Workforce constraint: a patient safety issue W Dunlop 25 th April 2007.

Workforce constraint:Workforce constraint:a patient safety issuea patient safety issue

W DunlopW Dunlop2525thth April 2007 April 2007

ContentContent

• Is there a problem?Is there a problem?

• Will more staff help?Will more staff help?

• What is happening now?What is happening now?

• What is needed for the future?What is needed for the future?

Is there a problem?Is there a problem?

• CEMACH dataCEMACH data

– Suboptimal care for mothers and babiesSuboptimal care for mothers and babies

• Northwick ParkNorthwick Park

– Insufficient supervision by experienced cliniciansInsufficient supervision by experienced clinicians

• NHS Litigation AuthorityNHS Litigation Authority

– Increasing payments for obstetricsIncreasing payments for obstetrics

00

100100

200200

300300

1996/971996/97 1997/981997/98 1998/991998/99 1999/20001999/2000 2000/012000/01 2001/022001/02

£ million£ million

NHSLA payments for obstetric-related incidentsNHSLA payments for obstetric-related incidents1996 - 20021996 - 2002

RCOG: Safer Childbirth:Minimum Standards for Service Provision and Care in Labour

ContentContent





Will more staff help?Will more staff help?

• Senior involvementSenior involvement

– Intervention ratesIntervention rates

• Trainee involvementTrainee involvement

– WTD complianceWTD compliance

• Midwife involvementMidwife involvement

– Funded establishmentFunded establishment

Compliance with WTD 2009 hours target by pay band and specialtyCompliance with WTD 2009 hours target by pay band and specialty

Source: 28th Ministerial Return March 2005 (NHS Employers)Source: 28th Ministerial Return March 2005 (NHS Employers)N.B. Actual numbers in each 'broad' specialty group vary considerably.N.B. Actual numbers in each 'broad' specialty group vary considerably.

% doctors% doctors in trainingin training

00

2020

4040

6060

8080

100100

Public H

ealth

Public H

ealth

Psych

iatry

Psych

iatry

A&EA&E

Patholo

gy

Patholo

gy

Radio

logy

Radio

logy

Dentis

try

Dentis

try

Paedia

trics

Paedia

trics

Avera

ge

Avera

ge

Anaest

hetic

s

Anaest

hetic

s

Med

icin

e

Med

icin

e

O&GO&G

Surger

y

Surger

y

48 hours and less48 hours and less

More than 48 hoursMore than 48 hours

Annual survey of UK Heads of Midwifery ServiceAnnual survey of UK Heads of Midwifery Service

In your view, is the funded midwifery establishment In your view, is the funded midwifery establishment adequate for the level of activity undertaken in your trust?adequate for the level of activity undertaken in your trust?

00 2020 4040 6060 8080 100100

20012001

20022002

20032003

20042004

20052005

YESYES NONO

YearYear

PercentPercent

ContentContent





Net NHS Expenditure, 2002-03 to 2006-08

England

00

2020

4040

6060

8080

100100

£ billion£ billion

70% of NHS funding is spent on staffing costs70% of NHS funding is spent on staffing costs

55.755.7

2002-032002-03

63.763.7

2003-042003-04

69.269.2

2004-052004-05

76.176.1

2005-062005-06

84.484.4

2006-072006-07

92.292.2

2007-082007-08Department of HealthDepartment of Health

00

500000500000

10000001000000

15000001500000

19951995 19961996 19971997 19981998 19991999 20002000 20012001 20022002 20032003 20042004 20052005

Total NHS staff 1995 - 2005Total NHS staff 1995 - 2005

House of Commons Health Committee, 2007House of Commons Health Committee, 2007

Nurses and doctors 1995 - 2005Nurses and doctors 1995 - 2005

00

100,000100,000

200,000200,000

300,000300,000

400,000400,000

19951995 19961996 19971997 19981998 19991999 20002000 20012001 20022002 20032003 20042004 20052005

Nurses,Nurses,MidwivesMidwives

Health VisitorsHealth Visitors

All doctorsAll doctors


Consultants, registrars and other training gradesConsultants, registrars and other training grades 1995 - 20051995 - 2005

00

5,0005,000

10,00010,000

15,00015,000

20,00020,000

25,00025,000

30,00030,000

35,00035,000

19951995 19961996 19971997 19981998 19991999 20002000 20012001 20022002 20032003 20042004 20052005

ConsultantsConsultants

Other traineesOther trainees

RegistrarsRegistrars


00

55

1010

1515

2020

19981998 19991999 20002000 20012001 20022002 20032003 20042004

Associate Associate SpecialistSpecialist

Staff GradeStaff Grade

Annual percentage increments in career Annual percentage increments in career grade doctors in UK*, 1998 - 2004grade doctors in UK*, 1998 - 2004

*Northern Ireland numbers included in 2001,2002 and 2003 only

ConsultantConsultant

NHS workforce growth 1999 - 2005NHS workforce growth 1999 - 2005

00 1010 2020 3030 4040 5050 6060 7070

Senior managementSenior management

Central functionsCentral functions

Clinical support staffClinical support staff

Scientific andScientific andtechnicaltechnical

Allied healthAllied healthprofessionalsprofessionals

NursesNurses

All doctorsAll doctors

percentpercent


Comparison of Comparison of NHS Plan NHS Plan (2000) growth targets(2000) growth targetswith actual workforce growth (1999 – 2004)with actual workforce growth (1999 – 2004)

-50-50

00

5050

150150

250250

350350

GPsGPs

105%105%

NursesNurses

340%340%

Allied healthAllied healthprofessionalsprofessionals

69%69%

ConsultantsConsultants

-3%-3%


Potential unemployment?Potential unemployment?

