NHS Forth Valley Workforce Plan

NHS Forth ValleyWorkforce Plan 2007

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Contents Chief Executive Foreword 1

Chapter 1 Introduction 2

Chapter 2 The Current Workforce 15

Chapter 3 The Emerging Workforce 24

Chapter 4 Staff Groups

• Medical Workforce • Dental Workforce • Nursing and Midwifery • Allied Health Professions • Healthcare Science, Technical and Pharmacy • Psychology • Administrative, Clerical and Senior Management • Estates, Trades and Ancillary

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4352556366

6870

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Chapter 5 Action Plan

Fit for Purpose Tests

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Annex A Workforce Projections

Annex B Workforce Characteristics–further statistical information

Annex C Abbreviations

Annex D Bibliography

NHS Forth Valley Workforce Plan 2007

Chief Executive Foreword

NHS Forth Valley has successfully delivered significant organisational change in recent years and therefore has a firm foundation in workforce planning and development.

Our ongoing commitment to workforce planning and development will ensure continuing improvements to health and health care in our local communities in line with agreed priorities in the short, medium and long term.

We understand that workforce planning is not solely about numbers, although this is important. NHS Forth Valley’s Integrated Healthcare Strategy illustrates our clear vision for the future of service delivery, consistent with the most recent National Policy Framework Delivering for Health. Implementing the Strategy will be underpinned by ensuring our workforce has the skills and competencies required to deliver our new models of care.

This, our second Workforce Plan, addresses national strategies and priorities as well as the local demographic and environmental factors that impact on supply of and demand for healthcare staff. Building on last year’s work this plan addresses all staff groups.

In developing our plan we have involved strategy directors, operational managers and clinical leaders as well as staff and their representatives to vision the impact of national and local strategies on specific workforce groups and services. I am grateful to all for their hard work and contribution to our plan.

Our plan will continue to be refined and revised consistent with emergent models of care and associated workforce information and analysis.

Fiona Mackenzie

Chief Executive NHS Forth Valley

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1 Introduction

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Introduction

Forth Valley NHS Board is aware of its statutory responsibility contained within the NHS Reform (Scotland) Act 2004 to have in place arrangements for workforce planning which supports the Board’s direct remit to secure the staff necessary to deliver required health services to the population.

In April 2006 we submitted our first single system Workforce Plan to the Scottish Executive Health Department (SEHD) and over the last year the Staff Governance Committee has continued to fulfil a monitoring role in relation to this particular responsibility. In addition regular workforce information and analysis reports have been provided to the Area Partnership Forum and to relevant Operational Committees and the Service Design Board has workforce planning and development as a standing item on its agenda.

HDL (2005) 52 provided workforce planning guidance to Boards, this guidance set out the detailed requirements for the production of Board workforce plans annually by 30 April. It also emphasised the importance of integrating service, financial, education and workforce planning.

In addition during 2006 the SEHD issued feedback on our 2006 Workforce Plan and further guidance relating to projections for all staff groups. This feedback and guidance has been addressed in preparing this updated edition of our plan.

The purpose of this document - NHS Forth Valley’s Workforce Plan 2007 is primarily to articulate and describe our workforce requirements in the short, medium and long term. The aim is to plan for the impact of national, local and regional drivers on our workforce and to ensure that our workforce is fit to deliver state of the art services to our population, now and in the future.

To date NHS Forth Valley has a good track record in planning and developing our workforce and has clearly delivered significant organisational change. During the past year considerable progress has been made in building capacity and embedding the principles of workforce planning and development across the organisation. As a result there is real enthusiasm and commitment from all key stake holders. This updated plan demonstrates progress towards integrated workforce planning and development and reflects our continued work to challenge traditional boundaries and silos.

Our challenge is to continue to build on this work and to ensure our workforce has the skills and competencies to deliver future models of care consistent with NHS Scotland’s vision Delivering for Health, and in our own local Healthcare Strategy which mirrors this vision.

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In addition NHS Forth Valley is currently developing a Workforce Modernisation Strategy. The purpose of this strategy is to ‘knit’ together all the strands of policy and procedure. The aim is to ensure that workforce planning and development is firmly embedded in the culture of NHS Forth Valley.

Key challenges

There are a number of key challenges which we will continue to progress:

• To demonstrate how e-Health will influence the size and shape of the workforce.

• To understand & identify workforce solutions to ensure maximum benefit from MMC.

• To obtain more detailed information on workforce planning and development across CHPs.

• To ensure fit for purpose workforce for our new hospitals and community based services.

• To further analyse & understand the impact of our workforce age demographic and identify innovative solutions which will enhance recruitment, retention and succession planning.

Throughout this plan there is a wealth of evidence which illustrates how these key challenges are being addressed.

Recruitment and retention

Within NHS Forth Valley there has been a good record of recruiting and retaining staff across all specialities. However it is recognised that shifting population and workforce demographics, changing career aspirations, the modernisation careers agenda for healthcare staff and the overall service modernisation and redesign agenda will all have a potential impact on our ability to attract, recruit and retain staff. In addition the development and growth of other employment sectors across the local area and the central locality of NHS Forth Valley may also have an impact.

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Recent changes in employment legislation, particularly in relation to flexible working arrangements, maternity leave, diversity and age will impact on how we recruit and retain staff in the future. In addition the changes in service delivery across NHS Forth Valley will mean the continued development of new roles for staff and the development of new skills to fill these roles.

The development of e-recruitment with the opportunity to increase the use of online advertising and application also creates challenges for NHS Forth Valley to ensure that robust recruitment systems and practices are in place to attract, recruit and retain a high quality workforce.

Work life balance initiatives will continue to be explored and implemented across the organisation to assist in attracting and retaining staff.

Role and competency development

NHS Forth Valley, funded by Skills for Health (SfH) are carrying out a workforce planning project to ensure the planned move from traditional models of care to future Community Hospitals can be achieved safely and smoothly, thereby supporting the Delivering for Health policy and our Local Delivery Plan (LDP). The project utilises Skills for Health’s competency tools and was initially targeted at Older People’s Services.

The project began with mapping future care needs for older people within rehabilitation and palliative care settings, using SfH competences to describe the future care needs profile.

The next stage in the process involved mapping the skills of all levels of staff with a clinical input to older peoples’ wards. The Team Assessment Tool on the Skills for Health website was used to identify areas for potential role redevelopment and up-skilling of existing staff. This approach will ensure that patient needs and pathways will be matched with appropriate care related competences from the Skills for Health database.

Using a competence based approach to workforce planning has clear advantages. The outcome will be a library of role profiles held on a data base, all of which link to KSF. This information will be used to create a development framework for existing staff and to support the recruitment process for new staff, based on the team requirements being competence based. New roles have been created to ensure that care needs will be met by the most appropriate staff.

A further advantage of using the competence based approach to workforce development is that it can help to identify where future training needs should be targeted.

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We will continue our work in developing models of care and identifying essential skills and competencies to deliver these. As a result the workforce roles and numbers required will continue to be defined and reviewed.

Drivers for Change

Our first Workforce Plan identified the national & regional drivers for workforce reform which we continue to address through national & regional planning. This plan focuses on the challenges specific to NHS Forth Valley to ensure that the needs of our population are met in the short, medium and long term.

Local context

An integral part of developing this plan was to identify from our staff what the drivers for change are from their perspective of the services they provide. For this purpose we revised our existing questionnaire. Analysis of the data highlighted the following emerging themes, building on last year’s plan, as the key challenges facing NHS Forth Valley:

Population demographics

The population of Forth Valley is growing, a unique feature in the West of Scotland. From 281,764 in 2004 the population is projected to reach 296,377 by 2024. This is associated with a rise in elderly people with the population over 64 increasing from 37,348 (13 percent of the total) in 2004 to 64,286 (22 percent) by 2024. Of greater significance for healthcare planning is the rise in the over 74 age group from 19,390 in 2004 to 32,211 in 2024. Although the number of women in the population is also increasing it is interesting to note that as male life expectancy increases and gender inequality reduces, the ratio of males to females in the over 64 population is actually projected to drop from 1.39 females for every male to 1.23 females for every male by 2024.

We must also further understand and plan for changes in the disease profile of our population. The Forth Valley population is growing older and more overweight. The Scottish Health Survey in 2003 shows the overall prevalence of obesity (BMI>30kg/m2) in men has steadily increased from 15.9% in 1995 to 22% in 2003 and from 17.3% to 23.8% for women.

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As the population ages there will be a greater burden of chronic diseases such as Cancer, Coronary Heart Disease (CHD) and Diabetes.

• Cancer

There will be about 2,000 cases of cancer diagnosed per annum in Forth Valley adults by 2017 compared to around 1,500 cases per annum actually recorded during 1996-2000. Numbers of new cases of most types of cancer are predicted to increase. Notable exceptions are stomach, lung and cervical cancers, all of which are predicted to decline. Overall, it is predicted that there will be a 1.4% increase in the number of people diagnosed with cancer each year for the next 10 years.

An increase of around 40 cases a year is expected in the under 75s and 70 in those aged 75 and over. Most of the predicted increase is attributed to a growing number of older people in the population. However, the individual risk of some types of cancer is also predicted to increase.

The numbers of new cases of cancer seen in a population are products of individual risks of developing cancer and the numbers of individuals actually at risk. The present analysis suggests that the dominating feature determining cancer incidence in Scotland in the next 20 years will be growing numbers of older people. Although an individual’s risk will increase for many cancers, there are notable exceptions: lung cancer risk is continuing to decline in men and is expected to begin to decline very soon in women; cervical cancer incidence is expected to fall further as screening and potentially other preventive measures become more effective; finally, the reduction in risk in stomach cancer is part of a long-term trend which has been seen in many developed countries. (source: Cancer in Scotland: Sustaining Change. Cancer Incidence Projections for Scotland (2001-2020)

• Coronary Heart Disease

Coronary Heart Disease (CHD) mortality rates in Scotland are amongst the highest in the Western Europe. The incidence of CHD is higher amongst men, the elderly and deprived areas of Scotland.Although overall incidence of and mortality from CHD in Forth Valley has halved over the past 20 years (from about 500 deaths per annum to about 250) CHD mortality is strongly related to age. The CHD mortality rate for 0-44 year olds is 4.1 per 100,000, and for those aged 75+, the rate is 1682.1 per 100,000.

The result is that as the population is ageing, the overall burden of CHD will be much slower to reduce than age standardised figures suggest.

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Indeed, as the population ages the number of people living in Forth valley with chronic conditions like CHD may actually increase. The estimated prevalence of CHD based on admission to hospital is 3.6% of the Scottish population suggesting that around 10,000 people are currently living in Forth Valley with CHD. Prevalence of CHD is higher in males (4.2%) than in females (3.0%) and is strongly related to age. An estimated 18% of the Scottish population aged 75+ are living with CHD. In the Clackmannanshire and Falkirk CHPs up to 25% of men aged 75+ have CHD (Stirling 21%). The corresponding figures for women aged 75+ are Clackmannanshire 17%, Falkirk 16% and Stirling 16%.

• Diabetes

Diabetes prevalence is increasing and is related to both age and obesity. Estimates of the overall prevalence of clinically diagnosed diabetes in Europe based on published studies suggested a prevalence of approximately 3% in 1997. Projections indicated an increase to around 3.6% by 2000 and to over 4% by 2010.

It is estimated that about 3% of the Scottish population have been diagnosed as having diabetes; that is, over 150,000 people. Using national age-specific rates for diabetes suggests that 8,313 Forth Valley residents were living with diabetes in 2002.

If Diabetes prevalence increases to 5% by 2024 then there will be around 15,000 people in Forth Valley living with diabetes. (source: Scottish Diabetes Survey 2002)

Workforce demography

Over 80% of our workforce lives within the Forth Valley area. Although the total working age population of Forth Valley (adults aged 16-64) will remain fairly constant over the next 20 years at about 182,000 it is important to recognise that percentage over 50 will increase from 41% currently to 53% by 2024. NHS Forth Valley has an ageing and increasingly female workforce. NHS Forth Valley recognises the need to identify and implement innovative solutions to this unprecedented workforce demographic. Supporting people throughout their working lives and providing opportunities for continued participation in the workforce beyond traditional retirement age is fundamental. Further analysis of our workforce is presented in Chapter 2.

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Impact of a new Forth Valley Hospital at Larbert

NHS Forth Valley is in the process of implementing our Integrated Health Care Strategy and is committed to building a new Acute Hospital Facility at Larbert. This requires transitional arrangements and new models of care to ensure single system working.

Impact of Community Hospitals and Community Health Partnerships

With a strong emphasis on streaming patient care, Community hospitals are vital to support patient pathways. The role of Community Health Partnerships in implementing Anticipatory Care, encouraging self help and having appropriate services for communities is a vital element of our strategy.

Local Strategy

NHS Forth Valley’s overall vision and purpose is to improve the health and healthcare of the people of Forth Valley, in partnership, and within the resources available.

This vision is consistent with the most recent National Policy Framework Delivering for Health and is constantly assessed against other National and Strategic documents that are published.

The NHS Forth Valley Integrated Healthcare Strategy was approved in 2005. Significant progress has been made in the past 2 years that will affect how future healthcare services are delivered in Forth Valley.

The NHS Forth Valley Integrated Healthcare Strategy states that

“…the future health service in Forth Valley must provide acute healthcare services from one site, while redeveloping community-based healthcare to ensure that as much care as possible is delivered closer to home.”

Forth Valley must also continue to strive to improve the health of the population. In particular, it must reduce inequalities and meet the needs of an increasingly elderly population.

For this to happen, a much more seamless service must be created through greater integration of primary and secondary care, supported by a modern information and communication system. This will allow the skills and competencies of staff in both primary and secondary care, to be used to best effect and to ensure the continuing provision of services that achieve quality, safety, sustainability and accessibility.”

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This Strategy is currently being refreshed to acknowledge the progress made to date and to provide ongoing strategic direction to NHS Forth Valley over the next three years. The developing Workforce Modernisation Strategy will underpin the delivery of the Integrated Strategy

The Local Health Plan is the overarching document which details both national and local priorities for action including implementation of the Integrated Healthcare Strategy, the Local Delivery Plan and action on the 12 work streams under Delivering for Health. This plan is reviewed and updated on an annual basis.

The purpose of the Health Plan is to: -

• Identify the key objectives and actions for NHS Forth Valley for 2007/08 and beyond, taking account of both national and local priorities.

• Clarify the next steps in implementing the Forth Valley Integrated Healthcare Strategy.

• Demonstrate our commitment to working in partnership.

• Ensure continuing improvement in the health of the population of Forth Valley and to develop effective, integrated services to meet the needs of individuals.

• Provide assurance that resources are utilised effectively and efficiently and targeted at the areas of greatest need.

Delivering for Health stated in 2005 that the existing Performance Assessment Framework should be replaced with a requirement that all Health Boards produce a Local Delivery Plan (LDP). This Delivery Plan has 4 overarching objectives for 2006/07:

1. Health Improvement for the People of Scotland.

2. Efficiency / Governance improvements.

3. Quicker and easier access to services.

4. Treatment appropriate to the individual.

Under these objectives there are 28 key targets, 32 key performance measures and 20 supporting measures. Each performance measure identifies workforce implications and solutions where appropriate

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NHS Forth Valley has taken a strategic view of the position of the LDP within planning and performance management. There remain a significant number of activities and priorities within the current Local Health Plan (LHP) that are not encompassed in the Local Delivery Plan but underpin overall performance at a high level with significant financial impact. In this context NHS Forth Valley has developed the Local Health Plan in conjunction with the Local Delivery Plan. The Local Health Plan takes account of the need for a co-ordinated approach to the Integrated Healthcare Strategy, Delivering for Health integrating requirements in planning and performance.

This approach is illustrated within the Strategic Map below underlining the vision, local corporate objectives and strategic priorities with linkage to core ministerial objectives namely the four HEAT targets contained within the Local Delivery Plan and the wider Local Health Plan / Financial Plan maintained by NHS Forth Valley. The map highlights that performance management and improvement cross cut and underpin these priorities.

