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3. NHSScotland Workforce

The NHSScotland Workforce

This section provides an overview of the workforce in NHSScotland during 2007/08. A workforce that is well prepared, appropriately educated and trained, and is proud to work for the NHS is core to delivering Better Health, Better Care. The significant workforce achievements delivered in 2007/08 stand NHSScotland in good stead to face new and emerging challenges.

Overview of the workforce

There has been significant growth in the workforce over the last 10 years. At the end of September 2007 the total number of NHSScotland staff (excluding GPs and dentists (General Dentists)) stood at 130,344 (whole time equivalent). In addition there were 4,721 GPs and 2,546 dentists (headcount). ¹ The table that follows shows the growth for most workforce groups over the period 1997-2007. This has enabled the workforce to contribute towards improving health and reducing inequalities, in addition to delivering healthcare services.

Table: NHSScotland Workforce Statistics - Overall summary by staff group ², ³

Source: ISD website

Workforce Planning

Improved workforce planning and better use of the talents and experience of staff supports the safe delivery of services in a way that is both affordable and sustainable. Workforce planning has become firmly embedded in NHSScotland at local, regional and national levels during recent years. It plays an important role in enabling Health Boards to deliver their planned service needs by ensuring that they have the workforce in place with the right level of skill and competency. To do this, workforce planning has to be alive to changing demographic and global labour market trends as well as ensuring it directly supports service planning. During 2007/08, Health Boards all demonstrated progress in ensuring that their workforce planning function links with service and financial planning through the development of integrated Local Delivery Plans.

Education and Training

Staff need to be prepared through education and training programmes to ensure they are undertaking their roles in a competent way, as well as developing new skills and competencies to meet future changing service needs.

The NHS Knowledge and Skills Framework ( KSF), a key part of Agenda for Change, has been designed to support the development of staff in their post and in their NHS careers. Ensuring a consistent approach to the education and training of staff through this framework, which embeds the policies and priorities of NHSScotland, means better care and improved health services for the patients and the public. Implementation of KSF continued through 2007/08, including the development of KSF outlines to support staff in their annual performance reviews. Progress on the development of the KSF outlines and Personal Development Plans was slower than anticipated, primarily due to the main focus on carrying out job evaluation and assimilating staff. A new HEAT target for 2008/09 was established for all staff to have KSF outlines and Personal Development Plans by March 2009, and subsequently for 80 per cent of all staff to have had formal KSF reviews recorded on e KSF by March 2011.

Health Boards, working closely with NHS Education for Scotland ( NES), began a programme of work during 2007/08 to provide staff with access to relevant education and training opportunities, both for traditional roles and for any new or expanded roles necessary to meet service redesign challenges. New and emerging roles established during 2007/08 included maternity care assistants to support the maternity care workforce.

The Scottish Government's Dental Action Plan ⁴ entered its third year in 2007/08. Key targets included building workforce capacity by increasing the numbers of undergraduate and postgraduate training places for dentists and the professions complementary to dentistry, and increasing the variety of continuing professional development opportunities available.

During 2007/08 further progress was made on two significant changes to the education and training of two specific professional groups: Modernising Medical Careers and Modernising Nursing Careers.

Modernising Medical Careers

Modernising Medical Careers ( MMC) aims to secure benefits for patients and doctors by improving the quality of and shortening the period of postgraduate training of doctors. This will result in patient care being delivered by more fully trained doctors through:

• formalising the content of postgraduate medical training;
• streamlining, and making more transparent, the mechanisms for selection and recruitment to training posts;
• accelerating junior doctors' career progression; and
• ultimately, shifting from a service delivered primarily by doctors in training to one delivered mainly by trained doctors.

2007/08 saw the completion of the key steps in the implementation of MMC, with new curricula and standards in place and annual, national recruitment to junior doctor posts.

In 2007, national recruitment had originally been organised on a UK-wide basis using an on-line application process. It became apparent that this system was not fit for Scotland's purpose and Scotland therefore stood aside from UK-wide systems and developed its own mechanism for selection and recruitment which continued into 2008. The main challenges in 2007/08 were therefore to overcome those earlier difficulties and to recruit to target numbers in Scotland with minimal disturbance to service continuity, and against a backdrop of competition for trainees from elsewhere in the UK.

Performance against the target recruitment numbers of trainees during 2007/08 was very good, as shown below:

* FTSTAs - Fixed Term Speciality Training Appointments

Modernising Nursing Careers

In Scotland, Delivering Care, Enabling Health articulated the Nursing, Midwifery and Allied Health Professions' contribution to the delivery of high quality care in Scotland. The Modernising Nursing Careers workstreams aim to deliver this commitment. Priority actions include updating career pathways and career opportunities for nurses to ensure a workforce ready to meet the healthcare needs of the population in the 21st century.

