NHS Shetland. Workforce Plan Update 2015/16

Transcription

1 Workforce Plan Update 2015 NHS Shetland NHS Shetland Workforce Plan Update 2015/16 Author Lorraine Allinson HR Services Manager Service Lead Lorraine Hall Director of HR and Support Services Delivery Team Lead Services Leads NHS Shetland Date Created: July 2015 Review Date: April 2016

2 Workforce Plan Update 2015 NHS Shetland Executive Summary... Error! Bookmark not defined. Step 1: Defining the Plan Introduction Ownership of the plan Update on Workforce Planning Action Plan 2014/ Step 2: Service Change Service Plan Step 3: Defining the Required Workforce Workforce Data Cleansing Exercise Workforce Projections Future Workforce Demand Step 4: Workforce Capacity and Capability Current Workforce Workforce/Service Redesign Finance Nursing and Midwifery Staffing for Quality Step 5: Workforce Action Plan Step 6: Implementation Monitoring Review / Refresh Appendix 1 Current Workforce Profile

3 Workforce Plan Update 2015 NHS Shetland Foreword The workforce is central to achieving the Quality Ambitions of safe, effective and person centred care and the 2020 Vision for Healthcare. Everyone Matters:2020 Workforce Vision was launched in June 2013 and sets the vision for how the healthcare workforce will need to evolve to continue to provide high quality services that the people of Scotland and Shetland expect and deserve. We acknowledge that the data provided in this update provides a snapshot of the workforce in place at 31 March 2015 and therefore has its limitations. The key workforce challenges expected for NHS Shetland in the following year remain unchanged: Attracting and retaining suitable skills to NHS Shetland specifically medical / specialist roles Implementing changes to services and structures to achieve appropriate skill mix to deliver safe, efficient, sustainable services. This will include integration of Health and Social care Developing and maintaining appropriate skills of current workforce Achieving financial balance The report provides the following updates Profile of workforce in post at 31 March 2015 Summary of Workforce Projections Training Plan Workforce Action Plan Workforce Risks At 30 th June we projected a 3.6% increase in the overall workforce for staff in post by 31 March This assumes filling all current vacancies at 1 April Some of these are supported by fixed term funding and longer term projections therefore show a subsequent decrease. In addition, the Board has a significant efficiency target if we are to continue to invest in the new services, including medicines required. With the majority of our costs liked to workforce a proportion of these efficiencies will need to be met through changes to our workforce, (at its simplest level the current efficiency target equates to 60 WTE). We are currently working on plans and redesign opportunities to close this gap. Natural turnover may not be sufficient to deliver the required change and managers may also need to reduce workforce through redeployment or redundancy mechanisms. Chief Executive Ralph Roberts 3

4 Workforce Plan Update 2015 NHS Shetland Step 1: Defining the Plan 1.1 Introduction The purpose of this document is to provide an update on the NHS Shetland Workforce Plan , published in August Focus therefore is on STEP 4 and STEP 5 of the Workforce Planning Cycle The report includes updates to: Workforce profile at 31 March 2015 Workforce projections made from staff in post at 31 March 2015 Workforce Action Plan update Education and Learning Plan Workforce Risk update Workforce Action Plan 2015/ Ownership of the plan The key stakeholders who have contributed to the report update are: Heads of Service Executive Management Team Area Partnership Forum 4

5 Workforce Plan Update 2015 NHS Shetland 1.3 Update on Workforce Planning Action Plan 2014/15 Description of Action 1 Medical Staffing Review outcomes implementation 2 Integration of Health and Social Care Lead Timescale for Implementation Short, Medium or Longer term RD Short / Medium / Longer Term SB Short / Medium / Longer Term Description of Potential impact on Workforce / Service Change in structure / roles / responsibilities / skills associated with repatriation of services Joint working / Locality projects Financial resources required Costs to be recovered from reduction in patient travel costs. Current cover by locum, reduction in locum spend anticipated following appointment No increase in costs Progress towards implementation 2015 Repatriation of services will progress with the successful appointment of a Consultant Obstetric and Gynae COO appointed IJB established Joint partnership forum established Locality project to establish locality based multidisciplinary teams Intermediate Care Team in place 3 Primary Care Strategy development & subsequent LW/SB Short / Medium / Long Term Change in structure / roles / responsibilities Potential spend to save. Increase in Advance Due for completion Dec Anticipated changes or aims to be achieved will be for implementation in 2016/17 and 5

