Evidence submitted by the Association
for Perioperative Practice (WP 61)
As a professional association, AfPP have been
involved in the National Practitioner Programmes, in particular
the Surgical Care Practitioner and Assistant Theatre Practitioner
projects. We have also had significant input into the development
of the Anaesthesia Practitioner project. In addition, we also
have a publication entitled Staffing for Patients in the perioperative
setting, which was published in 2003. This publication provides
information on staffing establishments as well as a formula for
safe staffing of both elective and emergency surgery. This publication
was endorsed by the Modernisation Agency at the time of publication
and has subsequently been recommended by the Healthcare Commission.
We trust that the information provided will
be of assistance to those involved in the Health Select Committee
in assessing workforce needs and planning for healthcare services.
This response is provided by the Association
for Perioperative Practice (AfPP). AfPP is a professional association
representing 8,000 perioperative nurses, Operating Department
Practitioners (ODPs) and support staff in the United Kingdom working
in the NHS and the independent sector. This response is the view
of the AfPP Board.
INTRODUCTION
Since 1997 there has been a significant growth
in the UK nursing workforce due to increased funding for pre registration
nurse training and international recruitment. In March 2005 there
were 672,897 qualified nurses, midwives and health visitors registered
with the NMC. Of this number 30,000 registrants which is one in
20 are approximately resident overseas according to the RCN labour
market report 2005. Therefore the pool population in the UK is
approximately 640,000. There were approximately 465,000 qualified
nurses and midwives employed in the NHS. In September 2004 seven
out of every 10 nurses on the register were working in the NHS.
In addition there were 167,000 unqualified nursing staff.
The Royal College of Nursing (RCN) recently
published the RCN annual labour market review 2005 which shows
that information used for NHS workforce planning remains inadequate.
The report highlights the lack of reliable information on the
number of many newly qualified nurses working in the UK as well
as the lack of information on vacancy rates and retirement. This
lack of information is unacceptable and AfPP recommend the Health
Committee are aware that NHS Employers are to put mechanisms in
place to address the lack of data. Reliable information is required
to inform workforce planners and DH as to the sustainability of
NHS projects to improve clinical services and patient outcomes.
This includes recent policy announcements such as Commissioning
a patient led NHS.
The NHS is the main employer of nurses in the
UK but nurses also work in other sectors such as nursing and residential
homes, independent hospitals, clinics, treatment centres, hospices,
medical device industry and public sector services such as the
prison service. It would be useful to have reliable data on employment
in other sectors where nurse currently work as this does not currently
exist.
The RCN report highlights an ageing nurse population
particularly in the community where the average age is 44. The
latest NMC figures indicate that nurses over the age of 40 account
for nearly two thirds of the workforce. The proportion over 55
has increased to 16% of those on the register. This change could
reflect the social trend of people taking up new careers in their
30s or 40s but we do not have reliable data to support this. AfPP
has recently analysed the age profile of its 8,000 members and
the profile indicates 68% of members are aged 40 or over. Such
a trend is worrying as a lack of competent registered theatre
personnel will have a major impact on the healthcare establishment's
ability to reduce waiting times for elective surgery.
Presently there are 20,000 new UK registrants
to the register annually, but the number of nurses due to retire
raises concerns as to whether this is enough. There is a real
risk that the UK may return to the chronic nursing shortages of
the early 1990s. This is potentially a staffing "time bomb".
The NHS National Workforce Projects/Workforce Review Team claims
that by 2014 we will need twice as many entrants as we do now
just to keep the workforce constant. We need to recruit more,
and more importantly make nursing an attractive career not only
to school leavers but those that have had families and are looking
for a new career. There is also an urgent need to review why up
to 50% of nursing students drop out of training. One cause is
the current bursary which is inadequate to support many student
nurses in training.
An ageing workforce means the health service
has to look at ways of encouraging older nurses to work longer.
