Workforce Modernisation and Development Strategic Plan 2012/13admin.fifedirect.org.uk/...WorkforceStrategicPlanfinaldocumentversio… · 2.2 The Workforce Modernisation and Development

WORKFORCE MODERNISATION

AND DEVELOPMENT STRATEGIC PLAN

2012/13

INDEX

SECTION 1: DEFINING THE PLAN PAGE NO

1. INTRODUCTION 4 2. PURPOSE 4 3. SCOPE 5 4. OWNERSHIP 9 5. UPDATE ON WORKFORCE MODERNISATION

& DEVELOPMENT PLAN 2010/11 11

SECTION 2: SERVICE CHANGE

1. POPULATION PROFILE 13 2. CURRENT & FUTURE FINANCIAL ISSUES 19 3. SERVICE CHANGE / REDESIGN 19 4. OTHER DRIVERS / CONSTRAINTS 30 5. HEALTH AND SOCIAL CARE INTEGRATION 36 6. SHARED SERVICES 37 7. LINKS ELSEWHERE 39 8. VOLUNTARY SECTOR 39

SECTION 3: DEFINING THE REQUIRED WORKFORCE

1. WORKFORCE PROJECTIONS 41 2. WORKFORCE MODELLING TOOLS 41 3. JOB PLANNING 41 4. SKILLS AND COMPETENCIES 41 5. SKILL MIX 42 6. NEW ROLES 42

SECTION 4: WORKFORCE CAPABILITY

1. CURRENT STAFFING PROFILE 44 2. WORKFORCE AGE PROFILE 53 3. SUPPLEMENTARY STAFFING USE 56 4. OVERTIME / EXCESS / ENHANCED HOURS 56 5. LABOUR MARKET ANALYSIS 57 6. NHS FIFE EMPLOYMENT INITIATIVE 57 7. RECRUITMENT 58 SECTION 5: ACTION PLAN

1. LEARNING AND DEVELOPMENT PLAN 60 2. ACTION PLAN 68

APPENDICES

1. EFFICIENCY AND PRODUCTIVITY POST CHANGES 2. WORKFORCE PROJECTION TEMPLATES 3. NHSS & SEAT WORKFORCE AGE PROFILES

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SECTION1 : DEFINING THE PLAN

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1.0 INTRODUCTION 1.1 NHS Fife has developed an annual Workforce Modernisation and Development

Strategic Plan since 2006 in line with HDL 52 (2005). The last Strategic Plan was for the year 2010 / 11 but approved by the Board in February 2011 due to the election for Board Members during 2010 A further revised Strategic Plan was not required for 2011 / 12 as the 2010/11 was updated to take account of the following year.

1.2 Revised Workforce Planning Guidance was issued under CEL 32 (2011) in

December 2011 and this Strategic Plan follows that Guidance and in particular the Six Steps Methodology as provided in Annex A to CEL 32 (2011).

2.0 PURPOSE 2.1 The purpose of this Strategic Plan is to:

• Provide an overview of the current workforce • Provide details of the key issues either within the workforce or that impact

upon the workforce • Ensure that Workforce, Service and Financial Plans are integrated • Ensure the highest quality of care for patients by ensuring that the right size of

workforce with the right skills and competencies are deployed in the right place at the right time

• Help inform SGHSCD of the direction of travel and provide workforce projections particularly for those staff groups that are subject to national contracts for student numbers and highlights nationally “hard to fill” posts

2.2 The Workforce Modernisation and Development Strategic Plan requires to be a

living document that is flexible and adaptable to ensure that it is responsive to further change along the way given the constantly changing dynamics of service provision and in particular the increasing involvement to community based care. It will significantly change as the development of plans for the Integration of Health and Social care continues.

2.3 In drawing up this Strategic Plan and the accompanying Workforce Projection Templates the tests of

• Affordability • Availability • Adaptability • And patient safety and quality

have been adhered to.

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3.0 SCOPE 3.1 This Strategic Plan covers all groups of staff employed by NHS Fife. Whilst the

Strategic Plan recognises the links with and dependencies upon GP practices, it does not include these staff.

3.2 Board Profile

3.2.1 The Kingdom of Fife is a peninsula in eastern Scotland with a coastline of 170 kilometres (105 miles) bounded by the Firth of Forth to the South and the Firth of Tay to the North. It is the third largest local authority area in Scotland and has the advantage of NHS Fife and Fife Council sharing the same boundaries.

3.2.2 NHS Fife is a progressive Health Board and has adapted over recent years

to meet the fast pace of change within health, to enable citizens to improve their own health and the health of others whilst providing the highest quality of care. Examples of recent development include the opening of a new Community Hospital in St Andrews, the New Wing at Victoria Hospital Kirkcaldy where all Acute in-patient services are now centralised, the Assessment and Treatment Unit and Regional Learning Disabilities Unit at Lynebank Hospital, Dunfermline, and the new Mental Health Units at Stratheden Hospital.

3.2.3 NHS Fife works in partnership with our population, our patients, our staff,

Fife’s Primary Care contractors and their teams and our colleagues in Fife Council and the third sector. For a number of specialist services, we rely on the neighbouring Health Boards and principally work with NHS Lothian and NHS Tayside to maintain healthcare arrangements by working together to benefit the people of Scotland.

3.2.4 Services are provided in people’s homes and from a range of locations and

premises across NHS Fife to ensure our prime responsibility for the protection and improvement of our populations health is achieved through the delivery of frontline health care services at the time and place most appropriate for these needs.

3.2.5 NHS Fife is currently made up of the Operational Division and 3

Community Health Partnerships (CHPs) and certain Corporate Directorates such as Finance, Human Resources etc.

3.2.6 The Operational Division consists of the Victoria Hospital, Kirkcaldy and

Queen Margaret Hospital, Dunfermline.

3.2.7 The Victoria Hospital, Kirkcaldy is a large District General Hospital which has recently been transformed with the opening of the new wing. The hospital provides a full range of general hospital services to the residents of Fife. There is a critical care area consisting of an Intensive

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Care Unit and both Medical and Surgical High Dependency Units. Fully equipped endoscopy rooms operate throughout the week. The new wing of the hospital also includes the Obstetric Unit for the whole of Fife.

On the VHK site:

• In-Patient Services – (General Medicine / MHDU, Anaesthetics /

ICU / SHDU, Elderly Medicine, General Surgery, Cardiology / CCU, Vascular Surgery, Nephrology, Orthopaedics / Trauma, Respiratory Medicine, Elective Orthopaedics, Gastroenterology, Maxillofacial Surgery, Diabetes / Endocrinology, Urology, Stroke Medicine, Ophthalmology, Infectious Diseases, ENT, Palliative Care / Hospice, Obstetrics and Gynaecology, Haematology and Medical and Surgical Paediatrics).

• Out-Patient Services – (As above, and in addition, clinics for

Dermatology, Thoracic Surgery, Plastic Surgery, Neurology, Radiation Oncology, Medical Oncology, GU Medicine, Rheumatology, Rapid Access TIA Clinic and Movement Disorders).

• Radiology – (In addition to General Radiology, there are facilities

for Digital Screening, Ultrasound, Radioisotope Scanning and DEXA Scanning. Specialist Vascular Interventional Radiologists for Nephrostomies, Angiography and Embolisation are available. New Spiral CT and MRI Scanners have recently been installed).

• Radiotherapy / Oncology – (Oncology Services are provided

from the Western General Hospital, Edinburgh. Clinical Oncologists with special interests in most cancers hold large outpatient clinics each week).

• Theatres – (There are 8 main theatre suites within the new build,

including a dedicated fully staffed 24 hour emergency theatre).

• Regional Laboratory Service – (The Fife Regional Laboratory is on site. The department provides a comprehensive service in Haematology, Immunology, Histopathology, Cytology, Microbiology and Clinical Chemistry on a Fife-wide basis. The Microbiology Department provides an overall Microbiological Surveillance System throughout the region. Departments previously on the Queen Margaret and Forth Park sites have moved onto the Victoria site with all departments now either in the reconfigured existing laboratory or newly built laboratory).

• Allied Health Professional Services

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3.2.8 Queen Margaret Hospital, Dunfermline, provides 24 hour Minor Injuries

Services, providing treatments for less serious injuries. In addition to the Minor Injuries Unit there are also a number of wards and services operating from the Queen Margaret:

Wards:

• Ward 5 –Elderly Rehab Inpatients • Ward 6 – General Rehab / Stroke Rehab Inpatients • Ward 16 – Hospice Inpatients • Ward 21 – Renal outpatients • Ward 15 – Dermatology • Ward 7 – Care of Elderly • Mental Health in-patient beds managed by Kirkcaldy & Levenmouth

CHP

Services:

• Diabetes • Haematology Day Unit • Pulmonary Function • Theatres • Breast Surgery • Outpatients • Allied Health Professional Services

3.2.9 Other Hospitals managed by the CHPs include:

Stratheden Hospital, (Mental Health Services), Randolph Wemyss Memorial Hospital, Whyteman’s Brae Hospital, Adamson Hospital, St Andrews Community Hospital, Cameron Hospital, Lynebank Hospital and Glenrothes Hospital. Our community hospitals provide local services in the community to meet the needs of service users. The model of care in the community is evolving to better represent the needs of services and users.

3.2.10 Dunfermline and West Fife CHP

Dunfermline and West Fife CHP comprises the following services:

• Care of the Elderly • Community Child Health • Community Nursing • Continence Service (Fife-wide) • Health Improvement Team • Learning Disabilities (Fife-wide) • Occupational Therapy

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• Primary Care Emergency Services (Fife-wide) • Speech & Language Therapy (Fife-wide) • Community Pharmacy • Podiatry • Physiotherapy • Clinical Psychology (Fife-wide) • Professional & Practice Development (Primary Care)

3.2.11 Kirkcaldy and Levenmouth CHP

Kirkcaldy and Levenmouth CHP comprise the following services:

• Public Health Nursing • Community Nursing • Physiotherapy • Occupational Therapy • Podiatry • Integrated Response Teams (health component) • Enhanced Healthcare Team • Community Hospital Services • Community Access to Outpatient & Diagnostic Services • Support to Community Based Services provided by the voluntary

sector • Contraceptive & Sexual Health Services (Fife-wide) • Dietetics & Nutrition • Older Peoples Services, including those in:

- Randolph Wemyss Hospital - Cameron Hospital

• Fife Rehabilitation Service • Rheumatology Service • Mental Health Service including Child & Adolescent Mental Health

and Addiction Services

3.2.12 Glenrothes and North East Fife CHP Glenrothes and North East Fife CHP comprises the following services:

• Community Hospitals (St Andrews, Adamson, Glenrothes) • Community Nursing • Podiatry • Occupational Therapy • Physiotherapy • Community Dental Services (Fife-wide) • Palliative Care (Fife-wide) • Community Equipment (Fife-wide) • Health Promotion

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3.3 Links with Other Boards 3.3.1 For a number of specialist services, NHS Fife relies upon

neighbouring Health Boards either as an individual Board or as a Regional Service to maintain healthcare arrangements and work together to benefit Fife patients.

3.3.2 Some examples are:

• Residents of North East Fife often access services in NHS

Tayside due to its closer proximity • ENT services outside core Monday – Friday hours is

provided by NHS Tayside due to limited medical staff availability in Fife

• Medical staff in-put for Learning Disabilities is provided by NHS Lothian

• Plastic Surgery is provided by NHS Tayside • Complex Vascular Surgery cases are treated by NHS

Tayside with NHS Fife surgeons participating in the Rota 4.0 OWNERSHIP 4.1 Method

In drafting this Plan, Leads were identified from the 3 CHPs and the Operational Division to co-ordinate input from all services and covering all staff groups. In addition representatives were identified to take the lead in respect of input from Finance, Strategic Planning, Public Health, OD & Learning as well as professional overview input from AHPs, Nursing & Midwifery and Medical staff. These Representatives together with the Deputy Director of Human Resources (Workforce Modernisation) and Staff Side Representation from the Employee Director formed a Short Life Working Group to take the drafting of the Strategic Plan forward.

4.2 The Leads from the CHPs and Operational Division were also required to ensure the involvement of local Staff Representatives through the relevant LPF. 4.3 On a Fife-wide basis the APF were kept informed and involved in the content of

the Plan.

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4.4 Timetable

A timetable was set out at the outset to ensure that all relevant groups were informed / consulted / included as appropriate as outlined below:

Date

Group

Action

23 January 2012 SMT Paper

20 February 2012 SMT Workforce High level Template / Framework for discussion

20 April 2012 APF Robust draft of Plan for comment

18 May 2012 APF (Staff Side) Draft of plan incorporating comments received

21 May 2012 SMT Workforce Draft of Plan incorporating comments received

31 May 2012 Staff Governance Committee

Final Draft for approval

22 June 2012 APF Final Draft for information

26 June 2012 NHS Fife Board Final Draft for approval

30 June 2012 Requirement to publish on Board website

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5.0 UPDATE ON WORKFORCE MODERNISATION & DEVELOPMENT PLAN 2010/11 5.1 General Hospitals and Maternity Services (GH&MS)

5.1.1 A significant feature of the previous Strategic Plan and indeed those of previous years was the plan to move all in-patient acute services to one site, Victoria Hospital, Kirkcaldy following a large PPP new build extension to the existing site. This would be matched with a state of the art Diagnostic and Treatment Centre at Queen Margaret Hospital, Dunfermline together with day case surgery and out-patient facilities.

5.1.2 Much of the workforce plans were based on this in terms of new ways of

working and in some cases it was envisaged as a solution to some workforce issues, such as no longer having to run multiple (2 or 3) rotas in some specialties putting a strain on a scarce resource.

5.1.3 Services were transferred into the new reconfiguration over December

2011 / January 2012. This has indeed eased the situation particularly for certain medical staff specialties now that they do not need to cover so many sites.

5.1.4 The need for some additional staff was identified under GH&MS and most

of these have now been recruited. The staff groups concerned included nurses, nursery nurses, domestics, porters, emergency nurse practitioners, radiographers. Due to changes elsewhere some of these posts were filled through redeployment of “at risk” staff and elsewhere it provided opportunities for existing staff as well as some external recruitment. A significant number of staff was required to move from Dunfermline to Kirkcaldy to work and this was successfully achieved without the need for any staff to be placed on the Redeployment Register. This was a result of excellent partnership working and flexibility from all parties.

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SECTION 2: SERVICE CHANGE

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SECTION 2 : SERVICE CHANGE 1.0 POPULATION PROFILE 1.1 As at June 2010 the total population of Fife was estimated to be around 364,000

people, the highest ever estimate, accounting for 7% of the Scottish population. This represents the seventh largest population of all Health Board areas but with an area of 1,325 km2 Fife is the third most densely populated health board in Scotland. Fife’s total population grew by 1,560 people (0.4%) between 2009 and 2010 which places Fife slightly below the Scottish national growth rate of 0.5%. However the overall population growth in Fife since 2000 was greater than that reported for Scotland at 4.8% compared to 3.1%.

1.2 Housing development is a major influence on population growth. The numbers of

births in Fife are increasing which is against the Scottish picture. The population is growing more slowly than originally thought as intra-EU migration has greatly reduced. The absolute numbers and the proportion of the elderly in Fife is likely to continue to increase. More accurate data will become available from the 2011 census. Current projections are likely to be inaccurate as they are derived from the 2001 census. The changing age structure of the population will affect the demand for services and while it will require additional community investment, the need for acute hospital care for the elderly will not reduce. About 6% of acute geriatric admissions are probably avoidable if significant investment in community resources is made. There is going to be an increasing need for geriatric consultants and their associated teams. The disease and indeed age profile in Fife is broadly similar to that for Scotland as a whole.

