white paper - workforce planning v024

July 2015 Strategic Workforce Planning in Health and Social Care: Making The Case For Change page 1 of 15

A Whole Systems Approach to the Health and Social Care Workforce

Our Proposition in Brief We exist to enable organisations to be whole and healthy. We help our clients to become whole and healthy workplaces by using the Tricord TM to establish core “Identity” by creating the right balance between Strategy, Systems and Culture. This whole systems approach includes our approach to workforce services, including strategic workforce planning, through which we help organisations make more timely and better-‐informed decisions about the size, make up and structures of their workforce and in doing so, deliver much better outcomes at lower cost. There is a great deal of emphasis on workforce planning within the Health and Social Care sector, though evidence of its successful deployment is patchy. We argue workforce planning, as practiced in the Health and Social Care sectors, places too much emphasis on technical aspects and not enough emphasis is placed on governance, decision making, or on the actual delivery of workforce capability; it is not strategic. In our approach, in addition to complex analysis and modelling, we take into account the wider governance issues around delivering planned benefits, the management of risks and on mitigation and contingency planning. We adopt a cyclical approach to strategic workforce planning where the emphasis is just as much on outcome as it is on analysis and planning. In our exploration of the practice of strategic workforce planning, we advocate a “whole systems” approach that addresses a much wider view of the organisation than is typically the case. Our view is that the successful outcome of strategic workforce planning is the delivery of outcomes: matching the workforce (capability, size and structure) to the needs of the organisation and its service users. We conclude that strategic workforce planning is really about the delivery of transformational change, a pre-‐condition of which is addressing the organisation as a whole system. We work collaboratively with our clients in the belief that by developing their own capabilities, we are equipping them for the long-‐term future, rather than creating an unhealthy dependency on our support.


Introduction We use the Tricord as our framework for thinking about healthy organisational design. This emphasises the need to consider both ‘hard’ aspects e.g. structures, processes and systems as well as ‘soft’ aspects such as identity, culture and ethos. For us, the Tricord highlights the central importance of identity and purpose in system design and organisation health. Our approach to strategic workforce planning places equal focus on all elements of the Tricord. Strategic workforce planning concerns the future; typically 2 or more years . The purpose of planning is to take measures now that avoid, in the future, the constant need to react to events as they unfold, many of which could have been foreseen. Working as a system within the wider organisational system, strategic workforce planning helps management teams to maintain a much closer match between workforce capabilities and organisational requirements, reducing the need for ad hoc responses and knee jerk reactions. In our experience, Organisations that are over reactive are rarely whole and healthy organisations, either for people working within them or for their service users. Successful implementation of the strategic workforce plan must therefore: • Be in keeping with the identity of the organisation

• Be attuned and supportive of its cultural norms,

• Clearly deliver on the strategic ambitions

• Be embedded in and supported by its work systems. In this White Paper, we explore the “whole systems” approach to strategic workforce planning and show how it can make a real difference in the transformation of health and social care services. We take the view that strategic workforce planning is in need of a fresh perspective focusing as much on implementation and delivery as the technical aspects of the discipline. We place strategic workforce planning in the context of sound analysis, careful design, robust change management and innovative organisation development. We go on to show that by taking this approach, organisations are much better able to match strategic direction with workforce capability, better able to deal with resourcing risks and better equipped to respond to the challenges they face.


The evidence suggests that while the need for strategic workforce planning has never been greater, the actual practice of producing deliverable plans and then implementing them is patchy iv, v, vi, viii. We feel that too much emphasis has been placed on workforce planning techniques and too little emphasis has been placed on good governance or on setting the right context for the delivery of planned outcomes. Why is workforce planning on the agenda? In England, the Health and Social Care Act 2012 established Health Education England (HEE) as the Accountable Body for education and training for the health and to some extent, social care sectors. HEE have placed a high priority on workforce planning, making it the primary route by which education and training requirements are gathered and aggregated at a national level, starting in 2013. Local Education and Training Boards (LETBs) play a key role in coordinating this activity at a local level. The same act requires local authorities and health trusts to work in an increasingly integrated way, overseen by newly created Health and Wellbeing Boards. Given the size and complexity of the NHS and the size and diverse nature of providers of social care (statutory, public, private and voluntary sectors), there is considerable complexity in managing the integration of health and social care services. In the face of such challenges, it is clear that “traditional’” models of workforce planning, based on notions of full time, permanent employment with a single “employer” are no longer fit for purpose in supply-‐side planning. At the same time, demand side planning based on patient attendance at defined provider locations and timeslots is equally wide of the mark. A diverse set of changes is taking place within the wider environment that are having an increasingly significant impact on future ways of working -‐ and therefore staffing. Some are driven by policy or planning, others by wider socio-‐

