Velindre Cancer Centre Strategic Workforce Analysis and Transforming Cancer Services Action Plan Contents

Transcription

1 Velindre Cancer Centre Strategic Workforce Analysis and Transforming Cancer Services Action Plan Contents 1.0 Introduction... 4

2 1.1 The Clinical Model Developing the Strategic Workforce Plan How has the Strategic Workforce Analysis and Transforming Cancer Services Action been developed? What is the aim of our strategic workforce plan? The Strategic Context What do our patients say? The Current Workforce Introduction Data Limitations Workforce Profile by Staff Group Workforce Profile by Band Workforce Profile Specifics Participation rates Gender composition of the Workforce Age of the Workforce Stability of the Workforce Recruitment & Retention Diversity of the Workforce Key Findings Workforce Supply Introduction Internal Workforce Supply External Workforce Supply Labour Market and Local Population Education Commissioning Medical Workforce Nursing Workforce Allied Health Professional Workforce Pharmacy Workforce IT and Information Workforce Healthcare Support Workers Estates and Facilities Workforce Administrative and Clerical Workforce Shortage Occupations List... 56

3 3.15 Key Findings Workforce Demand Horizon Scanning demand for the workforce Workforce Demand for the Cancer Centre The Clinical Model What does this mean for the future workforce? The Shape of the Future Workforce Introduction Workforce deliver the clinical model What do we know about our current services? Building the workforce of the future Recruiting the Workforce Retaining knowledge and skills Creating a Change Culture Risks and Opportunities Workforce Challenges Workforce Opportunities The Workforce Action Plan... Error! Bookmark not defined.

4 1.0 Introduction Velindre Cancer Centre is a tertiary non surgical specialist centre serving the population of South East Wales. The Cancer Centre provides Radiotherapy, Chemotherapy, Outpatients and Inpatient services along with some other support services. The Transforming Cancer Services Programme was established in 2014 explore options for the future provision of cancer services for South East Wales in the context of the Welsh Government Together for Health Cancer Deliver Plan. The Programme is developing a new delivery model for tertiary cancer services, which aims deliver care closer the patient s home that is sustainable and adaptive future increases in demand, by working with the Local Health Boards and patients. The Programme also seeks develop a model that takes a whole systems perspective including seeking options for improvements cancer awareness, prevention, early diagnosis, treatment and support through living with the impact of cancer, palliative care, and advance care planning. Figure 1 4

5 1.1 The Clinical Model A clinical model has been proposed that places the patient at the centre, with their treatment and support based at a new build cancer centre. This will be supported by a number of outreach settings in purpose built satellites and in the patients homes. The new model will facilitate the introduction of a number of new, national information systems, the introduction of new technical procedures, and will facilitate more integrated and innovative ways of working through the provision of modern facilities and the outreach facilities within Local Health Boards. Figure 2 5

6 1.2 Developing the Strategic Workforce Plan To support the delivery of Transforming Cancer Services, a strategic workforce analysis and transforming cancer services action plan has been developed. This is a high level plan that aims articulate the shape of the future workforce required, and a plan for how this will be delivered. Workforce planning is iterative and therefore the strategic workforce analysis and transforming cancer services action plan will be supported by more detailed and ongoing operational level workforce planning define the numbers, skill mix and training requirements of the workforce. This process has already commenced with the development of the combined activity, workforce and finance ol that has been developed as part of the Programme and VCC Outline Business Case. The strategic workforce analysis and supporting actions will also inform the ongoing Integrated Medium Term Planning process (IMTP) including any education commissions that will be required deliver the future workforce. We are committed engaging with our staff throughout this planning process and support them develop and change, providing them with the skills, knowledge, competencies and capability they require as we move wards the future. 1.3 How has the Strategic Workforce Analysis and Transforming Cancer Services Action Plan been developed? The strategic workforce analysis and transforming cancer services action plan has been developed through a process of engagement. We have considered the patient at the centre of our plan and have worked ensure that patient engagement is a part of the ongoing workforce planning process. Members of the Workforce team, along with the TCS Programme Team have visited a number of Cancer Centres across the UK who have undertaken or are embarking on a similar transformation Programme. This has provided an opportunity share learning and experience and has also offered the opportunity for networking. Links have also been made with other organisations in NHS Wales who have been implementing systems change in areas other than cancer services. The current workforce was analysed identify any emergent trends, risks and opportunities for change. Discussions with our managers, the ongoing work of the Programme team and consideration of national strategy and policy has provided an overview of the likely demand for workforce, skills and competences in the future. Work has also been undertaken look at the potential supply of the future workforce across the various staff groups employed within the Cancer Centre. This information, literature review, discussions with managers, and workshop outputs has informed a high level description of the shape of the future workforce for the Cancer Centre and outreach facilities. 6

7 Finally, a number of actions have been identified and prioritised that identify the work that needs be undertaken deliver our future workforce. Throughout our workforce planning, we are using the Prudent Healthcare Principles inform and guide our thinking on the future workforce skills and competences we might require. 1.4 What is the aim of our strategic workforce plan? Velindre NHS Trust is an employer of choice and aims build on this reputation by ensuring that its workforce is developed, skilled, adaptable, flexible, and supported change so that it can deliver world class services our patients. To deliver the workforce of the future, it will be built around the Prudent Healthcare principle for the workforce: Figure The Strategic Context The strategic workforce analysis draws on a number of national and Trust strategies identify the strategic drivers within the wider healthcare system that will drive the workforce actions identified within the final section of this plan. The strategies driving this plan include: Together for Health - Cancer Delivery Plan ( ) The current strategy, Together for Health: Cancer Delivery Plan was launched in 2012 and sets out a clear vision for cancer services in Wales: People of all ages have a minimised risk of developing cancer and, where it does occur, an excellent chance of surviving, wherever they live in Wales; Wales have cancer incidence, mortality and survival rates comparable with the best in Europe; The Delivery Plan, which is due be reviewed, sets out the strategic themes and actions required improve outcomes and those that impact on the workforce have been highlighted in table 1: 7

8 Table 1 Strategic theme Preventing cancer Detecting cancer quickly Delivering fast, effective treatment and care Outcomes People live a healthy lifestyle, make healthy choices and minimize risk of cancer. Cancer is detected quickly where it does occur or recur. People receive fast, effective treatment and care so they have the best chance of cure. People experience well coordinated services, which are safe, sustainable and available as locally as possible Specialist hospital cancer care in centres of excellence that match or surpass the best, and is seamlessly connected with local cancer services Flourishing cancer research improve treatment and making NHS Wales an attractive place live and work for high caliber clinicians Meeting People s Needs People are placed at the heart of cancer care with their individual needs identified and met so they feel well supported and informed, able manage the effects of cancer. Caring at the End of Life Improving Information Targeting research Services are available as locally as possible People have access timely information so they understand their condition and which service access should problems occur Every patient has a key worker who co-ordinates care and support in partnership with them People approaching the end of life feel well cared for and pain and sympm free. Specialist palliative care nursing is available 7 days a week Providing improved analysis and information which is available at the right time the right person. To support improvements in cancer treatment and care End of Life Care Delivery Plan ( ) The Delivery Plan sets out the vision for end of life care in Wales enable patients have access high quality care in line with their choices and decisions in terms of end of life. This includes staff 8

9 having appropriate skills communicate with and meet the needs of patients. The Delivery Plan sets aims for patients and staff have access palliative care support and advice and that this is seamlessly integrated Informed Health and Care A Digital Health and Social Care Strategy for Wales (2015) This national strategy sets out the aims for digital technologies and online services support the delivery of care across Health and Social Care. From a workforce perspective, it outlines the enabling potential of widening access information and the sharing of information, whilst recognising that this will impact on workforce knowledge, skills and future roles requirements. The strategy also recognises the need for cultural change ensure that new ways of working - using technology and electronic records - are fully embraced by staff Velindre Cancer Strategy What Matters me? The Velindre Cancer Strategy What Matters me? sets out a number of strategic aims for the delivery of high quality, person focused cancer care. The strategy seeks align our efforts drive forward medical advances, enhance survival and improve quality of life, and builds on the principles of the Wellbeing of Future Generations Act (2015). It seeks : Work better gether across organisations and care boundaries; Involve people, reflecting on the diversity of communities; Look the long term as well as focusing on now; Take action try and sp problems getting worse or even sp them happening in the first place. This strategy was developed through patient engagement. It has identified a number of strategic drivers and enablers, important patients and citizens that will have important implications the development of our future workforce, such as communication skills around challenging conversations involving complex messages and improved information sources. This may necessitate the development of different skills for our workforce InVigorate Strategy InVigorate is a strategy that considers the potential and opportunity for innovation, education and life science research and development for the Trust. It sets out the actions we must take make innovation, education, research and development and its dissemination central what we do as an organisation. It is designed as an integrated set of measures that will support the Trust achieve systematic changes the way the organisation operates. Our ambition for the workforce is be able develop the skills, expertise and knowledge of all our staff be able contribute and fully participate in research & development and innovation, so that 9

10 we are able provide the effective treatments of morrow. To do this we will need provide education not only for our workforce but for the wider workforce around the cancer patient. It will also support us create a culture where we consider the future skills, competences and roles we require and are involved in shaping the underpinning education required. This will enable us develop staff who are adaptable a changing scientific, medical & technological environment Research Fit for the Future This strategy is currently under development (due be completed by the end of 20). It highlights the achievements of the Cancer Centre s current research activity. The strategy sets out our aims for how we stand in the context of local, national and international research, the challenges we face in achieving research and development and innovation excellence, and identifies key actions and enablers. The strategy supports the TCS Programme and is a key component of InVigorate. It sets out: Creation of a vibrant culture of research & development; Translation of research & development in real service improvement for patients; Maximising partnership & collaboration across healthcare, academia and industry; Creation of an environment that will attract and retain high calibre staff. The strategy identifies our aim attract researchers from across all disciplines including; medical physics, radiotherapists, nursing and allied health professionals Radiotherapy Strategy Shaping the Future of Radiotherapy: A Strategy contains a strategic aim for the workforce; An appropriately skilled, flexible and empowered workforce that is motivated, values driven and innovative There are a number of actions achieve the aim: A workforce plan that ensures the skill mix and numbers of staff reflect the changing needs of the service; Promote a culture of continuous up-skilling of the workforce with clear and recognised support structures, that allows time for individuals pursue personal and professional development; Staff are given the opportunity and are appropriately skilled spend time, and communicate effectively with patients; There are sufficient and appropriate opportunities for staff from each profession engage in service development; be innovative; and supported in their ambitions develop and drive the service forward; 10

11 Establish formal links with Higher Education Institutes (HEIs) enhance opportunities in education, training and collaborative research projects; and expand our specialist skills resource; An educational programme will be introduced which supports horizon scanning, knowledge sharing, and information exchange nationally and internationally; Peer support and cross departmental collaboration will improve communication and understanding; create new opportunities in research, technology and innovation; and improve patient experience and outcomes; There will be continued investment in staff, new technology and advanced learning resources support training Prudent Healthcare WHC/002/14 Making Prudent Healthcare Happen, set out a Prudent Healthcare principle for the workforce Organise staff by the only do what only you can do principle, where all people working for the NHS in Wales should operate at the p of their clinical competence. This principle should be central our approach planning the future workforce ensure that patients are seen by the most appropriate, skilled and trained members of staff, and that our staff are skilled and adaptable a changing scientific, medical and technological environment Working Differently, Working Together The national workforce strategy (due be reviewed during 2017) sets 4 objectives for the workforce of NHS Wales; o An engaged workforce aligned and committed the delivery of the vision for NHS Wales in 20; o A sustainable and skilled workforce focused on helping the people of Wales improve their health as well as treating sickness; o A redesigned workforce, working gether deliver healthcare for 21 st Century; o A workforce that aims at excellence everywhere within available resources Building Excellence Building Excellence, the Trust Organisational Development (OD) strategy outlines how over the next 3 5 years the Trust will develop a culture that will enable all staff achieve the delivery of ambitious service change plans. The strategy lays out our organisational values and behaviours and an OD model achieve this. The OD Strategy will enable the Cancer Centre build a culture with shared values and beliefs across all the services it provides at the Cancer Centre and at the outreach settings and community. The implementation of this strategy is supporting staff engagement and will enable the changes required by creating a culture for change Education Strategy 11

12 The Education Strategy is currently under development and aims define the Trust s approach the future education and ongoing development over the next 10 years. This strategy will support the development of the workforce in line with Prudent Healthcare principles, that it is capable, competent and highly skilled. This strategy will enable the development of a workforce that is adaptable a rapidly changing medical, scientific and technological environment People Strategy The People Strategy will be developed during 2017 and will define how - over a ten year period- the Trust will employ and deploy its workforce. This strategy will support the changes we will need make workforce practices over the forthcoming years in areas such as how we support our staff work longer and increase wellbeing Diversity & Equality Strategy This strategy is under development and will be crucial achieving a workforce in the Cancer Centre that is reflective of the population that it serves, and is empowered meet the equality and diversity needs of that population Bilingual Skills Strategy The Trust Bilingual Skills Strategy is a long term strategy that recognises the importance of providing bilingual services giving equal status Welsh and English. It identifies the actions (including workforce actions, such as the requirement assess the language skills and requirements of a post) that the Trust is required undertake achieve compliance with the Welsh Language Standards. 1.6 What do our patients say? Patient engagement, as part of the development of the Trust s Cancer Strategy has identified a range of guiding values that are important patients. These are as follows: Information and communication; Services supporting enablement; Reputation and assurance. 12

13 1.6.1 What matters me? Figure 4 Choice Highest quality of care Control Health (physical and psychological) Information Communication Independence Patient engagement has identified that in order support patients we need develop skills and competences within our future workforce that will provide patients with the values and outcomes that they have identified as being important them. Patient involvement means more than simply engaging people in a discussion about services. Involvement means having the patient voice heard at every level of the service, even when that voice is a whisper Don Berwick 2013 Improving the Safety of patients in England 13

14 2.0 The Current Workforce 2.1 Introduction The Clinical Services Model for Transforming Cancer Services (TCS) has been built using activity data for 2014/15 and as a result workforce data has been analysed develop an understanding of the current workforce issues. Workforce data for the year 2009/10 has also been analysed identify whether there have been any significant changes in the workforce over a five year period which could indicate some emerging trends (although use of only two data points is not wholly reliable when trying establish a trend). 2.2 Data Limitations Workforce data has been extracted from the Electronic Staff Record (ESR). This system holds workforce information based on staff in post and does not hold establishment data, therefore, when this information is being considered within this plan, this fact will be referenced. Data will also be sensitive data cleansing activities that will have taken place between the two points. Some of the metrics are also dependent on managers and staff having entered and chosen the relevant data e.g. for equality information. For a number of the metrics, the junior medical workforce has been excluded as its inclusion would skew the results due the regular rotation of this staff group. The workforce in the Cancer Centre is also relatively small so changes tend have larger percentage impacts. In a number of areas, ESR data is limited and the reasons for it have been noted in the relevant sections with further explanation. 2.3 Workforce Profile by Staff Group As at 31 st March 2015, 712 (6.9wte) staff were employed at the Cancer Centre (NB ESR workforce information is Staff in Post data). This represents an increase of 27 staff (28.28wte) since 31 st March 2010 or 3.9%. The following graphs provide an illustration of the distribution of the workforce (by headcount) across the staff groups. The distribution has remained broadly the same between 2010 and The Admin & Clerical staff group makes up the largest proportion of the workforce (25% in 2010 and 22% in 2015) this staff group includes both administrative staff and a number of non clinical management posts which reduced by 6% over the period. Nursing (19% in 2010 and 21% in 2015) and the Allied Health Professional (17% in 2010 and 18% in 2015) staff groups make up the next biggest proportions of the workforce, which is in line with the main clinical services provided by the Centre i.e. Inpatients, Radiotherapy and Chemotherapy. The Admin & Clerical staff group decreased between 2010 and 2015, whilst the Nursing and Allied Health Professional staff groups increased. Additional Professional Scientific and Technical staff also decreased between the two dates (from 12% in % in 2015) which will be due, in part, the 14

15 recoding exercise for the Healthcare Scientists workforce and is reflected by the increase in that staff group by 2015 (2% in 2010 rising 9% in 2015). Figure 5 Headcount by Staff Group 31 st March 2010 Figure 6 Headcount by Staff Group 31 st March 2015 Tables 2 and 3 below show the numbers of staff employed across the different staff groupings. The Admin & Clerical staff group decreased by 6.5% between 2010 and 2015, and the Allied Health Professionals and Nursing & Midwifery staff groups increased (+11% and +10% respectively). Table 2 VCC Staff in Post as of 31st March 2010 Staff Group Headcount FTE Percentage Add Prof Scientific and % Technic Additional Clinical Services % Administrative and Clerical % Allied Health Professionals % Estates and Ancillary % Healthcare Scientists % Medical and Dental % Nursing and Midwifery % Registered Grand Total % Table 3 VCC Staff in Post as of 31st March 2015 Staff Group Headcount FTE Percentage Add Prof Scientific and Technic 6% Additional Clinical Services % Administrative and Clerical % Allied Health Professionals % Estates and Ancillary % Healthcare Scientists % Medical and Dental % Nursing and Midwifery Registered 21% Grand Total % 15

16 2.4 Workforce Profile by Band The following graph (figure 7) provides an illustration of the workforce profile by pay band over the two data points. It can be seen that whilst the profile has remained broadly similar between 2010 and 2015, there have been slight increases in the numbers of bands 6 8a and in medical staff. It should be noted that due the small workforce numbers overall, these differences will be small. Similarly only looking at 2 data points could indicate a trend which is not actual, so further moniring over time is advisable. Figure VCC Pay Band Comparison 31st March st March 2015 Bands 6 8a grew by 4% between 2010 and 2015, an increase of 35 people. The growth in Medical & Dental was 3 posts Services funded via Charitable and Endowment funding As at 31 st March 2015 a number of posts were funded from charitable and endowment funds. The areas with the largest proportion of charitable funded posts were as follows: Nursing Clinical Trials Psychology Complementary Therapies Some AHP positions

17 The level of risk associated with this method of funding will need be assessed, but there are also advantages the Cancer Centre having the flexibility be able fund temporary posts from charitable and endowment funding Services provided by Health Boards/ Health Boards A number of services are currently provided the Cancer Centre by Health Boards via Service Level Agreement (SLA) arrangements. These include: Pharmacy services at Prince Charles Hospital provided via an SLA with Cwm Taf and based at the MacMillan unit; Outpatients Clinic staff including Nursing, Porters and Catering - provided via an SLA with Cwm Taf and based at the MacMillan unit; Senior Healthcare Scientists in Nuclear Medicine provided via an SLA with Cardiff & Vale UHB; Pathology Services - blood sciences service provided via an SLA with Cardiff & Vale UHB. There are a number of emergent workforce issues arising for this staff group, which is explored further in the workforce supply section; Anaesthetics Consultant and Theatre staff sessions for Brachytherapy - provided by Cardiff & Vale UHB on an SLA; Research - medical staff from Cardiff University work within the Cancer Centre on an honorary contract basis. The Cancer Centre provides a number of services Health Boards via SLA arrangements. These include: One Wales - Palliative medicine docrs based in LHBs and Holm Towers; Radiotherapy Physics Radiation Protection Services for other LHBs and a Radiation Protection Post for PHW; Medical Sessions provided a number of other LHBs. A 2.5 Workforce Profile Specifics Consultants As at 31 st March 2015, there were 24.0 Consultants in Clinical Oncology, 2.70 Consultants in Medical Oncology, 8.6 Consultants in Palliative Medicine, 0.43 Consultants for Chronic Pain and 3.55 Consultant Radiologists in post (establishments will include those Consultants employed under the One Wales for Palliative Medicine) Training Grades As at 31 st March 2015, there were Specialty Registrars in post Non Medical Prescribers 17

18 Although ESR does not have the facility record extended roles, such as Non Medical Prescribers currently we have 28 members of staff within nursing and Pharmacy at independent Prescriber level and within Radiotherapy at Supplementary Prescriber level that undertake 69 clinics per week across the VCC and Health Board s. There are opportunities train further staff in Radiotherapy (at Independent Prescriber level) and Dietetics & Physiotherapy, should this be identified as a requirement. Independent Prescriber level is also anticipated become available for Diagnostic Radiographers Advanced Practice and Clinical Nurse Specialists As at 31 st March 2015, there were 8.40 Advance Practice Nurses and Clinical Nurse Specialists recorded within ESR. There was 1 Advance Practice post recorded for the therapists Consultant Healthcare Scientists As at 31 st March 2015, there were 2.0 Consultant Healthcare Scientists in post. One Higher Specialist Science Training Scheme (HSST) post, train a Consultant Healthcare Scientist in Medical Physics, has been approved start in 20 (all Wales training position hosted by Velindre NHS Trust) Off Site Working The ESR workforce information does not include whether staff are working in community settings, therefore, from discussion with managers it has been ascertained that the only staff currently working in both the Cancer Centre and outreach facilities are as follows: Nurses working in Chemotherapy; Consultant medical staff who undertake clinics and MDT in LHB Non medical Prescribers who undertake clinics in outreach Small Professional Groups The Cancer Centre has a number of departments that are staffed by what could be categorised within the NHS as small professional groups, which also typically have specialist skills which raise their own specific recruitment, retention and skills issues. These departments include Medical Physics (58.71 staff), Nuclear Medicine (7.20 staff) and Psychology (2.60 staff). Any specific issues with regards these departments and their workforces will be highlighted within the plan, but it is important note these issues at this stage. 18

19 2.6 Participation rates Participation Rate and Part Time Working The graphs below (figures 8 and 9) indicate the proportion of staff who were working part time at the two dates i.e and It can be seen that the proportion of staff working part time increased from 38.6% 40.2% over the five year period. Figure 8 Employee Category - 31st March 2010 Figure 9 Employee Category - 31st March 2015 The participation rate is a measure of the level of part time working within the overall workforce. The participation rate for the whole workforce increased between 2010 and 2015 from 85.8% 86.6%. This means that whilst slightly more staff opted work on a part time basis over that period, the amount of available hours for the Cancer Centre has increased Participation Rate and Gender Further analysis of the participation rates by gender shows that participation rates for both males and females increased over this time; shown in tables 4 and 5. Female workers have a lower participation rate than males, but this is still quite high, ranging between 82.85% in 2010 and 83.85% in The rates are relatively unchanged over the timescale being considered. Table 4 Participation Rate by Gender - 31st March 2010 Table 5 Participation Rate by Gender - 31st March 2015 Gender Headcount % FTE Participation Rate Gender Headcount % FTE Participation Rate Female % Female % Male % Male % Grand Total % Grand Total % 19