1.3 Within Fife, 19% of males and 17% of females are aged under 16. 65% of males

and 57% of females are of working age which is 2% less than the Scottish average. The proportion of males and females of pensionable age in Fife continues to steadily increase with 16% of males and 26% of females being of pensionable age in 2010 (a figure 1% higher than the Scottish average) compared to 14% and 25% in 2007 and 13.8% and 23.7% in 2001 respectively.

1.4 The ‘dependency ratios’ within the Fife population show how many working age

people there are in Fife compared to potential dependants defined as those who are children or of pensionable age.2 In 2010 there were 1.55 working age adults to every one dependant compared to a ratio of 1.66:1 in 2006. During this time the percentage of children in Fife has decreased whilst the proportion of people of pensionable age has increased.

1.5 The 2008 based population projections estimate that between 2008 and 2033 the

population of Fife will increase by 10.1% to 398,533. The number of children and working age people is projected to increase by 1.6% and 3.9% respectively while the number of pensionable age Fife residents will increase by 37% between 2008 and 2033. In the same time period dependency ratios in Fife are predicted to decline from 1.6 working age adults to every one dependant in 2008 to 1.4:1 in 2033.

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1.6 The Health and Wellbeing Profiles for each of the Board’s 3 CHPs as published by the Scottish Public Health Observatory (ScotPHO) in 2010 are provided below.

1.7 Dunfermline and West Fife CHP 1.7.1 Population Profile

Dunfermline and West Fife CHP has an estimated total population of 142,184. The percentage of the population aged 0-15 years is higher than the Scotland average (19.0%, compared to 17.6%) and the live birth rate is also above average. The percentage of the population who are of working age is lower than average, as is the percentage aged 75 and over (7.0%, compared to 7.7%).

1.7.2 Life Expectancy & Mortality

Male life expectancy is significantly better than the Scotland average and female life expectancy is not significantly different to the Scotland average. All-cause mortality (all ages), and mortality rates from coronary heart disease, cancer and cerebrovascular disease (under-75s) are not significantly different to Scotland.

1.7.3 Behaviours

In Fife, an estimated 26.0% of adults smoke, compared to 25.0% in Scotland as a whole. In Dunfermline & West Fife CHP, there have been 316 deaths from alcohol conditions in the last five years, giving a death rate significantly better than (below) the Scotland average. The proportions of the population hospitalized with both alcohol conditions and drug related conditions are better (lower) than average. Meanwhile, active travel to work and sporting participation in Fife are significantly worse (lower) than the Scotland average.

1.7.4 Ill Health and Injury and Mental Health

In the CHP, diabetes prevalence is significantly worse than average. All other ill health and injury indicators are significantly better than, or not significantly different to, the Scotland average. For patients hospitalized with cerebrovascular disease, and for patients hospitalized as an emergency, the CHP is significantly better (lower) than average. In Dunfermline and West Fife CHP, drug prescribing for anxiety, depression or psychosis is significantly lower than the Scotland average (8.9%, compared to 9.7% in Scotland) and for patients with a psychiatric hospitalization the rate is also significantly better (lower) than average.

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1.7.5 Social Care and Housing

In Fife, 18.8% of older people with intensive care needs are cared for at home, rather than in care homes or geriatric long-stay hospital beds (Scotland 31.7%). In Fife Council area, 5.3% of older people receive free personal care at home (Scotland 5.3%). In Dunfermline and West Fife CHP, the percentage of single adult dwellings is 36.8% (Scotland 37.8%). In Fife Council area, the percentage of households in extreme fuel poverty is significantly worse than average.

1.7.6 Education and Economy

The average tariff score of all pupils on the S4 roll is 169.6 in this CHP (Scotland 179.7). The percentage of the population who are income deprived is significantly better than average (13.9%, compared to 15.1%). The percentage of the working age population claiming Job Seeker’s Allowance is significantly worse than average (4.9%, compared to 4.4%) as is the percentage who are employment deprived.

1.7.7 Crime and Environment

The crime rate in Dunfermline and West Fife is significantly better (lower) than average. The rate of referrals to the Children’s Reporter for violence-related offences is the lowest of any CHP. Less than 6.0% of the population live in the 15% most “access deprived” areas in Scotland (Scotland 14.2%). In Fife, 48.0% of adults rate their neighbourhood “a very good place to live” (Scotland 52.0%).

1.7.8 Women’s and Children’s Health

In Dunfermline and West Fife CHP, breast screening uptake is significantly worse (lower) than average (73.0%, compared to 75.3%). The percentage of mothers smoking in pregnancy is also significantly worse (higher) than the Scotland average (24.2%, compared to 22.6%). For all other women’s and children’s health indicators, the area is either significantly better than, or not significantly different to, the Scotland average.

1.8 Kirkcaldy and Levenmouth CHP 1.8.1 Population Profile

Kirkcaldy and Levenmouth CHP has an estimated total population of 97,123. The percentage of the population aged 0-15 is higher than the Scotland average (17.9%, compared to 17.6%) as is the percentage aged 75 and over (8.9%, compared to 7.7%). Meanwhile, the percentage of the population who are of working age is lower than average.

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1.8.2 Life Expectancy and Mortality

Male and female life expectancies are not significantly different to Scotland. All-cause mortality (all ages), and mortality rates from coronary heart disease, cancer and cerebrovascular disease (under-75s), are not significantly different to the Scotland average.

1.8.3 Behaviours

In Fife, an estimated 26.0% of adults smoke (Scotland 25.0%). In Kirkcaldy & Levenmouth CHP, the death rate from alcohol conditions is not significantly different to Scotland. The proportion of the population hospitalized with alcohol conditions is not significantly different to Scotland. The proportion of the population hospitalized with drug related conditions is the fourth highest of any CHP. In Fife, active travel to work and sporting participation are significantly worse (lower) than average.


The CHP has an incidence of cancer not significantly different to the Scotland average. Diabetes prevalence is significantly worse than average. The proportion of the population hospitalized with asthma is also significantly worse than Scotland. For patients aged 65 and over with multiple hospitalizations, and for road traffic accident casualties, the proportions of the population hospitalized are significantly better (lower) than average. The area is not significantly different to Scotland on the three mental health indicators, with, for example, 9.6% of patients prescribed drugs for anxiety, depression or psychosis (Scotland 9.7%).


In Fife, 18.8% of older people with intensive care needs are cared for at home, rather than in care homes or geriatric long-stay hospital beds (Scotland 31.7%). In Fife, 5.3% of older people receive free personal care at home (Scotland 5.3%). In Kirkcaldy & Levenmouth CHP, the percentage of single adult dwellings is 42.8% (Scotland 37.8%). In Fife, the percentage of households in extreme fuel poverty is significantly worse than average.

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In Kirkcaldy and Levenmouth CHP, the average tariff score of all pupils on the S4 roll is 167.9 (Scotland 179.7). The percentage of the population who are income deprived is significantly worse than average (18.6%, compared to 15.1%). The percentage of the working age population claiming Job Seeker’s Allowance is the third highest of any CHP (6.1%, compared to a Scotland average of 4.4%).


The area’s crime rate is the fourth highest of any CHP. Over 37.0% of the population live within 500m of a derelict site (Scotland 30.0%). Less than 5.0% of the population live in the 15% most “access deprived” areas in Scotland (Scotland 14.2%). In Fife, 48.0% of adults rate their neighborhood “a very good place to live” (Scotland 52.0).


In Kirkcaldy and Levenmouth CHP, breast screening uptake is significantly worse (lower) than average (73.0%, compared to 75.3%). The percentage of mothers smoking in pregnancy is the fourth highest of any CHP (29.8%, compared to a Scotland average of 22.6%). The percentage of babies exclusively breastfed at 6-8 weeks is 24.5% (Scotland 26.4%). Child dental health in Primary 1 is significantly worse than Scotland. The under 18 teenage pregnancy rate is the second highest of any CHP.

1.9 Glenrothes and North East Fife CHP

1.9.1 Population Profile

Glenrothes and North East Fife CHP has an estimated total population of 124,153. The percentage of the population aged 0-15 years is lower than the Scotland average (16.5%, compared to 17.6%). The percentage of the population who are of working age is similar to Scotland. Meanwhile, the percentage of the population aged 75 and over is higher than average (8.1%, compared to 7.7%).

1.9.2 Life Expectancy and Mortality

Male and female expectancies are both significantly better than the Scotland average. All-cause mortality (all ages), and mortality rates from coronary heart disease, cancer and cerebrovascular disease (under 75s), are all significantly better than, or not significantly different to, the Scotland average.

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1.9.3 Behaviours

In Fife, an estimated 26.0% of adults smoke, compared to 25.0% in Scotland. In the CHP, there have been 238 deaths from alcohol conditions in the last five years, giving a death rate the fourth lowest of any CHP. The proportions of the population hospitalized with both alcohol conditions and drug related conditions are better (lower) than average. Meanwhile, active travel to work and sporting participation in Fife are significantly worse (lower) than the Scotland average.


The CHP has an incidence of cancer amongst the lowest of any CHP. For patients hospitalized with chronic obstructive pulmonary disease (COPD) Glenrothes and North East Fife is the sixth best (lowest) of all the CHPs. For patients hospitalized with coronary heart disease and cerebrovascular disease, for patients hospitalized as an emergency, and patients aged 65 and over hospitalized following a fall in the home, the proportions of the population hospitalized are also significantly better than average. The area is significantly better than Scotland on all ill health and injury and mental health indicators. For example, 9.0% of patients are prescribed drugs for anxiety, depression or psychosis (Scotland 9.7%).


In Fife, 18.8% of older people with intensive care needs are cared for at home, rather than in care homes or geriatric long-stay hospitals beds (Scotland 31.7%). In Fife, 5.3% of older people receive free personal care at home (Scotland 5.3%). In Glenrothes and North East Fife CHP, the percentage of single adult dwellings is 33.2% (Scotland 37.8%). In Fife, the percentage of households in extreme fuel poverty is significantly worse than average.


In Glenrothes and North East Fife CHP the average tariff score of all pupils on the S4 roll is 175.2 (Scotland 179.7). The secondary school attendance rate is significantly worse (lower) than average. The area is significantly better than Scotland on all economy related indicators, with, for example, 3.4% of the working age population claiming Job Seeker’s Allowance (Scotland 4.4%).

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The area’s crime rate is significantly better (lower) than average. The percentage of the population living within 500m of a derelict site is 30.3% (Scotland 30.0%). The percentage of the population in the 15% most “access deprived” areas in Scotland is worse than average (20.5%, compared to 14.2%). In Fife, 48.0% of adults rate their neighborhood “a very good place to live” (Scotland 52.0%).


In Glenrothes and North East Fife CHP, breast screening uptake is significantly better than average (78.3%, compared to 75.3%). The percentage of babies exclusively breastfed at 6-8 weeks is also significantly better than the Scotland average (31.0%, compared to 26.4%). MMR immunization uptake at 24 months is significantly better than average. Child dental health in Primary 1 is also significantly better than the Scotland average.

2.0 CURRENT AND FUTURE FINANCIAL ISSUES 2.1 The current economic climate requires NHS Fife to consider best value and to

consider cost reduction in all areas. As a significant element (41% of allocation) of our budget is spent on workforce it naturally follows that this area also has to be considered for cost reduction. Opportunities for new ways of working and optimizing workforce efficiency and productivity are therefore key. This is not however at the expense of patient safety which continues to be a prime consideration.

2.2 Efficiency Savings Plan Efficiency Savings Schemes continue to be required and identified across NHS

Fife. At the current time those schemes that have identified changes in wte staffing is attached at Appendix 1.

3.0 SERVICE CHANGE / REDESIGN 3.1 Modernising Nursing in the Community

3.1.1 Within NHS Scotland there is a clear need to ensure efficient and effective use of resources and services within community nursing. This must be aligned to the appropriate use of knowledge and skills to deliver against agreed corporate priority areas to support health improvement, patient safety and quality care delivery.

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3.1.2 In view of current priorities to increase care delivery within the

community, support health promotion and protection, tackle health inequalities, support long term conditions management and delivery anticipatory care, there was an identified need to consider the future delivery model for Community Nursing Services.

3.1.3 Community Nursing Services require to be focused and designed to

deliver the following:

• National Strategy • NHS Fife corporate priorities including HEAT targets and the

Balanced Scorecard • NHS Fife Strategies (including partnership working) • Local population health needs • Multi-disciplinary and multi-agency working which is person centred,

safe and effective

3.1.4 There is agreement and commitment to develop a shared Fife vision and associated work plan that can be delivered flexibly to meet local needs within the CHPs focusing on the four following priority areas within the Balanced Scorecard:

• Health Improvement • Staff and Patient Experience and Safety • Planning for service improvement • Delivery efficiency

3.1.5 The Public Health Nursing and District Nursing Frameworks were

developed within NHS Fife to deliver the following:

• Define the core work for Community Nursing Services which will focus on these priority areas

• Ensure that where relevant, core work is aligned to strategy and targets and that delivery against this can be evidenced

• Develop a work plan that outlines priorities for service redesign and/or health improvement

• Engage the workforce in developing and delivering this work

3.1.6 Skill mix has been introduced into the Community Nursing Teams, for a number of years now, however, it is recognised that this work requires to be built on and a detailed plan clarifying future action developed. Currently, as each vacant post comes up, a review is undertaken to determine the best option for replacing the post and skill mix is introduced wherever possible. This may result in the development of new roles and reallocation of work including non-nursing tasks being performed by Admin and Clerical Staff.

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3.1.7 Public Health Nursing (Health Visiting)

3.1.7.1 Dunfermline and West Fife CHP have undertaken a review of caseload numbers taking account of Health Plan Indicators (HPI). This has resulted in the redeployment of some staff across the CHP to establish equity within teams.

3.1.7.2 Lead Nurses are currently clarifying the time Band 6 staff allocate

to undertaking childhood immunisations. Alternatives will then be considered.

3.1.8 Public Health Nursing (Young People – School Nurse)

3.1.8.1 Where possible integration of Public Health Nursing Young People with Public Health Nursing Teams has taken place within neighbourhoods.

3.1.8.2 Within Dunfermline town, skill mix has been implemented and a

reduction in Band 7 staff achieved. A review of the work of this team is currently underway.

3.1.9 District Nursing

3.1.9.1 Lead Nurses are currently reviewing the practice populations and wte staffing at each base to establish the future staffing structure required. This has resulted in the redeployment of staff across Dunfermline and West Fife CHP to establish equity.

3.1.9.2 The number of Band 6 staff at each base has been reviewed and

where possible a move to ensure one Band 6 per practice has taken place. This approach will continue.

3.1.9.3 There has also been a reduction in Bands 6 and 7 working unsocial

hours.

3.1.9.4 Additional work is currently ongoing in relation to the following:

• Nursery Nurses being more widely used • Consideration being given to pooling the Band 5 Staff Nurses

to work across neighbourhoods • Consideration being given to introducing a Band 5

Immunisation Team to free up Band 6 time • Recruitment for the Intermediate Care and Support Service

Team nursing staff has taken place

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3.1.9.5 A detailed action plan identifying how Dunfermline and West Fife CHP will further modernise nursing in the community will be produced and widely circulated to staff and GP practices. Discussion regarding implementation will take place within Locality Team meetings in the near future.

