The need 

Effective design, development and deployment of the workforce is one of the most important aspects required to underpin Integrated Care System (ICS) sustainability in the short, medium, and long term. Skills for Health’s Six Steps Methodology to Integrated Workforce Planning® identifies the elements that are needed in any workforce plan, considering the current and future demand for services, the local demographic situation, and the impact on other services., It is also the only methodology cited as a tool in The NHS Long Term Workforce Plan to help with workforce planning. 

Some of the current challenges are: 

• The workforce – Ensuring the right skills are available to achieve consistent health benefits for the local population; 
• Transformation – Achieving greater service integration while meeting financial requirements; 
• Changing population health needs – Meeting health and care needs in the context of rising demand and complexity across the ICS. 

The solution  

The Six Steps Methodology was designed to give participants the tools and knowledge needed to understand and apply a robust approach to workforce planning. At its simplest, effective workforce planning ensures you have a workforce of the right size, with the required skills, organised in the right way, within the budget you can afford, delivering the best possible services.

Sara Hayes, Deputy Chief People Officer for NHS Shropshire, Telford and Wrekin, said: “We were delighted to partner with Skills for Health to offer this programme to our system colleagues, and we have been pleased by the enthusiastic response. The feedback has been extremely positive, and we should reap the benefits through effective workforce plans that meet the needs of the communities we serve in the years to come.”

Programme participants took part in an initial planning workshop and three ‘learning through action’ virtual sessions ahead of the final ‘show and share’ celebratory event in September. Participants were introduced to the Six Steps Methodology and used this approach to develop plans in their individual areas, following these integral steps: 

1. Define the plan 
2. Map the service change 
3. Define the required workforce 
4. Understand workforce availability 
5. Develop an action plan 
6. Implement, monitor and revise 

The impact 

Representatives from The Shrewsbury and Telford Hospital NHS Trust, Shropshire Community Health Trust and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust all took part in the programme. They have been working on important system projects including diabetes transformation, the STW Hospital Transformation Programme and the MSK Transformation Programme.

Some of the participants focussed on service specific plans within an individual organisation, including pharmacy, blood sciences and Allied Health Professionals (AHPs) at SaTH. 

The celebration event, held at Shrewsbury Town FC earlier this month, allowed them to showcase the progress they have made, demonstrate how the Six Steps Methodology has supported them on their journey to workforce planning, and share the challenges, obstacles and learnings experienced along the way.  

Download the Six Steps Planning Checklist

The Non-custodial Career and Competence Framework has been developed as part of the NHS England Health and Justice Inclusive Workforce Programme, which aims to improve the recruitment and retention of a larger, more diverse, inclusive and representative workforce for all health and justice services and programmes.  

The need  

The workforce challenges for health and justice services around the recruitment and retention of staff are similar to those faced by the wider NHS, with the additional challenge of delivering care within a range of justice settings, to patients and individuals that often experience a wide range of significant health inequalities.  

The Inclusive Workforce Programme, created about three years ago, was developed to promote the vast range of career opportunities and pathways that exist within the health and justice sector. 

Working with the Health and Justice National Team at NHS England and a range of subject matter experts, this newly created Non-custodial Career and Competence Framework is part of this wider programme. It’s aimed at raising the profile of health and justice careers, seeking to bring about a larger, more inclusive, and representative workforce that supports the four non-custodial areas: 

• Liaison and Diversion services 
• Healthcare in criminal court settings 
• Mental health treatment requirements  
• RECONNECT (care after custody) and enhanced RECONNECT (extension of care after custody) services.  

The solution   

The framework has used the National Occupational Standards (competences) to support the development of the workforce by providing an attractive career path and raising awareness of the range of opportunities available across the non-custodial pathway.  

Roles in the framework are competency based, so an individual can assess their current skillset and identify any gaps in their knowledge and/or training, to enable them to increase their skills to progress either vertically or laterally.  

What is the Non-custodial Career and Competence Framework? 

• Consists of 21 competence-based role profiles.  
• These roles range from level 2 through to level 8 of the Skills for Health Career Framework (levels are based on levels of responsibility, autonomy, and accountability and supervision that are required for a particular role). 
• The job profiles clearly identify the skills and knowledge required across the four non-custodial areas.  
• Each profile describes the scope of the role, entry requirements, education/training requirements. 

The impact 

The framework will support the on both the recruitment and retention of staff by offering more career pathways and increasing opportunities for career progression, and aid the development of a more flexible workforce, with enhanced opportunities for integrated working.  

• Promotes careers in the health and justice sector 
• Supports learning and identifies specific strengths 
• Greater work flexibility across non-custodial pathways 
• Career progression pathways 
• More career opportunities. 

“Working in the health and justice system can occasionally be challenging, but it’s also incredibly rewarding. The introduction of this framework will ensure that employees receive the support they need to develop the skills to deliver the best possible healthcare to some of the most health disadvantaged people.”

Glyn Thomas, Health and Justice Team, NHS England 

Desired outcomes for the framework   

The framework will help us achieve our goal of providing people (in the non-custodial system) with high-quality healthcare delivered by committed and valued professionals while reducing health disparities. 

• Used as a tool in building job specifications and supporting staff development. 
• Assist commissioners to develop service specifications. 
• Used as a resource for NHS England’s seven regional health and justice teams. 
• Used as a tool for sustainable recruitment and retention of staff. 

