Transcript Workforce Plan 2015/16 East of England

East of England LETB
Workforce Plan for Investment
in Education and Training in
2015/16
Content:
1. Workforce planning and commissioning process 2014
•
•
Workforce planning and commissioning process 2014
Taking a long view
2. Future workforce needs and priorities
•
•
•
•
Health needs
Service direction
Future workforce needs and priorities
EoE providers’ workforce forecasts 2015-2019
3. Analysis and investment plan 2015/16
•
•
•
•
EoE regional response to workforce priorities
Risks and confidences
EoE investment decisions 2015
EoE education commissioning plan 2015 headlines
4. Appendices
•
•
Appendix 1 EoE non-medical and medical commissioning plan 2015
Appendix 2 Forecast supply by professional group
2
Workforce planning and
commissioning process 2014
3
Workforce planning and commissioning process 2014
We have aimed to develop an education commissioning plan for the region which is supported by multiprofessional review, recognised by professional groups as being fit for purpose, affordable and supported by
quality outcomes for education providers and employers. To achieve this we:
1.
Developed a workforce planning process with a clear strategic focus, with a greater emphasis on
conversations with stakeholders about what future EoE workforce will look like in terms of skills, roles
and behaviours and what workforce development initiatives would achieve this view.
2.
Developed the knowledge of strategic workforce planning within the LETB, within the Workforce
Partnerships and the wider planning community, introduced new planning tools and raised the profile of
workforce planning among senior leaders.
3.
Developed an affordable EoE regional workforce forecast.
4.
Increased attention on safe staffing policies and guidance and their impact upon current and future
workforce supply
5.
Conducted a series of multi-professional reviews of regional workforce forecasts and commissioning
plans, prioritised investment for the whole workforce (non-medical, medical, pre-professional) using
intelligence about demand and supply position for each professional group to ensure best allocation of
resources.
6.
Extended the workforce planning process to General Practice workforce, working closely with
commissioners of services.
7.
Delivered further progress on integration of medical workforce planning into the main planning process.
8.
Began a dialogue with our planning partners about intelligence sharing and alignment of processes
and templates for greater system transparency.
4
Workforce planning and commissioning process 2014
We designed the 4-stage process with a greater emphasis on conversations about future workforce needs
February
2015
Planning processes at
provider level
LETB workforce
planning process 2014/15
Service Planning and
longer-term financial planning
Development of the process
Strategic Workforce Planning
Stage 1: Setting strategic context
Conversations about future
workforce needs and priorities
Developing our capacity
Operating workforce plans
People process management
Initial work on strategic
planning in 2014
Added to 2015
planning process
Stage 2: development of
providers’ workforce forecasts
commissioning plans in Workforce
Partnerships
January 2014
February 2014
March 2014
April 2014
May 2014
June 2014
Stage 3: Review of EoE workforce
forecasts and commissioning plan
July 2014
August 2014
Stage 4: Development of EoE
Investment Plan and strategy
update
September 2014
December 2014
Education commissioning and
Investment Plan
Strategy , Transformation
Recruitment and retention
Workforce planning and commissioning process 2014
Our workforce strategy provides the context for our activities as a LETB throughout the planning round in
2014. The strategy is also a live document that is continuously updated as new workforce intelligence
comes to light.
EoE Skills Strategy 2013 - 2020
Investment plan 2014
 Conversations with stakeholders about future
workforce needs and priorities
 Workforce forecasts and education commissioning
plans
 Reviews of plans
 EoE regional education commissioning plan
Updated EoE Skills Strategy 2013 - 2020
Investment plan 2015
6
Taking a long view
“…Many decisions about resources need to be made for the long term, for example, the numbers of people
to be trained, the skills they will require, the buildings likely to be needed...Taking a long-term view
should...provide the opportunity for more effective management of the health service. Good management
requires clarity about the long-term, strategic direction of the service coupled with flexibility to respond
decisively and appropriately to changes as they occur”.
Wanless report “Securing our future health: Taking a long-term view” (2002, p.1)
We recognise that:
•
Strategy is not just a product of the top management thinking, it is shaped by our stakeholders;
•
Strategy emerges slowly in response to a multitude of different influences. The process of strategy
development is iterative and continuous, reflecting the complexity of internal and external worlds;
•
Our assumptions need to be constantly re-examined, concentrating on important issues;
•
We must explore issues that are most uncertain and might result in discontinuities. It is these
discontinuities that the strategic planning is aiming to address;
EoE LETB commissioned specific education and training on Strategic Workforce Planning (through Henley
Business School) to build capability in relation to strategic workforce planning. We held five workshops,
including one in each Workforce Partnership, aiming to:
•
Increase understanding and confidence in Strategic Workforce Planning;
•
Identify future workforce needs and translate these into workforce priorities and actions to mitigate
risks;
85 attendees representing the acute sector, mental health, community, commissioners, local authority, social
care, patient groups, HEIs and Health Education East of England.
