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Staff census shows NHS workforce hits 1.4 million

BBC Health - 23rd March 2011 2:22 pm

New figures show a huge growth in the number of staff working for the NHS in England over the past decade, particularly among managers.

By the end of September 2010, 1.4 million people worked for the health service in England.

But the NHS workforce census reveals numbers are beginning to decline as budgets are squeezed. More jobs are likely to go when the government’s reforms to the health service take hold.

There were a quarter more GPs, an increase of more than 50% in the number of consultants and the number of qualified nurses was up by a fifth.

The number of managers has also climbed dramatically over the past ten years, to 41,962 - an increase of 66%.

But the census, carried out by the NHS Information Centre, also reveals that with the government’s radical reforms to the NHS in England on the horizon, the number of managers has actually been falling in the past year.

In the year to September 2010, the number of managers fell by 2,770.

Armageddon for out-of-hours rotas finally arrives

By Caroline Whymark - 23rd February 2011 12:08 pm

It has finally arrived - the staffing crisis that has long been threatening to hit out-of-hours rotas.

The crisis has been coming such a long time that you would have thought a plan for managing it would have been put in place. We thought it would arrive in 2007 when MMC restricted training numbers. We then thought it would arrive in 2009 when the 48-hour week finally became law. But only this year, has push really come to shove.

When will those at the top of the decision-making tree actually listen and take heed of the day-to-day difficulties currently facing clinicians?

Money has been found here and there and diverted from many pots to fund a couple of extra consultant jobs (which to date don’t solve the first on rota problem).

As trainee numbers have dwindled the unused salaries have been identified and made available to be used for specialty doctor posts. But that solution doesn’t work in practice. There are fewer and fewer applications for our almost continually run specialty doctor advert. This is largely because there are no such doctors out there anymore. They are either in Specialty Training or in Australia.

Nor are there any locums. Since the ‘lost tribe’ found other sources of employment and other doctors were refused entry to the country, there is no pool of locums. Trainees are limited to a 48 hour working week. They cannot readily do the locums shifts even when extra money is available.

But, crunch time is here. Forty per cent of our trainee cohort are about to leave the programme due to a variety of bona fida reasons: a year abroad, a specialist fellow post, an inter deanery transfer, a maternity leave. These leave unfilled and unfillable posts.

Unfortunately, it feels like no-one is really listening. Perhaps we are our own worst enemy by continually coping with such staff reductions. But the slack in our system has run out. We will no longer be able to run our rotas.

What’s the solution? The number of man hours available within the system is finite.

We could waive the working time regulations, and revert to an on call system with more hours in hospital, but recognising that all of them are not spent working.

The other option is to merge sites and reduce the number of rotas to maintain current out-of-hours staffing and services. This would undoubtedly be unpopular. Smaller hospitals would close, MSPs would lose their seats, the public would lose their local hospital services and have to travel further afield for treatment.

But, is this a bad thing? Maintaining medical staffing on a wing and a prayer is not a success at any level.

The hope is that we will struggle on managing in the short term. In 2012, a bulge of trainees will finish their training culminating in the CCT and entry to the specialist register. They will be consultants in all but name or pay (status went a long time ago). There will be plenty of them, desperate for any jobs with which to pay the mortgage. The old rules of supply and demand will force them to take the jobs on offer and, lo and behold, we will have specialists to deliver the service.

But we can’t wait for them. Our out-of-hours Armageddon happens before then. Our workforce is annihilated now and trainee numbers continue to be reduced.

There will be a gap, and this sort of gap will threaten patient care. The radical and unpopular decisions that are needed will be postponed until after 5 May, the date of the next Scottish parliamentary election. And there’s a danger that they’ll be postponed until after the next one, and the next one…

Tags: Locums, Workforce, WTD
Posted in Caroline Whymark | 7 Comments »

Not enough being done to promote diversity

By Mike Broad - 10:57 am

Most new training programmes designed to widen access to medicine in the UK are failing to increase the diversity of the medical student population, a study finds.

It shows that although historic under-representation of women and of minority ethnic groups has been redressed, a large proportion of medical students still come from the most affluent socioeconomic groups in society.

Recent years have seen major initiatives to broaden the demography of the UK medical student population, but it is unclear whether new programmes, such as graduate entry and foundation entry courses, have achieved this.

A team of researchers at the University of Birmingham set out to determine whether these new routes into medicine have produced more diverse student populations.

