Workforce Plan 2018/19 - NHS Ayrshire and Arran · Table 2 – Job seekers allowance (JSA) plus out-of-work Universal Credit claimant rates as at March 2018 (source: Office of National

Workforce Plan 2018/19

Version 1.3, August 2018

NHS Ayrshire & Arran - Workforce Plan 2018/19 1

Contents

Executive Summary ............................................................................................................. 2

1. Context ......................................................................................................................... 3

1.1 Wider Ayrshire workforce ........................................................................................ 3

1.2 Job families ............................................................................................................... 3

1.3 Corporate objectives ................................................................................................. 4

1.4 Local population ........................................................................................................ 4

1.5 Local labour market & employability .......................................................................... 5

1.6 National Context ........................................................................................................ 6

2. Drivers for change ........................................................................................................ 7

2.1 People ....................................................................................................................... 8

2.1.1 Local .................................................................................................................... 8

2.1.2 Regional .............................................................................................................. 9

2.1.3 National ............................................................................................................... 9

2.2 Quality ..................................................................................................................... 10

2.3 Service .................................................................................................................... 10

2.4 Finance ................................................................................................................... 12

3. Overview of the current workforce .............................................................................. 14

3.1 Workforce composition ............................................................................................ 14

3.2 Gender and full versus part time contracts .............................................................. 15

3.3 Age of the workforce ............................................................................................... 16

3.4 Staff health, safety and wellbeing ............................................................................ 17

3.5 Figure 8 - Headline figures ...................................................................................... 18

4. Defining and designing the future workforce ............................................................... 19

5. Workforce action plan – implementation, monitoring and review ................................ 20

Annex A – Action plan – Corporate Workforce themes 2018/19 ........................................ 21


Executive Summary Due to the extant workforce planning guidance for NHS Boards – CEL32(2011) Revised Workforce Planning Guidance – remaining unchanged this iteration of the NHS Ayrshire & Arran Workforce Plan is essentially a refresh of the 2017/18 version. As indicated in the plan for 2017/18 work has taken place to identify how best to accommodate the changing workforce planning environment to meet the respective needs and requirements arising from local, regional and national workforce planning activity. In late 2017 in conjunction with transformation programme leads, Health and Social Care Partnership (H&SCP) and local authority (LA) colleagues we decided upon a pragmatic approach to enable pan-Ayrshire workforce planning that was sensitive to the needs of NHS, H&SCP and LA stakeholders. We were mindful that it would be easy to create an unduly complex workforce planning environment in terms of meeting infrastructure and output in terms of workforce plans and to that end to avoid this scenario agreed that:

Each H&SCP should have a workforce planning group, supported by a workforce planning lead role, that has oversight of their partnership workforce plan and have membership representative of the services provided in the partnership and wider stakeholders e.g. HR, staff side, 3rd sector etc. Expectation that the workforce plan for each H&SCP will be shared with the HR Director (NHS) to ensure congruence between NHS and H&SCP plans;

NHS will reform its existing workforce planning group, the Workforce Planning Programme Board, to have a distinct focus upon Acute Services and corporate NHS functions – this will be called the Workforce planning Group. The NHS Workforce Plan will refer to the entirety of the health and social care workforce across Ayrshire (at a high level) and cross reference to the three H&SCP workforce plans so as to avoid unnecessary duplication, as well as detailing areas of pan-Ayrshire collaboration; and

An Ayrshire-wide Strategic Workforce Group would be established to facilitate a collaborative pan-Ayrshire view and approach across both the NHS and local authorities on common areas of interest.

This approach will continue to evolve as it ‘beds in’ however we feel this places all stakeholders (NHS, H&SCP and LA) in better stead to reflect a cohesive and congruent pan-Ayrshire workforce planning position whilst recognising the individuality of their respective requirements as well as reflecting regional and national drivers and requirements as appropriate. This plan provides a high level strategic overview and does not attempt to distil the totality of all workforce planning across NHS Ayrshire & Arran into a single document rather it sets out key influences (section 1) drivers (sections 2) and characteristics (section 3) which ultimately influence how we will need to design our future workforce (section 4) which will be articulated in specific operational plans.


1. Context 1.1 Wider Ayrshire workforce Health and social care provides major employment across Ayrshire. Whilst this plan distinctly focuses upon the NHS workforce it is important to illustrate the health and social care workforce in its entirety as all sectors are critical to the delivery of services across Ayrshire. The social care workforce within Ayrshire, as reported in the annual Scottish Social Services Council workforce information publication, is as follows:

5,300 headcount employed in public sector i.e. H&SCPs; 7,560 headcount employed privately; and 3,210 headcount in voluntary sector.

