SUMMARY

  Staffing difficulties are widespread and extend well beyond the professions most commonly identified by the media.

  The problems have been evidence for some time but it is only in the last year that they have been acknowledged by the DoH.

  Pay is not the only factor in influencing recruitment and retention but it is an increasingly important one.

  Lack of career progression, inadequate training and professional development provisions, poor and often discriminatory treatment of staff and excessive workload has undermined staff commitment to the NHS.

  The failure to address race discrimination and develop family friendly employment policies have been crucial. If the number of black nurses employed in the NHS twenty years ago were employed now, there would probably be no staffing problem in that profession.

  Changing patterns of service delivery and skill mix will affect future staffing needs. They are unlikely to significantly reduce the need for the professional staff represented by MSF.

  Please note our evidence is complemented by seperate submissions on behalf of the Community Practitioners and Health Visitors Association and by the Hospital Physicists Association sections of MSF.

1.  PREFACE

  MSF has 65,000 members in the NHS. We represent the broadest range of professions of any NHS union, including health visitors, laboratory scientists, pharmacists, speech and language therapists, clincal psychologists, technicians and chaplains. A full list is appended.

  It is this range of professionals within our membership that makes our evidence distinctive. We have also worked hard to raise equal opportunities as a priority for the NHS (particularly the failure to recruit and retain black and Asian staff, and staff with caring responsibilities).

  MSF welcomes the opportunity to present written evidence to the Committee on future NHS staffing requirements. It has been our view for some years, that the NHS is heading for a staffing crisis in a growing number of professions for a number of reasons. It is often the case that only the concerns of doctors and hospital nurses are publicised, but there are many other professional groups within the NHS who are also experiencing problems. Our evidence will highlight the issues around some of those staff groups.

  This evidence will particularly focus on the many factors that affect recruitment and retention. In our opinion these are pay, career structure, professional development, treatment of staff including discrimination and harassment and workloads, and these are set out in more detail below.

2.  THE SCALE OF THE PROBLEM

  Much media attention has been paid to shortages of doctors and hospital nurses. It is our belief that the problems are far more widespread. Consider two examples.

  Cytology screeners and laboratory scientists (MLSOs) provide an invaluable service in the cancer screening service. MSF has warned for several years that low pay was epidemic and would lead to a staffing crisis. As recently as August 1998 the Department of Health were denying this is a widespread problem. Our comprehensive survey of heads of pathology departments showed the problem clearly was widespread1.

  In 1994 the Health Visitors Association section of MSF published "Cause for Concern—an analysis of staffing levels and training plans in health visiting and school nursing"2. This discussed, in great detail, why there was already a serious staff shortage and why it was likely to get radically worse.

  Subsequent evidence to the Pay Review Body3 and comprehensive independent surveys of HVA membership confirmed this was so and identified the impact on morale and retention of staff.

  The HVA Omnibus Survey in 19944 recorded 34 per cent of staff who would leave the job immediately if they could with average workloads having risen sharply and morale low due to stress.

  The 1995 HVA London Survey5 showed that 48 per cent of black health visitors in London would leave the job immediately if they could. Over one third reported not being able to undertake "essential visits to vulnerable families".

  The separate evidence of CPHVA to the Select Committee has confirmed this pattern and noted that many employers have virtually given up trying to recruit health visitors at a time when their role is growing in importance.

3.  WORKFORCE PLANNING

  The HVA analysis Cause for Concern was very critical of the Working Paper 10 Balance Sheet approach to workforce planning. Even back in 1994 the "Floors and Ceilings"6 project carried out by the Institute of Manpower Studies confirmed many of our criticisms.

  We therefore welcome the determined current attemps by the DoH to improve workforce planning in a climate where those who know are able to speak openly.

  It is essential that the Local Education Consortia are truly representative of all professions and that, especially in primary care, they are not excessively dominated by GPs.

