WELSH AMBULANCE SERVICES NHS TRUST (INTERIM) WORKFORCE ... · WELSH AMBULANCE SERVICES NHS TRUST (INTERIM) WORKFORCE PLAN 2009-2015 Name of service organisation Welsh Ambulance Services

WAST WFP 2009-15 Page 1 of 63

WELSH AMBULANCE SERVICES NHS TRUST (INTERIM) WORKFORCE PLAN 2009-2015

Name of service organisation

Welsh Ambulance Services NHS Trust

Participants involved in the Process

Trust Executives, Senior Managers, Staff Side Representatives, other NHS Wales organisations

Date of submission for 2008-2009

31st March 2009

Main Lead Contact Details: Telephone Email Fax

James Moore 07866-446841 [email protected]

Detail the partners who have agreed to the workforce strategy and action plan

Staff Side partners - Unison, GMB, RCN, Unite

Strategy Time-Scale

April 2009- March 2015

We confirm that this Workforce Plan and accompanying narrative reflects the Service Delivery Plan for this service area and the entire workforce, and is a realistic and affordable projection of the workforce implications of those plans, based on our understanding of current workforce intelligence and knowledge of future developments and financial projections. We confirm that approval and validation of the information has occurred together with alignment to service and financial plans for all participants. We confirm that all planning occurred in multi professional teams and not by professional group Signature of Trust Lead: Alan Murray Name in Full: Alan Murray Organisation: WAST Date: 31st March 2009


Signature: Name in Full: Organisation: Date:









INDEX

STAGE 1: DEFINING THE FUTURE SERVICE PROVISION & PLANS STAGE 2: ANALYSIS OF CURRENT SERVICE AND WORKFORCE ACTIVITY &

CONFIGURATION STAGE 3: PREDICTED WORKFORCE REQUIREMENTS & CONFIGURATION TO MEET

SERVICE NEED

STAGE 4: PLANNING FOR DELIVERY

STAGE 5: PROPOSALS FOR IMPLEMENTATION, PERFORMANCE MANAGEMENT &

REVIEW STAGE 6: RECOMMENDATIONS FOR WORKFORCE DEVELOPMENT & ACTION PLAN

FOR HEALTH ECONOMY

APPENDICIES APPENDIX 1 – WAST LOCAL DELIVERY PLAN APPENDIX 2 – EMS RECRUITMENT PLAN APPENDIX 3 – NURSING RECRUITMENT & RETENTION STRATEGY APPENDIX 4 – KEY TRUST DATA IN GRAPH FORMAT APPENDIX 5 – BANK AND SESSIONAL WORKERS’ REQUIREMENTS APPENDIX 6 – RESOURCE CENTRE MAPPING PROJECT


STAGE 1: DEFINE THE FUTURE SERVICE PROVISION & PLANS

2008 - 09 STAKEHOLDER INVOLVEMENT The following have been involved and consulted in the creation of this plan:

NAME JOBTITLE TEAM/ SERVICE ORGANISATION Alan Murray Chief Executive WAST

Jo Davies Director of Human Resources

Human Resources WAST

Tim Woodhead Director of Finance Finance Department WAST

David Jackland Director of ICT ICT WAST

Steve Pryor Director of Operations

Operations WAST

Sara Jones Director of Unscheduled Care/Clinical Director

Unscheduled Care WAST

Steve West Regional Director – Central & West

Operations WAST

Grant Gordon Regional Director – South East

Operations WAST

Dafydd Jones-Morris

Regional Director – North

Operations WAST

James Moore

Head of Workforce Modernisation & Development


Pippa Rose Programme Manager

Programme Management Team

WAST

Gareth Jones Senior Project Manager

Programme Management Team

WAST

Angela Williams Workforce Information Officer


Unison, Unite, GMB, RCN

Staff Side Representatives

Staff Side

Mike Collins Head of Professional Education & Development

Clinical Directorate WAST

Andrew Jenkins Consultant Paramedic



Grayham McLean

Unscheduled Care Lead


Dawn Sharp Corporate Secretary Corporate Directorate WAST

Tony Cowley Head of Fleet & Logistics

Operations Directorate WAST

Terry Eckley Risk Manager Operations Directorate WAST

Lyn Turner Will Oliver

NLIAH NLIAH NLIAH

This plan was shared with the following in March 2009 in order that it could be shared appropriately with health and social care partners:

NAME JOBTITLE ORGANISATION Liz Harries Associate HR Director Hywel Dda NHS Trust

Sharon Vickery HR Modernisation Manager ABMU NHS Trust

Maria Andrews Workforce Planning Lead Velindre NHS Trust

Sandra Marshall Workforce Planning Lead Cwm Taf NHS Trust

Angela Salkeld Workforce Planning Lead (Central) North Wales NHS Trust

David Long Deputy HR Director Powys LHB

Gillian Jones Workforce Planning Officer Velindre NHS Trust

Sharon Cooke Workforce Planning Lead (Nursing) Gwent NHS Trust

Mike Mullan Workforce Information Manager Cardiff & Vale NHS Trust

Claire Waldicor-Evans Workforce Planning Lead NW Wales NHS Trust

Tracey Foulkes Workforce Planning Lead (East) North Wales NHS Trust


1.1 Format of this workforce plan The Trust serves a population of 2.9 million and provides a service to a diverse area of 20,640 kilometres which encompasses very rural locations and major urban conurbations. Therefore, the services are tailor-made for each community’s differing environmental and medical needs, from cycles to fast response cars, frontline ambulances, helicopters and nurses in the control centres. The Trust attends more than 250,000 emergency calls a year, over 50,000 urgent calls and transports over 1.3 million non-emergency patients to over 200 treatment centres throughout England and Wales. The Trust believes that its staff are its biggest asset, with approximately 76% of staff being operational – 1,310 on emergency duties and 693 on non-emergency and health courier services. The Trust operates from 90 ambulance stations, three control centres, three regional offices and five vehicle workshops. Additionally, NHS Direct Wales has become an integral part of the Trust by providing a 24 hour health advice and information service, signposting the people of Wales to the most appropriate level of healthcare for their needs. Working with and across all of the seven re-configured health economies, the Trust plays an integral role in shaping and delivering unscheduled and primary care services across Wales. This has, though, led to challenges in the development of a fully integrated workforce plan, especially in the context of the NHS Wales re-configuration. Therefore, the Trust has taken a pragmatic approach to the development of this plan and has, therefore, amalgamated individual directorate workforce plans from the following areas:

• North Regional Operations • South East Regional Operations • Central & West Regional Operations • NHS Direct Wales • Corporate Operations Directorate (including Risk & Resilience, Fleet Services and

Logistics) • ICT Directorate (including Estates, Informatics, IT and Programme Management

Department) • Clinical Directorate • Human Resources Directorate • Finance Directorate • Corporate Services

1.2 Summary of the key components of the Trust’s Strategic Plan to 2015 The main component of the service delivery strategy within the Trust is the development of Unscheduled Care Services across the health care communities. To support this the Trust will be moving towards the following Service Delivery Model over the next 6 years: 1. Establish a maximum of 3 Clinical Control Centres designed to pick up and triage all

unscheduled care calls within Wales. Key elements to these Clinical Control Centres are:


• EMS, PCS and NHSDW co-located in same control centre. • GP Out of Hours, Social Services and Capacity management services integrated with

Clinical Contact Centres either by co-location or virtual connections (N.B. this is dependant upon other stakeholders).

• Virtual capability across the Clinical Contact Centres. • Integrated with other emergency services (e.g. JESG initiative). • Greater integration with GP Out of Hours Services (dependant on other stakeholders). • Generic Call takers for EMS, PCS & NHSDW. • Ability to handle multi channelled access (e.g. web & phone). • Utilising a single IT triage system to assess patient care needs NHSDW, EMS & PCS. • Clinical Contact Centre will provide clinical support to clinicians in the field (e.g.

access to Directory of Service & Toxicology database). • Access to Individual Health Records will be provided to Clinical Desk & NHSDW in the

Clinical Contact Centre. • Clinical Model of Care will be led by a clinical lead.

2. Greater integration with primary and secondary care services in the delivery of the Trust’s

unscheduled care services. Key elements of this are: • Front line services provided by WAST will consist of:

o Rapid Response (RRV) (single manned) o Two manned ambulances (Emergency Medical services & transport) o High Dependency Service (HDS) o Alternative Emergency Responders (Community First Responders, PAD Sites &

Co-responders) o St John & Red Cross (non emergency responses) o Specialist Practitioners (which could be paramedics, nurses or another staff group)

• Front line service provision would be based on the principles of being Appropriate, Safe and Timely.

• Response assessment & disposition - triage at scene with a view to identifying alternative pathways rather than direct transport to A&E.

• Transportation of patient when required to most appropriate location (e.g. PCI centres, CCU, etc.).

• Access to Individual Health Record & ability to capture electronic patient records in the frontline.

• WAST would like to integrate more with the wider health community in proving more proactive health care rather than reactive, however significant stakeholder engagement need to be completed to progress this.

1.3 The main forces and drivers of change It is important to recognise that the Trust is in the process of undertaking a management review. This review commenced in November 2008 and it is anticipated that the results of this will be implemented during May/June 2009 after appropriate consultation with key individuals. No assumptions have been made in this document in relation to this review, however, it should be noted, that the Trust’s workforce plan may need minor adjustments once this review has reported and is implemented.


Context Across Wales, both within the NHS and outside, there are significant drivers to address the changing health and social needs of NHS Wales’ patients. The Trust faces significant challenges and opportunities in the development of appropriate services. The challenges include integration with other emergency services and other health and social care providers as well as the geographic nature of the Trust’s remit. All of these elements have been taken in to consideration when defining the Trust’s long term strategy outlined in section 1.2. The re-configuration of NHS Wales into the 7 health economy LHBs in October 2009 will have a significant impact on how the Trust interacts with other health and social care providers. It is anticipated that this will facilitate better cross-organisational working but it will also significantly increase the requirement for staff at all levels in the organisation to spend time engaging with colleagues within other organisations. The re-configuration will also have a significant impact on the planning and commissioning of the Trust’s services with the LHBs being responsible for this activity in the future. This means that new and stronger partnership working is critical to the integration of ambulance services into NHS Wales. With the re-configuration, the Trust anticipates that new NHS Wales’ strategies will lead to some amendments in the strategic direction of the Trust. However, the Trust will ensure that it continues to embed strategies such as Designed For Life. JESG has highlighted the need to ensure that all emergency services are co-located and are as integrated as possible in line with the Making the Connections Strategy. The scope of this work has yet to be defined, but the Trust will ensure that it continues to be fully engaged in this work. The One Wales Strategy provides the context for the Trust to take its place as a public sector employer in Wales. As part of the strategic planning process, the Trust will ensure that the requirements of this strategy are fully reflected within its own. The work arising from the Designed For Competence project in North Wales will need to be built upon in partnership with other health and social care partners. This will mean detailed development of services in line with patient needs which will then drive the required competencies for the new cross boundary roles. The Trust has an over-arching strategy, Time To Make a Difference, which attempts to intertwine the above into a Trust vision. This implementation of this strategy is supported by a Programme Management Department based within the Trust. Culture It is recognised that the culture within the Trust provides significant challenges in delivering improved services to patients. Issues identified include:

- The high profile nature of the Trust’s services has presented challenges in the Trust’s ability to implement strategies as it has had to focus on reacting to historical issues and problems.


- As a result of the above, the Trust has been challenged in delivering short term operational objectives whilst simultaneously implementing longer term building blocks (such as the introduction of a Personal Development Review system). This has challenged the Trust’s ability to innovate.

- It is recognised that the Trust’s management capacity and capability needs to be developed further.

- The Trust’s workforce needs to become more integrated with other health and social care colleagues.

- Although the Trust has made investments in its paramedic workforce, priority will now need to be focused on the rest of the workforce to improve the Trust’s learning culture.

- Some historic cultural issues remain following the integration of NHSDW into the Trust but it is anticipated that these will reduce with the move to Clinical Contact Centres.

Service Modernising Unscheduled Care The Trust is working in partnership to develop primary care models of care which meet the needs of each local population. In particular, the Trust is focusing on modernising unscheduled care. There are 7 key priorities which are intended to provide an integrated approach to the pan-Wales Modernising Unscheduled Care agenda. The Trust has specific responsibilities which are ‘surrounded’ by more global developmental priorities. Thus, the plan identifies:

• the USC Services’ Model once the priorities are clearly formulated into an action plan • social marketing and PPI involvement, will form the resultant action plan once clarity is

attained about what is being delivered; • with integration with and between the USC teams and establishing the map of current

services; • the encompassing of workforce developmental needs based on clinical models that are

being identified.

