May 2014 NHS QUALIFIED NURSE SUPPLY AND DEMAND SURVEY FINDINGS Report produced for the Health Education England Nursing Supply Steering Group
EXECUTIVE SUMMARY Purpose Further to discussions with HR colleagues at our network meetings and some of our recent events, we are aware that nurse supply and demand issues are proving challenging for a number of NHS organisations at present and that many organisations are assessing staffing levels in the light of recent reviews and the new guidance provided by the National Quality Board. Since April 2014, all hospitals have been required to publish staffing levels on a ward-by-ward basis together with the percentage of shifts meeting safe staffing guidelines. This is done on a monthly basis. By the end of next year this will be done using models approved independently by NICE. To support work in these areas, the NHS Employers organisation is working with a range of partners as part of a Health Education England Steering Group to lead a programme of work to improve recruitment and retention (including a Return to Practice Campaign) for nursing. NHS Employers was asked by Health Education England to carry out a short survey asking employers for information about the current nurse workforce demand and their views on supply issues. This survey provides information on demand and supply of the qualified nurse workforce in NHS service provider organisations. The data collected will help to inform and shape co-ordinated recruitment and retention initiatives. Method The survey asked Human Resource Directors/Directors of Nursing in NHS organisations in England for point prevalence nursing establishment data for week commencing 6 January 2014. The survey also asked for information about specific nursing supply challenges, their views on nursing workforce demand (for example is the demand for specific grades or specialism) and the actions they are implementing to resolve supply shortages they are facing. ww Results 244 NHS service providers in England were identified and surveyed A response rate of 43 per cent was achieved from NHS service providers (104 trusts) Responses were also received from three Clinical Commissioning Groups, one Special Health Authority and one Social Enterprise providing NHS services Total responses were received from 109 organisations employing qualified nursing staff supporting the delivery of NHS services. 2 May 2014
Headlines 90 surveyed organisations (83 per cent) reported that they are experiencing qualified nursing workforce supply shortages. ww 42 surveyed organisations (39 per cent) are estimated to have between 1-50 FTE hard to fill nursing vacancies. 39 organisations (36 per cent) are estimated to have 50 100 FTE vacancies. Nine organisations (8 per cent) are estimated to have over 100 FTE nurse vacancies (figures ranging from 110 250 FTE). The overall vacancy rate across organisations that provided their nurse staffing establishment data is calculated at 10 per cent (12566.35 FTE) i.e. posts not permanently occupied. Reported hard to fill vacancies span a wide range of nursing areas (over 40) and generally in low volumes. There are two exceptions at Band 5 where results may be reflective of more widespread challenges for theatre and medical nursing areas. Skill shortages at a local or national level are the most reported reason for recruitment difficulties. Local action to manage supply challenges has focused on skill mix reviews/ service reconfiguration, local recruitment campaigns and use of agency/ temporary staff. 49 surveyed organisations (45 per cent) have actively recruited from outside of the UK in the last 12 months to fill nursing vacancies. 96 per cent of reported overseas activity has been in EEA countries the trend has been to target EEA countries to fill Band 5 experienced general nursing positions Spain, Ireland and Portugal are most commonly targeted. 56 surveyed organisations (51 per cent) are considering actively recruiting qualified nursing staff from outside of the UK in the coming 12 months Spain, Ireland and Portugal look to continue being the primary destinations. 60 surveyed organisations are looking to increase qualified nurse numbers overall. Almost half of these organisations (28) reported that this is part of a skill mix review as a result of the publication of national safer staffing guidance. May 2014 3
KEY ISSUES In the wake of recent reports from Robert Francis, Don Berwick and the National Quality Board, we are aware that many employers have begun to revise their forecast demand for nursing staff. The workforce planning process by Health Education England has revealed that employers are intending to employ 2.1 per cent more nurses during 2013/14 (an additional 3,700 FTE nurses). The requirement for all hospitals to publish staffing levels on a ward-by-ward basis and the forthcoming guidance from NICE is likely to strengthen the demand for nursing in some areas. Heath Education England has reflected this emerging trend in their recent Workforce Plan for England, where there is a commitment to a 9 per cent increase in nursing commissions. However, these Newly Qualified Nurses will not be available to the system until 2017, therefore action may be needed now in order to support employers to meet existing needs. The data collected in this survey will help to inform and shape co-ordinated recruitment and retention initiatives, providing support and solutions where necessary. 4 May 2014