20 2.6.3 Participation Rate and Age The following tables (6 and 7) provide a comparative analysis of the participation rate by age band. Recent work undertaken by Workforce Education and Development Services (WEDS) has indicated that participation rates may decrease as the workforce ages i.e. an increased proportion of the aging workforce opting work part time. Table 6 Age Band - 31st March 2010 Table 7 Age Band - 31st March 2015 Age Headcount % FTE Participation Age Band Headcount % FTE Participation Band Rate Rate % < % % % % % % % % % % % % % % % % % % % % % % % There is a decrease in the participation rate between the ages of in 2010 which changes ages by However, this is only a small reduction, and is likely be accounted for by people having younger children care for. Participation rates then remain at around 85% until age 60+ when they decrease again. Noticeably, in 2015, participation rates for those aged have increased but decrease age 66+. It should be noted that small numbers of staff are being considered, which will have a greater impact on the percentage rates. What the figures do indicate is that, presently, people working beyond Normal Retirement Age are tending work less than full time. This is in line with current research regarding working over a longer time period. The Cancer Centre workforce participation rates also seem be broadly in line with the overall NHS Wales picture. 20

21 2.7 Gender composition of the Workforce As can be seen in the following graphs (figures 10 and 11), as with many other NHS Wales organisations, the gender split in the Cancer Centre is predominantly female; approximately four fifths of the workforce are female compared with one fifth male (78.9% Female: 21.1% male in 2010 and 79.4% female: 20.6% male in 2015). The split has also remained broadly static between 2010 and The graph below illustrates the gender split over the two data points. Figure 10 Headcount by Gender 31st March 2010, and Figure 11 31st March 2015 Overall, Velindre NHS Trust gender split is approximately 75% female 25% male, which would indicate that the Cancer Centre workforce has a slightly higher proportion of female workers than the Trust as a whole Gender by age The following graph (figure 12) shows gender by age band. This shows the workforce information as at 31 st March 2015, and shows that the age profile for the male workforce is broadly of normal distribution. For the female workforce, however, it can be seen that the age profile drops off aged 55+. This could be accounted for by the Nursing staff group; nurses currently under age 49 will still have preserved rights be able retire at age 55. Figure 12 VCC Staff in Post by Gender and Age Band as of 31st March & above Female Male 21

22 2.8 Age of the Workforce Age Profile The following graph (figure 13) illustrates a number of facrs: - the age profile for the higher age bands has increased in the five year period between 2010 and However, the Cancer Centre has also seen an increase in staff within the lower age bands over that time. Noticeably the age band decreased by 21% over the same period which may be due turnover. Figure Age of the Workforce st March st March & above Overall, staff aged 55+ increased between 2010 and 2015, from 11% of the workforce in % in Over the same time period staff in age band increased from 13% %; from 8% 9% and 61+ remained static at 3%. It would appear, like the rest of NHS Wales, the age profile of the Cancer Centre workforce is increasing, but only slowly at present. Due the drop off in percentage points between age bands and in each year, we could be seeing an impact of nurses choosing retire at around age 55. The following graph (figure 14) more clearly illustrates the emergent skew of the age profile for the Cancer Centre an older workforce. 22

23 Figure Age Band Comparisons by Headcount < st March st March 2015 It is not possible at this point compare the age profile of the Cancer Centre the all Wales picture; however, the following graph (figure 15) compares Velindre NHS Trust NHS Wales. For context, this shows that whilst our workforce is aging in line with that of NHS Wales, the age profile for the Cancer Centre is currently slightly younger. Figure Age Profile by Staff Group The following graphs (figures 23) compare the age profile of the different staff groups between 2010 and It can be seen that the age profile for the Additional Professional Scientific and Technical staff group has decreased, showing a younger age profile than in Changes due the recoding of the Healthcare Science workforce may have influenced this change, and when considering the graph comparing the age profile of the Healthcare Scientist staff group over the same five years, it can be seen that there has been an increase in their age profile. Additional Clinical Services have seen an 23

24 increase in their age profile and this would be in line with findings at an All Wales level where this staff group also has an older age profile as compared with other staff groups. Figures and 17 Add Prof Scientific and Technic Additional Clinical Services st March st March st March st March 2015 The age profile for the Admin & Clerical staff group shows a normal distribution curve for both years, with a peak of staff moving from ages ages The graph for the Allied Health Professionals staff group would indicate that this workforce has a relatively younger age profile although a peak has developed in ages Figures 18 and 19 Administrative and Clerical Allied Health Professionals st March st March st March st March 2015 The following graph for the Healthcare Scientist workforce illustrates the probable impact of the recoding exercise undertaken between the two comparison years. However, the graph shows two peaks at age bands and (NB this is for a small group of staff). The graph for the Medical & Dental staff group shows a younger age profile, however, this will be caused in part by the junior docrs. This age profile has increased between 2010 and 2015, especially for those aged 40 50, as the peak from 2010 starts move upwards through the age bands. This trend will need be monired as this group of staff are liable retire within the next years. 24

25 Figures 20 and 21 Healthcare Scientists Medical and Dental st March st March st March st March 2015 The age profile graph (below) for Estates and Ancillary shows a workforce where a large proportion of staff could retire within the next 5 years. Further analysis shows that the number of staff employed in Estates and Ancillary has fallen by 6 people over the last 5 years and it would appear that 8 people have left, probably due retirement. This is only a small workforce but given that 36.5% are aged over 56, this could be an emergent workforce risk over the next 5 years. Similarly, the workforce profile for the Nursing staff group at Velindre Cancer Centre reveals an aging workforce, in line with the rest of NHS Wales. In 2010, the age profile of the Nursing staff group had a more normal distribution. By 2015 this has started veer the right, with a significant proportional rise in those aged (30% increase, although actual numbers are small). As with the Medical & Dental and Estates & Ancillary staff groups, this trend will have be monired over the next few years, and strategies adopted mitigate any adverse impacts. Figures 22 and Estates and Ancillary 31st March st March Nursing & Midwifery Registered st March st March

26 2.8.3 Average Age of the Workforce It is useful measure and compare the average age of the workforce and monir this over time. This acts as a measure of the ageing of a workforce and can be used compare across staff groups and organisations, and establish whether the workforce is representative of the population from which it is derived. The following graph shows the change in the average age of the Cancer Centre workforce between 2010 and 2015, which has increased over this time. As at March 2015, the average age of the NHS Wales workforce was 44 and the average of the NHS workforce as a whole was 43.7 (Working Longer Review 2011). At 42.63, the Velindre Cancer Centre workforce was slightly younger than the NHS Wales average and the NHS workforce for England & Wales, but older than the average of the Welsh population which was 40 (Office of National Statistics (ONS) 2014). Figure 24 Average Age of Workforce st March st March 2015 The next graph (figure 25) considers the average age of the workforce for each of the staff groups. The graph shows that the overall increase in the average age is reflected across each of the staff groups, and that this increase is fairly even. Noticeably, there are two groups where the average age has decreased, those being the Allied Health Professionals (who have the youngest average age at 36.8) and the Healthcare Scientists (who have an older average age, at 40.76). Estates and Ancillary has the highest average age at 50, followed by Additional Clinical Services at Discussions with service managers have indicated that the Additional Clinical Services staff group also tends recruit workers in the higher age bands, which will be influencing the age profile of this staff group. The Nursing staff group has seen the largest increase in its average age, rising from in in an increase of 3.41 years. The Professional, Scientific and Technical staff group have had the second largest increase in average age having increased by 3.25 years. 26

27 Figure Average Age by Staff Group st March st March 2015 The following table (table 8) is taken from the national Focus on Age report (WEDS 20) and illustrates the average age per staff group for NHS Wales. It is shown that the average age for the Estates and Ancillary staff group in the Cancer Centre is older than the NHS Wales average - as is the Additional Clinical Services staff group- by approximately 3 years. The Nursing workforce average in the Cancer Centre is approximately 1 year older than the national average. The Cancer Centre Admin & Clerical, AHP and Healthcare Science workforces are younger than the national average, whilst the figures are broadly similar for the Medical and Dental staff group. Table 8 Staff Group Difference in Average Age Estates and Ancillary 45 Years 5 Months 48 Years 1 Month 2 Years 8 Months Administrative and Clerical 42 Years 10 Month 45 Years 2 Months 2 Years 4 Months Additional Clinical Services 42 Years 9 Months 44 Years 1 Months 1 Years 4 Months Nursing and Midwifery Registered 42 Years 1 Month 43 Years 11 Months 1 Years 10 Months Healthcare Scientists 41 Years 6 Months 42 Years 6 Months 1 Years 0 Months Add Prof Scientific and Technic 40 Years 11 Months 42 Years 3 Months 1 Years 4 Months Medical and Dental 40 Years 0 Months 40 Years 11 Months 0 Years 11 Months Allied Health Professionals 39 Years 4 Months 40 Years 6 Months 1 Years 2 Months NHS Wales 42 Years 5 Months 44 Years 1 Month 1 Years 8 Months 27

28 2.8.4 Average Age of the Consultant Workforce The following graph (figure 26) looks at the average age for the Consultant workforce within the Cancer Centre. It is useful look at this staff group separately as they constitute the permanent component of the medical workforce. Whereas the average age of the Medical & Dental workforce was 38.7 in 2010 and 40.0 in 2015, the following graph demonstrates that the average age for the Consultants was 44.7 and 46.7 respectively. Figure Average Age of Consultants st March st March 2015 The average age of the Consultants in the Cancer Centre has increased by 2 years over the timeframe. When compared the average age for the NHS Wales Consultant workforce- which is currently it can be seen that the Cancer Centre Consultant workforce is younger. However, the average age of the Consultant workforce is approximately 4 years older than that of the Cancer Centre workforce as a whole (42.63) in 2015, making it the third oldest workforce after Additional Clinical Services and Estates and Ancillary Proportion of the Workforce aged 50+ The following graph illustrates the change in the split of the workforce between those aged below 50 and those aged above 50. With current changes the NHS Pensions schemes and Normal Retirement Ages, it is becoming harder forecast potential turnover due retirements. However, for those staff currently aged over 55, their normal retirement age remains at 60 for their occupational pension (not state pension) and, therefore, it could be assumed that this proportion of the workforce may choose retire within the next 5 years. Those workers currently aged above 50 will have a mixture of pensions rights and as such, may choose leave the workforce due retirement over the next years. The graph shows that nearly a third of the Cancer Centre workforce are currently aged 50+, and this proportion has increased since 2010 from 24% 29%. The percentage of the workforce aged under 50 decreased by 2.3% whist those aged over 50 increased by 23.6% (39 staff). Further analysis of the workforce shows that in % of the workforce was aged less than 40, as compared with 28

29 32% for the Trust. Additionally, 25.7% of the workforce at the Cancer Centre was aged between 40 and 50, compared with 38% for the Trust. The proportion of the Velindre NHS Trust workforce aged over 50 is 32%, and for NHS Wales it is 36%. This indicates that whilst the Cancer Centre workforce is aging, there are currently less approaching retirement age than in the Trust and NHS Wales as a whole. This will have be monired over time as the proportion is increasing. Figure % 50% 0% Headcount - Under & Over % 28.65% 75.91% 71.35% 31st March st March 2015 Over 50 Under 50 Looking in more detail at those aged 50+ has indicated that, in 2015, approximately 13% of the Cancer Centre workforce was aged 55+. The highest proportions of this were within Additional Clinical Services at 25% and Estates and Ancillary at 19%. Nursing had a proportion of 11% whilst Medical was 5%. The lowest was in the AHPs at 3% and the remaining staff groups ranged between 12 13%. The following section will look at the average retirement ages test the likelihood of future retirement risk Average Age at Retirement Due the small workforce of the Cancer Centre, it is difficult calculate an average age of retirement for each staff group as in some years there is little or no retirement in a staff group. Analysis of the age at retirement over the last 5 years has been used create a best fit average age of retirement. Table 9 Average Retirement Age Staff Group 1st April st April st April st April st April st April st March 31st March 31st March 31st March 31st March st March Add Prof Scientific and Technic N/A N/A N/A N/A Additional Clinical Services 60.8 N/A 65 N/A Administrative and Clerical N/A 62.5 Allied Health Professionals N/A N/A 58.3 Estates and Ancillary N/A Healthcare Scientists N/A N/A N/A N/A N/A 63 Medical and Dental N/A N/A 45.5 Nursing and Midwifery Registered N/A N/A N/A 29

30 Using the NHS Wales Age Profiling Tool (produced by WEDS), we can profile a number of potential retirement scenarios for a number of the staff groups. However, as the Tool only works on Trust level data (which will include workforce information for the Welsh Blood Service and the Corporate Services of the Trust), the following can only be used as a rough approximation of any emergent retirement risks based on the age profile of our staff Retirements over five years From discussions with managers, a number of service areas are likely have people retire over the next 5+ years. In some areas this will lead opportunities for a review of skill mix as part of service developments, and in some areas will mean that senior skilled and experienced staff will need be succession planned for. In a number of the smaller service areas, the number of potential retirements will need careful planning for. These areas include Radiology, Nuclear Medicine and possibly Medical Physics. A number of medical Consultants may also retire over this period. Given the average age of retirement taken over the five year period , the number of staff currently aged over 55, and the information provided by the managers, there is a strong likelihood that up 13% of staff within the Cancer Centre could choose retire prior the opening of the new hospital and Velindre@ sites. The Workforce Demand and Supply sections of this plan will consider the implications of these potential retirements. Retirements are a predictable component of workforce planning and should be accounted for within the Trust s ongoing workforce planning processes, IMTP and education commissioning cycle. 30

31 2.9 Stability of the Workforce Over and above retirement, organisations will also loose staff due turnover and gain staff via recruitment. This section will consider these facrs, and others that contribute the overall stability of the Cancer Centre s workforce Length of service There is an impression within the organisation that there is a very stable workforce with a long average length of service. The following table illustrates the average length of service of the Cancer Centre. This information has been produced using the Business Intelligence reporting functionality in ESR. The data will be subject limitation however, due the potential for variation in the ESR data with regards start dates. The graph in figure 28 shows the average length of service in current employment, which indicates that the majority of staff had been in their current employment for an average length of 1 10 years. Figure 28 Length of Service in Current Employment - 31st March 2015 The following table (table 10) shows average length of service by staff group. It can be seen that the average length of service for a member of staff in the Cancer Centre is currently approximately 10 years, which is fairly uniform across all staff groups. Table 10 Average Length of Service by Staff Group Staff Group Average Length of Service (Years) Add Prof Scientific and Technic 9 Additional Clinical Services 8 Administrative and Clerical 10 Allied Health Professionals 10 Estates and Ancillary 9 Healthcare Scientists 11 Medical and Dental 7 Nursing and Midwifery Registered 10 VCC Average 10 31

32 2.9.2 Turnover The following table (11) shows the change in turnover rates for the Cancer Centre over the past 5 years: Table / / / / /15 Turnover % It can be seen, that in line with most other organisations, turnover has fallen. Turnover for the Cancer Centre was 9.5% in 2011 and fell 7.13% in When compared the turnover rate for the Trust as a whole (which was 8.99% as at March 2015), and NHS Wales (which was 6.51% - taken from iview), it can be seen that the Cancer Centre currently has a lower rate of turnover than the Trust but higher than the Wales average for that year Labour Stability Index The following tables give an illustration of the stability of the Cancer Centre workforce for 2010 and 2015 respectively. This information has been produced using the Business Intelligence functionality within ESR. The Labour Stability Index is a measure of the proportion of staff in post at the beginning of the year compared with the number in post at the end of the year. This gives an indication of the ability of the organisation retain and replace its workforce. The following tables (12 and 13) illustrate the stability of the workforce between 2010 and The first table shows that the labour stability index for 2010 was 88.91% and that this had increased 91.24% in Given that turnover has decreased over this period, it is not surprising see that labour stability has increased. Table 12 Start End Remain Index Headcount 1,689 1,680 1, % Assignment Count 1,707 1,696 1, % Table 13 Start End Remain Index Headcount 3,128 3,259 2, % Assignment Count 3,150 3,278 2, % The labour stability index for the Trust as at March 2015 was 91.21% and for NHS Wales it was 93.83%. Further analysis through iview shows that Velindre NHS Trust had the lowest Labour Stability Index second Public Health Wales, with both Betsi Cadwaldr and ABMU Health Boards having higher labour stability at around 93%. 32

33 2.9.4 Starters and Leavers Leavers: Analysis of the reasons for leaving for the years 2010 and 2015 has shown that 87 staff left in 2010 and 95 in Reasons for leaving were as follows: 63% voluntary resignation in 2010 as compared with 60% in 2015; 5% end of fixed term contract in 2010 and 9% in 2015; 18% age retirement in 2010 as compared 25% in This shows a rise of 7% in the retirement rate between the two years and a relatively steady state with regards resignation and end of contract over the two data points. Analysis on destination upon leaving does not reveal any emergent trends other than the natural progression of the workforce i.e. leaving work in other NHS organisations. A small number left work for private organisations. Starters: Analysis of the starters information for the two years has shown that 135 started in 2010 (120 new hires) and 104 (96 new hires) in Source of recruitment information within ESR shows that the majority of staff recruited came from other NHS organisations for both data points. 33

34 2.10 Recruitment & Retention The Cancer Centre does not currently experience difficulty in recruiting its posts. Generally, managers did not report that they currently experienced great difficulty in attracting staff, nor any current specific skills shortages. However, some managers did report that there were some emergent supply issues pertaining the experience of staff within the cancer field, and reported that they needed train staff gain this experience. Managers reported on the whole that they were currently able recruit both entry level and senior posts. Areas where managers reported that there were emergent recruitment difficulties, and from the returns submitted in the 2015/ IMTP and 20/17 included: Allied Health Professionals: Speech and Language Therapists - Where there is difficulty in attracting experienced people and Band 5 Diagnostic Radiographers where the small size of the team and the current layout of the department can lead difficulty in providing supervision additional numbers of Band 5 (although it is anticipated that this can improve in future) Nursing & Midwifery: Research Nurse in Cancer Band 5/6 - There is a requirement for this band level have experience of research nursing and oncology experience; there is a wealth of nurses with oncology experience but not research experience. The understanding of research governance is more important than oncology in this role. Advanced Nurse Practitioners recruitment has become difficult and therefore the Cancer Centre is training its own which takes 3 years IT Technicians: The private secr offers a higher salary for a number of IT posts than that of the NHS. Shortages could lead service support needs not being met, delays and limits service modernisation, and, introduction of new technologies, and potential delays the delivery of IT packages Information: There is a limited skill set within Wales. Information development, management and reporting would be impacted on and, without information (activity, outcomes, xicities, Radiotherapy DataSert, SACT etc), the Cancer Centre will be limited in terms of planning and implementing efficiencies, whilst using the right skill set of staff in the right place Clinical Coders: There is a limited resource in Wales. Training for coding trainees occurs once a year via an NWIS appointed supplier. Trusts are mandated clinically code the Finished Consultant Episodes for every patient admitted Hospital Health Care Scientists and Radiotherapy Staff - Senior Roles: There is a lack of experienced staff for senior roles due requirement for rapid expansion in the service. Both Nuclear Medicine and Medical Physics currently predominantly recruit staff from neighbouring organisations; however, there is a national shortage Medical & Dental - Core Medical Trainees (CT1&2): There is a national difficulty in recruiting these posts which impacts on the Cancer Centre s ability sustain a safe service and the ability 34

35 provide the required curriculum training. The Cancer Centre is in the process of securing two additional GP training posts, but again there may be difficulty in recruiting these posts on rotation Pharmacy: The short medium term supply of pharmacists has been affected by the recent increase in recruitment of pharmacists primary care. This will result in Velindre Cancer Centre needing recruit junior pharmacists in postgraduate training posts secure sufficient clinical pharmacists who are trained in oncology serve both the cancer centre and it s outreach clinics Skills retention No managers reported any current difficulty with the retention of skills, however, the increasing age of the workforce and the likely number of retirements in small departments - such as Radiology and Nuclear Medicine - will lead a loss of experienced and skilled workers. Further work will need be undertaken assess the impacts of these retirements and succession plan for any short term loss of skills and experience Training Capacity Discussions with service managers have not highlighted any difficulty in training capacity for undergraduate and postgraduate staff at present, with the exception of: Medical Physics: The changes training introduced as part of Modernising Scientific Careers has had an impact. Undergraduate students now spend blocks of time with departments, across each of the three years, replacing the old sandwich year. This now means that departments can be supporting three years of undergraduate trainees. The introduction of the Higher Specialist Training (HSST) for Consultant Healthcare Scientists, will see an in-house training requirement that, as yet, is unquantifiable (first trainee commencing September 20). Pathology: Whilst these staff are provided via an SLA with Cardiff & Vale UHB, the same issues apply as for those for Medical Physics. Pharmacy: Modernising Scientific Careers, is exploring increasing the amount of time that undergraduate pharmacist students spend within secondary care environment. Velindre Cancer Centre intends participate in this new undergraduate training programme which has significant increased commitment the current programme and will therefore require consideration of resources. Similarly, Velindre Cancer Centre intends recruit in its first formal postgraduate "Clinical Diploma Pharmacist" posts in 2017 in order help address current recruitment difficulties. As this is the first year of undertaking this commitment, it will be continually reviewed. 35

36 2.11 Diversity of the Workforce The following section explores the diversity of the current workforce based on a number of protected characteristics. The workforce information has been produced as at 31 st March 2015 and is produced as a description of the current workforce. There are a number of dimensions where there remain high levels of unspecified which indicates that staff have not filled in a category (there is an option not declare). Work will have continue increase the completion of categories following the roll out of ESR Self Serve Age by Age Band Figure 29 The age of the workforce is reasonably evenly distributed amongst the age bands up ages 56 60, where it drops from around % 9%. The reason for this could be due nurse retirement at Gender Figure 30 The gender split is 79.4% female 20.6% male 36