It is anticipated that engagement in this format will result in meeting the overall key objectives identified by each healthcare partnership and prevent a fragmented, duplicated effort that could potentially confuse progress. This format of engagement has been discussed and agreed with North Wales, South West & Mid Wales and South East Wales healthcare communities, and will address characteristic four of the LDP – WAST providing an efficient effective emergency care and transport service; appropriate use of ambulance services and unscheduled care services. Joint Emergency Services Group (JESG) In line with the MUC work, the Trust has already developed an integrated Clinical Contact Centre which is co-located with other emergency services in Cwmbran as well as having a co-located control centre in Carmarthen. Further work is being undertaken to implement the CCC model across the rest of Wales. The current plan is to implement the next CCC by 2012 with the final CCC being operational by 2015.


Workforce EWTD is a driver for the Trust because many staff work voluntarily in excess of their contractual hours (overtime or unpaid). With the expectation that the UK will lose the ability to allow staff to work in excess of 48 hours in a week, this is being factored into the Trust’s plans when considering appropriate establishments. In addition, many EMS operational shifts over-run as the crews are unable to end their shifts until they have “cleared” their patients and returned to their base. In a number of areas this can lead to an extra hour or above of additional working. This is an issue because many EMS shifts are 12 hours in length as standard, and the operational pressures take these to over 13 hours, meaning that there is less than an 11 hour rest break to the next shift. It is the Trust’s intention to ensure that there is full compliance with the EWTD requirements by August 2009. The Trust recognises that this is especially important in relation to improving the health and safety of its shift working staff. Following work undertaken which commenced in December 2008 examining the demand analysis for the Trust in each locality, work has been undertaken to examine the most appropriate cover levels for the on-the-road Emergency Services (EMS) across Wales. Early indications from this work have identified that it is likely that a larger establishment of operational staff will be required and within this increased capacity there may be a move to increase cover during periods of unsocial hours (which may lead to an increased cost to the Trust). There are key educational/learning and development drivers which will impact on the Trust’s workforce. These include the Webb Review and Leitch Reviews which highlight the importance of employers as commissioners of learning and education. It is important to note that the development of the Credit and Qualification Framework for Wales (CQFW) will assist the Trust in providing detailed career paths with appropriate accreditation, and engagement with NLIAH and others will be essential. The NHS Wales strategy of Designed to Work provides the Trust with the strategic framework for its HR practices. The Trust has been able to demonstrate progress with this strategy and will continue to work towards its aims. The introduction of the HEI model of paramedic training is leading and will lead to the following issues and changes:

- Cultural changes within the workforce with academically trained (predominantly young) staff mixing with vocationally trained and experienced (relatively long service) staff. Significant support will need to be provided for new staff as this transition is embedded. This will be achieved by the ongoing mentorship provided by the Practice Placement Educators (PPEs) and will be further supported by the full implementation of the Clinical Team Leaders (CTLs). - Many of the HEI students do not have the required driving licences (ie C1 and D1 elements). This means that unless they are prepared to fund this themselves, the Trust will need to ensure that these staff are appropriately skilled before they can practice as paramedics. - Historically the career path within the Trust has been through internal movement “through the bands”, but with the end of the IHCD accreditation and the primacy/embedding of the HEI training, this will lead to a dramatic reduction in such career opportunities and the Trust will address how this is managed.

The Welsh Language Board (WLB) have highlighted the need to develop bilingual capabilities across the workforce generally and specific roles (such as paramedics). This will lead to the need to increase welsh language capabilities within the current staff as recruitment is unlikely to


solely deliver the requirements. In response to the 2007 Staff Survey, WAG have identified the need to implement a hybrid of the Improving Working Lives strategy, which although is closely aligned to the Corporate Health Standards requirements, the Designed to Work objectives and other good people management practices, will require additional investment in staff and related issues. Financial The Trust must achieve financial balance from 2008/9 which will require stringent SCEP targets. Additionally, the Trust must achieve the financial recovery plan arising from any deficits resulting from 2008/9. This needs to be done in line with achieving the key targets for 2009/10 identified within the Local Delivery Plan. Additionally, the Trust also anticipates that it will be required to achieve a 3% across the board CIP savings target with a further 2 % saving (ie 5% in total) to be achieved from central initiatives. Finally, the Trust assumes that a “growth” assumption from 2010/11 onwards will require a 3-4% year on year saving or efficiency target. Relief is set at 35% for EMS (but less for PCS). This means that for every operational member of staff, a “down-time” of 35% is budgeted for which includes 6% sickness and 3% training. Some operational areas have sufficient resources to meet this requirement, whilst others will have to take an incremental growth approach which allows this to be met over a longer period. HORIZON SCANNING: 1.4 Anticipated external changes affecting the Trust The reconfiguration of NHS Wales has and will have impacts on the Trust and how it is able to meet the strategic direction of the Welsh NHS. Initially, the impacts are likely to detrimental as the new organisations form and new relationships are built, but then it is quickly anticipated that the Trust will be able to build positively on the focus for the new organisations of moving healthcare from the secondary to the primary sectors. In line with the Welsh Assembly Government’s Modernising Unscheduled Care initiative it is anticipated that the Trust will become the primary hub for access to all unscheduled care services by 2015. There is the possibility that Wales will choose to implement a secondary 3 Digit number for non emergency unscheduled care services which would be facilitated through WAST. WAST may also move into providing support for primary and secondary care services such as GP surgeries and Minor Injury Units. 1.5 Alignment of WAST plan with other services and organisation Key stakeholders that will be impacted by the strategic direction of WAST are :

o All Welsh LHB’s o All English locations WAST transport patient to


o GP Out of Hours o A&E departments o Primary and Secondary care services that provided pathways the Ambulance Services

need to access (e.g. Coronary Care, Falls prevention etc.) o Informing Health Care o Social Care Services o Other emergency services

It is intended that each stakeholder group will receive a copy of the WAST workforce plan for comments. It is also expected that the stakeholder plans will be shared with WAST to ensure that the Trust is meeting their expected needs.


STAGE 2: ANALYSIS OF CURRENT SERVICE AND WORKFORCE ACTIVITY & CONFIGURATION This stage aims to develop an understanding of the current service activity and workforce profile, together with identifying key issues within your current staffing configuration. SETTING THE BASE LINE (2009) 2.1 Key service indicators The draft key requirements for the Trust are (a full version of this can be found in Appendix 1): National Targets:

HCS

AOF 06 To achieve: • A monthly minimum performance of 60% of first

responses to Category A calls (immediately life threatening calls) arriving within 8 minutes in each new Local Health Board area;

• a monthly all-Wales average performance of 65% of first

responses to Category A calls (immediately life threatening calls) arriving within 8 minutes;

• a monthly all-Wales average performance 70% of first

responses to Category A calls (immediately life threatening calls) arriving within 9 minutes;

• a monthly all-Wales average performance 75% of first

responses to Category A calls (immediately life threatening calls) arriving within 10 minutes.

3

AOF 07 To achieve a handover of patients from an emergency ambulance to accident and emergency (in a major A&E department) within 15 minutes.

3

AOF 09 To implement the actions in the Service Improvement Plan, the Local Action Plans and the forthcoming guidance for transitional funding 2009-2011

3

The key requirements of each directorate are identified and incorporated within the Directorate assumptions in section 3.2. 2.2 Key associated service issues It is anticipated that the level of demand for the service will follow the historical patterns (3% annual increase in activity). However, with greater triage and treat capabilities within the local


health economies, it is anticipated that the level of emergency activity that requires transport to a secondary care provider will not grow at the same rate, although the level of acuity of patients being transported is likely to be higher. Additionally, it is anticipated that other health and social care organisations will meet their AOFs which will reduce the turnaround times within hospitals. DEFINING THE WORKFORCE 2.3 Current workforce configuration The current workforce configuration can be found within the attached and associated workforce configuration tool. WORKFORCE ANALYSIS 2.4 Review of workforce profile Some details of the review of the Trust’s workforce can be found in Appendix 4 with further information being available within the Workforce Configuration Tool including the Trust’s stability analysis by staff group and Directorate. It is important to recognise that the Trust has not historically invested in its employee information systems (particularly ESR) or its processes of ensuring clarity of organisational hierarchies. This has meant that for this workforce plan, there has been considerable additional work that has been undertaken to attempt to ensure that the figures are meaningful for each Directorate. It is important to note that the Trust will be investing considerable energy and resource into ensuring that hierarchies are agreed and understood, that these are accurately reflected on ESR, and that a robust mechanism is introduced to ensure that it is maintained. To support this, an audit of current positions within the Trust will be undertaken in May 2009 to ensure that each position is correctly coded (eg whether historical coding of some roles as paramedic officers is still correct). It is anticipated that a more robust picture of the required nature of the roles within the Trust will help improve the workforce planning. The Trust is undertaking an audit of the personal details (eg ethnicity, sexuality etc) of its workforce in April 2009 so that this information can be populated on ESR during April-June 2009. (Much of this information was lost when the Trust migrated its Payroll system to ESR, and no subsequent audit has been undertaken since.) An audit of non-substantive staff has been undertaken, and work is ongoing with the Directorates to identify whether the roles will be maintained and should be planned for or whether they will be dis-established at the end of the contract. This situation will continue to be audited on a regular basis with the information gained being updated on ESR. Wherever possible, the Trust is committed to recruiting substantive staff. The key strategies that will be implemented will be as part of the recruitment and retention strategy are:


• To create a more representative gender balance [currently 65% male] (as well as a better representation of the Welsh population when the Trust has a better analysis of its workforce following the planned audit of staff).

• Increase the percentage of part-time workers (currently the Trust’s participation rate is 0.94 against an NHS Wales average of 0.8).

WORKFORCE DEVELOPMENT 2.5 Identified new, extended or changed roles developed in the last 12 months The Trust has made the following amendments in the last 12 months:

- Introduction of the Clinical Team Leaders (an extension of a paramedic supervisor) - Broadening of current call-taking roles (with NHSDW staff working in the Control

centres) - Nurse Advisers working within a Control centre setting and triaging a broader range of

calls. - The introduction of the High Dependency Service (HDS) to deal with transporting lower

acuity patients. - Introduction of Customer Service Managers to manage customer relationships at a

Regional level - Introduction of Customer Service Supervisors to manage customer relations on PCS at

a local level - The planned introduction of PCS Operational Supervisors across all regions.

2.5.1 New roles

Job title Band Professional Group

Directorate/ service area

Educational/ development / regulatory issues or requirements

Other Staff groups effected ie: reciprocal staff area affected?

Identified issues or risks

HDS 3 None Operations Some training/ induction requirements

EMS paramedics are the most affected

Ensuring that appropriate triage is carried out prior to HDS arrival on scene

Consultant Paramedic

8c Paramedic Clinical Directorate

MSc level entry backed up by appropriate experience

None Importance of developing and embedding the highest standards of patient care

Customer Service Managers

7 PCS Operations Degree and or relevant experience

PCS Staff Contractual & customer relationship management

Customer Service Supervisors

4 PCS Operations Some training/ induction requirements

Liaison Supervisors

Contractual & customer relationship management


Operational Supervisors

4 PCS Operations Some training/ induction requirements

PCS Staff Removal of PCS responsibility from EMS supervisors

2.5.2 Extended Roles

Job title

Band Professional Group

Directorate/ service area

Educational/ development / regulatory issues or requirements

Other Staff groups effected ie: reciprocal staff area affected?


Clinical Team Leader

6 Paramedic Operations Participate with a 2 week university based course

Paramedic workforce

Details of protection for paramedic supervisor relating to previous agreements

Call Taker/ Handler

3 None Operations/ NHSDW

Some training/ induction requirements

None Complications of using 2 software systems

RRV paramedics

5 Paramedic Operations Some training/induction requirements

Some impact on EMS in reducing workload

Risk of duplicating workloads with normal ambulances

Practice Placement Educators

5 Paramedic Operations/ Clinical Directorate

2 day university development programme

Some impact on EMS staff

Potential loss of operational capacity

2.5.3 Changed Role See below 2.5.4 New Ways of Working The Trust has implemented Clinical Desks within its Control centres by utilising experienced nurse advisers to triage low acuity calls to the Trust. This has meant using the same staff in a different way to try to improve the appropriateness of clinical outcome in relation to received calls into the 999 service. Further work is being undertaken to ensure that telephone triage is provided to all 999 calls especially in periods of high demand. The Trust has introduced Rapid Response Vehicles so that it can provide life-stabilising expertise to as quickly as possible at the patient’s location. This has required the same staff to work in new ways (ie solo). The Trust introduced the provision of additional clinical support for paramedics in the Gwent area by creating access to GPs (out of hours) for clinical dialogue and referrals.


