Focus On: The Age of the NHS Wales Workforce 2015

Transcription

1 Partneriaeth Cydwasanaethau Gwasanaethau r Gweithlu, Addysg a Datblygu Shared Services Partnership Workforce, Education and Development Services Focus On: The Age of the NHS Wales Workforce 2015 GIG NHS GIG NHS GIG NHS GIG NHS Josephine Bloggs Partneriaeth Cydwasanaethau Gwasanaethau r Gweithlu, Addysg a Datblygu Shared Services Partnership Workforce, Education and Development Services

2 2 Contents... 1 Executive Summary Introduction Background Research Wales / UK Population trends Welsh Population Dependency ratios Census: Key Questions Profile of NHS Wales Workforce Age Profile Cumulative change in employment by age band 2008 to Staff aged 50 and over Gender age profiles Percentage age band and gender Age and participation rate/flexible working Key Questions Age profile of NHS Wales Workforce recruits Comparison of Starters during the periods 2007/08 and 2014/ Average age of Starters in NHS Wales Workforce Starters profile of Nursing and Midwifery Key Questions Age profile of NHS Wales Workforce Leavers Comparison of Leavers during the periods 2007/08 and 2014/ Comparison of Nursing and Midwifery Leavers 2007/08 and 2014/ Average retirement age Average retirement age by Grade Retire and return rates / 08 and 2014/15... Key Questions Age and sickness absence Sickness Absence by age and grade Age of the workforce compared to sickness absence percentage... Key Questions Conclusion... References... Appendices... Appendix 1 - Data limitations... Appendix 2 - Age Profile by Staff Group... Appendix 3 - Participation Rate by Staff Group Appendix 4 - Starters by Age Band by Staff Group Appendix 5 - Leavers by Age Band by Staff Group

3 Executive 3 Summary Executive Summary Population: As the largest employer in Wales, the workforce reflects the demographic characteristics of the wider population. Compared to the rest of the UK, Wales has the highest percentage of people aged 65+: 1 in 5 in 2014, set to increase to 1 in 4 by The increase in the proportion of the older population alongside the decrease in the proportion of the younger population is leading to a decrease in the dependency ratio. Therefore it is vital that NHS organisations consider their own population data and look at population trends for the next 15/20 years. Organisations should be thinking about population-based workforce planning to help plan services and their workforce more effectively. Retention: It can be clearly seen that the NHS Wales workforce is ageing. The biggest growth in the workforce is in age band (27%). 1 in 3 people in the NHS are 50 and over. In the light of pension age increases and changes to the NHS Pension scheme, Organisations need to plan and develop policies that will help retain employees aged between 55 and 64. As for the younger workforce, they perceive their career trajectory differently compared to previous generations. They will be working for a prolonged period and perhaps no longer expect or want a career / job for life. Strategies need to be developed to accommodate these cultural changes. Flexibility: The participation rate of the workforce has remained the same over the two reference periods. From the age of 55 and above, both male and female workers reduce their participation rate. Organisations need to have a better understanding of the factors that are influencing employees career-planning decisions so robust strategies and policies can be shaped around: health and wellbeing, retention, career planning and job design throughout all age bands. The data highlights the need for greater support and interventions with staff aged particularly over 50. Organisations need to consider policies that enable these workers to work flexibly and address underlying ergonomic/manual activities. These policies need to support employees in work as well as helping to reduce sickness absence rates.

4 4 Recruitment: The data shows nearly 50% of the new recruits are employed between the ages of and after the age of 30 there is a gradual decrease of new recruits. The average age of starters in NHS Wales has increased by 3 months from 32 years 11 months in 2007/08 to 33 years 2 months in 2014/15. While the pattern of recruitment remains relatively stable, policies and strategies could influence the future shape of the workforce. Leavers and Retirement: The data shows that the overall leaver profile has changed between the two reference periods. There were two definite leaver/ retirement peaks, one at age 60 and one at age 65. This has changed; there are now three main retirement milestones peaks, aged 55 for special class staff (predominately nurses), 60 for members of the 1995 pension scheme and 65 state pension change. It is anticipated that this pattern will change as pension scheme and state retirement ages make it financially unaffordable for many staff to leave. Overall the average age of retirement has increase by 8 months, from 58 years 9 months in 2007/8 to 59 years 5 months in 2014/15. Organisations need to actively engage with their employees to support and promote flexible working to ensure skills, knowledge and experience are retained. Research has identified that there are various push and pull factors affecting when people choose to retire or leave employment and that staff retention is often driven by the characteristics of the job rather than the individual s capabilities. In order to understand these push and pull factors, workforce information and the need for data to be reliable and complete is critical. Consideration needs to be given to how leaver reason and age-related information could be improved as NHS Wales introduces ESR Enhance Sickness: Analysis shows that the highest percentage of sickness absence occurs in staff who are the oldest and who have the lowest pay band. There is evidence in the report that shows lower pay bands (band 1-4) are working longer. This could potentially mean that if nothing changes the sickness absence will also increase. Also the two largest reasons for sickness are anxiety and stress and musculoskeletal, and these proportionally increase above the ages for 55. Given the age of NHS Wales workforce is increasing and the largest growth is in age bands 50-69, without any intervention, it is likely that the percentage of sickness reasons for anxiety and stress and musculoskeletal will also increase. It would appear to be critical that any strategies developed would need to consider potential sickness absence impact.

