COSLA’s response tothe Scottish GovernmentDiscussion document to support further engagement on Safe and Effective Staffing in Health and Social Care

Question 1a: Do you think it is important to have a coherent legislative framework across health and social care to underpin workforce planning and appropriate staffing in health and social care? [Yes/No] If you answered yes, how important 1 = extremely important, 2 = very important, 3 = moderately important, 4 = slightly important, 5 = not at all important

There is already a coherent legislative framework for the social care workforce.COSLA understands the rationale for strengthening the legislation in relation to health.Additional legislation for the social care workforce is unnecessary given:

  • The commitment under the COSLA/Scottish Government National Workforce Plan for Health and Social Part 2 to progress and co-produce workforce planning tools
  • The Health and Social Care Standards
  • Existing legislation which covers social care workforce planning –Regulation 15 Social Care and Social Work Improvement Scotland (Requirements for Care Services Regulations 2011)

The existing legislative framework for the provision of safe staffing in the social care sector is coherent, proportionate and well understood. There is already a statutory requirement on IJBs to workforce plan. COSLA does not believe that a compelling case has been made for introducing uniform legislation to apply to health and social care settings: the focus on inputs, methodologies and tools runs contrary to informed, strategic and locally sensitive workforce planning. Integration provides the opportunity for stakeholders to work in partnership to develop national workforce planning with a focus on staffing models that are fit for the future.

Question 1b: How should organisations’progress in meeting requirements be monitored and facilitated, taking account of what currently works well?

COSLA does not accept the premise that legislation should be introduced that could result in social care organisations being required to use specific workforce planning tools, methodologies or approaches. The existing duty to provide sufficient, competent staff and the existing regulation and inspection regime through the SSSC and Care Inspectorate provide appropriate and proportionate safeguards.

The means by which care providers decide the level of staffing needed in any given setting is an operational matter for employers, who are subject to inspection by the Care Inspectorate. Given the diverse range of social care provision that would be affected by the legislation, we have reservations about the wisdom of trying to legislate for the use of particular methodologies or approaches.

Given the existing legislative safeguards to ensure safe and effective staffing levels in the social care sector, the development of workforce planning tools and methodologies should be driven not by top-down legislation but in response local need. The National Workforce Plan for Health and Social Care and National Workforce Planning Group provide a strong foundation for partnership working to improve workforce planning where this is required.

Question 1c: Please provide any other comments you may have. [Text box]

Overarching principles applicable to health and social care service providers

Question 2a: What is your view of the proposal that there should be guiding principles for workforce planning to provide NHS Boards and care service providers with a foundation on which to base their staffing considerations?

Strongly disagree

COSLA believes that enshrining in law principles for workforce planning is unnecessary and provides no added benefits. The focus on inputs detracts from the core National Health and Social Care Standardswhich rightly focus on outcomes.

Whilst we talk of a social care sector, it is important to recognise the heterogeneity of the sector and the multitude of employers - third sector, independent, local authority and others. COSLA maintains that it is for individual employers to determine their approach to informed, strategic and locally sensitive workforceplanning.

Finally, we do not believe that workforce planning principles applying to both the health and social care sectors would mitigate any risk in relation to the skewing of resources.

The guiding principles within existing legislation e.g. Regulation 15, Public Bodies (Scotland) Act 2011 and the new Health and Social Care Standards provide a clear basis for social care workforce planning.

Question 2b:

Do you have a view on whether/how application of these principles should be monitored?

In light of the response to 2a and guiding principles within existing legislation, COSLA does not believe that monitoring the application of workforce planning principles would improve outcomes for service users.

The Care Inspectorate already monitors the application of Reg 15 (and the soon to be implemented Health and Social Care Standards) and additional legislative principles for the social care workforce add no further value.

Question 2c:

Please rate the following examples of potential principles on a scale of 1 to 4, where 1 is very important, 2=important, 3=not very important, 4=not important at all (note that the following do not represent draft wording for the principles to be included in legislation).

  1. Workforce planning must ensure an appropriate number and mix of staff to provide high quality services.
  2. Workforce planning must ensure an appropriate number and mix of staff to provide effective and efficient use of resources.
  3. Workforce planning must ensure an appropriate number and mix of staff to provide services that meet service user needs.
  4. Workforce planning must ensure an appropriate number and mix of staff to provide services that respect the dignity and rights of service

We are unable to rate these given our response at 2a.

Question 2d:

Are there other principles you think should be included?

See our response at 2a.