They analysed data from the Universities and Colleges Admissions Service (UCAS) on all UK residents admitted to one of the 31 universities offering medical degrees from 2002 to 2006. They compared age, sex, ethnicity, and socioeconomic status of students admitted to traditional (school-leaver) courses with those admitted to graduate entry and foundation courses (these are courses with entry criteria relating to the demographic characteristics of population groups typically under-represented in medicine).

Across all medical schools, they found no significant difference in the proportion of men and women between graduate entry courses and traditional courses.

They found that students on graduate entry courses were, as would be expected, significantly older than students on traditional courses and were more likely to define themselves as white (84% v 70%).

Two fifths of students on traditional courses declared their parental occupation to be higher managerial and professional compared with 27% of students on graduate entry courses.

In contrast, only 23% of students on foundation programmes (where entry is restricted to under-represented groups) defined their ethnicity as white and only 8% defined their background as higher managerial and professional. However, the numbers of places available on these courses are small.

Lead researcher Jonathan Mathers, research fellow at the University of Birmingham’s School of Health and Population Sciences, questions why are more universities not operating foundation programmes or offering explicit adjusted entry criteria to traditional courses.

One reason may be that foundation programmes are more expensive than other courses to run. Others include over-reliance on aptitude tests that can favour certain groups, the impact of tuition fees on students from poorer backgrounds, and the acceptability of such “affirmative action” admission policies.

The authors conclude on bmj.com: “Evidence of the advantages of increasing diversity is emerging, but the implementation of ‘new’ admission routes to the profession does not seem to be bringing significant change.”

They add: “In both the US and UK, the most successful programmes to increase student diversification seem to be those based on explicit affirmative action, yet these programmes are not universally welcomed among the public or the profession.”

Read the full study.

Tags: Medical students, Workforce
Posted in Hospital Dr News | 2 Comments »

PCT managerial redundancies cost the NHS £40m

Healthcare Republic - 26th November 2010 10:44 am

The NHS has paid out more than £40m to over 2,000 PCT staff who accepted a redundancy package, the NHS chief executive has told MPs.

PCTs have been shedding managers in an ‘uncontrolled’ way, Sir David Nicholson told the House of Commons health select committee. The mass exodus risks opening up a management hiatus until commissioning consortia form in 2013/4.

More than 2,000 staff took the redundancy package, and in total as many as one manager in 12 has left the health service in the past eight months, Sir David told MPs last week.

The ‘mutually agreed resignation scheme’ for PCT staff cost over £40 million and has now been halted. The deal was a financially attractive redundancy package that forbids managers to return for six months.

Female doctors facing maternity leave pressure

By Mike Broad - 24th November 2010 9:57 am

Female doctors are being pressurised into cutting their maternity leaves short and prevented from working part-time when they return, the president of the Medical Women’s Federation has warned.

Dr Clarissa Fabre says, in a letter to The Guardian, that staff shortages are to blame following cut backs.

The GP says: “Women doctors now make up 58% of medical school intake. Some 43% of these doctors are under the age of 35; many will have children and will want to work part-time for a short period for reasons of childcare.

“With the present cuts in hospital funding, and the high cost of locums, colleagues are left to provide locum cover, often at very short notice and for little extra financial reward. Women consequently feel guilty when they take maternity leave, and feel they should return to work as early as possible. There is talk also of not allowing doctor parents to work part-time when their children are very young because of the shortage of doctors to cover the rotas.”

Her letter was prompted by the recent Royal College of Surgeons research which showed that the cost of hiring locums in the NHS is now topping £750m a year - following the introduction of a 48-hour week for juniors.

Fabre called for “urgent” action. “Astonishingly, there is talk of cuts in the number of junior doctors. The reason for this is that there are not enough consultant jobs available for those already coming through the system,” she said.

“So the chaos with hospital on-call cover will get worse, with gaps in rotas, insufficient suitably trained locums available, and existing doctors being asked to do more and more. We heard only recently of a young doctor left, unsupported, to cover too many patients, and being asked to do tasks beyond her level of competency. Not only is this bad for doctors, it is unacceptable for patients.”

Tags: Equality, Part-time, Workforce
Posted in Hospital Dr News | 1 Comment »

Midwife staff cuts put women giving birth at risk

The Guardian - 16th November 2010 7:10 pm

Women giving birth are not getting proper care because NHS maternity units are having to deal with staff cuts, recruitment problems and smaller budgets, midwives warn today.

Increasing workloads caused by record numbers of births, more complex pregnancies and too few staff are having a negative effect on patient care, according to over half (54%) of 3,690 midwives polled.

