NES/17/64. Update on progress against the nine Strategic Outcomes in the NES Strategic Framework for

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1 NES Item 8a August 2017 NES/17/64 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Update on progress against the nine Strategic Outcomes in the NES Strategic Framework for Author(s) of Paper Caroline Lamb (Chief Executive) Donald Cameron (Director of Planning and Corporate Resources) Directorate contributions and editing by Planning and Corporate Governance staff (Simon Williams, Rob Coward and Helen Allbutt) 3. Purpose of Paper To update on progress against our nine key strategic outcomes for Key Issues The Board and the Finance and Performance Management Committee receive regular reports on progress against our annual Local Delivery Plans (LDP) and Operational Plans which are designed to deliver against our five strategic themes. Each year we set detailed targets and deliverables against these themes which are reported to our Board on a quarterly basis, with the annual summary of performance being set out in our Annual Report and Accounts. Our Strategic Framework for also identified nine key strategic outcomes and we report on our progress against these priorities on an annual basis. This document represents our third annual update. In this report, we provide detail about each of the nine outcomes and a narrative summary of progress highlighting specific areas of our work. The report also outlines key challenges (with mitigating actions) and presents concise case studies to illustrate development of a project, programme or other aspect of our business. The Board is aware of some of the developments and challenges in these areas from a range of reports and updates received over the last year. 5. Educational Implications This report includes the educational activity undertaken by NES over the period 1st April 2014 to 31st July 2017 in support of our nine strategic outcomes. 6. Financial Implications These activities are delivered within the financial plan agreed by the Board. 1

2 7. Which of the 9 Strategic Outcome(s) does this align to? These activities specifically support the nine strategic outcomes within the Strategic Framework Relevance to Better Health, Better Care These activities support the current Scottish health and care policy context allied to feedback from our stakeholders. 9. Key Risks and Proposals to Mitigate the Risks Some of the strategic challenges facing these activities are as follows: financial resourcing changing policy and political environment 10. Equality and Diversity The NES response to the equality and diversity agenda is set out in our Operational Plan. 11. Communications Plan A Communications Plan has been produced and a copy sent to the Head of Communications for information and retention: Yes No X A Communications Plan format template is available in the Meetings and Communications sections of the NES Intranet. 12. Recommendation(s) for Decision Board members are invited to consider and comment on the progress information presented in the report. NES July 2017 DC/ha 2

3 Update on progress against the nine Strategic Outcomes in the NES Strategic Framework July

4 Introduction The NES Strategic Framework focussed on five strategic themes: an excellent workforce; improved quality; new models of care; enhanced educational infrastructure; and an improved organisation. Each year we set detailed targets and deliverables against these themes which are reported to our Board on a quarterly basis, with the annual summary of performance being set out in our Annual Report and Accounts. In addition to our five strategic themes, the Strategic Framework also identified nine key outcomes, designed to improve excellence in key areas of our business. Those key outcomes are: A demonstrable impact of our work on healthcare services An excellent learning environment where there is better access to education for all healthcare staff Flexible access to a broad range of quality improvement education in the workplace Leadership and management development that enables positive change, values and behaviours A key role in analysis, intelligence and modelling for the NHSScotland workforce to strengthen workforce planning A range of development opportunities for support workers and new and extended roles to support integration Improved and consistent use of technology with measurable benefits for user satisfaction, accessibility and impact Consistently well-developed educational support roles and networks to enable education across the workplace An effective organisation where staff are enabled to give their best and our values are evident in everyday work This is the third annual progress report on the nine strategic outcomes set out in our Strategic Framework It provides a summary of our progress at the midpoint of the framework and includes information about the sources of data, key 2

5 challenges to progress and related mitigating actions. Concise case studies are provided for each strategic outcome to provide a flavour of our work. The commentary and case study material presented in the report affirms our continuing progress against each of the key strategic outcomes. Collectively, the commentaries highlight our close partnership with learners, health boards, regulators and other stakeholders to manage and enhance education and learning in a growing range of settings and across many dimensions of quality. We remain on target to achieve our planned outcomes by the conclusion of the Strategic Framework in 2019, but the stretched financial climate and increasing demands for our educational support represent significant challenges. We also recognise the changing context with the publication in December 2016 of the Health and Social Care Delivery Plan which has resulted in a re-assessment of our priorities. 3

