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STP and Operating Plan Workforce Issues
NHS Providers – Medical & Nursing Directors Network
Wednesday 11 October 2016
Workforce Issues to be covered
Current Position and How we got there • Nursing
• Consultant Medical
• AHP
Where Next? • WAB
• STPs and Operating Plans
• LWABs
Nurse Demand 2012 to 2016 – Adult acute nursing
• In 2015/16 trusts reported increased demand for the fourth consecutive year. The cumulative total
increase in established posts is 25,131fte in adult hospital settings alone (14.3%)
• Staff in post has increased significantly since trusts started trying to expand in 2012 by 12,199fte
• The outpacing of demand v supply growth was forecast to result in over 12,000 additional vacancies
Consultant Supply and Demand – 2008 to 2020
• Consultant vacancies appear to have been historically stable at 3.0% to 3.5%
• 2013/14 and 2014/15 both appear to have been periods of very high establishment of new posts, 5,909 - 15% in two years (as
reported by trusts)
• Supply did increase above the ‘norm’ in response but not enough to match increased demand
• Excess vacancies of a level previously unseen have therefore been created
• Unclear if extra posts are sustainably funded
• Concern that historically vacancies have been hidden if no prospect of filling them
Nursing Supply Measures
1. Additional Training Commissions
2. International Recruitment
3. Return to Practice
4. Retention
NHS ability to attract available supply
1. AHP registrant growth
v
NHS workforce growth
2. MH Nursing growth v forecast
Workforce Shortages by HEE region
• There is significant variation in
supply shortage between
regions
• Regional averages mask
outliers in respect of individual
trusts
HEE - April 2014
Summary Position – Nursing Midwifery and
main AHP
2013 to 2016
• Over 33,000 additional funded posts between 2013 and 2016 (9%)
• Over 19,000 more staff (5%)
• Therefore 14,000 additional vacancies created
2016/17 Initial Operating Plans (before financial reset)
• Plans indicate between 2000 reduction and 4,000 increase in
posts
• Trusts planning for 14,000 growth in substantive employed nurses
and midwives to reduce vacancies and agency / bank usage
• Net impact would reduce vacancies by 10,000 to 16,000
Workforce Intelligence in NHS Planning
Arrangements
ALBs sponsoring complementary planning processes:
• Operating plans 2016/17
• STPs (including Finance & Efficiency Template)
• Two year operating plans 2017/18 & 2018/19
All in context of 5YFV triple aim, Shared Delivery Plan and associated
policy priorities in Single Planning Guidance
These represent our best source of near term workforce demand
including the impact of service and workforce transformation
Working with DH for prospects beyond 2020
STPs – Planning assumptions as drivers of future
workforce demand
Provider Activity and Inflation Assumptions
Activity
Acute i % 2.3% 2.3% 2.4% 2.4% 2.3%
Mental Health i % 1.9% 1.9% 1.9% 1.9% 1.8%
Community i % 3.3% 3.4% 3.4% 3.4% 3.3%
Specialist i % 4.4% 4.4% 4.4% 4.4% 4.4%
Inflation
Tariff Inflator i % 3.1% 2.3% 2.0% 2.0% 2.9%
Tariff Efficiency Factor i % -2.0% -2.0% -2.0% -2.0% -2.0%
Other Internal (HEE, S7, LA, BCF) Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0%
Other External Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0%
Pay & Pensions Assumptions i % 3.3% 2.0% 1.6% 1.6% 2.9%
Drugs Assumptions i % 4.5% 4.6% 3.6% 4.1% 4.1%
Procurement Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0%
Capital Assumptions i % 3.1% 3.2% 3.2% 3.1% 3.1%
Litigation Assumptions i % 17.0% 19.7% 19.7% 19.7% 19.7%
Provider Other Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0%
2020 Workforce - STPs
• Workforce pay bill and WTE an integral part of STP finance and efficiency template
• Primary and Secondary care workforce
High level picture of size and make up of 2020 workforce integrated to triple aims including finance
Do Nothing Solutions Do Something
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
Commissioner Staffing
GP WTE - - - - - - - - - - - - - - - -
GP support staff WTE - - - - - - - - - - - - - - - -
Commissioner Administration Staff WTE - - - - - - - - - - - - - - - -
Provider Staffing
Ambulance Staff WTE - - - - - - - - - - - - - - - -
Administration WTE - - - - - - - - - - - - - - - -
Health care assistants and other support staff WTE - - - - - - - - - - - - - - - -
Medical and dental staff WTE - - - - - - - - - - - - - - - -
Nursing, midwifery and health visiting staff WTE - - - - - - - - - - - - - - - -
Nursing, midwifery and health visiting learners WTE - - - - - - - - - - - - - - - -
Scientific, therapeutic and technical staff WTE - - - - - - - - - - - - - - - -
Healthcare science WTE - - - - - - - - - - - - - - - -
General payments WTE - - - - - - - - - - - - - - - -
Total WTE WTE - - - - - - - - - - - - - - - -
Total Provider WTE Adjustments i - - - - -
Check i OK OK OK OK OK
Next Steps
21st October – STP submission including full finance and efficiency
template
• Do nothing / counterfactual
• Workforce consequences of solutions - key narrative on deliverability
• 2020 workforce plan (Includes primary care)
High level analysis (by main staff groups)
Financial analysis of expenditure on non-NHS provision
Activity assumptions
December – Two Year Operating plans
• Year 2 and 3 of STP
• Reconciliation of provider and Commissioner plans to place based STPs
• Granularity of workforce component to be agreed (inc. Pricare)
2020 STP plans by provider / greater granularity - tbc
• Priority areas (cancer, MH, maternity….