6 Workforce Plan Update 2015 NHS Shetland implementation ongoing from 2014 Nurse Practitioners at Lerwick Health centre to replace unfilled GP vacancies beyond. 4 Implementation of Acute Services restructure / redesign JM/KC Short/Medium Change in structure / roles / responsibilities / skills Changes in structure & skills relate to Child & Family Health Services to incorporate CAMHS service to include delivery of psychological therapies. SLA for LABS management with NHS Orkney 0.5 wte Redesign of LABS, shared leadership / management with NHS Orkney SLA NHS Grampian Clinical Governance Lead 0.2 wte UKAS accreditation achieved Local HCS lead established 5 Mental Health Review / implementation DM / SB Short / Medium Change in structure / roles and responsibilities Reduction in locum costs anticipated Drug and alcohol substance misuse services are now NHS led. Consultant Psychiatrist, and Associate Specialist Doctor now in post 6

7 Workforce Plan Update 2015 NHS Shetland 6 Dental Services Review 5 Soft Facilities Management Review implementation RC / SB LB / RR Short / Medium Short / Medium Change in structure / roles and responsibilities Attracting in independent practice Change in structure / roles and responsibilities Reduction in locum costs and staffing overtime anticipated. Reflected in projections Recommendations will be incorporated in financial savings plans Arrangements for an NHS Independent Dental practice are now in progress. Shortfall in Orthodontist remains HFS review of soft FM has been undertaken and recommendations to be taken forward. 7 Pharmacy Redesign CN Short / Medium Change in structure / roles and responsibilities to respond to an increase in volume and complexity with the vaccine programme roll out & maintain established services and continuation of leadership for NHS Orkney Pharmacy services Changes to structure to include Remote and Rural Specialist will be subject to funding through the remote and rural fellowship scheme. Pharmacy SLA with NHS G to be reinvested where possible Reduction in prescribing costs Natural turnover has resulted in further update to the structure to strengthen leadership and management of the service. The redesign is ongoing Anticipated this following year: Trainee posts and Prescription for excellence programme 7

8 Workforce Plan Update 2015 NHS Shetland 8 Implementation of eess and Shared Services 9 Implementation of Staff Survey & I Matter LH Medium / Longer Term LH / Sally / IAN Short / Medium / Longer Term Change in structure / roles and responsibilities, self service access to systems Increased access to data Improved data quality Avenue for staff feedback / temperature check of moral / satisfaction Increased costs for system. National delay in implementation has required temporary backfill of admin vacancy. Anticipate to continue for next months. Ongoing travel costs for training required for HR team I Matter Roll out started in December 2014 National challenges with the IREC module has resulted in a hold on progress with implementation of the system. Access to development sessions impeded by location. Savings target not achievable until fully implemented Short life working group established through APF to take forward actions to improve communications, reduce Bullying and harassment, & increase use of EKSF/ participation in appraisal Next Staff Survey to be rolled out in September 2015 results anticipated January Policies and Procedures LH Short / Medium / Longer Term Updates to policies and procedures in line with PIN guides as approved / potential for increase in costs PIN Guides in excess of legislation pose a risk of additional costs for the Board which add to financial pressure Imatter update on roll out & action plans Review policies in respect of risk of Board Financial constraints through EMT AND Area Partnership forum, in respect of increased costs 8

9 Workforce Plan Update 2015 NHS Shetland capacity feasibility (whether back fill required as additional cost) Local discretion should be considered for enhancements above legislative requirements to support achieving financial balance 9