“What I like about (the framework) is the fact that it’s very comprehensive. The links within the framework take you deeper and deeper within each section, but it’s very easy to navigate. And as a manager, that’s key. Having a framework that’s easy to navigate. If you’re looking at one area, say communication or role development, you can drill right down into each area without being overwhelmed at the front page.” 

Michael Blakey, Specialist Clinical Lead at Cumbria, Northumberland and Tyne & Wear NHS Foundation Trust 

Read more about the framework  

The NHS South East London Integrated Care Board (ICB) was established in July 2022, bringing together 17 local partners, including six local authorities as well as acute, community and mental health providers. The purpose of the ICB is to work together to meet the current and future health and needs of the 1.9 million residents within South East London.  

The need 

To fulfil this purpose, and to meet the diverse needs of communities across the region, the ICB are required to develop strategies and approaches for integrating the workforce across the Integrated Care System (ICS). This required the implementation of robust workforce planning measures to ensure that staffing numbers keep pace with long-term service needs.  

“We were looking to build workforce planning capacity and capability across primary care networks (PCNs) and to develop a sustainable model of workforce planning to meet long-term demand. As part of this, a key objective was to develop the first iterations of PCN level workforce plans and help those working across primary care to better collaborate with a broad range of stakeholders across the six boroughs and ICS as a whole.” 

Sam Hepplewhite, Director of Prevention & Partnerships, NHS South East London Integrated Care Board 

The solution 

NHS South East London ICB enlisted the help of Skills for Health to help them meet these needs.  

“Planning is not about what we’re going to do next week, it’s also thinking about what we’re going to do two to three years’ time. Skills for Health has a 20-year track record of empowering healthcare providers to plan their workforce requirements effectively. What’s more they have a reputation for delivering real value and leaving a lasting legacy for their clients by teaching them how to adapt their workforce plans and make them futureproof.” 

Sam Hepplewhite, Director of Prevention & Partnerships, NHS South East London Integrated Care Board 

Through our programme, which included facilitating workforce planning sessions and Six Steps Methodology training for participants, we enabled PCNs to connect, discuss their thoughts and build relationships that will embed a long-term approach to workforce planning.  

The impact 

“What you’ve left us with is a group of PCNs who are in a better place to start thinking about what an integrated workforce plan might look like. They’re now thinking much wider than just general practice. They’re thinking integrated neighbourhood, mental health, acute and community services in the round. I think that’s probably the lasting legacy of this programme, is that you left us with the ability to adapt our workforce plans iteratively and your approach ensures we can adapt our workforce assumptions to make it futureproof. And I think quite often, that’s not the case.” 

Sam Hepplewhite, Director of Prevention & Partnerships, NHS South East London Integrated Care Board 

Workforce Planning with Skills for Health

Since developing the Six Steps Methodology to Integrated Workforce Planning® and a suite of supporting tools, overt he past 15 years Skills for Health has continued to support the NHS and wider healthcare system in successfully utilising this now widely embedded methodology to strategic thinking. Through our practice, we offer strategic workforce planning consultancy, accredited strategic workforce planning development programmes, coaching and advisory, operational service and care pathway reviews, workforce planning diagnostics and readiness assessments, and quality assurances audits.

Skills for Health together with Health Education England South West, the Devon Training Hub, and 4 North Devon Primary Care Networks (PCN), successfully piloted an approach to workforce planning (WP) specifically designed for primary care.

Effective design, development and deployment of the workforce is one of the most important things required to underpin primary care services sustainability in the short, medium, and long term. The challenges cannot be understated:

• Meeting health and care needs in the context of rising demand and complexity – changing population health needs
• Achieving greater service integration while meeting financial imperatives – the transformation challenge
• Ensuring the right skills are available to achieve consistent health benefits to the local population – the workforce challenges

To be able to achieve all this an approach was needed that connected population health needs, service transformation and workforce planning in a meaningful way, without over-complicating things.

Additionally, there were opportunities available through the NHS Additional Roles Reimbursement Scheme for primary care to further enhance multidisciplinary working. This would require careful analysis of what skills were needed and how that translated into the different Multi-Disciplinary Team roles. Issues around an ageing workforce and difficulties with recruitment and retention added to the sustainability challenge.

The primary care workforce is recognised as the key asset of service provision so effective integrated workforce development plans are crucial for the sustainability of primary care services and the continuity of quality patient care.

“GPs are always busy, but workforce planning can help to alleviate the pressure points and is worth the investment of time to reap the benefits later”. Daisy Robinson GP Partner College Surgery Partnership.

”Networks need to work together and learn together if they are to become mature and this was a great opportunity to do that.” Programme participant.

Purpose

The key aim of the pilot project was to evaluate if, providing a WP framework specifically tailored for primary care, developing participants WP knowledge and skill, together with expert support and facilitation could enable PCNs to develop a meaningful workforce plan successfully.

The programme consisted of 5 virtual interactive workshops spread over 12 weeks, together with the provision of templates, tools and associated resources and online consultancy support.

The final aim was to review the suitability of the framework and approach to be rolled out to support other PCNs with workforce planning.