4.  PAY

  Pay within the public sector as a whole, and the NHS in particular, is low in relation to the economy as a whole. However, the actual levels of pay for staff remain somewhat mysterious to those outside the Service. For example, very few people are aware that cytology screeners, who do the routine testing of cervical smears, are paid a starting salary of £9,626. Trainee medical laboratory scientific officers, who enter the NHS as graduates, are paid on a scale starting at £7,346. A checkout assistant in Sainsburys earns £166.53 a week—or £8,660 per annum.

  The IDS Management Pay Review has specified that the average figure for the starting pay of graduates in 1998 is around £16,0007. This figure does not even compare to the current starting rate of a medical laboratory scientific officer (grade 1) of £11,608, let alone the trainee position.

  There is a very real crisis taking place within science in the NHS, as the private sector is very much an alternative employer. Science graduates can go and work in companies such as Smith Kline Beecham or Zeneca, who offer more attractive salaries. A laboratory attendant working in Glaxo Wellcome's laboratory in Barnard Castle earns £13,659, whilst a laboratory technician earns from £16,057 to £19,607.

  To a recent graduate, with a heavy burden of student debt, the level of pay has to be one of the most important considerations.

  Pharmacy is another area where the competition from the private (or community pharmacy) sector is beginning to overwhelm the Service. Staff can earn more by working out of retail outlets, for example. The recent staffing survey, conducted by MSF amongst our 2,000 local union representatives, showed that, amongst the pharmacists, 50 per cent of those who responded said that their department was finding it very difficult to fill vacancies. A further 39 per cent said their department was finding it fairly difficult. 47 per cent expected the recruitment situation to get much worse over the next two years.

  In a survey of the Professions Allied to Medicine (PAMs), undertaken by the PAMs staff side to form part of their evidence to the Pay Review Body, the most important reason respondents gave for having left the NHS is that rates of pay within the Service are too low. 35.2 per cent of respondents did not expect to be working for the NHS in three years' time, and listed pay as the most important reason for that verdict. The survey also revealed that half of PAMs have debts of up to £4,000 or more incurred only to subsidise their cost of living whilst training8.

  In the past, lower pay in the NHS was partly compensated for by the prospect of security of employment and a satisfying job. Yet a job in the NHS in recent years has increasingly not been seen as a job for life. Some services, such as school nursing and arts therapy, have repeatedly suffered the threat of budget cuts and redundancies. Even the previous cushion of earnings protection has been removed.

5.  CAREER PROGRESS

  Many people entered the NHS science workforce because it offered a career, yet that career structure has gradually been whittled away, as fewer posts in the high grades are maintained.

  One way to deal with pay concerns, alongside decent basic salaries is to have a decent system in which staff are rewarded for service and extra training. At the moment there is incremental progression, although not for all staff, depending on nature of contracts, but cuts have meant that higher grades, opportunities for promotion, higher pay and professional development are becoming fewer. Experienced staff are lost to the service when they can progress no more.

  The recommendation of the Pay Review Body in 19989 of a system of discretionary increments added to the top grade of the higher nursing and PAMs grades does not address the problems associated with career progress. This scheme is divisive, discriminatory and does not help those staff on the lower grades where morale is also low. It is hard to find anyone in favour of the scheme.

  The real career issue in community nursing, for example, has been the virtual elimination of the two senior clinical grades H and I.

  Our survey across all professions revealed that poor career prospects was the most mentioned factor leading people to leave the service. 64 per cent of respondents cited it as one of the most important factors.

 6.  TRAINING AND STUDY LEAVE

  One example of the problems faced by staff as regards study leave has been considered by the Guild of Healthcare Pharmacists (GHP), an autonomous section of MSF.

  The survey highlights that obtaining study leave is problematic for pharmacists in many Trusts, and the indications are that the problems are getting worse. 65 per cent of the respondents cited lack of staff cover as a reason for study leave having been refused. 49 per cent agreed that pharmacists do not apply for study leave as they feel guilty about leaving their work for overstretched colleagues. Despite the momentum of continuing (CPD) and the clinical governance agenda, 77 per cent of Trusts have done nothing at all to help pharmacists meet their continuing education requirements as laid down by their professional body.