In addition there approximately 294 headcount GPs (supported by their wider clinical and non-clinical practice staff teams) within Ayrshire as well as other independent practitioners within the primary care setting such as optometrists, community pharmacists, and dental practitioners and their associated support staff. Planning and management of primary care services within Ayrshire is within the East H&SCP which has lead responsibility for these services. The respective workforce plans of the three H&SCPs in the North, East and South, at various stages of development, provide detail on the wider social care workforce, as well as aligned NHS staff, and how future integrated models of service delivery will be delivered. 1.2 Job families

NHSA&A encompasses a wide and diverse workforce which is categorised nationally within ten distinct job families as illustrated in the table below:

Table 1 – Job family definitions

Job Family Roles / professions

Administrative services Various roles across areas such as, but not exhaustively, Health records; medical secretaries; clinical team support roles; information technology services; finance; and human resources

Allied Health Professions Arts therapists; dieticians; occupational therapy; orthoptists; physiotherapy; podiatry; radiography; and speech and language therapy

Healthcare Science 50 various roles across the job sub families of of life sciences; physiological sciences and physical sciences

Medical & Dental All grades of doctors and dentists (including those in training)

Medical & Dental Support Including dental nurses and dental technicians, and operating department practitioners in theatre services

Nursing & Midwifery Across all five branches: adult; children; learning disability; maternity; and mental health

Other Therapeutic Optometry; pharmacy; play specialists and psychology

Personal & Social Care Health promotion staff

Support Services Catering; domestics; estates and maintenance; and portering


1.3 Corporate objectives The revised corporate objectives, refocused to reflect the organisation’s current challenges and shifts through the transformational change programme included: ‘Working together to attract, develop, support, and retain skilled, committed, adaptable and healthy staff and ensure our workforce is affordable and sustainable.’ As highlighted in bold the key focus of workforce planning within NHS Ayrshire & Arran is to ensure an affordable and sustainable workforce. 1.4 Local population As shown in the chart below the General Register Office for Scotland projects (based on 2016 population figures) the make-up of the population within NHSA&A will radically alter over the next 25 years. Chart 1 – Population Projections by age group (source: National Records of Scotland)

The effect of the changing demographic is twofold, not only in relation to demand on services but also on the workforce (working age population), recognising that a significant proportion of our workforce is part of the local population. It should be noted that the pensionable age projections (for state pension) take account of legislative changes whereby from 2018 the pensionable age for women will rise to 65 (to match that for men) and thereafter increasing for both sexes to 66 by 2020, 67 by 2028 and 68 by 2039. As such it is imperative that NHSA&A pursues its ambition to become an attractive, known employer of choice to ensure we are able to secure employees from not only the local working age population but also other areas. A key lever in planning for this will be the promotion of the range and scope of careers available within the NHS in an informative and innovative way to potential future employees including individuals currently in school.

‐0.4 ‐2.7‐5.6

‐7.8 ‐10.1

0.9

‐2.5 ‐4.8

‐9.6 ‐12.6

‐3.8

3.77.7

15.7 18.411.7

30.0

42.0

57.3

74.6

‐20.0

‐10.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2021 2026 2031 2036 2041

% population chan

ge

Year

Population projection for NHSA&A area by age group (2016 based)

Children (0 to 15) Working ages Pensionable ages 75+


Decreases in children and working age populations within Ayrshire and Arran are contradictory to the steady growth within the pan-Scotland position predicted in these groups by 2041 i.e. the child population in Scotland is to decrease by 1.5% compared to 10.1% in Ayrshire and for working age an increase of 1.1% for Scotland versus a decrease of 12.6% in Ayrshire. Growth in the over 75 age group is consistent with the pan-Scotland position with significant predicted growth– from an 11.7% increase in 2021 (compared to 9.3% for Scotland) to an 74.6% increase projected for 2041 (20% higher than the Scottish projection of 54%). Big picture challenges related to demographics and population include:

Planning to meet the needs of an ageing population with an ageing workforce; Managing changing demand resulting from an increasing prevalence of complex

long-term conditions and co-morbidities; Managing demand from an increasing population with dementia; Managing public expectations about care they receive; and Addressing the considerable variations in life expectancy between geographical and

socio-economical groups. Many people within the older population remain relatively well and active into retirement. Through co-production of health and wellbeing patients across all age groups will be involved in the creation, design and delivery of services building upon patients’ own skills, knowledge and experience of receiving care. Co-production is about healthcare staff working together with the people who use our services to improve health and wellbeing. 1.5 Local labour market & employability The unemployment rate for each local authority area in Ayrshire is illustrated below. A proportion of these individuals will be long term unemployed and it is recognised that this necessitates additional support their readiness for work, which some of our employability schemes within NHSA&A, and our wider community planning partners, are designed to help facilitate. Whilst the unemployment rate provides an increased supply in the local labour market this is mitigated by constrained workforce demand from NHSA&A due to increased scrutiny and control of vacancies.