Benefits

• Skills for Health Primary Care Network Workforce Planning Framework and approach, has successfully engaged participating PCNs in the workforce planning process.
• The approach taken has facilitated increased levels of collaborative working across PCN practices and promoted new dialogues around shared workforce solutions.
• Over 70% of attendees thought the programme provided an extensive, structured, and practical approach to workforce planning and now felt confident to engage in workforce planning activities.
• The workforce development programme has facilitated a coordinated approach to the recruitment and retention of some staffing posts across PCNs.
• The PCNs involved now understand the imperative link between local population demographics, health needs analysis, and the impact on workforce planning for future primary care services.
• The pilot demonstrated that PCNs are at different stages of maturity and that to roll to other PCNs requires an adaptable menu of support recognising that ‘one size doesn’t fit all’ to support their workforce planning in practice.

“The sessions were engaging and transformed workforce planning from an enormous and complex thing into something doable.” Daisy Robinson GP Partner College Surgery Partnership.

“Working with Skills for Health, using their approach to Workforce Planning, was a very positive process, the action learning sets were pitched just right for us and the facilitators gave us just the right level of challenge. It was great to have that protected time for some blue-sky thinking, I don’t mean it was airy-fairy, it absolutely wasn’t. It was our first introduction to population health management, and we are now hooked and working on a collaborative project on that too!” Melanie Cullen, Practice Manager, Barnstable Alliance Primary Care Networks.

The future

The pilot was positively received by all those involved and has demonstrated that the Skills for Health PCN Workforce Planning Framework has value in underpinning the development of robust PCN workforce plans. The framework and approach SFH offer have been specifically designed to be flexible in its application, recognising that ‘one size doesn’t fit all’ and therefore can be adapted to meet the diverse workforce planning needs of different PCNs.

Workforce planning support, provided by our team of specialist consultants will enable PCNs to help plan their workforce more effectively based on population and health needs data and utilise their ARRS funding effectively to best meet the changing needs of their populations.

As a result of the piloting, the Framework is now available as a fully flexible programme which can be tailored to meet the requirements of individual Primary Care Networks across England and Clusters across Wales.

The aim of providing personal and professional development within Bupa was to:

• Enhance the quality of employees’ learning
• Continue to build excellence in teaching and supporting employees
• Provide clinical staff with the greatest opportunities for personal and career development

Bupa works in collaboration with the University of Huddersfield offering a degree pathway of a BSc (Hons) in Professional Studies to every clinical employee. It also offers a range of ten National Vocational Qualifications (NVQs), with over 200 assessors and candidates registered on these Health Awards. It is against this backdrop that the educational team of Bupa began to compile competence-based development frameworks in 2006.

Although the university and the NVQ programmes do much to prepare employees for the radical changes in the healthcare industry, BUPA recognised a need to increase capacity, capability and flexibility within new roles and responsibilities. Part of the solution was to design competency-based work systems to drive the service and role redesign that is required today to maintain their success.

“Competence-based frameworks are a very useful tool to help us support our staff development. The core competencies are the very foundation of what we want our clinical staff to be able to do.”

Chris Middleton MSc. FHEA, Clinical Education Manager, BUPA Hospitals

With nearly 7,000 employees, BUPA Hospitals recognises the importance of preparing employees for working in today’s healthcare industry. To achieve this they provide progression and achievement programmes to support practitioners facing the current radical workforce reforms in the healthcare industry.

Skills for Health has developed a bank of national workforce competencies (NWCs) and National Occupational Standards (NOS) which describe the skills and knowledge required to carry out a task or function effectively. Competences are designed to underpin and be integral to accredited and non-accredited education and training programmes.

Bupa first used competencies within a new employee’s employment pack. This is a professional portfolio of employment information, competence matrices and assessment frameworks. New employees now have a much clearer idea of exactly what is expected of them in employment – what, where, when and how.

Each employee has a unique folder detailing the competencies required to fulfil their job role. The competences designed by Skills for Health are either NWCs or NOS and are currently used within the induction pack and as free-standing tools for assessment for established employees.

Although competences used to design new roles are still in their infancy within the organisation, Bupa has already certificated their first perioperative employee as an assistant scrub practitioner and a further twenty assistants are registered for this health NVQ level 3 award.

The Competences used within Bupa employment portfolios are:

Core care competencies:

• Effective communication
• Promote, monitor, and maintain health, safety and security
• Undertaking physiological measurements
• Carrying out an effective intravenous infusion
• Discharge Service
• Administration of medicines

Competences are being used to define the following roles:

• Advanced Scrub practitioners
• Perioperative assistants
• Endoscopy practitioners
• Paediatric recovery practitioners
• Paediatric ward-based practitioners
• Cosmetic and Aesthetic practice practitioners
• Physi-nurse
• Infection Control Hospital Leads
• Pain practitioners

Skills for Health has developed its Sector Qualifications Strategy detailing qualifications which are fit for purpose for the health sector, intending to ensure that existing and new qualifications are competence-based, demand-led and based on employer/service need.

Additional role-specific competence pathways using Skills for Health competencies will be designed by Bupa over time that will allow new ways of working and role redesign. The aim is to establish an educational programme that will provide opportunities for skill acquisition and knowledge to be gained by each practitioner against each competence. This is followed by a professional and validated assessment process and as part of this programme, Bupa has recently launched an initiative with the paediatric recovery practitioners.