The following slides summarise our findings from these workshops.
7
Future workforce needs and
priorities
8
Health needs
•
The East of England is the second largest English region by area at around 19,100 square kilometers.
The region covers 9 per cent of the total area of the UK.
•
According to the Census 2011 there were 5.8 million residents in the East of England. This was an
increase of 8% since 2001.
•
In 2011 the East of England had 17% of people whose day to day activities were limited by a long term
health problem or disability and 10% of people who provided unpaid care for someone with an illness or
disability (the same percentage as for England and Wales as a whole).
•
The health of people in the East of England is generally better than the average for England. There are
inequalities in health within the region and these are closely related to deprivation. Health of people in a
small number of local authorities in the region, for example Peterborough, Luton, is generally worse than
average.
•
Although the rate of alcohol related admissions is lower than the England average it has continued to
rise. The proportion of adults participating in recommended levels of physical activity has fallen in the
region.
•
While death rates from smoking in the East of England remain lower than the England average,
preventing ill health by addressing smoking continues to be a priority for the region.
•
The median age of the region was 40 in 2011, 1 year higher than the England and Wales average. Within
the region this ranged from 31 in Cambridge to 51 in North Norfolk.
•
The East of England’s population is forecast to get older still, meaning an increase in demand for elderly
services such dementia and cancer and an urgent need to promote independent living for elderly. The
demand for mental health service continues to increase.
•
Local NHS workforce is also ageing, the average EoE workforce age is currently 43 and is forecast to
increase by 1 year between 2013 and 2020.
Sources: East of England health profile 2012, ONS analysis of Census 2011, EoE workforce analysis
Service direction
Our stakeholders identified the following service requirements common to all areas of East of England:
Person-centered
•
Person-centred care with the patients and public being at the centre of all our planning. In the future
the care will be created jointly between care professionals and service users. The co-production of care
is about establishing a greater quality of status and decision making between staff and those using the
service.
•
Education and empowerment of patients and carers, so that they become co-providers and active
participants in health care.
Shift in care from acute to community
•
Wider primary care and a significant shift in activity and resource from the hospital sector to the
community, ensuring patients have access to a broader range of services in primary care, centered on
the expanded role of general practice.
Integration
•
Development of a more integrated system of community-based services that provide responsive and
holistic services to communities, particularly for frail older people. This will include integration across
health and social care and across different elements of NHS care, integration of specific services and
organisations.
•
For patients with multiple long-term conditions, particularly elderly and frail, the model of integrated
care will require active co-ordination of the full range of support, including lifestyle and acute care.
•
Provide more responsive and patient-centred services across the seven days in order to reduce
variation in outcomes for patients ;
•
Design services that maximise quality and achieve an increase in productivity, with greater use of
technology, including telehealth and telecare.
Future workforce needs and priorities
In order to achieve the service ambitions the following future workforce needs and priorities have been
identified in consultation with stakeholders:
The future workforce will need to be:
•
Adaptable, with skills responsive to new evidence and new models of care;
•
Able to meet patient needs at all times and in all settings;
•
Capable of working collaboratively with patients and carers, helping them to manage their own care;
•
Able to provide and co-ordinate holistic care in all areas of physical and mental health;
•
Compassionate, caring, with high levels of knowledge;
In order to develop the workforce with the above skills and behaviours, the following need to be priority
areas:
•
Developing career progression for staff in bands 1-4;
•
“Growing your own” workforce, ensure wider participation of staff in education and training;
•
Developing transferability of skills to enable flexible working across sectors and teams, across health and
social care;
•
Developing capacity and competencies of staff working in the community, primary care and social care;
•
Maximising knowledge of technology;
•
Developing common core training for all staff, particularly in dementia and care of the elderly;
•
Developing new roles, such as Physician associates, that will increase workforce supply;
•
Increasing pre-registration commissions to address shortfall of registered professionals, particularly Adult
nurses;
•
Focusing effort on return to practice of registered professionals, particularly Adult nurses;
•
Developing new education programmes to address multi-disciplinary working, clinical decision-making,
risk management
Future workforce needs and priorities
This is summarised in the following diagram
Stated Aspirations
Shift in care from acute to
community and primary care
Person centred care /
empowered patients and carers
Working in new ways
Develop existing workforce
•
•
•
Integration of care across sector
boundaries and extended
day/week
Transferability of skills
Build capacity in clinical
decision making / risk
management
Develop new career structures,
particularly for bands 1-4
New workforce supply
•
•
•
•
•
New roles
‘Grow your own’ programmes
New Education programmes
Sustaining service delivery – quality and supply
•
Roles and career paths across
health and social care
Skills mapped to patient
pathways
Innovative training across
professions
EoE providers’ workforce forecasts 2015-2019
The providers’ workforce forecasts indicate an overall 3% reduction in the number of establishment posts
between 2014 and 2019, reflecting the service and financial planning background against which the NHS
has been performing for the last 4 years:
•
The current vacancy rates are 7% in the acute and the community sector and 12% in the mental health
sector
•
Existing vacancies will provide the scope for growth in staff in post numbers over the next few years.
