Health, Wellbeing and Local Government Committee

Committee Inquiry into Health and Social Care Workforce Planning - Evidence from the National Leadership and Innovation Agency for Healthcare

1. Purpose

This paper provides information to support the Committee’s review against the agreed Terms of Reference and will be supplemented by oral evidence from the National Leadership and Innovation Agency for Healthcare (NLIAH) on Health Workforce Planning from the perspective of the Workforce Development function in NLIAH.

2. Background

Designed for Life and Designed to Work are the underpinning policy direction for workforce development.

All Wales health workforce planning was traditionally undertaken in the Human Resource Division of the Department of Health and Social Services (DHSS), Welsh Assembly Government.  In April 2006 the Workforce Development function was established in NLIAH. The key roles and functions of Workforce Development are:

• Workforce Planning
• Education and Training for the non-medical workforce
• Workforce Modernisation
• Recruitment, Retention and Careers Information
• Education Contracting for the non-medical workforce

When the Workforce Development (WD) function was transferred to NLAIH in 2005/6 three Task and Finish groups were established to set the strategic context for its work.  One of the Task and Finish Groups was charged with developing a new integrated workforce planning process for NHS Wales and related organisations, because the limitations of the previous workforce planning process had been recognised.  The Task and Finish group produced a report which was endorsed by the Workforce development Stakeholder Board with recommendations for the design of a new system and was approved by the Management Board of the DHSS in August 2007.  An Implementation Board and an Advisory Board has now been established to manage the implementation of the new system from 2008.

The Workforce Development team’s remit for workforce planning extends to all staff groups in NHS Wales.

The NHS funds through the Workforce Development Team within NLIAH the training for a wide variety of registered practitioners such as Nurses, Allied Health Professionals and Various Clinical Scientists etc and also supports a limited number of initiatives for Health Care Support Workers. The funding for the pre-registration Medical and Dental workforce is primarily funded through Education while post registration education is funded through the Post Graduate Deanery which is funded directly by the Welsh Assembly Government.

While the funding is available through a number of sources Workforce Development, the Deanery and the Welsh Assembly Government work together on these complex planning issues.

Comments Relating to the Terms of Reference of the Committee

1. The division of responsibility amongst organisations charged with workforce planning and the mechanisms they use

The Welsh Assembly Government provides guidance on the workforce planning arrangements each year to the NHS which includes the process and timescale for the submission of workforce plans.

The guidance from the Welsh Assembly Government requires all NHS Trusts in Wales to produce an annual workforce plan which is submitted to the Workforce Development team in NLIAH.  

Local Health Boards (LHBs) are required to submit information on the staff they employ directly and also on local contractor staff and the staff the contractors employ, e.g. General Practitioners, Practice Nurses and their staff and for this to be submitted to the Workforce Development team.

The workforce plans submitted to the Workforce Development Team in August one year will inform the number of students taken onto an academic programme thirteen months later.

The Workforce Development team provides advice and recommendations on education and training priorities to the Workforce Development Stakeholder Board and to the Welsh Assembly Government Commissioning Board. This is achieved through the analysis of the workforce plans submitted from the NHS, keeping up to date with other workforce planning issues such as the supply and demand for health service staff across Wales, the UK and to some extent globally.

The Workforce Development Stakeholder Board has representation from the NHS, the Welsh Partnership Forum, and the education sector, and agrees priorities and options for education commissioning based on workforce plans from the NHS, policy initiatives and intelligence from a wide variety of sources.

Within the Welsh Assembly Government there is a Commissioning Board which is chaired by The Director DHSS and its membership includes senior Welsh Assembly Government advisors. The Commissioning Board considers the recommendations from the Workforce Development Stakeholder Board and makes its recommendations to the Minister for Health and Social Services to enable the Minister to make the final decision on the number of education commissions each year and how the education budget for the NHS should be utilised.

Professional Advisors in the Welsh Assembly Government are consulted on the results of the workforce plans and provide advice before final commissioning decisions are made.

2. The availability and quality of intelligence to inform workforce planning

The previous workforce planning process based education commissioning decisions on the forecast numbers of newly qualified staff required in five years time.  This was a narrow view of future NHS requirements.  The new integrated workforce planning process will link service, financial and workforce requirements and will provide a wider view of the future workforce. The Implementation of the new process will also address the link between Health workforce planning and planning for Social Care staff who are trained in the NHS, such as occupational therapists.

