Evidence submitted by the Department of
Health (WP 01)
EXECUTIVE SUMMARY
This paper contains the Department of Health's
written evidence for the Health Select Committee for the inquiry
into workforce planning in the NHS. The paper outlines the workforce
achievements since the Committee's last inquiry into workforce
planning in 1999, the current process of workforce planning in
the NHS and the challenges facing workforce planning in the near
future.
Workforce planning has undergone many changes
since the review of workforce planning in a Health Service
of all the Talents in 2000. There are now processes in place
that deliver a "bottom up—top down" approach to
planning that ensures local employers and national planners are
fully engaged and includes key stakeholder engagement. A vital
component of workforce planning is each organisation's Local Delivery
Plan (LDP) that integrates service, finance and workforce plans.
Each organisation now plans the workforce of the future that is
right for them rather than a rigid "one size fits all"
central plan. This concept is reinforced in the new Integrated
Service Improvement Programme (ISIP) that ensures workforce reform
is at the heart of local service delivery.
A lot has been achieved in the last five years
in terms of filling the gaps, ensuring the service has sufficient
staff and reforming the pay and reward systems to create a world
class workforce. We have achieved the challenging targets laid
down in the NHS Plan and met the European Working Time Directive
(EWTD) target in 2004. New pay structures have been agreed for
all staff groups and under Agenda for Change (AfC) the concept
of a skills escalator is enabling services to be redesigned and
supporting staff to develop new skills and new roles. The NHS
is now a flexible employer better able to attract and retain good
quality staff. The NHS Careers service and electronic recruitment
via NHS Jobs are now part of an infrastructure to deploy staff
more cost effectively and support their career development.
The NHS has seen a period of growth in both
financial support to the NHS and the size of the workforce. There
is now a much better balance between supply and demand with the
NHS becoming more self reliant in training its own staff to meet
the future needs. The past five years has been about staff growth
and the next five years will be about transformation into a flexible
affordable staff mix to deliver patient centred care. The NHS
already has developments in place that will enable organisations
to work in new ways and share best practice across organisations.
The future is not without several significant
challenges; this paper explores the impact of external drivers
such as the European Working Time Directive requirements for 2009
and the demographic shift in the population. In addition new providers,
greater choice and new financial systems, together with the 2006
White Paper, will drive changes in how and where healthcare is
delivered in the future.
Looking to the next five years, one thing is
very clear. The investment and reform we have made in the NHS
workforce puts us in good stead for dealing with A Patient
Led NHS, where organisations will need to meet the challenges
of patient choice, be able to compete in an environment of plurality
and provision and drive productivity and efficiency in an era
of lower financial growth. However this will not be achieved unless
all organisations improve their capability and capacity to undertake
workforce planning and development. Primary Care Trusts, Practices,
Trusts and Strategic Health Authorities will need to base their
service and financial plans on a clear strategy for the future
direction of their workforce that creates the right skill mix
in the workforce for the next five years. Only organisations with
a skilled, flexible workforce, where people are their greatest
investment, will succeed.
1. BACKGROUND
1.1 The need for workforce planning has
long been recognised within the NHS. Any organisation with the
size and staffing complexity of healthcare requires a system for
forward planning. Prior to 1999, workforce planning relied on
a central control of training numbers that were increased or decreased
according to central returns of staffing numbers.
1.2 In March 1999 the Health Select Committee
recommended a review of how workforce planning was undertaken
in the health service. This led to the publication of A Health
Service of all the Talents in April 2000 and recommendations
around four key areas:
— Greater integration and more flexibility
of workforce planning;
— Better management ownership, clearer
roles and responsibilities within planning;
— Improved training, education and
regulation; and
— Better planning for overall staff
numbers and career pathways.
1.3 Since the publication of the paper the
main recommendations have been implemented. There is a greater
integration of workforce planning with service and financial planning
within organisations and mechanisms to share and aggregate these
plans to support local health economies. The funding of education
and development is now within one budget and responds flexibly
to the needs of staff training. There is a clear national framework
for planning with all the key stakeholders represented on the
National Workforce Programme Board and clear lines of communication
to ensure all the associated programme boards are linked into
the plans.
1.4 One of the main structural changes as
a result of the paper was the creation of 28 Workforce Development
Confederations (WDC) to plan effectively for all staff groups
on a locality basis and to work collaboratively with other organisations
so that data and workforce plans could be aggregated nationally.
In April 2004 WDCs were integrated with SHAs to bring together
capacity for service and workforce planning within one body.
1.5 The move to more integrated workforce
planning has improved the links across organisations responsible
for education and training. There are improved links into the
Postgraduate Medical Deaneries with a greater clarity of data
to help plan the number of consultants entering service in future
years. The processes for commissioning education and training
are much improved. There is a clear structure for commissioning
that is based upon strategic planning, is built upon good relationships
across Higher Education Institutions (HEI) and involves links
to service to ensure that qualified trainees are "fit for
purpose".
1.6 The structures put in place by Health
Service of all the Talents were further supported by a clear
strategic direction laid out in the NHS Plan published
in 2000 and the HR in the NHS Plan which followed in 2002.
The two broad aims of these papers were to build upon the improved
workforce planning structures to create more staff, working differently.
1.7 The NHS Improvement Plan, published
in June 2004, set out the way in which the NHS needs to change
in order to become truly patient led. These changes are fundamental,
they affect the whole system and the way individuals and organisations
behave.
1.8 In 2005 Creating a Patient Led NHS
outlined how the improvements in capacity, with increased numbers
of staff and reductions in waiting times and improvements in mortality
rates, would be matched by changes in the structures of the NHS.
1.9 The paper Creating a Patient Led
NHS set out "the ambition for the next few years is to
deliver a change which is even more profound—to change the
whole system so that there is more choice, more personalised care,
real empowerment of people to improve their health—a fundamental
change in our relationships with patients and the public. In other
words, to move from a service that does things to and for its
patients to one which is patient led, where the service works
with patients to support them with their health needs."
1.10 This shift will have a large impact
on workforce planning in the future as organisations implement
the practical steps in moving care closer to the patient and see
the influence of the growth of the Independent Sector to meet
this need. Integrated planning will no longer mean integration
across service, finance and workforce but also integration across
Health, Social Care, the Voluntary and Independent Sectors.