Table 2 – Job seekers allowance (JSA) plus out-of-work Universal Credit claimant

rates as at March 2018 (source: Office of National Statistics)

North Ayrshire, followed by East Ayrshire, has the highest levels of unemployment claimant rates in Scotland compared to all local authority areas.

Area Rate Number of claimants

East Ayrshire

4.0 3050

North Ayrshire

4.5 3750

South Ayrshire

2.5 1700

Scotland 2.6


Employment is one of the most strongly evidenced determinants of health, the World Health Organisation (WHO) notes that ‘unemployment puts health at risk’ and ‘unemployment has a direct bearing on the physical and mental health and even life expectancy for unemployed people and their families’. Unemployment therefore has a direct impact upon service provision. Supporting employability is a shared goal across all three Community Planning Partnerships (North, South and East) in Ayrshire, and NHSA&A is committed to contributing to this goal. A key priority of the newly formed Ayrshire-wide Strategic Workforce Group is employability as detailed in section 2.1.1. 1.6 National Context Health & Social Care Delivery Plan The aim of the plan is for high quality services that have a focus on prevention, early intervention and supported self management. Where people need hospital care, the aim is for day surgery to be the norm, and when stays must be longer, the aim is for people to be discharged as swiftly as it is safe to do so. Services are required that have the capacity, focus and workforce to continue to address the increasing pressures of a changing society (as set out in the preceding section of this document). Improved outcomes for patients can only happen with a committed workforce that has the right skills, flexibility and support. National Health & Social Care Workforce Plan The National Health & Social Care Workforce Plan is instrumental to delivering the strategic intent of the Health & Social Care Delivery Plan and all three volumes of the plan have now been published:

Part I – a framework for improving workforce planning across NHSScotland;

Part II – a framework for improving workforce planning for Social Care in Scotland; and

Part III – improving workforce planning for Primary Care in Scotland. All three volumes form a composite roadmap for activity that is underway to improve workforce planning across the entirety of health and social care, with commonality of themes as illustrated in the diagram below: Audit Scotland There is a distinct column within Figure 1 which relates to recommendations arising from the Auditor General’s report into NHS Workforce Planning - the clinical workforce in secondary care, which set out areas where both NHS Boards and Scottish Government could both make improvements to workforce planning. Although the report was distinctly NHS related, specifically to acute secondary care, as illustrated in Figure 1 there is wider applicability, in terms of themes, across the composite volumes of the National Health & Social Care Workforce Plan.


Figure 1 – Key recommendations arising from national workforce plan volumes

2. Drivers for change There are four overarching drivers which will influence NHSA&A for the foreseeable future and these constitute the dimensions of success against which the organisation must deliver as illustrated below:

Figure 2 – Dimensions of success

The four dimensions of success are intrinsically dependent upon each other, therefore whilst the workforce plan is predominantly about people this cannot be taken in isolation from the other dimensions which will exert influence on the overall configuration of our workforce in terms of shape, size and skills required to deliver services.

Culture &

values

Finance People

Service Quality

Demography of workforce

National workforce supply

Delivery of the Healthcare Quality Strategy for Scotland

Reducing existing inequalities and preventing widening of

the gap

Capital Plan & Estates Strategy

Bridging recurring deficit

Demography of population and demand on services

Regional Plan

Transformational Change Improvement

Plan (TCIP)

NHSA&A as an employer of choice – attraction &

retention


2.1 People 2.1.1 Local The Workforce Plan is intrinsically linked to the People Strategy – People Matter, and the Corporate People Plan which details high level operational delivery of the priorities identified in the strategy which encompasses:

sets outs out where we aim to be as an organisation and employer to 2020 and beyond;

provides a strategic focus and coherent framework for all current and future people agenda programmes of work:

o Staff governance improvement plans; o Staff Health, Safety and Wellbeing Strategy and improvement plan; o Culture, values and behaviours; o Workforce Planning; o Everyone matters improvement plan; and o iMatter Implementation;

provides top line details of the strategic activity that will ensure we can retain, develop, support and attract our valued people.