Key Facts

• 70% of recurrent costs in the NHS (over £76bn) are staffing vi, xiii

• The NHS in England employs approximately 1.4 million staff and the independent sector a further 0.5 million, giving a total workforce of 1.8 million spread across more than 1,000 separate employers v

• The supply pipeline to the health care workforce is significant, with more than £5 billion spent annually on staff training xii

• Given the shift towards more integrated working between health and social care, it is interesting to note that the social care workforce is of a similar size, at 1.4 million, but distributed over a much larger employer base – estimated at around 35,000 separate employers viii

• In the UK national health Service, shortcomings in strategic workforce planning have led to a situation where the use of locum doctors, allied health care professionals and nurses has increased staffing costs ..vi

• Spending on locum doctors to plug the gaps in A&E units in England has risen by 60% in three years… (it costs) four times as much as filling a shift with permanent staff xiv


economic factors. The following examples serve to illustrate the emerging complexities: • The increasing availability of mobile technology and supporting

infrastructure for enabling health and social care professionals to diagnose, plan and deliver care in domestic settings. This impacts the design and delivery of services but is dependent on the availability of staff with the relevant skills and knowledge to exploit the undoubted opportunities it brings.

• Management of funding and resources moving from centralised towards personalised

• Increasing localisation and personalisation of health and care packages

• Demographic pressures at both ends of the population pyramid: increasing birth rates and the movement of the baby boomer generation into retirement and old age

• Socio economic and lifestyle choices giving rise to different profiles of health, ill-‐health and care requirements

• Increasing and diversifying types of substance abuse and consequential health and social impacts

• Long term pressure on budgets in the face of increasing demand

• Greater complexity in the supply chain for health services – greater separation between suppliers and service users and more complexity in arrangements for commissioning / service management

• Increasing expectations of employment flexibility both by employers and employees

• The increasing use of “zero hours” employment contracts

It is only by taking a “whole systems” approach to strategic workforce planning that we feel that it is possible to address all of these complexities. A Critique of Current Strategic Workforce Planning Practice In the preceding section, we make the case for a whole systems approach to workforce planning, arguing that many of the traditional approaches are no longer fit for purpose. In previous client work, we have seen a variety of symptoms brought about by ineffective strategic workforce planning practice, which rarely appear on workforce planning risk logs let alone featuring at Board level discussions, despite the threat to the delivery of organisational objectives or the management of change. We show a representative sample in the list below: • Lack of financial control or engagement between business units, HR,

workforce planners and the finance functions., eg business case (costs, benefits and risks) for proposed change programmes not taking account of workforce factors or costs


• Multiple versions of the “truth” about the workforce; frailties, inconsistencies and lack of confidence in data. Information used for key workforce decisions without reference to its provenance, quality or risk

• Incoherence between resourcing for the short term and planning for the long term.

• Weaknesses in the workforce management system; either over reacting to over or under supply with the result that the gap between supply and demand fluctuates wildly or reacting too slowly and sluggishly to changes in operating conditions

• The workforce management system being consistently unable to deliver the right people, with the right skills to the right place at the right time at the right cost, with the result that the organisation unable to deliver its current objectives, and is not agile enough to respond to future changes.

• The organisation is not able to retain key skills whilst at the same time having an over abundance of non-‐key skills

• Lack of succession plans for the key roles in the organisation

• Absence of sponsors, steering groups and governance structures to oversee the delivery of workforce plans

• Workforce plans created in isolation, not in collaboration

• Good practice in planning, but rarely leading to demonstratable achievement planned outcomes

• Workforce plans not taking appropriate account of people employed by partner organisations

• Workforce planning expressed as a single "take it or leave it" solutions rather than presenting analysis of alternative options and recommendations

• Absence of robust risk analysis, mitigation or contingency planning (lack of a “plan b”)

• Sub optimal (over reliant or underutilised) use of locum, temporary, agency and “people bank” staff, delivering poor value for money v

• Board reports and discussions on people and headcount that focus on current facts and figures, not decisions about what needs to happen in the future.


