Suffolk & North East Essex Integrated Care System

Workforce

Strengthening our health and care workforce is a key priority if we are to deliver the benefits to the people living in Suffolk and North East Essex described in this plan. We will enable this to happen in the following five ways:

  • Making Health & Care the Best Place to Work
  • Improving Leadership Culture
  • Tackling the Nursing Challenge
  • Delivering 21st Century Care
  • A new Operating Model for Workforce

We recognise that many of our solutions will cross cut most, or all five themes, and all these themes are closely linked with the digital and estates elements of this strategic plan. We will adopt an integrated approach to workforce, working closely with performance and finance to make sure our workforce plans are realistic and meet the needs of our local population.

The Suffolk and North East Essex ICS has recently established the post of Director of Workforce who will ensure workforce remains key alongside performance and finance. To meet the growing demand for health and care services and deliver our ambitions, we will adopt an integrated approach to workforce with system partners. This will allow us to think differently and develop a collaborative workforce strategy, to achieve local ambitions and the aspirations set out in national policy.

The triangulation of workforce, activity and finance, and the alignment with the digital and estates strategies are intrinsically linked to system integration.

Our ambition for our population is to have an integrated workforce that delivers care at the right time; in the right way; in the right place; by the right person.

By addressing our workforce needs and implementing our workforce strategy we will contribute to the following outcomes for our population:

  • Has a good start in life
  • Is able to live as healthy a life as possible
  • Has a good experience of ageing
  • Has a good experience at the end of their life
Our strategy needs to address our greatest challenges highlighted below:
  • Recruitment and retention of our workforce, including a shift from agency dependency to a permanent workforce.
  • Health and wellbeing of our workforce led by good leadership.
  • Ensuring supply timelines of learners/students and a consistent quality of education.
  • Supporting clinical accountability and confidence in upskilling and developing new roles.
  • The need for a joined up approach and capacity to support learning in practice.
  • Level of system transformation and resources required to meet the aims in this Five Year System Strategic Plan.
Our Workforce profile shows:
  • The NHS has an ageing workforce – retirements can lead to a loss of experienced staff and clinical leadership where there is no clear succession planning.
  • There are challenges in recruiting GPs – GPs want a portfolio approach to their careers, an acceptable and achievable workload and good leadership and culture within their practice leading to innovation.
  • We have an inconsistent approach to organisational/leadership development.
  • There are significant health and social care vacancies in some areas, including nursing, therapists, social workers and carers.
  • We have insufficient supply, especially among adult, mental health and learning disabilities nurses, A&E doctors and GPs and certain roles in social care.
  • We have been over-reliant on international recruitment and need to grow local talent
Workforce Planning

Currently our data shows that for health, the workforce is the largest part of our expenditure at around £586 million, with clinical staff accounting for
£317 million, medical and dental staff accounting for £157 million and support staff accounting for £113 million. As a system we spend £35 million on agency costs; £14 million is on medical and dental staff and£10 million on clinical staff. Our sickness absence rate as a system, ranges from 3.36% to 4%. A significant amount of work has been undertaken to reduce our vacancy rate which is 7.8% compared to a regional average of 9.9%.

Overall as a system the expected growth in our workforce is 5.53%, with year on year growth until  2024 of between 0.94% and 1.39% per year.Our workforce growth trajectory as a system takes account of productivity; and the transformation of services currently underway and planned for the
future. Examples include improved rostering across the workforce. Rostering has been phased, in the first instance, in areas of highest agency spend and where it is clear productivity can be increased by more effective use of staff. The use of digital solutions such as electronic job planning can triangulate planned activity with staffing. Recruitment processes are also being revised to ensure vacancies are filled in a timely manner.

The transformation of services, involving the transformation of current roles and establishing new roles, for both hard to recruit posts and areas where
service delivery needs to change, are already underway. This includes ensuring the expected outcomes are delivered from the changes implemented; the right training and development is provided and the right work pattern is implemented collaboratively with our partner organisations to support the service needs. Through the development of our workforce we will retain and, where necessary, retrain, to ensure we keep talent and skills in the health and care economy that address the changing needs of our population.

