Health CommitteeWritten evidence from current and former participants on the Postgraduate Certificate in Strategic Workforce planning (ETWP 95)

1. Context

This response reflects perspectives of a network of over 300 clinicians, social workers/social care leads, workforce analysts, planners, and development leads, service transformation managers and HR business partners. Members come from England, Scotland, Wales, Northern Ireland, Republic of Ireland and the Channel Islands. We responded to the 2006–07 House of Commons Select Committee, Workforce Planning.1 We have responsibility for developing and/or assuring workforce plans at local, regional and national levels and are uniquely placed to offer a perspective on the proposals. This summary reflects output of a focus group and survey to members.

2. Summary

We welcome greater employer involvement in the skills system. Bottom up planning may encourage innovation and creative thinking. The proposals have the potential to strengthen and improve workforce planning by shifting emphasis to local needs and away from the silo thinking noted by the previous Committee.

We are concerned at the lack of detail around a number of issues including:

Transition arrangements.

Funding for CPD and non-registered workforce (particularly health and social care assistants).

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

The possible domination of LETBs by professional bodies and secondary care organisations. This may limit a focus on the training and development needs of non-registered and non-clinical workforce.

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

The loss of workforce planning leadership following the recent healthcare systems reforms.

The potential impact of the workforce planning and education reforms on systems in the devolved administrations.

3. Detailed Responses

3.1 Right numbers

We are concerned at the tone of the proposals and much of the published debate. We note a continuing focus on planning by staff groups rather than by care pathway or by taking person and community centred approaches. Comments received include: “(provider organisations) no longer want to count beans by professions but describe workforce by services/outcomes for patients/workforce functions such that they have a workforce to deliver high quality care.” A focus on numbers will not provide a solution to the challenges that face us in the 21st century (provision of services for people with long term conditions, dementia, children, or for people with complex learning disabilities). Provision doesn’t necessarily require more professional staff, “Local government, along with social care, are our new partners and offer a lot of care to the same patients as the NHS. With the transition of public health teams to local authorities how will NHS organisations plan for and deliver a workforce which facilitates health and wellbeing of individuals, families, communities and populations rather than just the treatment of illnesses/conditions”

3.2 All providers and commissioners play an appropriate part

We are concerned at the dominance of the medical (& largely secondary care) agenda—as demonstrated both in the proposals. In particular, Social Care provision, which could make a significant difference to demand for services, cost, efficiency and supporting care pathways, is not integrated into the thinking.

“Where is social care?”

“The consultation exercise seems to be entirely focused on the Health Service and the health service workforce. There is an urgent need to expand and develop education and training in social care. Local authorities are struggling to implement the Social Work Task Force recommendations because they do not have the resources required to support and develop social workers. If it is not possible to provide the support and development needed for professional staff in social care, what hope is there for support staff—who are by far the largest staff cohort in social care?”

“ It (DH) has not taken sufficient account of the place of social care in changing and supporting care pathways beyond the end of medical intervention (or) potential role of social care in reducing costs by managing long term conditions in the community, avoiding unnecessary admissions etc.

“This has an associated risk of workforce shortfall, particularly across the traditional boundaries of Acute, Community and Social care, resulting in potential over-reliance on short notice, temporary workforce solutions such as high cost agency. Implementation of a flexible workforce retention strategy is needed.

3.3 Leadership AND High and consistent standards of education and training (with respect to workforce planning across health and social care systems)

Over the past five years we have noted the real investment in education and training by the Workforce Project team (now part of Skills for Health), NHS West Midlands, NHS South West and the Department of Health, Social Services and Patient Safety in Northern Ireland. This has produced a cadre of staff with the knowledge, skills and experience to lead workforce planning and workforce reconfiguration. We have seen significant improvements since our response to the 2006–07 Select committee, including:

an investment in training and development such as:

The Postgraduate Certificate in Strategic Workforce Planning, delivered by the University of West London.