Bupa has also designed a medical device assessment framework by adopting certain relevant competencies from the substantial resources within the Skills for Health framework. These have proved most useful for both practitioners and assessors in agreeing the required competencies for practice in all clinical disciplines.

Benefits

• Frameworks can work in conjunction with formal accredited programmes
• All employees have a clearer understanding of their unique competences
• Greater flexibility within new roles
• Perioperative employees being certified as assistant scrub practitioner
• Career frameworks being provided with job expansion, enlargement, and diversity
• Improved staff retention rates

Since competencies describe what individuals need to know and do, regardless of who is performing the task, they have many and varied uses.

The application of Skills for Health competencies and formal accredited education has provided Bupa with an educational framework that will support practitioners in the delivery of safe and effective services.

“BUPA Hospitals are synonymous with an exceptional education that benefits the patient first and foremost. Competence-based training is helping us achieve this objective and help us support our staff. We are delighted that people want to work for us and keep working for us!”

Chris Middleton MSc. FHEA, Clinical Education Manager, BUPA Hospitals

Bupa was voted one of the Top 100 Nursing Employers for 2006, at the time employing nearly 7,000 people, including approximately 4,500 nurses and numerous other non-medical clinical staff. Bupa was the first independent healthcare provider to offer the new NVQ Health Awards for clinical assistants in care and practice forward, outpatient, theatre, imaging, and physiotherapy assistants.

We continue to support the development of competence-based approaches to the design and redesign of roles and services. As part of this, we are helping health care organisations strengthen their professional development programmes.

As the Sector Skills Council for the UK health sector, NHS, independent healthcare providers and voluntary organisations, our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.

NHS Fife worked with role development specialists from the team here at Skills for Health to develop a new Level 3 Health Care Support Worker role for its Neonatal Unit and Maternity Service.

NHS Fife wanted to improve its continuity of care for babies and support for parents, including preparation for discharge from the hospital. It saw the need for a Neonatal Health Care Support Worker (NHCSW) role which would carry out specific care tasks for newborn babies, while allowing registered staff such as nurses to focus on more complex cases. The NHCSW would also provide a regular and familiar point of contact for parents.

Under the supervision of midwives, neonatal nurses, and other professional staff, the NHCSW will ensure the baby is able to feed and is well looked after. They would also provide support and guidance for families to assist in the smooth transition from hospital to home. The role would focus on nurturing the skills and behaviours of parents of babies that require special care, with the aim of improving care and helping parents form better bonds with their babies.

The NHCSW will be able to assist with the development and implementation of care plans for Special Care babies and families. They can operate equipment for the care of babies, and support the preparation of discharge plans. Their skills will include the ability to obtain and test blood samples, undertake hearing screens, insert nasogastric tubes, carry out emergency procedures to provide basic life support and use different feeding techniques for babies.

“We knew what we wanted to achieve with the new role, and so it was really useful to work with Skills for Health, who supported us in identifying the skills and competencies required. They were able to help us develop it as a Level 3 role and provided advice on evaluating its success. I think we’ve created a role which could be developed in other areas, in other neonatal
units, not just in Scotland.”

Jeana Arnott, Neonatal Clinical Educator, NHS Fife

Unlike registered roles in this area, the NHCSW will not be responsible for other supervisory and management duties, or compliance reporting and can dedicate their time to the babies in their care and to their parents. Implementation of the role would help registered nursing and midwifery staff to achieve and monitor a safe and secure environment for patients, staff and visitors. The role has recently been implemented, and NHS Fife hopes to assess its value through patient and workforce testimonies and questionnaires.

Outcomes

• improved level of care for babies who require specialist care
• more effective use of registered staff, freeing their time to spend on more complex cases
• improved continuity of service as parents form a relationship with the NHCSW
• better support for new parents in looking after their babies
• increased confidence of parents when babies are charged from hospital
• increased levels of satisfaction with the service.

Our team of workforce and NHS role development experts hosted a Role Redesign workshop with the Scottish Neonatal Network in Dundee, to look at the career framework level and key tasks and activities of a proposed neonatal nurse support role.

NHS Fife identified a need for a Level 3 HCSW role and worked with Skills for Health to develop and refine it. NHS Fife also developed learning to prepare candidates for the role. A range of learning activities has been agreed, encompassing informal learning, mentorship, clinical supervision, reflective practise and “shadowing”. In addition, a set of resources has been developed to support the implementation and induction of the new role including a workbook which new post holders will work through to demonstrate they have achieved the level of competence for each skill required.

As the UK’s Sector Skills Council for health, we help health sector employers across the UK optimise the potential of their workforce. Our proven solutions address not just improved productivity but also the quality of health and healthcare.

Oxford University Hospitals Foundation NHS Trust (OUH) provides a wide range of general and specialised healthcare services and employs over 11,700 staff primarily across four hospital sites. It provides over 90 different clinical specialties that are grouped into 5 clinical divisions.

Oxford University Hospitals NHS Foundation Trust‘s (OUH) HR department had historically produced workforce plans (WPs) in relative isolation from clinical services in response to a number of external drivers including NHS Improvement (now NHS England and NHS Improvement) and Health Education England Thames Valley (HETV).

The plans developed provided a top-down workforce numbers vision of their future workforce requirements. OUH recognised this was not the most effective way of workforce planning; they needed to engage staff from across their divisions including clinicians, service, and finance leads to exploring the workforce options to support both sustainability and transformation in response to the challenges they were facing. They also needed to become more forward-thinking and better prepared to ensure they have the workforce required to realise the future vision and aspirations of the
organisation.

