Item 7.2 for 4 June 2013 Workforce 2020 Report

Workforce 2020

Caring – Listening – Improving Do you have a visual impairment or have difficulty understanding the English Language?

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2 “One does not discover new lands without consenting to lose sight of the shore for a very long time”

Andre Gide1

1 Andre Gide, The Counterfeiters 1927, Nobel prize winner and author, 1869 - 1922

3 Grampian’s 2020 Vision

The Healthfit 2020 vision2 is now established in Grampian as the picture for the future healthcare delivery across NHS Grampian. The 2020 vision represents THE STRATEGY for NHS Grampian and all other actions and activities are regarded as plans which will move the Board and its services in that direction under the banner of Healthfit 2020.

NHS Scotland has also adopted the 2020 vision for services across Scotland.

What is the Grampian Healthfit 2020 Vision?

“The health of the people of Grampian and the health service in the area is radically different with how it was in 2011. People are healthier because they take responsibility for their own health…a reduction in premature death… people are less dependent on the health service…[but] when health services are needed, they are more effective and tailored to individual needs… possible because of release of staff, funding and buildings from traditional ways of working…The focus on the individual has been undertaken in partnership with local authorities and the third sector…”

Values of NHS Grampian

Core to delivery of the very different approach to service provision by 2020, is the continued commitment to safe, effective and person-centred care, now and in the future. NHS Grampian is publicly committed to working with the people of Grampian to improve health.

The core values of the Board are:

Caring, Listening, Improving

Embedding these values in everything we do is an important part of making the vision a reality.

Developing Workforce 2020

2 (2011) “Development of the Health and Care Framework for NHS Grampian” Item 5: 5 th April 2011, Board meeting, NHS Grampian.

4 Healthcare is delivered by people working in teams and in communities. Only through and with people, the people we employ and the people we serve, can we deliver this vision. So what is the 2020 vision for the workforce?

The vision for the future workforce in Grampian has emerged over many months, through workshops, feedback and debate, mainly with the people who work for NHS Grampian, but also from partners, including General Practice Colleagues, the three Local Authorities and other NHS Boards, particularly the island Boards and NHS Education for Scotland.

By 2020:

NHS Grampian will employ a leaner, more flexible, multi-skilled workforce, who will enable and empower people to take responsibility for their own health. The workforce will be organised in an integrated way, focussing on the needs of the individual rather than the desires of the professional. Whilst managing growth and demand, healthcare professionals will be more accessible to the public and to each other. There will be a sense of responsibility across the organisation that will focus on:

• Results & value for patients; • Enablement, anticipation & rehabilitation; • Safety & Quality; and • Those who need it most.

We have also been mindful of the emerging national 2020 Workforce vision, due to be launched in June 2013 and have ensured where possible that our vision will dovetail with the national direction.

5 Where are we starting from?

NHS Grampian’s detailed Workforce Plan3 provides comprehensive demographic and workforce projections for the Board. It highlights the changes in the shape and size of the workforce and the new roles and the ways of working that have been introduced over recent years. The key messages about the current workforce in NHS Grampian however, suggest a number of challenges.

 NHS Grampian employs 13,898.  Grampian also contracts with a number of independent contractors to provide primary healthcare services, including General Medical Practice, General Dental Practice and Optometrists. These practitioners and the people who work for them are a significant part of the wider healthcare family in Grampian. For example, there are 467 independent GPs across Grampian.  The growth in the ageing population and more modest growth in the younger age groups and its impact on health and care services are well known.  The average age of the workforce in 2013 was 43 years, rising from 42 the year before.  In 2013, 62% of the workforce were over 40 years of age and of these 29% were aged over 55 years.  Gender split is 82% female and 18% male and this has been consistent over the last 6 years.  Whole/part-time split is 49% whole and 51% part-time.  As expected nursing staff account for 42% of the workforce.  Grampian enjoys 5.1% higher employment than Scotland as a whole.

In terms of the workforce, what the above challenges mean for recruitment, job design, the number of employees and healthcare careers for the future?

3 http://intranet.grampian.scot.nhs.uk/foi/files/NHSG_Workforce_Plan_2012.pdf

6 Delivering Workforce 2020

Culture Changes

Delivering the 2020 vision will require the Board to actively seek acceptance of change and delivering in a different way across the population at large, if it is to be achieved. This has implications for the staff who work within NHS Grampian, for partners, the third sector, carers as equal and expert partners and for the general population. Clarity of direction for services and for those people who deliver services will be required.

