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NHS 24 05 APRIL 2017 BOARD MEETING ITEM NO 12.1

WORKFORCE REPORT

Executive Sponsor: Executive Lead for Human Resources

Lead Officer/Author: Deputy Director of Human Resources

Action Required The Board is asked to:

note the workforce report

Key Points This report provides the Board with an update on areas of workforce focus for the month of February. It provides analysis of workforce information to inform decision making in relation to the workforce and in addition identifies any workforce issues. The HR metrics collated in this report are derived from the NHS 24 HR Management Information System (Ciphr) and are reported real-time.

Financial Implications Currently, the Workforce Plan is on or below target numbers so there are no additional financial implications.

Timing This workforce report is presented to Executive Management Team prior to its presentation at the Staff Governance Committee and NHS 24's Board.

Contribution to NHS 24 strategy

Information on NHS 24's workforce allows NHS 24's governance committees to make informed decisions, which support achieving the resetting of our culture, creating capacity, capability and confidence in our people and teams.

Contribution to the 2020 Vision and National Health and Social Care Delivery Plan (Dec 2016)

An implementation board is being set up by the Director of Workforce and Strategic Change at the Scottish Government Health and Social Care Directorate following a period of consultation on the delivery plan. NHS 24 will link in to this structure to determine, in the coming months, how its workforce can contribute to the national agenda.

Equality and Diversity Not applicable for the month of February.

1. RECOMMENDATION 1.1 The Board is asked to discuss and note the information contained within the

Workforce Report and any actions identified to be taken forward.

2. TIMING 2.1 This report provides metrics and analysis for the month of February 2017 and

includes historic trends and future forecast information.

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2.2 This report will then be presented to Staff Governance Committee and NHS

24's Board. 3. BACKGROUND 3.1 To support workforce management across NHS 24 the importance of

accurate workforce information and intelligence to better understand both the current and future workforce is recognised.

3.2 The NHS 24 Workforce Plan is monitored on an ongoing basis. This paper,

supported by weekly workforce reports, is produced monthly to identify and monitor key workforce trends including workforce figures by staff cohort, workforce projections, attendance rates, workforce turnover, eKSF completion, health, and well-being.

3.3 Staffing information is provided to both the Staff Governance Committee and

the Board quarterly to further evidence that the Staff Governance Standards are embedded and adhered to as part of the governance framework.

3.4 Monthly performance and compliance information on attendance, eKSF,

CPD, stability, return to work and exit interviews is provided to the senior HR team and to senior line managers within the organisation.

4. UPDATES Workforce Planning 4.1 Charts one and two (page 9), show the predicted year-end forecast for 16/17. The workforce requirements for 2017/18 have been established based upon the new Unscheduled Care Operating model. Recruitment plans are now being developed with the objective of delivering the required numbers whilst taking into consideration other organisational priorities. e:ESS 4.2 The majority of business critical reporting has now been replicated within Oracle Business Intelligence Enterprise Edition (OBIEE) and the Workforce Planning and Development Team continue to work with the e:ESS National Core Project Team to finalise the outstanding absence reporting. 4.3 The suite of audit reports has now been expanded to include more fields including personal, assignment, address and contract details, to ensure that the information held within e:ESS reconciles with what is held on both payroll and Ciphr. These audits will continue to be run routinely until the point of cut over to ensure data quality is maintained and to help identify if there are any training issues or if further guidance is required to be developed for system users. The next step will be to review the mandatory fields required for the ePayroll interface transactions to function and to establish these as part of the standard e:ESS audits to ensure these are being populated accurately.

