NHSScotland Chief Executive's annual report 2015-16

Presents an assessment of the performance of NHSScotland from 2015 to 2016 and describes key achievements and outcomes.

Chapter 5 - Our Workforce

'Together we will create a great place to work and deliver a high quality healthcare service which is among the best in the world.'

Our NHSScotland workforce is vital in responding to the many challenges we continue to face and it is down to the extraordinary commitment and dedication of our health and social care staff across Scotland that we have the world-class NHS that we have today.

We know from evidence that staff who are valued, treated well and supported to give their best, deliver better patient care and overall outcomes. Everyone Matters: 2020 Workforce Vision [132] is our commitment to valuing our workforce and changing the workforce things that need to change or be done better to ensure that we can continue to deliver the high quality services that the people in Scotland deserve.

Our 2020 Workforce Vision is:

We will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations. We will continue to modernise the way we work and embrace technology. We will do this in a way that lives up to our core values.

Together we will create a great place to work and deliver a high quality healthcare service which is among the best in the world.

Our values that are shared across NHSScotland are:

  • Care and compassion;
  • Dignity and respect;
  • Openness, honesty and responsibility; and
  • Quality and teamwork.

Our five priorities to deliver our 2020 Workforce Vision are:

  • Healthy Organisational Culture - creating a healthy organisational culture in which our NHSScotland values are embedded in everything we do, enabling a healthy, engaged and empowered workforce;
  • Sustainable Workforce - ensuring that the right people are available to deliver the right care, in the right place, at the right time;
  • Capable Workforce - ensuring that everyone has the skills needed to deliver safe, effective, person-centred care;
  • Working to Deliver Integrated Services - health and social care workforce across NHS Boards, Local Authorities and third party providers; and
  • Effective Leadership and Management - leaders and managers lead by example and empower teams and individuals to deliver the 2020 Vision.

A huge amount of work has been carried out by NHS Boards and key partners in 2015/16 across these priorities. In September 2015, the Scottish Government published a Review of Progress which highlighted work by all NHS Boards to deliver our priorities and embed our shared values in everything we do.

The progress being made in Scotland was also highlighted by the Organisation for Economic Co-operation and Development ( OECD) in their review of the four healthcare systems in the UK [133] , which described our work to deliver our 2020 Workforce Vision as 'clear and impressive'. But we are not complacent and, while we are making progress towards our 2020 Workforce Vision, we are doing more to support our staff who are low paid, ensure that we have a true culture where staff are encouraged and supported to speak up when they see practice or behaviours that don't meet our shared values - without repercussion.

To drive forward the transformational agenda, work across boundaries and harness the talents of all those working in our organisations, we are doing more to support the continuing development of our current and future leaders. This is building on many of the well-established programmes already being offered at local and national level, with a fresh approach now being developed for our top leadership cohort at NHS Board-level. The key dimensions of our approach spans leadership development, talent management and succession planning, performance review and appraisal and moving towards values-based approaches in areas such as recruitment. These approaches will draw on existing good practice in Scotland, learning from elsewhere and the most up-to-date evidence of how organisations best serve and work with their stakeholders.

Key developments in 2015/16 include:

Improving Staff Experience

The implementation of iMatter, the continuous improvement model to improve staff experience across NHSScotland continues to be a particular achievement. All NHS Boards are engaged in rolling out the model across their organisations and are on track to complete this by the end of 2017. IMatter response rates are currently at much higher levels than those achieved by the NHSScotland staff survey with Employee Engagement Index scores for NHSScotland returning values which place them in the top percentile within the range of scoring on a world stage. This would suggest that the model is making a significant impact in involving staff in the decisions that affect them and making real changes for the benefit of patients and staff. In addition, some Health and Social Care Partnerships are now also using the model to measure and improve their staff experience.