Public acceptance of change requires dedication, involvement, engagement and time to ensure that the people we serve understand, identify with and accept the changes that the Board is trying to make. These changes require robust planning in order to be achieved by both the wider population and the workforce.

Staff acceptance is also key and requires the same dedication, involvement and engagement. Staff who support change, are more likely to persuade the people that they come into contact with that the change will be beneficial.

Staff Governance underpins and supports the values of the organisation. We need to ensure this becomes both more embedded across the organisation and work constantly towards the creation and maintenance of a healthy workplace culture across Grampian; ensuring that our staff work within ‘Dignified Workplaces’. NHS Grampian will proactively support our people to build positive working relationships, seek to celebrate good practice and distil learning of what is effective, disseminating this across the rest of the organisation.

Teams and team working is vital to successful delivery of the 2020 vision. Stronger interfaces and team work within and across healthcare teams as well as between health and social care, the third sector and with clients and their carers. Supporting teams to come together to work in a different, integrated way will require active encouragement. Teams must be empowered to actively remove barriers to delivering person-centred care, to work across the professional boundaries, to develop core behaviours and skills to enable better and more streamlined delivery of service.

The population of Grampian must be enabled to support themselves, living healthier and more active lives, supported by a health promoting and health aware staff. All staff have a role to promote public health and wellbeing to make every opportunity count. This is likely to become an increasing and extremely important role for many healthcare professionals, if the cultural shift towards improving health and

7 enablement is to be a reality. It will rely on staff being both engaged and working in an environment where they are able to confidently contribute.

Workforce

The 2020 Workforce needs to be flexible, dynamic and multi-skilled working, in what would currently be considered to be, ‘multi-agency teams’. This collaborative multi- agency workforce will consist of those who have a core range of generalist skills, common across different professional groups, as well as those with appropriate specialist skills, as required by the needs of the population.

As more of the population are managed at home and in their communities, an increasing number of roles within the workforce are likely to have a more community based focus. The role of staff in supporting health improvement, both as part of their work and as citizens, will need to be strengthened.

The need for greater flexibility in and between roles is recognised, as is the need to develop change in partnership with the workforce, both with those on the ground and through the formal partnership structures. The need to identify, develop and maintain different skills and competencies, particularly in new ways of working are important. This will require specific focus in relation to health interventions, health outcomes, telemedicine and technologies for diagnosing and treating patients remotely.

The ‘professional’ is more likely to deliver skills that are more technical in nature, with increasing reliance on engaged and competent patients and their carers to deliver more routine care. The crucial role that carers play is unlikely to diminish but increase, with older carers, caring for much older relatives and partners. The professional will have a more supportive role, coaching and encouraging enablement.

We will need to take a proactive approach to ensure an appropriate future workforce supply in what continues to be a competitive Grampian market.

The age demographic of a workforce that will work longer before retirement needs to be taken into account in job design and career mapping as well as the need to look after their own health. Teams should be encouraged to value both experience and encourage the contribution of younger workers.

The healthcare workforce of the future will be leaner. People will work differently, using resources more effectively, interacting and responding to the public in a way

8 that takes the needs of the individual into account in decisions that affect them. Staff will be encouraged to develop a can do attitude, supporting clients, through multi- professional teams. Our current workforce already have a wealth of skills and expertise on which they can build to develop competencies and behaviours required to meet the vision.

Partnership working between statutory agencies and the third sector will be common, working from common bases, sharing information and decision making in the interests of the client. Achievement of a more integrated and multi-agency workforce will require relationship building and genuine sharing and cooperation in terms of services, locations and training.

The majority of staff will work in teams, much as now, but for others, teams may be distributed. For non-clinical workers, there will be a greater reliance on technology to support work and with less reliance on publicly owned buildings, more staff may be home based, with links through IT and telelinks to their wider team.

For many staff, whilst they may have to work differently in the future, the role that they carry out may be the same, for example, a ward based nurse; a hospital porter; or clinic based Dietician; but for many front line, both clinical and non-clinical support staff, there will be differences in their future roles.

Specialist Workforce

Whilst there will be a greater emphasis and value of the generalist in the future, a Teaching Board, with close links to the universities in the region, will also require a clinically specialist workforce, across the wide range of medical specialties and within clinical science. Grampian aspires to maintain and enhance its reputation for clinical excellence, delivering high quality services and improving our research capability. To be the employer of choice, at the forefront of clinical development, our specialist workforce will be engaged in clinical redesign that delivers high quality services, improved access and increased value for patients.

