Workforce Planning & Redesign WORKFORCE PLAN 2016

Transcription

1 Workforce Planning & Redesign WORKFORCE PLAN 2016 Author Service Lead and Queries Executive Lead Caron Fraser Gerry Lawrie Dr Annie Ingram

2 Do you have a visual impairment or have difficulty understanding the English Language? This document is available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) or (01224) NHS Grampian will pay for Language Line telephone interpretation or face to face interpretation for staff whose first language is not English, should this be required. Similarly, NHS Grampian will pay for British Sign Language interpretation or the production of materials in different formats for staff with communication disability. Please call NHS Grampian Corporate Communications on Aberdeen (01224) or (01224) P a g e

3 Foreword NHS Grampian, like many NHS Boards, is in a time of significant change. The new Scottish Government have signalled a review of the structure and regulation of NHS Boards which will take place over the summer, following the National Conversation and in light of the changing landscape of health and social care and the recently published National Clinical Strategy. The challenges of the NHS, nationally and locally are to do more than change but to transform. Transform the approach to services, with a greater emphasis on prevention and anticipation; accessible and flexible services, centred on the needs of the individual; improving community empowerment and improving outcomes. There is also a growing emphasis on regional working in both clinical and support services. In April 2016, three Integrated Joint Boards for Health and Social Care (IJBs) in Grampian took over responsibility for the strategic direction and, for many services, delivery of services, previously delivered by the NHS alone. Improvement, empowerment and partnership working are key to delivery of the strategic outcomes identified by each IJB. The IJBs are now established as legal entities with NHS staff, Local Authority staff and those from the third sector being increasingly directed by the priorities of the IJBs. The IJBs will also have a different working relationship with Acute Services. The impact on NHS Grampian is that it is an organisation in transition and work is progressing to provide clarity of direction for the health system and for NHS Grampian s role locally and in the North of Scotland. The emerging Clinical Strategy will be one of a suite of strategies that the Board will use to focus on the strategic issues that the Board is uniquely placed to develop. It is in this context that this Workforce Plan has been developed. The Plan recognises the different staff groups within the NHS and within partner organisations, acknowledging that high quality services are delivered by hard working people, responding to the changing demand, evolving delivery models and rising public expectation in an ever-changing environment. Success will require a motivated, innovative, developed and capable workforce, working in collaboration with others: patients, public and partners to bring the vision to reality. I am confident that the people who work for NHS Grampian are up to that challenge. Past performance is an indicator of future delivery and the achievements of our staff, their capability and commitment would suggest that together we can deliver the best care in Scotland. Malcolm Wright Chief Executive 3 P a g e

4 Table of Contents Foreword... 3 List of Tables... 5 Step 1: Defining the Plan Introduction Purpose of the plan Scope of the plan Ownership of the plan Update on Workforce Planning Action Plan 2014/ Step 2: Service Change National context: Local context:...14 Step 3: Defining the Required Workforce Data Cleansing Projections Future Workforce Demand Specific highlights New roles...39 Step 4: Workforce Capacity and Capability Current Workforce Finance Nursing and Midwifery Workload Workforce Tools...50 Step 5: Workforce Action Plan The Workforce Risk Plan The Learning and Education plan The Workforce Planning Action Plan...58 Step 6: Implementation Monitoring Review / Refresh...61 Appendix 1: NHS Grampian Vision and Values...62 Appendix 2 Current Workforce Profile P a g e

5 List of Figures Figure 1: Map of NHS Grampian... 6 Figure 2: Grampian Clinical Services Strategy Proposed Strategic Themes...15 Figure 3: Health and Social Care and NHS Grampian Strategic Overlap...16 List of Tables Table 1: NHS Grampian wte and % Split by Job Family 31st March Table 2: Split between Whole-Time and Part-Time by Job Family 31 March Table 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March Table 4: NHS Grampian Gender Split 45 Table 5: NHS Grampian Sickness Absence Rates, Monthly ISD, April March Table 6: Job Planning Completion as at 31 April Table 7: Employment Rates Table 8: Unemployment Rates 48 Table 9: Expenditure on Overtime and Additional Hours 50 Table 10: Gender Split as at 31 March Table 11: NHS Grampian Age Range as at 31 March Table 12: Age Profiling by Job Family, by Headcount as at 31 March Table 13: NHS Grampian Age Range by Job Family as at 31 March Table 14: Age Profiling by Job Family as Percentages 31 March Table 15: wte (Whole Time Equivalent) as at 31 March Table 16: NHS Grampian wte by Job Family as at 31 March Table 17: NHS Grampian Headcount as at 31 March Table 18: NHS Grampian Headcount by Job Family as at 31 March Table 19: NHS Grampian Whole-Time Part-Time Split (wte) as at 31 March Table 20: NHS Grampian Whole-Time Part-Time Split as at 31 March Table 21: NHS Grampian Sickness Absence Information (SWISS) 1 April March Table 22: NHS Grampian Sickness Absences (SWISS) 1 April April Table 23: Aggregated Starters and Leavers 1 April March Table 24: NHS Grampian Turnover 1 April March Table 25: Current NHS Grampian Vacancies by Division and Unit 71 5 P a g e

6 Step 1: Defining the Plan 1.1 Introduction This workforce plan for NHS Grampian describes the future workforce required to ensure delivery of quality services within the agreed values of Caring, Listening and Improving, outlined in Appendix Purpose of the plan The aims of this plan are to describe: the overall direction of travel for the workforce; the context and drivers for change; the type and level of changes required; the new roles and skills requiring investment; the new ways of working with our colleagues; the workforce risks; and the key actions to implement change. 1.3 Scope of the plan The Workforce Plan covers all services and locations across NHS Grampian (see figure 1). Figure 1: Map of NHS Grampian 6 P a g e

7 NHS Grampian provides clinical, corporate and support services for the people of Grampian and through Service Level Agreements (SLA) for other NHS Boards, including NHS Orkney and NHS Shetland. The Board also provides some services for the population of Scotland, for example, Extra Corporeal Membrane Oxygenation (ECMO). These services are included within the Board and Sector Workforce Plans to ensure comprehensive planning across all services that the Board is responsible for providing. Integrated Joint Boards (IJBs) for Health and Social Care assumed responsibility for strategic commissioning and delivery of a number for services on the 1 April NHS staff who work in the IJBs remain NHS Grampian employees and the IJBs have therefore been involved in the development of this Plan to ensure that the entire NHS Grampian workforce is represented. There has also been some early work with partners including Health and Social Care Partnerships to develop a consistent methodology for workforce planning across these new organisations. Effective Workforce Planning supports strong financial governance, financial planning and ensures the capacity and capability of the workforce are developed to support service development plans. All staff referenced within this plan are covered under the following national job families: Administrative Services. Allied Health Profession. Dental Support. Healthcare Sciences. Medical and Dental. Medical Support. Nursing and Midwifery. Other Therapeutic. Personal and Social Care. Support Services. 1.4 Ownership of the plan This Plan has been informed by the local Workforce Plans developed in partnership within each Sector, each Health and Social Care Partnership 1, as well as with Corporate and Support Services. It is by its nature, a summary plan and does not cover the substantial detail of any given Sector. The Workforce Plan fully recognises and accounts for the wide stakeholder and partner organisations influence on the planning of workforce resources within NHS Grampian. NHS Grampian works closely with other NHS Boards in the North East of Scotland through SLA 1 Health and Social Care Partnerships (HSCP) are the organisations and the Integrated Joint Boards (IJBs) are the Boards that oversee the strategic direction and governance of these partnerships. 7 P a g e

8 arrangements, managed clinical networks and the North of Scotland Planning Group. NHS Grampian fully recognises the importance of working with other partner organisations such as Aberdeen University, the Robert Gordon University, North East of Scotland College (NESCOL) and the three local authorities within the Grampian region to ensure that sustainable services are provided by appropriately trained professionals. Through public involvement and feedback, as well as the recent Local Clinical Strategy consultation, NHS Grampian fully recognises the contribution and expectation of the public and service users. The Workforce Plan and Workforce Projections are jointly approved by the Senior Leadership and the Board. The Director of Finance approves the Workforce Projections for affordability. The Director of Nursing and Allied Health Professionals approves the Workforce Plan as the Executive Lead for the use of Nursing and Midwifery Workforce Workload Tools. 1.5 Update on Workforce Planning Action Plan 2014/15 The following provides a brief summary of the progress against the ten key actions identified from the annual workforce planning cycle across NHS Grampian in Whilst this was not a complete list, it highlighted the priorities across the Board. 1. Actions to achieve the Workforce 2020 Vision have continued to develop and emerge through recent workforce planning cycles, including the development of new roles, for example, Clinical Development Fellows. The emerging Clinical Strategy for NHS Grampian recognises workforce as one of the key enablers and the Workforce vision will be reviewed. 2. Integration of Health and Social Care was recognised as a key priority as the organisational structures of the shadow IJB s started to emerge. Workforce planning is recognised as key work stream within each Health and Social Care Partnership (HSCP). Developing joint workforce plans that reflect the entirety of the HSCP workforce has and will continue to be supported by the NHS Grampian Workforce Team, the Senior Project Officer for Integration and Local Authority partners. Progress to date includes the development of profile and workforce planning templates. 3. Recruitment and overall workforce supply was a focus in 2015 with increased investment in the overall establishment. Initiatives such as earlier recruitment of students to posts within NHS Grampian, agreement of an SLA for moving and handling training of healthcare students with Robert Gordon s University have each contributed to the improved recruitment and retention of nursing students. The strategic governance and oversight provided by the Nursing Resources Group has contributed to 186 additional nurses in the workforce. A Return to Practice Nursing scheme has proved successful and a third cohort is planned. International and UK recruitment has aided recruitment of GPs and other doctors. 8 P a g e

9 4. A Professional Lead for Health Care Support Workers (HCSW) was appointed by NHS Grampian in Throughout 2015, work to strengthen education links, increase training and education, provide more qualification opportunities and the redesign of the HCSW role were undertaken and will continue to be a priority. See section 3.4 for further information on the progress of this action. 5. Nursing and Midwifery Workforce and Workload Tools have been applied consistently across the organisation. The use of these Tools has been overseen and strategically supported by the Nursing Resources Group who have established workforce governance groups, agreed methodology for validating workforce establishments and identified risks. See section 4.3 for further information on the progress of this action. 6. The age profile of the NHS Grampian workforce has been discussed in the 2015 Workforce Plan, and again in this Workforce Plan. With changes to the Scottish Public Pension Agency retrial age for NHS employees further work on age profile modelling and sustainability of an ageing workforce will be required. 7. The Scottish Government investment in Primary Care includes a national GP recruitment and retention programme which will contribute to local work being undertaken in Grampian. In 2015, work to promote Grampian as a desirable place to live and work remained a local priority. Social media, (Facebook and Blogspot), were utilised to widely promote the General Practice opportunities in Grampian and have been widely used. The Facebook page has 281 likes and in an average week in June posts to the page reached on average 840 people. The last post on the Blogspot received 4063 views, the majority, 3164, were from the UK. However there has been a wide geographic reach; 247 views were from the USA, 94 from Russia, 25 from China. 8. Succession planning for staff about to retire is a key issue documented in the Sectors and Service Workforce Plans during the 2014/15 workforce planning cycle. A Talent Forum has been established comprising of some Directors and Chief Officers. A revised Talent Programme for band 7 and above has been developed and a programme for band 4-6 has now been designed. This new programme will commence in September. Discussions have commenced with North East Learning Collaborative (NELC) partners, in particular Aberdeen Council, Aberdeenshire Council, Police Scotland and the Scottish Fire and Rescue Service, to share development opportunities and learn from each other, opening up master classes to the wider public sector pool and further support the development of talent. 9. Work has continued on career pathways to support the development of our workforce. Recent work around AHPs and Healthcare Scientists highlight opportunities to further develop the workforce in support of service redesign. A 9 P a g e

10 significant programme to promote succession planning and the development of Careers within Facilities and Estates has been progressed, with the creation of specific new roles to target risk, compliance and governance arrangements. There is also a significant element of up-skilling and skills transfer, associated with development of new and changing roles. These changes link very closely to both Career Planning and Service Redesign across the Sector. 10. Sector, Service and CHP workforce plans in 2015 continued to identify a requirement for an improved local supply of Advanced Clinical Practitioners. This has included Advanced Nursing Practitioners, Allied Health Professionals, Healthcare Scientists and Physician Associates. Please see section 3.4 for further information on the development of new roles. 10 P a g e

11 Step 2: Service Change Change is now common place across all health and social care services with ever developing demands on these services. Within this context of development and change, NHS Grampian continues to provide services which meet the needs and expectations of patients. This is managed, whilst striving for greater efficiency, ensuring best use of public funds, meeting national targets for patient care whilst achieving all aspects of governance and energy efficiency. NHS Grampian works with its partners to deliver services within the context of national and local drivers for change and complexity of planning over which it has little or no control. Through the workforce planning process each sector has identified the local and national drivers for change and complexity of planning for their specific services. Within this Workforce Plan the broader national and local context is considered below. 2.1 National context: NHS Grampian provides local services within the national context of NHS Scotland. In 2015 the Scottish Government identified the need for transformational change in NHSScotland to meet people s health and social care needs by This has been further developed into A National Clinical Strategy for Scotland 3, published February 2016, which proposes how clinical services need to change in order to provide sustainable health and social care services fit for the future. This clinical strategy recognises a number of key principles: Quality must remain a primary concern; Service developments should be evidence based; Services will be based around supporting people rather than single disease pathways; Services will continue to be planned and delivered at a local level where clinically appropriate; and Health inequalities will be minimised to ensure equitable access to health and social care. Prevention, encouraging people to live healthy lives, assuming responsibility for their own health is a key policy driver. This requires a different approach across health and social care. Whilst prevention and anticipation is important, access, when necessary, is equally important. The National Strategy has an emphasis on well-designed, accessible Primary Care in recognition of evidence from around the world that systems with a strong primary care service tend to produce better overall outcomes 4. The Strategy recognises that secondary care settings will also need to adapt, providing evidence that complex operations should be planned on a national, regional or local level on population rather than 2 The Scottish Government, A National Clinical Strategy for Scotland. Edinburgh: The Scottish Government 3 ibid 4 ibid 11 P a g e

