Health CommitteeWritten evidence from Lincolnshire Health and Social Care Community (ETWP 85)

Summary

The Lincolnshire Health Community welcomes the opportunity to develop a system where there is greater employer ownership and accountability for workforce planning and education commissioning.

It is essential that employers are able to influence the supply of staff to the health community and generate innovative solutions to workforce and skills shortages.

The proposals have the potential to both strengthen and improve the value of workforce planning through a shift in emphasis to local needs.

We wish to draw attention to a number of risks including:

The narrow focus on “the healthcare workforce” and very limited consideration of the need to integrate health and social care planning.

The allocation of funding needs to be equitable across the country and needs to reflect the shift in location of service delivery.

The relationship between HEE and the LETBs should facilitate local ownership and accountability for determining future workforce requirements within a national governance framework.

Response

1. In 2007, the Lincolnshire Workforce Advisory Board and team were established as a result of Creating a Patient Led NHS and the creation of East Midlands SHA. The workforce board was established to deliver a number of workforce functions which were devolved from the SHA workforce and education commissioning team and has a remit to work with local healthcare and education providers, service commissioners, clinical staff and the SHA to implement the recommendations of the Health Select Committee report on Workforce Planning. The board is chaired by a Chief Executive from the health community.

2. Since the establishment of the board, some progress has been made against many of the recommendations from the previous select committee report in 2007:

2.1 Some of Lincolnshire’s achievements include:

2.1.1Development of an annual workforce plan based on care themes for the health and social care community; this incorporates organisational plans and is utilised to inform pre-registration education commissioning and priorities for workforce development.

2.1.2Linking service commissioning with workforce planning. The board works closely with service commissioners to identify workforce implications of commissioning plans and provides advice about risks and workforce assurance; this leads to provider workforce plans that include the commissioning intentions and outcomes.

2.1.3Supporting clinical involvement in the development and implementation of workforce plans.

2.1.4Workforce planning experts within local health community teams support individual organisations with capacity and capability for workforce planning, however the uptake of this resource is varied across organisations and can be considered a threat rather than an opportunity.

2.1.5Trusts who are Foundation Trusts and aspiring FT’s understand the significance of workforce and service planning being integrated into financial plans. This is now reviewed by Monitor as part of the application process and evidence can be provided in individual organisations’ annual plans.

2.1.6Developing county wide approaches in a number of areas including the management of practice learning and the development of the Assistant Practitioner role.

2.2 Some areas which require further development are:

2.2.1Planning for the whole workforce; planning for the medical workforce is difficult to influence at county level; additionally non-clinical support staff are often not included in plans as the focus is on delivering a care theme eg long term conditions.

2.2.2Increasing the capacity and capability of workforce planning in organisations; whilst organisations often have capacity for workforce information reporting; expertise in workforce transformation and workforce modelling is often restricted to one or two individuals per organisation. The board provides additional capacity to support organisations through a local health community team.

2.2.3There is limited freedom within centralised budgets and there remains a regional hierarchical system which still is predicated by a medical model.

2.2.4The commissioners responsibilities for workforce planning and the amount of scrutiny they should have in provider plans is still unclear, this will become more complex in the new commissioning arrangements.

2.2.5Further work is required to incentivise individual organisations to work collaboratively across care pathways to determine future healthcare workforce requirements, particularly when moving services from one organisation to another.

2.2.6Lincolnshire has a number of demographic challenges in terms of the health and social care workforce and the population that we serve; the current system for workforce planning and education commissioning does not provide sufficient flexibility at a local level for us to generate solutions that meet the needs of Lincolnshire.

3. In compiling this response to the call for evidence. The Lincolnshire health community have reflected on the strengths of the current system, the areas where improvements are required and the outcomes within the new system that would indicate “success” for our local health and social care economy. The comments reflect the priorities of service providers and the PCT cluster and therefore the submission is restricted to those points that the health and social care community felt were appropriate for comment.

Plans for the transition to the new system, up to April 2013

4. Through the East Midlands wide transition steering group; plans are underway which will enable transition to the new arrangements in April 2013. However there are a number of areas which will require clarification during the transition process including organisational form, functions of the LETB at East Midlands and county level, the role of HEE and retaining the knowledge and expertise from the current system.

5. More local consultation is required to ensure that all the stakeholders in the LETB are engaged and have the opportunity to create and own a locally responsive organisation.

6. The role of service commissioners needs to be clearly established in the new architecture; it is the view of the health community that the commissioners need to determine outcomes and quality: the providers need to innovate and skill mix to meet the challenges in the current climate.

7. The PCT cluster in Lincolnshire has supported the development of the CCGs and GP leadership to prepare them for their future roles.

The future of postgraduate deaneries

8. Whilst it is recognised that there are significant risks to the medical training programme if transition of the deaneries is not managed appropriately; there are also risks if the work of the post-graduate deaneries is not provider-led.

9. Providers need to be able to influence medical training and speciality numbers to ensure that we are developing a medical workforce that meets the needs of the population eg We have trained a whole cadre of highly specialised secondary care physicians yet neglected to train sufficient numbers to meet the needs of an increasingly elderly population with co-morbidity.

