotland Planning Group NWAHP Nursing and Midwifery & Allied Health Professional OOH Out of Hours PA / PAs Physician Assistant(s) P4I Planning for Integration PIN Partnership Information Network PMBRDP Pay Modernisation Benefits Realisation Delivery Plan QIS NHS Quality Information Scotland QUEST Quality and Efficiency Support Team RGH Rural General Hospital RRHEAL Remote and Rural Health Education Alliance RRIG Remote and Rural Implementation Group (18) RTT Referral to Treatment Time (18 refers to 18 Weeks) SAAT (Staff Governance) Self Assessment Audit Tool) SEHD Scottish Executive Health Department (now known as SGHD) SGHD Scottish Government Health Department SGDP Salaried General Dental Practitioner SMT Scottish Medical Training SOA Single Outcome Agreement SPA Special Programme Activity (in the Consultant Contract) SSSC Scottish Social Services Council SSTS Scottish Standard Time System ST Specialty Training (in terms of medical trainees) STBs Specialty Training Boards (in terms of medical trainees) SVQ Scottish Vocational Qualification SWISS Scottish Workforce Information Standard System UK United Kingdom VTE Venous Thromboembolism WTE Whole Time Equivalent NHS Highland Workforce Development Plan 2012/13 5

10 Introduction and Purpose NHS Highland Board is committed to improve the health of the Highland population and develop high quality health care and adult social care services that deliver Better Health, Better Care, and Better Value to the people of Highland. Workforce planning is an important task for all NHS Boards In order to deliver the requirements set out by the government in Better Health, Better Care: Action Plan 1, the Board must ensure it has a committed, well prepared, dedicated workforce that has the right knowledge, skills and behaviours, in the right place, at the right time, to respond to and deliver health and social care services now and in the future. Figure 1: Workforce Planning Approach Source: Centre for Workforce Intelligence 2012 Detailed arrangements for workforce planning were first outlined by HDL(2005)52 2. The NHS Scotland policy in relation to HDL 52 has been reviewed and is now superseded by CEL(2011)32 Revised Workforce Planning Guidance 3, which is responsive to the requirements set out in the Healthcare Quality Strategy for NHS Scotland 4 and the move towards more integrated health and social care services. In addition, the introduction of the Dementia Strategy 5, continuing commitment to Free Personal and Nursing Care 6 and Reshaping Care for Older People 7 programme, which is supported by the significant Change Fund 8 for older people s services, all demonstrate the determination to assure innovative, high quality care and support services that improve people s lives. 1 Scottish Government, Better Health, Better Care: Action Plan. Edinburgh: SGHD 2 HDL (2005) 52 Workforce Planning. Edinburgh: SEHD, CEL (2011) 32 Revised Workforce Planning Guidance Edinburgh: SEHD, Healthcare Strategy for NHS Scotland. Edinburgh. The Scottish Government, NHS Highland Workforce Development Plan 2012/13 6

11 NHS Highland workforce plans are integrated with service and financial plans through the development of its Local Delivery Plan 2012/13. In line with service improvement and redesign workstreams and to achieve financial balance, NHS Highland Workforce Plan 2012/13 demonstrates these links to deliver a three dimensional (integrated service, financial and workforce) approach, building on the iterative workforce plans developed in previous years and setting the scene for the workforce contribution against a very different landscape than in the past. NHS Highland and the Highland Council have sealed a ground breaking partnership agreement to improve outcomes for the people of Highland through the development of integrated services. Both agencies agreed that having separate arrangements and services was a significant barrier to making best use of all resources. In addition future demographics dictated the need to radically redesign services to support the ageing population. The aim was to develop supporting infrastructure to deliver better integration through a programme called Planning for Integration (P4I). A collaborative approach was announced in December 2010 to develop a single Lead Agency model. Organisational change policy was used to transfer, map and match staff into posts. The process actively involved staff side organisations, professional bodies, external advisors, voluntary sector and senior officials from both organisations. The formal Partnership Agreement was signed in March 2012 by NHS Highland and Highland Council. It detailed legal, governance and performance management arrangements for the joint delivery of health and social care services in Highland. NHS Highland became the lead agency for adult services; and Highland Council for children s services. On the 1 st April 2012, 1470 Highland Council adult social care staff, and 89million transferred to NHS Highland and 208 NHS Highland children s community staff and 8million transferred to Highland Council. In addition, NHS Highland has reorganised three of its operational areas, moving from 3 CHP areas in North Highland to establish a single North Highland Health and Social Care Partnership. This brings together, for the first time, within one organisation, community, primary, social care and acute services, co-terminus with Highland Council districts and operational areas. Argyll and Bute continues as a single CHP, co-terminus with Argyll and Bute Council. The 1st April 2012 marks one of the biggest structural changes in the delivery of health and social care services in Scotland for a generation. By having fully integrated services with single budgets, HR systems, IT systems, it provides the infrastructure to make the necessary changes to improve outcomes for the people of the Highlands, now and into the future. Making sure that the workforce planning function is integrated with financial and service planning functions ensures that staff have the capacity and capability to deliver safe, efficient, high quality health and social care services. Workforce planning must also be delivered in partnership with staff and trade unions to ensure that workforce solutions are fully debated, understood and implemented for the benefit of Highland population and service users. NHS Highland Workforce Development Plan 2012/13 7