• Professions
• Component providers
LWABs
LWABs are being established to meet the needs of STP areas in respect of action on both
their current and future workforce needs;
They will need to to focus on;
• Active management of both current supply and demand
• Workforce transformation – for both future service delivery but also as part of current
demand management e.g. team profiles
• Future workforce demand and supply – A workforce in line with FYFV and SDP goals
and assumptions, including overall affordability and the integration challenge. Will also
include managing the liberalised non-medical pre-registration training system.
A single place to discuss and act upon current and future workforce needs
supported by consistent diagnosis and analysis and HEE / NHSI teams
Aggregated to regional and national level with appropriate joint action e.g. IR / RTP
Need HEE/ NHSI agreement on current and future single data collection
STP 1 Acute, Elderly & General Nursing
2013 to 2016 • STP providers have funded above average additional
posts between 2013 and 2016 (rank 16/44)
• They have been able to achieve above low levels of
additional substantive staff in post (37/44)
• Consequently they have moved from a position of low
vacancies to above average (17/44)
2016/17 • STP providers have indicated that they intend to reduce
funded posts during 2016/17. This is an lower level of
growth compared to most STPs (35/44)
• Achieving HEE’s median supply forecast would result
in further reduction to vacancies
• Most providers have indicated plans to exceed this
forecast in their 2016/17 submissions to NHSI.
Posts Staff in Post Vacancies Vacancy Rate
2013 2,079 2,003 75 3.6%
2016 2,362 2,045 317 13.4%
Change 2013 to 2016 283 41 242 9.8%
% 13.6% 2.1% 320.0%
2017 Plan 2,327 2,131 196 8.4%
Change 2016/17 -35 86 -120 -5.0%
% -1.5% 4.2% -38.0%
Workforce Growth 2013 to 2016 and 2016/17 Planned Increase / Decrease:Sickness 2013 2014 2015
Trust 1 3.9% 4.2% 4.4%
Trust 2 5.2% 4.8% 5.1%
Trust 3 5.4% 4.7% 5.0%
ENGLAND AVERAGE 4.1% 4.2% 4.2%
Stability 2013 2014 2015
Trust 1 85.7% 86.2% 84.9%
Trust 2 84.3% 86.7% 87.6%
Trust 3 85.9% 87.3% 85.9%
ENGLAND AVERAGE 79.9% 85.2% 83.8%
The graph describes
increases in funded posts
v actual staff in post and
therefore vacancy levels
The table shows the 2013,
2016, and 2017 data points of
the graph including the actual
value of vacancies (number &
% rate)
The narrative box describes where the STP
sits compared to the national average and
ranked v the other 43 STPs for i) growth in
funded posts ii) growth in staff in post iii)
vacancies
These tables show how trusts within the
STP have performed on Sickness and
Stability (inverse of turnover) compared to
the national average
Annex – LWAB footprints and Co-Chairs
North STP – LWAB arrangements
LWAB Name STP covered LWAB co-chair HEE co-
chair
First
meeting
dates
The Cumbria &
North East
LWAB
• Northumberland, Tyne & Wear
• Durham, Darlington, Teesside,
Hambleton, Richmondshire &
Whitby
• West, North & East Cumbria
Ian Renwick, Chief Executive,
Gateshead Health NHS Foundation
Trust
Alex Glover October 2016
South Yorkshire
& Bassetlaw
South Yorkshire & Bassetlaw Kevan Taylor, Chief Executive,
Sheffield Health & Social Care NHS
Foundation Trust
Mike Curtis August 2016
Humber, Coast
& Vale
Humber, Coast & Vale Mike Proctor, Deputy Chief
Executive, York Teaching Hospitals
NHS Trust
Mike Curtis September
2016
West Yorkshire West Yorkshire Ros Tolcher, Chief Executive,
Harrogate & District NHS
Foundation Trust
Mike Curtis August 2016
Greater
Manchester
Greater Manchester
(Strategic Workforce Board)
Andrew Foster, Chief Executive,
Wrightington, Wigan and Leigh
NHS Foundation Trust
Neil
McLauchlan
September
2016
Cheshire &
