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BUILDING A MODERN WORKFORCE

Andrew FosterDirector of Human

ResourcesDepartment of Health

Dublin Masterclass 14 Feb 03

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INTRODUCTION

• The history of the NHS in three minutes

• The HR in the NHS Plan - The Strategy

• Building Workforce Capacity - The Plan

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NHS FACTS

NHS England (2001)

Headcount Paybill (000's)Doctors 97,450 £ 6,191,000Nurses, midwives 421,400 £ 7,673,000Other 472,090 £ 6,476,000

Grand Total 990,940 £ 20,340,000

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NHS LIFE CHANGING EVENTS

• Bristol Paediatric Cardiac Surgery

• Alder Hey Retained Organs

• Winter 1999

• Endemic waiting

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BUDGET 2000

• Three year 30% leap in funding

• Last chance saloon

• With funding must come reform

• The NHS Plan

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THE NHS PLAN

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SPENDING REVIEW 2002

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SPENDING 1996 - 2008Year Spend % % real terms

£bn increase increase

96/97 33.0 3.2 0.0

97/98 34.7 5.1 1.9

98/99 36.6 5.6 2.8

99/00 39.9 8.9 6.4

99/00 40.2 - -

00/01 44.2 9.8 7.4

01/02 49.4 11.9 9.3

02/03 53.7 8.8 6.1

02/03 55.8 - -

03/04 61.3 10.0 7.5

04/05 67.4 10.0 7.3

05/06 74.4 10.3 7.6

06/07 81.8 10.0 7.3

07/08 90.2 10.2 7.5

Cash

Stage 1 RB

Stage 2 RB

Total Net NHS Expenditure in England

RB - Resource Budgeting

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WORKFORCE COMMITMENTS April 04 April 05 April 08

From 99 From 00 From 01(NHS Plan) (Manifesto) (SR2002)

Nurses +20,000 +20,000 +35,000AHPs +6,500 +6,500AHPs&STTs +30,000GPs +2,000Consultants +7,500Doctors +10,000 +15,000

10Herding

Cats

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THE HR IN THE NHS PLANLaunched July 2002

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EXAM QUESTION

How can good HR Management improve the patient’s experience?

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ObjectivesoftheService

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Re-engineering NHS jobs

around patient Pathways

Increasing staff

numbersHeadline objectives

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The Four Pillars of Delivery

Re-engineering NHS jobs

around patient pathways

Increasing staff

numbers

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Three Star Trust

SkillsEscalator

Improving Staff Morale

HRMDevelopment

NHS as a Model Employer

Improving Working Lives

and beyond

NHS as aModel Career

4 Modernisations:

• Workforce Planning • Pay • Regulation

• Education & Training

Psychological Contract

Staff and employers

Staff and Government

Staff and patients

BuildingSkills,

Capacity,Quality, ‘Attitude’

The Four Pillars of Delivery

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THE STAFF PATHWAYFour Modernisations

LearningCommon core module.

Occupational core module.Patient/disease specific module.

Workforce PlanningBottom-up, top-down

and diagonal slice.Planning skills and

knowledge, not titles.

PayEight paybands.

Jobs expressed asresponsibility, knowledge,

and qualifications. New GP / Consultant contract.

RegulationExtension to all

who ‘touch’ patients. Convergence of process.

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THE STAFF PATHWAY

Pay Spine LearningLevel Career Stage

Regulation

Cadet Pre-emp- Work OrientationUnemployed/ loymentExcluded

Skilled Assistant Support Higher NVQs and HigherAssistant Workers Occupational StandardsStarter Induction, NVQs

Occupational Standards

Expert Qualified Higher disease/patientRegistered Professional modulesPractitioner Staff Disease/patient modules

Degrees Diplomas

Consultant Self Directing Higher Degrees Principals

Workload

and Roles

Car

eers

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The Golden Trust

The SkillsEscalator

Tackling Low Morale

HRMDevelopment

The NHS as aModel Employer

Improving Working

Lives and Beyond

The NHS as aModel Career

FourModernisations:

Workforce PlanningPay

RegulationEducation & Training

The Psychological Contract:

Between staff andEmployers

Between staff andGovernment

Between staff andpatients

BuildingSkills

CapacityQuality

and‘Attitude’

The Four Pillars of Delivery

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The Four Pillars of Delivery

