EXECUTIVE SUMMARY

  The Professions Allied to Medicine are: Arts Therapists, Chiropodists, Dieticians, Occupational Therapists, Orthoptists, Physiotherapists, Radiographers and Support Staff.

  Research shows that the recruitment and retention problems facing the Professions Allied to Medicine are the worst in the NHS. High vacancy rates and levels of turnover are having a direct impact on patient care and leading to increasing waiting lists. PAMs are essential to the Government's White and Green Paper proposals for a modern and dependable Service and as such, urgent steps need to be taken to address this worsening situation.

  There are a number of key reasons why PAM staff are choosing to leave NHS employment. These include poor pay and conditions of service, lack of career structure and poor promotion opportunities in the higher grades, very little support for continuing professional development and post-graduate study, poor resources and increased stress and increasing competition from the private sector.

  In order to facilitate accurate and dependable planning of current and future staffing levels and to monitor the effectiveness of any recruitment and retention strategies, we believe that there should be a national and systematic approach to workforce planning and data collection.

  We believe that a central NHS Workforce Data Collection and Analysis Unit should be established by the NHSE. All social partners should be consulted and involved in its work. This unit should collect, collate and publish workforce statistics for the whole Service. The data promulgated could inform Review Body, local providers, HIPs and education consortia decisions, amongst others. It should be made a requirement of local employers in all sectors of the Health Service, including primary care, to provide workforce statistics. These should be locally collected by professional heads each year.

 INTRODUCTION

  The Professions Allied to Medicine, PAM (PT`A') Staff Side welcomes the opportunity to submit evidence to the Health Committee on the recruitment and retention of PAM staff in the NHS. We have argued for a number of years that the staffing crisis facing the PAM professions is the most acute in the NHS.

  This submission will highlight the nature of PAM staff shortages in the NHS and examine the factors influencing the high vacancy levels and rates of turnover. We will consider the implications of the Government's announcement of additional NHS funding through the Comprehensive Spending Review (CSR). Finally, we will comment on the current arrangements for workforce planning and data collection in the NHS and make recommendations for improvement in these areas.

RECRUITMENT AND RETENTION—THE CURRENT POSITION

  The difficulties with recruitment and retention in the PAM professions are most severe in occupational therapy, physiotherapy and dietetics. There is evidence to suggest, however, that the situation facing the remaining PAM groups is worsening.

  In November 1996, the Incomes Data Services (IDS) produced a report into recruitment and retention in the public sector. This found that "by far the worst recruitment and retention problems in the NHS were concentrated in the PAM professions, particularly physiotherapy". In February 1997, the Audit Commission released its report "Finders Keepers: The Management of Staff Turnover in NHS Trusts". This found that turnover was significantly worse in physiotherapy (from 8 per cent-76 per cent) in comparison to nursing and administrative and clerical posts.

  More recently, the Office of Manpower Economics (OME) has carried out PAM staffing surveys for the Pay Review Body. In 1997 this survey showed particular problems with turnover in dietetics (23.5 per cent), physiotherapy (20.3 per cent) and occupational therapy (22.2 per cent). A report commissioned by the NHS Executive, "Recruitment and Retention in Professions Allied to Medicine" (Sharpe Associates, March 1998), revealed a deep sense of frustration and disillusionment amongst PAM staff in the NHS which was leading to significant problems with recruitment and retention.

 FACTORS INFLUENCING RECRUITMENT AND RETENTION

  We have conducted a number of surveys of PAM staff in the NHS, which have attempted to ascertain the reasons why such large numbers of PAM staff are leaving NHS employment. These factors can be summarised as follows:

—  Rates of pay and conditions of service which are seen to be unfair and uncompetitive.

—  Poor opportunities for career development. Many PAM staff will not proceed any further than the top of the Senior I grade unless they wish to move into management and relinquish clinical responsibilities.

—  Lack of support for continuing professional development. PAM staff feel that they receive little or no support in terms of funding or study leave for post graduate education, particularly when compared to other NHS professionals.

—  Increased workload and stress. As the recruitment and retention crisis worsens, the remaining staff are expected to cover greater numbers of patients, increase productivity and reduce waiting lists. This increase in workload results in higher levels of stress, increased illness and ultimately higher levels of turnover.