6 Outcome 1: A demonstrable impact of our work on healthcare services. What the outcome means This outcome reflects our priority of being able to identify and demonstrate the value that our work is adding to NHSScotland and beyond, assisting us in our understanding of what works, and enabling us to identify areas for improvement. Where do we want to be by 2019 and how will this be measured? The challenges faced by NES and other organisations in isolating the impact of education and training from other contributory factors are well documented. We have however made progress in moving the focus of organisational accountability away from outputs (courses, participation in training etc.) towards identifying and evaluating the impact or outcomes of our activities (improved professional practice, skills acquisition etc.). By 2019 we want to ensure that we have arrangements in place to set out the planned impact of educational activities in all programmes that lend themselves to this type of analysis, and to evaluate the achievement of these impacts. We anticipate that this will enable us to demonstrate a positive service impact across a range of projects. It will also assist us in identifying interventions that have not achieved the planned impact. The principal method of measuring progress has been through our Integrated Planning and Performance System, which records the planned impact for each activity in the Operational Plan and a RAG indicator of progress in the Performance Dashboard. Progress so far During we have maintained our focus on the impact of NES workstreams; aspiring to greater clarity about our contributions to health and social care services in Scotland. This is seen in the high proportion of impact oriented performance targets in our Performance Dashboard; most of which were met during the year (see Figure 1 below). The gathering momentum toward impact measurement is also evident in a 4

7 growing body of case studies, which indicate growing awareness of our impact framework and good practice in impact evaluation methods. Progress in implementing the impact framework Our work in this area has been the subject of oversight by the Board. The Educational & Research Governance Committee (7 Dec 2016) also noted our progress in identifying impact targets for their activities, while commenting on the difficulties in measuring impact meaningfully in some educational contexts. Our move towards a more impact oriented focus is underpinned by a framework linking outputs, intermediate effects and service outcomes through a logic modelling approach. Workforce development subsumes different elements of impact incorporating educational, service and organisational effects on the health care system. For example, between August 2016 and August 2017, 684 of our doctors in training have achieved, or are on course to achieve, their Certificate of Completion of Training, which will make them eligible to apply for consultant or GP posts. Our analysis over the past 5 years suggests that about 80% subsequently work in NHSScotland and about 14% work elsewhere in the UK. Our impact logic model is supported by guidance, staff development workshops, consultancy support and a new series of short e-learning bites. Our ongoing commitment to planning and measuring impact is further reinforced by our new management information system, MiTracker, which will require directorates and programme teams to specify the types of impact expected from our activities, and to provide regular progress updates Quarter 4 Performance Report The Quarter 4 Performance Report provides RAG status data on the impact targets linked to the strategic themes within our Strategic Framework. Four of these themes relate to our educational activities with the fifth focusing on NES as an Improved organisation. The following commentary concerns only educational themes given their relevance to Strategic Framework Outcome 1. 5

8 The Performance Report indicates that the majority (90.2%) of the SMART targets which support a planned impact are rated as green (or have been completed) with 12 (4.4%) as amber and 15 (5.5%) as red. This represents a decrease in the number of impact focused performance targets compared with the previous year but a 5% increase in the proportion rated Green. A breakdown of progress against impact targets for four of our strategic themes is provided at Figure 1 below. Figure 1: Impact targets by RAG status, 4th quarter ENHANCED EDUCATIONAL INFRASTRUCTURE NEW MODELS OF CARE IMPROVED QUALITY EXCELLENT WORKFORCE Green Amber Red Most of the performance targets focus on educational impact, as evidenced through attainment of qualifications or successful course and training programme completions. As in the previous year, a minority of the targets relate to changes in professional practice or improvements in healthcare services (better quality care, better patient satisfaction etc.). At this stage, it is also the case that numerous performance target updates still refer to project deliverables rather than impact on services; although many targets describe milestones toward future service impact. Challenges/necessary improvements and mitigating actions Our analysis of the Performance Dashboard illustrates that we now have a clear position which is enabling us to identify our contributions to health and social care services by As in previous years, we are sometimes challenged by activities 6

9 that have an indirect impact on services for example, training needs analyses, or which have longer-term outcomes. Identification of our unique contribution in joint programmes areas with other agencies and initiatives, such as Healthcare Associated Infections, can also be difficult to disentangle. For some workstreams, the resources and time needed to collect credible impact data may be viewed as disproportionate to the benefit. Guidance to staff emphasises the conditions under which impact data should be collected. These include (but are not limited to) projects that: relate to service improvements (cost savings, quality improvements, better patient satisfaction etc.), address areas of strategic or political importance, provide easy access to impact data, relate to high value initiatives, require large amounts of staff time, are pilots of longer-term projects. We will continue to support our programme teams in planning and measuring impact through the provision of training, guidance and consultancy advice. The introduction of the MiTracker system for operational planning and performance reporting management encourages greater focus on the development of clear impact measures for educational programmes in Case study: Medical Revalidation Impact on education, service and our healthcare system in Scotland can be illustrated by our work to support medical revalidation. The Scotland deanery is responsible for around 5,700 doctors in training who are subject to revalidation, almost a third of all doctors in NHSScotland. Through our training management systems, these doctors have approved trainers who conduct educational appraisal. This informs trainees annual process towards assessment of competence and progression which is accepted by the GMC as evidence leading to revalidation. Last year, 570 of these doctors completed training and were revalidated. A further 502 doctors were revalidated whilst still in training programmes. In total, 1,072 trainees were 7