EoE NHS Community providers' workforce
EoE NHS Acute providers' workforce
12,062
68,203
65,913
11,316
63,704
58,884
11,353
3,594
Actual SIP FTE
Establishment Plans 2014
Actual SIP FTE
Establishment Plans 2014
EoE NHS Mental Health providers workforce
16,596
15,565
14,873
14,189
The significant changes in staff in post numbers in the
community sector and the mental health sector in 2012
reflect the transfer of PCT clinical staff into community and
MH organisations
Actual SIP FTE
Establishment Plans 2014
13
Analysis and investment plan
2015/16
14
EoE regional response to workforce priorities
In response to the local providers’ workforce priorities and plans we developed a framework of activities
across the seven areas of workforce development and transformation
Workforce Supply
Primary Care
Ensure effective
workforce supply,
responding to identified
deficits
Support the
reconfiguration of
primary care at scale by
workforce
transformation
Increase preregistration
commissioning
Return to Practice
system wide approach
Employment offer –
maximise NQHP
return Rotation
programme for
registered nurses
New programmes – 2
year shortened
degree; 2 year
masters programme
Adaptation - system
wide approach for
adaptation/conversion
for registered nurses
Pre-registration review
Roll-out of CLIP
Shared streamlined
recruitment processes
Shared approach to
overseas recruitment
Flexible resourcing
across organization
boundaries
Leadership–talent
pipeline
Emergency Care
Dementia
Values
Bands 1-4
Skills Development
Improve urgent and
emergency care services
Improve patient care of
frail elderly and people
with dementia
Transform patient
experience through
embedding the values of
the NHS Constitution in
the workforce
Increase the number of
apprenticeships and
expand the
opportunities for bands
1-4 staff
Ensure transferability of
skills, cross sector
working and focus on
patient in skills
development
Recruitment of GP
training numbers
Commission 400
paramedic trainees
Recruitment,
retention and
career support
Expand recruitment
to ACCS EM and
DREEM
programmes
Commissioning
pathway for
Practice Nurse
Develop physicians
associate role
Supply pathway
and development
plan
Pre-professional
development
Expansion of preregistration
placements
Advanced
practitioner /
physician assistants
pathway and
commissioning plan
Develop local
opportunities for
Advanced
Practitioner and
physicians
assistants
Lead adoption and
spread of N&S
dementia approach,
dementia alliance
and training
approach
Performance
manage tier 1
training uptake
Development of
recruitment to
values benchmark
All HEEoE
programmes recruit
to Values
Establish dementia
alliance
Develop 360
behavioural
modelling tool for
VBC and roll out to
all HEE students
Mapping, reporting
and enhancing tier
one training
Commission VBR
core training
package
Development of
advanced dementia
training portfolio
Implementation of
VBR benchmark
across HEIs
Implementation of
dementia coach,
champion
VBR core training
package rolled out
across all EoE
clinical learning
environments
Establish
development
pathway for band 4
to band 5
Implementation of
national bands 1-4
project deliverables
Grow your own
approach
Develop education
portfolio for bands
1-4
Generic skill sets /
cross sector roles
Clinical decision
making
Skills cross sector
Common core skills
set
Patient experts
Self care and
health coaching
Technology
Rotations and
placement redesign
Risks and confidences
As we worked through this year’s planning round and the review sessions with providers we found that…
•
Strategic workforce planning provided the most valuable insights into current workforce issues and the
future workforce needs. Our workforce priorities have been developed jointly with stakeholders.
•
There is a strong link between the NHS vision, commissioners’ intentions and providers’ strategic
workforce planning narratives;
•
Development of reliable numerical forecasts remains a challenge for providers, as the need to
maintain and improve quality of services becomes increasingly challenging within the current financial
parameters and service configurations. Workforce forecasts will be re-visited during the 2015 planning
round.
•
The use of staffing planning tools remains patchy, providers need education support in this area;
•
Providers’ education plans are often based on the capacity to train rather than the demand for
workforce. In the future providers will receive greater support in the development of supply and demand
assumptions;
•
Despite the forecast reductions in demand, for some professional groups the current shortfall in
supply is likely to continue into the future. Overseas recruitment of Adult nurses will continue to be one
of the supply measures in the East of England.
•
The EoE NHS providers are facing competition from non-NHS sector and social care providers for
workforce supply. Additionally, the labour markets become increasingly global, and the international
workforce flows are difficult to predict. Outflows of newly qualified graduates and experienced staff from
EoE NHS present risk to supply. Maximising the EoE employment return on our educational investment
in pre-registration students is one of the local priorities.
