Changing the NHS Workforce

through collaboration and partnership

Patrick MitchellRegional Director, South of England

UHMLG – Brighton

29 June 2017

Health Education England’s Purpose

"Health Education England exists for one reason only: to

support the delivery of high quality healthcare and health

improvement to the patients and public of England by

ensuring that the workforce of today and tomorrow has the

right numbers, skills, values and behaviours, at the right

time and in the right place.”

The role of HEE

3

Quality &

Education

Commissioning

Workforce

Transformation

Education

Support:

Workforce

Planning &

Intelligence

HEE, through its Four Region’s delivers its mandate to the NHS through organising delivery through four main service offers.

Supported by a range of national/regional corporate

services – finance, HR, ICT etc.

• Of HEE’s 16/17 allocation, £4.5bn (89.5%) is effectively pre-

committed to future workforce commissions either through

undergraduate clinical (e.g. nurses) or PGMDE programmes.

• £104m (2%) was used to support workforce development and

allocated according to local priorities through HEE’s regional

offices.

• In addition £35m (0.7%) was allocated to national programmes in

support FYFV Transformation programmes

• Only £72m (1.4%) is admin spend. NHIR academic funding (listed

as “other expenditure”) of £53.8m is also distributed through HEE

mechanisms (but HEE has no role in its quantum or allocation)

HEE spending 16/17

HEE Spending 16/17Undergraduate non-medical

Undergraduate medical

PGMDE

Programme

Admin

Other

The Collective Challenge

• Cost containment

• Workforce shortages

• Rising workforce costs

• Fragmented approach to the design, development and training

of our workforce.

• Alignment of workforce skills, roles and capacity to service

models

• Collaborative System Leadership

Demographics

Mind the (generational) Gap

Potential impact of ‘Brexit’

NW London

South London

NC&E London

South West

Thames

Valley

East

Midlands

Yorkshire

& the Humber

North

East

North

West

West

Midlands

Wessex

Kent, Surrey

and Sussex

East of

England

• 5% of current NHS staff EEA nationals

• Variation by role (below) and geography* (right)

• Some reductions in EEA applications to non-medical

clinical undergraduate (why? CSR vs. brexit)

• No impact on applications to medical post-graduate

training (yet)

• More pronounced potential impact for social care

*Darker regions indicate a higher proportion of EEA clinical staff

• To deliver these plans, NHS providers, CCGs, Local Authorities, and other health and

care services have come together to form 44 STP ‘footprints’.

• These footprints are of a scale that should enable the transformation required to

implement the Five Year Forward View’s vision of health, quality care, and efficiency

by 2021.

• The STP footprints will not cover all planning eventualities – there are layers of plans

that sit above and below STPs.

• HEE have established coterminous Local Workforce Action boards to support the

STP’s workforce strategy and delivery

Sustainability and

Transformation Partnerships

The 44 English Geographies

In forming their footprints, local areas will

have taken the following factors into account:

• Geography (including patient flow, travel,

and how people use services);

• Scale (the ability to deliver sustainable,

transformed, and financially sound health

and care);

• Fit with footprints of existing change

programmes and relationships;

• The financial sustainability of organisations

in an area; and

• Leadership capacity and capability to

support change.

HEE’s changing role

2013: Education and

training commissioner

• Careers service

• Workforce planning

• Commissioning

education and

training

› PGMDE

› Undergraduate

clinical

• B1-4 staff (Care

Certificate)

2020: Strategic leadership, workforce intelligence,

and market intervention

• Workforce transformation (inc. Talent for care)

• Workforce intelligence

› Supply and demand; current and future

› Working with and influencing HEIs

• Future workforce

› Including improving the attractiveness of

healthcare careers and the ‘informal’

workforce, developing apprenticeship

standard

• Quality assuring clinical placements and education

• Delivering, overseeing, and transforming PGMDE

• Leadership development and talent management

• Quality assuring clinical placements and educational programmes

• Delivery of national programmes,

• Overseeing, delivery, and development of PGMDE programmes,

• Oversight of legacy non-medical commissions,

• Role in new SLC funded non-medical market to be determined by

consultation

• Oversight and assurance of LWAB delivery

HEE’s internal Structure

• Development of Workforce Strategy/Strategies, including FYFV

transformation programmes,

• Workforce Planning, including PGME commissioning,

• Policy development, e.g. development of Nursing Associate role.

