NHS-qualified-nurse-supply-and-demand-survey-12-May1

Headlines——90 surveyed organisations (83 per cent) reported that they are experiencingqualified nursing workforce supply shortages.ww——42 surveyed organisations (39 per cent) are estimated to have between1-50 FTE hard to fill nursing vacancies. 39 organisations (36 per cent) areestimated to have 50–100 FTE vacancies. Nine organisations (8 per cent)are estimated to have over 100 FTE nurse vacancies (figures ranging from110–250 FTE).——The overall vacancy rate across organisations that provided their nursestaffing establishment data is calculated at 10 per cent (12566.35 FTE)i.e. posts not permanently occupied.——Reported hard to fill vacancies span a wide range of nursing areas (over 40)and generally in low volumes. There are two exceptions at Band 5 whereresults may be reflective of more widespread challenges for theatre andmedical nursing areas.——Skill shortages at a local or national level are the most reported reason forrecruitment difficulties.——Local action to manage supply challenges has focused on skill mix reviews/service reconfiguration, local recruitment campaigns and use of agency/temporary staff.——49 surveyed organisations (45 per cent) have actively recruited from outsideof the UK in the last 12 months to fill nursing vacancies.——96 per cent of reported overseas activity has been in EEA countries – thetrend has been to target EEA countries to fill Band 5 experienced generalnursing positions – Spain, Ireland and Portugal are most commonly targeted.——56 surveyed organisations (51 per cent) are considering actively recruitingqualified nursing staff from outside of the UK in the coming 12 months –Spain, Ireland and Portugal look to continue being the primary destinations.——60 surveyed organisations are looking to increase qualified nurse numbersoverall. Almost half of these organisations (28) reported that this is partof a skill mix review as a result of the publication of national safer staffingguidance.May 2014 3NHS Qualified Nurse Supply and Demand Survey – findings

KEY ISSUESIn the wake of recent reports from Robert Francis, Don Berwick and the NationalQuality Board, we are aware that many employers have begun to revise theirforecast demand for nursing staff. The workforce planning process by HealthEducation England has revealed that employers are intending to employ2.1 per cent more nurses during 2013/14 (an additional 3,700 FTE nurses). Therequirement for all hospitals to publish staffing levels on a ward-by-ward basisand the forthcoming guidance from NICE is likely to strengthen the demand fornursing in some areas.Heath Education England has reflected this emerging trend in their recentWorkforce Plan for England, where there is a commitment to a 9 per cent increasein nursing commissions. However, these Newly Qualified Nurses will not beavailable to the system until 2017, therefore action may be needed now in orderto support employers to meet existing needs.The data collected in this survey will help to inform and shape co-ordinatedrecruitment and retention initiatives, providing support and solutions wherenecessary.4 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

CONTENTSPurpose6Method6Definitions6Results8Section A – Summary of respondents 9Section B – NHS qualified nurse staffing establishments and vacancy rates 11Section C – NHS registered nurse supply and demand 14Section D – Actions to resolve supply challenges 18Section E – Further support 23May 2014 5NHS Qualified Nurse Supply and Demand Survey – findings

