STP and Operating Plan Workforce Issues

NHS Providers – Medical & Nursing Directors Network

Wednesday 11 October 2016

Workforce Issues to be covered

Current Position and How we got there • Nursing

• Consultant Medical

• AHP

Where Next? • WAB

• STPs and Operating Plans

• LWABs

Nurse Demand 2012 to 2016 – Adult acute nursing

• In 2015/16 trusts reported increased demand for the fourth consecutive year. The cumulative total

increase in established posts is 25,131fte in adult hospital settings alone (14.3%)

• Staff in post has increased significantly since trusts started trying to expand in 2012 by 12,199fte

• The outpacing of demand v supply growth was forecast to result in over 12,000 additional vacancies

Consultant Supply and Demand – 2008 to 2020

• Consultant vacancies appear to have been historically stable at 3.0% to 3.5%

• 2013/14 and 2014/15 both appear to have been periods of very high establishment of new posts, 5,909 - 15% in two years (as

reported by trusts)

• Supply did increase above the ‘norm’ in response but not enough to match increased demand

• Excess vacancies of a level previously unseen have therefore been created

• Unclear if extra posts are sustainably funded

• Concern that historically vacancies have been hidden if no prospect of filling them

Nursing Supply Measures

1. Additional Training Commissions

2. International Recruitment

3. Return to Practice

4. Retention

NHS ability to attract available supply

1. AHP registrant growth

v

NHS workforce growth

2. MH Nursing growth v forecast

Workforce Shortages by HEE region

• There is significant variation in

supply shortage between

regions

• Regional averages mask

outliers in respect of individual

trusts

HEE - April 2014

Summary Position – Nursing Midwifery and

main AHP

2013 to 2016

• Over 33,000 additional funded posts between 2013 and 2016 (9%)

• Over 19,000 more staff (5%)

• Therefore 14,000 additional vacancies created

2016/17 Initial Operating Plans (before financial reset)

• Plans indicate between 2000 reduction and 4,000 increase in

posts

• Trusts planning for 14,000 growth in substantive employed nurses

and midwives to reduce vacancies and agency / bank usage

• Net impact would reduce vacancies by 10,000 to 16,000

Workforce Intelligence in NHS Planning

Arrangements

ALBs sponsoring complementary planning processes:

• Operating plans 2016/17

• STPs (including Finance & Efficiency Template)

• Two year operating plans 2017/18 & 2018/19

All in context of 5YFV triple aim, Shared Delivery Plan and associated

policy priorities in Single Planning Guidance

These represent our best source of near term workforce demand

including the impact of service and workforce transformation

Working with DH for prospects beyond 2020

STPs – Planning assumptions as drivers of future

workforce demand

Provider Activity and Inflation Assumptions

Activity

Acute i % 2.3% 2.3% 2.4% 2.4% 2.3%

Mental Health i % 1.9% 1.9% 1.9% 1.9% 1.8%

Community i % 3.3% 3.4% 3.4% 3.4% 3.3%

Specialist i % 4.4% 4.4% 4.4% 4.4% 4.4%

Inflation

Tariff Inflator i % 3.1% 2.3% 2.0% 2.0% 2.9%

Tariff Efficiency Factor i % -2.0% -2.0% -2.0% -2.0% -2.0%

Other Internal (HEE, S7, LA, BCF) Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0%

Other External Assumptions i % 0.0% 0.0% 0.0% 0.0% 0.0%

Pay & Pensions Assumptions i % 3.3% 2.0% 1.6% 1.6% 2.9%

Drugs Assumptions i % 4.5% 4.6% 3.6% 4.1% 4.1%

Procurement Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0%

Capital Assumptions i % 3.1% 3.2% 3.2% 3.1% 3.1%

Litigation Assumptions i % 17.0% 19.7% 19.7% 19.7% 19.7%

Provider Other Assumptions i % 1.7% 1.8% 2.1% 1.9% 2.0%

2020 Workforce - STPs

• Workforce pay bill and WTE an integral part of STP finance and efficiency template

• Primary and Secondary care workforce

High level picture of size and make up of 2020 workforce integrated to triple aims including finance

Do Nothing Solutions Do Something

2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21

Commissioner Staffing

GP WTE - - - - - - - - - - - - - - - -

GP support staff WTE - - - - - - - - - - - - - - - -

Commissioner Administration Staff WTE - - - - - - - - - - - - - - - -

Provider Staffing

Ambulance Staff WTE - - - - - - - - - - - - - - - -

Administration WTE - - - - - - - - - - - - - - - -

Health care assistants and other support staff WTE - - - - - - - - - - - - - - - -

Medical and dental staff WTE - - - - - - - - - - - - - - - -

Nursing, midwifery and health visiting staff WTE - - - - - - - - - - - - - - - -

Nursing, midwifery and health visiting learners WTE - - - - - - - - - - - - - - - -