2.6 Ongoing educational/developmental or regulatory issues The Trust faces significant challenges in embedding continuous personal and professional development across many of its staff groups. This is for a variety of reasons including: the historic vocational nature of many roles within the Trust; the issues of providing learning opportunities across a large geographical area; many staff being wholly operational and road-based; the lack of a broad learning and development function. This has meant that limited learning opportunities have been available for many staff. Whilst the Trust is in the process of embedding personal development reviews (supported by the KSF), there are ongoing issues of ensuring:

1) That all new staff are appropriately equipped to undertake their roles. 2) These staff are supported to maintain and improve their competence in relation the

work that they are being asked to undertake. This poses different challenges in different areas (e.g. in NHSDW, “down-time” training sessions were factored into the original planning of the service).

However, it is important to note that the Trust has delivered an ongoing programme to ensure that all HPC registered staff are able to maintain their registrations. It is envisaged, however, that over time all registered staff will need to participated appropriate self-directed learning that is suited to their learning needs and styles. WORKFORCE DEVELOPMENT PROJECTS 2.7 Workforce development projects/initiatives completed in the last 12 months The Trust has been attempting to ensure that it moves to a clinical leadership model within its EMS operational staff. This has involved attempting to ensure that an appropriately skilled cohort of first line managers is equipped to support clinical staff with their practice and development. Significant work has been undertaken to ensure that the Clinical Team Leader model is effectively embedded in the Trust as soon as possible. The Trust has implemented a management skills learning programme (MSLP) through a blended learning approach for all line managers. This seems to have had an impact operationally in areas where managers have attended and this has been shown in the evaluation of this programme with significant benefits being realised improved employee relations with team members. During the last 12 months, the Trust has created a unique health contact centre in South East Wales. Not only have 2 previous separate control centres merged, but also the lower acuity NHS Direct Wales and GP Out of Hours services have co-located. This project has already started to deliver benefits for patients.


CURRENT WORKFORCE RISKS 2.8 Key workforce issues, constraints and threats Recruitment & Retention One of the major workforce risks for the Trust is that the largest and operational staff groups are currently recruited in cohorts. This is for both the NMC/HPC registered staff as well as the non-registered staff. Specifically: - Nurses require a 10 week induction period (unless they have had previous specific relevant experience using the same telephone triage software). - Paramedics recruited through the IHCD route have been part of 3-4 cohorts in any given 12 months. - Paramedics recruited through the HEI route will be available in a large group every June/July from 2010 (with the expectation that jobs will be found for them within NHS Wales if they want one). - Technicians are subject to an intensive 3 month induction period (as part of a 12 month programme) and have been part of 3-4 cohorts in any given 12 months. - Call Takers/Handlers are subject to a 2-3 month induction period where there has been historically no more than 4 cohorts in any given 12 months. Inevitably, this means that the Trust has over and (normally) under supply within its key operational workforce depending on the number of cohorts the Trust inducts and trains. This problem will be exacerbated from 2010 with the graduation of the HEI student paramedics. It is likely, therefore, that the Trust will have significant peaks and troughs of staffing levels (once it is fully established). Discussions are ongoing with the education commissioners to attempt to have 2 intakes of HEI students per year to “level out” the peaks and troughs. It is worth noting that the Trust has historically not had issues attracting applicants (which is further supported by the high application rate for the HEI paramedic diploma course with Swansea University). Of a larger significance has been the capacity to train/induct appropriate numbers of staff. However, given the nature of the current vacancy situation, it is expected that significant investment will need to be made in the use of the IHCD model of paramedic training. With all of these staff expected to come from within the Trust’s Ambulance Technician’s workforce, in order to recruit into the vacancies that are then created, the Trust will need to invest in training IHCD Technicians. Historically, about 50% of these vacancies are filled by staff from within the Trust (e.g. Control and PCS staff), so further investment will need to be made in training into these roles. NLIAH have supported the training of paramedics through the IHCD route in the past and have done so again in 2009/10 with 25 places. However, it is not clear whether the Trust will continue to receive these monies beyond March 2010. If the Trust does not find a way of funding this training (and the knock-on training identified above) then there is a significant risk to delivering operational services and/or issues relating to “burn out” as a result of staff undertaking excessive over-time (with the consequent potential impact on EWTD compliance). It is worth noting that the Trust has an agreed strategy that it will ensure that there will be a


balanced mix of internal and external recruitment, and that it will need to manage the expectations of the current workforce appropriately. Paramedic/Technician Pay There is a limited risk from other ambulance service providers concerning the bandings of Technicians and Paramedics. In particular, WMAS appears to have some pre-A4C issues in relation to pay. It does not appear, however, that other ambulance services have chosen to follow this route. Further work will be undertaken in partnership with staff side colleagues to examine this issue. Sickness Absence The Trust currently has a relatively (to NHS Wales) high sickness absence rate (see Appendix 4), although there has been a marked decrease in this rate during 2008. The management skills learning programme has seemingly assisted managers in improving their ability to appropriately manage sickness absence. Demographics Being an organisation that covers the whole of Wales, there are some areas where workforce issues are greater than others. Typically, the largest vacancy areas have been in the larger centres of population. The Trust has developed, and will develop further, plans to try to ensure that the funded staffing establishment is recruited into. Skills Shortages There are areas of skills shortages both within the current workforce and in relation to external candidates. It is anticipated that the full implementation of the KSF will assist the Trust in identifying these skills shortages at an early stage. Maintenance of skills The Trust has not historically been able to deliver all of the appropriate learning and training to its operational staff without support from NLIAH. Whilst the Trust has attempted to explore the most effective and efficient methods of learning, it is anticipated that in order to maintain the operational workforce’s capability, non-workplace learning will need to continue and the Trust recognises that this is unlikely that there will be an increase in support from NLIAH. This will need to be carefully managed to ensure that the learning is as cost-effective as possible but most importantly provides staff with the appropriate skills to undertake their roles. 2.9 Specific recruitment difficulties Some parts of the Trust have carried significant vacancy factors which have been filled through the use of over-time. However, this has not been due to the difficulty in recruiting staff (other than issues of capacity and funding for IHCD training and the historic progression “train”). Some senior manager posts have taken some time to fill, but it is not clear that there is an underlying reason for this. NHSDW has had some issues recruiting and retaining qualified nursing staff and following the assimilation of the Nurse Advisers and the subsequent job evaluation, these were


exacerbated. However, the Trust implemented a Recruitment & Retention Strategy (Appendix 3) which has seemingly had a positive impact, as the level of nursing applications has significantly improved. 2.10 Measures taken to address issues The Trust has started to develop mechanisms to ensure that it can recruit and retain staff in every available way. This includes the setting up of a Bank system and exploring flexible working arrangements (see Appendix 5) with past, current and future staff. Work is being undertaken in line with the development of All Wales Bank policies to examine the parameters of a scheme (such as what are the minimum clinical requirements to maintain competence). The Trust has recognised that the current ways it manages working patterns and associated issues with its operational staff is likely to have had an impact on the absence rates. Therefore, a mixture of senior managers, staff side representatives, managers and others have been exploring appropriate solutions and have designed and are implementing appropriate protocols and procedures to ensure that the appropriate decisions are made at the appropriate levels (see Appendix 6). This is likely to have a very positive impact on the operational rostering of staff. FINANCIAL 2.11 Current available budget for current staff configuration Assumptions In order to build in appropriate cover within the staffing establishments, “relief” has been set at 26.84% of the operational workforce. This includes 3% training release and 6% sickness cover. Some operational areas have sufficient staff in post to meet this requirement, whilst others will have to take an incremental growth approach which allows this to be met over a longer period. It is assumed that the Trust will continue to receive funding from WDECU for paramedic refresher training and for new paramedic training (including cover costs). It has been assumed that the workforce required based on the recommendations of the efficiency review will be funded. In addition, it is assumed that LHBs will fund additional specialist practitioners on the basis that efficiencies will be achieved by a reduction in activity in A&E departments. The current overall budget for staffing within the Trust is £94.6m. 2.12 Vacancy issues The Trust currently does not automatically appoint to each vacancy as it occurs, but considers if there is an opportunity to cover the work required from the existing resources, and considers the business need of replacement in each case. This procedure is not expected to


change in near future. The Trust has recognised that it is carrying a number of vacancies and has plans to fill these. These are outlined in more detail in section 3.2 and in Appendix 2. It should be noted, however, that many non-operational vacancies have been held until the management review is implemented. It should also be recognised that the Trust’s staffing information systems have been under-invested (particularly ESR) and the Trust is currently implementing a series of actions which will ensure that a robust establishment control system is in place which reflects the configuration of the Trust. 2.13 Issues with regards to locum, agency, short term contracts The Trust only occasionally employs agency staff and this tends to be in relation to administrative work. However, the Trust has had significant issues of using staff on a short-term basis (typically through the use of secondments) to achieve immediate results. During 2008/9, significant work has been undertaken to ensure that as few short-term contracts are in place as possible. 2.14 Current financial constraints in relation to the workforce configuration The Trust must achieve financial balance from 2008/9 which will require stringent SCEP targets. Additionally, the Trust must achieve the financial recovery plan arising from any deficits resulting from 2008/9. This needs to be done in line with achieving the key targets for 2009/10 identified within the Local Delivery Plan. Additionally, the Trust also anticipates that it will be required to achieve a 3% across the board CIP savings target with a further 2 % saving (ie 5% in total) to be achieved from central initiatives. Finally, the Trust assumes that a “growth” assumptions from 2010/11 onwards will require a 3 - 4% year on year saving or efficiency target. 2.15 Length of Financial Constraints The Trust envisages that the current financial constraints will be in place for the foreseeable future. 2.16 Current financial opportunities The Trust is currently working with health economy partners to develop appropriate financial opportunities. In particular, the Trust is attempting to ensure that it secures appropriate funding for the development and delivery of new ways of working such as the Specialist Practitioner role. The Trust and its Commissioners have jointly commissioned several efficiency reviews to look


at the current and future EMS operational design and resources, and after competitive tendering exercises, these are being undertaken by Lightfoot Solutions and Baker Tilley. Their terms of reference are to examine how the Trust may be able to improve performance, maximise efficiency and reduce costs by better targeting and locating of resources, as well as the range of solutions we employ. The Trust and HCW are fully committed to implementing the recommendations of their reports. 2.17 Nature of funding The Trust assumes that the funding is recurring. 2.18 Identified opportunities to increase productivity within the workforce Following a workforce planning workshop held in January 2009, the following opportunities were identified by the participants (including staff side representatives).

Resource Inefficiency

Current State Desired Future State

Change Required Expected Efficiency Saving

Paramedic role

Desired 60:40 split unachievable

Additional paramedics to improve RRV and Air Ambulance implementation

Identify new roles that reflect demand profile front loaded model

Savings on overtime by filling vacancies Savings with cheaper skill mix

HDS Partial implementation of HDS teams across the Trust

Appropriate numbers of HDS staff

Conversion of EMT’s to HDS

Better match of staff resource to patient demands

EMT Unclear strategy for future EMT role

Clarity as to purpose of new role (eg ECA)

Define roles & expectations of future


PCS Ops Not currently working to a performance standard within contract plus suboptimal vehicle utilisation

Focus provision of directly employed staff

Demand and roster review

Increasing numbers of patients treated with same resource Increase in mileage on ACS utilisation

Control Still working with outdated methodology and equipment

• More flexible roles, plus performance focus

• New clinical role

• Review current role & consider restructure

• Introduce performance management posts

• Implementation of new technology

Emergency response avoidance with associated efficiency within the whole health system.

EMS Management

Current provision does not meet all needs

Decentralisation of current roles and creation of new roles

Specific structure to support core function

Improved productivity through clear line control and employee

PCS Management

Line control structure does not facilitate

Clear and logical management template

Implement new structure and template

Improved productivity through clear line control and employee


performance management

Specialist practitioners usage

Post holders are influencing change & strategy but are not operational (could be used to prevent unnecessary transports to hospital)

• More clinically based

• Assess & refer to alternative pathways

• Support Paramedics

Redesign of current AP role and expansion of numbers and adaptation into new Specialist Practitioner role

Reduction in the number of patients taken to A&E departments with an associated reduction in required resources.

Access to PROMIS remotely

Staff currently cannot access PROMIS remotely eg home, hospital.