12 geographical boundary basis. With the recent announcement of four major trauma centres to be created in Scotland, one of which will be in Aberdeen, the strategic vision to create regional tertiary centres becomes more tenable. More regionalised services across NHS Acute services is anticipated, this is further supported by the themes within the Chief Medical Officer s Annual Report for : Realistic Medicine 5 and the recent announcement by the Cabinet Secretary for Health Wellbeing and Sport at the NHS Scotland event where she announced a review of the number, structure and regulation of NHS Boards. The Chief Medical Officer s Annual Report Realistic Medicine supports the direction of the National Clinical Strategy, and recognises current models of healthcare services are stretched and do not always suit patients, their carers or the aspirations of the workforce 6. Through Realistic Medicine, a personalised approach to care can be built; where decision making is collaborative and relational; unnecessary variation in practice and outcomes is reduced; harm and waste are reduced and risk is better managed. Whilst, the national context steers strategic direction for NHS services and workforce planning, the Local Delivery Plan (LPD) Guidance 7 also highlights a range of measure and metrics which must be achieved and this has been considered in the development of this Plan, together with the Strategic Commissioning Plans of the Health and Social Care Partnerships (HSCP). The Scottish Government has prioritised investment towards transforming services to meet the needs of the future. The fundamental realignment of resources announced in the draft Budget are designed to build capacity of community-based services. Health and Social Care Integration Legislation to implement health and social care integration was passed by the Scottish Parliament in February 2014 and came into force on 1 April 2016; bringing together NHS and local authority care services under one partnership arrangement for each area. In total thirty one local partnerships have been set up across Scotland and will manage almost 8 billion of health and social care resources, including those currently associated with 96 per cent of delayed discharge and 83 per cent of unplanned admissions in the over 75s. HSCP will be jointly responsible for the health and care needs of patients, in particular the elderly, to ensure when people move between hospital and care settings their journey is better coordinated and, as seamless, as possible. One of the key aims is to ensure that local populations receive the care they need at the right time, in the right setting and that the workforce move towards a more preventative and community based approach. Governance and management arrangements are in place, but, 5 Calderwood, C Chief Medical Officers Annual Report : Realistic Medicine. Edinburgh: The Scottish Government. 6 ibid 7 The Scottish Government, NHSScotland Local Delivery Plan Guidance Edinburgh: The Scottish Government. 12 P a g e

13 there is still a degree of uncertainty as to how this will work in practice and significant longterm workforce issues need to be addressed, if integration is to successfully change the delivery of health and care services. For example, each partner body have long standing recruitment difficulties: within the NHS recruitment of GPs is recognised as a challenge; HSCP and Local Authorities report similar challenges in the recruitment and retention of care staff. Developing a suitably skilled workforce is crucial to the success of integration health and social care. This is challenging given the wide range of staff involved and the size of the workforce. NHS Scotland employs approximately 160,000 staff. Social services employ around 200,000 people, including those from local authorities, the voluntary sector and the private sector. Although HSCPs will not directly employ staff, they are responsible for coordinating services from a diverse mix of staff and carers and, as services change and develop, this will impact on the experience competence and capability required from these workforces to deliver more community-based support. The financial pressures on the NHS and Local Authorities will add to the challenge to meet the workforce needs; and difficulties in recruiting and retaining staff across different sectors, will impact on service delivery, including the role of the voluntary and private sectors. Once For Scotland The public service reform agenda, reiterated in the Programme for Government 8, has direct implications on health service provision, with an emphasis on the need to reduce duplication and inefficiency. The Once for Scotland 9 approach of shared services supports this through the anticipated reduction in geographical and organisational barriers to the delivery of support services and functions i.e. Finance, Payroll, Workforce, Catering, Decontamination, Linen and Laundry and Logistics. The Once for Scotland agenda promotes, where appropriate, that services should be managed on a Scotland-wide basis and should be delivered in a consistent way, unless a compelling reason exists for variation 10. Moving towards shared services at a regional or national level has implications for Corporate, Clinical and Support workforces across NHS Scotland. NHS Grampian fully recognises the potential benefits of working to the shared services agenda and has undertaken tests of concept for regionalised services outlined in section 2.2. Underpinning the shared services concept is the identified need for support services to sustain a health service that will increasingly have to work across boundaries, organised around the individual rather than a single disease pathway, as outlined in the National 9 The Scottish Government. NHS Scotland Shared Services accessed online; 10 The Scottish Government. NHS Scotland Shared Services accessed online; 13 P a g e

14 Clinical Strategy. The integration of health and social care services is a fundamental shift to achieving this, the potential regionalisation of Acute Services would be consistent with aims of the National Clinical Strategy and public sector reform. Staff Governance Staff, who are well informed, appropriately trained and sharing best practices can influence and deliver services in the changing health care setting. The Staff Governance Standard of NHS Scotland 11 supports, through a statutory commitment, the continuous improvement of the experiences of NHS staff. The Everyone Matters 20:20 Workforce Vision 12 recognises in order to provide a health service that is safe, effective and person-centred, the workforce of NHS Scotland must work within a healthy organisational culture, underpinned by a workforce that is capable, sustainable and integrated, managed and led by effective leaders. Everyone Matters 20:20 Workforce Vision provides the strategic workforce direction and Boards are also required to submit an implementation plan annually. The implementation plan 13 is the third of its kind since the launch of Everyone Matters. The focus this year moves away from embedding NHSScotland values, leadership and quality improvement, towards focusing upon on health inequalities and on integration. 2.2 Local context: The national context, within which NHS Grampian operates and provides services, influences the local context. Across NHSScotland there is a drive for improved financial efficiency and savings. NHS Grampian requires to make estimated cash savings of 18.5 million in 2016/17. To achieve this, NHS Grampian will require to consider how it can support its workforce to work differently, providing services in new and innovative ways to ensure long term sustainability, with strong financial governance. To achieve NHS Grampian s 20:20 Healthfit Vision and develop a sustainable health service, NHS Grampian recognises the need to encourage the workforce to be innovative, but this will also require investment in services, workforce and new infrastructure. NHS Grampian has an excellent track record of innovation, leading the way in service delivery and, importantly, improving care, health and patient outcomes. This is due to the dedication and drive of staff. Like many NHS Boards in Scotland, the population of NHS Grampian is ageing, with an increasing number of people living with multiple long term conditions. This has an impact on service models and, as the workforce ages, the way services are provided. 11 The Scottish Government Staff Governance Standard A Framework for NHSScotland Organisations and Employees. Edinburgh: The Scottish Government. 12 The Scottish Government Everyone Matters 20:20 Workforce Vision. Edinburgh: Scottish Government. 13 ibid 14 P a g e

15 Over the next thirty years, it is estimated that those over 85 years will increase by 123%, and those aged 65 to 84 years will increase by 39% 14. Currently 30% of the population of Scotland is obese, 20% smoke and 78% do not meet the recommended daily intake of fruit or vegetables 15. These estimates suggest the challenges currently faced will intensify over the coming 30 years. NHS Grampian is developing its local Clinical Services Strategy 16 to support the development of services and workforce to sustainably meet the health needs of the local population. The Grampian Clinical Services Strategy was consulted on between 9 th March and 6 th May The consultation had a focus upon the priorities identified below: Figure 2: Grampian Clinical Services Strategy Proposed Strategic Themes These strategic themes recognise that prevention of ill-health through promotion of healthy living is crucial if health and social care providers are to be sustainable in the long term. Recognising that many of the population do have one or a number of long term conditions, an approach that fosters active self management is a key aspect of living healthier for longer. Improved self management should reduce the requirements for both planned care and unscheduled care, or should ensure that interactions are planned rather than unplanned. There is a need to achieve the right balance to meet the needs of the population. As an organisation the aim is to ensure that the change and improvement across all four strategic themes is balanced. The expectations of patients, services users and the public were identified through the consultation on the Grampian Clinical Services Strategy. As reflected in the National Clinical Strategy and extensive consultation exercises in support of Integration, people do want to have greater say in how their health is managed. When care is required, this should 14 NHS Grampian Grampian Clinical Services Strategy The Case for Change: Factors Influencing Change in Planning For Health and Health Care. NHS Grampian : Aberdeen. 15 ibid 16 NHS Grampian Grampian Clinical Services Strategy Consultation Pack. NHS Grampian: Aberdeen 15 P a g e

16 be at home or closer to home in a homely setting, within their local community. Teams should be better aligned, with more joined up team working around individual needs. Better communication and coordination for complex care was also identified as important, reinforcing the move toward person centred care, over single disease pathway, supported by collaborative decision making. The consultations highlighted an expectation that the NHS should be using more technology, with better involvement of the community and community resources. The expectation of patients and service users that there are no boundaries between HSCP highlight challenges in the way we work. Not only of the NHS and social cares staff working in the HSCPs, or the Acute Sector, but also for those in the third sector. All three partnerships have different priorities based on client need and service demand, within the context of their localities, and are developing their own strategic plans to respond to current and future needs. Working with three individual partners in this way increases the complexity of future planning for a sustainable and capable workforce across the system. Figure 3: Health and Social Care and NHS Grampian Strategic Overlap In the current period of transition and looking to the future, the NHS Grampian Clinical Strategy and the supporting Workforce Plan must focus not only on NHS Grampian priorities, but also those of partners and must ensure appropriate support to develop and maintain strategic and operational links with the new organisations. Across all strategic plans, the focus on individual patient pathways and person centred care is the priority, not who is providing them. Efficient and effective strategic and operational relationships should enable the needs of individuals to be met across all services. Caring, Listening, Improving NHS Grampian seeks to foster a culture of Caring, Listening and Improving (Appendix 1). Cultures are created by people, not by organisations. Organisations can, however, 16 P a g e

17 influence culture through identification and embedding of accepted behaviours. During , the Staff Experience Group, reviewed the underpinning behaviours that support the NHSScotland Values 17, as defined within NHS Grampian (see Appendix 1), not only in relation to patient care but also to support the improvement of staff experience. Research 18 suggests that where staff experience a positive culture in a healthcare environment, outcomes improve and mortality reduces. Engaging employees positively can foster a culture where retention of staff is better and sickness absence and stress are reduced. Measuring staff experience, and measuring it over time, is important to demonstrate improvement. imatter is NHS Scotland s proprietary tool to measure staff experience, currently being implemented across Scotland under Everyone Matters 20:20 Workforce Vision. Over the course of the year from April 2015, imatter has been successfully implemented to 6167 staff, in three cohorts within NHS Grampian. The consistently high response rates across all three cohorts suggest that staff have greater ownership over the imatter tool than the national staff survey. Staff, Team and Directorate ownership of the tool is a fundamental part of empowering and engaging staff more effectively in their experience at work. The imatter tool is being implemented and utilised to support the values of NHS Grampian, supporting our workforce to be engaged. Shared Services Proving it Works NHS Grampian is involved with other regional partners to prove that shared services can work and deliver sustainability and improvements 19. The shared services agenda s influence and impact reaches beyond the immediate workforce involved in providing a particular service. It impacts on the broader workforce particularly when that service is a Workforce support service. NHS Grampian has for some time provided payroll services for NHS Shetland and NHS Orkney. Over , the HR Service Centre has been working with colleagues from NHS Tayside, to demonstrate how a collaborative approach for the delivery of Payroll, Car Leasing, Expenses and Scottish Standard Time System (SSTS) services might be delivered. A single management structure will be introduced, with the two Boards working as a virtual team to improve processes and increase areas of best practice, whilst continuing to deliver high quality local services for local people. NHS Highland have recently joined this collaborative. Key to the success of this collaborative is sustainability of services for the long term and protecting local jobs for local people. 17 NHS Scotland Values: Care and Compassion; Dignity and Respect; Openness, Honesty and Responsibility; and Quality and Teamwork 18 West, M Employee Engagement and NHS Performance. London: Kings Fund 19 The Scottish Government. NHS Scotland Shared Services accessed online; 17 P a g e

18 With an effective Service Level Agreement (SLA) in place since 2012, NHS Grampian was invited by NHS Orkney in 2015 to develop an integrated HR service. It was agreed by both organisations, that this could also be an important proof of concept, demonstrating how two HR services could integrate; ahead of the final roll-out of electronic Employee Services System (eess), which will assist the implementation of shared services. NHS Grampian and NHS Shetland are collaborating in terms of an SLA for Payroll Services and in relation to Public Health Services, with the Director of Public Health for NHS Grampian taking responsibility for NHS Shetland. This presents an opportunity to identify Public Health shared services across the boards and further connect acute care pathways which impact on Island patients. Such support for care networks may provide learning for future regional working. There are other shared services initiatives emerging, particularly in Facilities and Estates, where NHS Grampian is engaging in emerging regional solutions for laundry and linen, sterile supplies, logistics, waste, and procurement. Recruitment The local economy and labour market within Grampian is primarily driven and influenced by the oil and gas industry. The impact of this has been two-fold; attraction and retention of common staff groups, particularly trades staff within Facilities and Estates and IT experts; and through an increased cost of living and competition within the NHS that served to deter medical, nursing and AHP professionals from relocating to Grampian. Brent oil prices have fallen dramatically since 2014, and whilst there has been some recovery over 2015 and 2016, the industry remains in a significant downturn period. It is estimated that 375, individuals are employed within the Scottish oil and gas industry, with a significant proportion based within the North East of Scotland. With redundancies and employee benefit cuts expected to continue as the industry strives for sustained efficiencies, the labour market within the North East of Scotland remains significantly unsettled. This seems to have improved recruitment to a variety of hard to fill roles, as the ongoing downturn in oil and changing labour market has led to an increase in applications in a number of roles: Healthcare Support Workers, Administrative, HR, Finance and IT. Overall recruitment activity has continued to increase over the year and 2015/16 saw 2,248 vacancies being advertised, which attracted 50,237 applications. In comparison to 2014/15 figures (1,950 and 42,607 respectively), this equates to an increase of 15% in jobs advertised and 18% increase in applications. The average of twenty-two applicants for each vacancy is being maintained. Since 2012/13, the actual number of applications processed has increased by 65%. 20 Scottish Enterprise Scottish Keyfacts. Edinburgh: Scottish Enterprise. 18 P a g e

