nhs qualified nurse supply and demand survey – …...2.1 per cent more nurses during 2013/14 (an...

NHS QUALIFIED NURSE SUPPLY AND DEMAND SURVEY – FINDINGS

Report produced for the Health Education England Nursing Supply Steering Group

May 2014

2 May 2014 NHS Qualified Nurse Supply and Demand Survey – findings

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EXECUTIVE SUMMARY

PurposeFurther 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.

MethodThe 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.

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.

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May 2014 3 NHS Qualified Nurse Supply and Demand Survey – findings

Headlines — 90 surveyed organisations (83 per cent) reported that they are experiencing qualified nursing workforce supply shortages.

— 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.

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KEY ISSUESIn 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.


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


PurposeThe 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.

MethodThe 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.

DefinitionsGrades of staffAll 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.


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 EstablishmentThe 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 ratesA 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 vacancyA hard to fill vacancy is defined as a post being vacant for over three months.

Oversubscribed vacanciesVacancies that regularly receive a high vacancy per application (APV) rate.

Active recruitment outside of the UKIn the context of this survey ‘active recruitment’ is defined as the deliberate targeting of the labour market in countries outside of the UK.


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.


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


Figure 1.2 Survey responses presented by organisation type

Figure 1.3 Survey response rate per region


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.


Table 1a Staffing establishments – summary data for qualified nursing staff by region

NHS Qualified Nurse Supply and Demand Survey Page 11 of 24

Table 1a. Staffing establishments - summary data for qualified nursing staff by region

LETB areaRegional response

rate for establishment data %

Established Posts (FTE)

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%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%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%

*NO ESTABLISHMENT DATA PROVIDED*


Posts not permanently occupied (FTE)

(Vacancy Rate %)

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)

Figure 1.4. Number of organisations looking to increase qualified nurse numbers overall

60

34

12

3

0

10

20

30

40

50

60

70

Yes No Don't know Blanks

Num

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f Organisations

Figure 1.4 Number of organisations looking to increase qualified nurse numbers overall


Table 1a. Staffing establishments - summary data for qualified nursing staff by region

LETB areaRegional response

rate for establishment data %

Established Posts (FTE)

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%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%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%



Posts not permanently occupied (FTE)

(Vacancy Rate %)

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)

Figure 1.4. Number of organisations looking to increase qualified nurse numbers overall

60

34

12

3

0

10

20

30

40

50

60

70

Yes No Don't know Blanks

Num

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f Organisations



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.


— 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 Figure 1.6. Hard to fill vacancies by FTE volume

Yes (83%)

No (17%)

4

12

7

910

9

56

8

2

9

19

9

0

2

4

6

8

10

12

14

16

18

20

Num

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Hard to fill vacancies (FTE)

Table 1b. High level summary of reported hard to fill vacancies, reasons and actions to resolve

1-1

0

11

-20

21

-30

31

-40

41

-50

51

-60

61

-70

71

-80

81

-90

91

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No

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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%

No.hard to f ill vacancies (FTE) Unfilled for how long Actions to resolve Reason for dif f iculty recruit ing

Figure 1.6 Hard to fill vacancies by FTE volume



Yes (83%)

No (17%)

4

12

7

910

9

56

8

2

9

19

9

0

2

4

6

8

10

12

14

16

18

20

Num

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1-1

0

11

-20

21

-30

31

-40

41

-50

51

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61

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71

-80

81

-90

91

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No

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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%


Table 1b High level summary of reported hard to fill vacancies, reasons and actions to resolve



Yes (83%)

No (17%)

4

12

7

910

9

56

8

2

9

19

9

0

2

4

6

8

10

12

14

16

18

20

Num

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1-1

0

11

-20

21

-30

31

-40

41

-50

51

-60

61

-70

71

-80

81

-90

91

-10

0

10

0+

No

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(bla

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To

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0-3

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3-6

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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%



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)