OUH approached workforce development experts at Skills for Health to work with them to help review their workforce planning processes, systems, and data quality currently being used. The key aims were to help:

• Facilitate the development of an OUH integrated 5 year WP (2016-2021) utilizing Skills for Health’s Six Steps Methodology to Integrated Workforce Planning
• Develop OUH bespoke tools to support the process and facilitate reiteration of the WPs on an annual basis
• Build the capacity and capability across the Divisions to effectively WP in the future

The Trust’s intention was that this would improve the sophistication and quality of its workforce planning processes to the future benefit of Clinical Commissioning Groups, HETV, and OUH itself.

Skills for Health’s consultants worked with OUH staff to assess the data systems used to record, monitor, audit, develop and report on the workforce position across the Trust using Skills for Health’s workforce data diagnostic tools. They interviewed a diverse range of staff from across the organisation using the Skills for Health Workforce Planning Diagnostic Framework to identify the Trust’s current culture and capability around workforce planning. The information gathered from the diagnostics was used to develop a report identifying the WP challenges and barriers and to highlight areas of good practice. Key recommendations for areas of improvement were also made.

Delivered through a facilitated workshop approach Skills for Health’s healthcare workforce consultants utilised the Six Steps Methodology to Integrated Workforce Planning with each division to support them to develop their own WP over a period of 3 months. Each Division was provided with a set of templates to capture the narrative and workforce numbers which formed the basis of their workforce plan. This approach ensured consistency across the organisation and enabled divisional workforce plans to be brought together into an overarching OUH integrated workforce plan. Divisional teams completing the work required between workshops with support from Skills for Health as required.

Our team also delivered webinars for the Divisional Human Resources Business Partners (HRBPs) to build their workforce planning knowledge and discuss issues and challenges as they arose. Once all divisions had submitted their workforce numbers, our consultants brought the divisional plans together into an overarching workforce plan for OUH. Highlighting patterns of growth and development and providing analysis of the changes to the workforce that was in the workforce plans. A final workshop with the HRBPs and the Deputy Director of Workforce and Organisational Development focussed on:

• Reviewing the collated OUH workforce plan and its projected effect on the workforce configuration over the next 5 years
• Bringing together the key workforce challenges
• Identifying the major service changes and the associated workforce implications
• Sharing of the workforce changes that have the potential to improve productivity
• Areas of workforce innovation such as new role developments and new ways of working
• Cross organisational themes
• Next steps including drawing out interdependencies, validation, and quality assurance

Outcomes

There have been a number of key outcomes from the project for OUH, these include:

• OUH has developed its first 5-year Integrated Workforce Plan with engagement from across all divisions including clinical and service leads
• Their current workforce plan has been developed to meet the needs of multiple stakeholders that require workforce plan information from the organisation including HETV, Trust Development Authority, and Monitor
• For the first time, OUH have a workforce plan that is linked to service development, is based upon evidence of best practice in workforce utilisation, and provides a clear rationale for change linking with their financial projections and assumptions
• OUH has a workforce methodology and process that they are confident they can integrate into their annual planning cycle going forward
• The profile of workforce planning has been raised across the Trust with staff at a local level. Staff from a wide range of departments are now keen to engage with future workforce plans
• The project has highlighted the importance of building upon the workforce plan capacity and capability created by the project to ensure the learning can be cascaded and more staff can engage in future workforce planning exercises
• Sharing Divisional Level workforce plans at a final workshop enabled the identification of important areas of organisational interdependencies and enabled the identification of opportunities for further cross working and collaboration to develop effective workforce solutions

“The outputs of the project have exceeded our expectations; it has enabled us to be in a position to embed workforce planning into the business planning cycle across the organisation. We also recognise the need to develop more capacity and capability in workforce planning in order to build upon the project and identify more areas where the transformation of our workforce would be beneficial.”

Glyn Allington, Oxford University Hospitals Human Resources Lead – Workforce Information and HR Records

Berkshire West Integrated Care System (BWICS) approached Skills for Health as one of the pioneers of the Six Steps Methodology to look at their strategic workforce priorities to make sure they were fit for the future and all elements had been fully considered prior to their evolvement into its system-level workforce plan. The project required us:

1. To introduce the Skills for Health Six Steps Methodology for workforce planning to teams from a variety of settings and pathways across the BWICS
2. To consider adoption of Six Steps to provide standardisation for workforce planning across the system
3. To identify and prioritise those workforce issues with the potential highest impact, that apply across the system.

The priority areas identified were how to:

• Make the best use of workforce intelligence and think strategically about long-term workforce requirements
• Unite employers from multiple organisations and professions
• Ensure that the workforce strategies of partner organisations work together to promote the interests of service users and carers
• Make choices about what needs to be done at a system level, versus an organisational level

How did we achieve what we’d set out to do?

The Six Steps Methodology was successfully introduced to key stakeholders within the Berkshire West Integrated Care System through a one-day workshop. The stakeholders agreed that the Six Steps might offer a way of standardising the approach to workforce planning and wanted it to be trialled with a range of people and patient pathways on current workforce issues across the system.

