Health and Care Staffing (Scotland) Bill: Scottish Government response to stage 1 report
Response to the Health and Sport Committee's Stage 1 Report.
Part 2 Staffing in the NHS
Current Tools and Development of New tools
141. We understand the tools are only one part of the common staffing method. However, as they are providing a baseline figure which the other parts of the triangulation process then use to establish 'safe' working it is essential these are as accurate and relevant as possible.
142. We welcome the working group which has been set up to review the tools but are surprised this did not happen until after the Bill was introduced. It would have been helpful for this work to have been completed before legislation was introduced allowing us and the Scottish Government to be confident about the Health and Sport Committee Stage 1 report on the Health and Care (Staffing) (Scotland) Bill, efficacy of the tools. We are disappointed the review will not now be completed by the end of Stage 1 consideration of the Bill.
143. We ask the Scottish Government for the information from the review to be available prior to Stage 2 and welcome details on when the working group is expected to report on their review of the current tools. We would also welcome details of how it is proposed the results of the review will be implemented and impacts on the Bill promulgated.
Scottish Government Response
41. When the tools were initially being developed a tools and maintenance sub group was established within the Nursing and Midwifery Workload and Workforce Planning Programme (NMWWPP). This was disbanded when the programme went on a business as usual footing as tools were developed for 98% of nursing and midwifery service areas. The tools were then reviewed with oversight from the Directorate of the Chief Nursing Officer.
42. There has been a cycle of review of all the workload tools since they were created. This is done by:
- 6 monthly cycle of builds/revision to the software as required. This is undertaken by keeping an issues log for all of the tools and ensuring that issues are addressed in the 6 monthly build cycle as required.
- Bringing together of the clinical reference group for each tool to review current practice / policy changes in the specialty which may have impacted on workload to establish if further work on the tools are required, consideration of any common themes or issues with the tool from a service perspective and any technical issues that have arisen that have not been resolved in the 6 monthly review cycle identified above.
43. These reviews have been ongoing since development of the first workload tool. As previously advised the governance structure of the programme has recently been revised and a workload tools and maintenance group was established last year. The function of this group was to oversee and monitor the work described above, not to establish a mechanism for doing so as this was already in place.
44. There has been a mandate for use of all tools and existing triangulated methodology since 2013 and the expectation therefore is that Health Boards achieve this. The legislation will make the use of these tools and the common staffing method (which is an updated version of the current triangulated methodology) a requirement. In addition to training resources available in the form of video clips and an education toolkit the NMWWPP programme advisors are a resource that can be used by Health Boards to provide additional advice and training in application of tools and triangulation process, analysis of reports to make informed decisions about staffing requirements using available evidence from tools, professional judgment, local context and quality measures.
45. Once the decision was made to put the workload tools on a statutory footing as part of the Scottish Government's Programme for Government 2016-17, additional governance structures were re-established. This included re-establishment of the NMWWPP steering group which oversees the work of the programme and reports to the Health and Care Staffing Strategic Programme Board. The steering group then established two sub groups, the tools and maintenance group and the education and training sub group. The cycle of reviews will continue and will be enhanced by consideration being given at each review about the ability to extend each tool to a multi-professional/disciplinary approach.
46. The reviews have been ongoing, however extension to the multi-disciplinary approach will require detailed analysis of workload in the wider team and will require extension of the clinical reference group to other staff groups. This will allow for consideration of a methodology for extending the tools to other staff groups, development work to ensure activity analysis includes activities for all staff groups, extensive data collection by way of observation studies, testing, and refining before the tools can be validated for use in the multi-disciplinary team. The tools are kept under continuous review, the programme of which is planned but needs to be dynamic to respond to changing policy, models of care, research and best practice. There is therefore no end date to this work as it is crucial to constantly assess and continuously improve the tools.