Scientific, therapeutic and technical staff WTE - - - - - - - - - - - - - - - -

Healthcare science WTE - - - - - - - - - - - - - - - -

General payments WTE - - - - - - - - - - - - - - - -

Total WTE WTE - - - - - - - - - - - - - - - -

Total Provider WTE Adjustments i - - - - -

Check i OK OK OK OK OK

Next Steps

21st October – STP submission including full finance and efficiency

template

• Do nothing / counterfactual

• Workforce consequences of solutions - key narrative on deliverability

• 2020 workforce plan (Includes primary care)

High level analysis (by main staff groups)

Financial analysis of expenditure on non-NHS provision

Activity assumptions

December – Two Year Operating plans

• Year 2 and 3 of STP

• Reconciliation of provider and Commissioner plans to place based STPs

• Granularity of workforce component to be agreed (inc. Pricare)

2020 STP plans by provider / greater granularity - tbc

• Priority areas (cancer, MH, maternity….

• Professions

• Component providers

LWABs

LWABs are being established to meet the needs of STP areas in respect of action on both

their current and future workforce needs;

They will need to to focus on;

• Active management of both current supply and demand

• Workforce transformation – for both future service delivery but also as part of current

demand management e.g. team profiles

• Future workforce demand and supply – A workforce in line with FYFV and SDP goals

and assumptions, including overall affordability and the integration challenge. Will also

include managing the liberalised non-medical pre-registration training system.

A single place to discuss and act upon current and future workforce needs

supported by consistent diagnosis and analysis and HEE / NHSI teams

Aggregated to regional and national level with appropriate joint action e.g. IR / RTP

Need HEE/ NHSI agreement on current and future single data collection

STP 1 Acute, Elderly & General Nursing

2013 to 2016 • STP providers have funded above average additional

posts between 2013 and 2016 (rank 16/44)

• They have been able to achieve above low levels of

additional substantive staff in post (37/44)

• Consequently they have moved from a position of low

vacancies to above average (17/44)

2016/17 • STP providers have indicated that they intend to reduce

funded posts during 2016/17. This is an lower level of

growth compared to most STPs (35/44)

• Achieving HEE’s median supply forecast would result

in further reduction to vacancies

• Most providers have indicated plans to exceed this

forecast in their 2016/17 submissions to NHSI.

Posts Staff in Post Vacancies Vacancy Rate

2013 2,079 2,003 75 3.6%

2016 2,362 2,045 317 13.4%

Change 2013 to 2016 283 41 242 9.8%

% 13.6% 2.1% 320.0%

2017 Plan 2,327 2,131 196 8.4%

Change 2016/17 -35 86 -120 -5.0%

% -1.5% 4.2% -38.0%

Workforce Growth 2013 to 2016 and 2016/17 Planned Increase / Decrease:Sickness 2013 2014 2015

Trust 1 3.9% 4.2% 4.4%

Trust 2 5.2% 4.8% 5.1%

Trust 3 5.4% 4.7% 5.0%

ENGLAND AVERAGE 4.1% 4.2% 4.2%

Stability 2013 2014 2015

Trust 1 85.7% 86.2% 84.9%

Trust 2 84.3% 86.7% 87.6%

Trust 3 85.9% 87.3% 85.9%

ENGLAND AVERAGE 79.9% 85.2% 83.8%

The graph describes

increases in funded posts

v actual staff in post and

therefore vacancy levels

The table shows the 2013,

2016, and 2017 data points of

the graph including the actual

value of vacancies (number &

% rate)

The narrative box describes where the STP

sits compared to the national average and

ranked v the other 43 STPs for i) growth in

funded posts ii) growth in staff in post iii)

vacancies

These tables show how trusts within the

STP have performed on Sickness and

Stability (inverse of turnover) compared to

the national average

Annex – LWAB footprints and Co-Chairs

North STP – LWAB arrangements

LWAB Name STP covered LWAB co-chair HEE co-

chair

First

meeting

dates

The Cumbria &

North East

LWAB

• Northumberland, Tyne & Wear

• Durham, Darlington, Teesside,

Hambleton, Richmondshire &

Whitby

• West, North & East Cumbria

Ian Renwick, Chief Executive,

Gateshead Health NHS Foundation

Trust

Alex Glover October 2016

South Yorkshire

& Bassetlaw

South Yorkshire & Bassetlaw Kevan Taylor, Chief Executive,

Sheffield Health & Social Care NHS

Foundation Trust

Mike Curtis August 2016

Humber, Coast

& Vale

Humber, Coast & Vale Mike Proctor, Deputy Chief

Executive, York Teaching Hospitals

NHS Trust

Mike Curtis September

2016

West Yorkshire West Yorkshire Ros Tolcher, Chief Executive,

Harrogate & District NHS

Foundation Trust

Mike Curtis August 2016

Greater

Manchester

Greater Manchester

(Strategic Workforce Board)