12 Scope NHS Highland publishes a workforce plan every year. The purpose of the workforce plan is to inform the Board of the future workforce requirements for the organisation and provide workforce analysis and workforce projections aligned to health and social care demand, integrated with service and financial planning systems. NHS Highland s Workforce Planning process / cycle encompasses 6 stages in line with the Six Steps Methodology to Integrated Workforce Planning 9, as defined by CEL(2011)32 3, and is shown dramatically as follows: Figure 2: NHS Highland Workforce Planning Cycle STEP 1: Define the Workforce Plan and its objectives STEP 6: Implement. Monitor and Review progress quarterly STEP 2: Identify Workforce Demand and Drivers for Workforce Change STEP 5: Develop an Action Plan and confirm Monitoring / Governance arrangements STEP 4: Develop the Workforce Plan, identifying key workforce plans, key policy links, and key partner agency relationships STEP 3: Identify mechanisms to respond Workforce Demand and Drivers for Workforce Change Workforce planning arrangements within NHS Highland are facilitated by a partnership approach, engaged operationally with staff side representatives and Highland Partnership Forum (HPF). Specifically, workforce planning function is identified as part of the Staff Governance Standard and therefore accountable through the Staff Governance Committee to NHS Highland Board. A Workforce Planning and Development Sub Group of the HPF oversees the development of the workforce plan and its links with the service and financial planning agenda as well as its links with external partners. 9 Six Steps Methodology to Integrated Workforce Planning. Workforce Projects Team / Skills for Health. Available from: NHS Highland Workforce Development Plan 2012/13 8

13 Progress Made Against NHS Highland Workforce Plan Action Plan 2012/13 NHS Highland developed its Workforce Plan for 2011/12, which was agreed by the Board in August An associated Workforce Plan Rolling Action Plan identified 14 actions to be taken forward during 2011/12. The action plan has been overseen by the Workforce Planning and Development Sub Group of Highland Partnership Forum and is updated with progress reported monthly to HPF and quarterly to the Staff Governance Committee. Overall progress of the Workforce Plan Rolling Action Plan 2011/12 is as follows: 1. Develop a whole system approach to implement workforce planning requirements and outcomes across NHSH underpinned by risk assessment and quality outcomes: workforce risk assessment is now undertaken as part of the organisation s Service Improvement and Change Process Framework / Flowchart. Risk assessment and workforce transition plans are in place for nursing and AHP establishment reviews. Local face to face discussions are taking place through local partnership fora and HPF regarding the workforce impact of service change. Organisation Change PIN Policy in place. 2. Reduce 25% of senior management posts over 5 years, in line with SGHD guidance: Good progress has been made against the target to reduce senior management by 25% over 5 years (from March 2010). NHS Highland agreed its baseline with Scottish Government as 79.4 WTE senior managers, which translated into a planned reduction of 18.5 WTE to 60.5WTE over the next 5 years. The Board already made progress by reducing 3.0 WTE 2010/11. At M12 (end March 12), NHS Highland further reduced 2.0 WTE senior managers, against a planned 5.0 WTE reduction in 2011/12. To date the total number of posts reduced is 5.0 WTE, which represents just under a third of the target achieved. 3. Pan Highland Review of Administrative Services: This project has taken time to evolve and define key areas of work that will provide efficient and productive outcomes for NHS Highland. A projected WTE reduction of -80 WTE for 2011/12 was not achieved with the M11 position (at end February 2012) showing a reduction of WTE, mostly in corporate services in North Highland and Argyll and Bute CHP. 3 revised projects are now underway: Good Practice (including standardisation and use of technology) Personal Assistants; and Medical Secretaries. There is specific work being undertaken by the operational units: Raigmore Hospital Admin Review; and Argyll and Bute CHP Admin Review. This project is a major initiative which underpins all service redesign projects across the whole NHSH system, including the corporate services review (see 3a below). Whilst projected WTE reductions in administration have not been met, NHS Highland Workforce Development Plan 2012/13 9

