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The Report of the Student Nurse Intake Planning Exercise 2003

5 Modelling for the Future Workforce

5.1 INTRODUCTION

This paper outlines what is considered to be the likely scenario for the future workforce based on a range of stated assumptions about how employers; nurses and midwives; and nurse and midwives in training will behave over the next five years. These assumptions are based on an examination of past trends and how they might be influenced by such factors as the extent of the demand/supply gap (i.e. vacancy rates) in any one year and the impact of policy initiatives e.g. the 'One Year Guarantee' for newly qualified nurses.

As well as the 'likely case' scenario, 'worst case' and 'best case' scenarios were developed by altering each assumption within reasonable limits. The 'worst case' scenario contains altered assumptions that would have the effect of increasing the number of student nurses required. The 'best case' scenario would have the effect of reducing the number of student nurses required.

For each scenario, the Project Team considered two types of growth reflecting different assumptions made about the change in demand in the final projection year. The first type of growth assumes that demand growth in the final year is best represented by the average annual change in the demand forecast. The second type of growth, 'catch-up growth' takes at face value the model's projection of shortage or surplus prior to the final projection year and compensates for any imbalance in the following 12 months.

SNIP RECOMMENDATIONS

*Including short courses but excluded 1st to 1st conversions

For the purposes of this paper, we have assumed the continuing impact of the One Year Guarantee through to 2007/08.

The graph below shows the leaving and joining rates for all qualified nursing and midwifery staff in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce has dropped from 9.6% in 1989/90 to 5.6% in 2001/02.
• The percentage of entrants to the workforce who are newly qualified nurses has been increasing since 1997/98 (from 3.2% to 4.0% in 2001/02). The impact of the One Year Guarantee is yet to be reflected.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Across the five categories as a whole, demand has fallen as is shown in the above table. There are two reasons for this. In the case of Registered Nurses - Children and Registered Midwives, there is an increase in demand and this has been reflected in increases in the recommended intakes. In the case of Registered Nurses - General, Mental Health and Learning Disability, there has been a significant decrease in demand.

In each case, however, supply (in the form of the dynamics of the current workforce and of students in training) is the main factor determining the model scenarios. The matter of supply can be a complex issue which is affected by a number of parameters including turnover rates, number of retirals, part time workers, etc. The greater impact of supply has been influenced by the drop in demand.

Intake Recommendations

The overall result across the five categories of nursing and midwifery is a recommended student nurse and midwife intake of 3955 - up slightly on the recommendation of 3935 in 2002 and a substantial increase on the SNIP 2001 recommendation of 3410.

Each nurse category is considered separately in this paper.

5.2 REGISTERED NURSE - GENERAL

The additional demand for RNs - General over the next five years is:

The five-year demand forecasts from NHS Trusts and other employers of nurses were down slightly compared to last year's exercise. 3580 extra nurses are required - an increase of 10% compared to the increase of nearly 12% forecast in SNIP 2002.

The data collected on registered nursing homes in 2002 were derived from two sources; the ISD(S)34 data collection from care homes and the SNIP data collection from NHS Boards on care home bed forecasts. Anecdotal evidence from NHS Boards suggested high turnover and vacancy rates would continue to exist within this sector as well as significant recruitment pressures. In response to this the demand forecast includes a moderate increase of 110 nurses for this sector. The ISD(S)34 collection has now ceased to exist and as a result, data that were collected during the SNIP 2002 exercise has been carried forward to this year. A replacement collection has been planned, which will be carried out in March 2004, providing current data for SNIP 2004.

The following assumptions have been made about factors affecting supply:

The graph below shows the leaving and joining rates for RNs - General in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce has dropped from 10% in 1989/90 to just fewer than 6% in 2001/02.
• The percentage of entrants to the workforce who are newly qualified nurses has been increasing since 1997/98 (from 3.2% to 4.2% in 2001/02). The impact of the One Year Guarantee is yet to be reflected.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Taking account of the above trends, the following assumptions have been made about factors affecting supply:

• The table below is based on the assumption that the proportion of the workforce that is accounted for by former members of the NHSScotland workforce rejoining will fall from 2005/06 as the proportion accounted for by newly qualified nurses increases because of the One Year Guarantee leaving less vacancies to be filled by those returning to practice.

It is assumed that the non-practice rate of degree and diploma students will fall throughout the projection period as a result of the One Year Guarantee.

In each year of the projection period the following intakes have been assumed: 74 to the short course for graduates; 29 to the conversion course for non-RNs - General; and 262 to the degree course.

The result of modelling the future workforce using these assumptions is as follows:

Columns c and d include those entering and returning from conversion courses and movements between NHS and non-NHS employment.

The Project Team considered the effect of both average and catch-up growth in the three scenarios. As demonstrated in the above table, the result was a wide variation of levels of student nurse intake.

As was the case in SNIP2002, the likely case scenario was the favoured option and the Project Team considered the effect of both average and catch-up growth.

While there has been a decrease in demand this year, the catch-up figure of 2229 is also significantly lower than the figure of last year. The volatility in demand this year has resulted in the SNIP Project Team considering the following options:

1. Intake figure of 2230 - this reflects the large intake last year and the significant drop in demand this year.

2. Intake figure of 2750 - this maintains the intake level as at last year.

3. Intake figure of 2525 - this figure takes an average of the intake figures recommended over the past two years. It takes account of the drop in demand but recognises that demand may increase next year. If demand next year remains the same or decreases further, an intake figure higher than 2525 is likely to lead to a significantly lower intake figure than suggested in option 1, next year.

An intake figure of 2,650 was recommended by the SNIP Reference Group. A figure of 2750 was subsequently agreed by the Scottish Executive maintaining these numbers at the previous year's level.