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Employee Relations

Attendance 4.4 Monthly attendance has increased for the first time in 4 months from 91.44% in January 2017 to 93.36% in February 2017 (+1.92%). Both short- term and long-term absence have decreased this month, with short-term absence noting the most significant decrease (table 2, page 10). In comparison to February 2016, the monthly attendance rate has increased by 0.63%. 4.5 The Employee Relations team continue to work with managers on the effective implementation of the policy ensuring early intervention and appropriate meetings happen in a timely manner. Due to the continued high absence rates a workshop and a programme of auditing and reviewing the attendance management process, management interventions and employee experience is being planned. 4.6 Long Term sickness continues to attract the highest absence percentage, the Employee Relations team review all long-term sickness cases monthly to determine progress, interventions, to ensure supportive and timely action in line with the Attendance Management Policy and escalate where appropriate. NHS 24 commenced February 2017 with 52 staff off due to long term sickness, this peaked to 63 mid month. However, during the month of February, 23 people resumed to work from long term sickness. Additionally though, another 24 became long term sick in the same month, so despite the high levels of colleagues resuming to work, NHS 24 has not felt the benefit of this effort. A common theme across the long term sickness cases are mental health issues and NHS 24 continues to provide information, support and advice to managers and staff on this issue. 4.7 Due to the continued high absence rates the Employee Relations Team recently held a workshop, and the output from this exercise will be proposed to the Executive Management Team on some of the initiatives that could assist increase attendance in line with good practice. 4.8 Chart 5, page 11 shows that for February 2017 staff in the age groups, 50-59 and 60+ have had the highest level of sickness absence. This information is taken into account when considering actions in respect of managing attendance plans. Case Management 4.9 During the month of February 2017, (Chart 14, page 15) there was 6 new formal Employee Relations cases opened (1 Grievance, 1 Disciplinary case complaint and 4 Attendance Management Appeals) this is an increase of 3 on last month. In addition, 2 cases have closed this month. The continued focus on timeframes means cases are being closed off in a more timely manner. 4.10 The Employee Relations Team commenced February 2017 with 8 active cases; an increase on 3 from last month. There were 7 meetings that took place in February 2017 in relation to these cases. The ER team continues to work with managers and Trade Union representatives to resolve

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cases informally and at a much earlier stage. In January 2017, there were 3 cases of this kind, 2 of which have now proceeded to formal stage in February and one case was successfully resolved. In relation to informal cases there is is 1 case around dignity at work, which the manager and the ER team are working to resolve informally. Mediation continues to be an informal and successful method of resolving conflict and at present there are 2 cases of mediation planned. In addition, both Dignity at Work and Grievance policies have been reviewed and updated with an emphasis on mediation at early stages as well as providing colleagues with useful information on the concept and benefits of mediation. In addition, the Employee Relations Team are supporting an Organisational Change exercise for the Health Information Services Team, which will include consultation and matching exercise prior to implementation of the new structure planned for June 2017. 4.11 Chart 15, page 14 indicates the number of 2nd and 3rd formal attendance management meetings that have taken place across the last 12 months. Altough other case figures remain low, there is a continued focus on attendance management with 40 formal attendance management meetings taking place accross the organisation in February 2017, this continues to reflect the high figures. A member of the ER team is in attendance at all formal meetings and offers support to managers in advance of and post meeting. The graph shows that in February 2017, 16 meetings took place at Stage 2 and 1 Stage 3 meeting was held. The Stage 3 meeting resulted in the staff member being supported through ill health retirement. The other 49 attendance meetings that took place were at held at the informal stage of the policy in line with NHS 24's person centred approach, held at 1st Stage of the process or indeed the outcome of the meeting is on hold pending further information. It should also be noted that a number of meetings were cancelled, due to a variety of factors , the reasons for these are being reviewed to ensure this can be avoided in future. 4.12 Additionally, the first session on Attendance and Wellbeing as part of the Leading and Managing Succsesful Teams programme took place in February 2017. The focus of the session was around accountability, decision making and proactive wellbeing services. Initial feedback has been positive. Further dates will be scheduled once Service Delivery confirm preferred dates based on current priorities. Learning and Professional Education Clinical CPD 4.13 The percentage of staff that has completed all of their required mandatory Clinical CPD modules since April 2016 is 72% (of the total headcount). This includes all roles with a requirement to complete modules - for Call Handlers, the completion figure is 92% of total headcount and for Nurse Practitioners it is 84%. 4.14 Learning &Professional Education continue to work with Unscheduled Care to identify those staff who have not yet completed and who should be targeted as a priority moving forward. Completion rates for individual modules can be found in Table 4 (page 13).

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eKSF 4.15 As at the end February 2017, 34% (Chart 12, page 14) of staff had a review completed and signed off in e-KSF for the 2016-17 reporting period (from 1st April 2016 to 31st March 2017). The rolling 12-month figure as at end February 2017 – including all staff that have had a review recorded in the 12 months since 1st March 2016 – is 41%, and many of these reviews will become overdue again before the end of the annual reporting period.