3.1.9.6 The Modernising Nursing in the Community Toolkit and

Workforce Planning Tools will continue to be used locally to determine future staffing requirements.

3.2 Family Nurse Partnership (FNP)

3.2.1 The FNP is an evidence based, preventative programme offered to young

mothers having their first baby. It begins in early pregnancy and is orientated to the future health and well-being of the child. It is a nurse-led, intensive, home visiting programme and supports universal services in supporting teenage families.

3.2.2 In January 2012 the Scottish Government FNP National Implementation

Team delivered a presentation to the Strategic Nursing Team and a cohort of senior nurses within NHS Fife which highlighted the core elements of this programme. This allowed participants to gain an understanding of what it means to become a Family Nurse Partnership site.

3.2.3 Following this presentation and an initial discussion at SMT it was agreed

that NHS Fife would submit an Expression of Interest to the Scottish Government to become a Family Nurse Partnership site in 2012.

3.2.4 This bid was submitted in February 2012 and on 9 March 2012 the Nurse

Director NHS Fife was informed that, after careful consideration by the Scottish Government Expert Panel, it had been decided to accept the application from NHS Fife to proceed to Phase 1 with the FNP Programme. An early implementation date of May 2012 was requested by the Scottish Government.

3.2.5 Specific measures for Improvement will be determined and agreed with

the Scottish Government. These will be consistent with improvement measures in place in other UK test sites.

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3.2.6 These measures are likely to focus on:

• Improving the outcome of pregnancy by supporting women to improve their prenatal health

• Improving child health and development by supporting parents to provide more competent care of their children in the first 2 years of life

• Improving families’ economic self-sufficiency by supporting parents to develop a vision of the future, accomplish goals by planning timing of pregnancies and staying in school/finding work

3.2.7 All staffing and training costs will be met by the Scottish Government for

three full years. 3.2.8 Sustainability of the Programme (following satisfactory evaluation)

requires to be achieved via the redesign of current mainstream provision. 3.2.9 NHS Fife will contribute through the input of senior staff time to initiate

implementation and monitor achievement. Accommodation and equipment for FNP team members will also be provided.

3.2.10 Work has been undertaken to develop job descriptions for one Family

Nurse Partnership Supervisor post and four Family Nurses. These posts have currently been advertised and dates set for interview. Initial training for those appointed to the post will take place in May 2012. Further training is scheduled for June and November 2012.

3.3 Learning Disability Services

3.3.1 The Learning Disability Service, as with current trends throughout

Scotland, will lose a significant number of experienced staff in the next few years.

3.3.2 With an ageing workforce, many of the staff can retire if they wish, at 55

years of age. Consequently, we need to continue to maintain the establishment at the current level to ensure the service delivers safe, high quality nursing to the patients within our care.

3.3.3 There may be difficulty in recruiting to these posts in the future, though

currently retention of staff is high.

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3.3.4. Repatriation of Patient

The Learning Disability Service is currently in the process of planning for the repatriation of a patient. This will have a significant effect on recruitment to the Learning Disability Service as the individual requires a substantial number of staff to work in supporting care needs. The anticipated staffing establishment requirements are as follows;

• 20.0 wte nursing staff (mixture of trained and unqualified staff) • 0.1 wte Consultant Psychiatrist • 0.5 wte Occupational Therapist • 0.2 wte Clinical Psychologist • 0.5 wte Charge Nurse

3.3.5 Assistant Practitioner

The Learning Disability Service has recently completed a pilot for the Assistant Practitioner Project Group, in partnership with colleagues from NHS Tayside. Three staff have successfully participated in this pilot and are now working at this higher level within the Learning Disability Service. The Service will continue to work with NHS Tayside in taking this initiative forward in the future.

3.3.6 Other areas will now consider the appropriateness of developing staff to

Assistant Practitioner level. 3.4 Primary Care Emergency Services

3.4.1 Nursing staff within PCES undertake training to enable them to become Urgent Care Practitioners (UCPs). They work alongside GP colleagues to provide rapid access to appropriate assessment and treatment. The next stage in this development is to look at the skill mix of this group of staff and how PCES and the Minor Injuries Unit at Queen Margaret Hospital, work more closely together.

3.4.2 The PCES current service redesign programme has a planned

implementation date of 2012-2013 which will potentially impact on the workforce. The remodelling of the service, potential withdrawal of the See and Treat Service and the GH&MS changes, which have increased joint working, may all impact on the staffing profile.

3.4.3 There will be an overall reduction in GP’s when full service redesign is

complete. A reduction in sessional GP’s and the introduction of a salaried GP cohort will be established.

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3.4.4 Salaried GPs will be able to support the clinical audit and governance programme within PCES and participate in the clinical supervision/peer review process for non –medical staff.

3.4.5 With the reduction in medical staffing there is the potential to increase

UCP staffing levels. This also gives PCES an opportunity to introduce a lower grade UCP role which would be supervised through a professional development programme whilst offering a career development pathway. This would also increase eligibility to apply for these posts.

3.5 Salaried GPs

3.5.1 Linburn Road is likely to require further expansion of GP’s and other staff as the Practice population continues to increase. The practice is working towards becoming an independent practice in the foreseeable future.

3.6 Reshaping Care for Older People

3.6.1 The principle goal of the Reshaping Care for Older People programme is to optimise independence and wellbeing for older people at home or in a homely setting. The implications of the current financial situation and demographic changes make this a challenging task, as an increasing number of people will require improved service, care and support.

3.6.2 It is widely recognised that maintaining the status quo will not suffice and

significant shifts to anticipatory and preventative approaches are required to achieve and sustain better outcomes for older people.

3.6.3 Redesigned models of care will need to support the anticipated, significant

increase in demand for older people’s services and ensure that there is a considerable shift in the “balance of care” to allow people to be cared for at home. This change will need to be made across partnership services.

3.6.4 The changes have been articulated as:

• Changes in the bed modelling and numbers of beds across Acute and Community Hospitals

• Remodelling of Intermediate Care Services • The addition of Hospital at Home Services • Redesign of Home Care Services to move to reablement as a focus • The use of an Integrated Resource Framework to closer align resources

across partnerships to support change

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3.7 Intermediate Care & Support Services (ICASS) 3.7.1 The introduction of a new Model of Care to reshape care for older people

within Fife in the community has been planned and implemented to provide a new Hospital at Home Service which integrates with existing Intermediate Care Services and Reablement (Home Care Services).

3.7.2 There are a number of component parts required for delivery of this new

model;

a) Community Virtual Ward:

The concept of the virtual ward is to try to perceive the image of patients being “admitted” into a level of clinical care equivalent to that which they would receive in a hospital ward, and above what would normally be delivered within their own home.

Patients will not be admitted to a bed in a hospital building, but will be maintained in their own “bed” being cared for by highly specialist teams in the community.

b) Hospital at Home Team:

Patients “admitted” to the virtual ward will be addressed and managed initially by a member of the Hospital at Home Team.

Staff will provide a level of initial assessment that would have been expected in a hospital building previously. This includes clinical examination, blood tests and ECG’s. The team within Hospital at Home consists of Consultant Geriatricians, General Practitioner/Clinical Assistant Support, Nurse Practitioners and Clinical Support Workers.

c) Intermediate Care:

Intermediate Care teams will have two levels of responsibility. They will be an integral part of ICASS supporting and working alongside the Hospital at Home.

When a patient is being assessed by the Hospital at Home Team it may be considered that, as part of their care, they require the support of a Physiotherapist, a District Nurse and Home Care, this will be provided by the Integrated Care Team.

Integrated Care Teams will also have referrals to their caseload from other sources for patients who do not require the specialist skills of Hospital at Home teams but require the breadth of expertise of care contained within their teams.

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Homecare reablement seeks to support people and maximise their level of independence, in order to appropriately minimise their needs for ongoing homecare support. This includes clients who may have undergone a phase of Integrated Care but also people who remain within the community requiring support to live at home and have not gone near hospital or long term care placements. This model of care will result in inpatient bed reconfiguration and staffing resources shifting from hospital settings to community. The potential impact on Radiology may result in a need to increase Radiographers as the shift in care takes place so as to deliver a timely service. The implementation of this new model (ICASS) is planned across Fife during 2012 with initial implementation planned for Dunfermline & West Fife followed by Glenrothes & North East Fife CHP and finally Kirkcaldy & Levenmouth CHP (dates to be confirmed). The development of ICASS was, in the majority, the biggest part of Fife’s Reshaping Care Change Plan for 2011 / 2012. A new revised plan for 2012 / 2013 will consolidate the changes made in 2011 / 2012 and will continue to build on the wide range of work already underway. In particular the Fife Partnership will seek to incorporate the tertiary and Independent Sectors and to engage fully with public and carers to develop plans for Older People’s Services.

3.8 Children’s Services

3.8.1 Integrating Children’s Services at the point of deliver is a priority for NHS Fife. Workforce Planning for Doctors is considered on a regional level as well as a local level in an attempt to sustain the provision of medical services for children.

3.8.2 Fife, along with other Boards, has to adapt to a national shortage of

paediatricians by developing other aspects of the workforce e.g. AHP’s and Advance Nurse Practitioners.

3.8.3 Children’s Services in the community have only over the past year

reached a position where all of the paediatrician posts have been filled. There are now 2 wte Consultant and 10.2 wte Speciality Doctors delivering services in the community.

3.8.4 The Fife service is delivered across a number of community setting

providing general clinics which include, developmental delay, behaviour management, ASD and ADHD.

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3.8.5 In addition there remain a number of specialisms. These include:

• Adoption and Fostering • Audiology • Vision • Downs Syndrome

3.8.6 There is a specialist nursing service which provides services for children with complex needs at home. This is focussed on four categories of need.:

• Specialist medical needs • Learning disability • ADHD • ASD

3.8.7 The Team appointed a nurse who is currently training to take on the role

of Advanced Nurse Practitioner and who will take up post in September 2012.

3.9 Mental Health

3.9.1 Work is in progress on the development of a Low Secure Forensic Unit for Mental Health Services. It is anticipated that due to service redesign staff from other parts of Mental Health Services will be retrained to work in the Unit once it is established.

3.10 Rehabilitation Services

3.10.1 As part of the design of the service it is anticipated that there will be a reduction in establishment.

3.11 Community / Salaried Dental Service

3.11.1 NHS Fife continues to follow the National Strategic Plan for Dentistry which includes a 10% revision of Dentist and Dental Therapist skill mix over the next 5 years. This will result in a commensurate shift in staffing from the current Dental Officer provision to Dental Therapy teams. Previous issues around the recruitment and retention of Dentists are therefore expected to be minimised together with a significant and continued improvement in access to dental services.

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3.12 Chemotherapy

3.12.1 Repatriation of Chemotherapy patients from Lothian and the provision of an outreach service are expected to require additional medical, nursing and pharmacy staffing. The new regimes are now known and the impact is being determined. This service change will benefit patients by reducing their need to travel to Edinburgh and reduce potential admissions to hospital.

3.13 Orthopaedics

3.13.1 Orthopaedic service redesign and implementation of patient pathways across primary and secondary care. This will particularly impact on the physiotherapy service.

3.14 EEG / ECG Technicians

3.14.1 Flexibility of Respiratory and Cardiology Healthcare Scientists to work generically across specialties will change the profile of staff, requiring more at a basic level and less at higher grades. This increase in flexible working will afford patients simpler access to respiratory and cardiology diagnostic services and will provide additional opportunities for staff to increase their knowledge base.

3.15 Renal Dialysis

3.15.1 Renal Dialysis provision continues to expand and future changes include repartriation of transplant patients and home dialysis provision. This will require additional medical, nursing and AHP staff.

3.16 Advanced Nurse Practitioners

3.16.1 There are already a number of nurses working at advanced practice level within the Operational Division. These include teams of Hospital at Night ANPs, Emergency Nurse Practitioners (ENPs) working within the Emergency Department providing a Nurse Led Minor Injury Service, Medical and Surgical ANPs, Advanced Neonatal Nurse Practitioners, Advanced Paediatric Nurse Practitioners, Care of Older Person / Stroke ANP, Nurse Endoscopists and a newly appointed ANP supporting patients with a cancer diagnosis when they are admitted to hospital. These roles will continue to develop and new roles introduced, supporting medical and nursing staff. The longer term plan will be to provide additional Advanced Nursing Practitioner roles that provide advanced nursing and technical roles within Emergency Care, Ambulatory Care and Planned Care.

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3.17 Surgery

3.17.1 Redesign of Surgical Admissions ward to a 5 day ward will result in a reduced establishment.

3.17.2 The introduction of Enhanced Recovery across surgical specialties (shorter length of stay) 3.18 Midwife Led Unit

3.18.1 The GH&MS Plans include a Midwife Lead Unit at the Queen Margaret Hospital, Dunfermline.

3.19 Laboratory Services

3.19.1 A redesign of the Laboratory Services in line with GH&MS has identified savings from a skill mix review and realignment of management posts.

3.20 Pharmacy Services

3.20.1 Following relocation of services due to the implementation of GH&MS a further redesign is to be undertaken. An Efficiency and Productivity Report provides an opportunity to review Pharmacy Services across NHS Fife working more closely with colleagues in the CHPs.

3.21 Physician Assistants (Anaesthesia)

3.21.1 Work is being taken forward to ensure that the role of Physician Assistant (Anaesthesia) is maintained within the Anaesthetic Department, confirming funding resource.

4.0 OTHER DRIVERS / CONSTRAINTS 4.1 The Medical Workforce

4.1.1 NHS Fife has established a Medical Workforce Group, chaired by the Medical Director, Operational Division, to take forward issues and develop future medical workforce models. The following summary outlines the current key and common themes within NHS Fife:

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4.1.2 The general trend is towards a trained medical workforce rather than future reliance on trainee medical staff, with plans in place to recruit to additional Consultant posts in:

• Emergency Medicine • Obstetrics & Gynaecology • Paediatrics • Radiology

There is growing evidence that establishing Specialty Doctor posts, for example in Emergency Medicine, may not meet service needs, as there are either no suitable candidates for vacancies, or a quick turnover with attrition of Specialty Doctors who are CCST holders to Consultant posts.

Other services for example, Anaesthetics, Care of the Elderly, Laboratories, Psychiatry and Radiology are recruiting to established Consultant posts and expect to be able to recruit to vacancies.

4.1.3 Other factors:

• Early stage planning for relevant services working across specialities to provide appropriate Consultant led overnight cover on the Victoria site, with the intention to move to resident on call Consultants within relevant acute specialties in future. For example, forthcoming retirals within Anaesthetics will facilitate this within Anaesthetics.

• In addition, there is the suggestion that Neonatology should move to regional provision, which would require detailed regional planning and consultation.

• Feminisation of the medical workforce has led to capacity issues within some areas, as a result of periods of maternity leave and accommodating part time working.

• All other areas are in a relatively steady state.

4.1.4 Impact of Service Redesign

4.1.4.1 There will be changes within Care of the Elderly Medicine and to GP services as a result of the implementation of the new Hospital at Home teams working within the Integrated Community Assessment and Support Service. Approximately 1.5wte GPs with Special Interest in Elderly Care will be recruited across Fife in the current year, potentially up to 2.0wte. A new Consultant in Elderly Medicine will take up post later in 2012, which will release an existing Consultant to support ICASS. New ways of working for Care of the Elderly medical staff and the GP medical workforce in community settings will also be developed for ICASS.

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4.1.5 There will be potential changes to the community in-patient facilities and hospital based services aligned to the developments in community services. NHS Fife is outlining options for change throughout 2012/13.