Education of tomorrow’s clinicians – doctors, dentists, nurses, allied health professions, pharmacists and scientists - will remain an important role of the NHS now and in the future and the NHS workforce will continue to develop, lead and contribute to the provision of high quality education across our services.

9 Development

Coaching will no longer be limited only to those highly trained coaches but will become a core competency for both non-clinical and clinical delivery staff. Enablement means supporting others to do, not doing to and hence coaching will be a key competence required of the multi-professional in the future.

Leadership, including clinical leadership, is key to delivering a sustainable model of delivery for the future. Individuals need to be identified early and developed as leaders of the future. Teams that work together should be assessed together. The future will see team based approaches to objective setting, job planning and appraisal of performance. We need to develop the tools and skills to support this and promote a consistent performance appraisal and development culture.

Whatever changes are required within health and social care, partners need to engage early with education to ensure that the new and emerging roles are reflected in the education programmes that develop the future staff to work in teams, across ‘traditional boundaries’ and demonstrate the competencies required of the future.

Managers have a role to support and encourage their teams to develop; to support them to develop their individual 2020 vision and to lead the teams towards that vision. Leadership skills, trust, respect and a dedication towards developing themselves and others are key requirements for future leaders within the NHS. This will be supported through continued collaborative working with other public and voluntary sector partners in terms the development of management and leadership.

Partnership

Effective and enduring partnerships, at many levels are integral to the delivery of the 2020 vision. Partnerships between patients/clients and care providers; partnership between staff and managers; partnerships between different statutory bodies; with contractors; partnerships across healthcare; partnerships with the voluntary sector; and as an employer, partnership working in both formal and informal structures.

All partnerships require attention and leadership. There are often conflicting drivers for different partners to the partnership; making the partnership work will require time, debate and compromise, agreeing a fit or alignment that is congruent with the

10 goals of the partnership and the originating organisations that make up the partnership.

The partnerships should enable teams, support and deliver change and deliver improved access and care for the public of Grampian.

Partnership Working, working formally with staff side representatives, embedded within services will support delivery of improved staff experience. Staff will be well informed; appropriately trained and developed; involved in decisions that affect them; treated fairly and consistently, with dignity and respect, in an environment where diversity is valued; and provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients and the wider community4. NHS Grampian will continue to support the release of senior staff side representatives to facilitate good partnership working and support change.

Technology

Technology, particularly communication technology has increasingly become an essential factor of modern life and has changed the way that people interact, find information and communicate with each other. Technology can and does provide both health and social care providers with significant monitoring of people living on their own, who have health or mobility issues. The use of technology, including decision support systems essential to monitor, support and deliver care, is increasing and becoming more and more sophisticated.

Investment in technology does mean that the skills staff need may change, this has already been seen in the way some staff work, for example healthcare scientists. Making a diagnosis at a distance from a patient, using telemedicine has been proved to be safe and effective but the skills required to make that diagnosis are different from the traditional approaches. Staff require training, appropriate to their new roles.

Technology can bring people closer together but often public sector systems prevent rather than facilitate collaboration and sharing. Systems need to be appropriate and be able to connect to support a technologically adept system of care delivery.

4 (2012) “Staff Governance Standard: A Framework for NHS Scotland Organisations and Employees” 4 th edition p11, Scottish Government. Edinburgh. ISBN: 978-1-78045-830-4. www.scotland.gov.uk

11 What is your role in 2020?

Workforce 2020 is a vision, of necessity in a large employer, it will set the overall direction of travel. Services need to develop their own 2020, in partnership with staff and teams, identifying what roles will be needed and be empowered to develop the skills and competencies to deliver these roles.

12 Summary of Key Themes

1. Culture  Empowerment  Leadership  Ability and willingness to change  Trust/respect  Relationships  Enablement  Taking risks  Language  Flexibility  Primary/secondary care choice

2. Public  Engagement  Enablement  Shared responsibility – public/voluntary/patient  Consultation

3. Workforce  Defining the workforce  Unpaid carers  Attracting youth  Growing our own  Shared accountability

4. Technology  NHS24  Tele-medicine  Resources to use and to promote  IT systems that ‘speak’ to each other

12 April 2013

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