10 successfully and efficiently revalidated as a result of the infrastructures in place within our medical directorate. In addition, we provide national training for appraisers and our Digital SOAR platform records revalidation evidence for all practising doctors in Scotland, providing a single source of data. 8

11 Outcome 2: An excellent learning environment where there is better access to education for all healthcare staff. What the outcome means This outcome signalled our intention to improve the quality of the learning environment for all those who are training and developing their practice within NHSScotland; and in social care settings. The outcome recognises the amount of learning that takes place within the workplace and addresses several dimensions of educational quality, including: supervision, protected time for learning, educational support, learning facilities and inclusivity of learning, together with the accessibility of relevant educational opportunities. Where do we want to be by 2019 and how will this be measured? By 2019 we want to have access to data that enables us to assess the quality of the learning environment in which placements for all undergraduates and trainees (where we have a locus of responsibility) are delivered. By 2019 we also aspire to be able to increasingly join up this information across professional groups and link this to data from other national organisations to provide an integrated and holistic view of the learning environment. By 2019 we also want to have measures in place which enable us to demonstrate how our interventions have contributed to an improvement in the quality of the learning environment. Progress so far Our workforce and workplace intelligence is already sufficiently comprehensive to enable us to review and implement quality management processes along with partner organisations for dental, nursing and midwifery trainees and postgraduate medical and pharmacy trainees, and other staff in service. We continue to support high quality learning environments across healthcare professions and in an increasing range of social care settings. We provide support 9

12 and infrastructure, fund educational facilitation, and develop healthcare professionals including support workers in their training and educational roles. In nursing and midwifery, significant progress has been made in the development and roll out of the Quality Management of the Practice Learning (QMPLE) online database. This database enables the gathering and reporting of nursing and midwifery student feedback on their learning experience in each of their practice placements in health and social care settings. The system incorporates the Once for Scotland student practice learning experience feedback tool which ensures consistency of data reporting which can then be aggregated and triangulated with other data. QMPLE is now live in five universities and on schedule for implementation across all universities and board areas by March This will then provide robust data to contribute to overall intelligence about the learning environment at local, regional and national level. The quality of the education environment has also been a major focus for our Healthcare Science programme as documented in the 2016 Strategic Framework Progress report. In the intervening period, further steps have been taken to support self-assessments undertaken by health science training departments, crossreferenced with independent direct trainee experience surveys. The selfassessments are buttressed by national postgraduate training reviews, comprising scrutiny by an independent panel in each main specialty area. The self-assessment process and training reviews were also the focus of a national conference for Healthcare Science training departments in February Challenges / necessary improvements and mitigating actions Issues relating to the recruitment and retention of healthcare staff in some disciplines and specialties have placed increasing pressures on the quality of training environments. This is reflected in reports documenting situations where the quality of training has suffered due to an excessive reliance on trainees for service provision, gaps in rotas, and the absence of adequate educational and/or clinical supervision. We have effective processes for identifying problems relating to the quality of the educational environment, and such situations are monitored closely. This involves 10

13 working in partnership with Health Boards and other organisations to resolve issues timeously. Our Educational & Research Governance Committee takes a close interest in Enhanced Monitoring cases in Postgraduate Medical Education, which were the subject of a detailed report and extended discussion in February While these issues remain challenging, the Committee took assurance that the Medical Directorate s Quality Management team were addressing Enhanced Monitoring cases robustly. For example, the enhanced monitoring status placed on the Emergency Department at Aberdeen Royal Infirmary was recently removed by the GMC following improvements made to education, supervision and trainee support. Case study: The Pre-Registration Pharmacy Scheme A core activity for NES Pharmacy is the quality management of the Pre-registration Pharmacist Scheme (PRPS), which manages 170 funded pre-registration trainees across Scotland. The Scheme responds to the Scottish Government s vision of pharmacy integration between primary and secondary care, and is based on standards published by the General Pharmaceutical Council (GPhC); the pharmacy regulator. There are clear governance procedures in place for the key educational component of the PRPS and the obligation of training providers to participate in these is detailed in an Educational Agreement with NES. Various aspects of employment are included in this agreement to ensure consistency across sites. A comprehensive process of premises visits, conducted by us on behalf of the GPhC, ensures that premises and tutors meet the GPhC criteria. We are the first pilot GPhC Deanery with delegated responsibility for management of the Pre-registration Pharmacy Scheme within the UK. Trainees undertaking this programme combine training in three different settings involving community pharmacy, hospital pharmacy and a third optional setting which to date has included clinical specialities, education and primary care. Those undertaking the modular programme are being exposed to a broad range of practice and learning experiences, which in turn, will produce trainees who not only meet the performance standards expected by the GPhC but also show an appreciation of the 11

