SHuRePlan

What are the workforce inputs required to deliver specific services?

The service planning should have clearly identified the services that patients are expected to access and how these will be provided in terms of specific service delivery units. Typically a service delivery unit, whether it be a ward, an A&E department, a GP practice etc, will be associated with a team.

Understanding the working of these teams is generally the best starting point for assessing workforce demand. For each service unit the service plans should have identified what the mix and numbers of different patient types is expected to be. Each type of patient will have different needs. Meeting these will require the team to undertake a number of activities and tasks.

In addition to those activities which directly address patients’ needs all teams will have a range of support activities that are required to ensure the effective operation of their service e.g.:

• Management, planning and communication
• Training and development
• Record keeping and administration

Etc.

These activities are the required workforce inputs, which typically can be characterised in terms of:

• Time taken to complete them
• Skills required to perform them
• Whether they can be carried out by an individual or require two or more working together
• The standard to which they need to be carried out
• When they might need to be carried out
• Whether they need to be linked to other activities as part of a larger process

The picture that is built up of the activities forms the basis for the assessment of workforce needs in terms of roles and numbers that is described in step 3.3.

Activity analysis

Building the picture of what activities are required usually involves some form of activity analysis. This normally involves a combination of direct evidence gathering and judgement from experienced practitioners.

• Information on how long tasks take and how they relate to other activities is generally collected directly through observation, diaries or similar approaches.
• Information on what is needs to be done to achieve required clinical standards or what skills are required may be drawn from research evidence but in most cases will depend on a degree of professional judgement by experienced practitioners.

Skills and competencies

Enormous progress has been made, led by Skills for Health, in mapping healthcare activities and skills needed to undertake them.  Functional analysis maps the activities and their associate skills for a given service area and has been completed for a large part of the service.  This is followed by the more detailed establishment of occupational standards which set out the required levels of competence in the skill and how these can be measured and tested. 

A less detailed skills framework, the ‘Knowledge and Skills Framework’ has been developed to underpin the ‘Agenda for Change’ pay system.  This can be used to identify the level of skill but does not provide detailed measurement of individual competencies.

Skills for Health are working on embodying these into a ‘Team tool’ which will enable a manager to assess what skills are needed for a given set of workforce activities.

Practical approaches and shortcuts
Dependency measures

Full activity analysis is time consuming and few units will be able to carry this out on a regular basis. Because of this, practical workload tools have commonly sought to group patients into a small number of categories often based on an assessment of dependency or acuity.

Activities are also commonly grouped together in terms of total time required at a given level of skill or professional practice.

The development of such tools is always based on detailed activity analysis and evidence gathering. However, once this has been done, they can be used for regular demand assessment across a range of similar service units.