Staff Group Band Specialism / area of nursing 1-10

11 -

20

21-3

0

31-4

0

41-5

0

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Qualified Nurse AfC Band 5 Theatres (incl Anaesthet ics) 12 6 2 1 1 2 24 3 13 2 2 4 24 2 1 1 8 12 24Accident & Emergency 13 3 1 2 19 8 8 1 1 1 19 1 1 8 1 7 1 19Mental Health (community & inpatient) 4 2 2 1 1 10 5 3 1 1 10 7 2 1 10Children & Neonatal 9 1 2 12 1 4 3 3 1 12 5 2 4 1 12Stroke 1 2 3 3 3 2 1 3General surgery 6 3 1 3 13 6 3 2 1 1 13 1 1 2 8 1 13Medical 1 3 3 6 1 2 5 21 4 8 5 2 2 21 1 3 3 13 1 21Community & District 7 4 3 2 16 4 10 2 16 2 7 1 6 16Community Hospitals (ward based) 2 1 1 4 2 1 1 4 1 2 1 4Cardiac 3 1 4 3 1 4 1 1 1 1 4Fertility 1 1 1 1 1 1Haematology & Oncology 1 1 1 1 1 1Psychiatry 1 1 1 1 1 1Elderly 3 8 2 2 1 16 4 7 3 1 1 16 1 8 2 1 3 1 16Rehabilitation 1 1 1 1 1 1Trauma and Orthopaedics 4 4 2 2 4 1 1 1 1 4Medical Assessment Unit 3 3 2 1 3 1 2 3Urology 1 1 1 1 1 1ITU / HDU / ICU 9 4 1 14 4 7 2 1 14 1 3 1 8 1 14Adult 1 1 2 2 2 1 1 2Prison 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Radiology 1 1 1 1 1 1Musculoskeletal 1 1 1 1 1 1Neurology / Neuroscience 1 1 2 1 1 2 1 1 2School Nursing 2 2 1 1 2 1 1 2General Practice 1 1 1 1 1 1Gynaecology 1 1 1 1 1 1Endoscopy 1 1 1 1 1 1Gastroenterology 1 1 1 1 1 1Ophthalmology 1 1 2 2 2 1 1 2Admissions 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 8ITU / HDU / ICU 4 3 1 1 1 10 2 2 2 4 10 1 1 8 10

Mental Health (co mmunity & inp a tie nt)

7 1 8 2 4 1 1 8 3 2 3 8

Haematology & Oncology 3 1 4 2 1 1 4 1 1 2 4Community & District 5 2 2 9 5 1 1 2 9 1 4 1 2 1 9Theatres 4 1 1 6 2 2 1 1 6 3 3 6Intermediate care 1 1 1 1 1 1Accident & Emergency 6 1 7 3 4 7 3 4 7Outpatient 1 1 1 1 1 1Gynaecology 1 1 1 1 1 1Ophthalmology 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Transplant co-ordinator 1 1 1 1 1 1School Nursing 1 1 1 1 1 1Prison 1 1 1 1 1 1Stroke 1 1 1 1 1 1General surgery 1 1 2 1 1 2 1 1 2Medical 1 1 1 1 1 1

AfC Band 7 Sonographers (qualified nurse) 1 1 1 1 1 1Community & District (inc l sp e c ia lis ts )

5 1 6 2 2 2 6 3 1 2 6

Medical Assessment Unit 1 1 1 1 1 1Diabetes 1 1 1 1 1 1Mental Health 2 2 1 1 2 1 1 2Accident & Emergency 2 1 3 2 1 3 1 2 3Ophthalmology 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Children 2 2 2 2 2 2Epilepsy 1 1 1 1 1 1Neurology / Neuroscience 1 1 2 1 1 2 1 1 2Medical 1 1 1 1 1 1General Practice 1 1 1 1 1 1Elderly 1 1 1 1 1 1Apheresis 1 1 1 1 1 1ICU 1 1 1 1 1 1

AfC Band 8 Speech & language 1 1 1 1 1 1

Accident & Emergency 1 1 2 1 1 2 2 2

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 278Grand Totals

Reported hard to fill vacancies by area of nursing

No.vacancies (FTE) Unfilled for how long Reason for difficulty recruiting



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.