2. ACHIEVEMENTS
IN THE
PAST FIVE
YEARS
2.1 Healthcare organisations have made significant
progress in developing a workforce with the right skills and experience
to deliver patient care since the NHS Plan was launched
in 2000. Workforce Planning for an affordable workforce is an
integral element of all organisations' Local Delivery Plans (LDPs)
and a required component of all new developments and Private Finance
Initiatives (PFI) schemes.
2.2 The NHS Plan established the
Improving Working Lives (IWL) initiative, which provided
NHS trusts with a measured framework to create well-managed and
flexible working environments through policy making, good communication
and partnership between staff and managers. It has led trusts
to fundamentally look at the ways to offer better working conditions
such as access to childcare, carers support, safety and security
at work and flexible working opportunities. It has also given
staff the opportunity to discuss different ways of working that
accommodate both their outside interests and service needs.
2.3 The IWL initiative recognises that improving
the working lives of staff contributes directly to better patient
care. IWL is becoming a feature of every day management in the
NHS and all NHS trusts have achieved the IWL standard at Practice
level and over 300 NHS organisations have attained the Practice
Plus level, which requires them to provide demonstrable evidence
through partnership working that the working lives of staff in
all staff groups are continuing to improve.
2.4 Key elements of IWL include:
— Flexible Working—including
self-rostering, annualised hours, flexi-time;
— Flexible Retirement—providing
options for experienced staff to continue to work, sharing their
skills and knowledge towards the end of their career; and
— NHS Childcare Strategy—providing
good quality, accessible and affordable childcare through the
development of on-site nurseries, school clubs, holiday play schemes
and local childcare co-ordinators. The strategy was developed
to support the provision of quality, accessible and affordable
childcare, following the recognition that this led to improved
recruitment and retention.
2.5 In the NHS the Healthcare Commission
carries out an annual survey into staff views. This is a useful
tool for identifying where improvements are necessary and it is
available for use by all NHS trusts. The results for 2003, 2004
and 2005 are positive and show a trend of improvement, but there
is further work to do to demonstrate that the concept of a Model
Employer is embedded across the service.
2.6 Skills gaps and shortages have been
met as more staff have joined the NHS year on year. Since 1999
the NHS workforce has grown by a total of 234,000 staff. This
includes 23,000 more doctors, 68,000 more nursing staff and 11,000
Allied Health Professionals. Vacancy rates have fallen steadily
as these staff have entered service. The successful implementation
of EWTD 2004 has seen a significant number of staff working fewer
hours. For example, the majority of staff now work fewer than
48 hours and doctors in training work no more than 58 hours.
How return to practice midwives working within the Gloucestershire
Hospital NHS Foundation Trust (Gloucester Royal site) were supported.
In the last year, Gloucestershire Royal has supported two
midwives returning to midwifery practice each with varying requirements.
One midwife had been out of practice for 10 years but had done
a Return to Practice course. The other had not done the required
amount of hours needed to maintain her registration within the
given previous three years and was advised by the local University
to do the Return to Practice course.
Before embarking on the clinical part of the programme, the
midwives discussed their needs and requirement with either the
research and practice development midwife or one of the midwifery
managers.
A specific plan was then drawn up to suit the midwife (hours
to suit family life/commitments and other places of work commitments),
ensuring that all areas of midwifery practices were covered, for
example high risk delivery suite, community and midwife-led birth
unit.
Each midwife was given a named supervisor with whom they
met regularly during the course, with the opportunity of meeting
at any time to discuss practice or other issues. Advice and help
was also given with their essays, particularly content, style
and relevance.
OUTCOMES
Both midwives have since been successfully employed within
the trust. The success of these midwives is due to their motivation,
enthusiasm and flexibility along with a well planned, interesting
and appropriate programme.
2.7 Improved planning processes and increased staff numbers
are not enough on their own to cope with the complex structures
across health and social care. A range of initiatives has been
required to develop the flexibility, new skills and new ways of
working and productivity necessary to deliver world class healthcare.
New programmes, such as Agenda for Change and Modernising Medical
Careers (MMC) have put the building blocks in place for organisations
to develop skilled multidisciplinary teams. In addition great
strides have been taken to improve the working lives of NHS staff
and make the NHS a much better employer.
2.8 Some initiatives have served their purpose and will
not have a big impact in the next five years. International
recruitment was not intended to be a long-term strategy and
since 2005 there has been a steady decrease in the volume of international
recruitment in all sectors. Increasingly as the year-on-year increases
in training emerge, the health service will be more self-reliant
on UK trained doctors, nurses and other healthcare professionals.
International recruitment will be used sparingly to target specific
strategic areas, for example, to bring GPs from Germany, Italy
and Spain into under-staffed communities in England. Other initiatives
are now in the mainstream of good HR practice after a period of
central pump priming and support. For example, encouragement to
employers to provide access to flexible working and return to
practice.
2.9 In December 2005 the Department of Health launched
A national framework to support local workforce strategy development.
This document brought together all of the initiatives in a format
to help HR Directors in the NHS and Social Care integrate their
strategy for local staff development. The document covered six
main areas:
— 10 High Impact Changes in HR
2.10 The aim of the document is to help organisations
devise simple strategies to build upon the achievements of the
last five years but take the initiatives further to create a workforce
that is flexible, productive and affordable. There is no "one
size fits all" answer to the current complex staffing issues,
organisations need to devise local solutions based upon their
own service and financial development. These plans are supported
by national development programmes that share the results of pilot
projects and highlight best practice.
2.11 It is only by continually developing the workforce
strategy that the NHS will be in a position to solve the current
issues in workforce planning and respond to future challenges
in delivering high quality patient care.
2.12 The Department of Health and Workforce Review Team
(WRT), who lead on workforce planning across the health care workforce,
are developing a generic workforce-modelling tool, known as the
"Christmas tree" model. This will allow national and
local workforce planning by individual, local organisations to
assess skills needs and future workforce requirements across levels
rather than professions. In turn, this will support the development
of competency-based workforce planning across the whole healthcare
workforce: determining the skills and competencies needed to deliver
services and defining these by care group and pathways, rather
than specific healthcare professions.
2.13 This modelling approach enables the roles of the
doctors of the future to be captured as part of the multi-disciplinary
teams serving patients. Planning the medical workforce can then
focus on those roles that only doctors can deliver. Below is a
Christmas tree model which maps the medical workforce within the
overall healthcare workforce of the NHS.
2.14 Total NHS workforce
3. HOW WORKFORCE
PLANNING IS
UNDERTAKEN
3.1 Workforce planning in the NHS aims to provide the
future workforce needs of the service matching supply and demand.
