Thank you very much for the opportunity to talk about the Health and Care (Staffing) (Scotland) Bill and to answer the committee’s questions.
The bill’s aim is to provide a statutory basis for the provision of appropriate staffing in health and social care settings. That matters because in our national health service we focus all our work on meeting the triple aim of healthcare that is safe, effective and person centred, and all the evidence tells us that the provision of high-quality care requires the right people in the right place with the right skills at the right time to ensure the best health and care outcomes for those who need our services.
Our policy intention with the bill is to enable a rigorous, evidence-based approach to decision making on staffing that is safe and effective, takes account of the health and care needs of patients and service users, assists the exercise of professional judgment and promotes a safe environment. That means that we need to understand the workload that is generated in any given setting and circumstance and therefore the skills that are required and the staff mix that will provide them.
My intention is that the bill will put in place a framework to support the systematic identification of the workload needed to improve outcomes and deliver high-quality care. I know that each and every profession contributes to the delivery of positive outcomes for service users. Therefore, I have taken the decision to apply the legislation across all staff groups delivering health and social care services. In taking that broader approach, the bill achieves legislative coherence across the health and social care landscape. That coherence is demanded by the integrated approach that we are taking to health and social care, which rests on the important recognition of value across all staff groups. Providing that assurance for staff and service users is the right thing to do.
In taking that approach across health and care services, we have the advantage of having learned from the existing workload tools and methodology that were developed for nurses and midwives. The development of the tools has been an innovative, evidence-based and, importantly, professionally led approach. That has led to their use in the Welsh legislation on safe staffing and in the development of workload tools that are used by NHS England.
Even though we are starting from that positive position, it is not my intention that the current suite of tools will remain unchanged. It is imperative that they continue to be reviewed and renewed to effectively support multidisciplinary approaches to the delivery of care. The tools are important, but they are only one part of the much broader common staffing methodology and requirements that the bill sets out.
The bill puts in place a process that should be applied consistently across health and social care. It ensures that we use an evidence base to assess the workload that staff face and move away from a reliance on subjective assessments. However, critically, that is combined with staff using their professional judgment to tailor workload assessments to reflect the dynamics of their service and to take their local context into account when deciding how to staff services to deliver high-quality services. That local context will fluctuate, and it requires a common and consistent workload and staffing methodology as well as linked training, so that staff are equipped with the skills to make those assessments. That will have a positive impact on staff, on services and, importantly, on the care that is provided.
Health boards and care service providers and their staff have the shared responsibility to openly and transparently determine how best to ensure that we continue to provide safe and effective services. However, I would expect to see real-time adjustments made to take account of workload changes and more appropriate movement of staff to acknowledge more effectively the acuity and dependence of service users; substantive posts used, rather than bank and agency staffing; staff understanding how staffing numbers are decided; and staff knowing how to raise concerns and being confident that their concerns will be dealt with appropriately.
The bill does not explicitly define outcomes—nor should it. Our health and care standards and quality measures already define the outcomes that we want to see. In addition to those improvements, the effective application of the legislation will support the wider workforce planning process. If services can clearly identify the workload that is required to meet service users’ needs, it will be easier for them to do workforce planning based on that evidence. When local workforce plans are based on better evidence, provided by the consistent application of a common methodology, we will have more robust information to inform national workforce planning and supply.
In developing the bill’s provisions, we have listened carefully to those who deliver the services; we have also listened carefully to the evidence sessions that the committee has held. We will continue to engage with stakeholders and consider their views. As always, I will give full and careful consideration to all proposals to strengthen and improve the bill in the weeks ahead and to the committee’s own carefully considered views.