5 GIG NHS GIG NHS GIG NHS Josephine Bloggs GIG NHS has been considered from the 2011 Census and the NHS Employers Working Longer Review initial findings. It should be noted that this report does not take into account the health care professionals currently employed in the independent sector, contracted services, or by other public sector employers. The expectations of and demands upon these sectors is set to increase, a request of Welsh Government s strategic intent together with the significant challenges on workforce numbers already being experienced. Accordingly, the issues noted here are in all likelihood of a greater magnitude when considered for the health and social care system in Wales overall and will need to be revisited as additional data becomes available. A separate NWSSP, WEDS report is available which includes an analysis of the GP workforce by age and gender (Focus on GPs and their Practice Workforce ii ) 5 1. Introduction 1.1 Background This report has been prepared by Workforce, Education and Development Services (WEDS) and NHS Wales Employers, for the NHS Wales Working Longer Group and focuses on the age of the NHS Wales workforce and the potential impact of a number of age related factors. It is recognised that consideration of these issues is critical to the longer term sustainability of the NHS Wales workforce. The NHS does not currently have the older workforce it will in the future and how it will support these changes needs to be considered now. (i) Data contained in the report has been taken from the Electronic Staff Record (ESR) at a national level, creating a picture of the NHS Wales workforce as at 2007/8 and 2014/15. Some of the ESR data limitations in this report are listed in Appendix 1. Further data This report is seen as an initial baseline of the impact of ageing on the NHS Wales workforce. Revisiting this report in 5 year intervals will provide for future benchmarking and the tracking of possible emerging trends as a result of changes to the pension scheme and working longer. 1.2 Research There is now a large volume of research and publications on the potential impact of an ageing workforce and having to work longer. This report has considered a number of these publications, especially the work of the NHS Employers Working Longer Review. Research has identified a number of fundamental questions that organisations need to consider to assess any potential impact of an ageing workforce. There are a number of common factors that underpin the working longer research: The population and working population is ageing

6 6 There is a predicted shortfall in the age group coupled with an increase in the proportion of the population aged 65+ The state pension age is likely to increase Pension schemes are changing. The Working Longer Review found that there are a number of challenges facing the NHS due to an ageing workforce and the need to provide care for an ageing population. It found that of the 1.3 million NHS workers, 70% would need to work longer, due to the changes to the NHS Pension scheme. Research undertaken by Bath University as part of the review found that: The average age of NHS employees in 2011 was 43.7 and is projected to rise to 47 by 2023 A significant proportion of staff aged over 50 leave NHS Employment moving to alternative health-related employment with fewer hours Push and pull factors influence when people choose to retire: health, finance, family commitments, peer norms, job characteristics, and structural influences Staff retention is driven by characteristics of the job rather than the capabilities of the individual The review also found that sourcing workforce data from the multiple databases where it is held was challenging. The data is substantial, but is collected by different organisations for different purposes. This means tracking across the different data sets was impossible e.g. some data is held in ESR and some in the NHS Pensions database, neither of which can be easily crosstabulated. The report concludes that whilst the impacts of working longer are a challenge for the NHS it also provides an opportunity to think and act differently. Looking after the health, safety and well being of staff, from an early age, is one of the fundamental challenges the service must face. (i) The CIPD s 2015 Policy Report, Avoiding the Demographic Crunch, provides research into future labour supply across a number of industries. The report identifies that due to the high proportion of the workforce aged over 50 (30% currently in the UK) a large number of experienced and skilled workers are due to leave the workforce over the next decade, coupled with a projected shortfall of younger people to replace them. The report also notes that with a growing number of older workers there will be a growing demand for greater flexibility whilst acknowledging that the ageing population will also shift demand for future products and services. The report identifies a number of recommendations for how organisations should analyse their workforce data and areas that they should consider addressing if they have an emerging labour supply issue and states that: Board members need to know why managing an ageing workforce makes business sense, what the underlying demographic issues are for the particular organisation, the benefits of addressing them and the implications of ignoring them CIPD (iii) The following section analyses the NHS Wales data that is available in the light of the research referred to above, and highlights a number of key question that aim to support the development of strategies and plans at both a national and local level.

7 2. Wales/UK Population trends 2.1 Welsh Population When analysing the age of the NHS Wales workforce it is important to explore it in the context of the population of Wales and the UK in general. As the largest employer in Wales, the workforce reflects the demographic characteristics of the wider population. Wales population has changed over the past 20 years and the most noticeable difference is the increase in population age band In additional the graph shows the progression of the baby boomers moving through the system (highlighted by the three circles). In the next 10 years this peak in population will be in the age bands. This move is significant because these age bands are approaching retirement age. There is a peak that has emerged in 2004 (age band 10-14) and in 2014 (age band 20-24), that shows the shadow boom, the children of the baby boomers. The UK population is ageing, with a growing increase in the proportion of the total population aged 65+. The graph below shows the increase in that proportion since Wales has the highest percentage of people aged 65+, with 20% (1 in 5) in Population projections produced by the Office for National Statistics (ONS) and Stats Wales forecast that in 2034, 26% (1 in 4) of the population will be 65+. % over Thousands Graph Percentage of the population 65 and over by Country Dependency ratios Graph Wales Population by age band: The increase in the proportion of the older population alongside the decrease in the proportion of the younger population is leading to a decrease in the dependency ratio. The dependency ratio is calculated as the number of people of working age divided by the number of people of state pension age. This change means that there are decreasing numbers of working adults compared to non-working younger and older people. For the NHS, this can also be seen as a potential indicator of increasing demand and workload with younger and older people accounting for the main users of the health service.

