‘Providing efficiency and workforce – the key challenge’

1. ‘Providing efficiency and workforce – the key challenge’ Dean Royles Director, NHS Employers 17 March 2011

2. If HR developed film titles • The Good, the Bad and the Surgically Challenged • Four Civil Partnership Ceremonies and a Funeral • The Monarch’s Presentation and Assessment and Intervention by his Speech Language Therapist • Where Eagles Fail to Undertake a Comprehensive Risk Assessment

3. Changes to workforce development • The Department of Health has proposed changing the way the healthcare sector plans, commissions, trains and develops its workforce, both medical and non-medical, setting out significant changes to the way the system is organised. • This provides the opportunity to: • - Reshape and simplify the system so that it can respond to the changes that are happening in the NHS. • - Develop a multi-disciplinary approach to workforce planning with better links between those planning future workforce requirements and those commissioning education and training. • - Move to a demand led rather then supply led system aligned to the needs and expectations of patients

4. Past ten years of significant changes in the medical workforce • The introduction of the 2003 consultants' contract • The implementation of Modernising Medical Careers (MMC) • The development of training curricula with progress to CCT and beyond based on agreed specialty standards and competencies • The developing role of the Specialty Doctor grade • Implementation of the European Working Time Directive

5. Huge efficiencies savings needed across the entire health sector • Efficiencies savings can be realised by redesigning the structure and terms of specialty and consultant contracts to better reflect developing roles • The £400 million clinical excellence award scheme for doctors is out-dated, unfair and not clearly linked to the needs of today’s health service.

6. The future of the medical workforce • Shifts in UK demographics are likely to have a significant impact on the type of workforce we might need in the future. • Some specialist services being delivered closer to home • Local hospitals providing generalist care and more regional specialist centres. • Expansion of generalist skills and at the same time the development of super-specialist teams. • Career pathways will need to adapt to transformations in healthcare delivery and demographic shifts in the medical workforce itself. • With changing demographics, higher expectations and new demands on health services, a more flexible approach to training and career development is required. • A modular approach to training? • Core medical, mental health, research and surgical modules across a range of settings, continued professional development in more specialist areas.

7. The future role of specialists (1) • Role of non-consultant level medical staff is changing. • Not all qualified doctors will want to take on the teaching and managerial aspects involved in a consultant position, just as consultant and GP principal opportunities may not be available for all qualified doctors in the UK. • Temple suggested different levels within the consultant workforce may be beneficial, and with newly appointed consultants requiring mentoring especially where they feel they lack experience or expertise. • A more flexible career ladder would provide opportunities for doctors to practice effectively within clear limits of competence

8. The future role of specialists (2) • More innovative teaching within curricula will also be needed to ensure that doctors are able to develop the level of competence and capability required to work independently within a shorter timescale. • Employers want to enable specialty doctors and their trust equivalents to gain recognition for the knowledge, skills and experience they acquire throughout their careers. • A multi-disciplinary approach to workforce planning is needed with better links between those planning future workforce requirements and those commissioning education and training. • The NHS should move to a demand led rather then supply led system aligned to the needs and expectations of patients. Psychological contract?

9. Summary • The provision of good quality care is not only about treating high volumes of patients in a timely manner. It is about delivering patient safety and a good patient experience. • More of a balance is needed between training to achieve competencies and developing capable doctors, who can adapt to situations, react quickly and safely and instill confidence in the patients under their care. • Patients are less concerned with doctors’ job titles and more concerned with having experienced, up-to-date and qualified people to meet their healthcare needs promptly and effectively. • Still a big quality and productivity challenge.

10. income expenditure projected real income based on CSR projected expenditure based on current trends productivity cash 2015 2011 The QIPP Challenge £ QIPP Gap = £20 bn 1997

11. A productive workforce and the social political and economical environment • Efficiency savings of £15 - £20bn required in the NHS • A significant  programme of structural reform, including a 45 per cent reduction in management costs • An ageing demographic and rising expectation among the general public as a result of increasingly sophisticated methods of treatment.