14 there are anticipated outcomes in 2012/13 regarding skill mix review changes in line with the projects outlined above. This project will continue to be progressed and delivered throughout 2012/13. 3a. Corporate Services Review (CSR): this project did not progress as planned in 2011/12 for various reasons, including significant strategic organisation redesign and the integration of adult social care and children s services with the Highland Council. However, over the last 3-4 years North Highland Corporate Services have delivered savings of c 1M per year have been achieved year on year. This reduction in budget has however been achieved, in the main, pragmatically and without any significant service redesign. Savings have also been made year on year in Argyll and Bute CHP. The NHS H Senior Management Team has recently agreed revised proposals for the delivery of corporate services for 2012/13 and beyond and the workforce requirements in relation to these will be taken forward accordingly. 4. Nursing, Midwifery and AHP (NMAHP) Workforce Planning and Development Plan 2011/12 set out to: 1. Increase the HCSW contribution to the overall NMAHP workforce 2. Establishments should be filled by substantive staff at the appropriate level to cover normal activity and by supplementary staffing when required and remain in budget. 3. System in place to provide live establishment benchmarking data across NHSH. 4. All advanced practitioners have job plans that demonstrate the posts contribution to service priorities and strategic framework 5. CPN establishment reviews completed and transition plans in place Progress is as follows: 1. Establishment reviews have taken place but still need to be mainstreamed for N&M. AHP skill mix review underway. 2. Continuing to monitor and reduce supplementary staffing for NMAHP; evidenced in financial reporting 3. A data base was developed and due for implementation in December 2011, but this has had to be revised due to the implementation of a new financial system in the Board 4. A tool has been developed to support this 5. CPN Establishment review has been undertaken supported by in house and nationally validated tools 5. Workforce Workload and Deployment: this action sought to develop and monitor workforce plans to support the reshaping hospital care agenda including whole system capacity and patient flow (patient care capacity modelling (PCCM), being led by GE Healthcare); Reshaping Care for Older People; Planning for Integration; Care Pathways; and Pan Highland Surgical Services Review. Some workforce changes have taken place, in the absence of explicit workforce plans being developed. There has also been engagement with operational units to ensure workforce redesign, efficiency and productivity is applied to all service redesign process and outcomes with a focus on pan Highland consistency benefits realisation across scheduled care, anticipatory care and unscheduled care services. These discussions have also been replicated through the partnership fora across the organisation. NHS Highland Workforce Development Plan 2012/13 10

15 6. Reshaping Medical Workforce (and the contribution of Clinical Workforce): This project continues to be developed and delivered through the National Reshaping Medical Workforce Project Board and associated Regional Reshaping Medical Workforce Groups. There is engagement form Board Medical Directors to agree the process and methodology for medical workforce planning in relation to future workforce sustainability and the move to a trained doctor service / reduction in doctors in training. This is part of an on-going five year project plan up until 2014 and will continue to be progressed during 2012/ Rural General Hospital (RGH) Workforce Planning: NHS Highland continues to have challenges around sustaining the current model of RGH service provision. There are on-going difficulties in attracting doctors in training for RGHs and consultant succession planning is difficult and there are a number of locum doctors in training and locum consultants in post. A review of RGH workforce has been progressed through a Knowledge Transfer Partnership (KTP), a 2-year project run jointly by NHS Highland and UHI Centre for Rural Health which commenced in January 2011, however there are no new workforce solutions that will address sustainability of the current RGH service model. NES is providing assistance regarding the development of education solutions to support new roles and role development, for example, GP acute care competences and remote and rural practitioner competences. Although physician assistant (PA) roles have been considered, they are not currently a solution for RGHs as workforce contribution is required to sustain the out of hours period and current nonregulation and prescribing issues for PAs is a barrier to progressing this development at present. 8. Manage Workforce Establishment and Workforce Costs: Workforce Projections for 2011/12 described an anticipated net reduction of -195 WTE posts to be achieved against service redesign projects and skill mix review. The FYE M12 (March 2012) position shows that the Board delivered a net reduction of WTE overall. 9. Implementation of Health Care Support Workers (HCSWs): CEL 31 (2010) Health Care Support Workers Mandatory Standards and Codes are in place for new employees; The mandatory Code of Conduct is being introduced to existing staff through the KSF PDP process; Steps are being taken to ensure that newly-appointed social care staff are supported to meet the Standards and Codes An education framework has been developed to support NMAHP workforce development in line with Scottish Vocational Qualifications (SVQ); Local systems have been developed to record achievement of standards and codes and nationally on SWISS; Engagement with NES regarding the development and implementation of various HCSW strands, such as: o Education scoping for the role of rural generic health and social care support worker (also engaged with Scottish Social Services Council (SSSC); o HCSW work books for administration, clerical and support services workforce. NHS Highland Workforce Development Plan 2012/13 11

16 10. Workforce Supply: There continue to be challenges in sustaining Rural general Hospital workforce supply particularly in relation to maintaining medical rotas and the continuity of 24/7 care. There continues to be high locum spend in the RGHs to sustain services and this has been exacerbated by the delay in progressing regional and national medical workforce banks; although plans to take these forward are on-gong and are being progressed. Locum spend continues to be high in NHS Highland and the Board is still committed to securing a more sustainable workforce to ensure continuity and quality of care in remote and rural health care settings. 11. Prepare workforce plans to support the Integrating care in the Highlands agenda: workforce plans have not yet been developed to support Integrating Care in the Highlands. Workforce transfer took place on 1 st April 2012 and workforce planning for integration will be addressed in the Workforce Plan Rolling Action Plan 2012/13 and in line with the Board s overall Integrating Care in the Highlands Forward Action Plan. Work is however already underway in relation to ensuring the social care workforce is covered by Scottish Government policies and the procedural elements of PIN policies 12. Prepare workforce plans to manage the transition of prison staff to NHS: This has been completed with the transfer of 6.5WTE prison (nursing) staff to NHS Highland (conditioned hours: 37.0 WTE). 13. Review Healthcare Science Skill mix: there has been skill mix review undertaken in HCS, mainly in line with the opportunity to review skill mix in line with turnover, planned retirements and the integration of blood sciences (haematology, biochemistry and bacteriology) during 2011/ Develop workforce plans to clarify Physician Assistant (PA s) requirements in line with reshaping medical workforce and contribution of clinical workforce: During 2011/12, NHS Highland have had the opportunity to have student PA s on placement from St George s Hospital in London. NHS Highland is also working more locally with NHS Grampian to provide placements for PA s in 2012/13 and is working jointly with NHS G on the recruitment of PA s and their development. NHS Highland is keen to develop PA roles in its DGH in the following specialities: orthopaedics and gynaecology. There are on-going discussions with other specialties regarding how PAs could contribute to service delivery and it is anticipated that they will contribute in surgical and general medicine particularly in support of out of hours. Psychiatry are also considering PA roles in dementia care. These PA developments are well supported by the availability and proximity of senior medical staff for supervision, which is where PAs have the best fit for NHS Highland. The Board is aware that discussions are taking place at a national, 4 country level regarding the regulation of PA s with the Health Professions Council. Until the regulation issue is resolved, NHS Highland has no current plans to develop PA roles in the RGHs due to the availability and proximity of senior medical staff for supervision at the RGHs in the out of hours period, where their contribution would add the greatest value for service delivery and workforce sustainability (see 7 above). NHS Highland Workforce Development Plan 2012/13 12

