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

Content Is there a problem? Will more staff help? What is happening now? What is needed for the future?

Is there a problem? CEMACH dataCEMACH data –Suboptimal care for mothers and babies Northwick ParkNorthwick Park –Insufficient supervision by experienced clinicians NHS Litigation AuthorityNHS Litigation Authority –Increasing payments for obstetrics

/ / / / / /02 £ million NHSLA payments for obstetric-related incidents RCOG: Safer Childbirth: Minimum Standards for Service Provision and Care in Labour

Content Is there a problem? Will more staff help? What is happening now? What is needed for the future?

Will more staff help? Senior involvementSenior involvement –Intervention rates Trainee involvementTrainee involvement –WTD compliance Midwife involvementMidwife involvement –Funded establishment

Compliance with WTD 2009 hours target by pay band and specialty Source: 28th Ministerial Return March 2005 (NHS Employers) N.B. Actual numbers in each 'broad' specialty group vary considerably. % doctors in training in training Public Health Psychiatry A&E Pathology Radiology Dentistry Paediatrics Average Anaesthetics Medicine O&G Surgery 48 hours and less More than 48 hours

Annual survey of UK Heads of Midwifery Service In your view, is the funded midwifery establishment adequate for the level of activity undertaken in your trust? YESNOYear Percent

Content Is there a problem? Will more staff help? What is happening now? What is needed for the future?

Net NHS Expenditure, to England £ billion 70% of NHS funding is spent on staffing costs Department of Health

Total NHS staff House of Commons Health Committee, 2007

Nurses and doctors , , ,000400, Nurses,Midwives Health Visitors All doctors House of Commons Health Committee, 2007

Consultants, registrars and other training grades ,000 10,000 15,000 20,000 25,000 30,00035, Consultants Other trainees Registrars House of Commons Health Committee, 2007

Associate Specialist Staff Grade Annual percentage increments in career grade doctors in UK*, *Northern Ireland numbers included in 2001,2002 and 2003 only Consultant

NHS workforce growth Senior management Central functions Clinical support staff Scientific and technical Allied health professionals Nurses All doctors percent House of Commons Health Committee, 2007

Comparison of NHS Plan (2000) growth targets with actual workforce growth (1999 – 2004) GPs105% Nurses340% Allied health professionals69% Consultants -3% House of Commons Health Committee, 2007

Potential unemployment? Physiotherapy graduates in 2006: 68% unable to find NHS work (usual unemployment rate 5%) Nursing graduates in 2006: 40% unable to find NHS work within 6 months (usual rate 15%) House of Commons Health Committee, 2007 Medical trainees in 2007?

Workforce considerations: conversion to MMC training posts F 2 posts GP trainees Specialist trainees Surplus Total number of SHO and Trust grade posts = 21,000

ST posts 2007 Total number of SHO and Trust grade posts = 21,000 Predicted surplus = 3,700 Alleged number of applicants for ST posts = 33,000 Possible deficit = 8,300

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

Content Is there a problem? Will more staff help? What is happening now? What is needed for the future?

Training costs of health service professionals Nurses Doctors £ Professionals Allied to Medicine (Netten et al, 1998)

GBP Year Average consultant earnings, House of Commons Health Committee, 2007

Overspending on pay reform relative to projected spending Consultant contract Agenda for Change GP contract £ million House of Commons Health Committee, 2007

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 addressed Role of the doctor Length of training Service reconfiguration Plurality of provision Role redesign Hours of work

Other Factors for Change National Service Framework Election Manifesto Postgraduate training RCOG / RCM / NICE initiatives

National Service Framework for Children Young People and Maternity Services

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 Services

Manifesto Commitment By 2009: Choice of place and pain relief Named midwife Links to Children’s Centres

Choice of: Access to careAccess to care Type of careType of care Place of birthPlace of birth Postnatal carePostnatal care

“With an estimated more midwives needed to deliver first-class maternity services, there is still a long way to go.” RCM News and Appointments 2006 The RCM Position

2004 “Children’s and Maternity Services in 2009: Working time solutions” 2009

Aims of project Information from compliant units Impact upon training and CPD Evaluation of models Communication strategy

Antenatal careAntenatal care Caesarean SectionCaesarean Section Intrapartum careIntrapartum care Postnatal carePostnatal care Complex pregnanciesComplex pregnancies NICE guidelines for clinical care

Conclusion Workforce expansion unplanned Major changes anticipated Need to define roles Standards clearly defined Potential for more trained doctors