CONTENTS Purpose 6 Method 6 Definitions 6 Results 8 Section A Summary of respondents 9 Section B NHS qualified nurse staffing establishments and vacancy rates 11 Section C NHS registered nurse supply and demand 14 Section D Actions to resolve supply challenges 18 Section E Further support 23 May 2014 5
Purpose The aim of the survey is to produce a comprehensive snapshot of employer need, to better understand the nature of employer demand for nursing (for example is the demand for specific grades or specialism). The data collected will help to inform and shape co-ordinated recruitment and retention initiatives, providing support and solutions where necessary. In the wake of recent reports from Robert Francis, Don Berwick and the National Quality Board, we are aware that many employers have begun to revise their forecast demand for nursing staff. The workforce planning process by Health Education England has revealed that employers are intending to employ 2.1 per cent more nurses during 2013/14 (an additional 3,700 FTE nurses). The requirement for all hospitals to publish staffing levels on a ward-by-ward basis and the forthcoming guidance from NICE is likely to strengthen the demand for nursing in some areas. Heath Education England has reflected this emerging trend in their recent Workforce Plan for England, where there is a commitment to a 9 per cent increase in nursing commissions. However, these Newly Qualified Nurses will not be available to the system until 2017, therefore action may be needed now in order to support employers to meet existing needs. Method The information gathering exercise was undertaken via an online survey, the methodology and style were similar to previous workforce surveys conducted by the NHS Employers organisation. A link to the online survey was sent to the Human Resource Director in each organisation and this was supported by a letter from Health Education England to the Chief Executive and Director of Nursing in each organisation. The survey was also promoted through the NHS Employers HR regional networks. The survey asked for information about qualified nursing supply at a point in time (week commencing 6 January 2014); it considered posts available (the staffing establishment) and those occupied by permanent, temporary or agency staff. The survey also asked for information about specific nursing supply challenges, views on nursing workforce demand (for example is the demand for specific grades or specialism) and the actions being implemented to resolve supply issues where necessary. Definitions Grades of staff All staff are NHS Agenda for Change (AfC) bands. Full Time Equivalents (FTE) All data refer to NHS Agenda for Change full time equivalents (FTE) of 37.5 hours per week. 6 May 2014
Health Education England Local Education Training Boards (LETBs) Where information in this report has been categorised by region, LETB boundaries have been used as follows: North HE North East North HE North West North HE Yorkshire & Humber Midlands and East HE East Midlands Midlands and East HE West Midlands Midlands and East HE East of England London HE North Central & East London London HE North West London London HE South London South HE Kent, Surrey & Sussex South HE Thames Valley South HE South West South HE Wessex Staffing Establishment The staffing establishment is the pattern of posts and FTEs required to deliver the service and agreed at a point in time. An established post is one which is agreed as part of the funded staffing establishment. Agency Staff (FTEs) The number of FTE employees as agency staff to fill the established post. Temporary Staff (FTEs) The number of FTE employees as temporary staff to fill the established post. Vacancy rates A vacant post is defined as a post not permanently occupied. Some vacant posts may be filled by agency or temporary staff. The vacancy rate is therefore the percentage of posts not permanently occupied. Hard to fill vacancy A hard to fill vacancy is defined as a post being vacant for over three months. Oversubscribed vacancies Vacancies that regularly receive a high vacancy per application (APV) rate. Active recruitment outside of the UK In the context of this survey active recruitment is defined as the deliberate targeting of the labour market in countries outside of the UK. May 2014 7
Results 244 NHS service providers in England were identified and surveyed A response rate of 43 per cent was achieved from NHS service providers (104 trusts) Responses were also received from three Clinical Commissioning Groups, one Special Health Authority and one Social Enterprise for having nursing services Total responses were received from 109 organisations employing qualified nursing staff supporting the delivery of NHS services There is no representation from organisations in HE North West London, so particular care should be taken in interpreting trends for London. The results are presented in the following sections: Section A Summary of respondents Section B NHS qualified nurse staffing establishments and vacancy rates Section C NHS qualified nurse supply and demand Section D Actions to resolve supply challenges Section E Further support *Please print the report in colour. 8 May 2014
