Examination of Witnesses (Questions 140
- 159)
THURSDAY 1 DECEMBER 2005
SIR NIGEL
CRISP, MR
JOHN BACON,
MR RICHARD
DOUGLAS AND
MR ANDREW
FOSTER
Q140 Mike Penning: It would not be
very difficult. Kensington and Chelsea, which I understand is
one of the greatest employers of agency staff, has a £14.5
million deficit, so it has not been very difficult to find, but
would you think from your experience, Sir Nigel, that that is
a possibility?
Sir Nigel Crisp: I think purely
anecdotally that sounds right.
Mr Foster: It is certainly the
case that where Mr Douglas earlier on drew his line from the Wash
to Bristol there is a similar line about high prevalence use of
agency staff, with more in the south.
Sir Nigel Crisp: Yes, more in
the south, so there may be a correlation there.
Q141 Mike Penning: Why would you
think that correlation is there? Sir Nigel I was putting that
to, in particular. You are in charge.
Sir Nigel Crisp: Yes, but Mr Bacon
may know more of the detail of this. Why would I think that? I
suspect that if you look at that particular area it is probably
harder to recruit in that particular area than some other areas.
Q142 Mike Penning: The major deficit
is what I am interested in.
Sir Nigel Crisp: Yes, well, that
may be the reason there, but it may also be that there are problems
within the organisation and some instability within the organisation
so they may be using more agency staff. I do not know the answer.
I am sorry
Mr Bacon: As my colleague, Mr
Douglas, said, we adjust the allocations to health communities
by a market forces factor which seeks to reflect the market condition
in that particular area. In Central London the premium, I think,
is something like 30%, is it not, Richard, above the basic to
reflect mainly the employment conditions. Where you get imbalances
in the labour market you are bound to have to look at short-term
solutions around agency staff, and those have happened more in
the south than they have in the north. We have addressed that
through two ways. One is significantly to expand the number of
training places we have and therefore the number of people coming
into the work force, very significant numbers in the nursing areas.
The second is by establishing NHS Professionals, which seeks to
give more control to our utilisation of bank and agency staff
particularly in high cost areas. I think Dr Naysmith would remember
this from his Bristol experience where the balance of market supply
and demand were quite seriously against us in Bristol; and we
have done a lot of work, have we not, to redress that and now
we find that the agency costs have come down and that health economy
is operating much more stably.
Q143 Dr Naysmith: There was also
probably a management issue which contributed to it, taking both
explanations that have been given?
Mr Bacon: We have, as you know,
in answer to one of earlier questions, directed some of our very
best management talent to Bristol now so that you now have a combination
of things, and these things have to be seen holistically, but
I would not disagree that there is a correlation—although
we will try and prove it statistically—between high cost
labour markets where supply and demand we are able to balance
and the financial impact on trusts, and part of what we have been
doing is seeking to address that. I think there are some good
illustrations around the country of where we have been successful.
Q144 Mike Penning: You do not think
it could have something to do with the morale of full-time permanent
staff not knowing whether they are going to have a job tomorrow
and so they are moving into areas where it is more stable? For
instance in south-west Herts the chief executive there told me
recently that unless he made the £10 million cuts he would
not be able to pay the wages at the end of the fourth quarter.
You are not really going to feel stable in your employment and
perhaps move off to another job, which is one of the reasons why
you need staff in that particular area?
Mr Bacon: I think we have to look
at this against the background of an NHS which has added something
in excess of 200,000 to its workforce over the last five to six
years; so this is not an industry or a service which has been
cutting back on its staffing.
Q145 Mike Penning: I think you have
become a politician here for a second. That is not the question
I asked. Where we have instances of deficits in trusts and where
trusts are likely to make staff redundant that impacts on the
individuals?
Sir Nigel Crisp: I am afraid it
does, and I could imagine that there could be a correlation that
you are talking about in some areas, and I am sure if Mr Carver
is telling you that that will be the position in your area and
it is important we get rid of it.
Mike Penning: We will tackle that with
the Secretary of State on Tuesday when I expect that sort of answer
from her, not from civil servants, to be honest with you.
Q146 Mr Burstow: I just wanted to
ask a couple of questions about workforce planning and manpower
issues. Looking at the estimates for healthcare professionals
completing training and particularly looking at the various projected
new graduates each year which is set out in table 1.1.5, it does
not appear to be very reassuring when they are looked at against
table 116, which shows the numbers of retirements and one looks
also at information that has been provided in terms of vacancies
and unfilled posts, and so on. Can you give us some idea of where,
for example, we are in respect of midwifery and radiography in
terms of meeting the existing need and the forecast needs of the
NHS in terms of those workforce groups?
Mr Foster: You have correctly
identified two of the occupational groups where we have had most
workforce pressures, and in each case we have got dedicated plans
to address those. The numbers of trainees of midwives have gone
up by 60% since 1997, the numbers of trainee radiographers has
gone up by 90% particularly in response to those shortages and,
in addition, we have got specific return to practice schemes for
people who have left the NHS for whatever reasons, (such as to
have families) to bring them back and they have been very successful.