Workforce planning is intrinsic to fulfilling the organisational ambitions and objectives of the People Plan as set out in Figure 1 below:

Figure 3 – People Strategy Ambitions and objectives

As such we need to ensure we have the right workforce, with the right skills and competencies, at the right time to provide high quality services and further it is essential that we ensure that everyone works to the maximum of their professional capability. Whilst workforce planning actions distinctly appear within ‘attract’ of the Corporate people Plan, all four of the objectives materially impact upon workforce planning activity. In terms of pan-Ayrshire collaboration, the Strategic Planning Group (with NHS, LA and H&SCP membership) will focus upon the following key areas:

Employability schemes and encouragement of careers in health and social care; Education programmes in partnership with further and higher education institutes

(for the spectrum of generalist/specialist and registered/unregistered roles); Workforce planning and development for support worker roles across health and

social care; and Forum to discuss areas of workforce / service development which will/could impact

across all 4 stakeholders.


2.1.2 Regional NHSA&A contributed to the development of the West of Scotland Regional Workforce Profile Assessment paper which duly fed into the West of Scotland Regional Plan. The assessment highlighted a number of job families where there was commonality of workforce risk across the region in terms of the mismatch of demand and supply in some key clinical staff groups which chimes with both the findings of the Audit Scotland report (as flagged Section 1.6) and national supply challenges (as follows in Section 4).

Figure 4 – Regional ‘hotspot’ areas in terms of demand & supply

NHS Ayrshire & Arran has challenges across the breadth of regional hotspot areas, most acutely within medical staffing, but also within the other clinical professions whereby the demography of our existing workforce, in terms of age profile, coupled with demand both regionally and nationally with insufficient supply, presents future areas of risk. Going forward this will necessitate fundamental consideration of how changes to traditional roles ‘creatively filling gaps’ will help achieve our ambition of a sustainable workforce. The document highlighted a number of recommendations for strengthening workforce planning across the region in relation to the following themes which will be taken forward by the West of Scotland HR Directors:

Improved information & intelligence gathering; Improving approaches to demand and supply assessment; Implementing infrastructure to enable effective regional workforce planning;

and Developing strategic regional approaches to mitigate workforce risks e.g.

education and recruitment. 2.1.3 National Delivery of the ambitions and recommendations arising from the National Health & Social Care workforce plan volumes (see figures 1 in section 1.6) is implicit however in parallel NHSA&A will continue to undertake work in preparedness for:

Brexit - in order to assess potential impact / risk that may arise from the United Kingdom’s exit from the European Union; and

The Health and Care (Staffing) (Scotland) Bill – this will place a legal requirement on NHS boards and care services to ensure appropriate numbers of suitably trained staff are in place, irrespective of where care is received. It will also build on

Medical Nursing & Midwifery

• Anaesthetics•Medicine for the Elderly• Emergency Medicine• Psychiatry• Radiology•Histopathology•Ophthalmology• Trauma & orthopaedics•Gastroenterology

•Health Visitors•Mental Health•Midwives

Other Clinical Allied Health Professionals

•Healthcare Science• Pharmacy• Psychology

• Radiographers• Physiotherapists


Scotland’s profession-led approach to nursing and midwifery workload planning by facilitating the future development of this approach across health and care settings – NHSA&A will build upon its existing practice of using available nursing workforce tools at least annually.

2.2 Quality The Healthcare Quality Strategy for NHSScotland (2010) sets the foundation against which services in NHSA&A are both provided and developed ensuring people (public, patients and staff) are at the heart of the NHS and there is commitment to providing the best possible care and advice compassionately and reliably by making the right thing easier to do for every person, every time from making measurable improvements. The Quality Strategy identifies the links between staff engagement and the enhanced organisational performance and the correlation between staff experience and staff wellness with patient experience and patient outcomes. The importance of balancing the ambitions of quality, productivity and efficiency with the support and development for staff to feel engaged, valued and empowered in leading and driving quality is critical. The Health Promoting Health Service (CEL01(2012) & CEL14(2008)) concept that ‘every healthcare contact is a health improvement opportunity’ is central to the quality ambitions for person centred and effective services. ‘As well as treating illness hospitals can create a step change in health and wellbeing, while simultaneously contributing to a reduction in health inequalities, through promoting health and enabling wellbeing in patients, their families, visitors and staff.’ Ensuring that those within the workforce, who have a role to play in improving health, across all care settings both hospital and community, are adequately equipped to undertake this role is imperative to achieving our organisational commitment to improve health, prevent disease and reduce inequalities. 2.3 Service Local Transformation is a deliberate planned process that sets out a high aspiration to make a dramatic improvement and irreversible change to how care is delivered, what staff do (and how they behave) and the role of patients that results in sustainable, measureable improvement in outcomes, patient and staff experience and financial sustainability.

