Working Together – The Edinburgh Integration Joint Board workforce strategy 2022-25
Working in health and social care has always been challenging, and the pandemic has exacerbated those challenges. Our colleagues are integral to the delivery of our services, and we want to be able to support them in every aspect of their role across the Edinburgh Health and Social Care Partnership.
That’s why the Edinburgh Integration Joint Board are committing to its new workforce strategy – ‘Working Together’.
Through many engagement groups, surveys and at the direction of our senior leaders, we’re committing to building a stronger and more sustainable workforce, driven by our four key priorities.
- Health and wellbeing
- Culture and identity
- Workforce capacity and transformation
- Leadership and development
You can read ‘Working Together’ and also download the original PDF version.
This ambitious strategy has been developed to ensure we have a skilled and capable workforce for today and tomorrow that can deliver on our strategic priorities, and meet the health and social care needs of the citizens of Edinburgh.
‘Working Together’ is the Edinburgh Integration Joint Board’s (EIJB’s) inaugural blueprint for delivering a caring, healthier and safer future for the population of Edinburgh.
The needs of our citizens and the way we deliver health and social care across Edinburgh is shifting, and as a result we need to future proof the way we work, and how we deliver services. With advances in health and care we are living longer; however we are also seeing an increase in people living with frailty and multi-morbidity, putting an increased demand on our services and our workforce.
Alongside existing challenges to delivery of services, the recent Covid-19 pandemic created a period of uncertainty and additional pressures. Our workforce rose to the challenge of providing services throughout; one member of staff highlighted that they are “proud of the workforce we have, the commitment they show to the people in Edinburgh and also to the organisation. Staff have showed immense resilience, have adapted to change and continue to do so.”
Our workforce plays a key role in how we cope with this growing demand and changing environment; having well engaged, motivated and supported staff ensures that Edinburgh can continue to receive caring, compassionate, and person-centred services of the highest possible standard.
Whilst the Edinburgh Health and Social Care Partnership (EHSCP) is stronger and better together, there are some everyday challenges which can make it difficult to truly work as one team. These challenges, combined with growing demand, mean this is the time to stop and think about what our workforce needs to adapt to meet future needs, and the infrastructure to support that change.
We are already implementing a range of transformative changes to how we deliver services, and our whole workforce has a key role to play in successfully delivering these changes. ‘Working Together’ will help us support our staff to face the challenges and opportunities that lie ahead. It sets out our vision and priorities for the workforce and how we will get to where we need to be. The strategy will deliver against an overarching vision and aspirations, and our 4 workforce priorities: health and wellbeing; culture and identity; workforce capacity and transformation; and leadership and development.
Established on 1 July 2016, Edinburgh’s Integration Joint Board (IJB) is responsible for planning the future direction of and overseeing the operational delivery of integrated health and social care services for the citizens of Edinburgh.
Services delegated to the IJB from both the City of Edinburgh Council (the Council) and NHS Lothian (NHSL) fall under the broad headings of adult social care services, community health services and hospital-based services. These services are largely delivered by the Partnership, although some are managed by NHS Lothian and are referred to as “hosted” or “set aside”.
The EIJB is required to produce a strategic plan every three years, setting out the vision, intent and strategic objectives for health and social care in Edinburgh. The strategic objectives are now being reviewed and updated (2022-2025), with a focus remaining on prevention and early intervention to support independence and tackle health inequality, in order to help more people take control of their own health and wellbeing, and feel empowered with the resources, tools and support needed to live well.
The updated service strategy objectives for 2022-2025 are:
- embed improvements to prevention and early intervention
- work with partners to close the inequality gap
- positively transform the quality, experience, and impact of our services
- partner to shift care from hospital to community settings
- support our people and partners to use our collective resources effectively
The alignment of our Strategic Plan and ‘Working Together’ ensures we are able to take an integrated approach to our future planning arrangements. This is vital given what is an increasingly complex context for planning and delivering health and social care services across Edinburgh. We also anticipate these objectives will adapt to incorporate the new National Care Service objectives, as well as taking into account the Edinburgh Poverty Commission report, Fair Work agenda and other national initiatives.
What follows is a data overview, taken from:
- EIJB Annual Performance Report 2019-2020
- Insights into Social Care in Scotland (Report) (isdscotland.org)
- Carers Census: results 2018 to 2019 – scot (www.gov.scot)
- General practice – demographics data visualisation – Up to 30 June 2021 – General practice – demographics data visualisation – Publications – Public Health Scotland
One in 20 people of all ages in Scotland received social care support and services during 2018/19
Adult social care service types in Scotland, in decreasing order of number of people receiving support:
- social worker
- community Alarms/Telecare
- home care
- care home
- housing support
- day care
- meals
Home care hours provided in Scotland between Jan-Mar 2018: 1,122,155 hours
In tax year 2018/19, 91,810 people received home care in Scotland. This is equivalent to 17 people per 1,000 population.