SECTION A SUMMARY OF RESPONDENTS Headlines 244 NHS service providers in England were identified and surveyed A survey response rate of 43 per cent was achieved (104 organisations) (Figure 1.1) Responses were also received from two Clinical Commissioning Groups, one Commissioning Support Unit, one Special Health Authority and one Social Enterprise for having nursing services (Figure 1.2) Total responses were received from 109 organisations employing qualified nursing staff supporting the delivery of NHS services Responses are spread from across the HE regions, however there is no representation from HE North West London, so particular care should be taken in interpreting figures for London. *Care must be taken in interpreting the trends of data because 100 per cent response rate was not achieved, thus the information may not be representative of the full regional/national picture. The response rate for each HE region is shown in (Figure 1.3). Figure 1.1 Survey responses presented by region May 2014 9
Figure 1.2 Survey responses presented by organisation type Figure 1.3 Survey response rate per region 10 May 2014
SECTION B NHS QUALIFIED NURSE STAFFING ESTABLISHMENTS AND VACANCY RATES Headlines Table 1a shows the reported nurse staffing establishments and vacancy rates by region (for week commencing 6 Jan 2014)*. There are: 126330.74 FTE established nursing posts across the 89 organisations that provided this information The overall vacancy rate across these 89 organisations is calculated at 10 per cent (12566.35 FTE) i.e. posts not permanently occupied The number of qualified nursing posts in these 89 organisations filled by agency staff is 2087.76 (FTE). A breakdown of regional establishment and vacancy rates is provided in Table 1a. 60 surveyed organisations are looking to increase qualified nurse numbers overall (Figure 1.4). Almost half of these organisations (28) reported that this is part of a skill mix review as a result of the publication of national safer staffing guidance. *Care must be taken when interpreting the trends because 100 per cent response rate was not achieved for the vacancy establishment data, thus the information may not be representative of a regional/national picture. Checks have been made to authenticate this data as far as possible against National NHS Workforce Statistics (for October 2013) and these figures would appear to be in line. The regional response rate for establishment data is provided in Table 1a. May 2014 11
Table 1a. Staffing establishments - summary data for qualified nursing staff by region Table 1a Staffing establishments summary data for qualified nursing staff by region LETB area Regional response rate for establishment data % Established Posts (FTE) Posts occupied by Permanent Staff (FTE) Posts occupied by Temporary Staff (FTE) Posts occupied by Agency Staff (FTE) Posts remaining unoccupied after agency & temporary considered (FTE) Posts not permanently occupied (FTE) (Vacancy Rate %) North - HE North East 33% 5896.3 5518.62 94% 251.52 4% 2 0.03% 96.2 2% 349.72 6% North - HE North West 38% 18657.45 16967.83 91% 1353.4 7% 45.5 0.2% 484.44 3% 1883.34 10% North - HE Yorkshire & Humber 27% 8309.98 7565.62 91% 416.43 5% 148.2 2% 315.24 4% 879.87 11% Midlands & East - HE East Midlands 60% 17346.96 15933.35 92% 220.11 1% 504.41 3% 636.4 4% 1360.92 8% Midlands & East - HE West Midlands 38% 14776.19 13723.03 93% 312.23 2% 125.7 1% 675.65 5% 1113.58 8% Midlands & East - HE East of England 21% 7596.61 6687.78 88% 356.77 5% 253.76 3% 285.97 4% 896.5 12% London - HE North Central & East London 38% 11336.17 9985.2 88% 837 7% 443.09 4% 313 3% 1593.09 14% London - HE North West London 0% *NO ESTABLISHMENT DATA PROVIDED* London - HE South London 17% 7409.96 6161.17 83% 195.9 3% 76.88 1% 1052.89 14% 1325.67 18% South - HE Kent, Surrey & Sussex 44% 12444.03 11231.69 90% 621.14 5% 250.77 2% 372.06 3% 1243.97 10% South - HE Thames Valley 0% *NO ESTABLISHMENT DATA PROVIDED* South - HE South West 71% 18308.24 16959.81 93% 675.66 4% 218.39 1% 743.52 4% 1637.57 9% South - HE Wessex 20% 4248.85 3966.73 93% 237.86 6% 19.06 0.4% 25.2 1% 282.12 7% Grand Totals 126330.74 114700.83 91% 5478.02 4% 2087.76 1.7% 5000.57 4% 12566.35 10% Figure 1.4. Number of organisations looking to increase qualified nurse numbers overall Number of Organisations 70 60 50 40 30 20 10 0 60 34 12 3 Yes No Don't know Blanks 12 May 2014
South - HE Kent, Surrey & Sussex 44% 12444.03 11231.69 90% 621.14 South - HE Thames Valley 0% South - HE South West 71% 18308.24 16959.81 93% 675.66 South - HE Wessex 20% 4248.85 3966.73 93% 237.86 Grand Totals 126330.74 114700.83 91% 5478.02 Figure 1.4 Number of organisations looking to increase qualified nurse numbers overall Figure 1.4. Number of organisations looking to increase qualified nurse numbers o Number of Organisations 70 60 50 40 30 20 10 0 60 34 12 3 Yes No Don't know Blanks NHS Qualified Nurse Supply and Demand Survey May 2014 13
SECTION C NHS REGISTERED NURSE SUPPLY AND DEMAND Headlines 90 surveyed organisations (83 per cent) reported they are experiencing qualified nursing workforce supply shortages (Figure 1.5) Table 1b provides a high level summary of the reported hard to fill nursing vacancies Results indicate: 42 organisations (39 per cent) are estimated to have between 1 50 FTE* qualified nurse vacancies, 39 (36 per cent) are estimated to have between 50 100 FTE* vacancies and nine organisations (8 per cent) are estimated to have 100+ FTE* nurse vacancies (figures ranging from 110 250) 42 per cent of the reported hard to fill vacancies have been unfilled for 3 6 months, and 20 per cent for over 6 months Skill shortages at a local or national level are the most reported reasons for recruitment difficulties Local actions to manage supply shortages have focused on skill mix reviews/service reconfiguration, local recruitment campaigns and use of