Health, Wellbeing and Local Government Committee

Committee Inquiry into Workforce Planning- Evidence from Welsh Assembly Government Officials

1. Purpose

This paper provides background information to inform the Committee’s discussions in relation to the Inquiry into Health and Social Care Workforce Planning.

The second part of the paper outlines a response to key areas of interest.

2. Background

68,272 whole time equivalent staff were directly employed in NHS Wales in 2005.  These include all professional categories and support staff.  The numbers of staff have grown over the past 5 years from 57,595 in 2001 to 70,620 in 2006 (provisional data).  Of these 5,332 were hospital medical and dental staff, 27,901 were nursing, midwifery and health visiting staff and 10,242 were scientific, therapeutic and technical staff.  There were 9,904 healthcare assistants and other support staff.

Within the social care sector over 70,000 people are employed in a range of roles, with the majority of staff providing direct care in domiciliary, residential or day care settings.  Approximately 7% are registered with a social work qualification with the Care Council for Wales.  The service covers public, private and voluntary care.

2.1 Workforce planning in the health sector

Workforce planning was introduced in NHS Wales in 1988 because of shortages in some professional staff groups. Between 1988 and 2005 the workforce planning system was based on an annual circular and spreadsheet template which was sent to each organisation in primary and secondary care. Plans received centrally were analysed, aggregated and an all-Wales plan produced.  Information collection about the private sector/independent sector and social care workforce was undertaken biannually and was captured using a questionnaire. The purpose of the plan was primarily to inform the commissioning of training places.

In 1993 following the publication of the policy documents 'Working Paper 10’ in England and 'Towards 2000’ in Wales the budgets for pre-registration training and a small number of post-registration training programmes were top sliced from NHS organisations and held centrally. Included in the policy documents were lists of the professions whose education and training could be funded from the central budget.

Requirements in the aggregated plans were considered alongside the available budget.  Workforce plans were circulated to professional advisors in the Assembly for their views and comments on policy drivers etc.  The workforce planning process included all professional groups in the NHS.  The results of the workforce plans and aggregated advice were presented to a Workforce Development Steering Group, and recommendations subsequently made about education commissioning numbers. The Minister for Health signed off the final commissioning numbers.  

In 2001 the then Minister for Health, Jane Hutt changed the workforce planning process to be based on the assessment of need rather than what could be afforded.  However, in response to ongoing criticism of the process a project was undertaken during 2003 to inform the Review of Health and Social Care in Wales (Wanless 2004).  Conclusions drawn from the Project - Improving Workforce Planning in Wales (2003) indicated that data was inconsistent across Wales and there were concerns about accuracy and validity.  Workforce planning was undertaken in isolation from strategic and operational planning and did not consider total workforce needs, and did not support service workforce redesign.

In 2004, The Review of Health and Social Care in Wales (Wanless 2004), recommended that,

"The Welsh Assembly Government should review the current workforce planning mechanisms and put in place alternative methodologies which will ensure that the services are able to deliver the ambitious service strategy” (2003:4.56), and

"Workforce planning is an area where there is a powerful case for a central lead, because of the overarching strategic nature of the issues and to establish economies of scale.  The resource involved in workforce planning is currently dissipated.  It is important that it is concentrated and that sufficient human and financial resources are devoted to the task” (2003:4.55)

In response to these recommendations and as a result of the Welsh Assembly Government Merger Programme, proposals to establish a Workforce Development Unit were developed and consulted upon.  Connecting the Workforce: The Workforce Challenge for Health (July 2005) identified the benefits to be gained in relation to workforce development and workforce planning (2005:5, 17).

The Workforce Development Unit (WDU) as part of the National Leadership and Innovation Agency for Healthcare (NLIAH) was established in 2006 to provide the central workforce planning to support the successful implementation of Designed for Life (2005).  It is required to ensure that the NHS-trained staff required by local government and the voluntary and private sector have been included in the workforce plans.

A WDU led Task and Finish Group developed a new Integrated Workforce Planning Process for NHS Wales.

2.2 Social care workforce planning

The responsibility for recruiting and retaining a quality workforce to deliver local services, including the setting of terms and conditions and pay levels and for meeting required standards, lies with individual employers. There is no central commissioning of educational needs by WAG.

CSSIW, as part of its service improvement and development role, has led in the past on the development of a strategic framework within which local and regional partnerships can secure long-term improvement through better and more targeted workforce planning, management and development.   This framework builds upon the responsibility of local authorities as commissioners and providers of services and requires that they take the lead responsibility for workforce planning management and development in their area reflecting their lead service planning responsibility.  The framework has been taken forward in partnership at local, regional and national levels and integrates service planning and commissioning, training and development and human resource planning.  To underpin this approach CSSIW has issued guidance to local authorities on workforce planning and on training and development.