10 Step 2: Service Change 2.1 Service Plan The workforce plan for NHS Shetland was provided in June This report provides an update on action plans, projections and the workforce profile at 31 March The NHS Shetland Local Delivery Plan was updated April 2015, Step 3: Defining the Required Workforce The process followed is set out below: 3.1 Workforce Data Cleansing Exercise HR commences data cleansing for staff in post reported at 30 September which is received by the end of October. Summary data is circulated to Heads of Service by the end of December to enable them to confirm feedback on changes and updates. 3.2 Workforce Projections Heads of Service are required to complete both the excel projection sheets and the supporting word narrative documents for their respective service area and share with their lead from the Executive Management Team. The base line data at 31 March, received during May is entered by HR into the master excel template. Projection data received from Heads of Service is collated into the master templates. 3.3 Future Workforce Demand The projections shown below were made from staff in post at 31 March 2015 and not from budgeted establishments. The projections include outstanding vacancies not placed by 31 March 2015 and anticipated increase in demand for workforce in relation to known plans over the following 1-3 years. Many of the posts are anticipated to be fixed term or secondment opportunities as they are linked with finite funding to deliver specific projects e.g. e:health projects, therefore there will be a decrease in subsequent years. Main influences that may change projections include: Primary Care Strategy Medical staffing review / ongoing repatriation of services Independent NHS Dental Practice Integration of health and social care Projections summary anticipates the following by 2016: 10

11 Total staff in post is projected to increase by 20.1 WTE (up 3.6%). Medical (HCHS) is projected to increase by 2.8 WTE (up 8.4%). Medical and dental support is projected to increase by 2.1 WTE (up 4.5%). Nursing & Midwifery is projected to increase by 7.5 WTE (up 3.9%). Administrative services is projected to increase by 6.5 WTE (up 5.4%), with management (non AfC) remaining static at 4.0 WTE. Increases will be planned within budgeted establishments. NHS Shetland projected staff in post (WTE) changes for financial year 2015/16 by staff group Board 2015/16 projections baseline 31-Mar Mar-16 Staff group Change 3 Change % 3 All staff groups % Medical (HCHS) Dental (HCHS) Medical and dental support Nursing and midwifery Allied health profession Other therapeutic services % % % % % % Healthcare science Personal and social - - care Ambulance services Support services Administrative services Management (non AfC) % - - Source - NHS Board data. Projections are estimates and as a result are subject to change. 1. All figures in this table have been rounded to the nearest 1 decimal place. 2. Due to rounding, figures presented under board baseline 31-Mar-15 and 2015/16 projections for 31-Mar-16, may not sum to the total for all staff groups. 3. Figures presented under change and change % have been calculated from the original unrounded data provided by each NHSScotland board. As such, they may not be possible to reproduce from the rounded WTE figures presented in the table. 4. Management (non-afc) is a sub group of administration services and data are not 11

12 comparable to the 25% reduction target in senior management posts. The definition used in the target allows the exclusion of clinically orientated staff from within this group, and the inclusion of some AfC administration staff (band 8a and above). 'x' = not applicable; '-' = zero Step 4: Workforce Capacity and Capability 4.1 Current Workforce The update of the NHS Shetland workforce profile for staff in post at 31 March 2015 is detailed in Appendix 1. Gaps in supply continue requiring backfill of specialist skills by locum agencies. 4.2 Workforce/Service Redesign Three key areas in the workforce profile that need to change to deliver the workforce projections and the Workforce 2020 vision are: 1. Primary Care Strategy / Medical staffing review 2. Integration / maximising skills 3. Mental Health Service Review 4.3 Finance Three key financial or budget issues that require management to deliver workforce projections and the Workforce 2020 vision: 1. Reduction in spend to meet financial balance 2. Reduction in locum / agency spend 3. Reduction in Prescribing Costs 4.4 Nursing and Midwifery Staffing for Quality The Nursing workforce planning tools are used, however interpretation needs to be adapted to allow for remote and rural context and baseline data. 12

13 Step 5: Workforce Action Plan Learning and Education Plan Workforce Risk Plan 2015/16 Workforce Action Plan 2015/16 Learning and Education Plan To follow 13

14 Workforce Risk Plan 2015/16 WF Risk Context Existing Control Measures Actions Inability to successfully recruit to vacancies and retain essential skills Increased turnover Failure to fill vacancies Skill Shortages locally / nationally Low unemployment / high competition locally Locum availability / increased cost Increased advertising & recruitment costs Implementation of On line Recruitment via eess Resource planning to identify: Opportunities for redesign, Review of skill mix, Development opportunities, succession planning, options for integrated/ joint working with local authority / other Health Boards Attracting youth employment Implementation Plan for eess Turnover remains higher than mainland Boards during 2014/15 We continue to successfully appoint to vacancies, in the main within 3 months (repeat adverts sometimes necessary increasing recruitment advertising costs) Posts not appointed to are required to be reviewed for alternative solutions (this has an impact on locum costs). Youth employment return completed 2015 Number of applicants has decreased, implementation of IREC is considered to have had some negative influence on experience of applicants. 14