19 Despite the improving market, the difficulty of capturing the interest of suitable candidates and filling posts remains challenging, particularly for nursing and midwifery posts and some medical roles. In response, various initiatives have been put in place, including the implementation of Return to Practice courses to enable people to return to various specialties within Nursing and Midwifery, attendance at various careers fairs across the UK and a presentation to the Consultant s Sub Committee to raise awareness of the necessary Medical Recruitment procedures. 19 P a g e

20 Step 3: Defining the Required Workforce 3.1 Data Cleansing Effective workforce planning should describe the required future workforce, based upon drivers for change, utilising accurate and quality data on the existing workforce and identifying key workforce trends. To maintain the quality of this data, NHS Grampian continues to work with local managers and with Information Services Division (ISD), to maintain a robust data cleansing process. An annual data cleansing process commenced early December 2015 and was carried through to end of March Projections Workforce projections have been undertaken in each sector and are submitted to the Board separately to this Plan to ensure appropriate governance. These projections have influenced workforce planning with each sector and are published by Information Services Division (ISD). 3.3 Future Workforce Demand NHS Grampian has already made significant progress towards development of the future workforce following analysis of service need and changing landscapes to develop new roles and approaches. In recognition of changes to Corporate and Support Services, NHS Grampian is undertaking proof of concept of shared services, developing services which remove potential barriers to ensure flexible and efficient working. To meet the future demand on health care services and ensure a service fit for purpose, where heath and social care services fully integrated, there is a clinical focus on prevention, supporting self management and a move to support people within their community or locality. A changing focus of healthcare, with a stronger focus on support rather than intervention, will change the role of staff within community settings. The emphasis on hospital at home, for example, will mean that staff who have traditionally worked within the Acute sector will work across traditional boundaries, working within localities to support people in the Community. The emphasis for the Acute sector will be to provide more specialist services as the tertiary centre for the North with a specialist workforce. Increasingly, the workforce across NHS Grampian, including those working within the HSCP s, will need to operate within a digital environment, utilising innovative approaches, including digital platforms to support self management, hospital at home and the delivery of outpatient services. The aim is to reduce the number of return visits to hospital; provide more diagnostic tests locally and provide advice directly to service users at home. Through the workforce planning process each sector has highlighted the future demand for their workforce, summarised below: Aberdeen City Health and Social Care Partnership 20 P a g e

21 Aberdeen City Health and Social Care Partnership are responsible for planning and delivery of adult health and social care services across the City. Social Workers, Community Nurses, Allied Health Professionals, GPs and other colleagues from services in the health, care, third, independent and housing sectors will be working more closely together to offer an improved seamless service to individuals and their carers. Aberdeen City HSCP aims to invest in Telecare and Telehealth solutions to give people more control over the management of their health problems at home and reduce reliance on traditional health services. The involvement of service users and carers in the planning and delivery of community based health and social care services is seen as key and consideration is also being given to locality based roles including Link Workers and Local Area Co-ordinators. Their plan is to develop fully integrated teams that will work across sectors and pathways to ensure that individuals and their carers who use the services have more positive outcomes. Strong collaborative relationships will be developed with the Acute sector so that mutual challenges can be addressed and shared objectives fulfilled. The key workforce considerations for this first year are highlighted below and are mirrored in the other HSCPs in Aberdeenshire and Moray: Recruitment and retention of staff, particularly the resources required for care and support services for Adults living independently. As the population ages, the demand for support for people to remain at home for as long as possible is increasing. Investing in staff induction and training e.g. effective leadership skills, people management skills, advanced skills training, particularly for staff who are not affiliated to a professional body and are delivering care in the community, many of whom are involved in new ways of working. Change Management i.e. accepting the cultural differences of all partner organisations and professions. Acknowledging that integrating different cultures will require an understanding of roles and responsibilities and the support required in achieving this awareness and acceptance. Strengthening the links with all services that are hosted by and those that may move into the Aberdeen City HSCP. Engaging with staff at all levels, listening to them and involving them in decisions which will affect them. Gathering knowledge of what is important to staff, listening to what goes on at the front line, facilitating relationships that support collaborative working across all organisations through existing and new forums such as staff surveys, team meetings, appraisals and networking. 21 P a g e

22 Aberdeenshire Health and Social Care Partnership By the year 2035, the number of people living in Aberdeenshire aged over 65 will have increased by 65%. Health and social services in the area are not currently resourced, organised and provided in ways that are likely to equal these challenges. Recruitment and retention of staff is a major challenge; in some areas there are problems in employing enough home carers, health assistants and GPs. Health and Social Care Services in Aberdeenshire are primarily delivered through NHS Grampian and Aberdeenshire Council in partnership with the third sector and independent organisations. Although recruiting and retaining staff is a major challenge in some areas, as noted above, the plan for the next 12 months will be to focus on maintaining a stable workforce with limited change. As integrated teams develop, workforce and organisational development plans will be created, considered and approved by the IJB. Some of the key considerations for this first year are: Recruitment and retention of staff; particularly the resources required for care and support services for Adults living independently. As with Aberdeen City, the demand for support for independent living is increasing. Aberdeenshire will focus on: creative recruitment solutions for specific workforce groups with higher than average rates of turnover; developing and implementing robust recruitment processes; promoting the benefits of working within the Aberdeenshire HSCP; and developing closer links with schools, colleges and universities. Remaining mindful of the Christie Commission Report: investing in staff induction and training e.g. effective leadership skills, people management skills, advanced training, particularly for staff who may not be affiliated to a professional body but are a valued resource by delivering care in the community and becoming involved in new ways of working. With support from colleagues in Learning and Development, create a workforce which will deliver quality care; support all staff development needs, particularly those working in specialist units, encouraging positive leadership and accountability. Consider and implement a range of retention tools to help support, retain and develop specific workforce groups, initiatives may include grow our own schemes, offering existing staff career pathways for development; mentoring or buddy schemes. Change Management i.e. accepting the cultural differences of all partner organisations and professions. Acknowledging that integrating different cultures will require an understanding of roles and responsibilities and the support required in achieving this awareness and acceptance. Involving Organisational Development colleagues in cultivating a collaborative workforce which will create equal and reciprocal relationships between health and social care professionals. 22 P a g e

23 Strengthening the links with all services that are hosted by and those that may move into the Aberdeenshire HSCP e.g. Integrate Community Mental Health/Some Acute Medical Services into Aberdeenshire HSCP (once approved by the IJB). Engaging with staff at all levels, listening to them and involving them in decisions which will affect them. Gathering knowledge of what is important to staff, listening to what goes on at the front line and using this to influence working links across all organisations e.g. Staff surveys, team meetings, appraisals and networking. Moray Health & Social Care Partnership The Moray Health and Social Care Partnership (MHSCP) comprises of an integrated workforce delivering services to all adults (18+) in the Moray region. This includes existing service user client group s e.g. older people, learning disability, and mental health. Moray, like many areas, faces major challenges in recruitment and retention of appropriately skilled staff and there is a continuing need to train and develop skills as the nature and demands of jobs change within integrated services. Staff are a valuable resource and the changes required across health and social care will not happen without them. Supporting informal carers and volunteers and ensuring a flexible, well-trained, motivated and highly-valued workforce will be pivotal in the delivery of the Moray Strategic Plan. Services in Moray are primarily delivered through the NHS and Moray Council, in partnership with communities and the voluntary and independent sectors. Over the coming year, the plan is to retain a stable workforce with little change as the process of developing integrated teams are initiated and Workforce and Organisational Development Plans are updated, considered and approved by the IJB. Some of the key considerations for the coming year are: Focus on recruitment and retention particularly the supply of resources for highly skilled specialist units and targeting the supply of specific workforce groups with higher than average rates of turnover. Induction and Training e.g. Leadership skills, People Management skills, additional training particularly for staff who are not registered to a professional body and are involved in delivering The Reshaping Care for Older People programme. The aim of the programme is transforming the culture and philosophy of care and The Community Care Redesign programme that will assist in meeting future demands on services. Cultivate a collaborative workforce: develop equal and reciprocal relationships between health and social care professionals. Develop career pathways and provide opportunities for staff motivated to advance in their chosen career. Change Management: Support culture change by developing a positive ethos and working environment where needs and expectations are understood and responded to by staff with different cultural backgrounds. 23 P a g e

24 Strengthening the links with services that are hosted within or may move into the Moray IJB e.g. Integrate Mental Health and Learning Disabilities services into the MHSCP. Feedback from staff surveys and the ongoing benefits of the already established Employee Engagement Programme. Achieve a National Health and Wellbeing Outcome prescribed by Scottish Ministers i.e. Listen to the feedback from staff surveys, respect the workforce and provide the support and trust needed to help them achieve positive outcomes for their client group whilst feeling engaged with the work they do. Improve information sharing and develop easy access to service information across Moray. Acute The Acute sector care model is one of consultant led clinical services, delivered through multidisciplinary teams. It assumes continued development of community alternatives to inpatient care, together with more rapid and direct access to diagnostic services. The Acute model of care seeks draw a distinction between access to specialist opinion via either an elective or unscheduled care referral, and the requirement for a patient to be present to receive access to that opinion. Achieving the new model of care will require close working with other sectors, improved workforce planning and a fundamental shift in mind set. It will be facilitated via the use of technology e.g. the Clinical Guidance Intranet (CGI), and innovative solutions to enhance electronic analysis and communication. Integration of health and social care, working across primary and secondary care will impact upon the workforce requirements. Some of the key considerations for the coming year are: The continual refurbishment of the estate with particular developments within the timescale of this Workforce Plan, including the continuation of the Phase 2 refurbishment; development of new theatre capacity; the Baird Project to build a new Family Hospital and replace Aberdeen Maternity Hospital; and the Anchor Project to extend the Cancer Centre will all have a direct impact upon the workforce plans and roles required for the delivery of service. Recruitment of many staff groups remains a challenge within the sector. Whilst many of these are also national issues, including Oncologists, Interventional Radiologists and Pain Consultants, others are affected by more locally based conditions. Active recruitment is ongoing across professions and disciplines supported strategically through Recruitment 20:20 and the Nurse Resources Group; including new initiatives, such as the NHS Grampian Return to Practice nursing scheme. The Acute sector continues to utilise block adverts, external advertising and recruitment initiatives, and engagement with the local Universities to improve recruitment and reduce attrition rates. The need to continue to be inventive in recruitment endeavours and share successes across all areas is recognised. Ongoing skill mix redesign will continue across all teams, however some already defined patterns will remain; with more band 3 administration staff, more band 3 or 4 Health Care Support Workers and more band 2 Housekeepers. The difference in this workforce plan is the likelihood of recruitment, as the local labour market adjusts. 24 P a g e

25 There will be a broad requirement for generic skills training in support of band 3 and 4 roles. These roles are developing across the Acute sector, from very specialist areas like Laboratories and Intensive Care to general wards and out-patients. As an organisation, NHS Grampian needs to support staff to move across different sectors and services. Further work is required to develop a process supporting greater flexibility in the workforce, through movement of staff to ensure effective utilisation based on patient needs. Although there has been an increase in the medical and nursing workforce over recent years, the Acute sector will continue to engage with the development of and utilisation of new roles to support service delivery i.e. Physician Associates, Advanced Critical Care Practitioners, and Clinical Development Fellows. It is fully recognised that new roles will need new competencies and the organisation will need to be able to support staff in their training needs. Mental Health and Learning Disabilities The Mental Health and Learning Disability (MHLD) Services currently provide secondary and tertiary care for the population of Grampian. Support is also provided to NHS Orkney and NHS Shetland through the Obligate Network. In addition, the Specialism s Directorate hosts the Eden Unit, which is a North of Scotland facility for adults with Eating Disorders. Grampian is served by a Learning Disability Service comprising an eighteen bedded inpatient facility in Aberdeen (Elmwood), and five Community Learning Disability Teams (CLDTs). The MHLD Workforce Plan defines the future workforce and the changes that are required to ensure safe and sustainable service delivery. It covers all staff groups within inpatient, out-patient and community based services, including the impact on non-nhs services. Some of the key priorities the workforce plan covers are: Continuing a whole service redesign, in partnership with staff and their representatives, which will have a significant impact on the future workforce profile. Work to revise referral criteria is complete and the emphasis has moved to the MHLDS service pathway and the alignment of the Community Mental Health Teams (CMHT s) and Community Learning Disability Teams (CLDT s). The impact of this is un-quantified at this stage. The Child and Adolescent Mental Health Services (CAMHS) are also undergoing review. Future developments around health and social care integration will impact on future workforce demand. Current workforce planning is based on the current model and projections, but this is expected to change significantly over the next year as the MHLD redesign, and the integration agenda progresses. MHLD have seen a significant reduction in the number of Career Grade medical staff due to retirement and difficult to fill vacancies. Nationally, there are significant gaps in the Higher Training programmes for doctors in training and locally, there are substantially fewer doctors at all levels of training working with NHS Grampian. There are plans to merge rotas but there is an urgent need to address the gaps in training if Scotland is to secure a future Psychiatry workforce. Recruitment and retention of career grade medical staff and doctors 25 P a g e

26 in training, is likely to require further redesign for Nurse Practitioners, Physician Associates and Medical Support Nurses. Nursing workforce risks are generally related to vacancies, which are addressed through extensive use of bank staff to staff wards to a safe level. The use of bank staff ensures patient and staff safety, however, mental health care is provided largely through effective relationship building and unfamiliar bank staff impact on this therapeutic relationship and can increase the risks. The recent appointment of twenty two HCSW and the anticipated appointment of Robert Gordon University Stage 3 Students to band 5 registered Mental Health Nurse posts will help create a more sustainable workforce. This will have a positive impact on nursing vacancies and will lead to a significant reduction in bank use and, more importantly, an increase in quality of care. More opportunities for advanced and specialist practice will be available due to integrated services, service redesign and changes to the mix of health and social care staff. There are also ongoing difficulties with recruitment of MHLD AHP staff and in particular, recruitment of AHP staff from outwith Grampian. Some redesign and skill mix has been necessary to try to address these shortages. MHLD AHP Leads are working with leads in other sectors with similar recruitment challenges, to identify common solutions. In response to consistent challenges in the recruitment and retention of Psychology staff, MHLD are working in partnership with Primary Care colleagues, across the three Grampian Integrated Joint Boards (IJB). MHLD have supported the bids for Scottish Government money to redesign access to Psychological Therapies and CAMHS Services to include Psychology Assistants, Clinical Associate Applied Psychologist (CAAP s), and Primary Care Mental Health Workers. These roles can offer low intensity psychological therapies for mild to moderate psychological disorders in Primary Care and should reduce the likelihood of patients developing more complex and severe psychological disorders, and consequently, potentially reduce the demand on secondary care. The skill mix over all other disciplines continues to be reviewed; including a reduction in higher bandings and an increase in staff in lower bandings. Redesigned roles will allow specialist staff to concentrate time on those patients who most need their skills and expertise. It is planned that the acute MHLD service will be hosted within one of the IJBs. Work is ongoing to agree the budget. Several areas of financial review relating to service redesign and property have been explored with a view to a number of financial savings. Corporate Services Corporate Services are provided from across a number of Directorates: Workforce, Finance, Corporate Communications and Board Secretariat, Modernisation and ehealth. These services support clinical services and NHS Grampian as an organisation, to achieve its strategic aims and ensure that Clinical, Staff, Financial and Information Governance standards are maintained. 26 P a g e