This includes human resource policies encouraging flexible pension
schemes and more flexible working hours. AfPP welcomes NHS Employer's
commitment to fund a dedicated post within the NHS to work specifically
on policies that will help retain experienced nurses and address
the implications of age discrimination.
Staff shortages and inadequate funding are preventing
many NHS Trusts from offering patient choice. A new report on
NHS maternity services (www.reform.co.uk) states there is considerable
strain on midwife led units. This is because where there is a
recruitment crisis for midwifes consultant cover is inadequate
and administrative burdens are rising.
The future of the workforce must be home grown
as it is ethically questionable to rely on recruitment from overseas
to sustain workforce demands in the UK. This is especially true
where recruitment has adversely affected healthcare systems overseas
by causing nursing shortages.
Healthcare Assistants (HCA) receive vocational
training and are an increasingly important part of the healthcare
workforce often working under the supervision of nurses. They
are an important source of potential recruits into nursing. In
2005 the Department of Health in England allocated £185 million
to support HCAs to train as nurses on paid secondment. Despite
this investment funding available to support HCAs to do nurse
training is limited. It is recommended that further investment
is provided to enable more HCAs to convert to nursing. Some organisations
also provide nurse cadet schemes which are successful in encouraging
young people to become nurses. Cadet places are limited and availability
of places is ad hoc. Investment is required so all NHS
organisations have a cadet scheme in operation. It is difficult
to assess the accurate size of the HCA workforce but this will
be assisted with the introduction of regulation which is currently
being reviewed.
The independent sector is being utilised to
deliver in areas where the NHS does not have the capacity in terms
of staff or physical resources. The independent sector is the
largest employer of nurses outside the NHS but data does not exist
as to how many work in this sector. There is a need to collate
and monitor such data to assess future workforce trends.
The main challenge is to completely rethink
professional boundaries including the introduction of new roles
and responsibilities and flexible working patterns. AfPP is working
collaboratively with Skills for Health and national workforce
projects to develop non- medical perioperative roles which improve
patient outcomes. Many new roles, such as the Surgical Care Practitioner
(SCP) have developed in response to the impact of the European
Working Time Directive (EWTD). The EWTD has resulted in a lack
of medical personnel being available to assist in the operating
theatre. In practice many nurses have taken on these roles which
have created backfill problems within operating departments. AfPP
do not see the necessity of creating new roles and new titles
which often confuse patients. AfPP supports the expansion of existing
nursing roles to enable nurses to undertake tasks which improve
patient outcomes.
The demographics of the workforce highlight
an ageing population. Department of Health targets for increasing
training places will secure future health professionals. However
we also need to give attention to the best use of the staff we
presently have, to ensure safe quality patient care. The debate
regarding appropriate staffing levels and skill mix has also been
prompted by the political focus on the "skills escalator"
and the potential contribution that assistant grades may provide
in supporting the delivery of care.
The attention being paid to staffing establishments
sits against a backdrop of demands for increased theatre utilisation,
as respective organisations respond to the service changes and
improvements that are implicit in the NHS Plans of the home countries
within the UK.
Challenges of enhanced efficiency are also encountered
in the independent sector, and AfPP recognises that a competent
and skilled workforce is central to achieving service improvements.
AfPP believes that the delivery of the contemporary health care
agenda is dependent upon recognising the core nursing contribution,
as well as the skill sets arising from a flexible and diverse
perioperative workforce, which comprises registered, non-registered
and trained personnel.
AfPP believes that, to promote and achieve a
quality patient experience for individuals requiring diagnostic
and surgical intervention, the key core skills and competencies
of all staff must be utilised. The staffing resource needs to
be recognised as central to achieving clinical effectiveness and
efficiency within health care. Most importantly, all staff need
to be deployed across the diversity of perioperative activity
within a clinical governance framework. Proactive shaping of the
perioperative workforce is crucial if organisations are to achieve
the vision outlined in the respective NHS Plans within the UK.
John Brunt
Chief Executive, Association of Perioperative Practice
March 2006
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