15 Attracting and retaining local youth employment will remain challenging due to competing opportunities locally and nationally off island Provision of relevant development / training required to maintain existing and support to develop new skills to meet future service demands and delivering integrated services Focussing development needs / align with organisational future service needs Availability of appropriate development / training Review of skills through joint development reviews, Personal Development Plan s (PDP s) and corporate training plans Aligning Service / Resource planning Evaluation of the impact of training in the workplace Financial restraints restrict training to essential priorities as agreed by the Executive Management Team. Ability to maximise utilisation of skills / resources that supports integrated working Utilisation of skills available Geographical challenges Knowledge sharing Use of Technology Service / resource planning / role development Joint Development Reviews / eksf/ PDP s monitoring of measures in place Multidisciplinary team working Locality working Forums / Managed Clinical Networks 15

16 Integration plans Managing Attendance Availability of finance or short term funding to meet increasing costs Maintaining motivation and moral of staff Decreasing budgets / limitations v s increasing costs (development, succession planning, recruitment (advertising, use of temporary agency/ locums etc) Leadership Innovation Managing Change Health in the workplace Engagement Savings targets Aligning finance planning / budget management Service / resource planning Effective use of specific funding allocations Staff Governance Action plan Staff Survey ( implementation of I Matter) Exit Interview data Consultation for Change Health, safety and risk action plans Joint Development Review procedures / eksf Occupational Health availability of self & Management referral Independent Employee Assistance Provider Flexible working arrangements Revised controls for vacancy approval put in place Communication cascaded through team brief - providing feedback on board meetings / decisions and cascaded via team meetings / Area partnership Forum, team meetings Data Quality issues Data quality reviews Migration of data to eess eess capability - system not yet fully functioning Reporting Data monitoring & analysis ISD Data Quality returns Quarterly reports via SWISS Implementation plan for eess OBIEE Reporting / Dashboards Returns Ongoing. EESS implementation on going. VC arranged with ISD in Nov 2015 regarding SWISS & EESS 16

17 Ongoing development needs Reliance on technology / IT system functionality & maintenance / capability of users Network stability Availability and capability to use VC, WebEx, virtual networks, web based systems, self service models Successful implementation of eess ( Functionality) IT Department locally Access to facilities and usage guidance locally and nationally e:health national programme implementation plans - clinical and workforce systems) Ehealth Local implementation plan Availability and maintenance of appropriate buildings for work space and accommodation Provision of a Safe Working Environment fit for purpose Office space Availability of board / local accommodation H&S Policy and Risk Assessments Board Property Strategy Review and restructure of the safety, risk and clinical governance team Head of Estates set up Sustainability and environmental group (includes workforce). Draft policy in development 17

18 Workforce Planning Action Plan 2015/16 Description of Action Lead Timescale for Implementation Short, Medium or Longer term Description of Potential impact on Workforce / Service Financial resources required Progress towards implementation anticipated 2016 and beyond 1 Medical Staffing Review ongoing implementation RD Short / Medium / Longer Term Change in structure / roles / responsibilities / skills associated with repatriation of services and how supported Changes to clinical pathways Reduction in locum spend Reduction in patient travel costs Appointment of Obs and Gynae Consultant repatriation of services Acceptance by the Board of Proposals deriving from the Staffing Review and recruitment to any posts proposed. Detailed implementation plan developed 2 Integration of Health and Social Care 3 Primary Care Strategy development & subsequent implementation SB Short / Medium / Longer Term LW/SB Short / Medium / Long Term Joint working progression of Locality projects Changes to working patterns / location of work Joint staff forum Joint training Joint planning Change in structure / roles / responsibilities Changes to working patterns / locations Continued reduction in costs Savings to be determined / efficiencies sought Develop more joint posts. Develop locality leadership, and framework to build on community assets base. Strategy to be completed by February Detailed implementation plan developed from the output of the Primary Care Strategy 18

