Scottish Government

3. NHSScotland's Workforce

The NHS in Scotland employs over 165,000 people ⁶ whose diverse skills are at the heart of our desire to provide the highest quality person centred, safe and effective healthcare services for patients and their families. As an employer, we have to be committed to retaining and developing our people as they lead in delivering ever-improving services to the people of Scotland. Traditionally many of our NHS colleagues have chosen their careers for vocational reasons and will continue to do so. However, in the changing labour market, NHSScotland is competing with other employers for the best talent and we increasingly need to demonstrate that the NHS is an employer that people really want to work for.

Against this background, it is encouraging to report that NHS Boards are making a positive impact on recruitment, ensuring wide access to employment opportunities. Boards are investing in pre-employment strategies to attract staff for the future. Across NHSScotland, Boards are committed to developing people by nurturing their talent. This in turn has a positive impact on patients' experience with staff committed to achieving the best for patients and their families, and being proud to work for NHSScotland. To this end, considerable investment in education, training and personal development has been and continues to be made.

These efforts place NHSScotland in a good position to secure, develop and to deliver sustainable quality services. In January 2009, we published A Force for Improvement: the Workforce Response to Better Health, Better Care*. This provides a framework for NHSScotland to achieve our workforce vision, filling gaps in delivery and ensuring consistency in further developing our workforce as we prepare to meet the challenges that lie ahead. A Force for Improvement outlines the steps we are taking to ensure that we are an exemplar employer.

The five ambitions set out in A Force for Improvement are:

• All staff will be ambassadors for health improvement, safety and quality, using every interaction with individuals, communities and populations, and every patient care episode to maximise their public health and education role;
• NHSScotland will develop and implement multi-disciplinary and multi-agency models of care which are more responsive, more accessible and more joined up to meet the needs of local communities and ensure efficient utilisation of skills and resources;
• NHSScotland will be an 'employer of choice' that acquires the best talent, motivates employees to improve their performance, keeps them satisfied and loyal, and provides opportunities for them to develop and contribute more;
• All staff in NHSScotland will work together to promote the benefits of preventative action and measures of self care for patients and the public across a range of health issues, supporting them in ensuring that they have the knowledge and understanding to undertake this and, where appropriate, to seek expert advice and treatment; and
• We will work together with universities, further education and the wider education sector to encourage and maximise flexible access to education and training, for people already working in NHSScotland and those with aspirations to join, that is reflective of the changing demography and increasing diversity of Scotland.

Our workforce in NHSScotland has grown significantly over the last 10 years, and continued to grow in 2008/09, albeit at a slower rate - numbers have now reached record levels. At the end of September 2008, the total number of NHSScotland staff (excluding GPs and dentists) stood at 133,095 (whole time equivalent) ⁷. In addition, there were 4,916 GPs and 2,703 GDPs (General Dental Practitioners) (headcount). ⁸

NHSScotland Workforce Statistics - Overall Summary by Staff Group^{9, 10}

Key Developments in 2008/09

Employee Experience

NHSScotland continued to develop strategies in partnership with trade unions and staff side organisations to improve the quality of our employee experience, to develop their knowledge and skills, and to enhance their own health and wellbeing. These strategies support and promote our approach to developing a mutual NHS in Scotland.

The Staff Governance Standard sets out what each NHSScotland employer must achieve in order to improve continuously in relation to the fair and effective management of staff. Implementation of the Staff Governance Standard strengthened throughout 2008/09. Our commitment to our workforce and a positive employee experience has been given renewed priority and focus through the publication of A Force for Improvement.

A key mechanism for finding out how our colleagues feel about their work is the bi-annual staff survey. The 2008 survey identified significant improvements in a number of areas, including equality of opportunity, the opportunity for staff to contribute suggestions and an increase in the number of staff who feel NHSScotland is a good place to work.

Working Well* was launched and aims to enhance the whole employee experience from initial recruitment onwards. It complements existing commitments to improve the health, safety and wellbeing of staff. The objective of Working Well is to make NHSScotland an 'employer of choice' which attracts the best people, motivates employees to improve their performance, and provides opportunities for them to develop their skills.

A new Working Well Challenge Fund is to be set up for 2009/10 to fund projects being taken forward by NHS Boards to support the health, safety and wellbeing of staff. Two pilot projects aimed at reducing sickness absence were set up as part of this work.

A new national uniform and dress code for NHSScotland staff was introduced from 1 September 2009. As well as promoting a corporate image for NHSScotland it will be high quality and fit for purpose.

