WORKFORCE RISKS AND OPPORTUNITIES ADULT NURSES EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012

Transcription

1 WORKFORCE RISKS AND OPPORTUNITIES ADULT NURSES EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012 MARCH 2012

2 Welcome to the 2012 CfWI workforce risks and opportunities: education commissioning risks summary (WRO ECRS 2012) for adult nurses. The WRO ECRS 2012 reports cover all professions across health and social care, except the medical profession, which was covered in a report in 2011 ( Each report describes the key issues facing the different professions over the next three years, and aims to support local decisions on future education and training commissioning. The reports do not make specific recommendations for local commissioning decisions as these decisions are made through consultation between the education and training commissioner and employers. The reports will be submitted to the Department of Health in several tranches between March 2012 and the end of April This is a time of great change in the NHS. Employers are considering how best they can transform their services to maximise the quality of patient care, improve productivity and release the 20 billion savings to be reinvested in front line clinical care. This work could have a major impact on the future shape of the workforce and so needs to be considered alongside education and training commissioning decisions that are being made now. Financial allocations are a pivotal component of the overall education and training annual process across England. Presently the Department of Health secures funding to invest in the workforce through the Multi-Professional Education and Training (MPET) levy which is around 4.9bn for 2011/12. This funding is currently allocated to Strategic Health Authorities (SHA) largely based on historic patterns of training. The Department sets out key priorities and holds SHAs to account through a Service Level Agreement. SHAs develop plans for education commissions based on local workforce plans and then commission and fund training from education and clinical placement providers. Looking towards 2012/13, a flat cash settlement for MPET is likely. This allocation will have to accommodate a range of cost pressures which will include new costs, price increases and volume changes. In setting local investment priorities for the MPET allocation, SHAs are encouraged to consider the evidence presented within the WRO ECRS 2012 and the medical specialty training numbers reports. We hope you find the reports useful, and as always, appreciate your constructive feedback. Professor Moira Livingston Commissioning Director CfWI CfWI March

3 Purpose This information has been collated to inform decisions on education commissioning over the next three to five years. It considers the key factors influencing the estimation of future need of the profession and gives an assessment of the current workforce supply. It includes regional perspectives and a summary analysis of risks in education commissioning. work with old and young adults with diverse health conditions, both chronic and acute. They use caring, counselling, managing, teaching and all aspects of interpersonal skills to improve the quality of patients' lives. Work may be based in hospital wards, clinics or, increasingly, community settings. A first degree or diploma in adult nursing is a prerequisite to practice. Practice nurses are covered in a separate risk summary report. KEY FINDINGS Next steps The effect of degree level registration for all nurses from 2013 nursing in relation to skill mix, training attrition, and the number and profile of those undertaking undergraduate courses is as yet unknown (although it should be noted that a significant proportion of degree level nurses have been registered for many years). Transforming Community Services (TCS) and an increasing and ageing population will result in greater demand for nurses working in the community and able to manage complex caseloads. There is currently a net outflow of nurses from the UK. There has been a downward trend of adult nursing commissions since the 2003/04 academic year. In order to effect change, it is important that key stakeholders work together to gain greater understanding of: the adult nursing workforce in social care and the independent and voluntary sectors the numbers of nurses who move from the NHS into these areas the destinations of newly qualified nurses the nursing education workforce. CfWI March

4 CONSIDERATIONS FOR FUTURE REQUIREMENTS Policy drivers Table 1 summarises the key policy drivers and the relevant references. Table 1: Policy drivers affecting the workforce adult nurses Key drivers 1. Improving standards of care in nursing and equipping nurses to deal with increasing complexity of illness A consequence of the ageing population is that patients have increasingly complex needs, which will increase the demand for more highly skilled nurses. Relevant policy The move to degree level nursing from 2013 in England (Nursing and Midwifery Council (NMC), 2010) The move to degree level registration is to be rolled out in order to produce only newly-qualified graduate nurses from 2013 onwards. Potential consequences of this are improved standards of care in nursing, a change in the number of people interested in becoming nurses and a change in the student attrition rate. It is as yet unknown whether potential students will be attracted to the profession or discouraged by the removal of the diploma option. Similarly, it is unknown whether students will be more committed to the course or more likely to drop out. 2. Contributing to efficiency savings while maintaining quality and safety The QIPP agenda (DH, 2009a) Degree level nursing (NMC, 2010) Nurses are expected to give high quality fundamental care and take on increasingly advanced levels of practice. 3. Increasing the accessibility and quality of care closer to home Another consequence of the ageing population is that more care is required in the community, requiring more nurses to be available at a greater range of hours and nursing students to be given more experience in community health. Transforming Community Services (TCS) (DH, 2009b) Degree level nursing (NMC, 2010) CfWI March