Enabling a Healthy, Engaged and Empowered Workforce

NHS Boards must ensure that it is safe and acceptable for staff to speak up about wrongdoing or malpractice within their organisation, and much has been done in 2015/16 to further support this. Following a full public consultation on detailed proposals, work is underway to establish an Independent National Whistleblowing Officer. This will complement existing policies and provide independent and external review on the handling of whistleblowing cases in NHSScotland. Non-executive Whistleblowing Champions were introduced in each NHS Board in November 2015, providing a critical oversight and assurance role at local level. The contract for the National Confidential Alert Line has been extended for a further year to ensure that staff have access to additional independent support should they feel unsure about how or whether to whistleblow. NHSScotland has also responded to concerns and stopped the standard practice of using confidentiality clauses in settlement agreements. This was in response to a perception that they were used to 'gag' staff, and they are now only used with the explicit consent of staff.

Right Staff, Right Time, Doing the Right Things

The Scottish Government is committed to introducing national and regional workforce planning, with preparations underway to take proposals forward and publish a first iteration of a national healthcare Workforce Plan in spring 2017. In 2015/16, numbers of NHSScotland staff continued to rise to over 138,000 whole time equivalent ( WTE) [134] . However, the proposals are not exclusively about numbers. They will involve close consideration, with partnership stakeholders, of the many influences on workforce planning. That will not only mean ensuring sufficient numbers of NHSScotland staff, but that they are in the right place, at the right time, and doing the right things in pursuit of safe, high quality patient care. The proposals are expected to help bring about practical solutions to capacity issues which are experienced by NHS Boards.

Additional manifesto commitments were made to maintain, increase and improve staffing capacity, including specific plans to increase numbers of GPs, Nurses, Advanced Nurse Practitioners, Health Visitors, medical school places, community link workers and paramedics. This was designed not only to increase staffing levels throughout NHSScotland but to continue to attract and retain the best talent in the healthcare profession.

Providing Timely Access to High Quality Care

The aim of the Sustainability and Seven Day Services Programme [135] is to ensure that people who require healthcare have timely access to high quality care whenever they need it, on a basis that is sustainable in the long-term. Activity this year has focused on taking forward the next steps detailed in last year's interim report [136] . The Sustainability and Seven Day Services Taskforce accepted the service model proposed by the Scottish Clinical Imaging Network for reviewing and reporting diagnostic imaging and the provision of interventional radiology. Plans are now progressing for the implementation of this with NHSScotland Shared Services.

The Programme for Government 2015/16 [137] announced two innovative community health hubs would be tested in NHS Forth Valley and NHS Fife. A number of GPs have been recruited and are currently undergoing an additional year of training to provide them with the skills to work across Primary and acute care and to staff the hubs as part of a wider multidisciplinary team. The pilot NHS Boards are making good progress with their delivery models. Two distinct models are emerging in response to local needs, albeit both are centred around issues of frailty. The hubs are on course to go live in early 2017. A review of acute general surgery across NHSScotland is progressing well and a large amount of data has been gathered. The review is on track to be completed this year.

Supporting Nurses and Midwives to Return to Practice

During the reporting year, some parts of Scotland continued to experience challenges in recruiting to the nursing and midwifery professions because of their geographical location. In February 2015, the Scottish Government announced assistance to former nurses and midwives who wished to return to practice. The aim originally was to provide support for 75 nurses and midwives a year by providing funding for their university fees and for other support. The programme has been much more successful than originally planned, with many more applicants applying to return to practice. This has allowed a total of 150 nurses and midwives in the first year of the scheme to receive funding to re-join the nursing and midwifery workforce, alongside an additional 14 non-funded applicants also beginning the Return to Practice programmes [138] .

Supporting Decisions on Staffing

A ground-breaking, multi-disciplinary tool has been available since May 2015 for use in Emergency Departments/Emergency Medicine ( EDEM) settings. This tool is part of a suite of workload and workforce planning tools available to NHS Boards in Scotland which cover the majority of service areas helping to plan for the number of nurses and midwives they require to provide the best possible care for patients. The EDEM tool is unique because it not only informs the number of nurses required but also the numbers of medical staff needed. Scotland has led the way in developing these tools, looking at factors such as the number of patients, the complexity of the care required, local factors, shift patterns and also time for tasks such as administration. Feedback from NHS Boards demonstrates that use of the tools, including the EDEM tool, is encouraging an evidence-based approach to decisions on staffing.