Partnership Working in NHSScotland

There is a long standing commitment to partnership working in NHSScotland, of which we can be proud. This leads to better informed and shared decisions, which in turn deliver a better standard of service to patients and their families. It also supports more effective Staff Governance. Currently two key bodies, the Scottish Partnership Forum ( SPF) and the Scottish Workforce and Staff Governance Committee ( SWAG), represent partnership working at national level. Both bodies are tri-partite, taking their membership from representatives of the Scottish Government Health Directorates, NHSScotland employers and trade unions. The role of the SPF is to serve as the key forum were members discuss, debate and make recommendations around strategic issues where a single approach across NHSScotland is appropriate. Additionally, it takes responsibility for being the 'guardian' of partnership across NHSScotland. SWAG addresses specific workforce issues that require Scottish-wide solutions, working to ensure that NHSScotland operates as an exemplary employer.

Partnership Information Network Policy Guidelines

The Staff Governance Standard commits NHSScotland employers to ensuring that all staff are treated fairly and consistently and that the minimum standards as described in the Partnership Information Network ( PIN) policy guidelines are met or exceeded. These workforce policy guidelines have been developed over a period of years through extensive partnership working arrangements. The decision was made in early 2009 to review all 13 PIN policy guidelines. This was to ensure that all the guidelines were as up-to-date as possible and, in order to maintain their value, continue to reflect changing employment law and practice accurately and take account of best practice. The review will be complete in early 2010.

Sickness Absence

The Scottish Government set a challenging HEAT target of 4 per cent sickness absence for NHSScotland to be achieved by 31 March 2009. In order to achieve this target, NHS Boards were required to demonstrate through the annual review process that this issue was given priority at top management level.

The overall rate for sickness absence in NHSScotland for March 2009 was 4.43 per cent. This compared favourably with the March 2008 position of 5.06 per cent. This suggests improved health and wellbeing of our people and equates to around 650,000 more hours worked in 2008/09.

There are many models of good practice in supporting staff to reduce levels of sickness absence within NHSScotland. NHS Boards have worked to ensure that all areas, staff groups and levels of management have this as a high priority target and are following best practice. The Promoting Attendance and Managing Sickness Absence ( PAMSA) group, which was established in 2008 with a remit to identify, disseminate and encourage good practice in relation to promoting attendance, has been instrumental in identifying different types of intervention to deal with different types of absence. The group provides a focus for monitoring and reporting progress nationally against the HEAT target.

Dignity at Work

The National Dignity at Work Project is supported by the Scottish Government and hosted by NHS Dumfries & Galloway and NHS Fife and was established in response to the results of the 2006 staff survey. The project aims to promote a positive working culture and to develop tools which will identify and support positive behaviours. The findings of the project will also help inform a review of the national Dignity at Work Partnership Information Network ( PIN) Policy.

Pay Modernisation further progress on Agenda for Change

Pay reform has contributed to increased capacity, a stable recruitment and retention position in NHSScotland - and a fair deal for staff. The continued implementation of Agenda for Change during 2008/09, together with the previously-agreed arrangements with other staff groups, means we now have a set of contractual tools we can use in partnership to develop the workforce, enhance productivity and drive up quality. NHS Boards are expected to use these tools creatively and in close consultation with staff-side groups , to effect meaningful long-term change and to ensure that they have the right mix of skills in the most appropriate clinical teams.

Implementation of Agenda for Change continued throughout 2008/09 and has been a significant task for NHSScotland since it came into effect on 1 October 2004. Agenda for Change was the largest of the three pay modernisation initiatives and was designed to ensure that staff receive equal pay for work of equal value and provides for the flexible and modern working patterns expected of an exemplar employer. Owing to the size and complexity of the task of implementation, supported by the highly consultative partnership approach adopted by NHS Boards, completion of the assimilation of all staff and bank workers was achieved by the end of August 2009, with the exception of a small number of staff with special circumstances.

The Knowledge and Skills Framework

An integral part of Agenda for Change is the Knowledge and Skills Framework ( KSF). KSF defines and describes the knowledge and skills that all NHS staff need to apply in their work in order to deliver quality services. The Framework demonstrates our commitment to personal development and career progression for all staff. It provides a single, consistent, comprehensive and explicit framework which is designed to ensure that individuals are supported to be effective in their jobs. As part of the national agreement, each person working in NHSScotland will have a KSF outline and, at least once a year, they will have a meeting to review how they are applying their own knowledge and skills against this outline. The implementation of the KSF was ongoing throughout 2008/09 and was taken forward in partnership with colleagues from the trade unions and professional organisations. The HEAT target for 2008/09 for all substantive, permanent Agenda for Change staff to have a personal development plan was achieved in full by July 2009.

Quality and Workforce Modernisation

Developing the right workforce to have the right skills in the right place at the right time is a fundamental requirement of delivering high quality healthcare services. The range of workforce development programmes aimed at modernising medical, nursing and midwifery, allied health professional and scientific careers taken forward during 2008/09 demonstrates a commitment to achieving this aim. During 2008/09, we continued to make significant investment in the education and training of all staff across all staff groups, both nationally through NHS Education for Scotland and locally at individual NHS Board level.

