2.1 INTRODUCTION AND BACKGROUND
The SNIP exercise is carried out annually on a partnership basis between the
Scottish Executive, ISD Scotland as well as NHS and non-NHS Employers. For several
years it has offered the Scottish Executive advice and guidance on the number
of student nurses and midwives required across Scotland. The process is now
under review following the publication of the new workforce planning and development
arrangements in Working
for Health.
This year, consultation took place with NHS Trusts, NHS Boards and private hospitals. Information was also gathered from Higher Education Institutions, and the Prison Service. ISD Scotland generated baseline stock and flow information from centrally held workforce data sets, both for employers to use in their forecasting exercise and for central modelling at a Scotland-wide level.
Individual Trusts, Health Boards, private hospitals and education providers were requested to provide data on the predicted requirement for nurses and midwives up to the year 2007/08. NHS Education for Scotland produced information on uptake and wastage rates. Other factors that would influence supply and demand, such as age profiles, were applied to the national model.
A SNIP Project Team, led by the Executive, oversaw the collection of data and applied quality assurance measures before modelling the information against the supply and demand indicators. A range of projected intake requirements were arrived at for each of the registered nurse categories namely, Registered Nurse - General, Registered Nurse - Children, Registered Nurse - Mental Health, Registered Nurse - Learning Disability as well as Registered Midwives. Full membership of the Project Team is shown on appendix 3.
These intake recommendations were then presented to the SNIP Reference Group for further analysis, debate and agreement. The SNIP Reference Group is chaired by the Scottish Executive Health Department and consists of representatives from Higher Education Institutions, NHS Employers, ISD Scotland, Royal College of Nursing and the Royal College of Midwives. Once final intake recommendations are agreed, they are submitted to the Executive for a final decision. The full membership of the SNIP Reference Group is shown on appendix 1 and the Terms of Reference on appendix 2.
This report provides details on the recommendations made to the Executive by the SNIP Reference Group on the intake requirements for all nursing and midwifery student categories, and subsequent amendments, for 2004/05.
DIAGRAM - NATIONAL MODEL FOR SNIP
2.2 QUALITY ASSURANCE ISSUES
2.2.1 The continued co-operation and participation of service providers and educational establishments in the SNIP exercise provides a valuable contribution to achieving the correct number of student nurse training places for the academic year 2004.
2.2.2 While 100% of NHS Boards, Trusts and non-NHS service providers participated in the project a small number failed to provide the data required within the requested timetable.
2.2.3 A key element of quality assurance is the reconciliation of the Board/Trust baseline data (WTE) with the NAMS (payroll) data. This reconciliation is undertaken on three levels, the total of all registered nurses across Scotland, the total of registered nurses in each Board/Trust and by nurse registration category within each Board/Trust.
2.2.4 Achieving a reasonable reconciliation is dependent on the data source used by service providers and NAMs, being captured on the same date. Most service providers use data at 31 March; for technical reasons the NAMs data are captured six months earlier at 30 September. Consideration is given to this difference when undertaking quality assurance and Boards/Trusts have the opportunity to explain any difference.
2.2.5 The Board/Trust wide reconciliation is much improved from last year on all three levels. For Scotland as a whole an acceptable degree of variance was achieved. On a Board/Trust wide basis there was a significant variance in four Boards/Trusts. Follow-up was undertaken and a measure of co-operation from some of the local project managers resulted in improved data.
2.2.6 The baseline reconciliation within nurse categories is usually difficult due to anomalies in the payroll codes applied for registered nurses. Some Boards/Trusts have done corrective work on payroll codes and some improvement has been achieved. This work is commended. However in the majority of Boards/Trusts the data on registered nurse categories continues to be a weakness in the reconciliation process.
2.2.7 Notwithstanding the variance in dates when data are collected, the reconciliation discussed above is dependent on an accurate data source for the baseline of registered nurses in post and on the accuracy of payroll coding. It appears that in a minority of Boards/Trust there is not a robust data source and that the coding allocated to some registered nurses on the payroll continues to be inaccurate.
2.2.8 The demand forecasts demonstrate a Scotland-wide decrease in the demand for Registered Nurses - General; a number of Boards/Trusts forecast a small reduction in demand while in other areas, a significant increase in demand was forecast. There was an increased demand forecast for Registered Nurses - Children and Registered Midwives.
