18% 12% 15% 23% 25% 18% 23% 24% 5% 0% 20% -4%
E ngland S cotland Wales Northern Ireland total regis tered non-regis tered
The highest rate of growth in the registered nursing and midwifery workforce was in England with a 25% increase in FTE between 1999 and 2008, whilst Scotland had the lowest rate of growth in the registered workforce at 18%.
As noted earlier in this thesis, this growth in the nursing workforce was in response to policies that included specific targets to be achieved within defined timeframes. The NHS Plan in England (Department of Health 2000a) set a workforce target of an additional 20,000 nurses by 2004; however this target was exceeded, as the actual growth in headcount increased from 289,373 in 2000 to 336,615 in 2004 equating to an increase of 47,242
headcount. The increase in FTE over this time was 40,131 which was also more than double the original target set for the increase in headcount (NHS Information Centre). A later target for 35,000 nurses, midwives and health visitors by 2008 outlined in Delivering the NHS Plan (Department of Health 2002a) was achieved five years ahead of schedule.
In Scotland the Partnership Agreement (Scottish Executive Health Department 2003a) committed to bring 12,000 Registered Nurses and Midwives into the NHS in Scotland by 2007. The National Workforce Plan of 2006 reported that this target was close to achievement as 11,504 registered staff had been recruited into NHS Scotland between September 2002 and September 2005 (Scottish Executive Health Department 2006c). The manner in which the target had been presented left it open to different interpretations; as the focus was on recruitment numbers not net growth in the workforce. The workforce statistics for Registered Nurses and Midwives presented by the Information and Statistics Division (ISD) identified an actual increase of 3,03127 in the registered nursing and midwifery headcount in Scotland over this period.
In 2002 the Health Minister in Wales committed to increasing the numbers of Healthcare Professionals in the NHS which included the announcement that ‘by 2010 we will have planned for. . . 6,000 more nurses’ (Welsh Assembly Government 2002). One year later the Wanless Review reported that this target was insufficient and estimated that, based on workforce planning data for 2002, there was a need for ‘+8,046’ nurses by 2008 (Welsh Assembly Government 2003a, p.37). Subsequently Wales: a Better Country included a commitment for ‘3,000 extra nurses’ however the deadline for delivery of this target was unclear as the policy implementation plan detailed that ‘increased training of new nurses and recruitment policies should be delivered by 2006’ (Welsh Assembly Government 2003b, p.30). The original target of ‘6,000
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During the period under review ISD workforce data for Scotland changed to reporting by Agenda for Change banding. Not all staff had been assimilated to AfC therefore a pro-rata assessment was used by the researcher. This would not have had a significant impact as there were only small numbers of staff awaiting assimilation.
more nurses’ by March 2010 was again reinforced in Designed for Life (Welsh Assembly Government 2005a, p.75).
The registered nursing and midwifery headcount in Wales rose by 4,908 between 2003 and 2006 indicating that the commitment of 3,000 extra nurses had been exceeded. A press announcement in 2005 from the Health Minister informed that ‘we are well on our way to meeting our targets of recruiting 6,000 more nurses’ (Welsh Assembly Government 2005c), however by 2008 the overall registered nursing and midwifery headcount had reduced to 24,602 which was lower than the headcount of 25,821 in 200228. In common with the wording of the Scottish target, this nursing workforce target was open to mixed interpretations as recruitment of ‘6,000 more nurses’ did not necessarily equate to a net growth of this level, and it was dependent on the start and finish dates being defined.
In Northern Ireland ‘an estimated shortfall of 2,799 in the [nursing] workforce’ was identified (Department of Health, Social Services and Public Safety and KPMG 2002, p.14) however no specific target was set for nursing workforce growth.
Overall there was a lack of detail provided on how the targets for nursing workforce growth were calibrated and whether the numbers identified were full time equivalents or headcount. It was also unclear if these targets included or excluded nurses in training. Generally the statements relating to the nursing workforce targets were vague.
The rates of growth for the non registered workforce were also variable. In Scotland the size of the non registered workforce in 2008 was broadly comparable to that in 1999. In Wales there was initially growth in the non
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Significant anomalies were identified between nursing and midwifery FTE and headcount data reported by Health Statistics Wales for 2007-2008 for both the registered and non- registered workforce. Enquiries made by the researcher uncovered that this was linked to a change in how data was recorded and prior to 2008 there was double counting of individuals who held substantive and bank contracts.
registered workforce, however overall the 2008 FTE figure was 4% less than the figure for 1999. This was accompanied by a more significant reduction of 26% in the headcount over the same period, signifying either a reduction in part-time employment or alternatively that there is an issue with the data quality29. In England and Northern Ireland there was growth in the non registered workforce (FTE) of 5% and 20% respectively.
The data indicates that there was a variable but high level of growth in Registered Nurses across the period under review with lower rates of growth in the non-registered nursing workforce, resulting in a richer skill mix at the end of the study period than there was at the beginning. The different levels of staffing growth across the period under examination had not led to staff:population parity across the four UK countries. A report from the Nuffield Trust identified significant differences between countries in relation to the FTE nursing, midwifery and health visiting numbers per 1,000 population. England had the lowest levels of FTE/1,000 population whist Scotland had the highest (Connolly, Bevan and Mays 2010).
5.3.2 Nursing Skill Mix
The proportion of Registered Nurses and Midwives as a percentage of the total nursing and midwifery workforce provides a measure of the skill mix. Higher percentages of Registered Nurses or Midwives represent a higher skill mix. Based on FTE figures in Table 5.1 above, the lowest level of skill mix was in England where the proportion of Registered Nurses was initially 66% in 1999 increasing to 70% by 2008. In Scotland it increased from 69% to 73%, Wales moved from 73% to 78% whilst in Northern Ireland it remained consistent at 77%. This meant that three of the four UK countries reported a trend of a richer skill mix across the period, as well as the numerical growth identified in all four countries. The trends in the percentage of Registered Nurses and Midwives in the total nursing and midwifery workforce are detailed in Chart 5.2 below.
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Chart 5.2 Registered Nurses and Midwives as a Percentage of Total Nurses and Midwives in FTE (1999-2008)