168. (a). We recommend that the Government takes steps to introduce stronger formal links between the National Advisory Group for Scientists and Technicians (NAGST) and national professional bodies. (paragraph 31).

(b). We consider that with immediate effect there should be improved interaction between the medical and non-medical planning bodies. (paragraph 34).

(c). We believe that there should be regular meetings between MWSAC and REDGs, who should exchange information, discuss new ideas and develop plans. (paragraph 35).

(d). We recommend a major review of current planning procedures which should pay particular regard to their rationalisation and eventual replacement by an integrated planning system. We think it necessary that any new system should not only incorporate the national overview currently provided by the sub-group of the NHSE, but also actively promote a national strategy for workforce planning which, allowing for local conditions, brings a sense of consistency and cohesion at present notable for its absence. (paragraph 36).

(e). The issue of the provision of appropriate joint training throughout the UK should feature largely in the major review of current planning procedures that we have recommended. (paragraph 38).

(f). We suggest that DoH should ask the MWSAC to look in more detail at the balance between specialist and generalist training for doctors in achieving a flexible medical workforce. (paragraph 39).

(g). We recommend that efforts are made to co- ordinate local initiatives and assess their strategic impact on the future workforce numbers. We further recommend that co-ordinated pilot studies are undertaken to assess the impact of altering the skill mix. (paragraph 47).

(h). We recommend that the proposed number of medical students be increased by a minimum of 1,000 per year. This increase should be accompanied by a commensurate expansion in the number of senior doctors and consultants in order to provide for the necessary career opportunities and supervisory roles. (paragraph 59).

(i). The evidence we have received leads us to conclude that on current trends the projected increases in the number of nurses and other clinical staff fall well short of what is required to deal with current shortages and future developments in the NHS. We hope that recent Government initiatives will reverse these trends, but we suggest that the Government urgently reassesses its staffing figures to ensure an NHS workforce that is sufficient for requirements. (paragraph 64).

(j). We recommend that the Government consults with NHS employers and staff representative groups in order to establish a rigorous but fair system of efficiency appraisal.

(paragraph 68).

(k). It seems to us that the introduction of formal exit interviews would help workforce planning by providing a better sense of the reasons why staff leave the NHS. We also recommend that DoH initiate a formal consultation on standardisation of information as soon as possible. (paragraph 79).

(l). Since the NHS will rely on overseas staff for many years to come, it is important that the Service ensures their career opportunities are not being restricted by their immigration status. We recommend that DoH consults with the Home Office and the Department for Education and Employment on these issues. (paragraph 83).

(m). We urge the Government to collate information from trusts in order to allow them to formulate a specific recruitment and retention strategy for pharmacists, scientists and all of the Professions Allied to Medicine as soon as possible. (paragraph 93).

(n). We would encourage education consortia, universities and the NHS to collaborate to ensure that the opportunity exists for student nurses to experience clinical practice in a safe and supervised environment as early in the training programme as possible. (paragraph 111).

(o). We recommend that healthcare assistants working with nurses should be called "Assistant Nurses" and be registered with the UKCC. Healthcare assistants working with other professional groups should also be registered appropriately. Registration in such circumstances would provide professional motivation for the individual and would act as a necessary safeguard for the public who could then be assured that at all times care was being delivered by people whose competence was known and recognised. (paragraph 116).

(p). We recommend that every member of the NHS staff alone on duty in the community or otherwise at risk should have access to a mobile telephone or other means of establishing emergency contact with colleagues. (paragraph 128).

(q). We recommend that overtime payments should replace undue reliance on agencies as soon as possible. Moreover, the bank system should not be used as a method of cheap labour but should instead be used as a useful flexible working practice to cover unexpected shortages. (paragraph 135).

(r). We recommend that the NHS finances in full the relevant professional educational needs of its staff. We also believe that current study arrangements are inadequate and need to be extended. (paragraph 138).

(s). We regret the transfer of ancillary staff to the private sector that is currently a consequence of PFI. The often spurious division of staff into clinical or non-clinical groups can create an institutional apartheid which might be detrimental to staff morale and to patients. We believe the Government should limit PFI to a number of pilot schemes until a proper evaluation of the impact on staff and patient care is produced. (paragraph 152).

(t). We recommend that the time has come for the NHS to move towards a single pay spine for all personnel. Terms and conditions should be negotiated nationally. (paragraph 160).

(u). We think it is time now to reorganise the pay review body system in order to inculcate a greater sense of team spirit within the NHS. We therefore recommend its replacement with the establishment of a single body charged with the task of reviewing the pay of all NHS professionals. This body should have within its remit all NHS staff, for example, clinical scientists and ancillary workers, who are not included in the current pay review bodies. The independence of the body should be secure and unassailable. (paragraph 158).