Our ambition is to achieve one workforce across the system, with the easy movement of staff to meet population health needs. At our local triangulation
workshop, the system has identified agency spend as an area of specific focus, alongside repurposing of the current workforce where efficiencies are achieved

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We will know we are making a difference because we will see;
  • Improved staff retention rates
  • More providers’ Care Quality Commission ratings as ‘Well Led’
  • Lower nurse, GP and other clinical vacancy rates
  • Reduced sickness absence rates
  • Positive annual NHS Staff Survey feedback
  • Greater numbers of apprentices
  • More young people recruited into health and care career pathways
  • Improved supply and quality of pre-qualifying student placements
  • Implementation and effectiveness of e-rostering system
  • Closing of the gender and race pay gaps in partner organisations
  • Increased diversity of employees with protected characteristics at all levels
  • Improved support to NHS Boards to review their Workforce Race Equality Standard (WRES) and Disability Equality Standard (DES) and develop

We want to create an environment where staff are actively and consistently listened to, communicated with and involved in decisions. To achieve this, the workforce needs to be engaged directly and through partnership with the trade unions.

We already have system leadership and cultural programmes underway such as One Clinical Community, which look to develop, extend and embed the system approach to leadership cultures across local and wider system populations. Our ‘Leadership Compact’ will specify the cultural values behaviours our leaders should display to develop a positive, inclusive, equal and people-centred culture.

Over the next five years we want to:

  • Support individuals identifying as future leaders and develop a system-wide leadership competency framework to create inclusive compassionate leaders.
  • Build a positive inclusive culture across our system, where staff are proud to work for health and care. This will not only support the health, wellbeing and retention of our existing staff, it is critical to attracting new staff.
  • Involve people who use services and the wider population to inform our staff development.
  • Tackle the enormous scale of organisational change ahead by taking a collective, patient-centred approach will help to build relationships, trust and connections across the system.
  • Put people at the centre of all of our activities by providing clear incentives for leaders to collaborate to break down regional/organisational barriers and take a system-wide approach to workforce.

We want Suffolk and North East Essex to be the place of choice to work, so we will help employers to create attractive local employment offers, create one workforce by supporting staff mobility, provide an attractive recruitment offer and experience, strengthen retention, manage our talent and improve succession planning across the system.

Excellent work has taken place in organisations across health and care to address the health and wellbeing of staff, and we will build on this to develop a toolkit of best practice and a core system offer for our workforce. The mental health of our workforce is crucial, so training in mental health awareness will be consistent and mandatory. Flu vaccinations will be provided to all frontline health and care staff to help maintain low levels of sickness and reduce them even further. We have leadership development programmes for staff across a number of settings, and have rolled out the Jump Start programme of leadership development aimed at our current and aspiring system leaders. Our Health Ambassador programme works with schools, education and careers promotion to encourage young people into health and care.

Over the next five years we want to:

  • Ensure that all organisations place a greater emphasis on valuing and supporting the health and wellbeing of their employees and reducing sickness absence.
  • Support our workforce to carry-out their roles effectively, especially those in challenging environments, by extending a system-wide health and wellbeing approach which includes tools for mindfulness and enhancing resilience.
  • Implement the Suffolk and North East Essex Workforce Academy, a one-stop shop for the recruitment of people in health and care and develop their skills to support integrated working. In particular, we will work with education settings to increase young people’s awareness of the health and care career opportunities available.
  • Work in partnership across the East of England to address agency and locum pay caps, and encourage staff to move away from agency and into substantive employment.
  • Increase our current staff retention rate and in turn improve the workforce experience. This includes health and wellbeing programmes, a positive and flexible work-life balance, and career development through the one workforce model.
  • Tackle bullying and harassment by achieving a zero-tolerance environment, a transparent culture, with 100% reporting and high-quality support.
  • Promote equality and inclusion, beyond the protected characteristics in the Equality Act 2010, to widen participation and maximise support to our workforce.
  • Create ‘one’ workforce that can respond to the care needs of local populations and move seamlessly around the system as one, regardless of employer.

We will supporting organisations to address workloads, which will help attract and retain staff across all areas. Our initial focus has been in nursing, which has the largest area of shortfall in health and care, but our schemes will be extended across the health and care workforce. We have increased the number of student placements on offer, and we will continue to increase capacity particularly in primary care. We are exploring the movement of nurses and their entry points into the system. New roles will offer a fresh supply of workforce to the system; Student Nursing Associate; Advanced Care Practitioner; Physicians Associates. We are creating opportunities to ‘grow our own’ local workforce, including return-to-practice. We are expanding the number of clinical pharmacists and social prescribers, and we continue to expand the Advance Practice Physiotherapists (First Contact Physiotherapists) role.