4.1.6 Reduction in Medical Trainee Numbers.

4.1.6.1 The confirmed reductions of medical trainee numbers within the

South East Region will not be known until later this year, however, expected areas of disestablishment are within Emergency Medicine and potentially Psychiatry. Funding may be available to support service redesign from disestablished posts, which will be agreed regionally and then by SGHSCD. Emergency Medicine has plans in place and the Psychiatry rota will be sustainable with one less trainee.

4.1.6.2 Specialties where there are anticipated shortfalls in trainees for

other reasons are Obstetrics & Gynaecology and Anaesthetics. These specialties are planning for these scenarios, under the direction of the Medical Director, Operational Division.

4.1.7 Community Dental Service

4.1.7.1 A workforce plan for the Community Dental Service with skill mix

and projected savings, linked to new national terms and conditions being developed for Community Dental Officers, has been submitted to SGHSCD.

4.2 Allied Health Professionals

4.2.1 The Allied Health Profession (AHP) workforce project board has mapped baseline staffing and developed workforce plans for each of the five professions – nutrition and dietetics, occupational therapy, physiotherapy, podiatry and speech and language therapy.

These plans aim to maximise efficiency and productivity by: • Reviewing skill mix • Increasing the development of health care support worker posts to

achieve an optimal level of support worker activity across the professions.

• Review of management and leadership arrangements of posts within each profession

• Task analysis to inform current workload across all services and introduction of Releasing Time to Care

• Supporting older people in the community by ensuring AHP workforce is integral to redesign of services

• Evaluation of where services are hosted and make recommendations on changes where relevant

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• Using technological solutions and telehealth as alternatives to some future service delivery.

4.2.2 All services’ workforce plans have been affected by efficiency savings and

this will no doubt continue. In addition, Speech and Language Therapy has lost income from the contract with Fife Council Education service, which further impacts on workforce plans.

Individual services work is outlined below.

4.2.3 Physiotherapy

As part of service redesign plans, NHS Fife will review opportunities for greater integration of the physiotherapy workforce. Where possible we will: Examine opportunities for more efficient leadership and

management arrangements Review opportunities for greater skill mix

4.2.4 Podiatry

Podiatry services have developed a proposal outlining the rationalisation of clinic venues to support improvement efficiency in service delivery, development of support worker posts and thereby reduce cost per case.

The service is working with Queen Margaret University to develop a training programme for assistant practitioners (Level 4 Career Framework) to assume some of the responsibilities of registered staff.

Further use of community capacity building in the care homes sector has enabled previous podiatry patients to be managed by care homes staff.

Opportunities for more efficient leadership and management arrangements

are also under review.

4.2.5 Speech and Language Therapy The Speech and Language Therapy service is: • Introducing new service models to identify core activity and an

enabling approach • Redistributing activity by, for example disinvesting in the traditional

school model • Identifying new patterns of working and allocate the workforce

accordingly

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4.2.6 Occupational Therapy

Occupational Therapy services now have one Head of Service for the profession reducing duplication and are currently considering opportunities for integrating across NHS Fife ahead of the Health and Social Care Partnership agenda enabling similar opportunities as described for physiotherapy.

This coming 12 months will also build on the foundations for a professionally led Fife wide Occupational Therapy service and greater partnership with Fife Council colleagues.

The service has a 76% registered staff ratio to 24% support staff and will continue to use all opportunities to develop a robust career framework across the profession.

4.2.7 Nutrition and Dietetics

Nutrition and Dietetics are currently: • Reviewing task analysis to inform capacity planning and increase the

number of generic rather than specialist posts • Reducing domiciliary activity and utilizing the workforce more

efficiently by increasing out patient clinics to enable follow up from acute services

• Examining the use of technology and telehealth to further improve efficiency with all referrals moving to being electronic from May 2012

• Review of all clinical teams to ensure referrals have a care pathway and session plan to follow which is clinically effective.

4.3 Respiratory

The Respiratory Non-Invasive Service provision within the Critical Care Service will reduce establishment in the Respiratory Ward where this service is currently provided. There are eight ‘enhanced care’ beds in Ward 43(Respiratory) which is staffed at HDU level. Admitting patients to the critical care unit will ensure patients receive the correct level of care and that respiratory patients, who do require non-invasive ventilation and who are currently being cared for in other wards because of capacity in the respiratory ward, will be able to be admitted to ward 43.

4.4 Diagnostic & Treatment Centre (DTC)

4.4.1 Relocation of the Urology DTC from Victoria Hospital, Kirkcaldy and Queen Margaret Hospital, Dunfermline in line with GH&MS provides the opportunity to encourage staff to work more flexibility across the DTC.

4.4.2 Relocation of colposcopy and urodynamics to the DTC at Queen Margaret

Hospital will allow more activity to be delivered in an Out Patient setting.

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4.5 Service Location

4.5.1 Relocation of Paediatric Out Patients within Queen Margaret Hospital will release planned capacity in the Ante Natal Clinic for maternity services.

4.5.2 Movement of the ENT ward to Ward 5 and theatres to Phase 3, both at

Victoria Hospital, Kirkcaldy will allow for a more flexible team.

4.5.3 Intermediate Care Teams and Hospital at Home Teams are being co-located to improve communication, response rates and service delay. There will be a single point of access for referrals to Intermediate Care Team, Hospital at Home and Community beds.

4.5.4 There remains a desire to have services closer to patients communities and

as part of shifting the balance of care the Blood Borne Virus Service has been reviewed and integrated into and co-located with the Sexual Health Service and is delivered via a Hub and Spoke model.

4.6 eHealth

4.6.1 The drive for better and wider uses of technology is fundamental for supporting Workforce Planning. eHealth Strategy for Scotland and Fife for 2011-2017 directly underpins improvements in the safety and efficiencies of healthcare working across the NHS. This directly supports the drivers for change, and delivering for health by being more efficient, supporting care at home or in the community, better access to the workforce to key information, enabling people to better manage their own health and make medicines safer for patients. Information services, Modern Technology and a Programme of work helps deliver the modernisation needed to support a changing workforce. Information will be delivered through increasingly mobile technology that crosses traditional boundaries in primary, community and acute services where staff can share key information across a health and social setting, and also allow patients to better manage their own health and communicate better with the NHS. Developments like Clinical Portal, Hospital at Home (H@H), new GP Systems, Patient Electronic Monitoring, Digital Dictation and eReferrals with future plans like Patient Portal Services that will allow patients to book GP appointments, check results, confirm their hospital appointment, with the option to use Tele-Health to help manage their condition will require a workforce to be innovative and adaptive in meeting healthcare demand as well as making best use of eHealth technology. This needs to include being responsive to patients who wish to make early use of these technologies to better prevent, understand and manage their own health and those of their family. The NHS workforce over this period will continue to see increasing changes in patient demand and increasing options for better use of technology that will require a continued learning and development cycle as outlined in the WPS.

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4.7 Support Services

4.7.1 The structures have changed across this group of staff over the last five years to embrace the single system working model of the Board. In parallel, there have been major streamlining and other changes in the workforce as a result of the redesign of services and the desire to achieve improvements in quality, effectiveness and efficiency. There have been changes to the workforce due to major alterations to, and transfers of, clinical services over the recent past with refurbishment, new and extended facilities across the Board area.

4.7.2 The recent planned workforce changes, including internal transfers, due to

service redesign have been predominantly in “Soft FM” services and are now largely complete. These in the main related to GH&MS (see Section 1 Paragraph 5). There continue to be posts within Domestic Services which are being actively recruited but are not yet in post as had been projected for 31 March 2012. A formal review of portering workforce is being undertaken as post-reconfiguration there is a recognition that there is insufficient portering staff which is having an impact on service provision. A small number of additional portering staff are being recruited pending the outcome of the review.

4.7.3 Work continues in the review of catering facilities and provision across

the Board area. This will be from both a service redesign perspective but will also reflect the demand for the various non-patient catering services and the economy of that provision.

5.0 HEALTH AND SOCIAL CARE INTEGRATION 5.1 The aging population and increased prevalence of chronic disease requires a

strong re-orientation away from current emphasis on acute care towards prevention, self-care, more consistent standards of care that is well co-ordinated and integrated between health and social care. There is the need to develop capacity in primary and community care; priorities investment in social care to support rehabilitation and reablement; and take forward the subsequent downsizing of activity undertaken in acute hospitals

5.2 Integrated care is an approach for many individual where gaps in care, or poor

care co-ordination, leads to an adverse impact on care experience and care out comes. Integrated care is best suited to those living with long term conditions and to those with medically complex needs requiring urgent care which can be provided in their own homes.

5.3 In order to achieve the full benefits of integration there requires strong system

leadership, professional commitments, and good management.

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5.4 Clinical integration will focus on aligning the goals and working practise of health and social care professionals in order to deliver better care co-ordination and improved care out comes.

5.5 Where intervention are appropriately targeted, there is evidence that care quality

can be improved by health and social care teams providing co-ordinated care particularly to frail older people.

5.6 Importance of Leadership:

• Leaders in the NHS, local government and the third sector must take the initiative and promote integrated care. Staff will require to have clear objectives, and control over their work. Leaders of frontline teams will have a particularly important role in creating a climate in which staff feel empowered, all of which will play a central role in the success of integration.

• Leaders will require to have the skills and strategies necessary to understand,

influence and lead local agendas in the design, commissioning and delivery of integrated care.

• Leaders will need to work together across a health communities to achieve

financial and service objectives. 5.7 Core Components of Success:

• Effective leaders at all levels with a focus on continuous quality improvement • A collaborative culture that emphasises team working and the delivery of highly

co-ordinated and patient centred care.

• Multi-speciality groups of health and social care professionals in which, for examples generalist work alongside specialities to deliver integrated care.

• Patient and carer engagement in taking decision about their own care and support

in enabling them to self- care. 5.8 Over the coming 18 months NHS Fife with it partners in social care will be

focused on taking forward the integration agenda. Work has begun to identify the key work streams and the leads for these. This agenda is viewed as has a major piece of re-design work which has the comment of senior staff in both organisations.

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6.0 SHARED SERVICES There are three services being looked at nationally in respect of Shared Services:

• Finance • Human Resources • Facilities

6.1 Finance Shared Services has been under consideration for some years with much

work now completed through the Regional Consortia that are already in place. 6.2 HR services are split into Workstreams as follows: Phase 1 – April 2012 to March 2013 ● Employee Services ● Medical Staffing ● Recruitment ● Payroll & Benefits Advice Phase 2 – April 2013 – March 2014 ● Organisation Development ● Learning, Development and Education ● Workforce Planning ● Occupational Health and Safety 6.3 Facilities services are only now commencing 6.4 It is early days for some of these services but clearly there are implications for

staff. It should be noted however that Shared Services does not necessarily require co-location and such services could still be located in more than one Board area given technology. This is an important issue when wishing to retain employment opportunities in Board areas with higher rates of unemployment such as Fife.

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7.0 LINKS ELSEWHERE 7.1 Vascular Services

There will be further development of the Vascular Service Network with NHS Tayside, including a screening programme. This will involve movement of all in-patient services to Tayside whilst Fife will deal with all day cases for both Boards.

7.2 Breast Service

Discussions are on-going with NHS Lothian concerning the treatment of complex patients following GH&MS moves.

7.3 Oral Maxillofacial Surgery

Discussions are on-going on the development of a Regional Service to be able to sustain such a service.

7.4 Plastic Surgery

Discussions are on-going on the further development of the Tayside Plastic Surgery Network to include some Dermatology work.

7.5 Gynaecology Oncology

A joint Consultant post in Gynae Oncology is being developed with NHS Lothian.

8.0 VOLUNTARY SECTOR 8.1 NHS Fife employs 2 Volunteer Co-ordinators and work is planned to increase

volunteer input to help improve care to patients through supporting healthcare professionals eg helping at meal times.

8.2 Local management groups are looking at Community Planning and Capacity

through meetings with voluntary agencies.

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SECTION 3: DEFINING THE REQUIRED WORKFORCE

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SECTION 3 : DEFINING THE REQUIRED WORKFORCE 1.0 WORKFORCE PROJECTIONS The Workforce Projection Templates are attached at Appendix 2. 2.0 WORKFORCE MODELLING TOOLS 2.1 NHS Fife is committed to using the Nursing & Midwifery Tools that have been

developed and these have been used to inform the Projections. Across the Organisation, the Adult Inpatient Tool has been used where applicable together with the Professional Judgement Tool which has been used on its own for those areas not covered by the Adult tool. There is a plan to utilise the other tools as they are finalised and available on the SSTS platform.

2.2 The Operational Division undertook a Workforce and Workload Planning

Exercise during the weeks 2 – 16 April 2012. The purpose of the review was to assess the impact of the move to the New Build at Victoria Hospital, Kirkcaldy would have on nurse staffing levels and to provide assurance to the Health Board that the Division has safe nurse staffing establishments in place. Skill mix changes have been identified following the review and a plan to address these changes is in progress.

3.0 JOB PLANNING 3.1 Job Planning is being used to determine Consultant clinics and operating sessions

required to meet Waiting Time targets in Orthopaedics, General Surgery and Obstetrics and Gynaecology.

4.0 SKILLS AND COMPETENCIES 4.1 Each Service will require staff who have the defined competencies for their

individual service eg the potential Renal expansion requires skilled and experienced nursing staff. The same will apply to the Chemotherapy repatriation.

4.2 In order to meet a service demand we have taken a strategic approach to the

development of our Health Care Support Workers in recognition of the number of drivers and issues. The requirement to achieve best value and ensure future workforce sustainability in light of anticipated changes eg reduction of registered staff, an ageing workforce and increased competition from other employment sectors, requires all new HCSWs to complete the HCSW Mandatory Induction Standards and to undertake an SVQ Level 2 as a minimum requirement.

VERSION 7 28.06.12

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4.3 Future requirements are for the development of the Advanced Practitioner role and the Generic Healthcare Support Worker. The HCSW is also needed to support the role of the Public Health Nurse.

4.4 The Age Profile of the Workforce also highlights the issue of succession

planning. 5.0 SKILL MIX 5.1 All vacancies that arise across the organisation are considered in terms of skill

mix prior to replacing and this will continue. As part of our workforce modelling, all clinical areas are required to identify current and future skill mix profiles using Releasing Time to Care to identify skill mix opportunities

6.0 NEW ROLES 6.1 Advanced Nurse Practitioners have been identified within Cancer, Renal and

Acute Medicine. Paediatric and Neonatology ANPs are already in place but need to be increased.

6.2 Radiology and Endoscopy enhanced roles are required in order to detect cancer

early. 6.3 The Hospital at Home Practitioner role has been developed as part of service

redesign. The model is to keep patients in their home and to receive a higher level of clinical intervention.

VERSION 7 28.06.12

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SECTION 4: WORKFORCE CAPABILITY

VERSION 7 28.06.12

- 43 -

SECTION 4 : WORKFORCE CAPABILITY 1.0 CURRENT STAFFING PROFILE 1.1 NHS Fife Staffing Overview

At 31 March 2012 NHS Fife employed 8663 staff (excluding bank staff) with a wte of 7042.17. The diagram below demonstrates the trend during the last three years.

NHS Fife - Headcount and WTE

7000

7500

8000

8500

9000

9500

Headcount 8919 8950 9004 9035 9067 9065 9089 9051 9060 8983 8928 8841 8732 8663

WTE 7297.7 7307.3 7343.0 7367.4 7389.1 7373.8 7381.7 7359.3 7366.5 7312.1 7253.8 7184.6 7099.1 7042.1

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2008/09 2009/10 2010/11 2011/12

1.2 Job Families

The following table shows the distribution across job families within NHS Fife. At 31 March 2012 there was a headcount split of 4997.2 clinical staff to 2044.9 non-clinical staff.