27 Corporate Workforce Planning is influenced by the needs and demands of stakeholders, together with national and local strategic priorities. Some of the key considerations from across Corporate Services in the coming year are: In line with the Shared Services and Once for Scotland concept, workforce planning and service demands are being reviewed. Consideration given to how boundaries to providing services across current silo s can be provided internally, and shared with other NHS Boards through tests of concept of regional shared services. Across services, new ways of working, review of skill mix, increased flexibility and review of competencies are being taken forward to ensure capacity to respond to increasing demands on services. Improving opportunities for young people is a Government priority, with a stated aim to increase the number of Modern Apprenticeships (MA s). This will improve succession planning, enable services to build career pathways and address recruitment and retention difficulties. Modern Apprenticeship (MA s) have been established within a number of directorates, including Finance and Workforce. Facilities and Estates As a predominantly demand driven service, future projections in workload, and therefore workforce, are determined by the level of clinical and other healthcare demands placed on Facilities and Estates services. A key element in this demand is the delivery of the NHS Grampian Vision 21, supported by the Local Delivery Plan and the Property and Asset Management Plan 22. These are likely to lead to significant disinvestment in property and a reduction in estate. Future changes in workforce within the Estates and Facilities Sector will be mainly dependent on a variety of these factors. In previous years, the Facilities and Estates Sector has been able to make significant progress in service redesign aimed at increasing efficiency and effectiveness. The Workforce Plan, covering the period , builds on existing work and provides a renewed focus on workforce planning. Some of the key priorities being: The Facilities and Estates Sector will seek to ensure that staff resources are fully utilised at all times. Facilities staff frequently move between the various services, including between NHS Grampian sites. This model drives integration and flexible working within teams, the creation of generic roles to support service delivery, and the opportunity to increase quality, performance and safety. There are a number of changes to skill mix across the sector, most notably with the creation of specific new roles to target risk, compliance and governance arrangements. There is also a significant element of upskilling, skills transfer, associated with development of new and changing roles. These changes will link very closely to both Career Succession Planning and Service Redesign across the Sector. 21 NHS Grampian Health and Care Framework, the NHS Grampian 2020 A Possible Future. Aberdeen 22 NHS Grampian Local Delivery Plan & Property and Assets Management Plan. Aberdeen 27 P a g e

28 New ways of working have been indentified that seek to support the wider programme of clinical redesign. This will ensure that services can be provided in a different way, with minimal disruption to local health care needs. Skills transfer and upskilling will enable a more efficient process, and options around both out-sourcing and in-sourcing of specialist skills will be explored, investigated, and implemented where appropriate. Effective service redesign and workforce planning will equip the Facilities and Estates Sector with an increased ability to respond to service need, to improve the overall patient experience, and to meet mandatory and statutory requirements with respect to property, environment and risk. In addition, there is also heightened scrutiny around quality assurance of the physical built environment, hygiene and cleanliness of the clinical environment to ensure the continual achievement of the cleanliness standards, ensuring a safe environment for patients and staff. Public Health There are two overarching outcomes that set the vision for the whole public health system aim for the population s health: Increased healthy life expectancy, taking account of the health quality, as well as the length of life; and Reduced differences in life expectancy and healthy life expectancy between communities, through greater targeted improvements in more disadvantaged communities. The Public Health Workforce Plan describes the support required by NHS Grampian to become a public health organisation, which places the highest priority on improving and protecting health, delivering best possible health care and reducing inequalities. Public Health within NHS Grampian face local challenges in the delivery of the system wide aims. Although the service has the lowest number of consultants in public health per head of population in Scotland, it is anticipated that workforce numbers will need to be maintained. The workforce continues to develop and change. Some of the key considerations for workforce planning are: With a heavy reliance on ear marked funding, which will no longer be earmarked for health improvement areas, but replaced with a super bundle for public health, health improvement staff will require to take an innovate approach to financial resourcing, in terms of recurring and non-recurring monies, to enable capacity to address national and local priorities. In the context of Health and Social Care Integration, the priority is to ensure that a critical mass of public health expertise is available to drive the public health agenda, across the public sector with potentially different structures. With ongoing issues around capacity and recruitment, it is vital focus is maintained on key work programmes. Public Health are committed to ensuring that there is a workforce who are skilled and equipped to cope with delivery of these key work programmes. 28 P a g e

29 NHS Grampian and NHS Shetland are collaborating public health services with the Director of Public Health for NHS Grampian taking over responsibility for NHS Shetland. This presents new opportunities to develop services and work across boundaries. Dentistry Dentistry provides oral health care as an integral part of an individual s health. There is an increasing awareness about oral health and an increased demand exists for conservative treatments, including endodontics and dental implants, while dental extractions have taken a backseat. As prevention is a priority, the workforce will be well equipped and able to cope with the changing needs of the population. The strengthening role of primary and community services may lead to an increase in workload for General Dental Practitioners and Dentists with enhanced skills as well as Dental Care Practitioners (DCPs). The General Dental Council (GDC) provided for patients to have direct access to Dental Hygienists and Therapists in prescribed circumstances, with effect from May This means Dental Hygienists and Therapists are now permitted to provide dental treatment within their scope of practice without a prescription from a Dentist. These changes have the potential to enable clinicians to concentrate on more complex clinical work and focus on the development of enhanced skills but will require the necessary enabling legislation to allow the change in practice for hygienists and therapists. The establishment of an Managed Clinical Network in Endodontics within Grampian is responding to this need and will help to reduce waiting times within secondary care. Recent changes in this specialty include targeted training and recruitment of primary care practitioners into the North of Scotland, including the establishment of the Dental School in 2007, and the employment of overseas Dentists and those returning to practice. There has been an increase in the number of Dentists originating from EEA member states and from other overseas countries working in the North of Scotland. EEA policies on freedom of movement coupled with overtraining in some European countries have contributed to this trend. There is, however, no longer a shortage of NHS Dentists in the area, although Grampian has one of the lowest adult registration rates in Scotland. Given the risk of an oversupply in the future, the Scottish Government continue to monitor and reduce the annual student intake. The University of Aberdeen Dental School and Hospital currently offer 20 places per year on the 4 year graduate entry BDS course. Completion of this permits entry to the GDC Register. Following this, mandatory dental foundation training (formerly known as vocational training) is needed for new UK graduates wishing to work in NHS primary care. This training is a minimum of one year full-time and is spent in primary care, providing NHS general dental services. Post-foundation training is undertaken to develop basic skills and experience further, and (in some cases) prepare for specialist training. 29 P a g e

30 The PDS was created in January 2014 from the amalgamation of the Community Dental Service and the Salaried Dental Service. The key remit for the PDS is the provision of dentistry for the vulnerable population. The PDS provides a wide range of dental services which includes expert dental care for patients with: Special care needs e.g. people with significant learning and physical disabilities, significant mental health problems or with significant medically compromising conditions. Difficulties accessing high street dental services e.g. Looked after children, frail elderly housebound patients, migrants & homeless people and those with substance misuse and dependency Needs requiring behaviour management, sedation and general anaesthetic services. Needs requiring referral for specialised and specialist services e.g. special care dentistry, paediatric dentistry. In addition, the PDS has a role in dental public health and oral health improvement programmes, the provision of emergency and out of hours dental services, care for unregistered dental patients and education and training of the dental team. Given this very broad remit, the aspiration for the PDS in Grampian is for an equitable and responsive oral healthcare service with a focus on prevention, supported self-care and management and tackling oral health inequalities. Some of the key challenges for the PDS include: The management of the oral health of an aging dentate population with complex needs alongside a younger predominantly disease free population; The increasing requirement for specialist workforce input but with very limited or no capacity across the service in areas such as special care dentistry, paediatric dentistry, general anaesthetic (GA) and sedation. There is a need to support and invest in the PDS workforce to meet the current and future care needs of the Grampian population through: Training and up-skilling of current staff and by; Recruiting specialist staff in areas such as paediatric dentistry, special care dentistry and sedation. Secondary Care Dentistry The North of Scotland region has a variable Paediatric Dental Service across the 6 NHS board areas of Grampian, Highland, Tayside, Orkney, Shetland and Western Isles, with even more variable specialist or consultant input. There is no specialist input in Grampian and the island boards and NHS Highland have an interim arrangement buying 2 sessions of Paediatric Consultant cover every six weeks from Tayside. There is some paediatric service 30 P a g e

31 provision in the Public Dental Service across the boards, but this is variable and is not supervised by consultants nor has input from specialists. The role of the specialist paediatric dentist is to provide care as part of a multi-disciplinary team to a wide range of medically compromised children, children with learning or physical disabilities, those with inherited anomalies of the dentition and those with complex trauma liaising with colleagues in secondary care, primary care, social care, education and child protection as required. Paediatric specialists offer a full range of oral health care to anxious children who are unable to accept treatment under local anaesthesia and require additional behavioural management including conscious sedation and general anaesthesia. The current arrangements are not sustainable and are associated with some key risks in the management of children with conditions requiring specialist/consultant input. Efforts are ongoing through the Oral and Dental Health subgroup of NOSPG to develop a North of Scotland solution for specialist paediatric dental services across the North of Scotland (NoS). Depending on the outcome of this process, NHS Grampian will have to consider investing in specialist paediatric dentistry capacity either at a NoS level or at Board level Specific highlights The NHS Grampian 2020 Workforce vision recognises that going forward the workforce needs to be: By 2020 : NHS Grampian will employ a leaner, more flexible, multi-skilled, workforce, who will enable and empower people to take responsibility for their own health, the workforce will be organised in an integrated way, focussing on the needs of the individual rather than the desires of the professional. Whilst managing growth and demand, healthcare professionals will be more accessible to the public and to each other. There will be a sense of responsibility across the organisation that will focus on: Results & value for patients; Enablement, anticipation & rehabilitation; Safety & Quality; and Those who need it most. 23 The 2016 Workforce Plan continues to support this vision, but amended to reflect the national and local clinical strategies. An example of this is the development and growth of new roles such as Physician Associate and Clinical Development Fellows and the expansion of existing roles such as Advanced Practitioners and the extension of these to new areas outlined in section NHS Grampian Workforce NHS Grampian: Aberdeen 31 P a g e

32 It is not possible within this Workforce Plan to represent all the ways in which the workforce is being developed across the organisation. Whilst the individual sections above provide a summary of the priorities of the sectors and services, the following section provides examples of the different ways in which individuals, teams and projects have changed how they work together to provide efficient and effective services. Recruitment 20:20 In light of the continuing recruitment challenges, workstreams under Recruitment 2020 continues to be a priority. NHS Grampian attendance at medical and non medical recruitment events continues. In February 2016, NHS Grampian took the opportunity to participate in a week long Community Road Show event in the Bon Accord Centre, Aberdeen. This opportunity was used to produce a film to showcase the work of Health Care Support Workers and attract suitable applicants. This event attracted 179 applications, the vast majority of which were of a high calibre and suitable for appointment. Teams within the Workforce Directorate continue to work with Nursing and Midwifery, and AHP senior managers to progress a number of initiatives to attract staff to NHS Grampian. Through the Return to Practice programme nurses and midwives with lapsed registration are able to undertake education and clinical placement to regain their professional registration with the Nursing and Midwifery Council, whilst working for NHS Grampian. A total of thirty-eight nurses have been employed and the programme continues to run three times per year as demand necessitates, and in response to continuing recruitment challenges. Medical Workforce Planning for Secondary Care Recruitment of medical staff continues to be challenging in a number of specialties. A separate Secondary Care Medical Workforce Plan has been produced, in support of this more generic Plan to proactively support improved planning of the medical workforce, necessary to maintain vital services in the North East of Scotland. The Secondary Care Medical Workforce Plan Volume 1, provides workforce profiles, highlights risks and makes recommendations for the future direction of travel for the medical workforce in a number of secondary care specialties within both the Acute Sector and Mental Health and Learning Disabilities. This Secondary Care Medical Workforce Plan 2015/16 included a comprehensive workforce profile, provided baseline quantitative detail on the medical workforce employed in Secondary Care and qualitative information obtained from primary research by visiting individual specialities. The Volume 1 plan did not include all specialties within the Acute Sector; the 2016/17, Volume 2, Secondary Care medical will be completed during autumn P a g e

33 There have been a number of themes which have been recurrent throughout Volume 1. Consistently, services aim to ensure that the medical workforce have the relevant competencies capability and capacity necessary to meet the current and future service demand. Delivery of care and treatment in a patient centred, safe and effective way, with flexible and responsive staff, working in multi-disciplinary teams, appropriately skilled to meet the future demands is a consistent theme for all services. This is a time of uncertainty and opportunity for specialties around redesign of services, meeting efficiency targets and responding to the impact of integration of Health and Social Care. Most services recognise the need to deliver a different 24/7 service, with increased Consultant presence during peak activity periods, supported by a robust governance framework that delivers improved safety and quality of care. This is likely to require service re-design with extended hours and a different working pattern for Consultants. A shift towards more day case care will also change the pattern of care. A blended, integrated workforce that shifts seamlessly between community and acute environments is the future norm for many specialities within this plan. In addition, there is a need for national and regional networks to support local delivery and maintain specialist skills and expertise. There will be a continual increase in demand for services due to an increasing elderly population. The skill mix has to be appropriate for the demand. The recruitment into Consultant, Specialty Doctor and Doctors in Training posts remains crucial to enable continuation of service delivery. The age profile is of particular concern especially in: Dr Grays; General Adult Psychiatry; Forensic Psychiatry and Old Age Psychiatry. These are all areas where NHS Grampian finds replacement of senior doctors challenging. Improving the attractiveness of posts in Grampian and developing appropriate support roles, including development of a career framework for Doctors following nontraditional career pathway and the development of Medical Support workers will be key to future sustainability of services. Job Planning Improved Job Planning has been a key priority for NHS Grampian since Health Improvement Scotland (HIS) also highlighted this requirement in its 2014 Report: NHS Grampian should develop and implement a robust medical workforce plan 24. All Consultants and Specialty Doctors should have an agreed job plan and this should be reviewed annually. Job planning is a key mechanism through which objectives are agreed, monitored and delivered and therefore contribute significantly to the achievement of NHS Grampians objectives. In response to this, work was undertaken to review internal processes to ensure that the job planning process is as paper light and efficient as possible, without availability of a 24 (2014) Aberdeen Royal Infirmary: Short-Life Review of Quality and Safety. Healthcare Improvement Scotland, Edinburgh: 33 P a g e