16
EoE investment decisions 2015
•
To arrive at our investment decisions for 2015 we did a careful assessment of available workforce
intelligence including the workforce priorities collectively developed by stakeholders, providers’ workforce
and education commissioning plans and the existing and anticipated national guidance.
•
For non-medical professionals we modelled future supply using best knowledge of course attrition rates
and workforce flows. We made judgements about the likelihood of future over- and under-supply.
•
Medical commissioning has been undertaken nationally based on workforce forecasts and planning with
input from a number of stakeholders, including HEE, Medical Royal Colleges and the Centre for
Workforce Intelligence.
•
Changes to medical training posts are allocated locally, using a weighted capitation method and other
models, such as number of deliveries in obstetrics and dialysis activity in renal medicine. Local influence
has centred on where to place agreed posts rather than determining actual numbers. The EoE
directorate of education and quality have fostered close working relationships with Heads of School and
Programme Directors to shape the location of individual posts across Trusts based on a range of factors
including: quality reports, training provided, workload activity and intensity and historical information.
•
Our commissioning decisions reflect outcomes of a number of review and challenge sessions with
providers and stakeholders at Workforce Partnership level and at LETB level.
17
EoE investment decisions 2015
We are planning in a complex and changing environment, with a great deal of uncertainty. Our investment
choices tackle the current supply issues and anticipate the future needs, allowing for flexibility of response
to new service models that are yet to emerge. Our investment in 2015 will:
•
Help ensure security of future supply through investment in pre-registration commissions and postgraduate medical training;
•
Develop existing staff who will be providing care in the future through investment of our workforce
development fund
•
Support workforce transformation projects which will pave the way to new ways of working and adoption
of new roles
Indicative spend on workforce education, training and development in 2015
Non-medical pre-registration commissions
£147m
Undergraduate medical training
£34m
Post-graduate medical training
£159m
Education support
£12m
Workforce development
£19m
Of which post-graduate non-medical education – £11m
Of which transformation funding - £6m
National projects
£5m
Other (running costs, reserves, leadership)
£17m
Total
£393m
18
EoE education commissioning plan 2015 headlines
The following are the headline messages from the non-medical pre-registration and medical post-graduate
commissioning plan. The full version of the plan is shown in Appendix 1.
Increase in N&M commissions by
6%
The workforce intelligence indicates that Adult and Child nurse
commissions require an increase to protect the workforce against
forecast shortages. International recruitment of Adult nurses will
remain a recruitment measure for the next few years.
Increase in AHP commissions by
12%
We took the decision to significantly increase commissions in
diagnostic radiography (30%) to mitigate future supply risk, arising
from the many technological developments in Radiology and the
ageing workforce. Physiotherapy will see a 20% increase required to
meet demand of the increasing number of providers
Increase in other STT
commissions by 5%
14% increase in clinical psychology training places is needed to
maintain steady supply
Increase in training commissions
for staff in bands 1-4
The number of training opportunities for staff in bands 1-4, including
apprenticeships and assistant practitioners places, will increase again
as part of our commitment to widen participation and up skill existing
workforce.
IAPT training
Commissioning plans will be finalised by February 2015
Increase in training of
Paramedics
EoE paramedics will be trained through a university diploma route and
on the job within the EoE Ambulance Trust. We plan a significant
increase in the number of students joining the paramedic training this
year (up to 600 students).
Increase in medical commissions
by 2%
The numbers of training posts will increase in acute care programme
by 20% and general practice by 14%.
19
Appendix 1
EoE non-medical and medical
commissioning plan 2015
20
EoE non-medical education commissioning plan 2015
The following pages show our plan for commissioning non-medical training places
Specialty
Adult Nursing
Children's Nursing
Learning Disabilities Nursing
Mental Health Nursing
Total Nursing
Sep-14
Commissions
Sep-15
Commissions
Percentage
Change
Commentary
1329
139
42
273
1783
1430
150
42
273
1895
8%
8%
0%
0%
6%
Increase
Increase
Steady state
Steady state
Increase
Midwifery
273
287
5%
Increase
Physiotherapy
Occupational Therapy
Speech and Language Therapy
Dietetics
Radiography (Diagnostic)
Radiography (Therapeutic)
AHP Other
Total AHP
118
115
50
30
74
42
14
443
142
123
50
32
96
39
16
498
20%
7%
0%
7%
30%
-7%
14%
12%
Increase
Increase
Steady state
Increase
Increase
Decrease
Increase
Increase
Health Visiting
103
99
-4%
Decrease
Operating Department Practitioner
Pre-Registration Pharmacist
Pre-Registration Pharmacy Technician
Clinical Psychology
Other Therapeutic and Technical Staff
Total Therapeutic & Technical Staff
96
73
40
42
25
276
101
72.5
42
48
26
289.5
5%
-1%
5%
14%
4%
5%
Increase
Decrease
Increase
Increase
Increase
Increase
EoE non-medical education commissioning plan 2015
Assistant Practitioner
Apprenticeships
Maternity Support Workers
Total Bands 1-4
309
1731
31
2071
371
2000
39
2410
20%
16%
26%
16%
Increase
Increase
Increase
Increase
PTP Healthcare Science
STP Healthcare Science
HSST Healthcare Science
Total Healthcare Science
41
20
2
63
62
20
6
112
51%
0%
200%
78%
Increase
Increase
Increase
Increase
5012
5591
12%
Increase
0%
Steady state
Increase
Total
Paramedics (HEFCE-funded)
Paramedics (on the job training)
210
210
600 n/a
EoE medical commissioning plans 2015
The following pages show our plan for commissioning medical training posts at the foundation, core training
and higher specialty training level.