Local cascade of the national six-step tool (developed by National Workforce Projects) to support professional and managerial leads.

Investment in the development of shared tools/techniques and common processes, for example:

national investment in a range of nursing and AHP workload and workforce planning tools covering areas in both Acute and Primary Care.

More robust data and information which can be accessed at a local level. There is consensus that over the past 5 years there has been emphasis on gathering good workforce intelligence and using this in planning –for example:

In social care—the development & promotion of the National Minimum Data Set (NMDS) and use of NMDS by central government for resource allocations following the Comprehensive Spending Review.

In health—the continuing development of the NHS Benchmarking database and establishment of the Information Centre.

This investment has enhanced skills, knowledge and capability and has helped organisations make substantial productivity savings. “Within my own organisation we identified the need to reduce our workforce by approximately 1,470wte over the period 2010 to 2012 and are ahead of target with over 1,250wte achieved to date. These reductions have been achieved through c300 “bottom up” schemes to change the workforce and also a number of system-wide initiatives. I strongly believe that the investment in workforce planners and workforce planning capability has helped support this process.”

However over the past 12 months we note a loss of workforce planning expertise. Some parts of England have lost core workforce planning competence and, for example, have struggled to deliver plans to support the Transforming Community Services programme. One member comments “many experienced practitioners, me included, took the option to depart the NHS. .... now working on freelance basis. (My) current client has had to go out to external short term contract to get the necessary skill in workforce planning ... there is not an internal culture of valuing this role. Mr. Lansley’s management scythe did not assist workforce planning and many who were needed were allowed to go— now NHS has to go out for this expertise.”

Central funding to support the training of workforce planners has been withdrawn. A small number of NHS organisations can fund staff development but no funding has been provided to support our colleagues working in social care. Without continuing shared learning opportunities we risk a failure of integrated planning across the health and social care sectors.

There may be longer term benefits of investing in shared learning opportunities:

“this (SWP) network has been invaluable to me personally and professionally—I’m not sure that the committee understand that such courses provide far more than the initial learning.”

“Over the last eight months I have worked with management and clinicians to develop their workforce plans within the Organisation, this had not previously been the case and we are now looking to develop the internal process such that we can then feel more confidence in what is reported regionally/nationally.”

3.4 Development and re-skilling of the existing workforce

Arrangements need to be spelt out with some urgency. We consider the retention and re-skilling of our existing workforce a priority. The majority of our staff will still be delivering care in 10 years time. In a period where we are required to make large reductions in headcount, funding is needed to support current staff to work differently.

“Whatever shape the replacement levy for healthcare providers takes, it should contain the requirement to invest in and plan for the learning and development (CPD) of the whole workforce—with explicit mention of bands 1 to 4.”

“The proposals do not take account of how social care is changing with personal budgets, and an increasing number of Personal Assistants. It is challenging enough to count how many there are and build up a picture of that part of the sector. In addition, we should be identifying and resourcing their development needs and these proposals don’t begin to do that.”

3.5 Transition arrangements

The transitions arrangements are not sufficiently detailed to inspire confidence. We believe that the DH has underestimated the challenges of pulling together organisations with diverse and competing interests. We see risks associated with the abolition of SHAs. “SHA workforce planners are currently responsible for both workforce planning that underpins education commissioning and MPET investment, and also workforce planning that is part of the national integrated business planning process.

Although distinct, and covering different time horizons, these two planning processes are linked and should make sense together. Both run on an annual cycle, and both have related assurance and performance work.

It seems fairly clear how MPET workforce planning will operate in future, and how this can be further improved by the development of HEE and LETBs.

What remains unclear is operational workforce planning in the future system, how this will be done, what the future assurance/performance system for this will be and also how these two aspects of planning can remain aligned and complementary.