8 8 The following graph, produced by the Office of National statistics (ONS), shows the projected falling dependency ratio across the four nations of the UK. The decreasing dependency ratio illustrates the decrease in the availability of the workforce over time i.e. increasing demand at a time of potential decrease of available workforce. The graph shows that Wales dependency ratio is significantly lower than the rest of the UK and is set to remain at below the UK average. The peak in the graph around is due to the equalisation of men and women s retirement ages to 65 and the levelling off is due to the increases in State Pension ages, ultimately to 68. Graph Dependency ratios: number of working age population to each person of state pension age, 2012 to Census: 2011 The increase in the proportion of the population aged 65 and over is coupled with the fact that currently people are living longer. However, many people in Wales are also living with long term chronic conditions, which in turn increases demand for services. In 2011 Wales had a higher percentage of residents with a long term health condition or disability (just under a quarter of the population), higher than any English region. Linked with this, more people in Wales (12%) are caregivers, again higher than in any region in England. These factors will be important considerations for the NHS Wales workforce as the increase in service demand will be increasingly delivered by an ageing workforce, with increased health needs and caring responsibilities. This is supported by findings from the 2014/15 NHS Wales Integrated Medium Term Plans (IMPT) which identified increasing demand especially in services relating to frailty and dementia. Research into the impacts of an ageing workforce has identified that employers may soon have to replace large numbers of the skilled and experienced workforce. The 2011 Census identified that 1:4 (26%) of the population in Wales aged 16 and over reported having no recognised qualifications. Whilst the second largest qualifications category was Level 4 or above e.g. Bachelor s degree or above (24%) this presents a challenge in that the younger proportion of the population potentially may not have the right skills or qualifications to replace the numbers of leavers. The retention of skilled and experienced workers will therefore, become more important in the future. The IMPTs also recognise the need to plan to meet the needs of an ageing population with an ageing workforce and the need to attract younger workers with different expectations and attitudes to the workplace. Key Questions Do NHS organisations understand their own population data and population trends for the next 15/20 years? Can Organisations respond to population challenges and put in place strategies that will attract younger workers and retain the skills and experience of older workers? Are Organisations thinking about Population-based workforce planning to help plan services and their workforce more effectively?

9 3.Profile of NHS Wales Workforce 3.1 Age Profile In 2015, NHS Wales employed just under 86,300 people, an increase of approximately 1,800 (2%) of the numbers employed in The following graphs illustrate the changes to the NHS Wales workforce over that period. It can be clearly seen that the NHS Wales workforce is ageing. In 2015 the percentage of staff over the age of 50 is higher than The normal distribution curve of 2008 is starting to skew towards the right, indicating that more of the workforce is now within the higher age bands than seven years ago. In 2008, a third of the workforce was aged and in 2015 that third has moved to the age band Given the average retirement age of NHS Wales is 59 years old (see section 5. Average retirement age) in the next 5 10 years potentially 28,000 people (a third of the workforce) could retire. Further analysis (see Appendix 2) shows that not all the staff groups have seen the normal distribution curve move. Allied Health professional and Medical and Dental do not show any significant movement left or right on the graph. The two staff groups that show the biggest movement of the normal distribution curve are Estate and Ancillary, and Administrative and Clerical. 9 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Headcount % 2008 Headcount % 2015 Graph Age Profile of NHS Wales 2008 vs 2015 based on headcount

10 Cumulative change in employment by age band 2008 to 2015 The graph below shows the change in headcount by age band from 2008 to It shows the biggest growth in the workforce has been age band (27%). A large percentage of this growth has come from staff moving from the age band up to the age band The largest percentage reduction is from the under 30 age band, this could be an indication that NHS Wales is not recruiting the same amount of younger staff as it has done in the past. The age band that has seen the largest percentage increase is 60+ at 38%; an increase of 2,000 people. Nearly half of this increase (900) is from staff aged 65 and over. These people are currently electing to stay on in work past the traditional retirement age. If these trends persist and the workforce continues to increase in age there may be health related issues that will affect the workforce. Analysis carried out by WEDS on Sickness and age (Focus on Sickness Absence Trends NHS Workforce iv ) shows a strong correlation linked to sickness and age. The older the worker the higher propensity for sickness absence. This is explored further in section 6 of this report Headcount 6,000 4,000 2, , (27%) 60+ (38%) Under 30 (-13%) (-8%) Under 30-4, (-11%) -6, Years Graph NHS Wales Cumulative change by age band 2008 to

11 3.3 Staff aged 50 and over Section 3.2 indicates that the age composition of the workforce between 2008 and 2015 has changed. The biggest increase in numbers has been in the age band 50 and over. The graph below looks at the percentage of staff who are aged 50 and over by staff group. 60% 50% 40% 30% 20% 10% 0% 2008 Age Age 50+ Graph Percentage of staff age 50+ by staff group (2008 vs 2015) Overall, the NHS Wales workforce aged 50 and above has increased between 2008 and 2015 and now accounts for 36% (1 in 3) of the current workforce, compared to 29% in The above graph shows that Estates and Ancillary staff group are the outliers: not only do they have the highest percentage of staff aged 50 and over they have seen one of the largest percentage increases, an increase of 9.5%. Now over half of Estates and Ancillary staff group are over the age of 50. The staff group that has seen the largest percentage increase of staff age 50 and over is Nursing and Midwifery registered, an increase of 10%. This increase is significant because of the sheer numbers in this staff group. In 2008 there were 6,100 over the age of 50 compared to 8,740 in It is important to consider this data in more detail next to retirement profiles in order to forecast potential leavers. Section 5 looks at retirements in more detail. 3.4 Gender age profiles Graph shows staff in post (headcount) in 2008 (dotted line) and 2015 (bar) by gender split by age band. Overall the male and female workforce shows the same changes. The distribution curve has moved up the chart indicating that the workforce is getting older. In 2008 the apex of the graph was age band and now it is age band The largest reduction in the workforce can been seen in age band Under 20 5, ,000 10,000 Headcount Male Female Graph Male and Female age profile by gender 11

