‘Providing efficiency and workforce – the key challenge’

Dean RoylesDirector, NHS Employers17 March 2011

If HR developed film titles

• The Good, the Bad and the Surgically Challenged

• Four Civil Partnership Ceremonies and a Funeral

• The Monarch’s Presentation and Assessment and Intervention by his Speech Language Therapist

• Where Eagles Fail to Undertake a Comprehensive Risk Assessment

Changes to workforce development

• The Department of Health has proposed changing the way the healthcare sector plans, commissions, trains and develops its workforce, both medical and non-medical, setting out significant changes to the way the system is organised.

• This provides the opportunity to:- Reshape and simplify the system so that it can respond to

the changes that are happening in the NHS. - Develop a multi-disciplinary approach to workforce planning

with better links between those planning future workforce requirements and those commissioning education and training.

- Move to a demand led rather then supply led system aligned to the needs and expectations of patients

Past ten years of significant changes in the medical workforce

• The introduction of the 2003 consultants' contract

• The implementation of Modernising Medical Careers (MMC)

• The development of training curricula with progress to CCT and beyond based on agreed specialty standards and competencies

• The developing role of the Specialty Doctor grade

• Implementation of the European Working Time Directive

Huge efficiencies savings needed across the entire health sector

• Efficiencies savings can be realised by redesigning the structure and terms of specialty and consultant contracts to better reflect developing roles

• The £400 million clinical excellence award scheme for doctors is out-dated, unfair and not clearly linked to the needs of today’s health service.

The future of the medical workforce

• Shifts in UK demographics are likely to have a significant impact on the type of workforce we might need in the future.

• Some specialist services being delivered closer to home• Local hospitals providing generalist care and more regional specialist centres. • Expansion of generalist skills and at the same time the development of super-

specialist teams.• Career pathways will need to adapt to transformations in healthcare delivery

and demographic shifts in the medical workforce itself.• With changing demographics, higher expectations and new demands on

health services, a more flexible approach to training and career development is required.

• A modular approach to training?• Core medical, mental health, research and surgical modules across a range

of settings, continued professional development in more specialist areas.

The future role of specialists (1)

• Role of non-consultant level medical staff is changing.

• Not all qualified doctors will want to take on the teaching and managerial aspects involved in a consultant position, just as consultant and GP principal opportunities may not be available for all qualified doctors in the UK.

• Temple suggested different levels within the consultant workforce may be beneficial, and with newly appointed consultants requiring mentoring especially where they feel they lack experience or expertise.

• A more flexible career ladder would provide opportunities for doctors to practice effectively within clear limits of competence

The future role of specialists (2)

• More innovative teaching within curricula will also be needed to ensure that doctors are able to develop the level of competence and capability required to work independently within a shorter timescale.

• Employers want to enable specialty doctors and their trust equivalents to gain recognition for the knowledge, skills and experience they acquire throughout their careers.

• A multi-disciplinary approach to workforce planning is needed with better links between those planning future workforce requirements and those commissioning education and training.

• The NHS should move to a demand led rather then supply led system aligned to the needs and expectations of patients. Psychological contract?

• The provision of good quality care is not only about treating high volumes of patients in a timely manner. It is about delivering patient safety and a good patient experience.

• More of a balance is needed between training to achieve competencies and developing capable doctors, who can adapt to situations, react quickly and safely and instill confidence in the patients under their care.

• Patients are less concerned with doctors’ job titles and more concerned with having experienced, up-to-date and qualified people to meet their healthcare needs promptly and effectively.

• Still a big quality and productivity challenge.

 

 

Summary

The QIPP Challenge

£

1997 2011 2015

QIPP Gap = £20 bn

expenditure

projected expenditure based on current trends

income

projected real income based on CSR

cash

productivity

A productive workforce and the social political and economical environment

• Efficiency savings of £15 - £20bn required in the NHS

• A significant  programme of structural reform, including a 45 per cent reduction in management costs

• An ageing demographic and rising expectation among the general public as a result of increasingly sophisticated methods of treatment.