17 Strategic Drivers for Workforce Change In its Local Delivery Plan for 2012/13, the Board outlined its key workforce challenges for NHS Highland in 2012/13, which is largely unchanged from previous years. The vulnerability and sustainability of Rural General Hospitals continues to be a key issue for the Board evidenced by significant recruitment and succession planning challenges in medical staffing, including on-going high locum use in both trainee and trained grades. In addition there are workforce sustainability issues in GPs with a number of current and impending vacancies across rural GP practices. Recruitment to new roles (for example nurse practitioners) and succession planning (for example, AHP specialist roles) are becoming more of a challenge in rural areas. The Board continues to monitor its workforce spend, ensure that the workforce is as efficient and productive as possible. There are a number of workforce initiatives in place in line with the productivity and efficiency agenda. In an effort to ensure that the Board makes the best use of its workforce resource, there is a continual effort and approach to reducing the workforce cost base in terms of reviewing skill mix to meet current and future health care demand, monitoring establishments and workforce deployment and keeping to a minimum the need for, for example, locum agency spend (particularly in medical posts), enhanced payments associated with unsocial hours and waiting time management (affordability). An integrated approach to financial, workforce and service planning and the development of NHS Highland Strategic Framework and Board Vision provides the opportunity to reshape the size and skill mix of the workforce to respond to drivers for change. This requires on-going workforce planning and development plans that have to align with a very different financial background than there has been in the past; and maintain service continuity alongside recruitment challenges (availability). This will be challenging for the Board and a focus must be on skill mix review, matching workforce to service needs, and workforce development (adaptability) approaches that supports horizontal integration and the development of skills across agenda for change bands and across professional boundaries. This will include reviewing the balance and the interface between health and social care support roles, registered practitioners and advanced practitioners. Significantly, for NHS Highland, Integrating Care in the Highlands has seen the transfer of adult social care staff to NHS Highland and children s staff to Highland Council as lead agencies for service delivery. In this regard, specific work is required to further develop and deliver integrated health and social care services which will require a focus on skill mix review, workforce modelling linked to integrated service needs and robust succession planning and vacancy management using vacancies as an opportunity to redesign services and not merely replacing like with like to maintain the status quo. NHS Highland Workforce Development Plan 2012/13 13

18 Many of these issues are not just relevant for NHS Highland. More broadly, the demand and need for health and social care services is changing rapidly in response to the key drivers of: Increasing life expectancy; An ageing population, with marked decrease in the proportion of young people 10 ; Growth in chronic diseases and long term illness; The prevalence of health inequalities; Increasing emergency hospital admissions; Future lower levels of investment than has been seen in recent years; Developments in technology, medicines and new treatments; and Changes in National Policy and Standards. As a consequence, the provision of services needs to change and respond to: The impact of improvements already in place A focus on improving health and preventing illness; Greater responsiveness to the population s needs and expectations; More use of care pathways, multi-professional and multi-disciplinary working; More diversity in, and a changing balance between community and hospital based services integrated health and social care and more care in the community; The introduction of new technologies; and The increasing health and social care costs with reduced financial uplifts for the foreseeable future. At the same time workforce changes are focused on: Organisational change, service redesign and integration and the drive for improvement and increased productivity and efficiency; Working smarter, not harder supported by technology, automation and service improvement projects including LEAN approach; Workforce redesign across systems not just focussed on professional silos or operational areas; and the requirement for role development, new and extended roles and skill mix review across teams and across agencies; Reshaping Medical Workforce (and the contribution of clinical workforce) Reforming and modernising clinical careers and other health and social care professional careers; Reducing reliance on junior doctors in training for service delivery purposes while improving the educational experience Maintaining the requirements of the European Working Time Directive (EWTD) for all workforce groups; Rolling out job planning approach to advanced practitioners Assessing the impact of an ageing workforce; Solutions to addressing these challenges and drivers for workforce change lies in how the organisation assesses workforce risks and designs, develops and plans its workforce in the most efficient and effective way, whilst maximising talent and making the best use of financial resources. 10 See NHS Highland Population analysis in the next section. Population analysis (sourced from GRO(S); provided by NHS Highland Health Intelligence Unit. NHS Highland Workforce Development Plan 2012/13 14