37 Part time/full Time Figure 31 The split between part time and full time working is broadly 60% full time 40% part time as at 31 st March Part Time/Full Time by Gender Figure 32 Of the 40.17% of staff that are part time, 2.8% are male as compared 37.36% who are female Disability Figure 33 37

38 Approximately 60% of staff declared that they have no disability, and of those with a declared disability, the majority of staff preferred not declare the nature of that disability. The following graphic illustrates the breakdown of disabilities. Figure 34 No 2.50% 35.30% 58.40% 3.80% 70.37% 3.70% 14.81% 7.41% 3.70% Not Declared Unspecified Yes Learning disability/difficulty Long-standing illness Other Ethnic Group Approximately 85% of the workforce have declared that they are white/white other. The following graphic illustrates the ethnic makeup of the Cancer Centre workforce. Figure % 1.70% 5.80% 1.80% 7.30% 56.10% 12.20% 19.51% 9.76% 2.44% White White Other Ethnic Minority Not Stated Unspecified Mixed Asian 38

39 Religious Belief Figure 36 The largest religious belief is Christianity at 40% of the workforce, followed by atheism. A large proportion (28%) has chosen not specify their religious belief Sexual Orientation Figure 37 The majority of the workforce (66%) has stated their sexual orientation as heterosexual. Amongst the remaining percentage, 0.42% stated their sexual orientation as Gay, and 0.28% as Lesbian. Nearly 28% have chosen not specify Welsh Language The following graph (figure 38) indicates the level of proficiency in Welsh by staff group. Analysis has shown that as at 31 st March 2015 the majority of staff in the Cancer Centre categorized themselves as being at the lowest level of language proficiency and only a low proportion of the workforce currently has a high level of Welsh language skills. 39

40 Figure % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% VCC Welsh Language Overall Competence by Level and by Staff Group 5 - Proficiency / Hyfedredd 4 - Higher / Uwch 3 - Intermediate / Canolradd 2 - Foundation / Sylfaen 1 - Entry/ Mynediad 0 - No Skills / Dim Sgiliau 40

41 2.12 Key Findings As at 31 st March 2015, we employed 712 staff including Medical, Nursing, Radiography, Medical Physics, Therapy, Managers, Clerical and Support staff.. Our workforce is predominantly female (79.4%) The Cancer Centre participation rate is 86.6% and has increased slightly. It remains at broadly this level until age band 60+ when it decreases in line with the NHS Wales finding of older workers tending choose part time working. The proportion of staff working part time has increased 40.2% and females have a lower participation rate than male workers at 83.85% More females work part time than males (37.36%) The workforce is ageing; our workforce is currently slightly younger than that of the Trust as a whole and NHS Wales (Average ages: VCC = 42.6, NHS Wales = 44, NHS = 43.7 and the Wales population = 40) 28.65% of our workforce is aged over 50, slightly lower than that for The Trust as a whole. (NHS Wales = 36%) The proportion of our staff aged 55+ is increasing, with the proportion of staff in the older age bands increasing the most (small numbers currently) There is a drop off in the shape of the female workforce post age 55, which might be accounted for by nurses choosing retire at this age Estates staff and Support Workers are our oldest staff with an average age of 50 and 47.3 respectively. The average age of our nursing staff is 45.3 The average age of our Consultant staff is 46.7 which is 4 years older than the average age of the Cancer Centre workforce but slightly younger than the NHS Wales average age of the Consultant workforce (48.11) 13% of the Cancer Centre workforce is aged 55+ and, given that these staff are likely have retained their pensions terms and conditions allow them retire at 60, we could need replace up 13% of our staff over the next five/ten years due retirements. Whilst no area has identified any issues with regards retirements over the next 5 years, it is apparent that due age profiles that a number of areas, such as Nuclear Medicine, Radiology 41

42 and possibly Medical Physics, could experience loss of senior experience and expertise that could have a greater impact on these small departments. Retirements could provide opportunity for skill mix review and review of skill and competences required for roles moving beyond the new hospital and satellites opening. Our average length of service was 10 years. Turnover was 7% which was less than both the Trust and NHS Wales averages. Our Labour Stability Index showed that the Cancer Centre was the same as the Trust s and below the NHS Wales average. The majority of our staff leave due voluntary resignation, but retirements were increasing - up 25% of all leavers in 2014/15 (as compared 18% in 2009/2010) There were no issues with regards recruitment however there was evidence of emerging difficulties in areas such as IT, Nuclear Medicine, Clinical Coders and for senior Radiographers. Recruitment sources tend be from within the NHS. A number of our professions are on the Shortage Occupations List. Skills retention and loss of senior experience will become an issue in Radiology and Nuclear Medicine over the forthcoming years. With the recent changes training for Healthcare Science staff, Medical Physics was the only area that found that there was an impact on training capacity although this was currently manageable. However, it should also be noted that until the changes the Pharmacy undergraduate degree are further articulated as per Modernising Pharmacy Careers and the department has had an opportunity assess the impact of undertaking formal postgraduate training programmes that the training capacity within Pharmacy meet future training needs cannot be fully determined. 42

43 3.0 Workforce Supply 3.1 Introduction This section will consider the potential future supply of the workforce for the Cancer Centre and Outreach. This information is based on a number of sources as indicated below: Centre for Workforce Intelligence (CfWI) reports; Health Education England (HEE) reports; WEDS reports; WEDS education commissioning report (20); Education commissioning numbers requested by Velindre NHS Trust; Deanery training numbers for Oncology and Radiology; Workforce research papers (Kings Fund, The Nuffield Trust etc). The supply of the workforce is made up of a number of facrs both internal and external. 3.2 Internal Workforce Supply Work undertaken by both the Kings Fund and Nuffield Trust has estimated that up 80% of the workforce that NHS Wales requires over the next decade are already working for us. In order for us deliver our future workforce requirements, it will be necessary for us retain and retrain this proportion of our current workforce. Changes information, technologies, science and medical practice will necessitate the ongoing development of our staff knowledge, skills and competences. Succession planning and talent management will become important considerations in the planning of our future workforce, in order match our internal talent the future skills required, and develop our staff have these skills. Nationally in NHS Wales, there is work being undertaken on a number of workforce and OD areas including succession planning and this work will define some of the actions that the Cancer Centre will need enact. The developments anticipated within the Electronic Staff Record (ESR) for recording staff learning and development, and the development of the Trust s Education Strategy, will ultimately enable the Cancer Centre identify the current education training and skills of its current workforce, and enable better planning for the future. Retaining staff with the skills and knowledge that we require will also become an important consideration as we enter the transitional phase from those on the 1995 pension scheme (right retire at 60 or 55 for Special Classes) those on the 2015 scheme who will have work longer. Recent changes pension legislation, including annual and lifetime allowance, may also impact on internal workforce supply with an as yet unclear impact on higher earners working patterns and/or retirement plans. These changes may require a different approach how people work, including greater flexibility. Finally, internal supply of the workforce can also come from churn. This term is used refer the normal movement of workforce within and between NHS organisations. Analysis of current recruitment has identified that the Cancer Centre recruits a number of its staff from within NHS Wales, therefore, workforce supply issues affecting the wider service and staff groups will also impact 43

44 on our supply. Similarly, we need remain vigilant about other pull facrs, where developments in other services could attract the skilled and experienced staff we currently employ e.g. development of the wider primary care team pulling Pharmacists and AHP staff from secondary and tertiary care. 3.3 External Workforce Supply External workforce supply for the NHS comes from a number of different sources, including the general labour market, education commissioning route, the professional/specialist skills labour market, the wider NHS and overseas recruitment. The Health Education England (HEE) Commissioning and Investment Plan 20/17 outlines the recent changes education commissioning in NHS England which could impact on workforce supply for NHS Wales. It is planned that from 2017, the current arrangements for the payment of fees and bursaries will cease and be replaced with student loans. Whilst the impact of these changes workforce supply are still not known, they will remove the hisrical funding constraints for training the future workforce in England. NHS England forecasts that the numbers in training will be more than the numbers leaving across every profession in England by 2020, but this supply will still be dependent on employers ability recruit and retain staff. The plan also recognises that there are still current and local workforce shortages related current supply issues that need be addressed. NHS England has commissioned an independent cancer services review and intends implement the recommendations of the review including those linked earlier diagnosis. This will included increased commissions for Clinical Radiology and Diagnostic Radiographers. 3.4 Labour Market and Local Population When considering workforce supply, it is pertinent consider the local population as this is typically the source of the majority of the organisation s recruitment for both the professional/specialist and non professional/non specialist skills. For the purposes of this plan, the population statistics for Cardiff have been considered as the location of the outreach facilities are, date, undecided. From the 2011 Census, the population of Cardiff and Vale was 346,090 of which, 49% were male and 51% female. 80.3% of the population is White British, 2.9% Mixed Ethnicity, 8% Asian, 2.4% Black and 2% Other Ethnic Group. 68.7% of the population of Cardiff were born in Wales. It is recognised that the population is ageing, and the workforce is ageing in line with the population as a whole. Whilst it is recognised that Cardiff has a higher proportion of younger people than the rest of Wales, in part due the size of the local student population, it is useful consider the proportion of younger people in the population as a potential source of future recruits: 24.6% of the population were aged between the ages of 0 and 19, higher than Wales as a whole (23.4%). 11.2% of Cardiff s population were aged as compared Wales as a whole at 6.9% which reflects that the Cardiff population is swelled by a large student population. 44

45 In Wales as a whole, the proportion of 0 year olds is predicted rise until 2026 before decreasing and the number of people aged -24 is projected decrease by approximately 3% by % of Cardiff s population worked within the field of Human Health and social work activities. 21.5% were female as compared 7.6% of males. 5.5% of 24 year olds were unemployed as compared 2.4% of year olds. 37.7% of -74 year olds were long term unemployed and as such could be a source of recruitment. Approximately 20% of the working age population of both Cardiff and the Vale had no academic or professional qualification. 3.5 Education Commissioning It is important note that there is a time lag between the request for education/training places in the Trust s Integrated Medium Term Plans planning process (IMTP) and those staff becoming available for recruitment. For example, for a typical three year training programme a request for an undergraduate student made in the 20 IMTP will not commence in university until September 2017 and will not graduate until summer This is a time lag of approximately 4 years for planning the workforce. Training for a consultant can take anywhere between 12 and 15 years. Organisations are expected be able support the clinical placements and on the job training for undergraduates and training capacity and the ability of a department provide a good learning experience for students is an important consideration for planning the future workforce and our ongoing ability recruit and retain staff. There are a number of staff groups where VCC commission education and the requirement for these training places are derived through the IMTP process. The training numbers identified within the Trust s IMTP are fed in the national education commissioning process. The roles that the Cancer Centre can commission for are identified as follows: Docrs in training for GP and Core Medical Docrs in training for Palliative Medicine, Clinical and Medical Oncology and Radiology Nurses (graduate entry) Diagnostic Radiographers (graduate entry) Therapeutic Radiographers (graduate entry) Occupational Therapists (graduate entry) Speech & Language Therapists (graduate entry) Physiotherapists (graduate entry) Dieticians (graduate entry) Clinical Psychologists Pharmacist (pre registration training & postgraduate diploma) Medical Physics including Nuclear Medicine (graduate and postgraduate entry) 45

46 There are a number of additional courses that can be commissioned, including non medical prescribing and non medical authorisation of blood transfusion. In addition, there are a number of courses for advance practice for nursing; however none are specific oncology and for Physicians Associate. With regards the support workforce, additional funding is available organisations as part of Developing Excellence in Healthcare: An NHS Wales skills and competence framework for Healthcare Support Workers supporting Nursing and the Allied Health Professionals. Workforce supply for each of the main staff groups within the Cancer Centre is considered in more detail in the following sections. 3.6 Medical Workforce At Consultant level, the Cancer Centre employs Clinical and Medical Oncologists, Radiologists and Consultants in Palliative Medicine. At junior docr level, the Cancer Centre participates in rotations of Specialty Registrars in Clinical and Medical Oncology, Palliative Medicine, Core Medicine and General Practice Consultants: Work has recently been undertaken by the Centre for Workforce Intelligence (CfWI) on the supply of the Consultant medical workforce in Wales. This was commissioned by Workforce Education and Development Services (WEDS) on behalf of the All Wales Strategic Medical Workforce Group. This work is a high level analysis for NHS Wales as a whole. Supply was based on numbers in post, anticipated turnover, age of the workforce, trainees within the system and their likely CCT dates (Certificate of Completion of Training); Demand was assessed as being finished consultant episodes from PEDW, based on an assessment of the age of the patients, ONS population predictions on the age of the population. Radiology: there was a predicted under supply. Medical Oncology: there was a predicted under supply. Clinical Oncology: there was a predicted slight over supply. Palliative Medicine was not included; however as a small workforce where the Cancer Centre actively trains the junior medical staff, we can predict that the supply of trainees is currently adequate meet forecasted demand. The following is an indication of the number of medical staff in training who are anticipated have their CCT over the next six years i.e. up This information is from the Wales Deanery and represents the trainees for the whole of NHS Wales. From the analysis of the current workforce, there are potentially 4 Consultant staff that could choose retire over this time period and a further 8 within a 10 year window. The numbers of trainees gaining a CCT between 20 and 2021 (all Wales) Radiology 40 trainees (17 female and 23 male) (230 in NHS England) Clinical Oncology 17 trainees (14 female & 3 male) 46

47 Medical Oncology 6 trainees (4 female & 2 male) Palliative medicine 12 trainees (7 female & 5 male) The gender split of the trainees reveals that, in all but Radiology, there are more female trainees than male. The feminisation of this workforce could impact on the eventual participation rates. The above numbers relate All Wales, and the Cancer Centre will be competing with other areas recruit these staff. Typically the trainees within the Cancer Centre are part of the South Wales rotation. This is of particular concern with regards Radiology which is potentially in an under supply situation, with rising demand across all departments and where the Cancer Centre does not currently participate in a training rotation, although work is under way explore the potential for Specialty Registrars in Radiology undertake an oncology placement at the Cancer Centre Junior Docrs: The junior docrs on rotation at Specialty Registrar (StR) 1-2 level, are either Core Medical Trainees or General Practice trainees. Junior Docrs at StR 3-7 level are either training in Clinical or Medical Oncology or Palliative Medicine. The Cancer Centre does not currently have trainees in Radiology. Junior docrs undertaking specialist training in Clinical and Medical Oncology commence their specialist training at StR3 and typically come from the core medical training route. There is a UK level national recruitment scheme for Oncology and the Cancer Centre delivers joint training both the Clinical and Medical Oncology trainees where the trainees share the rota and provide acute oncology support. This provides broad based training along with the specific curriculum requirements and trainees report high levels of satisfaction with their training. The supply of junior docrs in training schemes impacts differently at the two levels of training within the Cancer Centre. Currently all Health Boards and Trusts are experiencing difficulty with fill rates of both their Core Medicine and GP training rotas at StR1 3 level. The training curriculums and length of training have changed due the introduction of Modernising Medical Careers and hours controls through the New Deal and the European Working Time Directive. In some instances this has led the foreshortening of training and less opportunity for exposure as wide a range of experiences as previous trainees had access. There is also the possibility of trainees across all specialism in medicine undertaking more core training in the future. This national supply issue, coupled with further anticipated changes training (Shape of Training Review) will necessitate the Cancer Centre giving consideration alternative workforce solutions both support the docrs in training and cover more of their service component, including out of hours/on call; this could include consideration of the introduction of the Physicians Associate. The Cancer Centre has undertaken work, looking at the recruitment and supply of trainees, including the establishment of a Medical Education Board, a website aimed at trainees, and offers oncology taster sessions Foundation Docrs and Core Medical Trainees. Despite this, as specialty trainees come from the Core Medical route, in the longer term the Cancer Centre will need be vigilant whether the supply issue for these trainees impact on the supply of trainees at higher level training and/or any planned additional posts such as Specialty Docr or Clinical Fellow. There is no difficulty in the recruitment in training schemes for the St3-7 trainees across the specialties within the Cancer Centre, however, there are some issues with regards Medical 47

48 Oncology nationally, due perceived limited opportunities, but is seen be improving. Clinical and Medical Oncology and Palliative Medicine have better fill rates due the quality of training provided (recently recognised by the GMC) and the Cancer Centre recognizes the link between the quality of the training delivered and recruitment. Recent work in the Cancer Centre has indicated, that on average, a specialty trainee in Clinical Oncology will take up 8 years train due facrs such as breaks for maternity and more trainees electing study for an MD. In Medical Oncology, trainees typically undertake an additional qualification such as an MD or PhD and take up 8 years train. In Palliative Medicine it can take trainees up 10 years train due trainees deciding train on a less than full time basis. This additional time train in these specialties will impact on the anticipated CCT dates and therefore on predicted supply. Overall, given the numbers of trainees within the system and the small number of potential retirements over the next 5 years, there would appear be an adequate supply meet planned retirements, however, planned increases in Consultant numbers and any plans replace with Consultants from a different specialty e.g. replacing a post held by a Clinical Oncologists with a Medical Oncologist, may become challenging depending the current supply, timings of CCT and whether the trainees are planning stay in Wales once qualified. The Cancer Centre will need remain vigilant on these facrs ensure that supply does meet demand. Consultants in both Clinical Radiology and Clinical Oncology both currently appear in the Shortage Occupations List. 3.7 Nursing Workforce The Cancer Centre employs nursing staff work across its Inpatient, Outpatient, Chemotherapy Inpatient and Outreach functions. The Cancer Centre also employs a number of specialist nurses with extended skills including non medical prescribers and a number of advanced practice roles. Nurses are typically from a medicine background and oncology skills training is provided post employment. There is a level of novice recruitment but many recruits have had previous nursing experience. In Wales, the supply of nurses has been challenging at a national level due a number of facrs; a reduction in training places between due AOF targets meant reduced numbers of graduates between 2012 and 2015 (education commissions have been increased from 2013/14 but the first cohort of increased numbers won t graduate until 2018), increased demand due Trusted Care and Welsh Government Safe Nursing Principles, an increase in retirements as the age profile of nurses starts increase, and the introduction of changes the pension scheme. In NHS England, nursing supply has been affected by a number of issues including the move all graduate training routes. Health Education England has recently consulted on proposals make changes the student bursary, which may have an impact on the numbers coming forward train in England. The CfWI has predicted a reduction in supply by 20 and HEE has adjusted the number of 48

49 commissions for the final year of commissioning address this. NHS England are experiencing significant recruitment challenges but anticipate supply be in balance with demand by Nursing supply has also been impacted over the past decade by an increase in Nurse Specialist and Advance Practice roles that have pulled staff from the main workforce pool. The Cancer Centre has a high number of extended and specialist skilled nurses including site specific Clinical Nurse Specialists, Advanced Practice and Non Medical Prescribers. Whilst the funding of the training for non medical prescribing is via the education commissioning route, there are currently no centrally funded courses for advanced practice in oncology, therefore, consideration needs be given the future extended skills required and a plan for how this can be achieved and funded. The balance of the numbers of these roles and skills required in the future should also be reviewed ensure that we have the right quotient of skilled and competent staff meet future demand and that we have succession planning in place. A project has recently been undertaken explore the efficacy of the NMP role within Chemotherapy pre assessment and has found that the role adds value. Further work needs be undertaken on the operating model and workforce planning of future training needs for this extended skill. When developing our operational workforce plans we need consider the aging of our current nursing workforce (average age is currently 45) and make projections of future numbers required based on our knowledge of likely retirements, turn over and demand for additional and extended roles. In the 2015 IMTP process the Trust requested education be commissioned for: 5.00 Adult Nursing 1.00 Return Practice 6.00 Full Independent Prescribing (this could be across more disciplines) 5.00 Full Masters 4.00 BSc Modules in Clinical Patient Assessment There are 3 providers of nurse training in South Wales (University of South Wales, Cardiff University and Swansea University). There are no reported difficulties in recruiting students, and attrition rates for training are also low. 3.8 Allied Health Professional Workforce The Allied Health Professional workforce at the Cancer Centre is made up of Therapeutic Radiographers, Diagnostic Radiographers, Physiotherapists, Speech & Language Therapists, Dieticians and Occupational Therapists, with the Radiographers making up the bulk of this workforce. The AHP workforce as a whole is a relatively young but approximately 18% are aged over 50, the majority of which are Radiographers. The age profile of AHP staff within NHS Wales indicates that 22% of the workforce are over the age of 50 and 10% over the age of 55 and this age profile could impact on future supply, especially with regards senior and specialist AHP staff within the next 5 10 years. 49

50 With the exception of the Therapeutic Radiographers, the AHPs within the Cancer Centre are made up of small numbers of staff. This can pose problems with supporting clinical placements for students, supporting new graduates and ongoing training due the small numbers of staff available. The impact on the AHP staff of the move of service wards providing care closer home and via outreach facilities is still not clear as the final service model is, date, still undecided. Initial contact with Health Board Therapies Departments has raised concerns that transfer of work Health Boards might be difficult within their existing resources and due a lack of oncology experience. Expanding the roles of the current workforce and/or increasing their input in outreach would be challenging given the small numbers involved. Whilst the Cancer Centre does not yet experience great difficulty in recruiting novice AHP roles, it has started have difficulty in attracting more senior staff with oncology experience. Given that the Cancer Centre is also likely have a number of retirements of senior, experienced and specialist skilled staff within both Radiography disciplines over the next 5 10 years, the overall national supply of this workforce could become an issue and in-house succession planning will become crucial Therapeutic Radiographers: were in short supply in NHS England and education commissioning places were increased with the first output of additional graduates anticipated in 20. Attrition from the training courses was also high, coupled with difficulty in securing training places for students. HEE has identified that this staff group has grown in numbers over the past 5 years and that supply will be meeting demand by Within NHS Wales there is one provider of training (Cardiff University) for Therapeutic Radiographers, who train all the students for Wales. Training places have remained fairly constant since 2012 when the numbers were increased, and recruitment of students is good. The Cancer Centre is able offer students clinical placements and does not currently have difficulty in appointing graduate posts. As we move forwards with Transforming Cancer Services and the expansion of Radiotherapy services, including the development of a satellite site and the introduction of new techniques, we will need make sure that we identify our training requirements within the IMTP due the 4 year time lag produce graduates. In the 2015 IMTP process, the Trust has requested education be commissioned for 11 Therapeutic Radiographers Diagnostic Radiographers: were in short supply in NHS England and education commissioning places were increased with an anticipated increase in graduates from 20. HEIs in England were experiencing difficulty in attracting students courses and attrition rates were high from the courses. HEE has noted that this workforce has increased by approximately 12% over the last 5 years and due, the increased commissions, anticipates that numbers in training will now provide the supply required meet increased demand by In NHS Wales, there is an acknowledgement of the increased demand for imaging and the education commissioning places for Diagnostic Radiography have been increased annually from There is no difficulty in attracting students the courses. Within NHS Wales there are two providers of training (Cardiff and Bangor Universities). Due the small size of the Radiology Department within the Cancer Centre and the age profile of this group of staff, succession planning will be crucial, as will the ability support and menr new graduates and trainees. Diagnostic Radiographers are on the Shortage Occupations List. 50