5.3 REGISTERED NURSE - CHILDREN

The additional demand for RNs - Children over the next five years is:

The following assumptions have been made about factors affecting supply:

The graph below shows the leaving and joining rates for RNs - Children in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce has dropped from 9.1% in 1989/90 to 5.4% in 2001/02.
• The percentage of entrants to the workforce who are newly qualified nurses has been increasing since 1999/00 (from 4.1% to 7.1% in 2001/02). The impact of the One Year Guarantee is yet to be reflected.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Taking account of the above trends, the following assumptions have been made about factors affecting supply:

It is assumed that the non-practice rate of degree and diploma students will fall throughout the projection period as a result of the One Year Guarantee.

In each year of the projection period the following intakes have been assumed: three to the short course for graduates and 10 to the conversion course for non-RNs - Children.

Columns c and d include those entering and returning from conversion courses and movements between NHS and non-NHS employment.

The Project Team considered the effect of both average and catch-up growth in the three scenarios with the favoured option being the likely scenario.

Last year the Steering Group recommended a reduced intake of 165. The effect of this reduction combined with an increase of 109 in demand this year explains the high
catch-up growth figures. This increase in demand is mainly due to service developments as well as the centralisation of certain services. Given this volatility, an intake figure of 180 was recommended. This was accepted by the Scottish Executive.

5.4 REGISTERED NURSE - MENTAL HEALTH

The additional demand for RNs - Mental Health over the next five years is:

The following assumptions have been made about factors affecting supply:

The graph below shows the leaving and joining rates for RNs - Mental Health in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce has dropped from 8.4% in 1989/90 to 4.6% in 2001/02.
• The percentage of newly qualified nurses entering the workforce has been increasing since 1998/99 (from 2.8% to 3.6% in 2001/02). The impact of the One Year Guarantee is yet to be reflected.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Taking account of the above trends, the following assumptions have been made about factors affecting supply:

It is assumed that the non-practice rate of degree and diploma students will fall throughout the projection period as a result of the One Year Guarantee.

In each year of the projection period the following intakes have been assumed: 15 to the short course for graduates and 32 to the conversion course for non-RNs -Mental Health.

The result of modelling the future workforce using these assumptions is as follows:

Columns c and d include those entering and returning from conversion courses and movements between NHS and non-NHS employment.

The Project Team considered the effect of both average and catch-up growth in the three scenarios. As demonstrated in the above table, the result was a significant variation of levels of student nurse intake.

The likely case scenario was the favoured option. As there is a minimal fall in demand compared to SNIP2002 and given the assumptions there appears to be no case to increase the student intakes, an intake figure of 750 was recommended. This was accepted by the Scottish Executive.

5.5 REGISTERED NURSE - LEARNING DISABILITY

The reduction in demand for RNs - Learning Disability over the next five years is:

The following assumptions have been made about factors affecting supply:

The graph below shows the leaving and joining rates for RNs - Learning Disability in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce is both relatively high and volatile. This reflects the transfer of services from institutional care to community care in recent years.
• There continues to be relatively few newly qualified nurses entering the workforce.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Taking account of the above trends, the following assumptions have been made about factors affecting supply:

* The leaving rates for NHSScotland are assumed to fall over the projection period as the transfer of staff to local authority and voluntary sectors is largely complete. As a result, from 2004/05 onwards, the average leaving rate of the other 4 categories has been used.

It is assumed that the non-practice rate of degree and diploma students will fall throughout the projection period as a result of the One Year Guarantee.

In each year of the projection period the following intakes have been assumed: nil to the short course for graduates and three to the conversion course for non-RNs - Learning Disability.

The result of modelling the future workforce using these assumptions is as follows:

Columns c and d include those entering and returning from conversion courses and movements between NHS and non-NHS employment.

The likely case scenario was the favoured option. The Project Team considered average growth to be the better outcome given that employers are continuing to reduce their demand. The Reference Group recommended a reduction from last year's intake figure of 90 to 75. This was accepted by the Scottish Executive.

5.6 REGISTERED MIDWIVES

The additional demand for RMs over the next five years is:

The following assumptions have been made about factors affecting supply:

The graph below shows the leaving and joining rates for RMs in the NHSScotland workforce over time. The trends from this chart show that:

• The percentage of those leaving the workforce has dropped from 8.5% in 1989/90 to 4.3% in 2001/02.

* Data are missing for 1994/95 on NQNs and other joiners due to data not being available following the transition of nursing and midwifery training to HEIs.

Taking account of the above trends, the following assumptions have been made about factors affecting supply:

* The rejoining rates for NHSScotland are assumed to change over the projection period, due to the lack of a shortfall in supply and priority being given to NQNs under the One Year Guarantee.

It is assumed that the non-practice rate of degree and diploma students will fall throughout the projection period as a result of the One Year Guarantee.

In each year of the projection period the following intakes have been assumed: 49 to the 18-month course throughout the period.

The result of modelling the future workforce using these assumptions is as follows:

Columns c and d include those entering and returning from conversion courses.

Midwives have been in oversupply for some years and the Project Team has in the past recommended reductions in intakes. Last year the recommendation was a reduction to 180 on the previous year's intake of 220.

This year, however, there is a sharp increase in demand which may result from recent policy guidelines. This increase in demand suggests a likely case average growth recommendation of 232, which is lower than last year, and a substantially reduced catch up growth recommendation of 132. The view of the Project Team, however, was that this increase in demand would need to be sustained in future SNIP exercises before being fully implemented in the recommendations. The SNIP Reference Group recommended that the intake be set at 200, this being the average of the intakes over the previous two years. This was accepted by the Scottish Executive.

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