Job Family Headcount WTE Administrative Services 1538 1213.66 Allied Health Profession 738 590.65 Healthcare Sciences 194 172.89 Medical and Dental 608 541.49 Medical and Dental Support 138 118.08 Not Known 0 0.00 Nursing/Midwifery (Trained) 2951 2506.61 Nursing/Midwifery (Untrained) 1018 809.85 Other Therapeutic 255 206.40 Personal and Social Care 62 51.23 Senior Managers 40 36.52 Support Services 1121 794.78 Total 8663 7042.17

VERSION 7 28.06.12

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NHS Fife - Job Family Distribution (Headcount)

Support Services1121 (12.9%)

Nursing/Midwifery (Untrained)

1018 (11.8%)

Nursing/Midwifery (Trained)

2951 (34.1%)

Other Therapeutic255 (2.9%)

Administrative Services

1538 (17.8%)Allied Health Profession738 (8.5%)

Healthcare Sciences194 (2.2%)

Medical and Dental Support

138 (1.6%)

Medical and Dental608 (7.0%)

Senior Managers40 (0.5%)Personal and

Social Care62 (0.7%)

0

500

1000

1500

2000

2500

3000

3500

4000

Headcount 8919 8950 9004 9035 9067 9065 9089 9051 9060 8983 8928 8841 8732 8663

Administrative Services 1634 1649 1651 1671 1682 1664 1678 1661 1664 1629 1611 1594 1561 1538

Allied Health Profession 736 749 756 760 750 750 762 759 772 766 757 742 746 738

Healthcare Sciences 189 192 194 194 208 198 205 210 214 211 200 201 198 194

Medical and Dental 608 544 611 600 592 592 590 614 611 602 601 622 607 608

Medical and Dental Support 148 162 165 163 168 171 169 156 155 155 152 143 140 138

Not Known 15 4 0 6 0 9 0 0 0 0 0 0 0 0

Nursing and Midwifery 4122 4173 4132 4126 4130 4128 4134 4123 4127 4129 4121 4072 4015 3969

Other Therapeutic 241 240 248 247 248 258 266 258 259 260 262 260 258 255

Personal and Social Care 54 54 54 58 61 67 70 75 75 71 68 64 67 62

Senior Management 49 54 48 53 53 46 46 45 44 42 41 41 40 40

Support Services 1123 1129 1145 1157 1175 1182 1169 1150 1139 1118 1115 1102 1100 1121

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2008/09 2009/10 2010/11 2011/12

VERSION 7 28.06.12

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1.3 Contract Type

Contract type has remained relatively consistent, with an overall split of 51.1% whole-time to 48.9% part-time contracts, with consistent differences between job families and genders.

Female

Whole-time311143%

Part-time 419757%

Male

Whole-time112183%

Part-time 23417%

NHS Fife - Contract Distribution

0%

20%

40%

60%

80%

100%

Administrative

Services (

1538)

Allied Health Professi

on (738)

Healthcare Sciences (

194)

Medical A

nd Dental (608)

Medical A

nd Dental Support (

138)

Nursing/M

idwifery (3969)

Other Therapeutic

(255)

Personal A

nd Social C

are (62)

Senior Managers

(40)

Support Servic

es (1121)

Part-time Whole-time

1.4 Equality and Diversity

1.4.1 Gender The gender distribution is shown below for the job families. The overall split is 84.4% female and 15.6% male with differences between the job families.

NHS Fife - Gender Distribution

0%

20%

40%

60%

80%

100%

Admini

strati

ve Serv

ices (

1538

)

Allied H

ealth

Profes

sion (

738)

Health

care

Scienc

es (1

94)

Medica

l And

Den

tal (6

08)

Medica

l And

Den

tal Sup

port (

138)

Nursing

/Midw

ifery

(3969

)

Other T

herap

eutic

(255

)

Person

al And

Soc

ial C

are (6

2)

Senior

Man

agers

(40)

Suppo

rt Serv

ices (

1121

)

Female Male

VERSION 7 28.06.12

- 46 -

1.4.2. Age Distribution

The age distribution curve of NHS Fife remains skewed towards the older age categories in line with the national picture of an ageing workforce.

Mean: 44.8 Median: 46 Mode: 50

NHS Fife - Age profile

11

229

653825 870

1298

16091505

1081

452

130

0

200

400

600

800

1000

1200

1400

1600

1800

16 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65+

Further analysis is included within this Section at Paragraph 2.

VERSION 7 28.06.12

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1.4.3 Ethnic Origin The ethnic origin of the workforce is shown in the table below along with percentages for comparison with the 2001 census of ethnic origin in Fife:

Ethnic Group % 2001 Census

WHITE

Scottish 54.81% 88.25

British 6.30% 8.54

Irish 0.78% 0.61

Any other White background 1.33% 1.33

MIXED

Any Mixed background 0.23% 0.22 ASIAN, ASIAN SCOTTISH, ASIAN BRITISH

Indian 0.33% 0.15

Pakistani 0.20% 0.34

Bangladeshi *

Chinese 0.08% 0.21

Any other Asian background 0.15% 0.06 BLACK, BLACK SCOTTISH, BLACK BRITISH

Caribbean * 0.03

African 0.23% 0.08

Any other Black background * 0.03

OTHER ETHNIC BACKGROUND

Any other background * 0.13

UNDISCLOSED

Declined 35.45% *5 or Less Respondents

All figures continue to be comparable with the 2001 census figures, apart from the White Scottish group. However, the aggregate percentage of White Scottish and Undisclosed staff is comparable to the 2001 census.

1.4.4 Religion

The declared religious demographic of NHS Fife staff is as follows:

Buddhist 0.10% Muslim 0.38% Christian - other 5.47% No Religion 20.79% Church of Scotland 26.28% Other 1.18% Declined 38.40% Roman Catholic 7.08% Hindu 0.28% Sikh 0.02% Jewish 0.01%

VERSION 7 28.06.12

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1.4.5 Sexual Orientation

The declared sexual orientation demographic of NHS Fife staff is as follows: Bisexual 0.17% Heterosexual 25.36% Declined 74.06% Lesbian 0.08% Gay 0.08% Other 0.24%

1.4.6 Transgender The declared transgender demographic of NHS Fife staff is as follows:

1.4.7 Disability

The declared disability demographic of NHS Fife staff is as follows: 1.5 Turnover

Staff annual turnover across NHS Fife as at 31 March 2012 was 7.17%. The rate for previous years are provided below: 2010/11 7.32% 2009/10 7.66% 2008/09 8.43% 2007/08 9.13% The following chart shows the turnover figure for each quarter of 2011/12.

NHS Fife - Turnover

1.00

1.20

1.40

1.60

1.80

2.00

%

Total Turnover 1.59 1.86 1.92 1.80

Q1 Q2 Q3 Q4

2011/12

Declined 97.36% No 2.64% Yes 0.00%

Declined 96.95% No 2.76% Yes 0.29%

VERSION 7 28.06.12

- 49 -

NHS Fife - Turnover

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

Admini

strati

ve S

ervice

s (15

38)

Allied H

ealth

Profes

sion (

738)

Health

care

Scienc

es (1

94)

Medica

l and

Denta

l (392

)

Medica

l And

Den

tal S

uppo

rt (13

8)

Not Kno

wn (0)

Nursing

/Midw

ifery

(3969

)

Other T

herapeu

tic (2

55)

Person

al And

Social C

are (6

2)

Senior

Man

agers

(40)

Suppo

rt Serv

ices (

1121

)

NHS Fife To

tal

1.6 Leavers 1.6.1 During 2011/12 615 staff left NHS Fife.

1.6.2 Trend

NHS Fife - Leavers by Job Family (Clinical)

0

10

20

30

40

50

60

70

80

Allied Health Profession 15 17 7 18

Healthcare Sciences 5 3 2 6

Medical & Dental 12 17 11 13

Medical & Dental Support 4 8 4 2

Nursing & Midw ifery 46 61 75 67

Other Therapeutic 2 7 8 6

Personal and Social Care 1 6 1 1

Total (Clinical) 85 119 108 113

Q1 Q2 Q3 Q4

2011/12

VERSION 7 28.06.12

- 50 -

NHS Fife - Leavers by Job Family (Non Clinical & Not Known)

0

10

20

30

40

Administrative Services 31 28 35 19

Senior Management 1 0 1 1

Support Services 22 13 20 19

Total (Non-clinical) 54 41 56 39

Q1 Q2 Q3 Q4

2011/12

1.6.3 Reasons for leaving

NHS Fife - Reason for Leaving

Pregnancy, 3, 0.5%

Retirement - Age, 141, 22.9%

Dismissal Capability, 2, 1%

New employment w ith NHS outw ith Scotland,

8, 1.3%

Ill Health, 14, 2.3%

End of f ixed term contract, 80, 13.0%

New employment w ith NHS Scotland, 43,

7.0%

Other, 49, 8.0%

Vol.Resignation - Promotion, 7, 1.1%

Not Know n, 6, 1.0%

Dismissal, 20, 3.3%

Vol. Early Retirement+actuarial

reduct., 15, 2.4%Vol.Resignation - Other, 165, 26.8%

Death in Service, 8, 1.3%

Vol.Resignation - Lateral move, 8, 1.3%

Vol.Resignation - Lack of opportunities, 2,

0.3%Retirement Other, 36,

5.9%

VERSION 7 28.06.12

- 51 -

1.6.4 Destination on leaving

NHS Fife - Destination on Leaving

Private Health organisation, 13, 3%

Abroad - EEA Country, 4, 1%

Other Private Sector, 16, 4%

NHS Scotland, 24, 20%

Abroad - Non-EEA Country,

5, 5%

Died, 8, 2%Education Sector,

4, 1% Further Education/Training,

7, 2%General Practice,

5, 1%NHS rest of UK,

9, 2%

Other Public Sector, 4, 1%

Other/Declined, 180, 46%

No Employment, 53, 13%

1.6.5 Age profile of leavers

NHS Fife - Leavers Age Profile

0

20

40

60

80

100

120

140

16 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65+

VERSION 7 28.06.12

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2.0 WORKFORCE AGE PROFILE 2.1 The Regional Workforce Planning Director for SEAT undertook an analysis of

trends over the last 10 years in the Scottish and SEAT population and workforce age profiles. This is attached at Appendix 3.

2.2 As with the NHSS and SEAT, the NHS Fife workforce has grown over the last 10

years since 2002 from 5978.8 wte to 7097.9 wte. However, more recently the wte has begun to fall with the December 2011 figure having fallen below that of 2008 by 136.1 wte.

NHS Fife staff - WTE(excluding GP's & GD's)

0

1000

2000

3000

4000

5000

6000

7000

8000

2002 2003 2004 2005 2006 2007 2008 2009 2010 Mar-11 Jun-11 Sep-11 Dec-11

2.3 The profile of the NHS Fife workforce has also changed mirroring the wider

changes taking place within the Scottish population and NHSS workforce as below:

NHS Fife Staff - Age(excluding GP's & GD's)

0

200

400

600

800

1000

1200

1400

1600

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

2007

2011

2.4 There are differences in the age profiles across the different staff groups. Some of

the staff group age profiles below demonstrate these differences.

VERSION 7 28.06.12

- 53 -

2.5 Nursing Profile

The following graph shows the shift in age profile of NHS Fife Nursing workforce between September 2007 and December 2011. The graph shows that during this period the percentage of nurses under 45 has fallen from 52.5% to 42.8% whilst those over 45 have increased from 47.5% to 57.2%. This increased age profile of the workforce has potential implications in terms of current and future job roles undertaken by an older workforce as well as for succession planning.

NHS Fife Nursing Staff - Age

0

100

200

300

400

500

600

700

800

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

2007

2011

2.6 Midwifery Profile

The following graph shows the shift in age profile of NHS Fife’s Midwifery workforce between September 2007 and December 2011. The graph demonstrates that during this period the percentage of midwives under 45 has fallen from 52.1% to 42.4%, whilst those over 45 have increased from 47.9% to 57.6%. This older profile of the workforce has potential implications similar to those outlined under Nursing above.

NHS Fife Midwifery Staff - Age

0

5

10

15

20

25

30

35

40

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

2007

2011

VERSION 7 28.06.12

- 54 -

2.7 Support Services Profile

Traditionally the Support Services workforce profile has had a significantly different age profile to other staff groups. There has been more of a reliance upon older employees in many of the support services roles. This reliance has become even more pronounced with the percentage of the workforce over 45 having grown from 63.6% to 70.7% over the last 4 years.

NHS Fife Support Services - Age

0

20

40

60

80

100

120

140

160

180

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

2007

2011

2.8 Healthcare Scientist Profile

The SEAT profile also refers to concerns with regard to the age profile for the Healthcare Scientist workforce. This older profile of staff is not shared by NHS Fife as a number of Healthcare Science staff have already retired over the last few years and a number of younger staff have been recruited. However, although the number of staff over 45 has decreased, it is still 43.7% and the number over 55 has remained the same at 17.4%.

NHS Fife Healthcare Sciences - Age

0

5

10

15

20

25

30

35

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

2007

2011

VERSION 7 28.06.12

- 55 -

3.0 SUPPLEMENTARY STAFFING USE 3.1 The table below summarises the cost of supplementary staff in 2011/12, and

2010/11 for comparative purposes. Note that the value for Medical locums includes internal locums as well as medical agency costs.

Locum, Bank & Agency Staffing 2010/11 2011/12 £000 £000 Medical Locums 3,705 3,688 Bank Nursing 4,318 4,445 Agency Nursing 49 2 Agency Allied Health Professionals 93 138 Agency Health Science Officers 63 33 Agency Admin 61 14 Agency Other 142 47 8,431 8,367

3.2 Overall in NHS Fife there was an increase in the number of requests for Bank

Nurses from 106753,23 hours (2010/11) to 139024.95 hours (2011/12) which is an increase of 32271.5 hours or 2760 shift requests.

The number of requests for qualified nursing shifts increased from 8674 (2010/11) to 10081 (2011/12) which was an increase of 1407 shifts. 91% of the 2011/12 shift requests were able to be filled.

Similarly the number of requests for unqualified nursing shifts increased from 7780 (2011/11) to 10544 (2011/12) which was an increase of 2764 shifts. 84% of the 2011/12 shift requests were able to be filled.

4.0 OVERTIME / EXCESS / ENHANCED HOURS

Overtime spend by pay group is provided below, with 10/11 comparative data also included.

Overtime Analysis 2010/11 2011/12 £000 £000 Nursing 308 270 Allied Health Professionals 32 36 Health Science Officers 53 66 Admin 114 112 Ancillary 446 435 953 919

VERSION 7 28.06.12

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5.0 LABOUR MARKET ANALYSIS1 5.1 As at March 2012, a total of 11,075 people in Fife were in receipt of Job Seekers

Allowance (JSA). This equates to 4.7% compared to 4.4% for Scotland and 4.1% for the United Kingdom. Almost half of these (6,075) had been in receipt of JSA for more than 6 months. Fife had a JSA rate of 2.1% for this group, compared to 1.9% for Scotland.

5.2 The number of people within the 18-24 age group have the highest claimant rate

for both up to 6 months and over 6 months. However the rate has decreased by 1.2% between March 2011 and March 2012. This could be due to an increase in the number of 18-24 year olds claiming for over 6 months (1.7% in March 2011 to 3.1% in March 2012).

