Select Committee on Public Accounts Appendices to the Minutes of Evidence

APPENDIX 2

Supplementary Memorandum submitted by the NHS Executive (PAC 152)

 

QUESTION 45

  Midwifery numbers have been flat over the last few years. Table 1 (attached) shows the growth in midwifery numbers that pre NHS Plan levels of training will provide and the growth that can be achieved with investment in Recruitment and retention initiatives from 2001-02 to 2003-04. Table 2 (attached) shows the age profile of the midwifery workforce.

  Table 1 shows headcount figures. The whole time equivalent (wte) in the baseline year 2000-01 is 17,600 wtes. This table shows the potential for growth in the midwifery workforce with the current (and NHS Plan) training levels and improved recruitment and retention measures. The principle ways to fill gaps and increase numbers in the short-term are through:

—  Retention—Increasing the investment in midwives and midwifery services would have a positive impact on retention—consultation from the NHS Plan showed what staff wanted most, alongside fairer rewards, were more staff and investment in services. Retention should improve again if the Improving Working Lives Standards are applied in midwifery but this will need long-term changes in traditional working practices.

—  Returners—getting more returners back is the best option for a quick increase in numbers.

—  Trainees—more midwives are coming out of training year on year.

POOL OF RETURNERS

  It has been indentified that getting more returners back is the best option for a quick increase in numbers. There are about 90,000 people on the UKCC register with midwifery qualifications and around 33,000 of these are practising midwives. A recent RCM survey of the non-practising pool indicated that around 1 in 6, or 10,000 would return to midwifery. The Department's own Return to Nursing survey—which covered nurses and midwives—gave a similar result with 1 in 5 of those not working in the profession recording an intention to return to practice and 3 in 5 unsure. The RCM figure excludes those whose registration has lapsed so the potential pool of returners is actually larger than 10,000-around two-thirds of the nurses attracted back into the NHS have lapsed registrations.

  The Department is working with the service and the RCM to encourage more midwives to return to the NHS. Over the last 12 months 209 have returned and there are 156 on their way back.

 

  The Chancellor announced additional funding for recruitment and retention initiatives from April 2001. This funding means we can improve the returner package so that returning midwives will now receive:

—  free refresher training;

—  a minimum of £1,000 in income whilst they are retraining;

—  help with childcare;

—  assistance with travel and subsistence, books etc.

TRAINING COMMISSIONS

  There are direct entry degree and diploma courses for midwives as well as post registration courses in order for nurses to become midwives. Applications for Midwifery Diploma courses for 1998-99 showed a dramatic increase (65 per cent), from 4,206 in 1997-98 to 6,952 in 1998-99. Applications for 1999-2000 are down slightly (1 per cent to 6,880) on the previous year's figures but continue to show an increase from the 1997-98 figures. Pre registration training commissions have risen by 55 per cent between 1996-97 and 1999-00, but the number of nurses training to be midwives has fallen steadily since 1992. Total training commissions for midwifery have risen from 1,540 in 1992-93 to 1,772 in 1999-00 (an increase of 15 per cent). Table 3 (attached) shows the numbers of pre-registration midwifery commissions since 1992-93.

APPLICATIONS FOR MIDWIFERY

  Data from NMAS does not include numbers of people applying for individual courses, only numbers of applications and each person can make up to four applications. On this basis, the numbers of applications and acceptances to midwifery courses for the last 3 years are set out in Table 4 (attached).

  Whilst the number of applications to nursing diploma courses has increased at a faster rate than midwifery, the ratio of the number of applications to places on courses remains much higher in midwifery.

 

Table 1

THE GROWTH IN MIDWIFERY NUMBERS THAT PRE NHS PLAN LEVELS OF TRAINING WILL PROVIDE AND THE GROWTH THAT CAN BE ACHIEVED WITH INVESTMENT IN RECRUITMENT AND RETENTION INITIATIVES FROM 2001-02 TO 2003-04

	1995-96	1996-97	1997-98	1998-99	1999-00	2000-01	2001-02	2002-03	2003-04
Before plan	22,020	22,600	22,380	22,840	22,800	22,570	23,535	24,656	25,717
With extra training	0	0	0	0	0	0	0	0	95
R & R Activity							324	647	971
Total Growth	22,020	22,600	22,380	22,840	22,800	22,570	23,859	25,304	26,783

Table 2

AGE PROFILE OF MIDWIVES CURRENTLY IN POST

Hospital and Community Health Services (HCHS): Registered Midwives by age band in England as at 30 September east year

	All staff	<25	25 to 29	30 to 34	35 to 39	40 to 44	45 to 49	50 to 54	55 to 59	60 to 64
1996	22,595	283	2,397	4,981	4,419	2,998	2,639	2,075	1,083	252
1997	22,385	294	1,916	4,669	4,548	3,254	2,481	2,150	1,103	311
1998	22,841	377	1,760	4,369	4,879	3,477	2,577	2,319	1,138	235
1999	22,799	417	1,495	3,813	4,920	3,799	2,669	2,353	1,177	247
2000	22,572	490	1,439	3,205	4,969	4,076	2,801	2,377	1,228	263

  Notes: Figures exclude learners and agency staff.

