MAPPING THE HEALTH

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					MAPPING THE PUBLIC HEALTH
IMPROVEMENT WORKFORCE
A rapid review of the evidence




A report for Alyson Learmonth, Head of School
of Public Health, Education North East.




Ruth McKeown, October 2008
Contents
Acknowledgements

 1.    Introduction
          1.1 Origin
          1.2 Background
          1.3 Aim
          1.4 Terminology

 2.    Methodology

 3.    Presentation of findings
          3.1 A note on categories used

 4.    Findings
       Examples of Primary Resources

 5.    Useful pointers from the evidence

  6.   Summary recommendations

Appendix 1.
  Data Sources

Appendix 2.
  Associated Resources


                                           1
Acknowledgements

     Thanks are due to:

Alyson Learmonth for initial guidance and
subsequent steering of this study.

John Barugh for supplementary research.
Ruth Mckeown, October 2008




                                            2
1.     Introduction


     1.1 Origin

This study was commissioned to examine available reports, tools
and other resources which have a focus on mapping the wider
public health improvement workforce. It contributes to the
workstream arising from the Public Health Improvement Workforce
Strategy and Implementation Programme for the North East of
England.

The resulting report is not a comprehensive, systematic review. It
does, however, provide a summary of some primary resources
directly relevant to workforce mapping, with an emphasis on
resources of practical utility.



     1.2     Background

The Report of the Chief Medical Officer's Project to Strengthen the
Public Health Function (Department of Health, 2001) identified
three primary categories of the workforce, including a large wider
public health workforce with significant influence on the social and
economic determinants of health. Significant work has since taken
place to define that workforce more precisely, to refine these
categories and to develop occupational standards, competences
and career frameworks, including the recent Public Health Skills
and Career Framework (PHRU/Skills for Health, 2008).




     1.3     Aim



                                                                       3
The aim of this study has been to provide a report of immediate
practical utility to the ten Regional Advisory Groups and four
PCT/LA clusters.

The intention was to provide accessible guidance to tools and other
resources in order to facilitate the selection of appropriate mapping
tools, in relation to differing circumstances, settings and
objectives.




1.4     Terminology
      1.4.1 Mapping or Auditing?

A study of the literature reveals a conceptual elision between
“workforce mapping” and “workforce audit” or “skills
mapping/existing competences/training needs mapping.” In many
cases, “mapping” has been used as a first stage to simply identify
those now considered part of the wider public health improvement
workforce. Used in this sense, accurate, defined mapping must
clearly always precede useful audit (whether this whole workforce
or thematic.)

Some studies have come to this conclusion only after proceeding
with a combined mapping/audit exercise, which, in some cases,
they subsequently recognise as being of only limited validity and
therefore utility.

In this report, “mapping” is defined as efforts to systematically
identify, record (and sometimes code) members of the wider public
health improvement workforce (for whatever objective) and
whether this is attempted within a single organisation or across
organisational boundaries.

“Audit” is defined as efforts to further examine the status and
needs of this workforce, in relation to existing skills and
competences. This can include competency development needs
arising from specific organisational objectives/requirements as well
as the requirements of broader workforce development strategies.


                                                                     4
Some of the primary resources examined combine these two aims
within a single approach. This study, however, is focused
specifically on “workforce mapping,” as defined above, although it
will include significant resources arising from the combined
approach.

     1.4.2 The “Wider Public Health Improvement Workforce”

The literature reveals wide variations in the definitions of the wider
public health improvement workforce, or the wider health
improvement workforce. In some cases, even when a “wide”
definition has been accepted, this has not necessarily been
reflected in the actual mapping/audit tools devised.

Some tools are clearly designed for use with NHS staff only, and
would be quite difficult, or inappropriate, to use with a much
broader workforce. As the majority of the “wider public health
improvement” workforce operates outside of NHS frameworks, this
generates some substantial methodological problems for mapping
exercises. If these methodological problems are ignored, the
results of mapping exercises can lack significant value and may be
of only limited use and validity.

There is clearly some degree of tension between, on the one hand,
making maximum use of professionally devised competency
standards and skills frameworks, and the need, on the other hand,
to connect with, relate to, and develop a health improvement
“workforce” (or “capacity”) of a very broad and diverse nature.
This is relevant to the question of how far the concept of public
health activity as “everyone’s business” can be practically and
pragmatically integrated into useful mapping, audit and training
initiatives.


An informative “bottom-up” research exercise, which could usefully
inform such considerations, has been carried out by Cardiff
Institute of Society, Health & Ethics. These studies provide some
insight into wider perceptions of the input and responsibilities
involved in health maintenance/improvement. The studies explored
the perceptions of: the general public; statutory and non-statutory

                                                                     5
sectors; businesses; schools and local government in relation to
involvement in and responsibility for health. The results of these
studies may be useful in informing efforts to address the “wider
workforce” in terms that that workforce can relate to and
understand.
http://www.cardiff.ac.uk/socsi/resources/wrkgpaper-77.pdf
Macdonald, Emily, (2006) ‘ Organisational roles and responsibilities for health: interviews
with representatives from the statutory and non-statutory sectors’, Working Paper 77,
Cardiff School of Social Sciences, Cardiff University.
Report prepared for the Welsh Assembly Government


An overview of all the studies in this programme can be found at:
http://new.wales.gov.uk/topics/health/ocmo/research/role-
health/?lang=en


One model of the workforce aspects of such considerations has
been provided by the Public Health Research Unit, whose useful
working definitions are shown below. This conceptual framework is
a valuable aid to the planning of any mapping or audit activity.




                                                                                              6
Source: PHRU




               7
     2.     Methodology
In the time available, it has not been possible to conduct a
comprehensive review. The timescale also precluded an in-depth
exploration of certain avenues of enquiry.

A primarily heuristic approach was taken in making a rapid search
and assessment of the evidence.

Searches were focused on both specific term-searches of the
literature and more general searches of relevant organisations.
In the latter case, web searches were made of:

     -organisations already known to have carried out work in
      this field

     - major academic and professional health organisations

For a listing of the major organisational sources consulted, please
see Appendix One.

In addition, searches were made of relevant electronic sources on
the UK Academic Data Archive.