14 population s pharmaceutical care needs across the healthcare settings. They will also develop an understanding of the working practices and pressures faced by colleagues within these settings. The number of trainees undertaking this style of training has been small initially, although is increasing year on year, to allow development of the concept. Anecdotal feedback from both trainees and tutors has been very positive with benefits to working practice being recognised. A formal qualitative evaluation of the programme is currently being undertaken. 12

15 Outcome 3: Flexible access to a broad range of quality improvement education in the workplace. What the outcome means The NHSScotland Quality Strategy is the approach and shared focus for all work to realise the 2020 vision. This outcome reflects our commitment to making quality improvement (QI) education available to all staff groups (clinical and non-clinical) to ensure that the workforce is supported to implement and deliver QI activities on a day to day basis in services. Where do we want to be by 2019 and how will this be measured? By 2019 we want to have trained a total of 284 people in the Scottish Improvement Leader (ScIL) programme and to have supported a further 60 Fellows through the Scottish Quality Safety Fellowship (SQSF). We also want to ensure that unit specific modules on QI are available to staff across the entire workforce, and we want to be able to quantify how many staff have completed these modules. We will measure this by tracking participation on the taught programmes and tracking those accessing specific modules through our digital platform. Progress so far We have made good progress against the Strategic Framework commitments. Key developments since 2014 include the following: Thirty-two SQSF Fellows are now accepted onto each cohort, comprising 18 Scottish fellows and 14 fellows from outside of Scotland. One cohort runs per year, with cohort 10 commencing in September Additional funding for two places on the Fellowship was made available in 2016 by the Cabinet Secretary for Health and Sport, as part of the Vale of Leven legacy fund. The ScIL programme set out in 2014, to have 284 Scottish Improvement Leaders operating across the public services by Funding in 2017 was secured to run an additional cohort per year from the Chief Nursing Officer, specifically for nursing staff, to support the Excellence in Care programme, therefore four 13

16 cohorts are now commissioned each year. In March 2017, 150 staff had completed this programme, and it is anticipated we will now have 360 Scottish Improvement Leaders working in our system by There are approximately 15 staff who consistently act as a Scottish Faculty on QI taught programmes. Through the faculty development and training programme now in place, the number is expected to double by The Workforce Development Tool is an online self-assessment tool that allows individuals and groups to self-assess their QI confidence and capability. By 2019 we anticipate this tool being widely available to all health and social care organisations. WDT Users by Month 250 Workforce Development Tool Users by Month Challenges / necessary improvements and mitigating actions The most significant challenge faced for delivering QI programmes and modules is meeting national demand for training in this area. The longer-term delivery of QI specific programmes is dependent on the availability of funding to support current needs whilst developing transformational change for alternative delivery models. A specific challenge relates to the Workforce Development Tool, which was originally developed specifically for a healthcare audience. Further development to customise the resource for social care and other staff has not yet been possible within existing resources. 14

17 Case study: A Leadership Project from the ScIL Programme Cheryl Clark, a midwife from Lanarkshire, selected the project topic of thermoregulation of the newborn for her focus during the ScIL programme. She was supported by NHS Lanarkshire, as it is one of the priority improvements within Maternity and Neonatal Care. Cheryl s aim over the programme was a reduction in term admissions to the neonatal unit by 15% through implementation of the warm bundle of care, a key process change of the Maternity and Children Quality Improvement Collaborative (MCQIC). Applying appropriate QI tools and techniques learnt through her experience of participating on the ScIL programme, she exceeded her initial aim and achieved a 40% reduction in admissions, as well as a reduction of 20% in unnecessary antibiotic administration. The impact of this work has meant mum and baby experience uninterrupted bonding and attachment, which is critical for optimising outcomes, at this early stage. 15