Health Foundation The Transformational Change Improvement Plan (TCIP), agreed by the NHS Board in June 2017, describes the planned transformational change that will deliver health and social care designed to meet the needs of the local population – Figure 3 provides a high level overview of the programmes. TCIP reflects the portfolio of transformational change and sets out the NHS Boards intention for the period of transformation from 2017 to 2020. TCIP is recognised as the sovereign plan for health services within Ayrshire and Arran and encompasses all health service planning including that for integrated services.


Figure 4 – Ayrshire Transformational Change Programme

Each programme is specifically tasked with delivering any service improvements with an expert, sustainable workforce that addresses the current workforce challenges across health and social care. In June 2018 the NHS Board approved the significant investment of £2.5million in our Intermediate Care and Rehabilitation Teams, which will support improvements in our unscheduled care through the recruitment of additional multi-disciplinary staff. The Board also approved the Primary Care Improvement Plan for submission to Scottish Government which set out an ambitious, collaborative and evidence based approach which will see the implementation of the new General Medical Services (GMS) contract (previously the GP contract). For both these developments we have undertaken an innovative and integrated approach to recruitment. The new model for general practice and primary care describes how clinical pathways, the role of the GP, and other health and care professional roles and their workload will be redesigned to enable consultation and treatment by the right person at the right time. Figure 5 gives an illustrative example of the model.

Figure 5 – Ayrshire & Arran Integrated Health and Care System

Governance

Strategic Planning & Operational Group (SPOG)

Programmes

UnscheduledCare

Planned Care –

Outpatients

Older people & people with

complex needs

Mental Health

Children’s Services

Primary Care

Support

Planning& Performance

Finance InfoManagement / IT / Communications

Workforce


Regional To deliver the Health & Social Care Delivery Plan, see section 1.6 earlier in the plan, a Regional Plan is being developed which, in conjunction with local Board level plans, will set out how the West of Scotland Boards and their partners will deliver safe, efficient and sustainable treatment and care over the next 10 to 15 years. Underpinning this plan will be detailed analysis of:

The needs assessment of the 2.7 million people served by the West of Scotland Boards;

Changing patterns of demand for future treatment and care for this population; The current capacity to safely and effectively meet these treatment and care needs; New service models and care pathways; and Resource plans including workforce, estate and specialised equipment.

The Regional Plan will clearly have a material impact upon the local workforce and going forward the NHS&A Workforce Plan will need to effectively accommodate both local and regional service drivers. 2.4 Finance NHSA&A has a baseline allocation for 2018/19 (excluding family health services, GP fees and other ring-fenced allocations) of approximately £694.9 million. Approximately 55% of the allocation is spent on staffing costs (which includes supplemental staffing costs). The financial environment is challenging and the organisation has an underlying recurring deficit of £23 million which the transformational change programme is intended to address in order to achieve a balanced health and care system. Key workforce factors contributing to financial position are:

Approximately 100 unfunded unscheduled care beds within Acute services being used to manage high unscheduled care demand at a cost of approximately £7 million pounds per annum; and

Spend of agency staff - £8.6 million on medical during 2017/18 and £1.9 million on nursing & midwifery.

Chart 2 – Consultant vacancies

(source ISD national statistics) Chart 3 – Medical agency spend

(source ISD national statistics)

8.8

15.0

27.6

41.4

50.1

45.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

March 2013 March 2014 March 2015 March 2016 March 2017 March 2018

Headcount of vacancies

ISD Vacancy Census Quarterly report period

Consultant Vacancies

3.10

3.964.57

7.42

9.46

8.60

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

£Millions

Financial Year

Medical agency spend


Charts 2 and 3, above, illustrate the significant challenge NHSA&A faces due to consultant vacancies and the direct correlation the trend in the underlying vacancy rate has had upon the medical agency spend (which predominantly is attributable to consultant grade posts). As flagged at section 2.1.2 NHS Ayrshire & Arran faces challenges across a number of distinct clinical areas which mirror the position both regionally, nationally (both from a Scottish and wider UK perspective), and in some cases internationally. This places further constraints on the labour market in that there is limited pool / supply that multiple employers are trying to successfully attract and given the lead in times in terms of training for some roles, particularly within medicine, adjusting the supply ‘pipeline’ will take years to facilitate an output. The medical specialities in which NHS Ayrshire & Arran faced multiple vacancy challenges, as reported by ISD in March 2018, were:

Specialty WTE vacancy

Specialty WTE vacancy

Clinical Radiology 8.0 Dermatology 2.0 Anaesthetics 4.0 Gastroentertology 2.0 General Psychiatry 4.0 Ophthalmology 2.0 Histopathology 3.0 Neurology 1.8 Acute internal medicine 2.0