In 2007/08, the Early Clinical Career Fellowships ( ECCF) were introduced. These provide a unique opportunity to support the development of skilled practitioners, and Fellows will be exposed to clinical, personal and academic development opportunities including clinically-focused Masters level preparation. The pilot initiative supports up to 100 Fellows.

The Scottish-led 'Advanced Practice Toolkit' has been developed to support consistent application of agreed national competencies, job profiles and Knowledge and Skills Framework outlines, educational preparation and broader governance issues for this key developing role. The web-based version will be launched in December 2008.

Employee Experience

Providing a positive employee experience is key to attracting the best talent, motivating staff to improve their performance, and ensuring they are proud to work for NHSScotland.

A range of commitments to improve the health, safety and wellbeing of staff are already in place via the Staff Governance Standard, which is underpinned by strong partnership working with NHSScotland employers and Trades Unions. Implementation of the Staff Governance Standard is supported by Partnership Information Network ( PIN) policies, which promote best employment practice and support NHSScotland to become an employer of choice. During 2007/08, the PIN policy review was launched to ensure these policies continue to comply with employment law and support NHSScotland as a modern employer for the 21st century. The review of all 13 PIN policies is due to be completed during 2009.

In response to the NHSScotland staff survey, which was undertaken during 2006 and which is currently being repeated (launched October 2008), action was taken to address issues that threaten the morale and productivity of staff. This included extending the Emergency Workers Act and implementing an innovative Occupational Health Strategy known as OHSxtra.

Violent assault against staff continues to be a major concern, particularly in Accident and Emergency departments, and for paramedics and nursing staff. As part of a range of measures to address these issues, the scope of the Emergency Workers Act was extended to provide additional protection for GPs, nurses and midwives working in the community. Since 1 April 2008, carrying a maximum penalty of
12 months' imprisonment or a £10,000 fine or both, the Act reinforces the message that violence against any healthcare worker is unacceptable and will not go unpunished.

To improve the health and wellbeing of staff, following a successful pilot, OHSxtra was implemented to provide staff with fast track access to physiotherapy, occupational therapy and mental health services including counselling and cognitive behavioural therapy. This initiative has been particularly successful at preventing absence and speeding returns to work. Independent evaluation of the pilot model, published in July 2007, suggested a reduction from 33 per cent to 9 per cent of clients absent from work following the post intervention assessment. The pilot also suggested that at least £1.69 was saved for every £1 invested. As a result, a total of 13 Health Boards were supported to implement OHSxtra during 2007/08.

Pay Modernisation

Modernised pay arrangements have been introduced for almost all of the staff who work within NHSScotland through the consultant and GMS contracts and also Agenda for Change. The development of a new contract for Staff and Associate Specialist Doctor grades complements these arrangements. The implementation of the new pay contracts realised a number of benefits for patients and for staff including:

• Enabling faster access to services for patients;

• Supporting service redesign;

• Developing new roles and multi-professional team working;

• Aligning consultant objectives to service and corporate objectives, and developing clear plans for achieving an increase in consultant related productivity;

• Supporting the shift in the balance of care; and

• Supporting wider efficiency and productivity improvements across NHSScotland.

Implementation of Agenda for Change has been a massive task covering some 185,000 staff including bank workers and those who have left the service since it came into effect on 1 October 2004. Agenda for Change is the largest of the three pay modernisation initiatives and is designed to ensure staff receive equal pay for work of equal value. In addition, Agenda for Change provides for working patterns that are flexible and responsive to family commitments. Work to complete implementation has been moving forward throughout 2007/08. By 31 March 2008 over 152,000 staff had been assimilated, which represents around 82 per cent of all staff affected by the new system. This provides a solid grounding for NHSScotland to ensure that all substantive staff will be assimilated onto Agenda for Change by the end of 2008.

Following the UK agreement on a new contract for Staff and Associate Specialist Doctor grades, the Scottish Government, NHS Employers and BMA Scotland worked in partnership to deliver a Scottish-specific contract. This was developed and implemented from 1 April 2008, but was made effective from 1 April 2007. The effect of this unique agreement was to ensure that staff were placed on the new contract pay scales as though they had been assimilated from 1 April 2007. This was made affordable through agreeing that there would be no element of back pay to the agreement. This effectively meant that Scotland led the way in the implementation of the contract.

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