19 ongoing from 2014 Actions will be planned as part of implementation 2016 and beyond. Headlines in relation to potential service and staffing changes should be signalled in the 2016/19 Joint Strategic Commissioning Plan and 2016/17 workforce plan, but details will need further planning. 4 Implementation of Acute Services restructure / redesign JM/KC Short/Medium / longer term Change in structure / roles / responsibilities / skills Development / maintenance of skills Succession planning pending retirements Improved sustainability of clinical staffing 5 Mental Health Review / implementation 6 Dental Services Review DM / SB RC / SB Short / Medium Short / Medium Change in structure / roles and responsibilities Change of clinical pathways Change in structure / roles and responsibilities Increase in establishments Independent practice Redesign ongoing no further increase in costs, and efficiencies off island from increase in local establishment. Projected decrease in PDS over 1-3 years Attracting in independent practice 19

20 5 Soft Facilities Management Review implementation LB / RR Short / Medium Change in structure / roles and responsibilities Savings Plan in place Projected decrease over 1-3 years 7 Pharmacy Redesign CN Short / Medium Change in structure / roles and responsibilities to respond to an increase in volume and complexity with the vaccine programme roll out & maintain established services and continuation of leadership for NHS Orkney Pharmacy services Invest to save on prescribing costs Redesign on going 8 Implementation of eess and Shared Services LH Medium / Longer Term Change in structure / roles and responsibilities, self service access to systems Increased access to data Improved data quality Ongoing travel costs required to support access to training Completion of Pilot has confirmed the continuation of EESS/ IREC rollout programme. Successful completion of EESS roll out will provide a platform for HR shared service model which will be determined 3-5 years 20

21 9 Implementation of Staff Survey & I Matter LH / Sally / IAN Short / Medium / Longer Term Avenue for staff feedback / temperature check of moral / satisfaction Staff development Staff Survey feedback anticipated in January Likely to be another survey undertaken to allow imatter to be established. Imatter roll out plan to continue 2015/ Policies and Procedures LH Short / Medium / Longer Term Updates to policies and procedures in line with PIN guides as approved / potential for increase in costs Costs to be determined WLB PIN implementation arrangements to be agreed to manage increase in costs and capacity issues Promoting attendance PIN still outstanding 21

22 Step 6: Implementation 6.1 Monitoring It is recommended that all three Workforce documents from Step 5 are reviewed on receipt of September data by the management team with input from HR, Finance and staff side representation. 6.2 Review / Refresh Workforce Plans are required to be refreshed and updated annually using this template. The cycle commences in October with data cleansing and profiling. Heads of Services to submit updated plans and projections to Executive Director and HR by the end of January. Data will be collated and reviewed again on receipt of workforce data at 31 March. Projections and Workforce Plans to be signed off by Area Partnership Forum. 22

23 Appendix 1 Current Workforce The workforce profile is provided against the diversity strands in the Equality and Diversity Employment Monitoring report published on the website. Report.pdf Gender Split/Age profile Nursing and administration are the largest staff groups within NHS Shetland, both occupations tend to have a higher ration of female:male employees. A detailed summary of gender pay gap information was added in April 2015 The gender pay gap is calculated as the percentage difference between women and men s average hourly pay, showing an overall 25% gender pay gap comparing all staff groups. Further details can be found on the website, via the following link: 23

24 Age Profile The current profile shows: 38.3 % are 50 years or over 35.9% are aged years 24.10% are aged years 1.7% aged below 20 years The largest proportion of staff remain 50 years or over. We are currently reviewing the risk and potential impact of the introduction of revalidation in 2016 within nursing. Compared with last year s summary NHS Shetland has increased the number of employees under 20 years. The NHS Shetland Youth Employment return confirmed WTE,16 24 year olds started employment with NHS Shetland after 1 April Some of these posts were fixed term opportunities. NHS Shetland continues to generate interest with the local youth community for work experience and volunteering through raising awareness with the local high schools and college. We hope to be able to attract youth back to the islands to fill future substantive vacancies following completion of further education on the mainland. 24