5 Strategic health authority (SHA) perspective 1 SHAs work in partnership with employers (service providers), service commissioners, education providers and each other to assess workforce requirements. This then informs education commissioning plans in each region. SHAs work with local employers to inform their decision making. This is a requirement of service level agreements between SHAs and the Department of Health for the investment of education and training funds. The CfWI has therefore engaged primarily with SHAs as the agreed route to ensuring the views of employers are considered as part of this work. Following NHS reform it is likely that the CfWI will engage with employer-led Local Education and Training Boards to gain this perspective. SHAs report that they are reducing student nurse commissions, as demonstrated in Figure 4. The policy of all graduate registration for nurses means that the education commission route is changing and degree qualified nurses will be the only output from training programmes from the 2013 cohort onwards. The adult nursing workforce is a large and diverse part of health and social care services and it is considered key to achieving many of the QIPP plans. This workforce is developing to take on more complex, advanced roles and devolving many other roles to assistant practitioners and the wider workforce. There is significant change for this workforce, notably TCS, as well as increased demand for services for the community and older people. Profession s view 2 In the shift to primary care there is pressure to move nurses into the community and for community nursing to become a more 24/7 service. However, representatives from the Royal College of Nursing (RCN) suggest that nurses have often been attracted into the community sector for a number of reasons, but from an employment perspective, moving into the community sector allows them to move away from traditional shift working, which is prevalent in the acute sector, to a more nine-to-five model of working. Increasing capacity in the community sector will require new ways of working for the existing workforce. All of this will require significant skills in change management. The RCN also reports that the acute and community nursing workforces also have different issues which need to be considered. The nursing workforce in the independent sector, and in the community, tends to have an older age profile than that in the acute sector. There is also geographical variation in supply, and the RCN is concerned that gaps between supply and demand may not be filled with appropriately trained healthcare assistants or assistant practitioners. Research commissioned by the RCN has also highlighted the vulnerability of NHS nurse staffing numbers to policy changes, for example, the reduction in the number of nurse 1 The CfWI engaged with workforce leads from each SHA in England to obtain their views on the adult nursing workforce. 2 The CfWI engaged with representatives from each profession to inform this report. This workforce summary will use the term representative to credit information presented by these representatives. Although in some cases the source is not explicitly named, this information may be available on a case-by-case basis. Please contact the CfWI if more information is required. CfWI March

6 training places and the possibility of some nurses taking early retirement due to changes to their pension (RCN, 2011a). Demographics typically care for patients aged 16 and over. According to 2008-based population projections by the Office for National Statistics (ONS), the number of people in England aged 15 and over is predicted to grow by 14 per cent over the next 20 years, and increase from 82.6 per cent of England s population to 82.9 per cent 3. In particular, the older population is growing due to the population ageing and living longer. This will have a notable impact on the adult nursing workforce, as the older population has a particularly high need for healthcare, with increasing complex needs. Almost one in three people in England have a long-term condition (LTC), and since LTCs are more common in those aged 60 and over, their prevalence is likely to rise as the population ages (King s Fund, 2009). A number of reports for example Lost in transition moving young people between child and adult health services (RCN, 2007) and Transition: moving on well (DH, 2008) have also highlighted the need for planned, integrated working between children s and adult services to improve transitions as patients move from one to the other. Additional drivers Skill mix The DH response to the report of the National Apprenticeship Advisory Committee (DH, 2010) states that Migration the emergences of new clinical support roles, such as assistant practitioners, are increasing the scope for apprenticeships. These new roles provide the opportunity to develop Advanced Apprenticeship programmes in the health sector. Active recruitment campaigns have resulted in increased numbers of UK nurses applying to work overseas. A reduction in international recruitment of nurses and increasing migration of UK nurses has resulted in a net outflow of nurses from the UK. In there were 2000 initial entrants to the NMC register from the EU plus 550 from non-eu countries, while 6357 UK-registered nurses requested verification of their registration as part of the process of applying to work abroad. This is a net loss of nurses from the UK of around 2.5 to one. (RCN, 2011c). However, it is not clear whether the migration of UK nurses is due, in the main, to the emigration of UK trained nurses, or those who have been trained abroad (Buchan and 3 Please refer to the South West Public Health Observatory for a tool illustrating the projected growth of the entire population in England, by age band, up to 2031 ( CfWI March

