Technical Papers

The R&D team shares its knowledge of best practice through an ongoing series of technical papers which focus on a variety of areas of workforce planning. This series of papers is also used to share new approaches that the R&D team has developed and may potentially include papers commissioned from external organisations and experts on topics of particular interest in the future.

Our published papers

Cover of TP14

Elicitation methods: Updated approaches to elicitation

This paper addresses improvements to the current elicitation process used by the Centre for Workforce Intelligence (CfWI). As part of the ongoing improvement and refinement to the Robust Workforce Planning Framework (RWPF), we have identified five potential areas of the elicitation process that could be improved.

This paper considers the following improvements to elicitation methodologies used by the CfWI:

  • If an alternative to the quartiles method in SHELF should be used: Would this yield usable judgements?
  • Correlation: If some parameters should clearly be correlated (such as life expectancy and prevalence of long-term conditions).
  • The three layer model: If we move away from the quartiles method in a SHELF workshop, and/or if we bring in elicitation of correlations, how will this impact on the three layer model? How do we complete the third layer with assessments of uncertainty.
  • Communicating uncertainty: The CfWI analysis produces complex projections over time; how can they most clearly and most usefully convey the uncertainties around those projections?
  • Training the experts: To reduce the time that experts have to spend training in face-to-face elicitation workshops, can we develop some training that they can undertake before the workshop?

The paper concludes that the CfWI undertakes the following steps:

  • Considering that there is more accuracy associated with eliciting tertiles, it is unlikely that we will continue eliciting quartiles. Nor do we feel that it would be necessary to investigate the roulette method in further detail, simply because it’s not as easily adaptable to the three-layer model or eliciting correlation.
  • We propose to carry out an internal workshop to test whether eliciting correlated quantities and/or tertiles is practical, considering the level of resource intensity required in a SHELF workshop alone.
  • The CfWI suggests that either facilitators ask for the minimum and maximum bounds as well, or they use a suitable comparable quantity whose distribution has been elicited by either SHELF or EFSA Delphi.

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Modelling supply, demand and need: a literature review

This technical paper is a short review of the literature available on factors to consider when designing a model. It aims to support the modelling process for the CfWI Horizon 2035 project, which will consider the skills and competences needed for the health, public health, and social care systems to prosper over the next 20 years. This literature review considers important issues in the modelling of supply, demand and need. It addresses three areas:

1. How need, demand and supply are defined in the health, public health and social care sectors, as well as non-health sectors. Demand and need are particularly difficult in the context of health and social care, so ideas from other fields are relevant.
2. How other sectors have modelled customer behaviour and the demand for products/services, with respect to their actual need. We can learn from these approaches, which may be applicable to the health and care system.
3. How the health sector has modelled customer behaviour and the demand for products/services in the health sector, with respect to their actual need. The CfWI uses system dynamics modelling but a number of other methods are available.

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Cover of TP4

Long-term NHS expenditure trends and affordability constraints

Commissioned by the Department of Health, this technical paper provides a high-level, exploratory analysis of long-term trends in government healthcare expenditure in the United Kingdom, measured as a proportion of GDP, share of government spending and in real per capita basis.

Preliminary findings highlighted in the report include:

  • Like other OECD countries, government healthcare expenditure in the UK has increased markedly since the 1950s in real per capita terms and as a share of total government spending.
  • Barring a major crisis, this secular trend is likely to continue in the decades ahead, albeit possibly at a slower pace than in recent decades.
  • However, trends over the last 64 years show there are plausible constraints for future healthcare spending which set effective ceilings and floors to future trends in healthcare spending.
  • Within those global parameters, large and sustained increases in real healthcare spending per capita can be expected to pose significant affordability challenges for government.
  • Conversely, falls in real per capita government healthcare spending are unlikely to be sustainable for a prolonged period. History shows prolonged declines to be rare.
  • In recent years we have moved from a period of above-median growth in real per capita government healthcare spending to a period of below-median growth. The current period may come to be seen as an important inflection point for healthcare spending. However, ultimately we expect to see regression to the median in healthcare spending.

These assumptions are dependent on a number of underlying assumptions and the CfWI has suggested that they would therefore benefit from further examination within the paper.

