NURSING & MIDWIFERY WORKLOAD & WORKFORCE PLANNING PROJECT RECOMMENDATIONS AND ACTION PLAN NOVEMBER 2006 UPDATE

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1 Forma cm NHS HIGHLAND WORKLOAD AND WORKFORCE PLANNING PROJECT RECOMMENDATIONS AND ACTION PLAN NURSING & MIDWIFERY WORKLOAD & WORKFORCE PLANNING PROJECT RECOMMENDATIONS AND ACTION PLAN NHS HIGHLAND NOVEMBER 2006 CONTACT: NIGEL HOBSON ASSOCIATE DIRECTOR OF NURSING

2 1 NHS Boards should have in place no later than 4 months after publication of this report an agreed action plan for taking forward the recommendations. The plan should include a timetable with costings backed by adequate resources and appropriate workforce planning capacity, and must be signed off by the relevant Partnership Forum. The Nurse Director will be the executive sponsor of the plan at Board level, and the action plan will form part of the formal accountability review process. Timeframes for review of systems should be made explicit in the plan. Accept NHS employers to implement. Comments: NHS Board Nurse Directors should take responsibility for the development of action plans for Nursing and Midwifery Staff. This should be undertaken within a four month period of publication. NHS Boards should consider the development of action plans that account for the wider workforce. Plan approved by Board October Plan approved by Highland Partnership Forum. September 2004 NHS Highland published its Workforce Plan 2006 which includes Student Nurse Intake Data requirements An Action Plan has been drawn up to implement the recommendations identified by NHS Highland Workforce Plan 2006 A structure and timeframe for the Nursing and Midwifery stream is being overseen by the Nurse Director, and takes account of NHS Highland Workforce Plan (2006) & NHS Clinical Strategy (2006), both of which are key underpinning documents to the implementation of Delivering for Health across NHS Highland A revised senior nursing structure now in place with Lead Nurses each having a portfolio of projects including workforce planning. Completed Completed Completed In place In place In place Nurse Director

3 2 The NHS Board action plan should demonstrate the balance between use of permanent, bank and agency staff. This must include savings targets on use of agency staff and details of how this money (or a proportion) will be reinvested in permanent nursing & midwifery staff. Accept NHS employers to implement. Comments: Action plans should be developed demonstrating methods to reduce costs associated with agency nurses and where this is being re-invested. These should build upon the recommendations of A udit S cotland s report P lanning Ward Nursing Legacy or Design? In addition, action plans should take into consideration the forthcoming recommendations on the Partnership A greem ent s com m itm ent to develop nationally co-ordinated nurse bank arrangements. NHS Highland has a relatively low usage of agency staff, (1.4% of total funded establishment). We are currently exploring how this can be further reduced particularly in respect of agency Nursing Auxiliaries. Bank utilisation is currently 6.2% of total funded establishment. Bank & Agency utilisation reports are regularly produced. An audit of bank & agency control measures is being conducted, and a standard for management will be agreed and implemented. The management of the nurse bank at Raigmore hospital has improved since its administration moved from the Job Centre to the NHS. Discussions are underway to examine the feasibility of administering the much smaller local nurse banks from an Inverness site. Unfortunately it has not been possible to purchase a computer system from Key IT this year, due to financial constraints, but we are continuing to explore how this can be resolved. In progress In progress: report to NHS Highland Board December 2006 In progress In progress Associate Director of Nursing

4 3 ISD, in partnership with representatives from NHS Boards and other relevant stakeholders, should progress to further develop appropriate indicators that allow accurate national comparisons of workload and workforce planning data. Progress towards any new or developed indicators should be reflected through the Performance Assessment Framework, accountability review and staff governance mechanisms. This will be taken forward nationally via the Nursing and Midwifery Workload & Workforce Planning Action Group. SNIP process in place which will continue and are incorporated into iterative Workforce Planning cycles. NHS Highland Workforce Planning Manager working directly with ISD to ensure data extrapolated from NHSH data systems and aggregated by ISD is improved in terms of accuracy. In place In place Manager: Nursing and Midwifery Workload and Workforce Planning Project; and ly Coordinated Nurse Bank Arrangements Project (SEHD) Nicola Rigglesford (ISD) 4 NHS organisations should have in place systems to demonstrate how flexible working practices are contributing to effective use of nursing & midwifery resources, increasing recruitment and retention rates and maximising benefits for patients. Quality indicators could include measures of workforce stability and turnover. Accept NHS employers to implement. Review of workforce planning information requirements has been completed Quarterly workforce planning reports including turnover; productivity; bank and agency use; employee friendly leave and vacancies in place A summary of nursing achievements during 2005/06 has been submitted to NHS Highland Board Recruitment and Retention Policy now in draft form Regular data now supporting progress and decision making Many Nursing & midwifery new roles and role development illustrated in Pay Modernisation and Benefits Realisation Delivery Plan Completed

