Health and Social Care Workforce StrategyApril 2019

Hertfordshire and West Essex

Sustainability and Transformation Partnership

Introduction

Our health and care system has

set out an ambitious strategy for

a healthier future of high quality,

person centred and proactive

care; which is better joined up,

improves outcomes, and

increases value.

This strategy set outs the STP’s

approach to ensuring we have a

workforce that delivers care at

the right time; in the right way; in

the right place; by the right

person, with the right skills and

values.

It will act as a guideline for the

STP and the organisations within it

to support and develop their

workforce.

Our health and care system has set out an ambitious strategy for a healthier future of high quality, person centred

and proactive care; which is better joined up, improves outcomes, and increases value. We will also harness new

technologies that offer an opportunity to deliver health and care on a more efficient and tailored basis than ever

before. We can only deliver this this by working together, as a single system, at greater scale and in a more

integrated way.

If we are to achieve this aspiration then our workforce - the single most important factor in the quality of care and

the way in which it is delivered - will be at the heart of this change and integral to realising our Integrated Health

and Care Strategy.

Against this backdrop, this Workforce Strategy set outs our approach to ensuring we have a heath and social care

workforce that delivers care at the right time; in the right way; in the right place; by the right person, with the right

skills and values. It will act as a guiding framework for the STP and the organisations within it to support and develop

their workforce.

The strategy has been developed through discussion with a range of stakeholders across Hertfordshire and West

Essex (HWE), facilitated through discussions with partners at the Local Workforce Action Board and associated

Workstream Leads meetings. In addition, content has been developed with inputs from a range of workforce

groups across Hertfordshire and West Essex and individual discussions, and also takes into consideration other

national and local drivers.

The strategy describes:

The workforce needs

identified from

implementing the

Health and Care

Strategy and other

drivers of change

A vision for the

workforce with a set of

associated core

principles, and how

we will know when we

have achieved it

A clear strategy to

deliver our vision

An evaluation of the

implications of

implementing the

strategy

Strategy Overview

In line with the Long term plan, our

Integrated Health and Care Strategy set

out an ambitious blueprint for a healthier

future of high quality, proactive care;

which is better joined up, improves

outcomes, and increases value.

At its heart is a population health

management approach; delivering

integrated, person centred care

designed around our population,

standardising treatment, and

transforming the key pillars of our system

to ensure their sustainability and

resilience.

Against this backdrop, we will need to

ensure that our health and care

workforce:

� Has the necessary capacity to meet

changing demand across the system

� Has the required skills, capabilities, and

roles to deliver our future model of care

� Works in new ways across professional

and organisational boundaries; and

� Is empowered to deliver change by our

culture and leadership

Our vision is therefore to create:

“One Health and Care Workforce

across Hertfordshire and West Essex;

delivering high quality, seamless, and

person centred care”

We will know we achieved this when:

The right care is delivered at the right

time; in the right way; in the right place;

by the right person,

who has the right skills and values.

Our strategy to deliver this vision is built on 5

key themes:

• Attraction, recruitment, and retention

• Education and Training

• Innovation and Technology

• Leadership and System Wide

Organisational Development

• Enabling a ‘One Workforce’ approach

Making our workforce strategy a reality will require investment, brave leadership, and a different mindset where we put the needs of the system above our

won organisations. Above all, we must commit to working in partnership in all that we do.

Health and Social Care Workforce

Our workforce strategy covers the

broad range of professionals that

contribute towards the health

and wellbeing of our population,

including:

Healthcare

Social Care

Voluntary sector

Private sector

Carers and families also play a

vital role in our workforce.

Schools, universities, and other

academic institutions are key

partners in securing our

workforce.

• Our workforce strategy covers the broad range of

professionals that contribute towards the health

and wellbeing of our population.

• This includes staff working in health and social

care, and also recognises the close links we must

make with voluntary, community, and private

sector organisations - who’s capacity and

capabilities will need to be harnessed to best

meet the needs of our population.

• We recognise the vital contribution that

volunteers, carers and families make as part of

our workforce.

• We will also need to work closely with other

partners, in particular schools, universities, and

other academic institutions to secure and upskill

our workforce.

• Our workforce strategy therefore sits alongside,

and is aligned to, a number of local workforce

strategies including Local Authority Social Care

workforce strategies and those of individual NHS

organisations

14% staff turnover rate across the STP, rising to 30% within social care, where

recruitment and retention is particularly challenged.