In the course of the searches, much material was retrieved of
potential relevance to workforce mapping and workforce
development. In some cases, there were indications that these
resources could be relevant to future stages of the Public Health
Improvement Workforce Strategy and Implementation Programme
for the North East of England. Some of these materials have,
therefore, been included, as a potential resource, in the Associated
Resources section (Appendix 2.), but they have not been formally
reviewed here.

In selecting materials for inclusion, the following process was used.
Each document/abstract/tool was scanned and assessed against
two primary relevance criteria: specific health improvement or
related focus; mapping involved.) The selected resources were
then further examined through the use of a data recording sheet to

                                                                      8
extract data in the categories detailed below. (3.1 A note on
categories used.)

The categorised data for each primary resource was then
supplemented with a short narrative account.




3. Presentation of findings

No major synthesis of the evidence is attempted in this report, but
some important lessons from the evidence are highlighted.

It was considered that the most useful presentation of findings
would take the form of a brief commentary on each of the primary
resources, detailing specific criteria, relevant to
those tasked with taking this work to the next stage (in the
context of the workstream arising from the Public Health
Improvement Workforce Strategy and Implementation Programme
for the North East of England.)

Items listed as Primary Resources are intended to exemplify
differing approaches, each with their own strengths and
limitations. They are not presented in any order of value, nor are
they presented as recommended models in all cases. These
resources do, however, illustrate how previous workforce mapping
exercises have been carried out, successfully, or unsuccessfully, in
specific contexts. (There are as many useful lessons to be learned
from poorly-designed or inappropriately-applied approaches, as
there are from approaches which have more obviously achieved
their objectives.)

Some Primary Resources also link the reader to key organisations
active in workforce development activity, who may be able to offer
valuable knowledge, experience or support to local mapping
activity.

This method of presentation was selected so that members of the
Regional Advisory Groups and four PCT/LA clusters could, from the
options identified, rapidly consider the tools/approaches that they

                                                                   9
  deemed most significant for progressing local
  mapping/audit/workforce development activity, taking account of,
  for example, limitations of previous studies, resources involved,
  scale of operations and specific organisational objectives.

    3.1       A note on categories used
  In order to facilitate selection from the resources reviewed, and so
  that the reader can go quickly to a resource which they feel is
  most relevant to their circumstances and objectives, a summary
  categorisation is provided in the left hand (highlighted) column. If,
  after reviewing the summary categorisation, it is felt that the
  resource is potentially useful, or useful in modified form, the
  reader can reach more detail in the Commentary section and also
  make use of the web-links provided to original source material and
  related resources.


Summary                              Explainer
Categories

Resource          Title of the document/tool

Web-link          Quick link to primary material
Category          Report/tool/research/associated material
Workforce         Health/Local Government/Voluntary Sector/
Mapping           Workforce mapping exercise or combined
                  mapping and audit
Auditing          Competency review only or competency review +
                  training needs analysis
Standards         Whether some form of occupational standards
                  were employed, or some other categories were
                  devised/employed
Focus             Within single agency/workforce, or multi-
                  agency/”wider” workforce
E-methods         Use of electronic tools for mapping/audit.
Strengths         Brief highlighting of positive aspects of
                  methodology
Limitations       Brief highlighting of possible methodological


                                                                     10
                      limitations in relation to
                      objectives/circumstances, where there is
                      sufficient evidence to do so.
    Commentary        More detailed summary of
                      approach/objectives/lessons
                      learned/development of the work
    Related           Other relevant documents available from this
    resource(s)       source which may provide useful context




           4.Findings

              4.1     Examples of Primary Resources

Resource      NHS KSF Mapping Tool. Skills for Health. (See also link to
              PHRU involvement)
Weblink       http://tools.skillsforhealth.org.uk/

Category      Tool for mapping health competences
Workforce     Aimed at wider PH improvement workforce, but NHS focus
Mapping       Yes
Auditing      Yes
Standards     KSF
Focus         Within and across agencies
E-methods     Yes. Interactive web-based tool
Strengths     Standardisation. Ease of use.
Limitations   ?
Commentary    Skills for Health is the Sector Skills Council (SSC) for the UK
              health sector. Skills for Health has developed Competences
              to describe what individuals need to do, in specific
              posts/programmes, what they need to know and which
              skills they need to carry out an activity. They can be used
              across the board - by all health professions, and all levels of
              staff, whether in the independent or voluntary sectors or in


                                                                           11
            the NHS. Competences can be used to meet the demands
            of the NHS Knowledge and Skills Framework [KSF].Some
            activities have more Competences associated with them
            than others. By entering the dimensions and levels of a
            specific NHS KSF post outline the user can see a list of all
            the competences that have been indicatively mapped to
            those dimensions and levels and are therefore potentially
            relevant to the role.

            Tools produced by Skills for Health allow for both a team
            assessment and an individual assessment. To create a team
            assessment a team profile is needed (a list of competences
            required for the team to perform effectively) and also a role
            profile (a list of competences mapped to a role) for each
            member of the team. For an individual assessment a tool
            enables the user to measure their level of competence
            against a specific list of competences (usually a competence
            list mapped to their current role). The results are saved and
            a future re-assessment can provide a record of skills
            progression.


Related     The Skills for Health website is a major resource for
resources   workforce mapping, audit and workforce development.
            www.skillsforhealth.org.uk

            Competence search tool
            http://tools.skillsforhealth.org.uk/competence/advancedSea
            rch

            Career Framework Tool
            http://tools.skillsforhealth.org.uk/careerframework

            Health Functional Map Tool
            This tool helps allows users to find competences that have
            been mapped to functional areas.
            http://tools.skillsforhealth.org.uk/hfmbrowser

            Skills for Health. Public Health Skills and Career Framework.
            Multidisciplinary/multi-agency/multi-professional.
            http://www.skillsforhealth.org.uk/js/uploaded/Public%20He

                                                                           12
            alth%20Skills%20and%20Career%20Framework/PHSCF%2
            0Final%20Version.pdf
            Supplementary guidance on using the framework is
            provided in:
               Public health skills and career framework - How to use
               Public health skills and career framework - Educators
               Public health skills and career framework - Practioners
               Public health skills and career framework - Wider workforce
               Public health skills and career framework - Employers and commissioners




Resource      National Minimum Data Set for Social Care (NMDS-SC)
Weblink       http://www.skillsforcare.org/view.asp?id=873
Category      Tool
Workforce     Social care
Mapping       Yes
Auditing      Yes
Standards     Yes
Focus         Social care agencies
E-methods     Yes
Strengths     Standardised occupational standards. Ease of use.
Limitations   ?
Commentary    www.nmds-sc-online.org.uk

              NMDS-SC is now available online for all establishments in
              the social care sector to log on and enter their
              information. Skills for Care ask employers to enter their
              worker information. Worker details can be entered and
              saved. Once these details are entered employers are able
              to take advantage of the standard reports that are
              available online.