12 Percentage age band and gender Comparing the genders by percentage of the workforce reveals the age distribution of males and females is similar up until the age of 44. From age there is a higher proportion of females compared to males and in the age bands 60 and over there are more males than females. This shows that males tend to work longer than females. 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Female % Headcount 2015 Male % Headcount 2015 Graph Percentage comparison of age band and gender 3.6 Age and participation rate/ flexible working The following graph shows the participation rate of staff by age band and gender. Participation rate is a number between 0 and 1 that is a measure of part time working. The number is derived by dividing the contracted FTE by the headcount. The higher the participation rate, the more hours, on average a person is working per week. For example, if an individual is working 37.5 hours a week they will have a participation rate of 1.0 (full time), if they are working 22.5 hours a week they will have a participation rate of 0.6. Overall the participation rate of the workforce has remained the same over the two time periods. There have been some changes in participation rate in the higher age bands (60+) but these figures will be sensitive to change because of the small numbers of people at these ages. In 2008 the average participation rate was 0.86; this has slightly increased to 0.87 in This increase has mainly come from women increasing their participation rate from 0.84 to 0.85 meaning that females are working more hours in 2015 as compared to Under Participation Rate Graph Participation rates working by age band, comparing males to females Female participation rates are at their highest between the ages of (0.9 FTE) then there is a reduction at age band to 0.85 FTE and the participation rate then remains at around this level until age band of 60-64, where it reduces further. The male participation rates differ from the female rates, as from the ages of 20 and 54 the majority of the male workforce is working full time. A comparison of the two reference periods shows that the participation rates for males have remained the same. Further analysis of participation rates by staff group (see Appendix 3) shows that for most staff groups participation rates between the two reference periods for the ages of have remained unchanged. In most staff groups most men are working full time and women show a reduction in participation rate around age band. This trend may, however change as the generation known as millennials (i.e. those born between 1980 and 2000) join the workforce. Male Female

13 These future employees will look for versatility and flexibility in the workplace, and strive for a strong work life balance in their jobs 13 Research into working longer has identified that older workers are choosing to work more flexibly, over time. Further analysis needs to be undertaken to establish whether NHS Wales workers choose to use flexibilities within their pensions schemes to reduce their working hours or choose other forms of flexible working. This will require consideration at national and organisational level of how such data could be captured and reported. Currently ESR only reports participation rates and not at the variety of flexible working patterns that could potentially be recorded. Whilst there is an option to record flexible working arrangements such as flexi time, term time working, annualised hours etc. within ESR, this option is not currently utilised. Key Questions In the absence of ESR functionality, are the variety of alternative working patterns being captured in other systems e.g. e-rostering? Does the culture within the organisation support flexible working and are managers supported to ensure that roles can be designed to retain skills, knowledge and experience across an individual career? Do organisations have a good understanding of the factors that are influencing employees career planning decisions so robust strategies and policies can be shaped around career progression? Are organisations focusing effort in creating strategies to support the retention of shortage professions e.g. Nursing and GPs? Are the needs of older workers and millenials reflected in job design and working patterns, as well as the inter-generational issues which might arise? Should elements such as flexible working, availability of childcare facilities, carer leave, sabbaticals and access to training and development be broadened to provide greater levels of anchorage and loyalty? Do organisations support staff with career planning, personal development and health and well-being?

14 14 4. Age profile of NHS Wales Workforce recruits The analysis in this section looks at new starters into NHS Wales by headcount. The dataset excludes anyone employed in NHS Wales who has changed jobs internally and excludes doctors in training (internal workforce movement). 4.1 Comparison of Starters during the periods 2007/08 and 2014/15 Overall the starter profile remains the same over the two reference periods, nearly 50% of the new workforce is employed between the ages of and after the age of 30 there is a gradual decrease of new starters. However, the profiles are not identical, in 2014/15 NHS Wales proportionally took on more staff at age than in 2007/8. In 2007/8 NHS Wales proportionally took on more staff in the age bands of and % 7% 6% 5% 4% 3% 2% 1% 0% / /8 ` Additional Clinical Services and Administrative and Clerical staff reflect the changes seen in the NHS Wales profile, i.e. a reduction in younger staff age and an increase in staff Estates and Ancillary staff group has seen the largest change in the starter profile with more older staff aged being employed and less being employed in the younger age bands of This change in profile helps to explain the high increase in staff over the age 50 (see section 3 on Staff aged 50 and over). 4.2 Average age of Starters in NHS Wales Workforce The average age of starters in NHS Wales has increased from 32 years 11 months in 2007/08 to 33 years 2 months in 2014/15: an increase of 3 months. This increase is reflected in the majority of staff groups with increases ranging between 4 months to 2 years 8 months. Only two staff groups have seen a decrease in the average age, Nursing and Midwifery and Allied Health Professions. These figures could be looked at in a number of ways, a lower figure would suggest we are recruiting staff to train and develop alongside current workforce. A higher age may suggest we have a balance between new entrants to the NHS and more experienced staff who have gained experience outside of NHS Wales or are returning. Therefore it is important to continue to look behind the figures to ensure that we are retaining staff in employment as appropriate and recruiting from a broad range of potential applicants. Graph NHS Wales Starter Profile: 2007/08 vs 2014/15 Further analysis (see Appendix 4) has shown the NHS Wales starter profile is not reflected in all staff groups. Different staff groups show differing peaks and troughs, but the overall trend in the starters profile in each staff group remains broadly unchanged. 2. Fuller Working Lives A Framework for Action, Department for Work & Pensions, June 2014