We plan for steady state in commissions on all medical specialties, except for the increases in General
Practice and Emergency Medicine (through increased recruitment in Emergency Medicine pathways training,
including Direct Recruitment into Emergency Medicine and the offer of run through training).
Specialty
Foundation Programme Year 1
Core Training
Core Medical Training
Core Psychiatry Training
Core Surgical Training
Acute Care Common Stem - Acute Medicine
Acute Care Common Stem - Anaesthesia
Acute Care Common Stem and run-through
Direct Recruitment into EM at ST3 (DREM)
EM ST4
Core Anaesthetics Training
Sub Total
Intensive Care Medicine
Intensive Care Medicine
Anaesthetics
Sub Total
Sep-14
Commissions
Sep-15
Commissions
Percentage
Change
Commentary
618
618
0%
Steady state
248
125
100
29
28
90
15
153
111
899
248
125
100
29
28
108
15
153
111
917
0%
0%
0%
0%
0%
20%
0%
0%
0%
2%
30
114
144
30
114
144
0%
0%
0%
Steady state
Steady state
Steady state
Steady state
Steady state
Increase
Steady state
Steady state
Steady state
Increase
Steady state
Steady state
Steady state
Steady state
EoE medical commissioning plans 2015
Specialty
Medicine
Respiratory Medicine
Dermatology
Neurology
Cardiology
Rheumatology
Genito-urinary Medicine
Clinical Pharmacology and Therapeutics
Geriatric Medicine
Medical Oncology
Clinical Physiology
Clinical Neurophysiology
Renal Medicine
Nuclear Medicine single CCT
Endocrinology and Diabetes Mellitus
Gastroenterology
Clinical Genetics
Clinical Oncology
Allergy
Acute Internal Medicine
Haematology
Immunology
Rehabilitation Medicine
Sport and Exercise Medicine
Occupational Medicine
Palliative Medicine
Medical Ophthalmology
Stroke Medicine
Metabolic Medicine
Sub Total
Sep-14
Commissions
42
12
18
64
24
3
5
43
10
6
2
19
1
26
41
6
17
3
39
20
4
4
3
5
16
3
15
0
451
Sep-15
Commissions
42
12
18
64
24
3
5
43
10
6
2
19
1
26
41
6
17
3
39
20
4
4
3
5
16
3
15
0
451
Percentage
Change
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Commentary
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
EoE medical commissioning plans 2015
Specialty
Surgery
General Surgery
Paediatric Surgery
Otolaryngology
Trauma and Orthopaedic Surgery
Urology
Plastic Surgery
Cardio-thoracic surgery
Vascular Surgery
Oral and Maxillo-facial Surgery
Sub Total
Psychiatry
Psychiatry of Learning Disability
General Psychiatry
Child and Adolescent Psychiatry
Forensic Psychiatry
Medical Psychotherapy
Old Age Psychiatry
Sub Total
Dental Foundation Programme Training
Dentistry
Orthodontics
Oral Surgery
Dental Public Health
Sub Total
Sep-14
Commissions
Sep-15
Commissions
Percentage
Change
71
4
25
54
17
26
13
3
6
219
71
4
25
54
17
26
13
3
6
219
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
14
71
16
7
0
22
130
46
14
71
16
7
0
22
130
46
0%
0%
0%
0%
8
1
1
10
8
1
1
10
0%
0%
0%
0%
0%
0%
0%
Commentary
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
EoE medical commissioning plans 2015
Specialty
Run through programmes
Paediatrics
Ophthalmology
Obstetrics and Gynaecology
Chemical Pathology
Histopathology
Clinical Radiology
Paediatric and perinatal pathology
Public Health Medicine
General Practice
Sub Total
Medical Micobiology
Medical Virology
Infectious Diseases
Sub Total
Infection Training/Medical Microbiology
Infection Training/Medical Virology
Infection Training/Infectious Diseases
Sub Total
Total
Sep-14
Commissions
226
40
161
4
40
95
1
40
292
899
13
2
5
20
13
2
5
20
3456
Sep-15
Commissions
226
40
161
4
40
95
1
40
332
939
13
2
5
20
13
2
5
20
3514
Percentage
Change
0%
0%
0%
0%
0%
0%
0%
0%
14%
4%
0%
0%
0%
0%
0%
0%
0%
0%
2%
Commentary
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Increase
Increase
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Steady state
Increase
Appendix 2
EoE forecast supply by
professional group
27
The purpose of forecast supply modelling
EoE stakeholders’
workforce priorities
Providers’ workforce
forecasts (demand)
Providers’ education
commissioning plans
EoE education
commissioning plan
Validation of providers’ plans
against:
1. EoE workforce priorities
2. Forecast supply and
demand
3. National policy
The purpose of the forecast supply intelligence is to inform validation of providers’ education commissioning
plans. Because the future is uncertain, providers’ workforce forecasts are of limited value as an indicator of
workforce demand in 5 years. We developed supply forecasts in order to determine which professions are
likely to be experiencing reducing supply in the future; we then made judgments about the desired level
of supply based on all workforce intelligence we have access to, and the required direction of travel for
education commissioning numbers to support the desired level of supply.