Local authorities have responded positively to the framework and have set up whole sector social care workforce partnerships. CSSIW and the Care Council for Wales have also supported the development of four regional social care workforce partnerships.  These provide a forum within which particular workforce issues can be tackled and where resources can be used more effectively.  This has included organisation of jobs and careers fairs and development of regional training and development programmes

The Care Council for Wales is the regulatory body for social care workers and social work training.  It also has the role of workforce planning and development for the social care sector.  The vision for the future of social services as set out in Fulfilled Lives, Supportive Communities (2007), in relation to workforce development is currently being led by the Care Council for Wales.  CCW will produce an action plan by December 2007 to inform how future arrangements can be taken forward in

partnership will other agencies.

3. Key areas of interest

3.1 The process of workforce planning

A new workforce planning system for the healthcare workforce integrates workforce planning with strategic and financial planning at national, local and employer levels.  The Executive Summary [(attached) (full report available at www.nliah.wales.nhs.uk and will be made available for the Committee)] details the changes. An implementation project has been set up, concentrating the first stage of work within NHS Wales, moving towards greater cohesion with social care processes and staff requirements thereafter.

New arrangements will take account of the established framework in social care and work with it rather than impose a new set of requirements on local partners. This will ensure that the potential for joint working on workforce issues both locally and nationally is maximised and that resources can be appropriately prioritised to support service and workforce development.   This will be particularly important for the successful implementation of the long-term conditions framework implementation which required the developments of care planning across the sectors.

As part of Fulfilled Lives; Supportive Communities (2007), the Care Council for Wales are developing a workforce action plan, initially for the period 2008-11.

Quantity and quality of workforce information

The WDU are currently developing processes to improve the quantity and quality of workforce information.  For example, a Benchmarking Database has been developed for NHS Wales to enable Trusts and LHBs to benchmark themselves against organisations in the same Office of National Statistics category band; England and Wales averages; England 3* Trusts and PCTs in relation to quality measures and other Welsh organisations.

An externally commissioned project to develop tools to enable effective workforce planning across midwifery services will be reported upon in October 2007.  The tool will be transferable to other specialist areas.

The utilisation of data collected via the Electronic Staff Record, the new integrated workforce payroll and financial computer system, will be utilised to provide accurate workforce information from NHS Wales.

Data in relation to medical workforce planning will continue to be collected by WDU centrally.  The utilisation of the information to inform the commissioning of post graduate medical education via the deanery is currently being reviewed to ensure that decisions can be made about the whole workforce based on provision and location of future health services.  Medical workforce planning data also informs the need for development of educational programmes to enable role redesign for all professionals.  The integration of medical workforce planning with other NHS professional groups will be an important step in the services ability to implement the consequences of service change described in Designed for Life.

There remains a need to improve the workforce data available in social care particularly at an all Wales level.  Whilst there is well established information collected from local authorities, there is currently no centralised system for collecting workforce data from services commissioned and not delivered directly by local authorities (plus private and voluntary organisational needs).  

3.3 Planning for long term demands

The new integrated system for workforce planning will facilitate a service led approach based on changing demands.  Guidance for the development of the health, social care and wellbeing strategies (2007), emphasised the need to workforce plan based on strategic direction.

A number of focussed workforce groups e.g. Access 2009, long term conditions chronic conditions management, cancer and cardiac services, modernisation of pathology and imaging services and national commissioning etc have enabled dedicated workforce issues to be addressed to meet future patterns of demand.

Since 2006, the Care Council for Wales has led the development of a children’s workforce strategy for all partner organisations involved.  This partnership approach is now being applied to develop a workforce plan for the services to older people.  

3.4 Involvement of all stakeholders and arrangements for joint working between health and social care

As part of the arrangements to support the delivery of Designed to Work (2006), the workforce and human resources strategy for health in Wales, three Regional Workforce Groups were set up to bring together local economies and facilitate workforce development across sectors.  The regional groups will support the new workforce planning system.

For social care, there is a strategic framework in place for workforce planning which acknowledges the particular roles of social service stakeholders.  There are strong workforce partnerships emerging at local and regional level and a well-established framework of workforce standards.

The implementation plan for the new integrated workforce planning system will address the demands within NHS Wales during the first stage of the project.  The second stage will concentrate on the bringing together of health and social care processes.

3.5 Cross border arrangements

For Trusts that recruit staff across borders, the data supplied for workforce planning purposes reflects their usual recruitment patterns and areas of difficulty in relation to recruitment and retention.

3.6 Impact of workforce planning on agency use

To date, workforce plans in health have been used to inform the commissioning of pre registration non medical education.  When shortages of professionals existed the utilisation of agency staff would have increased.  The use of agency staff has fallen significantly in recent years due to the increasing availability of new graduates. However, the demand for agency staff is often required for experienced staff with specialist knowledge, e.g. intensive care, neonatal care etc, for which the increased supply of novice professionals may not alleviate the demand.