6.0 NHS FIFE EMPLOYMENT INITIATIVE 6.1 NHS Fife has operated an Employment Initiative since 2004 with the aim of

supporting individuals from disadvantaged groups into employment by providing work placements and employment opportunities. This has included long term unemployed, single parents, people with disabilities, people with mental health problems and individuals from minority ethnic backgrounds. To achieve this we have worked closely with a range of organisations such as Jobcentre Plus, Fife Council, Fife Colleges, Momentum Scotland, Fife Employment Access Trust, and Equal in Fife. Introduction of the Government Work Programme, the increased emphasis on supporting young people and the current financial situation has meant that we have had to review our support arrangements and introduce revised measures. Currently the main areas of activity are:

6.2 Opportunities Fife Young People Initiative

Fife Council, on behalf of the Opportunities Fife Partnership secured funding to provide 13 paid work placement opportunities for young people aged between 16 and 24 and we recruited to more than 20 places within NHS Fife. The programme is being further developed with funding secured for 2012/13.

6.3 Get Britain Working

We have offered a range of 8 week work placement opportunities to Jobcentre Plus Clients. Places are across Fife mainly in Clerical and Support Services roles. We have also asked Fife Council to include the placements in the Opportunities Fife website to enable clients coming through that route to access the placements.

6.4 Triage Work Placements

Triage are delivering the Work Programme in Fife on behalf of Ingeus. We have offered placement opportunities to Triage clients.

1 Fife Economy Partnership, April 2012

VERSION 7 28.06.12

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6.5 Get Ready for Work Programme

We are working with Carnegie College clients to develop placements for 16 to 19 year old clients from North East Fife on the Get Ready for Work Programme

6.6 Training Programme for Domestic Assistants

We have been working with Asset Skills to deliver a Scottish Government funded training programme aimed at unemployed people who wish to work in cleaning roles. The first phase commenced in late January for 5 weeks and Phase 2 commenced at the end of March 2012.

7.0 RECRUITMENT 7.1 Robust scrutiny of vacancies is undertaken before posts are progressed for

recruitment. Whilst the review of posts before filling should be the norm in any case, this has taken on a higher level of importance in the current financial climate and all posts are considered against existing staff requiring redeployment prior to any internal or external advertising.

7.2 With the exception of certain medical specialties where difficulties have been

outlined earlier in respect of supply of doctors in training, there are no particular posts in NHS Fife currently that are considered to be “hard to fill”.

VERSION 7 28.06.12

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SECTION 5: ACTION PLAN

VERSION 7 28.06.12

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1.0 LEARNING AND DEVELOPMENT PLAN 1.1 Learning and Development (L&D) Strategic Framework

This NHS Fife Learning and Development Strategic Framework builds on and refreshes previous iterations encompassed in the NHS Fife Workforce Modernisation and Development Strategic Plan.

It provides a clear strategic direction and framework for NHS Fife to ensure its workforce is equipped with the necessary competences and skills to enable service improvement and transformation.

Six overarching strategic themes provide the framework for all learning and development activity: • The development of a supportive and enabling learning framework and

infrastructure • The embedding of personal development planning and review processes • Learning supports the delivery of national policies, key performance targets

and quality and service improvement • Continuing professional and personal development is aligned to service need • Staff are supported to become competent in their role and skills gaps are

bridged as roles evolve and new roles are developed • Learning and development is focussed on service priorities and needs

1.2 Governance and Planning

We recognise the NHS Fife workforce of the future will predominantly comprise the current workforce and that we are building on a strong foundation of staff competence and experience

The Knowledge and Skills Framework (KSF), and parallel Personal Development Planning and Review (PDPR) processes, will continue to be key in determining individual learning needs and enable staff to develop and maintain competence and, as services are redesigned and new ways of working introduced, support the development and introduction of new and enhanced roles.

The NHS Fife Staff Governance Committee and the NHS Fife Strategic Management Team (Workforce) will continue to provide oversight and review ensuring alignment with the “appropriately trained” strand of the Staff Governance Standard using a systematic self assessment audit tool (SAAT). Under this level there are a range of committees and groups overseeing particular subject and / or staff group specific themes

VERSION 7 28.06.12

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1.3 Technology Infrastructure

NHS Fife will continue to develop its L&D technology based infrastructure including e-KSF and eESS to provide a structured facility to record, monitor and report, at all levels, on the key elements of the learning and development process: identifying needs, prioritising and planning, promoting and accessing appropriate provision, and monitoring and reporting to ensure overall fit with service needs and effective use of resources.

Recognising the salience of e-learning approaches as an effective learning medium, and the expanding technological infrastructure, we will continue to develop our e-learning capability and its increasingly important contribution to the learning agenda.

1.4 Priorities

NHS Fife has determined its strategic learning and development priorities to be those which equip staff with the necessary knowledge, skills and attributes to deliver the Quality Ambitions of safe, effective, and person centred care, underpinned by national strategies and policies, NHS Fife key performance targets, and service delivery priorities. These are set out in the NHS Fife Local Delivery Plan (LDP), the Balanced Scorecard, the Financial Efficiency and Improvement Programme, and the Quality Improvement Plan amongst others.

1.4.1 Core Knowledge and Skills

A key learning priority for NHS Fife is to ensure all staff develop and apply the requisite knowledge, skills and behaviours to meet the requirements of the 6 core dimensions of the Knowledge and Skills Framework:

• Communication • Personal and People Development • Health Safety and Security • Service Improvement • Quality • Equality and Diversity

Acquisition and more importantly the transference of these knowledge and skills into appropriate behaviours applied in the workplace is essential for the delivery of quality services.

VERSION 7 28.06.12

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1.4.2 Core Competences

It is essential that all NHS Fife staff continue to develop and maintain the requisite “core” competences and role specific skill sets which underpin effective service delivery. For example:

• Public protection - encompassing Adult Protection, Child protection,

Gender Based Violence • Healthcare Acquired Infection / Infection Control • Equality and Diversity • Health and Safety • Personal safety and control and restraint • Fire safety • Manual Handling • CPR • Information Governance

Internal capacity and expertise will continue to be harnessed to meet core needs with e-learning increasingly utilised as a delivery medium.

The development and maintenance of role specific core competences must also be assured. These should be identified and met through the personal development planning process and local education plans.

1.4.3 Leadership and Management Capability

The ambitious plans for transformation and change within the NHS towards providing care which is responsive, personalised, and closer to home requires the organisation to embrace continuous, planned and emergent, approaches to change. We will continue to give priority to developing our leadership and management capability to support managers and staff to become more skilled in leading and delivering service change and improvement.

NHS Fife in collaboration with our community partners in Fife, NHS Education Scotland (NES) and NHS Scotland, will continue to provide a range of learning opportunities to develop our leadership capacity and management skills. National Leadership development programmes that NHS Fife supports currently include: NHS Board development, Chief Executive Officer development; ‘Delivering for the future’ designed for Strategic Clinical Leaders; and the Front Line Clinical Leadership programme

VERSION 7 28.06.12

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Locally, NHS Fife will continue to provide leadership and management development programmes and support using internal expertise and targeted at leaders at all levels across NHS Fife, eg;

• Foundation Management programme • Leading and Managing in Action • RCN Leadership Programme • Collaborative Leadership Programme

We will continue to provide further leadership development and support through individual and/or team coaching interventions supporting senior staff involved in service change.

1.4.4 Quality and Service Improvement

We will continue to embed the ethos and principles of “whole systems” approaches across NHS Fife. We will also continue to develop our capacity and capability to work effectively across organisational, professional and geographical boundaries.

Harnessing internal capacity and expertise we will continue to ensure the provision of quality improvement learning interventions, mapped against the national Quality Improvement Curriculum Framework, to equip staff with the knowledge and skills to undertake service redesign and quality improvement activities. These include:

• Scottish Patient Safety programme • Lean Methodologies • Releasing Time to Care • Leading Better Care (development of the Senior Charge Nurse, Charge

Nurse and Team Leader role(s)) • Clinical Effectiveness and Clinical Audit • Risk Management

We will continue to support NHS Fife staff to participate in national quality and service Improvement learning programmes, utilise the learning resources available in the national Quality Improvement Hub, and ensure our staff can access the nationally developed QI e-learning resources.

Effective teamwork is one of the cornerstones of high performing organisations and we will continue to provide a range of support, facilitation and coaching interventions to support individual and team engagement and effectiveness and building resilience through times of change.

VERSION 7 28.06.12

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1.4.5 Knowledge Services / Research and Development

The delivery of safe and effective services must be underpinned by robust evidence based practice and accurate information. We will continue to provide a range of our training programmes to support staff develop and improve data analysis, and knowledge search and usage skills. We will work with NES to encourage utilisation of the national e-library service, communities of shared practice, and Managed Knowledge Networks.

Recognising the importance of research as a key driver in the pursuit of clinical excellence NHS Fife will continue to develop established learning and development programmes to enable staff to acquire and apply the knowledge and skills to undertake effective research.

1.4.6 Health Promotion / Health Improvement

Led by our Health Promotion and Health Improvement Teams working with other NHS Fife staff, Community Partners and the voluntary sector we will continue to develop and provide learning programmes to support staff and other stakeholders working to improve the health and wellbeing of individuals and communities in Fife in line with the priorities set out in the Fife Joint Health Improvement Plan (JHIP).

We will continue to deliver training programmes to support colleagues working in the areas of Smoking Cessation, Drugs and Alcohol Abuse, Obesity, Sexual Health, Understanding Health Inequalities, Health Behaviour Change, Suicide Prevention and Keep Well among others.

1.4.7 eHealth

The use of technology to support service delivery and change continues to develop and it is essential our staff possess the requisite knowledge and skills to harness the full benefits arising from e-health systems. A series of learning and development programmes to provide staff with the necessary skills will continue to be provided.

We will continue to provide learning opportunities and support for staff to develop their information technology capabilities and to ensure Information Governance issues including security, data protection, and Caldicott requirements are addressed

1.4.8 Working in Partnership

The forthcoming integration of Health and Social Care will undoubtedly accelerate the further development of integrated community based services and the development of new clinical models and pathways and will require the clinical workforce to adopt and acquire new skills and ways of working.

VERSION 7 28.06.12

- 64 -

NHS Fife is heavily engaged in developing the NHS workforce of the future. Long standing relationships have been formed with the main clinical education providers and we will continue to provide placements and supervision for a substantial number of students across clinical and other professions. We also have regular intakes of doctors in training grades and will continue to provide structured, experientially based educational and learning programmes.

We will continue to ensure NHS Fife fully contributes to the development and delivery of a range of national learning and development initiatives and, working with learning and development leads across the SEAT region and NHS Education Scotland (NES), through participation in the South East Workforce Education and Development Advisory Group, to take forward our regional learning and development agenda. A priority will be to continue to develop our strategic engagement with NES and to build on the substantial portfolio of existing collaborations.

1.4.9 Work based Learning

Health Care Support Workers (HCSW) are a key component of the clinical workforce and we recognise the requirement to achieve best value and ensure future workforce sustainability in light of anticipated workforce changes, an ageing workforce, and the increased responsibility and accountability of HCSWs towards the provision of safe and effective care

NHS Fife will continue to support new HCSWs to complete the HCSW Mandatory Induction Standards, and undertake an SVQ level 2 (Health and Social Care) as a minimum requirement. Existing HCSWs will be encouraged and supported to undertake SVQ level 2 and / or level 3 qualifications prioritized in line with service needs.

We will continue to support the provision of practice based learning and education through our team of Practice Education Facilitators (PEF).

1.4.10 Improving Patient Care and Health Outcomes

Increasingly across both hospital and community settings staff are required to manage and care for patients with a range of complex health needs and specific clinical conditions and require the necessary knowledge and skills to do so safely and effectively.

Broadly similar levels of learning needs, albeit with differing knowledge requirements, have been identified across a range of health care priorities covered by Managed Clinical Networks (MCN): • Heart Disease • Stroke • Vascular / Diabetes • Respiratory Care • Palliative care • Cancer Services

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Each MCN has developed similar education and training strategies with 3 broad levels of learning need:

• Frontline clinical professionals and support staff require a general

awareness of the health issue, a basic knowledge of symptoms, an understanding of the appropriate care strategies and the ability to signpost to further service expertise

• Clinical professionals working mainly in the specific disease field,

and/or providing clinical support and advice to colleagues locally require a more in depth level of (remove disease) specific knowledge and skills (SCQF level 9-10)

• Clinical specialists operating wholly in their specific health field of

expertise and requiring Masters level (SCQF level 11) education and knowledge.

This approach and these broad levels of workforce learning and development needs will be applicable in other health care priorities areas where a broad spectrum of the clinical workforce will be providing care services to affected service users. Including inter alia: Dementia, Mental Health, Learning Disabilities, Long Term Conditions.

1.4.11 Core clinical skills

The acquisition and application of skills in empowering patients and supporting self management, behavioural change, and vocational rehabilitation are core multi-professional learning priorities. Other priorities for multi professional education provision include: HAI, Failure to Rescue, Pressure Area Care, Falls Prevention, Nutrition and Pain Management.

Speciality and / or role specific skill requirements are identified through the PDPR process and met through internal or external provision as appropriate.

1.4.12 Clinical Decision Making

In acute settings staff are caring for and managing patients with increasing acuity and complex care issues. This requires staff to develop improved and enhanced clinical decision making skills.

There continues to be a focus on recognition and response to deteriorating patients (Failure to Rescue). This continues to be enhanced through Acute Life Threatening Events, Recognition and Treatment (ALERT) training for professional staff. This is complimented by Clinical Observation training for support staff (Temperature, Pulse, Respiration, Blood Pressure and Blood Glucose monitoring).

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As acute service provision continues to migrate to a community provision model staff will require the competence and confidence to operate as “autonomous” practitioners.

“Reshaping Care for Older People” provides a focus for the continuing and increasing drive for the provision of care “closer to home” or “in the home”. The development of services such as “Hospital at Home”, the Integrated Community Assessment and Support Service (ICASS) and Reablement will require ongoing education and training for staff to practice safely and effectively within the model of care.

NHS Fife continues to develop new roles requiring skill sets previously only required by medical staff. We will continue to ensure appropriate education and development is provided to support the acquisition and application of a range of advanced clinical skills such as Advanced Clinical Examination, Clinical Decision Making, Non-Medical Prescribing, and Medicines management.

1.5 Conclusion

In planning and delivering our learning provision to meet identified needs and priorities we will continue to adapt and innovate to take account of finite resources, and learning capacity. We recognise the need for learning to be regularly renewed to ensure continuing competence and ongoing organisational success.

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2. ACTION PLAN

No Description of action Lead

Timescale for implementation

(Short, Medium or Long term)

Description of potential impact on Workforce

Financial resources required

Progress towards implementation

1 Redesign of pharmacy services across Fife

BM DC Short term

Review current workforce and roles and responsibilities to ensure making best use of staffing resource

No First meeting to establish role and remit has taken place

2 Impact of H @Home on radiology RD Short term Monitoring the impact of change in

service Not known Monitoring the impact of change in service

3 Respiratory / Cardiology Health care scientists – AF Short term

Increased flexibility will change the skill mix profile of staff. Require additional staff but with a reduced requirement for higher grade staff

Skill mix change will support funding

4 Realignment of surgical wards to change Ward 41 to Upper GI ward

MS Short term (August 2012)

Limited impact Realignment of junior medical staff for cover

No Meeting arranged to finalise arrangements.