              NMDS-SC Online provides;

              · A single source of holding information about services
              and workers that will enable employers to plan business
              activity and determine the skills base needed by the
              workforce now and into the future.

                                                                                          13
                · Provides an overview of the whole workforce, wherever
                they are situated or based.
                · Easier, faster completion and updating of records.
                · High level of security to protect employer and worker
                information.
                · A unique NMDS-SC identification number for counting
                each worker.
                · ‘On screen’ help and guidance and where needed a
                Skills for Care Helpdesk
                · Ability to build workforce information at a time and pace
                which suits employers’ business and information needs.
                · The NMDS-SC will provide reports to employers that will
                enable informed business decisions and enable
                employers to access different staff development or
                business development funding.

 Related        NOS Health and Social Care 2005
 resources      http://www.skillsforcare.org.uk/view.asp?id=582

                Skills for Care. A manager’s guide to making strategic
                uses of National Occupational Standards.
                http://www.skillsforcare.org/files/Manager%20guide%20
                to%20strat%20NOS%202006(1).pdf

                Skills for Care Regional Committees contribute to the
                improvement of social care and social work education
                and training. Skills for Care North East
                (Non-functioning web-link from Skills for Care.)




Resource     Workforce Development Resource Pack
             Long Term Conditions. National Workforce Projects, /NHS,
             2006
Web-link     www.healthcareworkforce.nhs.uk
Category     Guidance. Workforce planning checklists and frameworks.
             Good Practice Examples /Pilots
Workforce    Health and Social Care


                                                                         14
Mapping     Some relevant guidance and links
Auditing    Some relevant guidance and links
Standards   Recommends use of
Focus       Multi-disciplinary. Thematic.
E-methods   No
Strengths   Useful if a “thematic” or care-pathway type of mapping is
            intended, rather than a single or multi-agency mapping Clear
            guidance including exemplars
Limitations ?
            This resource pack has been designed to be used by all staff
            involved in planning and developing the long term conditions
            workforce – be they workforce, service or HR planners or
            clinical leads in primary, secondary or social care. The pack
            contains workforce planning checklists, together with
            examples of best practice and frequently asked questions
            (FAQ’s)
            that other organisations have developed to solve common
            issues.
            A section on useful contacts and resources together with
            contact details for each best practice example has also been
            included.
            Reference material – to help inform the development of
            either organisation specific or whole health community.
            • A guide to developing a workforce plan for the Long Term
            Conditions Transformational Change Programmes identified
            within local health community Integrated Service
            Improvement Plans (ISIP).

            The resource provides guidance relevant to mapping and
            workforce development. It contains
            pre-planning checklists:
            eg
            • Who are your stakeholders?
            • Is the scope of the plan agreed with all
            stakeholders?
            • Are you clear on what assumptions are
            being made and what issues are nonnegotiable
            within the plan?
            • Are there clear structures for visioning the
            financial implications for the plan?


                                                                       15
            • Have you agreed the level of detail used
            to classify staff and services?
            • Have you agreed the geographical area of
            the plan?
            Does your plan include a timescale agreed
            with all stakeholders?
            • Have all the different staff groups been
            covered by the plan? This needs to include
            all staff involved in the development of
            the solutions.

Related     Community Matrons/Case Managers
resources   Competences Framework
            www.networks.nhs.uk/113.php
            Which Staff Improve Care for People with Long Term
            Conditions – a rapid review
            of the literature
            www.hsmc.bham.ac.uk/news/workforce%20implications%20
            review.pdf
            Public Health Workforce Development Resource Pack
            http://www.healthcareworkforce.nhs.uk/resources/public_he
            alth/public_health_workforce_development_resource_pack.h
            tml
            Six steps E-learning Resource
            http://www.healthcareworkforce.nhs.uk/resources/latest_res
            ources/six_steps_e-learning_resource.html




Resource      Public Health Skills and Careers Framework. (With Skills
              for Health, as above)
Weblink       http://www.phru.nhs.uk/Pages/PHD/public_health_career
              _framework.htm

Category      Tool for mapping health competences
Workforce     Aimed at wider PH improvement workforce, but NHS focus
Mapping       Yes


                                                                     16
Auditing      Yes
Standards     Yes
Focus         Within and across agencies
(agency
E-methods     Yes
Strengths     Standardisation. Ease of use.
Limitations   ?
Commentary    The PHRU is a major resource for mapping and audit
              planners. PHRU can provide facilitation and training on a
              range of public health topics . They have developed
              teaching modules on a range of public health topics.

              Additional guidance:
              Public Health Skills and Career Framework. How to use it:
              ideas for employers and commissioners.
              http://www.phru.nhs.uk/Doc_Links/PHSCF02A5_Employer
              s%20%20Commissioners_copyrighted.pdf
              Public Health Skills and Career Framework. How to use it.
              http://www.phru.nhs.uk/Doc_Links/PHSCF01A5_How%20t
              o%20Use%20it_copyrighted.pdf
              Public Health Skills and Career Framework. How to use it:
              for educators.
              http://www.phru.nhs.uk/Doc_Links/PHSCF03A5_Educators
              _copyrighted.pdf
              Public Health Skills and Career Framework. How to use it:
              for public health practitioners.
              http://www.phru.nhs.uk/Doc_Links/PHSCF04A5_Practition
              ers-copyrighted.pdf

              Public Health Skills and Career Framework. How to use it:
              for the public health wider workforce.
              http://www.phru.nhs.uk/Doc_Links/PHSCF05A5_Wider%2
              0Workforce-copyrighted.pdf

Related       PHRU is a source for tools, either tested and being used,
Resources     or those in development.
              Eg West Midlands thematic approach to analysing
              competences. (PHSCF)
              North East mapping of health improvement competences
              across the children’s workforce. (PHSCF)


                                                                          17
              London Teaching Public Health Network examining
              development needs of workers in the third sector. (Self-
              assessment tool being developed.)




