Evidence submitted by Cheshire and Merseyside
Strategic Health Authority (WP 39)
WORKFORCE PLANNING—IN
PREVIOUS YEARS
1. Cheshire and Merseyside's Workforce Development
Confederation developed a local workforce planning submission—the
"Workforce Supply Strategy" which continued to be collected
annually by the Workforce Development Confederation until 2003
when it was discontinued.
2. This annual submission was provided locally
by all NHS organisations within Cheshire and Merseyside—with
workforce projections for a five year planning period (seven years
for medical staff).
3. The aim of the Workforce Supply Strategy
was to inform the commissioning process, and provide a source
of local intelligence on the NHS workforce. However, this process
was discontinued in 2003 for a number of reasons:
— It became evident that commissioning
numbers could be calculated in a simpler top-down way by the WDC(SHA)
commissioning team.
— Staffing projections from Trusts/PCTs
were often aspirational, and not consistently linked to financial
plans/constraints.
— A high degree of variance in the
quality of data submitted.
— Planning timescales revolved around
the Medical Workforce Census
— Difficulties in terms of "fit"
with the new "Local Delivery Plan" process.
— Expression of productivity and skill-mix
improvements in terms of the equivalent gains in full-time staff.
— Reconciling bottom-up planning submissions
from Trusts/PCTs with top-down DH targets for staffing increases.
[NHS Plan gave strategic direction although hindered by rigid
targets that did not reflect needs of local communities].
4. Previous approaches to workforce planning,
both locally and through the LDP have raised some common concerns:
— Little evidence of communication
between commissioner and provider organisations.
— A rigid approach to planning according
to traditional staff groups [Consultants, Qualified Nurses etc
. . .].
— Loss of local intelligence as soon
as returns are aggregated at SHA-level.
— Lack of coordination with activity
and finance plans.
5. Whilst Trusts/PCTs continued to develop
their own workforce supply strategies, they did not have an understanding
of how to implement.
WORKFORCE PLANNING—THE
CURRENT PROCESS
6. Since the local annual workforce submissions
were discontinued—SHA planning intelligence in Cheshire
and Merseyside is collected solely through the LDP. Through this
process, workforce submissions have improved in the following
respects:
— NHS targets less of a priority for
certain staff groups (related to access targets).
— More strategic direction (planning
assumptions submitted in advance of staff growth projections).
— DH improved links between different
policies (supported by ISIP).
7. A number of concerns remain however regarding
the LDP workforce submission.
— Still focus on national policies
rather than local workforce priorities.
— LDP (and ISIP) timetables enable
a focus, but not enough to benefit the system locally.
— Links between workforce/finance/activity
are still not firmly established at the local health community
planning stages.
— Coordination in the process across
local health communities does not appear to extend to workforce
planning (where the PCTs could potentially benefits from acute
Trusts' expertise).
— A rigid approach based on traditional
staff groups remains, with no scope to reflect the development
of new roles.
8. In addition to the LDP, It is assumed
that Trusts/PCTs across the SHA will undertake their own workforce
planning in ways that meet their own organisations/health economies
needs. In reality there is a risk that organisations vary in their
capacity and capability to effectively workforce plan.
9. Commissioning and the development of
new roles appear to have progressed without being directly linked
to the rest of the workforce planning agenda. In some areas/organisations
this has led to a lack of understanding of service models and
of the workforce required to deliver the service.
This could potentially result in services trying
to adapt to fit with newly developed roles—instead of roles
supporting the service eg community matrons.
10. Nationally, the development of organisations
such as "National Workforce Projects" has aided workforce
planning/development. They have been able to support a national,
coordinated message, being able to communicate/engage directly
and effectively with Trusts/PCTs, and provide valuable resources
and support for workforce planning capacity and capability.
NEW DEVELOPMENTS
TO MEET
FUTURE NEEDS
11. New staff contracts have recently been
put into place, but have not yet had time to become embedded—only
when this happens will the benefits be fully realised and reflected
in workforce plans. There is a lack of capability within the system
to actively performance manage the consultant workforce in relation
to job planning and review.
12. The new contracts, new roles, and new
ways of working (the latter facilitated largely by NPfIT) represent
some of the building blocks of change around which to base workforce
plans. However before organisations are able to fully reflect
these in their workforce plans they will have to better understand
the forthcoming organisational changes ie Commissioning and Patient
Lead NHS, the changes in the role of the PCT, and changing financial
environment.
13. New technology in the form of the "Electronic
Staff Record" (ESR) system should be able to provide organisations
with better (real time) workforce information.
14. Regardless of the technological improvements
promised by ESR, the information at the heart of the system also
requires significant modernisation. The occupation codes system,
which allows the DH to identify staff numbers by occupational
area needs to be modernised so that it properly reflects newly
developed roles and has the flexibility to identify staff in ways
that are useful both to DH centrally, and the NHS at local level.