Detailed within the map, the Integrated Healthcare Strategy - Shifting the Balance of Care is a key priority under the objective of Modernising services

Vision

Improving Health & Healthcare in Forth Valley

Integrated Healthcare Strategy Corporate

Objectives

Modernising services Improving the Health of the local

population

Ensuring effective use of resources

Managing and improving capacity and access across

the system

Improving the quality of patient

care

Strategic Priorities

• Integrated Health Care Strategy - Shifting the

balance of care • CHP

Development • Implementing new models of care – OD • Mental Health & MH

Delivery Plan • Child and Maternal Health • Primary care

development • MCN’s

• Health Improvement & Inequalities • Local Health Plan Priorities • Anticipatory care development • Partnership working & community planning • Health

Protection

• Compliance with Civil Contingencies

• Staff Governance

• Pay

Modernisation Workforce

Development

• Regional Planning

• Financial Balance

• Best Value

• eHealth & IT

• Unscheduled Care

• Diagnostics

• Planned Care

• Waiting Times

• Capacity

• Delayed Discharges

Shifting the balance of care

• Clinical Governance

• Risk Management

• National patient

Safety Initiative

• Patient centred Safe & effective care

• Patient

Experience

• PFPI

• HAI

• Equality and Diversity

Core Ministerial

Objectives LDP

Health

Health improvement for the people of Scotland

Efficiency

Efficiency and Governance

Improvements

Access

Access to services

more quickly

Treatment

Treatment most

appropriate to the individual

Local Health Plan &Financial Plan - Risk Management Performance Management & Improvement Framework - ForthStat External Assessment

Individual Objectives

The Local Delivery Plan was updated and agreed by the NHS Board in March 2007 and will be monitored by the local performance management process and subsequently the Director of Delivery at the SEHD and his team.

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The competency of our workforce is critical in ensuring that we achieve these targets and there will be changes in the way we deliver our services to ensure that we meet them. We will continue with our own local, community and regional planning arrangements in NHS Forth Valley involving our partners, staff and communities. This will ensure that the full range of NHS activity is comprehensively planned for. It will also ensure that local and regional partners can continue to play a full role in helping to plan for and deliver health care and related services.

Regional Context

Some of the residents of Forth Valley receive treatment in other Health Board areas either because it is easier to access another hospital, or because they need specialist treatment that is not available within NHS Forth Valley.

NHS Forth Valley participates in both the South East & Tayside and West of Scotland Regional Planning Group. These groups provide a focus for inter-Board co-operation in the planning and delivery of services for population groups which span more than one NHS Board area.

Forth Valley already has close regional links for key services, for example cancer, and has acknowledged readiness to work across boundaries in the future to help provide high quality care for our population.

NHS Forth Valley’s involvement in these groups (and through supporting planning arrangements) is two fold:

• To ensure that requirements for services for our local population, that cannot be delivered locally, are addressed at a regional level.

• To understand the changes and developments that are proposed in regional facilities, and the impact that this will have on local service delivery.

A variety of services are being addressed through regional working, for example learning disabilities and Managed Clinical Networks (MCNs) for cancer and diabetes and Multiple Sclerosis (MS), which will extend to cover other chronic neurological conditions to become a Neurology MCN.

Regional Planning

Workforce and service planners work very closely together within the region. The approach to regional workforce planning and development has always been based on integration with service planning and this is now firmly embedded within the region. The Workforce Steering Group, which involves all partners, enables real engagement with the Regional Planning Group and provides

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strategic leadership and direction to the region on workforce issues, while offering a vehicle to engage with national workforce planning.

The establishment of the Core Group ensures that the agreed actions are progressed. Each Board has a Workforce Development Manager who provides focus and capacity for Board workforce planning activity and who also supports the regional activity by leading on particular actions within the agreed action plan.

Workforce is a key element of the regional planning work streams

Regionally workforce planning and development is contributing strategically to a far greater number of services than was the case in early 2006. In January 2006 the regional workforce planning capacity was supporting the planning of 5 services – Forensics, Maternity, Cardiac, Cancer and CAMHS. The plan also mentioned that there were early plans to extend the coverage to also include Child Health and Renal services. The coverage has now more than doubled to cover 11 services being planned/delivered regionally – the 5 previous ones, together with Child Health, Oral Maxillofacial, Neurosciences, Plastics, Imaging and Sexual Health. For a number of services the input is at an early stage - developing baseline-staffing data or identifying the key workforce priorities to progress, while for others it is more developed. In line with the integrated approach taken within the West of Scotland workforce activity in relation to a particular specialty will be reported within the report on the specialist planning group detailed above.

National Context

In May 2005 Professor David Kerr delivered his report “Building a Health Service Fit for the Future” outlining a framework for service change over the next twenty years. The report looks towards a health service anchored in communities, built on fully integrated services, and more responsive to the healthcare needs of an ageing population. The main themes are:-

• More care in the future will be delivered in a non-hospital setting, through staff like health visitors, practice nurses, physiotherapists, pharmacists and family doctors.

• Currently care can be reactive, hospital centred and geared towards acute conditions. The future focus will be on integrated, anticipatory care, embedded in communities and geared towards long term conditions.

• Priority should be given to care in deprived areas to reduce health inequalities.

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• Emergency care will be separated from planned care so that planned care can be taken forward faster for patients and with fewer cancellations for them because of emergencies.

• Everyone needs to take more responsibility for their own wellbeing and adopt preventative measures.

• More regional planning for hospital based services, with new networks of hospitals sharing the responsibility for providing key elements of acute care.

The vision is of investment in patient pathways that span primary and secondary care, networks of rural hospitals linked to and supported by a major acute hospital.

Delivering for Health provides the Scottish Executives vision for the NHS in response to the Kerr Report – “to reapply its founding principles with vigour to meet the needs of the people of Scotland. Delivering for Health means a fundamental shift in how we work, tackling the causes of ill-health and providing care which is quicker, more personal and closer to home.” The report describes in practical terms what action we must take to turn the vision into reality. It applies the findings of Professor Kerr’s framework in a national context, setting them alongside the Executives existing initiatives and future plans. The report sets out a programme of action for the NHS to shift the balance of care, to reduce reliance on episodic, acute care in hospitals for treating illness, increasingly through emergency admissions. Instead, moving toward a system which emphasises a wider effort on improving health and well-being through preventive medicine, support for self care, and greater targeting of resources on those at greatest risk, with a more proactive approach in the form of Anticipatory Care services.

With the development of the new acute hospital at Larbert and the supporting infrastructure of the Community Hospitals and enhanced community based services NHS Forth Valley is well placed to achieve the vision set out by the Scottish Executive

NHS Forth Valley also requires to comply with Building a Better Scotland: Efficient Government - Securing Efficiency, Effectiveness and Productivity (November 2005). This details plans to achieve £900m of cash-releasing savings and £600m of time-releasing efficiencies by 2007-2008. Reducing sickness absence is key to securing time-releasing savings on work-force productivity. Each Board is expected to achieve a target of 4% sickness absence by 31 March 2008. Effective management, in line with staff governance principles, should reduce sickness absence, benefiting employees, employers and patients.

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2 The Current Workforce

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The current workforce

Workforce information

The starting point for assessing future supply is the workforce that exists currently. Robust workforce information is vital to provide a baseline for development. NHS Forth Valley’s Single System Workforce Information Project (SSWIP) commenced in October 2006. The aim of this twelve month project is to standardise the way workforce information is reported across NHS Forth Valley and submitted nationally through the workforce team.

The benefits of SSWIP within the context of this project will clearly be around:

• Reporting mechanisms that will meet the workforce information needs of all stakeholders from single or linked systems

• Standardised methods of data collection and data entry

• Standardised local systems in line with national initiatives

• Continuity of information held within NHS Forth Valley workforce information systems

• Area wide understanding of need and benefits of accurate and timely submission of workforce information and documentation.

• More robust information provision for national statistics and workforce planning and development

Understanding the size and shape of the current workforce is integral to planning the future workforce.

Our current workforce

NHS Forth Valley is a large employer with a workforce of clinical and non-clinical staff. At 30 September 2006, we employed 6,745 people (headcount) or 5501.4 whole time equivalents (WTE) (excluding GPs as no comparable WTE available) This represents a percentage growth of 1.5% (headcount) between 2005 and 2006, which is higher than the average annual growth rate for the five years from 2001 but is attributed to the impact of the retraction process undergone in Forth Valley in the early part of the averaging period. It is, however, consistent with annual growth rates for the area since 2003/04.

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• Nursing and Midwifery staff (including healthcare support workers) remains the largest single staff group with 2635.1 whole time equivalent (47.9%)

• Medical and Dental staff account for 6.77% of the workforce. This includes hospital doctors and general dental practitioners but excludes GPs (headcount 241) for whom no national WTE figures are available from ISD.

• In total 769.8 WTE (13.99%) of the total workforce (excluding GPs) work in the other clinical staff groups: Allied Health Professions (AHPs), Clinical Psychology, Healthcare Science, Technical and Pharmacy staff. These figures include Healthcare Support Workers in relevant categories.

• A total of 1593.4 WTE non-clinical staff (28.96% of the total workforce excluding GPs) are employed by NHS Forth Valley. The largest group are Administrative and Clerical staff and Senior Managers, numbering 985.5 WTE or 17.91% of the total workforce excluding GPs.

• There are 607.9 WTE staff in the Works, Trades and Ancillary groups. This amounts to 11.05% of the total workforce excluding GPs.

(These figures were sourced from tables A1 and A2 of the September 2006 release of the workforce statistics produced by ISD Scotland found at www.isdscotland.org/workforce)

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Trends

Chart 1: 2005/06 Turnover and percentage point change in turnover 2001/02 to 2005/06 (Source: ISD Workforce Statistics as at 30 September 2006 table A6)

2005/06 Turnover and Percentage Point Change in Turnover 2001/02 - 2005/06

-6.0

-4.0

-2.0

..

2.0

4.0

6.0

8.0

10.0

All Staff Medical andDental

Nursing andMidwifery

HealthcareScience staff(MLSO's andscientific and

Pro)

Therapeuticstaff (allied

healthprofessionalsand clinicalpsychology)

Technicians Works Admin andClerical (inc

SeniorManagers)

Ancillary Staff Maintenance Pharmacy

2005/06 Percentage Point Change in Turnover (2001/02 - 2005/06)

Chart 1

Turnover for all staff groups in 2005/06 was 6.4% which reflects a decrease of 2.3 percentage points from 8.7% in 2001/02. All staff groups have seen a fall in turnover rates between 2001/02 and 2005/06 except for Medical and Dental staff and Healthcare Science staff.

Chart 2 presents vacancy information for Nurses and Midwives (qualified and unqualified), AHP staff and assistants and Medical and dental staff. The AHP and Nursing and Midwifery vacancy rates have decreased between 2001/02 and 2005/06 (at 31 March) – AHP qualified staff: 3% to 1.41% and Assistants from 0.7% to 0%; Nursing and Midwifery registered staff from 3.6% to 0.8% and non-registered from 0.9% to 0.86%; while Medical and Dental vacancies have increased from 4.7% to 8.7%.

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WTE Vacancy Rate in 2002 and 2006 and Percentage Point Change

-4.00%

-2.00%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

Nursing & Midwifery Registered

Nursing & Midwifery Non-Registered

AHP Qualified

AHP Assistants

Medical & Dental

Total WTE vacancy rate 2002

Total WTE vacancy rate 2006

Percentage point change in total WTE vacancy rate (2002/06)

Chart 2

The highest vacancy rate in 2006 was for Medical and Dental staff. However, there have been significant changes in the Medical and Dental workforce during this time period with the implementation of Junior Doctors’ working hours targets, introduction of the new Consultant and GMS contracts, the onset of Modernising Medical Careers and a drive from SEHD to increase Consultant numbers. These initiatives have generally led to an increase in available posts, therefore some of this apparent increase is due to the creation of new posts rather than turnover of existing staff. In addition, as a consequence of the age profile of the Consultant workforce, a number of Consultant staff chose to retire following transfer to the new Consultant contract. (Source: ISD tables E10, F10, B12).

Over one quarter (27.37%) of the NHS Forth Valley workforce are aged 50 or over and there is significant variation in the age profile by staff group. Chart 3 shows these profiles. The over 50 population has increased from 25.35% in 2005 – an increase of just over 2%. However, it is still broadly comparable with the NHS Scotland value of 27.14% which has also risen by 0.84% from 26.3% in 2005. (Source ISD Table A4).

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AGE PROFILE OF ALL STAFF GROUPS (HEADCOUNT) AT 30 SEPTEMBER 2006

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Chart 3 above demonstrates the age profile of NHS Forth Valley staff by job family at September 2006.

PROPORTION OF NHS STAFF AGED 50 YEARS AND OLDER - NHS FORTH VALLEY AND NHS SCOTLAND

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NHS Forth Valley NHS Scotland

Chart 4

Chart 4 provides a comparison of the NHS Forth Valley workforce aged 50 years and older with that of NHS Scotland as a whole. It highlights that for all groups except Therapeutic staff and Healthcare Science staff, NHS Forth Valley’s percentage is broadly comparable with the national workforce age profile.

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NHS Forth Valley Year of Current Staff Reaching Age 65 by Job Family

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Year

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ADMIN SERVICES & MANAGERS ALLIED HEALTH PROFESSION HEALTH SCIENCE SERVICES MEDICAL AND DENTAL

NURSING/MIDWIFERY NURSING/MIDWIFERY (UNQUALIFIED) Other SUPPORT SERVICES

Source: NHS Forth Valley Local Workforce Statistics as at 30 September 2006Chart 5

Chart 5 shows the year when staff in-post as at 30 September 2006 (based on local workforce statistics) will reach age 65 between 2006 and 2016 and demonstrates that, although numbers in this group are already increasing, there will be a sudden increase in numbers (at least double current rates) from 2011 onwards, reflecting the impact of the post-World War II baby boom.

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Comparative Age Profiles of NHS Scotland and NHS Forth Valley as at 30 September 2006

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

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Under 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

Age Band

% o

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rkfo

rce

NHS Scotland NHS Forth Valley

Source: ISD workforce statistics as at 30 September 2006, Table A4Chart 6

Chart 6 provides a comparison of the overall age profile of the NHS Forth Valley workforce with that of NHS Scotland as a whole. It highlights that NHS Forth Valley’s age profile is broadly comparable with the national workforce age profile, although local percentages are slightly higher than the national percentages for ages 40 – 59.

Further information about NHS Forth Valley’s workforce characteristics (participation patterns, ethnicity and gender) is provided in Annex B.

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NHS Forth Valley Staff Opinion Survey

Understanding the characteristics of the workforce in terms of growth, turnover, vacancies, part time and full time patterns and ethnicity are all invaluable to workforce planning, but this does not provide the full picture. All employees were invited to complete the NHS Forth Valley’s 2006 Staff Opinion Survey. The objective of the survey was to measure trends on issues that affect NHS Forth Valley's ability to achieve its aspirations of becoming an exemplary employer. Overall 33% of employees returned a questionnaire. This is an improvement on the previous survey conducted in 2003 (26%) and is broadly representative of the NHS Forth Valley workforce. Key results relevant to this Plan are:

Key strengths

• Staff express a high level of intention to remain working for NHS Forth Valley in 12 months’ time – 68%.

• Staff feel their job makes good use of their skills and abilities – 70%• Most staff are clear about what they are expected to achieve in their job

– 78%• Staff are very positive about the support they get from work colleagues -

71%• Staff are happy with their ability to balance their work and home lives –

65%• A high proportion of staff have personal development plans – 65%.

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Key Messages

• The population of Forth Valley is growing

• NHS Forth Valley’s workforce has grown in recent years

• NHS Forth Valley’s workforce is ageing

• NHS Forth Valley’s workforce is 80% female and 54% of staff work full time


3 The Evolving Workforce

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Our workforce is changing and will continue to change as we implement Delivering for Health. Change is not new but there is an increasing impetus as more and more demands are placed on NHS Forth Valley to provide improved care for patients.

Redesigning services means changing the way we work by modernising our systems, our processes and our workforce. In our first Workforce Plan we demonstrated that NHS Forth Valley is committed to and has a sound reputation in redesign and for embracing change to benefit patients and improve the health of our local communities

This chapter provides some examples of the changing shape of our services and our workforce, highlighting some of the many new roles being developed. It is clear that we cannot sustain or depend on increasing staff numbers. Nor can we rely on the same traditional roles. We need new ways of working to meet the new demands made of a modern health service in NHS Forth Valley.

