FACING THE FUTURE Nursing and Midwifery
Recruitment and Retention
November 2003
Issue 3
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Welcome to the third in a series of newsletters designed
for Nurses and Midwives, whether in training or in practice.
These newsletters aim to keep you updated on the progress
made on the various initiatives under the banner of Facing
the Future.
What's in this newsletter?
- A Partnership for a Better Scotland: Partnership Agreement
- Nursing Workload - An update on the Nursing Workload Project
- 'New Nursing Roles - Deciding the Future for Scotland.'
Information on the forthcoming Consensus Conference for
Nurses
- Student Nurse Numbers
- New Website
The Partnership Agreement
As part of the discussions following the Scottish Parliament
elections in May 2003, the Labour/Liberal Democrat coalition
produced A Partnership For A Better Scotland: Partnership
Agreement as part of its programme to deliver excellent
public services in Scotland. This commits the Scottish Executive
Health Department to step up action on health improvement,
to improve the quality and consistency of care through national
standards, inspection and support; and to improve the delivery
of services. The Partnership Agreement also commits
the Scottish Executive Health Department to delivering improvements
to NHSScotland through the empowerment of the workforce. Within
the Partnership Agreement are a number of commitments which
are specific to nurses and midwives. These are:
- 'We will increase our programme to train, recruit and
retain nurses and midwives, bringing 12,000 into the NHS
by 2007 as part of our overall improvements in workforce
planning in the NHS.'
- 'We will treble existing numbers of Nurse Consultants
to 54.'
- 'We will continue our guarantee of one year's employment
for all newly qualified nurses and midwives.'
- 'We will implement nationally co-ordinated nursing bank
arrangements to assist nurse placement across Scotland,
to improve patient services and cut the costs of agency
nursing.'
In support of these commitments, a number of initiatives
are ongoing under the banner of Facing the Future.
The following provides an update against these as well as
other issues of interest.
Student Nursing Intake Planning (SNIP) 2002
The Student Nurse Intake Planning (SNIP) exercise is carried
out on an annual basis. For several years it has offered the
Scottish Executive guidance on the number of student nurses
and midwives required across NHSScotland. This is based on
5-year forecasts from NHS Trusts, Health Boards, private hospitals
and education providers.
As the SNIP exercise is conducted on an annual basis it allows
for adjustments to be made, therefore any increase/ decrease
in demand for nurses and midwives across NHSScotland will
be reflected in the number of places agreed year on year.
Earlier this year at the NT Live event, the Minister for
Health and Community Care announced that the SNIP 2002 recommendations
would be met in full this year (2003/04). SNIP 2002 recommends
an additional 525 student nurse places taking the total recommended
intake number to 3,935. This will see unprecedented numbers
of nurses and midwives in training.
As part of the large increase in the recommended intake,
a number of alternative paths to nurse training have been
approved. Concerns on the capacity to deal with the number
of clinical placements have also influenced the development
of alternative training routes. The additional 525 places
can be broken down as follows:
- 100 'traditional' students, i.e. 3-year Higher Educational
Institution (HEIs) based pre-registration students, have
been allocated across the seven contracted universities.
- 180 Healthcare students as developed by Facing the
Future sub-group chaired by Rosslyn Crockett, have been
funded and Trusts are currently recruiting to these places.
The majority of the HNCs will begin this autumn although
some have sought permission to postpone until February 2004.
All 180 must begin in academic year 2003/04, in order to
have a chance of completing the pre-registration programme
in 2006/07.
- 45 Open University students will be commencing early in
2004 in remote and rural areas in Highland, Orkney, Shetland
and Argyll. The Open University is working with the normal
HEI provider in each of these areas. This is a 4-year work-based
programme, and is currently being adapted and approved by
NES for Scotland.
- 200 additional Healthcare students as a one-off cohort
undertaking the HNC on a part-time basis.
To support clinical placements for these additional places,
100 Practice Educator posts will be established. These will
be funded on a tripartite basis from the Executive, Higher
Educational Institutions as well as NHS Employers. It is anticipated
that these posts will begin to come on stream in February
2004.
The latest figures from ISD Scotland (2002) indicate that
we are on track to achieving the recruitment target to bring
12,000 nurses and Midwives into the NHS by 2007. With the
measures taken to increase student numbers as well as a range
of other measures designed to build capacity, it is anticipated
that this target will be surpassed as these initiatives are
realised.
