GREATER MANCHESTER HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD

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1 GREATER MANCHESTER HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD 7 Date: 30 September 2016 Subject: Report of: Enabling Better Care Transformation Programme: Workforce Workstream Carolyn Wilkins, Andrew Foster, Su Long PURPOSE OF REPORT: The purpose of the report is to provide an update to the Strategic Partnership Board on progress on developing the workforce agenda RECOMMENDATIONS: The Strategic Partnership Board is asked to: Agree the seven point action plan in Section 1.5 Agree the principles outlined in Section 3.3 Agree the three initial priorities in Section 4.1 CONTACT OFFICERS: Yvonne Rogers yrogers@nhs.net Geoff Little g.little@manchester.gov.uk 1

2 1.0 INTRODUCTION 1.1. Over recent months, the development of the Health and Social Care Strategic Plan, locality plans and the GM Reform Strategy has been discussed by the Wider Leadership Team and Strategic Partnership Board. Each of these strands of work have highlighted the importance of developing integrated approaches to priority setting, governance, decision making, budgeting and delivery of services The pace and scale of change required to deliver on our health and social care commitments has inevitably focused attention on our capacity to integrate the health and social elements of the public service landscape. However, reform and devolution present a broader range of opportunities to consider how we drive the principles of integration across a wider range of issues This paper will focus at this point on the GM Health and Social Care Taking Charge Strategy (the GM Strategy),and will, as it develops, become integrated within the wider PSR context. Public service reform will require new models of leadership, new skills and new configurations of staff within neighbourhood teams. Work to deliver leadership and workforce development in GM therefore cuts across all parts of the GM reform landscape. The workforce changes required by the health and social care strategic plan will therefore be part of the wider workforce changes within the GM reform programme. This will include significant workforce changes arising from plans to further integrate health and social care, plans to shift resources away from hospitals (treating sickness) and into the community (preventing hospital attendance), the review of service to children, including an integrated multi agency approach to early years and early help; a specific focus on tackling mental health related barriers to employment as part of the expansion of the Working Well programme; an integrated employment and skills system and a range of workforce requirements within programmes focused on reducing or preventing offending. The place management aspects of public service reform, including tackling complex dependency and new approaches to targeted and specialist support services will connect at a district level with Locality Plans for health and social care The imperative to create, at scale, a health and social care workforce which is enabled to work within a place based care system, across organisational boundaries will require a shift in the way in which we are developing the workforce for the future. The GM Strategy provides the health and social care system with a unique opportunity to review and reimagine the type of workforce we require for the future by adopting a parallel approach to educational reform supporting workforce transformation for the current and future workforce, at pace and scale The paper supports the case to rapidly progress work to: Develop a GM Workforce Strategy and Workforce Transformation Programme for health and social care; 2

3 Take stock on the current size and shape of the health and social care workforce, including both public and private sector, and key challenges faced by employers identifying potential future mismatches in supply and demand for health and social care workforce Understand the implications of the GM strategy and Locality Plans on the required workforce both in terms of numbers and in skills and ways of working; Development of a wider set of new roles aligned to new and emerging service models; Develop a strategy and implementation plan in partnership with employers and education providers to ensure provision of robust education programmes aligned to the needs of emerging new service models and which aligns to emerging workforce demands. This will need to connect to new articulations/developments of professions such as health visitor, social worker etc as well as the development of new roles such as key worker; Understand the requirement for pan-gm workforce approaches which reduces duplication across Localities and promotes a consistent management approach. 2.0 THE WORKFORCE CHALLENGE IN CONTEXT Taking Charge of the Challenge 2.1. The scale of change proposed will impact significantly on ways of working, challenging traditional roles, introducing new relationships, new teams and indeed new professions including the vocationally qualified. Whilst the vision for integrated care delivery is clear in all parts of Greater Manchester and the neighbourhood pilots are generating confidence in the potential of the new models, delivery at scale will require significant attention to create the workforce that can deliver full population coverage of the new models of care. Additionally the creation of single shared services for the acute hospital services and specialist services to deliver improvements in patient outcomes and productivity through the establishment of consistent best practice specifications that decrease variation in care and enable the standardisation of information management and technology will inevitably see a change to the way of working within the acute environment Plans to address these issues are under development and work between commissioners, providers, Health Education England and Skills for Care will be critical to securing appropriate attention and capacity to match the strategic intentions of each locality A key aspect of the Strategic Plan will be the workforce programme and how this, as a key enabler, will support the delivery of the overarching strategic direction. 3