PurposeThe aim of the survey is to produce a comprehensive snapshot of employer need,to better understand the nature of employer demand for nursing (for exampleis the demand for specific grades or specialism). The data collected will help toinform and shape co-ordinated recruitment and retention initiatives, providingsupport and solutions where necessary.In the wake of recent reports from Robert Francis, Don Berwick and the NationalQuality Board, we are aware that many employers have begun to revise theirforecast demand for nursing staff. The workforce planning process by HealthEducation England has revealed that employers are intending to employ2.1 per cent more nurses during 2013/14 (an additional 3,700 FTE nurses).The requirement for all hospitals to publish staffing levels on a ward-by-wardbasis and the forthcoming guidance from NICE is likely to strengthen the demandfor nursing in some areas.Heath Education England has reflected this emerging trend in their recentWorkforce Plan for England, where there is a commitment to a 9 per cent increasein nursing commissions. However, these Newly Qualified Nurses will not beavailable to the system until 2017, therefore action may be needed now in orderto support employers to meet existing needs.MethodThe information gathering exercise was undertaken via an online survey, themethodology and style were similar to previous workforce surveys conductedby the NHS Employers organisation. A link to the online survey was sent to theHuman Resource Director in each organisation and this was supported by a letterfrom Health Education England to the Chief Executive and Director of Nursing ineach organisation. The survey was also promoted through the NHS Employers HRregional networks.The survey asked for information about qualified nursing supply at a point in time(week commencing 6 January 2014); it considered posts available (the staffingestablishment) and those occupied by permanent, temporary or agency staff. Thesurvey also asked for information about specific nursing supply challenges, viewson nursing workforce demand (for example is the demand for specific grades orspecialism) and the actions being implemented to resolve supply issues wherenecessary.DefinitionsGrades of staffAll staff are NHS Agenda for Change (AfC) bands.Full Time Equivalents (FTE)All data refer to NHS Agenda for Change full time equivalents (FTE) of 37.5 hoursper week.6 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Health Education England Local Education Training Boards (LETBs)Where information in this report has been categorised by region, LETB boundarieshave been used as follows:——North – HE North East——North – HE North West——North – HE Yorkshire & Humber——Midlands and East – HE East Midlands——Midlands and East – HE West Midlands——Midlands and East – HE East of England——London – HE North Central & East London——London – HE North West London——London – HE South London——South – HE Kent, Surrey & Sussex——South – HE Thames Valley——South – HE South West——South – HE WessexStaffing EstablishmentThe staffing establishment is the pattern of posts and FTEs required to deliver theservice and agreed at a point in time. An ‘established’ post is one which is agreedas part of the funded staffing establishment.Agency Staff (FTEs)The number of FTE employees as agency staff to fill the established post.Temporary Staff (FTEs)The number of FTE employees as temporary staff to fill the established post.Vacancy ratesA vacant post is defined as a post ‘not permanently occupied’. Some vacant postsmay be filled by agency or temporary staff. The vacancy rate is therefore thepercentage of posts not permanently occupied.Hard to fill vacancyA hard to fill vacancy is defined as a post being vacant for over three months.Oversubscribed vacanciesVacancies that regularly receive a high vacancy per application (APV) rate.Active recruitment outside of the UKIn the context of this survey ‘active recruitment’ is defined as the deliberatetargeting of the labour market in countries outside of the UK.May 2014 7NHS Qualified Nurse Supply and Demand Survey – findings

Results——244 NHS service providers in England were identified and surveyed——A response rate of 43 per cent was achieved from NHS service providers(104 trusts)——Responses were also received from three Clinical Commissioning Groups, oneSpecial Health Authority and one Social Enterprise for having nursing services——Total responses were received from 109 organisations employing qualifiednursing staff supporting the delivery of NHS services——There is no representation from organisations in HE North West London,so particular care should be taken in interpreting trends for London.The results are presented in the following sections:Section A – Summary of respondentsSection B – NHS qualified nurse staffing establishments and vacancy ratesSection C – NHS qualified nurse supply and demandSection D – Actions to resolve supply challengesSection E – Further support*Please print the report in colour.8 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

SECTION A – SUMMARY OF RESPONDENTSHeadlines——244 NHS service providers in England were identified and surveyed——A survey response rate of 43 per cent was achieved (104 organisations)(Figure 1.1)——Responses were also received from two Clinical Commissioning Groups,one Commissioning Support Unit, one Special Health Authority and one SocialEnterprise for having nursing services (Figure 1.2)——Total responses were received from 109 organisations employing qualifiednursing staff supporting the delivery of NHS services——Responses are spread from across the HE regions, however there is norepresentation from HE North West London, so particular care should be takenin interpreting figures for London.*Care must be taken in interpreting the trends of data because 100 per centresponse rate was not achieved, thus the information may not be representativeof the full regional/national picture. The response rate for each HE region isshown in (Figure 1.3).Figure 1.1 Survey responses presented by regionMay 2014 9NHS Qualified Nurse Supply and Demand Survey – findings

Figure 1.2 Survey responses presented by organisation typeFigure 1.3 Survey response rate per region10 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