The Social

PartnershipForum

Oversight of formulationand delivery

Re-engineering NHS Jobs

Around Patient Pathways

Increasing Staff

Numbers

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HRDirectorate

Modern-isationAgency

ExternalMembers

CapacityUnit

StHAsWDCs

SHRINEs

TheExecutive

Wing

Supportingdelivery

at groundlevel

Supportingsome

areas of delivery

Spreadingthe

message

Developingthe

HRMfunction

The Social Partnership Forum

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The Social

Partnership Forum

Oversight of formulation and delivery

The Four Pillars of Delivery

All supportedby an

evidence base

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All supportedby an

evidence base

The SocialPartnership

Forum

Oversight of formulation and delivery

Audiences

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HR Manage-

ment

General Manage-

ment

StHAsWDCs

Staff Unions

Audiences

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AudiencesAll supported

by anevidence base

FrontlineClinicalTeams

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FrontlineClinicalTeams

AudiencesThe

PatientExperience

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All supported by an Evidence Base

Frontline Clinical Teams

The Patient Experience

Model Employer

Improving WorkingLives and Beyond

Model Career4 Modernisations:

Workforce Planning, Pay, Regulation,

Education & Training

PsychologicalContract

Staff and Employers Staff and Government

Staff and Patients

BuildingCapacity

Skills, Qualityand

‘Attitude’

Three Star Trust Skills Escalator Improving Morale HRM Development

HR Management

GeneralManagement

StHAs/WDCs Staff Unions

The NHS PlanHeadline Objectives

Re-engineering NHS jobs around patient pathways

Increasing staff numbers

Supporting deliveryat ground level

Supporting someareas of delivery

Spreading themessage

Developing the HRM function

Executivewing

The Social Partnership ForumOversight of formulation and delivery

ExternalMembers

ModernisationAgency

HRDStHAs, WDCs

SHRINEsCapacity

Unit

28

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BUILDING WORKFORCE CAPACITY

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KEY OBJECTIVES WITHIN OUR SR2002 SETTLEMENT

• Raise overall activity levels

• Meet access targets

• Achieve clinical priority targets

• Shift from secondary to primary

care

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2003 2004 2005 2006 2007

Year

Illu

str

ati

ve

ac

tiv

ity

an

d q

ua

lity

im

pro

ve

me

nts

Specialist & Long TermConditions

Older people, children'sservices and mental health

CHD & Cancer

Access & Waiting

ACTIVITY LEADING TOWORKFORCE DEMAND

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ACTIVITY REQUIREMENT• Projected extra FCEs required (000s):

03/04 04/05 05/06

510 1,040 1,600

• Projected number of equivalent:03/04 04/05 05/06

Nurses 287,150 294,000300,180

GPs 28,220 28,830 29,560Consultants 26,630 28,130 28,930AHPs & STTs 98,900 102,570

106,350

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DEMAND MINUS SUPPLY EQUALS GAP

Projected gaps:

2003 2004 2005

Consultants1,959 (7%) 2,611 (9%) 3,100 (10.6%)

Nurses 25,165 (9%) 35,293 (12%) 43,599 (14%)

AHPs 2,144 (2%) 3,995 (4%) 5,846 (5%)and STTs

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GAP CLOSING MEASURES

‘NHS Plan Plus’ assumptions:• Skills Escalator skillmix• Increased international recruitment• Accelerated pathways to consultant• Improved retention• Increased productivity (offset

against increased quality)• Effect of additional training

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CONSULTANTS DEMAND AND INCREASED SUPPLY

YEAR

2003 2004 2005

20

21

22

23

24

25

26

27

28

29

30

WT

E

(0

00

’s)

Skill mix (net)

Increased

productivity

Expediting

recruitment

Improved

retention

Faster conversion

International

recruitment

Conversion of AS

Baseline supply

Demand

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230000

240000

250000

260000

270000

280000

290000

300000

310000

2003 2004 2005

YEAR

WT

E

Skill mix (net)

Productivity

Shorter training for NVQ3 HCAs

International recruitment

Extra NHS Plan training

Increased participation

Baseline supply

Demand

NURSES: DEMAND AND INCREASED SUPPLY

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SUMMARY

• A massive set of challenges• Reform, expansion and

delivery• Organisational objectives

with a workforce solution• We have a plan• Thank you for listening

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Footballers