As of 31 March 2019, Health and Social Care Partnerships were financially (partly or fully) supporting 45,845 people to stay long-term in a care home in Scotland.
In 2018/19, an estimated 136,900 people had an active community alarm and/or a telecare service. This is a 3.8% increase in provision from the previous year.
Around 20% of people aged over 75 are in receipt of a community alarm/telecare service.
In Edinburgh, 70 GP surgeries provided 3 million consultations / treatments in 2018/19
62% of adult carers supported by local services provided an average of 50+ hours of care per week.
The majority of young carers supported by local services (65%) provided up to 19 hours of care per week on average.
The number of patients registered at Scottish GPs are increasing year on year.
18-29% – the Scottish Government estimate of the increase in the need for health and social care services between 2010 and 2030
Within the Edinburgh Health and Social Care Partnership, there are four locality areas:
- North-West
- South-West
- North-East
- South-East.
The North-West locality accounts for 149,417 people (28.5% of the population of Edinburgh).
The South-West locality accounts for 120,553 people (23% of the population of Edinburgh).
The North-East locality accounts for 118,760 people (22.6% of the population of Edinburgh).
The South-East locality accounts for 136,200 people (25.9% of the population of Edinburgh)[1].
In the ten years to 2020, Edinburgh’s population grew by 12.3% (17% of this was in the over 65 population) from an estimated 469,930 to an estimated 527,620 people. In the same time period Scotland grew by 3.9%. The City of Edinburgh population is set to grow further to 586,566 by 2043, which inevitably will place additional demand for health and social care service delivery.
[1] EIJB joint strategic needs assessments (JSNA) 2021 – Population and demographics – Edinburgh Health and Social Care Partnership (edinburghhsc.scot)
The ratio of population increase (as per evidence) will lead to increase in demand for these health and social care services, and multi-morbidities requiring more multi-disciplinary team working.
In Scotland, 77.1% of people receiving care and support from social care in 2018/19 were aged 65 and over. Given that Scotland’s overall population for over 65s increased by 20% in the last decade, it follows that the demand for social care is likely to continue to increase too.[2]
Long-term conditions are the main challenge facing healthcare systems worldwide. Although having more than one long-term condition (multi-morbidity) is most common for older people, most people with multimorbidity in Scotland are under 65.[3]
The overall trend of more people receiving personal care services in their own homes likely reflects two underlying factors: an increasing older population, and a move away from long-term care being provided in hospitals and care homes towards care being provided in people’s own homes for as long as possible.[4]
[1] EIJB joint strategic needs assessments (JSNA) 2021 – Population and demographics – Edinburgh Health and Social Care Partnership (edinburghhsc.scot)
[2] Insights in Social Care: Statistics for Scotland (publichealthscotland.scot)
[3] University of Glasgow – Research – Glasgow Research Beacons – Addressing Inequalities – Tackling the spiral of multimorbidity
[4] Free personal and nursing care, Scotland, 2017-18 – gov.scot (www.gov.scot
Our total directly employed workforce across both the City of Edinburgh Council and NHS Lothian sits at just under 5,000 headcount. The following table shows both the split of the workforce by employer but also by headcount and WTE.
| Employer | Headcount | WTE | Percentage of total workforce |
|---|---|---|---|
| City of Edinburgh Council | 2,468 | 2,107.02 | 51% |
| NHS Lothian | 2,329 | 1,823.14 | 49% |
| Total | 4,797 | 3,930.16 | 100% |
While the majority of the workforce operates on a full-time basis the following table outlines the breakdown of full- and part-time staff across the Partnership:
| Employment type | Council | NHS Lothian | Total |
|---|---|---|---|
| Full-time | 1,664 | 1,190 | 2,854 |
| Part-time | 789 | 1,139 | 1,928 |
The gender profile of our total workforce highlights a predominantly female workforce – approximately 80% identify as female and 80% as male. Please note, this does not include a total of 63 headcount who preferred not to say or did not answer the question.