The following slides provide a forecast supply position for most non-medical professions for which we
commission training. The terminology used is as follows:
•
“Establishment to be filled” is the level of steady overall demand, assuming reduction in vacancy rate to
3%;
•
“Forecast supply” is estimated local supply based on assumptions about newly qualified output,
retirements and workforce flows;
•
“Forecast over- or under-supply “ is the gap between the “forecast supply” and the “establishment to be
filled”
The direction of travel for commissions is the outcome of the multi-professional review of providers’
education commissioning plans.
28
Adult nurse
Direction of travel for commissions:
Increase in commissions is agreed because our forecast indicates under-supply is likely
Context:
•
•
•
•
A number of key policy documents: the Francis enquiry, Keogh review and Berwick review
NQB guidance 2013, NICE guidance 2014
The use of staffing planning tools by providers is patchy;
Shortages are reported in all four Workforce Partnerships areas
25000
20000
15000
10000
5000
-1444
-1661
0
-1821 -1842 -1847
-1826
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
0
-200
-400
-600
-800
-1000
-1200
-1400
-1600
-1800
-2000
Over/under-supply
Demand and Supply FTE
Supply is forecast to reduce by 3.4% over 5 years
Supply forecast assumptions
Forecast supply
FTE
Forecast
Over/undersupply
establishment to
be filled assuming
vac. rate, FTE
Staff aged 55+: 13%
Net outflow from EoE NHS: -1% of SIP
p.a.
Course attrition: 2820%
Attrition after graduation: 5%
Establishment to be filled (for model):
5% growth over 5 years
29
Child nurse
Direction of travel for commissions:
A small increase in commissions is agreed to tackle localised supply issues
Context:
•
•
•
Growing public health needs specific to children;
Child health profiles indicate issues in parts of Norfolk, Suffolk and Bedfordshire where child health
indicators are below England average;
Shortages are reported in some parts of the region
Supply is forecast to increase by 30% over 5 years
250
194
1000
141
800
87
600
41
400
150
100
50
0
-1
200
0
200
-66
-50
-100
Over/under-supply
Demand and Supply FTE
1200
Forecast supply FTE
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 7%
Net outflow from EoE NHS: -4% of SIP
p.a.
Course attrition: 2222%
Attrition after graduation: 5%
Establishment to be filled (for model):
5% growth over 5 years
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
30
Mental Health nurse
Direction of travel for commissions:
Steady state in commissions is agreed, reflecting providers plans for service reconfiguration
Context:
•
•
•
•
A number of key policy documents: the Francis enquiry, Keogh review and Berwick review
NQB guidance 2013, NICE guidance 2014; The use of staffing planning tools by providers is patchy;
Reports of shortages of experienced MH nurses; outflows from Essex and Beds and Herts to London
Older workforce; unfilled vacancies of 8%
4000
0
3500
-50
3000
-100
2500
-150
2000
-208
1000
500
-200
-181
1500
-210
-209
-207
-250
-300
-295
0
Over/under-supply
Demand and Supply FTE
Supply is forecast to reduce by 1% over 5 years
Forecast supply FTE
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 16%
Net outflow from EoE NHS: -2% of SIP
p.a.
Course attrition: 26%20%
Attrition after graduation: 5%
Establishment to be filled (for model):
5% growth over 5 years
-350
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
31
Midwife
Direction of travel for commissions:
A small increase in commissions is agreed to tackle localised supply issues
Context:
•
•
NQB guidance 2013, NICE guidance 2014
Patchy use of staffing guidance and Birth Rate Plus tool therefore uncertainty about staffing needs in
the future
To maintain commissions at steady state is one of the HEE Mandate deliverables
•
Supply is forecast to increase by 15% over 5 years
240
2500
176
132
2000
65
1500
14
1000
0
200
150
100
50
-50
-100
-101
establishment to be
filled assuming vac.
rate, FTE
Establishment to be filled (for model):
4% growth over 5 years
Forecast supply FTE
250
0
500
Forecast Over/undersupply
Staff aged 55+: 13%
Net outflow from EoE NHS: -2% of SIP
p.a.