15 Staff group 2007/ /15 Difference Add Prof Scientific & Technic 33 Years 11 Months 34 Years 7 Months 0 Years 8 Months Additional Clinical Services 30 Years 9 Months 31 Years 5 Months 0 Years 8 Months Administrative and Clerical 33 Years 4 Months 35 Years 4 Months 2 Years 0 Months Allied Health Professionals 28 Years 8 Months 28 Years 1 Months - 0 Years 7 Months Estates & Ancillary 34 Years 6 Months 37 Years 2 Months 2 Years 8 Months Healthcare Scientists 29 Years 3 Months 31 Years 8 Months 2 Years 5 Months Medical & Dental 38 Years 3 Months 38 Years 7 Months 0 Years 4 Months Nursing & Midwifery Registered 33 Years 3 Months 32 Years 0 Months - 1 Years 3 Months NHS WALES 32 Years 11 Months 33 Years 2 Months 0 Years 3 Months 15 Table Average Age of Starter by Staff Group 4.3 Starters profile of Nursing and Midwifery Table shows the biggest reduction in average age is in Nursing and Midwifery, a reduction of 1 year 3 months. The graph below clearly shows a spike in employment between the ages and an overall reduction in age This reduction indicates an increased reliance on new graduates with less middle age staff being employed. 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% / /8 Graph Average Age of Starter by Staff Group Comparing data in this way will show the impact of different strategies and phenomena in recruitment practice. ' Currently there are difficulties in recruiting additional experienced entrants, however, in 2016, there is anticipated to be significant activity in respect of overseas recruitment and the age profile of these staff will be reflected in future data reports. The 2015/16 nursing commissioning numbers increased by 20%, and these again will impact on recruitment of nurses in their early 20s in 2018/19 when they graduate. Key Questions Do we actively encourage and enable potential applicants over the age of 50 to apply for vacancies? Do we analyse application data to establish trends in applicants, the groups attracted to particular posts and the age ranges of shortlisted and successful candidates? Are organisations doing enough to ensure students who graduate in Wales are encouraged to take up post in Wales? Is NHS Wales equipped to increase work experience opportunities and also attract those Not in Education, Employment, or Training (NEET) so as to increase people entering NHS workforce and choosing the NHS as a longer term career?

16 16 5. Age profile of NHS Wales Workforce Leavers The analysis in this section looks at leavers out of NHS Wales by headcount. The dataset excludes anyone who has left and re-joined NHS Wales and excludes doctors in training. 5.1 Comparison of Leavers during the periods 2007/08 and 2014/15 The data shows that the overall leaver profile has changed between the two reference periods. In 2007/8 there were two definite leaver/retirement peaks, one at age 60 and one at age 65. This has significantly changed in 2014/15, there are three main peaks but generally from age 50 proportionally more people are leaving. The actual headcount figures show NHS Wales is losing less staff from age but losing more staff from age 50 and over. In 2007/8 between the ages of NHS Wales lost 2,155 staff, this increased to 2,794 in 2014/15, an increase of 30%. In 2007/8, 36% of the leavers were in the age band of this has increased to 52% in 2014/15. The increase in people leaving at age 60+ could be the result of staff delaying their retirement plans. If this trend continues we may see a flattening out of staff retiring between the ages instead of the two peaks. 5% 4% 3% 2% 1% 0% / /8 ` The graph also shows the impact of the three current retirement milestones; 55 for special class staff (predominately nurses), 60 for members of the 1995 pension scheme and 65 state pension change. This pattern will change as pension scheme and state retirement ages make it financially unaffordable for many staff to leave. In 2014/15 NHS Wales was retaining more staff at the younger age bands. This retention in staff numbers could be in part related to the financial climate and that with the uncertainty in the jobs market could indicate that people are opting to stay within the NHS. Further analysis (see Appendix 5) shows the change in leaver profile is different for different staff groups. For the staff groups Estates and Ancillary, Additional Clinical Services and Administration and Clerical staff the leaver profile has moved to the right of the graph showing there is a higher percentage of people retiring/ leaving later. For Medical and Dental and Nursing and Midwifery staff, the leaver profile shows significantly more staff are leaving between the ages 55-60, indicating more staff are retiring/leaving earlier. Graph shows a significant increase in staff leaving at ages 55-58, this increase is predominantly the result of Nursing and Midwifery staff. See graph Comparison of Nursing and Midwifery Leavers 2007/08 and 2014/15 The Nursing and Midwifery staff leaver profile in 2014/15 shows a considerable increase in the numbers of leavers aged In 2014/15 out of all the staff who left between ages 54 and 70, over 30% left between the ages of In 2007/08 this percentage was less than 20%. The Nursing and Midwifery staff group are one of the only staff groups Graph NHS Wales leaver profile: 2007/08 vs 2014/15