Remote access – allows ops staff to view vacancies and offer to fill/cover from anywhere

Implement technological solution, options under consideration

Improved performance through coverage of operational shifts that were previously lapsed

Fill vacancies in SE Region

Large number of vacancies

Establishment agreed and vacancies filled

Recruitment & training Improved performance through full resourcing

Determine external influences and support of Paramedics on frontline

Lack of alternative pathways and turnaround times

• Engagement and common language with hospital

• Patient journey mapped across organisation

• Intelligent targets

• Proactive management of issues (prioritise and implement)

Implementation of WAG & NHS Wales strategies such as DECS and Designed for Life


Shift Patterns Currently 60% full time, 40% part time

70% full time Gradual alteration to staffing mix over next 12 months, and as vacancies arise

• Reduced attrition • Reduced cost per

call

Recruitment & Retention

High turnover in some sectors plus vacancy levels due to financial constraints

More even workforce maintained

Improve key staff impacting processes and policies, plus address staff survey feedback issues

Higher and more stable productivity as a result of improved staff morale and attractiveness of employment in WAST

Use of physical resources within NHSDW

Currently limited use of pods outside of normal office hours (9 to 5)

Maximum use of callcentre space

Explore expansion of call centre workload

• Income generation • Cost effective use

of space

Different Call Handler roles

Separate call handling work teams for PCS, EMS & NHSDW

Multiskilled workforce with a generic callhandler role

New call handler role, & a call handling curriculum to train staff

Improved productivity through lower cost per call, more flexible deployment based on demand and a logical and attractive career


pathway for staff Nurse Utilisation

Need for a face to face Nurse Triage Role

More diverse nursing role

Specialist Practitioner role

• Better recruitment & retention

• Reduced attrition • Target attainment

for frontline working

Large number of contact centres

Inefficient number of centres (6)

3 combined centres

Integrated Control Centre projects

Reduced costs Increased performance

Resource planning function

Several current departments

1 central function Integration projects Lower cost Higher efficiency

2.19 Opportunities to increase productivity within the service The Trust is working on a number of projects which will increase the productivity within the services offered to patients. These include:

• The implementation of AVLS (radio tracking system). • Use of Nurses in control to triage inappropriate calls (avoiding the need to send

emergency hands on staff to inappropriate patient requirements). • Use of integrating NHSDW to handle lower acuity calls. • The introduction of the Electronic Patient Record. • The introduction of Airwave. • Introduction of the Mobile Data system. • Introduction of Cleric booking system for PCS in SE and C&W regions. • Re-examination and implementation of demand analysis and rota reviews. • Review of rostering within the Control Centres to allow for better matching of supply

and demand. • A reduction in waiting at hospital sites leading to shorter turnaround times (these aren’t

within the Trust’s control but form part of other organisation’s AOFs). • The use of alternative methods of transport other than EMS. • Reducing CAT A prioritisation by reviewing AMPS script and introduction of additional

questions. 2.20 Productivity and benchmarking tools used As per 2.16 but additionally, in drawing this plan together, the Trust has used benchmarking tools and data from Skills for health, NHS England Ambulance Trusts, other NHS Wales organisations and sources such as the Workforce Review Team. In particular, a management consultant firm (Baker Tilly) have undertaken a specific benchmarking exercise with the best performing ambulance services in England. The Trust will continue to monitor its costs against these Trusts to ensure value for money is achieved.

WAST Workforce Plan 20th March 2009 Page 25 of 63

STAGE 3: PREDICTED WORKFORCE REQUIREMENTS & CONFIGURATION TO MEET SERVICE NEED This stage aims to quantify the future configuration of the workforce incrementally over the next 6 years, taking into account the future service plan articulated in Stage 1, and the current workforce configuration identified in Stage 2. DEFINING THE FUTURE WORKFORCE: 3.1 The future workforce configuration Details of this can be found in the attached and associated workforce configuration tool. As previously noted, the Trust has not been able to develop an integrated plan in partnership with health and social care partners. Therefore, there is a limited risk that the Trust has identified workforce needs based on planned service requirements which are accounted for in other organisations’ plans. It is important to highlight that there are 2 key elements to the future configuration of the workforce:

a) Recruitment to establishments (which is unlikely to happen prior to the end of 2010). b) A skill mix change which sees a decrease in the number of Band 5 paramedics with an

increase in the number of Band 6 Specialist Practitioners and their support workers (e.g. Technicians, HDS and other new roles). This will mean that there is less of a flat structure leading to a positive impact on career pathways.

3.2 Changes to the Workforce 2009-2015 General Specialist Practitioner - the main changes within the Trust will be the move to a triage and treat model of care in line with the developing unscheduled care pathways which are being developed across NHS Wales. In particular, it is anticipated that there will be the introduction and growth of the specialist practitioner role (with the assumption being made that about 50% of these staff will be paramedics), incrementally starting from 2009/10. Whilst the longer term aspiration is that this role will require a degree or above level qualification as an entry requirement, the selection will need to be based on appropriate vocational competencies. To resource the identified roles within the Trust, it is expected that the reduction in the size of the PCS workforce will lead to the release of resources to support new ways of working as well as additional funding being allocated to the support the MUC strategy. Additionally, the Trust will need to engage further with other health and social care providers to consider the role’s requirements in relation to the Specialist Pre-Hospital Nurses. Other issues identified are: - The need to ensure that a suitable number of clinical tutors are available to support improved

clinical performance, IHCD training (both paramedics and technicians), the HEI students, and


as a flexed operational resource. - The Trust wants all Rapid Response Vehicle (RRV) paramedics to be operating at a higher

level of competence and, therefore, at a higher banding (6). A plan as to how this will be achieved will be developed within the operations directorate.

- Developing clinical roles in Clinical Contact Centres. Operational Directorate (including overview of Regional Operational Directorates) Starting point: • Covers: Resilience Department, Risk Department, Fleet Department, Patient Transport

Services Controls (Status quo in terms of workforce), Ambulance Control • Under established by

– 17 staff EMS North – 48.61 staff EMS South East – 25 staff EMS Central and West

Assumptions • Work in progress

– Management structure review – Clinical Team Leaders – Practitioners – Possibility of Clinical Facilitators transferring to Operations Directorate (shown in

Clinical Directorate). – Customer Service Supervisors – PCS Operational Supervisors – Reduction of PCS establishment in line with the introduction of single person

operation and greater use of Ambulance Car Service Volunteers – AVLS, Mobile Data and ARRP – Cleric system will be introduced in SE and CW – Demand Profiles and rota reviews – Turnaround times will reduce in line with the AOF. – Control areas will become more efficient with better rostering of staff following a

review of working arrangements. – More call handlers/takers will be required in the short-term, but it would be expected

that less will be needed in the longer run. – The role of the call taker/handler will be redesigned to create a generic role.

Key workforce changes:

• No additional funding available in 2009-2010 • Activity increases above contracted level funded retrospectively and not available for

investment – activity of up to 3% therefore absorbed through efficiency • Outcome of Lightfoot efficiency review not taken into account • NHS Direct workforce plan completed by Clinical Directorate • NHD Direct transfers to Operations Directorate April 2009 • Approval of vehicle business case and Estates SOC • All Rapid Response Vehicles to be staffed by Practitioners

– Phased in over three years – Training on the job in preceptorship


– Carved out of existing workforce (band 5 to band 6 likely)

• 12 Paramedics trained in critical care as dedicated helicopter teams to improve outcomes for trauma patients

Year Key Changes

2009/10 • North 6 Specialist Practitioners • CW 15 Specialist Practitioners • SE 12 Specialist Practitioners • NHS Direct transfers to Operations • Vacancies filled including turnover • Increase in HDS where shown from converted Paramedic posts,

recruited from PCS • PCS establishment reduced in accordance with efficiencies

2010/11 • North 6 Specialist Practitioners • CW 15 Specialise Practitioners • SE 12 Specialist Practitioners • 12 Aircraft crew trained in critical care – no banding change

anticipated

2011/12 • North 6 Specialist Practitioners • CW 6 Specialist Practitioners • SE 12 Specialist Practitioners

2012/13 • North 6 Specialist Practitioners



Key risks:

• Training capacity to deliver numbers required in short term to fill vacancies to deliver performance

• Planned training capacity in medium term to meet turnover • Agreeing /sourcing replacement for Technician role • Peaks in recruitment cycle, impact of vacancy factor on operational and financial

performance • HEI vocational route for EMT to Paramedic to supplement undergraduate programme • Training capacity to deliver numbers required in short term to fill vacancies to deliver

performance • Planned training capacity in medium term to meet turnover • Agreeing /sourcing replacement for Technician • Peaks in recruitment cycle, impact of vacancy factor on operational and financial

performance


• HEI vocational route for EMT to Paramedic to supplement undergraduate programme Control Assumptions:

• Control services continue to be the most important factor in the Trusts provision of patient centred responses to emergency calls.

• Telephone activity and resource dispatch requirements continue to grow in accordance with levels experienced over recent years.

• The Trust introduces performance managers (band 7) and performance coaches (band 4) into the Control environment over the coming five years.

• New forthcoming consultation on the Trusts structure does not impact on Control structures.

• Funding for new posts is sourced through the commissioning route or through operational efficiencies.

Year Key Changes

2009 • 1 x Band 6 Duty Manager SE Control • 1 x Band 4 SE Control • Minus -4 x Band 3 CW Control • 3 x Band 5 CW Control

2010 • 2 x Band 3 North Control • 2 x Band 5 Dispatchers CW Control • 1 x Band 4 CW Control

2011 • 1 x Band 4 North Control • 2 x Band 5 SE Control • 1 x Band 4 CW Control

Central & West Starting Point:

• Currently 67% Paramedics, under-established on EMT, 25 WTE. • PCS over established post 2009/10 SCEP • Control has no established clinical desk • Actions:

– Recruit more Technicians, – Recruit qualified staff, – Consider conversion of nurses – Increase HDS – increase overtime budget until training capacity meets demand.

• Activity assumed 3% increase, no additional funding assumed • 28 productive hours per week per wte (35% relief)

Assumptions:

• 47 Paramedic Practitioner role introduced, working in solo response enabling decrease in conveyance rate to A&E based on priority locations for solo response from demand analysis


• 12 Critical Care Practitioners as dedicated helicopter teams to improve outcomes for trauma patients and stop impact on core UHP

• Both expected to be recruited primarily from current paramedic workforce • HDS and Technician recruitment assumed to be primarily from PCS

Year Key Changes

2009/10 • Vacancies filled including turnover • Increase in HDS from converted Paramedic posts, recruited from PCS • PCS establishment reduced by 10wte in lieu of ACS/SCEP • Commencement of Practitioner training from paramedic (15 wte)

2010/11 • Second cohort of paramedics trained to Practitioner level (15 wte) • Dedicated helimed critical care teams established (15 wte) • Dedicated Clinical Desk establishment, from NHSDW establishment

2011/12 • Third cohort of paramedics trained to Practitioner level (15 wte)

2012/13 • Fourth cohort of paramedics trained to Practitioner level (15 wte)

2013/14 • Fifth cohort of paramedics trained to Practitioner level (15 wte)

2014/15 • Sixth cohort of paramedics trained to Practitioner level (15 wte) Key Risks:

• Training capacity to deliver numbers required in short term to fill vacancies to deliver performance

• Planned training capacity in medium term to meet turnover • Agreeing replacement for Technician • Peaks in recruitment cycle, impact of vacancy factor on operational and financial

performance • HEI vocational route for EMT to Paramedic to supplement undergraduate programme

North Starting Point:

• Under established by 17 staff from frontline • Due to the SCEP reductions filling of vacancies will create financial deficit • Significant number of CTLs have been appointed, however region is still 11 short

(awaiting resolution to paramedic supervisor status before progressing)) • Demand is increasing yr on yr • Awaiting results of reformed NHS in Wales • Changes to speciality provision which will change patient flow in time • Discussion have started on how to work collaboratively across all health boundaries in

Wales • Shortfall in funding within wider NHS for staff , which has led to a debate on what post

can be funded and may lead to the possibility of implementing cross boundary posts Assumptions:


• No additional funding for ambulance specialist practitioners • Will engage with the wider NHS to provide specialist practitioners currently within the

system (e.g. primary care based) • Paramedic number will not reduce with the implementation of specialist practitioners • Will have to recruit from outside Wales from other universities & ambulance trusts • Future workforce will have to be more able to converse in the Welsh language • Demand will continue to increase • Choose Well campaign will be rolled out across the whole of North Wales 09/10 • Performance focus will shift towards patient outcomes as opposed to targets • Access to IHR within control and on the frontline • Increased use of other technologies (e.g. telemetry, EPR etc..) • Technician training will not change

Key Changes:

• Clinical Team Leaders – These roles are currently being implemented across the north region and will be responsible for providing clinical leadership to the frontline staff.

• Clinical Tutors - Currently within clinical directorate proposal to transfer to regional • Clinical Facilitator - Currently within clinical directorate proposal to transfer to regional

Specialist practitioners - enable the ambulance service to enhance their role in the provision of primary care and to prevent the unnecessary admission of patient to A&E departments by using the Specialist practitioners as an alternative pathway.