One Year Guarantee
The One Year Guarantee of employment for all newly
qualified nurses and midwives was introduced on 1 September
2002. The initiative was developed in full partnership
with NHS Employers, universities, professional organisations
(incl. RCN, RCM, UNISON), as well as NHS Education for
Scotland (NES) who administer the scheme. The guarantee
is based on the normal recruitment process, whereby
the majority of newly qualified nurses and midwives
secure a job through their own efforts, informed by
career aspirations and their choice of location. If,
after trying to obtain suitable employment, the nurses
or midwives have been unable to secure a job in their
part of the register or geographical location, and if
they wish to take advantage of the national scheme,
they can contact NHS Education for Scotland, who will
issue them with information about other locations in
Scotland who have suitable jobs.
The guarantee is designed to ensure that all newly
qualified nurses and midwives have the opportunity to
build on the clinical experience gained during their
pre-registration programme. Any vacancies offered should
have at least
a one-year contract of employment.
As part of the Partnership Agreement, this initiative
has been extended for a further year from September
2003.
Further information and guidance on the One Year Guarantee
is available on the Facing the Future website.
NHS Education for Scotland has carried out two evaluations
of the scheme. The first looked at the experience of
those who used the scheme in 2002-2003, and the second
was a random sample of newly qualified nurses and midwives
who did not participate in the scheme to evaluate how
they obtained employment. The results of the second
survey can be viewed on the Facing the Future
website.
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Nursing Workload
Facing the Future is taking forward a project
focusing on the workload of nurses and midwives in Scotland.
The project builds on the Audit Scotland report, Planning
Ward Nursing - Legacy or Design? - and aims to:
- review the systems for nursing workload and workforce
planning currently used throughout NHSScotland
- review how quality of care is currently measured
- clarify the information management systems used
to collect and collate data about nursing workload
and workforce planning
- collect examples of good practice from the service.
Pauline Milne, Principal Nurse in the Medical and
Associated Services Division of Lothian University Hospitals
NHS Trust, has been seconded to the Executive to take
the project forward from July to December 2003.
'The project covers all parts of NHSScotland where
nursing and midwifery services are delivered - acute
care, primary care, psychiatry, learning disabilities,
paediatrics and maternity', Pauline explains. 'The deadlines
are tight, but we are already making substantial progress.'
Five separate but broadly similar questionnaires have
been developed. In early August, each questionnaire
was piloted as follows:
Acute - North Glasgow University Hospitals and South
Glasgow University Hospitals Trust
Maternity - North Glasgow University Hospitals Trust
Paediatrics - Yorkhill Trust, Glasgow
Psychiatry and Primary Care - Lanarkshire Primary Care
Trust.
During the pilot, the questionnaires were also reviewed
by key individuals from a variety of areas. Feedback
from the pilot of the questionnaires and comments on
the questionnaire content were considered at the Nursing
Workload Steering Group meeting held on 20 August 2003.
The amended final questionnaires - designed to reflect
the specific characteristics of the areas in which nursing
and midwifery services operate - were distributed to
all Trusts in NHSScotland at the end of August. The
questionnaires focused on key issues relevant to nursing
workload and workforce planning, such as:
- workforce planning systems
- current funded establishments
- 'time out' from clinical work for charge nurses
- predictable absence allowances within establishments
- flexible staffing arrangements
- examples of best practice.
 'We
are trying to build up a comprehensive picture of what
is happening throughout Scotland', Pauline explains.
'The questionnaires were therefore very detailed, and
great credit should go to the nominated individuals
in each Trust and their Directors of Nursing for the
information and detail they were able to give us in
a relatively short period of time.'
Pauline is now conducting a series of visits all over
Scotland to talk over the issues with the people in
the Trusts who completed the questionnaires and other
relevant personnel, aiming to catch a sense of the reality
of nursing workload and workforce planning at ground-level.
There then follows a period of analysing the hundreds
of pieces of data collected, a process in which the
project will be assisted by the Information and Statistics
Division.
'We want to use the information obtained from the data
to develop some recommendations on what seems to be
working well for Trusts', Pauline says. 'That way, we
hope that the whole service will be able to benefit
from best practice'.
The project, which is supervised by a steering group
(see below), will deliver a final report to the Facing
the Future Group by the end of the year.
For more information, contact Pauline Milne, Project
Manager, Nursing Workload/Workforce Planning, at: Pauline.Milne@scotland.gsi.gov.uk.