Making it happen

Through analysis of our workforce questionnaire returns we are able to demonstrate many examples of where new roles and service improvements are benefiting the population of Forth Valley

Allied Health Professionals

• Podiatry - Biomechanics training is planned during 2007 and the introduction of further biomechanics clinics are planned. This will not be an increase in WTE but will be a redirection of time that was previously spent on basic foot care to biomechanics.

• Physiotherapy – Develop a further Extended Scope Practitioner post to reduce waiting times in the Orthopaedic & Rheumatology out patient clinics as required by the HEAT targets

• The post of a Specialist Advisor for Head & Neck oncology has been created out of existing resources. This post will ensure specific evidenced based care for this patient group.

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• An Occupational Therapist is currently working with Job Centre thus enabling people claiming incapacity benefit to manage their own health care more effectively with the ultimate goal of assisting them off incapacity benefit and returning to the workplace.

• Small numbers of Radiographers are attending training in gastro-intestinal (GI) reporting, mammography reporting, CT head and plain film reporting with the future potential to develop Advanced Practitioner roles and/or a Consultant Practitioner. Additionally a small number of staff are also attending the NES run Assistant Practitioner course. These developments will support the development of the 4-tier structure releasing Consultant Radiologist time and offering a more seamless service.

Nursing

There are a number of key service changes that will have a significant impact on the nursing workforce over the next 10 years. These include the Community Nursing Review, the impact of Delivering Care, Enabling Health, Delivering for Mental Health, the Review of Mental Health Nursing, our new Acute and Community hospitals, the Hospital at Night project (which is currently being implemented) and developments in Child Protection all of which will provide services that meet local needs and reflect national priorities.

• The Cancer Nurse Specialist Sustainability Review Project is currently underway and, when completed, this model will be applied to other parts of the Nursing & Midwifery workforce

In addition to the development opportunities offered by Leadership courses, independent coaching, supported education programmes, secondment opportunities and rotational programmes, as part of the Nursing Department’s Professional advisory role, the Skills for Health model is being used to develop:

• competency profiles for G grades to clarify expectations of these staff and improve performance in their own areas of responsibility

• competencies required of Community Nursing staff are being examined with respect to the implementation of the Review of Nursing in the Community

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• these competencies are also being used to identify skills required for nursing staff working with and in the shifting balance of care in community hospitals

• Diabetes Specialist Nurses

As stated previously it is anticipated that the prevalence of diabetes will rise due to our growing and ageing population. With advances in modes of insulin delivery and glycaemic monitoring, the majority of cases will have most or all of their care managed in the community but this means that there is likely to be an increase in the number of more complex cases requiring an extended scope approach to care referred to the hospital setting. The Diabetes Specialist Nurse service is in the process of implementing extended scope practice for team members. Structured education packages for patients are being developed in line with the Scottish Executive’s Framework for Diabetes Care and additional support and training is being provided for ward based staff. It is recognised that an effective out-patient service and appropriate training of ward staff could reduce the need for admission and/or decrease the patient’s length of stay following admission. To this end, in addition to the initiatives already outlined, it is planned to introduce evening sessional working over the next 3 years to accommodate patient preferences, to reorganise clinics to ensure appropriately trained staff are always in attendance and to expand involvement in the primary care setting through outreach and joint clinics from 2008/9.

• IT systems are being used to support a number of projects including the Senior Clinical Nurse Review and Clinical Quality Indicators Projects, care planning for the Clackmannanshire Pilot and the Stirling Child Protection project.

Clinical Effectiveness

From 2008 – 2012 it is anticipated that there will be further demand for Clinical Effectiveness support to demonstrate improvements in care/support programmes of clinical change and this will be additional to the impact of the National Patient Safety Alliance on demand for clinical outcome measures/audit. This may require the appointment of an Information Analyst/statistician and a new post to support clinical information requirements associated with the development of the National Patient Safety Alliance work.

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Learning Disability

Promoting Health, Supporting Inclusion (2002) a review of the contribution of all nurses and midwives to the care and support of people with learning disabilities had 24 recommendations regarding the health care and support needs of people with a learning disability. Recommendation 7 indicated that all Boards should consider having Acute Nursing Liaison posts to ensure people with learning disabilities received appropriate access to Acute Services.

Within NHS Forth Valley funding has been agreed for an Acute Nursing Liaison post to meet recommendation 7 of the above report. Funding has been identified for 2007 / 2008 and it is anticipated that this will become a permanent post.

Diagnostic services

With the increasing use of technology in the diagnostic services, many areas are beginning to develop support staff to have both assistant and clerical functions so that they can not only deal with patient/specimen reception but also input relevant details into IT systems.

Pharmacy Services

The Pharmacy Technicians Order 2007 (which currently applies in England and Wales) is expected to be accepted for adoption in Scotland later in 2007. This means that, for the first time, there will be a requirement for these staff to hold statutory registration. While it is unlikely that any existing qualified technicians will fail to meet the registration requirements, there will be a new requirement for mandatory continuous professional development to maintain eligibility for registration.

Pharmacists will begin to take on additional roles as independent prescribers within the next 12 months. It is likely that these staff will be supported by checking technicians and it is anticipated that this should reduce the amount of medical time spent on medication review and monitoring as well as supporting the development of acute and CHPs strategies.

Smoking Cessation

Delivering for Health is resulting in an increased outpatient workload with increasing numbers of patients requiring support from the smoking cessation service and there are also increased numbers of elderly long term smokers as

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the population grows and ages. Chronic Disease Management and SIGN guidelines have additional requirements for smoking cessation services.

Audiology

As per the Local Delivery Plan, from this year there will be a Direct Audiology Assessment Plan for all individuals referred for hearing assessment who presently go to Ear, Nose & Throat (ENT). Patients referred directly to Audiology can be discharged, referred on to hearing aid management or ENT ensuring both a reduced patient pathway and that ENT Consultants see more relevant patients. From 2007 there will be a routine one-stop hearing assessment and fitting service where adults with suitable hearing levels can receive assessment, management and follow up at a single appointment reducing the number of appointments from 3 to 1 and decreasing waiting lists. From 2008 the provision of an Audiology service at Clackmannan Community Hospital will ensure more local service delivery. The service is also planning a hearing impaired rehabilitation group in conjunction with Social Services to be based at the Forth Valley Sensory Centre.

An ageing population will bring more individuals with hearing loss requiring rehabilitation and it is likely that more Audiology staff will be required. The department is twinned with an Audiology service in North Wales and is arranging learning secondments.

Neurology

Service developments include IV drug administration for some drugs by Multiple Sclerosis (MS) nurses as MS treatments develop allowing better control of the disease process. Changes in ABN Guidelines for Disease Modifying Therapies mean that there will be more patients to monitor. The principles of the MS MCN will extend to cover other chronic neurological conditions to become a Neurology MCN giving rise to training needs and provision for staff in Health and Social Care. With the GP annual review of patients with epilepsy, there will be more referrals to neurologists and the Epilepsy Nurse. More acute/relapsed patients will be treated in the community and there will be more chronic disease management in community hospitals.

As the population increases there will be increased numbers with MS. Advances in treatment mean that more people will live longer with significant disabilities. There will also be increased numbers with epilepsy in the over 60 age group.

Parkinson’s Disease

There is the potential for increased numbers of potential patients with Parkinson’s Disease with chronic disease management resulting in greater

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numbers and more dependent patients as the population grows and ages. NICE guidelines recommend that Parkinson’s Disease patients are seen by a doctor or nurse within 6 weeks of diagnosis (likely to be mirrored by SIGN guidelines) and this will impact on the Parkinson’s Disease nurse service. The NICE guidelines have alerted GPs leading to increased referrals. Increased workload is also anticipated with the shift of patients to Primary Care nursing homes and community hospitals. The service hopes to have a nurse trained to prescribe by 2008.

Emergency Care/Acute Assessment/Admissions services

The service as a whole is planning a number of changes and new roles. Some of these changes are driven by initiatives such as the A&E access target which aims to reduce delays and trolley waits within A&E and the hip fracture target. Over the next 6 – 12 months the service is aiming to set up a chest pain pathway room and clinical decision room. It is also hoped to have fast track patient pathways e.g. ambulatory care/chest pain fast track arising out of a reduction in emergency bed days, clinics for minor, less acute emergency admissions/rapid access, clinics for minor procedures e.g. abscesses and rapid access clinics for GPs. Such services will require the development of training in nurse prescribing, minor illnesses, training in basic examination skills, further ENP training, training for all staff in the use of IT equipment and staff to do cardiac management. By 2008/9 it is hoped that senior nursing staff will be able to be more proactive in taking patient histories and forward planning diagnostics as well as the role of support workers being developed to assist with rapid diagnosis.

Programmed Investigation and Treatment Unit (PITU)/Medical Ambulatory Care Treatment Unit (MACTU)

The service has piloted a 7 day service from 8 a.m. – 6 p.m. which has resulted in a number of innovations such as:

• the introduction of 7 day Deep Vein Thrombosis (DVT) services which has resulted in reduced presentations to A&E and the Common Assessment Unit for DVT investigations and ensured that there is no break in the DVT service offered

• a 7 day ambulatory IV service• a 7 day next day review guarantee following discharge regardless of the

day of discharge• the service also supports the management of Crohns/colitis patients by

providing a nurse to oversee the management of patients for anti-TNF therapies.

Increasing GP referrals has led to a rise in the need for ambulatory care for patients not appropriate for admission but requiring services not found in primary care. Increased elective and diagnostic activities means the need for

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access with the potential fast tracking of more acute patients while avoiding admission and the Unit acts as a half way house between acute and primary care. Nurses are being sent on a nurse prescribing course to reduce the amount of medical time required for this and speed the patient journey.

Acute General Medicine

For 2009 the service hopes to develop a new model of care involving community hospitals consistent with the Local Delivery Plan. It is also hoped to develop a group of Nurse Practitioners in line with MMC proposals for junior doctors’ working hours and to assist Hospital at Night Teams. These staff will need additional examination skills, drug administration training and advanced clinical skills. However, it has still to be decided what services will transfer to community beds or the community itself and the resultant impact on activity.

Respiratory Medicine

If a sleep apnoea service is developed at the new Larbert site in 2010, recruitment of a physiologist with experience in a sleep centre would be advantageous but a decision has still to be reached about this. The service hopes to recruit TB tracing nurses to allow more efficient and timeous tracing of patients with TB.

Gastroenterology

Shorter waiting times targets and the 2 week cancer target have created a need to reduce waiting times. However, there has been increased demand for bowel screening. It is planned to redesign the Gastrointestinal (GI) service within 2 years including the integration of medicine and surgery elements. Nurse Endoscopists would relieve pressure on Consultants and the appointment of Specialist Nurses in Hepatitis C and Inflammatory Bowel Disease (IBD) result in replacement of Consultant clinics. A GI Specialist Nurse could also undertake chronic disease management. However, to do this, staff will require continued specialist training including advanced clinical examination and independent prescribing.

Rheumatology

The increasing use of Biologics drugs is resulting in an increased prescribing and monitoring workload and the shift of services from acute to primary care increases the workload as there is increased uptake of self help/monitoring of patients. The possible introduction of GPwSIs (GPs with Special Interests) may impact on the nursing workload.

Cardiac Rehabilitation/Rapid Access Chest Pain Clinic

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New roles include the development of nurse prescribing and the Rapid Access Chest Pain Clinic is considering consolidating the move from Clinical Assistant to nurse-led clinical examination.

Cardiology Investigation Service

During 2007 the service expects to provide local services in implantation of internal cardiac defibrillators, stress echocardiography for patients unable to tolerate treadmill testing and assess muscle damage and 3D/4D echocardiography which will allow greater access to views of all structures inside the heart. It is hoped to provide a local cardiac catheterisation laboratory in 2009. These advances in technology mean that there is greater need for Highly Specialist and Specialist Clinical Physiologists to undertake independent reporting and to work unsupervised. The service hopes to establish a Student Clinical Physiologist post in 2008. Gaps have been identified in the extended training needs of Assistant Technicians but the service has identified the trainers and assessors to address this.

The service hopes that they will be able to establish dicom links with all of their IT equipment to allow transfer of data into the Hospital Patient Information System and also into Clinical E-mail and allow cross-site and GP access to investigations.

Mental Health Services

Within NHS Forth Valley considerable work has been undertaken through the Choose Life National Strategy working with Community Planning Partners linking to the 3 Local Authorities. Key additional actions include:

• Provision of a CPN for the Homeless

• Primary Mental Health Worker services focussing on schools and young people and ‘accommodated’ and ’looked after children’

The ongoing redesign of Mental Health Services supports the ‘at risk’ population. The successful pilot of the Intensive Home Treatment Team is now being mainstreamed to be an immediate element of crisis response. Investment is being made in GMS Locally Enhanced Services for those suffering mild to moderate forms of illness in order to prevent further deterioration, which may escalate to crisis.

Oncology Services

Over the next year or two, NHS Forth Valley is planning to develop its chemotherapy service to repatriate services from the Beatson Oncology Centre, to develop palliative care services for non-malignant patients, bowel cancer

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screening and to develop the breast service further with the potential to offer reconstruction surgery. Forth Valley is also piloting the E-Prescribing chemotherapy system.

• Clinical Nurse Specialist – it is hoped to hoped a Clinical Nurse Specialist to support this work

• Nurse led services – the development of nurse led services in the areas of breast, head/neck, lung and upper GI cancers is also underway to see patients who do not require the services of a specialist medical Consultant.

Rehabilitation Services

Rehabilitation Services are at the forefront of the move from Acute to CHP delivery of care and a new model is being developed to support this. In addition 8 acquired brain injury/neurological rehabilitation beds will be established within an existing ward.

• Nurse/team led discharge and the continued development of Rehabilitation Support Workers are two of the initiatives planned to support the development of new services such as the brain injury service. These staff will be developed using in-house training and Skills for Health competencies.

Women and Children Services

Advanced Neonatal Nurse Practitioners - NHS Forth Valley currently has two nurses on the course at present and a further two nurses will be undertaking this course in the near future. This development will support existing midwives and medical staff and assist in reducing the impact of MMC.

Maternity Care Assistants – These posts will bridge between hospital and community services and will have a more defined role than traditional Nursing Assistants. The development of these posts will help meet the needs of early discharge e.g. breastfeeding support. NHS Forth Valley has its own training programme however additional support may be provided via the Aberdeen model.

Area Sterilising and Decontamination Unit (ASDU)

Over the next three years service changes which will affect the ASDU team include the impact of reduced waiting times, a compliant decontamination service and the introduction of GSI and MSI coding to help with contingency and loan instrument kit. In addition Primary Care decontamination will move

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from local decontamination units to a centrally provided service. The service is anticipating an extended working day to accommodate the additional workload. Although not using the Skills for Health model, the service does use competency based training for staff.

Impact of eHealth Delivering for Health outlines the need for eHealth to ensure that NHS staff across NHS Forth Valley have the right tools, support & training to deliver beneficial changes to patient care in line with the national eHealth strategy. Forth Valley NHS Board agreed the Area-wide IM&T Strategy. This strategy provided a clear direction for the NHS in Forth Valley. The main strands were:

• The development of an electronic care record, allowing real-time access by care professionals to up-to-date patient information subject to agreed access

• The implementation of IT systems to directly support clinical care.• Better access to information on clinical effectiveness, quality of care and

clinical decision support• Improved electronic clinical communication between clinicians.• Promotion of appropriate exchange of information with partner

organisations, including local authorities• Underpinning initiatives with a robust and reliable infrastructure, with

appropriate security and confidentiality

The use of IM&T in NHS Forth Valley has already moved forward considerably, including:

• Email is now a business-critical method of communication, and increasing patient-critical with the introduction of clinical email

• All clinicians have access to a wide evidence base through the Internet• SCI Store has been established, providing online access to laboratory

and radiology results in primary care• All practices are using, clinical support systems• Electronic protocol-based referrals • Online Care Plans• A&E Care Pathway supported by eHealth• “Turning off the paper” – There are 22 paperlight practices and acute

services are moving towards non-paper solutions

The NHS is changing - redesigning services means changing the way people work. New processes are being developed (e.g. protocol based referral). Tasks are being undertaken by different people (e.g. pharmacy prescribing, nurse led minor injury services). eHealth systems support many of these new processes.