Year Key Changes

2009/10 • Recruiting up to establishment for paramedics, technicians & HDS staff • Re-alignment of 1x band 8 and 1x band 7 more appropriately

2010/11 • Implement new post & structure within the region • Sector leads x 6 • LAO’s will shift responsibility to perform area manager role. This will mean

1x LAO post • 3x clinical facilitator (not in figure at moment as in other area) • 3 x tutor not in figure at moment as in other area)

2011/12 • Increase of call takers x 2 • Increase of HDS Staff x 10

2012/13 • Increase of call takers x 2 • Increase of HDS Staff x 10

2013/14 • Specialist Practitioners x8 • Increase of call takers x 2 • Increase of HDS Staff x 10

2014/15 • Specialist Practitioners x3 • Increase of HDS Staff x 10

Key Risks:

• Proposed structure change will not be adopted which will detract from regions ability to manage day to day issues/engagement requirement


• Slow progress in the implementation of practitioners • Reduced capacity in the community to deal with low acuity patients • Urgent care centres will be provided in central area which will increase transport

requirements • Competition between health service providers for additional funding or use of practitioner

staff • Inability to meet any one of the 7 key principals outline in the MUC plan

South East Starting Point:

• Currently under-established by 46.81 FTE in EMS • Training plan in place to train staff at appropriate grades. • Annual increase in EMS demand (impacted by NWofW) • PCS audit against contract more robust = efficiencies in numbers • Managing Unscheduled Care will have an impact both nationally and locally. This is

reflected by the content of the AOF.

Assumptions: • Primarily same as WAST assumptions. • However, Regional plan is based on appropriate finance, robust recruitment and training

plans, adequate candidates to fill vacancies, reduction in sickness absence and sound links with Health Communities.

Key Changes:

• HDS establishment will increase • SRP working to level of scope of practice (2009) • Clinical Team Leaders (2009) • Specialist Practitioners (2009)

Year Key Changes

2009/10 • Fill vacant positions to bring actual establishment to funded position. • Reconfigure establishment to increase HDS • Introduce Clinical Pathways

2010/11 • Specialist Paramedic role introduced • Additional relief capacity built into EMS establishment • Increase opportunities to reduce admission to EDs

2011/12 • Continue to recruit Specialist Paramedic • Add to EMS relief capacity • Increase opportunities to reduce admission to EDs

2012/13 • Continue to recruit Specialist Paramedic • Add to EMS relief capacity • Increase opportunities to reduce admission to EDs

2013/14 • Continue to maintain establishment at all grades


2014/15 • Continue to maintain establishment at all grades

Key Risks:

• Inability to recruit sufficient numbers of Paramedics to allow all developments to be implemented.

• Impact of SCEP (both WAST and LHB) on available funding • Impact on ability to achieve Performance Targets (AOF)

NHS Direct Wales Starting point:

• Current establishment meets telephony and web demand • Flexible staff cover matched via WFM with predicted activity • Online enquiries increasing • Increase A&E cover • Market NHSDW as SPA eg: Powys • Provide nurse telephone triage in WAST control and move to CCC Model

Assumptions:

• Virtual Clinical contact Centre model • Single point of access • Health information • Directory of resources • Call volume increase, clinical dialogue • New IT software • Practice coaches • New USC service models and care pathways • Flexible workforce 24/7 • Dynamic recruitment and retention to achieve effective skill mix • Finite pool, fast turnover • Opportunities for new roles • Developing generic call handlers – accreditation • Clinical call centre model • Fit for purpose

Key changes to the workforce:

• Right structure for now, changes required as we evolve • New Associate Nurse Director WAST • Reviewing skill mix • Experienced Clinical Nursing Decisions in CCC

Risks:

• Lack of awareness of key role NHSDW plays in WAST and NHS Wales • Uncertainty of future of Bangor call centre • Need clear vision and strategy for CCC • Wider nursing workforce availability • Require support to further develop Practice Coaches • Further development of Ed and training team


• Technological compatibility Risk & Resilience Department Starting point:

• 1 WTE Special Operations Team Leader Vacancy being recruited • 1.5 WTE Emergency Planner/ Special Events under established • One part time administrative vacancy being recruited to.

Assumptions:

• Team can manage the Resilience agenda and requirements reflected in the Emergency Preparedness Annual operating Framework and statutory obligations described in the CCA, supporting LRF and new health structure emergency preparedness framework

• LHB Funding for .5WTE Regional EP is maintained. • WAG Funding of Special Operations is maintained. • Administrative Support is supplied within the Regional Directorate Pool. • Team can coordinate and progress the organisational Business Continuity agenda until

2011. • No changes to workload for Risk team • Team can manage the organisational business continuity agenda until 2010-2011 • Addition of Business Continuity Manager in 2010-2011 funded through the

commissioning process. Key changes to the workforce:

- One additional BCM support manager funded through commissioning process. - 1.5 additional EP/Special Events managers funded through income generation initiatives. - One additional Trust Security Manager. - Introduction of organisational Business Continuity Manager - Requirement for Trust Security Manager in line with NHS Guidance - Equitable approach to BCM and Resilience issues across the three Regions

Year Key Changes

2009/10 Fill vacant position to bring actual establishment to funded position. Provide additional Emergency Planning Capabilities through Income Generation. Establish a Trust Security Manager

2010/11 Consider Risk and Resilience review Implement Business Continuity Manager funded through commissioning process.

2011/12 None identified



2014/15 None identified Risks:


• Increase workload to meet future AOF and CCA requirements. • Restructuring of other agencies impacting on emergency preparedness framework. • Impact of special events (Ryder cup, Olympics) • Significant changes and scores in community risk registers and threats. • Possibility of an increase workload for Risk team

Fleet Starting point:

• Currently under-established by 3 whole time equivalents. 1 Mechanic, 1 C&W Fleet Manager, 1 Admin supervisor

• A recent audit report indicated that the present staffing levels within fleet care administration, which was formed by the amalgamation of previous Trusts, is insufficient for the current workload and technical requirements.

• A number of staff are in seconded roles and need resolving and need their position substantiating and then their A4C agreed

• We have a shortage of one staff member in Bangor workshop as there is only three and this is covered by staff from Wrexham to cover leave and sickness. This position is to be covered by an apprentice position

• The department has a number of long standing staff that do not appear to have budgets. These budget lines to be resolved.

Key assumptions:

• Fleet Strategy and Vehicle Business Case will gain approval. • Estates SOC will be approved • Wrexham ‘Make Ready’ Business Case will be approved • New fleet administrative software will be secured and implemented in 2010-2011 –

funding sources discretionary capital and current software licence fees. • Shortages in Administration staff resolved meeting recommendations of the Audit report • The direction of travel will be to bring vehicle maintenance in-house in C&W through a

three year phased approach • Availability of discretionary capital to establish equipment necessary to facilitate

workshops • Phased introduction of apprentices over the next three years • A number of long term seconded Staff are to be appointed and appropriately A4C banded

with long standing positions to be substantiating • Resolve the shortfalls in the staffing budgets • The Fleet and logistics departments will interface

Year Key Changes

2009/10 3 x band 3 stocker washers as part of the Wrexham ‘Make Ready’ project – funding source identified through business case with mobile programmed initiation. 3 x band 4 Mechanical technicians as one workshop is established in-house in C&W – revenue source is savings on external parts and labour Introduction of two band 3 apprentice Mechanical technician one South East and the other North at Bangor (funding source = efficiencies from not using external garages)


2011/12 3 x band 3 stocker washers as part of the Swansea ‘Make Ready’ project – funding source commissioning. 3 x band 4 Mechanical technicians as one workshop is established in-house within the C&W (funding source = efficiencies from not using external garages) Introduction of one band 3 apprentice Mechanical technician (funding source = efficiencies from not using external garages) Introduction of one band 3 apprentice Mechanical technician (funding source = efficiencies from not using external garages)

2012/13 As the Estates strategy develops within the C&W region, any new facilities will include workshops as part of this process with appropriate staffing funded to meet operational needs. As with other Fleet and logistics programmes, any staffing my develop as a mobile option and then migrate into the workshop once completed.

2013/14 As the Estates strategy develops within the C&W and others regions, new workshops will be a part of this process with appropriate staffing funded to meet operational needs. As with other Fleet and logistics programmes, any staffing my develop as a mobile option and then migrate into the workshop once completed.

2014/15 As the Estates strategy develops within the C&W and within other regions, any new estates will include new workshops as part of this process with appropriate staffing to meet operational needs. As with other Fleet and logistics programmes, any staffing my develop as a mobile option and then migrate into the workshop once the estate program is completed.

Key risks:

• Increase in activity must be matched by resources within Fleet and logistics • Loss of key personnel • Absence of support for discretionary capital • Efficiencies not achieved • Fleet Strategy and Vehicle Business Case not approved • Increasing parts and labour costs • Increasing fuel cost Yes • Unable to attract suitably experienced and qualified Mechanical technicians. • Unable to source estate capacity for in-house garage workshops • If Fleet and logistics are not combined as part of any future estates strategy, additional

costs will be experienced plus additional lost hours will result in a loss of UHP Logistics Starting Point

• National Equipment Manager currently manages the Logistics Department under the direction of the National Fleet & Logistics Manager

• 2 Regional Equipment Managers (SE & C&W) on light duties currently seconded to Fleet & Logistics

• Current acting S/E Equipment Manager due to return to full operational duties April 1st


2009 • Current acting C&W Equipment Manager unlikely to return to full operational duties due

to long term orthopaedic condition • Tony Hargreaves HCS Manager North Region carrying out the duties of HCS Manager

and North Region Equipment Manager • Substantive posts currently under-established by 3 whole time equivalents. • Considerable work already achieved within the limited resources available in Fleet &

Logistics Assumptions:

• Fleet and Logistics Strategy and Vehicle Business Case will gain approval. • Estates SOC will be approved • Wrexham ‘Make Ready’ Business Case will be approved • New fleet administrative software which will include equipment and consumables will be

secured and implemented in 2010-2011 – funding sources discretionary capital and current software licence fees.

• Availability of discretionary capital to establish equipment necessary to facilitate the logistics department across the Trust.

• Additional storage facility strategically located within the three regions for the provision of equipment, consumables and uniforms

• The provision of suitable laundry facilities in-house or provided by external contractors • The management of medical gases across the trust • The management of equipment maintenance contracts • The future of logistics and Fleetcare will be combined under one leadership

Year Key Changes

2009/10 2010/11

To formally appoint the current National Equipment Manager and take due consideration for his replacement via succession planning within the next 12 to 18 months: Appoint 3 x band 6 Regional Equipment Managers 3 x band 3 stocker washers as part of the Wrexham ‘Make Ready’ project – funding source commissioning - to be managed by the North Regional Equipment Manager 3 x band 3 stocker washers as part of the Cardiff ‘Make Ready’ project – funding source commissioning - to be managed by the SE Regional Equipment Manager 3 x band 3 stocker washers as part of the Swansea ‘Make Ready’ project – funding source commissioning - to be managed by the C&W Regional Equipment Manager

2011/12 Roll out the scheme to further develop the facilities to meet operational needs utilising mobile resources

2012/13 Roll out the scheme to further develop the facilities to meet operational needs utilising mobile resources and working in partnership with the Estates Strategy

2013/14 Roll out the scheme to further develop the facilities to meet operational needs


utilising mobile resources and working in partnership with the Estates Strategy. Any current mobile staff will then be transferred across to the new make ready Stations. Ensure that the logistic operation has an interface with Fleetcare

2014/15 Roll out the scheme to further develop the facilities to meet operational needs utilising mobile resources and working in partnership with the Estates Strategy. Any mobile staff will then be transferred across to the new make ready Stations Ensure that the logistic operation has an interface with Fleetcare

Risks:

• Risk to the Trust of litigation claims key is cross infection • Impact on Unit Hour production • Inefficient management of equipment • Inefficient management of ambulance consumables • Very costly to manage with no financial savings • Loss/absence of key personnel • Absence of support for discretionary capital • Efficiencies not achieved • Fleet Strategy and Vehicle Business Case not approved

Clinical Directorate Starting Point: New corporate team established (1 year in existence) that supports WAST in terms of :

– Professional standards – Quality assurance – Clinical leadership – Service modernisation – Clinical education & professional CPD

Assumptions:

• Integral corporate support function of WAST • Corporate and governance function is still developing • Developments are linked to the professional skill mix required by operational services –

Clinical Directorate will develop infrastructure to support WAST’s clinical/ operational model (e.g. specialist roles, clinical roles in contact centres)

• Finite resources Key changes to the workforce:

• Integrated roles to provide clinical leadership & support at every level of the Trust. • Potential new roles include:

– Unscheduled Care Development Manager (to support North region) – Consultant Nurse Telephone Triage (role to be further developed in 2010/11) – Practice – Based Tutor (shared post with Swansea University to provide HE

support) – Practice Placement Coordinator (to facilitate clinical & vocational placements) – Posts developed to provide a professional infrastructure to support WAST’s

clinical/ operational model


– New A&C roles to support future PIH/professional infrastructure

Year Key Changes

2009/10 • USC Development Manager (North region) • Practice Based Tutor (shared post with Swansea University • Practice Placement Coordinator role (organise & facilitate HE clinical &

vocational placements) • PIH and Health Information Team currently under review

2010/15 • Consultant Nurse (further exploration required) • Roles to support clinical & professional practice (e.g. R&D, audit, risk,

clinical pathways, post graduate education)

