https://www.nhsfife.org/about-us/annual-reporting-and-strategic-planning/hcsa-annual-report-2024-25/

Overview

Implementation of the Health and Care (Staffing) (Scotland) Act 2019 (HCSA) took place on 1 April 2024; with the commencement of formal monitoring and governance also from 1 April 2024.  NHS Fife must provide information to the Scottish Ministers on the steps taken to comply with the legislation and the first Ministerial reports to Parliament are expected in April 2026.  In addition, NHS Fife will need to demonstrate how the specific duties of the Act have been met.

The HCSA stipulates that Boards have a duty to follow the Common Staffing Methodology, for staff in scope of the legislation.  This includes using the outputs of the staffing level and professional judgement tools to inform and ensure they have appropriate staffing in place for the speciality specific areas where there are currently tools developed – Nursing & Midwifery and Emergency Departments at present. There is also a new Generic Real Time Staffing Tool in place.

NHS Fife has an established local HCSA Steering Group, which supported Board preparations for implementation of the Act and participated in national draft Guidance Chapter testing.  This has helped inform preparations and access to resources.

There is an agreed schedule of Tool Runs which is overseen by the Corporate Nursing Directorate team and the results of these tool runs are provided to services for consideration after quality assurance checks have been completed.  The Operational Levels Escalation Tool (OPEL) in the Acute Services Division and Fife Health and Social Care Partnership are a good source of information to support reporting.  This has been adapted for use in other services, for example, Physiotherapy and Podiatry.

Introduction

  •  The report describes how NHS Fife gathered data to demonstrate evidence to support Act compliance in respect of the specific duties of the Act, including staffing levels and workforce planning.
  • Assurance processes are in place to monitor safe staffing in health and social care services.
  • Staff training relating to the Act and in respect of Common Staffing Method Tool Runs has been delivered and is monitored and the output of Tool Runs is reported within the Board.
  • Evidence collected includes feedback from services via a bespoke template aligned to the requirements of the Act.
  • One of the highlights is collaboration across different service areas through our Local HCSA Steering Group.

Each numbered tab of the Annual Report is aligned to Sections 12IA – 12IL of the Act and covers:

  • Detailed assurance reporting by service and across profession (e.g. Acute, Corporate functions and HSCP).
  • Risks identified and mitigations taken.
  • Staff engagement and involvement in decision-making about staffing.
  • Continuous assurance processes are in place to maintain safe, high-quality staffing across services.
  • Guiding principles (such as safe, effective, person-centred care) were embedded in staffing processes.
  • Planning frameworks align with national guidance from the Scottish Government.
  • Evidence-based tools and professional judgement used to set appropriate staffing levels.
  • Continuous monitoring processes are described, including escalation pathways if risks are identified.

The information provided in this report has been used or will be used to inform workforce plans, as follows:

The detail and content of our quarterly reports and this Annual Report have been produced in collaboration with and have been shared with various groups, managers and Professional Heads of Service within NHS Fife, including but not limited to the NHS Fife local HCSA Steering Group, Executive Directors Group, NHS Fife and HSCP Workforce Planning Groups, Nursing & Midwifery Workforce Group, Learning Disabilities and Mental Health Workforce Sustainability Group, eRostering Programme Board,  Area and Local Partnership Fora, Area Clinical Forum, Staff Governance Committee and Fife NHS Board.

In addition, we have considered the output in relation to feedback and actions identified from the recently developed and implemented excel based Service / Professional Assurance Template Questionnaire to Managers and services, having previously used an MS Forms based approach.  This has provided us with more detailed and robust information for our quarterly internal reports and this Annual Return.

This is in addition to the continued development of specific local service based workforce plans, workforce actions being driven from the People & Change Board set up as part of our Re-Form, Transform and Perform programme, issues arising from the Workforce Tool runs and from implementation of eRostering within NHS Fife in terms of the identification of workforce and related risks and their regular review.

Summary of key achievements and outcomes as a consequence of carrying out the duties and requirements in the Act:

The NHS Fife Local HCSA Steering Group continues to meet at six weekly intervals, with multi-disciplinary and staff side representation, sharing information and resources between functions to assist with Act requirements, for example, the Fife-wide Physiotherapy OPEL Tool use, Podiatry Service OPEL Framework development, SWAY and staff feedback, national Hub feedback, learning from Health Improvement Scotland (HIS) visits and follow-up requests, alongside quarterly Board Engagement calls with HIS.  Several services, including our Out of Hours, Public Health and Public Dental Services, have developed and implemented new HCSA related Standard Operating Procedures.  A monthly newsletter to all HSCP Nursing staff is in place, highlighting learning and educational resources for staff, with an emphasis on the duties of the Act. 

We regularly share information such as Standard Operating Procedures and resources from the HCSA Hub via our HCSA MS Teams Channel.  While the feedback from use of the HCSA Assurance Questionnaire enabled a more evidential conclusion, this has been strengthened by the new excel based template, aligned to the content and requirements of the Annual Report.   This approach has also facilitated feedback to services on their path to green. 

This is alongside presentations and reports to the NHS Fife Area Clinical Forum, Senior Charge Nurse Development sessions, local Workforce Planning training sessions and participation in the recent Generic Realtime Staffing Resource training sessions.  Specialty specific Staffing Level (Workload) Tools continue to be run and reported per our local schedule.  A Common Staffing Method reporting template is in use to support reporting and governance, with the importance of the Common Staffing Method Tools being highlighted within on-going work within NHS Fife to consider the implications of the further planned reduction to the hourly working week for AfC staff groups.   One of our Speech & Language Therapy Teams recorded a podcast as part of the national HIS approach to learning from Act Chapter Testing and this was shared within the Board.

Summary of key learning and risks identified as a consequence of carrying out the duties and requirements in the Act

Key areas for follow-up identified from the use of the service based template include knowledge and awareness of the principles of the Common Staffing Method, escalation of risk processes and recording / evidence of Time to Lead.  We continue to see learning from sharing of information at our local HCSA Steering Group, within our local Teams Channel and from National meetings / Teams Channels and general discussion at our local HCSA Steering Group meetings.  The group has continued to evolve in terms of engagement and participation. 

The Board Action List is used on a continuous basis for follow-up in the next quarter, in addition to areas identified from completion of quarterly returns and HIS feedback.  In addition, the revised plan for implementation of eRostering and SafeCare, taking account of the recent Deep Dive and Lessons Learned exercise within NHS Fife, is a regular feature at the local Steering Group.

The planned further reduction in the working week for staff covered by the AfC agreement will have an impact on staffing within clinical (and other) functions within NHS Fife and this will be reviewed in conjunction with our programmed Common Staffing Method activity.  There is a formal workstream in place, with Programme Management Office support, to assist with the implications of the future reduction in the working week.  This is reported to the People & Change Board, to our Local and Area Partnership Fora and the Staff Governance Committee.

REPORT APPROVAL

  • NHS Fife is required to formally approve this report through its governance structures.
  • Sign-off from a Senior Board Executive (Director of People & Culture) was obtained.