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Cover of elicitation methods technical paper

Elicitation methods: Applying elicitation methods to robust workforce planning

The CfWI use expert elicitation as part of our robust workforce planning framework, which we use in all workforce reviews. The purpose is to provide workforce planners with an understanding of how the future might evolve for health, public health and/or social care professions. It can also be used for groups of professions. This includes simulation of future supply and demand, in terms of workforce numbers and skills. It also includes an assessment of the effectiveness of different policy options, for example, increasing the intake to training, altering working patterns, or influencing the drivers of demand. This paper explores our elicitation methods in more detail.

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Image of technical paper cover on policy analysis update

Policy analysis update

Policy analysis is the thread that runs through the CfWI’s Robust Workforce Planning Framework. The purpose is to determine which of a set of alternative policies will best meet a specific set of goals.This requires determining which policy is the most effective, according to the measures used, against a set of plausible but challenging future scenarios. Some workforce policies may perform well across all these futures; we would then say that they are robust against future uncertainty. However, other policies may not perform as a well. Specific scenarios may be challenging and the outcome may not be good. Decision-makers will then need to judge which policy to choose in situations where several policies perform adequately, but no single policy is outstanding.

This paper includes the following:

  • an updated review of the literature with particular focus on the importance of evidence in policy making and approaches to policy analysis
  • selecting policies for analysis, including the conceptual steps to take
  • structuring the analysis and the principles for a CfWI policy analysis tool.

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Technical paper cover imageRobust workforce planning framework: An introduction

The health and social care system is complex. It is made up of many organisations and professions, and different parts of the system respond to change in different ways. The environment that the system has to operate in is uncertain. In this context, planning the right workforce for the future is challenging. The risks of not planning effectively are huge: lives can be put in jeopardy, morbidity may increase and huge sums of money wasted.

This paper introduces a new method developed by the CfWI called robust workforce planning (RWP). We think first about what health and social care may look like in the future, and create a set of scenarios to capture the inherent uncertainty. We then focus on policies to deliver the required workforce, and test them against these scenarios. This allows us to select the policy that is the most robust against unexpected change.

Here we present the framework for RWP and explain the key steps in the process. Guidance is given on how the framework might be used in practice, based on learning from recent projects. We show how horizon scanning and scenario generation can be used to produce plausible but challenging futures, and how these may be quantified for modelling. This approach is new for health and social care workforce planning in England, and provides policymakers with a new way of thinking about the future, testing prospective policies and avoiding unexpected consequences.

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Robust workforce planning: Experiences and best practice

Rather than attempt to predict the future, RWP recognises the intrinsic uncertainty and complexity of factors influencing workforce demand and supply. Decisions made about workforce requirements need to work well across a range of futures in order to be robust against uncertainty. By analysing the key issues and uncertainties, we generate a set of plausible and highly challenging scenarios.

Workforce demand and supply is then forecast for each scenario to understand how workforce numbers or skills might change over time. Prospective policies can be tested against these scenarios to see which one is the most effective. This paper describes key learning points in applying the framework across a number of projects.

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Robust workforce planning: Medical model technical description

This paper describes the model used to quantify the future supply and demand of doctors. The model was developed as part of project for the UK Department of Health (DH) to inform a Health and Education National Strategic Exchange (HENSE) review of the intake to medical and dental school. The purpose of the work was to provide intelligence to inform recommendations of the HENSE review group on future student intakes to medical and dental schools looking forward to 2040.

Due to the complexity of the model scope and scale it was decided that the system dynamics approach was best suited to meeting the modelling requirements. System dynamics is a simulation method that enables the behaviour of complex systems over time to be understood and simulated. System dynamics models represents changes to a system over time by using the analogy of system flows accumulating and depleting over time in stocks. Historically, the CfWI has developed Excel-based models to represent these complex systems.

The system dynamics approach meant that robust, evidence-based supply and demand models could be created to test potential policies and their impact. It also meant the model was “transparent” and enabled expertise of several hundred stakeholders from the healthcare system to be synthesised. As a result of these benefits, the system dynamics approach is considered fundamental to the CfWI’s ongoing workforce modelling strategy. The approach is being used by the CfWI to develop additional supply and demand models for other workforces across the health and social care systems, including nursing, midwifery, pharmacy and a range of medical specialties.

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Literature review guidelines

The CfWI informs health and social care planners, clinicians and commissioners seeking workforce planning and development expertise to improve health and social care services. With the aim of supporting long-term and strategic scenario planning for the whole health and social care workforce, the CfWI relies on research, evidence and analysis to build strong leadership and capability in workforce planning.

There are three key areas on which the CfWI focuses: leadership, workforce intelligence, and, last, the support and resources to improve the effectiveness of workforce planning.