7 Total on register Education commissioning risks summary Seccombe, 2006). The CfWI has recommended operating department practitioners (ODPs), specialist nurses in neonatal intensive care units, and specialist nurses working in operating theatres for inclusion on the Shortage Occupation List (CfWI, 2011a). As there is no overseas equivalent to an ODP, nurses may be used as substitutes for this role. Please refer to the WRO report on ODPs for details on the ODP workforce. CURRENT AND FORECAST SUPPLY Existing workforce Supply Figure 1 shows the breakdown of nurses and midwives on the NMC register, by year and nursing field, for England. It shows that the total number of adult nurses registered in England has increased by 13 per cent over the last five years. However, other nursing fields have seen higher proportional increases; the number of registered children s nurses has increased by 20 per cent over the same period, and learning disability nurses have seen an increase of 17 per cent. The data below shows only those registered nurses with an address in England, and therefore does not reflect the number practising, nor whether they are practising in the NHS. There is limited data on nurses working outside the NHS, but the majority are employed within the NHS (RCN, 2010). Figure 1: Number of nurses and midwives on NMC register, England, by nursing field and year, ,000 Nurses and midwives on the NMC register, England ( ) 600, , , , , ,000 Midwifery Mental health Learning disabilities Children Adult 0 Year Source: (NMC, 2011) CfWI March

8 Table 2 shows the variation in the nursing groups defined as acute, elderly and general, community services and education staff on the NHS Information Centre for Health and Social Care (NHS IC) Census (NHS IC, 2011a). This gives an indication of the number of nurses working in each of these areas in the NHS in a variety of settings including school nursing and health visiting, the majority are assumed to be adult nurses, as registration data would suggest. Table 2 shows all three nursing groups to have significantly increased in size over the past ten years. The supply of nurses in FTE in community services has increased more dramatically than the FTE of acute, elderly and general nurses, highlighting a shift of care into the community. Also, the FTE in community services increased more dramatically than HC for the same group, which shows an increase in the participation rate over recent years. Table 2: Change in headcount and full time equivalent of NHS adult nurses, by sector, % change since 2000 HC* FTE HC* FTE HC* FTE Supply (thousands) Acute, elderly & general Community services Education staff** *Please Note: The new headcount methodology for 2010 data is not fully comparable with previous years data due to improvements that make it a more stringent count of absolute staff numbers. Further information on the headcount methodology is available in the NHS IC publication (NHS IC, 2011a). **Education staff are registered and qualified nurses who coordinate or teach practice or professional development to other nurses. They may still provide care but would usually work in education for at least 50 per cent of the time. Source: NHC IC Non-Medical Bulletin Tables, (NHS IC 2011a) CfWI March

9 Under and over Total Education commissioning risks summary Age profile Figure 2 below shows the age breakdown of adult nurses (defined according to the occupation codes listed) employed in the NHS as at July Figure 2: HC and FTE age profile by ten-year age band, 2011 adult nurses 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Age profile (HC and contracted FTE) - adult nurses Contracted FTE Headcount Source: NHS Information Monthly Workforce Extract (20/07/ :57). Uses occupation codes N0A, N6A, N7A, NAA, NCA, N0H, N4H, N5H, N6H, N7H, NAH, NCH, NEH, N0J, N6J, N7J, NAJ, NCJ. Note that the Under 25 age bracket only contains those between the ages of 21 and 24, whereas the other groups are in 10-year bands, therefore the relative numbers for that age band in figure 1 will be smaller. The RCN is particularly concerned that community nursing and the academic workforce have older age profiles than acute nursing, as newly qualified nurses are more likely to go into an acute setting (RCN, 2011c). Also, it cannot be assumed that all newly qualified nurses are 21; if there are any changes to the numbers of mature nursing students in future, the age profile could change. The age profile for the NHS adult nurse workforce is not necessarily representative of the significant numbers of adult nurses working outside the NHS. According to representatives, the nursing workforce in the independent sector tends to have an older age profile than that of the acute sector. Newly qualified nurses are more likely to move initially into the acute sector, often moving outside of the NHS when they are older. Current vacancies and employment Age bracket (years) The NHS IC Vacancies survey (2011b) records a national three-month vacancy rate of 0.5 per cent for nurses in acute, elderly and general care (with the highest vacancy rates in the South East Coast and South Central SHAs) and for district nurses (with the highest vacancy rates in the London SHA). CfWI March