34 dedicated electronic system to capture job planning information directly. This significantly contributed to the highest return of Job Plans within NHS Grampian for April A decline in the completed Job Plans for 2016 has emphasised the need for continued support. To ensure return rates and the quality of job plan completion continues an options appraisal exercise for an electronic system is currently being undertaken. Medical Leadership Framework Clinical leadership, and within that context medical leadership, is fundamentally important to delivery of safe, effective and person centred services. Engagement of all doctors in the future of their services, within the overall NHS Grampian framework is a priority for the Board and is recognised as a priority for NHS Grampian. In 2015, a principle based, Medical Leadership Framework was developed with stakeholders, that sought to increase the number of medical leaders in the Acute and Mental Health and Learning Disability Sectors; refining the required roles and reward those leaders in line with performance management approaches used for other senior leaders in the Board. This is being rolled out from April The principles were also commended to the IJBs. Medical Education Attracting medical students and doctors in training to NHS Grampian not only ensures stability of rota s for doctors in training, with a reduction in gaps; it ensures stability of training and improves the experience across this workforce. Longer term, those who have had positive training and education experiences, within NHS Grampian, are more likely to be retained as Career Grade medical staff, supporting the maintenance of a capable and sustainable senior medical workforce, addressing recruitment issues at these grades. To support medical education, the Medical and Dental Education Governance Group (MDEGG) has been established as a sub-group of the Staff Governance Committee. This group is responsible for the development of the medical and dental education governance priorities for NHS Grampian and assure the quality of education provided. This will include the development of a medical and dental education strategy for Grampian to include mandatory and statutory learning for established staff and ensure that as a Local Education Provider (LEP), NHS Grampian has the appropriate workforce and resource to provide educational governance. The General Medical Council (GMC) survey Doctors in Training each year and completion is mandatory. The results are used to inform the Board of the educational profile of departments within NHS Grampian and identify priorities for action. MDEGG will ensure that there is Board level oversight of the survey result and actions. MDEGG will also interpret and provide strategic guidance in relation to national professional and workforce developments e.g. Shape of Training 4. Working collaboratively with regional and national partners, NHS Education for Scotland (NES) and key education partners, such 34 P a g e

35 as Aberdeen University, MDEGG will foster an integrated approach to medical education governance. To support medical education within each division and sector, Associate Medical Directors (adme) have recently been appointed, with one aligned to each of the following divisions: Medicine and Unscheduled Care, Surgery, Women and Children, Clinical Support Services and Dr Grays Hospital. Appointments are also expected for Mental Health and Primary Care in the near future. The adme's will support the Directors of Medical Education and have become part of the Workforce Directorate Medical Education Team. The inaugural NHS Grampian Medical Education Conference held in November 2015 was a success and plans are underway for another conference to take place on the 18 November The General Medical Council (GMC) standards for the delivery of Medical Education Promoting Excellence 25 were released in January The Medical Education Team have created a quality group which meets weekly with the aim to implement the new standards in partnership with colleagues from Aberdeen University and NHS Education for Scotland (NES), and gather evidence prior to the GMC visit. NHS Grampian is actively supporting those who provide the training and development of doctors in training through the Grampian Learning Initiative for Trainers (GLINT). GLINT is a joint initiative with Aberdeen University, launched as a pilot project in July The aim of GLINT is to introduce and establish peer facilitated learning in NHS Grampian. Modules have been developed on educationally themed topics which enable participants to gain educational knowledge and skills, as well as show evidence of engagement in educational activity for GMC recognition of trainers. To date six modules have been developed, on topics such as Feedback and Learning in the Workplace with further topics planned for the coming months. At the launch, three participant groups were established, aimed at developing supportive networks of educators across the organisation. GLINT was promoted at the NHS Grampian conference in November 2015 and through this and word of mouth, four more groups have since been established. Further promotion of GLINT will take place in an ongoing basis. erostering NHS Grampian identified existing doctor in training rostering practices were outdated, time consuming and lacked robust governance. These impact on the ability of wards and departments to provide optimum medical cover to care for patients, and the ability to provide the best possible training experience and work life balance for staff. 25 General Medical Council Promoting Excellence: Standards for Medical Education and Training. General Medical Council: Edinburgh. 35 P a g e

36 NHS Grampian was approached by the Scottish Government and asked to pilot an electronic rostering system for doctors in training, Doctors Rostering System (DRS) RealTime. DRS RealTime is a tool to support senior medical staff when building and managing rosters and to provide current rostering information to doctors in training. DRS RealTime is currently in pilot phase, however, the outcome of the pilot work to date indicates it will be of benefit to both doctors in training, as well as to the senior clinicians who are building and managing the rosters. Some benefits associated with DRS RealTime are: Clear, understandable and accountable rosters; Having the right staff, in the right place at the right time; and Having rosters built and managed which are Working Time Regulations and New Deal compliant. Currently DRS RealTime is being utilised with the Emergency Department, Acute Medical Initial Assessment and Anaesthetics, with a full roll out plan currently out for consultation. Professionalism Compliance Analysis Tool (PCAT) NHS Grampian is piloting the use of PCAT on a Board level. The tool analyses rotas in terms of their ability to foster patient-centred care, high quality of training and trainee wellbeing. At Board level, the principles of PCAT underpin the Rota Quality Improvement Database and the High Risk Rota register; which are soon to be available for relevant stakeholders to view on the intranet. The accessibility of such databases will allow decision makers to formulate workforce plans in holistic approach, resulting in higher quality rotas and significant savings in locums and Band 3 financial penalties. At a departmental level, PCAT was used in Emergency Medicine, General Surgery, Vascular Surgery, Paediatric Surgery and Anaesthesia. The tool empowered trainees engagement in the process of improvement and quantified challenges faced by junior doctors across the Acute sector objectively and comprehensively. The PCAT work has resulted in Pan-Surgical approach to Rota challenges and united Clinical Leads and Management in identifying tangible solutions that include healthier rota designs and diversifying workforce to fill rota gaps creatively when trainee doctors are not available. Bank Review Under the strategic direction of Nursing Resources Group (NRG), an external review of the bank nursing arrangements within NHS Grampian was undertaken from August This review recognised the pivotal role a nurse bank has on resourcing workforce requirements. 36 P a g e

37 It highlighted that to ensure efficiency and effectiveness; issues in relation to demand and supply need to be addressed. NHS Grampian has four main nurse banks in operation, with a number of local banks in operation leading to inconsistency in process. The review recognised the need to improve the governance of the current approach and the need for services to consider wider organisational requirements and cross cover between Departments, Divisions and Sectors. The review made nine recommendations all of which were accepted by NRG. These recommendations set out the need to move to a single Nurse Bank; with greater integration with Corporate Services and all request arrangements being coordinated through one Bank. The need to maintain local knowledge and relationships was recognised; but the need to achieve higher performance, governance, consistency and standardisation was also highlighted. In the interests of ensuring efficiency and effectiveness, services should consider when additional hours and/or overtime are more cost effective alternatives to using bank staff, as well as increasing the number of substantive posts, as an alternative to long term bank positions. The recommendations also highlight the ongoing need for work on rostering shift patterns; a review of funded establishments which includes budget and skill mix; and the use of workload tools to develop a robust workforce plan. Nursing and Midwifery Workload and Workforce Tools NHS Grampian continues to use all 12 Nursing and Midwifery National Workload and Workforce Tools (NMWWT). NHS Grampian is currently following the national guidance when applying these tools, which aligns with the Healthcare Quality Strategy for NHS Scotland. It aims to build upon quality healthcare services ensuring all work is integrated and allied to the quality ambitions resulting in measurable improvements within the local workforce. Section 4.3 provides a full update on the use of these tools within NHS Grampian to support staffing for quality services. Primary Care Workforce Planning General Practice (GP) workforce challenges for NHS Grampian have been well documented since publication of the NHS Grampian 2013 General Practice Workforce Survey 26. In response to these challenges, a NHS Grampian General Practice Workforce Action Plan 27 was created with stakeholders and has now undergone a fifth iteration. This plan supports the recruitment, development and retention of the GP workforce; it is supported by the Primary Care Education, Training and Workforce Sub-Group. This Group s remit is to bring together organisations that have an interest and remit in education, training and workforce management in Primary Care to address key workforce, 26 NHS Grampian General Practice Workforce Survey. NHS Grampian: Aberdeen. 27 NHS Grampian Grampian General Practice Action Plan. NHS Grampian: Aberdeen. 37 P a g e

38 training and education issues, and make recommendations to the Primary Care Integrated Management Group (PCIMG). Initially there has been a focus on the findings of the 2013 Survey 26 and implementing the Action Plan. The group is chaired by the local Training Programme Director for General Practice, who also has one session a week working for the Workforce Directorate to support recruitment and retention of the General Practice workforce. This group has worked to promote and market General Practice in Grampian and explored, via education and training, the multi-disciplinary workforce that can support General Practice into the future. The work to promote Grampian as a good place for GPs to live and work has included the development of web based blog, which includes current vacancies. The team have also created and maintain a Facebook page; posting regular vacancy information and articles for followers to view. The popularity and engagement with the Facebook page continues to grow. The Facebook page can be found by searching GP Jobs Grampian on Facebook. The Blogspot is accessible via: The Virtual Community Ward The Virtual Community Ward (VCW) concept aims to improve care at home and reduce avoidable admissions, particularly of elderly patients. A multi-disciplinary team of doctors, carers, care managers, district nurses and AHPs hold a virtual ward round every morning to share information and make collaborative decisions about the needs of patients that day. The initial VCW, which was based within a practice in Elgin has proven successful and the concept is now being spread across Health and Social Care Partnerships in Grampian. The success of VCW model has required dedicated medical, caring and nursing resource, utilising their skills and working in a new way based within a community setting. No Delays To aid self management of conditions, support care within the community and prevent unnecessary scheduled and unscheduled care visits, the No Delays digital platform was developed by NHS Grampian. It supports patients to manage their long term condition(s), use medication effectively, or prepare for appointments or treatment. The platform holds video clips and other resources developed by local clinical teams. The video clips are prescribed to patients by their health care professional, as a digital postcard, via a secure link. On receiving a digital postcard, the patient can view the content as often as they wish and share it with family and carers, if they choose. The platform currently holds content developed by eleven different teams, including footage to 38 P a g e

39 support patients with type 2 diabetes, chronic obstructive pulmonary disease (COPD) and heart failure. The No Delays team works with clinical teams to understand the various contact points and exchanges of information that occur along the patient pathway. This allows the clinical team to identify opportunities to change the way they work with patients and digitise elements of the care pathway. The team then create video content and if appropriate, patients are invited to participate and share their story. The majority of the content on No Delays has been created in Grampian but clinical teams from other NHS Boards and indeed other parts of the world have expressed an interest in developing their own No Delays resources. No delays supports the self management of conditions and care in the community, this in turn reduces unnecessary planned care appointments and interventions, and consequently reduce unscheduled care needs. Through this work, NHS Grampian s workforce has developed to enable them to work differently, utilising technology to meet patient needs effectively and efficiently. 3.4 New roles Physician Associates The Physician Associates workforce continues to grow and is extending to more specialties across NHS Grampian. There are 18, headcount, and 17.9 wte Physician Associates (PA) employed across primary and secondary care within Grampian. This role has been recognised in many Sector Workforce Action Plans as having potential to provide valuable support alongside doctors in training. The University of Aberdeen Course has just advertised for its 6 th cohort of Physician Associates, and across the UK there are at least ten PA courses recruiting, or about to recruit students with another 5-10 courses anticipated. Clinical Development Fellows A new role of Clinical Development Fellow (CDF) has been identified and developed as a solution to the ongoing risk associated with unfilled posts, resulting in non-resilient junior doctor rotas. The aim of the role is to ensure high quality, safe and patient-centred care is maintained; improve the resilience of doctors in training rotas to ensure high quality training; and support the recruitment and retention of high quality doctors in training. The development package agreed with the University of Aberdeen, at no additional cost, highlights excellent cross working between organisations to support the medical workforce development in Grampian. The development aspect of the CDF year will support 39 P a g e

40 incumbents to engage positively with local service issues turning them into quality improvement projects. This will add value to services beyond the initial benefit of ensuring resilient rotas. There has been interest from several departments in hosting CDF s, and 9 have been appointed to date. It is hoped that a second round of recruitment for CDF posts will attract further applicants. Advanced Practitioners Advanced Practitioner roles within the nursing and AHPs have existed for some time. Work is ongoing in NHS Grampian to extend these further within a wide range of specialisms. These roles ensure NHS Grampian can meet the changing service demands, as professionals work to the top of their licence within a specialised area; and are supported through appropriate training and development. An example of such a role is the Advanced Critical Care Practitioner (ACCP) within Intensive Care Unit, which was initially created in response to an expected reduction in Foundation Year 2 doctors. Within ICU, this role has proven very successful and has enabled development of robust standardised protocols and procedures, to ensure that the ACCP s practice safely. Due to an anticipated reduction Higher Specialist Trainees in ICU projected for autumn 2016, and the increase in the role and remit of the ACCPs, discussions are ongoing to further expand the team. This would ensure resilience within this small specialist workforce. Different AHP professions have progressed with Advanced Practitioner roles in a number of areas. Currently, there is a Consultant Occupational Therapist within Stroke Services, leading on a number of Grampian wide projects. One particular achievement is a significant reduction in length of stay for some stroke patients, through the use of goal setting in discharge planning. Within ENT, an Advanced Practice Speech and Language Therapist is responsible for the operation of the Throat Therapy Clinic, using nassendoscopy and biofeedback. This has supported an improvement in Head and Neck Cancer waiting times by freeing up appointments within the cancer clinics; and has assisted in reducing the waiting times for patients from referral by the GP to point of contact for treatment. AHPs possess a range and diversity of skills and knowledge, which position them well to develop further Advanced Practitioner Roles, supporting the delivery of some services traditionally provided by medical staff. The further development of these roles faces challenges such as the availability of resources and sourcing appropriate training to underpin these roles as new models of care. Health Care Support Workers Partly due to vacancy levels, the number of band 2 to 4 nursing vacancies has decreased by 20% between 2015 and 2016, however, the development of band 4 roles continues. Whilst there are existing education pathways for development, professional development 40 P a g e