Figure 1.7 Most common reported actions to resolve supply shortages


Figure 1.7. Most common reported actions to resolve supply shortages Figure 1.8. Active recruitment outside of the UK during the last 12 months

16%

13%

7%

7%17%

9%

15%

1% 8%

7%Skill mix review / service reconfigurationIncreased empasis on workforce planningReturn to practice scheme

Expanded practice placement capacityLocal recruitment campaign

Active recruitment outside of the UK

Agency / temporary staff

Recruitment & retention premia

Planned overtime

Other

49, 45%

58, 53%

2, 2%

Yes

No

Blanks

Figure 1.9. Overseas recruitment activity by region Figure 2.0. Where has targeted recruitment activity taken place

12%

12%

8%

6%

2%15%

2%

27%

2% 6%

6%

2%

East Midlands

East of England

Kent Surrey & Sussex

North Central & East London

North East

North West

South London

South West

Thames Valley

Wessex

West Midlands

Yorks & Humber

96%

4%

EEA countries

Non -‐ EEA countries

Figure 1.8 Active recruitment outside of the UK during the last 12 months



16%

13%

7%

7%17%

9%

15%

1% 8%






Planned overtime

Other

49, 45%

58, 53%

2, 2%

Yes

No

Blanks


12%

12%

8%

6%

2%15%

2%

27%

2% 6%

6%

2%

East Midlands

East of England



North East

North West

South London

South West

Thames Valley

Wessex

West Midlands

Yorks & Humber

96%

4%

EEA countries



Figure 1.9 Overseas recruitment activity by region



16%

13%

7%

7%17%

9%

15%

1% 8%






Planned overtime

Other

49, 45%

58, 53%

2, 2%

Yes

No

Blanks


12%

12%

8%

6%

2%15%

2%

27%

2% 6%

6%

2%

East Midlands

East of England



North East

North West

South London

South West

Thames Valley

Wessex

West Midlands

Yorks & Humber

96%

4%

EEA countries


Figure 2.0 Where has targeted recruitment activity taken place



16%

13%

7%

7%17%

9%

15%

1% 8%






Planned overtime

Other

49, 45%

58, 53%

2, 2%

Yes

No

Blanks


12%

12%

8%

6%

2%15%

2%

27%

2% 6%

6%

2%

East Midlands

East of England



North East

North West

South London

South West

Thames Valley

Wessex

West Midlands

Yorks & Humber

96%

4%

EEA countries



Figure 2.1 Countries targeted for recruitment campaigns in last 12 months


Figure 2.1. Countries targeted for recruitment campaigns in last 12 months Figure 2.2. Considering active overseas recruitment during next 12 months

24

18

28

2 2 1 1 1 2

0

5

10

15

20

25

30

Num

ber o

f Organisations

56, 51%

34, 31%

13, 12%

6, 6%

Yes

No

Don't know

Blanks

Figure 2.3. Countries targeted for recruitment campaigns in next 12 months

15

24

21 1 1

18

21

5 5

2 21 1

7

12

0

5

10

15

20

25

30

Num

ber o

f Organisations

Figure 2.2 Considering active overseas recruitment during next 12 months



24

18

28

2 2 1 1 1 2

0

5

10

15

20

25

30

Num

ber o

f Organisations

56, 51%

34, 31%

13, 12%

6, 6%

Yes

No

Don't know

Blanks


15

24

21 1 1

18

21

5 5

2 21 1

7

12

0

5

10

15

20

25

30

Num

ber o

f Organisations


Figure 2.3 Countries targeted for recruitment campaigns in next 12 months



24

18

28

2 2 1 1 1 2

0

5

10

15

20

25

30

Num

ber o

f Organisations

56, 51%

34, 31%

13, 12%

6, 6%

Yes

No

Don't know

Blanks


15

24

21 1 1

18

21

5 5

2 21 1

7

12

0

5

10

15

20

25

30

Num

ber o

f Organisations


SECTION E – FURTHER SUPPORT

HeadlinesSurveyed 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.


Table 1d Direct quotes from the survey – further support

Support for Return to Practice Schemes

Co-ordinated approach to careers campaigns/recruitment and retention initiatives

Education and training

More National initiatives around Return to Practice.

More secure funding for CPD from central NHS funds.

More flexible ways to train to be an RGN whilst in service.

Some idea of whether there is a Return to Practice population.

Funding to support recruitment initiatives.

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.

More national recruitment campaigns to encourage moving into nursing, return to practice etc.

Increased specialty training and support for older adult care.

Return to Practice and rotation funding.

Open days and recruitment initiatives in rural areas to attract nurses who would like to live and work in rural areas.

Investment in education and training to develop new roles.

Increase in RTP course numbers. Coordinated approaches across trusts within regions, similar to Deanery arrangements.

Development and registration of new roles.

Financial support for return to nursing and adaptation courses.

Links with local schools and colleges to promote working in the NHS.

Regional co-ordination of placements from Universities to allocate on need in line with demand.