SECTION B – NHS QUALIFIED NURSE STAFFINGESTABLISHMENTS AND VACANCY RATESHeadlines——Table 1a shows the reported nurse staffing establishments and vacancy ratesby region (for week commencing 6 Jan 2014)*.There are:— 126330.74 FTE established nursing posts across the 89 organisations thatprovided this information— The overall vacancy rate across these 89 organisations is calculated at10 per cent (12566.35 FTE) i.e. posts not permanently occupied— The number of qualified nursing posts in these 89 organisations filled byagency staff is 2087.76 (FTE).— A breakdown of regional establishment and vacancy rates is provided inTable 1a.——60 surveyed organisations are looking to increase qualified nurse numbersoverall (Figure 1.4). Almost half of these organisations (28) reported that thisis part of a skill mix review as a result of the publication of national saferstaffing guidance.*Care must be taken when interpreting the trends because 100 per cent responserate was not achieved for the vacancy establishment data, thus the informationmay not be representative of a regional/national picture. Checks have been madeto authenticate this data as far as possible against National NHS WorkforceStatistics (for October 2013) and these figures would appear to be in line.The regional response rate for establishment data is provided in Table 1a.May 2014 11NHS Qualified Nurse Supply and Demand Survey – findings

South - HE Kent, Surrey & Sussex 44% 12444.03 11231.69 90% 621.14South - HE Thames Valley 0%South - HE South West 71% 18308.24 16959.81 93% 675.66South - HE Wessex 20% 4248.85 3966.73 93% 237.86Grand Totals 126330.74 114700.83 91% 5478.02Figure 1.4 Number of organisations looking to increase qualified nurse numbersoverall Figure 1.4. Number of organisations looking to increase qualified nurse numbers oNumber of Organisations7060504030201006034123Yes No Don't know BlanksNHS Qualified Nurse Supply and Demand SurveyMay 2014 13NHS Qualified Nurse Supply and Demand Survey – findings

SECTION C – NHS REGISTERED NURSE SUPPLYAND DEMANDHeadlines——90 surveyed organisations (83 per cent) reported they are experiencingqualified nursing workforce supply shortages (Figure 1.5)——Table 1b provides a high level summary of the reported hard to fill nursingvacanciesResults indicate:— 42 organisations (39 per cent) are estimated to have between 1–50 FTE*qualified nurse vacancies, 39 (36 per cent) are estimated to have between50–100 FTE* vacancies and nine organisations (8 per cent) are estimatedto have 100+ FTE* nurse vacancies (figures ranging from 110–250)— 42 per cent of the reported hard to fill vacancies have been unfilled for3–6 months, and 20 per cent for over 6 months— Skill shortages at a local or national level are the most reported reasonsfor recruitment difficulties— Local actions to manage supply shortages have focused on skill mixreviews/service reconfiguration, local recruitment campaigns and use ofagency/temporary staff. See further detail in section D.*Organisations were asked to provide FTE information for each hard to fill areafrom pre-defined ranges (i.e. 1–10, 11–20, 21–30) these trends are based on acalculation of the highest number in the range, thus presenting the worst casescenario in terms of the number of vacancies.——Table 1c provides a breakdown of reported hard to fill vacancies by nursingarea so we can observe where the demand is.Results indicate:— 278 reports of hard to fill nursing vacancies from the surveyed organisations(across all A4C bands and specialisms)— The general trend indicates that there are low volumes of vacancies (FTE)in any one organisation for a given specialism. Although many organisationsreport hard to fill vacancies in a number of different nursing specialismswhich compounds their recruitment challenges (refer to FTE vacancyfigures above).— Demand spans a wide range of nursing areas (over 40). There is minimalevidence to indicate serve recruitment difficulties in specific areas ofnursing on a national/regional level – the two exceptions where resultscould possibly indicate more widespread challenges are at Band 5:Band 5:— Hard to fill vacancies in Band 5 theatre nursing were reported by 22 percent of survey organisations, however most of which were for low volumes(between 1–20 FTE nurses) with posts vacant for periods of 3–6 months.National and local skills shortages are reported to be the primary reasonsfor recruitment challenges in this area.14 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