In addition to our own observations from practice, we take influence from published sources, illustrated by the following perspectives:

The potential consequences of not taking a wide, whole systems view of the organisation in strategic workforce planning include risks to the future sustainability of the organisation, and whether change will fully address the challenges facing the organisation. To illustrate this point a recent study on care in the community (Haycock-‐Stuart and Kean, 2012) x found that “While nurse leaders see the leadership role as critical to improving quality through workforce planning and organisation, front line staff perceive individual nurse’s skills as more pertinent to the quality of community nursing care”. The key point here is that if the scope and planning horizon of workforce planning are set appropriately, one of the target outcomes should be quality of care, in contrast to scope which appears to have focused on the narrower outputs of staff numbers and structure.

Strategic workforce planning is neither simple nor is it cost-‐free; organisational leaders owe it to their stakeholders to maximise the return on the investment they are obliged to make in workforce planning. A variety of approaches exist for evaluating return on investment, Hodges Detuncq and Schmidt (2013) vii provide a set of practical alternatives.

“Most ‘top-‐down’ directives don’t work, and most workforce plans come out of a centralized corporate planning office or process. Effective planning cannot be something that is ‘handed down’ as a directive from top management or corporate headquarters. If low-‐ and mid-‐level managers are not involved in the workforce planning process (if they don’t feel that they ‘own it,’ have any input, or maintain some degree of control over the process) they won’t use it. Line managers must be involved, because most of the basic information that is needed to refine workforce plans comes from them. Either involve the bottom and middle of the organization early on or your plan will fail”. iv

“Those that fail to study and understand history are bound to repeat it. This famous thought can be applied directly to workforce planning. If you don’t understand precisely why workforce plans fail, you are likely to repeat the catastrophic errors made by others. But you won’t be alone, because workforce planning failures are as common as the fleas on a dog. Fortunately, when workforce planning avoids the above “pain points” it has a high ROI.” Sullivan(2009) iv


The workforce of the future, driven by currently visible socio-‐economic trends and emerging technologies will require a different management mindset that takes into account 1. The strategy behind the design of work arrangements

2. The settings in which work is done. 3. The organization of workflows and how individual contributors add

value.

4. The technologies used to support higher achievement. 5. The degree to which employment arrangements are tailored to

individuals. HBR: The Third Wave of Virtual Work (2013) ix

Our Approach In the public sector (particularly within health and local government), nationally imposed methodologies controlled by parliamentary recommendation and regulation have brought the subject of strategic workforce planning onto the agendas of senior management teams, but by their very nature such initiatives are frequently concerned with doing the bare minimum rather than achieving the best outcome The Tricordant approach to workforce planning is underpinned by our belief that workforce design and change is much more than modelling supply and demand (however sophisticated the workforce analytics may be). A precondition to any successful workforce planning activity is a clear understanding of an organisations, purpose, strategy, and operating model. All of these factors influence the options available to manage the workforce. At the start of any engagement, we work with clients to help them to think through the assumptions that they bring into their workforce management and challenge the alignment of assumptions to the Strategy. This can include strategic assumptions that may not be backed up by existing workforce capability and assumptions about capability that limit strategic ambition.


A unique aspect of the Tricordant approach in analysing how an organization operates is the concept of "Significant Events", which we define as points within business processes in which: a) A new concept is created b) Material or information is converted or people transformed c) People are inspired, healed, energised d) Any combination of these, leading to a change in defining identity of the input. We propose that if organisations identify these points, they will then know what resources they need and how they should be aligned to increase the possibility of achieving them. Achieving Significant Events often requires deep knowledge and difficult to find skills, both of which are within the domain of strategic workforce planning to deliver. The Analysis stage involves identifying, selecting and analysing the most appropriate information on those factors influencing workforce decisions. This is a notoriously difficult area where the risk of “analysis paralysis” is at is greatest – the perceived need for ever more data and deferring difficult decisions until information is shown to be complete and perfect. Our approach is to help clients to assess the risks and uncertainties in the available data sets and to help them to build a consensus around managing them. The outcomes of good analysis are insights that are good enough on which to base workforce decisions, a point emphasised by Kemsley (2012) i. Based on solid factual foundations with known risks and agreed assumptions, we help our clients through a process of building and analysing alternative options during the Synthesis stage. This stage of the cycle involves selecting the business change interventions that are most likely to deliver the required changes in the workforce. The type of interventions that normally occur within the synthesis include: • Developing new knowledge and skills