51 In the 2015 IMTP process the Trust did not request education be commissioned for Diagnostic Radiography Dieticians: In NHS England the supply of Dieticians is set increase from 20 which is due an increase in commissions since Decreasing participation rates due the proportion of young females within the workforce is impacting on the available workforce and NHS England has also found that many leave the profession between the ages of 40 and 50 (similar work has not been undertaken in Wales) with pull facrs including the move working in private practice. In Wales there is one training provider (Cardiff Metropolitan University); Education commissions increased between 2014/15 and 2015/ and are likely remain at the same levels. There are small numbers of staff within the Cancer Centre and the age profile is young. In the 2015 IMTP process the Trust requested education be commissioned for: 1 Human Nutrition Dietician Physiotherapists: In NHS England the supply of Physiotherapists is set increase from 20 due increases in commissions since There is no current anticipated issue with supply in NHS England or NHS Wales. There are pull facrs for this workforce, including opportunities work for charities and private practice (for more senior posts). In Wales, there is one training provider (Cardiff University) and whilst education commissions increased between 2014/15 and 2015/ they are likely remain at the same levels. This is a small department within the Cancer Centre and the age profile is younger. In the 2015 IMTP process the Trust requested education be commissioned for: 1 Physiotherapist Speech and Language Therapists: In NHS England the supply of Speech & Language Therapists is set increase from 20 due a number of facrs, however, demand is also anticipated be increasing due the ageing population, rise in dementia, and number of children with complex needs. There is no current anticipated issue with supply in NHS England. In Wales there is one training provider (Cardiff Metropolitan University), and education commissions increased between 2013/14 and 2015/ and are likely remain at the same levels. This is a small workforce in the Cancer Centre and the age profile is young. The rise in Head & Neck cancers is anticipated increase demand for Speech & Language Therapy input. In the 2015 IMTP process the Trust requested education be commissioned for: 1 Speech & Language Therapist Occupational Therapists: In NHS England the supply of Occupational Therapists has increased over the last 5 years, however, this has not been reflected in an increase in the same proportionate increase in NHS workforce. Occupational Therapists work in health, social care and education settings, and the increase in supply has been absorbed by non NHS employment of these staff. Demand is increasing due the ageing population with complex needs. There is no current 51

52 anticipated issue with supply in NHS England. In Wales there is one training provider (Cardiff University) and education commissions increased between 2013/14 and 2015/, and are likely remain at the same levels. This workforce is small within the Cancer Centre and has a younger age profile. In the 2015 IMTP process the Trust requested education be commissioned for: 1 Occupational Therapist Healthcare Science Workforce The Cancer Centre employs Medical Physics staff across a range of sub-specialism positions including Dosimetry, Nuclear Medicine and Radiation Protection. There are also a number of engineering posts within the structure that relate maintenance and servicing of the Linacs. The workforce comprises of Consultant Healthcare Scientists, Clinical Scientist, Healthcare Science Practitioners and Technicians. Training for Healthcare Scientists has changed as part of Modernising Scientific Careers, which has led changes the training programmes for all levels of the workforce. The Degree and Masters level training is in situ and the training for Consultant practitioners is commencing this year. The training for the Assistant Practitioner levels is still being developed and as such existing training routes remain. There is also an emergent accreditation route recognize prior learning and experience Practitioner Training Programme (PTP): NHS England does not commission PTP training. In NHS Wales there is one provider of training at both BSc Practitioner Training Programme (PTP) and MSc Scientist Training Programme (STP) which is Swansea University. The PTP provides graduates for both Nuclear Medicine and Dosimetry and typically has very small cohorts of trainees. The new training programmes require departments provide blocks of work based training over the three year duration of the courses and this has an effect on departments training capacity as they might be training students from years 1 3. Physics graduates are able be recruited and trained in house for Dosimetry posts here the department will be competing with other employers such as the banking secr for graduates. The department also recruits staff with engineering degrees fill technical posts which require knowledge of electronic and computing. This recruitment is subject availability within the labour market and a number of these skills set are in short supply Scientist Training Programme (STP): The STP trainees are recruited via the national recruitment process with the National School of Healthcare Science, with the education for NHS Wales provided through Swansea University. Again, these are small cohorts of trainees. Commissioning has been relatively consistent over the last few years. The new training programmes require departments provide blocks of work based training over the three year duration of the courses and this has an impact on departments training capacity as they might be training students from years

53 Higher Specialist Scientific Training: HSST is the new training route for Consultant Healthcare Scientists and the Cancer Centre is hosting the first trainee in NHS Wales. The impact of the training requirements on the department is as yet, unquantified. The age profile of the Medical Physics workforce is relatively young, however, there are likely be a number of retirements of senior and experienced staff over the next 5 10 years, some of whom work in specialist areas where the team is relatively small. Succession planning will be an important consideration. Any additional posts required due the expansion in number of Linacs for the satellite and the new Cancer Centre will need be planned for. These posts will either come from the education commissioning via the IMTP process (taking account of the 4 year time lag between commissioning and production of graduates), in house development of staff, and recruitment from the labour market and overseas. Posts are likely be required prior the opening of the new facilities, therefore, consideration will also need be given the impact of any additional training requirements that this may cause. The following table (14) gives an indication of the likely trainee output for NHS Wales over the next 4 years. Other departments will also be looking recruit from these graduates. Table PTP STP In the 2015 IMTP process the Trust requested education be commissioned for the following in a consortium with Cardiff & Vale: 1 BSc Healthcare Science Nuclear Medicine & Radiotherapy Physics 3 MSc in Clinical Science Medical Physics (trainees share across C&V and Velindre) Medical Physics staff are on the Shortage Occupations List. 3.9 Pharmacy Workforce The Pharmacy workforce in the Cancer Centre is made up of Pharmacists and Pharmacy Technicians, both of which are registered professions. As such, their education is also regulated. Pharmacy workforce operates in the Dispensary, Aseptics and on the Ward and oversees medicines management governance. There are a number of non medical prescribers who undertake independent clinics and prescribe chemotherapy and supportive care. Neither NHS England nor NHS Wales commissions the education of Pharmacists. Currently, NHS Wales commissions placements for Pre Registration Pharmacists, places for the Pharmacy Postgraduate Clinial Diploma and NVQ3 for Pharmacy Technicians. Pharmacy degrees are offered by Cardiff University, which is currently a 4 year Masters degree. The graduates from pharmacy degrees will typically find employment in the NHS, community pharmacies and industry. There are 53

54 ongoing discussions as whether the existing 4 year degree should become an integrated 5 year degree, which would include the current pre-registration year and where graduates would also be independent prescribers. Work undertaken by the CfWI for NHS England in 2013 identified a potential for oversupply in graduate pharmacists due a national ongoing increase in pharmacy student numbers between 1999 and 2009, but supply for the NHS is affected by the number of pre-registration placements available. However, in the intervening period there has also been a growth in demand for Pharmacists from Primary Care. The drive increase the number of Pharmacists who prescribe across a number of services, along with changes NHS commissioning in England impacting on community pharmacies. This is impacting on supply in the short medium term and the local ability recruit and retain experienced staff. The Cancer Centre does not offer pre registration placements currently and is about embark on recruiting junior pharmacist postgraduate clinical diploma posts so that they gain experience and exposure oncology. Across NHS Wales the number of pre registration placements being commissioned has remained broadly consistent for the last 10 years. In the 2015 IMTP process the Trust requested education be commissioned for: 1 Pharmacy Diploma (although it should be noted that due the specialised nature of the Trust that the postgraduate course commissioned would have be from outside of Wales currently, most likely through distance learning) IT and Information Workforce The Information and IT workforce in the Cancer Centre is made up of a range of roles including Health Records (who form the bulk of this workforce), Clinical Coders, IT Technical and service desk staff and Information Analysts. Nationally, this workforce has traditionally been difficult recruit in the NHS due the abundance of higher paid jobs in other industries. The British Computer Society (BCS) has estimated that at a UK level, there is a shortage of approximately 340,000 IM&T staff; however, this is predominantly for software developers, who are employed by NWIS. The workforce in Health Boards and Trusts are Technical and Information staff. A recent NWIS survey has revealed that whilst there is turnover amongst these staff, no organisations are having difficulty in recruiting. Most organisations are, however, looking expand their information workforce over the next few years due the rising demand for informatics skills. The education for this workforce is not commissioned and their supply comes from the local and national labour markets. NWIS is working with Higher Education in Wales and has recently set up an Informatics degree with Swansea University. Due the launch of the NHS Wales strategy; Informed Health and Care: A Digital Health and Social Care Strategy for Wales, planned changes the IT infrastructure in the Trust, and an increase in demand for information skills, supply of these skills may become more challenging recruit. 54

55 3.11 Healthcare Support Workers Healthcare Support Workers cover a wide range of duties within the Cancer Centre, from nursing, therapies, pharmacy and healthcare science domestics, catering and porter duties. This workforce is more generally recruited from the local labour market. This workforce has the highest average age within the Cancer Centre ranging between ages (spans two staff groups). Discussion with managers has revealed that recruits these roles also tend be older and that there is no current difficulty in recruiting, although turnover is generally higher in some of these roles. The local population statistics reveal that currently about 14% of the population are employed in health related activity. Cardiff has a slightly higher proportion of younger people than the rest of Wales and approximately 5% youth unemployment as compared only 2% for year olds. The Nuffield Trust has also recently reported that there is an increase in demand for support workers from across health and social care secrs. Whilst supply is not currently an issue, the Cancer Centre will need consider the age of this workforce, future expansion and changes working patterns and how they could impact on this workforce. There is a drive ensure that this workforce is trained and competent and this needs be planned for ensure that we remain an employer of choice and make the most from this valuable resource Estates and Facilities Workforce The estates & facilities workforces are subject local market and national labour market conditions. The more recent rise in the availability of apprenticeships across the industry is increasing supply of staff qualified work within the estates functions. However large national construction projects such as the Jubilee Line can affect supply of certain skills. This workforce is older than average but is likely change its skills focus due transformation of service provision. The facilities workforce tends be recruited more locally and tend have an older age profile both in employment and at recruitment. They are trained in house and their supply could be affected in any large scale employment opportunities locally e.g. opening of a large sre. There is a nationally recognised increase in demand for caring skills, however, the Cancer Centre does not experience major turnover issues related these issues. There will be an increased demand for this workforce and a need build and develop new skills Administrative and Clerical Workforce This staff group is the largest within the Cancer Centre. It is made up of administrative and clerical staff and non clinical managers. This staff group covers a broad range of skill sets from general administrative duties specialist skilled roles such as Workforce, Finance, Information, IT, Clinical Coding and Research. This workforce is typically drawn from the local labour market for administrative and clerical skills and from a wider professional labour market for specific skills and management posts. There are some local skills specific supply issues e.g. Clinical Coders, for which the Cancer Centre has put strategies in place. 55

56 3.14 Shortage Occupations List The most recent Shortage Occupations List was published in April These are roles that are nationally recognised as being hard fill and therefore in shortage. The following roles, which are employed within the Cancer Centre, appear on the list: Consultants Clinical Radiology ST4 ST7 in Clinical Radiology Consultant in Clinical Oncology Diagnostic Radiographers Nuclear Medicine Practitioner Nuclear Medicine Scientist Radiotherapy Physics Practitioner Radiotherapy Physics Scientist 56

57 3.15 Key Findings Workforce supply comes from a number of sources including our existing staff (internal labour market), the local population, local and national professional labour market (external labour market),through NHS Wales education commissioning, and from overseas recruitment. Workforce supply is a system and is influenced by facrs at a national, regional and local level and these facrs can influence the ability recruit in both the short and long term. It has been estimated that up 80% of the workforce the NHS requires over the next decade are already working for us. We will need plan for how we need up-skill and/or retrain and retain that part of the workforce match the internal talent pool the future skills required. Succession planning and talent management working ongoing in the Trust will be important develop and replace skills and experience. The workforce is ageing with the potential for up 13% of the workforce reaching retirement age within the next 5 years. Changes education commissioning, especially the payment of fees and bursaries in NHS England, could impact on workforce supply, in an as yet unquantified way. NHS England is moving wards graduate education training routes for nursing which has been in place in NHS Wales for the last decade this may have a short term impact on nursing supply in NHS England. Local labour market analysis shows that Cardiff has a larger proportion of younger people than other parts of Wales (the student population accounts for some of this). However, whilst the proportion of people aged 0 is predicted rise until 2026, it is then predicted decrease by approximately 3% by Approximately 20% of the local population has no qualifications and just over 37% of 74 year olds were long term unemployed at the time of the census Education commissioning is driven by the training numbers submitted via the IMTP process. There is on average a 4 year time lag between requesting education be commissioned and production of a graduate, and between years for a consultant. Not all our workforce is commissioned, and those that are require the organisation have the training capacity support the in house training elements required as part of the education. o Docrs in training for GP and Core Medical o Docrs in training for Palliative Medicine, Clinical and Medical Oncology and Radiology o Nurses (graduate entry) o Diagnostic Radiographers (graduate entry) o Therapeutic Radiographers (graduate entry) o Occupational Therapists (graduate entry) o Speech & Language Therapists (graduate entry) o Physiotherapists (graduate entry) o Dieticians (graduate entry) 57

58 o Clinical Psychologists o Pharmacist (pre registration training & postgraduate diploma) o Medical Physics including Nuclear Medicine (graduate and postgraduate entry) Other courses commissioned include Non Medical Prescribing, Non Medical Authorisation of Blood, Advance Practice (not for oncology) and Physicians Associate National funding is also available support the development of Healthcare Support Workers as part of the career framework for those Healthcare Support Workers in Nursing and therapies. Education is not commissioned for: o IM&T staff o Pharmacists o Healthcare Scientist Assistant Practitioners o Radiography Assistant Practitioners o Estates and facilities workforce The following professions employed within the Cancer Centre appear on the Shortage Occupations List 2015: o Consultants Clinical Radiology o ST4 ST7 in Clinical Radiology o Consultant in Clinical Oncology o Diagnostic Radiographers o Nuclear Medicine Practitioner o Nuclear Medicine Scientist o Radiotherapy Physics Practitioner o Radiotherapy Physics Scientist 58

59 4.0 Workforce Demand 4.1 Horizon Scanning demand for the workforce The Centre for Workforce Intelligence recently completed a large scale piece of work, horizon scanning for the NHS workforce up The following model (figure 39) illustrates the high level issues that are likely impact on and create demand for the NHS workforce over the next 20 years. It is likely that these issues will also impact on the future workforce we will require. Figure 39 We are entering a period of rapid medical, scientific and technological change which is and will continue introduce new treatments, drug regimes and diagnostic testing which will have an impact, not only on our patients, but on demand for our services and the skills and knowledge of our staff. Work is ongoing in the Cancer Centre develop the Cancer Strategy and the InVigorate Strategy which will help us identify these changes and the likely impacts. Work has commenced work through a number of scenarios linked likely changes treatment. The impact, and the workforce elements of this work, will continue inform our workforce planning. 59

60 4.2 Workforce Demand for the Cancer Centre Workforce demand for the Cancer Centre will be driven by the anticipated increase in demand for cancer services due the predicted rise in the incidence of cancers, the ageing of the population, the increased availability of treatments and the increased survival rates: Figure 40 Cancer incidence is increasing; we must meet increasing demand There continues be variation in outcomes throughout Wales; we must help close the gap and ensure equity of services More people are living with and beyond cancer; we must work with people as equal partners achieve best possible quality of life and experience Resources are scarce; we must deliver services in innovative ways make the best of our resources with sustainability and prudent healthcare at heart New advances such as immunotherapies and personalised medicine are emerging; we must be ready deliver We are working within a wider policy context; we must ensure we are aligned The availability of new treatments such as immunotherapies, and the advent of personalized medicine will drive demand for specialist skills and knowledge. Changes treatment technologies such as in radiotherapy could change workforce demand as treatments become more complex, more frequent, and people live longer and might require additional treatments or care. There are also a number of unknown and unquantifiable drivers of workforce demand, including the impact of scientific and medical advances that could change our understanding of cancer, prompt quicker diagnosis, and potentially cure. 60

61 4.2.1 Our Population Challenges It is important understand the health and wellbeing of the population that we serve, and the challenges and opportunities that this presents, as this will impact on demand for workforce and the skills and competences required. The following infographic (figure 41) provides an illustration of the health challenges that are driving our need transform services. We have a growing population, predicted rise by 5% 3.17 million by 2020, an ageing population with a greater proportion of the population aged over 65, and there is significant variation in the life expectancy for people in different communities in Wales due socioeconomic inequalities. We also know that the incidence of cancer is increasing, along with survival rates. Figure 41 Demographic trends over the last few decades have indicated that whilst the proportion of the population aged over 65 is increasing, the proportion of the population under working age is decreasing. The dependency ratio (which measures the proportion of the working age population) has been decreasing which means that there is likely be less young people available employ whilst demand for healthcare is increasing due an ageing population. 61

62 4.3 The Clinical Model The following illustration of the new clinical model sets out the hub and spoke approach providing services. Our workforce will, in future, be providing services in a number of different settings and in partnership with other service providers. The new model is designed around patient needs and will enable the Cancer Centre deliver sustainable services in the future. The model has been designed based on the anticipated increases in activity and demand for services over the next decade these increases in demand are illustrated in the following diagram (figure 42): Figure 42 62

63 4.4 What does this mean for the future workforce? The Transforming Cancer Services Programme has considered a number of reasonable assumptions for anticipated growth in demand for services. These estimations of demand have informed the development of the clinical model and have been used underpin the initial workforce modelling, which has indicated that there will need be an increase in the numbers of staff deliver this activity. The following illustrations (figures 43 45) show how activity will be split between that delivered at the Cancer Centre hub and that delivered at the Outreach settings spokes. The provision of services through a hub and spoke model will also increase demand for workforce through the need work differently e.g. multi-based and the potential demand for different skills e.g. Advanced Practice. More detailed workforce planning will be undertaken match the workforce required the demand for services. Figure 43 63

64 Figures 44 and 45 64

65 5.0 The Shape of the Future Workforce 5.1 Introduction Given the increases in demand and the workforce and financial challenges facing all NHS organisations, we need consider how we can work differently and find different workforce solutions. The development of the strategic workforce plan, the accompanying analysis of our workforce issues and our initial workforce modelling has enabled a period of reflection consider what will impact on our ability create our workforce, the type of workers, skills and competencies we might require and how we will deliver the future workforce. The development of a new clinical model and the opportunity have modern, purpose built facilities has provided context for us consider the potential for different ways of working, different skill mixes and extended and multi-skilling of staff. The Trust is in the process of developing a number of enabling strategies, which will set the direction and help us create a workforce with the right people, with the right skills, in the right place at the right time. During 20, strategic level workforce modelling was undertaken linking workforce activity, assess the numbers of workforce we would require deliver our proposed clinical model. The modelling has anticipated that our workforce numbers will need increase by approximately 170 staff by 2021/22 (the proposed opening date for the new Cancer Centre). It is important remember that workforce planning is iterative and, therefore, this plan is a first step in our developing journey and sets a vision for how we can develop our future workforce. This is a large scale change process that will be phased in over the next 5 years. A workforce action plan has been developed that details the further pieces of work that need be undertaken refine and deliver our future workforce requirements. Work has already commenced in a number of areas that will support the delivery of our future workforce. 5.2 Workforce deliver the clinical model The clinical model is based on a hub and spoke approach, with a new build Cancer Centre from March 2022, supported by a number of dedicated Outreach facilities, including a Radiotherapy Satellite Centre which will open in 2021, and a Medicines at Home service for the provision of an element of chemotherapy treatments. The Cancer Centre will continue provide Inpatient care and services for more complex patients including more complex Radiotherapy. There will be the addition of an Assessment Unit and an Ambulary Care service. Support will be provided the Health Boards through a dedicated Acute Oncology Service run from the Cancer Centre and staff, including Consultants, will continue undertake clinics based within the Health Boards. In the outreach settings patients will be seen in Outpatients, via a small Ambulary Care service and for Chemotherapy delivery. Less complex Radiotherapy patients will be seen in the Radiotherapy Satellite Centre. Whilst not all the services provided by the Cancer Centre will be available in the outreach setting, Cancer Centre staff will work in the outreach settings. An element of staffing will need be provided from the Health Board in which the outreach facility is located. The location of the outreach facilities and Radiotherapy 65

66 Satellite Centre has not yet been decided but it is likely that there will be requirement for the following workforce services be provided by the hosting Health Board: Estates Facilities Domestics, Portering and Catering Information Technology support Pharmacy Pathology Imaging Medical if crash team cover is required Nursing if outpatient nurses are not rotated from the Cancer Centre Therapies support Patient Transport The provision of services in outreach will require the development of multi-disciplinary and multiorganisational teams. To ensure that we provide consistent services and levels of care our patients, where ever they are receiving our services, we will need build skilled teams who share the same values and beliefs. Our workforce is part of a wider system, so we need undertake engagement with a wider range of staff and stakeholders refine our workforce plans and explore whether any changes our workforce could impact on other services within or outside of the new clinical model. 5.3 What do we know about our current services? We have been undertaking work define our current services and explore the potential transform our future services, and the workforce that will deliver these services. Following a number of workshops and discussions with managers, a number of key themes have emerged for the development of the future workforce. The following SWOT analysis was developed by the service managers, considering our current service and its ability meet the future vision. As the clinical model continues be refined, further and more detailed workforce planning and modelling will need be undertaken so that we can refine our plans and explore the following themes in more detail. 66