— Hard to fill vacancies in Band 5 medical nursing were reported by almost20 per cent of surveyed organisations. This area of nursing sees trendsof higher volumes (21+ FTE nurses) with posts vacant for longer periodsof between 3–12 months. National skills shortages are reported to be theprimary reason for recruitment challenges in this area.— Above average reports of hard to fill vacancies (but by smaller numbersof organisations) were also reported of Band 5 nurses in accident &emergency, general surgery, children & neonatal, community & district,elderly and intensive treatment units. Skills shortages at national andlocal levels and the desirability of the nursing area are reported to be theprinciple reasons for difficulty recruiting into these nursing areas.Band 6:— Most commonly reported hard to fill vacancies at Band 6 are in specialistroles; children & neonatal, accident & emergency, intensive treatment units,mental health and theatres and in community & district nursing – howeverthe numbers are small and reflective of local issues rather than widespreadnational or regional challenges (less than 10 per cent of surveyedorganisations reported hard to fill vacancies in any of these areas).Band 7 and 8:— Numbers of reported recruitment challenges across nursing areas inBands 7 and 8 were low, and where there are reports of shortages, the FTEvolumes are also low (between 1–10 FTE) – suggesting there are pockets oflocal recruitment challenges rather than widespread problems.Figure 1.5. Experiencing qualified nurse workforce supply shortagesFigure 1.5 Experiencing qualified nurse workforce supply shortagesNo (17%)Yes (83%)Table 1b. High level summary of reported hard to fill vacancies, reasons aNo.hard to fill vacancies (FTE)Unfilled for how longMay 2014 15NHS Qualified Nurse Supply and Demand Survey – findings