41 for specific services and sectors requires to be further developed. The professional lead for HCSW is reinvigorating the role, recognising the support and empowerment required by services to develop these roles. Partnership links with Further Education Colleges have been strengthened through the provision of work experience placements for students undertaking the Health and Social Care Certificate programme of study within North East Scotland College (NESCOL). Fifteen students attended for one day per week, over a six month period. The work experience placement students were mentored by more experienced HCSWs, who were provided with additional training to support them in this role. A new band 4 Associate Practice Educator role has been developed and will be piloted as a one year secondment during The primary function of the role is to support the education and the development of HCSWs in clinical settings. Services are being supported to further develop and maximise HCSW roles, with support from NES. Band 4 roles and professional career pathways developed within Theatres and ITU. The career pathway for HCSWs has been expanded, through funding provided by the Scottish Government to enable three HCSWs to register for the Adult Nursing and Mental Health Nursing degree programme in September 2016 with the Open University. This is a pilot project to test the feasibility of this distance learning route to Nursing within NHS Grampian. NHS Grampian continues to work in partnership with Moray College, NESCOL and Robert Gordon University to provide HCSWs with a route to become Registered Nurses, via the HNC Care in Administrative Practice programme. Applications for the HNC were higher this year with thirty-seven HCSWs submitting an application. NHS Grampian will also offer up to five Modern Apprentices (MA) for young people in Nursing, Midwifery and Allied Health Professions during 2016, with Moray College as the provider. The induction programme for newly recruited HCSWs has been redesigned, with a three day programme provided through the Professional and Practice Development Unit. The programme will continue to be evaluated during NHS Grampian participated in a week long community road show event, which resulted in one hundred and forty-five out of one hundred and seventy-nine applicants being interviewed for HCSW roles. In addition, Mental Health Services undertook a large recruitment initiative, which resulted in twenty-two additional appointments to band 2 HCSW posts. To meet growing demand on laboratory services specialist healthcare support workers band three and four roles have been developed for all sub-specialist areas. This has ensured demand is met whilst maintaining qualified staff require as a regulated services and regulated. 41 P a g e

42 Modern Apprenticeships For many years, NHS Grampian has employed Modern Apprentices (MA) within Estates trades, with an annual intake of one Mechanical and one Electrical MA. This will continue in The range of MA Frameworks now available in Scotland means that these roles are suitable to support the learning of new recruits in a wide range of service areas and is being utilised within NHS Grampian to recruit and develop the workforce, in line with a national drive to develop MA s within the NHS in Scotland. An MA in Accounting and one in Business Administration are being appointed to during Summer 2016 and as stated above, the HCSW MA framework is also being offered, which can be clinical or non-clinical based. This new pathway is being currently being considered across NHS Grampian. 42 P a g e

43 Step 4: Workforce Capacity and Capability 4.1 Current Workforce This section of the Workforce Plan provides a summary of data with comparisons to previous years information whilst providing analysis which informs all aspects of workforce risk assessment and action planning 28. Detailed workforce information is provided in Appendix 2 Current Workforce Highlights Staff in Post NHS Grampian employed 11,967.8 whole time equivalent (wte) staff and a headcount of 14,442 as at 31 March 2016, which is shown below broken down into job families. Across the entire workforce there has been an increase of wte staff from 31 March 2015, as a result of improved recruitment and the increase in full-time working, as indicated in table 2. Table 1: NHS Grampian wte and % Split by Job Family 31st March 2016 Senior Managers, 42.3, 0% Support Services, , 14% Nursing / Midwifery, , 43% Personal and Social Care, 78.1, 1% Other Therapeutic, 317.6, 3% Medical Support, 49.6, 0% Medical and Dental, , 11% Administrative Services, , 15% Healthcare Sciences, 425.4, 3% Dental Support, 186.5, 2% Allied Health Profession, 919.6, 8% Whole/Part Time Working 28 The workforce figures throughout this section do not include Honorary Contracts or GP s with clinical lead roles. 43 P a g e

44 Over the previous 4 years, there has been a shift from whole time towards more part-time working across the Grampian workforce, although more staff still work whole time (62.9%), which is only slightly reduced from last year s 63% whole time staff. The chart below shows the split between whole and part-time by job family. Support Services continues to be the only job family with a higher ratio of part-time to whole time. Table 2: Split between Whole-Time and Part-Time by Job Family 31 March % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 65.3% ADMIN SERVICES 58.4% Allied Health Profession % Part-Time % Whole-Time 61.7% Dental Support 79.0% Healthcare Sciences 85.4% Medical and Dental (inc Trainees) Medical Support Nursing / Midwifery Other Therapeuti c Personal and Social Care Senior Managers Support Services % Part-Time 34.7% 41.6% 38.3% 21.0% 14.6% 17.4% 39.7% 30.1% 34.7% 5.3% 53.9% 37.1% % Whole-Time 65.3% 58.4% 61.7% 79.0% 85.4% 82.6% 60.3% 69.9% 65.3% 94.7% 46.1% 62.9% 82.6% 60.3% 69.9% 65.3% 94.7% 53.9% 62.9% 37.1% Total Age and Gender Profiles Understanding the workforce age profile is required to ensure appropriate and considered succession planning, and prevent a void in knowledge and or experience within any profession. It is also be recognised that there are increasing numbers of individuals who are choosing to work beyond State Pension Age (SPA) and many are having to work longer than planned to assure their income in retirement, particularly in light of recent changes to SPA 29. NHS Grampian needs to consider the employment needs of older people to ensure a sustainable and capable workforce. The chart below shows the age profile of NHS Grampian workforce. The three largest clinical job families have been plotted relative to each other along with the overall population represented by the dotted line. Nursing and Midwifery, as the largest group within NHS Grampian, is influencing the overall age profile and highlights a drop in the number of younger people following behind the soon to retire baby boomer group, (50 and over). Table 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March P a g e

45 21.00% 16.00% 11.00% Overall Staffing Allied Health Profession Medical and Dental (inc Trainees) Nursing / Midwifery 6.00% 01 thru thru thru thru thru thru thru thru thru % Gender This gender profile has varied by less that 1% in the last 5 years and indicates that the organisation will continue to be predominantly female. Table 4: NHS Grampian Gender Split Male 17% NHS Grampian s workforce is predominantly female (83%). The chart on the left shows this in pictorial form. Female 83% Sickness Absence NHS Grampian s sickness absence rate has fluctuated throughout 2015/16 between 4.06% and 5.14%. NHS Grampians sickness absence levels are still consistently below the average for NHS Scotland. Throughout the year the absence rates reflect a pattern, as seen in previous years, with lower absence in summer and higher in winter. NHS Grampian s long term absence is consistently below all other territorial Boards in Scotland. This reflects the work by managers, HR and Grampian Occupational Health Services to support staff back to work using appropriate adjustments, where required. Table 5: NHS Grampian Sickness Absence Rates, Monthly ISD, April March P a g e

46 6.00% 5.00% 4.00% 3.00% 2.00% Scotland 4.78% 4.86% 4.78% 4.88% 4.81% 5.17% 5.24% 4.95% 4.26% 4.20% 4.31% 4.06% 4.40% 4.58% 4.53% 4.45% 2.48% 2.58% 2.62% 2.43% 2.47% 2.54% 2.26% 2.20% 1.92% 2.00% 1.83% 1.94% 1.86% 1.84% 1.91% 1.91% 5.42% 5.70% 5.31% 5.33% 4.89% 5.14% 4.98% NHS Grampian 4.81% HEAT Target 4% 3.11% 2.68% 2.86% 2.86% 2.21% 2.03% 2.13% 1.95% 1.00% 0.00% Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 short-term long-term Total National HEAT Target Scotland Short-Term = 28 days or less Long-Term = greater than 28 days ISD = Information Services Division In comparison with other boards within the north region, the year ending annualised figures are as follows: Highland 5.09%, Orkney 5.10%, Tayside 5.04%, Western Isles 5.93%, and Shetland 5.20%. Compared with Grampian at 4.62%, shows a good performance compared with the Scottish average, and also at regional level. The Scottish average for was 5.16%. A study to improve sickness absence levels is currently underway, the NHS Grampian+ Attendance Management, Short Life Working Group (SLWG) is about to survey managers in order to better understand the management and recording of sickness absence. Job Planning The contractual arrangements for Consultant Medical Staff and for Specialty Doctors require these staff have an agreed job plan, which describes all of their professional and service commitments. Table 6: Job Planning Completion as at 31 April 2016 Year Consultants Honorary Consultant Job Plans Submitted 2014/ % 2015/ % % Job plans Submitted There has been a decline in Consultant submissions from last year from 84.3% returned in 2015 to 63.4% returned in In 2016, 22.9% of Associate Specialist and Specialty Doctors job plans were submitted; this represents an improvement of 7.9% from last year. Understanding Workforce Availability and Supply 46 P a g e

47 Grampian continues to have one of the highest employment rates in the country at 77.0%, despite the recent downturn in the oil market. Scotland, as a whole, averages at 73.1% 30. Moray has suffered from a downturn in employment rates over the last 3 years from 78.7% down to 73.3%, now mirroring the Scottish average. Table 7: Employment Rates % 80.0% 78.0% 76.0% 74.0% 72.0% 70.0% 68.0% 66.0% 64.0% Scotland 72.6% 73.0% 73.7% 73.9% 73.6% 72.0% 71.0% 70.5% 70.5% 70.8% 72.6% 73.1% Aberdeen City 74.3% 77.2% 79.7% 77.7% 77.9% 78.3% 78.4% 75.0% 77.0% 76.3% 76.0% 77.1% Aberdeenshire 77.7% 78.3% 79.5% 80.5% 80.2% 80.4% 81.1% 79.5% 80.0% 78.7% 80.9% 80.5% Moray 75.7% 75.0% 76.7% 78.0% 79.6% 77.8% 79.9% 78.5% 77.6% 78.7% 77.1% 73.3% Grampian 75.9% 76.8% 78.6% 78.7% 79.2% 78.8% 79.8% 77.7% 78.2% 77.9% 78.0% 77.0% Unemployment rates 31 over the past year have decreased slightly over Scotland. However, Aberdeen City has seen an increase in unemployment rates, with the downturn in the oil and gas industry having had a significant impact upon these figures. Unemployment rates within Aberdeen City, in particular, have increased by 1.10% over this period. The longer term view, from a low of 2008 (Table 8) is showing that the north-east of Scotland unemployment figures fluctuate in line with the fortunes of the Oil & Gas market Economy and Labour Markets in Scotland; Statistics from the Annual Population Survey Economy and Labour Markets in Scotland; Statistics from the Annual Population Survey 47 P a g e

48 Table 8: Unemployment Rates Unemployment Rates Geography (Residence Based) Change on year Change since 2008 Rate Rate Rate Rate Rate Rate Rate Rate Rate Rate Scotland 4.9% 6.9% 7.7% 8.2% 8.0% 7.7% 6.2% 5.8% -0.40% 0.90% Aberdeen City 3.6% 4.0% 5.1% 5.8% 5.0% 4.6% 4.5% 4.7% 0.20% 1.10% Aberdeenshire 2.5% 2.8% 3.6% 4.0% 3.3% 3.3% 2.9% 2.7% -0.20% 0.20% Moray 3.7% 4.4% 4.6% 5.3% 4.9% 4.9% 4.5% 4.2% -0.30% 0.50% Equality and Diversity The ethnic makeup of the NHS Grampian Workforce, as at July 2015, is shown in Appendix 2. The ethnic makeup of the NHS Grampian workforce is less ethnically diverse (2%) than the wider population of Grampian (4%). Those that preferred not to declare ethnicity accounted for 30% of NHS Grampian workforce. Risk and Issues Analysis of the workforce profiles within the national and local context of NHS Grampian indentifies a number of risks to a sustainable and capable workforce. Ageing Workforce 33.1% of the Nursing workforce are aged over 50; 38.5% of Healthcare Scientists are aged over 50; 25% of Administration Services staff are aged over 55 and within Support Services 32% of the workforce are aged over 55. With a high percentage of over 50 s across a number of job families and the increase of the Scottish Public Pensions Agency (SPPA) retirement age, in line with state pension age, there is a requirement for NHS Grampian to continue closely monitor the age profile. To ensure a sustainable workforce, NHS Grampian must support professions such as Nursing to stay in the workforce longer than was historically required. Return to Practice programmes and the strengthened links with Robert Gordon University to support the recruitment of Nursing staff has the potential to mitigate some anticipated gaps in workforce capacity and experience when staff choose to retire. Given the identified risk of an ageing workforce, supporting staff to maintain their health and well being could influence their ability to remain in the workplace and will improve stability of the workforce. 48 P a g e