Prior to 2006 the workforce data from NHS Wales relied on individual Trust Human Resource (HR) and Payroll systems which provided data of varying quality on Human Resources.  In November 2006 NHS Wales implemented a new combined (HR) /Payroll system called the Electronic Staff Record (ESR).  The first priority in implementing the new ESR system was to ensure that staff received the correct pay and this has resulted in some of the HR information not being available immediately.  This is currently being addressed across NHS Wales.  

The Electronic Staff Record includes a data warehouse function which provides anonymised data automatically downloaded on a monthly basis for central use by The Welsh Assembly Government and NLIAH.  

There is currently very little data available from Primary Care contractors of staff employed. There is however work underway under the remit of the "Corporate Health Information Programme” to address this through the GP Information Project. This is currently in the early stages of identifying information gaps in the GP domain, one identified area of which is workforce, the project aims to submit recommendations to the CHIP board for approval of future work in this area in early 2008 to address the identified unmet information needs.

The other three UK countries have very similar issues relating to workforce intelligence and workforce planning.  Workforce planning staff from the four UK countries share workforce intelligence and data on a regular basis.

The Workforce Development team, the Welsh Assembly Government and the Welsh Partnership Forum work closely with Skills for Health who have a remit regarding the future needs of NHS workforce across the UK.

3. The involvement of all relevant stakeholders in the planning process

As identified above the new integrated workforce planning process was developed with collaboration and involvement of all relevant stakeholders, as there was wide involvement in the membership of the Task and Finish Group.

At the present time the following stakeholders are involved in the planning process:

• The NHS - Trusts and LHB
• Education providers
• Welsh Partnership Forum
• Welsh Assembly Government Professional Advisors
• Professional Advisory Committees
• Voluntary organisations
• Social Care
• Independent Sector
• Skills for Health

4. Changing patterns of demand (including an ageing population) and service provision in the health and social care sectors, (including reconfiguration of services, use of new technology, new public service delivery arrangements)

The Workforce Development Stakeholder Board has representation from a wide range of stakeholders and one of the terms of reference of the group is to look at the future workforce needs given these conditions.

The new integrated workforce planning process includes specific work at the All Wales level (Welsh Assembly Government and NLIAH) to ensure that all relevant information is included in the process.  The Workforce Development are currently working with an external consultant on the development of a comprehensive data base of information to inform planning, including demographic data, morbidity, social deprivation, staffing, etc. this will be central to the new planning process.

5. Cross border arrangements with the NHS in England

Workforce planners in England and Wales exchange workforce intelligence on a regular basis.  The workforce planner within the Workforce Development team is a member of the four countries workforce planning forum which meets two to three times a year in order to share and discusses common workforce issues.  The most recent meeting focused on the implementation of Modernising Medical Careers (MMC) and workforce planning for professions with small numbers (such as Orthoptists).

The Workforce Development team also attend the English workforce planners’ network meetings in order to exchange information and best practice in workforce planning.

6. Changing professional roles and training programmes

One of the key functions for the Workforce Development team is the modernisation of the NHS workforce.  This is achieved through the Senior Workforce Modernisation Managers working with the NHS in order to identify areas of development and facilitating implementation of the changes.  The Workforce Development team also works closely with education providers, Skills for Health, Credit and Qualifications Framework Work, and regulatory bodies in order to ensure that education and training meets patient and service needs.

7. Joint working between health and social care agencies

As identified above there is a need for close collaboration between Health and Social care agencies and work is underway to ensure this occurs. One area of close working focuses on workforce issues relating to childrens’ services in Wales and a set of common competences for caring for children across health and social care has been developed and is currently out for consultation. This work is being led by the Care Council for Wales with the Workforce Development Team leading the consultation events within health.

The implementation of the new integrated workforce planning process is intended to further develop the joint working arrangements

8. The workforce needs of the public, voluntary and private sectors

Different methodologies have been used over the years to assess the workforce needs of the private and voluntary sectors.  The main methodology used in the past has been via a questionnaire to all organisations who employ NHS trained staff.  The constraint with this methodology was that the response rate was only around 50% but it did allow intelligence to be gathered to some extent; for example were organisations planning on employing newly qualified staff or experienced staff or were organisations contracting staff numbers or expanding.  

One of the areas in the implementation of the new workforce planning process includes a specific piece of work to assess the most appropriate methodology for gathering workforce intelligence for the voluntary and independent sectors.  While this is not currently in place it is recognised as an essential element of the new process.