17 with Special Class status, which means they are able to retire on a full pension at 55. It appears from the data that even though they were able to take retirement at 55 in 2007/08 few took up this option. Whereas in 2014/15 the data suggests more staff may have taken advantage of this option as the numbers leaving at age have increased. Anecdotally it is suggested that there may be a combination of push (workload) and pull (ability to access pension) factors which is driving this behaviour. Section 3.3 showed that 34% of the nursing workforce are over 50. If this trend continues there may be a dramatic reduction in the nursing workforce which may affect the organisations capacity to staff services. 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% / /8 ' Data in this section and section 5.4 includes only staff who have retired and not returned. Research has identified that there are various push and pull factors affecting when people choose to retire or leave employment and that staff retention is often driven by the characteristics of the job rather than the individual s capabilities. In order to understand these push and pull factors, workforce information and the need for data to be reliable and complete is critical. Consideration needs to be given to how age related information could be improved as NHS Wales introduces ESR Enhance and further roll out ESR Manager Self Service. Table compares the average age of retirement between 2007/8 and 2014/15 by staff group. The information extracted has been based on the following retirement leaving reasons: Flexi Retirement; Retirement Ill Health; Retirement Age; Voluntary Early Retirement No Actuarial Reduction; Voluntary Early Retirement with Actuarial Reduction 17 Graph Nursing and Midwifery leavers profile: 2007/08 vs 2014/ Average retirement age The following information has been based on the leaving reasons entered into ESR. In 2007/8, 43% of the reasons for leaving were Voluntary Resignation - Other/ Not Known. Whilst this has reduced to 23% in 2014/15 the information on reason for leaving is likely to be underreported. Therefore the numbers in this section are indicative numbers only.

18 18 Staff Group 2007/ /15 Difference Add Prof Scientific & Technic 59 Years 1 Months 58 Years 11 Months 0 Years -2 Months Additional Clinical Services 58 Years 6 Months 60 Years 3 Months 1 Years 9 Months Administrative & Clerical 59 Years 7 Months 60 Years 9 Months 1 Years 2 Months Allied Health Professionals 57 Years 8 Months 58 Years 6 Months 0 Years 10 Months Estates & Ancillary 60 Years 0 Months 61 Years 10 Months 1 Years 10 Months Healthcare Scientists 60 Years 3 Months 59 Years 3 Months -1 Years 0 Months Medical & Dental 59 Years 7 Months 60 Years 2 Months 0 Years 7 Months Nursing & Midwifery Registered 57 Years 5 Months 57 Years 3 Months 0 Years -2 Months NHS WALES 58 Years 9 Months 59 Years 5 Months 0 Years 8 Months Table Average Age of Retirement by staff group The average age of retirement leavers in NHS Wales has increased from 58 years 9 months in 2007/8 to 59 years 5 months in 2014/15, an increase of 8 months. The increase in average retirement age closely relates to the above section on leave profile. Estates and Ancillary, Additional Clinical Services and Administration and Clerical are the three staff groups that have seen the biggest increase in retirement age and they are also the three staff groups that have seen the leaver profile shift to the right of the graph indicating they are leaving later. A potential reason these staff groups are experiencing their workforce working longer could be due to home financial pressures. The majority of staff who are in these staff groups are Band 1-4. Staff in bands 1-4 may have a greater reliance on receiving their state pension to enable them to retire, hence the increase in retirement date. This trend is set to continue as the retirement age for women increases to 65 by the end of December Nearly all the Bands from 6 to 9 have seen their retirement age reduce. There are clearly drivers influencing this change; the older age profile tipping into more frequently meeting the criteria of the eligibility to retire amongst special class status staff, who are availing themselves of the ability to retire at 55 (these staff would tend to be in Bands 6/7&8a), factors such as workload and professional requirements (revalidation) have also been cited as influencing behaviour. 5.4 Average retirement age by Grade In 2015, Bands 1 to 4 and Non AfC have seen increases to their retirement age pushing the average retirement age to over 60 years old. This is most likely due to the equalisation of male and female retirement ages, with the retirement age for women increasing from 60 in 2010 to 62/63 at the end of March Consultant Other M&D Salaried Dentist Non AfC Band 9 Band 8a-d Band 7 Band 6 Band 5 Band 4 Band 3 Band 2 Band 1 59 Years 6 Months 60 Years 10 Months 56 Years 8 Months 58 Years 0 Months 60 Years 0 Months 52 Years 3 Months 58 Years 10 Months 60 Years 9 Months 60 Years 0 Months 59 Years 6 Months 59 Years 1 Months 57 Years 10 Months 58 Years 1 Months 58 Years 1 Months 58 Years 9 Months 58 Years 0 Months 56 Years 11 Months 58 Years 1 Months 59 Years 11 Months 60 Years 9 Months 59 Years 2 Months 60 Years 5 Months 59 Years 4 Months 61 Years 2 Months 59 Years 5 Months 62 Years 4 Months Apr 07 - Mar 08 Apr 14 - Mar 15 Graph Average retirement age by Grade