The next stage was to identify specific groups who were ready to address their workforce issues and introduce the Six Steps Methodology so they could use the framework to develop short to medium term workforce plans, addressing both current and future pathways and services.

Representatives from the different groups attended a plenary session to examine the progress made and decide if the Six Steps might be adopted as a standard methodology across the system, creating a common framework and language for workforce planning. The plenary session was also used to discuss shared priorities and to make recommendations for key system-wide workforce development areas.

The five areas were:

1. Social Care
2. Berkshire Healthcare NHS Foundation Trust (BHFT) focussing on:
   1. Community Nursing
   2. Community Mental Health
3. Royal Berkshire NHS Foundation Trust (RBFT) focussing on:
   1. Pharmacy
   2. Elderly Care
   3. Neonatal
   4. AMU
4. Urgent and Emergency Care Pathway
5. Cancer Services

The agendas were tailored to the needs of participants at the workshops, so they were able to experience each step in the context of their own current workforce issues. At each workshop, the template was used to structure the discussions for each of the Six Steps using the knowledge of the participants and data provided by the Workforce Planning and Intelligence team at Health Education England.

From each workshop, suggestions were produced for workforce development that participants identified as relevant system-wide. The suggestions were then prioritised, and further progress was reported at the Plenary workshop.

Priorities

All groups identified different components that cluster around retention as a key issue when planning the workforce. If addressed in a system-wide coordinated way, this would have a considerable impact on retaining existing talent.

• Valuing staff was a recurring theme with the suggestion that creative consistent rewards (including non-financial) might play a part
• Consistency and parity within terms and conditions were an important mechanism to reduce inter-system competition for staff and help drive the move to an integrated workforce
• A willingness to explore new ways of working and new roles was evident and would support transforming services to meet future needs
• System-wide the cost of housing for workers within the health and social care was a recurring theme in the difficulty to recruit. People felt that recognising the resident population as a potential pool of future workforce may be a particularly important strategy.

All these factors are difficult to address at the level of the individual organisation but could be addressed at the system-level to stabilise workforce supply.

Agreeing on system-wide workforce priorities

Our project allowed for discussion and agreement on which of the system-wide priorities would have the greatest impact on supporting their workforce plans.

The plenary group decided that within the three broad headings of retention, the supply pool and recruitment, they could identify priority actions that might benefit from being taken forward across the ICS. The analysis was undertaken to consider what forces were in support of the three priorities and what system-wide mechanisms were working against them.

Impact

The project achieved its aim of bringing a wide variety of stakeholders together to work collaboratively to address system-level workforce issues and provide a logical approach to workforce planning by utilising the Six Steps. Furthermore, the project demonstrated how our workforce planning methodology can support system-level workforce planning with a wide group of stakeholders and challenges.

“Skills for Health’s Six Step Methodology was selected due to its accessibility and credibility within health and social care. Embedding the model facilitated a proof of concept for our collaborative approach to workforce planning and has enabled us to identify priority areas as an Integrated Care Partnership (ICP) which will feed into the wider BOB ICS ‘People’s Plan’ workforce strategy.”

Maggie Neale, ICS Workforce Manager, NHS Berkshire West CCG

The Nuffield Hospital Guildford, one of Nuffield Health’s 30 hospitals, identified that a competence-based approach to staff training and development would enhance patient safety, address clinical incidents, and support staff development.

After using Skills for Health competencies to develop training packages for all their nurses around the use of syringe drivers and specimen labeling, errors were reduced to zero and managers were impressed with the results. They built on this and adopted a competency-based approach to all staff induction. Following these early successes, managers used competencies to develop extended roles for Healthcare Assistants (HCA).

“The Skills for Health competencies are easy to use, they deliver what you need, and they enabled us to make a quick impact on clinical effectiveness. We use competencies for anything that we need to assess because they’re multi-disciplinary teams designed and validated. We think that’s as safe as it gets.”

Jean Holloway, Clinical Effectiveness Nurse, Nuffield Health

Benefits

• No incidents reported in three years since the programme began
• Competences used for risk assessment to reduce clinical incidents
• Over 100 nurses completed competency-based assessments since 2008
• Competences support a multi-disciplinary approach and increased patient safety with more timely interventions
• HCA role extended to assist in theatre for specific procedures with the backing of qualified staff, consultants, and theatre manager
• Releases scrub sisters for more complex procedures
• Patients transferred from the theatre by extended HCA post holder, freeing up registered nursing staff

How we helped

Managers searched the Skills for Health database for competencies relating to both areas of practice – monitoring and maintaining people from theatre to ward, and simple scrub procedures. The competencies were used to inform a specially devised training package which the HCAs completed over a four-month period.

Both HCAs welcomed the opportunity to extend their scope of practice. One was a level 3 NVQ HCA where managers identified competencies to enable the HCA to upskill and extend their practice around patient transfer. Another HCA experienced in theatre had their role extended so they can ‘scrub’ for specified procedures which have been risk-assessed e.g. hand lift, ENT, and some maxilo facial surgery.

Staff recognised that the up-skilled HCA carrying outpatient transfer increased her awareness and assessment skills and enabled the capacity to be released onto the wards.

The theatre example has been viewed as an unqualified success as the HCA, consultants involved, and the theatre manager has all seen this role extension as a ‘win’. Colleagues are released to do more complex activities, so making better use of their time and skills. Managers have welcomed the way evidence-based and measurable competences can be used to address clinical incidents, enabling staff to quickly pinpoint what needs to change.

