STP and Operating Plan Workforce Issues NHS Providers Medical & Nursing Directors Network Wednesday 11 October 2016
Workforce Issues to be covered Current Position and How we got there Nursing Consultant Medical AHP Where Next? WAB STPs and Operating Plans LWABs
Nurse Demand 2012 to 2016 Adult acute nursing In 2015/16 trusts reported increased demand for the fourth consecutive year. The cumulative total increase in established posts is 25,131fte in adult hospital settings alone (14.3%) Staff in post has increased significantly since trusts started trying to expand in 2012 by 12,199fte The outpacing of demand v supply growth was forecast to result in over 12,000 additional vacancies
Consultant Supply and Demand 2008 to 2020 Consultant vacancies appear to have been historically stable at 3.0% to 3.5% 2013/14 and 2014/15 both appear to have been periods of very high establishment of new posts, 5,909-15% in two years (as reported by trusts) Supply did increase above the norm in response but not enough to match increased demand Excess vacancies of a level previously unseen have therefore been created Unclear if extra posts are sustainably funded Concern that historically vacancies have been hidden if no prospect of filling them
Nursing Supply Measures 1. Additional Training Commissions 2. International Recruitment 3. Return to Practice 4. Retention
NHS ability to attract available supply 1. AHP registrant growth v NHS workforce growth 2. MH Nursing growth v forecast
Workforce Shortages by HEE region There is significant variation in supply shortage between regions Regional averages mask outliers in respect of individual trusts HEE - April 2014
Summary Position Nursing Midwifery and main AHP 2013 to 2016 Over 33,000 additional funded posts between 2013 and 2016 (9%) Over 19,000 more staff (5%) Therefore 14,000 additional vacancies created 2016/17 Initial Operating Plans (before financial reset) Plans indicate between 2000 reduction and 4,000 increase in posts Trusts planning for 14,000 growth in substantive employed nurses and midwives to reduce vacancies and agency / bank usage Net impact would reduce vacancies by 10,000 to 16,000
Workforce Intelligence in NHS Planning Arrangements ALBs sponsoring complementary planning processes: Operating plans 2016/17 STPs (including Finance & Efficiency Template) Two year operating plans 2017/18 & 2018/19 All in context of 5YFV triple aim, Shared Delivery Plan and associated policy priorities in Single Planning Guidance These represent our best source of near term workforce demand including the impact of service and workforce transformation Working with DH for prospects beyond 2020
STPs Planning assumptions as drivers of future workforce demand Provider Activity and Inflation Assumptions Activity Acute i % 2.3% 2.3% 2.4% 2.4% 2.3% Mental Health i % 1.9% 1.9% 1.9% 1.9% 1.8% Community i % 3.3% 3.4% 3.4% 3.4% 3.3% Specialist i % 4.4% 4.4% 4.4% 4.4% 4.4% Inflation Tariff Inflator i % 3.1% 2.3% 2.0% 2.0% 2.9% Tariff Efficiency Factor i % -2.0% -2.0% -2.0% -2.0% -2.0% Other Internal (HEE, S7, LA, BCF) Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0% Other External Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0% Pay & Pensions Assumptions i % 3.3% 2.0% 1.6% 1.6% 2.9% Drugs Assumptions i % 4.5% 4.6% 3.6% 4.1% 4.1% Procurement Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0% Capital Assumptions i % 3.1% 3.2% 3.2% 3.1% 3.1% Litigation Assumptions i % 17.0% 19.7% 19.7% 19.7% 19.7% Provider Other Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0%
2020 Workforce - STPs Workforce pay bill and WTE an integral part of STP finance and efficiency template Primary and Secondary care workforce High level picture of size and make up of 2020 workforce integrated to triple aims including finance Do Nothing Solutions Do Something 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 Commissioner Staffing GP WTE - - - - - - - - - - - - - - - - GP support staff WTE - - - - - - - - - - - - - - - - Commissioner Administration Staff WTE - - - - - - - - - - - - - - - - Provider Staffing Ambulance Staff WTE - - - - - - - - - - - - - - - - Administration WTE - - - - - - - - - - - - - - - - Health care assistants and other support staff WTE - - - - - - - - - - - - - - - - Medical and dental staff WTE - - - - - - - - - - - - - - - - Nursing, midwifery and health visiting staff WTE - - - - - - - - - - - - - - - - Nursing, midwifery and health visiting learners WTE - - - - - - - - - - - - - - - - Scientific, therapeutic and technical staff WTE - - - - - - - - - - - - - - - - Healthcare science WTE - - - - - - - - - - - - - - - - General payments WTE - - - - - - - - - - - - - - - - Total WTE WTE - - - - - - - - - - - - - - - - Total Provider WTE Adjustments i - - - - - Check i OK OK OK OK OK
