Chapter 5 - Making Change Happen – Our People
'Our workforce is our greatest asset and is key to delivering modern, sustainable health services.'
Visit www.nhsscotannualreport.com for the online version of the Annual Report, including peoples' stories and key facts and figures.
Our workforce is our greatest asset and is key to delivering modern, sustainable health services. NHSScotland needs to have a committed, supported workforce that has the right skills, flexibility and support. Everyone needs to be valued, treated well and supported to give their best – we know that this improves patient care and overall outcomes for patients. Everyone Matters: 2020 Workforce Vision remains the key strategic statement of our commitment to our workforce.
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.
Promoting Our Values
The NHSScotland values are:
- Care and compassion;
- Dignity and respect;
- Openness, honesty and responsibility; and
- Quality and teamwork.
To support the delivery of the 2020 Workforce Vision, our priorities remain:
- 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 person-centred, safe, effective care;
- Integrated Workforce – working to deliver integrated 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 people to deliver the 2020 Vision.
Everyone Matters: 2020 Workforce Vision  was published in 2013. During 2016/17, the focus started to shift to the period beyond 2020 by taking stock of the progress made to date and considering what is needed to support both the health and the social care workforce in the future. This involved engaging with partners to consider the development of a workforce vision for both health and social care staff working in integrated settings. This work will continue during 2017/18, and will involve engagement across health and social care. During this time, Everyone Matters: 2020 Workforce Vision will continue for NHSScotland staff, and is being refreshed during 2017/18 to align it with recent and current policies and developments.
Valuing All Our Staff
Everyone Matters: 2020 Workforce Vision recognises the importance of supporting and valuing all of our workforce. However, the result of the EU Referendum in June 2016 brought uncertainty for some of those working across NHSScotland. That is why, on the day following the referendum result, I wrote to the Chairs and Chief Executives of all NHS Boards, emphasising how much I valued the contribution of all members of staff, regardless of citizenship. Scottish Ministers have also emphasised their support on many occasions, and have given their commitment to do all they can to ensure that those European Economic Area ( EEA) citizens from outside the UK who are working in NHSScotland can continue to live and work in Scotland.
Healthy Organisational Culture
Improving Staff Experience
A key action in promoting a healthy organisational culture over recent years has been the implementation of iMatter, the continuous improvement model to improve staff experience across NHSScotland. The implementation programme has gone from strength to strength during 2016/17. This transformational approach, which was developed by NHSScotland staff, has now been rolled out by all NHS Boards. Between 2015 and August 2017, a total of 172,281 health and social care staff have checked into the system. Furthermore, 23 Health and Social Care Partnerships have chosen to participate in this staff experience measure, and it is anticipated that this number will grow. This demonstrates the recognised success of the iMatter model and the benefits of involving staff in decisions that affect them, particularly as the integrated health and social care landscape continues to mature.
Ultimately, improved staff experience should benefit patient and client care. During 2017, to ensure a full picture of staff views on working for NHSScotland and to build on the success of iMatter, the approach will be supplemented with a short dignity at work survey. The survey will give NHSScotland staff and Local Authority staff working in participating Health and Social Care Partnerships the opportunity to express their views on dignity at work issues not currently covered by iMatter, including: bullying and harassment, discrimination, abuse and violence from patients and the public, resourcing and whistleblowing. The results of this survey, together with the national iMatter results, will provide a full overview of staff experience and will inform a national report which is expected to be published in February 2018.
Enabling an Engaged and Empowered Workforce
A healthy organisational culture is one which ensures that it is safe and acceptable for staff to speak up about wrongdoing and malpractice within their organisation. Working with NHS Boards, the Scottish Government continues to develop policies to support and promote an open and transparent reporting culture across NHSScotland. Development of the role of the Independent National Whistleblowing Officer ( INWO) for NHSScotland has continued during 2016/17, with a focus on getting the role right. The Scottish Government is working to ensure that the INWO role is introduced as soon as possible and that it has the ability to provide independent challenge and oversight with the powers it needs to make a real difference. It is anticipated that this role will be introduced in late 2018. The service that provided the NHSScotland Confidential Alert Line ( NCAL) has been expanded and, from 1 August 2017, became the Whistleblowing Alert and Advice Services for NHSScotland. The service continues to offer support to staff from legally-trained advisers on whether or how to whistleblow but also now has an increased focus on resources and support for staff and managers. The oversight and assurance role of non-executive Whistleblowing Champions in NHS Boards has also been maturing. This role was introduced in 2015 to ensure that NHS Boards comply with their responsibility to promote whistleblowing, support whistleblowers, and ensure that all concerns raised are appropriately investigated. The Whistleblowing Champions meet on a regular basis to share their experiences and learn from each other to ensure that their role makes a difference.