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The role of eHealth in supporting changing roles is illustrated by the following examples:

• GPs using protocol based referrals• Pharmacists providing a Minor Ailment Service and moving towards

electronic transfer of prescriptions• Nurses using online care plans• Bed managers monitoring capacity• Junior Doctors processing electronic discharge information• Physiotherapists accessing clinical decision support• HR using electronic systems for workforce planning.

Automating processes does not always lead to staff reduction. However the skill set requirements for staff are changing, with an increased need for IT and eHealth capabilities. Consequently there is an ongoing and increasing requirement to offer training & learning opportunities to ensure an informed flexible workforce.

Given the current & future increase on reliance on IT for business processes there is a need for eHealth to be a key skill requirement embedded in all KSF outlines and clinical induction programmes. In addition there is a need to make “time for training“, with a priority given to eHealth / ICT training

NHS Forth Valley eHealth Programme Team are looking at further developing effective and innovative training approaches. These include the development of online eLearning which, evidence shows, save time & money and support the growing demand for flexible learning.

In order to support this expanding eHealth agenda there will be a need for increased people capacity within IT Information Services, eHealth project Management & Training. Reskilling of health records and other administrative staff may help address some areas, particularly information governance and systems administration

Regional Medical Workforce Project

The West Region Medical Workforce Project has been a key area of work since July 2006. The high priority given to this project has required a significant amount of regional workforce capacity and Medical Director input. The intention is to improve bottom up medical workforce planning, with Boards working together to predict future workforce requirements. The approach taken has encouraged a new level of regional working within a range of specialties. The commitment given to this project from all Boards demonstrates a new willingness to think and work regionally.

Project Aims

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The aim of this project is to bring together groups of clinicians, leaders and planners from across the 5 Health Boards in the West of Scotland in order to bring focus and consistency to medical workforce planning over the next 9-10 years. By 2015/16 current service reconfigurations and MMC implementation will be complete. The aims are to develop a regional consensus on the future medical workforce composition based on commonly agreed assumptions. In particular it is assumed that service will be delivered by trained staff. Trainee numbers will be commensurate with retirement of trained staff rather than the requirements of service delivery. Whilst it is recognised that a multi-disciplinary approach is necessary to ensure all roles are considered in modelling the future workforce, this project focussed on the medical workforce because of the urgency of agreeing trainee numbers based on robust service input.

The Project initially focussed on 4 discrete specialities:

• Anaesthetics• Obstetrics• A&E / Acute Medicine• CHPs

The key outputs will be to ensure a more consistent approach across the Region, to inform Board workforce plans for April 2007 and to provide a more robust basis for national decisions regarding future training numbers.

The consensus model includes a new “sub-consultant” role within the medical career structure. This role would be an autonomous, judgement safe practitioner, who would be focussed on clinical service delivery, rather than service/department management. Relying on expansion of consultant numbers alone to meet the need for service delivery by trained staff is not appropriate and is unlikely to be affordable. Some consultant expansion together with the creation of a sub consultant grade could be an attractive, appropriate and affordable way to deliver high quality care and provide career posts for the “MMC bulge” of trainees completing training from 2009 onwards. It is not realistic to expect consultant posts for all trainees.

The West of Scotland model recognizes the importance of SAS doctors in the future sustainability of the service. However consideration needs to be given to how the SAS role can be developed in order to make it an attractive career option. This together with a contract which supports recruitment and retention is essential to workforce planning.

A Project Board has been established to steer the work, monitor progress with the project plan and ensure it is grounded in the service and MMC developments. The Board which is chaired by one of the Chief Executives, comprises all Medical Directors, has representation from Chief Executives, Directors of HR, Nursing, Finance, and Postgraduate Dean.

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A methodology has been developed to lead the work with the speciality groups to ensure consistency of approach. Indicative future doctor numbers are emerging which continue to be tested.

Although the initial work was focused on long term planning, it has not been possible to complete this as the work of the project for the last 3 to 4 months has had to focus on training numbers for 2007. Once this is concluded, the longer term planning will reconvene. Work is also underway with the Deanery on the distribution of trainees for 2007.

Local Workforce Redesign

Two linked projects are currently underway in Forth Valley. The MMC 2007 Project addresses the short and medium term issues of supporting MMC implementation for August 2007.Looking to the medium and long term the Workforce Redesign Project is unpacking the implications of MMC after 2009. Patient pathway mapping is being used to specifically identify the skills, competencies and service gap that will need to be met in order to provide a service no longer dependent on junior doctors in training. The project runs to December 2007 but aims to establish a process for on-going regular review of the workforce plan within each clinical area and as close as possible to the point of service delivery.

Both projects are multidisciplinary, led by Associate Medical Directors and report to the Local Medical Workforce Steering Group.

CHPs Workforce Development

The formation of Community Health Partnerships (CHPs) and the development of partnership working, including single assessment for older people and children will have an impact on the workforce. Other influences within community settings are around the GMS contract, implementation of Hall 4 and public health nursing. Work is being taken forward in developing a new model for nursing practice within the context of CHPs. An equity review of General Practice aligned health visiting and district nursing staff has been completed and future work will involve an analysis of this in terms of allocation and distribution of the workforce. However it is anticipated that changes will occur as the opportunity arises rather than through a re-organisation of staff and the timeframe will therefore evolve.

The new Community Hospital model of care is still being developed and will involve a review of medical, nursing, AHP and support roles. There will be the opportunity within the detailed planning phase to address predicted absence when considering funded establishments and final budgets

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• The Community Nursing Review highlights a significant change in the way that CHPs teams will work. The current responsiveness to patient need that is achieved by the teams working closely together, informally and formally will change over time. As identified this reorganisation will be gradual and the impact on the educational and training needs of Practice attached staff and Community nurses will become clear.

• MMC: GP training schemes will have GPs who have had to have 18 months in a GP practice and 18 months in Hospital environment. (Currently 12 months in Practice and 24 in Hospital).

• NHS Forth Valley currently employ a number of GPwSI: GP with a Special Interest (e.g. Dermatology and Orthopaedics), enabling delivery of care in a variety of ways- often closer to home and supporting the integration of Primary and Secondary care.

Out of Hours Service

NHS Forth Valley continues to make significant progress in the delivery of its Out of Hours (OOH) service since its inception in September 2004. The service continues to be delivered via the approved three-centre Primary Care Emergency Centre (PCEC) model with an enhanced level of support from the Scottish Ambulance Service for our rural area to the North and West of Forth Valley.

Service Developments

Out of Hours Service Delivery North and West of Forth Valley

This year has seen the consolidation of the model of care for the general public within the rural area to the North and West of Forth Valley. The Scottish Ambulance Service (SAS) is now an integral part of the delivery of OOH services to this area, providing first line minor injury and paramedic response, in addition to an element of minor illness cover as well. There are a total of 3 qualified Paramedic Practitioners (minor injury and illness) and a further 2 in training.

Nurse Practitioners

Nurse Practitioners are a key component of the integrated nursing service within the Out of Hours Service. Training of the Nurse Practitioners has continued throughout the year. The service now has a total of five trainee Nurse Practitioners and five fully qualified Nurse Practitioners (three core components of minor illness, minor injury and prescribing). Two trainee Nurse

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Practitioners are working towards completion of their minor injury component, and a further two are working on the minor illness component (all four having completed the prescribing component). One further trainee Nurse Practitioner is currently undertaking the prescribing component.

Unscheduled Care Delivery – Model of Care

The co-location of the Out of Hours services at Falkirk with the new Minor Injury/Illness service has been operating successfully for one year. Identified Nurse Practitioners are currently receiving minor injury training with corresponding Emergency Nurse Practitioners receiving minor illness training. The Minor Injury/Illness service was initially supported by two General Practitioners between the hours of 2pm and 10pm; however, following monitoring and review of activity and discussions with staff involved, this was reduced to one GP between the same hours.

Staffing

There has been considerable development with staffing issues within the last year. A further nine General Practitioners (GPs) [2.52 WTE] have joined the service. This brings the total number of salaried GPs to nineteen.

Learning and Development

Robust Learning and Development processes are in place within NHS Forth Valley which support our Workforce Planning and Development Agenda. These are profiled in our Local Learning Plan, Leadership Development Plan and various Organisational Development (OD) Frameworks. Specific elements which support the Workforce Planning and Development process are outlined below.

Coaching for Succession Planning

We have developed a core programme which ultimately all staff with line management responsibility will go through called Coaching for Succession Planning. Its focus is on encouraging managers to actively succession plan as well as developing a coaching mindset in how managers work with staff. This course is currently being rolled out starting with the most senior managers, and is seen as critical in helping us to address approximately one third of our staff retiring over the next 10 years. In addition to this we have employed an Executive Coach for one day per week who provides coaching for a variety of staff and supervision to an internal bank of trained coaches.

Leadership Development Plan

Core elements of our Leadership Development Plan include

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• Learning to Lead; a 6 day programme for all staff whether they have line management responsibility or not, on the basis that we need leadership at all levels in the organisation to support us to deliver our agenda.

• Postgraduate Certificate in Healthcare and Local Authority Management accredited by the University of Strathclyde and offered to both NHS Forth Valley and Local Authority staff. We are now running our 4th programme.

• Post graduate Certificate in Frontline Leadership and Management accredited by De Montford University and run by NHS Education Scotland. This course will commence in September 2007 and will be open to NHS Staff.

• Strategic Leadership Programme which is directed at ensuring we have staff developed to fill senior clinical and managerial leadership roles within HS Forth Valley and Regionally. We are now running our 2nd cohort of this programme.

KSF/PDPs and Investors in People

In moving people through KSF gateways and ensuring the supporting PDP focus we need to develop a Career Planning focus. We also need to work to refresh and revitalise roles given that we have a stable workforce with low turnover. Encouraging staff to think broadly about their development and providing opportunities for project work and secondments will help. The Coaching for Succession Planning programme will also help managers in supporting staff to think more broadly.

Additionally, the CHPs collectively have achieved Investors in People with a commitment for the rest of NHS Forth Valley to achieve it within 3 years and this will help in maintaining a strategic focus on PDPs and KSF.

OD Planning

NHS Forth Valley is currently undergoing a period of unprecedented change as we create three new Community Hospitals and a single new Acute Hospital. This entails developing new Models of Care and an extensive programme of Service Redesign. Within that we are identifying how individual roles may change and ensuring that this is reflected in PDPs. Further details on the specific clinical training related to this will be found in the sections on Medical Nursing and AHP Workforce development needs.

SVQs

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We have an SVQ Co-ordinator in place who is supporting unqualified Nursing Staff to achieve the SVQ in Care Level 2 and 3. This is a key programme in developing unqualified staff and we need to consider what further SVQs/development opportunities for unqualified staff we should offer. We have recently developed a Peripatetic Assessor post which will be filled by an unqualified member of staff who has completed SVQs levels 2/3. This is the first post of its kind in Scotland which recognises the development opportunities for unqualified staff.

A strategy for developing unqualified staff is currently being developed and will be completed by the end of 2007.

Key Messages• Roles for staff are evolving and developing and

this should continue

• Competences are being developed for all jobs in NHSScotland. NHS Forth Valley must continue to be actively involved in this process.

• The evolving workforce will help us to achieve Delivering for Health and the benefits it will bring to patients

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4 Staff Groups

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The Medical Workforce

This section seeks to clarify the future medical staffing requirements for NHS Forth Valley. It covers two main areas of medical service provision: Acute Services and Primary Care

Acute Services

Following wide consultation the Clinical Change Project developed a vision for the future shape of Acute Service Delivery in Forth Valley which is represented by the diagram below. The vision creates a clear distinction between scheduled work and unscheduled work and illustrates the range of routes through which patients may be channelled according to clinical need. This is different from the way in which services are currently delivered where there is a much less clear distinction between elective and emergency work. Significant steps towards the “Larbert Model” been made over the past year with increasing proportion of surgery as day case and day of surgery admission, supported by redesign of the pre-operative assessment process.

There are major challenges in terms of designing and organising a workforce to deliver the new model, particularly in the light of other, external workforce influences which will be described in the next section.

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Larbert 2009 – the vision

scheduled

consultation

diagnostic procedure

therapeutic procedure

day case (most)

specialistinpatientbed

specialistinpatientbed (few)

unscheduled

non-health care needs

minor ailments

minor injuries

significant acute health problem

acute-on-chronic health problem

pharmacist / community nurse / general practitioner

rapid response home careprivate / voluntary residential careNHS community hospitalGeneral Practitioners

stabilisetreat &observe

emergency nursepractitioner

NH

S24

pre-assessment

Influences affecting the future shape of the medical workforce

A wide range of factors will influence the shape of the workforce in the coming years, and indeed some of these factors have been drivers for changing the shape of service delivery. While it is important to have a clear vision about the way services can best serve the population of Forth Valley, and to strive to secure a workforce that will allow this to be achieved. There are several major external factors which will affect our ability to do this for example;

• Demographic and societal changes – ageing, increasing long term care requirements, implications for recruitment to health care jobs, increasing age profile of health care workforce, upward trend in older people living alone, reduction in informal care, more demand on professional care

• Rising expectations – patients better informed about health services, patients less deferential to healthcare professionals, increase in the number and influence of organised patient groups

• Health informatics and telemedicine – development of seamless patient records, improvements in the speed and cost of health services

• New medical technologies – genomics, biotechnologies, nanotechnologies and robotics

• Increasing costs of health service provision – increasing expenditure, growth in demand, shift to a primary care focus

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It is important, therefore, either to develop strategies to influence these external factors where possible, for example being proactive in managing patient expectations and harnessing the potential of eHealth and telemedicine or to develop local policies, procedures and working patterns which will make NHS Forth Valley ‘the employer of choice’ and allow the service vision to be realised as far as possible. All of these challenges are captured in our Action Plan

Medical Models for 2009

There will be three main streams of activity within the Acute Services:

• Scheduled work – consultations, diagnostic procedures and pre-assessments;

• Front door medical cover for unscheduled patients (24/7);• 24/7 medical cover for inpatient areas

Within each stream, pathways of care are being redesigned. Such redesign demands a different skill mix within professional staff groups. It also requires role development of frontline clinical staff, so that roles reflect the needs of patients, whether or not these match traditional professional roles. Within each professional staff group, there will be core competencies and generic skills gained during the earlier years of professional training, which must be maintained as new skills are acquired and careers develop. These principles will apply to doctors, dentists and all healthcare professionals.

Scheduled care

Scheduled care will be predominantly based on an outpatient model of consultation → diagnosis → treatment and it is anticipated that this will be delivered largely by consultants and other trained staff. Currently both outpatient and inpatient activity is significantly dependent on junior Medical staff in training.

From 2009 the effect of MMC changes will mean a gradual reduction in the numbers of medical trainees with significant impact on service delivery unless alternatives are developed. This means increasingly that care, including investigations, diagnostic procedures and treatment will be delivered by teams of healthcare professionals, including Midwives, Specialist Nurses, Allied Health Professionals and Support staff as well as Consultants and trained Medical staff.

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Medical cover for unscheduled care

The following diagram shows a possible model for streaming patients for whom hospital admission is being considered. Pre-arranged admissions would not require assessment in Accident & Emergency.

Minor injuries

Separating unscheduled and planned work should allow the scheduled work to progress relatively unaffected by the peaks and troughs of emergency activity and ensure that only individuals who require to be admitted reach inpatient areas – ‘decide to admit’ rather than ‘admit to decide’.

It is anticipated that a dedicated and experienced multidisciplinary team will be required 24/7 for the Front Door (Common Assessment and A&E) to manage the flow of unscheduled patients. Medical cover will include some trainees mainly in a learning capacity but that in the long term service will be delivered by Consultant and other Career Grade Medical staff, working within an emergency team.

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Single Front Door – Senior, fully trained clinicians

A&E and Common Assessment

CR

ITI

CASPECIALIS

T WARDS

Labour ward ACUTE RECEIVING UNIT

For all acutely unwell patients

CO

R

Obstetric Triage


Assumptions

In developing a projected workforce a number of assumptions have been made;

• A careful re-examination of the interface between the roles of medical staff and other key clinical staff will be essential to ensure that scarce medical skills are deployed to optimum effect and that other staff have the opportunity to develop roles and career pathways in a planned way.