2019Figure Figure 1.61.6. Hard Hard to fill to vacancies fill vacancies by FTE by volume FTE volume2018Number of organisations1614121086420No (17%)1210998765421999Yes (83%)Number of organisations18161412108642041279109865Hard to fill vacancies (FTE)299Hard to fill vacancies (FTE)Table 1b. High level summary of reported hard to fill vacancies, reasons and actions to resolveTable 1b High level summary of reported hard to fill vacancies, reasons and actions to resolved actions to resolveNo.hard to fill vacancies (FTE) Unfilled for how long Actions to resolve Reason for difficulty recruitingActions to resolveReason for difficulty recruitingGrand TotalSkill mix review / service reconfigurationIncreased emphasis on workforce planningReturn to practice schemeExpanded practice placement capacityLocal recruitment campaignActive recruitment outside of the UKAgency / temporary staffRecruitment & retention premiaPlanned overtimeOtherGrand TotalCompetition from NHS orgsDesirability of areaInsufficient pay/rewardLocal skill shortageGeographical locationNational skill shortageother please state(blank).0% 16.1% 13.2% 7.4% 6.8% 16.7% 8.6% 14.8% 1.4% 7.6% 7.4% 100.0% 4.7% 8.0% 1.1% 34.5% 7.2% 38.8% 4.3% 1.4% 100.0%1-1011-2021-3031-4041-5051-6061-7071-8081-9091-100100+NonePage 14 of 24(blanks)Grand TotalGrand Total0-3 months3-6 months6-12 months12+ months(blank)Grand TotalSkill mix review / service reconfigurationIncreased emphasis on workforce planningReturn to practice schemeExpanded practice placement capacityLocal recruitment campaignActive recruitment outside of the UKAgency / temporary staffRecruitment & retention premiaPlanned overtimeOtherGrand TotalCompetition from NHS orgsDesirability of areaInsufficient pay/rewardLocal skill shortageGeographical locationNational skill shortageother please state(blank)Grand Total4.0% 11.0% 6.0% 8.0% 9.0% 8.0% 5.0% 6.0% 7.0% 2.0% 8.0% 18.0% 8.0% 100.0% 30.0% 42.0% 12.0% 8.0% 8.0% 100.0% 16.1% 13.2% 7.4% 6.8% 16.7% 8.6% 14.8% 1.4% 7.6% 7.4% 100.0% 4.7% 8.0% 1.1% 34.5% 7.2% 38.8% 4.3% 1.4% 100.0%NHS Qualified Nurse Supply and Demand Survey Page 14 of 2416 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Table 1c Reported hard to fill vacancies by nursing area (please print to view)Table 1c. Reported hard to fill vacancies by nursing area (please print to view)Reported hard to fill vacancies by areaof nursingNo.vacancies (FTE) Unfilled for how long Reason for difficulty recruitingStaff Group Band Specialism / area of nursingQualified Nurse AfC Band 5 Theatres (incl Anaesthetics) 12 6 2 1 1 2 24 3 13 2 2 4 24 2 1 1 8 12 24Accident & Emergency 13 3 1 2 19 8 8 1 1 1 19 1 1 8 1 7 1 19Mental Health (community & inpatient) 4 2 2 1 1 10 5 3 1 1 10 7 2 1 10Children & Neonatal 9 1 2 12 1 4 3 3 1 12 5 2 4 1 12Stroke 1 2 3 3 3 2 1 3General surgery 6 3 1 3 13 6 3 2 1 1 13 1 1 2 8 1 13Medical 1 3 3 6 1 2 5 21 4 8 5 2 2 21 1 3 3 13 1 21Community & District 7 4 3 2 16 4 10 2 16 2 7 1 6 16Community Hospitals (ward based) 2 1 1 4 2 1 1 4 1 2 1 4Cardiac 3 1 4 3 1 4 1 1 1 1 4Fertility 1 1 1 1 1 1Haematology & Oncology 1 1 1 1 1 1Psychiatry 1 1 1 1 1 1Elderly 3 8 2 2 1 16 4 7 3 1 1 16 1 8 2 1 3 1 16Rehabilitation 1 1 1 1 1 1Trauma and Orthopaedics 4 4 2 2 4 1 1 1 1 4Medical Assessment Unit 3 3 2 1 3 1 2 3Urology 1 1 1 1 1 1ITU / HDU / ICU 9 4 1 14 4 7 2 1 14 1 3 1 8 1 14Adult 1 1 2 2 2 1 1 2Prison 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Radiology 1 1 1 1 1 1Musculoskeletal 1 1 1 1 1 1Neurology / Neuroscience 1 1 2 1 1 2 1 1 2School Nursing 2 2 1 1 2 1 1 2General Practice 1 1 1 1 1 1Gynaecology 1 1 1 1 1 1Endoscopy 1 1 1 1 1 1Gastroenterology 1 1 1 1 1 1Ophthalmology 1 1 2 2 2 1 1 2Admissions Unit 1 1 1 1 1 1AfC Band 6 Children & Neonatal 5 1 1 1 8 4 1 2 1 8 1 1 6 8ITU / HDU / ICU 4 3 1 1 1 10 2 2 2 4 10 1 1 8 101-1011 - 2021-3031-4041-5051-6061-7071-8081-9091-100100+Mental Health (co mmunity &7 1 8 2 4 1 1 8 3 2 3 8inp a tie nt)Haematology & Oncology 3 1 4 2 1 1 4 1 1 2 4Community & District 5 2 2 9 5 1 1 2 9 1 4 1 2 1 9Theatres 4 1 1 6 2 2 1 1 6 3 3 6Intermediate care 1 1 1 1 1 1Accident & Emergency 6 1 7 3 4 7 3 4 7Outpatient 1 1 1 1 1 1Gynaecology 1 1 1 1 1 1Ophthalmology 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Transplant co-ordinator 1 1 1 1 1 1School Nursing 1 1 1 1 1 1Prison 1 1 1 1 1 1Stroke 1 1 1 1 1 1General surgery 1 1 2 1 1 2 1 1 2Medical 1 1 1 1 1 1AfC Band 7 Sonographers (qualified nurse) 1 1 1 1 1 1Community & District (inclsp e cia lists)5 1 6 2 2 2 6 3 1 2 6Medical Assessment Unit 1 1 1 1 1 1Diabetes 1 1 1 1 1 1Mental Health 2 2 1 1 2 1 1 2Accident & Emergency 2 1 3 2 1 3 1 2 3Ophthalmology 1 1 1 1 1 1Continuing Healthcare 1 1 1 1 1 1Children 2 2 2 2 2 2Epilepsy 1 1 1 1 1 1Neurology / Neuroscience 1 1 2 1 1 2 1 1 2Medical 1 1 1 1 1 1General Practice 1 1 1 1 1 1Elderly 1 1 1 1 1 1Apheresis 1 1 1 1 1 1ICU 1 1 1 1 1 1AfC Band 8 Speech & language 1 1 1 1 1 1(blank)Accident & Emergency 1 1 2 1 1 2 2 2Grand Totals 158 48 21 10 3 4 0 0 1 1 2 30 278 83 115 35 23 22 278 12 22 3 95 18 112 12 4 278Grand Total (of reported shortages)0-3 months3-6 months6-12 months12+ months(blank)Grand Total (of reported shortages)Competition from NHS orgsDesirability of areaInsufficient pay/rewardLocal skill shortageGeographical locationNational skill shortageother please state(blank)Grand TotalNHS Qualified Nurse Supply and Demand Survey Page 15 of 24May 2014 17NHS Qualified Nurse Supply and Demand Survey – findings