Our workforce profile outlined below highlights the aging nature of our workforce. It also highlights the need to ensure future supply, particularly across our younger workforce. The table shows the age profile for both Council and NHSL employed staff:
| Age | Number of Council staff | Number of NHS staff | Total | Percentage of workforce |
|---|---|---|---|---|
| Under 20 | 0 | 12 | 12 | 1% |
| 20-24 | 23 | 73 | 73 | 3% |
| 25-29 | 106 | 225 | 225 | 10% |
| 30-24 | 151 | 251 | 251 | 11% |
| 35-39 | 252 | 259 | 259 | 11% |
| 40-44 | 301 | 278 | 278 | 12% |
| 45-49 | 295 | 313 | 313 | 13% |
| 50-54 | 440 | 364 | 364 | 16% |
| 55-59 | 465 | 321 | 321 | 14% |
| 60-64 | 332 | 168 | 168 | 7% |
| 65-69 | 85 | 53 | 53 | 2% |
| 70+ | 0 | 12 | 12 | 1% |
| 70-74 | 11 | 0 | 0 | 0% |
| 75+ | 2 | 0 | 0 | 0% |
| 2,329 | 100% |
We are also able to look at our workforce in more detail for both Council employed staff and for NSHL employed staff.
The table below highlights the NHSL cohort split by job family. By far the biggest group of staff within the NHS cohort is our nursing workforce (52%), followed by our admin and clerical workforce (17%) and our allied health professions (AHP) workforce (16%):
| Job family | Number of NHS staff | Percentage of NHS staff |
|---|---|---|
| Support services | 45 | 2% |
| Senior management executive | 2 | 0% |
| Personal and social care | 13 | 1% |
| Other therapeutic | 125 | 5% |
| Nursing band 8+ | 15 | 1% |
| Nursing band 5-7 | 841 | 36% |
| Nursing bank 1-4 | 357 | 15% |
| Medical and dental support | 2 | 0% |
| Medical | 126 | 5% |
| Healthcare sciences | 35 | 2% |
| AHP bands 5+ | 312 | 13% |
| AHP bands 1-4 | 69 | 3% |
| Admin services | 387 | 17% |
| 2,329 | 100% |
We have also endeavored to split our Council cohort of staff in a similar way. The following table outlines a particular mapping scenario based on a combination of 6 ‘job group’ headings and grades. The largest group of staff within the Council cohort are those within the social care job group, which accounts for 70% of the total Council workforce.
| Job group | Number of Council staff | Percentage of Council staff |
|---|---|---|
| Social work grade 8 | 149 | 6% |
| Social work grade 7 | 181 | 7% |
| Social work grade 1-6 | 48 | 2% |
| Social care grade 6+ | 260 | 11% |
| Social care grade 4-5 | 1,099 | 45% |
| Social care grade 1-3 | 383 | 16% |
| Nursing | 1 | 0% |
| Management and administration | 131 | 5% |
| Ancilliary | 111 | 4% |
| Allied health professional grade 7+ | 91 | 4% |
| Allied health professional grade 1-6 | 14 | 1% |
| 2,469 | 100% |
However, our collective workforce is much wider. The Partnership is fortunate to work closely with health and care providers, charities, unpaid carers, third sector/ independent organisations, as well as being supported by many volunteers and unpaid carers. Together, this workforce makes a big difference to the daily lives of many people across the city of Edinburgh.
As Edinburgh’s population continues to grow, we anticipate increasing demand for services, including primary care, mental health services, homecare and reablement, public health, care homes and district nursing. Especially in the aftermath of the Covid-19 pandemic, where there have been rapid and potentially long-term changes in health and social care, and an ongoing impact on the mental wellbeing of our workforce.
With these growing pressures, we have significant unmet need in the provision of our services, alongside sustainability challenges with our existing workforce due to a market that has been hit by competing industries, Brexit and the Covid-19 pandemic.
One of the sectors key strategic challenges is attracting, recruiting, and retaining staff. We have a predominantly ageing workforce (approximately 48% over 50 years), putting us at risk of losing essential knowledge and experience. Presently we have only 8.6% of our workforce under the age of 30, so ensuring a steady supply of talent will be crucial to building capacity,
With ongoing financial pressures in the public sector, we face a real challenge in how we tackle some of these issues in Edinburgh, and our workforce is supported, and our citizens receive the care and support they need.
Working Together will look to capitalise on the opportunities that these challenges present.
Pressures and challenges for the IJB:
- the need for staff to support/drive strategic change on top of their operational workload
- supply issues to off-set vacancies, retirals, and absence
- finding time and opportunities for staff to improve and sustain their knowledge, skills and experience
- ongoing impact on our workforce and their mental health and wellbeing
- a shift to providing more care and support in the community, and the need for training, development and resource to do this
- attracting, recruiting and retaining staff, building the next generation of our workforce
- aligning our workforce priorities with upcoming National Care Service priorities
- increasing financial pressures in the public sector
- ensuring staff have the tools and equipment to do their job
- addressing the increasing inequalities gap.
This workforce strategy has acknowledged recent changes, and the impact on staff.