67 Table 15 STRENGTHS Good organisational reputation Motivated, enthusiastic, quality staff Skilled and specialist staff MDT working Attractive as an employer retain staff Small organisation, ability for decision making Specialist knowledge and skills People & patients at centre Collaborative working (e.g. 3 rd Secr) Research culture Financially secure WEAKNESSES Keeping up with technological change Balance between clinical duties & service improvement Duplication of effort - services which could be done elsewhere Transfer of care between services Rescuing - are we person centred? Role development not consistent all areas Inequity of support services across sites Availability of soft monies blocks necessity change Bureaucracy/Internal structures creating complexity & delay Inconsistent ways of working Limited skills resource e.g. size of departments who support change Lack of funding provide resource meet demand Insular thinking/stand alone/small organisation OPPORTUNITIES Empowering patients have control of own pathway Implement technological changes increase productivity Develop staff skills develop new services, pathways and increase flexibility Drive wards 7 day working for equitable care Service improvement make changes New building new adjacencies TCS programme structure Career development think differently about roles Clinical trials, research, improve pathways and treatments Work more collaboratively with partners common language Culture care & change Information drive improvement THREATS Pron beam private facility Terms & conditions of service Aging workforce losing experience through retirements Skills shortages Change fatigue Health Boards taking on our services Not daring be different & taking a risk, instead doing more of the same 7 day working/extended hours (workforce barriers) Financial constraints - Short term not long term focus Organisational complacency we re already the best Expectations, political change and approach Dependency on external organisations Small size = small voice in NHS Wales Velindre feel as we move hubs NHS England different treatments 67

68 5.4 Building the workforce of the future Work carried out by the Nuffield Trust has recognized that 80% of staff currently working in the NHS will remain employed with the NHS for the next 10 years. This means that we need develop our current staff ensure that they have the skills and competences that they will require deliver the clinical model over the next decade and beyond. The impact of working longer has thrown a spotlight on the importance of this, as our current staff are likely be working with us for longer than they would have in the past. It is important that we understand the skills of our current workforce and are able map these against the skills they will require. The report, NHS Workforce Planning: Limitations and Possibilities (Kings Fund 2010) identified that we need concentrate on the development of the skills of the staff we currently employ improve the quality of services by: Role enhancement: a person taking on new skills Role substitution: working across professional boundaries Delegation: moving a task up or down the roles within a profession Innovation: creating new roles fill a competency gap A number of pieces of work have commenced review the skills of our current workforce and start map these against what skills will be required and opportunities for working differently. This includes a skills review of the Clinical Nurse Specialists (including training needs analysis), Facilities staff and Health Records staff. As we start implement the clinical model and provide more services through the hub and spoke model, we will need undertake a further pieces of work with managers ensure that we develop an agile workforce who are able continually adapt change and who can deliver services more flexibly. Work develop patient/clinical pathways has commenced and this, along with the ongoing role and skills reviews, will support the Cancer Centre identify and make decisions on where we should be developing extended skills sets, redesigning roles and/or introducing new roles that will improve patient experience and support patient flow through the system. The outputs of national programmes of work being undertaken by the Direcrs of Workforce & OD will support our transformational work. These programmes include the Hire Retire Programme, where work is underway roll out Electronic Staff Record (ESR) Enhance and the Talent Management functionality within ESR and Oracle Learning Management (OLM) which will enable the Cancer Centre more easily record and interrogate its workforce information, skills, and 68

69 competences on line. Other programmes include work looking at working longer, succession planning and talent management, workforce planning and the shape of the future workforce and the outputs of this work will continue inform the work that we undertake. A number of ols and resources are available support managers through changes that they need make the workforce. A number of the resources available from Workforce Education and Development Services (WEDS) can be found below: Standards and Guidance for Role Redesign in the NHS in Wales Framework for Advanced Nursing, Midwifery and Allied Health Practice in Wales All Wales Guidelines for Delegation NHS Wales Skills and Career Framework for Healthcare Support Workers Physicians Associate Governance Framework There are also a number of workforce information ols that can be accessed via the Trust Workforce Information Team Workforce Efficiency and Productivity The NHS Wales workforce has increased in size over the last decade, but overall the shape of the workforce has not changed significantly. What has changed is what staff are doing and how they are delivering those services. There has been a national drive increase the productivity and efficiency of the workforce and this is likely be where the greatest savings are possible with the ability absorb increasing demand. Prudent Healthcare principles will help us focus on a prudent workforce. New facilities with better adjacencies will enable us create different skill mixes. A future that includes efficiencies from the implementation of IT solutions and new technologies will help, but will not in themselves create all the productivity increases we require unless we work differently Enabling technology The Digital Health and Social Care Strategy for Wales outlines the importance of access timely and accurate health related information. The roll out of a number of national and local information systems over the forthcoming years will support our ambition work more efficiently and provide care closer the patient. 69

70 These technologies will provide wider data connectivity and sharing across Wales for patients and clinicians which will help remove duplication, and support staff work remotely from their base, whilst still being able access information. The new IT systems will enable us streamline our processes which will help release staff time through new working practices. Systems such as e- Rostering and e-scheduling are due be rolled out within the next two years and are good examples of this e.g. releasing nursing administrative and nursing staff time due more efficient scheduling and re-scheduling of patients and design and management of staff rotas. In order maximize the efficiencies of these systems, the Cancer Centre will need ensure that its staff have the right skills use these systems effectively Defining the future shape This model (figure 46), taken from recent work undertaken by the Nuffield Trust, gives a good illustration of our approach the creation of the future workforce. It shows how analysis of the current workforce leads defining the future (by identifying facrs including supply, skills development, and roles, creates the future workforce. Figure 46 Analysis of our current workforce and of future workforce supply has highlighted that the Cancer Centre employs a number of staff with specialist skills who come from some of the smaller NHS professional groups, and a number of roles funded through soft monies. Whilst this creates potential workforce vulnerability for the Cancer Centre (as supply for a number of these roles is challenging), these staff have always been challenging resource and careful workforce planning in these areas should ensure that the Cancer Centre is able recruit, train and develop these groups in the future Building the future skills The implementation of the clinical model will require a proportion of our staff support the outreach facilities within the Local Health Boards and a number of new ways of working, including the establishment of an Assessment Unit, Ambulary Care and an enhanced Acute Oncology Service. 70

71 The modern facilities will enable us work differently and more efficiently, due better adjacencies and technologies. Whilst some of these changes require additional staff, they will also require a skill mix that reflects the clinical service be delivered, so that our patients are seen by the most appropriate, skilled and trained member of staff. This will require further assessment of whether work can be discharged by our existing staff, whether it could be delivered by any of our partners, whether it could be delivered by staff that have developed new skills or whether we need develop new roles Extended skills New (alter Old Source:Bohmer, Imison. Health Affairs 2013, 32(11), The Cancer Centre has a proven track record in the development of the skills of its staff. A number of extended skills practitioners have been created including: Redist handing off existing tasks other Capacity increasing the numbers Old Creati creating new jobs for work previously Retrai expanding the job description s of Ne Clinical Nurse Specialists who support patients through site specific cancer treatment pathways; Nurse Clinicians who provide advanced clinical skills input improved patient care; Non medical prescribers over a range of professions who run independent clinics which improves patient experience and flow; Extended skills Radiographers who are able scan and report and Support Workers in therapies that support the delivery of care plans. There are opportunities for the development of more extended skills roles, however, this needs be undertaken in a planned way ensure that we develop the most appropriate and effective roles following Prudent Healthcare principles. Discussions with managers have identified a number of areas across all the service areas where there is the potential develop staff with extended and/or additional skills, from registered staff Healthcare Support Workers. Recent legislative changes have increased the number of professions who could become independent prescribers. The ongoing work develop clinical pathways will enable the Cancer Centre identify where extended roles would be beneficial patient care and help identify if there is potential for overlap in the development of roles. Advantages of developing extended skill staff within the Cancer Centre is that they can be achieved relatively quickly with relatively short times train and can support the redistribution of workload from other staff; disadvantages include the impact of creating these roles by drawing these staff from the main pool of staff, the lack of workforce resilience where only small numbers have these skills, a lack of succession planning and the risk of duplication of effort. 71

72 There is potential developed further extended roles, including: o Radiographer undertaking MRI scans and reports for spinal cord compression o Physiotherapist for spinal cord compression enable faster discharge o Radiographers undertaking radiotherapy planning o Advance Practice/non medical prescriber nurses lead chemotherapy delivery o Multi skilled Healthcare Support workers in therapies delivering care/exercise package Role redesign There will be opportunities redesign a number of roles within the Cancer Centre. The new facilities will provide a modern working environment where departments are better located and staff will be able move more easily between them. Whilst this will ultimately enable more flexible use of staff, it also has the potential allow changes of skill mix in areas such as Radiology where senior staff will be able provide supervision junior and support staff due improvements in layout. New technologies will force changes in delivery models that we have not yet thought of. Without building capacities and capabilities in our workforce for a world of continuous change and emergence of new roles and possibilities, we risk being perpetually out of step and continually rebuilding our workforce do yesterday s not morrow s health work - Professor Richard Bohmer The new layouts will also provide opportunities explore other working efficiencies, changing ways we need some groups of staff work. There will be opportunities review the roles of Healthcare Support Workers and Admin and Clerical staff due the implementation of new IT systems, enabling technologies such as electronic task allocation and centralized booking systems. This could mean that we are able multi-skill staff be able undertake a wider range of duties. Working with partners in different secrs and across networks will enable us explore possibilities appropriately redistribute tasks. An example of this would be the opportunities work with Maggie s Centre explore different ways provide psychological support and complementary therapies our patients, with staff in Maggie s Centre providing more, lower level interventions whilst the Cancer Centre staff could work more prudently delivering the high level, more specialist interventions. Work will need be undertaken explore the best way deliver therapies interventions as services are moved be delivered in outreach. Examples of good practice exist, such as the Head & Neck pathway, whereby therapists in the Cancer Centre, Local Health Boards and community teams are able provide seamless handover of care. 72

73 New technologies will also enable and require role redesign. Within Radiology there is the potential for remote reporting of scans, where scans could be undertaken at different locations of by different staff and reported on by the Consultant Radiologists at the Cancer Centre. The Cancer Centre has generated a number of scenarios, based on emergent technologies and treatments and these can be used continue explore the future workforce requirements and possibilities New Roles The potential for a number of new roles has been identified and will need be explored further ensure new roles are only created where they are needed, are a cost effective solution, and would be sustainable. New roles provide the opportunity create a specific set of skills and competences deliver a set of tasks by a new type of worker. Disadvantages the creation of new roles can include lack of registration in some areas, the risk of not being accepted by existing roles and a potential create something new without de-commissioning the older roles and hence duplication. The new roles identified include: o Healthcare Scientist apprenticeships o Physicians Associate support junior docrs and the wards o Clinical Fellows in palliative medicine o Consultant practitioners Working Differently The clinical model represents a different way of delivering our services, so that we are able respond patient needs and meet the increase in demand for our services. In order do this, we will need work differently which will include; o Providing more services in outreach and community settings o providing more services in patients homes o providing more services over seven days o providing some services over longer hours It is recognised that a number of our staff currently rotate between work locations or work areas and that a number work extended hours (including on call arrangements) over a seven day week. To ensure that we have effective and efficient working practices, we will work with the service managers explore the best deployment models for our staff and identify the contractual implications of such changes. Staff which currently work across locations include the consultant staff who provide input in multidisciplinary meetings within Local Health Boards, undertake outpatient clinics and see inpatients as part of an Acute Oncology Service. To deliver the future clinical model, work will need be undertaken create consultant job plans that enable our consultants minimise their travel time, and that create an efficient distribution of our consultant resources across the clinical model. The 73

74 development of the Acute Oncology Service provides an opportunity provide the inpatient elements of this on a more structured and planned basis. Our chemotherapy nurses currently provide services from multiple locations. As these clinics are reduced and provided from our outreach facilities, we will need create a different skill mix for the chemotherapy nursing workforce so that they are able deliver chemotherapy via a nurse led model. This could include the development of extended skills; including Advance Practitioners and non medical prescribing skills. To enable staff work at multiple locations, we will need explore the efficacy of creating rotations that build our staff skill and create a flexible and agile team, able move seamlessly between locations. Travel time and costs will need be modelled, and the possibilities of moving multiplebase contracts explored. Where the service requires longer opening hours over more days per week, VCC will need plan identify the skill mix distribution for the workforce, the impact of the number of shifts required cover the opening hours, most efficient on call/shift arrangements for junior docrs. In addition the financial impact of the requirement for our staff work unsocial hours, shifts or on-call, so that we achieve the most efficient and effective workforce solutions the service needs. To successfully implement these changes, we will need work with our staff, managers and trade union partners. We will need effectively utilize our local and national workforce policies and the flexibilities within the terms and conditions of service. The new clinical model will mean changes services which may require changes the current and future working practices of our staff and as such may impact on employment contracts in key areas such as: o location and base of work o change of working hours and days o requirement for staff rotate between locations and/or areas of work o requirement for staff undertake additional development o departmental restructure o job plans o on call arrangements Multi-disciplinary and cross secr working The provision of services in outreach settings, based within the Health Boards, will mean that more of our staff will be working in multidisciplinary teams, some of which will be made up with staff who are employed by different NHS organisations, charities etc. These teams will be built around patient needs and will in most instances, be a different way of working for our current staff. To release the potential of these teams, work will need be undertaken build teams and develop clear roles 74

75 within those teams. This work is described in a following section and will build on work already undertaken within the NHS where cross secr teams have been successfully created deliver seamless care Developing the workforce Through the development of knowledge, skills and competencies we will create a flexible, adaptable and sustainable workforce deliver the clinical model, and new treatments and technologies required by the patients. The NHS is facing a period of unprecedented advances in medicine, science and technology. Genetics and genomics will advance the implementation of novel treatments and personalised medicine across all cancer types; immunology and pron beam being current examples of these changes. This is going require changes working practices, new skills development and potential changes service delivery over time. In addition the current development requirements, a number of strategies indicate the need develop further skills sets within our workforce: o Communications skills support conversations with patients, carers and families based on the principles of co-production and prudent health o Palliative care skills, across the wider team, enable earlier conversations with patients o Specialist skills enable use of new equipment e.g. stereotactic radiotherapy, PET o Knowledge and skills use new treatments and personalized medicine e.g. Radium 223 o Clinical Patient Assessment skills work with complex, acutely unwell patients with comorbidities o Skills make best use of new information technologies o Research skills support Invigorate o Skills enable multi-organisational cross-secr working o Sharing our knowledge with the wider team around the cancer patient Education and training will be a vital component of the successful changes required and the development of the Trust Education Strategy and ESR/OLM will help us focus on these needs. To support the future education and development of our staff, the Cancer Centre is seeking develop a Centre for Learning and Innovation as part of the new hospital facilities. Velindre NHS Trust is an ILM accredited organization. ILM improve the leadership skills and success levels of over 90,000 managers each year. Getting the right mix of inspirational leadership and effective management skills and practices can have a significant impact on organisational performance. As part of the City & Guilds group, ILM offer unrivalled experience in the secr and our Royal Charter brings the highest level of prestige. 93% of employers see tangible increase in their managers' capability after an ILM qualification. 75

76 Centre for Learning and Innovation The Centre for Learning and Innovation will be integral the way that we develop our future workforce. The Cancer Centre s ambition is have this facility as part of the new hospital. The Centre for Learning will support four pillars: Sustainable and innovative educational programmes develop the cancer workforce Research and development continuously develop & improve future clinical services Innovation in treatments, life science research & development Translation of innovation in patient care through service improvement Figure 47 To research and develop the treatments of morrow, train the workforce of morrow whilst delivering better treatments day The Centre for Learning and Innovation (C4LI) will support the delivery of multi disciplinary learning at a national and international level and support leadership development across secrs. The C4LI will provide facilities and resources support this learning and development that will ensure that all staff are well trained, and develop their skills/knowledge. The C4LI will also support our research, which will help develop new treatments for the future, will assist us in planning for future changes linking this with service improvement and education supports translating new evidence based treatments in routine clinical practice. The Centre for Learning and Innovation will be an invaluable resource for the Cancer Centre support the development of the skills and knowledge of its current workforce. In addition it will help build wider skills such as those in research, enable staff gain new skills and knowledge as treatments and technologies change, and facilitate the sharing of knowledge, skills and expertise amongst the wider teams caring for the cancer patient. The clinical model will mean that our staff will 76

77 be working within multi-disciplinary and multi-organisational teams and the C4LI will be able support the development of these teams through shared learning. Finally, the C4LI will support the Cancer Centre be able attract and retain high calibre staff in line with the strategic vision laid out in the national delivery plan Personal Appraisal and Development Review The Trust Personal Appraisal and Development Review (PADR) process will help managers identify and plan for the staff development required and is a vital ol in embedding the values and beliefs of the organization and supporting change Rotation of staff for development The Cancer Centre already has a number of successful rotations in place which are supporting the development of staff skills, broadening experience and knowledge and enabling succession planning. Examples include the Palliative Care Nursing rotation that has recently been established between the Cancer Centre, local hospices and one of the Local Health Boards. 77

78 5.5 Recruiting the Workforce The importance of developing our current workforce become our future workforce has been discussed previously. The initial phase of workforce modelling has indicated that the Cancer Centre will need recruit additional staff over the forthcoming 5 years. Robust workforce planning will be required underpin how we plan for the additional staff required and ensure that we do not simply recreate a traditional workforce model and are able recruit and retain staff. Recruiting the workforce is subject wider systems issues including local demographics of the population from which it is sourced. An example is the impact of the age distribution within the population on the supply of potential recruits. There is also evidence emerging of the shift in expectations of the different generations of workers that will need be taken in consideration Generational Changes The nature of the workforce is changing with the emergence of a number of differences between the generations we will be employing over the forthcoming decades. Not only will the workforce be working longer, the span of the age groups within the workforce and their expectations of the work and the workplace will be important manage. The Working Longer Review has identified that teams will, in future, likely contain up three generations of workers. Mind the Gap Exploring the needs of early career nurses and midwives report identifies the difference between the generations and their work life expectations. The current workforce predominantly comprises Baby Boomers born at 25% of the NHS workforce, and Generation X born at 40% of the NHS workforce. These workers approach work is centred on vocation and structure. The emergent generations; Generation Y ( ) and Generation Z ( ) appear have a much different approach work and their careers, being technology driven generations who expect more rapid responses and flexibility. One of the challenges faced by Transforming Cancer Services will be transform not only the services we provide our future patients, but also develop and sustain a working environment that is attractive our future workforce. We will need develop multiple approaches how we attract and retain the different types of workers Recruitment Planning Our workforce profile is heavily weighted wards professionally trained and skilled staff and the supply of these staff is subject a number of constraints. The analysis of the sources and supply of our workforce has identified that different staff groups and professions are resourced from different sources including: education commissioning, other education and training routes, the national and local labour markets and in some cases from abroad. The analysis of the current workforce has indicated that our workforce comprises a number of highly specialist roles that come from the smaller professional groups within the NHS and that a number of the roles that we employ appear on the 78

79 Shortage Occupations list which is an indication that it may be difficult recruit these types of roles. Planning for the future workforce needs take in consideration a number of facrs including; o The types of roles and skills required e.g. are new types of workers required. o The requirement for roles have Welsh Language skills. o The likely source of that role as novice recruits can come from different routes compared experienced staff. o What the national supply situation is like. o The most appropriate route for advertising as this can be different simply NHS Jobs. o Other ways promote recruitment opportunities. o How VCC could work with partner organizations recruit e.g. Job Centre, recruitment agents. o Recruitment often starts at the entry university and the recruitment of students. o Careers activities attract candidates courses. o Widening access recruit staff from all backgrounds. o Growing our own and how promotions work through the system. The IMTP process will be an important component this planning as this is where we identify our training requirements for the education commissioning route. These students require clinical placements within the service. Succession planning and talent management also needs be part of the planning for how we recruit senior, expended and new roles as these can typically be recruited from the existing workforce and result in the requirement for recruitment more junior roles. Capacity support the training requirements of undergraduate and postgraduate students and for developing our own staff will need form a component of this plan. The recruitment plan will be developed with the service managers identify the required posts and when they will need be recruited and the approach that recruitment. The Cancer Centre will need plan closely with Employment Services in NHS Wales Shared Services Partnership enable the delivery of any increased volume in recruitment. The option for the recruitment of a flexible workforce will also need be considered, where appropriate. This workforce is typically sourced from agencies Values based recruitment The use of values-based recruitment will ensure that the Cancer Centre is able recruit applicants who share our values and beliefs. Our values and beliefs will be reinforced through Induction and during other internal development activities following recruitment. During the period of transition, it will be important that we provide information applicants and recruits of our planned changes service and working practices so that they are fully aware of planned changes posts and/or working practice. This will ensure that we attract and retain recruits Employer of Choice 79

80 The Cancer Centre enjoys a reputation of being an employer of choice which means that people choose work for us and commit our vision, culture and success. This has meant that the Cancer Centre has been able recruit staff easily although analysis has revealed emergent difficulty in attracting a number of posts, typically those that require additional skills or experience. The Cancer Centre has put a number of actions in place address these areas of recruitment challenge. The Cancer Centre has a high level of workforce stability and has benefited from reduced turnover over the last 5 years. Early indications predict that this will further decease around 5% in the next 12 months. Staff engagement has remained high; findings from the 2015 employee pulse survey results indicated that: 76% satisfied with present job 94% happy go the extra mile at work if required 91% are proud tell people they work for Velindre NHS Trust 94% believe that Velindre NHS Trust acts fairly as an employer 92% feel trusted by their line manager 98% support the need for change The Trust s ongoing ambition and desire be an employer of choice will be supported by a number of Trust Workforce & OD strategies. The development of a Trust People Strategy and an Education Strategy will support our implementation of the contractual and educational changes that are required deliver our future workforce. The Trust is keen demonstrate its ambitions be world class by engaging with national bodies and gaining recognition for excellent people management practices. These include: Invesrs in People (IIP) is a management framework for high performance through people and its prestigious accreditation is recognised across the world as a mark of excellence. Retention of this external recognition is important as a measure of the positive behaviour, culture and values that are in place within our NHS Trust. The Trust has been accredited since The Diversity Champions Programme is Britain's good practice employers' forum on sexual orientation. Working and sharing best practice with its members help make the workplace the best it can be for all staff, patients, donors, visirs and stakeholders. Velindre NHS Trust s Strategic Equality Objectives demonstrates our commitment promote and deliver equality, diversity and human rights. 80