NHS Pay and Conditions

NHS Pay Review Bodies' recommendations for salaries in 2016/17 have been implemented in full, leading to all NHSScotland staff on salaries over £22,000 receiving a 1 per cent pay increase from 1 April 2016. Staff earning under £22,000 received an increase of at least £400, underpinned by an uprated Living Wage. In addition, a review of use of the lowest pay band available within NHSScotland was instigated which would ultimately offer those currently on band 1 of the Agenda for Change system the chance to move to band 2 with an expanded job description. This initiative was taken forward in partnership between employers and staff with a view to creating a higher skilled and more flexible workforce on the one hand and allowing staff to access higher pay on the other.

A new NHS pension scheme was successfully introduced from 1 April 2015 following communication with all staff. The new scheme includes a later pension age. Work to consider the implications of this and to develop support for staff and employers has been taken forward through the UK NHS Working Longer Group and a Scottish Working Longer Group.

Meeting Recruitment Challenges

Scotland's needs are different to those in the rest of the UK due to Scotland's distinctive demographic structure and migrant workers remain an important labour source. Whilst the UK Government remains committed to reducing dependence on migrant workers and tightening the rules around entry to the country, Scotland has some power through the Shortage Occupation List (Scotland only) to facilitate entry routes for certain skilled migrant workers.

Although recruitment of staff remains the responsibility of individual NHS Boards, the Scottish Government has been able to help their recruitment challenges. For example, following a review of the Shortage Occupation List ( UK and Scotland only), the Scottish Government worked with NHS Boards to gather evidence of shortages across medical specialties and submitted this to the Migration Advisory Committee ( MAC) in December 2014. This evidence successfully met the strict criterion set down by the MAC which recommended the UK Government increase the number of medical specialist roles on the Scotland only Shortage Occupation List. The UK Government accepted the MAC recommendations and a revised list was published in April 2015 [139] . NHS Boards seeking to recruit international specialists from this list should find it quicker and less expensive to do so.

When recruiting internationally, NHS Boards must adhere to The Code of Practice for the International Recruitment of Healthcare Professionals in Scotland [140] . The code highlights the ethics that should be considered in international medical recruitment, including seeking the agreement of the government of the country being targeted. In May 2015, the Scottish Government worked with NHSScotland and the Government of the Netherlands through the European Recruitment Services ( EURES), to promote NHSScotland as a good place to work and Scotland as an attractive place to live. As a direct result of this work, over 50 firm expressions of interest in working in NHSScotland were received and shared with NHS Boards. The Scottish Government, working with NHSScotland, will continue to build on this work as it continues to support NHS Boards to recruit the staff they need.

Developing the Young Workforce

NHS Boards continue to implement the Developing the Young Workforce: Scotland's Youth Employment Strategy [141] and in particular the commitment to reduce youth unemployment by

40 per cent by 2021. Over the reporting year 2015/16, 14 NHS Boards provided new Modern Apprentice opportunities. A total of 144 Modern Apprentices utilising differing frameworks were appointed and contribute to the ministerial target of 500. Combined with 96 last year, there is evidence that a total of 240 MAs have been appointed by NHS Boards since the introduction of this target. This is 72 per cent of the target for all NHS Boards to recruit from August 2014 - March 2016 and 48 per cent of the overall target. Over the reporting year 2015/16, NHS Boards have delivered 4,187 new employment opportunities for young people (aged 16 to 24). This figure includes Modern Apprentice opportunities. This is an increase of 37 per cent over the same period last year when 3,050 were appointed. Evidence suggests that a total of 10,699 employability opportunities for young people have been offered by NHS Boards over the past three years [142] .

Working to Deliver Integrated Services

As the integration of health and social care progresses, consideration continues to be given to the associated workforce aspects. The Human Resources Working Group on Integration [143] continues its work to address strategic-level workforce issues and to identify issues which may require national co-ordination. In addition, a further two events in the Strengthening the Links series were held over the year. These events successfully brought together those with an interest in workforce issues to share learning and experience of integration both within and across sectors and to facilitate peer support and networking around common workforce challenges and opportunities.


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