19 Highland Population and Health Care Needs Population Trends Key messages: The population is projected to increase by around 10% over the next 20 years. The population of very elderly people is projected to increase more rapidly in the same time. Life expectancy is increasing, in line or better than the rest of Scotland, but it is still poor compared to parts of Europe. Inequalities in health are not reducing. NHS Highland covers an area of 32,500 square kilometres, just over 40% of the land mass of Scotland, but only 310,500 people (6%) of the Scottish population live in the area. This headline population is an increase of 630 people on the previous year and a continuation of the trend in growth that has seen a 3% increase in the total Board area population since This estimate is based on the last Census in 2001, adjusted for births, deaths and migration, but may undergo considerable revision after the next Census in The main influence on population growth in recent years for Scotland as a whole has been inward migration, rather than an increase in births or reduction in deaths, but population movements across Europe have made it increasingly difficult to provide accurate estimates and projections of future growth. The recent pattern of population growth dependent on net migration gain has not been evident across all NHS Highland and while the Highland population has increased by over 5% the population of Argyll & Bute has fallen by 1.7% over the last 10 years. Figure 3: Components of population change by administrative area NHS Highland: NHS Highland Workforce Development Plan 2012/13 15

20 Assuming the continuation of recent high net migration gains off set an established pattern of negative natural population change, the NHS Highland resident population is projected to continue to grow over the medium term to potentially 340,000 people by Over 75% of the NHS Highland population lives in a remote or rural location, including 35 inhabited islands. Geographical barriers such as extensive coastline and mountains and climate contribute to the physical aspects of remoteness, but social aspects such as low incomes, poor transport and small but ageing populations contribute to disadvantage in our most remote and rural areas. In contrast, other areas of NHS Highland are rapidly developing with rapid housing growth. There is a need for health care planning to be considered in both contexts.it is also important when designing new developments, that the new environment provides support for healthy lifestyles. Social changes include a move towards more single occupancy households, and fewer multi-generational households. If this trend continues, the number of single person households in the NHS Highland area is expected to increase from 48,920 in 2008, to 74,900 in Of these, 37,360 are expected to be people aged 65 years or older living alone. NHS Highland Workforce Development Plan 2012/13 16

21 Figure 4: Projected Population Change Numbers by Age Group and Gender, NHS Highland Area, 2008, 2023 and 2033 Assumptions about migration affect younger people in the main, so estimates of the number of older people are likely to be more reliable. Figure 4 shows the most likely population changes for 2023 and 2033, compared to Assuming that migration does not change this, by 2033 the single largest age group in the area is likely to be people aged years. The predicted percentage change by age group is shown in Figure 5. Taking a longer view, compared to 1980, the number of people aged 65 years and over will have increased from approximately 43,000 people in 1980 to over 103,000 people in NHS Highland Workforce Development Plan 2012/13 17

22 Figure 5: Projected Population Change Percentage Change by Age Group, NHS Highland Area, 2008 to 2033 According to the last census, only around 0.5% of the population in NHS Highland are from an ethnic minority background; again estimates of this proportion are likely to increase following the next census. No single ethnic minority group is predominant in the area and people are distributed widely across geographical communities.. Inward migration from Europe, largely Eastern Europe, has accounted for substantial changes in the ethnic minority population in recent years. Health and Health Care Needs in NHS Highland Long Term Conditions (LTCs): The prevalence of LTCs is increasing as a result of the ageing population and improving survival from previously fatal conditions such as cancer. There are increasing numbers of fit younger elderly people; but there are also increasing numbers of frail very elderly people, requiring a fresh approach to prevention and management of Long Term Conditions. Long Term Conditions and undefined symptoms represent a high proportion of GP consultations and hospital bed use. Dementia: The term dementia includes a variety of diseases that result in impairment of brain function, reduction in intellectual ability and personality change. Alzheimer s disease is one form of dementia. Prevalence rates are difficult to calculate, but do rise with advancing age, so a likely effect of the ageing population will be an increase in dementia prevalence. Currently, about 5,000 people in NHS Highland are estimated to be suffering from dementia. Many people with dementia have other co-existing long term conditions, such as circulatory disease or arthritis, requiring a holistic approach to clinical care planning and not just a single condition focussed approach. NHS Highland Workforce Development Plan 2012/13 18

