Examination of Witnesses (Questions 912-919)
PROFESSOR CHRISTOPHER
FOSTER, MR
PHIL GRAY
AND MS
LOUISE SILVERTON
18 JANUARY 2007
Q912 Dr Naysmith: Good morning. I welcome
you to the Select Committee on Health. At the start of the session
I apologise for the absence of Kevin Barron, our Chairman. He
is on important parliamentary business elsewhere in the world
and cannot be with us today. If you listened to the previous session
you will know that we allowed it to stray rather widely, but we
have you with us today to talk particularly about your colleges
and the society. We will focus particularly on your problems and
the matters you have put to us in writing. You all represent staff
groups which face particular challenges with regard to workforce
planning. What are the most important problems facing your organisations
and the clinical groups you represent? Before you deal with that,
for the record perhaps you would introduce yourselves.
Ms Silverton: I am Louise Silverton,
deputy general secretary of the Royal College of Midwives. I have
been a midwife for some 28 years and have delivered in excess
of 1,000 babies, so if anybody needs any advice on that I am available.
Professor Foster: I am Professor
Christopher Foster, director of workforce planning at the Royal
College of Pathologists. I am also the George Holt professor of
pathology at the University of Liverpool, having been trained
in both this country and the United States of America.
Mr Gray: I am Phil Gray, chief
executive of the Chartered Society of Physiotherapy. I have been
involved in industrial relations, healthcare and workforce matters
for the best part of 25 years. I was previously director of labour
relations for the Royal College of Nursing.
Q913 Dr Naysmith: There are problems
for all of the professional groups you represent.
Professor Foster: Dr Naysmith,
perhaps I may answer that question at the very beginning. You
asked what the major problem was. Perhaps I may say that the way
the college was invited or not invited to be present here exemplifies
exactly the problem with pathology, that is, profile and perception.
Not only within the lay community but also within much of the
medical community there is a profound failure to understand the
role of pathology across all the specialties, what it does and
what it contributes and how it is fundamental in underpinning
the vast majority of the medical activities that go on in this
country from the time that a person presents.
Q914 Dr Naysmith: Therefore, do you
think that there is a problem in the way we have introduced it?
Professor Foster: The fact we
were not invited to be present right from the very beginning so
that our written submission was not included in the book which
was published meant that no profile of pathology was included.
I think that that absolutely exemplifies a major problem with
healthcare in the United Kingdom.
Sandra Gidley: It is up to organisations
to be proactive. We do not specifically invite anything from anybody,
as I understand it.
Q915 Dr Naysmith: It was not a question
of issuing individual invitations.
Professor Foster: But the answer
is profile. If there is not a profile, whether it is in the medical
school or in the community, we are unlikely to attract large numbers
of people who want to come into pathology, whatever be the specialty.
Without a profile it is unlikely that the lay community outside
understands what it is we do.
Q916 Dr Naysmith: You probably are
unaware that I was a lecturer in pathology for 25 years at the
University of Bristol Medical School, although I am not medically
qualified. As you will know, you can be a pathologist without
being medically qualified. Therefore, there is some knowledge
around the table as to how important pathology is.
Ms Silverton: We have a similar
problem in midwifery. We put ourselves forward to be here, but
many people think that we are nurses; we are not. We are the senior
professionals present at in excess of 65% of births in the UK.
We work with women from the point of pregnancy up until four to
eight weeks after birth. We find ourselves with a very serious
problem. Three years ago the Government recognised that there
was a significant shortage of midwives; they put in place a six-point
action plan to address that shortage. We had some increase in
midwifery numbers, but we find ourselves now in a position where
midwives, for whom there is a need, cannot get jobs when they
complete their training. We have an increasing birth rate and
medicalisation of births. The make-up of the child-bearing population
with immigration has changed markedly. We also seek to implement
government initiatives with respect to the manifesto commitments
and the maternity standard within the national service framework.
There is no sight at all of any work on the requirements for additional
midwives and training for those midwives who are currently in
post to take on new roles in relation to being the first point
of contact in pregnancy and to work in non-medicalised units,
be they midwife-led or at home. We think that we have really serious
problems. We hear that because of the financial cuts some areas
seek to stop all post-natal care. What is happening? On the one
hand, the Government say that midwifery is important; it is there
at the start of life; they want the best possible care for mothers
and babies, and yet nobody is paying any attention to midwives.
Q917 Dr Naysmith: Do you know of
any workforce planning in this area?