10 2002/ / / / / / / / / /12 Commissions Education commissioning risks summary Students Figure 3 shows that the total commissions for pre-registration adult nursing training in England have followed a downward trend since 2003/04, with further reductions planned for 2011/12. Figure 3 shows that this was due to a reduction in commissions of diploma courses (which historically have accounted for the vast majority of adult nursing commissions), and that commissions of degree courses have increased steadily since 2002/03. The graphs show that commissions have historically favoured the diploma-entry route over the degree route. The latest figures for planned commissions reflect the fact that nursing is to become a degree-only profession. There has been a reduction in total actual commissions since the academic year 2002/03.There is a possible risk that due to the increased fees for other degrees, potential students may choose to study for a funded nursing degree without intention to ever practise as a nurse. Figure 3: Total national commissions of pre-registration training, planned and actual 4 adult nurses 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Total planned and actual commissions of pre-registration courses, England (2002/03 to 2011/12) - adult nurses Planned Actual Year Source: Multi Professional Education and Training (MPET) 02B - Non Medical Education and Training (NMET) Commissions, 2002/03 to 2011/12 4 The 2011/12 planned commissions should be regarded as indicative. CfWI March

11 2002/ / / / / / / / / /12 Commissions Education commissioning risks summary Figure 4: National commissions of pre-registration degree and diploma courses for adult nursing, planned and actual 5 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Planned and actual commissions of pre-registration degree and diploma courses, England (2002/03 to 2011/12) - adult nurses Degree - planned Degree - actual Diploma - planned Diploma - actual Year Source: Multi Professional Education and Training (MPET) 02B - Non Medical Education and Training (NMET) Commissions, 2002/03 to 2011/12 (DH, 2011a) Recruitment According to the RCN, the attrition rate for nursing students in England had been increasing up to 2010, and was around 28 per cent for the cohort beginning training in It is not clear whether the degree and diploma figures include students switching from diploma to degree courses. Attrition rates were higher among diploma students than degree students so it is possible that, with the move to degree level registration, attrition rates may improve (RCN, 2010). The latest data from the DH (2011b) indicates that attrition has indeed begun to improve; for adult nursing, the diploma course attrition rate was 27.8 per cent for the 2010/11 academic year, while for the degree course attrition was at 10.2 per cent. There is currently a lack of data on the destinations of newly qualified nurse registrants, and on the number of re-entrants who stay working in the NHS after refresher training (RCN, 2010). This data could inform improved workforce planning. Geographical distribution Figure 5 shows the headcount of adult nurses in the NHS in each SHA in September 2010 (NHS IC, 2011a), the actual commissions for training in adult nursing in the 2010/11 academic year and planned commissions 2011/12 (DH, 2011a), and weighted capitation (DH, 2011c). 5 The 2011/12 planned commissions should be regarded as indicative. CfWI March

12 Figure 5: Map showing NHS staff, planned and actual commissions in relation to weighted capitation by SHA 6 Source: NHS IC Census (NHS IC, 2011) (headcount); DH NMET Monitoring Quarter 4, 2010/11 (commissions); DH 2011c (weighted capitation). Figure 5 indicates that the London SHA has a higher headcount of adult nurses, and more planned and actual commissions, than would be allocated according to weighted capitation alone. By contrast, the East of England and East Midlands SHAs have lower HC, and number of planned and actual commissions, than if provision were to follow weighted capitation. 6 The 2011/12 planned commissions should be regarded as indicative CfWI March