19 5.5 Retire and return rates / 08 and 2014/15 19 The graph below demonstrates a significant uptake of Retire and Return. Of the leavers who retired during 2014/15, 25% returned to NHS Wales compared with 21% during 2007/08. NHS Wales Nursing and Midwifery Registered Medical and Dental Healthcare Scientists Estates and Ancillary Allied Health Professionals Administrative and Clerical Additional Clinical Services Add Prof Scientific and Technic Graph Percentage/Number of staff who returned after retiring by staff group All staff groups have seen an increase in the number of retirees returning, with Nursing and Midwifery staff having the highest number, almost double the number seen during 2007/08. Estates and Ancillary has seen the highest increase in retiree and returner rates from 9% to 19%. Even though Healthcare Scientist has seen a doubling of people returning after retirement there has been an increase in retirees, therefore reducing the percentage % 5% 10% 15% 20% 25% 30% 35% 2014/ /8 # = of Retire - Key Questions Organisations need to actively engage with their employees to support and promote flexible working to ensure skills, knowledge and experience are retained. Is the data quality for Reason for Leaving in ESR robust enough to make appropriate decisions on leaver and retention strategies? What will retention and long term engagement mean for NHS staff whose state pension ages are set to rise beyond the current top level of 68 i.e. for those born after April 1978? Should NHS Wales seek to increase and promote Retire and Return rates? Could retire and return be used in a more structured and supported way? How sustainable is this? Could it prevent other staff from progressing? Do we use the term retire inappropriately, when it is more about pension planning and continuation of working in the NHS but in potentially a different role or on different hours?

20 20 6. Age and sickness absence 6.1 Sickness Absence by age and grade The NWSSP, WEDS report, Focus on Sickness Absence Trends in NHS Wales iv identified a number of correlations between sickness absence and age. The most striking of these was the correlation between pay band / age and sickness absence rates. The highest percentage of sickness absence occurs in staff who are the oldest and who have the lowest pay band. Even though Band 4s are an exception, in terms of sickness being below the national average, sickness absence for Band 4s does still increase as the age band increases. The top right quadrant of the table gives an indication of the section of the workforce who will need the most support in managing sickness in the future. Agenda for Change Band / Medical & Dental Under Over 60 Band 1 5.7% 7.9% 6.9% 8.0% 6.7% 7.3% 7.8% 7.9% 11.4% Band 2 4.6% 6.4% 7.0% 7.7% 7.4% 7.3% 7.7% 8.1% 9.0% Band 3 3.8% 5.1% 5.7% 6.9% 6.8% 6.7% 6.8% 7.2% 8.3% Band 4 2.5% 2.8% 4.3% 4.5% 4.5% 4.3% 5.4% 6.2% 6.8% Band 5 1.9% 3.8% 5.5% 6.0% 6.2% 6.8% 7.3% 8.3% 10.0% Band 6 1.1% 2.3% 3.7% 4.7% 4.6% 4.9% 6.1% 6.6% 6.7% Band 7 1.0% 1.1% 2.3% 2.9% 3.2% 3.9% 4.6% 5.3% 6.2% Band 8a 0.0% 1.6% 1.1% 2.5% 2.5% 2.8% 3.0% 3.5% 3.4% Band 8b 0.0% 0.2% 0.8% 0.8% 2.7% 3.4% 3.0% 2.1% 2.2% Band 8c 0.0% 0.0% 3.7% 0.4% 1.2% 2.0% 2.3% 2.3% 4.8% Band 8d 0.0% 0.0% 0.0% 0.0% 2.3% 4.9% 1.8% 4.4% 3.1% Band 9 0.0% 0.0% 0.0% 0.3% 0.5% 0.6% 0.9% 2.1% 5.6% Medical & Dental Non AfC Band All Pay Bands 0.7% 0.7% 0.8% 1.0% 1.6% 1.7% 2.1% 2.9% 3.0% 1.1% 0.4% 2.1% 0.8% 2.1% 1.3% 4.2% 2.6% 3.5% 3.0% 3.6% 4.4% 4.9% 5.1% 5.4% 6.0% 6.7% 7.9% Table Sickness by Pay Band and Age band (2014/15) (Highlighted cells are results above the Welsh average of 5.4%). In section 5.4 of this report, (retirement ages) there is a trend for the lower band workers to be working longer. This could potentially mean that if nothing changes the sickness absence will also increase.

21 6.2 Age of the workforce compared to sickness absence percentage 21 The graphs in this section compare the distribution of sickness absence rates for anxiety and stress and musculoskeletal against age bands. It might be expected that the distribution of the sickness absence rates broadly follow that for the age profile, however, it can be seen that there is a marked difference in the distribution of sickness for anxiety and stress and musculoskeletal. If sickness was equally distributed across the age bands, it would be reasonable to expect to see similar percentage rates of both staff in post and sickness. Deviation from the rate of sickness of staff in post is an indication that a particular age band contributes more, or less, according to their population size. Graph Musculoskeletal sickness absence by SIP Whilst sickness absence for anxiety and stress is more equally distributed across all age bands compared to that for musculoskeletal reasons both increase as age increases, especially from age 50 onwards. From the age of 45, NHS Wales workforce are proportionally more stressed, with staff age appearing to be the most stressed and more likely to suffer from musculoskeletal sickness absence. Given the age of NHS Wales workforce is increasing and the largest growth in age bands are and 65+ (Graph 3.2.1), without any intervention, it is likely that the percentage of sickness reasons for anxiety and stress and musculoskeletal will also increase. Graph Anxiety and stress Sickness absence by SIP Key Questions Are organisations doing enough to address both stress and musculoskeletal sickness absence as an issue for all staff, not just those currently absent due to these causes? Given the requirement of staff to work into their 60s, are national and locally led strategies in place to support staff in remaining fit, active and healthy?