Question 3a: What is your view on the proposed requirements for Health Boards?

Neither agree nor disagree

Question 3b: Are there any other requirements you think should be included?

No

Question 3c: Please provide any other comments on the proposed requirements set out in section 3.

N/A

Question 4: Do you agree with the proposed role for the Care Inspectorate in leading work, with the social care sector, to develop workforce planning tools for application in specified settings, where there is an identified need?

It remains unclear how and by whom a decision would be reached to ‘identify a need’for a tool. COSLA does not accept the premise that legislation should include provision for Ministers to require specific workforce planning tools to be used in specified social care settings at some point in the future.

We have concerns about the proposal to give the Care Inspectorate a role to lead on the development of workforce planning tools on the grounds that it may create an unhelpful focusin the organisation on process and inputs rather than outcomes. In addition, it risks the Care Inspectorate having a conflict of interest if its inspections are, in part, about the application of tools it has developed rather than nationally agreed standards of care.

Question 4b:

Do you think that social work should be included within the scope of this legislation (while there is currently no proposal to include social work, this could be considered for inclusion at a later stage).

Strongly disagree

Question 4c:

Please provide any other comments on the inclusion of social work within the scope of the legislation.

Our position for ‘social care’extends to social work. As the main employer of social workers in Scotland, we do not consider there is any evidence to support the extension of this legislation to social work.

Question 5a:

In delivering the function described under 3 above, the Care Inspectorate could be required:

  1. To work with employers/service providers and commissioners from the sector to identify and agree specified settings where there is a need for the development of workforce planning tools and methodologies
  2. To work with service providers and commissioners from the appropriate parts of the sector to develop and validate workforce planning tools and methodologies to demonstrate that they are practicable and beneficial for specific settings
  3. To consult with the sector before a requirement to use validated workforce planning tools and methodologies is confirmed in regulations.

In relation to all of the above “1 very important “

Question 5b:

Are there any other routes you think should be considered to ensure appropriate engagement with the sector? [text box]

Question 5c: Please identify any settings where you think the development of appropriate workload and workforce planning tool or methodology is most important; and any care settings where you think this is not relevant or required. [text box]

The Bill should not extend to social care. There may be an argument to be made around nursing in care homes, but we are unconvinced that this legislation will help us collectively to address the issues around recruitment and retention which exist and are challenging the viability of some nursing homes.

Question 6: What support do you think will be required / most useful to enable the development of validated tools and methodologies for the social care sector? Please mark each suggestion on a scale of 1 to 4, where 1 is very important, 2=important, 3=not very important, 4=not important at all

COSLA’s position is that legislation focussing on the development of tools is unhelpful. However, if a legislative approach is taken is as follows.

  1. Dedicated central expertise for the identification of specified settings where the development of workload and workforce planning tools and methodologies would be practicable and beneficial.

1-very important

  1. Additional resource for the Care Inspectorate to enable the proposed functions

1-very important

  1. Training for key personnel in the sector in the development of workforce planning approaches.

1-Very important

  1. Dedicated resource for service providers who engage in the development and validation of approaches, tools and methodologies.

1- Very important

  1. Training for key personnel in specified services once validated tools and methodologies are confirmed through regulations.

1-v.important.

  1. Other [please specify]

Additional resource to provide upgrades of Information Systems to ensure any tools are compatible with existing HRIS systems (which will be different in different settings).

Given the current and anticipated future financial climate we need a quantification of the costs in developing and implementing workforce planning tools. It is COSLA’s expectation that all new initiatives are fully funded.Social care sector would need appropriate resources (both financial and staff) to support the development and implementation of tools.

Risks and unintended consequences

Question 7a: What risks or unintended consequences might arise as a result of the proposed legislation and potential requirements? [ text box]

Additional administrative burden / bureaucracy, detracting from focus on outcomes. A risk that focussing on the use of specific tools results in a ‘tick box’culture.

A legislative requirement to use particular tools could stifle innovation in the development of new ways of working, and is unlikely to be sufficiently dynamic to meet changing demands in the integrated landscape, nor sensitive enough to respond to the local labour market or diverse social care settings (in terms of scale and nature of services delivered).

Question 7b: What steps could be taken to deal with these consequences? [text box]

We would recommend that time, space and resources are given to delivering the recommendations in the National Workforce Plan for Health and Social Care,rather than extending the proposed legislation to social care at this time.

Work is currently ongoing to develop, with the Care Inspectorate, a dependency tool for care homes with the potential to extend beyond into all social care.