Growth in NHS workforce since 2001 by staff group

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Kimberly Harris
5 years ago
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1 Notes from NHS Employers presentation to the NHS Confederation Hospitals Forum Thursday 21 February 2013 The first part of the presentation explores the current pressures on the pay bill relative to the economic situation in the NHS. It then goes on to outline the challenges in changing contracts for doctors and renegotiation the NHS Pension Are employers happy with the pay system? No, many of them now are not. They perceive it to be expensive and see a forever growing wage bill in 2010 it was around 44bn (including doctors). In theory So what are the drives to increased costs Are there more staff? Slide 1 Growth in NHS Workforce Since 2001 by staff group Growth in NHS workforce since 2001 by staff group 70% Growth in full-time equivalent staff numbers since % 50% 40% 30% 20% 10% 0% Year of Workforce Census Consultants General Practitioners All doctors Agenda for Change Other medical and dental staff Junior Doctors Qualified nursing staff Yes - Between 2001 and 2011, the lower of the two dotted lines shows that overall the AfC workforce has grown from 753,000 to 937,000 ( 24% increase). The number of doctors has grown proportionately even more but there numbers overall are smaller and there was a large expansion of medical schools in the late 1990s which has fuelled this. 1

Slide 2 Agenda for change Proportional distribution Agenda for Change proportional band distribution 2008-2012 25% 20% 15% 2008 2009 2010 2011 2012 10% 5% 0% 1 2 3 4 5 6 7 8a 8b 8c 8d 9 So what else

2 Slide 2 Agenda for change Proportional distribution Agenda for Change proportional band distribution % 20% 15% % 5% 0% a 8b 8c 8d 9 So what else might be happening is their grade drift? This chart shows little change in the proportional distribution of staff across the Agenda for Change bands over the 5 year period. The average Agenda for Change banding has increased by just 1% between 2008 and So although there is a bigger NHS, at an aggregate level it has roughly the same band mix as before. This may broadly indicate a robust job evaluation framework and/or a fairly constant requirement for the proportions of senior/ skilled to junior/ less skilled workers. (Although the specific skills required may change) This national aggregate analysis may hide the changes which have occurred at a staff group, regional, or local level. For example, anecdotally, in London there is a richer skill mix. Partly due to the historic concentration of teaching hospitals and tertiary centres. 2

3 With the exception of bands 1 & 2 the total headcount of staff in all bands has grown. 1 shrunk by 3.2%. The reduction in the number of band 1 staff is likely to be due to the outsourcing of services such as cleaning and catering Also of interest is that whilst the headcount of band 2 reduced by 0.5%, the FTE increased by 2%. This suggests on average there is less part time working (either more staff working full-time, or part-time staff have increased their hours). The willingness of the lowest paid to increase their hours could be in response to the economic climate. As the electronic staff record was introduced in 2008, we don't have a data time series which stretches back to the start of AfC in Therefore we only have a partial picture. Any band drift may well have happened in the early years, and 2008 onwards represents steady state. Also coding quality has significantly improved since ESR was introduced. For example there are registered nurses on bands 1-4 (i.e. miscoded), and apparently medical and dental staff with agenda for change bands. There is a clear trend that there are significantly fewer anomalous records in the 2012 data than the 2008 data. This may distort any trends. Slide 3 inflation and AforC (1) Comparison between Agenda for Change Annual Pay Uplift and Consumer Price Index (CPI) Expressed as monthly % change on a year earlier 6.0% 5.0% 4.0% AfC Pay uplift CPI as at April 3.0% 2.0% 1.0% 0.0% A J A O D F A J A O D F A J A O D F A J A O D F A J A O D F A J A O D F A J A O D F A J A O So, what has been the impact of inflation? This slide shows CPI inflation from 2005 to 2012 as you can see from the dark blue line it is pretty volatile between 1% and 5% ( although that itself is a narrow range compared to some historic periods) 3

The light blue line represents inflationary uplifts paid to the Afor C staff (it does not include increments) For 20111 and 12 the line reflects the pay freeze.