Course attrition: 2720%
Attrition after graduation: 5%
300
Over/under-supply
Demand and Supply FTE
3000
Supply forecast assumptions
-150
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
32
Clinical Psychologists
Direction of travel for commissions:
An increase in commissions is agreed in response to likely future under-supply
Context:
•
•
Significant change in staff in post numbers in the past;
Significant outflows due to demand from the non-NHS sector, ranging between -4% and -7% p.a. of
staff in post;
Retention of supply is an issue
•
700
600
500
400
300
-19
-17
-17
-19
-20
-20
200
100
0
-41
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19 Mar-20
0
-5
-10
-15
-20
-25
-30
-35
-40
-45
Over/under-supply
Demand and Supply FTE
Supply is forecast to increase by 1% over 5 years
Forecast supply FTE
Forecast Over/undersupply
establishment to be filled
assuming vac. rate, FTE
Supply forecast assumptions
Staff aged 55+: 10%
Net outflow from EoE NHS: -4% of SIP
p.a.
Course attrition: 5%
Attrition after graduation: 0%
Establishment to be filled (for model):
4% growth over 5 years
33
Diagnostic Radiographers
Direction of travel for commissions:
A significant increase in commissions is agreed in response to significant forecast under-supply
Context:
•
•
•
•
Demand is likely to grow due emergency care, 7 day working and stroke targets.
Radiographers provide skill mix in Radiology which is an area of growth.
Persistent shortage of ultra-sonographers in EoE;
High retirement rate
Supply is forecast to decrease by 10% over 5 years
0
Forecast supply FTE
1400
-50
1200
1000
-100
800
600
400
200
-104
-123
-123
-150
-147
-176
-200
-205
0
-250
Over/under-supply
Demand and Supply FTE
1600
Forecast Over/undersupply
establishment to be
filled assuming vac. rate,
FTE
Supply forecast assumptions
Staff aged 55+: 16%
Net outflow from EoE NHS: -3% of SIP
p.a.
Course attrition: 2120%
Attrition after graduation: 5%
Establishment to be filled (for model):
7% growth over 5 years
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
34
Dieticians
Direction of travel for commissions:
A small increase in commissions is agreed to tackle localised supply issues
Context:
•
•
•
Not a hotspot currently
Growing public health roles likely to impact on NHS providers
Obesity agenda
Supply is forecast to increase by 14% over 5 years
Demand and Supply FTE
400
36
350
25
300
17
250
200
7
150
40
30
20
10
0
100
-10
50
0
50
-15
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
-20
Over/under-supply
46
450
Forecast supply FTE
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 8%
Net outflow from EoE NHS: -1% of SIP
p.a.
Course attrition: 15%
Attrition after graduation: 0%
Establishment to be filled (for model):
1% growth over 5 years
35
Occupational Therapists
Direction of travel for commissions:
An increase in commissions is agreed in response to likely future under-supply
Context:
•
•
•
Difficulty recruiting to bands 7 and 8 in EoE NHS
Demand from non-NHS sector where there is difficulty recruiting to posts too;
Uncertainty about Cambridgeshire Community Services due to the contract end
Supply is forecast to decrease by 10% over 5 years
0
1400
-50
1200
1000
800
600
-88
-112
-100
-102
-121
-150
400
200
-200
-185
-205
0
-250
Over/under-supply
Demand and Supply FTE
1600
Forecast supply FTE
Forecast Over/undersupply
establishment to be filled
assuming vac. rate, FTE
Supply forecast assumptions
Staff aged 55+: 11%
Net outflow from EoE NHS: -6% of SIP
p.a.
Course attrition: 2320%
Attrition after graduation: 5%
Establishment to be filled (for model):
5% growth over 5 years
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
36
Operating Department Practitioners
Direction of travel for commissions:
A small increase in commissions is agreed to tackle localised supply issues
Context:
•
•
Currently a hotspot in Cambridgeshire, Bedfordshire and Hertfordshire;
Anecdotes of attrition to private sector; data supports a significant outflow of staff from NHS last year,
6% of staff in post;
Shortages of experienced staff;
•
Supply is forecast to increase by 1% over 5 years
9
900
5
800
0
700
-3
-4
400
-5
-10
-20
200
-25
100
0
5
-15
300
-26
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
Forecast supply FTE
10
0
600
500
15
Over/under-supply
Demand and Supply FTE
1000
Forecast Over/undersupply
establishment to be
filled assuming vac. rate,
FTE
Supply forecast assumptions
Staff aged 55+: 11%
Net outflow from EoE NHS: -6% of SIP
p.a.