Modernising Medical Careers

Modernising Medical Careers ( MMC) introduced a major reform of postgraduate medical training across the UK designed to bring a more structured, streamlined and transparent approach to junior doctors' selection, recruitment and training. The key principles were that this should be based on clear selection criteria and standards, including standardised/fair scoring at interview. It was also designed to give junior doctors the potential for accelerated progression through training grades based on the achievement of specified competences at each level rather than on time served.

The implementation phase of MMC was effectively completed in 2008/09, with postgraduate medical training in Scotland subsequently re-branded as Scottish Medical Training. The focus of attention shifted to working towards a medical service delivered increasingly by trained doctors over the period 2010-2014. This will enhance the capacity to provide high quality care, improve patient outcomes and increase clinical effectiveness, as more patient contact will be with accredited senior doctors.

Modernising Nursing and Midwifery Careers

Nurses, midwives and the allied health professionals comprise the largest part of our workforce. They have great responsibility for ensuring high quality, safe and effective professional practice and have a real influence on the quality of the patient experience.

The delivery of high quality, safe and effective patient-centred care is being led through the work set out in Curam: Scotland Cares (2008) - the nursing, midwifery and allied health professions' response to Better Health, Better Care. This work programme provides a range of key components including work to strengthen clinical leadership and improve clinical and professional practice and outcomes. Following on from this progress, work is being taken forward on further practitioner development, including guidance on implementation of both advanced and consultant-level roles.

Scotland has also been leading UK work for Midwifery 2020 which aims to maximise the midwifery contribution to improving women's experience during their maternity care. It is also designed to meet their health and social care needs and improve outcomes for mothers, babies and families. Specifically, Scotland is leading workstreams including workforce and workload planning and on public health issues such as inequalities, parenting education, early years and multi agency working. This work has continued in 2009 with a final report expected in spring 2010.

Modernising Allied Health Professional Careers

There are 12 Allied Health Professions ( AHPs), including radiographers, physiotherapists and dieticians, who provide a broad range of diagnostic, therapeutic and rehabilitation services across NHS services. They are trained as first point of contact practitioners providing expert advice and support to patients in managing their own conditions.

Modernising AHP careers is a new programme of work initiated in 2008/09 that seeks to maximise the potential of our AHPs by:

• identifying education and training priorities to support high impact change;
• providing tools and resources to support workforce development and an efficient skill mix;
• supporting staff to develop their skills and expertise as effective practitioners through ongoing continuing professional development opportunities and training; and
• building research and practice development capacity to demonstrate clinical improvement and impact.

Modernising Scientific Careers

There are 51 Healthcare Science disciplines which collectively make a vital contribution to over 80 per cent of all diagnoses. These include scientists in laboratories, imaging services and clinical physiology teams.

Safe, Accurate, Effective: an Action Plan for Healthcare Science * is Scotland's key policy document for healthcare science which was launched in 2007. Good progress was made in implementing the recommendations outlined in the action plan during 2008/09. In addition, a UK-wide programme of work on modernising scientific careers, being led by the Department of Health, aims to modernise the healthcare science workforce to deliver and contribute to high quality healthcare in the UK.

Clinical Healthcare Support Workers

NHSScotland employs over 19,000 clinical healthcare support workers ( HCSWs). This number is likely to increase in response to changing employment demographics and to meet the needs of our changing Scottish society. Our HCSW colleagues are increasingly developing their roles to provide additional support to patients and other clinical staff and a range of policy and strategic initiatives have explored the development of this vital section of our workforce.

Administrative, Clerical and Other Non-clinical Healthcare Support Workers

Building on feedback from staff, progress has been made throughout 2008/09 in beginning to address the educational, training and development needs of administrative and non-clinical support service staff in Agenda for Change bands 1-4. Our colleagues in this group play a pivotal role, often behind the scenes, in supporting frontline delivery of patient care. To support and develop those already in this staff group and to attract vital new recruits in the future, NHS Education for Scotland ( NES) will be rolling out an extensive programme of educational development over 2009/10.

Regulation

In 2008/09, progress was made towards the regulation of Practitioner Psychologists and Pharmacy Technicians (both devolved professions). We worked in partnership with the UK Government to implement the White Paper Trust, Assurance and Safety: the Regulation of the Health Professional in the 21st Century *, which made recommendations about strengthening regulation to protect patients and the public. The HCSW pilot, on the employer-led model of regulation, was also completed.

Looking Ahead

We will continue to encourage best practice in staff management, in order to enhance both the employee experience and the delivery of high quality care. We will aim to improve our approaches to recruiting the right people, and to continually develop and support them throughout their careers in NHSScotland. We will listen to what they tell us so that we can help them reach their full potential, and through this, help NHSScotland provide a truly world-class service.