What are competences?

Skills for Health has developed a bank of national workforce competences that describe the skills and knowledge required to carry out a task or function effectively. They are designed to underpin and be integral to accredited and nonaccredited education and training programmes. Since competences describe what individuals need to know and do, whoever is performing the task, they can be used.

As the Sector Skills Council, we support all health sector employers, NHS, independent, and third sector organisations. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.

Porters, healthcare, domestic and catering assistants – the health sector often struggles to recruit and retain staff in these traditionally hard to fill posts.

For some years, Cwm Taf Local Health Board (formerly Cwm Taf NHS Trust) in South Wales had recruited those who were already in employment. For the many long term unemployed residents of Merthyr Tydfil and Rhondda Cynon Taff, working for the NHS didn’t seem a realistic prospect.

In a bid to improve recruitment and community engagement, the Trust developed a pre-employment programme with local partners aimed at people who had been unemployed long term and/or had health problems. Skills for Health invited Cwm Taf to trial its sector employability toolkit (SET) – resources to support individuals to develop the skills required for entry level
health sector posts.

The partnership with Skills for Health and the local community to use the toolkit has provided several exceptional benefits for Cwm Taf:

• Estimated £900,000 savings in recruitment and bank staff costs
• 50% less turnover in this group of recruits – 80% of recruited admin staff are still with the Trust 18 months on
• 30% lower sickness levels of recruits
• Strategic human resources benefit – 30% of healthcare assistant recruits are likely to go on to train as qualified nurses
• Recruits preparedness for the role

“The SET provided a good structure and source of materials but also provided the flexibility to enable Working Links to use our own experience and to include other activities. The interview questions were appropriate both for the job role and the level of candidates.”

Sue Dann, Employers Solutions Performance Manager, Working Links

Cwm Taf Local Health Board worked with local partners Job Centre Plus, the Neighbour Learning Centre (the training facility of Merthyr Tydfil County Council), Want2Work, Working Links and Remploy to use Skills for Health’s Sector Employability Toolkit.

Job Centre Plus encourages job seekers to participate in the Trust’s pre-employment programme, which comprises a recruitment and selection process, two-week training course and guaranteed interview.

The Employability Toolkit adds a three-week work trial during which, crucially for a low-income community, candidates continue to receive job seeker’s allowance. The Toolkit’s resources can be used to support individuals to develop the skills required for entry-level health sector posts. Other features include employability skills and recruitment checklist and materials, plus guidance to support recruitment and selection. Training is then linked to the NHS knowledge and skills framework (KSF), national occupational standards (NOS) and national standards for adult literacy and numeracy.

The work trial allows individuals to demonstrate their ability and highlights areas for future development while focused feedback boosts their confidence and motivation. At the end of the programme, both managers and participants have a clear understanding of whether an individual is suited to the job. Informed decisions on both parts mean a strong likelihood of a successful, long term partnership between employer and employee.

“The tangible benefits of the Sector Employability Toolkit are enormous. The nature of the selection process means that we get to recruit very motivated, committed individuals which has a really positive effect on retention levels. It’s a win-win approach, with great benefits for us and also for the local community”

Patrick Riley, HR manager, Cwm Taf Local Health Board

As the Sector Skills Council for Health we support NHS, independent and third sector healthcare employers. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.

Blackpool Fylde and Wyre Hospitals (now part of Blackpool Teaching Hospitals NHS Foundation Trust)  have around 4,500 staff, catering for a local population of 330,000 – which includes a significant retirement community. However, given Blackpool’s popularity as a tourist destination, the NHS in Blackpool also has to deal with the diverse healthcare needs of more than 12 million annual visitors. Not surprisingly, its accident and emergency unit is the busiest in the country.

As well as facing significant financial difficulties, when Julian Hartley took over as Chief Executive of the Trust, he inherited a workforce that was low in morale and anxious about the future. Julian knew that in order to tackle the Trust’s financial deficit, he needed an organisation that was pulling together and a workforce that was motivated and willing to respond to the changes he would need to implement. He also recognised that transforming people’s behaviours, attitudes and management styles would require open and honest dialogue and ongoing investment in learning and development.

“People come into the health service because they want to care for people; they want to put something back; they want to contribute. But often, in a traditional hospital model, things
start to go wrong because people don’t feel they are able to do that. Other stuff gets in the way.

By involving staff in identifying exactly what was going wrong, getting their input on where we ultimately wanted to be, and imagining how that would feel once we got there, we were able to create a blueprint of what somebody working at Blackpool would be like – in terms of skills and behaviours. We then repeated the exercise for managers. The end result was widespread staff agreement on explicit statements of expected behaviours for Blackpool employees and their managers.”

Nick Grimshaw, Director of Human Resources and Organisational Development

Enlisting the support of his management team, Julian’s first step was to consult extensively with the Trust’s workforce. This involved open discussions with around 4,000 staff to find out about the problems and frustrations they were experiencing and establish what behaviours and culture changes were required. Staff groups distilled the issues – creating meaningful visions and values – with the focus firmly on quality of care for patients.

The Blackpool person will be considerate, conscientious, reliable, honest, open to change, friendly, positive, team-orientated, customer focused, patient-focused and have initiative.

