The East Scotland National Hospital is sited in Edinburgh. It is an NHS Special Health Board treating patients from all over the east and north-east of Scotland, dealing with acute cases including major surgical procedures. A key remit of the hospital is to reduce patient wAIting times. More than 22,000 procedures were carried out last year. It is estimated that the number of procedures will increase by 11 per cent next year and 5 per cent in each of the two succeeding years. Thereafter, the increase is likely to follow the population growth in the region, estimated at an average of 2 per cent a year for the next seven years.
A recent survey showed that over 98 per cent of patients are delighted or satisfied with the nursing and consultant care they received. No incidents of hospital-acquired MRSA have taken place in the last two years.
There are 630 full-time equivalent (FTE) staff in post, including 220 qualified nurses and 33 unqualified nursing assistants. To cover planned and unplanned shortfalls, increasing use is BEIng made of bank nurses (NHS employees contracted to work when required) and less use is being made of more expensive agency nurses. The policy is to phase the latter out completely and reduce dependence on bank nurses by better workforce planning. A major new development has been planned – the creation of a new cardiac unit that will invoLVe closing down tHRee cardiac units in other hospitals in the region and transferring their staff, which will include 120 qualified nurses (assuming they all wish to move).
It was noted that sickness rates for nursing staff were relatively low – last year they were 7.2 per cent (in the previous two years they had increased from 6.0 to 6.4 per cent). The annual turnover rate for nurses has been fairly steady for the last three years at around 6 per cent. It has been stated in the National Scottish Workforce Plan that the supply of qualified nurses is generally goOD but that there may be difficulties in recruiting specialized nurses, particularly in cardiac and theatre work.
The hospital has been required to produce its own workforce plan by the Scottish NHS authority. The following infrastructure for the hospital has been defined:
The workforce planning group consists of an assistant director of operations, a senior accountant, and a senior HR adviser. They were briefed that their first task was to produce a workforce plan for nurses. Audit Scotland had issued national rules on building additional time into nurse staffing requirements to cover annual leave, sickness absence, study leave, maternity leave and protected time. It was recommended that this ‘predictable absence time’ should be a minimum of 21 per cent to avoid putting too much pressure on existing staff and to avoid higher costs if overtime or the use of temporary staff were increased.
The Senior HR Adviser was asked to produce guidelines on what should be covered in the workforce plan for nurses. She took note of the following model reproduced in the National Planning Framework.
As the Senior HR Adviser, what proposals would you make on the considerations to be taken into account in preparing the workforce plan for nurses?
The task is not to produce the workforce plan itself but to set out the information required and the headings under which the planning development group should make its recommendations. The considerations include:
●The likely increase in activity levels as measured by the forecast number of procedures (or any other measure of activity levels that might be appropriate).
●Current staffing numbers and data on sickness and turnover.
●Projections of numbers of qualified and unqualified nurses required assuming no change in the present division of work between qualified and unqualified nurses (the skills mix) or in the range of duties assigned to qualified nurses.
●The feasibility of changing the skills mix and amending roles.
●The likely supply of qualified nurses.
●The implications of creating the new cardiac unit and the requirement to have 120 specialized cardiac nurses in post – they are available from existing units, but will they transfer and what needs to be done to encourage them to transfer and retain them when they have? (Note that specialist cardiac nurses are in short supply.)
In terms of the actions required it may be concluded that there are unlikely to be any special problems in planning for future requirements in the existing activities of the hospital, although the Scottish NHS authority will still require projections to be made. But workforce planning is not just about projecting future demand and taking into account supply in purely numerical terms. For example, it may well be the case in this situation that there is room to plan for changes in the skill mix and in roles to make better use of skills.
However, the workforce plan will also need to focus on the implications of the transfer and what needs to be done. Again this is much more than just a numbers game. Workforce planning covers the whole spectrum of the ways in which people are employed and the means of attracting and retaining the skills required.
The actual plan prepared by another Scottish hospital facing similar issues included:
●The continuation of targeted recruitment campaigns (recruitment fairs and overseas).
●Supporting return-to-work nurses.
●Specialized in-house re-skilling training to match skills to changing demands.
●Using the NHS knowledge and skills framework (KSF) as the basis for the review and development of staff.
●Close liaison with the local university on nurse training schemes.
●Role development programme to release professional capacity to make services more patient focused.
●Development of family-friendly flexible working arrangements.
●Pre-transfer visits to staff who are transferring.
●Pre-planned induction and, as necessary, further training programmes for transferred staff.