Key Risks:

• Priority setting of key objectives by WAST • Outcome of current Management Review • No clear unscheduled care/operational service model • Cultural shift – ability to absorb change • Funding internal (e.g. cost improvement plans) & external (e.g. NLIAH funding of

Paramedic education) • Impact of clinical service models introduced by partner health communities (as part of

modernising USC services). Human Resources Starting point:

• Historical configuration-three regional operational services with limited corporate activity e.g. A4C, equality, workforce planning. Leads to inconsistency

• Limited specialism • Currently several vacancies, (4 plus 2 on maternity leave) • Need to move towards less admin & more advice • Heavy agenda fundamental to changing culture and service modernisation • General recognition of the need to augment function

Assumptions:

• All vacancies will be filled following review of skill mix – urgent 2009 • Some transactional activity will move to line managers • Operating model - locally embedded HR with corporate co-ordination e.g. Recruitment,

monitoring IR activity, reporting etc • Need significant input to up-skill Trust capabilities • Define career paths for HR staff • Cost neutral – to support Trust financial position • Use opportunity of current vacancies to restructure Communications Team


Key changes to the workforce: • Introduce Deputy Director role • Fill all vacant senior posts at band 8a and use skill mix review to appoint to additional

band 8a – corporate policy role • Introduce directorate administration role to release advisory capacity • Skill mix changes to facilitate career path in each region • Fill all junior vacancies • Introduce Welsh Language Officer - band 6 (2009/10) • Replace SE and C&W vacancies with band 5 posts and reband 4 post to 5 (2009/10) • Review contribution to be made to communications by RDs and duty managers

Year Key Changes

2009/10 • Fill vacancies • Introduction of Welsh Language Officer • Skill mix changes

2010/11 • HR Management Trainee becomes substantive

2011/12 • None anticipated



2014/15 • None anticipated Risks:

• Inability to recruit calibre/NHS reconfiguration • Failure to comply with WAG policy arising from lack of dedicated Welsh language officer • Legal challenges risks of failure to meet policy timeframes • Costs of poor employee/industrial relations climate and failure to engage staff • Poor managerial skills – failure to provide line management training • Failure to deliver HR agenda

Finance Starting point:

• Currently staff within the finance department that do not work on finance (PCS & car leasing)

• 2 permanent secondments currently sit within the finance department • Financial service functions are contracted out to BSP

Assumptions:

• Permanently seconded staff that are re-charged to seconding organisation will not be shown on the establishment

• No significant change in the finance departments remit or staffing • It is assumed that the Car leasing department that currently sits within the finance

department will be transferred across to BSP in 09/10. • Existing PCS staff sitting within finance will transfer across to the operational scheduling


department once PROMIS has bee implemented in PCS which it is assumed will happen in 2010/11

• From 2009/10 onwards permanently seconded staff will no be included in the finance budgets as they are completely re-charged therefore no impact on establishment.

Year Key Changes

2009/10 0.88 x Band 5 & 5 x Band 3 will be removed from the financial workforce structure as Car leasing department transfers across to BSP. 1 x Band 8 a & 1 x 7 removed from the financial workforce structure as all permanently seconded staff will no be included in the finance budgets. Issue – still need to determine where these individuals sit 1x Band 8C will be removed from the financial workforce structure with the move of the PCS Modernisation manager to operations Exploration of opportunities to second any displaced senior staff as a result of the NHS reconfiguration to support the Director of Finance

2010/11 2.14 x Band 3 will transfer from the financial workforce structure into the CW & SE resource units

2011/12 No changes identified



2014/15 No changes identified Risks:

• Turnover of key staff • Increase in workload, especially if there are changes to the financial regime • Increased usage of knowledge economy would require additional analytical skills • Increased number of capital schemes will need additional financial input • Loss of key staff to other opportunities presented by the NHS reconfiguration • The increased costs of the future workforce configuration do not have identified funded

source. These posts will be funded if a funding source becomes available. ICT, Estates and Programme Management Department Starting Point:

• The ICT department consists of 4 departments: – Estates – ICT – Health Informatics – PMD

• Currently short of key roles including ICT Operations Manager, helpdesk analyst and project manager


• Actively recruiting to these key roles Assumptions:

• ICT directorate will remain accountable for environmental management as per the Scheme of delegation

• WAST will adopt the Information Management structures proposed by IHC • More technological advances, new buildings and potential for more joint working with

health bodies and other emergency services could increase specialist support needs Key changes to the workforce:

• Increase in specialist informatics staff to match requirements of IHC informatics skills matrix

• Increase in estates roles to cover legal requirements and new responsibilities such as Environmental Officer requirements as per scheme of delegation

• PMD is funded through capital with mix of fixed term & permanent staff • DECS strategies and estates legal requirements may directly impact the local workforce

Year Key Changes

2009/10 • Estates: 3 x handyperson (3); contracts officer (7); environmental officer (7)

2010/11 • HI: Head of health records & information governance (8a);; Performance manager(6);

2011/12 • None identified



2014/15 • None identified Risks: • Not complying to legal requirements • Increased demand without increased resources • Programme runs beyond planned lifetime (and capital funding) • Departments working beyond define remit with existing capacity • Expectation to share and manage data with other emergency services • Requirement for 24/7 help desk Corporate Services Starting Point: There has been a significant increase in complaints in last twelve months which has made the team under resourced. Following the centralisation of some administration work, time is required to bed this in. The requirement to undertake investigations as a result of the increased complaints has highlighted significant under resourcing issues which have been exacerbated as a result of current pressures to meet operational targets. The increase in complaints shows a


strong correlation with the decline in performance at the end of last year. With the recent improved performance, it is hoped to see this trend reversed. There has been a 65% increase in Freedom of Information requests in last twelve months which may be linked to activity within the media about WAST performance. Some issues with general administration function with reception which is only funded at 80% (30 hours) with cover support historically provided by other areas. The required time cover time is 42 hours per week. Assumptions:

• Current structures assume no further increase in Complaints or FOI requests. • Do not take into account any changes as a result of ongoing Management Structure

Review • Dedicated pool of Investigating Officers would improve overall quality and timeliness of

responses – cost implications • Possible future review of governance structures will free up resources to counteract

increase in demand elsewhere eg FOI requests. Key Changes:

• Claims Management – currently provided via SLA (carrying certain degree of risk) • Development of Senior Administrative role (Band 3) through formalised Claims

Management Training • Ongoing development of Corporate Support Staff to add value/improve quality • Broadening scope of reception duties for Reception Staff • Options for future – centralised pool of administrative staff within HQ (and other key

locations within the Trust) coupled with increased use of new technology • Redesign of reception area • Appointment of Senior Investigating Officer (Redress)

Key Risks:

• Continued increase in level of complaints. • Continued increase in level of FOI requests. • Inability to respond to level of work in a timely and quality controlled manner. • Reputation risk to Organisation as a whole. • Withdrawal of WRP from SLA arrangement on claims management. • Non compliance with KPIs. • Increased number of IRP and Ombudsman referrals. • Redress implications.

Volunteers Whilst the Trust has not included volunteers within this workforce plan (in relation to numbers), it is important to recognise that there are over 1,500 registered volunteers with the Trust. These form 2 key groups who require appropriate selection and ongoing assessment and training. Ambulance service car volunteers (part of PCS) - the ambulance service has historically provided a transport service to patients when they require outpatients appointments within the (predominantly) acute hospital setting. The Trust’s strategy is to gradually reduce these services to a core level and replace them with a volunteer car service. Whilst some constraints have


been identified with this model, it is anticipated that these are resolvable. Community/Co Responders - these are members of the public who are provided with a level of training to allow them to meet the immediate needs of patients on the basis that they are “at the scene” in the local community. Co-responders are members of emergency services (eg fire and police services, St John’s Ambulance etc) who have been trained by the Trust to deliver immediate basic health care. Studies have shown that they can have an important impact on improving the clinical outcomes to patients. As is identified above, the volunteer workforce provides an integral element of the Trust’s service delivery. In addition, the Trust’s strategic direction has identified the increased importance of volunteers (with a planned reduction of PCS) to the delivery of services. To ensure that the Trust is maximising the quality of healthcare and the efficient use of its staff, the Trust will seek the development of integrated volunteer networks with other health and social care providers. WORKFORCE REDESIGN: 3.3 Planned changes to create the newly configured workforce profile This section identifies new roles and extended roles that the Trust will develop by categorisation and staff group to meet the service needs to achieve this workforce plan. New roles in WTE for the life of this plan:

Year 1 (2009-10): 33 x Specialist Practitioners (Band 6) 1x Deputy HR Director (Band 8c) 1 x Welsh Language Officer (Band 6) 3 x Communications Officers (Band 5) 1 x Workforce Information Adviser (Band 5) 1 x Practice Placement Co-ordinator (7) 3 x Stocker washers (Band 2) 3 x Auto Technicians (Band 4) 1 x Auto Technician Apprentice (Band 3) 1 x Environmental officer (Band 7)

1 x Special Operations Team Leader 1.5 x Emergency Planners 1 x Security Manager 1 x Unscheduled Care Development Manager (8a) 1 x Practice Based Tutor (joint appointment with Swansea University) 3 x Handypersons (Band 3) 1 x Contracts officer (Band 7)

Year 2 (2010-2011): 1x Consultant Nurse (Telephone triage) (Band 8c) 33 x Specialist Practitioners (Band 6) 3 x Stocker washers (Band 2) 3 x Auto Technicians (Band 4) 1 x Head of Health Records & Information Governance (Band 8a)

1x Business Continuity Manager 2 x Auto Technician Apprentice (Band 3) 1 x HR Management Trainee (Band 6) becoming substantive 1 x Performance Mgr (6)

Year 3 (2011-2012):


24 x Specialist Practitioners (Band 6)

Development of roles to support clinical and professional practice (R&D, audit, risk, clinical pathways)

Year 4 (2012- 2013): 6 x Specialist Practitioners (Band 6)

Year 5 (2013-2014): 33 x Specialist Practitioners (Band 6)

Year 6 (2014-2015): 33 x Specialist Practitioners (Band 6)

Further information can be found on these roles in 3.3.1 – 3.3.2. 3.3.1 New roles This section includes roles that the Trust plans to introduce which are entirely new and will create a new type of worker. It should be noted that these are new roles are not additional posts, i.e. not more of existing roles.

Job title Band Directorate/ service area

Educational/ development / regulatory issues or requirements (section 3.5 requires identification of skills and competencies)

Other Staff groups effected i.e.: reciprocal staff area affected?


Welsh Language Officer

6 HR Welsh language Experience of advising on Welsh language agenda

None Failure to appoint will lead to statutory issues with WAG

Communic-ations

5 HR/Coms Degree Experience of dealing with the media

Current Band 4 to be reviewed. 2 Band 6 vacancies disbanded

Workforce Information Officer

5 HR CIPD Experience of workforce information

None Removal of ESR Administrator role creating an individual risk

Specialist Practitioner

6 Operations/ NHSDW

HPC/NMC registration Post graduate experience and qualifications Competency based training

Reduced demand on A&E/ EMS services with more appropriate triage

Cultural issues of integrating nurses and paramedics

Consultant Nurse

8c Clinical Directorate

MSc level experience and qualifications

Possible impact on senior nursing staff in new LHBs

Potential failure to develop the very best practice within the nursing workforce

Deputy HR Director

8c HR CIPD, MSc level experience and

None Removal of one of current 8b


qualifications posts creates risk

Stocker washers

2 Fleet None identified None identified None identified

Auto Technicians


Auto Technician Apprentice


Environmental officer

7 Estates None identified None identified None identified

Security Manager

TBC Estates None identified None identified None identified

Practice Based Tutor (joint appointment with Swansea University)

TBC Training Team

None identified None identified None identified

Handypersons 3 Estates None identified None identified None identified

Contracts officer

7 Estates None identified None identified None identified

Head of Health Records & Information Governance

8a ICT None identified None identified None identified

Performance Manager

6 ICT None identified None identified None identified

Practice Placement Co-ordinator

7 Clinical Directorate

Recognised paramedic tutor and have experience in IHCD and HE training

Loss of service elsewhere in the Trust

3.3.2 Extended Roles This section includes roles that the Trust has identified that will continue to work within the existing role parameters. The following extended roles will have additional or new duties, tasks or competences requirements. These roles may require broader or deeper knowledge, skills and understanding.

Type of Role Band Directorate/ service area

Educational/ development / regulatory issues or requirements (section 3.5 requires identification of skills and competencies)

Other Staff groups effected i.e.: reciprocal staff area affected?