agency/temporary staff. See further detail in section D. *Organisations were asked to provide FTE information for each hard to fill area from pre-defined ranges (i.e. 1 10, 11 20, 21 30) these trends are based on a calculation of the highest number in the range, thus presenting the worst case scenario in terms of the number of vacancies. Table 1c provides a breakdown of reported hard to fill vacancies by nursing area so we can observe where the demand is. Results indicate: 278 reports of hard to fill nursing vacancies from the surveyed organisations (across all A4C bands and specialisms) The general trend indicates that there are low volumes of vacancies (FTE) in any one organisation for a given specialism. Although many organisations report hard to fill vacancies in a number of different nursing specialisms which compounds their recruitment challenges (refer to FTE vacancy figures above). Demand spans a wide range of nursing areas (over 40). There is minimal evidence to indicate serve recruitment difficulties in specific areas of nursing on a national/regional level the two exceptions where results could possibly indicate more widespread challenges are at Band 5: Band 5: Hard to fill vacancies in Band 5 theatre nursing were reported by 22 per cent of survey organisations, however most of which were for low volumes (between 1 20 FTE nurses) with posts vacant for periods of 3 6 months. National and local skills shortages are reported to be the primary reasons for recruitment challenges in this area. 14 May 2014
Hard to fill vacancies in Band 5 medical nursing were reported by almost 20 per cent of surveyed organisations. This area of nursing sees trends of higher volumes (21+ FTE nurses) with posts vacant for longer periods of between 3 12 months. National skills shortages are reported to be the primary reason for recruitment challenges in this area. Above average reports of hard to fill vacancies (but by smaller numbers of organisations) were also reported of Band 5 nurses in accident & emergency, general surgery, children & neonatal, community & district, elderly and intensive treatment units. Skills shortages at national and local levels and the desirability of the nursing area are reported to be the principle reasons for difficulty recruiting into these nursing areas. Band 6: Most commonly reported hard to fill vacancies at Band 6 are in specialist roles; children & neonatal, accident & emergency, intensive treatment units, mental health and theatres and in community & district nursing however the numbers are small and reflective of local issues rather than widespread national or regional challenges (less than 10 per cent of surveyed organisations reported hard to fill vacancies in any of these areas). Band 7 and 8: Numbers of reported recruitment challenges across nursing areas in Bands 7 and 8 were low, and where there are reports of shortages, the FTE volumes are also low (between 1 10 FTE) suggesting there are pockets of local recruitment challenges rather than widespread problems. Figure 1.5. Experiencing qualified nurse workforce supply shortages Figure 1.5 Experiencing qualified nurse workforce supply shortages No (17%) Yes (83%) Table 1b. High level summary of reported hard to fill vacancies, reasons a No.hard to fill vacancies (FTE) Unfilled for how long May 2014 15
20 19 Figure Figure 1.61.6. Hard Hard to fill to vacancies fill vacancies by FTE by volume FTE volume 20 18 Number of organisations 16 14 12 10 8 6 4 2 0 No (17%) 12 10 9 9 8 7 6 5 4 2 19 9 9 Yes (83%) Number of organisations 18 16 14 12 10 8 6 4 2 0 4 12 7 9 10 9 8 6 5 Hard to fill vacancies (FTE) 2 9 9 Hard to fill vacancies (FTE) Table 1b. High level summary of reported hard to fill vacancies, reasons and actions to resolve Table 1b High level summary of reported hard to fill vacancies, reasons and actions to resolve d actions to resolve No.hard to fill vacancies (FTE) Unfilled for how long Actions to resolve Reason for difficulty recruiting Actions to resolve Reason for difficulty recruiting Grand Total Skill mix review / service reconfiguration Increased emphasis on workforce planning Return to practice scheme Expanded practice placement capacity Local recruitment campaign Active recruitment outside of the UK Agency / temporary staff Recruitment & retention premia Planned overtime Other Grand Total Competition from NHS orgs Desirability of area Insufficient pay/reward Local skill shortage Geographical location National skill shortage other please state (blank).0% 16.1% 13.2% 7.4% 6.8% 16.7% 8.6% 14.8% 1.4% 7.6% 7.4% 100.0% 4.7% 8.0% 1.1% 34.5% 7.2% 38.8% 4.3% 1.4% 100.0% 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 100+ None Page 14 of 24 (blanks) Grand Total Grand Total 0-3 months 3-6 months 6-12 months 12+ months (blank) Grand Total Skill mix review / service reconfiguration Increased emphasis on workforce planning Return to practice scheme Expanded practice placement capacity Local recruitment campaign Active recruitment outside of the UK Agency / temporary staff Recruitment & retention premia Planned overtime Other Grand Total Competition from NHS orgs Desirability of area Insufficient pay/reward Local skill shortage Geographical location National skill shortage other please state (blank) Grand Total 4.0% 11.0% 6.0% 8.0% 9.0% 8.0% 5.0% 6.0% 7.0% 2.0% 8.0% 18.0% 8.0% 100.0% 30.0% 42.0% 12.0% 8.0% 8.0% 100.0% 16.1% 13.2% 7.4% 6.8% 16.7% 8.6% 14.8% 1.4% 7.6% 7.4% 100.0% 4.7% 8.0% 1.1% 34.5% 7.2% 38.8% 4.3% 1.4% 100.0% NHS Qualified Nurse Supply and Demand Survey Page 14 of 24 16 May 2014