5

Relocation of Urology DTC from VHK to QMH in line with Right for Fife strategy. Allows the opportunity to encourage staff to work more flexibly across the DTC.

SM Short term Need to cover 2 sites will affect the on call availability of consultants. Yes

Discussions have started but scoping of the effect of 2 site working needs to be completed. Also the issue of the standard of the decontamination facilities at QMH also needs to be amended.

6

Relocation of colposcopy and urodynamics to DTC in QMH. This will allow more activity to be delivered in an OP setting.

SM Short term Allocation of staff nurses between VHK and QMH but should be possible within current resources

No Location identified and working towards transfer of equipment.


Timescale for implementation (Short, Medium or Long term)




7

Relocation of Paediatric outpatients to Ward 14, QMH. This will release planned capacity in the ANC for maternity services (i.e. scanning).

CC Short term Possibility of moving more clinics to QMH for Paediatrics and Maternity.

No Awaiting refurbishment of area before clinics and staff can relocate.

8

Movement of ENT ward to Ward 5 and ENT theatres to Phase 3. This will allow a more flexible theatre team.

SF Short term ENT staff based in one area but audiology staff may be split between Ward 5 and 8.

No Redesign of services required to improve the patient pathway.

9 Joint post for gynae oncology with NHS Lothian SM Short term Increase gynaeoncology consultant

availability No Position filled and new consultant due to start in August.

10

Improvement in reception service at Victoria Hospital main reception ie : increase in opening hours

BH Short term Additional 0.43WTE No - Met from existing resources

advertisement imminent as at June 2012

11 Continued recruitment of Domestic staff commensurate with GH & MS Business Plan

BH Short term Addition of minimum of 10wte over March 2012 establishment

No - Met from approved GH & MS funding

Recruitment is current and ongoing

12 Improvement in Portering service provided on VHK site BH Short term Addition of 4wte Portering posts

over March 2012 establishment No - Met from existing resources


13

Provision of in house Gardens and Grounds Service to sites which cannot be served by Local Authority

JR Short term Addition of 1wte post over March 2012 establishment

No - Met from existing resources


VERSION 7 28.06.12






14 Hospital at Home (CHP wide) AW Short term

Development of Advanced Nurse Practitioner role in community setting. Reduce admissions and facilitate earlier discharge.

Change Fund

Staff recruited to allow implementation. Commenced in DWF CHP, to be rolled out to G&NEF CHP August 2012 and K&L CHP Oct 2012.

15 Introduction of new wheelchair satellite clinic at Whyteman’s Brae Hospital

KA Short term

There may be limited on the workforce through working practices; more local provision should increase efficiency.

There will be financial implications with extra costs incurred to support staff from AAH travelling to Kirkcaldy to provide the clinical service. The revenue trail [£117,000 p/a] from the wheelchair modernisation fund will support this service

With the revenue tail funding in place this clinical activity should be put in place within a few months. The clinical facility is ready to receive patients.

VERSION 7 28.06.12






16 Integration of Leadership and Service Delivery

CDF/LB Short term

Integration of Physiotherapy leadership and service planning already in place. Integration planned around Care Group models with OD and Primary Care Physiotherapists working together to support the patient journey.

Integration supported within existing budgets

Joint workforce plan created by OD and Primary Care Physiotherapy Leads. Joint Heads of Physiotherapy services meeting to standardise operating procedures across Fife.

17 Recruit to additional Consultant in Emergency Medicine posts CD Short term Need to enhance trained doctor

capacity to ensure service delivery. Within existing resources

Adverts about to be placed

18 Recruit to gaps in ICU rota CD Short term Short term gap in rota due to changes in core training programme

Within existing resources Appointments in hand

19 Recruit additional Consultant in Elderly Medicine CD Short term

Medical input required to support service redesign for ICASS and to release existing Consultant to support Hospital at Home

Within existing resources, supplemented by Change Fund

Consultant takes up post in August 2012

20

Development of an open access system to enable patents or their carers to apply for treatment without the need for a professional referral

CE Short term

Time to change from previous system Equity of access across Fife Time released for professional referrers who no longer need to complete the documentation

None

Paper copies available in all clinics and GP surgeries. Electronic versions available through DWF CHP website SCI gateway referrals now being investigated

VERSION 7 28.06.12






21 Recruit additional Consultant in Dermatology CD Short term Required to support service

delivery Within existing resources

Advert about to be placed

22 Recruit additional Consultant in Radiology CD Short term Required to support service


Within recruitment process

23 Recruit additional Consultant and Specialty Doctor within Psychiatry

BMc Short term Required to support service delivery

Within existing resources


24 Recruit to additional Consultant Physician (Acute Care) CD Short term Required to support service



25 Repatriation of Patient MP Short – December 2012

Recruit a significant number of staff multi-disciplines.

Yes - detail to be confirmed

Working group taking project forward

26 HCSW – extended roles SMT Short to medium term

HCSWs undertaking activities that have traditionally been undertaken by clinicians. Examples include some standardised assessment and caseload management. Maximising resources, maintaining waiting times against increasing referral rates and reduced staffing. Examples of post vacancies being transferred to efficiency savings


HCSW trained to carry out visual perceptual standardised assessment, interpret, report and treat

27 Review roles of band 6 nurses across a range of services AS Short; medium term Review current skill mix and

identify required changes Not known

VERSION 7 28.06.12






28 Reshaping care of older people project AF Short - Medium term

Will require staff to potentially provide outreach services (Band 6&7)

Not known

29

Renal dialysis provision continues to expand and future changes include repatriation of transplant patients and home dialysis provision

AF Short – medium term

Requires additional medical, nursing, AHP staff ( Band 5 expansion)

Yes

Staffing resources may be able to be identified from existing establishment

30

Acute Medicine requires advanced nursing skills Longer term plan will be to provide additional advanced nursing practitioner roles that provide advanced nursing and technical roles

AF Short –medium term

Band 6 expansion ANP Renal ANP Cancer ANP Acute Medicine

Not known Scoping work being undertaken

31

Respiratory Non Invasive Service provision within Critical Care Service rather than ward 43

AF Short – medium term Will reduce wte in respiratory ward No Scoping work being

undertaken

32 Recruit and develop GP input for ICASS PPG Short to medium

term Medical input required to support service redesign for ICASS

Within existing resources, supplemented by Change Fund

DWF CHP recruitment has been completed; one part time GP took up post 12/6/12, other part time GP will start in August 2012. Plans for other CHPs being concluded

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33 Implementation of eHealth solutions TBC Short to long term

Improved data collection, management reports statistical analysis for more efficient and effective service planning and delivery. Prediction of service demands/needs. Scheduling and waiting list management systems improving the efficient use of resources and timely care. Telehealth – opportunities to deliver health care in different ways. Maximising use of available resources – increasing activity in anticipatory care.


eHealth profession subgroups working through action plans for eHealth implementation – focussing firstly on areas that will have greatest impact which can be achieved quickly.

VERSION 7 28.06.12






34 Plan for future disestablishment of Trainee Doctor posts

GBi/CD Short to long term

Need to consider service redesign, replacement of Trainee Doctor time with trained doctor or alternative staffing complement.

Within existing resources / disestablishment funding

Subject to national processes. Emergency Medicine plan in place. One post in General Adult Psychiatry indicated for August 2012. Obs & Gynae is a specialty potentially affected – plan is being considered. Occup. Medicine is another potentially affected area

35 Review sustainability of existing Trainee Doctor rotas where posts are disestablished

GBi/CD Short to long term

Need to consider rota and service redesign to ensure compliance with training, New Deal and EWTR requirements.


Plans being developed for consideration at Medical Workforce Committee.

36 Contribute to National Reshaping Medical Workforce Group and Regional Group

GBi Short to long term Ensure that impact on NHS Fife Trainee Doctor establishment is identified at an early stage.

Claim for disestablishment funding

Participation in regular meetings.

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37 Changing skill mix from Band 5 to Band 3 within the Homecare service

JY

As this action is dependent on Band 5 nurses leaving the service to be replaced by Band 3s the timescale could be short medium or long term

Skill mix change None

Within the last 12 months we have replaced 1.2 wte of Band 5 with 1.2 wte Band 3

38 RTC SMT Medium term Efficiency – maximising use of resources


Currently implementing module 2

39 Change lab structure MH OG Medium term

New lab manager appointed 1/4/2012. Now need to review and change the supporting structure.

No

Currently refining proposed structure for further discussion with partnership /senior staff.

40

Introduction of Enhanced Recovery across surgical specialties (shorter Length of stay)

SM Medium term Improved efficiency No

Implemented in Orthopaedics and planned to roll out to Urology and Colorectal next.

VERSION 7 28.06.12






41 Integration of acute and community paediatric services SMA Medium term Possible streamlining of services Not Known

42

Secure the role (and funding) of Physician Assistants in Anaesthetics. SM Medium term

These 4 posts continue to support the junior anaesthetic rota and would need to be replaced if removed from the workforce.

Yes

Staff currently in post. Posts are extended on a 3 monthly basis.

43

Further development of Vascular service network with Tayside including screening programme. Movement of inpatient cases to Tayside and Tayside day cases to Fife.

SF Medium term Consultant staff working across boards. No

Some movement of patients has occurred but progression required to move more daycases from NHS Tayside to NHS Fife.

44

Sustaining of Oral Maxillofacial service on a regional basis SM Medium term Loss of consultants in NHS Fife No

Joint advert with NHS Tayside for consultant post. Interviews to be held 26 June 2012.

VERSION 7 28.06.12

No

Description of action

Lead





45

Revision of Salaried Dental Officer/Dental Therapist skill mix

DA Medium term

10% decrease in Dental Officer staffing through natural turnover, proportionate increase in Dental Therapist staffing via recruitment

Met within current resources

The revision is part of the National Strategic Plan for Dentistry – this revision in Fife is likely to be implemented 2013/14 when sufficient numbers of appropriately trained staff become available to sustain service delivery.

46 Salaried Dentists Pay Modernisation DA Medium term

Unified terms & conditions for Salaried & Community Dental Officer staff


Work is underway within Scottish Government to analyse options and costs, with a view to unification of the terms & conditions. Linked to Action 50 above.

VERSION 7 28.06.12






47 Delivery of HEAT target H9 by 31 March 2014

GB/DA Medium term

The role of the Childsmile Team and relevant staff may evolve considerably to release resources to focus on areas required to meet HEAT target. Deployment of staff beyond April 2014 will be determined by oral health needs in Fife and the future of the Childsmile programme.


Integrated action plan to deliver against HEAT target in place. Plan and progress against target under quarterly review

48 Reshaping Care of Older People (CHP wide) VI Medium term

Review of Community services and in-patient facilities within NHS Fife. This will support a shift in the balance of care and improved utilisation of resources.


Development of ICASS Model and review of in-patient facilities in progress.

49 Development of ICASS (CHP wide)

MT/AW/GF

Medium term Remodelling of intermediate care services with integration of workforce. Partnership working.

Change fund within current resources

SPOA set up integration of health care teams undertaken. Relocation of reablement teams under review.

VERSION 7 28.06.12






50 Health Promotion / Health Improvement KN Medium

Continue to work with other stakeholders and the Voluntary Sector to ensure the Health and well being of individuals and communities in Fife are met in line with JHIP.


Progress on healthy working lives. HEAT target for smoking cessation linking in with K&L CHP Zone 1.

51

Workforce plan towards a skill mix of 70% to 30% registered to non-registered staff in Physiotherapy

CDF/ LB Medium

Senior staff focused on high level assessment and intervention with appropriate skill mix planned to support all levels of activity.

Identification of “core business” is being undertaken and workforce plans are in place to identify an appropriate skill mix. Split presently standard at approx 80% to 40% across the service.

52

Physiotherapy - Move towards 6 and 7 day working patters in both OD and Community Settings

CDF/ LB Medium term

Discussion and agreement with existing staff to change working hours on a voluntary basis. Involvement of HR and Staff Side required.

Uplift in budget will be required. Pilot objects in OD will identify financial resource required to sustain 6 and 7 day working.

Pilot projects started within OD involving 7 day working. 6 day working under discussion within D&WF CHP in relation to ICASS

VERSION 7 28.06.12






53

Increase in the number/wte of SLT support practitioners in hospitals to support transition into and further therapy in the community. This is in response to the increased throughput in acute. At present it may be the case that some patients may be missed in terms of service provision.

CM Medium term

Further reduction in number of qualified staff and introduction of skill mix. Ability to support patients in community for additional therapy intervention.

Skill mix of vacant SLT posts

Posts in recruitment but further skill mix will be implemented as finance and vacancies allow.

54 Increased work with social care staff in Care Homes CM Medium term

Decrease in direct contacts while SLT staff build capacity in other staff groups in the management of swallowing and in enabling communication, through training and modelling.

Difficult to tell financial impact may need extra finances to support training process

Discussions with SLT service already underway. This practice exists in a limited fashion.

55 Learning Disabilities - To progress Assistant Practitioner following pilot

MP Medium Upskilling of staff – Band 3 to Band 4

From current vacancies

Job Description being developed for these posts

56 Strengthening Anticipatory Care LM / RB Medium term

Anticipatory care nurses require time out for education. More patients being kept in the community

Managed within budget

1 nurse released to undertake training

VERSION 7 28.06.12






57 Staged service provision SMT Medium term

Provision of level of service (universal, targeted & specialist) reflective of need. Focus on self management, empowerment and health promotion. Safe guarding against finite specialist resource whilst increasing clinical effectiveness with anticipatory care.


Examples of targeted work within schools. Schools now continuing these programmes without OT involvement (consultation only). Drop in clinics for advise and support.

58 Advance practice clinicians SMT Medium to long term

Clinicians developing advanced skills and doing some clinical tasks historically undertaken by paediatricians.


Clinician’s undertaking masters modules, mentoring

59 Review of Nursing in the Community (CHP wide) MT Medium to Long

Further introduction of skill mix identification of new roles. Development of Healthcare Support Worker role.


Skill mix already introduced in Public Health Nursing and Community Nursing in the Home.

VERSION 7 28.06.12






60 Rebalancing Care Agenda CDF/ LB

Medium to long term

Planned movement of individual staff within the workforce with Physiotherapists following the patient within agreed pathways of care

Agreement to move resources from one area of service provision to another

First transfer of Physiotherapy staff has taken place from OD to Primary Care in K&L CHP to support ICASS model of change of activity following closure of Pentland Day Hospital.

61 Modernising Nursing in the Community. Efficient and effective use of resources

TL Medium to long term

Releasing Time to Care being rolled out within community teams


Commenced within office bases

62 Reconfiguration and Redesign of Primary Care Emergency Service provision

JB Medium to long term

Review of current staffing to be aligned with patient attendance profile. Multidisciplinary approach to nursing skill mix to allow career progression pathway. GP staffing to include a cohort of salaried staff to support service and include peer review and audit

Reconfiguration of existing resources to enable developments to progress

Staffing for new model reflective of service requirements. Further review after implementation at 3 and 6 months may require further changes

63 Preventing Hospital Admission, supporting early discharge GT Medium to long

term

Bands 7 & 6 focused on high level assessment. Bands 5 & 3 supporting and maintaining patients in the community setting

Re-shaping Care for Older People Change Fund

All staff in post for Hospital at Home. Training commenced. Admissions to service taking place

VERSION 7 28.06.12






64 Development of Midwife Led Unit in QMH CC Long term Additional staff would be required

to provide this service in QMH Yes

65 Aging workforce within the Learning Disability Service

MG /MP Long term In order to maintain establishment

to ensure safe service delivery Cost neutral

Succession planning ongoing in service. Disability Nursing review. National Learning Disability Nursing Workforce Planning Review

66

Orthopaedics service redesign and implementation of patient pathways across primary and secondary care

SM Long term Increase in consultant and theatre staff numbers

Yes

Locum consultant arranged. Possible funding for additional theatre staff identified Service improvement work started

67

DCAQ and job planning exercise to be undertaken to determine consultant clinics and operating sessions required to meet waiting time targets for Orthopaedics, General Surgery and Obs and Gynae.