SECTION D – ACTIONS TO RESOLVE SUPPLYCHALLENGESHeadlines——Figure 1.7 shows a breakdown of the most common local action taken by thesurveyed organisations to resolve their supply shortages.Results indicate:——Local action to manage supply shortages has focused on skill mix reviews/service reconfigurations, local recruitment campaigns, and use of agency/temporary staff——Other reported strategies in place to ensure nursing workforce supplymeets current and predicted future demand on services include; increasedemphasis on workforce planning, active recruitment outside of theUK, planned overtime, return to practice schemes, expanding practiceplacement capacity, recruitment & retention premia, the Overseas NursingProgramme, social media and up-skilling the support workforce——49 surveyed organisations (45 per cent) have actively recruited from outsideof the UK during the last 12 months to fill qualified nursing vacancies(Figure 1.8). A breakdown of overseas recruitment activity by region is providedin Figure 1.9——96 per cent of reported activity has been in EEA countries (Figure 2.0)——Trend for filling Band 5 experienced general nursing positions from EEAcountries. Spain, Ireland and Portugal are the most commonly targetedcountries. A breakdown of the countries targeted for recruitment campaignsis provided in Figure 2.1——Outside of the EEA, the Philippines has been targeted by two surveyedorganisations, both of which were looking to fill gaps for theatre nurses——Data collected to indicate the volume of nurses recruited from outside ofthe UK suggests that on average those organisations that have reportedundertaking overseas recruitment campaigns have employed 50 FTE qualifiednurses through these campaigns in the last 12 months (*care must be takenwhen interpreting trends because this data was not provided by all surveyedorganisations)——56 surveyed organisations (51 per cent) are considering actively recruitingqualified nursing staff from outside of the UK in the coming 12 months(Figure 2.2)— — A breakdown of the countries being considered for future targeted overseascampaigns is provided in Figure 2.3 – Spain, Ireland and Portugal look tocontinue being the primary destinations.18 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Figure 1.7. Most common reported actions to resolve supply shortagesFigure 1.7 Most common reported actions to resolve supply shortages1% 8%7%16%Skill mix review / service reconfigurationIncreased empasis on workforce planningReturn to practice scheme15%13%Expanded practice placement capacityLocal recruitment campaignActive recruitment outside of the UK9%17%7%7%Agency / temporary staffRecruitment & retention premiaPlanned overtimeOtherrtagesFigure 1.8. Active recruitment outside of the UK during the last 12 mFigure 1.8 Active recruitment outside of the UK during the last 12 monthsFigure 1.9. Overseas recruitment 2, 2% activity by region2%UK2% 6%58, 53%6%12%12%49, 45%East MidlandsEast of EnglandKent Surrey & SussexNorth Central & East LondonNorth EastNorth WestYesNoBlanksSouth London27%8%South WestThames Valley6%WessexWest Midlands2%15%2%Yorks & HumberFigure 2.0. Where has targeted recruitment activity taken placeNHS Qualified Nurse Supply and Demand Survey4%nMay 2014 19NHS Qualified Nurse Supply and Demand Survey – findings

17% Otherply shortagesce orkforce meement paignside of the UKaffon premiaFigure 1.8. Active recruitment outside of the UK during the last 12 monthsFigure 1.9. Overseas recruitment activity by regionFigure 1.9 Overseas recruitment activity by region2, 2%6%2% 6%58, 53%27%2%2%12%49, 45%12%8%6%15% 2%East MidlandsEast of EnglandKent Surrey & SussexNorth Central & East LondonNorth EastNorth WestYesNoBlanksSouth LondonSouth WestThames ValleyWessexWest MidlandsYorks & HumberFigure 2.0. Where has targeted recruitment activity taken placeFigure 2.0 Where has targeted recruitment activity taken place4%NHS Qualified Nurse Supply and Demand Surveyssexast LondonEEA countriesNon -­‐ EEA countries96%Page 17 of 2420 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Figure 2.1. Countries targeted for recruitment campaigns in last 12 moFigure 2.1 Countries targeted for recruitment campaigns in last 12 months30282524Number of Organisations20151050182 21 1 12t 12 monthsFigure 2.2. Considering active overseas recruitment during next 12 moFigure 2.2 Considering active overseas recruitment during next 12 monthsFigure 2.3. for recruitment campaigns in next 12 mo6, 6%Countries targeted13, 12%302524YesNo2018151556, 51%Don't knowBlanks34, 31%1075 55222 21 1 111 1 120Number of Organisationsxt 12 monthsNHS Qualified Nurse Supply and Demand SurveyMay 2014 21NHS Qualified Nurse Supply and Demand Survey – findings