Table 1c Reported hard to fill vacancies by nursing area (please print to view) Table 1c. Reported hard to fill vacancies by nursing area (please print to view) Reported hard to fill vacancies by area of nursing No.vacancies (FTE) Unfilled for how long Reason for difficulty recruiting Staff Group Band Specialism / area of nursing Qualified Nurse AfC Band 5 Theatres (incl Anaesthetics) 12 6 2 1 1 2 24 3 13 2 2 4 24 2 1 1 8 12 24 Accident & Emergency 13 3 1 2 19 8 8 1 1 1 19 1 1 8 1 7 1 19 Mental Health (community & inpatient) 4 2 2 1 1 10 5 3 1 1 10 7 2 1 10 Children & Neonatal 9 1 2 12 1 4 3 3 1 12 5 2 4 1 12 Stroke 1 2 3 3 3 2 1 3 General surgery 6 3 1 3 13 6 3 2 1 1 13 1 1 2 8 1 13 Medical 1 3 3 6 1 2 5 21 4 8 5 2 2 21 1 3 3 13 1 21 Community & District 7 4 3 2 16 4 10 2 16 2 7 1 6 16 Community Hospitals (ward based) 2 1 1 4 2 1 1 4 1 2 1 4 Cardiac 3 1 4 3 1 4 1 1 1 1 4 Fertility 1 1 1 1 1 1 Haematology & Oncology 1 1 1 1 1 1 Psychiatry 1 1 1 1 1 1 Elderly 3 8 2 2 1 16 4 7 3 1 1 16 1 8 2 1 3 1 16 Rehabilitation 1 1 1 1 1 1 Trauma and Orthopaedics 4 4 2 2 4 1 1 1 1 4 Medical Assessment Unit 3 3 2 1 3 1 2 3 Urology 1 1 1 1 1 1 ITU / HDU / ICU 9 4 1 14 4 7 2 1 14 1 3 1 8 1 14 Adult 1 1 2 2 2 1 1 2 Prison 1 1 1 1 1 1 Continuing Healthcare 1 1 1 1 1 1 Radiology 1 1 1 1 1 1 Musculoskeletal 1 1 1 1 1 1 Neurology / Neuroscience 1 1 2 1 1 2 1 1 2 School Nursing 2 2 1 1 2 1 1 2 General Practice 1 1 1 1 1 1 Gynaecology 1 1 1 1 1 1 Endoscopy 1 1 1 1 1 1 Gastroenterology 1 1 1 1 1 1 Ophthalmology 1 1 2 2 2 1 1 2 Admissions Unit 1 1 1 1 1 1 AfC Band 6 Children & Neonatal 5 1 1 1 8 4 1 2 1 8 1 1 6 8 ITU / HDU / ICU 4 3 1 1 1 10 2 2 2 4 10 1 1 8 10 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 100+ Mental Health (co mmunity & 7 1 8 2 4 1 1 8 3 2 3 8 inp a tie nt) Haematology & Oncology 3 1 4 2 1 1 4 1 1 2 4 Community & District 5 2 2 9 5 1 1 2 9 1 4 1 2 1 9 Theatres 4 1 1 6 2 2 1 1 6 3 3 6 Intermediate care 1 1 1 1 1 1 Accident & Emergency 6 1 7 3 4 7 3 4 7 Outpatient 1 1 1 1 1 1 Gynaecology 1 1 1 1 1 1 Ophthalmology 1 1 1 1 1 1 Continuing Healthcare 1 1 1 1 1 1 Transplant co-ordinator 1 1 1 1 1 1 School Nursing 1 1 1 1 1 1 Prison 1 1 1 1 1 1 Stroke 1 1 1 1 1 1 General surgery 1 1 2 1 1 2 1 1 2 Medical 1 1 1 1 1 1 AfC Band 7 Sonographers (qualified nurse) 1 1 1 1 1 1 Community & District (incl sp e cia lists) 5 1 6 2 2 2 6 3 1 2 6 Medical Assessment Unit 1 1 1 1 1 1 Diabetes 1 1 1 1 1 1 Mental Health 2 2 1 1 2 1 1 2 Accident & Emergency 2 1 3 2 1 3 1 2 3 Ophthalmology 1 1 1 1 1 1 Continuing Healthcare 1 1 1 1 1 1 Children 2 2 2 2 2 2 Epilepsy 1 1 1 1 1 1 Neurology / Neuroscience 1 1 2 1 1 2 1 1 2 Medical 1 1 1 1 1 1 General Practice 1 1 1 1 1 1 Elderly 1 1 1 1 1 1 Apheresis 1 1 1 1 1 1 ICU 1 1 1 1 1 1 AfC Band 8 Speech & language 1 1 1 1 1 1 (blank) Accident & Emergency 1 1 2 1 1 2 2 2 Grand Totals 158 48 21 10 3 4 0 0 1 1 2 30 278 83 115 35 23 22 278 12 22 3 95 18 112 12 4 278 Grand Total (of reported shortages) 0-3 months 3-6 months 6-12 months 12+ months (blank) Grand Total (of reported shortages) Competition from NHS orgs Desirability of area Insufficient pay/reward Local skill shortage Geographical location National skill shortage other please state (blank) Grand Total NHS Qualified Nurse Supply and Demand Survey Page 15 of 24 May 2014 17
SECTION D ACTIONS TO RESOLVE SUPPLY CHALLENGES Headlines Figure 1.7 shows a breakdown of the most common local action taken by the surveyed organisations to resolve their supply shortages. Results indicate: Local action to manage supply shortages has focused on skill mix reviews/ service reconfigurations, local recruitment campaigns, and use of agency/ temporary staff Other reported strategies in place to ensure nursing workforce supply meets current and predicted future demand on services include; increased emphasis on workforce planning, active recruitment outside of the UK, planned overtime, return to practice schemes, expanding practice placement capacity, recruitment & retention premia, the Overseas Nursing Programme, social media and up-skilling the support workforce 49 surveyed organisations (45 per cent) have actively recruited from outside of the UK during the last 12 months to fill qualified nursing vacancies (Figure 1.8). A breakdown of overseas recruitment activity by region is provided in Figure 1.9 96 per cent of reported activity has been in EEA countries (Figure 2.0) Trend for filling Band 5 experienced general nursing positions from EEA countries. Spain, Ireland and Portugal are the most commonly targeted countries. A breakdown of the countries targeted for recruitment campaigns is provided in Figure 2.1 Outside of the EEA, the Philippines has been targeted by two surveyed organisations, both of which were looking to fill gaps for theatre nurses Data collected to indicate the volume of nurses recruited from outside of the UK suggests that on average those organisations that have reported undertaking overseas recruitment campaigns have employed 50 FTE qualified nurses through these campaigns in the last 12 months (*care must be taken when interpreting trends because this data was not provided by all surveyed organisations) 56 surveyed organisations (51 per cent) are considering actively recruiting qualified nursing staff from outside of the UK in the coming 12 months (Figure 2.2) A breakdown of the countries being considered for future targeted overseas campaigns is provided in Figure 2.3 Spain, Ireland and Portugal look to continue being the primary destinations. 18 May 2014