4.16 Monthly reports continue to be sent to senior managers to advise of progress in percentage terms at organisation and directorate level, and support is offered via signposting to online resources and providing contact details for manager support.

iMatter 4.17 The iMatter reporting period is by calendar year. The response rate for 2016 was 84% and Employee Engagement Index was 75%. These figures represent the 27% participation rate to date including teams participating in their anniversary cycles. Teams for 2017 are still at manger team confirmation stage, therefore the response rate is still zero. 4.18 The complementary survey is likely to be issued early November 2017 to all twenty two boards with results being made available early 2018 to Scottish Government. Branding, Demographics and operational process discussions are underway. It has been agreed it will be targeted at Directorate level, not team level, utilising the Webropol portal. The questions will be reflective of the National Staff Survey questions relating to bullying, and harassment, abuse and violence, discrimination, whistle blowing and resourcing. 4.19 The Scottish Government iMatter National Lead has proposed that a key measure for iMatter will be that 61% of Action Plans are completed within 12 weeks of receipt of the team report. The figure of 61% is the national NHSScotland average for 2016. NHS 24 achieved 11.7% in 2016 and successful implementation will require a focus on this area in 2017. Values 4.20 The Values Group in Clydebank has requested Learning & Professional Education to facilitate the one hour Fish ! Philosophy training to members of the group with the commitment of them cascading this in the Centre, following feedback of the sessions delivered to Health Information Services Operational teams. 4.21 Scripting and key messages for the CEO values film are now with the Communications team, for filming to conclude in the forthcoming month. 4.22 The first one hour Values Q&A session with the CEO is scheduled for Tuesday 21st March. Health Information Services, Scheduled & Unscheduled Care, Dental, Physiotherapy and Pharmacy lead trainers have been invited to attend this opportunity.

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Modern Apprenticeships 4.23 There is a requirement to employ three Modern Apprentices by July 2017 to meet the Scottish Government national target of four in NHS 24. It is anticipated this target will be achieved by the recruitment of a possible three Non-clinical Healthcare Worker Modern Apprentices and a Creative Digital Skills Modern Apprenticeship, all of whom will be supported by Health Information Services. Engagement with Borders College for fully funded training places for the Non-Clinical Healthcare Worker framework has taken place. Leadership and Management Development 4.24 Delivery of the Core Fundamental sessions of the Leading and Managing Successful Teams Programme delivery is now underway. Initial reaction level evaluation and verbal feedback to date has been extremely positive. 4.25 Discussions with senior management in the Unscheduled Care Management team have taken place to prioritise off line time for this programme, to ensure fairness and equity for all Team Leaders. 4.26 CEO Endorsement has been signed off, this will now be incorporated in the formal invite to all new managers on joining NHS 24. To ensure effective utilisation of scheduled dates throughout the year sessions with spaces will opened up and the opportunity to anyone with people manager responsibilities aspiring managers, in addition to the priority target audience of Team Leaders and those in a people manager role within the last 18 months. 4.27 Discussions are underway with Communications team on creating an inspiring professional visual for the programme to incorporate key messages of Values, iMatter, personal accountability, leadership and empowerment. HR Business Support Recruitment and Retention 4.28 There were 4 Band 6 (3.24 WTE) Nurse Practitioners recruited to NHS 24 during February.

4.29 Call Handler recruitment continued to progress during February with a pipeline is being built to source 30 WTE to start 10th April and a further 30 WTE to start 2nd May. To date over 450 applications have been received and the current pipeline is working over 180 candidates. Changes have been made to the recruitment process to ensure targets are met.

4.30 21st Century Training was delivered to the senior SEDS Team at the beginning of February, and a waiting list continues to build for another session.

4.31 Planning started in December for Job Fairs that NHS 24 has committed to attending early 2017, specifically Health Sector Jobs in Edinburgh.