—  Many staff feel that the increased emphasis on productivity and reducing waiting lists is forcing them to compromise professional standards of care. Staff feel that they are not "allowed" to spend as much time with patients as they judge to be either appropriate or in the patients' best interests.

—  Lack of understanding by NHS Trust management of the role and skills of PAM staff and their importance to the delivery of care and rehabilitation.

—  Lack of involvement in the process of change at both local and national level, as demonstrated by the lack of involvement of PAM staff in the implementation of the Government's White Paper.

—  Increasingly attractive employment opportunities in the private sector and abroad.

  The NHSE Report (Sharpe Associates 1998) also identifies an "NHS grapevine". It suggests that PAM staff will learn about the attractiveness, or otherwise, of particular posts by talking to colleagues in other Trusts. This is clearly true of existing NHS staff but also PAM students who will reach similar conclusions from their experiences on clinical placement.

  Unless steps are taken to address the current state of frustation and disillusionment in the NHS, this grapevine will continue to play its part in the worsening of recruitment and retention problems.

 FUTURE TRENDS IN RECRUITMENT AND RETENTION

  As part of our evidence to the Pay Review Body this year, we conducted a survey amongst a 10 per cent sample of PAM staff who had qualified in the last five years. This was intended to determine staffs' attitudes towards the NHS and their long-term career aspirations.

  This survey illustrated the extent of the recruitment and retention crisis in the PAM professions and more importantly, the fact that the current position could be predicted to worsen considerably over the next five years.

  The main findings can be summarised as follows:

—  Less than 4 per cent of those surveyed saw themselves working in the NHS for the majority of their careers.

—  Only 10 per cent of those surveyed believed that they would definitely be working in the NHS in three years.

—  Of those who had decided to leave NHS employment, the reasons given (in order of importance) were: poor pay and conditions of service, poor promotion opportunities, very poor support for continuing professional development, high levels of stress and inadequate staffing levels.

  The NHS is no longer a monopoly employer. PAM staff have considerably more employment opportunities outside the NHS than may have been the case 10 years ago. These include private practice, industry, sports and leisure, retail, charities and working abroad. Many of these employers offer salaries which are extremely competitive and terms and conditions of employment which are significantly more attractive than the NHS. The NHS needs to focus on attracting and retaining staff against this more competitive market.

NHS FUNDING

  The Government's announcement of £21 billion additional funding in the NHS following the Comprehensive Spending Review is extremely welcome. The public focus of this appears, understandably, to be the reduction of waiting lists and the improvement of resources. It must be remembered, however, that staff are the NHS's best resource and it is hoped that the Government will use some of this additional money to address the current problems with recruitment and retention.

  Although additional funding is not the only answer, it is clear that many of the factors influencing the levels of turnover highlighted above could be tackled with increased resources. At a fundamental level, a pay increase which was seen to be fair and competitive would do much to tackle low morale.

 CURRENT WORKFORCE CONFIGURATION—DATA COLLECTION

  This section discusses the technical requirements, in terms of labour force statistics, required to facilitate staffing requirements.

  We recognise that forecasting future staffing requirements can never be an exact science. This is particularly true for complex workforces and work environments such as the NHS. In addition there is relatively little expertise, experience or resources (such as appropriate information technology systems) in the Health Service, particularly at provider level. Despite this the NHS should be able to measure accurately its current workforce and identify trends, using time series data. Building on this and other techniques, forecasting can be developed more accurately than is currently the case. Workforce planning should also form part of overall organisational planning and strategy.

  Central to the process of workforce planning is the collection of good quality statistics on labour force supply, wastage and demand, together with an assessment of the factors that may or will influence each of these. Time series data allows trends to be identified which facilitates forecasting. To be meaningful data must be comprehensive (in terms of both staff groups and workplaces) and timely. Given the high level of staff turnover in the NHS (approaching 20 per cent per annum for PAMs) the annual planning and priorities process, size and cost of the NHS workforce data should, in our view, be collected annually.