• Availability of doctors in training and trained doctors/dentists to deliver the service will be affected by the output from training schemes. Based on current numbers plus expected changes, Forth Valley’s share of doctors (including Public Health and Psychiatric specialties) is likely to be in the order of:

Scotland Forth Valley “share”

specialists 3900 187

specialist trainees 1800 86

foundation year 2 840 40

foundation year 1 800 38

• No trainee is anticipated in Forth Valley where the Scottish total of trainees in that specialty is projected to be below 20 in 2009.

• Current employment terms will not change significantly with regard to study leave, annual leave, and public holidays.

• All training grade doctors will work full shifts, i.e. resident shifts not exceeding 13 hours (including 2 half-hour rest breaks), with at least 11 hours off duty between shifts, and with 48 hours off duty in each 14 days.

• Where there are vacancies between one trainee leaving, and the next starting, there will be interim cover for the vacancy. The numbers on each rota do not permit prospective internal cover for vacancies.

• Where there are rotas requiring additional persons beyond the expected number of trainees, these additional posts will continue to be filled by doctors, as at present, who are neither fully trained specialists, nor in recognised training posts. Specialist Trainees could fill such non-training posts if training numbers were increased, but Consultant numbers might also require to be increased to ensure appropriate ratios of trainers to trainees.

• The number of Consultants assumes a productivity gain through redesign of service and reshaping the medical skill mix, that is, the extra Consultant hours are fewer than the reduced junior doctor hours.

• No allowance has been made for the impact on Consultants of the increased commitment to training and assessing junior doctors, who

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must achieve competencies much faster than in the past. Current estimates of the time required per trainee is around 4 Consultant hours per week which requires an additional 5% efficiency gain in Consultant work.

• The number of Consultants assumes no more than a 44 hour job plan. The new contract allows up to 48 hours per week on average, but it is expected that a significant proportion of Consultants will choose to work less. The extra Consultants required to achieve an average working week of 40 hours will not be available. Indeed, the 44 hour projection is very optimistic in terms of Consultant recruitment.

Details of all run-through training programmes are not yet clear but it seems likely that from 2009 medically staffing for District General Hospitals will be mainly Career Grades (Consultants, sub-Consultants and SAS doctors) with Foundation Years 1& 2 and GP Vocational Trainees. The numbers of Specialist Trainees will be halved and rotations dependent on training needs rather than service demand.

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Mental Health Services

Within Mental Health there are significant service and legislative changes that will impact on the future requirements for Psychiatric Medical Staff. Over the past few years there have been dramatic changes to Mental Health Services with a move away from long term in patient care towards community based care supported by a highly specialised in patient services. The development of community hospitals has been previously described in this document however the impact on psychiatric services has been considerable.

The transitional arrangements are now in place for Acute Mental Health Services and this has resulted in the in-patient facilities being relocated on the Falkirk Royal Infirmary site prior to the opening of the new Larbert Hospital.

Drivers for Change

The following issues have been identified as the main drivers for change for the medical staff within Mental Health Services over the next 10 years.

Over the next three years there will be a need for development of alternatives to In Patient Acute Care (i.e. prevent admission/facilitate discharge) e.g. Intensive Home Treatment Team Development and Enhancement required.

Introduction of new Mental Health Act has provided significant increase in paperwork, clinical work and introduction of Mental Health Tribunal attendance to consultant workload. Need for increased capacity both for Consultant/non-training grade doctors.

At the same time enhanced roles for other professionals need to be developed and training is required to support this.

There is also a gap in services for learning disabled children needs to be addressed.

Within five years we anticipate there will be a need to develop trained, competent doctors at sub-Consultant grade together with further development of enhanced roles for other professionals.

Looking to ten years from now we anticipate the development of more non-training grade doctors who are supporting the Consultant/service. (They will have specific competences to work within).

There will also be changing roles for Consultants involving more delegation, supervision and a focus on complex cases. The need to develop enhanced specialist training/roles for other professionals will be even greater.

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Modernising Medical CareersOne of the potential impacts of MMC from August 2007 is that the trainees allocated to Forth Valley in some specialties may have a different experience and career profile than the current cohort. This will be clear when the MMC interview process is complete (May 2007). There is contingency planning to recruit suitably experienced locums if necessary.

Details of all run-through training programmes are not yet clear but it seems likely that from 2009 Medical staffing for District General Hospitals will be mainly Career Grades (Consultants, sub-Consultants and SAS doctors) with Foundation Years 1& 2 and GP Vocational Trainees. The numbers of Specialist Trainees will be halved and rotations dependent on training needs rather than service demand.

From August 2007 towards enforcement of European Working Time Directive (EWTD) in 2009, all trainees will have less service commitment, greater training/assessment/supervision needs, and are likely to emerge from training schemes with less clinical experience. It is clear that there will be a direct impact on Consultant workload in the short term and a need for increased capacity, however skills re-profiling will see the emergence of new clinical and non clinical roles thereby ensuring service sustainability.

Although we will shortly be entering the phase of MMC when trainee numbers are relatively abundant for a short time, it is a matter of considerable urgency that the competences and skills of other staff groups are developed and expanded. In Forth Valley there is a wide variety of non-medical staff with enhanced skills, e.g. Advanced Neonatal Nurse Practitioner, Nurse Endoscopist, Physician’s Assistant, Anaesthesia Practitioner, Maternity Care Assistants and Nurse Colposcopist. Workforce planning must support these extended roles.Developing competences in other staff groups and establishing alternative models of care makes some Consultant expansion in advance of 2009 essential.

The “MMC bulge” will start reaching CST from 2009 providing the personnel to feed in to expansion of the trained Medical workforce. This is a great opportunity to improve quality of care and service delivery.

Hospital at Night will provide the out of hours emergency cover for the main hospital specialties, with trained and experienced staff being on-site in the hospital 24/7. Other specialties e.g. Obstetrics, Paediatrics, Anaesthetics, A&E, will also have specialists resident at all times. It is likely that the resident specialist cover will be made up from Non-Consultant career Grades as well as Consultants.

The Board’s financial plan supports expansion of Consultant numbers. However, it is assumed that these changes will be neutral in terms of supporting resources, i.e. services will have the same beds, clinics, procedure sessions,

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secretarial support, etc., sharing these between the increased number of Consultants as appropriate.

Part of the funding is the return from NHS Education Scotland to the Board of the core salaries of all trainees as posts are phased out over the next 4-5 years. However some pump-priming is essential to anticipate the changes ahead.

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The Dental Workforce

Good oral and dental health is recognised as an essential component of good general health. While there have improvements recently Scottish children have some of the worst teeth in Europe. The current Forth Valley position is better than the Scottish average. However we know that we need to make substantial changes to NHS dental services to meet the expectations of patients and dental professionals.

The vast majority of Dental care is provided in CHPs by independent contractors. In 2000 The Scottish Executive published Workforce Planning for Dentistry in Scotland: A Strategic Review: Interim Report and Recommendations and NHS Education (NES) recently published its third report http://www.nes.scot.nhs.uk/documents/publications/classa/analysisandmodelling.pdfas a result of close collaboration between NES and the Information Services Division (ISD) of NHS National Services Scotland. The Scottish Executives Dental Action Plan (DAP) has seen training capacity for dental professionals in Scotland expand with a target of 135 dental graduates per annum. Following the DAP a target of dentist: patient ratio of 1:1750 has been set by Chief Dental Officer.

Nationally and locally there are two salaried CHPs dental workforces (salaried practitioners and community dental practitioners) these are set to merge into one managed dental primary care service following the publication of the Scottish Executive’s Review of Primary Care Salaried Dental Services in Scotland 2006.

Dentists have been supported in practice by Dental Nurses, Dental Hygienist and Dental Therapists, collectively termed Dental Care Professionals (DCPs). New training courses for DCPs have been recently established with the aim of producing 40 dental therapists nationally per annum. Work is needed to develop and redesign dental services locally and nationally integrate therapists into the workforce.

Secondary Care Dental Services

The General Dental Council recognises a range of Dental Specialities

Oral and maxillofacial surgery OrthodonticsSurgical Dentistry ProsthodonticsEndodontics PeriodonticsRestorative Dentistry Dental Public HealthPaediatric Dentistry Oral MedicineOral Microbiology Oral Pathology Dental and Maxillofacial Radiology

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http://www.nes.scot.nhs.uk/documents/publications/classa/analysisandmodelling.pdf

http://www.nes.scot.nhs.uk/documents/publications/classa/analysisandmodelling.pdf

Locally two Dental specialities Oral and Maxillofacial Surgery and Orthodontics are provided and since the NICE guidance on Head and Neck Cancer and the development of the MCN there is a need to have local Restorative Dental specialist cover to meet the requirements of this service.

Traditionally the other additional specialties have been provided in the dental schools but there is increasing demand for these to be available more locally. Locally the need to develop Periodontal Endodontic and Restorative specialities services would seem greatest.

Linked to this is the proposed development of Dentists with Special Interest (DwSI). The development of DwSI could see the development of more MCN type arrangements to provide better local access to specialist dental services.

The current dental workforce

Figures for the dental workforce in Forth Valley as of Sept 2006 are shown in table 1

Table 1. Dental Workforce in Forth Valley (excluding Oral and Maxillofacial surgeons and DCPs)

Sept-2006NHS Forth

Valley

All dentists ( excluding OMFS ) 132

General Dental Service 121Non-salaried dentists 110Principals 101Assistants 0Vocational Dental

Practitioners 9Salaried dentists 12

Hospital dentists 6

Community dentists 15• data from ISD.

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Future Workforce

To meet the target dentist patient population ratio of 1:1750 we would need to attract 28 dentists to Forth Valley (currently expansion of independent contractor services is supported via the Scottish Executive Access Grant Initiatives and General Dental Services funding).

Development and service redesign should see the integration of dental therapists, CHPs practitioners and additional specialist practitioners providing local dental services in the future. The specialist practitioners could either be within secondary care as dentists with special interests. There is need for Consultant Restorative Dental input to support the Head and Neck Cancer Service locally this could also provide general advice to practitioners locally. Other specialist services will need to be developed in the next ten years with periodontal and endodontic restorative services being the most likely.

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Nursing and Midwifery

Context

The future model of health care in Scotland set out in Delivering for Health is geared towards prevention and the proactive management of long term conditions. It will be embedded in communities, team based and provide care that is continuous, integrated and sees the patient as a partner. This planned shift in the balance of care from acute to community based settings gives Nursing, Midwifery and Allied Health Professionals (NMAHPs) an unprecedented opportunity to increase their capacity to influence, shape and deliver services to meet the vision set out in Scotland’s health care policy.

The nursing and midwifery workforce continues to be vital to the delivery of safe and effective care to the people of Forth Valley. Nurses and midwives are ‘front-line’ practitioners, delivering services designed to meet peoples health and healthcare needs across the age spectrum and in all communities and they account for 47.9% of all healthcare staff working in the area.

NMAHP policy

Major policy frameworks have been produced throughout 2006 and 2007 to date, which facilitate the shift in the balance of care and ensure the vision set out in Delivering for Health is realised through the NMAHP Workforce.

• Delivering for Care – Enabling Health (SEHD 2006a) the NMAHP strategy document which builds on and draws together the earlier nursing and AHP strategies, Caring for Scotland (SEHD 2001a) and Building for Success (SEHD 2002)

• Visible , Accessible and Integrated Care (SEHD 2006b) A Review of Nursing in the Community

• Delivering for Mental Health (SEHD 2006c)• Coordinated, integrated and fit for purpose (SEHD 2007) A Delivery

Framework for Adult Rehabilitation in Scotland

As the context of nursing changes, so must the nursing workforce. We must develop a competent and flexible nursing workforce and prepare nurses to lead, in a rapidly changing health care system. Furthermore we must update career pathways and career choices to maintain motivation. Ensuring that staff feel motivated to do their best at work is important in all workplaces, and the NHS is no exception. In NHS Forth Valley we strive to be an exemplar employer and thus want all our staff to feel appreciated, involved, challenged and motivated

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Local challenges

The role of nurses and midwives in NHS Forth Valley continues to develop to meet the needs of the service. Equally the service is continuously developing to meet the needs of the local population and the requirements of Scottish Executive Health Department policy as encompassed in Delivering for Health and Better Health Better Health Care. This will see a significant shift in care from hospital to community services, which will require different ways of working. For Nursing & Midwifery this process continues with the redesign of acute hospital services and also with the implementation of community health partnerships and into complete single system working.

Demographic challenges for the Nursing and Midwifery workforce (see Annex B) are similar to those as discussed throughout the earlier chapters of this document. However there are some key issues for Nursing and Midwifery and these are grouped around Student Nurses, Qualified Nurses, Non registered nurses and Operational Service issues:

NHS Forth Valley maintains an excellent relationship with Stirling University and we are working together to address issues such as:

Attrition

• Stirling University delivers training over three campuses, Stirling, Highland and Western Isles and they are currently discussing how best to manage the local attrition rate of 21% and still provide the number of nurses required for future years. The national attrition rate is 25%

• Nurse training recruits from a nationally reducing pool of school leavers. In addition there are a significant number of mature students now entering the profession. For many it is a second career choice and there is no doubt that their existing skills enhance the profession. Nevertheless some students find the academic aspects of the course challenging.

• Financial implications of living on a bursary are testing and many have to rely on part time work and partners to make ends meet

• Family issues come first

We will continue to seek more information on • the age profile of student nurses • where (post codes) they are recruited from• their reasons for leaving• their reasons for staying on in the profession

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Changes in nurse training programmes have meant there is an increase in the clinical supervision required for student nurses, which has an impact on the quality and volume of mentoring available during clinical placements.

The Nursing and Midwifery Council have recently published their Standards to Support Learning and Assessment in Practice (March 2007). These standards will have an impact on the quality of the student experience in practice and their enhance their learning.

• There is no up to date formula for working out mentoring levels although the above standards do recommend that 40% of a student’s time must be spent with a mentor (p29).

• Locally in NHS Forth Valley ward and community nursing establishments do not meet the national recommended time out levels which has a consequent impact on the numbers and quality of mentoring available

Recruitment

Nurse Training recruits from a nationally reducing pool of school leavers of about 20% over the next 10years

Qualified Nurses

The challenges around this group of our nursing workforce relate to training and education requirements and recruitment and retention which is critical to advancement of the profession.

The recruitment process is challenging specifically around specialist areas e.g. theatres and critical care and is beginning to have an impact on general ward areas. The recruitment process is also influenced by one output a year from the principal education provider (Stirling University).

External recruitment is becoming progressively challenging with public and private healthcare organisations competing for the same workforce pool

The average age of the nursing workforce is 40 and 11% is over the age of 50. Flexible working patterns should exist over the whole career life span and not just focussed on child bearing and child rearing years. Our workforce plan is an opportunity to consider and identify constructive solutions to this dilemma.

Newly qualified nurses require support to fully integrate and become socialised into the workforce and the profession. In addition for the more experienced member of staff there is an increasing requirement for organisational mandatory training and also that required by the Nursing and Midwifery Council (NMC) to ensure competence and the delivery of a safe and effective service for

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the people of NHS Forth Valley. These requirements also ensure the fitness to practice of nurses themselves which in turn seeks to protect the public. This however requires an adequately established workforce to maintain the quality of nursing care to allow the support to happen. Adequate training provided at the right time helps maintain a stable and developing workforce through clinical supervision and succession planning commencing with

• Two week Orientation/Induction• National (on line 1 yr) and Local Flying Start Programmes - 3 days• Role rotation programme – 18 months (NHS Forth Valley)• Clinical Skills training

Experienced nurses require continuous professional development (CPD) to maintain competence and assist the advancement of the profession to care for the needs of the people of Forth Valley. The organisation has therefore to provide and deliver

• Access to training to support CPD, Clinical Priorities for action, national and local

• Succession planning based on competency based career pathways

In addition as the service develops so does the nurses role to meet the changing patterns of disease and health needs of the population.

• Nurse Prescribing Roles• Consultant Nurse Roles• Emergency Nurse Practitioner Roles working in both Acute and Primary

Care (Out of Hours) settings

Senior Clinical Nurse Review

A national review of this role and responsibilities has taken place and NHS Forth Valley was a development site for this work. The outcome will be a recommended generic modern job description and (Knowledge and Skills Framework (KSF) profile with a recognised development tool kit to support and develop staff in this role.

Clinical Nurse Specialist Roles (CNS)

There are a significant number of CNS posts and it is important to ensure that these roles continue to develop and expand to support new models of care which are focussed around the needs of specific populations.