Those results, from the NHS Staff Survey, underline serious concerns outlined today ina separate survey of heads of midwifery (HOMs). Among 83 HOMs in England questioned by the Royal College of Midwives (RCM), 30% said their budget had been cut and 33% said they had been asked in the last year to reduce their staffing levels. Two-thirds said they did not have enough personnel to cope with demand.

Pressure is growing on maternity services. The number of births in England rose from 563,744 in 2001 to 671,058 last year, a 19% rise. But during the same period the total number of midwives grew from 23,075 to 26,451 - a rise of 14.6%.

The growing number of mothers-to-be who are obese, older or teenagers - many of whom need extra support for high-risk pregnancies - is placing extra demands on services. Despite that, 47% of HOMs said they expected to have to lose some staff next year.

The findings have prompted fresh concern about the quality and safety of maternity care, said the RCM general secretary, Cathy Warwick.

“Generation of unemployed doctors in Scotland”

Healthcare Republic - 12th November 2010 12:35 pm

BMA Scotland has warned the country may be left with large numbers of unemployed doctors unless medical student places are cut.

The level of specialty training intake between 2011 and 2015 means 5% of medical graduates are expected not to secure a foundation training place in Scotland, BMA Scotland warned.

The concerns were raised in a manifesto outlining what the BMA believes the political parties’ priorities for health should be ahead of the Scottish Parliament elections in 2011.

The manifesto says 21% of those on the foundation programme will not progress further in Scotland.

“Foundation years need better supervision”

By Mike Broad - 5th November 2010 3:04 pm

Foundation year doctors need better supervision with some being asked to practise beyond their level of competence, a review finds.

Medical Education England’s evaluation of the Foundation Programme warns that it’s compromising patient safety.

While it calls on trainees to “step up” in their level of responsibility as they move from F1 to F2, it says this must be undertaken under appropriate supervision.

It suggests that supervision deteriorates in specialties with a large number of foundation placements and recommends that some of these placements should be reviewed.

Professor John Collins, review chair and visiting professor at the University of Oxford, said: “In meetings with trainees across England, the evaluation panel heard the repeated theme of some trainees being asked to practise beyond their level of competence and without adequate supervision.

“This places patients at unnecessary risk and gives the trainee the message that suboptimal care is condoned, neither of which is part of the professional values and aspirations of a good doctor.”

The review says that a lack of understanding about the role and the level of competence of F1 and F2 doctors could be contributing to their deployment in inappropriate roles beyond their level of competence.

In addition, the review acknowledges that the assessment of foundation doctors is considered to be excessive, onerous and not valued.

It describes the number of assessments required as “formidable” with a total of 249,564 clinical assessments being performed between August 2008 and August 2009 in 24 foundation schools, and 193,338 multi-source feedback appraisals undertaken on about 14,500 trainees.

The review also describes the large number of medical graduates who continue to apply for oversubscribed specialties as “a major issue which must be addressed”. It wants best practice in the provision of careers information and advice to be defined, and key workforce data collated to help trainees to make “early and wise decisions” regarding their long-term careers.

It makes 33 recommendations and the principal findings are supported by similar evidence from the 2009 PMETB Survey of Foundation Doctors, reports from Lord Patel and Professor Sir John Temple and the recently released GMC National Training Surveys 2010.

The Foundation Programme was implemented in 2005 as part of a substantial restructuring of medical education. The current evaluation follows the Tooke Report, which proposed in 2008 that “the structure of postgraduate training should be modified to provide a broad based platform for subsequent higher specialist training, increased flexibility, the valuing of experience and the promotion of excellence”.

On the positive side, MEE’s review believes the length of the programme should remain two years and says it successfully provides a critical interface between medical school and medical practice.

Health secretary Andrew Lansley called for a quick response to the recommendations. He said: “I have asked Medical Education England to work with the profession, the service and medical royal colleges to take forward the recommendations as swiftly as possible.

“This will fit with MEE’s ongoing work to improve the quality of training, ensuring that trainees have appropriate supervision and are not undertaking tasks for which they are not yet competent.”

Dr Tom Dolphin, co-chair of the BMA’s junior doctors committee, said: “We need to address the system failures that allow newly qualified doctors to be put in a position where they are working beyond their level of training. It is incredibly stressful for doctors to be put in this position and it will inevitably threaten patient safety.

“Where this is happening, employers need to be accountable for the systems in place to support juniors in clinical decision-making, and this must include juniors being withdrawn from a department if those systems are inadequate. We also need to urgently investigate problems with the selection of doctors into the programme, the length of work placements and the excessive levels of assessment.”