18 Outcome 4: Leadership and management development that enables positive change, values and behaviours. What the outcome means The health and care sector in NHSScotland is undergoing transformational change and the leaders in our health and care system are dealing with complex and demanding issues in the implementation of strategy and policy and in the design and delivery of services. This change requires the right leadership at all levels across the health and care system to achieve the required culture and behaviours to deliver the 2020 Vision and beyond. Where do we want to be by 2019 and how will this be measured? We wish to be an effective partner, which is highly valued by Scottish Government and a wide range of stakeholders, in the design and delivery of innovative ideas, policies and initiatives that are scalable and deliver the capacity and capability the health and care sector requires to meet their leadership challenges. We will be delivering on a wider platform of organisational and leadership development; and delivering digitally enabled solutions with significant progress made on assessing impact and continually improving our contribution at pace. We wish to be delivering on the Once for Scotland ambition. Measurement of progress will be based on feedback, impact assessment and progress against agreed objectives. Progress so far During 2016/17 we completed a programme of organisational change which has established an Organisational & Leadership Development department that reflects the priority attached to both activities by Scottish Government and stakeholders across the health and care system. This involved reconfiguring and aggregating existing resources to develop a single team focussed on impact, which will make more versatile use of the existing skills of staff involved in these activities. 16

19 These developments have enabled us to play a key role in both informing the development of Scottish Government s Executive Level Leadership and Talent Strategy and beginning to lead its implementation. This work has been progressed alongside an extensive range of programmes, interventions and initiatives designed to support values-based leadership and management development activities that support positive change. Referencing Scottish Government and Health Board Chief Executives published priorities for leadership and management development, highlights include: Leadership development for the future: continuing to support the Scottish Clinical Leadership Fellows; recruiting a further 5 graduates to the NHS General Management Training Scheme and working collaboratively with boards to develop new and innovative placements that reflect the changing nature of the environment in which leadership is being practiced. Understanding the complexity of, and changing the culture to enable, crosssectoral working; by delivering in collaboration with RCGP and SSSC Leadership for Integration packages of learning and support for those working at the interface of primary care, secondary care and social care (see case study) and introducing a new online 360 Tool via Turas that explicitly focusses on the 6 x Leadership Qualities for Health & Social Care; and continuing to deliver Leading for the Future in partnership with other Health Boards and partners, to over 100 senior middle managers. A values-led approach which is underpinned by honest dialogue and effective performance appraisal and performance management; by undertaking a review with partners of the use of Dialogue as a tool for improving cross boundary working through improving the nature of conversations, continuing to co-facilitate the Workforce Scotland cross public sector Dialogue Community of Practice in support of this; completing the 11th and final cohort of Delivering the Future, which provided a values based leadership development opportunity for a further 24 aspiring executive level leaders. A constant focus on developing people, leadership development and talent management; by developing with health boards and testing with managers in the service a Leadership and Management Development Framework for 17

20 Health & Care that draws together existing resources to focus on three pathways: leadership, people management and quality improvement. This will provide the basis for coalescing learning resources on Turas that support leaders and managers at all levels and stages of their career and the future development of a manager s e-portfolio; developing a SMART objective setting animation to support NES managers get the best out the key PDPR process with their staff, which can be made available across Scotland in support of more meaningful appraisals. Ensuring leaders lead across a wide range of teams and engage people. As part of the national imatter Phase 2 project, providing tailored development using the 7 Habits for Managers package to 53 first line and middle managers from across 8 Health Boards to both test these learning resources and coproduce a refreshed dimension G6 People Management for the Knowledge and Skills Framework which will directly inform the content of the Leadership & Management Development Framework for Health and Care; contributing via a Scottish Clinical Leadership Fellow to begin pilot testing imatter as a tool for use by medical trainees to determine the feasibility of implementing within a fluid team environment. Challenges / necessary improvements and mitigating actions Significant time in 2016/17 was committed to participating in processes linked to delivering a successful organisational change programme. As such, our focus in planning for 2017/18 was to ensure that the reasonable expectations of stakeholders around continuity of service in the short term were met, with the coming year one of transition before a significantly different and improved delivery plan is implemented from 2018/19. Working in the integrated space has also presented challenges, with so many different demands on potential and actual participants time. Finally, developments since the publication of the Health and Social Care Delivery Plan in December 2016 have seen an increasing focus placed by stakeholders on organisational development. This has implications for how we continue to resource leadership and management development activities, with the potential in some areas 18