Clinical Nurse Specialist roles provide a significant opportunity for nurses to develop and extend their skills and expertise in new models of care however

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the challenge remains that there are attractive career opportunities within generic nursing.

CNS roles across Acute and Primary Care services should be maximised to share skill and expertise across the health care systems in NHS Forth Valley.

Currently the Cancer Nurse Specialist Review is taking place. The results of this will inform all advanced nursing practice and support succession planning.

Unqualified Nurses

Changing models of care will require continual development and preparation for this group of staff. Great strides in this area have been achieved over the last 2-3 years with Support Workers having had the opportunity to acquire a named award to at least SVQ Level 2 or equivalent. In NHS Forth Valley 84 support workers have achieved the qualification

Historically this group of staff experience high levels of sickness and absence, recent organisational change having had an impact. This has implications for the future as NHS Forth Valley moves into the next stage of modernising its services and is an area that requires close monitoring across the organisation.

In addition there are also opportunities on the HNC programme – In NHS Forth Valley 48 have undertaken this award, 36 have achieved it and have gone on to student nurse training and 12 are currently on the programme

The changing model of healthcare provision in NHS Forth Valley will increase the opportunities available for non registered staff and as a result be able to better support recruitment and retention in our service.

Operational Service Issues

NHS Scotland is changing rapidly. In Forth Valley we have recently delivered a new model of care providing a transformation in service delivery which allows us to deliver safe, effective and sustainable healthcare for the future as locally as possible as . This has incorporated single system working, the development of Community Health Partnerships, Transitional Arrangements (TAs) in the Acute Division and planning for our new acute hospital in Larbert in 2009 and also the development of new community hospitals across NHS Forth Valley.

This has presented several challenges for our Nursing and Midwifery Workforce and several opportunities for development;

We need to be able to determine:

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• the impact of new models of care on Nursing and Midwifery and the Delivery for Health on neighbouring Health Boards and how that will reflect back on NHS Forth Valley

• the impact of the changes in the model of care provided by Acute Services on patient care and the Nursing and Midwifery workforce in Primary Care Services in particular Community hospitals.

• the impact of Information Technology on the workforce, electronic record - will it change the way we work?

• the impact of the development of other professions – Allied Health Professionals

• Modernising Medical Careers what does that mean for nurses and midwives and what opportunities does it present for developing the nursing and midwifery workforce

The Nursing and Midwifery Workload and Workforce Planning Project in NHS Forth Valley

Overview

Audit Scotland's report into nursing workforce planning at ward level, Planning Ward Nursing - Legacy or Design? (Audit Scotland, 2002), raised important questions on how nursing and midwifery workforce development was being taken forward.

The Facing the Future group commissioned a project to examine the situation in nursing workload and workforce planning in Scotland commenced in July 2003. The aim of the project, which was overseen by a steering group and run by a project manager, was to develop a national picture of all key areas of nursing and midwifery workload and workforce planning activity. The outcomes of the project were published in April 2004.

The National Nursing and Midwifery Workload and Workforce Planning Project represented a major development in workforce planning and brought focus to the importance of the issue. It outlined twenty recommendations to be actioned at Executive, Regional and local level. All NHS Boards are charged with developing and implementing action plans to address the relevant recommendations

The recommendations are set out in broad principles:

• principles to govern Nursing & Midwifery Workload and Workforce Planning

• education and development to adequately equip those involved in determining Nursing & Midwifery staffing levels, skill mix etc.

• Nursing & Midwifery Workload and Workforce Planning systems: National Expert Advisory Groups are taking forward the development of Workload /

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Workforce Planning tools (A representative from Forth Valley is actively participating within these groups)

• principles to ensure that ward managers and community team managers have 7.5 hours per week protected time to develop and manage their staff and service.

• a specific recommendation for a national standard of 21% predicted absence allowance. This excludes the additional annual leave allowance as a result of Agenda for Change

• a specific requirement to establish a local Nurse Bank

Progress and Work To Date

To date NHS Forth Valley has made steady progress in achieving these recommendations and major achievements to date include

• Dedicated staff in place to implement the recommendations• Nurse Banks amalgamated• Time out allowance is now 19.5% throughout acute services• 7.5hrs protected time – variable across NHS FV• Workload assessment rolled out across Primary Care bed holding areas

It was agreed nationally that progress reporting on the 7 recommendations would be monitored using a traffic light system. At the present time NHS Forth Valley has 4 of the recommendations at green and the remaining 3 at yellow and these can be summarised as follows

Green• Workforce planning being taken forward via an approved action plan• The continued introduction of flexible working practices• Ongoing training needs analysis of the workforce• Dedicated clinical leadership programmes are in place

Yellow• While the Nurse Banks have been amalgamated further work is required to

achieve bank/agency targets to achieve savings and reinvestment in substantive posts

• 7.5hrs a week protected time has been achieved for ward sisters with 24hr responsibility however this requires to be rolled out throughout the Board

• Further work required to achieve the recommended 21% (min) absence allowance for nursing establishments

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Future Challenges

In order that NHS Forth Valley can continue to develop nursing and midwifery services several future challenges require to be addressed. These challenges include;

• Maintaining progress on our green recommendations and implementing fully the yellow

• Undertake the Senior Clinical Nurse Review• Implementation of Nursing Clinical Quality Indicators• Continued reduction of bank and agency usage• Keep alert to potential recruitment and retention issues • Steady progress in workforce planning and availability of workforce

information which is necessary for future planning

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Allied Health Professions The nine Allied Health Professions (AHPs) in this chapter are those identified in the National Workforce Planning Framework. They are: Arts Therapists, Podiatrists, Dieticians, Occupational Therapists, Orthoptists, Physiotherapists, Radiographers, Speech and Language Therapists, Prosthetists and Orthotists.

The complexity of the AHP workforce is challenging in terms of workforce planning and developing service models. It is important to recognise that ‘allied health’ is not one discipline but many. Although the professions often work closely together in multi-disciplinary teams, each profession has its own areas of specialisation. To presuppose that Allied Health Professionals are a homogenous group is akin to saying that all doctors and medical specialists are alike – that a Cardiologist, for instance, has similar skills to a Psychiatrist. Service and Role Redesign

There has been an increasing drive towards the development of a flexible workforce to meet the challenges of a redesigned health service, where multiple professionals are able to take on tasks traditionally seen as the domain of one profession thus, the NHS has seen the creation of a host of new roles. In Allied Health Professions (AHPs) these roles are divided broadly into four tiers:

• Assistant practitioners• Registered practitioners (entry-level AHPs),• Advanced practitioners (clinical specialists and extended scope practitioners),• Consultant practitioners.

Across the spectrum of the AHP professions in NHS Forth Valley, it is difficult to predict with any certainty the impact that service re-design will have on the AHP professions.

There are however excellent examples of innovate practice in Forth Valley examples of which are in the current NHS Forth Valley Service Benefits Realisation Plan.

Balancing the Workforce

Matching the supply of qualified staff with the demands placed on health services is perhaps the essence of workforce planning. However, a clear and direct link between demand and supply cannot be assumed. This is because the supply of qualified graduates is not determined by the health system in a planned way. Increases in student places are often ‘one off,’ and not sustained, and, unlike in other professions, or as in England, the Scottish Executive do not commission student numbers.

In this respect it becomes the education system that determines the supply of qualified AHPs for the NHS, without any regard for service planning.

A Pathway to Work is a new initiative from the Department of Works and Pensions designed to assist clients approaching their sixth month of

unemployment to return to work. This initiative could have implications for particular AHP services in Forth Valley such as Occupational Therapy and Physiotherapy.

Regional Planning

In NHS Forth Valley we are convinced that there is a need to take a wider regional perspective on the workforce planning issues for some of the smaller AHP professions in order to support these professions. Other areas needing to be considered under this heading include ratios of skill mix, role development and induction of new graduates.

Local Arrangements

The reconfiguration of the acute hospitals as previously described, and the proposed shift in emphasis of care will require careful management to ensure that services do not become skewed in either area. To assist in this process consideration will be given to joining up the capacity planning mechanisms that “straddle” both Acute and CHPs. Only by taking the wider view will the maximum potential be realised.

Professions such as Audiology have received substantial national funding from the Scottish Executive to implement a digital hearing aid programme. In addition, further monies were invested in a neo natal screening programme. This funding has allowed the service to expand predominantly in staff in the Assistant and Technical Instructor grades.

The demographic changes in Forth Valley’s population will have a major impact on the requirement for AHP’s. As has previously been discussed in this plan the increasing and ageing population will result in a greater demand for services in support of chronic disease management and AHPs play a key role in the care of people with chronic disease. There is also a move towards providing 7-day services and extended hours clinics to support reduced lengths of stay within in-patient settings and to meet the CHPs waiting time target of 48 hours.

Within the community there is an expectation from Local Authorities that anyone requiring home support will be assessed by NHS Occupational Therapists resulting in increased workload for the current service.

There are also a number of redesign initiatives such as the Back Pain Service that may require increased resources to facilitate.

ESP physiotherapists are graded Superintendent II currently and there will be development of these type of posts in various specialties. For the outreach teams, skill mix will change more senior Is to support Senior IIs. Senior II numbers will not increase until more Senior I’s are in post, thus providing a more stable workforce within the teams. Also there is a need to up skill and use rehabilitation assistants more within outreach teams. More rehabilitation will be undertaken in the community in future, hence the increase in workforce required to accommodate this increase.

Education and Development Continuing Professional Development (CPD) is the key for all staff groups. There is a need to move the emphasis to CPD activity that is more care group focused and multi-disciplinary delivering better outcomes and economies of scale and organised in a more co-ordinated way, across both Health and where possible Social Care.

AHP Assistants & Technicians require support and development through access to health-related vocational training programs leading to the award of SVQs or other appropriate qualifications.

Exploratory work is underway to identify future clinical leaders and consultants from within the AHP workforce.

Radiology services

Radiology is a demand led service which has/is seeing a number of service developments e.g. the continuing rollout of the PACS system which allows electronic viewing of all radiological images by all clinicians without the hard copy film being present and makes the images available at other hospitals nation-wide, other advances in equipment and technology – especially CT and MRI allowing less invasive studies and increased reporting sensitivity; and in the next two years developments in interventional techniques such as aortic stent grafts, radio frequency ablation – allowing less invasive studies/procedures and the potential to treat surgically unfit patients, make more patients operable and act as an adjunct to chemotherapy. In an effort to meet waiting times targets the service has participated in the Diagnostics Collaborative. Annual growth in GP referrals and elective/diagnostic activities make it likely that the service welcome under increasing pressure as the local population expands. The impact of the move to Larbert and the Community Hospitals Project has still to be determined pending some key decisions being made and will require to be revisited in future iterations of the plan. The development of new and/or expanded roles will support the development of the 4-tier structure releasing Consultant Radiologist time and offering a more seamless service.

Healthcare Science, Technical and Pharmacy Staff

Pharmacy

The move to the new acute hospital at Larbert will have an impact on how the pharmacy services are provided. The impact of this move and the Community Hospitals Project has still to be determined. Detailed planning of staff requirements needs to be undertaken, but it is unlikely that the numbers required will reduce. Increased numbers of pharmacists and/or technician grade staff have been proposed to support the pre-assessment and cancer business cases (including clinical trials) in 2007 and the ICU and vaccine cases from 2008. It is also anticipated that increased numbers will be required to support education and training requirements arising not only from the likely introduction of legislation requiring the statutory registration of pharmacy technicians in 2007/2008 but also changes to the way in which pre-registration pharmacy students are allocated and increasing requests from medical and nursing groups for pharmacist input into their training programmes.

The IM&T strategy continues to be developed and includes the continued rollout of E-Ward, automation and HEPMA (Hospital Electronic Prescribing and Medicines Administration system) over the next 3 – 5 years.

Electronic prescribing will change the way that clinical pharmacists operate and will improve efficiency in stores and dispensaries. The change is subject to a national agenda and the impact on staffing levels is still to be fully determined.

Recruitment & Retention

Changes to the allocation of pre-registration pharmacy students could impact on Forth Valley’s ability to recruit these staff on qualification. With the co-ordination of placements being taken over by NES, it is possible that there may be times when Forth Valley is not allocated a student for some or all of the year. These placements have previously proved to be a useful source of applicants for junior graded posts. Recruitment of hospital pharmacists and technicians presents a challenge and it remains to be seen what impact the new Community Pharmacy Contract will have on this.

Laboratory Staff

Local laboratory services are currently provided in Microbiology, Pathology, Haematology/Transfusion and Clinical Chemistry. All services are reporting increasing levels of activity. Influencing factors include an increasing population; annual growth in GP referrals; reduced emergency bed days; annual growth in diagnostic and elective activities; increased awareness of Hospital Acquired Infection; the emergence of hospital “superbugs”; increased high dependency patients and reduced bed numbers; initiatives such as the sexual health initiative and colorectal screening; introduction of the EU Blood Directive requiring improvements in the storage, labelling and handling of blood and blood products; increased specimen complexity and numbers. Multi-Disciplinary Team Meetings are increasing and demands from clinicians and oncologists will increase immunocytochemistry numbers.

All services are reporting increased use of technology. In addition the new GP contract has also influenced service developments e.g. the introduction of the dawn anticoagulation software, demands for faster turnaround times and direct reporting to clinical areas and integration of the system for Gyn-Cytology (SCURRS) over the next few years. This increased use of technology is also driving the development of multi-function roles for support staff.


Recruitment and retention has been highlighted as an ongoing area of concern for all laboratory services with additional pressures being put on the system by the additional annual leave entitlement under Agenda for Change.

Clinical and Applied Psychology

The service provides psychological advice, treatment and assessment to patients and staff in Mental Health, Learning Disabilities and Health (Acute OD).

Psychologists work with teams in Mental Health (CMHTs, CLDTs, Rehabilitation, and Forensic) and in Physical Health (Cancer Team, Area Rehabilitation Team, Pain service, Diabetes). They work jointly with team staff on the psychological problems of patients, provide supervision and advise on service delivery, development and audit. 50% of service time is spent on direct patient contact with people who have complex psychological and psychiatric difficulties.

There is a substantial outpatient service to GPs. Innovations over the last 24 months have increased throughput of patients and opened new methods of access to psychological help. These innovations are, first the website Moodjuice, which provides self help and a resource database, and second access to computer assisted CBT for GP practises.

The Adult Psychology service comprises 15.2 WTE; 1.2 WTE of these are counsellors, the remainder being Clinical and Forensic Psychologists.

• Skill mix affects numbers. • We anticipate increased numbers if we have the choice of recruiting the

grades we need for the jobs we have. The advent of the one year MSc course to train Applied Psychologists in Health together with increased numbers of Clinical Psychology graduates will allow more junior staff to be recruited.

• We currently have temporary staff to design, service and administer the Forth Valley self help website, Moodjuice, and the computers which deliver CBT to GP services. Over the next 3 years we anticipate continued funding to employ 1-2 administrative staff for this.

• The NES schemes for Psychology trainees. Due to funding anomalies in NES we have been offered extra trainees who come with a service component attached to their posts. This means that we are showing an increase of 0.5 WTE clinical psychologist in 2006 and a further 1 WTE member of staff in October 2008. Each increase is maintained for a period of 4 years.

• The small Forensic Learning Disability Service anticipates an increase of 0.2 WTE in this financial year.

• The SAT has given money for 1 WTE A Grade psychologist to work in addictions within the MCN between Fife, Tayside and Forth Valley.

• 25% of the Clinical Psychology workforce will be retiring over the next 5 years. The increase in training numbers will not compensate for this. There may, then be some difficulty in filling posts and the age profile of the service will change and become younger.

• Psychologists working in physical health. There is a huge potential for Psychology to interact with providers of acute health services to improve compliance with treatment. There should be an increase in posts in this area once commissioners understand this.

• Forensic services. The new Mental Health Act and the establishment of the Risk Management Authority will make demands for psychological treatment for patients with severe and enduring illnesses and for the assessment of violent offenders respectively. An increase in staff will be needed to accommodate these.

• Older Adult services. Forth Valley is one of only 3 Health Boards in Scotland with no specialist Psychology service to older adults. This should change in the next 5 years.


Historically, Psychologists are very difficult to recruit due to the bottleneck at training. This will ease over the next 3 years as NES has increased training places substantially, however, in the next 5 years 25% of the workforce will retire. This will ensure that recruitment remains a challenge.