SM Long term

Improvement of efficiency within job planning and ability to introduce some flexibility to meet service needs.

No Initial discussions have begun.

VERSION 7 28.06.12






68 Recurring efficiency savings DA Long term

Review of all vacancies on an ongoing basis, balanced against service need and required CDS and GDS provision


Reductions in Administration and Dental Health Support Worker staffing since 2011 sustained within service. Ongoing review of all vacant posts.

69 Recurring efficiency savings (CHP wide)

VI/SM Long term

Review of all vacancies on an ongoing basis, balanced against service need and required


Reductions in management, and administration staffing since 2011 sustained within service. Skill mix introduced in nursing, podiatry, physiotherapy occupational therapy. Ongoing review of all vacant posts.

VERSION 7 28.06.12






70

Physiotherapy - Increase of Band 6 and Band 5 grades by reconfiguration of Band 7 posts as vacancies arise

CDF/ LB Long term

Less highly specialised taskforce with strengthening of specialist Band 6 grade. Strong education and training programme required to up skill Band 6/5 grades and fast-trac learning to meet complex patient demands.

Managed within existing budget

Skill mix exercise with focus on decreasing numbers of Band 7 grade and increasing numbers of Band 6 and 5 has been ongoing within the Physiotherapy service since the advent of Agenda for Change in 2004/5.

71 Review structure of Occupational Therapy in acute areas

AMc 2012/13 Potential for some staff in acute to move to community to support Health and Social Care Integration

Unknown Plans currently being drawn up

72

Modernising Nursing in the Community. Introduction of skill mix to District Nursing and Public Health Nursing Teams .

LM / RB Ongoing

Reducing the number of Band 6 District Nurses to 1 per team as vacancies occur. Supporting service delivery with an increase in Bands 5 & 3. Reviewing further skill mix to PHN teams, increasing the number of Nursery Nurses and Staff Nurses as appropriate. Within PHN team if appropriate review number of Band 2 and 3’s.


Only one base remaining with 2 Band 6 District Nursing posts.

VERSION 7 28.06.12





Progress towards Implementation

73 Implementation of Family Nurse Partnership

PS/ RB/ LOD

Ongoing

Funding from Scottish Government for 3 years to implement FNP programme. Team recruited and implementation date 1 August 2012. Workforce increasing by 1 Family Nurse Supervisor and 4 Family Nurses also 0.5 wte Admin / Data Manager. Total number of clients will be 105 across Fife.

Managed within budget from Scottish Government over 3 years

Progress within timeline set by Scottish Government.

74 Introduction of access criteria CE April 2012

Equity of service delivery All staff aware of eligibility criteria for NHS Fife podiatry treatment Only those patients at risk of complication are now eligible for treatment which means that podiatrists’ caseloads are more complex and time intensive

None Implemented

75 Development of electronic records LH 2010 onwards

Additional training Increased efficiency to retrieve records

Staff time to develop records and to roll out programme

Initial electronic records discarded TIARA record system to be developed

VERSION 7 28.06.12

Key to Leads:

AF Andrea Fyfe Divisional General Manager, Emergency Care Directorate AMc Anne McAlpine Lead Occupational Therapist, NHS Fife AS Arlene Saunderson Directorate Nurse Manager, Ambulatory Care Directorate AW Aileen Whyte Community Services Manager, Glenrothes & North East Fife CHP BH Barrie Higgins Facilities Manager BM Brian Montgomery Medical Director BMc Bob McLean General Manager, Mental Health Services CC Cath Cummings Directorate Nurse / Midwifery Manager, Planned Care Directorate

CD Designated Clinical Director for the area involved

Clinical Directors

CDF Carol Duncan Farrell Head of Physiotherapy, Operational Division CE Cheryl Easton Head of Podiatry CM Christine Malcolm SALT Manager DA Dawn Adams Clinical Director DC Donald Coxon Chief Pharmacist GB Graham Ball Consultant in Dental Public Health GBi Gordon Birnie Medical Director, Operational Division GF Gillian Fenton Hospital Services Manager, Glenrothes & North East Fife CHP GT Gwyneth Thom Team Leader JB Janette Brogan Lead Nurse JR Jim Rotheram Facilities Manager KA Ken Andrew Mobility & Technology Service Manager KB Karen Baxter Podiatry Head of Service KN Karen Nolan Palliative Care Services Manager, Glenrothes & North East Fife CHP LB Lesley Bruce Head of Service Physiotherapy, CHP LM Liz Mitchell Lead Nurse, Lynebank LO Louise Osborne Diabetologist

LOD Lesley O’Donnell Lead Child Protection Training LH Les Hogarth Senior Podiatrist

MG Malcolm Gordon Lead Nurse, Learning Disabilities (Community Services) MH Margaret Henderson Divisional General Manager, Ambulatory Care Directorate MP Margaret Pirie Lead Nurse, Learning Disabilities (In-patient Services) MS Maureen Speedie Directorate Nurse Manager, Planned Care Directorate MT Mollie Tevendale Associate Nurse Director, Glenrothes and North East Fife CHP

VERSION 7 28.06.12

NL Nancy Little Head of Service, SALT OG Olga Greenan Laboratories Manager

PPG Lead to be identified by PPG as appropriate Partnership Project Group

PS Pauline Small Associate Nurse Director RD Rae Dickson Diagnostic Imaging Services Manager RB Rhona Brown Lead Nurse

SAM Susan Manion General Manager, Dunfermline and West Fife CHP SF Susan Fraser Divisional General Manager, Planned Care Directorate SM Steven Monaghan Clinical Director, Planned Care

SMT Sarah Mitchell Thain Senior Occupational Therapist

TL Team Leader for the area involved Team Leaders (Community)

VI Vicky Irons General Manager, Glenrothes and North East Fife CHP

VERSION 7 28.06.12

APPENDIX 1

EFFICIENCY AND PRODUCTIVITY POST CHANGES SUMMARY

A. NURSING & MIDWIFERY

B. OTHER THERAPEUTIC SERVICES - PHARMACY

C. ALLIED HEALTH PROFESSIONALS Diagnostic Radiography

Band

WTE

8a -1.00 7 -1.63 6 -2.50 5 -30.57 3 +2.00 2 -33.54

Band

WTE

7 -2.00 6 +2.00 5 -1.00 4 +1.00

Band

WTE

7 -2.20 6 -0.20 5 +2.20 4 -1.00 3 -1.60 2 +0.80

Physiotherapy

Band

WTE

8a -1.11 7 -0.50

Podiatry

Band

WTE

8a -1.00

Occupational Therapy

Band

WTE

5 -1.17 3 -0.07

D. MEDICAL & DENTAL

Grade

Specialty

WTE

Locum Orthodontics +0.40 Consultant Community Paediatrics -0.70 Consultant Public Health -0.85

E. MEDICAL & DENTAL SUPPORT

Band

WTE

Orthodontics Tech 7 -0.30 GNEF CD Allowance -0.40

VERSION 7 28.06.12

F. SUPPORT SERVICES Estates

Band

WTE

4 -0.50

Portering Services

Band

WTE

2 -3.00

Catering Services

Band

WTE

2 -2.00 1 -3.00

Domestic Services

Band

WTE

4 -1.00 1 -4.08

G. ADMINISTRATIVE & CLERICAL

Band

WTE

Senior Manager -1.00 8b -1.02 8a -1.00 7 -2.00 6 -1.68 5 -0.82 4 -2.72 3 -3.04 2 +2.42

VERSION 7 28.06.12

APPENDIX 2

WORKFORCE PROJECTIONS TEMPLATE

S:\KarenC\NHS Fife Projections Master 20

VERSION 7 28.06.12

APPENDIX 3 NHSS & SEAT WORKFORCE AGE PROFILES Scotland’s Population Changes 2000 - 2010 The General Registrar of Scotland (GROS) mid 2010 populations estimates for Scotland 1 identify that Scotland’s population grew over the 10 year period from 2000 by 3.1% (c160,000) from 5.06 million to 5.22 million. The majority of this growth has resulted from an increase in net immigration into Scotland. During this period Scotland’s population has seen significant changes in both its age profile and distribution. The change in age distribution is shown below. The greatest increase in population occurred in the 45+ year old age categories. The population aged below 45 fell by 9%.

Source: General Registrar of Scotland Scotland’s population also grew at different rates across NHS Health board areas, with the South East and Tayside (SEAT) boards showing the highest rates of growth over this period, as shown below:

Source: General Registrar of Scotland SEAT boards have seen the highest population growth of any region in Scotland during the period 2000 – 2010. Changes in the population profile are accounted for in the NRAC methodology for funding the NHS in Scotland (NHSS). However there is a time lag in making funding adjustments and the above population changes has put additional pressure upon services within SEAT. Scotland’s Population Projections GROS forecast that the growth in the population of Scotland will continue over the next 25 years. GROS project that the population will rise from 5.22 million in 2010 to 5.49 million in 2020 and to continue to rise to 5.76 million in 2035 – an increase of 10% over the 25 year period. However, as in the period 2000 – 2010, the population will continue to ‘get older’ and will continue to increase proportionally faster in SEAT boards in comparison with the rest of NHSS. The projected increase of 10% in Scotland’s population will result from the increase in the over 60 year olds. As the graph below shows, the population aged under 60 is projected to remain fairly constant whilst the number of 60+ year olds is projected to continue to increase significantly.

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This has significant implications for NHSS. The large increase in older people will increase demand for NHSS services. Also the small decrease in the 16 – 60 age groups will require the NHSS to compete in a labour market where the numbers of new entrants to the market will fall over this period. Secondly the projected increase of 10% in Scotland’s population is not spread evenly across all the NHS Boards. As in the previous decade the population of SEAT Boards is projected to increase significantly, as shown below:

This has significant implications for NHSS. It will require the ongoing shift in resources to those boards projected to have significant increases in population, particularly given this growth will be mainly in the over 60 year olds. This will be implemented via the existing NRAC formula. It will also require growth in the workforce of those boards in order to deliver the increased demand in clinical services.

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NHS Scotland Workforce The NHSS workforce has grown over the last 10 years since 2002. From 2010, because of the fiscal climate within the public sector, this trend has reversed and since then we have seen a small decrease in the workforce. This is shown below:

All NHSScotland staff - wte (excluding GPs & GDs)

100,000

105,000

110,000

115,000

120,000

125,000

130,000

135,000

140,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 Mar-11 Jun-11 Sep-11 Dec-11

Source: ISD. Note: since March 2011 ISD have moved to quarterly reporting of workforce statistics The profile of the NHSS workforce has also changed, mirroring the wider changes taking place within the Scottish population. The following graph shows the changes in the NHSS workforce age profile over the period from September 2007 to December 2011 (this is the furthest back ISD age profile data goes).

All NHSS staff (excluding GPs and GDs)

-

5,000

10,000

15,000

20,000

25,000

30,000

Under

20

20 - 2

4

25 - 2

9

30 - 3

4

35 - 3

9

40 - 4

4

45 - 4

9

50 - 5

4

55 - 5

9

60 - 6

465

+

Sep-07Dec-11

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Source: ISD The graph clearly shows the increase in the workforce aged over 45 and the corresponding decrease in the numbers of staff aged 20 – 44. The ‘aging’ of the NHSS workforce has been anticipated in previous board workforce plans and this phenomenon is clearly demonstrated in the above graph. The ‘Age as an Asset’ research by the SEAT boards and NHS Education Scotland (NES) during 2009-11 identified a range of issues associated with an aging workforce that will require NHSS and individual NHS boards to consider current employment practices. For example, older employees may find shift working or physically demanding roles more difficult and may require redeployment to less taxing roles as they near retiral age. The above graph however masks significant differences in the age profile of different staff groups. For example the age profile of all NHSS nursing and midwifery staff, shown below, demonstrates a more pronounced shift than the above graph.

All NHSS - Nursing and Midwifery

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Under 2

020 -

24

25 - 29

30 - 34

35 - 39

40 - 44

45 - 49

50 - 54

55 - 59

60 - 64

65 +

Sep-07Dec-11

Drilling further into this staff group demonstrates that there are specific challenges with the age profile of midwifes, where a significant proportion of the workforce are between 45 and 64, see below. This profile suggests that NHSS will lose a significant proportion of the midwifery workforce over the next 5-10 years as these employees reach the average retiral age, perhaps accelerated by forthcoming changes in NHS pension schemes. The drop in those employed aged less than 45 would suggest that further work is required to ensure an adequate replacement midwifery workforce over the next 5-10 years.

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NHSS - Midwifery

-

100

200

300

400

500

600

700

800

Under 2

0

20 - 2

425

- 29

30 - 3

435

- 39

40 - 4

445

- 49

50 - 5

455

- 59

60 - 6

465

+

Age profiles within staff groups vary for a variety of reasons. For example the age profile for consultant medical staff is more ’balanced’ and less skewed towards the older age groups. This reflects the significant increase in the consultant workforce over recent years which have resulted in a large increase in newly qualified doctors gaining consultant grade posts. However, apart from a few exceptions such as consultant medical staff, the overall picture is of an NHSS workforce that is getting smaller and older. SEAT NHS Workforce As with the NHSS the SEAT workforce has grown over the last 10 years since 2002 with a similar small decrease from 2010. This is shown below:

SEAT NHS staff - wte

22,000

23,000

24,000

25,000

26,000

27,000

28,000

29,000

30,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 Mar-11 Jun-11 Sep-11 Dec-11

The profile of the SEAT workforce has also changed, mirroring the wider changes taking place within the Scottish population and NHSS, as below:

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SE - All NHS Staff 2007 - 2011

0

1000

2000

3000

4000

5000

6000

7000

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

Within this profile some staff groups require further consideration, as detailed below. SEAT Nursing Profile The following graph shows the shift in age profile of the SEAT boards nursing workforce between September 2007 and December 2011. The graph shows that during this period the percentage of nurses under 45 has fallen from 57% to 49%, whilst those over 45 have increased from 43% to 51%. This ‘aging’ of the workforce has potential significant implications in terms of current and future job roles undertaken by an older workforce and also succession planning over the next 5-10 years.

SEAT Nursing 2007 - 2011

0

500

1000

1500

2000

2500

3000

3500

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

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SEAT Midwifery Profile The following graph shows the shift in age profile of the SEAT boards midwifery workforce between September 2007 and December 2011. The graph shows that during this period the percentage of midwifes under 45 has fallen from 57% to 47%, whilst those over 45 have increased from 43% to 53%. This ‘aging’ of the workforce has potential significant implications in terms of current and future job roles undertaken by an older workforce and also succession planning over the next 5-10 years.

SEAT Midwifery 2007 - 2011

0

20

40

60

80

100

120

140

160

180

200

Under20

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 +

D Phillips Regional Director of Workforce Planning SEAT Region May 2012

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Workforce Modernisation and Development Strategic Plan 2012/13admin.fifedirect.org.uk/...WorkforceStrategicPlanfinaldocumentversio… · 2.2 The Workforce Modernisation and Development