  *  Five or less and greater than zero

  Source: Department of Health non-medical workforce census.

 

Table 3

NUMBERS OF NHS FUNDED PRE-REGISTRATION MIDWIFERY TRAINING COMMISSIONS

Midwifery Year	Degree	Diploma	Total Pre-Reg	Other5	Total
1992-93	42	206	248	1,292	1,540
1993-94	92	450	542	1,215	1,757
1994-95	92	522	614	1,044	1,658
1995-96	128	485	613	1,030	1,643
1996-97	161	498	659	993	1,652
1997-98	224	572	796	908	1,704
1998-991	255	597	852	899	1,751
1999-002	395	620	1,015	757	1,772
2000-013	475	615	1,090	926	2,016
2001-024	600	577	1,177	942	2,119
2002-034	618	603	1,221	955	2,176

Notes:

¹ Unvalidated 1998-99 outturn.

² Actual outturn based on Q4 1999-00 performance management report.

³ Forecast outturn based on Nov 2000 FWIR and subject change.

⁴ Planned commissions are based on Nov 2000 FWIR and are provisional estimates and subject to change.

⁵ Other includes 18 and 24 month diploma courses.

 

Table 4

	97-98	98-99	per cent	99-00	per cent
Midwifery
Applications	4,206	6,952	65.29	6,880	¸1.04
Acceptances	499	548	—	488	—
Ratio of applcations to acceptances	8.43	12.69	—	14.10	—
Nursing
Applications	41,208	79,313	92.47	89,699	13.09
Acceptances	12,068	14,292	—	14,331	—
Ratio of applications to acceptances	3.41	5.55	—	6.26	—

QUESTION 46

  The pay for midwives working in the NHS is recommended by the independent Nursing Pay Review Body and agreed by the Nurses and Midwives Negotiating Council.

  Nurses and Midwives share the same clinical grading structure. However, newly qualified midwives enter the grading structure at a higher level than nurses in recognition that midwives are professionally deemed to be autonomous practitioners once qualified. Starting salary for midwives, who enter at Grade E is now £16,510 as opposed to nurses who enter at Grade D who start at £15,445. Midwives (like nurses) can potentially aspire to a consultant post with a maximum salary in excess of £45,000.

  In response to concerns that the contribution of midwives had not been sufficiently recognised, the NHS Plan announced new arrangements that will allow midwives faster progression up the salary scales. From April 2001 midwives with a year's satisfactory service will have access to the top three pay points of grade E and eventual progression to the top of Grade F without the need for promotion. These arrangements, which do not apply to nurses, were endorsed by the Pay Review Body and agreed with Staff Side organisations.

QUESTION 203

  A number of factors will have affected decisions on the number of training commissions for nurses in the early 1990s, including views on the number of qualified nurses needed in the future. Some of the more significant factors are set out below.

  First, in the early 1990s there was lower wastage from the nursing workforce than in previous years. At the same time many hospitals sought to reduce costs and, as part of this work, looked either to reduce staff numbers or to change skill mix. This often led to slowing down or stopping nurse recruitment. Taken together with the low wastage rates from the workforce at the time this led to falling recruitment of newly qualified nurses, who in some cases had no job to go to on qualification. This in turn led to concerns, including from the nursing profession, that there was an imbalance between numbers being trained and available posts.

  Second, there were significant changes in nurse training with the introduction, from 1989, of Project 2000. This involved a move to largely super-numeracy training. It also contained a commitment to phase out the 2nd level enrolled nurse grade. Thinking at the time suggested that while there would be increased costs from this change it would lead to a range of benefits including:

—  Skill-mix changes which included making better use of health care assistants to undertake work previously carried out by enrolled nurses;

—  Lower attrition from training and better retention of qualified staff, together with increased productivity from nuses trained under Project 2000;

—  A rationalisation of pre- and post-registration education programmes.

  Third, Working Paper 10 following "Working for Patients", published in 1990, transferred the responsibility for commissioning non-medical education and training to Regional Health Authorities (RHAs]. The aim of the new arrangements was to ensure that workforce planning was responsive to employer needs. Regions, in consulation with local employers, were responsible for identifying the demand for qualified nurses and for deciding the number of students to be recruited and trained. Each Region was expected to train sufficient staff to meet its own needs. In order to co-ordinate their decision making, RHAs developed their own "Regional Balance Sheet" in 1991 to ensure each region met local demand as well as making a fair contribution to the national training picture. The Department maintained a national overview in relation to overall supply. Concerns that training levels were too low began to be raised by the Department in 1994 and led to requirements to increase nursing commissions. The number of commissions increased in 1995-96 and has increased each year since then.

NHS Executive

27 April 2001

 

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Prepared 30 July 2001