• National Programme development and delivery e.g. NME programme,

• Accountability to Parliament via the DH and ministers,

• Oversight and assurance of Regional Team delivery

National Team

Regional Teams (4)

Local Workforce Action Boards (38)

• Cover labour markets and coterminous with STP planning areas,

• Allow Local providers access to and support from from HEE analytical and

policy capabilities,

• Support for local place-based workforce planning,

• Distribution of local transformation funding (dependant on 17/18

settlement),

Everyone “does” workforce planning

Strategy

Implementation

Future

DH(Pay, Pensions, etc.)

Present

PROVIDERS(Service provision, planning and transformation)

HEE (Education, training, commissioning and market management)

NHSI (Provider support, financial

sustainability)

The best predictor of the future is

the past…

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

% Increase in NHS employed staff 2004-2014

Consultants

Allied HealthProfessionsHealthcare Scientists

Ambulance staff

Total GPs

Specialty recruitment:

round 1 – acceptance and fill rates

2017 R1 2016 Comparison

Posts Accepts Fill Rate Posts Accepts Fill Rate Posts Accepts Fill Rate

ACCS Acute Med/Core Medical Training 1385 1027 74.15% 1334 1084 81.26% 51 -57 -7.11%

ACCS Anaesthesia/Core Anaesthesia 499 462 92.59% 487 483 99.18% 12 -21 -6.59%

ACCS Emergency Medicine 304 238 78.29% 309 290 93.85% -5 -52 -15.56%

Cardio-thoracic surgery 8 6 75.00% 5 5 100.00% 3 1 -25.00%

Clinical Radiology 221 221 100.00% 212 212 100.00% 9 9 0.00%

Community Sexual and Reproductive Health 4 4 100.00% 5 5 100.00% -1 -1 0.00%

Core Psychiatry Training 406 236 58.13% 417 274 65.71% -11 -38 -7.58%

Core Surgical Training 499 498 99.80% 507 505 99.61% -8 -7 0.19%

General Practice 3250 2399 73.82% 3250 2282 70.22% 0 117 3.60%

Histopathology 76 54 71.05% 74 65 87.84% 2 -11 -16.79%

Neurosurgery 25 25 100.00% 23 23 100.00% 2 2 0.00%

Obstetrics and Gynaecology 234 229 97.86% 230 228 99.13% 4 1 -1.27%

Ophthalmology 54 54 100.00% 61 61 100.00% -7 -7 0.00%

Oral and Maxillo-facial Surgery 7 7 100.00% 3 3 100.00% 4 4 0.00%

Paediatrics 377 303 80.37% 379 351 92.61% -2 -48 -12.24%

Public Health Medicine 67 67 100.00% 57 57 100.00% 10 10 0.00%

Total 7416 5830 78.61% 7353 5928 80.62% 63 -98 -2.01%

Workforce plan vs. reality - Consultants

The Future of Medical Rotas?

Consultants/GPs (CCT holders)

Non-Consultant

Non-Trainee Medics

“Training Grade” Medics

The wider workforce

Underlying supply constraints limit the number of

trainees available to deliver service and will

continue to do so in the medium/long term

• Need to attract/recruit/retain NCNT doctors?

• Use medical resource across STPs?

• Hot/Cold sites?

• Non-medically led/delivered services?

• Better, different, use of non-medical

workforce to support efficient delivery of

medical rotas? (ANPs, ACPs, Pas?)

• Enabled by holistic/multi-professional learning

environments?

• An additional 1,500 medical students;

– 2 cohorts, 2018 and 2019

– Clinical placement capacity?

– Clinical Placement funding (SIFT/Tariff)

– Overseas Students and cap?

– Point of Registration/Medical Licencing Assessment?

• Beyond 2019?

• New Schools entering the market?