Ms Silverton: As a college we
have done a lot of workforce planning, and there is also a workforce
planning tool called Birthright-Plus, which is supported by the
Government, that will tell you how many midwives are needed in
a particular setting for a particular population and will also
deal with the skill mix. Many units have done that, but what they
have not done is to say, "We are 20 midwives short. Let us
go and get midwives." We know that this is costing the NHS
money, because shortage of midwives leads to poorer care and maternity
services are a major contributor to litigation costs. It is very
foolish to be skimping on midwives and not giving women access
to the care they need, coming poorly prepared to labour and seeing
the result in intervention rates.
Q918 Dr Naysmith: We will come to
some of these matters later on. Mr Gray, your written submissions
state that allied health professionals are being subject recently
to poor guesswork, not workforce planning. What is your justification
for that statement?
Mr Gray: Many of the comments
that I have to make would apply specifically to physiotherapy
but also to many of the allied health professionals who have significant
problems: speech and language therapy; occupational therapy; radiography
to some extent; dietetics and healthcare science. There are common
problems. We have big problems in workforce planning which we
believe has been subject to poor guesswork. Starting with the
position that has been reflected already in the previous discussions,
only three years ago there was a very serious shortage of physiotherapists.
Interestingly, the history over the years was that planners grossly
underestimated the number of physiotherapists that would be required
and the demand that the jobs have created has exceeded that—hence
the reason why the year before last we ended up with a situation
where we had difficulties filling 1,500 vacancies in physiotherapy.
We recognise that workforce planning is not easy, and I have been
involved in the system long enough not to pretend that it ever
is a simple magic formula. The problem arises where the occasional
long-term vision gets lost by short-term demands and is buried
by them. For example, we believe that there is a complete lack
of resource going into properly assessing these groups. The reason
I say that it is a guesstimate for AHPs and healthcare science
is that a week ago the Health Service Journal released
a document from the Department of Health which appeared on the
front pages of most national newspapers announcing predictions
of 3,200 too many consultants, too few junior doctors, too few
nurses and—this is a wonderful one—that by 2010 there
would be 16,200 too many allied health professionals, healthcare
scientists and technicians. When one looks—I have seen the
document—there are no data, evidence or breakdown. What
one has is a series of long-term forecasting done by the very
scientific method of putting a wet finger in the wind; in other
words, it is a guesstimate; there is no evidence to back it. There
is a lack of resource to look at that long-term need. It needs
to be done and can be done because, for example, the medical sub-specialties
devote a lot of resources from the Department of Health and others
to doing precisely that. We believe that there is a real problem
about lack of follow through. It is one thing to commission future
workforce. Once one has taken in those students, paid for by the
taxpayer and commissioned by the NHS, there should be a contractual
responsibility to ensure that the service does some thinking about
what to do with the people who have been commissioned. All too
often that does not happen. It almost appears as though six months
or two months before or afterwards there is a sudden rush and
people ask, "What should we do with these people?" They
have not planned it. We believe that there is a genuine and scandalous
waste of highly committed and talented people, 30% of whom are
mature students with second careers who come into physiotherapy
as a result of advertisement by the Government. They now feel
very let down and a significant number feel betrayed.
Q919 Dr Naysmith: That has probably
obviated the need for one or two questions later on. Professor
Foster, do you have any general points to make at this stage?
Professor Foster: To an extent
I endorse what I have just heard, but I think that pathology is
in an almost unique situation in that we span not only the medically
trained pathologists but also, in terms of our responsibilities—mine
is that of the director of workforce planning—the clinical
and bi-medical scientists. You will probably be aware that under
the Knowledge and Skills Framework led by Sue Hill, with whom
we have co-operated very closely, there is a strong move to look
at the career pathways of all three groups. We look at the roles
and what will be necessary not only to deliver pathology as we
understand it today but to scan the horizon and identify new technologies
that need to be introduced. We look at how to devolve responsibility
sideways from groups currently practising or taking responsibility
for certain of the tests to other groups so they can be performed
perfectly competently, whilst allowing those with other training,
for example medical training, to become more patient-interactive
or interfaced in an appropriate manner, or to be at the cutting
edge in terms of developing technologies through a new understanding
of disease processes. Here is an ongoing education component,
if you like, which affects the medically and scientifically trained
which I think is of paramount importance in the development not
only of pathology but all medicine and the delivery of healthcare.
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