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

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

3. 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

4. 0 100 200 300 1996/97 1997/98 1998/99 1999/2000 2000/01 2001/02 £ million NHSLA payments for obstetric-related incidents 1996 - 2002 RCOG: Safer Childbirth: Minimum Standards for Service Provision and Care in Labour

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

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

7. 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 0 20 40 60 80 100 Public Health Psychiatry A&E Pathology Radiology Dentistry Paediatrics Average Anaesthetics Medicine O&G Surgery 48 hours and less More than 48 hours

8. 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? 020406080100 2001 2002 2003 2004 2005 YESNOYear Percent

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

10. Net NHS Expenditure, 2002-03 to 2006-08 England 0 20 40 60 80 100 £ billion 70% of NHS funding is spent on staffing costs 55.7 2002-03 63.7 2003-04 69.2 2004-05 76.1 2005-06 84.4 2006-0792.22007-08 Department of Health

11. 0 500000 1000000 1500000 19951996 199719981999200020012002200320042005 Total NHS staff 1995 - 2005 House of Commons Health Committee, 2007

12. Nurses and doctors 1995 - 2005 0 100,000 200,000 300,000400,00019951996199719981999200020012002200320042005 Nurses,Midwives Health Visitors All doctors House of Commons Health Committee, 2007

13. Consultants, registrars and other training grades 1995 - 2005 1995 - 2005 0 5,000 10,000 15,000 20,000 25,000 30,00035,00019951996199719981999200020012002200320042005Consultants Other trainees Registrars House of Commons Health Committee, 2007

14. 0 5 10 15 20 199819992000200120022003 2004 Associate Specialist Staff Grade Annual percentage increments in career grade doctors in UK*, 1998 - 2004 *Northern Ireland numbers included in 2001,2002 and 2003 only Consultant

15. NHS workforce growth 1999 - 2005 010203040506070 Senior management Central functions Clinical support staff Scientific and technical Allied health professionals Nurses All doctors percent House of Commons Health Committee, 2007

16. Comparison of NHS Plan (2000) growth targets with actual workforce growth (1999 – 2004) -50 0 50 150 250 350 GPs105% Nurses340% Allied health professionals69% Consultants -3% House of Commons Health Committee, 2007

17. 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?

18. Workforce considerations: conversion to MMC training posts 2800 5500 9000 3700 F 2 posts GP trainees Specialist trainees Surplus Total number of SHO and Trust grade posts = 21,000 www.mmc.nhs.uk

19. 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

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

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

22. Training costs of health service professionals 0 100000 200000 300000 Nurses Doctors £ Professionals Allied to Medicine (Netten et al, 1998)

23. 0 40000 80000 120000 2002-03 2003-34 2004-05 2005-06 GBP Year Average consultant earnings, 2002 - 2006 House of Commons Health Committee, 2007

24. Overspending on pay reform relative to projected spending 2004 - 2005 0 50 100 150 200 250 300 Consultant contract Agenda for Change GP contract £ million House of Commons Health Committee, 2007

25. 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?

26. Factors to be addressed Role of the doctor Length of training Service reconfiguration Plurality of provision Role redesign Hours of work

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

28. National Service Framework for Children Young People and Maternity Services

29. 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

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

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

32. “With an estimated 10 000 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

33. 2004 “Children’s and Maternity Services in 2009: Working time solutions” 2009

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

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

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