22 22 7. Conclusion The NHS Wales workforce is derived from the population, and is the largest employer in Wales. Over the past 20 years the population of Wales has changed significantly and the most noticeable difference is the increase in population age band In 2014, 1 in 5 was aged 65 + and population projections forecast that in 2034 there will be 26% (1 in 4). The increase in the proportion of the older population alongside the decrease in the proportion of the younger population is leading to a decrease in the dependency ratio. For the NHS, this can also be seen as a potential indicator of increasing demand with younger and older people accounting for the main users of the health service. Research indicates that employers may soon have to replace large numbers of the skilled and experienced workforce across many sectors and potentially the younger workforce will not have the right skills or qualifications to replace these leavers. The overall profile of NHS Wales is complex and varies from staff group to staff group but the overall analysis shows that the workforce is getting older. Currently 36% (1 in 3) of the workforce is 50 and over and set to increase in the future. Also at least half the workforce are showing signs that they will be working beyond the traditional retirement age. These two factors alone will have a significant impact on the attitudes and behaviours of the future workforce. This overlaid with the anticipation there will be an increase in demand for NHS services in the future poses some real challenges to the NHS. In supporting this work the NHS Working Longer Group has produced a checklist to assess organisational readiness. The checklist was developed as a tool to enable NHS organisations to assess how prepared they are for the opportunities and challenges an ageing workforce might

23 bring. The checklist has been adapted for use in NHS Wales and supports Health Boards and NHS Trusts in assessing their current performance and helps identify areas for action planning. The checklist considers: Age profiling Workforce and service planning Employment policy and practice Occupational health, safety and wellbeing Job design and the working environment Pension education and retirement planning Learning and development Staff experience In summary NHS Wales and individual organisations should: Consider the key question posed in the document. Complete the Ageing Workforce: Checklist To Assess Organisational Readiness Consider their own population data and look at population trends for the next 15/20 years Plan and develop policies that will help retain and increase employees aged between Consider a broad range of strategies around health and wellbeing, retention, career planning and job design throughout all age bands Consider policies that enable workers to work flexibly and address underlying ergonomic/manual activities. These policies need to support employees in work as well as helping to reduce sickness absence rates Record alternative working patterns on ESR/e-rostering systems as appropriate Review the way Reason for Leaving data is captured to ensure organisations understand why employees are leaving the NHS 23

24 24 References i) NHS Working Longer Review, Preliminary findings and recommendations report for the Health Departments, NHS Employers March 2014 ii) Focus on GPs and their Practice Workforce, NWSSP, WEDS September 2015 iii) Avoiding the Demographic Crunch: Labour Supply and the Ageing Workforce, CIPD Policy Report, June 2015 iv) Focus on Sickness Absence Trends in NHS Wales, NWSSP, WEDS Jan 2015

25 Appendices Appendix 1 - Data limitations 25 All Data relating to the NHS Wales workforce has been sourced from the Electronic Staff Record Data Warehouse (ESR DW). This data excludes staff with a full time equivalent (FTE) of zero and excludes anyone with an assignment category of Locum or Bank. Participation rate is a measure of part time working and is derived by dividing the contracted FTE by the headcount. Within this report, staff who work more than 37.5 contracted hours (some Medical and Dental staff) will be capped at 1.0 FTE. So when calculating the participation rate there is a possibility that the FTE analysis will be under-represented. This limitation within ESR has been addressed with a recent development that allows the recording of job plans. Once organisations fully implement this feature, organisations will be able to report contracted hours above 37.5 hrs. The comparison between one data period and the next will be sensitive to data cleansing activities within the organisations. One staff group that has undergone a significant data cleansing are the Healthcare Scientists. While this workforce only makes up 2% of the NHS Wales workforce, care should be taken when considering the staff group in isolation. Leaver and starter analysis uses the leavers and starter reports within ESR DW. For the purpose of these reports any activity relating to doctors in training has been excluded. A leaver has been identified as an individual not returning to NHS Wales and a starter as an individual new to NHS Wales. The report lists the majority of the leavers and starters activity, however, some staff may not appear on these reports if their record assignment status has been changed. For example, if someone s record assignment is changed from substantive to bank or their FTE is changed to zero they will not appear on the leavers report because they have not left ESR but due to the exclusions within the reporting parameters will no longer appear on the staff in post list. Likewise, if an assignment is changed from bank to permanent and their FTE changed from zero to reflect the hours worked they will not appear on the starters report but will appear on the staff in post list. In both these examples changes are reflected in the staff in post lists which cannot be accounted for within the starters or leavers reports. The retirement analysis is based on the leaving reasons entered into ESR. This field is heavily reliant on organisations/managers choosing the correct reasons for leaving. As a result, the information held in this field may not be 100% correct and therefore these numbers may be under-reported. Back to - Section 1. Introduction

26 26 Appendix 2 - Age Profile by Staff Group Back to - Section 3. Age profile of the NHS workforce

27 Appendix 3 - Participation Rate by Staff Group 27 Participation rate is a number between 0 and 1 that is a measure of part time working. The number is derived by dividing the contracted FTE by the headcount. The higher the participation rate, the more hours, on average a person is working per week. Changes in participation rate in the higher age bands (65+) may show large variations because of the small number of people in that age band. Back to - Section 3.6. Age and participation rate/flexible working

28 28 Appendix 4 - Starters by Age Band by Staff Group Back to - Section 4. Age profile of the NHS Wales Workforce

29 Appendix 5 - Leavers by Age Band by Staff Group 29 Back to - Section 5. Age Profile of NHS Wales Workforce Leavers