  The introduction of clinical governance and the statutory duty of quality will intensify pressure to provide better training and CPD—and greater frustration if it is not provided.

7.  TREATMENT OF STAFF

  In April 1997 MSF obtained a copy of the most up-to-date statistics on the employment of ethnic minority workers in the NHS. The most striking statistic to emerge was the sharp drop in the number of black nursing, midwifery and health visiting staff. The proportion of African Caribbean people (and, though unstated, the vast majority of them are women) employed in these staff categories and aged between 55 and 64 years was 8\7 per cent compared to only 0\8 per cent of those aged under 25 years. It is evident that black people are not considering work in the NHS as a career, and so talent and opportunity are being wasted. It is interesting to note that if the proportion of black staff working in the NHS remained consistent across all ages then the recruitment problem for nursing would clearly not be as severe as it currently is. Potential staff have been lost to the Service by actual, or perceived, racism10.

8.  WORKLOADS

  The recent MSF staffing survey has revealed the great concern of staff about the excessive workloads that they are experiencing. Many respondents made particular reference to the danger of high workloads and the effect on the quality, and sometimes the safety, of the Service.

  Fewer staff and unfilled or unfillable vacancies, lead to these higher workloads. The extra work increases stress, particularly amongst MLSOs who will also be covering additional shifts, and increases the likelihood of stress related sick leave. This leads to fewer staff still, and hence greater workloads for those left.

  These factors also greatly reduce morale within the Service.

  The increase in workloads resulting from staff shortages is not mstematically for each profession. Where it is the figures are alarming. For example, health visitors reported dramatic increases in caseloads in 1994 and 1995 whilst in 1996 59 per cent of school nurses reported caseloads were up by a fifth or more11.

  The excellent DoH initiatives on tackling stress will need to recognise that excessive workloads are a key cause of stress which is in turn a key contributor to retention difficulties.

9.  FAMILY FRIENDLY POLICIES

  The recent Industrial Relations Services report commissioned by the DoH on Equal Opportunities contained some good examples of what is possible12. Under the previous Government such initiatives were the exception not the norm.

  The gap between Government initiatives and local practice is enormous, not helped by the refusal until recently to monitor what was happening.

  Although many of the Trusts formally have family friendly policies in place, the failure, until now, to tackle this in a determined manner has contributed to the failure to retain staff and attract them back.

  We are hopeful that with the new HR strategy, the NHS will make these concerns more central. The one initiative which we believe would make a decisive contribution to this issue would be the establishment of a nationwide network of nurseries on NHS premises for use by NHS staff.

10.  RECOMMENDING WORK IN THE NHS

  MSF's recent staffing survey asked whether respondents would leave their job now if they could. 57 per cent said they would, a truly stunning figure.

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  The survey also asked whether respondents would recommend their job in their trust to a young person contemplating a career, and only 36 per cent said that they would.

  However, of those people who would leave their job now, only 16 per cent felt able to recommend their job to someone else.

11.  FUTURE WORKFORCE REQUIREMENTS

  The NHS is changing. The shift to a primary care led NHS is leading to significant staffing changes. Shortages of doctors has already led to skill mix with nurses. Scientific advance is changing the nature of many jobs.

  What is clear is that the need for skilled professionals will not decline. The workforce of ten years time will be different, but no less skilled and no less in number. Wildly optimistic estimates of skill mix and generic working have not been borne out.

  Changing work necessitates not less skilled staff but a more flexible workforce linked to a career structure with transferable and constantly updated skills.

  With that proviso, the need to attract professional staff into the NHS and retain them, will remain as urgent as ever.

12.  CONCLUSION

  We now have a Government that:

—  acknowledges the scale of the problem

—  is overhauling workforce planning

—  has recognised the important of equal opportunities

—  has an HR strategy

—  is committed to a fairer pay system

—  acknowledges stress and staff treatment as major issues

  What is now needed are the determination and resources to address the problems whose existence is common currency amongst Government, employers and trade unions.

  We would be happy to develop the specific concerns about impact of equal opportunities, pay level and workloads in oral evidence.

October 1998