Resource           Mapping the public health workforce 1. A tool for
                   classifying the public health workforce. R. Walters, F.
                   Sim and G. Shiller
Weblink            Through Science Direct. Public Health. Vol 116, Issue
                   4, July 2002, pp 201-206
Category           Report and tool
Workforce          Stated “wider public health improvement”
Mapping            Yes
Auditing           No
Standards          No
Focus              Applicable to all agencies
E-methods          No
Strengths          Major strength is the breadth of categorisation of
                   posts, leading to inclusion of many more posts.
Limitations        Earlier work has since been developed to address
                   identified limitations. Modified by LPHO and PHRU.
Commentary         The researchers developed a tool to identify members
                   of the PH workforce and classify them using
                   categories developed for the Chief Medical Officer’s
                   project to strengthen the PH workforce. Employs a
                   useful expansion of the original CMO categories. The
                   tool was developed to obtain a picture of London’s PH
                   workforce. It sought to be reliable and easy to use in


                                                                         18
                many settings inside and outside the health service.
                Posts were classified from brief information without
                interrogation of postholders so that the entire
                workforce of large organisations could be classified
                from information provided by only a few key
                informants. The classification tool takes the form of a
                flow diagram and questionnaire. The tool has now
                been applied extensively in London and has yielded
                useful mapping results. It has the advantage of being
                applicable to and able to track the non-medical PH
                workforce. It introduces new sub-divisions of the
                “wider public health” category of posts. Uses the
                categories: public health specialists; public health
                practitioners; wider public health workforce; public
                health key influencers; wider public health workforce
                – service quality and outcomes; wider public health
                workforce – “practitioner” component.
                This work has been further refined and developed by
                the Public Health Resource Unit. (See PHRU, below)
Related         Mapping the Pubic Health Function in London. A
Resources       Report to the DHSC London, 2002.
                Mapping the Pubic Health Function in London. A
                Report to the DHSC London. Supplement on Data
                Collection, 2002.



Resource    West Midlands PHO Public Health Skills Audit, 2008
Weblink     www.wmpho.org.uk/skillsaudit/frontpage.asp

Category    Interactive questionnaire Tool
Workforce   Public Health (narrowly defined)
Mapping     na. Could be used to map PH workforce
Auditing    Yes
Standards   Yes. Based on 10 PH domains and 85 sub-domains for
            specialist public health practice.
Focus       Primarily within NHS. Not wider workforce
E-methods   Yes.
Strengths   Ease of use by individual. Good use of standards and skill
            levels. Good simple scoring system. Open to all PH


                                                                     19
            workers.
Limitations In development. Currently, not necessarily user-friendly
            to the non-NHS, wider health improvement workforce.
            Intention to create “more appropriate professional
            groupings in the future.”
Commentary Allows the individual to assess their personal skill level
            and to compare the results with a comparison group,
            drawn from previous users of the skills audit tool. Allows
            users to identify their existing PH skills, those that are
            needed in their current job, and to recognise skill
            gaps/development needs. The tool is useful for specialist
            PH workers, but is not likely to be seen as appropriate (or
            user-friendly)by some of the non-specialist public health
            improvement workforce. The questionnaire is based on
            work commissioned from the NHSP/Conrane Consultants
            by the NHS Executive, West Midland Region. It has been
            re-mapped onto the standards in public health specialist
            practice produced by Healthwork UK on behalf of the
            Tripartite Steering Group. The results also include a
            scattergraph showing the relationship between
            performance and requirement for the 10 key areas.
            Takes approximately 30 minutes to complete and the
            results can be saved. Reliance on self-assessment leaves
            the results vulnerable to subjective error.
Related     WMPHO Job Evaluation Facility
Resource    www.wmpho.org.uk/skillsaudit/jobintro.asp


Resource           Public Health Skills Audit Tool
Weblink            www.phskills.net/

Category           Interactive questionnaire tool.
Workforce          Attempts a broad focus. Includes local government
                   and community workers. Expanded CMO groupings.
Mapping            Yes
Auditing           Yes
Standards          10 areas of specialist PH practice. Each skill set has
                   7 – 15 competency questions.
Focus (agency      Could be multi-agency.
E-methods          Yes


                                                                        20
Strengths     Good support documentation to guide individual or
              group use.
Limitations   Emphasis on generic skills. (Could be strength or
              limitation, depending on context.)
Commentary    In its original form, represented pioneering work in
              this field. The Public Health Skills Audit Tool,
              commissioned by the former Health Development
              Agency, aimed to establish a profile of public health
              skills, capacity and shortfalls that can be used to
              develop practice and tackle inequalities in health. It
              is an interactive online system with built-in analysis
              functions, which consists of 10 skill sets each with
              7-15 competency questions and can be used for a
              variety of purposes (with variable completion
              times):

                      public health teams carrying
                                                                                 2 to 3
                    - out skills gapping workshops
                                                                                 hours
                      (via a facilitator)
                      conducting personal                                        1 to 2
                    -
                      development reviews                                        hours
                      individuals analysing their
                                                                                 30 to 40
                    - own skill gaps and training
                                                                                 minutes
                      needs

              The online analyses allow an evaluation of individual
              skill gaps, a comparison of skills with others in the
              same job role and an identification of other job roles
              with similar skill sets.

              The quantitative findings are based on self-assessed
              skill levels and therefore prone to subjective error.
              Additional validation would improve the objectivity
              of the data produced. Need for greater coverage of
              the wider health improvement workforce was
              identified as a limitation in 2004.
Related       Public health skills audit 2001: Audit tool (participant's pack)
              11 November 2003
Resources     Public health skills audit 2001: Facilitator's pack
              11 November 2003
              Public health skills audit 2001 (research report)
              11 November 2003
              Public health skills audit 2001 (short report)



                                                                                            21
                  11 November 2003




Resource      Public Health Workforce Census Results, Public Health
              Resource Unit,February 2007
Weblink       http://www.phru.net/learning/Shared%20Documents/Workforce%20Census.pdf.