13 Regional variations Overall, the regions are projecting a decrease in demand for adult nursing commissions as a result of over-recruitment in the past. There are reported increases of nurse consultant numbers and decreasing numbers of modern matrons and district nurses. Nurse-led services are reported to be increasing continually (Chin, 2011). London SHA information, which is yet to be validated, is projecting a reduction in demand and a potential oversupply. This is being investigated and the London SHA is currently undertaking a re-tendering exercise as a result of feedback from providers that if commissions continue to reduce, some courses will not be viable. The East Midlands SHA has taken a decision to reduce commissions by eight per cent between the 2010/11 and 2011/12 academic years and may reduce by a further five per cent in 2012/13. The SHA estimates supply to be greater than demand over the next three years. There was an initial plan for a ten per cent reduction in commissions. However, due to increased demand for health visitors, many of whom will come from this future pool of newly qualified adult nurses, the proposed reduction was capped at eight per cent. The East Midlands SHA is also planning to increase the use of the degree level entry scheme. Commissions at the Open University and University of Lincoln are to remain at a steady state to maintain the viability of programmes. The North East SHA has traditionally recruited to nursing programmes from the local population, and following qualification staff have been employed locally. A move to a degree-entry programme may change the demographics of those applying and their mobility for employment. This move to degree level registration may also lead to future workforce risks as traditionally the North East has had a higher proportion of diploma nurses than the national average due to the local training and recruitment of nurses. This may lead to an undersupply of qualified nurses as the diploma programme is decommissioned in line with the NMC s review of pre-registration nurse education. The South East Coast SHA is in the process of finalising commissions for 2012/13. There has been a modest amount of overseas recruitment. This is not indicative of generalised long-term undersupply. There is some evidence of small but growing deployment of assistant practitioners in some organisations. Supply projections Figure 7a shows that the NHS adult nursing workforce has expanded by 6 per cent during the past five years. CfWI modelling estimates that the supply of registered adult nurses available to the NHS and any other services to provide clinical duties in England will decrease to approximately 442,369 (HC) (361,911 FTE) in 2016 which is a reduction of 1 per cent from Figures 7a and 7b show that there are many more adult nurse registrations than are working in the NHS. This reflects information from representatives; there has been a shift from many CfWI March

14 Full time equivalent Headcount Education commissioning risks summary NHS providers to social enterprises, for example in the South West there are seven new social enterprises, and there are also a significant number of nurses working in the independent sector. Figure 7a: Historical and projected workforce supply by HC adult nurses Summary of the available workforce headcount adult nurses 500, , , , , ,000 High and low scenarios of supply forecast Historic NHS headcount Forecast of register staff (HC) 200, , ,000 50,000 Weighted change in demand based on population growth and age based activity of the age group 20 and older Historic NMC registrants 0 Other demand drivers exist, but they have not been shown on this graph Year Source: Historical supply data is from the NHS IC (2011) and the NMC register (2011). Forecasts are based on NMC data and workforce assumptions. Figure 7b: Historical and projected workforce supply by FTE adult nurses Summary of the available workforce full time equivalent adult nurses 400, , ,000 High and low scenarios of supply forecast Historic NHS FTE 250, ,000 Forecast of register (FTE) 150, ,000 Weighted change in demand based on population growth and age based activity of the age group 20 and older 50,000 Estimate of historic registrants potential FTE 0 Year Other demand drivers exist, but they have not been shown on this graph Source: Historical supply data is from the NHS IC (2011) and the NMC register (2011). Forecasts are based on NMC data and workforce assumptions. CfWI March

15 The model uses a method of mapping occupation codes to areas of adult nursing in order to obtain HC and FTE for the NHS adult nurse workforce. This method of mapping is in its infancy and will be reassessed in future in order to improve its accuracy. The figures in the graphs above do not include non practitioners and those working within the adult nursing scope of practice without direct patient contact, for example: those in management in posts both within the NHS, DH, Health Protection Agency (HPA) and other national or professional bodies those providing education to undergraduate courses in England adult nurses working in planning Macmillan adult nurses working in information and support roles adult nurses working in research roles. CfWI modelling 7 from 2010 onwards is based on current commissions, assumptions reached by analysing past trends, and engaging with the profession to identify other indications. The most likely scenario (black line) indicating the estimate of future supply uses the agreed baseline assumptions in Table 3. The upper line (long dashes) indicates the estimated future demand for adult nursing staff (482,164 HC, 394,468 FTE). The darker shaded area on the right of the graph shows the forecast range of adult nurses in the NHS and the private sector estimated to be available to provide direct clinical care in the future, and is based on the low and high scenario assumptions in Table 3. The modelling uses the workforce headcount in 2010 (all registered professionals NHS and non-nhs) as a baseline and calculates the future weighted change in demand due to population growth and age based activity. This model assumes that service activity continues to be delivered in the same way as now, however according to SHAs, the recent reduction in attrition rates and the QIPP efficiency measures the workforce may be currently in a state of oversupply. We accept service reconfiguration and skill mix are likely to alter future demand, and so future modelling can be adapted when we know more about these changes. Current modelling suggests that demand will outstrip supply from this year onwards in the low scenario, or will outstrip supply by 2013 in the high scenario. In both scenarios, the gap between supply and demand is forecast to widen over time. 7 Further details of the modelling used in the CfWI workforce risks and opportunities education commissioning risks summaries from 2012 (WRO ECRS 2012) can be found in the WRO ECRS technical report. CfWI March