In order to minimise service disruption and to ensure service standards are maintained NHS A&A utilises a range of supplementary staffing solutions for the following main reasons: staff absence; patient acuity; patient observation; or alternatively in the case of medical staff to provide cover for hard to fill vacancies in the short to medium term, the duration of cover being variable dependant on circumstances. Links between the use of supplementary staff and patient outcomes was demonstrated in the report into Mid-Staffordshire NHS Trust, therefore it is the organisation’s ambition to reduce to the lowest possible level the use of bank, locum and agency staff usage. The Medical, and Nursing & Midwifery, Workforce Delivery Groups are respectively scrutinising the utilisation of supplemental staffing solutions and specifically seeking to drive down agency costs as far as practicably possible against identified and agreed targets. As set out in section 4, later in this plan, the deliverability of this intent is greatly influenced by national pan-Scotland workforce demand and supply. Given the underlying deficit position a Workforce Scrutiny Group (WSG) has been established to ensure overall operational grip with a very specific focus upon workforce cost specifically in relation to:

Vacancies; Supplementary staffing; Staff deployment – including the re-absorption of staff aligned to unfunded acute

beds into funded roles; Absence; and Management variation.

WSG meets weekly, reports directly to the Corporate Management Team, and is chaired by the HR Director.


3. Overview of the current workforce 3.1 Workforce composition As at 31st March 2018 NHSA&A employed 8936.2 whole time equivalent, approximately 10,894 headcount, across 10 nationally defined job families as detailed below – note this does not include bank staff. Job families are nationally defined and commonly applied by all NHS Boards.

Chart 4 – Workforce Composition

The roles/professions within job families are detailed at page 3. Nursing is the largest job family representing 49% of the overall workforce. *Note the administrative job family includes posts that are part of the clinical team and are patient facing and cover a very wide range of roles from junior admin roles, within for example health records, through to senior general management roles for clinical services.

712.0

33.0

98.0

5,050.0

838.0

328.0

155.0

298.0

1,752.0

1,630.0

647.6

25.3

73.1

4,358.6

698.0

294.4

138.7

253.3

1,473.2

974.0

‐ 1,000.0 2,000.0 3,000.0 4,000.0 5,000.0

Medical

Dental

Med & Dent Supprt

Nursing & Midwifery

AHPs

Other therapeutic

Personal & Social Care

Healthcare science

Admin

Support services

Makeup of the NHSA&A workforce

Whole time equivalent (WTE) Headcount


3.2 Gender and full versus part time contracts

Figure 6 – Comparison of gender and contract versus NHSScotland (source ISD national statistics)

Overall workforce gender split Overall workforce full time / part time

split

As shown in figure 3 NHSA&A has a higher proportion of females as compared to NHSScotland and a higher proportion of part time workers.

Chart 5 – Gender & Contract type (source ISD national statistics)

Whilst the workforce is predominantly female in all job families the exception is medical where there are a higher proportion of males although this is in relative terms – within medicine more women are entering training however a larger proportion are choosing to

Male 16.3%

Female83.7%

NHSA&AMale 20.8%

Female79.2%

NHSScotland

Full time 46.6%Part

time 53.4%

NHSA&A

Full time 56.9%

Part time 43.1%

NHSScotland

36.1

30.3

39.6

34.5

43.9

55.5

53.5

40.6

44.7

4.2

11.7

27.3

47.5

56.5

47.7

30.0

28.7

38.6

43.7

66.4

44.7

33.3

12.9

6.9

7.3

13.3

14.6

19.1

10.7

20.0

7.6

9.1

2.1

1.1

1.2

3.2

1.7

1.0

9.4

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Medical

Dental

Med & Dent Supprt

Nursing & Midwifery

AHPs

Other therapeutic


Healthcare science

Admin

Support services

% of workforce

Gender & contract type by job family

Female FT Female PT Male FT Male PT


work part time and utilise family friendly entitlements thus extending the time taken to train which will ultimately impact on future trained doctors. 3.3 Age of the workforce

Figure 7 – Comparison of age versus NHSScotland (source ISD national statistics) Overall workforce age split

As illustrated in figure 7 NHSA&A has a slightly older overall workforce as compared to NHSScotland. The age of the workforce when allied to supply for some clinical staff groups presents a significant and common challenge not only for NHSA&A but wider NHSScotland. As Chart 5, following, illustrates the age profile as a percentage of the workforce and there is clear variability between job families.