Next Steps 21 st October STP submission including full finance and efficiency template Do nothing / counterfactual Workforce consequences of solutions - key narrative on deliverability 2020 workforce plan (Includes primary care) High level analysis (by main staff groups) Financial analysis of expenditure on non-nhs provision Activity assumptions December Two Year Operating plans Year 2 and 3 of STP Reconciliation of provider and Commissioner plans to place based STPs Granularity of workforce component to be agreed (inc. Pricare) 2020 STP plans by provider / greater granularity - tbc Priority areas (cancer, MH, maternity. Professions Component providers
LWABs LWABs are being established to meet the needs of STP areas in respect of action on both their current and future workforce needs; They will need to to focus on; Active management of both current supply and demand Workforce transformation for both future service delivery but also as part of current demand management e.g. team profiles Future workforce demand and supply A workforce in line with FYFV and SDP goals and assumptions, including overall affordability and the integration challenge. Will also include managing the liberalised non-medical pre-registration training system. A single place to discuss and act upon current and future workforce needs supported by consistent diagnosis and analysis and HEE / NHSI teams Aggregated to regional and national level with appropriate joint action e.g. IR / RTP Need HEE/ NHSI agreement on current and future single data collection
STP 1 Acute, Elderly & General Nursing The graph describes increases in funded posts v actual staff in post and therefore vacancy levels The narrative box describes where the STP sits compared to the national average and ranked v the other 43 STPs for i) growth in funded posts ii) growth in staff in post iii) vacancies 2013 to 2016 STP providers have funded above average additional posts between 2013 and 2016 (rank 16/44) They have been able to achieve above low levels of additional substantive staff in post (37/44) Consequently they have moved from a position of low vacancies to above average (17/44) 2016/17 STP providers have indicated that they intend to reduce funded posts during 2016/17. This is an lower level of growth compared to most STPs (35/44) Achieving HEE s median supply forecast would result in further reduction to vacancies Most providers have indicated plans to exceed this forecast in their 2016/17 submissions to NHSI. Workforce Growth 2013 to 2016 and 2016/17 Planned Increase / Decrease: Posts Staff in Post Vacancies Vacancy Rate 2013 2,079 2,003 75 3.6% 2016 2,362 2,045 317 13.4% Change 2013 to 2016 283 41 242 9.8% % 13.6% 2.1% 320.0% 2017 Plan 2,327 2,131 196 8.4% Change 2016/17-35 86-120 -5.0% % -1.5% 4.2% -38.0% The table shows the 2013, 2016, and 2017 data points of the graph including the actual value of vacancies (number & % rate) Sickness 2013 2014 2015 Trust 1 3.9% 4.2% 4.4% Trust 2 5.2% 4.8% 5.1% Trust 3 5.4% 4.7% 5.0% ENGLAND AVERAGE 4.1% 4.2% 4.2% Stability 2013 2014 2015 Trust 1 85.7% 86.2% 84.9% Trust 2 84.3% 86.7% 87.6% Trust 3 85.9% 87.3% 85.9% ENGLAND AVERAGE 79.9% 85.2% 83.8% These tables show how trusts within the STP have performed on Sickness and Stability (inverse of turnover) compared to the national average
Annex LWAB footprints and Co-Chairs