Category      Report, tool and research. Contains useful algorithm
              and questionnaire
Workforce     Wider public health improvement workforce
Mapping       Yes. Piloted in NHS Greater Glasgow and Clyde.
Auditing      Planned as Stage Two. Work currently proceeding.
Standards     Yes. 10 key areas of public health practice.
Focus         Inter-agency
E-methods     Yes. Survey distributed electronically through Survey
              Monkey.
Strengths     Addresses wider workforce in a more complete way.
              Can link to KSF. Good, refined questionnaire based on
              original London PHO work, already tested.
Limitations   Total reliance on electronic distribution leaves certain
              gaps. A cascade model of distribution is not robust in
              terms of returns and knowing the total number of
              questionnaires delivered to staff, and hence response
              rate. Additional qualitative element perhaps needed.
              Also: “There are knowledge gaps in relation to our
              understanding of the overall profile of the family of
              public health, and parallel work is underway to take
              this forward.”
Commentary    In 2006, an Interim Report reviewing the public health
              workforce was produced from a multidisciplinary
              working group. Key recommendations from this
              working group were to establish a methodology for
              surveying the workforce to find out about public health
              qualifications and identify the practitioner workforce. In
              addition it was suggested that the tool would also be
              used in an attempt to map the public health workforce
              against recognised public health qualifications and
              competencies.


                                                                                        22
              It was recognised in the interim report that accurate
              characterisation of the practitioner workforce would not
              be straightforward. This was due to the fact that the
              recently devolved health improvement workforce had
              disparate job titles and there was no current, accurate
              database of staff from which to identify the HI
              workforce.
              This survey was stage one of a two–stage process.
              Stage 1 involved a survey of professionals within
              NHSGG&C area to establish their location and the
              broad type of public health work they were currently
              involved in.
              The survey was administered over an eight week
              period in February /March 2007 using a questionnaire
              developed by the London Observatory. A pilot survey
              was administered in January 2007 with support from
              health improvement staff in Glasgow City.
              The questionnaire was modified following the pilot. An
              algorithm guided survey users through the survey
              questions. The algorithm was modified, to meet the
              needs of the local workforce, based on the
              methodology developed by the London Observatory.
              The survey was administered electronically through
              Survey Monkey, utilising the Public Health Resource
              Unit database and targeted at the core public health
              workforce. The survey ran over a two-month period
              with reminders sent out at the half way stage. Along
              with the survey, a guidance note was sent out from the
              Director of Public Health.




Resource   Public Health Practitioners in Wales. A report on the
           provision of education and training, Wales Centre for
           Health, 2003.
Weblink    http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid
           =568&id=31462

Category   Report of scoping study. Questionnaire.


                                                                    23
Workforce     Wider public health workforce
Mapping       Yes
Auditing      Yes. Self-identified skills and training needs. Creation of
              directory of available training
Standards     Yes. NOS
Focus         Inter agency
E-methods     Yes, partially. Mail also used.
Strengths     Serious attempt to take broad view of wider workforce.
Limitations   Initial sample inadequate and likely to be
              unrepresentative. Limited initial questionnaire. Work is
              now underway to address this, especially in relation to
              community/voluntary sector workers. (See Related
              Resources)
Commentary    Although primarily focused on education and training,
              and the objective of scoping post-qualifying training and
              education available to public health practitioners in
              Wales, the study included a preliminary workforce
              mapping stage. In addition, a number of projects are
              now looking at the education needs and the barriers to
              training of different sectors of the public health
              workforce, for example, the Voluntary Sector,
              the Community Engagement Sector and the Nursing
              Sector.
              The study combined workforce mapping and audit of
              skills, training received and training required. A
              questionnaire was issued to previously identified target
              groups electronically, by mail and via websites. NOS
              were used as a guide by the reference group who
              identified target groups. Wide distribution was sought
              through a “cascade” distribution.
              There was a recognition that the sample was too limited
              and potentially unrepresentative. Also a recognition that
              definitions were still problematic and further work was
              required.
               Amongst the final recommendations were: a detailed
              project be conducted to establish an agreed definition in
              Wales for ‘Public Health Practitioner’.
              -Work be undertaken with established professional
              groups with a remit of public health, to facilitate their
              recognition and understanding of the contribution they


                                                                            24
          make to public health and other
          organisations/professions. This work to be focused on
          inter professional and multi- disciplinary working and
          learning.
          -To conduct a mapping exercise to identify current
          numbers within each profession and projections for the
          future
          -Attention be paid to identifying public health
          practitioners from the voluntary and community sectors,
          assessing their needs and access to training and funding,
          alongside the needs of voluntary and community sector
          participants supporting the Health Social Care and Well
          Being agenda. Once a clear definition of Public Health
          Practitioner has been established, career paths and
          progression for these groups be reviewed in line with the
          NOS for Public Health Practice.
          -Their contribution to public health be recognised and
          valued
          -A study be conducted in conjunction with others to
          review the viability of establishing a voluntary register for
          practitioners.
          The report identified that many practitioners did not
          recognise the contribution they made to public health,
          and did not regard themselves as public health
          practitioners. This could have an adverse impact on the
          dissemination and acceptance of the NOS for Public
          Health Practice, as the workforce may not see their
          relevance. A key finding and recommendation was:” in
          undertaking this study, a number of issues arose which
          have not been raised or addressed previously, e.g. the
          public health workforce not recognising their contribution
          towards the public health agenda, the difficulties in
          locating and contacting key public health practitioners.”
Related   Wales Centre for Health/Skills for Health. Identifying
          Public Health/Health Improvement Roles in Swansea,
          2006.