Working Together provides the platform to support a step-change in our approach. By delivering against our four strategic workforce priorities of health and wellbeing; culture and identity; workforce capacity and transformation; and leadership and development we can build a workforce capable of meeting the health and social care needs of Edinburgh’s citizens. This strategy sets out our vision and priorities for the workforce and how we will get to where we need to be together.
The strategy content has been developed through ongoing engagement with stakeholder groups, including representatives from the third and independent sector. We have also incorporated feedback from staff via focus groups and a survey.
One of the most prominent points raised during our engagement with staff was the need to build capacity within the workforce. This will be a key focus of the delivery groups.
The focus of the following pages is on the 0-3 year delivery plan; the medium-to-longer-term objectives have been noted, but we are unable to commit to a delivery plan for these yet, given the need for more discussion and collaboration required between various groups before enough detail and direction is known for these to take place.
Stakeholders have acknowledged that the delivery plan laid out in this strategy are at different stages of development and implementation, as some are already underway. We are happy that this is the case, and they are being implemented under the same governance as the other actions will be.
The IJB also recognises the importance of the third and voluntary sector colleagues in the delivery of a range of important services; this will be a key component of the medium- and longer-term actions.
7.1 The road map
Following a series of workshops held with key stakeholders and partner organisations, four strategic workforce priority headings were identified for the 0-3 year action plan. These being:
- health and wellbeing
- culture and identity
- workforce capacity and transformation
- leadership and development
8.1 Health and wellbeing
“Support the holistic health and wellbeing needs of employees and enhance their experience, both inside and outside work.”
8.1.1 Overall themes
- what does “health and wellbeing” mean to the Edinburgh health and social care partnership?
- work-life balance
- ways of working and flexible working choices
- mental health awareness and support
- access to health and wellbeing resources
8.1.2 Commitments
We will:
- value every member of staff
- promote a positive work-life balance for all staff, and ensure leaders act as role models to achieve this
- continually listen to our staff and ask questions so we can promote a positive, healthy and safe working culture
- commit to building resilience across our workforce, to help manage and adapt to change
- commit to promoting positive mental health, and supporting employees with their mental health
- ensure that equal resources are available to all staff
8.2 Culture and identity
“Create a shared, safe and inspiring culture that strengthens our internal and external relationships and reputation.”
8.2.1 Overall themes
- values
- partnership’s identity
- communication
- basic understanding of the Partnership’s set-up
- parity and equity, and addressing inequalities
8.2.2 Commitments
We will:
- identify, build and promote a shared culture for the Partnership
- champion equality, equity and fairness at the heart of everything we do
- enable staff to understand the teams and functions within the Partnership
- ensure equal/equitable engagement with staff
- ensure staff feel recognised and valued for the work they do
- treat our staff with the dignity, respect, kindness and compassion they deserve
- reflect and adopt the culture within in the Edinburgh health and social care pact
- champion new ways of working for the better
8.3 Workforce capacity and transformation
“Develop a workforce that is adaptable and agile – ensuring we have the right people with the right skills in the right place at the right time.”
8.3.1 Overall themes
- tools and equipment
- considerate, timely changes
- mapping skillsets and knowledge sharing
- capacity and recruitment
8.3.2 Commitments
We will:
- engage with those impacted before planning or making any changes
- utilise the opportunities presented by IT/ digital developments that can help transform our workforce
- promote knowledge sharing, map skillsets and identify gaps to be filled
- promote new roles and working practices that help develop our future workforce
- build capacity and flexibility within our workforce
- integrate and streamline our recruitment processes
- modify and enhance the induction process for new members of staff
8.4 Leadership and development
“Develop a leadership approach that supports individuals at all levels to attain their full potential in order meet the care and support needs of Edinburgh.”
8.4.1 Overall themes
- Development
- Retaining staff
- Training
- Leadership
8.4.2 Commitments
We will:
- champion personal and professional development, to support staff retention
- ensure equal and open access to a range of training approaches across all contracts and positions
- lead the development of a Lothian-wide development hub
- develop strong links with universities and colleges to inform a more strategic approach to the future development needs of our workforce
- promote the role of leadership within the Partnership
This workforce strategy sets the direction and ambition for the support and development of an engaged, motivated and valued health and social care workforce, with the capacity, competence and confidence to meet the needs of the people of Edinburgh. We will achieve our vision through a series of implementation plans which will be co-produced in partnership with staff, stakeholders and social partners, to deliver the commitments and actions identified in this strategy.
Longer-term actions have also been identified – these are just as relevant, but require more collaboration and discussion before delivery of them can be considered.
Delivery governance structure:
“Working Together: One workforce to deliver a caring, healthier and safer Edinburgh”