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Nursing Workload/Workforce Planning Project
steering group members
Gerry Marr (Chair), Chief Executive, Tayside
University Hospitals NHS Trust
Irene Barr, Deputy Director of Nursing, South
Glasgow University Hospitals NHS Trust
David Benton, Director of Nursing, Grampian University
Hospitals NHS Trust
James Buchan, Faculty of Social Sciences, Queen
Margaret University College, Edinburgh
Teresa Crawford, Associate Director of Nursing,
North Glasgow Hospitals NHS Trust
Kathy Dallest, eCHIP Project Manager, Primary
Care Division, Scottish Executive
Alan Gall, Director of Finance, Grampian University
Hospitals NHS Trust
Bridget Hunter, Lead Officer for Nursing, UNISON
Scotland
James Kennedy, Secretary to the Scottish Board,
Royal College of Nursing
Alex Mathieson, Freelance Writer and Editor, Edinburgh
Pauline Milne, Project Manager, Nursing Workload/Workforce
Planning
Patricia Purton, Director, Royal College of Midwives
(Scotland)
Lesley Summerhill, Director of Nursing, Tayside
University Hospitals NHS Trust
Neil Wilson, National Workforce Unit, Human Resources
Directorate, Scottish Executive
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Return to Practice
The Return to Practice scheme was launched with a
view to increase the number of nurses and midwives in work
across Scotland. As well as helping to reduce the number of
vacancies, the scheme is aimed at minimising the loss of skills/expertise
invested in to date. Funding was made available in 2002 for
each individual for Return to Practice programmes and
is linked to an offer of employment in NHSScotland, either
on a permanent basis or on a nursing bank with regular hours
of work required. Up to £1,500 of funding is available for
each successful returnee.
In 2002, managed implementation programmes were set up in
seven Health Board areas to measure the effectiveness of providing
funding for return to practice. 152 people commenced these
programmes, and are tracked every 3 months to see if they
had taken up and retained NHS employment. In April 2003, 71%
or 109 people had successfully completed return to practice
programmes. By August 2003, this number had increased to 87%
or 132 people.
Of those that successfully completed programmes, 76% were
employed 6 months after completing programmes. A further 14%
of people stated that they were waiting to be registered before
they could start their post.
Of those that are employed 6 months after completing programmes,
97% are employed within NHSScotland where: 70% are employed
in NHS Trusts and 27% are employed in nursing banks. The remaining
3% had taken up employment in the private sector.
£1 million has been allocated to fund Return to Practice
for nurses and midwives across NHSScotland for the next 2
years and it is estimated that between 400 and 600 nurses
and midwives will be attracted back to work via this route.
To date, 117 individuals have commenced Return to Practice
programmes in 2003/04. This means a total of 269 have been
brought back so far, keeping us on track to meet our target.
Nationally Co-ordinated Nurse Bank Arrangements
Demands on hospitals/trusts for bank and agency staff to
fill gaps in the service continue to escalate. This was highlighted
in the Audit Scotland report of 2002. The report identified
a need for more effective management and co-ordination in
the provision of bank and agency staff.
- The Partnership Agreement commits to implementing nationally
co-ordinated nurse bank arrangements. This is to assist
with nurse placement, improve patient services and help
reduce the reliance upon and associated costs
of agency nurses.
- A Steering Group has been established to oversee work
on an option appraisal which is to be project managed over
a period of not less than 6 months. The first meeting of
the Steering Group, chaired by Miss Anne Jarvie, Chief Nursing
Officer, took place on 21 October 2003.
- Applications have been sought within NHSScotland for the
secondment as a project manager to undertake this work,
with interviews scheduled for October. An announcement on
this appointment is anticipated in November 2003.
New Roles
Another strand of Facing the Future has been to look
at the career development patterns. In particular, patterns
that reflect flexibility and transferability - with practitioners
moving sideways into new roles within clinical areas and organisations.
These can prove to be enormously beneficial for individuals
and organisations alike.
A two-day Consensus Conference entitled 'New Nursing Roles
- Deciding the Future for Scotland' has been developed in
partnership with the Royal College of Nursing. The conference
will be held at the Royal College of Physicians, Edinburgh
on 17 and 18 November 2003.
The Minister for Health and Community Care will open the
Conference with an address to the delegates. The purpose of
the event will be to set out to agree a national framework
for developing new nursing roles across Scotland.
The event will focus on a number of areas:
1. Role expansion and development
2. Evidence to support further investment
3. Generic v Specialist roles
4. Conditions necessary for nursing roles to flourish
in Scotland
5. A vision for the long-term future
This Consensus Conference provides the ideal opportunity
for nurses to make their voice heard and to influence the
future direction of the nursing profession. Delegates will
be able to engage, question and challenge on a range of issues
as well as to work towards a consensus. Nurses often say they
are not involved in policy and decision making - this provides
nurses with the vehicle to contribute to modernising nursing
in Scotland.