In addition, over the next five years we want to:

  • Recognise and address the diverse needs of different generations and communities within the workforce.
  • Further develop return-to-practice courses and support to encourage people back into health and care.
  • Redistribute and redesign services through development of new roles.
  • Work in partnership with digital leads to deliver 21st century care.
  • Work with universities to attract nursing students and then retain them throughout their training and early careers, and promote blended learning for students.
  • Develop a system-wide approach to international recruitment.
  • Develop a system wide approach to apprenticeships, and develop a modern apprenticeship strategy to meet a broadening role portfolio and explore new trail blazer roles.
  • Develop a system-wide integrated retention strategy, which allows the movement of the workforce with ease, for example ‘training passports’ to help remove barriers between organisations.

We will grow our overall workforce, introducing a more varied and richer skill mix, with additional reimbursed roles in primary care networks and different ways of working based around local population needs. Workforce planning will help adapt and predict the future workforce required, recognising ongoing changes in productivity, environments and technology. This is of particular importance in primary care where we are challenged in recruiting and retaining GPs. Learning and development will take a place-based approach to meet the population’s health and care needs.

Over the next 5 years we want to:

  • Understand our workforce profile and gaps, and the profile of the volunteer workforce
  • Develop an informed workforce plan that recognises and addresses the diverse needs within the workforce, and the changing needs of employers.
    The new operating model is ‘one workforce’. There are three strands to achieving this ambition.
  • 1. A transformed multi-disciplinary team, with roles designed, transformed and focused on local needs. This approach provides a joined up team where roles move beyond traditional boundaries and focus on personalised care.
  • 2. A workforce that can move around the system efficiently and effectively with minimal disruption and cost. This focuses on offering our existing talent opportunities to develop within the system. We need to develop processes and resolve the challenges and barriers that exist, to enable this to happen.
  • 3. Bringing together workforce planning with population health management. In order to plan our workforce effectively we need the availability of single workforce data, capable of being interrogated and analysed through different lenses. We will establish a system-wide, shared and transparent approach to workforce planning to facilitate innovative outputs that meet local needs and support recruitment, retention and new ways of working
  • Where we are and future action

    The placed based People and Culture Groups are established. Each of these three placed base groups have held workshops to understand the Strategic
    People and Culture Plan, and explored how this relates to the priorities for each locality area, based around the local workforce issues, local place based
    requirements and transformation.

    Over the next few weeks, in partnership with our ICS People and Culture Board, we will be developing our ICS People and Culture operating plan. This plan will set out the phasing of our workforce schemes, the delivery plans and timeframes.

    We have identified three clear and immediate priories for the ICS workforce programme.
    1. One workforce
    2. The supply of workforce including the workforce academy
    3. Agency spend and the shift to permanent employment

    Whilst these are three significant programmes of work, it is imperative they are developed and implemented over the initial years of the 5 year strategic plan. This will ensure we are responding to the requirements of both the workforce and organisations within the ICS, the development of one workforce in response to population health need, the transformational need and the demand for workforce.

    The supply of workforce, especially where we are looking to the current school generation as our supply, requires immediate action to be able to realise the impact within the timeframes of this plan. The Workforce Strategy is a long term strategy with a time lag in coming to fruition. Currently agency spend is significant. As well as being important from a financial perspective this also impacts on the quality of care and the wider workforce.

    Through collaboration with partners, enticing this workforce into permanent employment is key. If the workforce can be transferred to a permanent basis, workloads will decrease and the temporary workforce will benefit from all the interventions available to the permanent workforce. To do this we must develop an attractive core offer of employment across the system. Working as one workforce offers many of these opportunities.

    Case Study: Building self-management and coaching skills

    NHS England state ‘People have a key role in protecting their own health, choosing appropriate treatments and managing long-term conditions. Self-management is a term used to include all the actions taken by people to recognise, treat and manage their own health’. It was considered that the training given to NHS (or equivalent) Band 2/3/4 to support the medical model would probably not equip with them the interpersonal skills needed to support the self– management agenda. A successful bid was made to fund the further development of a personal development intervention rolled out by Anglia Community Enterprise CIC in the past for Band 3s. The training was updated as a result of the funding and specifically developed and designed for Band 2/3/4 (and equivalent) employees across the local health and social care community. The course ran initially as a pilot and was then tweaked. Cohorts 15/16 are running during September 19. One difficulty encountered during roll out was finding all the organisations to offer the course. This was overcome although more contacts would always be welcomed. The training was offered as widely as possible to employees for example of NHS, Primary Care, Care Providers, Care Homes and Essex County Council. The intention was to provide each with a similar set of tools to ensure the good work of one group would not be undermined by another not following the same approach. Feedback from attendees has been excellent. A two-stage evaluation process has been used. Training for leaders and higher bands is planned.

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