North STP LWAB arrangements LWAB Name STP covered LWAB co-chair HEE cochair The Cumbria & North East LWAB South Yorkshire & Bassetlaw Humber, Coast & Vale Northumberland, Tyne & Wear Durham, Darlington, Teesside, Hambleton, Richmondshire & Whitby West, North & East Cumbria South Yorkshire & Bassetlaw Humber, Coast & Vale Ian Renwick, Chief Executive, Gateshead Health NHS Foundation Trust Kevan Taylor, Chief Executive, Sheffield Health & Social Care NHS Foundation Trust Mike Proctor, Deputy Chief Executive, York Teaching Hospitals NHS Trust West Yorkshire West Yorkshire Ros Tolcher, Chief Executive, Harrogate & District NHS Foundation Trust Greater Manchester Cheshire & Merseyside Lancashire & South Cumbria Greater Manchester (Strategic Workforce Board) Cheshire & Merseyside Lancashire & South Cumbria Andrew Foster, Chief Executive, Wrightington, Wigan and Leigh NHS Foundation Trust Kath Thomson, Deputy Chief Executive, East Cheshire NHS Trust Heather Tierney-Moore, Chief Executive, Lancashire Care NHS Foundation Trust First meeting dates Alex Glover October 2016 Mike Curtis August 2016 Mike Curtis September 2016 Mike Curtis August 2016 Neil McLauchlan Jenny Cavalot Jenny Cavalot September 2016 September 2016 September 2016
M&E LWAB Development LWAB CX Co-Chair HEE Co-Chair LWAB in place Lincolnshire Leicestershire, Leicestershire & Rutland Northamptonshire Nottinghamshire Derbyshire Staffordshire & Shropshire The Black Country Jan Sobieraj, United Lincolnshire Hospitals NHS Trust Peter Miller, Leicestershire Partnership NHS Trust Sonia Swart, Northampton General Hospital NHS Trust Lyn Bacon, Nottingham CityCare Partnership CIC Gavin Boyle, Derby Royal Hospital NHS Foundation Trust Simon Wright, Shrewsbury and Telford Hospital NHS Trust Paula Clarke, University Hospitals of North Midlands NHS Trust Jane Johnson Adrian Brooke James McLean Jane Johnson Sheona McLeod Russell Smith Suzanne Harris 3
LWAB CX Co-Chair HEE Co-Chair LWAB in place Birmingham & Solihull Arden, Hereford & Worcester Cambridgeshire & Peterborough Tracy Taylor, Birmingham Community Healthcare NHS Foundation Trust Andy Hardy, University Hospitals Coventry and Warwickshire NHS Trust Matthew Winn, Cambridgeshire Community Services NHS Trust Mandy Shanahan Beverly Ingram Bill Irish Mid & South Essex Caroline Rassell, Mid Essex CCG Boyd Mullins Bedfordshire, Luton & Milton Keynes Hertfordshire & West Essex Suffolk & North East Essex Norfolk & Waveney Matthew Winn, Cambridgeshire Community Services NHS Trust Jinjer Kandola, Hertfordshire Partnership University NHS Foundation Trust Sam Hepplewhite, North East Essex CCG Rosin Fallon-Williams, Norfolk Community Health & Care NHS Trust Boyd Mullins Boyd Mullins Boyd Mullins Rob Bowman
London and South East LWABs LWAB Co-Chair HEE Co- Chair LWAB in place North Central London Maria Kane CEO Barnet, Enfield & Haringey MH Trust Chris Caldwell North East London Tracey Fletcher CEO, Homerton FT Therese Davis North West London Delvir Mehet Asst Dir Workforce & Development NHS NWL Lizzie Smith 1 st meeting end Oct South East London Angela Bhan Chief Officer, Bromley CCG Aurea Jones South West London Dr Marilyn Plant Clinical Lead SWLCCG Sean Farran Kent & Medway Hazel Carpenter Accountable officer of CCGs Philippa Spicer Surrey Heartlands Suzanne Rankin. CEO of Ashford & St Peter's Hospitals NHS Foundation Trust Philippa Spicer Sussex and East Surrey Richard Tyler CEO, Queen Victoria Hospital Foundation Trust Philippa Spicer 3
South England LWABs LWAB CEO Co-chair HEE Co-chair LWAB in place Bath, Swindon and Wiltshire Bristol, North Somerset and South Gloucestershire Buckinghamshire, Oxfordshire and Berkshire West Cornwall and the Isles of Scilly Devon Dorset Frimley Heath Gloucestershire Hampshire and the Isle of Wight Somerset James Scott CEO, Royal United Hospital Bath Robert Woolley CEO, University Hospitals Bristol Neil Dardis CEO, Bucks Healthcare Phil Confue CEO Cornwall Partnership Angela Peddar Full-time STP CEO Patricia Miller CEO, Dorset County Hospital Alison Alexander Strategic Director, Windsor and Maidenhead LGA Mary Hutton Accountable Officer, Gloucestershire CCG Sue Harriman CEO, Solent NHS Trust Matthew Dolman GP and Chair, Somerset CCG Clare Hines Assoc. Dir. Workforce Strategy and Plans Clare Hines Assoc. Dir. Workforce Strategy and Plans Pauline Brown Local Director, Thames Valley Clare Chivers Health Dean Clare Chivers Health Dean Ruth Monger Local Director, Wessex Pauline Brown Local Director, Thames Valley Clare Hines Assoc. Dir. Workforce Strategy and Plans Ruth Monger Local Director, Wessex Clare Chivers Health Dean (meets 30/9)