15. Current developments that are hampering
workforce planning are:
— New ways of working remains orientated
around a service within a particular organisation rather than
across a local health community.
— National policy ie keeping a service
local, remains in conflict with financial/service requirements/planning.
— Foundation Trusts not providing workforce
information.
— There is no clear message on if or
how the independent sector will support the training and education
of junior doctors.
QUESTIONS FROM
THE SELECT
COMMITTEE
In considering future demand, how should the
effects of the following be taken into account:
— Recent policy announcements, including
Commissioning a patient-led NHS.
— The increasing use of private providers
of services.
16. Key to future planning is allowing changes
brought about by policy to become embedded within organisations
and their impact on commissioning and across the health economy
understood.
17. There is a lack of clarity around the
provider arm function of PCTs and this hampers future planning
18. A clearer understanding of the impact
of "choose and book" is required. Implementation as
it currently stands removes the predictability of workforce planning.
How will the ability to meet demands be affected
by:
— The European Working Time Directive.
— Increasing international competition
for staff.
19. Financial constraints reduce funding
available for development of a workforce that is fit for purpose.
20. It is likely that some financial constraints
will lead to a review of how services are delivered and the competencies/workforce
required delivering it. It will help focus organisations thinking
around productivity.
21. EWTD has already had a dramatic affect
on the ability of service to meet demands within the financial
constraints. This will be further hampered by EWTD 2009 that should
be considered in parallel with the implementation of the specialist
training programme of MMC, both of which will drastically reduce
the availability of doctors in training to service. EWTD 2004
was achieved through changes to rotas/working practices, increased
funding for additional medical and non-medical staff and on a
more limited level through Hospital at night. Future planning
will need to be across LHC rather than by organisation as more
radical collaborative approaches will be required to ensure services
are delivered; this may require reconfiguration of services in
some cases.
22. Early retirement, particularly of the
consultant medical workforce is becoming more difficult to predict.
Information on consultant ages is limited at a strategic level
making planning difficult. However, the introduction of MMC could
be seen as an opportunity to change the model of service delivery
ie service in the main led by "senior medical appointments"
not necessarily consultants.
WORKFORCE PLANNING
IN THE
NEXT 3-5 YEARS
23. Workforce planning must change over
the next 3-5 years in order to meet the requirements of a modernised
NHS and to meet patient and employee expectations.
24. The greatest single improvement in productive
time may be obtained through developing a competency based approach
to strategic workforce planning that will involve defining job
roles in terms of the competences required and then evaluating
them in accordance with AfC.
25. There will be a requirement for greater
flexibility in the way staff are employed eg ROE (retention of
employment model), self employment/Chambers and secondments, and
flexible contracts to help address issues around early retirements,
increasing percentage of female medical workforce and ageing workforce.
26. The implications of CPLNHS and provision
of primary care services is still uncertain. This will become
clearer in due course but at present is of great concern due to
the planned shifts from secondary to primary care. Improving the
patient experience must be central to changes to services; however
without robust integrated service/workforce planning maintaining
efficacy of provision will be problematic.
27. It is vital to make the connection between
National policy and initiatives and what organisations want to
achieve in terms of service delivery.
28. Workforce planning should be integrated
into service planning in order to provide flexible, responsive,
qualitative, cost-effective services. Without true integration
service modernisation will be hampered. Should this be provided
at an organisational level or at a local health economy level
to ensure that the workforce plans/development follow the patient
pathway across all sectors:
29. Workforce development must be linked
to service modernisation, to fully reflect the changing nature
of work, service provision and patient expectations.
30. Workforce planning must support service
requirements, it should not be service developed around workforce
(ie traditional professional workforce groups).
31. The changing population demographics,
with its implications for workforce demographics, may work against
national policy. The workforce will need to be more flexible to
provide 24/7 when intelligence is showing that early retirement,
and part-time working are becoming more popular.
32. Patients are becoming more knowledgeable—this
will have implications of what treatment they want and where they
may want it. Clinical need and patient choice are both paramount
but this will impact on income and expenditure for organisations.
Patient demands will put more pressure on service and the workforce
and this will need to be effectively managed.
33. The impact of MMC needs to be understood
to determine the impact on service—loss of junior/consultant
doctors.
34. Increased female participation rate
into medical/dental schools will lead to an increase in future
flexibility by necessity. This needs to be resolved before its
becomes a service issue—plan now, implement in the future.
This should provide the impetus to change working practices across
the NHS not just in medical specialties.
35. Lead in times for professional training
cause a "time lag" for service modernisation/change.
Therefore, the educational requirements need to become more flexible
and responsive to service changes. Modular training determined
by service need, not professional bodies, must be implemented—a
business model.
36. The impact of international/European
political and economic policy may impact on service or workforce
provision—eg age discrimination, medical training programmes.
Cheshire and Merseyside Strategic Health Authority
March 2006
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