Current context – Operating Framework 2011

This year’s NHS Operating Framework continues the Government’s programme of change, addressing key workforce issues including:

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

Workforce Cost-

effectiveness = Cost-weighted

activity/ Workforce

Costs

Legend

Central benchmark

Ideal benchmark

Inputs Unit Costs

Contextual metrics

Sickness absence (%)

Outputs and Quality

Unit Costs drivers

Paybill per FTE/ cost-weighted

labour input per FTE

Skill mix

Staff satisfaction (composite indicator)

Value-weighted activity.

In practice, this would be quality-

adjusted, cost-weighted activity

Cost-weighted

activity (£)

Workforce costs (£)

Non-workforce inputs

(£)Paybill (£)

Temporary staff costs

(% of workforce

costs)

Turnover (%)

Labour Productivity

Hospital acquired

infection rates

Composite indicator of three

dimensions of

quality - clinical

effectiveness,

safety and patient

experience

Patient satisfaction

Waiting times

Labour Productivity

= Cost-weighted

activity/Cost weighted

labour input

Staff numbers

(FTE)

Paybill per FTE

(£)

Temporary Staff average unit cost

(£ per FTE)

Temporary staff

volume (FTE)

Cost-weighted

labour input

Off

fra

mew

ork

Volume

Cost-weighted labour input,

excluding staff in the

community

Total measure of activity, including

activity in the community

setting

Note that community based activity data

are not readily available, therefore

labour inputs are adjusted to account

for the lack of community in the

outputs

Note that community based activity data

are not readily available, therefore

labour inputs are adjusted to account

for the lack of community in the

outputs

Core metric framework

Regional QIPP dashboard

Detailed page: Sickness absence

Staff engagement context

Background:• The Francis Report and the NHS Staff Survey

Context:• Using survey scores as an indicator of local performance• Developing a score that covers multiple behavioural factors• The Staff engagement score

The Evidence:• Comparing the staff engagement score with other

performance data in the NHS• What can it mean?

Developing a score that covers multiple behaviour factors

The evidence tells us that staff with high levels of engagement display a number of positive behavioural traits:• increased commitment,

• a belief in their organisation,

• a desire to work to make things better,

• suggesting improvements,

• working well in a team,

• helping colleagues,

• a likelihood to ‘go the extra mile’

Engagement & health and wellbeing

2.5

2.7

2.9

3.1

3.3

3.5

3.7

3.9

Overall Intrinsic engagement

Involvement Advocacy

Gen

eral

Hea

lth

(Low

er s

core

s be

tter

) General Health by Engagement

Low

Medium

High

Survey data shows that overall engagement is linked to better general health & well-being, lower presenteeism and less work-related stress.

This link is reflected in each of the 3 areas that make up overall engagement

Engagement & the Annual Health Check results

1

2

3

4

Low Medium High1 =

Wea

k, 2

= F

air,

3 =

Goo

d, 4

=

Exce

llent

Engagement

AHC Results by Engagement

Quality of services

Use of resources

Overall staff engagement significantly relates to Annual Health Check data. The higher the engagement score, the higher the Annual Health Check score

This is especially seen in the ‘Quality of Services’ element.

Staff engagement and patient satisfaction

74

75

76

77

78

79

80

81

Low Medium High

Patient Satisfaction by EngagementImportantly the chart shows this is a relationship where it is moving to high levels of engagement that makes the biggest difference

Overall staff engagement significantly relates to Patient Satisfaction scores.

Staff engagement and rates of absenteeism

3.7%3.8%3.9%4.0%4.1%4.2%4.3%4.4%4.5%4.6%4.7%

Low Medium High

Absenteeism by EngagementImportantly the chart shows this is a relationship where it is moving to high levels of engagement that makes the biggest difference.

Overall staff engagement significantly relates to rates of Absenteeism.

The NHS Constitution

The NHS belongs to the people.

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

The NHS Constitution – values

• Respect and dignity

• Commitment to quality of care

• Compassion

• Improving lives

• Working together for patients

• Everyone counts

The NHS Constitution – staff pledges

• To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals

• To provide all staff with personal development and access to appropriate training

• To provide support and opportunities for staff to maintain their health, well-being and safety

• To engage staff in decisions that affect them

• Meaning, belonging, hope, growth

Thank you