81 5.6 Retaining knowledge and skills Workforce analysis has indicated that the Cancer Centre workforce is ageing. Over the forthcoming years, the workforce will be required work longer and due the phased implementation of the recent changes the NHS pensions schemes; there will be a window where a number of staff retains their right retire at 55/60, and a tapering period of protection. This may affect retirement patterns for the next 5 10 years, and recent changes pensions (annual and life time allowance) could also impact on the retirement and working patterns of higher earning staff. Retaining our older workforce is multi-faceted and involves balancing a number of competing facrs, such as awareness of health issues, personal commitments (caring) and managing absence. A number of ols have been developed by the NHS Working Longer Review Group and will be used support our understanding of the needs of this component of our workforce, so we can support them continue contribute the delivery of our services. Planning for retirement and the need retain certain skill sets, knowledge and experience will be an important consideration for the Cancer Centre during the transition period the delivery of the new clinical model. This might involve planning for retirements so that we can identify which skills we need retain and for how long, identify the feasibility offer flexible working older workers we wish retain and have adequate succession planning in place. 81

82 5.7 Creating a Change Culture The Organisational Development (OD) Strategy, Building Excellence; Helping each other be great, outlines how over the next 3-5 years the Trust will develop a culture that enables all staff be great and achieve the delivery of ambitious and exciting service change plans. Through conversations with staff we know we need a values driven culture where world class services are delivered by a workforce that understands the difference it makes the donor and patient experience. The Trust will deliver this through its resilience and flexibility, and a culture that encourages ambition Figure 48 and improvement and is agile and responsive change. Building Excellence provides the building blocks enable the Cancer Centre deliver the new clinical model and the changes that requires, through agreed organisational values and behaviours and an OD model (see figure 48) that outlines the inputs, activities, outputs and outcomes required enabling the workforce engage and achieve excellence in a culture and climate supportive of change. Workforce planning is an intrinsic component of this model. The core organisational values and associated behaviours have been embedded across the Trust in a variety of ways. Cancer Centre staff were engaged in the development of the values and behaviours understand how they translate in their part of the organisation. The Trust is actively seeking out different creative opportunities reinforce the agreed values and behaviours ensure deep alignment between individuals and the Trust and provide the firmest of foundations with the OD Strategy s fundamental aim, which is move the organisation forward and improve the services provided patients. Focused work is also happening across the Trust through 7 Think Tanks understand what excellence looks like for the Trust at the activity level of the model. The areas are: Communications; Workforce Planning; Service Improvement, Organisational Structure and Design; Leadership and Management Development; Performance Management; Talent Management and Succession Planning, and staff from across the organisation are involved in the work. 82

83 Figure 49 Our local values support the recently launched NHS Wales principles (figure 49) which describe how everyone in NHS Wales is expected behave. The Core Principles also help give us common ground and understanding as we work gether as part of NHS Wales serve our communities across Wales and support us deliver the goals of the Well-being of Future Generations Act. While the six Principles are at the core of NHS Wales, they also reinforce the values of Velindre NHS Trust, as fulfilled in all our different roles, departments and Divisions Supporting staff through change Change can be challenging for some staff and therefore we place significant emphasis on supporting our staff contribute, embrace and be involved in the changes that we need deliver. In order achieve this, we will need put a number of interventions in place and monir the impacts of the changes as we move through the implementation of the clinical model. The role of our managers and senior leaders will be crucial this Staff engagement Ensuring effective engagement with our staff will be fundamental the successful implementation of the changes. The Trust and the Cancer Centre have enjoyed good levels of staff engagement and recent pulse surveys have shown that 74% of Trust staff understand and support the need for change. It is important that we build on and maintain these positive levels. We will need consider the results and recommendations of the 20 Staff Survey (due be published in December 20) explore whether the TCS Programme has had any impact on overall staff engagement. It will be important undertake regular pulse surveys throughout the changes, monir and quickly address any impacts on staff engagement Staff communication Keeping staff informed and able comment on and discuss the proposed changes will be important. A number of communication events and information sources have already been put in place. These include articles in newsletters and regular lunch and learn events. A programme of senior manager 83

84 walkabout is about commence, where staff will have the opportunity meet and discuss the proposed changes. Be Connected There is also recognition that through times of change it is important for staff have the opportunity talk senior leaders across the Trust. Leadership visibility is important staff who have indicated through engagement processes that regular access Trust Board members will help create links and develop a greater understanding of front line pressures. The Trust has responded with Be Connected, an approach whereby Independent Members and Trust Direcrs visit different departments across the Trust and spend time with staff. As the TCS Programme develops and the changes working practices, locations of work and skills requirements become more clearly defined, additional staff engagement and communications will need be implemented. This will include more regular and defined team briefings the opportunities for individual discussions on the impact of changes at individual levels. Our trade union representatives will be critical partners in this work Promoting staff health & wellbeing It is important that staff health and wellbeing is maintained, not only throughout the change process but going forward. Staff health and wellbeing is an important ol attract and retain good quality staff, adding organisational reputation as being and employer of choice. As our workforce ages, good staff health and wellbeing will become even more important help us support our staff work longer. Velindre NHS Trust is committed the promotion of good staff health and wellbeing, demonstrated by the following: The Trust has recently been awarded Platinum in the Corporate Health Standards. The ethos of the Corporate Health Standard is encourage and enable the development of good practice in the promotion of health and well-being. The Mindful Employer Charter recognises that the Trust shows a positive and enabling attitude employees and job applicants with mental health issues. The Trust is committed providing non judgemental and proactive support individual staff who experience mental health issues. The Trust has been successful in providing ongoing evidence of compliance with the principles of the charter maintain charter status. Velindre NHS Trust has many services and supportive mechanisms in place help support the health and wellbeing of its staff. However, it recognises that there is always more do and through the Health and Wellbeing Framework the Trust 84

85 is committed working more collaboratively across the wider Trust, with partner and third secr organisations ensure that we continue support our staff and share best practice Creating the Velindre culture in outreach One of the challenges of the new clinical model will be our ability maintain the Velindre culture across the outreach facilities and in the community. This will be important, if we are ensure that our staff continue feel valued and part of our organisation, despite where and with whom they might be working. It will be important recognise that the outreach settings will be delivering services in, and receiving services from, our partner Health Boards whose staff may have a different culture. In the future, our staff will be working more in multi-disciplinary teams, which in many cases will be made up of staff from different organisations or secrs. We will need implement a number of organisation development interventions ensure that we build and maintain effective and collaborative teams. From the patient s perspective, this work will be vital ensure that the patient receives the same standards of care that they would expect receive in the Cancer Centre, no matter what location that care may be provided at in the future Supporting mangers deliver change The changes required deliver Transforming Cancer Services are large scale and complex and will be phased in over the next 5 years and beyond. Our managers will be key players so we will need develop our managers be able lead and deliver these changes whilst supporting staff through the change process. Ensuring effective engagement with our staff will be fundamental the successful implementation of the changes, and the Trust acknowledges that change can be challenging for some staff and therefore places significant emphasis of good staff health and well being. Leadership development has commenced and over the past three years, the Trust has invested in the development of its leaders ensure increased capacity and capability deliver large scale cultural and service change. This has been achieved through a number of initiatives: Velindre NHS Trust Leadership Development Programme the Trust is currently running its third annual programme, meaning that 48 junior or aspiring leaders have completed a 14 month programme of bespoke leadership development which enables experiential learning via workshops, action learning sets, 360 feedback and personal coaching sessions. The Trust intends continue offer this programme on an annual basis Velindre NHS Trust Senior Leadership Contingent a group of the 50 most senior/influential leaders within Velindre NHS Trust form a discrete group who come gether once a quarter explicitly explore the practical impact of their leadership role and responsibilities in light of the Trust s current performance and strategic plans. 85

86 5.7.9 Velindre NHS Trust Leadership Alumni former and current Leadership Development Programme delegates, along with IQT Silver graduates constitute our 60 strong Leadership Alumni. This group are offered ongoing development opportunities and are supported undertake specific projects and role extensions within the Trust Learning for Leadership enables a diverse timetable of leadership development talks/workshops be run across Velindre NHS Trust, inviting a wide range of speakers with an interesting/useful perspective on leadership deliver a session on one of our Trust premises Coaching support change coaching skills will be essential for our managers develop in order for them support staff through the change process so they can embrace and engage with the changes that are required of them. The Cancer Centre managers will be supported undertake coaching for performance Workforce Planning workforce planning training will be provided for managers in the Cancer Centre (via Workforce Education and Development Services). This training will build managers skills and knowledge in workforce planning, taking them through the recognized Skills for Health Six Step Methodology for Integrated Strategic Workforce Planning Workforce & OD support for planning and change The Workforce and OD team within the Trust has a range of skills and expertise that will support the Cancer Centre plan and deliver workforce transformation and changes required deliver the new clinical model. The team will work with managers, bringing in specific skills and expertise as required. This will included: o Support with workforce planning & transformation/modernisation of the workforce; o Workforce information including regular reporting of progress against strategic actions; o Workforce intelligence inform planning decisions; o Provision of education & development support change; o Leadership and management development; o Specialist advise support WOD advice and support change; o Expert advice on employment legislation, contracts, terms and conditions, policy and procedure; o OD interventions support change, staff engagement, values & behaviours and team building; o Promotion of staff health and well being Partnership Working The Trust places considerable value on its partnership working with the various Trade Unions recognised by NHS Wales. Through their attendance at various meetings (Programme Stakeholder Board and the Workforce Workstream) we welcome their contribution the successful development and delivery of the future workforce model. 86

87 The Trust has agreed a Partnership Working pledge promote partnership working and demonstrate Trust Board level support. It states: The Velindre NHS Trust pledges support partnership working through open and honest conversation, enabled through trusting relationships with a respect for the staff voice at all levels. Effective partnership working will support a culture that enables the delivery of high quality patient / donor care day, while engaging with transformational change plans for the future. 6.0 Risks and Opportunities 6.1 Workforce Challenges Age profile of our workforce/ageing of the workforce Impact of changes pensions and the affect on retirements Impact of changes higher earners pensions allowances on retirements Increased turnover/retirements due change fatigue Loss of skills and experience due retirement of people in small departments Reliance on small departments comprising staff from small professional groups and who have specialist skill and knowledge Emerging recruitment difficulties for experienced staff in some areas A number of professions that appear on the Shortage Occupations List Charitable/soft funding for some staff and functions Ability maintain a shared culture for staff working across the Centre, outreach and the Community Need develop a shared culture of staff working in multi-disciplinary and multi-organisational teams Long term supply of certain staff e.g. Consultant Radiologists Impact of Brexit on ability recruit from Europe/overseas 6.2 Workforce Opportunities New build, better facilities, technology and adjacencies creating an attractive workplace Increased staff wellbeing through innovative, modern building design and Trust interventions Integrated workforces and multi-disciplinary working - working across LHB and Third Secr Development of the Centre for Learning and Innovation which will provide access cutting edge learning & development Cancer Centre s leading role in Clinical Trials, Research and Development will provide career enhancement, increase links with academia and attract staff The Cancer Centre s reputation as an Employer of Choice, high levels of staff engagement and low turnover rates The suite of interlocking strategies that will give direction for the shape of the future workforce i.e. Cancer Strategy, People Strategy, OD Strategy, Education & Training Strategy etc IT systems that will enable access timely patient information 87

88 E-Rostering support planning and management of staff rosters ESR Enhance, ESR Self Service and Business Intelligence support managers access staff information Patient engagement inform the development of future workforce skills Development of Careers activities including work experience for students e.g. junior docrs Training placements attract staff e.g. Pharmacy, Radiotherapy student placements, Medical Trainee in Radiology Revisiting SLA arrangements in small professions Clinical networks development Explore different senior medical models of working and different skill mix support junior docr working models Large number of transformation opportunities identified through workshops and workforce planning discussions Review of skill mix, roles and workforce efficiencies Extended skills development Flexible working for the workforce 88

89 7.0 The Workforce Action Plan Table Operational Workforce Planning Timescales Responsible Comments Plan the workforce deliver services in the outreach settings including the non-velindre workforce support required from the health boards Jan 2018 TCS/Service Managers Work with commissioners, both locally and nationally, in the planning of new services and the impact this may have on our current and future workforce modelling. April 2018 TCS/Service Managers/HB Through the IMTP planning cycle, identify the requirements for education commissioning of graduate and postgraduate trainees and for extended skills such as non medical prescribers Various IMTP/Service Managers/TCS Undertake workforce benchmarking once the operational workforce plans are developed Various IMTP/Service Managers/TCS/Senior Workforce Business Partner Workforce Information Realise the benefits for new ways of working through the implementation of an e-rostering solution for staff working across the clinical model June 2018 Helen Watkins /ESR Team/Service Managers 89

90 Regular workforce analysis/moniring and measures monir emergent trends and gap analysis for the workforce changes e.g. turnover, retirements etc Organisation Development & Engagement Undertake work with our staff engage them in the change process and develop and deliver a coaching programme that will support staff make the transformations in working practices that will be required over the next decade. Continual with quarterly monthly review Bespoke sessions delivered long term ESR Team/ TCS/Service Mangers/Senior Workforce Business Partner TCS/Service Managers/OD Team/Communication Team Work with stakeholders including Local Health Boards and Third Secr develop integrated teams working across the Velindre outreach facilities and in the community. July 2018 TCS/Service Managers/HB Through implementation of the Trust s OD Strategy, Building Excellence, undertake work engage with and create a sustainable Velindre NHS Trust culture across the outreach facilities, both for staff directly employed by Velindre NHS Trust and those who work in partnership with us, ensure our staff retain a sense of belonging the organization and so that our patients receive a consistent service no matter where they are treated. Delivered as part of the Trust OD Strategy Helen Watkins Participate in the ongoing patient engagement work ensure that the patient voice is also central the planning of the future workforce. Ongoing TCS/Communication and Engagement Mgr/Patient Liaison 90

91 Work with the leads for development of the clinical model on the patient pathways identify and explore workforce Modernisation and transformation opportunities ( in line the Prudent Healthcare principle only do what only you can do ) e.g. skill mix, new competences, role redesign etc building on the recent work from the Nuffield Trust. April 2018 TCS/Service Managers/Clinical Teams Using the results, develop actions deliver any recommendations from the 20 Staff Survey (due December 20) maintain our positive levels of staff engagement. December 2017 Helen Watkins / Senior Workforce Business Partner / Service Managers Work with service leads ensure that the core skills and competencies required by our future workforce are mapped enable us create the skilled, knowledgeable, adaptable and flexible workforce we need. April 2018 Training and Development Mgr/Service Managers / TCS Based on the national work, develop succession planning and talent management strategies that will enable us develop our existing staff so that we have the skilled staff fill roles that we require and that we retain staff April 2018 Ongoing OD Team / Service Managers / Senior Workforce Business Partner Working with the Working Longer Group for NHS Wales and using the outcomes of the Velindre NHS Trust Deep Dive, identify a suite of actions that will support our staff work longer December 2017 Senior WOD Team /Senior Workforce Business Partner/TCS/Service Managers Develop a Trust approach Careers activities that will support our long term recruitment, skills availability and the widening access April 2018 Senior WOD Team/ Senior Workforce Business Partner/TCS 91

92 Continue develop cross cutting themes of work that will support Velindre NHS Trust s aim be an employer of choice and enhance our ability recruit high calibre staff Ongoing Senior WOD Team/ Senior Workforce Business Partner/TCS People Management Finalise the People Strategy (2017) and review the workforce actions for the Transforming Cancer Services Programme in line with the strategic aims of this strategy. December 2017 Senior WOD Team Explore the potential and/or need for a Physicians Associate or other appropriate workforce support the junior docrs ward duties and enhance patient care. April 2018 Clinical Direcr/WEDS/ Service Leads/Senior Workforce Business Partner/TCS To facilitate future flexible working patterns of staff, work be undertaken on potential contractual changes required from staff having work shift patterns, changes on call, working across the 7 day period, staff rotation and multi-based workers 2022/23 Senior Workforce Business Partner/TCS/Service Managers Working within the national work programme, Hire Retire, making best use of developments such as ESR Enhance, explore opportunities develop a record of the whole workforce skills that can be used in future workforce planning. 92 Dec 2017 Karen Wright, Assistant Direcr of Workforce/ESR Team/Senior Workforce Business Partner/Education and Development

93 Team Implement the recommendation from the Equality Impact Assessment of the workforce elements of the Transforming Cancer Services Programme Actioned throughout the duration of the project plan TCS/Service Managers Undertake a project map and record the current sessions of commitment for both DCC and SPA for the Consultant Workforce including the locations of the sessions of commitment, the site specific specialism and the remuneration routes. Through Job Planning define a medical model that creates the most efficient work patterns within new model and across LHBs. April 2018 Clinical Direcr/TCS/Senior Workforce Business partner Explore alternative workforce solutions and options both support the junior docrs training and provide more service continuity; this could include consideration of on call arrangements, training capacity and the introduction of new roles such as the Physicians Associate or extending the skills of other appropriate workers. April 2018 Clinical Direcr/Junior Docrs/TCS/Senior Workforce Business partner Support the review of the Clinical Nurse Specialist and Advance Nurse Practitioner roles inform the development of the future nursing workforce, ensure the best use of appropriate and specialist skills meet patient need as per Prudent Healthcare principles. December 2017 Nursing Lead/TCS/ Senior Workforce Business partner/education and Development Team 93

94 Explore the potential for the rotation of staff between the Cancer Centre and the outreach facilities and the contractual implications of such a change April 2018 TCS/ Senior Workforce Business partner /Nursing Lead Implement the workforce recommendations from the Trust Radiotherapy Strategy and Cancer Strategy. April 2018 TCS/ Senior Workforce Business partner /Service Managers Plan for an ageing workforce through the development and utilisation of workforce strategies, policies and ols ensure that proposed changes working practices and skill development enable us attract and retain older workers, their experience and knowledge. This will include exploring flexibility for ageing workforce, retention of shortage skills especially within the smaller professional groups and will consider the impact of pensions changes. April 2018 ongoing Senior WOD/ TCS/ Senior Workforce Business partner /Service Managers Work with our trade union partners deliver change ensuring attendance at appropriate meetings. Ongoing Senior WOD/ TCS/ Senior Workforce Business partner /Service Managers 94

95 Develop a recruitment/resourcing plan that identifies our approaches the resourcing of the additional staffing required by changes the clinical model that identifies the resources required achieve this e.g. A4C matching capacity and maximises our recruitment opportunities, exploit all options for retaining our current workforce and introduce ways of attracting returners. Implement the requirements of the Welsh Language Standards including an ongoing review of roles ensure that we identify those roles where Welsh speaking would be essential. April 2018 TCS/ Senior Workforce Business partner /Service Managers Ongoing Welsh Language Officer/ TCS/ Senior Workforce Business partner /Service Managers Work with Third Secr review posts that work within our service that are charitably funded ensure that the right mix of skills is available meet shared goals and provide an enhanced service for our patients. December 2017 TCS/Service Managers/ Senior Workforce Business partner/finance Lead Work with Third Secr identify and develop opportunities work across secrs e.g. development of Psychology services in partnership across the Cancer Centre and Maggie s Centre. April 2018 TCS/Service Managers/ Senior Workforce Business partner/finance Lead Explore the implications of Brexit on the workforce including recruitment and retention and potential changes the research environment impacting on staffing. April 2018 Senior WOD/ TCS/ Senior Workforce Business partner /Service Managers 95

96 Education & Learning Development Develop the Education Strategy define the Trust s approach the future education and ongoing development for the next 10 years enable the development of the workforce so that it is capable, competent, highly skilled and adaptable a rapidly changing medical, scientific and technological environment. Work with WEDS lead develop apprenticeship routes in areas including Medical Physics. Work with the Clinical Lead for the development of the Centre for Learning and Innovation (C4LI) ensure that its proposed lead role in education, research and development and innovation enables us deliver the education needed create our future workforce and enhance the skills of the wider team. December 2017 September 2017 December 2017 Education & Development/Service Managers WEDS/Service Managers/TCS/Senior Workforce Business Partner/Education & Development Education & Development/ Clinical Managers / Service Leads/TCS Develop our leader s skills sets support then deliver the service changes through the delivery of the Trust Leadership Development Programme. Ongoing Senior OD Business Partner / OD Team Work with service leads develop career pathways that will attract and retain staff e.g. for Healthcare Support Workers Using the Healthcare Support Worker Framework, develop and extend the skills of our clinical and non clinical healthcare support workers. Ongoing Service Managers/TCS/Senior Workforce Business Partner/Education & Development Ongoing Service Managers/ Education and Development/TCS Develop managers skill sets support then deliver the service changes through the development of the Managers Skills Framework. Ongoing Senior WOD/ Education and Development/TCS 96

97 Develop a development programme that will increase the Workforce & OD staff skills sets support the service changes. Ongoing Senior WOD/ Education and Development Develop a change management package of guidance and training that will support managers deliver a complex, ongoing and multiple layered change programme. December 2017 Senior OD Business Partner Make changes the current Trust induction programme and other relevant training programmes ensure that existing and new staff are aware of the planned changes services and working arrangements. Ensure that Cancer Centre managers are able access workforce planning training for managers being offered by WEDS. September 2017 Education and Development/Senior Workforce Business Partner April 2017 Senior WOD Completed Support managers undertake training need analysis that will support ongoing work on succession planning and talent management. Support managers undertake skills mapping assess our future skills needs and create attractive career pathways for our current and future staff that will enable recruitment and retention. April 2018 Education and Development/Senior Workforce Business Partner December 2017 TCS Work with WEDS ensure that managers from the Cancer Centre are able participate in the recruitment of students courses. April 2018 TCS/WEDS/Service Managers/ Education and Development Work with partner organizations and education providers develop and provide training where appropriate e.g. NWIS for Information skills. April 2018 TCS/Service Managers/Education and Development 97