14% of staff leaving Social Care go to the NHS

Adult nurse recruitment was down 27% in 2018. Learning disabilities nurse recruitment was down 63%

c. ¼ of our workforce are over 50. This number is higher

still within Primary Care settings

38% of staff surveyed in 2018 are not sure if there is

a system leadership group in place

Over 50% of our healthcare staff work in hospitals.

In 2017/18, c. 85% of workforce growth was in the acute sector.

There was a reduction in community staff

12% vacancy rates average across the STP, and a

reliance on bank and agency staff to fill gaps

Our Current Workforce

70%Of our workforce will still workin the system in 10 years time

51,000 staff commission or

provide health and social care to our

population

7% of Social Careworkforce are

directly employed by our Local Authorities

Context

There are a number of

factors at a national,

system, and local level

which will not only

influence our behaviours

but also shape our

workforce requirements

The health and care system within Herts and West Essex does not operate in isolation, with a

range of connections within and outside of the system at a national, system, and local level.

This strategy must therefore be cognisant of these developments, whether they be national

policy, social and cultural trends, or other drivers so that the strategic direction it sets out will be

effective and deliverable. Key examples are outlined as follows:

Nationally there have been a number of reviews, strategies and policy

documents for the whole of the health are care system which have an

impact on how services will be delivered locally in the future. These

include the recently published long term plan, Topol review, and

upcoming HEE workforce strategy. Additionally, national political

decisions which aren’t directly within the health and care landscape are

likely to have an impact on future workforce requirements.

Our local system of Hertfordshire and West Essex is a key driver in what

our future workforce requirements will be. Our current workforce position

future ambition (as set out in the Health and Care Strategy), changing

demographics, and medium term financial plan all influence this

strategy and have helped to shape what our future workforce needs to

look like.

Our system is a collection of health and social care providers and

commissioners who have their own pressures and opportunities. The

strategies of these organisations, and their implications on the future

workforce, have been considered to ensure that this strategy is aligned

with local needs.

Local places and

neighbourhoods

System

National

The Key Drivers for Change

HWE System

• Our current workforce has high vacancy rates, is

aging, and we are facing difficulty in recruiting new

staff, especially in social care. Workforce growth is

higher in hospitals than in other settings. However,

70% of our current workforce will still be with us in 10

years time.

• Ambition to develop integrated, person-centred

care, designed to meet the needs of our

population, delivered in local neighbourhoods

wherever possible.

• Population health management approach.

• Effective and efficient health and care delivered in

the right place, by the right person, at the right time.

Shift care from reactive to proactive when possible,

and standardise our approach to treatments.

• Transform the key pillars of our health and care

system, to ensure they are sustainable and resilient.

• Put in place the staff, culture and systems we need

to support transformation.

Local

• West Hertfordshire - Future model of care based on

prevention, joined up care, the centralisation of

specialist care, and a locality based community

model. Reconfiguration of acute services is planned

to meet this model - for example through the

development of hot and cold sites and capital

investment to improve facilities and infrastructure.

• East and North Hertfordshire – Improved prevention

and Primary Care services, and enhanced

community model and improved acute services.

Investment in the hospital estate to make it more

suitable for the delivery of modern healthcare.

• West Essex – Primary and community service

integration through the development of

neighbourhood model and Primary Care Networks;

supporting the system to manage demand away

from hospitals. Improving the quality of acute

services and developing new hospital facilities.

• Development of Primary Care Networks built on

populations of 30-50k.

National

The NHS Long Term Plan (LTP) - continued focus on

Primary, Community and Mental Health care and a shift

away from silo working towards a more integrated

services delivered closer to people’s homes. Investment

in the development of Primary Care Networks.

The Topol Review - genomics, digital medicine and

artificial intelligence to improve care. The workforce will

need to develop the skills, attitudes and behaviours

required to become digitally competent and confident.

Leadership vital in planning and delivering these

changes.

Nationally, many staffing groups have significant gaps

where demand is outstripping supply – high vacancy

rates in nursing, midwifery and medical professions in

particular. Furthermore, the impact of Brexit still

unknown

A 2019 funding settlement will also be reached with

Social Care, although the publication date of the Social

Care Green Paper is still to be confirmed. A funding

settlement will also be reached with Health Education

England (HEE).