• Talent management and development initiatives

• Changes to working arrangements for individuals and groups of employees

• Changes to the way that services are commissioned, delivered and managed

• Recruitment initiatives

• Retention activities

• Downsizing and outplacement

• Upsizing and bringing into core

• Succession planning

• Interdependences with Organisational Design activities

• Changes in Organisational structures

• Changes in budgets


It is our experience that the successful navigation of this stage of the cycle involves recognising and managing the inevitable risks (the governance of which we cover later). One such risk arises from limitation of ambition or creativity in looking at the full range of options open for the management of workforce capability gaps. Another risk comes from the assumption that all characteristics of future supply and demand modelling can be predicted on the basis of projection from the past. In our experience, stakeholders lack confidence in forecasts because they expect them to be an accurate predictions of the future (which are always wrong, so why bother?) rather than a continually evolving set of assumptions resulting in a particular future, which becomes the baseline for planning and managing future change. This point in the cycle is where we recommend alternative approaches that take into account the wider environmental factors impacting the organisation. One of the techniques we use with clients is Scenario Planning in which factors (i.e. changes to assumptions) currently considered to be of potentially high impact are used to test workforce strategy options. We take the view that the purpose of strategic workforce planning is to create a workable plan that delivers the necessary workforce outcomes. While this may appear to be a truism, the point is that a workable workforce plan will inevitably include some level of Managing Change; managing the implementation of workforce plans should include all of the elements of any other well-‐structured change initiative. Our approach is to work with clients to provide challenge and guidance around the management of implementation. This is to ensure that initiatives have appropriate leadership, governance structures, resources and visibility to deliver the planned changes in line with cultural norms of the organisation. We believe that this point sets our approach apart in delivering and maintaining whole, healthy organisations. The point at which business change becomes embedded in our approach is in Taking Stock. Re-‐looking at what has actually been achieved in relation to initial strategic intent and in relation to the current / emerging situation gives the opportunity to move on to the next priority where possible and to re-‐enforce any previous initiatives where necessary. Which brings us back to the Tricord TM. We find that strategic workforce planning activity in many organisations is concerned with and confined to the “Systems” domain, focusing on data, modelling, techniques and structure, with ineffective links to strategy, culture or identity. In our experience, it is only by taking the wider view both of the organization and the strategic workforce planning function that the change journey can be fully understood and therefore managed.


Our Insights

The Cyclic Nature of Strategic Workforce Planning We deliberately show strategic workforce planning in the form of a cycle -‐ this opens up the question of planning cycle time: just how often and how fast should the cycle operate? We believe that planning cycle times are entirely context specific and should be influenced by a number of factors: • The internal and external

business environment

• Current and required operational performance

• The characteristics and current state and the forecast future state of the workforce

• Workforce dynamics: Flows of starters, leavers, movers, the time taken to bring trainees fully up to speed.

• The level of planning – micro versus macro level changes

• Organisational planning and performance management cycles.

• Performance measurement must be conducted more frequently than planning so that workforce planning decisions can be made on the basis of the latest information, and not on gut feel only.

• In good workforce planning practice, there is an irreducible minimum ‘tick over’ cycle rate ensuring that workforce plans remain valid, , even if the organisation strategy remains unchanged, and to maintain a core level of expertise in workforce planning.

Scoping and Prioritising We recommend that workforce planning cycle times be driven by strategic, operational and tactical demands rather than a fixed, centrally determined planning cycle. This means that different planning cycles can and should be in operation for different parts of the organisation and for different workforce segments, driven by an agreed and managed set of priorities. It does not imply however a need to address the whole workforce all of the time. This may seem counter-‐intuitive, particularly where organisations face regulatory requirements to demonstrate workforce planning as part of ongoing governance.


The notion of segmenting the workforce by strategic priority has been described by several authors: Bechet (2000) ii suggests • Focus on issues, not organizations.

• Tailor the process for each

• Focus on particular positions, not all positions.

• The organisation needs time to respond. Taking this into account allows plans to be segmented into activities that can be delivered in manageable pieces without succumbing to the very real danger of over optimism about what can be practically achieved in any given timescale.

Healthy Tensions We recognise that some client issues are short term and need quick wins, some are driven by the need for a longer-‐term view and that the two coexist in most organisations. Recognising and managing this as a “healthy tension” can actually be very helpful by providing legitimate challenge around planning horizons and planning cycle speed. In our support for clients, we help them to identify these tensions and guide them to the level of planning appropriate to the task in hand. We believed that this is a far more pragmatic approach then adopting a rigid “one-‐size-‐fits-‐all” planning framework.