23 Cancer: One in three people will develop cancer during their lifetime, and the condition is responsible for approximately 25% of deaths in the UK 11. Cancer incidence has been increasing in NHS Highland residents since the mid 1980 s, a trend that is likely to continue. During , an average of 2,244 Highland residents are likely to be diagnosed with cancer each year, rising to 2,467 cases a year during (Scottish Cancer Registry). This rising incidence is mostly due to the ageing of the population. Premature deaths from coronary heart disease and cancer are decreasing. The prevalence of smoking is slowly reducing, but smoking remains the biggest cause of avoidable mortality. The prevalence of obesity is still increasing and is likely to halt or reverse the downward trend in premature mortality. More effective interventions are still needed to prevent and treat obesity. Premature deaths from circulatory disease and cancer continue to decrease, while alcohol-related deaths are still increasing. Life expectancy and healthy life expectancy continue to increase, but the gap between the two is not reducing; while people are living longer and staying healthy for longer, many older people are still tending to spend the last years of their life with one or more chronic long-term health problems. Socioeconomic inequalities in health are also not reducing, despite the overall reduction in death rates. Health care over the next 20 years is likely to be dominated by the growing population of older people, particularly the rapidly increasing numbers of people aged 75 years and over. While many older people remain fit, active and able to live independently, there needs to be a fresh approach to helping and supporting the minority of the elderly population who are frail with multiple long-term conditions. One important health improvement intervention is preventing falls in elderly people, as fractured hips resulting from falls is a major reason for older people being admitted to hospital and being unable to maintain independent living subsequently. Up to half of all circulatory diseases and cancers could be prevented by major reductions in the prevalence of three common risk factors: smoking, alcohol and obesity. Providing targeted individual and group support to help smokers stop smoking, coupled with wider initiatives such as banning tobacco advertising and smoking in public places and promoting smoke-free homes and cars, have led to a steady decline in smoking prevalence in the adult population. However, around a quarter of the adult population still smoke and these efforts must continue if we are to reduce smoking prevalence further. We are now taking the same approach, of both targeting individuals with supportive services and developing healthy environments, to reduce alcohol consumption and obesity levels, but it is too soon to note any encouraging trends in the levels of these risk factors in our population. Nevertheless, it is important to continue with our current health improvement activities to reduce levels in the future information supplied to the Board by ISD (personal communication to Director of Public Health in 2010) NHS Highland Workforce Development Plan 2012/13 19

24 More detailed information about population, health and health care needs can be accessed from The Annual Report of the Director of Public Health 2011, which is available on the NHS Highland web site: df A key challenge for NHS Highland will be to maintain service delivery in rural areas where the population is falling. This will require the Board to work in partnership with the local authority and other agencies to maintain and enhance sustainable community infrastructure and development. From a workforce perspective it is crucial that the Board has in place workforce plans and workforce development approaches that are aligned to and address the health and social care needs of Highland population. A key focus for the Board is to support staff to see their role as supporting people in maintaining their own health, for example, ensuring front-line staff are aware of the more specialist services available to help with health behaviour change and direct people to them as necessary. NHS Highland Workforce Development Plan 2012/13 20

25 NHS Highland Strategy The Board s vision is: Quality Care to every person every day NHS Highland has three strategic aims which are underpinned by seven characteristics of service delivery. Strategic Aims In order to ensure delivery, NHS Highland has established its overall strategy based on the Triple Aim of: 1. To deliver better health (BH) of our communities through population wide and individually focused initiatives to maximise health and well being and prevent illness. 2. To deliver better care (BC) of our patients through quick access to modern services, in the most appropriate settings and in clean and infection free facilities by well trained professional staff. 3. To deliver better value (BV) for the use of the public money we spend. This is by ensuring there is no waste and inefficiency, where money is spent only on what is needed and has evident therapeutic benefits. Seven Characteristics of Service Delivery 1. promoting good health, self care and independence 2. high quality, integrated, equitable, needs and evidence-based, and cost effective 3. increasingly community based with hospital beds preserved for the most acutely ill and those with specialist needs 4. anticipatory care 5. run by health, flexible, well-motivated and well-trained staff working to their maximum potential and capability 6. using modern, flexible, efficient, green assets to maximum effect 7. with zero wastage and inefficiency across all services and no unnecessary overheads This approach embraces the Healthcare Quality Strategy for NHS Scotland 4 and the Efficiency and Productivity Framework for SR Quality is therefore at the heart of the Board Vision. NHS Highland believes that a focus on efficiency without attention to quality is unthinkable but equally that promoting quality with no regard for efficiency is unsustainable. Whilst it is recognised that the Service Characteristics are based on providing a high quality and efficient service, there is merit in being explicit that the overall strategic direction is based around a Quality & Efficiency Framework. This framework is 13 NHS Highland Workforce Development Plan 2012/13 21

26 designed to bring together the requirements of the Healthcare Quality Strategy and the Productivity & Efficiency Framework in a way that is meaningful to staff and also delivers the organisational requirements to maintain financial balance year on year. Quality & Efficiency Framework The aim of the NHS Highland Quality Approach is to improve the experience and outcome of care while systematically identifying and removing waste. There is considerable national and international evidence that better quality, safer care is more efficient and delivers financial benefits. The Board is therefore committed to bringing together our quality and patient safety approach and business transformation approach into one Framework. The focus of the Framework will be on targeting the following: Harm Clinical Variation Waste NHS Highland Quality Objectives 2012/13 To progress the delivery of our Vision in 2012/13, NHS Highland has identified 10 Quality Objectives that will lead to improvements in the quality and efficiency of services to our population. 1. Our Vision and Strategy (supports BH,BC,BV) Provide continuing clarity of strategy direction and ambition through the promotion and delivery of the strategic framework, the Highland Quality Approach and by improving quality and efficiency, by aligning objectives with practice and influencing and making sense of local, regional and national policy. Ensure that all key objectives in the Local Delivery Plan including the HEAT Targets and Single Outcome agreements are achieved. What this means for people they understand how services are delivered now and how they will be improved and changed for them and their families now and in the future. 2. Improvement and Change (supports BH,BC,BV) Lead and promote transformational change and continuous quality improvement, through visible and committed leadership, learning from others, developing capacity and capability for improvement, providing leadership for improvement work-streams and applying, accountability, transparency and rigour, through governance arrangements. What this means for people they are knowledgeable, committed, enthusiastic and actively involved, in improvement and change and can see how this makes a difference to service delivery on the ground. 3. Living our Values (supports BH,BC,BV) NHS Highland Workforce Development Plan 2012/13 22