Physiotherapy graduates in 2006:Physiotherapy graduates in 2006:68% unable to find NHS work68% unable to find NHS work

(usual unemployment rate 5%)(usual unemployment rate 5%)

Nursing graduates in 2006:Nursing graduates in 2006:40% unable to find NHS work within 6 months40% unable to find NHS work within 6 months

(usual rate 15%)(usual rate 15%)


Medical trainees in 2007?Medical trainees in 2007?

Workforce considerations:Workforce considerations: conversion to MMC training postsconversion to MMC training posts

2800

5500

9000

3700

FF2 2 postsposts

GP traineesGP trainees

Specialist traineesSpecialist trainees

SurplusSurplus

Total number of SHO and Trust grade posts = 21,000Total number of SHO and Trust grade posts = 21,000

www.mmc.nhs.ukwww.mmc.nhs.uk

ST posts 2007ST posts 2007

Total number of SHO and Trust grade posts = 21,000Total number of SHO and Trust grade posts = 21,000

Predicted surplus = 3,700Predicted surplus = 3,700

Alleged number of applicants for ST posts = 33,000Alleged number of applicants for ST posts = 33,000

Possible deficit = 8,300Possible deficit = 8,300

““There has been a There has been a disastrous failure of disastrous failure of workforce planning.”workforce planning.”

ContentContent





Training costs of health service professionalsTraining costs of health service professionals

00

100000100000

200000200000

300000300000

NursesNurses DoctorsDoctors

££

Professionals AlliedProfessionals Alliedto Medicineto Medicine

(Netten et al, 1998)(Netten et al, 1998)

00

4000040000

8000080000

120000120000

2002-032002-03 2003-342003-34 2004-052004-05 2005-062005-06

GBPGBP

YearYear

Average consultant earnings, 2002 - 2006Average consultant earnings, 2002 - 2006


Overspending on pay reformOverspending on pay reformrelative to projected spendingrelative to projected spending

2004 - 20052004 - 2005

00

5050

100100

150150

200200

250250

300300

Consultant contractConsultant contract Agenda for ChangeAgenda for Change GP contractGP contract

£ million£ million


Some Questions

• What can be done by others?

• What must be done by doctors?

• What is the added value of a doctor?

• What do patients want?

• How will health care be delivered?

• How do we train for new roles?

Factors to be addressedFactors to be addressed

Role of the doctorRole of the doctor

Length of trainingLength of training

Service reconfigurationService reconfiguration

Plurality of provisionPlurality of provision

Role redesignRole redesign

Hours of workHours of work

Other Factors for ChangeOther Factors for Change

• National Service FrameworkNational Service Framework

• Election ManifestoElection Manifesto

• Postgraduate trainingPostgraduate training

• RCOG / RCM / NICE initiativesRCOG / RCM / NICE initiatives

National National Service Service

Framework Framework for Children for Children

Young People Young People and Maternity and Maternity

ServicesServices

• Standards for service provisionStandards for service provision

• Framework for clinical guidelinesFramework for clinical guidelines

• Adaptable to local circumstancesAdaptable to local circumstances

• Acceptable for womenAcceptable for women

• Workable for health carersWorkable for health carers

Maternity ServicesMaternity Services

Manifesto CommitmentManifesto Commitment

By 2009:By 2009:

• Choice of place and pain reliefChoice of place and pain relief

• Named midwifeNamed midwife

• Links to Children’s CentresLinks to Children’s Centres

Choice of:Choice of:

•Access to careAccess to care

•Type of careType of care

•Place of birthPlace of birth

•Postnatal carePostnatal care

““With an estimated 10 000 more midwives With an estimated 10 000 more midwives needed to deliver first-class maternity needed to deliver first-class maternity services, there is still a long way to go.”services, there is still a long way to go.”

RCM News and Appointments 2006RCM News and Appointments 2006

The RCM PositionThe RCM Position

20042004

““Children’s and Children’s and Maternity Maternity

Services in 2009:Services in 2009:Working time Working time

solutions”solutions”

20092009

Aims of projectAims of project

• Information from compliant unitsInformation from compliant units

• Impact upon training and CPDImpact upon training and CPD

• Evaluation of modelsEvaluation of models

• Communication strategyCommunication strategy

• Antenatal careAntenatal care

• Caesarean SectionCaesarean Section

• Intrapartum careIntrapartum care

• Postnatal carePostnatal care

• Complex pregnanciesComplex pregnancies

NICE guidelines for clinical careNICE guidelines for clinical care

ConclusionConclusion

• Workforce expansion unplannedWorkforce expansion unplanned

• Major changes anticipatedMajor changes anticipated

• Need to define rolesNeed to define roles

• Standards clearly definedStandards clearly defined

• Potential for more trained doctors Potential for more trained doctors

Workforce constraint: a patient safety issue W Dunlop 25 th April 2007.

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