HEE it is due to release a national workforce strategy to

compliment the LTP

These drivers will require our workforce to evolve in response to a changing landscape, and continue to provide the highest possible quality of care to our population

What happens if we don’t change*?

Our workforce makes up c.70% of the costs of

delivering care to our population

It is the single most important factor in the quality of

care and the way it is delivered

If we do nothing, we know that activity will increase

by 29% over the next 10 years across all parts of the

system*

It therefore follows that our workforce will also need

to increase – estimated as some 22% within the NHS

alone*, and a 3% increase per annuum in social

care+

This increase will also contribute towards a funding

gap of some £1bn across health and social care by

28/29*

Give our current levels vacancy rates and difficulties in recruiting staff, this position is neither viable, sustainable, or affordable

*Figures aligned to HWE MTFP / +Hertfordshire Social Care Workforce Strategy

Impact on workforce numbers

We recognise the need to do further modelling work in order to determine the size and shape of our future

workforce, if we a)do nothing; and b) implement the changes proposed in the Health and Care Strategy

and this workforce strategy.

This will include taking account of factors such as:

Current staffing

numbers Vacancy rates

Recruitment and

retention rates

Changes in

demographics and

demand

New models of care

New ways of working,

innovation, and

technology

Increased productivity New roles

• A more flexible generalist skills base

working across a wider range of health

and care support needs

• Better understand each others roles

and the value we add

• Make best use of specialist skills, doing what

only they can do

• We will need new roles such as care planning

and care navigation

• Increased use of alternatives to GPs in primary

care as part of Primary Care Networks

• Improved digital competence and confidence

• Ability to use new tools and better interpret

data

Our

Workforce

Needs

Against this backdrop, we will need

to ensure that our health and care

workforce:

Has the necessary capacity, in

the right places, to meet

changing demand across the

system

Works in new ways across

professional and organisational

boundaries;

Has the required skills,

capabilities, and roles to deliver

our future model of care ; and

Is empowered to deliver change

by our culture and leadership

• There will be collective leadership

at all levels of the system, which is

inclusive and compassionate

• More diversity in our leadership

• Our leaders will put the needs of the

population first; before that of

their individual organisations

• A collaborative and trusting culture that

enables staff to work in different ways

• Empower staff to put change in to action and

do the right thing by people

• Our leaders will champion the adoption and

spread of new technology

• Talent will be shared across the system

• Our workforce will need to be person centred

rather than organisationally focussed

• Staff will be able to work anywhere, in any

way across the system to deliver integrated

care and improved outcomes for our

population

• Multidisciplinary working across traditional

organisational and professional boundaries

neighbourhoods and primary care networks

will be common place

• Digital technology will mean less face to

face and more virtual interaction

• Our healthcare workforce will need to remain

around the same overall size as is budgeted

for now, yet mitigate against rising demand for

services. The social care workforce will

increase in line with changing demographics.

• Workforce capacity will shift towards planned

and preventative care, with a relative

increase in workforce numbers across primary,

community and mental health services

• There will be more growth in generalist roles

relative to those with highly specialist skills

• There will be a reduced reliance on

temporary staff, in particular external

agencies, to fill gaps in capacity

Our vision and principles

We therefore have a vision to

create “One Health and Care

Workforce” across Hertfordshire

and West Essex; delivering high

quality, seamless, and person

centred care”

We will know we have achieved

this when the right care is

delivered at the right time; in the

right way; in the right place; by

the right person; with the right

skills and values.

This will involve working closely

with our partners in the voluntary,

community, and private sectors;

as well as universities and other

academic institutions

“One workforce across Hertfordshire and West Essex; delivering high

quality, seamless, and person centred care”

PRINCIPLES

Embrace innovation,

technology, new roles,

and new ways of

working

Value staff as integral to

delivering care now and

in the future

Promote the health and

wellbeing of our workforce

and empower staff to deliver

change

Recognise the contribution

of, and develop close links

with, the voluntary, private,

and education sectors

Adopt a consistent and

collaborative approach to

managing the workforce

Become the employer of

choice – retaining our

current staff and

attracting new talent

where needed

Right

Care

Right

Time

Right

Place

Right

Person

Right

Skills

Right

Values

Right

Way

Our workforce strategy on a page

Our strategy to deliver this vision is

built on 5 key themes:

Attraction, recruitment, and

retention

Education and Training

Innovation and Technology

Leadership and OD

Enabling a ‘One Workforce’

approach

Capacity Capability Ways of working Culture and leadership

Attraction,

Recruitment, and

Retention

Education and

Training

Innovation and

Technology

Leadership and

OD

Enabling a ‘One Workforce’ approach

HWE Talent

Academy

Affordable

Housing

New curriculums

and pathways

Growing our own

supply of staff

Digitally enabled

working

New ways of

working HWE Leadership

Academy

System Wide OD

Single

HWE Bank

Integrated

Empl’t Approach

Workforce

Passports

Shared Support

Services

Close Links with

Voluntary Sector

Multi-professional working

Attraction, recruitment, and retention

Hertfordshire and West Essex

Talent Academy – supporting

the system to attract, recruit,

and retain staff

Affordable Housing and Transport

- influence the creation of

affordable housing and

improved transport for our

workforce to help us attract and

retain staff

Single apprenticeship scheme

and pooled levy - focussing on

core workforce requirements

across the system

In order to ensure our workforce

has the necessary capacity to

meet changing demand across

the system, we will focus on

attracting, engaging, recruiting,

and retaining staff – by making

HWE a place to fulfil people’s

career ambitions.

We will target four groups of

young, apprentices and students,

our current workforce, and our

alumni.

Core areas of work will include

the development of our own

talent academy, a single

appreciates scheme, and

ensuring there is affordable

housing for staff.

Targeted attraction and

retention strategies - best

practice learning and

adoption so that we do all we

can to make staff want to join

and stay within the system.

Focus on young, students,

current workforce, alumni. Influence private and

independent sectors–

recognise our roles as market

makers and our ability to

influence the private sector

through commissioning

Education and Training

Improved education and

training - new curriculums,

training portfolios & pathways

to develop the right skills and

capabilities for our workforce

Ownership and influence over

our supply chain – growing staff

within HWE through our own

training programmes

Harmonised approaches to

training – standardising

capability and delivering

greater consistency of practice

across the system

System wide funding for CPD –

using local funding to maintain

skills and centralised funding to

transform and develop new

skills Improving education and training

will be vital in developing a more

flexible and generalist skills base

that supports a wider range of

health and care needs.

Greater influence over the supply

of our future workforce will allow

us to grow staff within HWE

through our own training

programmes, and enable us to

develop new curriculums and

training pathways which support

new roles and job descriptions.

Developing our staff to work

differently – supporting, training

and developing our existing

workforce to work in new ways

or perform new roles within the

system

Career development pathways

– looking after our workforce

and supporting them develop

their careers within the HWE

system, across health and

social care

Innovation and Technology

Digital and technology

enabled working – increasing

productivity and driving

additional capacity from our

current establishment by

adopting technology

Innovation and technology will

mean our workforce is able to

work in smarter and more flexible

ways across the system – making

it more productive and enabling

a more collaborative and

integrated approach.

Supporting staff to implement

new technology – so that we

can harness the potential of

areas such as genomics, digital

medicine, and artificial

intelligence

Enable staff to make better use

of data – so that we can adopt

an evidence based approach

and embrace the principles of

population health

management

New ways of working –Multi

professional working across

organisational and professional

boundaries to deliver

integrated care

Development of new roles and

job descriptions – for example

community navigators to

deliver our new models of care

An agile workforce – enabled

by technology to work

anywhere within the system

Leadership and OD

Shared executive

responsibilities and roles across

the ICS / ICAs – promoting a

‘one workforce’ approach and

delivering efficiencies

Leadership Academy – to

develop greater system

leadership capacity and

capability at all levels within the

system

Develop system leadership

networks – bringing leaders

across professional groups and

organisations together to

promote ‘one workforce’

approach

Proactive succession planning

– to increase and sustain

leadership capacity

Developing collective leadership

at all levels of the system, which

puts the needs of the population

before that of their individual

organisations and empowers staff

to deliver change, is a core part

of our strategy.

This will be achieved through the

development of a system wide

leadership academy and a

system wide approach to

organisational development.