Merseyside
Cheshire & Merseyside Kath Thomson, Deputy Chief
Executive, East Cheshire NHS
Trust
Jenny Cavalot September
2016
Lancashire &
South Cumbria
Lancashire & South Cumbria Heather Tierney-Moore, Chief
Executive, Lancashire Care NHS
Foundation Trust
Jenny Cavalot September
2016
M&E LWAB Development
LWAB CX Co-Chair HEE Co-Chair
LWAB in
place
Lincolnshire Jan Sobieraj, United Lincolnshire
Hospitals NHS Trust
Jane Johnson Yes
Leicestershire, Leicestershire &
Rutland
Peter Miller, Leicestershire
Partnership NHS Trust
Adrian Brooke Yes
Northamptonshire Sonia Swart, Northampton General
Hospital NHS Trust
James McLean Yes
Nottinghamshire Lyn Bacon, Nottingham CityCare
Partnership CIC
Jane Johnson Yes
Derbyshire Gavin Boyle, Derby Royal Hospital
NHS Foundation Trust
Sheona McLeod Yes
Staffordshire & Shropshire Simon Wright, Shrewsbury and Telford
Hospital NHS Trust
Russell Smith Yes
The Black Country Paula Clarke, University Hospitals of
North Midlands NHS Trust
Suzanne Harris Yes
3
LWAB CX Co-Chair HEE Co-Chair LWAB in
place
Birmingham & Solihull Tracy Taylor, Birmingham Community
Healthcare NHS Foundation Trust
Mandy Shanahan Yes
Arden, Hereford & Worcester Andy Hardy, University Hospitals
Coventry and Warwickshire NHS Trust
Beverly Ingram Yes
Cambridgeshire & Peterborough Matthew Winn, Cambridgeshire
Community Services NHS Trust
Bill Irish Yes
Mid & South Essex Caroline Rassell, Mid Essex CCG Boyd Mullins Yes
Bedfordshire, Luton & Milton
Keynes
Matthew Winn, Cambridgeshire
Community Services NHS Trust
Boyd Mullins Yes
Hertfordshire & West Essex Jinjer Kandola, Hertfordshire
Partnership University NHS
Foundation Trust
Boyd Mullins Yes
Suffolk & North East Essex Sam Hepplewhite, North East Essex
CCG
Boyd Mullins Yes
Norfolk & Waveney Rosin Fallon-Williams, Norfolk
Community Health & Care NHS Trust
Rob Bowman Yes
London and South East LWABs
LWAB Co-Chair HEE Co-
Chair
LWAB in
place
North Central London Maria Kane CEO Barnet, Enfield & Haringey MH
Trust
Chris Caldwell
North East London Tracey Fletcher CEO, Homerton FT
Therese Davis
North West London Delvir Mehet Asst Dir Workforce & Development NHS
NWL
Lizzie Smith
1st meeting end Oct
South East London Angela Bhan Chief Officer, Bromley CCG
Aurea Jones
South West London Dr Marilyn Plant Clinical Lead SWLCCG
Sean Farran
Kent & Medway Hazel Carpenter Accountable officer of CCGs
Philippa Spicer
Surrey Heartlands Suzanne Rankin. CEO of Ashford & St Peter's Hospitals
NHS Foundation Trust
Philippa Spicer
Sussex and East Surrey Richard Tyler CEO, Queen Victoria Hospital
Foundation Trust
Philippa Spicer
3
South England LWABs
LWAB CEO Co-chair HEE Co-chair LWAB in
place
Bath, Swindon and Wiltshire James Scott CEO, Royal United Hospital Bath
Clare Hines Assoc. Dir. Workforce Strategy and Plans
Bristol, North Somerset and South
Gloucestershire Robert Woolley CEO, University Hospitals Bristol
Clare Hines Assoc. Dir. Workforce Strategy and Plans
Buckinghamshire, Oxfordshire and
Berkshire West Neil Dardis CEO, Bucks Healthcare
Pauline Brown Local Director, Thames Valley
Cornwall and the Isles of Scilly Phil Confue CEO Cornwall Partnership
Clare Chivers Health Dean
Devon Angela Peddar Full-time STP CEO
Clare Chivers Health Dean
Dorset Patricia Miller CEO, Dorset County Hospital
Ruth Monger Local Director, Wessex
Frimley Heath Alison Alexander Strategic Director, Windsor and
Maidenhead LGA
Pauline Brown Local Director, Thames Valley
Gloucestershire Mary Hutton Accountable Officer,
Gloucestershire CCG
Clare Hines Assoc. Dir. Workforce Strategy and Plans
Hampshire and the Isle of Wight Sue Harriman
CEO, Solent NHS Trust Ruth Monger Local Director, Wessex
Somerset Matthew Dolman GP and Chair, Somerset CCG
Clare Chivers Health Dean
(meets
30/9)