3.7 Arrangements to ensure appropriate representation of Welsh speaking and Black and Minority Ethnic staff

Workforce plans reflect future demands for numbers of staff rather than specify equality requirements.  Education provision through the medium of Welsh is monitored via the contracting arrangements for courses commissioned by WAG.   However, organisations have a responsibility to ensure that the workforce reflects the needs of the users and therefore the numbers of Welsh speakers or minority ethnic speakers required have to be detailed in their plans.

Individual employing organisations have key roles in ensuring that equality and diversity policies and Welsh language policies are effectively implemented.

3.8 Planning for changing service roles

The Sector Skills Council for Health summarised a Case for Change Report as part of Delivering a Flexible Workforce to Support Better Healthcare and Healthcare Services; SSA Summary for Wales (2006)  Work is ongoing to model the impact of workforce redesign and skill mix balance to inform the pace of change.

In October 2007, the WDU will seek approval for a report summarising the work of a task and finish group and make recommendations to support the establishment of a flexible and sustainable workforce in Wales which will address the issues of new and expanded roles and the registration of non professional staff.

3.9 Planning for leadership and management needs

Centrally held workforce planning data does not capture future leadership and management demands for the health service.  The Leadership Directorate as part of NLIAH does work with the service to identify future requirements and provides appropriate training.

Fulfilled Lives Supportive Communities identifies the need for leadership development in social care and work is being taken forward by the Social Services Improvement Agency.

3.10 Impact of the European Working Time Directive and international recruitment

The European Working Time Directive came into force on 1^st August 2004 for junior doctors in training; all other hospital doctors and staff were already under its regulation in 1998. Regulations regarding the work and rest requirements were set which were to run in parallel with the existing New Deal requirements. An average weekly working time of 48 hours is set to come into force on 1^st August 2009 with interim steps of 58 hours in 2004 and 56 hours in 2007.

In 2001 the Junior Doctors SAFER Taskforce was re-launched to assist NHS Trusts in Wales meet the requirements of Junior Doctors contractual commitments under 'The New Deal’.  Since then the remit of the Taskforce has changed to encompass work connected to EWTD compliance.  This includes helping NHS Trusts in Wales to implement new ways of working including the Hospital at Night model.

Achieving EWTD compliance does not automatically mean an increase in numbers in the workforce.  The Welsh Assembly Government evaluation report Designed to Comply (2006) shows that there are four central themes to achieving compliance, i.e. rota management; Hospital at Night; remodelling the medical workforce, and reconfiguration  of services on a local and national level.

International recruitment has been used in times of shortages for certain professions and for staffing of specialist areas.  Employer evaluations have demonstrated that international recruitment campaigns have ensured the provision of experienced nurses who have greatly contributed to the expertise within the workforce and the quality of healthcare.  They have contributed to the development of a workforce which reflects the cosmopolitan nature of local communities.  Many have now settled in Wales and are integrated into our society.  Workforce planning data for the NHS collects the number of staff in post together with predicted leavers/retirements.  It does not differentiate international recruits.  

Summary

Designed for Life (2005) and Fulfilled Lives, Supportive Communities (2007), have set a clear vision for health and social care in Wales over the next ten years.  Effective workforce planning across the whole workforce is integral to achieving that vision.   It is acknowledged that detailed planning must be undertaken locally by those who are in a position to respond to citizen needs.  The central role has been to work with the service, to provide a national overview and to ensure that policy direction and national trends are understood and built into local plans.  Workforce planning is not an exact science and future arrangements will need to focus on scenario planning.  However the emphasis that has been put on developing a new integrated system for workforce planning in Wales is evidence of the importance that has been given to this area of work.

Executive Summary

A New Integrated Workforce Planning System for Wales

1. Introduction

The Task and Finish Group was set up with the remit of designing a new and integrated workforce planning system for NHS Wales.  Paper summarises the main recommendations following from this work.

2. Proposed Approach

2.1 Principles

A review of workforce planning in Wales led by Paul Williams, Chief Executive of Bro Morgannwg Trust and the Review of Health and Social Care in Wales, led by Derek Wanless, both identified a range of problems with existing approaches.  To address these, the Task and Finish group identified a number of principles that need to apply to the new system:

• Workforce planning needs to be fully integrated with service and financial planning so that workforce plans can reflect the major changes in service delivery that are planned and anticipated for the future.
• If workforce planning and service planning are to be fully integrated there needs to be a clear methodology for relating planned service activity and workforce demand.
• Workforce planning needs to address future workforce capability in terms of skills, roles and ways of working in teams rather than simply numbers in individual professional groups.
• Long term workforce development decisions should be made using a methodology that is appropriate to strategic planning.
• The level of expertise and resource devoted to workforce planning needs to be increased, particularly in relation to strategic planning.
• Workforce information systems need to be improved to support better workforce planning.