10. The current workforce planning system does not enable planning for the whole workforce and there remain supply and demand issues in a number of medical specialities. Whilst there is no guarantee that the new system would solve the difficulties in recruiting either doctors in training or staff grade/consultants to Lincolnshire; it is essential that employers are able to influence the supply of appropriate medical staff to the health community and generate innovative solutions to medical workforce shortages. It is the view of the local health economy that this has a greater chance of success if the Post-graduate deanery is part of the provider led LETB.

The future of Health Innovation and Education Clusters

11. Whilst it is recognised that HIECs have funded a number of innovative projects locally, regionally and nationally; the broad engagement of service in HIEC activity and dissemination of innovative practice has been limited and it is the view of the health community that the outcomes that HIECs were expected to deliver have not fully been achieved. Consideration should be given to how the functions of the HIEC are delivered through the LETBs and what the interface with CLAHRCS should be in the new system.

The proposed role, structure, governance and status of Health Education England (including how it will take on the roles of Medical Education England and the Professional Advisory Boards), and its relationship to professional regulators and to the other parts of the new NHS system architecture

12. The delay in establishing the role and function of HEE has the potential to add risk to the timescales within the transition programme.

13. The emphasis within the LETB must be local ownership, accountability and responsiveness to its members. The framework for authorisation by HEE should recognise that provider organisations are the best placed to articulate their workforce issues and requirements for the future.

14. HEE should work on earned autonomy based on the maturity, financial management arrangements and involvement of all partners in the LETB. Where there are national policies regarding specific professional groups, the LETB should have the opportunity to provide an evidence base and rationale for adopting alternative solutions to that policy.

The proposed role, structure, status, size and composition of local Provider Skills Networks/Local Education and Training Boards, including how plans for their authorisation by Health Education England will address issues relating to governance, accountability and potential or perceived conflicts of interest, and how the Boards will relate to Clinical Commissioning Groups and the Commissioning Board

15. The size and structure of the LETB in the East Midlands has been based on consultation with stakeholders and an examination of what works and what can be improved in the current system. Governance structures including the resolution of conflicts of interest are being developed.

16. The diverse geography of the East Midlands and the size of the LETB will make meaningful dialogue and partnership with a wide range of stakeholders difficult. In the East Midlands, there will be structures at local health economy level enabling interface with Health & Wellbeing Boards, local authorities, other providers of NHS services and Clinical Commissioning Groups.

17. In order to assure best value for money and better outcomes for patients; The LETB should be responsible in relation to the allocation of resources; this is best achieved through provider ownership and accountability. This will provide flexibility for the LETB to undertake specific activity mandated by members but perhaps outside of the core functions of LETBs.

18. The system needs real protection of funding streams which offer flexibility to study routes for all ages eg apprenticeships, vocational, foundation degrees etc. The flexibility of funding is a key issue for Lincolnshire where “growing our own” is a successful workforce development strategy.

The implications of a more diverse provider market within the NHS; and how the workforce requirements of providers of NHS and non-NHS healthcare will be balanced

19. The LETB and local health community structures will need to develop partnerships with a wide range of providers and will quickly need to understand to their issues and engage with them in a meaningful dialogue. The building of relationships and the generation of health and social care workforce discussions; rather than NHS discussions will be critical to the success of the LETB. The benefit of engaging a wider range of providers could be better workforce planning and education commissioning for the whole system—particularly in areas where there is currently a significant amount of non-NHS provision eg Learning Disability services.

The role of the Centre for Workforce Intelligence and how future healthcare workforce needs are being forecast

20. The role of the CfWI as envisaged in the Next Stage Review has considerable potential to support the role of LETBs; however the function of the organisation currently has focused on profession specific information and has had little engagement at organisational level. Unless we create an integrated healthcare system it will always be difficult to express workforce needs in anything other than profession specific terms; however there is insufficient use of scenario planning and competence based planning when future workforce needs are articulated.

21. For the centre to contribute effectively to workforce planning and education commissioning—there is a need to confirm the core role and for the LETBs (perhaps through HEE) to commission the work of CfWI in the future.

How funding will be protected and distributed in the new system

22. The governance arrangements of the LETB must include accountability for the way in which funding is spent—ensuring that the funds allocated for education and training are spent for that purpose.

23. Funding needs to be allocated fairly across the country, and whilst a funding formula for allocation may be helpful; it also preserves the status quo and may not facilitate the training of the workforce for future service delivery eg increased service delivery in primary and community care. It is recognised that this may have a disproportionate effect in some organisations—but the shift in resources does need to take place and prolonged transition may not be helpful.

How the public health workforce will be affected by the proposals

24. The partnerships developed at health community level should ensure that the needs of the public health workforce are identified and planned for; however there is a risk that there will be a lack of clarity around the role and responsibilities of the LETB and the local authorities in relation to commissioning and developing the public health workforce.

Conclusion

25. The priority for Lincolnshire is have a system for workforce planning and education commissioning that gives employers greater accountability for, and ownership of, the development of the healthcare workforce and the success of the system is dependent on the funding flows, the role of Health Education England, the function of the LETB and the level of accountability and autonomy of healthcare providers (which may vary depending on FT status).

26. The staff of the NHS are its greatest asset but employers have had constrained influence in the education, training and development of their workforce. Lincolnshire wants to ensure that we are part of creating a system that is accountable, responsive and transparent, which will deliver excellence in outcomes and in patient experience.

December 2011

Prepared 22nd May 2012