Supplementary evidence submitted by NHS
Employers (WP 29A)
Since the submission of evidence to the Health
Select Committee by NHS Employers and our oral evidence session
there have been a number of major policy developments in areas
of concern to the committee. Below is an update on each of these
developments and on the work of NHS Employers to support them.
POLICY ON
EDUCATION AND
TRAINING EXPENDITURE
NHS Employers believes that expenditure on training
and education is an investment by the NHS in its "human capacity"
and is concerned to ensure that the NHS continues to make adequate
resource available in this area. We believe that the central allocation
of money for education and training via the Multi-Professional
Education and Training (MPET) budget has helped ensure long-term
investment is being made in education and training. The system
of funding may need to be reformed and we are currently working
with the Department of Health on ideas for improvement.
NHS Employers understands that there is now
greater flexibility in the allocation of central budgets to Strategic
Health Authorities including over the use of MPET funding. We
are aware of concerns that this may result in lower levels of
spending on education and training. We believe that, just as money
allocated for capital investment is safeguarded from diversion
into day-to-day expenditure, investment in education should also
be protected.
NHS Employers supports a strong role for SHA
in workforce development and clearly this should include balancing
investment in education and training with local service priorities.
We believe, however, that there needs to be adequate investment
in education and training to avoid the re-emergence of "stop-go
cycle" that contributed to the workforce planning problems
in the 1980s. Expenditure on post graduate training and training
for non-professionally qualified staff is essential if the NHS
is to meet its staffing objectives.
NHS Employers believes that there may be value
in assessing the impact of the first year of greater flexibility
in expenditure on education and training and suggests that the
Health Select Committee might be interested in exploring this
further. We welcome the assurance that the Department of Health
will be asking SHAs to report on spending allocations in this
area.
OVERALL JOB
REDUCTIONS IN
THE NHS
According to the Department of Health, the number
of reductions in NHS posts has stabilised around 14,000. In the
majority of cases this is being achieved by a combination of vacancy
controls, reductions in temporary staffing, natural wastage and
voluntary redundancy measures. However, in a small number of trusts
compulsory redundancies are likely to be necessary for a variety
of reasons and some redundancies have been declared. NHS Employers
will be asking trusts for an update on their situations in the
autumn.
NHS Employers is supporting employers in seeking
to manage job reductions and avoid redundancies, working with
national staff side organisations. We have recently issued a range
of information to advise and support NHS organisations facing
workforce changes.
OPPORTUNITIES FOR
NEWLY QUALIFIED
STAFF
There has been more publicity recently about
the difficulties that graduate nurses and physiotherapists are
having in finding posts. New graduates in these professions are
likely to find more competition in finding their first job that
in the recent past and may have to be prepared to be mobile to
secure a post. NHS Employers is identifying and sharing good practice
examples of what trusts are doing to address this issue.
RECRUITMENT AND
RETENTION IN
THE NHS
In our original evidence to the Health Select
Committee NHS Employers drew attention to the potential challenges
created by the large expansion of medical school places. [28]We
welcome the fact that the Department of Health has provided funding
to ensure that all medical students graduating this year will
be able to find places in the Foundation Programme. With support
from deaneries and employers it appears this will be achieved,
although newly qualified doctors will need to be flexible about
where they are willing to practice. We continue to believe that
a modest measure of "oversupply" does have some benefits,
eg for recruitment.
NHS Employers is also working with Modernising
Medical Careers and the Department of Health to address concerns
over the transition of existing doctors into the new Foundation
Programme or Fixed Term Speciality Training Appointments. The
aspirations of doctors need to be balanced with the needs of the
service in both the short and the longer terms.
All existing Senior House Officers (SHOs) cannot
expect to get straight into run-through training in 2007 anymore
than all SHOs were able to get Specialist Registrar jobs in the
past; nor can SHOs expect to be able to train in the specialty
of their choice if this does not give the NHS the right mix of
consultants in the right specialties to deliver clinical services.
In the medium-term there will remain an issue
of how the growing numbers of medical students can best be employed
in future.
NHS Employers has recently set up a Medical
Workforce Forum to engage employers in shaping policy on how best
to use these increased numbers of medical graduates eg by changing
job roles.
ISTC CHANGES TO
ADDITIONALITY POLICY
To address current staffing challenges, there
has been a change in the "additionality" rules to allow
newly qualified nurses or those at risk of redundancy to be employed
by ISTC providers. NHS Employers has worked in partnership with
the trade unions and the Department of Health to develop these
new rules.
WORK PERMIT
CHANGES: MEDICAL
As the committee will be aware, the increasing
supply of graduates from UK medical schools has led the Government
to alter the work permit regulations for entry to seek a post
as a doctor in the UK. NHS Employers supports this change, which
brought doctors in line with other occupations so that work permits
are now required before medical students can enter the UK to study.
Transitional arrangements have been implemented for students already
in the UK. NHS Employers is offering advice to trusts on the implementation
of these changes.
NHS Employers is concerned however about the
operation of the Highly Skilled Migrants Programme. This means
that that large numbers of overseas students will continue to
be able to compete for places against a rising number of UK and
EU graduates.
WORK PERMIT
CHANGES: NURSING
The Home Office has taken nurses at Band 5 (entry
level newly qualified nurse) off the "shortage list".
This means that employers will not be able to recruit to a vacant
post without first placing an advert within the UK. They will
have to demonstrate that they cannot fill a post with a UK or
EEA applicant first. After they have advertised, if employers
are still unable to fill a particular nursing post, they may then
apply to the Home Office for a work permit. Work permits may be
granted for a period of up to five years. We broadly welcome this
change as it will assist the service to employ the increasing
numbers of UK nurse graduates in the NHS.
Due to a growing number of newly qualified UK
nurses, trusts are likely to be able to recruit UK nurses at Band
5. However, there are still shortages in certain specialties among
the most advanced and senior nurse grades in bands 7 and 8 and
they are unaffected by this change. Most international nurses
permanently employed by the NHS will have time-limited contracts
of employment. There are arrangements within the work permit rules
to allow an employer to seek an extension of a work permit without
needing to test the resident labour market. The position for other
health professionals should be kept under review. NHS Employers
is advising trusts on implementation of the new arrangements.
PRODUCTIVITY
On behalf of the Department of Health, the NHS
Institute for Innovation and Improvement has published a set of
workforce productivity metrics including sickness absence, use
of temporary staff and Finished Consultant Episodes.
NHS Employers will be working with the service
to use this data effectively. We believe this type of data is
useful as long as it is used in a balanced way and takes account
of the different pressures on trusts. Such data can be taken into
account in job planning for consultants.
NHS Employers has been asked by the Department
of Health to develop best practice advice on the devolution of
budgets to clinical teams.
NHS Employers
4 September 2006
28 Fifth Report of the Health Committee, Session 2005-06,
Workforce Planning, HC 1077-11, Ev 126-Ev 132. Back
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