5 5 The Scottish Executive Health Department should ensure that systematic approaches are applied to nursing & midwifery workload and workforce planning across NHS Scotland. Accept Workforce planning and development arrangements should be aligned to national, regional and local systems. This work will be taken forward through the Nursing and Midwifery Workload & Workforce Planning Action Group, membership of which includes the four Sub Group Chairs. The sub groups are responsible for the development & piloting of nationally agreed tools for: adult acute care paediatrics mental health primary care Betty Flynn, Regional Nursing Advisor, NoSPG is liaising with NHS Highland and updating regarding the national work. Regional links in place 6 Tools/systems need to be adapted at national level to take account of emerging patient acuity and workload issues, using a systematic process to ensure valid and reliable outcomes. This will be taken forward through the Nursing & Midwifery Workload & Workforce Planning Action Group and four sub groups (detailed above). Reassess the position in relation to the use of Birthrate Plus Local Action: Consultant Midwife

6 7 A balance needs to be achieved between resource intensity related to use of nursing and midwifery workload and workforce planning systems and the outputs of these systems. During pilot phase information on the resource intensity of using the workforce planning systems will be evaluated awaiting clarification from national group (linked to recommendation 6.) Comment: option to explore through pilot site in NHS Scotland. 8 Education and training on the use of recommended nursing & midwifery workload and workforce planning systems should be mandatory prior to implementation of any system, with regular updates made available. Accept co-ordinate at national level to ensure consistent approach to the use of tools. NHSH staff linking into the national Nursing and Midwifery Workforce and Workload Planning Module developed at jointly by NHS Grampian and Robert Gordon University. The course is delivered by Virtual Campus. First cohort complete in December 2006 Scottish Executive has processes in place for evaluation In place In progress

7 9 Directors of Nursing should lead an education and training needs analysis (E&TNA) of staff contributing to workforce planning locally to identify education and training requirements in relation to establishment setting, budget control, and resource allocation. This will help ensure consistent understanding of concepts and approaches. As Recommendation 8. Links with Workforce Planning Manager KSF will assist this process As above In place In progress Associate Director of Nursing Workforce Planning Manager Accept NHS employers to implement. 10 Continuing support should be provided for appropriate clinical leadership development initiatives at Charge Nurse / Team Leader level and Allied Health P rofessionals (A H P s). Accept - Support for continued clinical leadership development should be led by local NHS boards. For Nursing, Midwifery & AHP staff, this will be monitored and supported via the Facing the F uture group. T his should fit w ithin a national leadership framework which is presently being developed for all staff. 283 N urses, M idw ives and A H P s across N H S Highland have undertaken Clinical Leadership Courses as follows: 173 N urses, M idw ives and A H P s have completed the Long Program which commenced in September Four Long Programs have run, with one in progress until June N urses, M idw ives and A H P s have completed the Short Program which commenced in August Seven Short Programs have taken place. Benefits Realisation from clinical leadership investment now beginning to be quantified Progress Report to NHS Highland Board February 2007 Program evaluation and Action Learning Audit systems in place; course widened to include staff from other professional and non-professional groups. Incorporated into Pay Modernisation and Benefits Realisation Delivery Plan Associate Director of Nursing

8 11 A combination of tools should be used, with all services using a nationally agreed T elford -type approach as a minimum. This will be co-ordinated via Nursing & Midwifery Workload & Workforce Planning Group. 3 x Regional Advisors 12 The combination adopted should include patient dependency measure 1 standardised for each of the areas for which questionnaires were developed and sufficiently sensitive to detect changes in patient acuity. As Recommendations 5 & 6 above 4 x Sub Groups of Action Group responsible for identifying patient dependency (or dependency on community nursing team) tools Accept see recommendation 11. Pilot sites welcomed. 1 In com m unity settings, dependency refers to the com m unity nursing service, rather than patient dependency

9 13 NHS Scotland should adopt a standardised approach to determining quality of care. To avoid duplication, outcomes of the work being undertaken nationally by NHS QIS should inform actions on quality tools. Until that project produces its conclusions, a nationally agreed quality tool should be used in conjunction with a workforce planning tool and patient dependency measure. Accept NHSQIS are commencing work to scope, develop and pilot agreed clinical quality indicators for nursing for use across NHSScotland. SEHD have funded and commissioned this project recognising that the clinical quality indicators have the potential to benefit a number of areas including workforce planning and service re-design. Greater integration of Nursing & Midwifery Workload Project with NHS QIS clinical indicators in nursing work. Linkages between quality indicators & staffing levels to be explored. Initial work could be taken forward in pilot sites for NHS QIS data collection. Reviewing quality data and nurse staffing levels. Sept December 2006 (to allow for implementation of tools)

10 14 To satisfy the expressed wish for standardisation, systems for workforce planning currently being used should be tested to identify which best meet the needs of NHSScotland. This work will be taken forward through the NHS Highland Workforce Action Plan (2006) and Nursing and Midwifery Workload & Workforce Planning Action Group, membership of which includes the four Sub Group Chairs. The sub groups are responsible for the development & piloting of nationally agreed tools for: adult acute care paediatrics mental health primary care 15 A standardised approach to T elford, supported by IT, should be developed and applied consistently across NHSScotland. Accept - further scoping work required, will be commissioned at a national This will be co-ordinated via Nursing & Midwifery Workload & Workforce Planning. 3 x Regional Advisors

11 16 A national process for validating Recommendations should be developed and implemented. This work will be delivered via the Nursing & Midwifery Workload & Workforce Planning Group. Plans to be agreed. Existing national recommendations to be evaluated. All NHS Board Action plans to provide details of national recommendations currently in use. NHS Highland currently uses the guidelines from the Intensive Care Society for ITU, and adapts these to other critical care areas. In theatres the NATN guidelines are used.