The NHS is very labour intensive with around 60% of budgets spent
on staff costs. Training times vary across different professions.
It takes up to 15 years to train a medical consultant and up to
six years to train an experienced senior nurse, therapist or scientist.
Thus any workforce planning has to take account of long term trends
in healthcare if it is to meet the needs of patients in the next
five to 10 years.
3.2 Robust workforce planning needs to bring together
a "bottom up—top down" approach to the planning
process. Each organisation needs to plan for its own workforce
needs, based on their strategic service, financial and local workforce
plans. Plans need to be shared widely to ensure that the local
health economy's requirements are met. These plans then need to
be aggregated to ensure their wider coherence and that nationally
there is sufficient provision for smaller specialties.
3.3 Each PCT, practice, Trust and SHA has a workforce
plan that is shared via the Local Delivery Plan. These plans include
the service, financial and workforce plans of the organisation
for the next three years. SHAs are charged with monitoring these
plans and ensuring equity of provision across the health economy.
SHAs work across their patch to coordinate the planning activity
via a network of workforce planners to ensure that emerging trends
are incorporated in the LDP.
3.4 Service wide planning
3.5 Workforce Planning across local health economies
operates within a streamlined framework of national analysis and
support.
The Social Partnership Forum comprises representation from the major health unions, management bodies and the Department of Health. It was set up in December 2002 and is the stakeholder group for the Workforce Programme Board.
The Workforce Programme Board was established in May 2003 to review and oversee the delivery of workforce strategy. The membership of the board includes workforce leaders in DH and SHAs, as well as key partners such as Skills for Health and NHS Employers, and reflects the strategic role played by the DH as a result of Shifting the Balance of Power and the responsibility of SHAs for implementation and delivery.
The National Workforce Group (NWG) meet regularly and influence policy and practice in planning the health and social care workforce of the future, with the view that objectives can be better achieved by acting collectively. The National Workforce Group has strong representation on the Workforce Programme Board and agrees the action required to deliver the workforce strategy. Membership is drawn from the Workforce Development Leads of SHAs and WDC Chief Executives (where applicable), was well as the Department of Health and other key partners.
The Workforce Review Team (WRT), is hosted by Hampshire and IOW SHA on behalf of the NHS. Its role is to synthesise workforce supply and demand intelligence provided by a variety of national and local organisations including SHAs and professional bodies. Its analysis of the intelligence is gathered and used to develop a variety of options for SHAs to use in planning for an affordable workforce with the right skills, in the right numbers to meet local service plans.
NHS National Workforce Projects' (NWP) works very closely with the Workforce Review Team (its "sister" organisation), informing and using their analysis. Its role is to help provide the NHS with the skills, transfer of knowledge, best practice and information to support effective local workforce planning. NWP aim to eliminate potential duplication to work across the service by providing a single credible source for knowledge management and to develop a more sophisticated approach to workforce planning with a greater integration of service and financial planning.
Skills for Health is a Sector Skills Council (SSC) with a UK wide remit. Their role covers all healthcare employers—including those in the NHS, independent and voluntary sectors. Skills for Health was established in April 2003. It is licensed by the Department for Education and Skills as the SSC for the health and healthcare sector. The aim of Skills for Health is to help the whole sector develop solutions that deliver a skilled and flexible UK workforce in order to improve health and healthcare. Skills for Health are members of the Workforce Programme Board and the National Workforce Group.
NHS Employers is the employers' organisation for the NHS in England, giving employers throughout the NHS an independent voice on workforce and employment matters. Their goal is to make the NHS an employer of excellence. NHS Employers are members of the Workforce Programme Board and the National Workforce Group.
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3.6 The Workforce Programme Board sets strategy
and is responsible for the delivery of major workstreams such
as Agenda for Change. It is informed by the Social Partnership
Forum which is its stakeholder forum.
3.7 The board oversees delivery through individual workstream
boards that concentrate on specific areas. These involve all interested
parties in the NHS family. Local delivery is facilitated through
the National Workforce Group where SHAs come together with the
DH and partners. The work of NWG is supported by a broad range
of organisations including WRT, NWP and Skills for Health.
3.8 Funding education, training and development. There
is significant central investment in the funding for education
and training of the future workforce via the Multi Professional
Education & Training (MPET) Levy. This funding provides pre-registration
training for the main healthcare professions and supports the
investment made by employers to develop the skills and education
of their staff.
3.9 MPET funding is allocated to Strategic Health Authorities
(SHAs) at the start of the financial year although money for new
training posts, particularly for postgraduate doctors, may be
allocated in-year. Where new ways of working lead to the development
of new roles MPET can also support training. An example of this
would be the burgeoning numbers of assistant practitioner roles
currently being developed. The costs of training for such new
professionals may in differing circumstances come through DfES
Foundation Degree funding routes, through investment from employers
and through investment by SHAs using MPET development money. The
challenge is to ensure cohesion in funding streams and to find
new ways of allocating the MPET budget so that money for development
is not squeezed out by existing contractual commitment for traditional
three year diploma and degree courses.
3.10 The NHS as a Model Employer. There is a wealth
of research evidence which demonstrates clear links between good
employment practices and business outcomes. Creating an environment
where staff are valued, rewarded, appropriately trained and developed,
regularly appraised and properly managed has an impact on people
who use services and their carers. Model employers are also more
likely to attract and retain high-quality staff and are also more
likely to have high-performing and motivated staff who are more
flexible and take less time off work. Becoming a model employer
is not the result of one initiative, it is made up of several
linked projects. Within the NHS the Improving Working Lives initiative
promotes equality and diversity policies and includes the NHS
Childcare Strategy. As part of the initiative there is zero tolerance
of violence and harassment for all staff within the NHS. Underpinning
all of the employer initiatives is clear staff involvement and
staff partnerships to create a culture of continuous improvement.
3.11 A range of workforce supply initiatives have supported
local NHS organisations to ensure that the NHS workforce continues
to be sufficient to meet local service needs. These recruitment
and retention initiatives have been effective in the past
five years as the NHS workforce has increased significantly. The
current priority for workforce supply policies is balancing supply
and demand, whilst ensuring that we maintain the profile of a
career within the NHS.
3.12 National initiatives have included:
— promoting careers in the NHS through the NHS Careers
service;
— national and local recruitment campaigns;
— attracting former staff back to the service;
— improving retention by continuing to make
the NHS an employer of choice;
— offering flexible retirement schemes and
flexible employment opportunities; and
— providing access to good quality, accessible
and affordable childcare.