          Directory of Training and Education Courses and
          Prgrammes in Public Health 2006-07



                                                                      25
              http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgid
              =568&id=57514

              Voluntary Sector Scoping Summary Report

              http://www.wales.nhs.uk/sites3/docmetadata.cfm?orgId
              =568&id=59972




Resource      Mapping the needs of the NHS Public Health Practitioner
              Workforce in PCTs
Weblink       http://www.southeastcoastpublichealth.org.uk/document
              .aspx?id=479&siteID=1011

Category      Report. Tools: focus group interview guides; audit tool;
              telephone/Email interview pro-forma
Workforce     PCT-based. PH staff in 6 PCTs in the south-east
Mapping       Limited
Auditing      Yes
Standards     Own category codes devised
Focus         Within agency (across 6 PCTs.) Some involvement of
              local government staff in previous visioning exercise.
E-methods     No
Strengths     Some useful tools
Limitations   PCT focus only
Commentary     The Healthcare Workforce Research Centre at the
              University of Surrey were commissioned by the Surrey
              and Sussex Public Health Network to identify a vision for
              public health in Primary Care Trusts (PCTs), audit the
              public health skills of the local workforce and implement
              the initial stages of the vision through proposals for
              practitioner development programmes.
              The research team worked collaboratively with local
              practitioners and key stakeholders in public health.
              Focus group interviews were used, as well as a postal
              questionnaire audit.



                                                                          26
                  Key objectives:

                    -Outline workforce development needs in relation to
                    clarification of roles, expectations and raising
                    awareness of public health functions;
                    -Provide a blueprint of specific public health skill
                    development required by the workforce to achieve the
                    vision;
                    -Provide a blueprint of broader training needs to
                    achieve the public health vision;
                    -Identify the PCT role in creating a culture of improved
                    public health from the perspective of the workforce.

Related                 Appendices to Mapping the Needs of the NHS
                  Public Health Practitioner workforce in PCTs

                         Feedback on Mapping the needs of PH
                  Practitioners - Presentation
                         University of Brighton - courses mapped against
                  the Standards of Public Health Practice




Resource           Targeted Intervention on Obesity. Audit and Review of
                   Workforce Capacity and Capability. Explain, 2008 (for
                   GONE). (Presentation material.)
Weblink            -
Category           Report. Thematic audit and review
Workforce          Child Obesity Leads in regional PCTs, “other key players.”
                   Largely PCT based.
Mapping            Attempted
Auditing           Yes
Standards          ?
Focus              Acknowledges wider input, but concentrates primarily on
                   PCT staff.
E-methods          No
Strengths
Limitations        Insufficiently precise focus, leading to results of limited
                   value in some aspects. Attempts to combine


                                                                                 27
              mapping/audit with service review approach.
              Mapping/audit results may not be sufficiently specific as
              to yield reliable data for planning purposes.
Commentary    Amongst a wide range of project aims, some relate
              directly to mapping. “Identify and support training for the
              workforce involved in commissioning and delivery.
              Identify current workforce capacity across obesity care
              pathway, including numbers of dedicated staff working in
              localities. Design an appropriate data collection tool to
              collect information including data relating to: numbers
              and grades of staff in post and planned; training received
              by staff; gaps already indentified.” The broad focus of the
              review, its thematic nature, and particularly it’s
              overlapping of “service review” with “mapping”made its
              findings – specifically in relation to mapping – of limited
              utility. Provides a listing of frontline staff considered to
              be involved at each stage of the pathway. Describes
              current staffing and grade levels and examples of
              internal and external training undertaken. Attempts to
              identify gaps in training delivered. One of the report’s
              final recommendations is “A full assessment/review of
              staff numbers in each PCT following the reconfiguration
              should be conducted.”

Resource     A Workforce Development Project for Public Health for
             Fareham, Gosport and Havant, 2007
Weblink      http://www.networkfareham.org.uk/pdf/lspdoc93.pdf



Category     Report. Public Health Workforce Classification Tool.
Workforce    Public health workforce within 3 local authorities (as part
             of wider development programme relating to the
             practitioner and wider public health workforce.)
Mapping      Yes
Auditing     Yes
Standards    NOS
Focus        Local authority workforce
E-methods    No
Strengths    Model is based upon earlier London study. Takes account
             of lessons learned. Useful classification tool. Useful

                                                                           28
              workforce lists and definitions. Makes use of “key
              informants.”
Limitations   Relies on accurate selection of “key informants.”
Commentary     The consultant to the project, R. Walters, was involved
              in developing the original Public Health Workforce
              Classification Tool, used in the London study. (Mapping
              the public health workforce 1. A tool for classifying the
              public health workforce. R. Walters, F. Sim and G.
              Shiller.)

              Aimed to involve three local authorities in a project to
              map out the public health workforce in their organisation
              and to develop a programme to support development to
              enhance delivery of priorities established by the Area
              Public Health Liaison Board (including measures to tackle
              obesity.)

              Steps:
              Work through the Area Public Health Liaison Board as
              initial key informants.
              Establish the range of LA services to be included.
              Within each service, use a key informant at senior
              operational level to work with the researcher.
              Identify the number of people employed on work which
              falls within an agreed definition of the PH workforce
              (based on refinement of CMO categories.)
              Sample the agreed services, weighted towards those
              most closely associated with the target workforce (eg
              obesity.)
              Establish where knowledge and skills gaps exist.
              Raise awareness of public health across the
              organisations.
              Use mapping work to inform a workforce development
              plan.

              This work is ongoing as part of a wider public health
              workforce development programme.




                                                                          29
Related          Walters, Rhiannon and Chapman-Andrews, Joanna
                 Public Health Development in Three South East
                 Hampshire Local Authorities. A Report to NHS Education
                 South Central, June 2008
                 http://www.networkfareham.org.uk/pdf/lspdoc75.pdf
                 Mapping the Pubic Health Function in London. A Report to
                 the DHSC London, 2002.

                 Mapping the Pubic Health Function in London. A Report to
                 the DHSC London. Supplement on Data Collection, 2002.

             




            5. Useful pointers from the evidence
      It is not appropriate to make any universalist recommendations,
      based upon this evidence, without further detailed discussion of
      the specific context in which mapping/auditing activity may take
      place, and the organisational purposes of that activity. However, it
      is possible to raise for consideration some questions which will
      need to be addressed before any individual activity proceeds.