Generic Call Taker/Handler

3 Operations/ NHSDW

Utilise the accredited call handler programme

Call Handlers and Call Takers will be

Potential that staff will resist making


expected to work across the services

the roles generic. It relies on common software across NHSDW, Control and Out of Hours

HART Team 5, 6, 7 & 8a

Operations HART, IRU and USAR Potential loss of staff from other areas

UK Govn’t requirement not met

3.3.3 Changed Role This section includes roles that the Trust has identified for which the volume of existing activity has changed. These roles are likely to involve some tasks being moved to a different worker or provided through use of technology, so that a role can focus on a higher volume of specific, or specialist work. This following have been identified as potentially changed roles. It is recognised that there is overlap with the new and extended roles and this is due to some of the detail of the above roles not been fully identified.

• Clinical desk and NHSDW triage (nurses and paramedics) • Call handlers/takers move to multiskilled role • Nurses/paramedics move to multiskilled/specialist practitioner role • Nurses/paramedics providing extended clinical support within ambulance control • Paramedics working as a triage point in the Clinical Contact Centres/Control • Clinical leadership expertise to co-ordinate new ways of working for both face-to-face and

CCC contact NEW WAYS OF WORKING (CONSIDERING ALL STAFF GROUPS INCLUDING SUPPORT STAFF) 3.4 Required new ways of working New Ways of Working Full details of the planned projects can be found in section 4. They include:

• Reviewing current working practices (such as shift lengths) • Up-skilling staff so that they are able to work to a higher competency level • Ensure that appropriate support processes are in place

NEW SKILLS AND COMPETENCES


3.5 Required new skills and competences to deliver the future service Work is at a developmental stage in identifying the requisite competencies. Of particular note, the Trust is currently undertaking a study into the scope of practice of paramedics which is likely to inform decisions concerning the specialist practitioner and RRV paramedics (if these are scoped as different roles). TECHNOLOGICAL ADVANCES 3.6 Technological advances that will support this workforce development These are detailed in sections 2.18 and 2.19. FINANCE 3.7 Actual cost of the reconfigured workforce By 2015, the actual cost of the reconfigured workforce will be £109,353,115 (see the configuration tool for year on year changes). SUPPLY OF THE FUTURE WORKFORCE 3.8 Source of future workforce These are covered in more detail in other parts of this plan. 3.9 Required recruitment and retention actions The Trust has identified that it has a number of vacancies within most directorates in the Trust, some of which have not been recruited in order not to pre-empt the results of the management review. In particular, significant work was undertaken in partnership with staff side representatives in relation to the operational workforce. This resulted in the development of a specific action plan (which is detailed in Appendix 2). When considering recruitment into new, amended or existing roles, the Trust is currently redesigning and developing its recruitment processes so that when it is anticipated that a vacancy will occur, work commences on ensuring that an appropriate process supports the commencement of the successful candidate as swiftly as possible. Additionally, give the strategic aim of increasing part-time workers, it is important to note that the participation rate (ie WTE/headcount ratio) will reduce. Given the significantly higher rates of part-time workers among female staff and given that a majority of the first year of HEI


paramedics are female, it is important to identify that additional numbers of HEI (& IHCD) students will need to be commissioned to meet the each WTE requirement. This pattern is likely to need to be repeated across other staff groups. The Trust will need to decide whether it will follow some other UK ambulance services by providing HEI paramedic graduates with, effectively, a “golden hello” by resourcing their driving training for the C1 and D1 categories. Whilst there is some ability to deliver this in-house (other training requirements depending), the Trust will also examine accessing other providers of this training, in particular the Welsh police services. To achieve the above, the Trust will develop a robust Recruitment and Retention strategy and plan to support all staff. Issues to be considered and included will be increasing the sourcing of external candidates (especially paramedics and nurses) from across the UK, the EU and beyond as required. 3.10 Impact of workforce developments on other service provision General It is recognised that the Trust does not employ relatively large numbers of staff in any one particular geographical location. Therefore, generally, the Trust’s recruitment activity is not expected to have significant impact on other health and social care providers. The only exceptions to this are: Specialist Practitioners Based on modelling from other parts of the UK, the Trust has assumed that the role of the Specialist Practitioner is likely to be sourced from a range of current health and social care employees who are predominantly already working within Wales. This is because their work will be based on a redesigned service model which is broadly attempting to move appropriate triage and treat services from secondary and emergency care into primary care. Therefore, the Trust’s assumption is that paramedic and nursing roles (which are likely to be developed from similar roles) will be filled from the current NHS Wales workforce by candidates with the appropriate level of education. Nurse Advisers Historically, NHS Direct Wales has attempted to ensure that it has not over-sourced its staff from any particular area of NHS Wales. In part, this is why there have been three NHSDW sites across Wales which are virtually linked. Historically, the largest site has been Swansea which has traditionally sourced most of its staff from the immediate health economies. With the move to three distinct Clinical Contact Centres, it is possible that there will be an increased pressure to recruit nursing staff in the North and South East areas with a reduction of staff within the Swansea area. 3.11 Anticipated identified recruitment issues The key issues relate to the recruitment of paramedics and these are detailed elsewhere within this plan.


STAGE 4: PLANNING FOR DELIVERY In Stage 3 the plan has identified the future workforce configuration to meet the service needs over the next 6 years and the key changes that will take place to achieve this. Stage 4 attempts to describe the process of planning for these changes in more detail. TRAINING AND DEVELOPMENT 4.1 The following training and development will be required to meet the future workforce

requirements (including NVQ’s) It is important to recognise that it is a possibility that the Management Review will lead to changes in the structure and configuration of learning and development activities within the Trust. These changes, therefore, are likely to impact on the focus and capacity of the function to deliver learning internally. General It is important to recognise that the Trust is in a unique position where many of its staff are not able to easily access central training activities due to the geographical nature of the Trust. It is also important to highlight that many staff work as mobile lone or “buddy” workers who are part of fixed rotas. This can lead to difficulties when considering appropriate learning delivery. An additional issue for the Trust is that whilst many organisations can readily move towards using e-learning as an effective form of learning, the Trust’s IT infrastructure across many of its 110 sites is not sufficiently robust to support many of the e-learning packages provided by the Trust or NHS Wales. The Trust has historical had a career pathway which has meant that an employee can start at a support worker level, and progress through roles to become a paramedic. With the introduction of HEI programme, the Trust will attempt to make a balanced approach to the recruitment of staff so that not all paramedics, for example, are sourced through only HEI candidates. This will mean that the Trust will need to develop appropriate programmes, supported by other organisations (such as funding) to support continued internal career progression. Implementation of new systems and software With the implementation of new systems and software, there is a requirement to ensure that anyone using these are appropriately trained. As much of this training will be focused on operational staff, there is a need to ensure that these staff have appropriate time allocated to their training and that the training is delivered by appropriately resourced individuals. Welsh Language It has been identified that the North Operations Directorate requires investment in its current workforce to increase its ability to meet its service requirements. Additionally, NHSDW has identified that further support would be beneficial for the patient-telephone contact staff so as to improve the availability of a bi-lingual service.


Technician Training Whilst it has been identified that the Trust will no longer be able to accredit Technicians through the IHCD route (likely to be 2011, although further developments may occur with this date), it is important that a vocational training package remains which is “conversant” with the HEI paramedic training. This will allow in-house Technician staff to be APL some of their learning and reduce the amount of time required to complete the HEI paramedic course. The Trust will, therefore, explore opportunities in partnership with NLIAH to provide appropriate learning for these staff to progress to become paramedics. HEI Paramedic Commissioning Given the issues identified in 2.8 in relation to the swings in supply and demand for paramedics (with unsustainable vacancy/over-supply issues), the Trust has identified the need to attempt to ensure that the HEI provider(s) are able to provide two intakes of paramedic students every 12 months. The Trust will discuss the practicalities of this with NLIAH and relevant HE providers. Additionally, given the strategic aim of increasing part-time workers, it is important to note that the participation rate (ie WTE/headcount ratio) will reduce. Given the significantly higher rates of part-time workers among female staff and given that a majority of the first year of HEI paramedics are female, it is important to identify that one HEI student is likely to only yield (over-time) 0.9 WTE, and in time as the gender balance within the Trust becomes more reflective of Wales, this is likely to be closer to 0.8 WTE (in line with other parts of NHS Wales). With the planned introduction of bank working, this is likely to lead to an increase in the headcount requirement for paramedics as well. HEI Students With many of the HEI students being relatively young in comparison with the current paramedic workforce, it is clear that many will not have the requisite driving licence requirements to allow them to undertake a role as a paramedic. The Trust will need to decide whether it is prepared to fund the HEI students to undertake the C1 and D1 licences through an external provider (such as the police who have indicated that they have capacity) or provide the training in-house through the training school. It should be noted that assessment and examination of these qualifications must be achieved through approved Driving Standard Agency centres. In order to ensure that the HEI students in Wales see the Trust as their natural employer on completion of their diploma, the Trust will actively consider ways of providing paid employment to the students during their holiday periods as a form of induction. Given the cultural issues that many of the HEI students may find when they commence employment with the Trust, the Trust will consider supporting these new staff with appropriate buddies/preceptors/mentors/PPEs. It is anticipated that these buddies will be appropriately skilled through appropriate learning activities Apprenticeships Given that many of the Trust’s roles require vocational skills, the Trust will actively explore opportunities to develop apprenticeships in areas such as the Fleet Directorate. It is hoped that this will not only help support the Trust’s workforce requirements cost effectively, but that it will also help support WAG policies especially during the current recession.


4.2 Organisational development interventions The Trust recognises the need for significant organisation developments particular in relation to cultural issues and business change management. It is anticipated that the results of the management review will ensure that appropriately skilled individuals are working with colleagues to help meet the Trust’s requirements. As identified in 1.3, the Trust will need to undertake OD work that ensures that the Trust’s workforce becomes more integrated with health and social care colleagues. This can be adressed through buddying, mentoring, coaching and networking programmes across Welsh (and beyond) health and social care partners. Therefore, there is likely to be a requirement for a dedicated resource of OD expertise to be formed from within the Trust’s current workforce. 4.3 Requirements from future pre- registration programmes As has been identified previously, the Trust employs two main staff groups who require professional registrations namely paramedics and nurses. (There is also a small team of 11 registered dental nurses.) In relation to nurses, it is important to note that the Trust does not currently employ any newly qualified nurses and has no plans to do so because the current and planned services require a degree of experience when triaging patients. This will also be the case with the development of the Specialist Practitioner role where lone workers will be expected to triage and treat a range of emergency/primary care health needs. With this in mind, this section is primarily focusing on the pre-registration requirements for paramedics. As has been identified throughout the plan (and in line with NHS England Ambulance services), the Trust has a large risk if it is not able to gain NLIAH funding for the continuation of the IHCD training for paramedics and technicians. The Trust must also accept the risks of this approach, because of the high potential that staff moving through the “traditional” career ladder creates further training needs in other roles. So training interventions and significant release time would be required at every stage with: - a Clinical Team Leader/Specialist Practitioner (if a graduate) being appointed from the paramedic workforce - this would require a technician to be trained through the IHCD route to become a paramedic - in 50% of cases, this would require a PCS/HDS/Control member of staff to be trained as a technician - the role which was vacated would require someone to be trained into it. It should also be noted that from 1st April 2009, the IHCD now have a requirement that increases the length of time that paramedic students must spend being non-operational from 12 to 15 weeks with the total length of time before HPC registration can be gained being 24 weeks. Given that this workforce plan identifies the need to fill not only existing vacancies but also new roles and that the expected graduates from the HEI route will not be sufficient in number to do this, further IHCD training will be a requirement. If NLIAH are not able to fund sufficient places, the Trust will have to do this itself to the detriment of another use of the resource.


As identified in 4.1, it is likely that a greater number of HEI places will need to be commissioned in order to meet the expected fall in the participation rate. Recommended changes to current HEI commissioning The Trust has previously identified that being the only NHS employer of paramedics in Wales and with the move to the HEI training of paramedics, there is a large risk of carrying vacancies before the graduation/employment of HEI graduates and being over-established after this. This is based on the Trust’s assumption that it will be required to employ all HEI paramedic graduates within a short time-scale of the completion of their diplomas. Whilst there is some probability that some of the graduates will not remain within Wales and/or that there may be some “drop out” during the two year programme (in nursing this can be as high as 30% over the 3 year period), the Trust’s assumption is that the vast majority will become employees in WAST. It is important to note that the Trust currently employs between 60-80 graduate paramedics who could be developed into the Specialist Practitioner roles in order to meet the redesigned service models. Additionally, whilst the Trust covers the whole of Wales, the current HEI training provision is only being delivered within Swansea, and currently there is only one HEI student who is from North Wales. If this trend continues, the Trust will not be effectively planning its workforce as there are likely to be vacancy gaps in the North Region. Therefore, working in partnership with NLIAH, the Trust recommends following:

• The commissioning of HEI training that releases two cohorts of graduates per year to reduce the staffing peaks and troughs.