98 Staff Wellbeing and management Address any actions that relate staff health & wellbeing from the 20 Staff Survey. Dec 2017 Senior Workforce Business Partner/TCS Using the Trust Health & Wellbeing Framework implement interventions that will support our staff and managers through the change process e.g. stress awareness assessments, stress awareness training etc. Ongoing Senior Workforce Business Partner/TCS/Service Managers Undertake work ensure that we widen access employment with the Cancer Centre ensure that our workforce is representative of the population that it serves Ongoing Senior Workforce Business Partner/TCS/Service Managers Promote the availability of management training and development ensure that our managers have the skills they require undertake this large scale change programme e.g. ILM qualifications, service improvement skills etc. Ongoing review attendance yearly Senior Workforce Business Partner / Education and Development / TCS/ Service managers 98

99 WORKFORCE AND OD COMMITTEE Delivering Excellence - Progress report Meeting Date: 11th May 2017 Author: Sponsoring Executive Direcr: Report Presented by: William Oliver, Associate Direcr of Planning and Performance Sarah Morley, Executive Direcr of OD and Workforce Sarah Morley Direcr of OD and Workforce Trust Resolution : (please tick) Approve: Endorse: Discuss: Note: Recommendation: The Committee is asked DISCUSS and NOTE the contents of this report. This report supports the following Trust objectives as set out in the Integrated Medium Term Plan: (please tick) Equitable and timely services Providing evidence based care and research which is clinically effective Supporting our staff excel Safe and reliable services First class patient /donor experience Spending every pound well This report supports the following Health & Care Standards: Staff and resources: 7.1 Workforce

100 2 Delivering Excellence Progress report 1. Introduction / Background 1.1. This report provides an update the committee with respect progress against the Velindre NHS Trust s three year strategic plan - Delivering Excellence and against Trust wide key performance metrics. 2. Timing: 2.1. Reporting period February Description: 3.1. The Progress Report has been developed and produced by the Trust Planning and Performance team; working closely with the Executive leads, and provides a summary of progress against the objectives and performance metrics in the three year plan which have been deemed either a Level 1 or a Level 2 priority and which fall within the remit of this Committee. Definitions of the priority levels are shown below: 4. Financial Impact: 4.1. Delivery of the performance metrics presented in the report and work associated with delivering improved performance supports sound financial governance across the Trust. 5. Quality, Equality, Safety and Patient Experience Impact: 5.1. Work in support of improving and sustaining performance is subject assessment against healthcare standards and other relevant standards and is subject full EQIA processes in line with Trust policy Page 2

101 3 Delivering Excellence Progress report 6. Considerations for Board / Committee: 6.1. The report identifies the following performance measures that may have fallen below the agreed target and reported as Red. These are highlighted the committee as requiring further discussion. Additional objectives at an amber level are reported in the performance report. Area Objective Issue / Action Page number in report Performance (February 2017) unless indicated otherwise VCC- 85% PADR Rate Issue: As at 28 th February 2017 the Velindre Cancer Centre PADR rate has decreased 61.35%. The last few months has shown a notable decrease in PADR rates at VCC and an improvement will be required achieve the 85% target. Actions: Monthly moniring and reporting at VCC SMT and direct managers % COP 006 Issues: There has been a 5.2% increase in activity in Corporate Services Corporate- 85% PADR Actions: An ongoing programme of PADR activity reporting is underway, with regular Divisional and departmental reports being distributed, along with calculations of how many additional PADR s are required in each area in order meet the Trust s activity target. Two drop in sessions have been arranged at Welsh Blood Service support managers with the completion of the new PADR form % Page 3

102 4 Delivering Excellence Progress report Trust Wide- 85% PADR WBS- 85% PADR Individual discussions about PADR activity take place with all Executive Direcrs in their CEO one--ones, and Workforce Business Partners and Assistants also raise PADR activity on a regular basis with departmental managers. Issue: As demonstrated in the chart below the overall Trust-wide PADR activity % at of the end of February 2017 illustrates a % decrease (the overall Trust PADR rate is now 68.89%). Actions: An ongoing programme of PADR activity reporting is underway, with regular Divisional and departmental reports being distributed, along with calculations of how many additional PADR s are required in each area in order meet the Trust s activity target. Individual discussions about PADR activity take place with all Executive Direcrs in their CEO one--ones, and Workforce Business Partners and Assistants also raise PADR activity on a regular basis with departmental managers. Issue: The PADR compliance rate at WBS as at 28 th February 2017 is 78.01%, which is a decrease on January s 81.21%. Actions: The revised PADR policy is currently out for consultation. Comments should be submitted by 10th January. The draft PADR policy is % % Page 4

103 5 Delivering Excellence Progress report available view on the Trust intranet. Issue: The Velindre Cancer Centre January long term sickness figure is 2.73% which has reduced since December. Short term sickness increased slightly 1.52%. VCC- 3.54% Sickness absence rate Actions: A review of long term sickness cases is due take place with managers in the New Year with actions agreed % (January 2017) COR 007 Corporate- 3.54% Sickness absence rate The Workforce update report for SMT from early 2017 will include the number of staff in each department who have hit triggers in line with the Sickness Absence Policy but there is no record of them being managed in line with the policy. Workforce currently report on the number of staff who are currently being managed in line with the Sickness Absence Policy. Issue: Corporate cumulative sickness absence rate for January is 4.89% which is a decrease from December 4.98%. Long terms sickness increased in Corporate in December by approximately 1% (4.77%), whilst short term sickness absence decreased slightly (0.65%) % (January 2017) Actions: NWSSP Internal Audit have submitted the Managing Absence Audit Report. Priority actions have been completed following the management response Page 5

104 6 Delivering Excellence Progress report Trust Wide- 3.54% Sickness absence rate WBS- 3.54% Sickness absence rate Issue: Sickness management support continues be provided by the Workforce team across the Trust. Actions: From early 2017 the Workforce team will be reporting on the number of staff who have hit triggers but are not being managed in line with the Sickness Absence policy. This will be reported SMTs. Issue: The Welsh Blood Service cumulative sickness absence rate for January is 4.93% which remains unchanged from December. Actions: Senior Workforce & OD Business Partner present sickness management on a regular basis the Senior Management Team and also the Workforce team present sickness metrics and information at departmental operational meetings % (January 2017) % (January 2017) 3 Year Plan objectives Level Status WOD01 Leadership & Management Capability 2 WOD02 Quality & Continuous Improvement 2 WOD03 Diversity & Inclusiveness 2 WOD04 Staff Engagement & Well Being 2 Page 6

105 7 Delivering Excellence Progress report WOD05 Collaborative & Partnership working 2 7. Next Steps: 7.1. The Committee is asked DISCUSS and NOTE the contents of this report and the current status of the objectives and performance measures. Page 7

106 Workforce & Organisational Development Committee Delivering Excellence Reporting Period February

107 May 2017 Workforce & Organisational Development Committee Contents Keys... 2 Section 1 At a Glance Summary - Service Performance Status... 3 Velindre Cancer Centre... 3 Supporting our Staff Excel... 3 Corporate Services... 4 Workforce and Organisational Development... 4 At a Glance Summary Progress against 3 Year Plan Objectives... 5 Welsh Blood Service... 6 Supporting our Staff Excel... 6 At a Glance Summary Progress against 3 Year Plan Objectives... 6 Section 2 Progress against Strategic Priorities... 7 Velindre Cancer Centre... 7 Our Key Performance Metrics... 7 Corporate Services Workforce and Organisational Development Our Key Performance Metrics Welsh Blood Service Our Key Performance Metrics

108 May 2017 Workforce and Organisational Development Committee Keys Green Red Service Performance Target achieved this month Target not achieved this month Green Amber Red Closed Purple Grey Delivery again Plan Actively managed processes proceeding as planned - no major risks or issues identified Problems have surfaced, considered manageable in the normal course Serious problems have surfaced make Senior Management Team aware Major issues remain unsolved- on hold until resolved - senior executive engaged Deliverable activity at feasibility/initiation stage Risk Status Likelihood and impact of non - achievement 2

109 May 2017 Workforce and Organisational Development Committee Section 1 At a Glance Summary - Service Performance Status Velindre Cancer Centre Supporting our Staff Excel Metric Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Assuring Committee Highlight Report Page No. COR % PADR Rate COR % Sickness absence rate 56.8% 56.2% 59.4% 61.1% 71.3% 74.1% 75.7% 75.7% 66.6% 65.1% 62.2% 61.4% WoD 4.20% 4.08% 4.05% 4.00% 3.91% 3.73% 3.59% 3.60% 3.56% 3.50% 3.53% Data is one month behind WoD 7 8 3

110 May 2017 Workforce & Organisational Development Committee Corporate Services Workforce and Organisational Development Level 1 Metric Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Assuring Committee Highlight Report Page No. COR % Sickness Absence rate (Trust Wide) 4.46% 4.33% 4.28% 4.22% 4.18% 4.14% 4.11% 4.19% 4.18% 4.14% 4.15% Data is a month behind WoD 13 COR % PADR (Trust Wide) 60.4% 59.7% 64.2% 66.2% 72.2% 75.1% 77.6% 77.6% 70.8% 71.8% 70.0% 68.9% WoD 10 COR % Sickness Absence rate (Corporate Services) 4.11% 4.11% 4.20% 4.27% 4.17% 4.64% 4.90% 4.91% 4.86% 4.98% 4.89% Data is a month behind WoD 13 COR % PADR (Corporate Services) 43.8% 42.9% 62.8% 68.5% 72.9% 76.4% 77.4% 77.4% 74.3% 73.2% 71.6% 76.8% WoD 10 4

111 May 2017 Workforce & Organisational Development Committee At a Glance Summary Progress against 3 Year Plan Objectives Area Objective Level Status Forecast Status Risk Assuring Committee Highlight Report Page No. Workforce and Organisational Development WOD01 Leadership & Management Capability 2 WoD N/A WOD02 Quality & Continuous Improvement 2 WoD N/A WOD03 Diversity & Inclusiveness 2 WoD N/A WOD04 Staff Engagement & Well Being 2 WoD N/A WOD05 Collaborative & Partnership working 2 WoD N/A 5

112 May 2017 Workforce & Organisational Development Committee Welsh Blood Service Supporting our Staff Excel Metric Level 1 Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Assuring Committee Highlight Report Page No. 85% PADR Rate 71.3% 70.1% 73% 74.3% 73.5% 76.4% 77.4% 80.7% 76.3% 81.5% 81.2% 78.0% WoD % Sickness absence rate 5.02% 4.82% 4.67% 4.58% 4.63% 4.67% 4.74% 4.94% 5.00% 4.94% 4.93% Data is a month behind WoD 22 At a Glance Summary Progress against 3 Year Plan Objectives Strategic Theme Objective Level Status Forecast Status Risk Assuring Committee Highlight Report Page No. Supporting our staff excel WBS 021 To deliver new service models through an engaged and empowered workforce 2 WoD N/A WBS 022 To ensure optimal flexible working patterns support new service models 2 WoD N/A WBS 023 To develop a flexible laborary workforce using Modernising Scientific Careers 2 WoD N/A 6

113 May 2017 Workforce & Organisational Development Committee Section 2 Progress against Strategic Priorities Velindre Cancer Centre Our Key Performance Metrics COR 006- PADR rate VCC PADR's 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target Sry behind progress and performance : As at 28 th February 2017 the Velindre Cancer Centre PADR rate has decreased 61.4%. The last few months has shown a notable decrease in PADR rates at VCC and an improvement will be required achieve the 85% target. The overall Trust PADR rate is 69.9% which is a drop on the previous month which was 70.0%. PADR compliance information for Corporate, WBS and VCC continues be sent all managers on a weekly basis, which also details the shortfall against the 85% compliance target. PADR compliance is reported at SMT on a monthly basis (for all departments) by Workforce and in the service area operational meetings. Drop in sessions for managers so they can raise queries in relation the completion of the new PADR form and the changes the PADR policy have been held at WBS and VCC with more be scheduled in the near future. The PADR policy has been finalised following consultation and will be 7

114 May 2017 Workforce & Organisational Development Committee available on the Trust intranet shortly. Action(s) and dates for improvement: Risks and Issues: Accountable manager: Monthly moniring and reporting at VCC SMT and direct managers. Managers are reminded raise queries with the Workforce team if they consider the reporting figures are not accurate in ESR. Direcr of Cancer Services COR 007- Sickness absence rate Trust (excl. hosted) Sickness/Absence Rates 5.50% 5.00% 4.50% 4.00% 3.50% 3.00% Mar-15 Feb- Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Velindre NHS Trust (excluding hosted) Corporate Services Velindre Cancer Centre Welsh Blood Service Sry behind progress and performance : The cumulative sickness absence rate for January is 3.5% which is slight increase on December s 3.5%. The Velindre NHS Trust cumulative sickness rate is 4.2%. The Velindre Cancer Centre January long term sickness figure is 2.7% which has reduced since December. Short term sickness increased slightly 1.5%. The Workforce team are requesting regular updates from managers on long term sickness absence cases, which will be reviewed at monthly sickness absence meetings within Workforce. Both Band 5 Workforce Advisors and Band 4 Assistant Workforce Advisors continue work closely with managers providing support on sickness absence cases as appropriate. Anxiety/stress/depression remains the p reason for sickness episodes. Managers are reminded not enter reasons for sickness absence as unknown or other in ESR. 8

115 May 2017 Workforce & Organisational Development Committee Action(s) and dates for improvement: Risks and Issues: Accountable manager: A review of long term sickness cases is due take place with managers in the New Year with actions agreed. The Workforce update report for SMT from early 2017 will include the number of staff in each department who have hit triggers in line with the Sickness Absence Policy but there is no record of them being managed in line with the policy. Workforce currently report on the number of staff who are currently being managed in line with the Sickness Absence Policy. The Workforce Advisors who meet regularly with managers have reported concerns that managers are not seeing employees in line with the Sickness Absence Policy. This is being addressed with managers directly and they are being reminded of employees being managed in a fair and consistent way. Direcr of Cancer Services 9

116 May 2017 Workforce & Organisational Development Committee Corporate Services Workforce and Organisational Development Our Key Performance Metrics Level 1 Ensure all staff have a PADR Primary Responsibility for Assurance: Workforce & OD Committee 100.0% 80.0% 60.0% 40.0% 20.0% Trust (excl. hosted) PADR's 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target VCC PADR's 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target 10

117 May 2017 Workforce & Organisational Development Committee WBS PADR's 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target Corporate PADR's 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target Progress against actions within the IMTP: Month Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Status Sry behind progress and performance : As demonstrated in the chart below the overall Trust-wide PADR activity % at of the end of February 2017 illustrates a % decrease (the overall Trust PADR rate is now 68.9%). There has been a 5.2% increase in activity in Corporate Services, a 3.2% decrease in activity at WBS and a 0.8% decrease in activity at Velindre Cancer Centre. A concerted effort is required move the Trust closer the 85% target achieve our minimum required level. 11

118 May 2017 Workforce & Organisational Development Committee The ongoing pattern of Divisional and Trust-wide % activity at the end of February is presented in the run chart overleaf and illustrates increased activity in all three Divisions: 85.0% 80.0% 75.0% 70.0% 65.0% 60.0% 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% Trust-wide VCC WBS Corporate VCC: As at 28 th February 2017 the Velindre Cancer Centre PADR rate has decreased 61.4%. The last few months has shown a notable decrease in PADR rates at VCC and an improvement will be required achieve the 85% target. The overall Trust PADR rate is 68.9% which is a drop on the previous month which was 70.0%. PADR compliance information for Corporate, WBS and VCC continues be sent all managers on a weekly basis, which also details the shortfall against the 85% compliance target. PADR compliance is reported at SMT on a monthly basis (for all departments) by Workforce and in the service area operational meetings. Drop in sessions for managers so they can raise queries in relation the completion of the new PADR form and the changes the PADR policy have been held at WBS and VCC with more be scheduled in the near future. The PADR policy has been finalised following consultation and will be available on the Trust intranet shortly. WBS: The PADR compliance rate at WBS as at 28 th February 2017 is 78.0%, which is a decrease on January s 81.2%. The Velindre NHS Trust rate is 68.9%. The target remains 85%. PADR compliance is reported at SMT on a monthly basis by Workforce, also at the WBS Workforce Management Meeting. The Workforce Advisors also attend the local operational department meetings and provide a monthly report which also includes 12

119 May 2017 Workforce & Organisational Development Committee Action(s) and dates for improvement: PADR compliance. Managers are requested raise any queries with Workforce in relation the PADR reporting figures An ongoing programme of PADR activity reporting is underway, with regular Divisional and departmental reports being distributed, along with calculations of how many additional PADR s are required in each area in order meet the Trust s activity target. The PADR policy has been revised and agreed. The pay progression guidelines will shortly be available on the Trust intranet. Drop in sessions have been held at Welsh Blood Service and Velindre Cancer Centre with more be scheduled. Individual discussions about PADR activity take place with all Executive Direcrs in their CEO one--ones, and Workforce Business Partners and Assistants also raise PADR activity on a regular basis with departmental managers. Risks and Issues: It remains challenging ensure PADR is a high departmental priority in all areas of the Trust. Failure improve PADR rates will have a direct impact on the All Wales Pay Progression process. Accountable Executive Direcr of OD & Workforce manager: Optimise staff attendance Primary Responsibility for Assurance: Workforce & OD Committee Trust (excl. hosted) Sickness/Absence Rates 5.50% 5.00% 4.50% 4.00% 3.50% 3.00% Mar-15 Feb- Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Velindre NHS Trust (excluding hosted) Corporate Services Velindre Cancer Centre Welsh Blood Service 13

120 May 2017 Workforce & Organisational Development Committee Number of Sickness Episodes Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 Corporate VCC WBS Estimated Sickness Costs 1,000, , , , ,000 0 Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 Corporate VCC WBS Progress against actions within the IMTP: Month Dec 15 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Status Sry behind progress and performance : Sickness management support continues be provided by the Workforce team across the Trust. Monthly review meetings have commenced within the Workforce team monir sickness activity and provide updates on sickness cases. Sickness absence audits have commenced in high sickness areas with the first being held at VCC. WBS sickness audits are also due commence shortly. The compliance rates will be reported in Workforce & OD update reports 14

121 May 2017 Workforce & Organisational Development Committee at SMTs commencing April. VCC: The cumulative sickness absence rate for January is 3.53% which is slight increase on December s 3.50%. The Velindre NHS Trust cumulative sickness rate is 4.15%. The Velindre Cancer Centre January long term sickness figure is 2.73% which has reduced since December. Short term sickness increased slightly 1.52%. The Workforce team are requesting regular updates from managers on long term sickness absence cases, which will be reviewed at monthly sickness absence meetings within Workforce. Both Band 5 Workforce Advisors and Band 4 Assistant Workforce Advisors continue work closely with managers providing support on sickness absence cases as appropriate. Anxiety/stress/depression remains the p reason for sickness episodes. Managers are reminded not enter reasons for sickness absence as unknown or other in ESR. WBS: The Welsh Blood Service cumulative sickness absence rate for January is 4.93% which remains unchanged from December. Sickness absence audits in WBS are due commence the last week of March and compliance rates will be reported in the Workforce & OD report SMT. The Workforce team (band 5s and Band 4s) have dedicated areas throughout the service and are currently meeting with managers support them in managing their sickness cases. Monthly update meetings have been scheduled within the Workforce team, so the Band 5 and Band 4s provide updates on sickness cases following local meetings with managers. Anxiety/stress/depression remains the p reason for sickness at WBS which is in keeping with VNHST and other Health Boards. It has been noted in WBS there is a high level of unknown and other being selected as reason for sickness absence on the Electronic Staff Record (ESR). It is important that the correct reason for sickness is 15

122 May 2017 Workforce & Organisational Development Committee entered in the ESR system. If managers are unsure of the reason when employees commence sickness leave, they should update ESR accurately when they close sickness (when staff return work). Action(s) and dates for improvement: Corporate cumulative sickness absence rate for January is 4.89% which is a decrease from December 4.98%. Long terms sickness increased in Corporate in December by approximately 1% (4.77%), whilst short term sickness absence decreased slightly (0.65%). In the first quarter of 2017 the Workforce team will be reporting on the number of staff who have hit triggers but are not being managed in line with the Sickness Absence policy. This will be reported SMT. NWSSP Internal Audit have submitted the Managing Absence Audit Report. Priority actions have been completed following the management response. Risks and Issues: Not achieving the WG target of 3.54%. Not achieving the 1% reduction in sickness absence as requested by the Minister by 20. Increase the usage of Self Service by managers ensure up date data is available. A number of actions have been agreed by the ESR Project team address this issue. High sickness absence has a direct impact on the services that we provide and often results in additional financial pressures cover the absence through bank or overtime. In addition the absence of a team member often puts pressure on colleagues cover the work. This often has a negative impact on the quality of services and staff moral and wellbeing. Accountable manager: Executive Direcr of OD and Workforce

123 May 2017 Workforce & Organisational Development Committee Support staff undertake all Mandary and Statury Training Primary Responsibility for Assurance: Workforce & OD Committee st January 2017 th February 2017 CSTF Subject WBS VCC Corporate Trust CSTF Subject WBS VCC Corporate Trust Equality 76% 65% 50% 60% Fire Safety 84% 67% 51% 64% Health & Safety 78% 70% 61% 68% Infection Control 43% 64% 40% 44% Information Governance 83% 70% 60% 69% Manual Handling 27% 53% 39% 36% Resuscitation 37% 52% 49% 45% Safeguarding Adults 36% 57% 51% 46% Safeguarding Children 40% 59% 41% 43% Violence & Aggression 32% 69% 51% 46% Overall Compliance 63% 48% 63% 52% Equality 77% 52% 69% 62% Fire Safety 87% 53% 71% 66% Health & Safety Infection Control Information Governance Manual Handling 81% 63% 74% 70% 59% 52% 67% 56% 90% 61% 73% 72% 31% 41% 55% 39% Resuscitation 48% 55% 55% 53% Safeguarding Adults Safeguarding Children 72% 59% 62% 63% 63% 55% 61% 58% Violence & Aggression Overall Compliance 39% 52% 71% 50% 65% 54% 66% 59% 17