27 Demonstrate a deep and broad commitment to our vision and to our values, ensuring people are at the centre of what we do, by showing interest and understanding of local issues on a daily basis and by learning in an honest and open way and sharing and celebrating success. What this means for people they see Leaders and Managers behaving in a way that is consistent with the organisations values. 4. Engaging Effectively (supports BC) Continue to improve meaningful engagement with patients and service users and the public, with staff and staff side colleagues, through partnership working and with clinical colleagues to ensure that wide engagement enhances and supports the Boards quality and efficiency agenda and the redesign of services. What this means for people they understand both their rights and responsibilities and feel able to contribute and be heard in a way that makes a real difference to services. 5. Focussing on Population Health (supports BH) Ensure that the Board continues to improve the health of the population and that of its own staff, so that more people take responsibility for their own health and care and enjoy good health for longer. Ensure that the focus on reducing the inequality gap is maintained and resources prioritised appropriately in supporting disadvantaged groups. What this means for people they feel healthier and are more independent and that the Board is interested and cares about their and their family s health and wellbeing and supports those that are most in need. 6. Promoting Community Responsibility (supports BH) Support communities to become more resilient themselves, through community planning, community development approaches and by taking an asset-based approach to health improvement as well as supporting community development initiatives, volunteering and other local initiatives. What this means for people they feel that they themselves and their communities are more resilient and self sufficient and are able to improve their own health and make best use of the resources they have and use them to solve local issues and problems. 7. Delivering Integrated Care (supports BC) Ensure that there is an integrated approach to the provision of seamless health care across primary and secondary care and between health, social care and the independent and voluntary sector and that services are redesigned to ensure that resources are used efficiently and effectively to benefit patients and service users. What this means for people their experience of services is seamless and are designed to meet their particular health and social care needs. NHS Highland Workforce Development Plan 2012/13 23

28 8. Delivering Person Centred Services (supports BC) Ensure the development of mutually beneficial partnerships between patients, service users, their families and those delivering health and social care services, which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision making. What this means for people they feel that their needs are paramount and everything that is being done is designed for their benefit and delivered in a caring manner. 9. Delivering Safe and Effective Services (supports BC) Ensure there is no avoidable injury to people from the health and social care that they receive or provide and that an appropriate, clean and safe environment is provided. Ensure that the most effective, evidence based treatments, interventions and support are provided at the right time to everyone who will benefit and that wasteful variation is eradicated. What this means for people they are treated appropriately and no further harm comes to them, whilst they receive care or participate in care delivery. 10. Delivering Efficient Services (supports BV) Ensure that services provided are as efficient as possible and that wasteful activity that doesn t add value is eliminated. Ensure that the organisation achieves breakeven and reduces its reliance on non recurrent funding, developing a sustainable financial position into the future. What this means for people they can see that the public pound is being spent wisely to give maximum value and that the financial future for NHS Highland is secure. The Highland Quality Approach recognises that workforce is an essential element in delivery of the Highland Strategic Framework ensuring that the workforce is planned, developed and aligned in an efficient and effective way to meet service delivery requirements in line with affordability, productivity, business transformation and service improvement. NHS Highland Workforce Development Plan 2012/13 24

29 NHS Highland Workforce Analysis NHS Highland has developed robust systems that monitor workforce trends. Detailed workforce information is provided on a quarterly basis to the Board, its formal committees and operational units. The following figures and graphs, illustrate NHS Highland workforce profile and trend analysis in whole time equivalent (WTE) for 2011/12 (year to 31 st March 2012), before the integration of adult social care staff from Highland Council and the transfer of community children s staff to Highland Council on 1 st April A summary of the adult social care staff is also provided at the end of this section. Table 1: NHS Highland Staff in Post as at 31 st March 2012 by WTE Staff Group Staff in Post 31 st March 2012 WTE Medical Dental 82.3 Medical and Dental Support Nursing and Midwifery Allied Health Professional Other Therapeutic Services Healthcare Science Personal and Social Care 30.2 Support Services Administration Services Management (non AfC) 65.9 Total 6,964.7 Source: Publication Summary, ISD NHS Scotland Information Statistics Department Topics/Workforce/Publications/ / Workforce-Summary.pdf? NHS Highland Workforce Development Plan 2012/13 25