Figure 2.3. Countries targeted for recruitment campaigns in next 12 moFigure 2.3 Countries targeted for recruitment campaigns in next 12 months302524Number of Organisations201510501521 1 118215 52 21 1712NHS Qualified Nurse Supply and Demand Survey22 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

SECTION E – FURTHER SUPPORTHeadlinesSurveyed organisations were asked what additional support they would find usefulto help resolve their qualified nursing workforce supply challenges.Emerging themes:——Support for Return to Practice schemes——Co-ordinated approach to nursing careers campaign/recruitment & retentioninitiatives——International recruitment initiatives——Facilitate sharing of good practice——Facilitate closer links with universities——Developments/changes to nursing education and training——Increase training commissions.Table 1d overleaf provides further information with direct quotes from surveyedorganisations under each of the themes above.May 2014 23NHS Qualified Nurse Supply and Demand Survey – findings

Table 1d Direct quotes from the survey – further supportSupport for Returnto Practice SchemesMore National initiatives aroundReturn to Practice.Some idea of whether there is aReturn to Practice population.Co-ordinated approach tocareers campaigns/recruitmentand retention initiativesMore secure funding for CPDfrom central NHS funds.Funding to support recruitmentinitiatives.Education and trainingMore flexible ways to train to bean RGN whilst in service.Directed ring fence funding forspecific post registration training.Return to Practice support. Innovative options for recruitment. Greater exposure to PaediatricOncology during training.Materials to use in targetingReturn to Practice.Return to Practice and rotationfunding.Increase in RTP course numbers.Financial support for return tonursing and adaptation courses.Further Return to Practiceprogrammes commissioneddirectly through HEE.National campaigning andcollective support arrangementsfor initiatives such as Return toPractice.Increased, continual andfinancially supported Returnto Practice schemes.Mental Health Return to Practiceprogrammes and nationalawareness raising/campaigns.More national recruitmentcampaigns to encourage movinginto nursing, return to practice etc.Open days and recruitmentinitiatives in rural areas to attractnurses who would like to live andwork in rural areas.Coordinated approaches acrosstrusts within regions, similar toDeanery arrangements.Links with local schools andcolleges to promote working inthe NHS.Generally, to promote medicalspecialities as a valuable careeroption.Better analysis of the impact ofpolicies such as pension changeson the profession.More emphasis on retention withflexible working arrangementssuitable for older workers in highpressure posts.National media coverage andadvertising campaigns to supportReturn to Practice similar to thePublic health nursing campaigns.Increased specialty training andsupport for older adult care.Investment in education andtraining to develop new roles.Development and registrationof new roles.Regional co-ordination ofplacements from Universitiesto allocate on need in line withdemand.We also require specific trainingprogrammes for HCAs to allowthem to take on additional dutieswhich will give a new skill mix.Review of nursing training toreturn to allocation by Trust toenable closer relationship withfuture workforce.Bursaries to support AssociatePractitioners in nurse trainingprogrammes.Backfill monies to supportsecondments to undertake nursetraining.24 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Support for Returnto Practice SchemesReturn to Practice provision whichis easy to access and flexible tomeet organisational needs.More attention to the fit of trainingplacements and support for RTPtogether with pre-registrationnursing.We do NOT anticipate benefittingfrom Return to Practiceprogrammes as we have not doneso in the past – many of our staffwho leave e.g. for children willwork locally rather than returnto work in London; and would notopt to return to a highly specialistworking environment if they havebeen out of the profession.Developing more Return toPractice courses for nurses whohave been out of the professionfor some time, our most local RTPorganisation is some miles awayand a more local provision mayattract local residents back intothe profession (we receive regularenquiries about RTP).Co-ordinated approach tocareers campaigns/recruitmentand retention initiativesNational advertising to attractnurses into training or Returnto Practice (like the military).Nationally drive initiativestowards substantive employmentaway from temporary resourcesolutions.For nurses free travel on all trainsinto and out of London, similar tothe Metropolitan Police.Further focus groups with nursesnationally to understand what wecan do nationally to attract nursesinto the service i.e. pay, flexibleworking, schools etc.Nationally I think there needs tobe something that promotes thenursing profession (it has receivedso much negative press recently).National initiatives (e.g. currentvalue based recruitment) havingdetail from a central hub, so eachemployer isn’t left to work out itsown way of doing something.Regional wide campaigns wouldsurely provide better economicand resourcing sense, value formoney – rather than competingwith neighbouring Trusts.Education and trainingDH instruction to requireuniversities to offer two intakesof nurses a year.Keep secondments to branch,the blanket removal of allsecondments has impacted onour workforce development plans.As a community trust it would bebeneficial if training providerscould cover more in relation toskill and competency of managingout of hospital care.That on completion of theirtraining, newly qualified nursesare expected to work a first yearin the hospital that provided theirtraining.It would be helpful to look atsponsorship of health careassistants to nurse training(something which has beenreduced in recent years).A national career developmentand competency based frameworkbringing into alignment KSF, bandspecific competencies and skillsfor health.Emphasis currently seems to beon pre-reg training (i.e. how manynurses are in the system) whenactually we need to be thinkingabout the increasing specialisationof nurses in order to care.May 2014 25NHS Qualified Nurse Supply and Demand Survey – findings