21 to establish stronger local and national support arrangements. The planned review of leadership and management development provision across NES will help to inform where improvements could be made to our offer across all professions that would help to improve quality, consistency and efficiency of service delivery. Case study: The RCGP/SSSC/NES Leadership Programme In partnership with the RCGP and SSSC we develop and deliver programmes to health and social care professionals from across the public, independent and third sectors working at the interface of primary, secondary and social care. One of these, 'You as a Collaborative Leader, is a blend of one-to-one coaching, 360 degree assessment, workshops and a tailored development plan to help people recognise their own leadership strengths and sources of resilience. Linda Dickinson is a Service Manager in an Out of Hours Social Work Response Service in the East Ayrshire Health and Social Care Partnership who has taken part in the programme. She commented: I ve been seconded to integrate all of the local out of hours services primary care on call and social work, mental health crisis work and so on. I did two workshops and four sessions with a mentor. What I found particularly helpful were the getting unstuck models, looking at the reasons why people might resist change. I also appreciated taking a step back and getting clarity on what was getting in the way, what I could change, and what I just needed to live with. What I could do differently and what skills I needed to develop. I d recommend it to anyone who is trying to lead change in the multi-disciplinary, integrated world that we all work in these days. Case study: The SCLF Programme The Scottish Clinical Leadership Fellowship (SCLF) programme is a joint NES and Scottish Government initiative, in conjunction with partner ( host ) organisations. These one-year Clinical Leadership Fellow posts are an integral aspect of NHSScotland s approach to developing professionalism and excellence in the medical and dental professions. The programme is open to senior medical and 19

22 dental trainees in established training programmes who have the curiosity and ambition to realise their potential as tomorrow s clinical leaders. Fellows have a bespoke opportunity to develop leadership capabilities and contribute to aspects of contemporary health- and care-related activity in an apprenticeship-style model. Fellows work closely with leading figures in the host organisations, and find themselves immersed in the practicalities of running an organisation at a national level. Leadership and personal development is achieved through commitment to a project with the host organisations, a tailored leadership development programme, and a wide range of other experiential opportunities. It is a chance for Fellows to show professional autonomy under the guidance of the programme organisers. The programme aims to provide NHSScotland with a cadre of doctors and dentists who are committed to living and working in Scotland and have enhanced capability to offer leadership in their workplace and potentially at national and international levels. NHS Scotland is continually improving and developing its services. Successful improvement needs leaders who can engage and work with others across all disciplines. The Scottish Clinical Leadership Fellowship is an excellent programme that offers our future clinical leaders the opportunity to learn about the wider organisation, and to work alongside policy makers, managers, and clinicians. Through the Fellowship, I see clinicians building the skills that will enable them to lead change and improvement in the future. Paul Gray (Director General of Health and Social Care) 20

23 Outcome 5 A key role in analysis, intelligence and modelling for the NHSScotland workforce to strengthen workforce planning What the outcome means One of the challenges identified in Everyone Matters is "strengthening workforce planning to ensure the right people, in the right numbers, are in the right place, at the right time". We are not responsible for workforce planning, but we do have access to significant, and growing amounts of data about the trainee workforce, and increasingly about the way in which individual cohorts of staff are accessing training and development. This outcome reflects the importance of ensuring that best use is made of this data and the intelligence contributes meaningfully to workforce planning. Where do we want to be by 2019 and how will this be measured? By 2019 we want to be in a position whereby we are making effective use of the data from all the systems which we control and to which we have access; and our analysis intelligence and modelling is sought out by those responsible for workforce planning. We will measure this through anticipating increasing demand for the intelligence reports e.g. Nursing and Midwifery Annual Statistical Supplement (NMASS). Progress so far NES adopts a data, analysis and reporting approach to support workforce planning in dentistry, nursing and midwifery, optometry, psychology, and medicine. For example, in the Psychology Directorate we produced quarterly workforce and trainee data on psychology services, child and adolescent mental health services (CAMHS) and psychotherapy. We also provided a data report on the workforce capacity of psychological therapies, their qualifications and requirements for clinical supervision. We also made data available on the scope, reach and clinical outcomes of evidence- 21

24 based parenting interventions to support six-weekly review meetings, parenting programmes and target setting. Our support for workforce planning in health and social care consists of: a data tool that enables data linkage, for example linking education and employment data for nurses and midwives with appropriate information governance; a platform that facilitates data analysis, such as the estimates of completion probabilities for pharmacy students in Scotland and the estimates of the impact of the Dental Undergraduate Bursary Scheme; a reporting platform that reports the results of the analysis in an accessible format, including the biennial dental workforce report, quarterly psychology and CAMHS National Statistics and the nursing and midwifery, and dashboards developed to inform the Nursing and Midwifery and Dental Student Intake Reference Groups. Working in partnership with the Scottish Funding Council to continue Scottish Government's widening access ambitions to medicine, and support for the intended changes to the ACT levy for non-uk and EU students. Challenges / necessary improvements and mitigating actions A key challenge is to ensure robust information governance when datasets are linked. In , we have been working with NSS and the Scottish Government to link our pre-registration nursing and midwifery data to the Scottish Government s copy of Higher Education Statistics Agency data. In addition, we are working on a digital solution to the problem of allowing stakeholders to get secure access to data and analysis. Currently data is collected separately but needs to be analysed together. The requirement for better linked data provides a rationale for a single cloud based data platform that acquires and links end to end workforce data and which supports workforce analysis, intelligence and reporting to plan and improve services. This needs to be underpinned by a new governance model designed to remove 22