16 Table 3: Summary of assumptions used in the supply forecast Variable Low scenario Baseline High scenario Training pipeline Trainee commissions Diploma (3 years) and degree (3 years) Commissions 5% lower Diploma (3 years) and degree (3 years) 12,017 per year from 2011/12 onward 24% diploma (2 years), 76% degree (3 years) until 2013 when 100% 3 year degree Commissions 5% higher Training attrition 30% 27.6% 25% Trainees registration on graduation Net international flow 98% with NMC 99% with NMC 99% with NMC 25% lower 2,000 per year out of England 25% higher FTE/HC ratio 99% of current As current 101% of current Retirements Retirement trends shifted 2 years earlier, and 50% greater Retirement profile as Retirement trends shifted 2 years later It is assumed that new graduates register within the same year. Some diploma courses are two years, but that the base line assumption is that all diploma courses run for three years. Interplay with related groups Nurses are ubiquitous within the healthcare workforce and work alongside many professional groups including doctors, physiotherapists, occupational therapists, pharmacists, radiographers and healthcare assistants. Therefore changes within the workforce of any number of healthcare professions are likely to have repercussions for adult nursing. CfWI March

17 CONCLUSION The adult nursing workforce is likely to face significant pressures due to factors such as the current service reconfiguration, productivity and efficiency savings driven by QIPP, an increasing and ageing population, transfer of services into the community and an ageing workforce. Based on medical modelling and other relevant factors, the CfWI (2011b) recommended a reduction in training posts for hospital-based medical specialties. If such a reduction takes place, there may be a greater pressure on adult nurses to deliver service. However, the CfWI also recommended an increase in GP training posts in order to provide more service in the community. If this happens and fewer patients are treated in hospital, there could be less pressure on nurses in hospitals to provide service. Although policy changes, demographics and increasing migration suggest that the requirement for adult nurses will continue to increase, feedback from the SHAs has shown that many are decreasing commissions. This poses a potential risk to service delivery. Measures such as upskilling the existing workforce, as well as effectively utilising assistant practitioners to take on some nursing tasks, may help to alleviate potential shortages. However, this will need to be balanced with quality of service delivery in order to be effective. Overall these factors could increase or decrease demand for nurses in future and the impact of all degree registration could affect numbers progressing through training. SHA plans assume that taken together these factors justify a reduction in commissions. There is a significant risk that this could lead to future shortages. The factors referred to above should be closely monitored so that action can be taken in the event that commissions have been reduced too much. CfWI March

18 REFERENCES Buchan, J., and Seccombe, I. (2006) Worlds Apart? The UK and International Nurses. RCN, London. [online] Available at: data/assets/pdf_file/0007/78703/ pdf [Accessed 26 August 2011]. Centre for Workforce Intelligence (2011a) Migration Advisory Committee (MAC) Shortage Occupation List Update, Healthcare Profession Submission Jun Centre for Workforce Intelligence (2011b) Shape of the medical workforce: Informing medical specialty training numbers [online] Available at: [Accessed November 2011]. Chin, WY, (2011) Quality of care of nurse-led and allied health personnel led primary care clinics, Hong Kong Medical Journal 17: Department of Health (2008) Transition: moving on well. February. [online] Available at: digitalasset/dh_ pdf [Accessed 27 September 2011]. Department of Health (2009a) Implementing the Next Stage Review visions: the quality and productivity challenge. Letter- David Nicholson. 10 August. [online] Available at: /dh_ pdf [Accessed 6 September 2011]. Department of Health (2009b) Transforming Community Services: Enabling new patterns of provision. 13 Jan. [online] Available at: /dh_ pdf [Accessed 6 September 2011]. Department of Health (2010b) Department of Health Response to the report of the National Apprenticeship Advisory Committee: Making Apprenticeships an Important and Sustainable Part of the Health Sector Workforce, 16 Nov. [online] Available at: ents/digitalasset/dh_ pdf [Accessed 15 September 2011]. Department of Health (2011a) Non-medical education and training (NMET) monitoring Quarter 4; Re: Quarterly Commissions data. [ ] (Personal communication, 17 August 2011). CfWI March