Building a Sustainable Workforce
Everyone Matters: 2020 Workforce Vision also recognises the importance of having a sustainable workforce with the right people available to deliver the right care, in the right place, at the right time. The numbers of NHSScotland staff continued to rise during 2016/17, with the March 2017 figures showing 139,431 WTEs  . During the reporting year, considerable progress was made on workforce planning issues, including a number of manifesto and Programme for Government commitments which had a direct impact on the NHSScotland workforce, including: commitments for an additional 500 health visitors to be recruited by 2018; a commitment to increase the number of GP training places from 300 to 400 a year; and to train another 1,000 paramedics to work in the community, helping to reduce pressure on A&E services.
Scottish Ministers also signalled a new approach to workforce planning, making a commitment to the Scottish Parliament in autumn 2016 to publish a national workforce plan. This recognised the need for workforce planning to keep pace with changing services. The Health and Social Care Delivery Plan was explicit about the need for workforce issues to be considered alongside service and financial planning issues, and emphasised the importance of better coordination of national, regional and local workforce planning against a complex and shifting health and social care background.
A series of discussions with stakeholders across health and social care identified issues for further consideration, and a discussion document was produced for public consultation in January 2017. This identified recommendations covering a number of key areas including governance, roles, data, recruitment and retention, guidance and student intakes. The response to the consultation was very positive, with 79 responses received. These contributed to key themes in the eventual publication in June 2017 of Part One of the National Health and Social Care Workforce Plan  , with Parts Two and Three, on integrated social care and primary care respectively, scheduled to follow later in the year (with Part Three subject to the conclusion of GMS contract negotiations).
Part One of the National Health and Social Care Workforce Plan strengthens and harmonises NHSScotland workforce planning practice nationally, regionally and locally. Measures set out in Part One – including the establishment of a National Workforce Planning Group and increases in the number of training places for medicine, nursing and midwifery – focus on ensuring NHSScotland has the workforce it will need to address future demand for safe, high-quality services for Scotland's people. These important steps will enable different health and social care systems to move together towards publication of a second full Health and Social Care Workforce Plan in 2018 and beyond.
Supporting Decisions on Safe and Effective Staffing
The link between safe and sustainable staffing levels and high-quality care is well established. It is vital to have the right number of staff in place, with the right skills. The Scottish Government's Programme for Scotland 2016/17, published in September 2016, made a commitment to begin work to engage with stakeholders to shape the consultation on enshrining safe staffing levels in law, putting Scotland's innovative nursing and midwifery planning tools on a statutory footing, and exploring how this model can be extended to other parts of the health and social care workforce. A formal consultation period began in April 2017  . Proposals are being developed in consultation with stakeholders, including staff bodies, reflecting our ongoing commitment within NHSScotland to work in partnership with staff side colleagues. The timetable for the work will continue through to 2019 when the legislation will be enacted.
Meeting Recruitment Challenges
The Scottish Government has continued to work with NHS Boards across Scotland to review existing recruitment arrangements and explore new recruitment models, particularly in areas of acute staffing need. Scoping activity is being undertaken by human resource ( HR) specialists to examine the sequencing of the international recruitment process and identify potential barriers and disincentives at all stages, from the advertisement of roles, to appointment and induction. This work is taking place as part of proposals to design a pan-Scotland international recruitment campaign across radiology specialisms. It is anticipated that the outcomes of this programme will provide a model for pursuing regional and national approaches to recruitment across other medical specialties. In addition, NHS Boards are looking at the recruitment challenges presented by Scotland's distinctive demographic structure, including how they might work together to increase the attractiveness of recruitment to posts in hard-to-fill specialties. NHS Boards continue to monitor areas of staffing need and gather evidence of shortages across services, and a series of actions are also being progressed by NHS Education for Scotland to improve the approach to recruitment and retention, reflecting its inclusion as one of the key themes in Part One of the National Health and Social Care Workforce Plan.
Developing the Young Workforce
During 2016/17, NHS Boards and the Scottish Government have been working in partnership to pursue a strategic approach to youth employment that aligns the current and future staffing needs of NHSScotland with opportunities for young people to pursue NHS careers. A Young People Working Group has been developed and was convened in June 2017. The Group comprises HR specialists from NHS Boards and representatives of the Scottish Government, and will specifically examine how existing pre-employment support might be expanded across NHS Boards, with a view to providing onward access entry-level posts, including Modern Apprenticeships, for young people from disadvantaged backgrounds. More broadly, the Scottish Government is working with NHS Education for Scotland ( NES) to gather data to improve our strategic planning activity in relation to developing the young workforce, including funding for a dedicated post to audit current youth employment activity across NHS Boards.