Course attrition: 2320%
Attrition after graduation: 5%
Establishment to be filled (for model):
0% growth over 5 years
-30
37
Pharmacists
Direction of travel for commissions:
Steady state in commissions
Context:
•
Awareness of potentially new roles for the pharmacy workforce in Emergency Care in the future in
conjunction with community pharmacies: more pharmacist prescribers, pharmacy triaging of patients
and medicines reconciliation.
There is recognition that the employment market is more buoyant compared with the past 2-3 years
•
Supply is forecast to increase by 8% over 3 years
27
700
9
600
500
400
-10
300
200
100
0
Mar-14
Mar-15
Mar-16
40
30
20
10
0
-10
-20
-30
-40
-50
-60
Forecast supply FTE
Over/under-supply
Demand and Supply FTE
800
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 10%
Net outflow from EoE NHS: -4% of SIP
p.a.
Course attrition: 5%
Attrition after graduation: 5%
Establishment to be filled (for model):
4% growth over 3 years
Mar-17
38
Pharmacy Technicians
Direction of travel for commissions:
A small increase in commissions is agreed to tackle localised supply issues
Context:
•
•
Awareness of potentially new roles for the pharmacy workforce;
Pharmacy Technicians provide the flexibility within the pharmacy workforce to develop skill mix
opportunities and develop new ways of working across a range of organisations;
There is recognition that the employment market is more buoyant compared with the past 2-3 years
•
Supply is forecast to increase by 1% over 4 years
10
4
700
600
0
-2
500
400
-8
-5
-10
-8
300
-15
200
-20
100
-25
0
Forecast supply FTE
5
Over/under-supply
Demand and Supply FTE
800
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 12%
Net outflow from EoE NHS: -1% of SIP
p.a.
Course attrition: 15%
Attrition after graduation: 5%
Establishment to be filled (for model):
1% growth over 4 years
-30
Mar-14
Mar-15
Mar-16
Mar-17
Mar-18
39
Physiotherapists
Direction of travel for commissions:
An increase in commissions is agreed to tackle localised supply issues
Context:
•
•
•
Impact of significant amount of private sector provision;
Difficulty recruiting to bands 6 and 7 but not a problem for band 5;
Recognition of the need to develop newly qualified to level 1 and 2 as opposed to increasing entries
at band 5
2000
40
17
12
0
1500
20
0
-3
-22
1000
-20
-40
-60
500
-80
-100
0
-98
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
-120
Over/under-supply
Demand and Supply FTE
Supply is forecast to increase by 4% over 5 years
Forecast supply FTE
Forecast Over/undersupply
establishment to be
filled assuming vac. rate,
FTE
Supply forecast assumptions
Staff aged 55+: 6%
Net outflow from EoE NHS: -3% of SIP
p.a.
Course attrition: 11%
Attrition after graduation: 5%
Establishment to be filled (for model):
3% growth over 5 years
40
Speech and Language Therapists
Direction of travel for commissions:
Steady state in commissions is agreed
Context:
•
•
Significant outflow from NHS in the past; retention is key if commissions to remain at steady state;
Difficulty recruiting to bands 6+ across all specialties; in some specialties (Learning Disabilities)
difficulty recruiting to band 5 too;
Impact of increasing number of private sector providers, particularly education
•
Supply is forecast to increase by 1% over 5 years
10
15
11
500
3
5
0
400
-5
300
200
-7
-9
100
0
Forecast supply FTE
10
600
-10
-15
-20
-22
Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19
Over/under-supply
Demand and Supply FTE
700
Forecast Over/undersupply
establishment to be filled
assuming vac. rate, FTE
Supply forecast assumptions
Staff aged 55+: 9%
Net outflow from EoE NHS: -4% of SIP
p.a.
Course attrition: 14%
Attrition after graduation: 5%
Establishment to be filled (for model):
1% growth over 5 years
-25
41
Therapeutic Radiographers
Direction of travel for commissions:
A small reduction in commissions is agreed because of likely future oversupply
Context:
•
•
•
Not a hotspot currently
Potential impact of “proton beam” by 2018
Increasing cancer rates
Supply is forecast to increase by 24 % over 5 years
67
350
50
250
35
200
40
30
20
150
20
8
10
100
0
50
0
70
60
51
300
80
-10
-12
Mar-14
-20
Mar-15
Mar-16
Mar-17
Mar-18
Forecast supply FTE
Over/under-supply
Demand and Supply FTE
400
Forecast Over/undersupply
establishment to be
filled assuming vac.
rate, FTE
Supply forecast assumptions
Staff aged 55+: 9%
Net outflow from EoE NHS: -1% of SIP
p.a.
Course attrition: 4730%
Attrition after graduation: 5%
Establishment to be filled (for model):
1% growth over 5 years
Mar-19
42