• First trainees reach FY1 in 2023, CCTs 2028-2032

Medical Student Expansion

Workforce plan vs. reality – Allied Health

Professionals

Workforce plan vs. reality –

Nurses and Midwives

Nursing & Midwifery

Cumulative

Intake Intake Annual Increase

Year Size Increase v 2012/13

2012/13 20,124

2013/14 20,572 448 448

2014/15 21,769 1,197 1,645

2015/16 22,858 1,089 2,734

2016/17 23,285 427 3,161

2017/18 - est 23,285 0 3,161

Supply to 2020/21 111,769 11,149

HEE are currently training over 3,000 more nurses each year compared to

2012. 2012-2016 NHS adult nurses in post 13,751 (8.3%).

Source : NHS Improvement

Variation in staff turnover

National Transformation Programmes

FYFV priority programmes

• Urgent and Emergency

Care

• Cancer

• Mental Health

• Seven Day Services

• Maternity

“Five Pillars” approach to

workforce Strategies

• Increasing the attractiveness of

NHS Careers and improving

retention

• New Staff

• Adopting New Roles

• New Skills

• Delivering Care Differently

FYFV programme outcomes

• Improved access

• Improved outcomes

• Better patient experience

• Higher staff engagement

Given the importance of workforce to delivering on the Five Year Forward View (FYFV) priority areas HEE is supporting the

national programmes of work by producing national workforce strategies for each.

HEE will support the system to continue attract the vast majority of the educational output, look at how care pathways can

be designed to make use of a wider range of staff to support specialists in delivering care, rationalise the deployment of

staff where there are potential shortfalls, as well as how to better retain the existing staff that the NHS employs.

HEE’s local transformation offer

The HEE STAR is a web based tool, designed to inform and present

the HEE LWAB ‘offer’ to meeting the workforce requirements

described by the STP process. The tool has two functions;

• It creates a single ‘go to’ directory, for providers and systems to

access information on tools, resources and investment available to

deliver their workforce transformation plans

• Further, it provides a single, coherent framework to guide local

conversations with provider systems to better understand and

define their workforce transformation requirements

The STAR is a simple, step by step, staged approach that helps to

tackle workforce transformation in bite sized chunks, prompting

creative solutions to workforce planning, retention, skill mix and re-

design.

The STAR is in pilot phase with a small number of LWABs/STPs

across the country before being shared more widely in the Autumn.

@NHS_HealthEdEng #HEELKS

Sue Lacey BryantSenior Advisor, Knowledge for Healthcare

@SueLaceyBryant

UHMLG – Brighton

29 June 2017

How can we future proof the profession?

The Evolving

Librarian

Questions for today

• What can we draw on from the past?

• How are we positioning health librarians centre stage?

• How can we put quality at the heart of our work?

• How can we demonstrate our impact?

• What can we see on the horizon?

• How can we prepare?

H

EE

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

Image credit

C12th

1879

1960s to 1980s

HEE

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

Image credit

Image credit

Dibrary: National Digital Library of Korea

1990’s and 2000’s

“NHS bodies, their staff,

learners, patients and the public

use the right knowledge and

evidence, at the right time, in

the right place, enabling high

quality decision-making,

learning, research and

innovation to achieve excellent

healthcare and health

improvement.”

Knowledge for Healthcare

http://www.hee.nhs.uk/our-work/research-learning-innovation/library-knowledge-services

HEE

CILIP

PHE

SCL

NIHR

NICE

NHS

England

Making it real

HEE

CILIP

PHE

SCL

NIHR

NICE

NHS

England

Making it real

NHS Library & Knowledge Services in England

Policy

http://kfh.libraryservices.nhs.uk/nhs-lks-policy/

All NHS staff to be able to

freely access library and

knowledge services

Developing NHS librarians

and knowledge specialists

to use their expertise

Developing a coherent

networked national serviceNick Youngson - link to - http://nyphotographic.com/

www.cilip.org.uk/amilliondecisions

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

http://kfh.libraryservices.nhs.uk/knowledge-management/km-goals-tools-and-techniques/

Skills, techniques and tools to mobilise

evidence and organisational knowledge

E-Learning and

postcards

Knowledge

Management

Toolkit Synthesis and

summarising

training

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

With thanks to Rachel Cooke, SASH and acknowledging her work with Chris Collison

Board self-assessment tool

CILIP

PHE

HEIs

SCL

NIHR

NHS

England

http://kfh.libraryservices.nhs.uk/patient-and-public-information/ideas-bank-2/

Supporting local networks

Cascade training

Health

Information

Week

3- 9 July 2017Ideas Bank

Supporting health and wellbeing

HEE

CILIP

PHE

HEIs

NIHR

NICE

NHS

England

How can we put quality at the heart?