Workforce Risk – the missing element in the Business Case Whatever the choice of organisational strategy, unless the organisation is a start up, there is already a workforce. Any change to strategy must be delivered through the workforce and this inevitably leads to change. Workforce strategy is therefore a key determinant of the success of a new strategy. Large business change programmes frequently have business cases that show significant reductions in cost due to planned changes in workforce composition but rarely take into account environmental change following the completion of the programme. As a result the future sustainability of the change programme is put at risk in a way that rarely appears in risk registers or financial appraisals. Our whole systems approach to strategic workforce planning and business change ensures that the less visible, more difficult to pin down factors involving people behaviours, attitudes, beliefs and resistances are fully taken into account in delivering workforce design and change. This helps to ensure that workforce plans are practical and pragmatic and that their required outcomes are fully delivered. An illustration of this point is in the way that NHS organisations in the UK deal with short term, temporary staffing difficulties. One of the impacts of tight staffing levels is that when higher than planned absences or staff turnover takes place say in critical services, the reaction of the organisational system is to deploy temporary cover at short notice through people banks; the shorter the notice, the higher the cost. The cost of managing the shortage internally is an “easy-‐to-‐under-‐report” element of this cost. Typically, great attention is paid to the operational efficiency of such arrangements and success is measured on the


ability to fill all open roles. Our analysis indicates that between 2% and 3% of NHS staffing is continually provided on this basis. The focus on operational efficiency masks the real issue of addressing the problem as a supply side workforce management issue. Predictive analytics can play a key role in managing this in the most cost effective way for the organisation in that realistic targets, forecasts and costs can be planned and acted upon rather than having to react after the event. This is a situation where rapid “cycle time” workforce planning can be an extremely cost effective way of managing seasonal variations in staff turnover and absence. The Distinctiveness of the Tricordant Approach It is our belief that process, tools, templates and modelling methods should reflect the culture, needs and norms of each organisation and that by taking whole systems approach there are real, previously untapped benefits to be gained from our approach to strategic workforce planning. Elements that we include in our approach to workforce strategy include: • Leadership styles and behaviours that are most likely to deliver a flourishing,

sustainable workforce strategy

• Knowledge and skills required to gather the best external intelligence to inform sustainable workforce strategy

• Data capabilities around leading measures and predictive analytics

• Supporting clients in building the case for strategic change based on workforce insights

• Building workforce strategy into an iterative cycle to manage gaps between organisational demand and supply

• Helping to identify the best sourcing strategies

• Identifying and analysing alternatives for managing the commissioned / indirectly employed workforce (i.e. not employed but still has a high impact on service users).

Case Study: Birmingham City Council Part of an organisational transformation programme, the Excellence in People Management programme at Birmingham City Council set out to fundamentally change the approach that the organisation took towards managing it’s people. The programme introduced a new operating model for HR, a new HR Information System, employee portals and a new approach to managing people performance. It shifted the emphasis and accountability in managing people issues to line managers and positioned HR firmly in the rôles of strategic adviser and expert, while addressing the legitimate concerns over administrative efficiency and effectiveness of the management of employee relations. A key element of the transformation was the formation expert groups in HR; Reward and Recognition, Employee Engagement, Organisational Design and Workforce Intelligence and Planning (“WIP”). The remit of the WIP team was to


build a strategic workforce planning capability, using workforce intelligence as its foundation. The authority is responsible for providing of a diverse and complex portfolio of services; having insights into the dynamics of the workforce was at the core of its aspirations to transform those services. It was impossible however to ignore the tightening fiscal demands in the aftermath of the 2008 financial crisis even though demands for its services were increasing. In order to predict and respond to an increasingly unstable operating environment, it was clear that the authority would need a much richer fact base on which to base its newly developed capability in workforce demand and supply modelling. The WIP team responded to these challenges by collaborating with local universities and professional bodies, commissioning research, marshaling economic data from a wider set of sources and building alternative planning scenarios, with which to test strategic planning assumptions. In taking this approach, the WIP team was able to provide to the authority, for the first time, real strategic insights into factors affecting its own workforce and to be a strategic partner in shaping, selecting and implementing workforce planning options. As a result, the WIP team became “…pivotal to delivering headcount and budget reductions while dealing with the growing financial constrictions…” iii. Using these new capabilities, the council was quickly able to make a 3 per cent reduction in headcount (cutting costs by £7 million a year) and a 23 per cent reduction in reliance on agency staff (saving £3 million per year). The WIP team has been at the heart of the continuing activity to consolidate and increase these savings for the authority. Roger Cooper, Associate consultant with Tricordant, undertook an extended assignment with the authority as part of the transformation project team, providing the following support: • Leading process design for the WIP function