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4.32 Three Nurse Practitioner Assessment Centre events were completed during February; two in Cardonald and one at Norseman. These events identified 4 Band 6 and another 4 Band 5 Preferred Candidates. The Recruitment team will work with Service Delivery to make changes to the paperwork and process following feedback from the sessions. Health and Safety 4.33 The rolling figure for accidents is 20, an increase of 2 from the month of January, as shown in Chart 13 (page 14). Currently plans are in place to undertake fire warden and D.S.E training. Workforce Information Turnover 4.34 Turnover is monitored by NHS 24 on a monthly basis. The turnover figures contained in this report are calculated by dividing the number of leavers by the total headcount for that staff group. 4.35 Chart 7 (page 12) shows the monthly turnover percentage for NHS 24 split by full time and part time workers over the past 12 months. As the number of part time staff is considerably more than the number of full time, the number of full time leavers tends to be lower. However given the smaller numbers of full time staff on a monthly basis there can be a noticable fluctuation of turnover amongst this staff group. 4.36 Chart 8 (page 12) shows that over the last 12 months, 62.50% of leavers had between 1 and 3 years service. The proportion of leavers with 1 – 3 years service is also the highest proportion of February leavers (41.74%). 4.37 Chart 10 (page 13), shows that 44.24% (96 out of 217) of leavers during the last 12 months were Call Handlers, who consistently make up the largest group of leavers on a monthly basis, though it should be noted this is the largest skill set of staff. Call Handlers account for 37.5% (3 out of 8) of leavers in February 2017. For the second consecutive month running, there were no leavers within the Nurse Practitioner skillset this month. 4.38 A comparison of leavers aged 50 and under against leavers aged 50+ is shown in Chart 9 (page 12). The chart shows that there is no consistant turnover pattern with staff leaving aged 50 and over when compared to staff under the age of 50. In the month of February, turnover for staff over 50 was just 0.21%, compared to 0.73% for staff under 50. Workforce Profile 4.39 Chart 16 (page 15) illustrates the percentage age composition of the NHS 24 frontline nurse workforce as at 28th February. The figures show that across the frontline nurse resource (Nurses, Team Leaders and Clinical Service Managers) 49.46% of staff are aged 50 and above (table 6, page 15). 4.40 Table 5 (page 15) provides a further breakdown of the frontline nurse workforce by age profile and full time/part time split, this shows that 80.00%

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of all frontline nurse resource work part time hours (Clinical Service Managers, Team Leaders, Nurse Practitioners Band 6, Nurse Practitioners Band 5, Mental Health Nurse Practitioners and Clinical Supervisors). It is worth noting that the majority of frontline staff who are full time are within managerial positions (Clinical Services Managers and Team Leaders) as detailed in table 11 (page 18). This can be further illustrated by the fact that 90.07% of Clinical Supervisors, Mental Health Nurse Practitioners, Nurse Practitioners Band 6 and Band 5 are part time workers. 5. ENGAGEMENT 5.1 Appropriate engagement has taken place with relevant managers from across

all Human Resource functions, Service Delivery and Finance. 6. FINANCIAL IMPLICATIONS

6.1 Currently, the Workforce Plan is on or below target numbers so there are no

additional financial implications.

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Appendix 1: Human Resources Performance Dashboard

Table 1

Annual Average

Target (WTE)

Annual Average Prediction

(WTE) Variance (WTE)

The above figures are based upon projected attrition and anticipated intakes post festive. Predicted numbers are subject to fluctuation throughout the year. Work has started to determine the workforce requirements for 2017/18.

Total Call Handlers Available to service 327 378.52 51.52

Total Nurses 200 153.09 -46.91

Total Clinical Frontline 222.65 171.57 -51.08

The above Total Nurse figure is for Call Handling Band 5 and Band 6 Nurse Practitioners only. Mental Health Nurse Practitioners and Clinical Supervisors have been split out separately and are included within the Total Clinical Frontline target, which also includes – Nurse Practitioners Band 5 and 6, Pharmacy Advisors and Physiotherapy Specialists.

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In Chart 4: All Local Centre and Remote Working staff are included within the main centre they are managed.

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Appendix 2: Workforce Intelligence Tables

Staff who are internally seconded into other positions are recorded in the position they are seconded in to. * 2016/17 service requirement for band 5 & band 6 nurses is 200 WTE, however from a financial perpective it is affordable as a year end positon. ** The 327 WTE figure is a service requirment however the starting position for 2016/17 was far greater (412.81 WTE in April 2016) *** The Clinical Service Manager (1 head, 0.8 WTE) and Team Leader figure (1 head, 0.5 WTE) includes staff who are deployed to the Cancer Treatment Helpline.

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