• The commissioning of HEI training that covers all parts of Wales (particularly North Wales).

4.4 Requirements from future post- registration programmes As section 3 has identified, the Modernising Unscheduled Care work-stream across NHS Wales has identified the need for a specialist practitioner role in relation to emergency/primary care triage and treating. The design of this role will be competency based but it will need to be supported with a modular academic approach to ensure that the post-holders are appropriately skilled both vocationally and academically. This is likely to be in line with some of the post-registration nursing programmes. The Trust will need to continue to work with colleagues in all the health care economies to fully understand the service needs and the subsequent competency requirements.


The Trust has the following workforce development projects commenced or planned. Description of Project / Key Actions to achieve your future workforce configuration

Summary of Key Outcomes

Lead Person

Start Date

End Date

Implementation of specialist practitioners

- Setting up a project group to oversee this development including other health economy partners

- Identification of role competencies

- Identification of specific training requirements (vocational and academic)

- Engagement with NLIAH to support delivery/funding

- Development of recruitment plan of action

- Development and delivery of an appropriate induction programme

Director of Ops & Consultant Paramedic Project team Project team Head of WMD Project team Project team and Head of PE&D

May 09 June 09 June 09 June 09 June 09 June 09

June 09 Aug 09 Sept 09 Sept 09 Sept 09 Nov 09

Implement RRV paramedics working to a higher level of competence

- Identify new levels of competency requirements (linking into specialist paramedic work)

- Identify a process for implementing “policy”

Director of Ops

Apr 09 June 09

Introduction of apprentices within as many staff groups as possible

- Understand details of the available apprenticeship schemes

- Identify potential services which could utilise an apprentice

- Discuss with Heads of Service appropriate implementation

- Action appropriately

Head of WMD Head of WMD Head of WMD Heads of service

April 09 April 09 April 09 July 09

April 09 May 09 July 09

Detailed review of current ways of working (such as shift lengths) to optimise staff welfare and operational efficiency Ensure that EWTD compliance is achieved

- Project team to be formed involving all key stakeholders

- Areas for research identified and actioned

- Recommendations made for decision

- Agreed recommendations actioned

Director of Ops Project team Project team EMG

May 09 May 09 Aug 09 Sept 09

May 09 Sept 09 Oct 09 Jan 10

Review of working practices within the resources teams to

- Appropriate working practices which support operational efficiency, local requirements

Director of Ops

Dec 08 April 09


improve balance between efficiency and employee needs

and the needs of staff

In order to up-skill managers to be able to meet the requirements of the management review

- Review MSLP and ensure that fresh impetus is given to the programme

- Produce and deliver a detailed plan as to how the MSLP will be delivered throughout 2009/10

Head of WMD Head of WMD

Apr 09 Apr 09

May 09 Apr 10

Development of a Trust wide integrated learning and development plan

- Project team created to identify all L&D requirements

- Plan produced and delivered

Head of PE&D Project Team

Apr 09 July 09

Embedding PDR practices within the Trust

- Ensure that all staff have regular contact with their manager

- Ensure that all staff have annual PDR

CEO CEO

Jul 08 Apr 10

Successful HEI graduate induction and integration project

- Project team to be established to examine issues relating to HEI students and graduates with NLIAH engagement

- Recommendations to be made and implemented

Head of PE&D Project team

Apr 09 Apr 09

Apr 09 June 09

Ensure that benefits of new ways of working of realised

Group to be established to ensure that outcomes of new care pathways are effective

Clinical Director

Apr 09 Oct 09

Development and implementation of a Trust wide Recruitment and Retention plan including covering setting up of a Trust Bank system

- Set up project group - Develop R&R plan and

strategy for the Trust - Monitor implementation of the

plan

HR Directorate

Apr 09 Sept 09

Ensure that appropriate capacity is available within the learning and development function to deliver increased training requirements as well as meeting recruitment/induction requirements for a number of staff

- Identify required training needs and audit current capacity

- Highlight gaps and seek clarification on priority if resources cannot be found

HR Director/ Clinical Director & Head of PE&D

Apr 09 June 09

Develop appropriate HE options

- Set up a group with Swansea University and NLIAH to examine HE options

- Explore appropriate approaches (eg modular)

- Make recommendations to NLIAH/Trust

Head of PE&D

April 09 June 09


- Implement actions Improve Trust’s workforce capabilities to integrate with health and social care (and other) partners

- Form group to examine current issues

- Explore options such as mentors, buddies, coaches and networks

- Make recommendations - Implement

HR Directorate & Head of PE&D

May 09 Sept 09

Ensure ESR (and other systems) are utilised and integrated into the Trust’s activities to the greatest effect

- Scope out requirements - Benchmark against other

organisations - Update systems appropriately - Introduce appropriate

processes to ensure systems are maintained

HR Directorate

Mar 09 June 09


STAGE 5: PROPOSALS FOR IMPLEMENTATION, PERFORMANCE MANAGEMENT & REVIEW The Trust’s plan is meant to be a living document which will support the implementation of the workforce development plan for the forthcoming years. It is the Trust’s intention that this plan will be reviewed and refreshed quarterly and when new strategies and service developments are planned. It will be formally updated annually as part of the workforce planning process. The Trust will consider using the balance score card as a mechanism for managing this process. IMPLEMENTATION 5.1 Key requirements to ensure the plan is implemented It is essential that this key elements identified within this plan are resourced both within the Trust and externally. 5.2 Lead responsibility for this The responsibility for delivering this plan will rest with the Chief Executive. 5.3 Monitoring the implementation The plan will be monitored through the Trust Board and the Executive Management Group (EMG) on a regular basis. REFLECTION ON THE 2008- 10 WORKFORCE PLANNING PROCESS 5.4 Positive elements of the 2009 WFP submission Following the lessons learnt session (see 5.6) which will be held in April 2009, the Trust will be able to provide more detailed feedback. 5.5 Difficulties encountered during the workforce planning processes Following the lessons learnt session (see 5.6), the Trust will be able to provide more detailed feedback.


5.6 Lessons learnt The Trust will spend some time considering what lessons have been learnt as a result of developing this workforce plan in April 2009 as part of an evaluation of this plan and the results of this will be shared appropriately. Additionally, the Trust is developing mechanisms to ensure that workforce planning is embedded into “business as usual” which will mean each Directorate ensuring that their plan is reviewed regularly to support the Trust plan being updated, as well as ensuring that any new service developments and strategies are considered for their workforce implications. At this stage it appears that the key learning involves participants having a clear understanding of the strategic direction, and being able to articulate this into detailed plans. To assist this, it seems clear that not only does the workforce planning work need to commence at early stage than was the case this year, but that work needs to be undertaken to ensure that integrated workforce planning is fully embedded in service planning.


STAGE 6: RECOMMENDATIONS FOR WORKFORCE DEVELOPMENT & ACTION PLAN FOR HEALTH ECONOMY PARTNERSHIP INVOLVEMENT 6.1 Partnership involvement and engagement undertaken in developing the

plan As has been previously identified, the Trust has encountered some difficulties in building this workforce plan. This is in part due to the Wales wide nature of the Trust and in part due to the re-configuration issues within other Trusts/LHBs. The Trust has, however, engaged health and social care colleagues through the Modernising Unscheduled Care networks, links with the education providers, NHS Wales networks and the like. Therefore, the Trust has been able to engage with the following organisations to develop elements of this plan: All Welsh LHB’s & Trusts Third Sector Voluntary Organisations (eg Age Concern, St John’s Ambulance) Local Authority Social Services Depts (eg Conwy & Denbighshire) Partner emergency services (eg North Wales Police, Mid & West Fire Service), Education Providers (eg Swansea University, University of Glamorgan) Community Pharmacies, Community Health Councils National representative bodies (eg WEDFED, Emergency Care Advisory Group). Trade Union/Staff side association bodies (RCN, GMB, UNISON, UNITE) REGIONAL / HEALTH ECONOMY / ORGANISATIONAL LEVEL REVIEW 6.2 Action taken to review this plan locally, organisationally or at a health economy

basis The Trust developed an action plan in June 2008 in order to ensure that this plan was developed in an integrated way both internally and externally. Whilst the external development of the overall plan has been problematic, the Trust has made significant progress in embedding an integrated approach within the Trust. The key elements of this have been: - The setting up of a Workforce Planning Steering Group chaired by the Director of

Finance - Operational assumptions session in January 2009 - Directorate workshops from December to March 2009 - Directorate WFP validation day in March 2009 - Validation of the plan within the Trust in March 2009 - Sharing and some validation of this plan with NHS Wales health economies in March

2009


RECOMMENDATIONS 6.3 Recommendations regarding education, training, modernisation, and

recruitment and retention The Trust will provide feedback through the HR Directors’ forum and the workforce modernisation groups. 6.4 Recommendations for NHS Wales The Trust will provide recommendations through the Head of Workforce Modernisation and Development to NLIAH along with other NHS Wales workforce modernisation leads in April 2009.


Appendix 1 – WAST Local Delivery plan Appendix 2 – Recruitment & Retention plan Appendix 3 – Nursing Recruitment & Retention Strategy Appendix 4 – Trust’s Workforce Information Table 1 showing age profile by gender

Table 2 showing gender mix within the Trust


Table 3 showing ratio of part-time working by gender

Table 4 showing sickness rates by Directorate in 2007 and 2008


Table 5 showing the Trust’s sickness absence rate in 2007 and 2008

Table 6 showing the Trust’s sickness absence rate (2008) by staff group

2008 01

2008 02

2008 03

2008 04

2008 05

2008 06

2008 07

2008 08

2008 09

2008 10

2008 11

2008 12

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

% Abs Rate (FTE)

Cumulative

% Abs Rate (FTE)

Trust Figure 8.40% 6.67% 6.44% 6.56% 6.37% 6.59% 6.51% 6.65% 7.24% 6.59% 6.28% 7.67% 6.83% Amb Officer 3.53% 2.22% 1.52% 1.98% 2.24% 4.40% 3.18% 5.96% 6.25% 5.12% 4.32% 6.65% 3.89% Trainee 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.44% 0.00% 0.00% 0.00% 3.64% 9.38% 1.55% Para. Practitioner 0.00% 1.15% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.07% Paramedic 8.43% 6.58% 7.53% 7.02% 7.24% 7.23% 6.30% 6.29% 7.45% 7.11% 6.84% 8.06% 7.18% Technician/HDS 10.09% 8.08% 7.06% 7.64% 8.07% 8.89% 8.58% 8.19% 8.59% 7.50% 7.70% 9.86% 8.35% Senior Manager 6.07% 4.01% 2.15% 2.37% 1.04% 2.95% 2.78% 1.96% 5.34% 5.15% 3.41% 2.02% 3.25% Manager 4.48% 4.72% 3.62% 4.29% 2.65% 4.30% 3.95% 3.73% 4.41% 0.46% 1.74% 1.84% 3.32% Admin & Clerical 6.21% 4.35% 3.57% 3.84% 3.17% 3.65% 4.32% 3.66% 4.87% 3.88% 3.60% 4.80% 4.16% Nurses 4.72% 4.64% 7.23% 9.19% 7.84% 7.62% 8.92% 9.52% 11.01% 8.79% 5.08% 4.48% 7.40% Control 9.36% 7.88% 5.00% 5.15% 6.20% 5.15% 6.74% 8.26% 7.60% 6.53% 6.53% 9.78% 7.01% Fleet/Workshop 3.61% 5.88% 6.09% 4.39% 0.00% 2.75% 0.00% 1.33% 5.88% 9.49% 8.24% 1.90% 4.11% PCS 10.35% 7.85% 7.76% 7.97% 7.17% 7.01% 7.46% 7.85% 7.35% 7.25% 7.44% 8.60% 7.85% HCS/NAT/Domestics 6.94% 7.20% 7.86% 7.99% 5.37% 5.60% 5.92% 4.91% 4.62% 5.99% 3.23% 3.69% 5.84% Dental 9.22% 7.11% 9.58% 4.10% 1.18% 12.12% 6.73% 0.00% 0.65% 0.00% 0.90% 1.86% 4.49% N.E.D 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%


Appendix 5 – Bank & Sessional Working Requirements See attached file Appendix 6 – Resource Centre Mapping Exercise See attached file

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WELSH AMBULANCE SERVICES NHS TRUST (INTERIM) WORKFORCE ... · WELSH AMBULANCE SERVICES NHS TRUST (INTERIM) WORKFORCE PLAN 2009-2015 Name of service organisation Welsh Ambulance Services