4 The light blue line represents inflationary uplifts paid to the Afor C staff (it does not include increments) For and 12 the line reflects the pay freeze. It appers to be zero but with the increases for those earning under 21,000 this cost around 0.3 percent of the paybill. Slide 4 Inflation and AforC (2) Comparison between Agenda for Change Annual Pay Uplift and Consumer Price Index (CPI) Expressed as cumulative % increase since % 25% 20% AfC Pay uplift CPI as at April 15% 10% 5% 0% 2004 Baseline If we smooth this out to show the cumulative increase we can see that the overall increase up to 2010 almost exactly followed inflation (and this included a three year deal during that period So it is the pay freeze during the past two years which has effectively slowed the increase in costs but has not halted it This started a call from employers late in 2010 to make changes Our Current Proposals For Agenda for Change Incremental progression Allowing performance standards to be determined locally (rather than the current satisfactory in AfC) Gateways at every point 4

5 Non consolidated points for the overlapping points at the top of the higher paybands Removing the job weighted criteria for what defines senior manager, for which alternative arrangements may apply Sick pay When off sick being pay basic pay only (and not enhancements) We have been very clear that these proposals are aimed at improving quality of patient care These proposals are under discussion with the trades unions and we expect a response by 28 th February some unions have already signalled their consent, others disapproval Medical Contracts New Discussions Two reports were published by the department of health on 17 th December 2012: The Doctors and dentists Review Body Report on Clinical Excellence Awards and consultant compensation levels review NHS Employers Scoping report on the contract for doctors in training Both reports proposed significant reform to the current contracts. This work is at a very early stage - On 29 January 2012 The NHS employers organisation held an event to discuss stakeholders views. Representatives from a wide range of bodies attended. We have begun exploratory discussions and are awaiting a remit to negotiate on both contracts. Slide 5 Consultants Medical contracts Clinical Excellence Awards and consultant remuneration Report by DDRB, commissioned by the government Recommends: Stronger link between local awards and performance Local awards up to 35,000 as a one-off lump sum, 25% of consultants National awards up to 40,000 held for up to 5 years, 10% of consultants Consultants can hold both local and national awards Change to payscale to reward performance Introduction of a principal consultant grade 5

6 The current consultant contract dates from 2003 when objectives were to retain a scarcer supply of consultants and drive down waiting lists. Responding to the report, we seek to do three things: To improve the quality of care for patients by access to a consultant over seven days To reward current innovation and enhancement of services for patients To recognise senior medical leaders Slide 6 Doctors in training Medical contracts Junior doctors contract Report by NHS Employers, commissioned by four UK governments Report recommends a complete renegotiation of the current contract New contract should focus on: - better patient care and outcomes - juniors feeling valued and engaged affordability - producing next generation of medical professionals - better relationships between employers, doctors in training and deaneries The contract for doctors in training dates back to 2000 and was designed to reduce hours of work by using punitive rates of pay for long hours. Punitive for employers that is - the doctors got more money for breaches of the rules. This has led to litigation and a confrontational approach. What is needed going forward is a more streamlined contract which supports training and service together. Fewer rules and greater certainty of earnings. Pensions There is significant work to be done on the NHS pension scheme over the next two years. Additional contributions - three phases to 2015 as with other public sector schemes we are about to commence year two of the increase to contributions 6

7 Reviews on scheme access and working longer Part of the agreement with our Trade Unions about our new pension scheme has been to review both who can access the scheme and look into the impact of longer working lives this work is due to report later this year. Auto enrolment the largest NHS organisations are approaching autoenrolment and all should be preparing for it now. New pension scheme from Key elements of the proposed scheme design for 2015 include: Full protection of your benefits earned to date (your accrued rights ). Protection for staff with less than 10 years to their pension age (with partial protection for those within a further 3.5 years of this). A move to a career average earnings scheme rather than final salary for pension benefits earned from An improved accrual rate of 1/54ths for this scheme. Re-procurement of system platform for pay and pensions. It is intended to secure a joint platform for payroll and pensions going forward A big agenda and it has been contentious. The final slide sets out the pensions work plan between now and 2015 which shows some pretty complex interdependencies and a lot of work to cover this year including new governance arrangements as well as new scheme design. Gill Bellord NHS Employers February

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