Select Committee on Health First Special Report

Future NHS Staffing Requirements

SESSION 1998-99
Health Committee Recommendations: Progress - Future NHS Staffing Requirements

Third Report: Future NHS Staffing Requirements (HC 38)Published: 03/03/99

Government Reply: Cm 4379 Published: 06/99


Government Response and Action

We welcome the establishment of this body, the National Advisory Group for Scientists and Technicians (NAGST)... Both the Conference of Clinical Scientists' Organisations and the Council of Science and Technology Institutes, Health Care Scientific Advisory Committee told us that stronger formal links are required between NAGST and national professional bodies. We recommend that the Government takes steps to introduce such links. (Paragraph 31).


we consider that with immediate effect there should be improved interaction between the medical and non- medical planning bodies. (Paragraph 34).

Implementation of the workforce planning review will drive forward multi-disciplinary working and planning arrangements.

The DoH memorandum informed us that: "Education consortia, REDGs and LMWAGs liaise closely...this is reinforced by cross-membership between the various groups." We believe that this should extend to regular meetings between MWSAC and REDGs, who should exchange information, discuss new ideas and develop plans (paragraph 35).

Following the review of workforce planning arrangements set out in A Health Service of all the talents: Developing the NHS Workforce the future arrangements for planning will be undertaken in a multi-disciplinary way. New integrated structures at local and national level are being developed to ensure that planning is done in a holistic and relevant way. This will be a major strand of implementation of the review.

we recommend a major review of current planning procedures which should pay particular regard to their rationalisation and eventual replacement by an integrated planning system. We think it necessary that any new system should not only incorporate the national overview currently provided by the sub-group of the NHSE, but also actively promote a national strategy for workforce planning which, allowing for local conditions, brings a sense of consistency and cohesion at present notable for its absence (paragraph 36).

A major review of current planning procedures was completed earlier this year. Ministers launched the second phase of the review by publishing a consultation document "A Health Service of all the talents: Developing the NHS Workforce" on the reviews findings in April. Responses to the document have been analysed and havel informed an action plan (part of which is outlined above) being prepared to support the implementation of the reviews findings.

The issue of the provision of appropriate joint training throughout the UK should feature largely in the major review of current planning procedures that we have recommended. (Paragraph 38).

The review recommended that Higher Education Providers and the NHS develop training and education arrangements which are genuinely multi-professional and which will enable students to transfer readily between courses without having to start their training afresh. It is planned to take this forward within the implementation of the review's findings.

We suggest that DoH should ask the MWSAC to look in more detail at the balance between specialist and generalist training for doctors in achieving a flexible medical workforce. (Paragraph 39).

MWSAC advises "on future developments in the balance of medical workforce supply and demand in the United Kingdom and makes recommendations about the medical school intake". The Government has ensured that the balance between general and specialist training, and its implications for education and training as a whole, were considered in its assessment of future workforce needs. The workforce planning review has proposed new arrangements that will take forward such work.

We recommend that efforts are made to co-ordinate local initiatives and assess their strategic impact on the future workforce numbers. We further recommend that co-ordinated pilot studies are undertaken to assess the impact of altering the skill mix (paragraph 47).

We accept the thrust of this recommendation. The proposed National Workforce Development Board will commission work on skill mix issues to inform local planning and roll out good practice.

We recommend that the proposed number of medical students be increased by a minimum of 1,000 per year. This increase should be accompanied by a commensurate expansion in the number of senior doctors and consultants in order to provide for the necessary career opportunities and supervisory roles. (Paragraph 59).

 The Higher Education Funding Council for England has announced 1,126 new medical school places. Universities have planned to provide over 1,050 of these places by autumn 2002. The government has also announced that their will be 7,500 more consultants and 1,000 more specialist registrars than now by 2004 who will contribute to the supervision and training of these extra students

The evidence we have received leads us to conclude that on current trends the projected increases in the number of nurses and other clinical staff fall well short of what is required to deal with current shortages and future developments in the NHS. We hope that recent Government initiatives will reverse these trends, but we suggest that the Government urgently reassesses its staffing figures to ensure an NHS workforce that is sufficient for requirements. (Paragraph 64).

The NHS Plan published in July 2000 revised the future need for healthcare professionals and the Government has provided funding for the increased number of training places

We recommend that the Government consults with NHS employers and staff representative groups in order to establish a rigorous but fair system of efficiency appraisal. (Paragraph 68).

The Government's proposals for modernising the NHS pay system were published on 15 February 1999 in Agenda for Change - Modernising the NHS Pay System aimed at delivering better care for patients by improved productivity through more flexible job design and patterns of working.
As part of the Agenda for Change talks, a Joint Working Group is developing a model for career and pay progression for staff in the NHS.
Officials have agreed in principle with the British Medical Association that the new consultants' contract will make annual appraisal and effective job plans mandatory for all consultants from April 2001. Having agreed this officials are now discussing and negotiating the specifics with the BMA.

It seems to us that the introduction of formal exit interviews would help workforce planning by providing a better sense of the reasons why staff leave the NHS. We also recommend that DoH initiate a formal consultation on standardisation of information as soon as possible (paragraph 79).

Employers meeting the Improving Working Lives Standard will have to provide evidence that there has been a " reduction in staff turnover due to inflexibility recorded in exit interviews/forms.We have collected and published vacancy information twice annually since the HSC recommendation (1999 and 2000), and are continually reviewing assumptions about staffing requirements with the NHS in the light of this information.