49 Sickness Absence Whilst the overall sickness absence of NHS Grampian is below the NHS Scotland average it presents an ongoing risk to a sustainable and capable workforce. With absence levels fluctuating across professions and sectors, the need to help staff to return and stay in work through appropriate management and Occupational Health support must be maintained. This could have an impact on reducing bank and locum usage. Vacancies Turnover of staff within any organisation creates opportunity to redesign and review the workforce and skill mix as required. However, a high turnover rate may suggest staff are not appropriately engaged or having positive experiences in the workplace. NHS Grampian s turnover rate averages a healthy 10.72%, allowing opportunity for reviewing roles. This rate does not suggest concerns in relation to staff governance. Whilst turnover rates are broadly positive, AHP s, Nursing and Midwifery, and Medical staffing hold a large proportion of vacancies for more than 3 months. This creates additional pressures on existing workforce and creates instability. An example of this is the increase in band 5 to 9 nursing and AHP vacancies in the last year, see Appendix 2. The focus upon Consultant recruitment since 2014 highlights the benefits of the Recruitment 2020 work, with Consultant vacancies almost halving from 2015 to 34.5 wte at 31 st March Continued targeted recruitment through the agreed Recruitment 2020 actions will be required to maintain this success and allow the work Nursing and AHP s have commenced to come to fruition. 4.2 Finance NHS Grampian s expenditure on staff costs for the financial year was 559 million. Excluding Family Health Services costs, this represented 64% of total expenditure by NHS Grampian. It is therefore imperative that NHS Grampian uses all staff resources in an efficient and effective way. To achieve financial balance, NHS Grampian estimates a requirement to make 18.5 million of cash savings in the 2016/17 financial year. NHS Grampian s expenditure on Agency Medical Locums, Agency Nursing and Nursing Bank for the 2015/16 financial year was 33.8 million: Agency medical locums 16.0m; Agency nursing 2.0m; and Bank nursing 15.8m Whilst the expenditure on bank was slightly above that in , the expenditure on Medical locums increased by 9m and the nursing agency expenditure doubled. 49 P a g e

50 NHS Grampians expenditure on additional hours for 2015/16 is broadly consistent with that in 2014/15, with a small reduction in overtime. Table 9: Expenditure on Overtime and Additional Hours Expenditure 2014/ /16 Difference In Expenditure Overtime 2.687m 2.614m - 73,000 Additional Hours 2.933m 2.966m + 33,000 Consideration of appropriate use of bank and agency staff, versus use of overtime and additional hours is required, as highlighted through the Bank Review. Limitations on additional hours, or overtime, may not be effective in reducing financial impact of staff shortages or vacancies, when compared with cost and use of bank or agency staff. Better use of staffing is a key action in delivering safe and effective workforce, as well as potential savings. Spending on the following areas are being targeted: Reducing the demand for agency medical locums, by a combination of: filling long term vacancies; improving controls around demand management; creating more accurate billing for breaks taken and a new payment mechanism which should deliver savings on VAT charges; Eliminating non-compliant junior medical rotas by filling vacancies, including the planned recruitment of Clinical Development Fellows; Reducing the amount of agency nursing used, by recruiting to vacancies and improved use of bank nursing; Implementing improved processes around rostering to deliver efficiencies in the use of bank nursing staff; Continued vacancy management to ensure that all new and replacement posts are properly scrutinised for potential efficiencies before being filled; and Ongoing review of skill mix opportunities to ensure an appropriate grade mix for duties performed. 4.3 Nursing and Midwifery Workload Workforce Tools Nursing and Midwifery staff account for 43% of the NHS Grampian workforce, including the varied Healthcare Support Worker role. To meet service, safety and quality requirements a balance must be struck between registered and unregistered staff and those in both generic and specialist roles. 50 P a g e

51 Understanding the capacity and demands will ensure this workforce can not only respond to service needs but provide a quality service. The Nursing and Midwifery Workload and Workforce Tools (NMWWTs) are utilised within NHS Grampian with this aim. NHS Grampian continues to use all 12 Nursing and Midwifery National Workload and Workforce Tools, following national guidance when applying these tools. The tools are used across NHS Grampian, on a rolling programme, to ensure that there is current measurable information for all areas. As part of this process, Nursing Workforce Validation meetings have been used to identify baselines for safe and effective practice. This is done using a triangulated approach, taking account of the current workforce, the local context, Clinical Quality indicators and the results from the Tools used. Using the triangulated information, the Nursing Resources Group agreed to additional investment in the established nursing workforce (50.88 wte). The NMWWTs have also been used to monitor and highlight risk to ensure safe staffing levels across the organisation and in conjunction with NHS Grampian s new governance process to support the escalation, management and reduction of risk. 51 P a g e

52 Step 5: Workforce Action Plan 5.1 The Workforce Risk Plan The Workforce Risk Plan highlights the workforce risks, how these are being controlled, mitigated and managed. The risks are identified by sectors through the Workforce Planning and Workforce Projection Process. Within this section a broad summary of the NHS Grampian identified risks is provided. Recruitment Recruitment challenges continue across many sectors and professions, most keenly within Medical and Nursing professions, however, some of the small occupational groups such as those within HealthCare Science or AHP professions are also vulnerable in terms of their level of vacancies. Currently, 44% of AHP posts have been vacant for more than three months and 59% of Consultant posts have been vacant for more than six months. There continues to be a national shortage of GPs and recruitment has been challenging. A bid to the national GP Recruitment and Retention Fund has been submitted to support the attraction and recruitment to the area. Recruitment of Doctors in Training is a further challenge and there are a number of gaps in rotas, as posts have not been filled for August Although work continues to fill these gaps, alternative roles are also being used such as Physician Associates, Medical Support Nurses, Advanced Practitioners and Clinical Development Fellows. Throughout this Plan, the challenges of recruitment are recognised and the strategic and operational innovations to counter and mitigate this risk are identified. This will continue to be a priority for NHS Grampian in Age Profile As recognised in Section 4.1, the age profile of the organisation presents a risk to a sustainable workforce, particularly in light of changes to pension age. To ensure a sustainable workforce, NHS Grampian must support employee to work longer, particularly in professions such as Nursing where historically, some specialties could retire at age 55 without loss of pension benefits. There is a view that, as staff get older, absence is likely to increase and anecdotal evidence suggests that more physical roles, longer shifts and full time working will be less attractive. Further work is required around understanding the overall workforce to identify how the organisation can retain the skills and experience of the older workforce, whilst providing safe and manageable roles. 52 P a g e

53 Change Management The rate of change continues to quicken across the organisation, responding to impact of changes in legislation, as well as the overall strategic direction of the NHS, nationally, regionally and locally. This is a permanent and ongoing process; change itself is recognised as having the potential to cause a level of destabilisation on the workforce and this risk is acknowledged. Change processes and work with Partnership and staff side colleagues are already well developed and work collaboratively to ensure that issues are handled swiftly and sensitively acknowledging the importance of ongoing communication. Balancing the demands of the changes through the IJBs, with the potential regionalisation and the move towards shared services, will impact on all services. For those who provide support to clinical services, these changes are likely to be greater. There will be a need to ensure that the workforce required for the future is appropriately developed both in terms of their individual competence, as well as in sufficient numbers. For some areas, this will need to be completed in conjunction with the IJB s and three partner local authorities, all of whom have differing needs and requirements; this also creates a level of risk. Building on relationships and working collaboratively will provide an improved opportunity for this to be successful. The pace and level of change are also driven by the public and patients expectations for services and their delivery of a convenient community basis in their locality. 5.2 The Learning and Education plan The Learning and Education Plan supports the development of the workforce responding to the needs identified from both mandatory requirements, such as Prevent and the analysis undertaking within each sector, as part of the workforce planning process. NHS Grampian supports this through design, delivery and evaluation of learning solutions for staff and partners in the provision of: blended learning activities in the workplace; classroom; online; via telephone learning and systems support; e-learning; coaching; facilitating work experience opportunities; through the provision of a suite of management development programmes; supporting and contributing to national learning activities and policy; improving induction processes and facilitated events. It is recognised that future working with Integrated Joint Boards will provide another opportunity to review learning and training plans, as staff from all partner organisations provide services to the same clients. This review could benefit by; sharing and learning; reducing duplication across organisations; improving efficiency in organisations and supporting change in partnership. The current key priorities of the Learning and Education Plan are outlined below. 53 P a g e

54 Induction Process for New Starts The purpose of induction is to ensure that employees are integrating well into or across the organisation for the benefit of both parties. For employees, starting a new role in NHS Grampian can be an anxious time and an induction programme enables them to understand more about the organisation, their role, and ways of working. At induction, all new staff now receive access to NHS mail and corporate statutory and mandatory training via embedded induction processes provided by close working with ehealth and Recruitment teams. From the 1 st April 2015 to March 2016, 3767 requests have been processed via the Induction Spreadsheet of which 2152 are new staff to the organisation, with 619 internal moves, and a further 916, Service Desk Requests to add individuals to the system. Induction for Doctors in Training has been reviewed after annual delivery in 2015 and will be more closely linked with departmental induction and educational induction in The staff handbook has been reviewed and an orientation checklist provided for managers and new staff. Induction roles and responsibilities will be clearly defined in the new Statutory and Mandatory training policy being made ready for consultation early A revised Learning and Development policy is being agreed at the Grampian Area Partnership Forum Policies and Procedures sub group. National Learning Activity NHS Grampian is part of a national group reviewing statutory and mandatory training requirements for all Boards to achieve Once for Scotland. It is recognised that, while necessary, statutory and mandatory training (whether face to face or e learning) can be time consuming. There is a clear need to remove, or at least reduce, duplication of training when staff move from location to location. This should reduce time away from service, whilst maintaining safety and corporate governance responsibilities and maintaining or improving the quality of learning. The initial focus of this work is to develop a framework consisting of a list of training topics which are considered necessary for everyone within the NHS in Scotland. This will be followed by grouping of job families to determine who should do what mandatory training. This will show training considered core for all staff and for specific roles. Doctors from training through to Consultant grades will be the exemplar cohort. This work is to be published in P a g e

55 Learning Management Systems AT Learning is the online learning management system through which staff book and record their learning. AT Learning is already being accessed by Medical and Dental undergraduates of the University of Aberdeen. Access is being progressed for Care Homes and Robert Gordon University health related undergraduates and partners in the third sector to provide further consistency for students on placements and future potential employees. All staff in General Practice have AT Learning accounts which allows them access to core elearning and development. Employability NHS Grampian participated in the Aberdeen based Skills Scotland event in late The event was accessed by around 2000 pupils and students and the organisation worked jointly with the University of Aberdeen. A certificate was awarded to NHS Grampian for participation at this event for the last five years. The launch of the NHS Grampian Work Experience Website continues to receive a positive response from parents, staff, schools and local authority work experience units. NHS Grampian have organised of one hundred and eighty-nine work experience placements for pupils and mature persons from across the region from March 2015 to the present day: mostly for pupils interested in Allied Health Professionals e.g. Radiography and Dental careers. The Doctors at Work scheme was been developed in partnership with the University of Aberdeen Medical School and has run for several successful years. This week long programme offers one hundred and fifty two pupils, (in 2016) and undergraduates; (in other disciplines) the chance of finding out if a career in medicine is the correct choice for them. Management Development The Management Development Programme has developed in late 2015, with a challenging schedule put in place to deliver a three day Supervisor s Course every four weeks and a four day Middle Manager s Course every six weeks. The core part of this training predominantly involves effective communication training and awareness as well as presentations from both HR and Health and Safety colleagues and to date, has been very well evaluated. Venues have been identified in both Aberdeen and Elgin, with one taking place in Huntly. Interest, and subsequently bookings have also increased as word gets around and the remainder of courses for the year are generally fully subscribed. 55 P a g e

56 There is also ongoing work to design and implement Medical Management Development; this project is still in the early stages with a plan to commence September Medical Workforce Development Medical workforce learning activities such as the Quality Improvement course are administered by the Learning and Development Administration team. There are 2-3 courses a year with up to 18 Consultants and 4 Trainers attending each session. The Doctors in Training corporate Medical Induction was delivered in July and August Each revision of the programme aims to reduce the numbers of adverse patient incidents attributable to junior staff. Diligent partnership working involving Recruitment, ehealth, IT Security and Learning and Development teams have helped NHS Grampian work towards the full implementation of CEL10 Guidance on the Induction and Shadowing of Foundation Years Doctors 32. Planning for the August 2016 programme, is underway and will involve spending more time on individual medical staff requirements at induction events, having made online access available for other important induction resources and information. Appraisal and Development The staff engagement issues with electronic Knowledge and Skills framework (eksf) can be evidenced from the annual completion rates for Personal Development Plans and Personal Development Reviews. A critical review was carried out to identify and understand why this is and how the system is currently being used to support effective appraisal. This has revealed a number of areas where there is scope to improve and a comprehensive strategy has been designed to address these area. This will take the form of effective stakeholder engagement, legitimate shortcuts for recording evidence, accurate and meaningful reporting and effective workplace training. It is anticipated that this will improve engagement, competence and overall confidence in the system and in turn demonstrate that effective appraisal is taking place. A successful Endowment bid pilot of 20 hand held devices for improvement of access for learning and development review work is underway. An effective evaluation could see the purchase of a further 180 devices for sharing across Grampian. 32 Scottish Government. CEL 10 (2013), FY1 Induction and Shadowing Arrangements, Edinburgh, Scottish Government 56 P a g e

57 Prevent Prevent is part of the UK s counter terrorism strategy, preventing people from becoming involved in terrorism or supporting terrorism. Legislation and guidance from NHS Scotland has been issued which includes training expectations on Health Boards. The Joint Training Co-ordinator has been leading across Grampian the learning and development perspective of the strategy on behalf of NHS Grampian and the other statutory partners to ensure compliance. elearning elearning is a part of a blended learning approach, which is designed to help staff gain knowledge and understanding on a wide range of topics in their workplace (see table), at a time that is convenient for them and their service meet whilst meeting staff the Governance Standard. 33 This approach can help ensure a consistency of message for staff, avoids duplication of effort for providers of training and also supports effective and measurable compliance for the manager and the organisation. elearning under development Published during 2015/16 Healthcare Waste Fire Safety 2016 Prevent IV Administration of medicines Nutritional Screening Hand Hygiene 2016 Controlled Drugs Accountability, Capacity & Consent Pressure Ulcer Prevention imatter Child Protection Module 2 Moving and Handling 2016 Paediatric Patient Controlled Analgesia AT-Learning for Cascade Trainers Stress & Distress Skin Care at Work Getting It Right For Every Child Violence and Aggression - Phone Rage Caring, Listening, Improving Welfare Reform Moving and Handling Think Capacity, Think Consent Standard Infection Control Precautions Verification of Expected Death The Prevention of Falls in Hospital Nicotine Replacement Therapy P a g e