47. However, should this review, or any future review of the tools and method, require the common staffing method or staffing tools to be updated there is an ability to do so. Section 12IB(4) contains a power enabling the Scottish Ministers to change the description of the common staffing method set out in new section 12IB(2). Section 12IC(3) contains a power enabling Scottish Ministers to add remove or change the table setting out the types of health care in 12IC to which the application of the common staffing method, and the use of the tools, applies. Both powers are affirmative and so Parliament will have an adequate opportunity to scrutinize any changes which may be proposed. The specific tools to be used as part of the common staffing method will be set out in regulations made under the power contained in 12IB(3).
151. We are pleased NSS is undertaking work to procure a new platform. Issues have been raised with SSTS and we would welcome details on how these will be rectified if the tools are not moved to a new system.
152. As with the review of the current tools we are surprised the required replacement platform was not addressed prior to the introduction of the Bill. We ask the Scottish Government to confirm the expected time frame for having a new system up and running and how that links with commencement of the relevant Bill provisions.
Scottish Government Response
48. The current suite of staffing tools sit on the SSTS platform as this is accessible to all Health Boards. Regardless of which system is used to host the staffing tools, the process of using the tools remains unchanged. As set out elsewhere in this response, significant resources are being put in place to ensure staff using the common staffing method are appropriately trained in the use of the tools, this includes accessing the system on which the tools sit.
49. NHS Education for Scotland (NES) as part of their broader piece of work on workforce systems in NHS Scotland led by NES and supported by National Services Scotland (NSS), are working to procure and implement an e-Rostering system for NHS Scotland to cover all staff groups. This will then inform the next steps in the programme of work. However no part of the current system will be decommissioned until there is a replacement in place and consideration will be given to where hosting of the workforce tools is best placed in the new environment.
163. Training is a crucial aspect of any process and will impact on the success of the process. We were disappointed to hear from front-line staff how little (if any) training had been provided on the tools. Many felt completely confused by the process and the outputs and as a result felt completion of the tools was more time consuming than anticipated.
164. Whilst we welcome the detail in the Financial Memorandum around training costs we are concerned these may not be a true reflection of likely amounts required given their reliance on "existing knowledge and experience." 53 Given the evidence we have received coupled with our survey responses we are concerned the number of staff required to be trained is much higher than anticipated. We are also concerned the potentially extensive training required as a result of the procurement of a new platform has not been included.
165. We have a further concern around the assumption that time for training will be available within continuous professional development. We have heard during numerous inquiries staff just do not have the time to access such training, work priorities always take over. As the success of the common staffing method relies on the understanding of the tools by staff we ask the Scottish Government to reconsider how time is provided for training.
166. We ask the Scottish Government to provide information on the numbers of staff they consider will require training, broken down by health board together with an estimate of the length of the training. We recognise the latter will depend upon the trainee, and in particular, whether they are familiar with the existing models or not.
167. The Scottish Government advised details on access to training and the continuous roll-out of training to new staff would be covered in guidance should the Bill be passed. We would welcome further detail on what might be proposed here prior to Stage 2.
Scottish Government Response
50. Health Boards have access to on line learning resources on applying the tools and to the education tool kit. In addition professional advisors provide advice and face to face training on request. It is for Health Boards to establish their training requirement and to access the resources available as required. Each of the programme advisors are aligned to Health Boards. As set out in the Financial Memorandum, the Scottish Government committed to increasing the number of advisors (para 44). These assistant programme advisors have recently been appointed and will focus on training requirements in Boards.
51. The education and training sub group of NMWWPP are currently developing a learning needs analysis to inform the review of the on line education and training resources, education tool kit and face to face training sessions. The training needs analysis will inform content and methods for training in the future. Once complete, this analysis will be shared with the Committee, it is anticipated this will be complete by Summer 2019.
52. Procurement of a new platform will not necessarily impact on training requirements. The tools themselves will not change and therefore training on application of the tools will not change as a result of any new platform.
53. There are areas of good practice where tools are running well and staff are fully engaged in the process. There is therefore some level of understanding and knowledge available within the system. Scottish Government will continue to engage with Health Boards and NHS Education for Scotland to assess the need for training.