25 Headcount and Whole Time Equivalent Headcount 25

26 Whole Time Equivalent 26

27 Full/Part-time Split There has been an 11% increase in part time working in the last 12 months. This will reflect flexible working arrangements, but also that some staff hold multiple part time employments with NHS Shetland. 27

28 Sickness Absence The percentage absence for the year at 31 March 2015 is 4.56%, above the 4% HEAT target butt below the Scottish average of 5.04%. Long term sickness absence for the year was 2.44% below the Scottish average of 3.21%. Short term sickness absence for the year was 2.13% above the Scottish average of 1.83%. 28

29 Turnover Turnover - 01/04/14 to 31/03/2015 No. of starters for last 12 months No. of leavers for last 12 months Current Headcount Turnover Job Family Administrative Services % Allied Health Profession % Dental Support % Healthcare Sciences % Medical and Dental % Medical Support % Nursing/Midwifery % Other Therapeutic % Personal and Social Care % Senior Managers % Support Services % Grand Total % Note: Training Grade Doctors are included within the Turnover figures. Turnover is defined as employees leaving NHS Shetland employment Data does not include internal moves and changes to posts. Excluding Junior Doctors WTE left NHS Shetland employment. Of the wte leavers 40% had less than 2 years service, 35 % 2-10 years service, 25% 10 or more years service. Reasons for leaving: 67% Other (New Job, relocating, personal) 18% Retirement 11% End of Fixed term contracts 1% Ill Health Retirement 1% Dismissal 1% Death In service The increase in turnover has provided some opportunity for change and redesign, however has increased costs for recruitment advertising, relocation and training commitments. 29

30 Bank Nursing by Month Month Total April May June July August September October November December January February March Total Agency usage is summarised below by service: SERVICE TOTAL (ex VAT) MEDICAL STAFF - TRAINING 222, MEDICAL CONS 303, MEDICAL OBS AND GYNAE 37, MEDICAL PRIMARY CARE 649, MEDICAL MENTAL HEALTH 88, MEDICAL 1, DENTAL 210, NURSING 21, AHP'S (Radiography/ SPL) 34, SUPPORT SERVICES (Estates) 5, ,575, There has been considerable Agency spend to cover vacancies, including gaps in provision of Doctors in training and leave requirements across the year. Trend data reported through procurement is detailed below. Supplier Apr-Jun 14 Jul-Sept 14 Oct-Dec 14 Jan-Mar 15 Contract Athona Ltd (NP500/12)

31 FMSG (NP500/12) 57,940 54,419 7,721 Medacs (NP500/12) 73,184 19,784 34,234 21,538 Reed Doctor (NP500/12) Templars (NP500/12) 110,560 10, , ,767 Contract Total 241,684 29, , , ,876 Non Contract Buchannan Locums 34,125 28,856 37,112 55,368 Deltingpharm Limited (Locums) 25,677 20,000 DRC Locums 22,351 21,785 13,891 LOCUM PEOPLE 22,990 Medical Locums 365 Ltd 6,090 National Locums 30,823 43,896 NC HEALTHCARE LIMITED 10,028 Non Contract Total 59,802 71,207 89, , ,992 Shetland Total 301, , , ,479 1,068,868 31

32 Vacancies Current clinical vacancies at 31 March 2015 are summarised below. (Definition of a vacancy is an unfilled post that you are in effect actively trying to fill). Vacancies as at 31 March 2015 Job Family Band/Grade Total WTE Nursing and Midwifery Hospital Band Band 3 1 (Including: Mental Health 3 wte, Midwifery 1 wte) Band 5 4 (Including :Mental Health 1 wte, midwifery 3 wte) Band 6 5 Nursing and Midwifery Community (District Nurse) Band Band Allied Health Professionals Occpational Therapy Band 5 1 Medical Staffing: Consultant Physician ( Acute Medicine) 1 Consultant Obs and Gynae 1 Length of time of vacancy varies, at the time of reporting: Allied Health Professional, occupational therapy less than 3 months Community nursing posts - 3 months or more Consultant posts more than 6 months Back fill for Consultant vacancies has been covered by locum or agency staff; both posts were required to be re-advertised. Nursing vacancies were frequently covered by Bank, with occasional use of Agency for specialist skills during long term related absence. 32