The midwifery figures are actually one of the best successes that
we have had in recent times. The latest year for which figures
are available, which is the workforce census of September 2004,
show that that year has been the biggest growth in midwifery numbers
in recent times. There was a growth of 900 full-time equivalent
midwives in that year. I am sorry, a 900 head-count and 400 full-time
equivalents. Indeed, the latest vacancy survey that we have had
shows the vacancy rate for midwives running at its lowest (1.8%)
since we have kept records in this particular way. I do not have
the exact corresponding figures for radiographers in front of
me, but they are showing a similar trend and I would be happy
to let you have those.
Q147 Mr Burstow: Just looking at
the two tables that you supplied information, the additional information
you have given us today, it would be helpful to have that tabulated
as well. Trying to get a clear picture of how workforce issues
go forward is one of the issues I want to come on in a minute
because the data collections here seems to be changing, but when
we look, for example, at the answers that have been supplied around
radiographers, we see that the number of radiographers is going
up by, I think it is, 4,267 over the next five years, but the
numbers, just on the figures around retirement, who are leaving
is 1,280. What this does not tell us and what I want to try and
get underneath and get you to give me some sense of what the Department's
forecasts are in terms of increased need is whether the additional
2,987 radiographers that will come into the workforce over the
next five years is sufficient (a) to address the shortages that
are currently in existence and (b) to in fact meet the very significant
increased demands around scanning and other matters that the Department
is pressing on at the moment?
Mr Foster: That is exactly the
basis of those figures. We look forward in terms of activity planning
to see what extra requirements are imposed, for example particularly
by the 18-week target that we are working to in 2008 where it
is acknowledged that diagnostics is going to be one of the most
important bottle-necks we have to solve; so effectively that creates
a demand figure. Then we have an existing workforce, and we know
about the rate of people coming into it from training and from
returning to practice, we know about the age of it and its propensity
to retire, we also know our capacity to recruit from overseas
is somewhat less in radiography than in some of the other professions,
and so the figures that you have in front of you are the result
of all those calculations.
Q148 Mr Burstow: So these projected
new graduates each year are after taking into account attrition
during training and people not actually entering into the NHS
workforce. These are the ones you actually think will wind up
working in the NHS?
Mr Foster: That is correct. In
addition to that, this has been one of the major areas of workforce
re-engineering where we have been creating the role of radiographers
assistant, which is somebody who has got a set of skills which
enables them to carry out certain tasks that were formerly carried
out by radiographers, thus freeing up their time to carry out
more complex tasks. It has been one of the particular successes,
the five-stage career pathway for radiography.
Q149 Mr Burstow: You are telling
us that the figure of 2,987 additional diagnostic radiographers,
I think this is, by 2009, 2010 is going to be sufficient to meet
all the current planned and expected additional activity that
the NHS is going to need to deliver on its 18 weeks?
Mr Foster: That is the best available
plan we had at the time we did a long-term workforce plan. From
my involvement in long-term workforce planning, I would be the
first to tell you that things change and obviously we would revisit
that on an annual basis. Indeed the number of training commissions
that we will be ordering about now will be the ones that will
be starting training in September 2006 who will be coming out
in 2009; so we are constantly reviewing those workforce plans.
Q150 Mr Burstow: That brings me on
to the other issue, which is around data collections, which is
something which has been highlighted as a bit of a concern in
terms of whether the Department is collecting the right information
to enable it to look into this rather murky future and adequately
plan and be able to inform members of this House as to whether
or not we are getting value for the money that is going in. What
I wanted to particularly point to was that there are a number
of things that you used to collect you have stopped collecting
in order to achieve efficiencies. I think in the Annual Report
you talk about a 20% reduction in data collection. I know, for
example, the NHS Confed has been pressing you about an issue,
but they talk about "smart reporting" as being, if you
like, what they want to see, not necessarily overall less reporting.
I notice also that the King's Fund have claimed that large swathes
of mental health workforce data, for example in the voluntary
and private sectors, are unaccounted for and can only be ascribed
in relation to the services for which they are employed. Do you
believe currently, in terms of your job as the person responsible
for human resource planning, that the NHS does collect the information
necessary for you to make really meaningful and reliable forecasts
about workforce needs?
Mr Foster: The principal workforce
data collection that we currently use is the annual September
census, and, as you will have seen from the table, the workforce
data collections that we have discontinued are the collections
of medical workforce numbers which were being collected on a quarterly
basis precisely because there were targets set for GPs and consultants
and we were monitoring our progress towards those targets which
have all now been completed; but I think that conceals a wider
question that you are asking about the difficulty of workforce
planning when you are working across sectors, and what we have
here is what used to be called workforce development confederations
but were bodies which had stakeholder arrangements at local level
in order to do cross-sectoral planning with social care and the
private sector, and we recognise that with the increase provision
from the private sector we are going to have to strengthen those
arrangements. One particular thing that I would draw your attention
to for NHS staff is that we are currently rolling out something
called the "Electronic Staff Record". This is a common
software system for recording not just workforce numbers but all
of the details about the workforce. We have currently reached
approximately 20% roll out. By the time that is completed in about
2008-09, we will have instant data warehouse access and a much
more sophisticated ability to provide national workforce information.