12. Current context – Operating Framework 2011 • This year’s NHS Operating Framework continues the Government’s programme of change, addressing key workforce issues including: • Staff engagement:The framework acknowledges the challenges that the service is currently facing and the importance of ensuring that staff are engaged (more later). • Health and wellbeing: The framework reiterates an earlier commitment to improving staff health and well-being and reducing sickness absence, as set out in the Boorman review. • Finances: The framework outlines proposals to provide staff with significantly improved security of employment in return for foregoing pay increments for two years • Workforce planning, education and training: The framework promises to put employers at the forefront of new arrangements for workforce planning, education and training. The education and training consultation seeks to ensure, workforce planning is driven by employers. Consultation now launched.

15. Legend Central benchmark Ideal benchmark Core metric framework Workforce Cost-effectiveness = Cost-weighted activity/ Workforce Costs Inputs Volume Unit Costs Unit Costs drivers Labour Productivity Outputs and Quality Non-workforce inputs (£) Paybill per FTE/ cost-weighted labour input per FTE Paybill per FTE (£) Paybill (£) Value-weighted activity. In practice, this would be quality-adjusted, cost-weighted activity Skill mix Off framework Staff numbers (FTE) Cost-weighted labour input Workforce costs (£) Labour Productivity = Cost-weighted activity/Cost weighted labour input Temporary staff volume (FTE) Cost-weighted labour input, excluding staff in the community Cost-weighted activity (£) Temporary Staff average unit cost (£ per FTE) Temporary staff costs (% of workforce costs) Total measure of activity, including activity in the community setting Note that community based activity data are not readily available, therefore labour inputs are adjusted to account for the lack of community in the outputs Sickness absence (%) Composite indicator of three dimensions of quality - clinical effectiveness, safety and patient experience Hospital acquired infection rates Contextual metrics Staff satisfaction (composite indicator) Waiting times Turnover (%) Patient satisfaction

16. Regional QIPP dashboard

17. Detailed page: Sickness absence

18. Staff engagement context • Background: • The Francis Report and the NHS Staff Survey • Context: • Using survey scores as an indicator of local performance • Developing a score that covers multiple behavioural factors • The Staff engagement score • The Evidence: • Comparing the staff engagement score with other performance data in the NHS • What can it mean?

19. Developing a score that covers multiple behaviour factors • The evidence tells us that staff with high levels of engagement display a number of positive behavioural traits: • increased commitment, • a belief in their organisation, • a desire to work to make things better, • suggesting improvements, • working well in a team, • helping colleagues, • a likelihood to ‘go the extra mile’

20. Engagement & health and wellbeing Survey data shows that overall engagement is linked to better general health & well-being, lower presenteeism and less work-related stress. This link is reflected in each of the 3 areas that make up overall engagement

21. Engagement & the Annual Health Check results Overall staff engagement significantly relates to Annual Health Check data. The higher the engagement score, the higher the Annual Health Check score This is especially seen in the ‘Quality of Services’ element.

22. Staff engagement and patient satisfaction Overall staff engagement significantly relates to Patient Satisfaction scores. Importantly the chart shows this is a relationship where it is moving to high levels of engagement that makes the biggest difference

23. Staff engagement and rates of absenteeism Overall staff engagement significantly relates to rates of Absenteeism. Importantly the chart shows this is a relationship where it is moving to high levels of engagement that makes the biggest difference.

24. The NHS Constitution • The NHS belongs to the people. • It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

25. The NHS Constitution – values • Respect and dignity • Commitment to quality of care • Compassion • Improving lives • Working together for patients • Everyone counts

26. The NHS Constitution – staff pledges • To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals • To provide all staff with personal development and access to appropriate training • To provide support and opportunities for staff to maintain their health, well-being and safety • To engage staff in decisions that affect them • Meaning, belonging, hope, growth

27. Thank you