Administrative, Clerical and Senior Management

Administrative and Clerical staff, along with Senior Managers makes up the second largest staff group across NHS Forth Valley. At September 2006, they accounted for 17.9% of the total workforce with over 985 WTE in post. The majority of this group consists of staff employed on the lower Admin and Clerical grades (up to A&C 4) with many providing supporting roles to clinical services, for example Medical Secretaries and Medical Records.

Demand

It has not been possible to establish a Forth Valley wide figure on future demand for this element of the workforce. However, through the production of the workforce plan, we have identified that the future roles of Administrative, Clerical and Senior Management staff will change to be more focused on supporting the delivery of clinical care. Indeed, the future design of clinical services will be dependent on the continuation and development of non-clinical roles across the Administrative, Clerical and Senior Management workforce.

In line with other staff groups, we will need this particular workforce to be more flexible in its approach to service delivery. In addition, it is anticipated that we will require to develop new and extended roles for those more traditionally associated as forming part of this staff group. The main driver that will impact future demand is eHealth

Supply

It has been possible to identify certain supply characteristics for this element of NHS Forth Valley’s workforce. The main issues are detailed below:

• An ageing workforce - at September 2006, 32% of the workforce were aged 50 years and above.

• There is a high level of part time working (approx 42% of workforce). • The workforce continues to grow ahead of other staff groups. In the year to

September 2006, this workforce increased by 1.8% (WTE). Since September 1999 the administrative workforce has grown by 32.75% (243 WTE).

• The workforce, although growing, remains relatively stable with absence rates relatively low.

Estates, Trades and Ancillary

Supply and Demand

At September 2006, there were 607.9 WTE Estates, Trades and Ancillary staff in NHS Forth Valley, representing approximately 11% of the total workforce. The labour market for these staff groups is more local than regional or national, and is highly competitive, especially across Central Scotland and also in the North East, where the buoyant oil industry and supporting services offer private sector salaries that can be significantly higher than in the NHS. This can lead to staff recruitment and retention difficulties. Competition is acute for building and maintenance staff (Electricians, Plumbers and Joiners). Indeed, in the wider economy, the construction industry is reporting skills shortages and NHS Forth Valley will have to be competitive in order to sustain service delivery. In addition to this competitive labour market, NHS Forth Valley faces the challenge of recruiting to an ageing workforce.

Two major Public Private Partnerships will impact on our workforce however as the projects are not yet at Financial Closure detailed workforce plans are still to be compiled.

Clackmannanshire Community Hospital PFI

Hard FM Services (Estates) will be provided by the new private sector employer whilst Soft FM (domestic) services will be provided in-house.

There are no significant staffing issues regarding this new partnership venture as the staff have been identified and ready to take up their posts at the commencement of service. We do not envisage any retention or recruitment difficulties.

Acute Hospital Larbert PFI

Hard and Soft FM services will be provided by the new private sector employer and by working in partnership with the new providers we will work towards matching our skilled workforce to posts in their structure to ensure a quality services is provided.

We do not foresee any recruitment difficulties and the challenges will be in supporting the staff in the new joint venture and ensuring they receive training and acquire new skills to deliver any innovative solutions to service delivery.

Projections for all staff groups are provided in Annex A.

Key Messages

• The need to align roles to services is understood

• New roles are continually being developed

5 Action Plan

Action Plan

This chapter reports on progress on actions from NHS Forth Valley Workforce Plan 2006/07

26 Actions were identified or NHS Forth Valley to take forward. Some of these had specific time frames; others are ongoing.

The following table reports on progress and achievements.

Report on Board Actions 2006/07

Action Progress Ensure workforce activity is connected to/ reports to/sits within a Board service planning context and ties back to the Workforce Design and Information Group through this Action Plan.

Achieved

Develop a Workforce Strategy OngoingReview and develop the remit and membership of NHS Forth Valley Workforce Design and Information Group

Achieved

Undertake a service mapping exercise within NHS Forth Valley and agree service units.

Ongoing

Develop individual workforce plans for each service unit

Ongoing

Roll Out SSTS to ensure 100% usage within NHS Forth Valley

Ongoing

Develop a Board wide Workforce Information reporting system

Ongoing

Develop a recruitment strategy that addresses the potential recruitment difficulties that may be experienced over the next 10 years

Ongoing

Introduce a Recruitment Database to support the recruitment process within NHS Forth Valley

Achieved

Further analysis of the number of staff who are over 50 and who may retire in the next 10 years

Ongoing

Action Progress Develop and implement succession planning and talent management initiatives

Ongoing

Apply affordability tests to workforce plans

Ongoing

Develop integrated staffing profiles and competencies. Apply affordability and availability tests.

Ongoing

Develop and implement plans for the full impact of the Working Time Regulations in 2009

Ongoing

Improve absence rates to achieve 4% sickness absence target by March 2008

Ongoing

To create a group to steer and champion recruitment, retention and workforce planning for Nursing & Midwifery

Achieved

Review position with nursing establishments post -Transitional Arrangements

Achieved

Further review of Nurse Bank and Agency budgets

Achieved

Develop a new model for nursing practice within the context of CHPs.

Ongoing

To examine the Mental Health (Care and Treatment) (Scotland) Act 2003 which, came into effect in April 2005

Achieved

Develop a new Community Hospital model of care involving a review of medical, nursing, AHP and support roles.

Ongoing

Review the nursing model within new Acute Hospital to determine projected time-out allowance on implementation

Ongoing

Set up an area wide Nursing and Midwifery Workforce Planning Steering Group

Achieved

Carry out local SNIP and Clinical Nurse Specialist data collections

Achieved

To monitor the impact of MMC on the workforce

Ongoing

Action ProgressEnsure workforce planning supports the overarching objectives within the Local Delivery Plan

Ongoing

Ensure all workforce planning activity supports improved patient pathways & experience.

Ongoing

The Workforce Development Group will refresh the current action plan to incorporate actions from both the National and Regional Workforce Plans as well as actions arising from this iteration of our local Workforce Plan.

Actions for 2007/08

Action Regionally and individually develop and improve analysis of drivers for change and their impact on the future workforce.Improve the quality of workforce data provided regionally and nationally and used within the Board. Raw data must be robust and accurate.Improve the quality of data available on CHPs and General Practice in particular.Improve the quality and frequency of vacancy data reported to allow swifter and more accurate identification of any hotspots that may be arising.Regionally and individually further develop and improve the integration of workforce planning with service and financial planning. Particularly where services are to be redesigned and where options are to be considered to address factors such as Working Time Regulations for 2009. Furthermore proactively plan and implement the changes that will come about as a result of the 12 work streams under Delivery for Health.

Action Improve forecasting of demand for staffing, especially expansion or contraction of demand. Clear and visible links must be made to the Local Delivery Plan. To reflect this, projections should be made for the immediate 3 year period with robust affordability tests for all staff groups. Projections should also be made for 5 years for nursing and midwifery and GPs; and for 10 years for all medical specialties and dentistry. Affordability tests are not required on these longer term figures, but Directors of Finance must indicate they are content. The baseline for all projections should be the funded establishment but if there are significant differences with the theoretical establishments then these should be considered. Continue to develop capacity to workforce plan on the basis of patient services, as well as collating projection data in traditional staff groups. The benefits of regional planning should be maximised.Consider and address the implications of the implementation of the next phase of MMC, not just for the medical workforce but for other staff groups as well. Consider and plan for the opportunities offered by increased availability of CCT holders once the ‘bulge’ of trainees complete their training; and plan how to address the concurrent reduction in training numbers.Continue to extend coverage of services planned at regional level in the 2007 Workforce Plan.Develop a Workforce Strategy

ActionUndertake a service mapping exercise within NHS Forth Valley and agree service units.Develop individual workforce plans for each service unitRoll Out SSTS to ensure 100% usage within NHS Forth ValleyDevelop a Board wide Workforce Information reporting systemDevelop a recruitment strategy that addresses the potential recruitment difficulties that may be experienced over the next 10 yearsFurther analysis of the number of staff who are over 50 and who may retire in the next 10 yearsDevelop and implement succession planning and talent management initiativesApply affordability tests to workforce plansDevelop integrated staffing profiles and competencies. Apply affordability and availability tests.Develop and implement plans for the full impact of the Working Time Regulations in 2009Improve absence rates to achieve 4% sickness absence target by March 2008

Develop a new model for nursing practice within the context of CHPs. Develop a new Community Hospital model of care involving a review of medical, nursing, AHP and support roles.Review the nursing model within new Acute Hospital to determine projected time-out allowance on implementationTo monitor the impact of MMC on the workforceEnsure workforce planning supports the overarching objectives within the Local Delivery Plan

ActionEnsure all workforce planning activity supports improved patient pathways & experience.

Fit for Purpose Tests

The National Workforce Planning Framework identifies three principles which must be met to ensure workforce planning conclusions are fit for purpose:

• affordability• availability• adaptability

Affordability

Integration with Services

The majority of NHS funding is used to meet staff costs – this means we must ensure that we make best use of this resource. Working across boundaries is vital for both service and workforce planning. The complexity of services and inter-relationships between organisations make workforce planning difficult but most fundamentally we need to align workforce planning with service planning.

NHS Forth Valley will endeavour to ensure that workforce planning is effectively integrated with arrangements for service planning (and redesign), and financial planning, and that it links appropriately with arrangements for educating and developing its staff.

This is most recently demonstrated by workforce planning for the Clackmannanshire Community Hospital Project due to open in 2007 and early workforce planning that has been undertaken for the New Acute Hospital Development at Larbert. In this latter project it was recognised that new models of care were being introduced in support of the overall Health Strategy and funding was identified for retraining and re-skilling and incorporated into the local Health Plan. This funding will be kept under review as the detail underpinning the new hospital development matures.

Financial Strategy

NHS Forth Valley has an agreed financial strategy 2007 – 2012 which ensures that there is a balanced budget on a recurrent basis and that in each year of the strategy we live within the resources available.

NHS Forth Valley is an Arbuthnott ‘gaining’ Board and these additional funds are being retained to fund the implementation of the Healthcare Strategy. In workforce terms this means funding prioritised to support

• Additional nurse staffing for Clackmannanshire Health care facility

• Introduction of new models of care within the new Acute hospital requiring re-skilling supported by funding in advance of the new hospital

• Redistribution of existing resources within long stay/community setting to meet the new models of care for Community Hospitals.

Significant resources have already been invested in pay modernisation covering the changes to Junior Doctors’ contract, the new GMS contract, the Consultants contract and Agenda for Change. Changes to the provision of Out of Hours services has also required significant investment. Further changes are envisaged in the new Pharmacy and Dental contracts.

The service implications for Modernising Medical Careers are also under review. Resources have been identified to meet the impact of MMC and it is envisaged that this will require further review.

The NHS has undoubtedly enjoyed significant investment in recent years with the vast majority of this increase meeting the cost of pay modernisation. Based on predictions, future year’s increases are likely to be inflationary only. This means that making the best use of our staff resource is essential and also that unless savings are identified from non-pay there will be no additional funding to meet staffing increases.

The Workforce Plan has been assessed financially – increases in numbers have been assessed against existing funding availability including:

• Modernising Medical Careers• Clackmannanshire Health Care Facility• Agenda for Change Backfill• Conversion of bank / agency funding to substantive posts• Local Renal Dialysis expansion

This leaves a small financial gap of £0.400m, given the levels of funding invested in staff this is deemed to be within tolerable levels and therefore is confirmed as affordable.

Availability

Whilst NHS Forth Valley is advantaged by its geographical location enabling us to recruit across the East and West of Scotland, as well as from the central belt we recognise that we are recruiting from an intensely competitive labour market. We must to continue to be an exemplar employer and to ensure that we retain and recruit the staff we need to deliver the highest standard of services for our patients.

Adaptability

This iteration of NHS Forth Valley’s Workforce Plan clearly demonstrates that our workforce is changing to meet the needs of our population and is aligned with both financial and service planning, as well as supporting our Local Delivery Plan. We will continue to develop roles and services to ensure that we have the right people, doing the right thing, in the right place at the right time.

In addition our future projections aim to ensure that National planning for all training places takes account of capacity throughout NHSScotland to provide clinical placements, mentoring, assessment, tutelage and guidance.

Annexes

Annex A: Staff ProjectionsNHS Forth Valley

Workforce Predictions Summary ISD Baseline Data Year 1 Year 2 Year 3 Year 5 Year 10

2006 2007 2008 2009 2011 2016

WTE Staff in post

WTE Vacancies

(at 30th Sept) 2

WTE Expected

WTE Expected

WTE Expected

WTE Expected

WTE Expected

Total 5203.4 5275.3 5323.9 5363.2

HCHS medical staff 200.7 14.0 211.3 221.3 228.9 227.4 236.4

Consultant 1 139.5 14.0 151.8 160.5 167.0 168.6 177.6Staff and Associate Specialist

grades 61.2 - 59.5 60.8 60.9 58.8 58.8

HCHS dental staff 4.5 - 4.9 4.9 4.8 4.8 4.5

Consultant 2.5 - 2.9 2.9 2.8 2.8 2.5Staff and Associate Specialist

grades 2.0 - 2.0 2.0 2.0 2.0 2.0

Nursing and midwifery staff 2,635.1 17.2 2,677.8 2,700.7 2,710.9 2,715.5 -

Registered 1,832.9 12.1 1,858.8 1,880.7 1,887.9 1,892.5 -

Non-registered 802.1 5.0 819.0 820.0 823.0 823.0 -

Allied Health Professionals 418.4 5.1 430.1 439.6 450.5 - -

Qualified 349.5 5.1 356.1 362.6 370.5 - -

In Training - - - - - - -

Assistant 68.9 - 74.0 77.0 80.0 - -

Clinical & Applied Psychologists, Clinical Associates, Counsellors, Therapists and Child Psychotherapy 25.8 - 26.3 28.3 29.3 - -

Qualified 19.3 - 19.3 21.3 22.3 - -

In Training 5.0 - 5.0 5.0 5.0 - -

Assistant 1.5 - 2.0 2.0 2.0 - -

Healthcare Science Staff 109.8 - 112.1 113.9 116.8 - -

Qualified 78.3 - 79.8 79.6 80.5 - -

In Training 3.0 - 2.0 4.0 4.0 - -

Unqualified 28.4 - 30.3 30.3 32.3 - -

Technical staff 116.6 - 117.1 117.1 117.1 - -

Qualified 78.0 - 78.0 78.0 78.0 - -

In Training 8.5 - 8.5 8.5 8.5 - -

Unqualified 30.1 - 30.6 30.6 30.6 - -

Pharmacy Staff 99.2 - 102.5 104.9 112.5 - -

Qualified 75.6 - 80.5 83.9 91.5 - -

In Training 2.0 - - - - - -

Unqualified 21.6 - 22.0 21.0 21.0 - -

Administrative and estates staff 1,067.7 - 1,067.6 1,067.6 1,067.6 - -

Admin & Clerical (AfC bands and Whitley grades) 938.7 - 938.7 938.7 938.7 - -

Non AfC Senior management grades 46.7 - 46.7 46.7 46.7 - -

NHS Forth Valley

Workforce Predictions Summary ISD Baseline Data Year 1 Year 2 Year 3 Year 5 Year 10

2006 2007 2008 2009 2011 2016

WTE Staff in post

WTE Vacancies

(at 30th Sept) 2

WTE Expected

WTE Expected

WTE Expected

WTE Expected

WTE Expected

Works 14.4 - 14.4 14.4 14.4 - -

Trades 67.8 - 67.8 67.8 67.8 - -

Ancillary 525.7 - 525.7 525.7 525.7 - -

ANNEX B: Workforce Characteristics–

further statistical information

Working Patterns

Figure 1 below shows the proportion of staff in each group working full and part-time. Within the clinical group, Nursing and Midwifery staff have the highest proportion working part-time. Many GPs (including those who have contracts) also work part time. Within the non-clinical group, Ancillary staff have the highest proportion working part-time. There has been a slight overall decrease in numbers of staff working part-time from 47.26% in 2005 to 45.87% in 2006. The largest changes have been a decrease in the numbers of Healthcare Science staff working part-time from 38.52% in 2005 to 31.78% in 2006 and also in the numbers of Hospital Medical and Dental staff working part-time from 23.21% in 2005 to 17.91% in 2006 and an increase in the number of Technical staff working part-time from 39.72% in 2005 to 4.37% in 2006. (Source: ISD Workforce Statistics September 2006 Table A3)

CONTRACT TYPE BY STAFF GROUP AT 30 SEPTEMBER 2006

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ancillary

Trades

Works


Pharmacy Staff

Technical staff

Healthcare Science Staff

Therapeutic Staff

Nursing and midwifery staff

Dental

GPs

Hospital medical and dental staff

Whole Time Headcount Part Time Headcount

Ethnicity Figure 2 below, sourced from ISD Workforce stats Table A5 provided in the

September 2006 release provides a picture of NHS Forth Valley’s workforce. (These figures only relate to staff who provided data and so should be treated with caution).