58 This risk assessed approach can release trainer time for the more detailed and specialist face to face interactions required by individual staff and teams, given that, where appropriate, basic principles of topics will have been conveyed using e learning. Staff in NHS Grampian have followed the national trend of embracing elearning and its associated technologies as one of the key elements used to underpin their development, competence and confidence in delivering their role. 5.3 The Workforce Planning Action Plan NHS Grampian will continue to support Services, Directorates, Sectors and HSCP s develop their own Workforce 2020, through the annual Workforce Planning process. Supporting them to ensure workforce capacity, capability and sustainability is understood, accounted and planned for; enabling service developments in line with Health and Social Care Integration, estate and clinical developments (i.e. Theatre s, Anchor and Baird Project) and the Grampian Clinical Services Strategy, when approved by the Board. NHS Grampian will continue to support Workforce Planning for Medical Staff with Primary and Secondary Care to support and inform local, regional and national workforce planning. This will ensure that the implications of the future medical workforce in these specific contexts are understood, alongside the impact this is likely to have on other staff groups, and how these contexts are likely to influence workforce planning across the system. This will further support the planning and utilisation of innovative recruitment opportunities for nationally and locally difficult to fill medical posts. NHS Grampian will continue to support improvements, moving towards NHS Grampian being an exemplary employer for Medical Training posts. This will be achieved through the implementation of the new DRS Realtime system, supporting Clinical Leaders to achieve effective, safe rosters for doctors in training. Further support to Doctors in Training will be provided by ensuring medical education is appropriately supported and governed within NHS Grampian through the newly developed Medical and Dental Education Governance Group (MDEGG) structure. Supportive work for this agenda, overseen by MDEGG, will be the ongoing development and recruitment of the Clinical Development Fellows, Clinical Leadership and support to medical trainers through initiatives such as Grampian Learning Initiative for Trainers (GLINT). It is recognised that further work is required to prepare for the anticipated 2017 GMC visit. NHS Grampian will continue to support recruitment initiatives and overall workforce supply across professions, Sectors and Divisions through the Recruitment 2020 strategy. There will be an ongoing NHS Grampian presence at recruitment events and ongoing campaigns to ensure momentum is maintained in the professions and roles targeted to date. NHS Grampian will work with services to identify professions and roles which require additional support for recruitment. NHS Grampian will work with partners to identify opportunities to develop sustainable accommodation for key workers to address cost of living and accommodation barriers to recruitment. 58 P a g e

59 NHS Grampian will continue to utilise Nursing and Midwifery National Workload and Workforce Tools (NMWWT) to support the ongoing review of nursing resource, ensuring that the nursing workforce is the most appropriate workforce available. This work will support and ensure the appropriate skill mix and resource is available supporting an improved balance, where possible, between the substantive and bank and agency staff. To further support recruitment and retention, the Return to Practice programme will continue to run up to 3 times per year as demand necessitates. Career Pathways will continue to be developed across professions and sectors with the development of new roles outlined above. NHS Grampian will continue to work collaboratively with Moray College, North East of Scotland College (NESCOL), Aberdeen University and Robert Gordon University to achieve this. An example of the work that will continue in this area is HNC Care in Administrative Practice which is the first step in supporting HCSW to become registered nurses. NHS Grampian will continue to identify opportunities to develop new roles or expand the areas in which recently developed roles are utilised; such as Advanced Clinical Practitioners, Physician Associates and specialised Band 4 HCSW roles. This will only be delivered through a collaborative approach with NHS Education Scotland, NESCOL, the University of Aberdeen and Robert Gordon University, as well as regional and national colleagues. NHS Grampian will support the recommendations of the Nurse Bank Review being taken forward to ensure the Nurse Bank fully supports a sustainable, effective and capable nursing workforce. A focus of this shall be ensuring efficiency and effectiveness, whilst addressing issues in relation of supply and demand as highlight within the nine recommendations. NHS Grampian will undertake further work on age profile modelling and sustainability of an ageing workforce; in the continued recognition of the risks identified given the age profile of the NHS Grampian workforce, and in light of changes to the Scottish Public Pension Agency retrial age for NHS employees and State Pension age. Work is required to understand the overall workforce in the workforce groups and identify how NHS Grampian can retain the skills and experience of the older workforce whilst providing safe and manageable roles. Succession planning for staff about to retire continues to be a key issue documented in the Sectors and Service Workforce Plans. The Talent forum will continue to be developed with discussion with North East Learning Collaborative (NECL) partners (in particular Aberdeen Council, Aberdeenshire Council, Police and Fire) so all can share and learn from each other and open up master classes jointly to support the development of talent. 59 P a g e

60 NHS Grampian will continue to reflect upon the National Clinical Strategy and Grampian Clinical Services Strategy, working with stakeholders to work collaboratively to identify the operational and service developments required to achieve strategic clinical aims. NHS Grampian will continue to increase collaborative working between Teams, Divisions and Directorates within NHS Grampian and HSCP s to support ever developing services across boundaries. NHS Grampian will continue to extend its collaborative working, building on existing relationships with other NHS Boards and partner organisations. To achieve this, NHS Grampian will continue to support the proof concept for shared services and hub working currently being undertaken in Operational HR and the Human Resource Service Centre. Utilising learning from these proof of concepts will support NHS Grampian moving forward towards regionalised models of working in other services and areas. NHS Grampian will continue work collaboratively with all partners including primary care, third sector, other public services, the education sector, carers and patients as well as our organisational partners in the local authorities in terms of integration of Health and Social Care. NHS Grampian is currently working with the three IJB s and partner organisations on priority work streams to ensure the continual improve the quality of care and provide a more seamless person centred service through appropriate support for the workforce. Workforce Planning and Development has been identified as one of these priority work streams. Other priority work streams being taken forward are in relation to HR support to the New Partnerships; Staff Governance and Staff Partnership Working; Recruitment and Resourcing; Organisational Change and Organisation Development; Health Safety and Wellbeing; Workforce Performance and Reporting; Policies; and The Integration Scheme. NHS Grampian recognises it will, in light of the anticipated Scottish Government guidance, require to review current processes for Workforce Planning and Workforce Projections. This review will respond to the updated guidance, developments within the Workforce Team and recognise the support management and partnership require to enable an effective Workforce Planning and Workforce Projection process. NHS Grampian will continue to support the engagement of staff through effective partnership working, upholding the Staff Governance Standard. NHS Grampian will continue to measure the experiences of staff through the use of local and national tools, such as imatter, to support and empower teams, and individuals and to be involved in the improvement of their experiences at work. The implementation of imatter will continue across the Board; by the end of 2017 all NHS Grampian employees will be using this annual tool. The development of Staff Governance Action plans (at board and at partnership forum level) will continue to be informed by the views of staff through the use of tools such as imatter. 60 P a g e

61 Step 6: Implementation 6.1 Monitoring The Workforce Plan and its Actions within Step 5 will be managed and monitored through the Staff Governance Committee. This will be done on biannually and will include review of progress. 6.2 Review / Refresh The Workforce Planning process within NHS Grampian is undertaken annually to evaluate current workforce capacity and sustainability and assess required developments to ensure continued capacity and sustainability within the national and local context ensuring quality services are provided in a Caring, Listening and Improving manner. 61 P a g e

62 Appendix 1: NHS Grampian Vision and Values 62 P a g e

63 Headcount Workforce Plan Appendix 2 Current Workforce Profile The data used in this appendix was derived from local downloads from the Scottish Workforce Information Standard System. Gender Split/Age profile Female members of staff out number males by, 11,976 headcount to 2,466 headcount respectively. Table 10: Gender Split as at 31 March 2016 Male % Female % Age Profiles Table 11: NHS Grampian Age Range as at 31 March % 14.00% 12.00% % 8.00% thru thru thru thru thru thru thru thru thru 59 Headcount (left axis) Percentage (right axis) 0.89% 6.49% 11.00% 10.63% 10.68% 11.61% 14.04% 15.05% 11.84% 7.76% % 4.00% 2.00% 0.00% 63 P a g e

64 Headcount Workforce Plan Overall 34.6% of NHS Grampian s workforce is over 50 years old. 33.1% of the nursing workforce is aged over 50; 38.5% of healthcare scientists are aged over 50;25% of administration services staff are aged over 55 and within support services 32% of the workforce are aged over 55. Table 12: Age Profiling by Job Family, by Headcount as at 31 March 2016 Job Family 01 thru thru thru thru thru thru thru thru thru Grand Total ADMINISTRATIVE SERVICES ALLIED HEALTH PROFESSION DENTAL SUPPORT HEALTHCARE SCIENCES MEDICAL AND DENTAL MEDICAL SUPPORT NURSING/MIDWIFERY OTHER THERAPEUTIC PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES Grand Total Table 13: NHS Grampian Age Range by Job Family as at 31 March thru thru thru thru thru thru thru thru thru ADMINISTRATIVE SERVICES ALLIED HEALTH PROFESSION DENTAL SUPPORT HEALTHCARE SCIENCES MEDICAL AND DENTAL MEDICAL SUPPORT OTHER THERAPEUTIC PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES NURSING / MIDWIFERY P a g e

65 Workforce Plan Table 14: Age Profiling by Job Family as Percentages 31 March 2016 Job Family 01 thru thru thru thru thru thru thru thru thru ADMINISTRATIVE SERVICES 0.2% 4.4% 6.5% 7.8% 9.3% 12.5% 17.3% 16.0% 14.7% 11.3% ALLIED HEALTH PROFESSION 0.0% 6.6% 13.9% 16.1% 11.2% 13.1% 13.6% 11.5% 9.6% 4.4% DENTAL SUPPORT 0.4% 9.8% 16.9% 16.4% 13.3% 11.6% 14.7% 9.3% 6.2% 1.3% HEALTHCARE SCIENCES 0.2% 7.8% 10.0% 11.8% 11.4% 9.4% 10.8% 16.1% 15.1% 7.3% MEDICAL AND DENTAL 0.0% 4.5% 19.9% 13.9% 16.0% 11.8% 11.5% 9.8% 8.8% 3.7% MEDICAL SUPPORT 0.0% 0.0% 28.3% 17.0% 5.7% 9.4% 11.3% 15.1% 9.4% 3.8% NURSING/MIDWIFERY 0.4% 7.9% 10.9% 10.3% 10.6% 11.8% 15.1% 16.7% 11.4% 5.0% OTHER THERAPEUTIC 0.0% 6.1% 15.3% 13.2% 15.6% 14.2% 11.1% 12.4% 8.7% 3.4% PERSONAL AND SOCIAL CARE 0.0% 3.0% 6.1% 12.1% 7.1% 11.1% 17.2% 12.1% 12.1% 19.2% SENIOR MANAGERS 0.0% 0.0% 0.0% 0.0% 0.0% 2.3% 14.0% 48.8% 23.3% 11.6% SUPPORT SERVICES 4.4% 5.8% 7.1% 7.8% 7.6% 9.6% 10.8% 15.2% 13.6% 17.9% Grand Total 0.9% 6.5% 11.0% 10.6% 10.7% 11.6% 14.0% 15.1% 11.8% 7.8% Whole Time Equivalent and Headcount Table 15: wte (Whole Time Equivalent) as at 31 March 2016 Table 16: NHS Grampian wte by Job Family as at 31 March ADMINISTRATI VE SERVICES ALLIED HEALTH PROFESSION DENTAL SUPPORT HEALTHCARE SCIENCES MEDICAL AND DENTAL MEDICAL SUPPORT NURSING / MIDWIFERY OTHER THERAPEUTIC PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES wte P a g e

66 Workforce Plan Headcount Table 17: NHS Grampian Headcount as at 31 March 2016 Table 18: NHS Grampian Headcount by Job Family as at 31 March ADMIN SERVICES 1177 ALLIED HEALTH PROFESSION 225 DENTAL SUPPORT 490 HEALTHCARE SCIENCES 1444 MEDICAL AND DENTAL MEDICAL SUPPORT NURSING / MIDWIFERY OTHER THERAPEUTI C PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES Total P a g e

67 Workforce Plan Whole-Time Part-time Split (wte) Table 19: NHS Grampian Whole-Time Part-Time Split (wte) as at 31 March 2016 Table 20: NHS Grampian Whole-Time Part-Time Split as at 31 March % 94.7% 90% 80% 70% 60% 50% 40% 30% 20% 85.4% 82.6% 79.0% 69.9% 65.3% 65.3% 61.7% 58.4% 60.3% 41.6% 38.3% 39.7% 34.7% 34.7% 30.1% 21.0% 17.4% 14.6% 53.9% 46.1% 10% 5.3% 0% ADMIN SERVICES ALLIED HEALTH PROFESSION DENTAL SUPPORT HEALTHCAR E SCIENCES MEDICAL AND DENTAL MEDICAL SUPPORT NURSING / MIDWIFERY OTHER THERAPEUTI C PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES % Part-time 34.7% 41.6% 38.3% 21.0% 14.6% 17.4% 39.7% 30.1% 34.7% 5.3% 53.9% % Whole-time 65.3% 58.4% 61.7% 79.0% 85.4% 82.6% 60.3% 69.9% 65.3% 94.7% 46.1% 67 P a g e

68 Workforce Plan Sickness Absence from Scottish Workforce Information Standard System (SWISS) Table 21: NHS Grampian Sickness Absence Information (SWISS) 1 April March 2016 Table 22: NHS Grampian Sickness Absences (SWISS) 1 April April % 5.00% 4.50% 4.00% 3.50% 3.00% Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Absence Rate 4.03% 4.59% 4.27% 4.21% 4.10% 4.32% 4.54% 4.46% 4.91% 5.15% 5.00% 4.82% HEAT Target 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 68 P a g e

69 Workforce Plan Turnover Table 23: Aggregated Starters and Leavers 1 April March 2016 Note: Training Grade Doctors are not included within the Turnover figures. Turnover is defined as employees leaving NHS Grampian. The current headcount is as at 31 st March 2016 Table 24: NHS Grampian Turnover 1 April March % 12.51% 8.96% 10.20% 9.33% 9.39% 9.43% 11.48% 11.11% 9.30% 7.34% Admin Services Allied Health Profession Dental Support Healthcare Sciences Medical and Dental Medical Support Nursing / Midwifery Other Personal and Therapeutic Social Care Senior Managers Support Services Turnover 8.96% 10.20% 9.33% 9.39% 7.34% 9.43% 11.48% 15.57% 11.11% 9.30% 12.51% 69 P a g e