Since the NHS will continue to rely on overseas staff for many years to come, it is important that the Service ensures their career opportunities are not being restricted by their immigration status. We recommend that DoH consults with the Home Office and the Department for Education and Employment on these issues. (Paragraph 83).

Acknowledges importance and continues to have close contact with HO & DfEE, but does not want to actively poach staff from developing countries

We therefore urge the Government to collate information from trusts in order to allow them to formulate a specific recruitment and retention strategy for pharmacists, scientists and all of the Professions Allied to Medicine as soon as possible. (Paragraph 93).

The Department has been working closely with the professional bodies and other key stakeholders to address recruitment and retention issues in these areas within the overall Recruitment and Retention strategy for all NHS staff.

We would encourage education consortia, universities and the NHS to collaborate to ensure that the opportunity exists for student nurses to experience clinical practice in a safe and supervised environment as early in the training programme as possible (paragraph 111).

Consortia are working with universities and NHS employers to ensure that practice placements are of high quality and that the practice component constitutes 50% of the nurse training programme. This was announced as part of the new model of education announced in "Making a Difference" (July 1999 and HSC 1999/219, Sept 99). From September 1999 consortia and universities are expected to work in partnership to ensure:
Students start to acquire the necessary clinical skills for practice from the beginning of their programme enabling students to gain "hands on" experience from the outset
Students receive high quality teacher support from trained nurses who have up to date skills and who are actively practising

We recommend that healthcare assistants working with nurses should be called "Assistant Nurses" to reflect their role and be registered with the UKCC. Healthcare assistants working with other professional groups should also be registered appropriately. Registration in such circumstances would provide professional motivation for the individual and would act as a necessary safeguard for the public who could then be assured that at all times care was being delivered by people whose competence was known and recognised. (Paragraph 116).

The NHS Plan signals the Government's intention to publish proposals for the effective regulation of health support workers. The Government has commissioned De Montfort University to undertake a study of the role and functions of support workers in healthcare settings and to make recommendations about the need for regulation. Their report is expected shortly and will be considered in the light of work to take forward the implementation of the NHS Plan.

We recommend that every member of the NHS staff alone on duty in the community or otherwise at risk should have access to a mobile telephone or other means of establishing emergency contact with colleagues (paragraph 128).

As part of the continuing NHS zero tolerance zone campaign, the NHS Executive has issued (October 2000) more specific guidance to support staff working in high risk settings, which includes 'Managing Violence in the Community'.
All NHS zero tolerance zone materials are explicit that prevention of violence at work must start with a full assessment of the risks. If the local risk assessment suggests that it would be beneficial for staff to be provided with mobile phones, then managers should do so. The new guidance also stresses the importance of maintaining effective communications channels with staff working in the community.

we recommend that overtime payments should replace undue reliance on agencies as soon as possible. Moreover, the bank system should not be used as a method of cheap labour but should instead be used as a useful flexible working practice to cover unexpected shortages (paragraph 135).

The Department of Health has undertaken a major study of temporary staffing and is due to publish new national direction and guidance in this area. The purpose of this guidance will be to reduce the overall costs of temporary staffing, establish good practice and promote better value for money and equity.

We recommend that the NHS finances in full the relevant professional educational needs of its staff. We also believe that current study arrangements are inadequate and need to be extended. (Paragraph 138).

 The NHS Plan highlighted that £280 million is being set aside over the next 3 years to provide greater opportunities for health professionals to extend their roles and to develop the skills of all staff. It is for local health service employers to ensure that all professional staff receive the appropriate support to fulfil the requirements of clinical governance and revalidation. HSC 1999/154: Continuing Professional Development: Quality in The new NHS was issued on 16 July 1999, and provides guidance on the principles and criteria for establishing locally managed systems of CPD. Given the pressures on staff and the attendant problems of staff cover, the guidance stresses the importance of developing more work based learning and development activities, supported by easily accessible modern learning resources and library facilities.

The often spurious division of staff into clinical or non-clinical groups can create an institutional apartheid which might be detrimental to staff morale and to patients. We believe the Government should limit PFI to a number of pilot schemes until a proper evaluation of the impact on staff and patient care is produced. (Paragraph 152).

Can not accept

We recommend that the time has come for the NHS to move towards a single pay spine for all personnel. Terms and conditions should be negotiated nationally. (Paragraph 160).

Negotiations on a new pay system for the NHS commenced in May 1999. The Government's proposals are for three pay spines, two of these pay spines will have their pay determined through the recommendations of the Pay Review Bodies (the Nurses, Midwives and PAMs coverage will be expanded). There will be linkage between the process for pay uplift for Spines 1 and 2 and Spine 3 (non-Pay Review Body) to preserve equal pay for jobs of equal weight. The exact form of linkage is yet to be agreed.

We therefore recommend its replacement with the establishment of a single body charged with the task of reviewing the pay of all NHS professionals. This body should have within its remit all NHS staff, for example, clinical scientists and ancillary workers, who are not included in the current pay review bodies. The independence of the body should be secure and unassailable. (Paragraph 165).

Agenda for Change proposes that a single negotiating Council be established which will comprise of staff groups which are not within the remit of the two NHS Pay Review Bodies.
Some groups of highly qualified staff and their trainee grades will be brought within the scope of the NPRB, without changing its fundamentally professional character. Entry criteria was proposed in the Joint Framework of Principles and Agreed Statement on the Way Forward which was published on 8 October 1999.

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