Figure 1.7. Most common reported actions to resolve supply shortages Figure 1.7 Most common reported actions to resolve supply shortages 1% 8% 7% 16% Skill mix review / service reconfiguration Increased empasis on workforce planning Return to practice scheme 15% 13% Expanded practice placement capacity Local recruitment campaign Active recruitment outside of the UK 9% 17% 7% 7% Agency / temporary staff Recruitment & retention premia Planned overtime Other rtages Figure 1.8. Active recruitment outside of the UK during the last 12 m Figure 1.8 Active recruitment outside of the UK during the last 12 months Figure 1.9. Overseas recruitment 2, 2% activity by region 2% UK 2% 6% 58, 53% 6% 12% 12% 49, 45% East Midlands East of England Kent Surrey & Sussex North Central & East London North East North West Yes No Blanks South London 27% 8% South West Thames Valley 6% Wessex West Midlands 2% 15% 2% Yorks & Humber Figure 2.0. Where has targeted recruitment activity taken place NHS Qualified Nurse Supply and Demand Survey 4% n May 2014 19
17% Other ply shortages ce orkforce me ement paign side of the UK aff on premia Figure 1.8. Active recruitment outside of the UK during the last 12 months Figure 1.9. Overseas recruitment activity by region Figure 1.9 Overseas recruitment activity by region 2, 2% 6% 2% 6% 58, 53% 27% 2% 2% 12% 49, 45% 12% 8% 6% 15% 2% East Midlands East of England Kent Surrey & Sussex North Central & East London North East North West Yes No Blanks South London South West Thames Valley Wessex West Midlands Yorks & Humber Figure 2.0. Where has targeted recruitment activity taken place Figure 2.0 Where has targeted recruitment activity taken place 4% NHS Qualified Nurse Supply and Demand Survey ssex ast London EEA countries Non - EEA countries 96% Page 17 of 24 20 May 2014
Figure 2.1. Countries targeted for recruitment campaigns in last 12 mo Figure 2.1 Countries targeted for recruitment campaigns in last 12 months 30 28 25 24 Number of Organisations 20 15 10 5 0 18 2 2 1 1 1 2 t 12 months Figure 2.2. Considering active overseas recruitment during next 12 mo Figure 2.2 Considering active overseas recruitment during next 12 months Figure 2.3. for recruitment campaigns in next 12 mo 6, 6% Countries targeted 13, 12% 30 25 24 Yes No 20 18 15 15 56, 51% Don't know Blanks 34, 31% 10 7 5 5 5 2 2 2 2 1 1 1 1 1 1 1 2 0 Number of Organisations xt 12 months NHS Qualified Nurse Supply and Demand Survey May 2014 21
Figure 2.3. Countries targeted for recruitment campaigns in next 12 mo Figure 2.3 Countries targeted for recruitment campaigns in next 12 months 30 25 24 Number of Organisations 20 15 10 5 0 15 2 1 1 1 18 2 1 5 5 2 2 1 1 7 1 2 NHS Qualified Nurse Supply and Demand Survey 22 May 2014
SECTION E FURTHER SUPPORT Headlines Surveyed organisations were asked what additional support they would find useful to help resolve their qualified nursing workforce supply challenges. Emerging themes: Support for Return to Practice schemes Co-ordinated approach to nursing careers campaign/recruitment & retention initiatives International recruitment initiatives Facilitate sharing of good practice Facilitate closer links with universities Developments/changes to nursing education and training Increase training commissions. Table 1d overleaf provides further information with direct quotes from surveyed organisations under each of the themes above. May 2014 23
Table 1d Direct quotes from the survey further support Support for Return to Practice Schemes More National initiatives around Return to Practice. Some idea of whether there is a Return to Practice population. Co-ordinated approach to careers campaigns/recruitment and retention initiatives More secure funding for CPD from central NHS funds. Funding to support recruitment initiatives. Education and training More flexible ways to train to be an RGN whilst in service. Directed ring fence funding for specific post registration training. Return to Practice support. Innovative options for recruitment. Greater exposure to Paediatric Oncology during training. Materials to use in targeting Return to Practice. Return to Practice and rotation funding. Increase in RTP course numbers. Financial support for return to nursing and adaptation courses. Further Return to Practice programmes commissioned directly through HEE. National campaigning and collective support arrangements for initiatives such as Return to Practice. Increased, continual and financially supported Return to Practice schemes. Mental Health Return to Practice programmes and national awareness raising/campaigns. More national recruitment campaigns to encourage moving into nursing, return to practice etc. Open days and recruitment initiatives in rural areas to attract nurses who would like to live and work in rural areas. Coordinated approaches across trusts within regions, similar to Deanery arrangements. Links with local schools and colleges to promote working in the NHS. Generally, to promote medical specialities as a valuable career option. Better analysis of the impact of policies such as pension changes on the profession. More emphasis on retention with flexible working arrangements suitable for older workers in high pressure posts. National media coverage and advertising campaigns to support Return to Practice similar to the Public health nursing campaigns. Increased specialty training and support for older adult care. Investment in education and training to develop new roles. Development and registration of new roles. Regional co-ordination of placements from Universities to allocate on need in line with demand. We also require specific training programmes for HCAs to allow them to take on additional duties which will give a new skill mix. Review of nursing training to return to allocation by Trust to enable closer relationship with future workforce. Bursaries to support Associate Practitioners in nurse training programmes. Backfill monies to support secondments to undertake nurse training. 24 May 2014