The Blackpool manager will be visible and approachable, accountable, decisive, facilitative, fair, professional, competent, pro-active, and motivational.

“The management team then worked backwards to identify and implement the changes required. We asked ourselves: How do we do things now? How can we do them better? What skills do we need to develop? What changes do we need to make to help us work in a better way and what are the implications? How will this impact on our people, on job plans, and on the way things are structured?”

Aidan Kehoe, Chief Executive and former Deputy Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

To bring about the changes required across the workforce, Julian and his team had to ensure that managers behaved differently and adopted a more enlightened style of management.

Based on the qualities and behaviours already identified for the ‘Blackpool Manager’ duringg the staff consultation, a management questionnaire was devised and completed for every manager, every six months. Each manager’s direct reports were asked to rank their manager’s performance. Is he/she approachable? Does he/she motivate and inspire you? Does he/she delegate effectively? Does he/she give you the training you need? Does he/she appraise you regularly? It was made clear to everyone from the start that the exercise wasn’t some sort of hard-nosed performance management tool – it was about improving people’s performances as managers.

Working together to tackle the financial deficit the management team realised that significant reconfiguration was required to reduce the financial deficit. Rather than make staff redundant, the decision was made to find alternative options, such as changing the way that services worked – at the same time focusing on improving patient care. This approach inevitably involved large scale staff redeployment. In total, around 500 jobs were changed. Some people moved into entirely different roles, others moved into similar areas but at alternative sites. To inform the process, individuals’ skills and abilities were identified and their interests and home locations were also taken into account. Where appropriate, staff were given the opportunities to re-skill and move into other areas and provided with the training and support they needed to help them adjust successfully.

“What’s really interesting is that this is the sort of thing that, traditionally, the health service has put no emphasis on whatsoever. We’ve concentrated on the length of waiting lists and access targets, more recently we’ve focused on decreasing infection rates, but a focus on the style and effectiveness of management was missing. Once you start giving it some attention – telling people that it is important, providing the necessary training and development, and giving appropriate recognition of a job well done – surprise, surprise, things really start to improve. People buy into it rather than being scared and confidence grows across the board.”

Nick Grimshaw, Director of Human Resources and Organisational Development, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

Outcomes

• 20 point reduction in mortality rates in the last 18-months
• 80% reduction in MRSA rates in 1 year.
• £24million annual deficit successfully addressed and turned around within 18 months
• 18-week maximum waits implemented 12 months before the stipulated deadline
• operational targets for Accident and Emergency consistently delivered in 2008, the management team’s inclusive approach to tackling the staff issues resulting from the financial deficit led to the Trust winning a Healthcare People Management Association national award for partnership working
• In 2009, the Trust won the same award for its innovative Stress Reduction Project
• increase in staff appraisals from 24% to 88% in two years
• significant reduction in staff sickness absence
• ranked as top 20% overall performer by the Healthcare Commission following the 2008 national staff survey (compared to the bottom 20% in 2006)
• ranked as top 20% performer in the same survey due to staff saying they would recommend the Trust as a good place to work a transformed workforce – better motivated, happier and more confident

A common-sense approach to effective employee engagement and high performance based on four key steps:

1. Good communication: educating, informing and involving all staff at all levels
2. Recognition: acknowledging and rewarding staff both formally – through award
   ceremonies, certification for learning and qualifications completed, and regular
   appraisals – and informally, through effective day to day line management
3. Continuous improvement: looking at people’s individual skills and abilities and
   committing to ongoing investment in learning and development across the
   organisation
4. Enlightened management style: changing behaviours, attitudes and culture and improving management skills

“The changes in behaviour and attitude have been nothing short of astounding. Staff can now be heard saying – that’s not very ‘Blackpool Way’ – on occasions when people default to the old way of doing things. More and more people are getting involved; making improvements without having to ask permission first. That is obviously resulting in some huge issues around change and training – for staff, who are suddenly being allowed to use their own initiative, and for managers, in terms of learning how to let go.”

Nick Grimshaw, Director of Human Resources and Organisational Development, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

“You have always got to invest in training and development. We see that as a key part of our business and would resist any attempt to scale that down – because if ever there were a time when we need to invest in training and development, it’s now.

I do believe that training and development is critical to our hospitals – and to the health sector as a whole. We have got to invest in our workforce if we are going to meet the challenges that are posed by 21st-century healthcare. We need people – in our hospitals, in our primary care system, in our health sector as a whole – who have got the right skills to provide high-quality patient care, but have also got the right skills in terms of customer service, interaction, flexibility, willingness to change; and the appetite to take on fresh skills and the challenges that are always there in the health system.”

Julian Hartley, former Chief Executive, Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust

As well as addressing organisational needs, the strategy also helped ensure the Trust’s delivery against the NHS Constitution’s four Staff Pledges:

Staff Pledge 1: to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference – to patients, to their families and carers, and to communities.

Staff Pledge 2: to provide all staff with personal development, access to appropriate training for their jobs, and line management support to succeed. Staff Pledge 3: to provide support and opportunities for staff to maintain their health, well-being and safety.

Staff Pledge 4: to engage staff in decisions that affect them and the services they provide individually, through representative organisations, and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.

As the Sector Skills Council for the UK healthcare sector, we support the NHS, independent healthcare providers and voluntary organisations. Our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.