5.1 Introduction
This chapter analyses nursing workforce data and provides some of the workforce context to the issues examined in the interviews. It outlines the changes and trends in the UK nursing workforce since devolution and provides detailed information on the profile of the nursing workforce at the time of the interviews in 2008.
A summary of nursing workforce data in each of the four countries is presented and key trends are identified. The data used is taken from a range of official sources including the NHS Information Centre England; Information Services Division (ISD), Scotland; Information Analysis Directorate, Department of Health, Social Services and Public Safety, Northern Ireland; Statistical Directorate, Welsh Assembly Government; Nursing and Midwifery Council (NMC) and Royal College of Nursing (RCN). Limitations of the available data are identified and gaps in the data are highlighted.
5.2 Background Information Regarding Nursing Workforce Data
Five main data-sets of nursing workforce data have been developed for this thesis. The first four data-sets were national data-sets from each of the four UK countries developed from information obtained from the government health departments in Scotland, Wales and Northern Ireland and from the NHS Information Centre, England. These datasets contained details of the Registered Nurses, Registered Midwives and nursing and midwifery support staff employed, principally within the NHS, in each of the four UK countries. The fifth dataset was UK wide and was derived from the Nursing and Midwifery Council (NMC) registrant database which provided details of Registered Nurses and Registered Midwives who were eligible to practice in the UK. The data from the NMC included Registered Nurses and Registered Midwives who were eligible to practice but who were not in employment along with some UK Registered Nurses and Midwives who were working overseas. The NMC data set included ‘whole population’ data for the
profession across the UK, and as such provided a backdrop to the more detailed country specific data.
The main focus of this research study was the registered nursing workforce; however inclusion of the non registered nursing workforce provided a profile of the total nursing workforce and an insight into changes in the composition and skill mix of the workforce over the period 1997-2008. The registered nursing workforce includes all Registered Nurses who have completed first or second level training. First level training is generally undertaken over a minimum period of three years and currently is based on a degree or diploma qualification. Second level registration22 involved a two year period of training but this level of preparation ceased in the UK in the mid 1980s. Subsequently a high proportion of second level Registered Nurses undertook conversion courses to become first level Registered Nurses. There are four recognised fields of nursing 23 on the NMC Register:
Adult / General Nursing Mental Health Nursing Learning Disability Nursing Children’s Nursing.
Another approach to delineating the registered nursing workforce is to use the NHS Agenda for Change24 pay bands, with bands five to nine defining Registered (‘qualified’) Nurses and Midwives (Department of Health 1999b). The non registered nursing workforce, which includes Nursing Auxiliaries, Health Care Support Workers, Assistant Practitioners and Associate Practitioners, can be defined as the elements of the overall nursing workforce employed on Agenda for Change bands one to four.
22
Second level nurses were also known as Enrolled Nurses. 23
a fifth for Registered Fever Nurses is now closed. 24
Agenda for Change is the national pay system for the majority of NHS staff (excluding doctors and dentists). The pay bands range from 1 (lowest) and 9 (highest).
In the data analysis, it was not always possible to separate out the number of Registered Midwives or midwifery support staff from the nursing workforce data. Therefore midwifery information has been included in the datasets where it has not been possible to isolate the nursing workforce data. In order to provide an indication of the size of this workforce, the registered midwifery workforce in England represented approximately 7% of the registered nursing and midwifery workforce during the study period (NHS Information Centre 2009).
There was no uniformly agreed method for collecting nursing workforce data across the UK and separate systems existed in England / Wales, Scotland and Northern Ireland. Consequently it was more difficult to make direct comparisons between the four countries, for both the registered and the non registered workforce.
The workforce data published by each country is based on the number of staff in post (SIP) and predominantly reflects the nursing and midwifery workforce employed in the National Health Service (NHS), although attempts are now being made to expand data collection to include non NHS employers, particularly as increasing numbers of nursing staff are now being employed by Local Authorities and the independent sector. The data is generally obtained through the Electronic Staff Record (ESR) in England and Wales, the Scottish Workforce Information Standard System (SWISS) and the workforce census in Northern Ireland. There are limitations to the robustness of the workforce data, predominantly because it is dependent on the accuracy of staff records within NHS employing organisations, which may be incomplete or out of date. The reliability of the workforce data is however improving as the ESR and SWISS systems become more embedded within healthcare organisations. Prior to the introduction of the ESR and SWISS in 2006 and 2007 respectively, all workforce data was collected from annual or bi-annual workforce census or from independent payroll systems.
The NHS nursing workforce data is generally presented in two formats: one is headcount25 which is the total number of people employed and the other is full time equivalent26 (FTE) previously known as whole time equivalent (WTE). The ratio of FTE to headcount is an indicator of the level of part-time working, for example a ratio of FTE/HC=1 means that all staff work full time, whereas a ratio of FTE/HC=0.6 means that on average staff work 60% of the full time hours which in the NHS equates to 22.5 hours per week.
5.3 Overview of the Nursing Workforce Statistics and Trends (NHS data) 5.3.1 Rates of Workforce Growth
Table 5.1 below provides an outline of the full time equivalent numbers of Registered Nurses and Midwives in England, Scotland, Wales and Northern Ireland. The data is presented at three points in time, namely:
1999 representing a baseline position at the introduction of devolution 2004 five years after devolution
2008 when the interviews were undertaken.
25 ‘Headcount is literally a count of heads’ (NHS National Workforce Projects 2005, p153). 26 Full time equivalent (FTE) also known as whole time equivalent (WTE) ‘is the standard
method of defining the amount of work of an employee or in a position……WTE is calculated by dividing contracted hours or contracted sessions by the standard hours (or sessions) for the grade’ (NHS National Workforce Projects 2005, p193).
Table 5.1 The Nursing and Midwifery Workforce as at 1999, 2004 and 2008 FTE 1999 FTE 2004 FTE 2008 % Growth 1999-2004 FTE % Growth 1999-2008 FTE England Registered 240,831 286,841 299,917 19% 25% Non Registered 123,098 137,755 129,181 12% 5% Total 363,929 424,596 429,098 17% 18% % Registered 66% 68% 70% Scotland Registered 35,597 38,907 41,966 9% 18% Non Registered 15,777 15,614 15,783 -1% 0% Total 51,374 54,521 57,749 6% 12% % Registered 69% 71% 73% Wales Registered 17,482 20,126 21,426 15% 23% Non Registered 6,371 7,020 6,118 10% -4% Total 23,853 27,146 27,544 14% 15% % Registered 73% 74% 78% Northern Ireland Registered 11,239 13,056 13,940 16% 24% Non Registered 3,422 3,846 4,110 12% 20% Total 14,661 16,902 18,050 15% 23% % Registered 77% 77% 77%
Sources of Data: NHS Information Centre England; ISD, Scotland; Information Analysis Directorate, DHSSPS, Northern Ireland; Statistical Directorate, Health Statistics Wales, Welsh Assembly Government Data excludes the non NHS workforce which is not routinely collected.
Overall the nursing and midwifery workforce employed in the NHS grew significantly over the period of the study. The rates of growth for the registered nursing and midwifery workforce were higher than the rates of growth for the non registered workforce, with variations across each of the countries. The percentage change in the registered and non-registered workforce is detailed in Chart 5.1 below.
Chart 5.1 Percentage Change in Nursing and Midwifery FTE (1999-2008)