25 organisational and sectoral barriers to data access. Key areas that require linked data are: activity and workforce data; health and social care workforce data; primary care workforce data; and education, training and employment data. The single digital platform will provide easily accessible information for workforce planners across the whole system and other stakeholders, allowing them to quickly develop a national picture of the workforce and to scenario plan more easily. Case study: Student and Trainee Recruitment Dentistry: Each year the Scottish Government recommends the number of undergraduate dental students they will fund for the following academic year. This recommendation is informed by the Dental Student Intake Reference Group (DSIRG), which draws on data and analysis provided by us and includes forecasts of the demand for and supply of dentists. In previous years, these forecasts were presented in a static format. This meant that scenario planning was difficult because DSIRG members had to submit requests to NES to change assumptions. We had to apply those assumptions and calculate their effects on the forecasts, and then report the results back to DSIRG members. This year, we have developed an interactive dashboard which allows DSIRG members to immediately see the impact of changing several assumptions relating to factors such as new technology, changing patterns of demand and the ageing workforce. Nursing and Midwifery: Recruiting and retaining the right number of nursing and midwifery students for the projected workforce demand is a critical element of workforce planning. As part of 23

26 our performance management function we provide robust data on all student intake, progression and completion at each university. We have now developed an interactive dashboard to enable the Nursing and Midwifery Student Intake Reference Group to consider different workforce planning models. Medicine: The Scottish Shape of Training Transitions Group meets regularly to review medical speciality trainee establishment numbers and plans for annual national recruitment. Significant intelligence and data are collected and coordinated by each of our Speciality Training Boards with input from a range of stakeholders including health boards and Royal Colleges' training programme leads. The Transitions Group also oversees other initiatives such as the international medical recruitment fellowship scheme and, in collaboration with the Scottish Deanery, promotes recruitment to and retention of medical trainees in Scotland. Following discussion at the Transitions Group, we are also developing a new programme of broad based training and other activities to promote take up of General Practice. 24

27 Outcome 6: A range of development opportunities for support workers and new and extended roles to support integration. What the outcome means Support workers represent around 40% of the NHSScotland workforce but have traditionally received very little training and development support. Our ambition in relation to this group of staff is to increase access to and awareness of national learning pathways and sustainable learning and development opportunities. This outcome also recognises that we need to ensure a national and coherent approach in relation to the development of new and extended roles, which are identified by the service as being required as part of an integrated team. Where do we want to be by 2019 and how will this be measured? By 2019, we aim to support Everyone Matters by embedding and sustaining learning development opportunities and pathways for all Health Care Support Workers (HCSWs). We also aim to have been proactive and supportive in providing education and training on a consistent and national basis, including the development of new and extended roles. Progress so far Some examples of work include the following: We have developed Education Pathways for all staff in Business & Administration, Estates, Facilities and Clinical Healthcare Support roles. To date, six Business & Administration Networks and five Education Pathway Implementation Teams for Estates and Facilitates staff have been established within NHSS Boards to disseminate the pathways and promote local uptake of learning for support staff. Healthcare Support Workers now have improved access to information about learning and development and feedback indicates that they are more confident in applying new and existing skills. We continue to provide a large number of learning workshops, regional and health board roadshows and other national events. Feedback has 25

28 demonstrated a high level of satisfaction with the learning, resources, events and support provided. We have worked intensively with five NHS Boards to support HCSW role development; delivering four learning roadshows, two masterclasses for leaders and supporting the implementation of action plans through sharing examples of practice. We have also provided educational advice via steering groups and presented at seven local HCSW events and workshops. We have hosted the 3 rd National Learning Event for Healthcare Support Workers, launched a learning framework for clinical support workers and continued to embed the education pathways and support for meaningful Personal Development Planning with all NHS Boards. We have worked with further education partners and the SQA to develop a HNC in Facilities Services Management. This qualification will offer a middle manager level qualification that provides an opportunity for Estates and Facilities staff to increase expertise and apply for senior roles. Implementation teams have been set up in 5 NHS Boards to support learning and development for Estates and Facilities staff. These teams comprise an executive sponsor and 4 champions including a member of Learning & Development staff. NES and Health Facilities Scotland will work with these teams to facilitate training to support implementation of Education Pathways and develop internal and external networks. Challenges / necessary improvements and mitigating actions The diversity of the support workforce across NHSScotland and other sectors means that collaborative working, whilst challenging, provides an opportunity for us to offer expert advice on education for HCSWs. Embedding and sustaining information and support can also be a challenge due to limited infrastructure for this workforce. With health boards increasingly under pressure, they may not be able to release staff to participate in learning. In addition, the learning and development needs of support workers are not always prioritised and supported by relevant communication and IT infrastructure. 26