9. The recruitment of a workforce that reflects the diversity of the Welsh communities, including Welsh speaking staff and those from BME groups

Individual organisations are responsible for the recruitment of staff to their organisations and have specific requirements under the equality and human rights agenda.

The Workforce Development Team monitors the diversity of the students recruited to NHS training programmes within the HEI as we commission these placements and need to ensure they reflect the population of Wales for which they will serve in the future.

Additional Key Questions

1. Is workforce planning undertaken by the right agencies and in such a way that takes into account other key factors such as finance, service planning and training capacity? Should it be more or less centralised?

As previously identified the new integrated workforce planning process will have finance and service planning as key elements of the process.  There will also be a requirement for workforce planning to be undertaken at different levels within NHS Wales, i.e. National, Regional, Local level in order for capacity modelling to be undertaken.

Training for staff across NHS Wales in workforce planning is an essential component of the implementation of the new workforce planning process and will be delivered

2. Is the information available to workforce planners of sufficient quantity and quality to ensure effective planning?

The quantity and quality of the available data and information is improving greatly but there is still further work to be undertaken as previously identified e.g. ESR data.  

The greatest challenge in workforce planning is forecasting for future years.  For example the lack of knowledge of future funding availability for staff and for education makes forecasting extremely difficult.  New policy initiatives can also create demands for which the workforce is not geared up to meet. Therefore workforce development needs to ensure we have flexibility within our workforce to develop staff to meet new challenges within a short timescale.

This is to be overcome partially by using scenario planning as a methodology for accommodating different future scenarios for funding.  

3. Is workforce planning undertaken with sufficient regard to future patterns of demand for services?

Workforce planning is not an exact science and it is not possible to determine the exact number of professional staff to train for five years ahead.

The most sensitive data item which affects workforce planning is staff turnover.  For example, when turnover is high there is an increase in demand for staff and when turnover is low there is a lower demand for staff.  NHS staff turnover tends to follow the economy of the country.  When the economy is booming turnover is high as staff have opportunities to work in other areas, move house etc when the economy is in recession there are few or no opportunities for staff to move on.  There are also other influences on staff turnover such as new policies which can come into effect within the 5 year timescale it takes to identify a need, commission education and provide the training.

Forecasting turnover in 5 years time is extremely difficult but this is what is needed to ensure that new graduates are able to find posts.  Within the workforce planning community it is recognised that workforce plans will never meet service needs exactly.  There will always be either a shortfall or surplus and the intention of effective workforce planning is to minimise this variability.

4. What are the arrangements for work force planning in areas with cross border patterns of service use (e.g. health services in North Wales)?

NHS Wales Trusts who border England have local experience of the cross border workforce issues and take these into account when producing their workforce plans.  Recent research has shown that no country has developed 'the perfect’ workforce planning system for health services and that the UK as a whole is more advanced than other countries

5. To what extent do the current workforce planning arrangements affect the use of agency staff and what is the impact of this on budgets?

Annual guidance to NHS organisations in Wales on workforce planning instructs them to assume no vacancies in their forecasts for staffing needs.  The assumption of no vacancies in the future should ensure that the supply of staff in future years would be adequate and therefore the reliance on agency staff would be nil or minimal.  

6. Are the current arrangements addressing the need for Welsh speaking and Black and Minority Ethnic staff?

As previously identified individual service providers are responsible for employing staff, the Workforce Development Team monitors through the contracts with Higher Education Providers the equality and human rights agenda

7. To what extent is workforce planning anticipating changing patterns of service commissioning and provision and the changing or blurring of professional roles?

The Workforce Development Stakeholder Board has a key remit to look ahead at future workforce patterns and changes to roles. This Board has representation from all key stakeholders and is central to the future direction of the NHS workforce. One of the key challenges is looking ahead and planning for that while having to meet immediate needs.

8. Does workforce planning take sufficient account of the need for trained and effective managers?

Please see response to section 1 question 2.

9. To what extent have the European Working Time Directive and the increasingly international labour market had an impact on, and been acknowledged in, workforce planning?

Organisations are expected to include the effect of the European Working Time Directive changes in their plans and indeed the workforce within NHS Wales has changed through the introduction of initiatives such as 'Hospital at Night’ over the past 5 years.  

Intelligence on the increasing international labour market for health staff is collected centrally and used to inform workforce planning.