2.2 Planning Elements

In order to apply these principles we propose that there should be three core elements to the new workforce planning arrangements each of which forms an integral part of the new arrangements for planning services.

• National Strategic Workforce Planning
• Local Strategic Workforce Planning
• Employer Operational Workforce Development Plans

This is illustrated in the diagram below:

2.3 National Strategic Workforce Planning

The national strategic planning will have four main functions:

• Informing recommendations to the WAG on education commissioning.
• Showing the impact of national strategies such as Designed for Life on future workforce needs.
• Informing national strategic service planning of workforce issues that could have an impact on service delivery.
• Providing a strategic framework and analysis for local workforce planning.

Local Strategic Workforce Planning

Building on the national strategic planning, local strategic plans will be required to reflect local circumstances and priorities such as specific plans for future service configuration, service priorities based on local needs and local labour market issues.  The workforce requirements will be driven by the Health, Social Care and Wellbeing Strategies and Children and Young People’s Plans and the commissioning plans drawn up by LHBs to reflect these local issues.  For each of the changes planned in the delivery of services within the HSCWbS the workforce implications should be identified in terms of numbers, skills, how and where people will be working

Employer Operational Workforce Development Plans

Workforce planning at employer level has two elements.  Employers will input to the strategic planning process described above but will also need to carry out operational workforce planning which focuses delivering an effective workforce to meet their service delivery objectives.  

• Mapping service activity and workforce - developing clear models to related planned activity to the workforce needed to deliver it.
• Forecasting future workforce needs - applying these models to identify how the workforce will change.
• Skills development planning - planning the workforce in terms of skills and roles not just numbers.
• Service improvement - identifying and implementing the new ways of working needed to improve service delivery.
• Improving workforce management - maximising the utilisation of the workforce through improved attendance, turnover and motivation.

3. Planning Arrangements

The workforce planning process will not only need to be integrated into service and financial planning but also to provide for input and advice from staff and professional representative bodies.  It also needs to underpin the national process for commissioning education.  This is quite complex. The diagram below shows some of the main elements of the cycle.

The purple arrows show the planning cycle and grey the points where professional advice will feed into the process.  The cycle will feed national decisions on education commissions and the timetable for this is shown at the end of this section.

Overall Strategic Direction - by August or earlier

The starting point for the planning process will be the national strategic direction as set out in national policy guidance.  Locally the process will need to take into account both proposals for secondary care reconfiguration and the local response to the Community Services Framework to be issued in Spring 2007.  In 2007 the intention of WAG is to issue a set of priorities guidance in the Summer to support the development of the Health Social Care and Wellbeing Strategies for 2008-2001.  These will contain guidance on key workforce issues.

Local Strategic Planning - September - March

A prime basis for local strategic planning will be the Health Social Care and Wellbeing Strategies and Children and Young People’s Plans. The accountability for social care workforce planning rests with Social Services Directors so these strategies will also be the main focus for bringing together Health and Social Care workforce plans. The workforce strategies will identify clearly the workforce implications of planned changes in service delivery in terms of numbers, skills and ways of working.  Plans for new ways of working will also form part of the Designed for Improvement modernisation action plans.  

The longer term view will be informed by the strategies that regions are developing for future service configuration and provide a perspective across the wider health economy.

Local Operational Planning - September - March

This element comprises the planning processes which are primarily focused on delivery and may have a shorter timescale. Service plans will need to have the workforce implications and costs clearly identified. In addition organisations should have clear plans for taking forward the modernisation of their workforce.  

Regional Aggregation and Sign Off - January - March

The plans for each health economy will need to be jointly agreed by the Trusts and LHBs and, where appropriate, partner organisations. The regional HR and Workforce Networks will have a key role in coordinating process and ensuring that the workforce requirements reflect the needs of the service strategies.

National Strategic Planning - April - September

The national strategic planning will have several functions. It will inform the national process for agreeing future medical and non-medical training numbers.  It will also form the basis of advice to the Welsh Assembly Government to inform the future strategic direction and policy guidance.  

Decision making by Welsh Assembly Government - December

The final sign off for the workforce planning and recommendations for future education and training provision will rest with WAG.  They will agree the non-medical training commissions and the number of post-graduate medical training posts by specialty.

4. Implementation

The aim is to develop the new workforce planning system as part of the process for developing the next round of Health Social Care and Wellbeing Strategies and Children and Young People’s Plans.  This means that local strategic workforce planning will need to be completed as part of these strategies by March 2008.  

Within the context of this outline planning timetable, 2007/8 will be a transition year for implementing the new arrangements.  WDEC are developing an implementation project plan to support this process.  

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