Teaching Excellence Framework

How to articulate the Library’s

contribution to quality taking

into account:

• Student satisfaction?

• Retention rates of students?

• Employment outcomes?

HEE

CILIP

PHE

HEIs

NIHR

NICE

NHS

England

How can we demonstrate our impact?

1. Organisations are more effective in mobilising evidence and

internally generated knowledge

2. Patients, carers and the public are empowered to use

information to make health and well-being choices

3. Improved consistency and increased productivity and

efficiency of healthcare library & knowledge services

4. Enhanced quality of healthcare library and knowledge

services

5. Partnership working is the norm in delivering knowledge to

healthcare

6. Increased capability, confidence and capacity of library and

knowledge services workforce

@NHS_HealthEdEng #HEELKS #aMilliondecisions

Making a positive impact

£500,000 saved: clinical librarian crucial

to success of Nursing Supplies Group

University Hospitals of Morecambe Bay

NHS Foundation Trust

Rapid response to clinical supply problem

relative efficacy of two agents –MRSA

Wirral University Teaching Hospital NHS

Foundation Trust

http://kfh.libraryservices.nhs.uk/value-and-impact-toolkit/kfh-impact-tools/impact-case-studies/

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

http://kfh.libraryservices.nhs.uk/value-and-impact-toolkit/

Quality and Impact Tools

Value and Impact

ToolkitHigh Profile Health

Libraries Toolkit

Metrics Guidance

http://www.thebluediamondgallery.com/a/advocacy.html

What can we see on the horizon?

HEE

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

EnglandSix key developments in

technology:

• Big Data

• Digital Scholarship Technologies

• Library Services Platforms

• Online Identity

• Artificial Intelligence

• Internet of Things

NMC Library Edition 2017 Developments in

Technology for Academic and Research Libraries

https://www.nmc.org/publication/nmc-horizon-report-2017-library-edition/

Looking to the future

HEE

CILIP

PHE

HEIs

NIHR

NICE

Top Strategic Predictions for 2017 and

Beyond: Surviving the Storm Winds of

Digital Disruption

Horizon scanning

What's next in digital technologies

and how can we help?

HEE Blue Sky

Event

Will a robot take our jobs?

http://www.bbc.co.uk/news/technology-34066941

… It is All about the people

John Gill 1970’s

Victoria Treadway with Dr Girendra Sadera and medical colleagues at

Wirral University Teaching Hospital NHS Foundation Trust. Image

copyright Wirral University Teaching Hospital.

2016c. 1970

John Gill, District Librarian, Poole Hospital Library, 1970

How can we prepare?

www.libraryservices.nhs.uk/pksb

CILIP

PHE

HEIs

SCL

NIHR

NHS

England

What do we need?

2017 Training Needs Analysis

Resources for role redesign

Demonstrating impact

to critical appraisal;

information for patients

to emerging technologies.

HEE

CILIP

PHE

HEIs

SCL

NIHR

NICE

NHS

England

http://kfh.libraryservices.nhs.uk/learning-zone/

Learning and development

Leadership DevelopmentLearning Zone

Talent Management Toolkit

“Tomorrow

belongs only to

the people who

prepare for it

today.”

Malcolm X

By Ed Ford, World Telegram staff photographer - Library of Congress.

New York World-Telegram & Sun Collection. http://hdl.loc.gov/loc.pnp/cph.3c12133, Public Domain,

https://commons.wikimedia.org/w/index.php?curid=1304014

QuestionsPatrick.mitchell@hee.nhs.uk

Sue.Lacey-Bryant@hee.nhs.uk