3.13 Two current initiatives are at the forefront of
this policy.
3.14 NHS Careers is an interactive service, managed
by NHS Employers on behalf of the Department of Health, which
provides information on careers in the NHS through a national
call centre and website at http://www.nhscareers.nhs.uk/.
3.15 NHS Jobs was created in 2003 as a new electronic
recruitment internet site that provides information on vacancies
including an instant online application process, meaning that
job-hunters can apply for jobs anywhere in England. NHS Jobs is
currently funded by the Department of Health and is free to both
the employer and the applicant. Over 510 NHS organisations are
now participating in the service and, on average, over 3,500 jobs
are live on the system at any one time. The website address is
www.jobs.nhs.uk.
3.16 International recruitment has been an important
part of the strategy to tackle key skills gaps and "hard-to-fill"
jobs over the last five years. Local Delivery Plans will inform
the approach to tackling the workforce supply gaps in the future.
International recruitment, carried out in accordance with the
Code of Practice for the international recruitment of healthcare
professionals, is likely to have a smaller role in future but
will be important in some of the most challenging recruitment
areas such as social work and psychiatry.
3.17 Any development of international recruitment in
the future would need to take account of international competition
for healthcare professionals. In the past different country's
health economies have expanded at different times. For example,
the USA are advertising widely for healthcare roles as the UK
international recruitment slows. In the future the effect of the
demographic shift in populations across Europe may mean that many
developed countries are looking for international recruitment
to fill skills shortages at the same time. In planning the long
term workforce it cannot be assumed that any shortfall in particular
skills can always be filled by targeted international recruitment.
3.18 A large organisation such as the NHS needs to ensure
that the NHS has the leadership and management skills it needs
to deliver the depth and breadth of reform in health services,
particularly with respect to sustainable improvements in quality
and value. Put simply the NHS needs to:
— Develop leaders so that they have the skills
and competencies to deliver—with a particular focus on increasing
productivity and financial capability.
— Ensure greater learning and skills transfer
between leaders from across the broader health and social care
system—including the private and third sectors and local
government.
— Ensure we are developing and retaining talent
at all levels.
3.19 The vast majority of management training and leadership
development takes place locally, organised around clinical networks,
teams and individuals.
3.20 There are still issues to be addressed in workforce
planning. The section above outlines the planning process and
the steps that organisations can take to ensure integrated planning
takes place. It should be emphasised that whilst we have good
processes in place, the capability and capacity to undertake detailed
planning varies across the NHS. Although the LDP process is in
place there are still organisations where service, finance and
workforce plans are linked only in the short term and do not contain
an integrated long term strategy. The new ISIP process should
help these plans develop further, but this integration will need
to be driven by the new organisational structures outlined in
Creating a Patient Led NHS.
3.21 The emphasis on performance targets in previous
years has achieved measurable success but has not created a culture
where long term solutions to issues in 2010 can be carried forward.
There is a growing realisation across health and social care that
action needs to take place today to solve the complex challenges
that face organisations in the future. The initiatives outlined
in section 4 will support the changes that need to take place
but these changes need to be supported by a culture of integrated
long term planning within organisations. The short term pressures
will not disappear from the NHS and indeed are increasing but
successful organisations will balance these pressures and still
continue to develop longer term solutions.
3.22 Some NHS organisations are caught up in short term
fire fighting due to structural, geographical or financial pressures
that have existed for many years. These organisations may struggle
to implement the large scale systems change required to meet the
challenges in the medium term. These organisations will require
support to implement the practical lessons from the many pilot
sites and initiatives to develop the future flexibility of the
workforce.
4. ISSUES IMPACTING
ON THE
HEALTH AND
SOCIAL CARE
WORKFORCE
4.1 The current processes for workforce planning have
been outlined above and the need to develop a strategic framework
for workforce planning has been highlighted. There are a range
of issues facing the NHS at the current time that demand an integrated
local response.
4.2 Issues such as the European Working Time Directive
(EWTD) and demographic shift in the population are external drivers
that affect all of the workforce in the UK but have a large impact
on the NHS as the employer of 1.3 million staff. The demographic
shift in the working population will have an increasing effect
in the next five years. The combination of increased longevity,
declining birth rate and the "baby boom" generation
entering retirement age will all combine to shrink the available
workforce of traditional working age. The effect of this change
has been well documented and is already included in the national
modelling of the workforce. The implications of this demographic
shift need to be taken into account by organisation's recruitment
and retention policies. Initiatives to attract more mature entrants
and flexible retirement options to retain the skills of the over
50s (and increasingly the over 60s) will become more important.
It will also be crucial to ensure flexible working practices are
fully utilised to maintain workforce capacity. Details of the
demographic issues facing the UK are outlined in Annex 1.
4.3 The European Working Time Directive 2009 builds upon
existing legislation but goes further and requires a rethink of
how a service to patients is to be provided with a 17% drop in
the hours doctors in training will work. The NHS health reform
is supported by Payment by Results, Choice and the development
of a plurality of providers. The workforce strategy builds upon
this with programmes to develop flexibility in the workforce through
Model Employer, Modernising Medical Careers, Agenda for Change,
the new consultant contact and the new GMS contract for GPs. Elements
of these linked developments are outlined in detail in section
4 but the effect of these initiatives will be to reward those
organisations that are able to put in place streamlined clinical
pathways that put the patient first.
4.4 This paper highlights six ways that organisations
will work to develop an integrated strategy.
4.5 Planning for service priorities
4.5.1 The Department of Health has established four Workforce
Boards to develop solutions and support the workforce needed to
deliver the Public Sector Agreements (PSA). The boards cover services
for :
— 18 Week Patient Pathway
4.5.2 Each of the boards is working with the National
Workforce Group (NWG) around the identification of the new roles
which will have the most impact in delivering the PSA targets
and the development of support tools to help local commissioners,
providers and workforce planners.
4.5.3 Health Improvement. This board covers all the workforce
work programmes arising from the Choosing Health White
Paper. Coverage includes all the contributing disciplines: health
improvement, health protection, health information and academic
public health.
4.5.4 Long Term Conditions. This board has representation
from key stakeholders across health. The board has collated best
workforce development practice across different organisations
in support of the DH Long term conditions model. The aim is to
improve the care of long term conditions in primary care and community
settings, with the appointment of 3,000 community matrons and
to reduce the overall emergency bed days by 5%
4.5.5 Urgent Care. The main aim of the board are to reduce
the overall emergency bed days by 5% by 2008 and to improve access
to urgent care.