Chart 6 – Age profile of the workforce

Aged 16‐4959.4 %

Aged 50+ 40.6%

NHSA&A

Aged 16‐49 61.5%

Aged 50+ 38.5%

NHSScotland

49.2

48.5

33.7

33.1

38.4

57.0

32.9

28.9

23.8

19.7

26.7

21.2

33.7

28.0

29.1

25.0

29.7

31.2

30.3

18.9

10.1

15.2

19.4

18.4

14.9

10.4

13.5

18.1

18.8

20.4

8.7

15.2

10.2

13.8

13.2

5.5

14.8

14.1

15.9

19.6

5.3

3.1

6.6

4.3

2.1

9.0

7.7

11.2

21.4

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Medical

Dental

Med & Dent Supprt

Nursing & Midwifery

AHPs

Other therapeutic


Healthcare science

Admin

Support services

% of workforce

Age profile by job family

16 to 39 40 to 49 50 to 54 55 to 59 60+


Ensuring robust succession planning for the 50+ age group will be a key organisational consideration albeit this will require to be countered against national legislation. Up to 70% of the workforce will now have a pension age of between 65 and 68 depending on their date of birth. The table below illustrates the variability in average retirement age for our five largest job families:

Table 3 – Average retirement ages in 2017/18

A key role of the reformed Workforce Planning Group will be to assess the potential impact of the ageing workforce and seek assurance from service that this is robustly being considered and planned for accordingly.

Ensuring the health needs of our ageing workforce is critical, not least in recognising that some roles, e.g. nursing, have a substantial physical element and may become more onerous. As identified by the Health & Safety Executive (HSE: Diversity in the workforce – Age) there are differences in the sickness absence patterns between younger and older workers. Typically younger workers tend to be absent more often, but for shorter periods of time, whereas older workers are likely to be absent less frequently but are more likely to have a longer period of absence. Younger age profiles also need to be considered carefully, for Allied Health Professions and Other Therapeutic (which includes pharmacy and psychology staff) job families there is a direct correlation between the gender (predominantly female) and age (a younger age profile compared to the organisation average) and associated maternity leave rates. 3.4 Staff health, safety and wellbeing As identified in the quality strategy there is a correlation between staff experience and staff wellness with patient experience and patient outcomes and therefore continuously improving staff health, safety and wellbeing is of paramount importance to the organisation. The Staff Health, Safety & Wellbeing Strategy and Action Plan sets out the range of actions the Board is progressing to assist staff with the intention of achieving a sustained reduction in the sickness absence rate.

Job family Average retiralage

Administrative 63

Allied Health Profession 61

Medical 61

Nursing & Midwifery 59

Support Services 65

All job families 61


3.5 Figure 8 - Headline figures

5.26% sickness absence in 2017/18 1.86% short term absence 3.40% long term absence Highest rate of absence is within

unregistered nursing at 8.47% NHSScotland absence = 5.39%

1.7% maternity leave in 2017/18 Two job families are more than double the organisational rate:

Other therapeutic 4.1% Registered AHPs 3.3%

6.9% turnover in 2017/18

Lowest turnover rate for any territorial Board

NHSScotland turnover = 7.1% Highest turnover in medical &

dental 12.3% (NHSS rate 9.5%)

87.4% completion of mandatory and

statutory training (MAST) topics as at

31st March 2018


4. Defining and designing the future workforce The future workforce requirements for NHSA&A will be driven by three key factors: Service design –which will encompass all aspects of the service planning continuum

as illustrated below in Figure 9:

Figure 9 – Service planning continuum

Critical will be balancing the unique, but mutually dependent, workforce requirements arising from each level to ultimately achieve the dimensions of success as detailed earlier in Figure 2 within Section 2. Emergent service plans, at any of the levels, will need to be cognisant of the workforce skills required to deliver future service models.

Demography of the existing workforce - As detailed earlier, at section 3.3, the age

profile of within the various job families presents challenges – from both older and younger profiles – in terms of service sustainability.

Older workforce profiles present challenges with regard to succession planning particularly for professional staff groups. This is not unique to NHSA&A and is flagged as a particular challenge for NHSScotland as a whole within the Audit Scotland – NHS Workforce Planning report ‘...over a third of the nursing and midwifery workforce is over 50...’ in terms of the national supply available to replace posts as staff retire.

National workforce demand and supply - There are recognised issues, as flagged

by Audit Scotland, within the current demand and supply modelling for controlled staff groups (i.e. medical, dental, nursing and midwifery whereby Scottish Government set the number of undergraduate training places for Scotland) in that there is limited supply for some specific roles.