Support for Return to Practice Schemes Return to Practice provision which is easy to access and flexible to meet organisational needs. More attention to the fit of training placements and support for RTP together with pre-registration nursing. We do NOT anticipate benefitting from Return to Practice programmes as we have not done so in the past many of our staff who leave e.g. for children will work locally rather than return to work in London; and would not opt to return to a highly specialist working environment if they have been out of the profession. Developing more Return to Practice courses for nurses who have been out of the profession for some time, our most local RTP organisation is some miles away and a more local provision may attract local residents back into the profession (we receive regular enquiries about RTP). Co-ordinated approach to careers campaigns/recruitment and retention initiatives National advertising to attract nurses into training or Return to Practice (like the military). Nationally drive initiatives towards substantive employment away from temporary resource solutions. For nurses free travel on all trains into and out of London, similar to the Metropolitan Police. Further focus groups with nurses nationally to understand what we can do nationally to attract nurses into the service i.e. pay, flexible working, schools etc. Nationally I think there needs to be something that promotes the nursing profession (it has received so much negative press recently). National initiatives (e.g. current value based recruitment) having detail from a central hub, so each employer isn t left to work out its own way of doing something. Regional wide campaigns would surely provide better economic and resourcing sense, value for money rather than competing with neighbouring Trusts. Education and training DH instruction to require universities to offer two intakes of nurses a year. Keep secondments to branch, the blanket removal of all secondments has impacted on our workforce development plans. As a community trust it would be beneficial if training providers could cover more in relation to skill and competency of managing out of hospital care. That on completion of their training, newly qualified nurses are expected to work a first year in the hospital that provided their training. It would be helpful to look at sponsorship of health care assistants to nurse training (something which has been reduced in recent years). A national career development and competency based framework bringing into alignment KSF, band specific competencies and skills for health. Emphasis currently seems to be on pre-reg training (i.e. how many nurses are in the system) when actually we need to be thinking about the increasing specialisation of nurses in order to care. May 2014 25
Support for Return to Practice Schemes Co-ordinated approach to careers campaigns/recruitment and retention initiatives Focus on raising the profile of nursing in the community undergrad nursing management placements in the community as well as giving ward nurses opportunities to rotate to the community. Predicted numbers of students studying to become a registered nurse remain below the level of demand, therefore initiative to encourage people to consider nursing as a career would help to alleviate this issue. It seems strange why the NHS has its hospitals competing against each other for the nursing workforce, the same will be true of the international recruitment. Is there not scope for a North West scheme where nurses are allocated to Trusts rather than giving them a choice between a small town hospital and a large teaching hospital it s obvious who always loses out and therefore experiences the greater pressure. Education and training In the short term we will need to be creative in role development nationally and locally. A pathway for non registered nursing to registered nursing with appropriate training pathways and funding streams would support long term gaps. Career Pathway of supporting unqualified clinical staff into Assistant Practitioner roles and then re-engaging with the secondment programme. This will support the Trust in succession planning and we are working with Health Education North West on this. Recognition that eye problems affect a huge proportion of the population, and that the current undergraduate curriculum does not reflect this. Few student nurses have enough exposure to ophthalmology to consider this as a career path. 26 May 2014