4.5.6 18 Week Patient Pathway. This board has representation
from key stakeholders across health and social care. The target
is to decrease the waiting time for a patient pathway from referral
to treatment to under 18 weeks by 2008. There are currently a
range of pilot sites and development projects underway to help
organisations develop their services.
4.6 Planning for change and productivity
4.6.1 Productive Time aligns the modernisation strategies
for people (pay and workforce reform), process (10 High Impact
Changes) and technology (NHS Connecting for Health) in order to
maximise service improvement recognising that these modernisation
strategies will be most effective if implemented in an integrated
way to meet both national and local service improvement expectations.
4.6.2 Within the NHS, productive time initiatives are
designed to increase the time spent by health care professionals
(clinicians, managers and administrators) on activities integral
to delivery of improved services for patients. Improving productivity
and efficiency underpins service improvement over the three years
(April 2004 to March 2008). Productive time will contribute approximately
£2.7 billion of the expected cumulative annual efficiency
gains of £6.5 billion.
4.6.3 The 10 high impact changes in HR are outlined in
Annex 2.
4.6.4 The Integrated Service Improvement Programme (ISIP)
is the delivery vehicle for Productive Time to develop local integrated
plans. ISIP supports integration across a number of dimensions
and places workforce at the heart of reform. ISIP consist of:
— Integration of the major "enablers of change":
workforce reform, operational process improvement, technology
solutions and infrastructure (estates and facilities). Typically,
these have to be used in combination to maximize the benefits
of investment in change. The ISIP process and guidance helps to
integrate the deployment of all these enablers of change.
— Integration across local health communities: primary
care, acute care, mental health, social services and ambulance
services. Often a patient journey moves across NHS organisations
which have to collaborate to provide fast, efficient, safe and
effective care. For care services to be transformed to meet all
priority objectives, there needs to be collaboration across organisations
which serve a local population. Hence ISIP focuses on health economies
not individual care organisations.
— Involvement of all professions in the transformation
of the way services are provided. Change needs to involve clinicians
of all disciplines, including nurses, allied health professionals
and scientists. It needs to involve managers and those with specialist
skills in, for example, workforce role reform, IT and finance.
Assistant and advanced practitioners in radiology, City Hospitals Sunderland
Implementing assistant and advanced practitioners in radiology at City Hospitals Sunderland (CHS) has advanced the role of the radiographer within the fluoroscopy on the barium enema service and as a result the fluorocopy room is used much more effectively. It has also had dramatic effect on waiting times for routine barium enemas, reducing them from 30 weeks to less than two weeks in the space of 11 months. Increased activity was achieved because these radiographers were given sessions to perform and report barium enema lists, some of which were dedicated radiographer lists, while others were lost sessions created due to radiologist leave.
Barnsley heart diagnostics
By reorganising their way of working, a team of cardiac physiologists have helped to cut the echocardiography waiting times from four months to just two weeks. This was achieved by training some of the junior grade physiologists to carry our exercise and lung function tests, freeing up more senior staff to carry out the echocardiograhy testing. A healthcare assistant was introduced to prepare patients for screening and return them to the ward afterwards. This has helped cut delays as the reports can be written up while patients are being prepared or taken back to the ward.
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4.7 Planning for new technology
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4.7.1 NHS Connecting for Health is delivering the National
Programme for IT to bring modern computer systems into the NHS
which will improve patient care and services. Over the next 10
years, the National Programme for IT will connect over 30,000
GPs in England to almost 300 hospitals and give patients access
to their personal health and care information, transforming the
way the NHS works.
4.7.2 The National Programme is central to the Government's
policy goals of changing the delivery of health care to one that
is citizen-led and responsive to the needs and wishes of patients
and their carers as set out in the NHS Plan.
4.7.3 Technological change needs to be taken into account
in considering future demand for the workforce. Technological
advances will enable organisations to be much more flexible in
the provision of services in the future. The vision for future
services outlined in the 2006 White Paper will take advantage
of more compact and comprehensive patient testing equipment to
provide an integrated near patient diagnostic service.
4.7.4 Currently future workforce plans take account of
known research developments that may affect service delivery but
we are on the threshold of another wave of innovation that will
alter how services are delivered in the future. Developments in
gene therapy and certain cancer treatments will mean that whole
sections of service will have to change the way that they work.
In recent times the same has happened within cardiac surgery with
many conditions now being treated as day cases within radiology
departments as the technology to perform procedures without major
surgery improves.
4.7.5 The Electronic Staff Record (ESR) will offer a
major step forward in workforce planning when the system is fully
rolled out. This major IT project replaces the fragmented HR and
finance systems in Trusts and SHAs with one single unified system.
Workforce planning data will be available through the data warehouse
and allow planners to work with and share accurate validated data
from across the health economy.
4.8 Planning for a more flexible workforce
4.8.1 The NHS used innovative approaches to meet compliance
with the European Working Time Directive from August 2004 for
doctors in training. In 2002 the Department of Health funded 20
WTD pilot projects, and four Hospital at Night (H@N) pilots each
testing innovative ways of delivering services while complying
with the requirements of the WTD legislation. For most, this involved
some combinations of new roles for non-medical staff, new rotas
and working patterns for doctors (consultants as well as doctors
in training) and new service delivery patterns.
4.8.2 The Hospital at Night model consists of a multidisciplinary
night team, which has the competencies to cover a wide range of
interventions but has the capacity to call in specialist expertise
when necessary. This contrasts with the traditional model of doctors
in training working in relative isolation, and in specialty-based
silos. The project was a partnership between the Department of
Health, the NHS Modernisation Agency, the British Medical Association
and the Royal Colleges.
4.8.3 The NHS needs to build on successes to date in
meeting the 2004 target and ensure that arrangements are sustainable,
linking in with new ways of working, modernising medical careers
and finding ways to improve productivity and efficiency whilst
enabling doctors to enjoy a good work life balance.
4.8.4 Maintaining good quality medical education and
patient services and delivering key priorities including waiting
times is made more difficult by restrictions on working patterns
from the SiMAP/Jaeger judgments, which has led to a rapid increase
in shift working, replacing traditional resident on-call rotas,
and inflexible rest breaks. Consequently, the EWTD 2009 target
will have a major implication on workforce planning and will lead
to new ways of working for the NHS. Work is well underway on planning
and preparation for 2009. In the summer of 2005 NWP was appointed
the lead organisation to support the NHS in finding and implementing
solutions to WTD 2009. Its aim is to provide the NHS with models
that can be adapted across the service, facilitate new solutions,
address barriers to WTD compliance and ensure that solutions to
WTD compliance are sustainable in the long-term.