          1. The purpose of the mapping should be clearly established.
             There are examples of mapping exercises which may require
             significant resources, but yield few tangible results.
          2. Distinguish between mapping and auditing. Clear, informed
             decisions are needed on the “development” objectives, before
             any decision can be made on whether it is feasible to combine
             mapping and auditing exercises into a single process.
          3. Taking account of the cost/resource implications of certain
             mapping exercises, is there an option, in certain contexts, to
             do broad estimation rather than detailed mapping?
          4. Maximum use should be made of electronic tools and
             methods that have been developed, if they are appropriate
             for the specific development objectives being pursued. Note
             the limitations of “cascade” methods.
          5. Electronic methods, where used, should be supplemented
             with a qualitative element such as validation workshops,


                                                                         30
     designed to balance the weaknesses of a purely quantitative
     approach.
  6. Maximum use should be made of Occupational Standards and
     Skills & Career Frameworks if they are appropriate for the
     specific development objectives being pursued. Attention
     should be paid to the evidence that, in some cases, workers
     in the wider health improvement workforce may not readily
     relate to such standards.
  7. When the specific development objectives are defined,
     choices can be made about the most suitable form of
     mapping/audit:
        - the whole health improvement workforce? This has the
           advantage of employing a measurable, standardised
           approach but the disadvantage of a “one size fits all”
           approach through occupational standards.
        - single agency workforce only? There needs to be a
           meaningful agreed measure of standardisation across
           agencies if it is hoped to create a composite picture from
           the results of various single agency mapping/audit
           exercises.
        - issue based “thematic” or pathway approach? eg
           obesity, long term conditions? This presents different
           methodological problems from agency mapping/audit
           and requires considerable sophistication in its planning.
           Good use can be made of key informants, but careful
           selection of the right informants is needed at each stage
           of the process. Eg would a public health practitioner
           lead for obesity be the right person to identify workforce
           mapping issues in relation to this care pathway? Or is
           there a need for the involvement of those with a wider
           strategic overview, able to link workforce mapping with
           capacity planning across organisations.

In each case, a clear distinction needs to be made between a
primarily service development activity or a primarily workforce
development activity. Clearly both aspects can be involved, but
pre-planning needs to clarify this distinction so that the most
suitable approaches can be selected to produce valid, useable
results.




                                                                   31
  8. Some workers belong to strong professional communities,
     and have strong role identity, others do not. In planning any
     development activity involving, for example, third sector
     members of the wider workforce, real attention should be
     given to the evidence that they may not relate well to
     initiatives which present as “public health” development.

6. Recommendations

6.1 If a choice is made to undertake a full mapping exercise of the
wider public health improvement workforce, the London study
model, since developed in the Glasgow study by PHRU, is a very
useful starting point. This is based on the work of Walters,et al,
subsequently refined in the Wales study and A Workforce
Development Project for Public Health for Fareham, Gosport and
Havant, 2007.

6.2 If a thematic or care pathway approach to mapping is selected,
different methodological problems arise. Approaches which ignore
these problems are unlikely to yield results of maximum value. The
Walters model could be adapted for use with a thematic approach.
Other useful starting points to build upon are the West Midlands
work identified by PHRU, the NHS KSF Mapping Tools from Skills
for Health, the Public Health Skills and Careers Framework and the
Long Term Conditions workforce planning guidance from the
Workforce Development Reports/Skills for Health. Care pathway
approaches require:
      - identification of the evidence base for effective actions
        at each stage of the pathway
      - identification of the potential workforce at each stage of the
        pathway. (High level key informants with a strategic
        understanding are needed as well as operational leads)
      - identification of the required level of competences at each
        stage of the pathway, making use of PHSCF where
        appropriate
      - accurate measurement (or assessment) of existing levels of
        competency. (Either by auditing individual’s skill levels or
        through assessment by key informants.)



                                                                    32
6.3 Early consideration should be given to clear definition of
target groups. Eg “Workforce” being defined as paid workers
across agencies whereas “capacity” can also include people who
are improving health on a voluntary basis, or as part of other roles
such as local authority Councillors.

6.4 A clear distinction is required between “competences for
    delivery” and “leadership” of the development activity, which
    is needed across the whole system.

6.5 Workforce mapping and development activity should be
    clearly situated within an overall organisational capacity
    building framework, taking account of organisational
    development, resource availability and allocation,
    partnerships and clear leadership.
    ( A good account of the ingredients of organisational capacity
    building is provided in:
    NSW Health Department, A Framework for Building Capacity
    to Improve Health. NSW Health Dept, 2001
    http://www.health.nsw.gov.au/public-health/health-
    promotion/capacity-building/framework/ )




                                                                  33
Appendix One (Data Sources)
Academic and Professional Bodies

Learning and Skills Council
Faculty of Public Health
Public Health Research Unit
Skills for Health
Skills for Care
Workforce Development Confederations
Kings Fund
Picker Institute
EUPHA
Improvement and Development Agency (IDeA)
SCHAR
APHO and regional observatories
NICE
NIHR
NHSCRD
WHO

Databases

Through UK Academic Data Archive:
ASSIA
CAB Abstracts
Global Health
Web of Knowledge
DOH


                                            34
WHOLIS
Cochrane Library
University of York Library’s Health Information Resources
University Of Leeds International Health Website




Appendix Two

Findings: Associated Resources

Abbott, S and Killoran, A. Mapping public health networks,
Health Development Agency/NHS, 2005.

Allegrante, J P; Moon, R W; Auld, M E; Gebbie, K M
Continuing-education needs of the currently employed public
health education workforce. American Journal of Public Health; 91
(8) Aug 2001, p.1230-4

Australian Government Department of Health and Ageing. Report
on the Audit of Health Workforce in Rural and Regional Australia,
2008. Commenwealth of Australia, Canberra.

Black, Nick
Health care workforce: how research can help. Journal of Health
Services Research and Policy; 9 (1) Supplement 1 Jan 2004,
pp.S1: 1-S1: 2

Brocklehurst, NJ Hook, G. Bond, M. Goodwin, S.
Developing the public health practitioner workforce in England:
lessons from theory and practice. Public Health. Elsevier, Oxford,
UK: 2005. 119: 11, 995-1002.