2.2.9 The quality of the comments to support the demand forecasts was patchy. Some Trusts provided useful text about the assumptions that were taken into consideration when arriving at their forecast; others provided no supporting text at all. An example of this is that one or two Trusts indicated that they had taken account of Agenda for Change but the majority made no reference to this.
2.2.10 As organisational change is implemented and the collation of data for SNIP is
at Board level, the person undertaking data collation will be more remote from the data collection activity. It will be more important than ever that forecast data are supported by commentary provided by the Board data collator.
2.2.11 While a general appraisal of a forecast can be undertaken with reference to
previous forecasts, a more rigorous assessment of the demand forecast would be achieved if all Trusts completed all the sections on the data collection and collation forms. There may be scope to improve the guidance given to SNIP participants about factors that affect demand forecasts.
2.2.12 It was noted that most Primary Care Trusts while anticipating changes in the demand forecast for practice nurses, arising from the changes in General Medical Services (GMS contract), were unable to quantify such changes due to incomplete planning and funding arrangements. These changes may appear in the SNIP 2004 exercise.
2.2.13 The collection of current data and demand forecast continues to be most difficult where registered nurses are part of the services provided within the scope of the Care Commission. Because no systems are in place to capture the Registered Nurse category the information for SNIP was derived from an annual survey of Care Homes undertaken by ISD.
2.2.14 The SNIP project team continues to review how data about registered nurses in employment in Scotland are collected. An example of this is the exploration regarding the collection of information about registered nurses working within the scope of the Care Commission.
2.2.15 The term Registered Nurse (RN), which is now a feature of professional identification, should be reflected in the SNIP documentation next year.
2.2.16 Despite guidance, some Primary Care Trusts fail to include post holders who are second level nurses (formerly enrolled nurses) as registered nurses.
2.3 OTHER OBSERVATIONS ARISING FROM SNIP 2003
2.3.1 The development of National and Regional Workforce Units will create opportunities for the development of information systems that support the SNIP exercise. There will also be scope to bring the SNIP exercise into a timetable that is linked to and is cohesive with other elements of regional workforce planning. This should lead to a more rigorous forecasting of the demand for registered nurses.
2.3.2 Some of the changes in the organisational structures of NHSScotland were implemented in the SNIP exercise this year and in two instances one comprehensive SNIP return was produced for a Board where previously individual Trust returns had been received. In 2004, the formation of unified Boards will result in a reduction in the number of participants in the SNIP exercise.
2.3.3 While the key purpose of the SNIP exercise is to determine the number of student nurses and midwives needed to train for entry to the professional register, there would appear to be some scope to use the SNIP exercise to capture information about staff working in the team who are not registered (nursing assistants/care assistants). This information may enhance the SNIP exercise and assist in workforce planning. Year-on-year data will build up trend and supply data and create opportunities to map the changes in the workforce structure and in the range of competencies available.
2.4 THE KEY MESSAGES FROM SNIP 2003
The SNIP 2003 exercise recently culminated in the SNIP Reference Group agreeing on the recommended intakes for each student category for 2004/05. The key messages from this year's exercise are:
Forecast Demand
Forecast demand for nurses and midwives is still rising. However, this year the rate of increase has slowed compared to the previous year. NHS employers still require additional nurses and midwives.
For the purposes of the SNIP exercise, demand means: the number of nurses and midwives employers wish to employ - which is driven by the impact of health policy; developments in the nature of health service provision; and changes in the overall size of NHSScotland.
For key messages on vacancy information see Chapter 8.
Nursing and Midwifery Supply
For the purposes of the SNIP exercise, supply refers to: the number of nurses and midwives who are available to work for these employers or existing employees who are prepared to work additional hours.
Supply numbers are influenced by a number of assumptions. These are based on trends (such as leavers, joiners and re-joiners) as well as 'knowns' such as certain policy initiatives (e.g. the One Year Guarantee).
The Gap
In order to meet this forecast demand, the gap between current supply and forecast demand needs to be bridged. This gap is largely bridged by Newly Qualified Nurses (NQNs)
Modelling
Using these assumptions, the future workforce can be modelled, using various scenarios to simulate how the workforce might be affected and how many nurses and midwives may be required. It also allows for some professional judgement to be exercised to determine the appropriate intake numbers for each student category.
2.5 STUDENT NURSE INTAKE PLANNING REPORT
The outcome of the Student Nurse Intake Planning process is set out in this annual report which this year presents the work within the framework of workforce planning and development launched in August 2002 in Working for Health, The Workforce Development Action Plan for NHSScotland.