Further Return to Practice programmes commissioned directly through HEE.

Generally, to promote medical specialities as a valuable career option.

We also require specific training programmes for HCAs to allow them to take on additional duties which will give a new skill mix.

National campaigning and collective support arrangements for initiatives such as Return to Practice.

Better analysis of the impact of policies such as pension changes on the profession.

Review of nursing training to return to allocation by Trust to enable closer relationship with future workforce.

Increased, continual and financially supported Return to Practice schemes.

More emphasis on retention with flexible working arrangements suitable for older workers in high pressure posts.

Bursaries to support Associate Practitioners in nurse training programmes.

Mental Health Return to Practice programmes and national awareness raising/campaigns.

National media coverage and advertising campaigns to support Return to Practice similar to the Public health nursing campaigns.

Backfill monies to support secondments to undertake nurse training.





Return to Practice provision which is easy to access and flexible to meet organisational needs.

National advertising to attract nurses into training or Return to Practice (like the military).

DH instruction to require universities to offer two intakes of nurses a year.

More attention to the fit of training placements and support for RTP together with pre-registration nursing.

Nationally drive initiatives towards substantive employment away from temporary resource solutions.

Keep secondments to branch, the blanket removal of all secondments has impacted on our workforce development plans.

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.

For nurses free travel on all trains into and out of London, similar to the Metropolitan Police.

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.

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).

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.

That on completion of their training, newly qualified nurses are expected to work a first year in the hospital that provided their training.

Nationally I think there needs to be something that promotes the nursing profession (it has received so much negative press recently).

It would be helpful to look at sponsorship of health care assistants to nurse training (something which has been reduced in recent years).

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.

A national career development and competency based framework bringing into alignment KSF, band specific competencies and skills for health.

Regional wide campaigns would surely provide better economic and resourcing sense, value for money – rather than competing with neighbouring Trusts.

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.





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.

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.

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.

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.

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.

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.


Facilitate sharing of good practice

Facilitate closer links with universities

Increase training commissions

Some sharing of international recruitment challenges.

Increased responsiveness of pre-reg education providers.

Increase commissions of nursing students.

Good Practice Examples. Working closely with universities to ensure the right students are selected for nursing programmes.

Increase in education numbers.

Increased sharing of good practice across the country.

More co-ordinated approaches by Higher Education Institutes and the return of secondment opportunities from the existing workforce.

We increase the number of student nurse places.

Case studies on the integration of new roles to relieve short staffing issues.

Facilitation of closer links between trusts and universities to encourage students to stay on at some of the trusts who struggle geographically.

Increase the number of HEI training places.

More direct communication to both HR and Nursing Directors to inform us of what strategies other organisations are adopting – shared learning.

Working in partnership with universities nationally, local links are successful but wider links need to be made which could be supported externally.

Actual nurse training numbers to be slightly more than estimated numbers.

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.


International recruitment initiatives Miscellaneous (other ideas)

That the Band 5 is recognised on the skills shortage list.

Continue with leadership development.

Support with coordination of overseas recruitment. Reducing cost of agency workers.

Fast track and better joined-up routes to recruit overseas staff, between NMC and UKBA.

More proactive involvement in workforce planning regionally.

More fluid movement of registered nurses from EU and other non-UK countries.

A local workforce forecasting tool.

Support for programmes for overseas nurses who need to adapt to UK practices.

Region-wide initiatives to reduce use of agencies in local areas.

Specialist areas like Paediatric Intensive care, theatres, Adult Intensive care, Transplant must be put back on the UK Border Agency Shortage Occupation List.

Assistance to co-ordinate a regional approach and reduce competition within the NHS for the limited supply.

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.

Supply information covering the West Midlands to support workforce planning and resource planning.

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.

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.


SummaryThe survey has provided data and analysis on aspects of supply and demand levels and trends amongst the NHS qualified nurse workforce in England.

Report authorNHS Employers

Contact: NHS Employers, 2 Brewery Wharf, Kendell Street, Leeds, LS10 1JR

0113 306 3000

Date of issueMay 2014

NHS EmployersThe 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 usFor more information on how to get involved in our work, email [email protected] www.nhsemployers.org [email protected]

@nhsemployers

NHS Employers

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NHS Employers 2 Brewery Wharf Kendell Street Leeds LS10 1JR

This publication was produced by the NHS Confederation publications team: [email protected] 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 5252407Ref: EINF36001

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