4.8.5 Modernising Medical Careers (MMC) aims to improve
patient care by delivering a modernised and focused career structure
for doctors through a major reform of postgraduate medical education.
It aims to develop demonstrably competent doctors who are skilled
at communicating and working as effective members of a team able
to meet the needs of patients. To this end, trainees' progress
will be through structured programmes of training following competency-based
curricula.
4.8.6 This model provides the opportunity to ensure that
the majority of service will be delivered by fully trained doctors.
The aim is to provide patients and the NHS with a workforce that
is safe and demonstrably competent and that has the flexibility
to meet service needs.
4.8.7 The current system encompasses a centralised pay
framework linked to skills, competencies and knowledge for a majority
of staff. For doctors the new consultant contract uses the job
planning structure to ensure the service provided fits with the
needs of commissioners. The existing system is designed to be
"equal pay proof", although some risks remain in the
different pay systems between doctors and other staff.
4.9 Planning for new staff roles
4.9.1 The National Practitioner Programme (NPP) co-ordinates
a range of pilot projects which introduce new roles and which
were started by the Modernisation Agency (MA). With the devolvement
of MA programmes to the NHS, the practitioner projects have moved
to new host organisations. NPP is ensuring that the practitioner
projects stay linked together, share information, identify common
needs, address common policy issues, such as regulation, and develop
a communication strategy. The NPP is hosted by North West London
Strategic Health Authority.
4.9.2 The new roles include Medical Care Practitioner,
Emergency Care Practitioner, Surgical Care Practitioner, Anaesthetic
Practitioner and Endoscopy Practitioner. Some projects are well
ahead and already making an impact on the way services are delivered.
For example there are now over 700 Emergency Care Practitioners
improving access to urgent care and bringing services closer to
the patient.
4.9.3 These new ways of working reflect the aims of the
NHS Improvement Plan to modernise the service by ensuring
that staff talent and skills are recognised and for registered
staff to practice in roles with increased breadth and depth.
4.9.4 The Large Scale Workforce Change Team is hosted
by NHS Employers. Its purpose is to build and develop HR capacity
within the NHS, focusing on the development and spread of an adaptable
and flexible workforce that can deliver benefits that are measurably
better for patients, better for staff and better for organisations,
in respect of improved efficiency and productivity.
4.9.5 Current programmes include the development and
implementation of:
— Maternity Support Worker roles and new ways of
working across maternity services.
— A wide range of new and extended roles across
children's services to meet NSF targets.
— New ways of working in integrating health, social
care and education.
— The maintenance and distribution of the national
NHS modernisation tools to SHAs and to local service providers,
providing training and guidance on the use of the tools.
4.9.6 The Care Service Improvement Partnership (CSIP)
is hosted by the National Institute for Mental Health (NIHME)
and is funded by the Department of Health. The purpose of CSIP
is to support reform of the NHS and local government services
and help to create and implement effective policy through a joined
up approach across key stakeholders. CSIP maintains very close
links with the Department for Education and Skills (DfES).
4.9.7 CSIP's role provides an opportunity to help implementation
across health and social care and to ensure that the necessary
links are made to the work of other Government departments. CSIP's
regional development teams provide a local resource to facilitate
whole system change at a grass roots level with workforce as part
of the whole rather than an add on.
4.10 Improving planning and skills
4.10.1 National Workforce Projects (NWP) has created
an accredited planners development programme designed to ensure
skills are built up in this field—this will lead to the
first postgraduate certificate in strategic workforce planning.
This development work is seen as crucial if the NHS is to improve
workforce planning in the future as the people in the service
need to have the skills to deliver the improvements. A step-planning
process has been created to facilitate good planning and resource
packs produced to guide trusts through planning in key service
areas that link into service priorities around provision of care
such as long-term illness and the 18 week patient pathway.
4.10.2 The practical resources NWP provide are designed
to be building blocks and guidance for the NHS that have been
tested and proven in the field. Many of the tools facilitate the
sharing of data across organisations. Benchmarking in this way
is essential to long term workforce planning as it ensures that
organisations can compare, contrast and cooperate on sustainable
workforce plans rather than work in isolation. The need for this
benchmarking has been a recurring theme in national NHS guidance
issued on workforce planning in recent years.
4.10.3 Further details of the resources available to
workforce planners in the service and each of the training programmes
is available at www.healthcareworkforce.org.uk
Service redesign in Audiology
Reducing waiting times in audiology was a key challenge for the Royal Berkshire and Battle Hospitals NHS Trust. In March 2002, more than 2,000 patients were on their waiting list for hearing assessments and hearing aid fitting—some had been waiting more than two years—with a further 20 being added each month. Did Not Attend (DNA) rates for appointments were high, ranging from 15-35%, and staff morale was low.
In order to begin tackling the situation, and with the full cooperation of the audiology team, the trust undertook a range of initiatives as part of a whole system review of audiology. Their starting point was to examine the diagnostic and treatment processes in order to identify and remove unnecessary stages so as to create more efficient care pathways. They also looked to dismantle professional boundaries between staff, and redesign roles, with emphasis placed on education, training, and continuing professional development.
The working day was extended by starting patient contact time earlier and finishing later, suppported by assistants who set up rooms, etc. During specific "waiting list initiatives", they also extended to working week, with staff volunteers working evenings and weekends. The trust worked closely with patients to build confidence in the assessment system, negotiating appointment times and telephoning them the day before the check attendence, a collecting feedback on sevices through a patient satisfaction questionnaire. The trust also worked in partnership with local voluntary sector organisations including the National Deaf Children's Society and the RNID to ensure that their knowledge and experience contributed to the modernisation process.
The result of all this activity has been extremely positive. Since January 2004, all patients have been seen within 18 weeks, DNA rates are now below 4% staff retention is high, and patients report satisfaction rates over 90%. In order to maintain the momentum, the service is continuously reviewed and changes made to ensure improvements are sustainable. The trust also carries out quarterly analysis of patients feedback and comments.
The head of audiology at the trust says that large gains in efficiency, reduced waiting times and high staff morale have been achieved by "working smarter and providing a high quality service that is informed by user participation and choice".