The purpose of this summary on writing literature reviews in this field is to support analysts delivering research and workforce intelligence in the field of health and social care. It is a brief synthesis of the extensive literature on how to conduct a literature review. Highlighted are the elements to consider when undertaking a literature review for an organisation such as the CfWI. The overall process of a research project includes research question formulation, literature search, data evaluation, analysis and interpretation.

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Horizon scanning: Analysis of key forces and factors

This technical paper addresses improvements to the horizon scanning stage of the CfWI RWP framework around the use of systems thinking to understand the system under investigation. The CfWI uses horizon scanning (the exploration of possible futures) to investigate likely future developments that may occur within the health and social care system and impact on workforce supply and demand.

Horizon scanning is part of wider range of activities concerned with a systemic and systematic analysis of the system under investigation, and its past, present and future. It is important that the horizon scanning process integrates with this approach, and in particular with the scenario generation stage of the framework. Improvements may be needed to how horizon scanning ideas or issues are analysed to determine the key factors of interest in the system, and to the horizon scanning website or ‘hub’ ( that is used to capture them.

A consistent set of definitions has been produced and tested. It is presented in this paper. The review of the hub confirms the utility of a web-based approach for collecting data about the system under investigation. Detailed analysis of hub data has identified areas where improvements can be made. Causal loop diagrams have proved a simple and effective method for mapping the system and highlighting areas of interest. They are a promising basis for the analysis of system factors.

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Developing robust system-dynamics-based workforce models: A best-practice approach

Central to the RWP framework are workforce models developed using the system dynamics (SD) method that calculate workforce supply and demand. System dynamics modelling is used since it is most appropriate for complex systems with feedback, such as health and social care workforce planning.

This technical paper describes the formal approach adopted by the CfWI for the development of workforce based system dynamics models. The benefits of having a formalised approach to workforce model development include models that are better designed, easier to use, more focussed and more efficient. Applying a rigorous formal approach also results in increased stakeholder confidence in model outputs.

The approach is composed of four steps: model scoping, model construction, model documentation and model testing. Each stage is described in detail in this report and supported by best practice guidance.

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Scenario generation: Enhancing scenario generation and quantification

This technical paper addresses improvements to the scenario generation stage and includes the following:

  • a short review of the history of scenarios and scenario planning, the different types of scenario and methods for generating them
  • a formal approach for creating a set of scenarios to present alternative, plausible and challenging visions of the future to inform workforce planning and generating scenarios at different levels of scale, where higher-level scenarios frame scenarios at a lower level of detail, enhancing the coherence of the overall set
  • a best-practice method for checking the consistency of scenarios, so that only consistent ones are taken forward for quantification and modelling, eliciting uncertain scenario parameters (all scenarios contain parameters that are inherently unknowable but where values need to be defined for modelling and simulation; this requires input from experts using a formal and defined protocol)
  • substantive improvements to the scenario generation process as a result of the above, and areas for future research.

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Policy analysis: Applying robust decision-making to the workforce planning framework

Policy analysis is a thread that runs throughout the Centre for Workforce Intelligence (CfWI) robust workforce planning framework, from the horizon scanning phase through to scenario generation and workforce modelling. The literature review in this technical paper provides an introduction to the subject of long-term policy analysis and its specific NHS workforce planning context in the UK, allowing the reader to clearly see the links between the CfWI’s methodology and the wider robust decision-making process.

In the CfWI’s robust workforce planning methodology, the engagement of subject matter experts and their continual consultation throughout rigorous horizon scanning and scenario generation phases allows the CfWI to have confidence in the models developed during the later workforce modelling phase. Research and output validation further underpin the value of the policy analysis results these exercises deliver. This process has enabled the CfWI to execute a number of successful workforce policy studies. This technical paper explores how additional focus on retrospective policy testing and the adoption of a wider range of scenarios could add further value to the CfWI’s workforce planning research.

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Robust workforce planning framework: Update from practice

The Centre for Workforce Intelligence robust workforce planning framework has existed largely unchanged for more than two years. This is perhaps a testament to its simplicity and ease of understanding. Over 20 reviews of health and social care professions have used the framework. Recent technical papers have reviewed and recommended improvements to the core stages – horizon scanning, scenario generation, workforce modelling and policy analysis – in some depth.

This paper reviews the latest development and provides a revision to the framework. The structure is unchanged but each stage now reflects practical experiences from projects, and key findings from our research and technical papers.

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