From the discussions and debates around each of the five
areas, a report will be produced and circulated. This product
will provide a picture of where the profession needs to go
over the next five years. However, further discussion will
be required in order to allow the profession to move further
forward.
As a sign of the importance in which this event is held among
the nursing profession, the number of delegate places has
already been filled and registration to the event is now closed.
The Expert Panel membership will be made up as follows:
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Slot
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Nominated
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Chair
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Professor Sheila Maclean, Glasgow
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Nursing Journalist
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Stephen Black, Edinburgh
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Nursing Education
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Professor Barbara Parfitt, Glasgow
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Research
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Bernice West, Aberdeen
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Chief Nursing Adviser
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Frances Hughes, New Zealand
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Doctor
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Erik Jespersen, Oban
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Lay Representative
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Mrs Elizabeth MacDonald, Scottish Consumer Council
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HR/Manager
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Mr Richard Carey, Chief Executive, Highland Acute
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A.H.P.
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Sonia Lamb, Therapy Services Director, Lothian NHS
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Chairman
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Mr Peter Bates, Chairman, Tayside NHS Board
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Nurse Manger
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Mrs Cathy MacGillivray, Argyll & Clyde
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Nurse Consultants
This represents another commitment within the Partnership
Agreement. An Action Plan to deliver 54 Nurse Consultants
has been developed in partnership with Chief Executives
and Medical Directors to take this forward.
To date, 18 Nurse Consultant posts are in place. Fields
of practice include midwifery, older people's services,
public health, paediatrics, pain management, perinatal
mental illness, epidemiology, acute medicine/surgical
receiving, cancer, enduring mental health, learning
disabilities, forensic rehabilitation, health protection,
family planning and sexual health, infection control
and Macmillan cancer nursing.
A further five posts have been established and are
in the process of being filled.
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Facing the Future yAction Plans
Action Plans form each NHS Board area have been submitted
on progress made locally on issues falling under the
banner of Facing the Future. In order for individuals
to view progress made within their own area as well
as to look at work ongoing in other board areas, these
action plans have been posted onto the new website.
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Facing the Future Website
Work has been undertaken to update and redesign the
Facing the Future website. It contains updates
on all the themes under the banner of Facing the
Future as well as information on key topics.
The website can be accessed at: www.s
how.scot.nhs.uk/sehd/facingthefuture
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Flexibility
Employers need to adopt a range of more family friendly/
flexible working arrangements designed to improve upon
the recruitment and retention of staff. The Scottish
Executive's Centre for Change and Innovation (CCI) is
currently providing a nationally supported programme
of development on flexible working for nursing and midwifery
staff.
The CCI have produced two information booklets detailing
their work under the title "Balanced Working Lives:
a 'can do' approach to employing nurses and midwives".
- Creating Balanced Working Lives details why
it is essential to establish flexible working and
what the benefits will be for staff, Employers and
patients. Examples of useful flexible working patterns
and considerations to be made about implementing changes
are also included.
- Sharing the Picture defines the current state
of play while summarising a diagnostic workshop that
aimed to promote balanced and flexible working practices
in the NHS, to illustrate good practice and to offer
practical assistance.
Good Practice Event - 'Balanced Working Lives'
- 1 October 2003
The Balanced Working Lives Conference, held in Dunblane,
was attended by over 60 delegates from numerous backgrounds
including nursing, human resources and trade unions.
The event started with a researcher from the Work Foundation
who recently published a report on work life balance
and flexibility.This allowed the issue of flexibility
within nursing to be set within a wider context.
David Benton, Director of Nursing, NHS Grampian, then
described the process adopted in Grampian. This was
followed by Ann McPherson with a discussion on partnership
from an HR perspective.
There were two opportunities within the event for people
to go into workshop sessions.These ranged from looking
at the different approaches taken to flexibility in
England to an opportunity to look at a system to support
and develop managers in flexible working practices.
The evaluation received so far has been very positive
and a booklet will be produced on good working practice
in early November 2003. Discussions with the HR forum
are ongoing on agreeing next steps.
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Questionnaire
Please take time to let us know your opinion about the ongoing
Facing the Future work by logging on to the website
and completing our questionnaire and emailing it to facingthefuture@scotland.gsi.uk
Feedback
The website will undergo development over time in response
to national policies and any specific requests by users.
All requests for advice and support as well as comments on
the content, suggestions for improvement and/or contributions,
should be directed to the Facing the Future mailbox.
Contact
For further information on any of the initiatives within
Facing the Future, please contact:
Neil Wilson, National Workforce Unit,
Ground Floor Rear, St Andrew's House,
Regent Road, Edinburgh EH1 3DG
neil.wilson2@scotland.gsi.gov.uk
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