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5. WORKFORCE PLANNING
FOR OUR
HEALTH, OUR
CARE, OUR
SAY AND
A PATIENT LED
NHS
5.1 Developing a service built around patients
5.2 The NHS has responded to the needs of the patient
and has started to introduce new ways of working and services
that better meet the patient's needs. This has been developed
further in the new White Paper: Our Health, Our Care, Our Say:
a new direction for community services which sets out a direction
to deliver a greater proportion of services at a time and location
that is more convenient to the patients.
5.3 System Reform, as elaborated in Health Reform
in England aims to set in place local freedoms and incentives
"to achieve an NHS that is self-improving". The initiatives
to achieve this end include: patient choice, wider range of providers,
more freedom for hospitals, stronger commissioning, new patient
mechanisms and independent inspection of quality. These initiatives
should ensure that the NHS is led by the needs and wishes of patients
and supported by staff with an in-built dynamic for continuous
improvement. "The reforms will give doctors, nurses, managers
and other NHS professionals incentives to help drive improvements
in health and healthcare and to increase responsiveness to patients."
5.4 The reforms are interrelated and mutually reinforcing.
There are four connected streams of work:
— more choice and a much stronger voice for patients
(demand side reforms);
— more diverse providers, with more freedom to innovate
and improve services (supply side reforms);
— money following the patients, rewarding the best
and most efficient providers, giving others the incentive to improve
(system management reforms); and
— system management and decision making to support
quality, safety, fairness, equity and value for money (system
management reforms).
5.5 Organisations workforce strategies must be adapted
to match the vision embodied in System Reform. The next five years
have significant implications for workforce planning. We are moving
from a rapid expansion in staffing and investment in healthcare
to a "steady state" of investment and a focus on productivity.
We have put in place the building blocks of Agenda for Change,
MMC and the Competency Skills Framework necessary to support a
flexible workforce. We have many initiatives and projects aimed
at sharing best practice across organisations to help them develop
an affordable flexible workforce that delivers the needed productivity
and service redesign.
5.6 The challenge is to create the skills and competences
needed in the future workforce where there is greater focus on
prevention and early intervention, where people have greater choice
and services are provided closer to home by a bigger range of
providers from across health and social care.
5.7 In essence, the last five years has been 80% about
growth and 20% about transformation and new ways of working. The
next five years will be almost exclusively about transformation
of the workforce. Future plans will need to incorporate new and
extended roles and new ways of working in order to deliver the
gains in productivity that will be necessary to achieve patient
led care and the PSA targets.
5.8 Workforce planning in the next five years will develop
in three ways.
5.8.1 Competency based workforce planning
5.8.2 The work on developing and listing the competencies
for each role in the NHS by Skills for Health is vital to future
workforce planning. The growth in new roles has blurred the previous
professional boundaries and a new language to describe these roles
and teams is required. The Career Framework for Health is a tool
being developed by Skills for Health which enables local health
organisations adopt a competence based approach to local workforce
planning. The aim is to map the whole healthcare workforce. This
will enable workforce and service planners to see what competences
will be needed to deliver a particular service (eg imaging services,
urgent care services) and which professions will have those competences.
Although the framework does not extend to postgraduate medical
training, the competency based approach is a central tenet of
the MMC initiative.
5.8.3 As the data from the roll out of ESR becomes available
the ability to plan with robust data will be much improved. This
together with improved workforce planning models currently being
developed will mean that workforce plans will be able to reflect
the strategic needs of the organisation much better.
5.8.4 The training programmes to develop the skills and
competencies needed by workforce planners themselves will be in
place to take advantage of all these new planning tools and techniques.
The use of the electronic Knowledge and Skills Framework for all
staff will enable education commissioning planning for the future
workforce to be based upon real needs of individuals rather than
a collated general training needs analysis.
5.8.5 In addition the language of planning will be much
further developed with Skills for Health developing a full description
of the skills and competencies for each role in each profession.
The ability to implement competency based planning will offer
a far greater range of scope to planners than the existing professional
role based model.
5.8.6 Improved organisational strategic planning
5.8.7 The planning processes already in place at a local
and national level will start to have their full impact with the
implementation of the ISIP process that will allow truly integrated
development of service. At the heart of ISIP is the need for effective
long term strategic plans for the organisation that can be shared
with the wider health community. Only when the future plans are
integrated across Health, Social Care and the Independent Sector
will organisations be able to solve the challenges set by the
changes over the next five years.
5.8.8 One fundamental change will be better integration
between those working in the NHS and those working in social care.
A better-integrated workforce—designed around the needs
of people who use services and supported by common education frameworks,
information systems, career frameworks and rewards—can deliver
more personalised care, more effectively.
5.8.9 The key to closer integration will be joint service
and workforce planning. The NHS and local authorities need to
integrate workforce planning into corporate and service planning.
The Department of Health will consider and develop plans to achieve
this in line with proposals to align service and budgetary planning
across health and social care and in consultation with stakeholders.
Workforce issues will also be fully integrated in service improvement
planning by the Care Services Improvement Partnership and the
NHS Integrated Service Improvement Programme.
5.8.10 Increasingly, employers will plan around competence
rather than staff group or profession. To encourage integration,
we will bring skill development frameworks together and create
career pathways across health and social care. Staff will increasingly
be expected to have the skills to operate confidently in a multi-agency
environment, using common tools and processes.
5.8.11 Skills for Care and Skills for Health, in partnership
with other relevant organisations, will together lead this work
so that staff can develop skills that are portable, based on shared
values, recognised across the sectors and built around the needs
of patients and service users.
5.8.12 Improved clinical pathways that focus on the patient
5.8.13 The need to redesign clinical pathways to meet
the 18 week wait initiative and the shift to primary care are
well known and examples of best practice are available. The challenge
will be to implement these changes across all of the patient pathways
and integrate them with the support structures in GP surgeries,
Social Care provision and the growing Independent Sector. The
implementation of best practice will require a much bigger shift
towards multi skilled teams than at present, although a majority
of staff in the future will remain in the traditional professions
supported by new roles and integrating new ways of working across
all staff.
5.8.14 Although these strands of work are already in
place, workforce planning in the future will also be more complex.
Drivers such as EWTD 2009 and the need to demonstrate productivity
or quality improvements will change how teams are structured.
The full implementation of PbR will alter what services an organisation
offers and with what staff support. The 2006 White Paper will
effect where service take place with the growth of IS and the
need to deliver patient centered care.