30 Table 2: Workforce Trend for NHS Highland 2011/12 Staff in Post SWISS Extract Published by ISD 29 th May 2012 Staff in Post 31 st March 2011 Workforce Projections for 2011/12 WTE Staff in Post 31 st March 2011 WTE Staff in Post 31 st March 2012 WTE WTE Change WTE Highland % WTE Change Scotland % WTE Change Medical % 3.9% Dental % -0.4% Medical and Dental Support Nursing and Midwifery Allied Health Professional Other Therapeutic Services Healthcare Science Personal and Social Care Support Services Administration Services Management (non AfC) % 1.4% % -1.2% % -0.9% % 2.2% % -3.8% % -4.9% % -3.3% % -4.7% % (% calculated within overall Administration Services ) Total (or down 2.7%) 7, , % annual % change -1.6% annual % change Staff in Post Workforce Trend key Messages (table 2): Medical: projected increase as planned Dental: Exceeded planned projections, explained by vacancies at the beginning of 2011/12 that are now filled. Medical & Dental Support: expansion explained by medical and dental expansion above. NHS Highland Workforce Development Plan 2012/13 26

31 Nursing and Midwifery: projection exceeded. NHS Highland planned to reduce 54.0 WTE nursing and midwifery posts in 2011/12 in response to service redesign supported by skill mix reviews using, where available, nationally validated N&M workload and workforce planning tools. The Board continues to contribute to workforce information data quality in line with NHS Scotland overall approach and some data cleansing can explain the exceeded projection: o Primary Mental Health Workers were coded in nursing and midwifery job families. These have been removed and recoded to the correct workforce group. o Radiotherapy assistants were coded in midwifery and were identified and removed during the national midwifery data cleansing exercise. o Some posts in relation to Argyll and Bute mental health redesign that should have come out in 2010/11 (retirements) came out at the beginning of April These were not acknowledged as part of the 2011/12 workforce projections, but became apparent in the 2011/12 staff in post reductions. AHP: increase is directly related to the Change Fund; there has been a reduction of 10.74WTE in terms of CRES as a result of service redesign. Other Therapeutic: includes pharmacy workforce that did not reduce any WTE. Healthcare Science: is comparable with the trend for the rest of Scotland; can be evidenced by planned retirements and skill mix review, particularly in Blood Sciences as a result of integration of laboratory services. Personal and Social Care: no planned projections; no change to note Support Services: just short of projected WTE reduction. Administration Services: The largest workforce reduction which shows the most reduction of WTE and %staff change down for NHSH, which is also in line with and comparable to the rest of Scotland trend. NHS Highland Workforce Development Plan 2012/13 27

32 Figure 6: NHS Highland Workforce Staff Group Pie Chart as at 31 March 2012 (staff in post by staff group Headcount %) (Source NHS Highland extracted from SWISS) Nursing/Midwifery (Qual) 33.38% Staff Breakdown (headcount) Nursing/Midwifery (Unqual) 10.89% Other Therapeutic 2.40% Medical and Dental Support 3.21% Personal and Social Care 0.62% Senior Management 0.77% Medical 6.14% Support Services 13.07% Healthcare Sciences 3.05% Dental 0.91% Allied Health Profession 7.74% Administrative Services 17.82% NHS Highland Workforce Development Plan 2012/13 28

33 Figure 7: NHS Highland Age Profile as at 31 March 2012 (Headcount) (Source NHS Highland extracted from SWISS) HC Percentage Grand Total < NHS Highland s workforce age profile reveals an ageing workforce with the majority of staff in the age group, closely preceded by age group and age group (figure 7). This will have significant impact for NHS Highland in the coming years as the workforce ages and retires % (3,240 HC) of NHS Highland s workforce are over 50 years of age. Using the average retirement age projections, the percentages of our workforce that will still be with us in 5 years is 93%; in 10 years is 81%; and in 15 years is 69%. A third of NHS Highland s workforce will be eligible for retirement and can leave over the next 15 years; and in 20 years, 50% of the workforce will have reached retirement age. In addition, 81% of NHS Highland s workforce are female; of these 55% are working work part time. NHS Highland Workforce Development Plan 2012/13 29

34 Figure 8: NHS Highland Workforce Equality & Diversity Distribution 15 as at 31 March 2012 (Source NHS Highland extracted from SWISS) ETHNICITY DISABILITY Prefer Not To Answer 23.14% Prefer Not To Answer 14.80% Blank 2.38% Mixed 0.32% Black (inc British) 0.31% White 80.66% Yes 1.65% Blank 4.89% Asian (inc British) 1.39% Any Other 0.14% No 70.32% RELIGION and BELIEF Christian 49.97% Hinduism 0.40% Islam 0.46% Judaism 0.07% None 24.80% Buddhism 0.27% GENDER Blank 2.60% Other Faith/Belief 1.50% Prefer Not To Answer 19.92% SEXUAL ORIENTATION Transgender 0.09% Female 80.89% Lesbian/Gay Woman 0.24% Blank 5.27% Other 0.52% Bisexual 0.47% Male 19.02% Hetrosexual 93.05% Gay Man 0.45% 15 Ongoing effort that has been put into improving E&D data has seen significant reductions in blank returns for most of the categories. (Ethnicity from 13.42% to 8.97% in 2011 and down to 2.38% in 2012; and Disability from 66.77% to 24.48% in 2011 and down to 4.85 in 2012 are good examples) This data is important to ensure the Board is complying with its statutory requirements under Equal Opportunity legislation.. NHS Highland Workforce Development Plan 2012/13 30