54. The implementation of the new e-rostering system will come with a separate training programme on the use of the system, which will be costed separately but aligned to the predictable absence allowance element of the current tools.
55. The on-line training videos which guide clinicians through each of the tools vary in length depending on the complexity of the tool. The time taken to watch the videos varies from 7 to 15 minutes. Each video is accompanied by a written user manual which can be referred to when inputting information. This information is sufficient for staff to input information to the tool.
56. The education tool kit goes into more detail about using the output from the tools and using the triangulation method to make decisions about staffing. This level of understanding will not be required by all staff. The revised training programme will include training on the common staffing method. This training will commence from Summer 2019.
57. As set out in the Financial Memorandum and referenced elsewhere in this response, the Scottish Government has already provided funding for additional staff to support Health Boards to consistently apply the methodology, and to collate, analyse and report information across the organisation. These staff have been apportioned across all Health Boards and will play a key role in ensuring Health Boards are adequately training their staff to carry out the common staffing methodology. It is important to note that Health Boards will have a new statutory duty to ensure that staff have adequate time to apply the methodology, under section 4 inserted section 12ID.
58. The NMWWPP team also provide advice and training to Health Boards where required. The team has recently been expanded to ensure there is capacity within the team to develop tools in other areas and to ensure appropriate advice is available to Health Boards in preparation for the proposed legislation.
59. The Scottish Government will review the number of staff who will need trained based on the outcome of the learning need analysis and share this with the Committee.
60. Guidance will lay out that all staff using the tools should access on-line training and what other training modalities may be pertinent. It will then further detail the training required at each level of decision making following application of the common staffing method. Further details will be provided prior to Stage 2.
Compliance and Sanctions
177. We welcome confirmation from the Cabinet Secretary that health boards will be expected to report on how they have ensured appropriate staffing and the outcomes from running the tools as well as the application of the tools. We note Audit Scotland have on a number of occasions stressed the importance of new policies including clear monitoring provisions at the outset. Clear monitoring should allow both ease of scrutiny and the means to spread and incorporate learning and best practice. We would welcome confirmation from the Scottish Government prior to stage 2 how these aspects are met by this Bill.
178. We have noted the powers of sanction in the 1978 Act and believe it would be helpful for us and health boards to understand the process in the context of noncompliance. While we hope use of the powers never becomes necessary we would welcome a breakdown of the steps that could follow.
Scottish Government Response
61. A number of measures are already in place to monitor Health Boards' compliance with their legal duties and it is therefore expected that non-compliance with the duties in the Bill would be managed in line with the existing performance and monitoring process and escalation levels. Healthcare Improvement Scotland provide public assurance about the quality and safety of health care, including monitoring and inspecting services provided by Health Boards. They also provide improvement support where required and ultimately have the power to close wards where necessary improvements are not made.
62. The Care Inspectorate regulate a range of care services. It undertakes strategic inspection of local authority social work services and scrutiny of care services, and can take action where problems are found.
63. The Scottish Government and HIS are currently revising the escalation process to deal with issues, concerns and service failures and how these are more effectively escalated and resolved between Scottish Government, HIS and Health Boards for the protection of the public.
64. If successful resolution is not achieved the steps that could follow if there is an issue with Health Boards' compliance with their duties are set out clearly in the 1978 Act. Ministers have powers to hold inquiries into NHS services under section 76; may declare a Health Board to be in default of their obligations under section 77; and have defined powers of direction and intervention under section 78A where there has been some sort of failure in provision of service. There is also the power of direction in section 2(5) of the 1978 Act which can be used generally or for specific matters – this could involve directing a particular Board to undertake specific actions before the use of the other powers mentioned above is contemplated. These powers will all apply to the duties placed on Health Boards by this Bill, as will the existing powers of Health Improvement Scotland to monitor, inspect, and in extremis to shut down services.
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