Andrew Foster, Chief Executive,

Wrightington, Wigan and Leigh

NHS Foundation Trust

Neil

McLauchlan

September

2016

Cheshire &

Merseyside

Cheshire & Merseyside Kath Thomson, Deputy Chief

Executive, East Cheshire NHS

Trust

Jenny Cavalot September

2016

Lancashire &

South Cumbria

Lancashire & South Cumbria Heather Tierney-Moore, Chief

Executive, Lancashire Care NHS

Foundation Trust

Jenny Cavalot September

2016

M&E LWAB Development

LWAB CX Co-Chair HEE Co-Chair

LWAB in

place

Lincolnshire Jan Sobieraj, United Lincolnshire

Hospitals NHS Trust

Jane Johnson Yes

Leicestershire, Leicestershire &

Rutland

Peter Miller, Leicestershire

Partnership NHS Trust

Adrian Brooke Yes

Northamptonshire Sonia Swart, Northampton General

Hospital NHS Trust

James McLean Yes

Nottinghamshire Lyn Bacon, Nottingham CityCare

Partnership CIC

Jane Johnson Yes

Derbyshire Gavin Boyle, Derby Royal Hospital

NHS Foundation Trust

Sheona McLeod Yes

Staffordshire & Shropshire Simon Wright, Shrewsbury and Telford

Hospital NHS Trust

Russell Smith Yes

The Black Country Paula Clarke, University Hospitals of

North Midlands NHS Trust

Suzanne Harris Yes

3

LWAB CX Co-Chair HEE Co-Chair LWAB in

place

Birmingham & Solihull Tracy Taylor, Birmingham Community

Healthcare NHS Foundation Trust

Mandy Shanahan Yes

Arden, Hereford & Worcester Andy Hardy, University Hospitals

Coventry and Warwickshire NHS Trust

Beverly Ingram Yes

Cambridgeshire & Peterborough Matthew Winn, Cambridgeshire

Community Services NHS Trust

Bill Irish Yes

Mid & South Essex Caroline Rassell, Mid Essex CCG Boyd Mullins Yes

Bedfordshire, Luton & Milton

Keynes

Matthew Winn, Cambridgeshire

Community Services NHS Trust

Boyd Mullins Yes

Hertfordshire & West Essex Jinjer Kandola, Hertfordshire

Partnership University NHS

Foundation Trust

Boyd Mullins Yes

Suffolk & North East Essex Sam Hepplewhite, North East Essex

CCG

Boyd Mullins Yes

Norfolk & Waveney Rosin Fallon-Williams, Norfolk

Community Health & Care NHS Trust

Rob Bowman Yes

London and South East LWABs

LWAB Co-Chair HEE Co-

Chair

LWAB in

place

North Central London Maria Kane CEO Barnet, Enfield & Haringey MH

Trust

Chris Caldwell

North East London Tracey Fletcher CEO, Homerton FT

Therese Davis

North West London Delvir Mehet Asst Dir Workforce & Development NHS

NWL

Lizzie Smith

1st meeting end Oct

South East London Angela Bhan Chief Officer, Bromley CCG

Aurea Jones

South West London Dr Marilyn Plant Clinical Lead SWLCCG

Sean Farran

Kent & Medway Hazel Carpenter Accountable officer of CCGs

Philippa Spicer

Surrey Heartlands Suzanne Rankin. CEO of Ashford & St Peter's Hospitals

NHS Foundation Trust

Philippa Spicer

Sussex and East Surrey Richard Tyler CEO, Queen Victoria Hospital

Foundation Trust

Philippa Spicer

3

South England LWABs

LWAB CEO Co-chair HEE Co-chair LWAB in

place

Bath, Swindon and Wiltshire James Scott CEO, Royal United Hospital Bath

Clare Hines Assoc. Dir. Workforce Strategy and Plans

Bristol, North Somerset and South

Gloucestershire Robert Woolley CEO, University Hospitals Bristol

Clare Hines Assoc. Dir. Workforce Strategy and Plans

Buckinghamshire, Oxfordshire and

Berkshire West Neil Dardis CEO, Bucks Healthcare

Pauline Brown Local Director, Thames Valley

Cornwall and the Isles of Scilly Phil Confue CEO Cornwall Partnership

Clare Chivers Health Dean

Devon Angela Peddar Full-time STP CEO

Clare Chivers Health Dean

Dorset Patricia Miller CEO, Dorset County Hospital

Ruth Monger Local Director, Wessex

Frimley Heath Alison Alexander Strategic Director, Windsor and

Maidenhead LGA

Pauline Brown Local Director, Thames Valley

Gloucestershire Mary Hutton Accountable Officer,

Gloucestershire CCG

Clare Hines Assoc. Dir. Workforce Strategy and Plans

Hampshire and the Isle of Wight Sue Harriman

CEO, Solent NHS Trust Ruth Monger Local Director, Wessex

Somerset Matthew Dolman GP and Chair, Somerset CCG

Clare Chivers Health Dean

(meets

30/9)