• Change Management

• Organisational design and implementation

• Establishing relationships with universities and other research providers

• Building the workforce intelligence capability

• Developing and deploying a range of workforce planning models and tools

• Support for the Social Care teams in analysis and detailed supply and demand modelling

Analysis It is clear that by investing time and resource into the workforce planning team, the authority were able to create effective plans, based on “single version of the truth” workforce intelligence. Seeing these plans though to implementation delivered tangible differences to the financial performance of the organisation. Bringing together external information sources with internal data allowed real insights into underlying causes of some long running workforce issues and this


allowed some tough decisions to be taken at a time of unprecedented financial challenge. During the implementation stage of the HR transformation, the WIP team experienced early resistance to what was initially seen as a centralised function making unreasonable demands on directorates. As a loosely federated organisation, each directorate had its own culture and a good degree of autonomy; disregarding a central edict was the cultural norm in several parts of the organisation. The resistance to the new workforce planning processes was gradually broken down by engaging directorate staff in the process from the defining stage onwards and working collaboratively to plan and deliver changes to achieve the required outcomes. The key learning here is that even the impression of a centrally dictated process can disengage potential beneficiaries. While a process may be outlined centrally, successful planning and implementation of workforce interventions must start locally, with the people that know most about the day-‐to-‐day service challenges.


References i Maximising the effectiveness of HR data, Nick Kemsley on 25 Jan 2012 in HR practice, HR

strategy, http://www.personneltoday.com/hr/maximising-‐the-‐effectiveness-‐of-‐hr-‐data/ ii Bechet, T. B. (2000) Developing Staffing Strategies That Work: Implementing pragmatic

non-‐traditional approaches. http://search.un.org/search?as_q=&as_epq=%22developing+staffing+strategies%22&as_oq=&as_eq=&ie=utf8&output=xml_no_dtd&client=UN_Website_en&proxystylesheet=UN_Website_en&oe=utf8&as_q=&q=&adv=true&as_occt=any&site=&lr=lang_en&as_qdr=all&as_filetype=&num=10&sort=score&Submit2=Search

iii How HR made a difference – People Management, 25th November 2010, CIPD iv Sullivan, J, 2002, “Why Workforce Planning Fails (part 2)”,

http://www.ere.net/2002/08/19/why-‐workforce-‐planning-‐fails-‐part-‐2/ v “Locum Doctor Costs Spiral Due To Workforce Planning Failures”

http://www.nhsprofessionals.nhs.uk/News/Pages/article109.aspx vi NHS Workforce Planning Limitations and possibilities

http://www.kingsfund.org.uk/publications/nhs-‐workforce-‐planning vii NHS and social care workforce -‐ Meeting our needs now and in the future?

http://www.kingsfund.org.uk/time-‐to-‐think-‐differently/publications/nhs-‐and-‐social-‐care-‐workforce

viiii Eboral C, Griffiths D (2008). The Third Report of the Skills for Care’s Research and Intelligence Unit: The state of the adult social care workforce in England. Leeds: Skills for Care.

ix Hodges Detuncq, T and Schmidt, L, 2013, “Examining Integrated Talent Management”, T+D. Sep2013, Vol. 67 Issue 9, p30-‐35.

x Haycock-‐Stuart, E. and Kean, S. 2012, “Contrasting perceptions about the delivery of care in the community”, Nursing Management March 2012 | Volume 18 | Number 10

xi The Third Wave Of Virtual Work, 2013, Harvard Business Review, 00178012, Jan/Feb2013, Vol. 91, Issue 1 / 2

xii Workforce Planning Guidelines 2014/15 Health Education England, published 16th April 2014, http://hee.nhs.uk/wp-‐content/uploads/sites/321/2014/04/Workforce-‐planning-‐guidance-‐2014-‐15.pdf

xiii “About the National Health Service (NHS)” http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx

xiv “Sharp rise in spending on A&E locum doctors” http://www.bbc.co.uk/news/health-‐25713374

white paper - workforce planning v024

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