  We strongly believe that NHS workforce statistics must be collected nationally by the Department of Health and that it is made a requirement for all local workplaces, including the primary care sector, to complete returns. The majority of NHS staff, including PAMs are recruited from national labour markets. Few, if any, Trusts or Health Authorities have sufficient expertise or resources to undertake their own workforce modelling. A local approach rather than a national one would result in a duplication of effort (it would, for example, seem to make little sense for each HA separately to attempt to forecast the future supply of PAMs) and would not mean a strategic approach being taken to workforce planning. As pointed out above, expertise locally in workforce planning is not well developed. National collection should also ensure full coverage of staff groups and care settings and be cost effective.

  Our experience is that data on vacancies, staff in post, leavers and joiners and so on is best completed by professional heads such as PAMs' managers. Response rates for the Joint National Professional Manpower Initiative (JNPMI), when completed by PAM managers was frequently in excess of 90 per cent. Since the Department of Health stopped collecting the JNPMI in 1995, the only PAM workforce survey has been carried out by the Office of Manpower Economics, on behalf of the Pay Review Body. The returns have been completed by Trust Personnel Departments and the response rate has halved. Using professional managers makes data collection more manageable for local Trusts (by spreading workloads) and ensures that information is gathered as accurately as possible.

  In order to have an accurate and comprehensive picture of the present state of the NHS workforce the following data should be collected for all NHS employees:

—  Numbers of staff in post (SIP)

—  Funded establishment (FE)

—  Frozen posts

—  Turnover

—  Destinations of leavers (both within and without the NHS)

—  Sources of new entrants

  From this data vacancy rates can be calculated (the difference between FE and SIP). Data on all destination of leavers and sources of new entrants should, as far as reasonable, cover as many destinations and sources as possible.

  All information should be disaggregated by staff group, care setting (eg primary, community etc) gender, age, grade, part-time/full-time status and ethnicity.

  Until recently, for PAMs, the majority (although not all) of this information was gathered through the JNPMI or the Office of Manpower Economics. However, progressively the amount of data gathered through these sources has been reduced, so that this year only the following has been collected—joiners and leavers broken down by grade and region, the destinations of leavers and reasons given for leaving, staff in post and funded establishment. This only allows a very partial picture to be built up of the current state of the PAMs workforce. It is not even possible to calculate vacancy rates from the data collected. This is a major omission. Without an accurate description of present staffing levels it is impossible to make any meaningful future forecast.

FORECASTING

  The introduction of three-year Health Improvement Programmes in England from April 1999 and national planning priorities should make long-term forecasting of demand easier. A sensible time frame needs to be introduced for forecasting of staffing requirements. Given the new service planning process the minimum should be three-year forecasts (indeed this is implicit in HIPs) and the maximum ten years.

  Forecasting should be based on a large number of variables (both from inside and outside the NHS and at national and local level), including future demand for services, trends in workforce configuration and deployment, changes in organisational structures (such as the growth in primary care), funding, demographic trends, the impact of retention and recruitment trends and strategies, and internal labour sources.

  We believe that the functional Whitley Councils would provide the most effective fora to discuss forecasts and their implications. The proposed NHS Workforce Data Collection and Analysis Unit would undertake, in partnership, the detailed work required.

CONCLUSION

  We welcome the Government's recognition of the recruitment and retention problems in the NHS. These are at there most acute in the Professions Allied to Medicine, in particular, occupational therapy, physiotherapy and dietetics, although evidence suggests that vacancy rates and levels of turnover are increasing in the other PAM professions.

  Action needs to be taken to address these problems by examining the factors influencing vacancies and turnover and tackling the causes of the recruitment and retention crisis. We hope that the additional funding made available through the Comprehensive Spending Review, will be used, at least in part, to make the NHS a more attractive and competitive employer.

  There is also a clear need for a more systematic approach to workforce planning and data collection. We believe that this should be done centrally. As well as enabling clear planning of future labour demands, a systematic approach to data collection will help to monitor the effectiveness of any recruitment and retention strategies.

  PAM staff have an essential part to play in the care and rehabilitation of patients and are also central to the Government's proposals for an efficient, modern and dependable Service as detailed in the Green and White Papers. Unless steps are taken to stem the flow of PAM staff from the NHS, the Government's proposals will be extremely difficult, if not impossible to realise.