4 2.4. To deliver a changed relationship between citizens and the state, it is critical that we review the way in which we work. Thus change is necessary not only for our services, systems and processes but also for workforce behaviours, values and ethos. This change in mindset is needed at both leadership level and in the frontline workforce making reform happen in practice Acting collectively at scale to break down organisational barriers, focus on prevention, implement new models of care and reform will provide GM the opportunity to address these challenges Alongside this plan, GM needs to recognise and respond to existing gaps and future shifts in the supply of the health and social care workforce including: The current shortage of clinicians and nurses arising from increased emphasis on safe staffing levels following Mid-Staffs; Specific and damaging workforce shortages including middle grade doctors, social workers and specialist nurses The impact of demographics on the supply of clinicians especially the large number of GPs and nurses due to retire in the next ten years; The challenges of recruiting and retaining a high quality workforce in the care home and domiciliary sector which is likely to be exacerbated by the introduction of the National Living Wage and which demonstrates why our current working model is not fit for purpose. The increased participation of women amongst the GP and consultant workforce and the changing demographic (e.g.: older workforce, increased carer responsibilities etc.) of the workforce is driving the shift towards more flexible careers; The timescales involved in training new staff and the impact of previous education commissioning decisions on the supply of new professionals The need to acknowledge the input from carers and volunteers in the provision of care and develop their skills and competencies to support the new models of care The challenges of working within the current employment model for social care. 3.0 WORKFORCE STRATEGY 3.1. The Strategic Workforce Board is now established and reporting to the Strategic Partnership Board, it provides the governance structure to deliver the strategic workforce agenda through creation of a GM strategic workforce strategy. The Board will also be responsible for operational oversight of specific workforce 4

5 challenges within the system and will work with partners to facilitate appropriate solutions The GM Workforce Strategy will also establish a framework so that as Locality Plans develop, there is a defined process in place which both supports and enables delivery of the Locality Plans. This will be an iterative process which needs to be flexible and adaptive and which can facilitate delivery of the workforce transformation programmes being driven by Locality Implementation plans GM Principles It is not proposed to impose a set of principles which impinge and impact upon the individual employment responsibilities of employers within GM, however, it is proposed that a number of key principles are established which will enable standardisation, consistency of process/approach and avoid duplication across GM. The following principles are proposed and the SPB Executive is asked to comment on their applicability within GM: GM remaining part of the NHS and social care system - upholding the standards set out in national guidance and will continue to meet statutory requirements and duties including those of the NHS Constitution and HEE mandate, the Care Act and those that underpin the delivery of social care and public health services. Flexibility of staff moving across organisational boundaries and consequent employment security - That in return for flexibility, staff will be more likely to avoid the negative consequences of the 2bn savings requirement being found by cutting services. We are offering a progressive and positive way of managing huge workforce changes. The certainty and scale of GM Devolution gives us the opportunity to do this but it will only work with full Trade Union and staff involvement. We should suggest a concordat with staff and trade unions to outline that we will need flexibility from staff being prepared to move across organisational boundaries and in return will try to avoid cutting staff numbers in one part of the system whilst increasing them in another. This will require alignment with key principles/messages included in Trade Union fora and discussions. Whilst accepting national pay systems it will still be appropriate for GM to develop innovative approaches to rewarding new roles, especially those which cross the health and social care boundaries. GM will want to also take an overview of issues such as managing agency spend and ensuring adequate recruitment and retention in areas of workforce shortage. CPD Opportunities - All staff to be afforded CPD opportunities as appropriate to individual work role and responsibilities and aligned to new ways of working. 5

6 Equality, Diversity and Inclusion - All staff to be treated with dignity and respect and within an agreed values based culture GM HR/Workforce Strategies - Development of a suite of common HR/Workforce Strategies to support a standardised approach Safe Staffing to ensure adoption of national strategies on safe staffing levels Joint Education and Commissioning Arrangements To work with Universities, employers and providers (HEE, Skills for Care, Further education etc) to deliver the future health and social care workforce Engagement to work with trade unions and employer representatives to facilitate integrated working between health and social care unions and management representatives. Positive and meaningful employee engagement is integral to the successful achievement of GM ambitions and the delivery of the devolution agenda. Good Employer practices to develop a brand for GM as a good place to work through looking after staff well-being, providing good career and personal development opportunities and offering high employment security (dependent on role flexibility). 4.0 IMMEDIATE PRIORITIES 4.1. In its first few meetings the Strategic Workforce Board has identified three immediate priorities: To support each Locality in the production of a high quality, robust, Locality Workforce Plan which sets out the workforce change requirements arising from each Locality Plan. This will include the need to own and communicate the overall message to the GM system on what the transformation means for staff and future opportunities. To aggregate the Locality Workforce Plans and to support their implementation working with Health Education England, Skills for Health and Higher Education partners in and around Greater Manchester. To identify the most pressing and immediate workforce shortages and other challenges with a view to providing both short term fixes and longer term permanent resolution A number of other priorities such as Apprenticeships and development of Nursing Assistants will be joined by others arising from the Locality Plans. 6

7 5.0 RECOMMENDATIONS 5.1. The Strategic Partnership Board is asked to: Agree the seven point action plan in Section 1.5 Agree the principles outlined in Section 3.3 Agree the three initial priorities in Section 4.1 7