This post will also examine the implementation of new frameworks and initiatives to increase the youth employment talent pipeline, in line with the commitments made in the National Workforce Plan.
Developing a Capable Workforce
Widening Access to Medicine as a Career
The 2020 Workforce Vision also prioritises ensuring that all staff have the skills they need to deliver person-centred, safe and effective care. Widening participation in medicine contributes to this, both through addressing inequality for those from social and geographically disadvantaged situations and creating a diverse environment that benefits all our students and medical practice in Scotland. The Scottish Government has developed a package of measures supporting these aims. It includes funding for a new pre-medical entry programme with Glasgow and Aberdeen Universities, providing 40 places for students from disadvantaged backgrounds to provide the best possible chance of meeting the entry requirements to study medicine.
In 2016, university medical schools successfully recruited an additional 50 medical undergraduates, with a focus on widening access principles  . Medical schools are being encouraged to maintain and improve on this in 2017.
Discussions on delivering Scotland's first Graduate Entry Medicine ( ScotGEM) programme in partnership with Dundee and St Andrew's Medical Schools are progressing well and this will commence in autumn 2018. The Scottish Government will pay the tuition fees of eligible students who are accepted onto ScotGEM. This provides exception to the normal rules which apply to those who already have a degree.
An additional 100 new GP Specialty Training posts were added from 2016, taking overall annual GP trainee posts advertised to 400 and, following national recruitment, there were 37 successful applicants  . In tandem, to promote General Practice as an attractive career choice, a one-off taxable bursary of £20,000 is available to trainees in posts that historically have been more difficult to recruit to. The bursary payment is made to trainees as a lump sum on taking up the post and in return they agree to complete the three-year placement in that location  .
Supporting Access to Nursing and Midwifery Education and Careers
The Scottish Government's Programme for Government 2016/17  committed to create 1,000 additional training places for nurses and midwives over the course of this Parliament, to keep tuition for nursing and midwifery students free and to retain the nursing and midwifery student bursary at least at its current level.
To help deliver these commitments, in January 2017, the First Minister announced measures to increase the number of nurses and midwives in Scotland and help widen access to training places. The number of funded university places for those starting nursing and midwifery training will increase by 4.7 per cent in the 2017/18 academic year, bringing the total recommended intake to 3,360 places – the fifth successive increase. Adult nursing, mental health nursing, children's nursing and midwifery will all see an increased number of new students. The number of student training places in the north-east of Scotland will also increase. In addition, the First Minister announced that an extra £3 million per year will be invested to increase financial support for nursing and midwifery students with children or dependants – supporting 800 to 1,000 students who are most in need. A £1 million discretionary fund to provide a safety net for student nurses and midwives has also been put in place and commenced in October 2016.
During 2016/17, the Scottish Government also continued to provide financial 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 continues to be much more successful than originally planned, with a total of 310 former registrants taking up the opportunity to retrain between May 2015 and February 2017  .
To ensure that nursing roles keep pace with changing needs, the Chief Nursing Officer's Transforming Roles programme continued work to agree nationally-consistent roles and education preparation for advanced nurse practitioners, district nurses and school nurses.
In November 2016, a further important step was taken along the pathway to empowering patients to take control of their own health to maintain independence and reduce unnecessary use of healthcare services by extending supplementary prescribing rights to dietitians and independent prescribing rights to therapeutic radiographers. The measure followed a UK-wide public consultation in 2015 and makes better use of the skills of Allied Health Professionals.
Effective Leadership and Management
Executive Leadership and Talent Management Programme
Work to develop the Executive Leadership and Talent Management Programme continued during 2016/17. The Leadership and Talent Management Group continued discussions to set out the rationale, aims and outcomes for the development of a new end-to-end approach to executive level leadership and talent management within the NHS in Scotland. The approach, which was being discussed across a range of stakeholders – including NHS Board Chairs and Chief Executives and the Chairs of the Executive Director level professional groups – was looking specifically at six key workstreams to be planned and delivered nationally. These cover: values-based recruitment; executive performance management and appraisal; talent management and succession planning; leadership development; governance and oversight; and communications and engagement. An overview paper was published in May 2017, setting out the new approach.