5.8.15 For instance the White Paper has highlighted the
need for scientists and scientific services to be provided closer
to patients to provide improved access and turnaround times. We
are working on a framework to support the introduction of scientists
working in primary care. However, to ensure that quality services
in many areas of diagnostics and some therapeutics are provided
it is critical that the HCS workforce is recognised and included
in any planning and commissioning arrangements—for example
in equipment management.
5.9 These are only a few of the interrelated issues facing
the NHS and all of them will combine to affect how care is delivered
in the future. NHS organisations are still charged with getting
workforce plans correct all of the time with no under/over supply.
Organisations will need, not only to develop workforce plans that
incorporate the firm "known" impact such as EWTD but
also variable "unknown" outcomes such as the speed of
the shift into primary care.
5.10 Looking to the next five years, one thing is very
clear. The investment and reform we have made in the NHS workforce
puts us in good stead for dealing with A patient led
NHS, where organisations will need to meet the challenges
of patient choice, be able to compete in an environment of plurality
and provision and drive productivity and efficiency in an era
of lower financial growth. However, this will not be achieved
unless all organisations improve their capability and capacity
to undertake workforce planning and development. PCTs, Practices,
Trusts and SHAs will need to base their service and financial
plans on a clear strategy for the future direction of their workforce
that creates the right skill mix in the workforce for the next
five years. Only organisations with a skilled, flexible workforce,
where people are their greatest investment will succeed.
Department of Health
15 March 2006
Annex 1
DEMOGRAPHIC IMPLICATIONS FOR WORKFORCE PLANNING
The demographic shape of the western world is changing due
to the combination of increased life expectancy, falling birth
rates in developed countries and the effect of the "baby-boom"
generation coming towards retirement age.
With each generation on average living longer than the last,
and this trend continuing for the current generations, UK government
actuary figures predict that a child born in 2000 has a life expectancy
of 81 years[1]. These figures
are by their nature averages and in future years a significant
portion of the population will be living well into their 90's
and beyond.
These demographic issues will impact on the health and social
care workforce in many ways. In addition to the impact of increased
life expectancy on the provision of healthcare, the age of the
workforce providing the service will also rise. The fall in birth
rate will provide less young workers to the labour market than
in previous generations whilst changes to the current pension
arrangements include the expectation that people will work on
past the current retirement age of 60.
In addition, currently, 60% of adults in England have a long
term condition, and 80% of GP consultations relate to long term
conditions. The demographics of the population show that by 2020
incidence of long term conditions in the 65+ age range will have
doubled.[2]
In addition a larger proportion of staff will be in their
50's and 60's which will have implications for staffing front
line services and health and safety issues such as lifting and
handling of patients. This is not saying that older staff are
any less able but it is also unrealistic to expect staff to stay
within a demanding role for 40 years without it taking its toll.
However, it may also mean that those people providing front line
services to those with long term conditions may indeed be living
with a long term condition themselves. Therefore the staffing
structure of health and social care organisations that delivers
care to patients with long term conditions will need to take into
account these demographic issues.
The demographic changes are one element of the wider changes
within health and social care that will combine to fundamentally
alter the delivery of healthcare services in the future. Together
with the growth of the independent sector it will alter what care
is delivered where in the future. The demographic changes combined
with the Working Time Directive (WTD) 2009, which will limit staff
working hours to a maximum of 48 per week, will affect the number
of staff skills available to any organisation. Other developments
such as the focus on productivity, payment by results and financial
settlements after 2008 will also influence what care is delivered
where and by whom in the future.
All of these initiatives will impact on the service in the
next 3-5 years and will require a flexible workforce that can
be described in terms of skills and competencies, rather than
rigid professional boundaries.
Importantly other changes such as agenda for change, improving
working lives (IWL) and competency frameworks will combine to
help organisations to create and deliver this flexible workforce.
Organisations will require long term plans that map out the effects
of all these changes and work through the right skill mix for
the delivery of services in the future. This long term plan then
needs to inform and shape the workforce commissioning decisions,
ISIP and local delivery plans within each organisation to bring
about the workforce of the future.
Annex 2
THE 10 HIGH-IMPACT CHANGES:
A National Framework To Support Local Workforce Strategy
Development—A Guide for HR Directors in the NHS and Social
Care
Improving organisational efficiency
1. Support and lead effective change management—Organisations
can expect to undertake major re-organisation every three years
according to some experts. Many re-organisations fail to meet
original objectives, which has a high cost in terms of both employee
and customer satisfaction. The HR function has a major contribution
to make.
2. Effective recruitment, good induction and supportive
management—These are strategies that reduce turnover
rates, save money and prevent service disruption. Some studies
estimate that the cost of turnover can be 118% and up to 156%
for specialist staff. As many as 85% of UK organisations in a
Chartered Institute of Personnel and Development (CIPD) survey
found filling vacancies difficult.
3. Develop shared service models and effective use
of IT—Shared service arrangements for things such as
payroll can achieve major efficiencies with savings of between
20 and 40% possible. Ashford and St Peter's NHS Hospitals in Middlesex
and Surrey reduced advertising spend by 60% through e-recruitment.
4. Manage temporary staffing costs as a major source
of efficiency—East Kent Hospitals NHS Trust saved over
£3.5 million in a year by implementing NHS Professionals.
5. Promoting staff health and managing sickness absence—This
can significantly boost capacity and improve morale. The average
cost of absence per employee in 2004 was £558 (CIPD 2004).
Reports suggest that average sickness absence cost in an acute
trust is £5.4 million per annum.
Improving quality and the patient experience
6. Job and service re-design—A redesign
of therapy services in Milton Keynes PCT saved £200,000 and
reduced length of hospital stay by seven days.
7. Appraisal policy development and implementation—One
study has demonstrated that staff appraisal has a strong association
with lower patient mortality. The 2004 NHS staff survey showed
63% of staff had received appraisals.
8. Staff involvement, partnership working and good
employee relations—These are particularly important
during times of change. Research evidence suggests that higher
rates of staff involvement lead to lower absence rates, better
organisational results, higher commitment and trust (West 2002).
9. Championing good people management practices—A
recent Confederation of British Industry (CBI) survey shows that
40% of UK businesses see developing management skills as the most
significant contributor to improved business performance.
10. Effective training and development—The
use of the Careers Escalator in radiography to develop assistant
and advanced practitioners has boosted capacity and has had a
direct impact on waits for diagnostics services. Medway NHS Trust
has increased capacity to take and read MRI scans by 50%, with
waiting times falling from 48 to 12 weeks.
1
Source: Government Actuary Department, UK. Back
2
Source: Department of Health. Back
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