12 17 Establishments should ensure that nurses and midwives who have overall team leadership responsibility in the direct care area have a minimum 7.5 hours per week of protected time to enable them to focus on leadership, managerial, education and clinical governance-related aspects of their role. Comment: Currently the situation varies across NHS Boards. As part of effective management of resources, all NHS Boards Nursing Workforce plans should reflect the principle of protected time for nurses in this leadership role. This should be managed within the total resource envelope that is available for nursing establishments and should be part of the effective management of predictable absence allowance. A survey conducted earlier in 2006 demonstrated significant variation in provision, for example, Charge Nurses in Mental Health in-patient services are supernumerary, whilst general / acute and community nurses have currently limited provision of protected leadership time. The mental health model was implemented by the former Highland Primary Care Trust. Since then Highland Primary Care, Highland Acute Trust and Highland Health Board have merged into one NHS Highland Board system. In addition, NHS Highland widened its boundary in April 2006 to incorporate Argyll and Bute CHP of the former NHS Argyll and Clyde. CHP Lead Nurses each have Workforce Planning as part of their portfolio. In addition Clinical Leadership programs are developing staff: A further piece of work is required to ensure that leadership protected time is uniform across the new organisation. April 2007 Associate Director of Nursing

13 IDENTIFIED LEAD 18 The predictable absence allowance should be a minimum of 21% 2, with a proportion (recommended as 1 of 21%) defined to support systematic management of maternity leave. The calculations on which predictable absence is based and the funding sources to support it should be clearly demonstrated in each nursing and midwifery establishment and NHS Board action plan. Comment: Recognising the situation is currently variable, each NHS Board, as part of their Action Plan, will need to specify to how they will reach this target, all within a timescale. Future revisions will need to identify how the 21% absence allowance will be achieved. A simple baseline survey conducted (April 06), demonstrated variability in the provision of a built in allowance for absence leave. Where such a provision existed it was 20%. Some establishments have not been reviewed and there is now additional pressure to account for the effect of Agenda for Change additional annual leave, and family friendly policies within PIN guidelines. The development of monitoring systems via quarterly workforce information reports and iterations of workforce plans will provide the data required to support decision making in establishments. April 2007 Associate Director of Nursing Workforce Planning Manager 2 21% is the figure recommended in the Audit Scotland report (Audit Scotland, 2002)

14 IDENTIFIED LEAD 19 Further research on nursing and midwifery workload and workforce planning is required in the specialty areas of paediatrics, psychiatry and primary care teams. This work will be taken forward through the NHS Highland Workforce Action Plan (2006) and Nursing and Midwifery Workload & Workforce Planning Action Group, membership of which includes the four Sub Group Chairs. The sub groups are responsible for the development & piloting of nationally agreed tools for: adult acute care paediatrics mental health primary care NHS Highland Workforce Strategy attached at Appendix 1 20 Although any tool used needs to take account of Level 1 patients, additional work in relation to these patients (and equivalents in non-adult acute areas) should be commissioned and undertaken. This work will be taken forward through the Nursing and Midwifery Workload & Workforce Planning Action Group, membership of which includes the four Sub Group Chairs. The sub groups are responsible for the development & piloting of nationally agreed tools for: adult acute care paediatrics mental health primary care

15 NHS HIGHLAND WORKLOAD AND WORKFORCE PLANNING PROJECT RECOMMENDATIONS AND ACTION PLAN Appendix 1: NHS HIGHLAND OVERARCHING WORKFORCE FRAMEWORK STRATEGIC FRAMEWORK: Clinical Strategy to support the implementation of Delivering for Health (2005); NHSH Corporate Objectives; Local Health Plan; Delivery Plan; & Development Plan ACCOUNTABILITY FRAMEWORK: NHS Highland Board; Staff Governance Committee; Pay Modernisation and Workforce Planning Board; Workforce Planning and Development Team: Action Plan to Implement Recommendations from NHS Highland Workforce Plan 2006 OVERARCHING WORKFORCE FRAMEWORK: KEY WORKFORCE PLANS Accessing the Future Workforce Recruitment Plan WORKFORCE PROJECTS Retention Plan (Staff Governance Integrated Action Plan) Delivery of Workforce Plans on an annual basis Nursing and Midwifery Workload and Workforce Planning Project Allied Health Professional Workload and Workforce Planning Project Workforce Development (new roles and role development) Shared Services Projects Modernising Medical Careers Consultant Recruitment Roll out Workforce planning skills across NHS Highland ENABLERS Pay Modernisation &Benefits Realisation Delivery Plan Workforce Information Systems and SWISS

16 NHS HIGHLAND WORKLOAD AND WORKFORCE PLANNING PROJECT RECOMMENDATIONS AND ACTION PLAN