Facilitate sharing of good practice Some sharing of international recruitment challenges. Good Practice Examples. Increased sharing of good practice across the country. Case studies on the integration of new roles to relieve short staffing issues. More direct communication to both HR and Nursing Directors to inform us of what strategies other organisations are adopting shared learning. More proactive support on alternative skill mix options and funding for training for specialist nurses as for a DGH this can be often difficult to release people to do the training to prepare them for succession. The Trust would find it useful to identify how other Trusts are meeting supply challenges in Theatres and Critical Care. In addition case studies on where other trusts have introduced Advanced Nurse Practitioner roles. Facilitate closer links with universities Increased responsiveness of pre reg education providers. Working closely with universities to ensure the right students are selected for nursing programmes. More co-ordinated approaches by Higher Education Institutes and the return of secondment opportunities from the existing workforce. Facilitation of closer links between trusts and universities to encourage students to stay on at some of the trusts who struggle geographically. Working in partnership with universities nationally, local links are successful but wider links need to be made which could be supported externally. Increase training commissions Increase commissions of nursing students. Increase in education numbers. We increase the number of student nurse places. Increase the number of HEI training places. Actual nurse training numbers to be slightly more than estimated numbers. May 2014 27
International recruitment initiatives That the Band 5 is recognised on the skills shortage list. Support with coordination of overseas recruitment. Fast track and better joined-up routes to recruit overseas staff, between NMC and UKBA. More fluid movement of registered nurses from EU and other non-uk countries. Support for programmes for overseas nurses who need to adapt to UK practices. Specialist areas like Paediatric Intensive care, theatres, Adult Intensive care, Transplant must be put back on the UK Border Agency Shortage Occupation List. We consider an adaptation programme for our overseas colleagues who are registered but currently work in Nursing Homes as carers as their registration is not recognised by the NMC. Recruitment of nurses from overseas is limited due to registerable qualifications. The Nursing and Midwifery Council (NMC) should review those countries, take into account not just training experience, but additional experience and qualification gained, and length of actual time practicing. Miscellaneous (other ideas) Continue with leadership development. Reducing cost of agency workers. More proactive involvement in workforce planning regionally. A local workforce forecasting tool. Region-wide initiatives to reduce use of agencies in local areas. Assistance to co-ordinate a regional approach and reduce competition within the NHS for the limited supply. Supply information covering the West Midlands to support workforce planning and resource planning. More intelligence about potential nurse supply in non-nhs organisations. Support from the commissioners and primary care to further support discharge of patients from the Acute hospitals will mean less staff in acute areas and possibly more beds and staff in the community with different skills. That the NMC improves the time it takes to register newly qualified nurses. Greater visibility of workforce planning at all levels organisation regional national level. More emphasis from professional bodies and leads on competency, so that the issue around supply is not about qualifications but competencies. Competencies are more in the control of organisations, qualifications are not. It would help if newly qualified nurses that are subsequently taken on at the Trust did not have to go through all their safer recruitment checks. These have already been carried out by the University in question and should be transferred to the new post automatically. 28 May 2014
Summary The survey has provided data and analysis on aspects of supply and demand levels and trends amongst the NHS qualified nurse workforce in England. Report author NHS Employers Contact: NHS Employers, 2 Brewery Wharf, Kendell Street, Leeds, LS10 1JR 0113 306 3000 Date of issue May 2014 May 2014 29
NHS Employers The NHS Employers organisation is the voice of employers in the NHS, supporting them to put patients first. Our vision is to be the authoritative voice of workforce leaders, experts in HR, negotiating fairly to get the best deal for patients. We help employers make sense of current and emerging healthcare issues to ensure that their voice is front and centre of health policy and practice. We keep them up to date with the latest workforce thinking and expert opinion, providing practical advice and information, and generating opportunities to network and share knowledge and best practice. We work with employers in the NHS to reflect their views and act on their behalf in four priority areas: pay and negotiations recruitment and planning the workforce healthy and productive workplaces employment policy and practice. The NHS Employers organisation is part of the NHS Confederation. Contact us For more information on how to get involved in our work, email getinvolved@nhsemployers.org www.nhsemployers.org enquiries@nhsemployers.org @nhsemployers NHS Employers www.youtube.com/nhsemployers NHS Employers 2 Brewery Wharf Kendell Street Leeds LS10 1JR This publication was produced by the NHS Confederation publications team: publications@nhsconfed.org This document is available in pdf format at www.nhsemployers.org/publications Published May 2014. NHS Employers 2014. This document may not be reproduced in whole or in part without permission. The NHS Confederation (Employers) Company Ltd. Registered in England. Company limited by guarantee: number 5252407 Ref: EINF36001