Sharing talent – Putting the

workforce needs of the system

above individual organisations

and sharing talent where it is

needed most

A system wide approach to

organisational development

to embed the right culture and

behaviours

Enabling ‘one workforce’

A single bank operating across

all acute trusts - enabling

temporary staff to be deployed

flexibly across the system to

reduce reliance on agency

staff

Adopting a more integrated

approach to employment - e.g.

harmonized job descriptions and

contracts, allowing capacity to

be deployed more flexibly

Workforce passports - enabling

staff to work across

organisational boundaries and

capacity to be deployed more

flexibly across the system

Closer links with the voluntary

and private sectors – supporting

the system to harness the

capacity of local volunteers and

our wider partners

Alignment and co-location of

staff – facilitating staff to come

together to support integrated

/ multidisciplinary working within

local places and

neighbourhoods

Shared support services - Single

support services across the

system, with central functions

and localised delivery. What

can be done once is done

once (small steps)

We will ensure that our workforce

will is person centred rather than

organisationally focussed.

This will mean that staff can work

anywhere, in any-way, across the

system to deliver integrated care

and improved outcomes for our

population

What makes our strategy stands out?

Attraction, Recruitment, and

Retention

Education and Training

Innovation and Technology

Leadership and OD

Enabling a ‘one workforce’

Approach

� The development of a HWE Talent Academy

� Influencing the development of affordable housing

� Greater ownership of nursing, midwifery, and medical

education within HWE

� Digitally competent and confident staff

� Embedding technology and a culture of quality improvement

� A HWE leadership academy, developing collective

leadership at all levels of the system

� System wide OD

� A single temporary staffing bank

� A single and consistent approach to employment

The implications of our strategy

Making our workforce

strategy a reality will

require investment,

brave leadership, and a

different mindset where

we put the needs of the

system above our won

organisations.

Above all, we must

commit to working in

partnership in all that we

A commitment to ‘One workforce’

Realising our vision for ‘one workforce’ will

mean putting the needs of the system

above individual organisations and

thinking of our own staff as part of the

HWE workforce

Bold Leadership

We will need to make bold decisions as

leaders – for example will we commit to

working together to deliver affordable

housing or new education courses within

HWE?

Investment

Delivering our strategy will require

investment in talent; technology;

organisational development; and

education

Consistent Partnership Working

The partnership working required to deliver

our strategy cannot be a pick and mix

approach – we must adopt a consistent

approach to working partnership across all

that we do.

Future Workforce Planning

The diagram below provides an early indication of where workforce planning roles and

responsibilities could sit within the future system architecture:

ICP

(500k)

Primary Care Network (30-50k)

• System-wide workforce strategy as a guiding framework

• System wide organisational development

• Investment and funding

• Single and consistent employment approach

• Development of leadership and talent academies

• Establishing a single staff bank and shared support services

• Greater ownership of education and training and partnerships with Universities

• Developing new roles and ways of working aligned to local models of care

• Detailed workforce planning to establish local capacity requirements

• Influence over private and independent sectors through commissioning

• Implementation of affordable housing and transport with local partners

• Enabling staff to work across organisational boundaries

ICS

(1.5m)

• Implementation of new roles and ways of working

• Alignment and co-location of staff

• Multi professional working

• Closer links with voluntary sector

Manging and assuring the delivery of our strategy

In order to assure the delivery of our strategy, we have put in place a robust governance structure based around key workstreams. Each

workstream is headed by a leader within the system with an appropriate programme and project governance in place. These workstream will

report into the Hertfordshire and West Essex LWAB and subsequently into the STP CEO Steering Group. This will ensure both local and system focus

on our work in line with this strategy.

Next Steps

• Workstream leads to check if current

workstream plans will deliver strategy

• Incorporate any newly identified

areas into existing plans

• Scope and develop plans for newly

identified initiatives

• Agree what will be delivered in the

next 1,3, and 5 years

• Baseline of current workforce

projections under a ‘do nothing’

scenario

• Quantify the impact of STP care area

workstreams on future workforce

requirements

• Quantify impact of workforce

strategy initiatives on recruitment,

retention, etc.

• Model future workforce requirements

• Gap analysis between future

requirements and do nothing

projections

• Adopt a robust portfolio management

approach to manage implementation

and realise benefits

• Evaluation of future investment costs

e.g. Talent Academy, Leadership

Academy etc

• Business case development as

applicable

• Regular reporting against delivery plan

milestones and benefits

• Regular programme reviews to ensure

work continues to be aligned with

objectives and outcomes

Programme

Planning

Workforce

Modelling Implementation01 02 03

Ongoing Programme Management

April – June 2019 May – June 2019 June 2019 onwards