Not Known

White 2

Other white

Any mixed background Indian

Pakistani and

other South Asian 3 Chinese

Black 4

Other ethnic

background DeclinedNHS Forth Valley 71.93 26.32 0.51 * 0.32 0.07 0.07 0.14 * 0.45

NHS Forth Valley Ethnic Origin Percentage distribution (based on information recorded in the Scottish Workforce Information Standard System – SWISS) as at 31 March 2006

1 Information presented in this table is based on self-reporting by staff in NHS Scotland. Data are collected via staff engagement forms when people join, or change organisations within, NHS Scotland, or via the "e:you" questionnaire exercise undertaken for all staff in post during 2005. Completion of the questionnaire exercise was optional and response rates varied across the country. Those staff who did not return their questionnaires are counted under "not known".

2 Comprises White Scottish, White British, White Irish3 Comprises Pakistani, Bangladeshi, Other Asian4 Comprises Caribbean, African, Other Black

Gender Over three-quarters of the workforce are female (82.66%). This is largely accounted for by the high proportion of females in the Nursing and Midwifery staff (91.4%), Administrative, Clerical and Senior Management staff (88.49%) and the collective grouping of Therapeutic, Healthcare Science, Technical and Pharmacy staff (85.95%). Comparison to last year shows that there has been no significant gender shift overall or by staff group.

As figure 3 below shows, the percentage of each staff group that is female ranges from 0% for Works and Trades staff to 91.4% of Nurses and Midwives.

GENDER SPLIT BY STAFF GROUP (HEADCOUNT) AT 30 SEPTEMBER 2006

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ancillary

Trades

Works


Pharmacy Staff

Technical staff

Healthcare Science Staff

Therapeutic Staff

Nursing and midwifery staff

Dental

GPs

Hospital medical and dental staff

Male Female

(Source: ISD Workforce Statistics September 2006 Table A3)

Nursing and Midwifery Age Profile

REGISTERED STAFF - AGE PROFILE

0

100

200

300

400

500

600

Under 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

September 2006 September 2004

The above graph shows that 79.23% of the registered workforce is under 50 years of age with the largest bracket being for ages 40-44 as at September 2006. In contrast, the non-registered age profile shows an ageing workforce with approximately one-third of the workforce aged 50 years and over as at September 2006.

NON-REGISTERED STAFF - AGE PROFILE

0

50

100

150

200

250

Under 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+

September 2006 September 2004

(Source: ISD Workforce Statistics September 2006 Table E4)

Annex C: Abbreviations

A & C Administrative & Clerical

A & E Accident & EmergencyABN Association of British NeurologistsAfC Agenda for ChangeAHP Allied Health ProfessionalsASDU Area Sterilising and Decontamination UnitCAMHS Child and Adolescent Mental Health ServicesCBT Cognitive Behaviour TherapyCCT Certificate for Completion of TrainingCHD Coronary Heart DiseaseCHP Community Health PartnershipCLDT Community Learning Disability TeamCMHT Community Mental Health TeamCNS Clinical Nurse SpecialistCPD Continuing Professional DevelopmentCST Certificate of Specialist TrainingDAP Dental Action PlanDCP Dental Care PractitionerDGH District General HospitalDVT Deep Vein ThrombosisDwSI Dentist with Special InterestENP Emergency Nurse PractitionerENT Ear, Nose & ThroatESP Extended Scope PractitionerEWTD European Working Time DirectiveFM Facilities ManagementFY Foundation YearGI Gastro-Intestinal GMS General Medical ServicesGPwSI General Practitioner with Special InterestsGSI Global medical coding standardHCHS Hospital, Community & Public Health ServicesHEAT Health, Efficiency, Access, TreatmentHEI Higher Education InstituteHEPMA Hospital Electronic Prescribing and Medicines AdministrationHR Human ResourcesHV Health VisitorICT Information and Communications TechnologyICU Intensive Care UnitIM&T Information Management & TechnologyISD Information and Statistics DivisionKSF Knowledge and Skills FrameworkLDP Local Delivery PlanLHP Local Health PlanMACTU Medical Ambulatory Care Treatment UnitMCN Managed Clinical NetworkMDT Multi-Disciplinary TeamMMC Modernising Medical CareersMS Multiple SclerosisMSI On-line databaseN & M Nursing & MidwiferyNES NHS Education for ScotlandNICE National Institute for Clinical Excellence

NMAHP Nursing, Midwifery and Allied Health ProfessionalsNMC Nursing & Midwifery CouncilOD Organisational DevelopmentOMFS Oral & Maxillo-Facial SurgeryOOH Out of HoursOT Occupational TherapistPACS Picture Archiving and Communication SystemPCAT Primary Care Audit ToolPCEC Primary Care Emergency CarePDP Personal Development PlanSAS Staff and Associate SpecialistSAS Scottish Ambulance ServiceSCI Scottish Care InformationSEHD Scottish Executive Health DepartmentSfH Skills for HealthSHO Senior House OfficerSIGN Scottish Intercollegiate Guidelines NetworkSSTS Scottish Standard Time SystemSSWIP Single System Workforce Information ProjectSVQ Scottish Vocational QualificationSWISS Scottish Workforce Information Standard SystemTB TuberculosisTNF Tumour Necrosis FactorWIR Workforce Information RepositoryWTE Whole Time EquivalentWTR Working Time Regulations

Annex D: Bibliography

The main documents that have been referred to in this plan are listed below,together with useful websites.

ABN Guidelines for Treatment of Multiple Sclerosis With β-Interferon and Glatiramer Acetatehttp://www.abn.org.uk/downloads/ABN-MS-Guidelines-2007.pdf

Agenda for Changehttp: //www.paymodernisation.scot.nhs.uk/AfC/

An Action Plan for Dental Services in Scotland, Scottish Executive Health Department, August 2000

http://www.scotland.gov.uk/library3/health/apds-00.asp

Building a Better Scotland - Efficient Government - Securing Efficiency, Effectiveness and Productivity, Scottish Executive Health Department November 2004http://www.scotland.gov.uk/Publications/2004/11/20318/47372

Building a Health Service Fit for the Future, A National Framework for ServiceChange in the NHS in Scotland (the Kerr Report): Scottish Executive HealthDepartment, May 2005http://www.scotland.gov.uk/publications/2005/05/23141500/15035

Cancer in Scotland: Sustaining Change May 2004http://www.scottishexecutive.gov.uk/Publications/2004/05/19344/36943

Cancer Incidence Projections for Scotland (2001-2020) An Aid to Planning Cancer Services, December 2004http://www.scotland.gov.uk/Publications/2004/12/20257/46697

Co-ordinated, integrated and fit for purpose: A Delivery Framework for Adult Rehabilitation in Scotland, Scottish Executive Health Department, February 2007http://www.scotland.gov.uk/Publications/2007/02/20154247/0

Delivering Care, Enabling Health: Harnessing the Nursing, Midwifery and Allied Health Professions' Contribution to Implementing Delivering for Health in Scotland, Scottish Executive Health Department, November 2006http://www.scotland.gov.uk/Publications/2006/10/23103937/0

Delivering for Health: (Scottish Executive Health Department Response to the Kerr Report), Scottish Executive Health Department, November 2005http://www.scotland.gov.uk/Publications/2005/11/02102635/26356

Delivering for Mental Health, Scottish Executive Health Department, December 2006http://www.scotland.gov.uk/Publications/2006/11/30164829/0

Department for Work and Pensionshttp://www.dwp.gov.uk/

Facing the Future: Report of the 19th November 2001 Convention on Recruitment and Retention in Nursing and Midwifery, Scottish Executive Health Department 2001http://:www.sehd.scot.nhs.uk/publications/bb005dec2001.pdf

Fair to All, Personal to Each – The Next Steps for NHS Scotland: Scottish

http://www.dwp.gov.uk/

http://www.scotland.gov.uk/Publications/2006/11/30164829/0





http://www.scottishexecutive.gov.uk/Publications/2004/05/19344/36943

http://www.scotland.gov.uk/publications/2005/05/23141500/15035


http://www.scotland.gov.uk/library3/health/apds-00.asp

http://www.paymodernisation.scot.nhs.uk/AfC/

http://www.abn.org.uk/downloads/ABN-MS-Guidelines-2007.pdf

Executive Health Department, December 2004http://www.scotland.gov.uk/Publications/2004/12/20400/48699

HDL(2005)52: National Workforce Planning Framework 2005 Guidance,November 2005 http://www.show.scot.nhs.uk/sehd/mels/HDL2005_52.pdf

Investors in Peoplehttp://www.investorsinpeople.co.uk/Pages/Home.aspx

ISD Scotlandhttp://www.isdscotland.org

Mental Health Care & Treatment (Scotland) Act 2003, HMSO 2003http://www.opsi.gov.uk/legislation/scotland/acts2003/20030013.htm

Modernising Medical Careers The Next Steps: The Future Shape of Foundation, Specialist and General Practice Training Programmes, UK Health Departments 2004http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4079530

National Health Service Reform (Scotland) Act 2004, HMSO 2004http://www.opsi.gov.uk/legislation/scotland/acts2004/20040007.htm

National Workforce Planning Framework: Scottish Executive Health Department,2005http://www.scotland.gov.uk/Publications/2005/08/30112522/25230

Nationally Co-ordinated Nurse Bank Arrangements: Report and Action Plan, Scottish Executive Health Department March 2005


NHS Forth Valley Websitehttp://nww.fv.scot.nhs.uk/ NHS Forth Valley/

NHS Forth Valley Board Documentshttp://nww.fv.scot.nhs.uk/ NHS Forth Valley/pubs/pubs.htm

Nursing and Midwifery Workload & Workforce Planning Project: Scottish ExecutiveHealth Department, 2004http://www.scotland.gov.uk/Publications/2004/04/19299/36370

Pay Modernisationhttp://www.paymodernisation.scot.nhs.uk

PCA(P)(2006)02 New Community Pharmacy Contract: Implementationhttp://www.sehd.scot.nhs.uk/pca/PCA2006(P)02.pdf

PCA(P)(2007)1 New Community Pharmacy Contract: Situation Update http://www.sehd.scot.nhs.uk/pca/PCA2007(P)01.pdf

Pharmacists and Pharmacy Technicians Order 2007http://www.opsi.gov.uk/si/si2007/20070289.htm

Planning Ward Nursing - Legacy or Design?, Audit Scotland December 2002http://www.audit-scotland.gov.uk/index/02pf07ag.asp

http://www.audit-scotland.gov.uk/index/02pf07ag.asp

http://www.opsi.gov.uk/si/si2007/20070289.htm

http://www.sehd.scot.nhs.uk/pca/PCA2007(P)01.pdf

http://www.sehd.scot.nhs.uk/pca/PCA2006(P)02.pdf

http://www.paymodernisation.scot.nhs.uk/


http://nww.fv.scot.nhs.uk/nhsfv/pubs/pubs.htm

http://nww.fv.scot.nhs.uk/nhsfv/



http://www.opsi.gov.uk/legislation/scotland/acts2004/20040007.htm

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4079530

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4079530

http://www.opsi.gov.uk/legislation/scotland/acts2003/20030013.htm

http://www.isdscotland.org/

http://www.investorsinpeople.co.uk/Pages/Home.aspx

http://www.show.scot.nhs.uk/sehd/mels/HDL2005_52.pdf


Planning Ward Nursing - Legacy or Design? A Follow Up Report, Audit Scotland January 2007http://:www.audit-scotland.gov.uk/publications/pdf/2006/06pf12ag.pdf

Promoting Health, Supporting Inclusion - The National Review of the Contribution of All Nurses and Midwives to the Care and Support of People With Learning Disabilities Scottish Executive Health Department, July 2002http://www.scotland.gov.uk/Publications/2002/07/15072/8572

Race Relations (Amendment) Act 2000, HMSO 2000http://www.opsi.gov.uk/ACTS/acts2000/20000034.htm

Registrar General for Scotlandhttp://www.gro-scotland.gov.uk/statistics/index.html

Scottish Diabetes Survey, 2002http://www.scotland.gov.uk/Publications/2003/05/17178/22035

Scottish Executive Review of Nursing in the Community Draft Report, June 2006http://www.scotland.gov.uk/Publications/2006/06/07110615/0

Scottish Health Workforce Plan 2006, Working in Health: Scottish Executive HealthDepartment, 2006http://www.scotland.gov.uk/publications/2006/12/13130027/0

Scottish Health Survey 2003http://www.scotland.gov.uk/Publications/2005/11/25145024/50251

Scottish Health Workforce Plan - 2004 Baseline, Scottish Executive Health Department April 2004http://www.scotland.gov.uk/Publications/2004/04/19306/36434

Scottish Workforce Information Standard Systemhttp://www.show.scot.nhs.uk/swiss/

Standards to Support Learning and Assessment in Practice: NMC Standards for Mentors, Practice Teachers and Teachers, Nursing & Midwifery Council, March 2007http://www.nmc-uk.org/aArticle.aspx?ArticleID=98

Temporary Measures Managing Bank and Agency Staff, Accounts Commission for Scotland, February 2000http://www.audit-scotland.gov.uk/index/00hs_01.asp

West Region Workforce Planning Websitewww.westworkforceplanning.scot.nhs.uk

Workforce Planning for Dentistry in Scotland: A Strategic Review: Interim Report and Recommendations, Scottish Executive Health Department, September 2000http://www.scotland.gov.uk/library3/health/sacd-00.asp

Visible, Accessible And Integrated Care Report Of The Review Of Nursing In The Community In Scotland, Scottish Executive Health Department, November 2006http://www.scotland.gov.uk/Publications/2006/11/08125906/0

European Working Time Directive (93/104/EC) and Horizontal AmendingDirective (HAD) (2003/34/EC)


http://www.scotland.gov.uk/library3/health/sacd-00.asp

http://www.westworkforceplanning.scot.nhs.uk/

http://www.audit-scotland.gov.uk/index/00hs_01.asp

http://www.nmc-uk.org/aArticle.aspx?ArticleID=98

http://www.show.scot.nhs.uk/swiss/



http://www.scotland.gov.uk/publications/2006/12/13130027/0



http://www.gro-scotland.gov.uk/statistics/index.html

http://www.opsi.gov.uk/ACTS/acts2000/20000034.htm


Statutory Instrument (SI No. 1833) “Working Time Regulations” (1993)and subsequent amendments

NHS QIS Nursing Clinical Quality Indicators Project Report

Senior Clinical Nurse Review

Pathway to Work – Department of Work and Pensions

NHS FORTH VALLEY (2003) NHS Forth Valley Integrated Healthcare Health Care Strategy

NHS FORTH VALLEY (2005) NHS Forth Valley Local Health Plan 2005/06 -2007/08

NHS FORTH VALLEY 16th Annual Report of the Director of Public Health:The Health of the Population of Forth Valley 2004/2005

NHS FORTH VALLEY (2004) Baseline Workforce Report 2004

NHS FORTH VALLEY Workforce Modernisation Strategy

NHS FORTH VALLEY Local Delivery Plan: Key Performance Measures 2006/07 2007/08

NHS FORTH VALLEY Local Financial Plan

NHS FORTH VALLEY Staff Opinion Survey 2006

NHS FORTH VALLEY IM&T Strategy

NHS FORTH VALLEY Local Learning Plan

NHS FORTH VALLEY Leadership Development Plan

NHS FORTH VALLEY Service Benefits Realisation Plan 2005/2006

NHS FORTH VALLEY Financial Strategy 2006 - 2011

If you or someone you know, would like this document to be sent to you in an alternative format, such as audiotape or large print then please either phone free on 0800 456033 or email [email protected]

www.show.scot.nhs.uk/nhsfv