Similar to other NHS Boards medical vacancies, across grades but most acutely for both for hospital based consultants and general practitioners, within NHSA&A present a significant risk and challenge. As at 31st March 2018 NHSA&A had 45.4 WTE consultant vacancies with 80% of these vacant for 6 months or more – this is a considerable increase for the position as reported in the last workforce plan whereby 47% had been vacant for 6 months or more. A lack of supply, coupled with increased service demand, manifests in the requirement to utilise high cost supplemental staffing options to ensure service sustainability


however even locum/agency availability can be equally challenging in terms of demand and supply.

Further exacerbating the situation is national, on a UK basis, supply issues. The Migration Advisory Committee undertook a partial review of the shortage occupation lists (both for the UK and Scotland) in the last quarter of 2014; this specifically included the health sector. The shortage occupation list details specific roles for whereby out-of country, non European Union citizens, may be permitted to work in the UK to address the shortage. The recommendations arising from this review, which was published in February 2015, are detailed in Figure 10 below. The Workforce Planning Group intends to undertake work during 2018 to capture specific risk / hot spot / pinch points within the workforce to better target work in defining and designing our future workforce.

Figure 10 – National occupation shortage lists

As set out in section 2.3 previously work is underway across a number of programmes to develop our workforce, for example we already utilise Advanced Nurse Practitioner roles across acute and community settings and are planning to introduce more. In addition emerging service models, such as that illustrated in figure 5, show the absolute importance of a multi-disciplinary team to ensure patients are treated by the right person with the right skills and capabilities at the right time. 5. Workforce action plan – implementation, monitoring and review Annex A sets out the high level action plan against the five key corporate workforce themes, for 2018/19. The Workforce Planning Group / Workforce Scrutiny Group will routinely monitor respective actions that are detailed within the plan. In addition the Workforce Planning Group will have a key role in receiving assurance of operational areas having clear workforce plans in place.

UK Shortage Occupation List Scottish Shortage Occupation List

Consultants in:• Emergency Medicine• Clinical Radiology•Old Age Psychiatry

Consultants in:•Anaesthetics• Paediatrics•Obstetrics & Gynaecology• Psychiatry• Clinical Oncology

Medical non‐consultant, non‐training posts in:• Emergency Medicine• Paediatrics•Old Age Psychiatry

All grade medical (other than consultant roles) in:•Anaesthetics• Paediatrics•Obstetrics & Gynaecology• Psychiatry (excluding CP1)

Medical training grades:• Psychiatry (core trainees)• Emergency Medicine (CT3 and ST4‐7)

Non‐consultant, non‐training roles and trainees at CT2 and ST4‐7 in:• Clinical Radiology

Non‐medical roles:•Diagnostic radiographer (including MRI)• Sonographer•Nuclear medicine practitioner• Radiotherapy physics scientist or practitioner•Neurophysiology practitioner or healthcare scientist• Prosthetist•Orthotist

Specialist nurses in:•Neonatal• Intensive Care


Annex A – Action plan – Corporate Workforce themes 2018/19

Aim What we will do How we will do it Who will do it Reported to

Ensure our workforce

is affordable

and sustainable

A - Improve staff attendance at work

A1 Deliver a 0.5% improvement (reduction) in overall organisational sickness absence during FY 2018/19

Directors and Management Teams

in conjunction with HR Managers

Workforce Scrutiny Group

B – Optimise recruitment and

retention

B1 Participate in national programmes to improve prospects for successfully recruiting to vacant medical consultant posts

Medical Director HR Director

HR Mgr – Medical Workforce

Workforce Planning Group

B2 Determine strategy to best use social media as a tool to encourage interest in NHS careers and support recruitment

HR Director Communications

Team Assist HR

Director - CES C – Control the use of supplemental staffing minimising the use of

high cost agency solutions

C1 Deliver agreed trajectories for decreasing agency usage, for medical and nursing staff, as far as practicably possible whilst

maintaining patient safety

Nurse Director via Nursing & Midwifery Workforce

Delivery Group Medical Director

via Medical Workforce Spend

Group


D – Assess our current workforce

D1 All National Nursing & Midwifery Workforce & Workload tools to be run at least annually

Nurse Director via Nursing & Midwifery Workforce Delivery

Group


D2 Identify areas of risk / hot spots / pinch points within our current workforce

Workforce Modernisation

Manager


E – Ensure staff are deployed affordably

E1 Absorb staff aligned to unfunded unscheduled care beds into funded posts as the closure programme for these beds

proceeds

Assistant Directors of Acute Services

supported by HR Managers


Workforce Plan 2018/19 - NHS Ayrshire and Arran · Table 2 – Job seekers allowance (JSA) plus out-of-work Universal Credit claimant rates as at March 2018 (source: Office of National

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