NHS Tayside Transformation Support Team: second progress report

AAG Recommendation 4 – Workforce

" NHS Tayside should undertake an early and comprehensive review of staffing levels across all services and sites, including those delegated to or utilised by HSCPs [Health and Social Care Partnerships]. This review should aim to clarify key drivers of NHS Tayside's workforce levels compared to peer Boards and to identify safe options for bringing redesigned services and sites within available resources."

NHS Tayside's assessment

"In October 2017 we deployed a 'Tayside Establishment and Payroll Analysis' ( TEAPA) tool. It encompasses job grade mix and workforce age profiling and has been critical in informing workforce management decisions and used to inform recruitment authority. It also forms the basis of the development of 2018/19 workforce plans. The tool provides a strategic and service level analysis of headcount and whole time equivalent. This enables staff groups, for the first time, to understand their establishment movement over time, disaggregated to individual ward level.

Benchmarking analysis was completed during September 2017 of current NHS Tayside establishments against national NHS Board comparators. Further additional analysis was undertaken with NHS Grampian to review clinical quality indicators, safety and risk management and workforce planning for a small group of ward areas. Benchmarking data has been presented to NHS Tayside Board, Executive Review Team and Senior Management Team and also shared with individual directorates. Updated workforce plans for 2018/19 were considered at the Directors' Group meeting on 18 December 2017, in advance of wider consultation in January 2018 at the Area Partnership Forum, Staff Governance Committee and NHS Tayside Board.

Additionally it was agreed at the Transformation Programme Board on 20 December 2017 that, reflecting benchmark analysis, the review of Administrative and Clerical provision across all NHS Tayside services will also feature in all service level workforce plans for submission in January and February 2018. These workforce plans are also reviewed in each of the service redesigns that have been undertaken; Shaping Surgical Services, Community District Teams and Theatre Service Improvement.

Positive progress has been made with vacancy management and staff turnover. A new governance protocol was implemented during August 2017 with the establishment of a refreshed Vacancy Management Group. This group only reviews posts that are being progressed to fill. Chaired by the Medical Director/Deputy Chief Executive and including Staff Side, HR, Finance, Nursing and Midwifery and Chief Officer representation, the group ensures Director-level grip with the recruitment process requiring financial, clinical, HR and senior line management approval prior to consideration for authority to advertise.

An early decision was taken to approve a moratorium on the recruitment of external administrative posts given the benchmarking position and workforce transformation plans. Vacancy management data forms part of the review of the weekly cost metrics by the Executive Review Team. Since April the overall headcount has reduced by 117 whole time equivalent which was largely in support services, administration services and nursing and midwifery (Bands 1-4).

Significant progress has been made to reduce the requirement of Non-Contract Nursing Agency ( NCA) staff. From 1 November 2017 the Board agreed to suspend the use of NCA in all areas with the exception of those where significant clinical risk remained, with all use requiring completion of a multi-stage approval process. The monthly expenditure has reduced from £553,000 in August 2017 to £272,000 to November 2017, a reduction of 51% in that period. Other initiatives include recruitment of newly qualified practitioners, introduction of nursing staff pools and modification of nurse bank contracts. New standardised shift lengths have been implemented in a number of wards. Further actions for improvement have been identified for the period to March 2018 such as enhancement to nurse bank recruitment process with dedicated HR support. Additional internal leadership has been provided to managing bank staff which will ensure an ongoing review and adoption of best practice from other health boards. Daily escalation and scrutiny of Key Performance Indicators will continue.

A modified nursing and midwifery education and workforce resourcing toolkit was cascaded throughout the organisation on 2 September 2017. This was used to inform clinical staff of good practice in terms of effective rostering, associated staffing costs and alignment with local and national policy. A workforce dashboard was developed and is now presented at both the Staff Governance and Finance and Resources Committees. This tracks the following key areas: whole time equivalent; absence; turnover; vacancy; supplementary costs; skill mix and workforce demographics. This has enabled Non-Executive Members to be aware of activity in order to scrutinise progress against trajectories.

Critical to the success of sustainable workforce plans through and from 2018/19 is dependent on the outcomes from clinical model and service redesign.

Next Steps

The analysis from TEAPA, aligned with benchmarking and service delivery plans will be used to inform safe, affordable workforce plans for 2018/19 and beyond. This work will be completed at local service level in partnership during January - February 2018, with sign-off from the Area Partnership Forum and Tayside Board. Further actions relating to the optimal deployment of bank staff have to be completed during Quarter 4 of 2017/18 with a revised benchmark of service costs based on the December 2017 annual cost book."

TST comment

The TST concurs that the Board has made some progress with the implementation of this recommendation, particularly in relation to undertaking an early and comprehensive review of staffing levels across all services and sites.

Including the information available from the recently-developed TEAPA (Tayside Establishment and Payroll Analysis) system, NHS Tayside now has access to an extensive range of data about its existing workforce, encompassing absence and turnover rates, whole time equivalent ( WTE) staff in post and spend on supplementary staffing. This provides a powerful tool to enable a detailed and robust understanding of key cost drivers, including trends over time, disaggregated to service and indeed ward level. It is recognised that the Board is currently working through some of the Information Governance issues regarding TEAPA to facilitate use of the tool at a frontline management level within the organisation. Once achieved, this will support the roll out of informed decision making to operational levels within the Board.

We have seen a range of evidence of this data being put to effective use to inform and support the changes being made to staffing models and working practices as well as to inform decision making by the Vacancy Management Group ( VMG). We have also received feedback that it is providing a sound foundation and greater confidence at a frontline level to underpin collaborative, patient focused working and professional judgements about safe staffing.

The TST welcomes the contribution that these changes have made to the substantial decrease in expenditure on agency staff that is evidenced in the figures for November 2017.

Updated benchmarking information on workforce, both quantitative and qualitative, is also being used intelligently to better understand where the Board's greatest challenges lie and to identify where more radical and longer term transformational change may be needed. The information has supported the start of improvements in some areas but disparities continue to exist in others. It is recognised that context specific factors will be a legitimate consideration in identifying where these disparities may require to be addressed. However, continuation of existing models necessitating higher staffing ratios should continue to be questioned, and must be seen through the lens of the need at Board level to achieve overall financial sustainability.

The further development of the ICS will create an opportunity to consider many of these models within a broader picture of the strategic principles driving the overall configuration of services.

It has also been less evident to us that workforce data is being used as effectively as it could be, to identify safe options for bringing redesigned services and sites within available resources. Workforce data and planning assumptions will be an absolutely key element of the modelling and scenario planning needed to take forward the development of the ICS and the budget planning process for 2018/19 and beyond. Our amber rating reflects an implicit assumption that NHS Tayside will fully utilise all planning data at its disposal in the transformation and business planning work it undertakes during 2018.

TST rating in September 2017 = Red
TST rating in January 2018 = Amber