124 May 2017 Workforce & Organisational Development Committee Progress against actions within the IMTP: Month Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Mar 17 Status No data Sry behind progress and performance : The elearning for Velindre NHS Trust has been accessed via ESR since 21 st November 20. Accessing elearning for Safeguarding Adults, Safeguarding Children and Infection Prevention and Control at level 2 on the old Learning@Wales platform did not aumatically give the competence for level 1. Completion of the said courses at level 2 via ESR will now award both competencies (level 1 and level 2). Therefore, a significant amount of work has taken place in the background of ESR award those staff the level 1 competency who achieved level 2 within the old platform. The upload has been completed approx. 60% mainly WBS staff with the target complete before the next reporting date in April. The overall compliance for the 10 CSTF level 1 has increased by 7% 18

125 May 2017 Workforce & Organisational Development Committee since last reported in January. Work is underway ensure clear communication on what level is required for each staff group gether with the frequency. To understand the challenges with current performance and identify ways of improving understanding of individual requirements, a Mandary & Statury Steering Group was set up, the first meeting ok place on 7 th Ocber 20, from this group a Task and Finish group was formed produce a training needs analysis/diagnostic ol for the 10 CSTF s identify the requirements for staff groups within Velindre NHS Trust. The TNA has been produced electronically and will be rolled out the piloted areas in April, suggested areas are Nursing and Estates teams. The data collected will be manually inputted in ESR by the Education and Development Team. Lessons learned from piloted areas be noted with the rollout for the remainder of the Trust in May 2017 The benefits of the project will be: Improved performance compliance across the Trust. Clear definitions and requirements for managers and staff Employee compliance matrix correctly identify training requirements and compliance Data input in ESR will record accurate requirements for staff groups, allowing for statistical reports be generated using BI Managers will have access generate own accurate departmental statistics Monthly reporting on 10 CSTF compliance Quarterly reporting for all other identified M&S training Cleansing of the Learning Management System within ESR is underway with the aim that individuals compliance matrix will reflect the pathway of training required for their role. The 10 CSTF is currently the main focus but this will follow with the remainder of the statury and mandary training. The majority of the old KSF competencies have now been removed, completion of this project end of April Local competencies are being replaced with national competencies eg 19

126 May 2017 Workforce & Organisational Development Committee Mandary and CSTF, so there will be movement within the compliance matrix over the next few months. Actionpoint has been implemented as the elearning helpdesk, this is managed by the Education and Development team, the queries that have come through show real engagement from staff within their own personal compliance matrix which is a positive sign. The compliance matrix and targeting of poor complying departments/individuals will be the driver improving the compliance percentage in the very near future. This will reflect in the benchmarking on the National Dashboard. Action(s) and dates for improvement: Risks and Issues: Knowledge Skills Framework Competencies removal April 2017 Roll out TNA piloted areas April 2017 Completion of ESR Cleansing, Level 1 competencies, Local competencies end of April 2017 Trust wide Roll out May 2017 Data upload May July 2017 The Trust will not achieve Welsh Government targets for Mandary and Statury compliance Regulary compliance issues may be identified as a failure undertake appropriate training Accountable manager: Executive Direcr of OD and Workforce 20

127 May 2017 Workforce & Organisational Development Committee Welsh Blood Service Our Key Performance Metrics PADR rate Primary Responsibility for Assurance: Workforce & OD Committee WBS PADR's 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Mar- Feb-17 % Reviews Complete % Target Progress against actions within the IMTP: Month Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Feb 17 Mar 17 Status Sry behind progress and performance : The PADR compliance rate at WBS as at 28 th February 2017 is 78.0%, which is a decrease on January s 81.2%. The Velindre NHS Trust rate is 68.9%. The target remains 85%. PADR compliance is reported at SMT on a monthly basis by Workforce, also at the WBS Workforce Management Meeting. The Workforce Advisors also attend the local operational department meetings and provide a monthly report which also includes PADR compliance. Managers are requested raise any queries with Workforce in relation the PADR reporting figures. 21

128 May 2017 Workforce & Organisational Development Committee Action(s) and dates for improvement: The revised PADR policy is currently out for consultation. Comments should be submitted by 10th January. The draft PADR policy is available view on the Trust intranet. A revised PADR form has also been created which reflects the Trust Values and is now available on the Trust intranet. Two drop in PADR training sessions have also been held at WBS, so manages will have an opportunity of raising any queries with regard the new form/process. Guidance notes have also been produced with regard pay progression. This will be available in the New Year. Risks and Issues: Accountable manager: Failure continue the improvement in PADR rates will have a direct impact on the All Wales Pay Progression process. Direcr of Welsh Blood Service Sickness absence rate Trust (excl. hosted) Sickness/Absence Rates 5.50% 5.00% 4.50% 4.00% 3.50% 3.00% Mar-15 Feb- Apr-15 Mar- May-15 Apr- Jun-15 May- Jul-15 Jun- Aug-15 Jul- Sept-15 Aug- Oct-15 Sept- Nov-15 Oct- Dec-15 Nov- Jan- Dec- Feb Jan-17 Velindre NHS Trust (excluding hosted) Corporate Services Velindre Cancer Centre Welsh Blood Service Progress against actions within the IMTP: Month Dec 15 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan 17 Status 22

129 May 2017 Workforce & Organisational Development Committee Sry behind progress and performance : The Welsh Blood Service cumulative sickness absence rate for January is 4.93% which remains unchanged from December. Sickness absence audits in WBS are due commence the last week of March and compliance rates will be reported in the Workforce & OD report SMT. The Workforce team (band 5s and Band 4s) have dedicated areas throughout the service and are currently meeting with managers support them in managing their sickness cases. Monthly update meetings have been scheduled within the Workforce team, so the Band 5 and Band 4s provide updates on sickness cases following local meetings with managers. Anxiety/stress/depression remains the p reason for sickness at WBS which is in keeping with VNHST and other Health Boards. It has been noted in WBS there is a high level of unknown and other being selected as reason for sickness absence on the Electronic Staff Record (ESR). It is important that the correct reason for sickness is entered in the ESR system. If managers are unsure of the reason when employees commence sickness leave, they should update ESR accurately when they close sickness (when staff return work). Action(s) and dates for improvement: Senior Workforce & OD Business Partner present sickness management on a regular basis the Senior Management Team and also the Workforce team present sickness metrics and information at departmental operational meetings. Risks and Issues: Not achieving the Welsh Government target of 3.54%. Not achieving the 1% reduction in sickness absence as requested by the Minister for 20. Increase the usage of Self Service by managers ensure current data is available. High sickness absence has a direct impact on the services that we provide and often results in additional financial pressures cover the absence through overtime. In addition the absence of a team member often puts pressure on colleagues 23

130 May 2017 Workforce & Organisational Development Committee cover the work. This often has a negative impact on the quality of services and staff morale and wellbeing. Accountable manager: Direcr of Welsh Blood Service 24

131 1 Workforce & OD Update Report WORKFORCE AND OD COMMITTEE WORKFORCE & ORGANISATIONAL DEVELOPMENT UPDATE REPORT Meeting Date: 11 th May 2017 Author: Sponsoring Executive Direcr: Report Presented by: Committee/Group who have received or considered this paper: Workforce & OD Team Sarah Morley Executive Direcr of OD and Workforce Sarah Morley Executive Direcr of OD and Workforce N/A Trust Resolution : (please tick) Approve: Endorse: Discuss: Note: Recommendation: The Board is requested NOTE the contents of the report and actions being taken. Acronyms AFC Agenda for Change ESR Electronic Staff Record SMT Senior Management Team URS User Requirement Specification WEI Workplace Equality Index PENNA Patient Experience Network BSL British Sign Language This report supports the following Trust objectives as set out in the Integrated Medium Term Plan: (please tick) Equitable and timely services Providing evidence based care and research which is clinically effective Supporting our staff excel Safe and reliable services First class patient /donor experience Page 1

132 2 Workforce & OD Update Report Spending every pound well This report supports the following Health & Care Standards: Governance, Leadership and Accountability Safe Care Effective Care Staying Healthy Dignified Care Staff and Resources 1. Introduction / Background: The report reflects the specific workforce priorities required ensure that staff are supported excel. 2. Timing This report covers the period March May Description: This report provides an update on the Workforce and OD elements of the Trust s Three Year Plan Delivering Excellence and current workforce and OD issues of importance or significance. Hire Retire The programme of work continues be undertaken via the seven work streams. Good progress is being made on the HR / Recruitment Work Stream, with the majority of actions now complete, which will improve the efficiency and effectives of the recruitment and specifically the pre-employment checks process. The final piece of work will be determined the viability of using the Trac system direct hire those staff who have traditionally be recruited outside of the core NHS Wales recruitment process. The Self Service Work Stream is finalising a proposal create an all Wales ESR help desk. This proposal will be presented the May 2017 WfIS Programme Board for approval. There appears be wide spread NHS Wales support create an all Wales ESR Help Desk, deal with routine ESR queries. Progress within the other five work streams has been slow, but it is anticipated that their pace of activity will pick up over the course of the next few months. ESR Self-Service All Trust staff now have access an ESR account, which is a NHS Wales ESR World Class standard. NHS Wales will cease issuing staff with paper pay slips from July In readiness for this change, the Trust has commenced the implementation of online pay slips. The Trust is currently in Phase 5 of Phase 6 of the implementation plan. Training and support is being provided staff in advance of their go live phase, ensure that they have the ability Page 2

133 3 Workforce & OD Update Report access their monthly pay data. To date this change has been received favourably by those staff that have already received an online pay slip. This process will be completed by June 2017 Beta testing of the ESS portal has been completed. The portal has now been successfully launched Trustwide, including within the hosted organisations. E-Rostering Work progresses with the E Rostering case including potential changes the funding stream. A further business case is being prepared for EMB, which will set out in further detail the range of benefits of a system along with further information on the revenuereleasing element. A user requirement specification (URS) is being refined for use in the tendering process as is a technical specification. A number of site visits have been arranged understand and observe the experience of local Health Boards of e rostering systems. Back Basics Workforce team At the end of March the Workforce team worked gether review the content of the Trust intranet site; data cleansing where appropriate ensuring that the up date forms, template letters and processes are available. The aim is ensure a consistent approach Workforce issues across the Trust and be able signpost managers and staff relevant and up date information on the WOD intranet site. The work has been positively received. Patient Experience Network (PENNA) In March, Velindre NHS Trust were awarded the Communicating Effectively with patients and Families award as part of the Patient Experience Network (PENNA) for the development of the children s books Caring for my family with Cancer. This is the second award the books have received and they have also been shortlisted for the RCNi awards which will be announced on the 5 th May. Excellence Wales Awards Velindre NHS Trust s work around the Accessible Information and Communication Standards for those with Sensory Loss has also been recognised in the Excellence Wales Awards. The Trust has been shortlisted in the Health Category and the winner will also be announced on the 5 th May. British Sign Language Training The Trust has held several BSL taster sessions over the past few years and the feedback has always been positive, with many staff commenting that they would like learn but are unable free time from clinical duties or that the costs have been prohibitive. The Trust Equality Manager met with Sarah Lawrence from Deaf Friendly Solutions see if there was a way a training course could be designed meet our staff needs. As a result a 20 week programme was developed providing over 150 hrs of learning, tailored the Trust s service needs, including patient and donor care. Page 3

134 4 Workforce & OD Update Report One hundred staff have signed up for the first training programme of its kind in the UK, where they will have an opportunity achieve Level 1 BSL at the end of the course. Annual Equality Moniring Report The Trust publishes its Annual Equality Moniring Report every year in April, for the previous year s data, as part of its legal responsibilities. This means that the data is a year out of date and not in sync with the Trust Annual report data. As such this year the Trust published the data in April 2017 and will be including the data in the Trust Annual report, bring everything in line. Building Excellence: Velindre NHS Trust s Organisational Development Strategy Think Tanks: A meeting of all Think Tank leads and members was held in April 2017 in order share learning and identify shared next steps. Feedback on themes was shared with the CEO the following week and agreement reached that they will contribute the next Senior Leadership Group workshop in June. The Workforce Planning Think Tank are in the final stages of confirming their recommendations, with the other six groups maintaining momentum wards their own outputs. A BE Connected process map has been published which outlines the steps associated with requesting, arranging and hosting a BE Connected event. Only one event is currently being planned, with the Blood Collection teams in North Wales. Requests for further events are welcomed. Leadership Development The Trust s third Leadership Development Programme cohort will complete their course in May, with presentation of their service improvement/change project an invited audience of Executive Board members and deputies. 18 colleagues have been confirmed as commencing the next programme in June, and will complete a 12 month programme of workshops, action learning sets, coaching and 360 o feedback. Change Toolkit Three Learning for Leadership sessions have now taken place at venues throughout the Trust. A timetable has been published through the end of the year, but is subject flex as speakers need rearrange around emerging diary commitments. Publicity for events is launched 2-3 weeks prior each session, and all events can be joined by video-conference reduce travel requirements and maximise attendance opportunities. Our recent NHS Wales Staff Survey results illustrate that staff who work in Velindre NHS Trust are open, and supportive of, workplace changes; but that they feel change isn t always managed particularly well. The Trust is preparing for a period of significant organisational change, in the Cancer Centre and Corporate Divisions as well as ongoing changes in Welsh Blood and so the Trust knows it s really important learn lessons about what we do well and less well when we plan and implement workplace changes. Page 4

135 5 Workforce & OD Update Report The Workforce and OD team is developing a Change Toolkit which will support both staff and managers manage and engage with change positively. One of the critical aspects of this development is consultation with staff who have been subject workplace change, hear honest opinion about what change processes worked well and less well for them. An important first step is scheduled in May, when a member of the OD team is running a Focus Group with WBS Donor Contact Centre staff explore their views about their recent experience of workplace change. Further work will be planned with staff from other areas of the Trust which, when combined with input from other stakeholder groups, will form a practical olkit of best practice. NHS Wales Staff Survey members of Velindre NHS Trust staff have been given access our NHS Wales Staff Survey data via the online reportal SOLAR. This means that multiple colleagues from all three main areas of our Trust are able use Staff Survey results support understanding of local issues and decision making. The Trust has committed additional expenditure obtain comparison data and separate comments reports for each of our substantive Divisions. This will allow for review of staff opinion in each area in 2013 and 20, and enable tracking of any improvement or deterioration in staff opinion. This information will then enable Divisional Senior Management Teams tailor local communications and influence local actions. As of 26 th April, data reports have been received for both Velindre Cancer Centre and the Welsh Blood Service. The Corporate report, and all comments reports are expected by the end of the month. Bottled Lightening From various sources of evidence it has been known that many staff on the WBS Blood Collection Teams have been feeling less than satisfied over recent years. Following a specific request from Welsh Blood Service our Organisational Development Business Partner designed and delivered 8 Bottled Lightening sessions during the period January- March 2017, one on each of the recent Blood Collection Team training days. The Bottled Lightening session addressed the impact of changes that the teams had been through over recent years, the potential for forthcoming changes, and the range of emotions that change can provoke in us. It also explored what triggers negative/positive thinking, and how thinking habits can be formed and concluded with recognition of the impact of negative/positive thinking on individual behaviour and on colleagues who work with that individual, before exploring practical ways of promoting positivity. Feedback from the sessions has been that they have been predominantly well received by staff, and have promoted some useful discussions. The medium/long term impact of these sessions won t be undersod for a number of months, but it is hoped that they will contribute an encouraging shift in culture for the Blood Collection teams. Mandary and Statury Training Improving the compliance with Mandary and Statury training remains a priority for the organisation. A Steering Group has been established with a core component of its work being the development of a robust Training Needs Analysis (TNA) identify the level of need and allow staff group pathways be reflected in employees training compliance Page 5

136 6 Workforce & OD Update Report matrix. The TNA has been produced and is currently being piloted in Radiotherapy and Nursing. The benefits of the project will be: Improved performance compliance across the Trust. Clear definitions and requirements for managers and staff Employee compliance matrix correctly identify training requirements and compliance Data input in ESR will record accurate requirements for staff groups, allowing for statistical reports be generated using BI Managers will have access generate own accurate departmental statistics Monthly reporting on 10 CSTF compliance Quarterly reporting for all other identified M&S training All hisrical data relating the 10 CSTF s have been uploaded via IBM. In order achieve accurate data level 1, competencies have been awarded staff who have already achieved the level 2 competency in Safeguarding Adults and Children, Infection Prevention and Control, Fire Safety land Resuscitation. With individuals training compliance visible on the portal of ESR there has been an increase in the drive for accuracy from staff ensure their own personal compliance matrix reflects their job role. A project is underway cleanse ESR removing old competencies and replacing with national competencies. A training needs analysis will be produced identify what subjects outside of the 10 CSTF s are essential for the job role. Once identified ESR will be updated accordingly. A pilot is underway through the Mandary and Statury Steering Group on targeting individuals who are out of compliance with their training. By working in the first instance with the Information Governance Manager, BI reports are being used identify those staff and departments who are non-compliant or are due come out of compliance. Feedback on the pilot will be presented at the next Mandary and Statury Steering Group in June ITV Wales Series on Velindre Working in partnership with ITV Wales and the Cardiff University Medical School with students from the Oncology Project, a television series will be filmed centred in Velindre Cancer Centre following both the patient and the professionals. Following the journey of 6 cancer patients and their Medical Team, the series will show the challenges faced by the different parties during their challenging journey over a period of 4 months, from clinical trials and research breakthroughs coping with diagnoses and the wider impact of cancer. Filming will commence in September through December. 4. Financial Impact: The paper has outlined initiatives (Benefits Realisation of ESR, Electronic Rostering) support the development of a productive and efficient workforce which will have a positive financial impact. 5. Quality, Equality, Safety and Patient Experience Impact: Page 6

137 7 Workforce & OD Update Report The four key outcomes of the Trust OD Strategy are: Values driven culture; Excellent patient and donor experience; World class performance and productivity, and; Organisational flexibility and resilience. The interventions identified through the strategy will impact in these areas across the whole organisation. 6. Considerations for the Board. The Board is requested NOTE the contents of the report and actions being taken. 7. Next Steps Work will continue as per agreed timescales for the different programmes of work. Page 7

138 WORKFORCE AND OD COMMITTEE Alignment of PADR Activity Pay Progression Policy Meeting Date: 11 th May 2017 Author: Sponsoring Executive Direcr: Report Presented by: Committee/Group who have received or considered this paper: Maxine Pring, Senior Workforce and OD Business Partner Sarah Morley, Executive Direcr of OD & Workforce Karen Wright, Assistant Direcr of Workforce N/A Trust Resolution : (please tick) Approve: REVIEW: INFORM: ASSURE: Recommendation: The Committee is asked Note the impact on changing PADR review meeting dated within 12 weeks of an employee s annual increment due, align with the Trust s Pay Progression Policy. This report supports the following Trust objectives as set out in the Integrated Medium Term Plan: (please tick) Equitable and timely services N/A Providing evidence based care and research N/A which is clinically effective Supporting our staff excel Safe and reliable services N/A First class patient /donor experience N/A Spending every pound well ACRONYMS PADR Personal Appraisal Development Review This report supports the following Health & Care Standards: Staff and Resources

139 2 Report title Introduction / Background On 1 st April 20 the NHS Wales Pay Progression Policy was issued. A key requirement of the policy was that NHS Wales organisations were required implement procedures which manage staff progression through incremental points on an annual basis. To this end, managers were required align PADRs for their staff take place at least 12 weeks prior their annual incremental date. The Trust is now considering the impact of this requirement on the Trust s PADR performance target. 1. Timing: This is part of an ongoing implementation. 2. Description: This document informs the committee of the impact on changing PADR review meeting dated within 12 weeks of an employee s annual increment. 3. Financial Impact: The Trust must bring the PADR dates in line with incremental progression in order minimise the financial impact of awarding increments which do not reflect current performance in a role. 4. Quality, Equality, Safety and Patient Experience Impact: Work in support of improving and sustaining performance is subject assessment against healthcare standards and other relevant standards and is subject full EQIA processes in line with Trust policy 5. Considerations for Board / Committee: The following analysis was undertaken on data covering the reporting period 1 st April st March 2017, across Corporate, Welsh Blood Service and Velindre Cancer Centre Divisions. Compliance rates as at 31st March 2017 were as follows:- Org L4 Assignment Count Reviews Completed Reviews Completed % 120 Corporate Division Velindre Cancer Centre Welsh Blood Service Grand Total 1, The data from the above compliance rates has been analysed identify what the assumed impact will be as a result of moving PADR dates, align them within 12 weeks of increment dates. As at 11 th April 2017, there were a tal of 60 PADRs across the Trust (excluding hosted organisations) that ordinarily should have been completed, but have now been allocated revised later PADR dates, align them the employee s increment date. Page 2

140 3 Report title In the same period the number of PADRs that are not scheduled be completed but should be undertaken early align them increment dates is 9. Assuming that all of these PADRs had been completed within their expected 12 month period the assumed compliance position would have been:- Division Actual Compliance as at 31 st Assumed Compliance at 31 st March 2017 March 2017 Corporate 85.71% 85.71% Welsh Blood Service 73.36% 81.54% Velindre Cancer Centre 59.37% 64.88% Overall Velindre NHS Trust Compliance 66.98% 77.38% The data table at Appendix 1 provides a more detailed breakdown. 6. Next Steps: The Workforce and OD Committee is asked Note the impact on changing PADR review meeting dates within 12 weeks of an employee s annual increment due, align with the Trust s Pay Progression Policy. Page 3

141 4 Report title Appendix 1 Detailed breakdown of PADR data by Division Page 4

142 WORKFORCE AND OD COMMITTEE Workforce and OD Risk Register Update Meeting Date: 11 th May 2017 Author: Sponsoring Executive Direcr: Report Presented by: Committee/Group who have received or considered this paper: Karen Wright, Assistant Direcr of Workforce Sarah Morley, Executive Direcr of OD & Workforce Karen Wright, Assistant Direcr of Workforce N/A Trust Resolution : (please tick) Approve: REVIEW: INFORM: ASSURE: Recommendation: The Workforce and OD Committee are asked Note the progress being made by the Workforce and OD Function develop a robust risk register, which accurately reflects the risks identified by the team and the service. This report supports the following Trust objectives as set out in the Integrated Medium Term Plan: (please tick) Equitable and timely services N/A Providing evidence based care and research N/A which is clinically effective Supporting our staff excel Safe and reliable services First class patient /donor experience N/A Spending every pound well ACRONYMS DCC Direct Clinical Care SAS - Specialty and Associate Specialist SPA Supporting Professional Activity WOD Workforce and Organisational Development This report supports the following Health & Care Standards: Staff and Resources