Q151 Mr Burstow: I think it would
be useful if we could have a note on that, because it might be
something we might want to come back to. I just want to come back
to what the King's Fund have been reported as saying around the
mental health workforce. The point, in a way, that you are alluding
to is that because we are increasingly moving to a mixed economy
of provision in healthcare large parts of the workforce already
are outside of the NHS family and potentially more so in the future.
That must make your task of planning for workforce needs more
complicated. Do you believe you currently have sufficient information
that captures that complexity?
Mr Foster: We do not have sufficient
at present, but we are currently putting into place arrangements
for effectively the new workforce planning world where there will
be the ability to set up local data collection arrangements with
both the private sector and with social care, further data collections,
I should say, than we have at present.
Q152 Mr Burstow: I think the last
thing I wanted to pick up on was again an issue about the question
around commercial confidence. There is an issue here which I raised
with Mr Bacon, I think, a couple of weeks ago but it is also relevant
to this issue of meaningful workforce planning, because a lot
of information now is being labelled as "commercial in confidence"
and it is not always accessible to Members of Parliament, let
alone members of the general public. Are you concerned that in
a way that is being used in an abusive way that actually means
that it is not possible to get at whether or not the organisation
is performing in a satisfactory way and delivering value for money
for the public and does it get in the way of workforce planning?
Mr Foster: In so far as you are
directing the question at me, I would say, no. I have no shortage
of problems that come across my desk and this is not one that
has ever come across my desk.
Q153 Mr Burstow: Perhaps we can come
on to the list of problems you have coming across your desk. Perhaps
you could give us a list of those!
Mr Foster: Workforce planning!
Mr Bacon: I think you are right,
we had an exchange on this the last time I was here, and I think
I said to you at the time that we seek to observe as closely as
we possibly can the Freedom of Information Act but also against
the confidentiality requirements of public contracts, and that
is often quite a difficult course to steer. Explicitly relating
to the point that you were addressing to Mr Foster, the contracts
that you were particularly interested in, which I think were the
independent sector treatment contracts.
Q154 Mr Burstow: It was more Allianz
medical, but yes?
Mr Bacon: That is essentially
part of the same programme. That is a relatively small element
of our business—it is less than 1% of the activity of the
NHS—so, in terms of its overall impact on the workforce
statistics, I suspect it is not easily significant at the moment.
Q155 Mr Burstow: To finish off on
that (and it is useful you have made reference to that), the thing
that I am particularly vexed about is the access to the key performance
information that comes from those contracts. I have asked questions
in which a previous minister of state responsible for this area
declined to provide information on grounds of commercial confidentiality.
It was hard to see how providing the information about the performance
of the organisations delivering on the scanning contracts should
be deemed to be commercially confidential, because it goes to
the heart of determining whether the public are getting value
for the money that they are putting into those contracts. Has
there been any further reflection upon whether or not the position
that was taken at that time in giving those answers was the right
position in the light of what you have told me today about of
freedom information?
Mr Bacon: As I have said, we look
both in the general policy sense and on an ad hoc basis at each
request either through FOI or from your good selves, and we would
be as liberal as we can in the interpretation of the commercial
confidentiality and FOI requirements. I think we can say our department
has a pretty good record in the generality of freedom of information,
but this is in very, very sensitive territory commercially and
I take very careful advice from our lawyers and my commercial
people. Our predilection is to make as much information available
as we possibly can.
Sir Nigel Crisp: Absolutely.
Q156 Mr Burstow: Could you possibly
revisit the questions I have asked about this and see whether
or not you could be a little bit more liberal (with a small "l")
in terms of releasing information about performance, not about
what I would regard as commercially sensitive but just about how
the contract is performing from the point of view of the punter
in the street in terms of the service they are actually getting?
I think we should be entitled to have that information.
Sir Nigel Crisp: We will re-look
at that. I cannot give you the answer, but we will look at it.
Q157 Chairman: I think there is a
further restriction in this area in terms of commercial in confidence
in relation to the NHS prescription service and the classes of
drugs, not necessarily the individual drug concerned. Why is that
not available?
Sir Nigel Crisp: I am not sure
if I know the answer to that, and I do not know if any of my colleagues
do.
Q158 Chairman: It would seem to me
that, whilst it may not be a target, it would be a measure of
what has been dispensed up and down the country of how either
public health initiatives or acute initiatives are actually working
out. It would be a measure; it may not be a terribly accurate
one. Is there an issue about commercial in confidentiality?
Sir Nigel Crisp: I am sorry, I
just do not know.
Q159 Chairman: Would you mind getting
back to us on that?
Sir Nigel Crisp: We will get back
to you.
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