29 Case study: HCSW Local Learning Networks To promote uptake of learning opportunities, we encouraged local staff to establish local networks to help shape and influence their own learning & development. One example is NHS Shetland which has set up its 'Shetland Administration Network' after attending a NES focus group on the development and implementation of Education Pathways. The group is led by Administrators for Administrators with senior support from the Executive Management Team. To date, the network has sourced online learning opportunities to help individuals meet their PDP requirements, obtained permission for an annual half day for all administrative staff and is currently developing its own web presence. Case study: National Educational Development for HCSWs To support national education developments for clinical healthcare support workers and share best practice across Scotland, we hosted a stakeholder workshop in March. Stakeholders included representatives from the NHS Boards and AHP career fellows. The aims of the day were to explore successful approaches to developing HCSW roles, share best practice and resources, and facilitate effective networking. Feedback from this event was extremely positive with recognition of our ability to broker a national network as being valuable. Future events will be held in September and November 2017, with each session concentrating on a key area for discussion, such as the Chief Nursing Officer s commission on Widening Access. 27

30 Outcome 7: Improved and consistent use of technology with measurable benefits for user satisfaction, accessibility and impact. What the outcome means This strategic outcome was set as a result of our having surveyed our users for their views on our online products and services. The results of this indicated that, whilst we had some very good products and services, users experienced a great deal of frustration in trying to locate and access these and they were not joined up, with different systems separately holding the same data. At the same time, we were aware that many of our systems were complex to administer and that we were at risk through having small pockets of developer staff spread across the organisation with no common understanding of, or cover for, our different systems. Where do we want to be by 2019 and how will this be measured? By 2019 we intend that NES will have completed its journey to being truly digital by default, exploiting all opportunities to deliver educational solutions that support excellence in health and social care for the people in Scotland. This will have been achieved when we can demonstrate that we: provide access to education for the entire NHSScotland workforce, whenever and wherever it is needed; create intuitive and personalised services for all our users, with non-digital alternatives wherever needed; provide advice and support on exploiting the latest digital and technical learning innovations; provide access to the right skills, training, suppliers and partners; ensure staff and patient safety, security and privacy are never compromised; collaborate with educational partners, NHSScotland boards and services, social care services, industry and academia; and ensure data, records and content are always up to date and accessible to those with the authority to do so, and not to those without. Progress so far NES Digital in now in its third year and continues to deliver new, digital services based on our strategy of developing a user-centred, Cloud based, single unified platform, Turas. The use of Cloud ensures that Turas and the applications running 28

31 from the platform are accessible from any device, and from any internet connection regardless of employer or sector. The platform concept enables the development (by us or others) of applications to interact with data that are held separately, allowing data to be held once, but used for many different (appropriate) purposes. It drives standards both in quality and technically. The Turas platform has been designed to create a personalised experience with the ability to push content to users dependent on their role, stage of training and learning pathway. We have delivered a single system for the management of healthcare trainees. Currently, trainee doctors, dentists and pharmacists can access their records and clinical psychologists and healthcare scientists are due to follow imminently. We have also redeveloped the Scottish Foundation Schools e-portfolio which went live in August 2016 and is a fully integrated application on the platform. The development of the Turas Learn application during 2016/17 led to this application going live in April This application provided for the first time a single learning record for all staff of all types across the whole of the NHS. Integrating with our Turas Portfolio applications means that NHS staff can manage their training and keep structured evidence for revalidation, CPD or performance indicators from anywhere, at any time. We are working towards the ISO27001 information security standard to apply for full certification in The implementation of O365 and the move to the Cloud has enhanced our ability to support agile working and opens the potential for direct collaboration with staff in other health boards as well as social care and the wider public sector. NES Digital staff have been working with NSS and ehealth to support the wider adoption programme for Office 365 across NHSScotland. NES Digital has supported the Care Inspectorate (CI) in their transformation and journey to Agile methodology with training and project support. As a result CI will be developing a new application to run on the Turas platform in support of Care Home of the Elderly Inspections in 2017 with a go live date of April