19 Department of Health (2011b) Re: Adult nurse training attrition rates. [ ] (Personal communication, 12 December 2011). Department of Health (2011c) Resource allocation: weighted capitation formula - seventh edition. 8 March. [online] Available at: dance/dh_ [Accessed 13 September 2011]. King s Fund (2009) Long-term conditions. 31 March [online] Available at: [Accessed 27 September 2011]. NHS Information Centre for Health and Social Care (2011a) Non-Medical Staff Census as of 30 September [online] Available at: [Accessed 6 June 2011]. NHS Information Centre for Health and Social Care (2011b) Vacancies Survey March [online] Available at: [Accessed 6 June 2011]. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education (2010). [online] Available at: [Accessed 15 September 2011]. Nursing and Midwifery Council (2011) NMC registrants by field of practice, England. [ ] (Personal communication, 31 August 2011). Office for National Statistics (2010) 2008-based Subnational Population Projections by sex and quinary age; England and Government Office Regions. [online] Available at: [Accessed 13 September 2011]. Royal College of Nursing (2007) Lost in transition moving young people between child and adult health services. [online] Available at: data/assets/pdf_file/0010/157879/ pdf [Accessed 27 September 2011]. Royal College of Nursing (2010) Sustaining the long view The UK nursing labour market Review Buchan, J. and Seccombe, I. [online] Available at: data/assets/pdf_file/0004/347953/ pdf [Accessed 19 August 2011]. Royal College of Nursing (2011a) Nursing numbers could be slashed over the next decade RCN. 18 July. [online] Available at: ed_over_the_next_decade_-_rcn [Accessed 18 July 2011]. CfWI March

20 Royal College of Nursing (2011b) Engagement meeting. CfWI. 9 August. Royal College of Nursing (2011c) A decisive decade The UK nursing labour market review Buchan, J. and Seccombe, I. [online] Available at: data/assets/pdf_file/0007/407257/ pdf [Accessed 9 December 2011]. CfWI March

21 DISCLAIMER The Centre for Workforce Intelligence (CfWI) is an independent agency working on specific projects for the Department of Health and is an operating unit within Mouchel Management Consulting Limited. This report is prepared solely for the Department of Health by Mouchel Management Consulting Ltd, in its role as operator of the CfWI, for the purpose identified in the report. It may not be used or relied on by any other person, or by the Department of Health in relation to any other matters not covered specifically by the scope of this report. Mouchel Management Consulting Ltd has exercised reasonable skill, care and diligence in the compilation of the report and Mouchel Management Consulting Ltd's only liability shall be to the Department of Health and only to the extent that it has failed to exercise reasonable skill, care and diligence. Any publication or public dissemination of this report, including the publication of the report on the CfWI website or otherwise, is for information purposes only and cannot be relied upon by any other person. In producing the report, Mouchel Management Consulting Ltd obtains and uses information and data from third party sources and cannot guarantee the accuracy of such data. The report also contains projections, which are subjective in nature and constitute Mouchel Management Consulting Ltd's opinion as to likely future trends or events based on i) the information known to Mouchel Management Consulting Ltd at the time the report was prepared; and ii) the data that it has collected from third parties. Other than exercising reasonable skill, care and diligence in the preparation of this report, Mouchel Management Consulting Ltd does not provide any other warranty whatsoever in relation to the report, whether express or implied, including in relation to the accuracy of any third party data used by Mouchel Management Consulting Ltd in the report and in relation to the accuracy, completeness or fitness for any particular purposes of any projections contained within the report. Mouchel Management Consulting Ltd shall not be liable to any person in contract, tort (including negligence), or otherwise for any damage or loss whatsoever which may arise either directly or indirectly, including in relation to any errors in forecasts, speculations or analyses, or in relation to the use of third party information or data in this report. For the avoidance of doubt, nothing in this disclaimer shall be construed so as to exclude Mouchel Management Consulting Ltd's liability for fraud or fraudulent misrepresentation. CfWI March

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