Niall Dickson, chief executive of the GMC, commented: “We support Professor Collins’s conclusion that the Foundation Programme has many strengths and that, while some changes are needed to improve its effectiveness, they should be approached in a spirit of evolution, not revolution. The GMC will now address the recommendations about the regulation of the Foundation Programme, some of which already form part of our new education strategy, including defining the outcomes required to complete the Foundation Programme and evaluating the case for student registration.

“The report confirms evidence from our own quality assurance activity that some foundation trainees are not being adequately supervised and supported, pressuring them to act beyond their competence with obvious risks for patients. We will continue to act where we become of aware of this, but it is important that NHS organisations deploy foundation doctors appropriately.”

Read the full report.

Tags: Foundation years, NHS: MEE, Training, Workforce
Posted in Hospital Dr News | 7 Comments »

Hospital shuts departments over staff shortages

The Independent - 23rd September 2010 10:13 am

A hospital is set to shut its emergency and maternity departments because of fears over public safety due to “serious” staff shortages, officials confirmed.

Managers at Queen Mary’s Sidcup, in south-east London, said the temporary closures were necessary because there were not enough middle and junior grade doctors, or midwives, to cope during the winter months.

The move came after the NHS stepped in to commission a safety review at South London Healthcare NHS Trust.

Trust chief executive Dr Chris Streather said: “A clinical safety review carried out by independent senior clinicians commissioned by NHS London across all of our sites, and supported by the trust’s medical and nursing directors, has concluded that there are significant safety risks, particularly in regard to a serious shortage of emergency medicine middle and junior grade doctors, and midwives.”

Foundation Year jobs will be in short supply

By Francesca Robinson - 10th September 2010 9:13 am

Some final year medical students may be denied a place on the 2011 Foundation Programme because more than 1,000 additional applications have been received from overseas.

This year the UK Foundation programme Office (UKFPO) has received an unprecedented 1,606 extra applications from non-UK medical schools plus a few UK graduates who have been out of medical school for more than a year. Last year there were only 577 applications over and above those from UK medical schools.

Officials are stressing that not all of these overseas applicants will be eligible to work in the UK under immigration rules. But they are preparing for the possibility that there will be more eligible applicants than vacancies.

The final number of applicants who are fully eligible to compete for a 2011 Foundation Programme place will not be known until November when all eligibility documentation must be submitted. The majority of this year’s extra applications have come from medical schools in Pakistan and the Sudan.

Around 7,600 UK medical students are due to take their finals next year and based on historical data around 300 are expected to fail. There will be approximately 7,600 FY1 jobs to be filled in August next year.

The potential crisis was the subject of a heated debate at the July meeting of the Medical Programme Board, the professional advisory group that oversees specialty training in England. The body has called for additional foundation posts to be created.

But the Department of Health has declined to promise any extra funding. A spokesperson said: “There is always a possibility that the Foundation Programme may be over or under-subscribed and the UKFPO has agreed contingency plans for both scenarios.”

Richard Marks, head of policy at the pressure group Remedy said they had seen this problem looming for some time: “There is no easy answer and funding additional posts might simply move the bottleneck forward a few years. We already have Core trainees unable to progress into Higher Training; the indications are that in the future Higher Training posts are more likely to be cut than expanded.”

With medical students embarking on their degrees in the expectation that they would become doctors, Marks warned “this will be a bitter pill for medical students to face”.

BMA medical students committee co-chair Nick Deakin said: “To have a situation where any UK graduates are denied a place on the foundation programme is completely unacceptable.

“It will lead to serious concern and anger among students who are currently trying to focus on their intensive final year of study, strangled with average debts of £37,000, especially as failure to obtain a place on the foundation programme will deny them full registration with the GMC and the ability to practise medicine.”

BMA junior doctors committee chair Shree Datta added: “Given the financial implications of training our medical students, it is simply unthinkable to leave them with nowhere to go upon graduation.”

Katie Petty-Saphon, executive director of the Medical Schools Council, said: “The situation is tighter than it has been in other years. But under the new immigration rules we are pretty sure the number of eligible overseas applications will come down dramatically.

“What this is likely to mean is that there will be increased uncertainty for final year students who will probably not know where they will be working until quite close to August 1. The UKFPO will have to wait for people to fail exams to know where the gaps will open up.”

She advised students that given the level of competition this year it was more important than ever to submit a high quality application.

A UKFPO statement said: “The four UK health departments, the UKFPO, BMA and Medical Schools Council are working together to plan ways of managing and supporting those applicants who do not secure a place during the main recruitment round in December. The UKFPO will publish full details of this management plan on November 30.”

Tags: Foundation years, Graduates, Workforce
Posted in Hospital Dr News | 2 Comments »