                                                                     35
Brown, JS Learmonth, A. Mind the gap: developing the PH
workforce in the North East and Yorkshire and Humber regions: a
scoping stakeholder study. Public Health. Elsevier Ltd, Oxford, UK:
2005. 119: 1, p. 32-38.

CDC/ATSDR Strategic Plan for Public Health Workforce
Development. Towards a life-long learning system for public health
practitioners. Task force report on public health workforce
development.nd http://www.phac-aspc.gc.ca/php-
psp/pdf/cdc.ph.strategic_plan_for_public_health_workforce_development.pdf.


Centre for Research into Childhood Policy Research Institute, A
Review of the Evidence of Effectiveness of Workforce Reform: an
annotated bibliography, Leeds Metropolitan University, 2008.

Combined Universities Interprofessional Learning Unit, Summary
Report. CUILU, Sheffield University, nd

Cornish, Y. Developing Public Health Capacity and Capability in the
South East. Part 1: Capacity, South East Institute of Public Health,
Tunbridge Wells (1999).

Cornish, Y. Developing the Public Health Workforce. A Study of the
Public Health and Health Promotion Workforce in the South East
Region of the NHS, Centre dor Health Service Studies, University
of Kent, Tunbridge Wells (2000).

Dearden Consulting (for HDA) Training and development of the
public health workforce, Health Development Agency/NHS, 2002

Department of Health. Report of the Chief Medical Officer’s Project
to Strengthen the Public Health Function in England, Department
of Health, London (2001).

Ewijk, Hans van, et al, Mapping of Care Services and the Care
Workforce. Summary of Consolidated Report, Thomas Coram
Research Unit, Institute of Education, University of London, 2002.
http://144.82.35.228/carework/uk/reports/index.htm

Gabow, P. et al, A Toolkit for Redesign in Health Care,
Agency for Healthcare Research and Quality, Maryland, 2005


                                                                             36
Gately, Claire; Kennedy, Anne; Rogers, Anne
From patients to providers: prospects for self-care skills trainers in
the National Health Service. Health & Social Care in the
Community; 13 (5) Sep 2005, pp.431-440

Gerzoff, R B; Van Devanter, N L
Recent data are needed to support public health training and
workforce initiatives. American Journal of Public Health; 90 (5)
May 2000, p.809-10

Gray, S. Perlman, F. Griffiths, S. A survey of the specialist public
health workforce in the UK in 2003. Public Health. Elsevier,
Oxford, UK: 2005. 119: 10, p.900-906.

Johnson, S. et al Mapping qualifications and training for the
Children and Young People’s Workforce. Short Report 6. Research
Review, Sheffield Hallam University, 2005.

Kinder, G L; Cashman, S B
A community oriented definition of the health workforce and core
competencies. Journal of Interprofessional Care; 12 (2) May 1998,
p.141-55

Lean methodology – Choosing the right approach and tools
Office of Government Commerce, HM Government, nd

McPherson, Kathryn et al, A Systematic Review of Evidence about
Extended Roles for Allied Health Professionals. Journal of Health
Services Research & Policy, vol. 11, no. 4, pp. 240-247, Oct 2006

Mallinson, Sara; Popay, Jennie; Kowarzik, Ute,
Collaborative work in public health? Reflections on the experience
of public health networks
Critical Public Health, vol. 16, no. 3, pp. 259-265, Sept 2006

Merry, S. Children and Young People’s Services Workforce Strategy
Mapping Project, South Gloucestershire Council, 2007.

Morgan, Antony Revitalising evidence based public health: an
asset model, Karolinska Institute, Sweden, 2008.

                                                                       37
http://www.cardiff.ac.uk/socsi/cishe/pages/Events/HCW_sem_6_A
ntony_Morgan.pdf

Musselwhite, Charles B. A.; Freshwater, Dawn
Workforce Planning and Education: Mapping Competencies, Skills
and Standards in Mental Health. Nurse Education Today, vol. 26,
no. 4, pp. 277-285, May 2006

NSW Public Health Bulletin. Vol 11, No 3, March 2000
Building capacity for Public Health

NSW Health Department, A Framework for Building Capacity to
Improve Health. NSW Health Dept, 2001
http://www.health.nsw.gov.au/public-health/health-
promotion/capacity-building/framework/

Public Health Workforce in Local Government July 2004, The State
of Queensland, Queensland Health, 2004

Pearson, Richard; Reilly, Peter; Robinson, Dilys
Recruiting and developing an effective workforce in the British NHS
Journal of Health Services Research and Policy; 9 (1) Supplement
1 Jan 2004, pp.17-23

Potter, M A; Pistella, C L; Fertman, C I; Dato, V M
Needs assessment and a model agenda for training the public
health workforce. American Journal of Public Health; 90 (8) Aug
2000, p.1294-6


Public Health Workforce Development Australia, England and the
United States. A. Nevis Consulting Group, 2004.
http://www.phs.utoronto.ca/SPH_Doc_and_Ref/Final%20report.pd
f.

Ritchie*, Deborah; Smart, Helen
A reflection on the proposed Educational provision for the
"practitioner level" public health/health improvement workforce in
Scotland: a discussion paper on the benefits of work-based
learning.Health Education Journal; 62 (2) Jun 2003, pp.113-124


                                                                  38
Saks, Mike; Allsop, Judith
Social Policy, Professional Regulation and Health Support Work in
the United Kingdom. Social Policy and Society, vol. 6, no. 2, pp.
165-177, Apr 2007

Sector Skills Agreement for Health
http://www.skillsforhealth.org.uk/uploads/page/236/uploadablefile
3.pdf

Wales Centre for Health. Implementing the National Occupational
Standards for the Practice of Public Health: Conference Report,
2004.


Walters, Rhiannon and Chapman-Andrews, Joanna
Public Health Development in Three South East Hampshire Local
Authorities. A Report to NHS Education South Central, June 2008
http://www.networkfareham.org.uk/pdf/lspdoc75.pdf


Wright, Jenny, Somervaille, Lillian and Dunkley, Ros
Review of the Public Health Function of National Health
Organisations and Units in Wales. Results and commentary from
the consultation with key organisations, units and stakeholders.
PHRU/NHS 2006.




                                                                    39

				
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