The strong alignment of MPET workforce planning with provider organisations, whilst operational planning (service, financial and workforce) is likely to be led by the national commissioning board. The future system needs to be designed to ensure that there are mechanisms in place to draw these two worlds together, otherwise we are in danger of trying to plan the future workforce supply (MPET) in splendid isolation from strategic service redesign and financial realities—a criticism made by the previous health select committee.”

We are not confident that the proposed arrangements are more efficient–”Any split between Service Commissioning (Commissioning Board) and Education Commissioning (LETB) could lead to complex sharing arrangements of planners or duplication of function/roles.”

3.6 Role, structure, status and size of the LETBs

LETB’s have the potential to:

engage service providers, get them to be more responsible/accountable;

forge and strengthen the links between service providers and education providers;

increase the knowledge about workforce planning and education commissioning/contracting from small few to a more collective approach;

offer a fresh start and more equitable approach based on what is needed rather than what professional bodies dictate; and

pool funding for the whole workforce not simply professional groups.

However we need clarity around structures, powers, operational details and relationships. Will the system deliver as intended?

3.7 Roles of Skills for Health and Care and CFWI

We recognise the real contribution of National Workforce Projects/Workforce Projects Team (now part of Skills for Health). Their role in building a common approach to workforce planning and in supporting the development of staff with a workforce planning remit has been invaluable. We are less confident about the contribution of Skills for Health and Care or the Centre for Workforce Intelligence—“feels very cumbersome and not easy to navigate”. If these bodies are to play a relevant role in the system they will need:

To challenge, not just accept or respond to, DH instruction.

Greater accountability to health/social care employers, who should define their remit and drive assessment of their priorities.

To have access to workforce utilisation data for all staff groups, including temporary staffing utilisation and spend in order to provide a holistic workforce planning overview and assess the impact of flexible workforce models, particularly during the transition.

We understand that these organisations may charge for services—this may encourage financially challenged organisations to look to other sources of support and could result in a raft of competing products. We believe this may undermine the consistency of approach that we regard as important to effective integrated workforce planning (see 3.3 above).

3.8 Funding distribution and protection

The proposition is that MPET funding should be used to fund the next generation of clinical staff only. The term clinical excludes other key occupations such as health sciences, management, estates and facilities. The focus on next generation is misplaced (see 3.4 above).

“The risk ... with plenty of evidence to support it—is that budgets for learning and development for existing staff will be squeezed when times are financially tight. Budgets for the learning and development of staff in bands 1 to 4 (health) in some regions have disappeared altogether in times of financial crisis- 2006 for example.”

“The key difference now (in comparison to previous reforms to workforce planning and education commissioning) is that the health and social care systems are cash-strapped. There is a real risk of a return to the “slash and burn” approach of the early 90s and, in my experience, it took us 10 years to recover from the supply shortages that resulted.”

“Funding sources are drying up for the band 1–4 in this sector (social care) as Local authorities cut back and very little support now available from the Skills Development Agency.”

(I have a) “great concern that the proposals don’t take account of the requirements of the Social Care, Private & Independent sectors. It is difficult to see a) how arrangements could be made to charge them a levy b) The vast majority are SMEs, and have no spare cash to invest in staff development. This gap in the considerations is particularly significant, as the private & independent sector (largely SMEs) employs at least as many social care staff in this borough as health staff. It is vital in enabling the flow of people through hospitals and supporting them so that they are less likely to have unplanned hospital admissions.”

3.9 Impact on the devolved administrations

We ask for further analysis of the impact of the proposals on the wider healthcare system. A Scottish member comments “Differences in approaches to training numbers within foundation and specialty training in the medical workforce have the potential to impact on the medical workforce.”

An English member reflecting on skills shortages in the labour market notes “I also think we need to consider beyond UK, as healthcare and workforce planning are a global market. The UK is often looked to (for skilled staff)— there is risk that many of our talents will go outside UK.”

December 2011

1 Fourth Report of Session 2006-07, Volume 1 pp 37

Prepared 22nd May 2012