Support for Returnto Practice SchemesCo-ordinated approach tocareers campaigns/recruitmentand retention initiativesFocus on raising the profile ofnursing in the community –undergrad nursing managementplacements in the communityas well as giving ward nursesopportunities to rotate to thecommunity.Predicted numbers of studentsstudying to become a registerednurse remain below the level ofdemand, therefore initiative toencourage people to considernursing as a career would helpto alleviate this issue.It seems strange why the NHShas its hospitals competingagainst each other for the nursingworkforce, the same will be trueof the international recruitment.Is there not scope for a NorthWest scheme where nurses areallocated to Trusts rather thangiving them a choice between asmall town hospital and a largeteaching hospital – it’s obvious whoalways loses out and thereforeexperiences the greater pressure.Education and trainingIn the short term we will need tobe creative in role developmentnationally and locally. A pathwayfor non registered nursingto registered nursing withappropriate training pathways andfunding streams would supportlong term gaps.Career Pathway of supportingunqualified clinical staff intoAssistant Practitioner rolesand then re-engaging with thesecondment programme. This willsupport the Trust in successionplanning and we are working withHealth Education North West onthis.Recognition that eye problemsaffect a huge proportion of thepopulation, and that the currentundergraduate curriculum doesnot reflect this. Few studentnurses have enough exposure toophthalmology to consider this asa career path.26 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

Facilitate sharing ofgood practiceSome sharing of internationalrecruitment challenges.Good Practice Examples.Increased sharing of good practiceacross the country.Case studies on the integration ofnew roles to relieve short staffingissues.More direct communication toboth HR and Nursing Directorsto inform us of what strategiesother organisations are adopting –shared learning.More proactive support onalternative skill mix options andfunding for training for specialistnurses as for a DGH this can beoften difficult to release people todo the training to prepare them forsuccession.The Trust would find it usefulto identify how other Trusts aremeeting supply challenges inTheatres and Critical Care. Inaddition case studies on whereother trusts have introducedAdvanced Nurse Practitioner roles.Facilitate closer linkswith universitiesIncreased responsiveness ofpre‐reg education providers.Working closely with universitiesto ensure the right students areselected for nursing programmes.More co-ordinated approachesby Higher Education Institutesand the return of secondmentopportunities from the existingworkforce.Facilitation of closer linksbetween trusts and universities toencourage students to stay on atsome of the trusts who strugglegeographically.Working in partnership withuniversities nationally, local linksare successful but wider linksneed to be made which could besupported externally.Increase training commissionsIncrease commissions of nursingstudents.Increase in education numbers.We increase the number ofstudent nurse places.Increase the number of HEItraining places.Actual nurse training numbers tobe slightly more than estimatednumbers.May 2014 27NHS Qualified Nurse Supply and Demand Survey – findings

International recruitment initiativesThat the Band 5 is recognised on the skillsshortage list.Support with coordination of overseas recruitment.Fast track and better joined-up routes to recruitoverseas staff, between NMC and UKBA.More fluid movement of registered nurses from EUand other non-UK countries.Support for programmes for overseas nurses whoneed to adapt to UK practices.Specialist areas like Paediatric Intensive care,theatres, Adult Intensive care, Transplant mustbe put back on the UK Border Agency ShortageOccupation List.We consider an adaptation programme for ouroverseas colleagues who are registered butcurrently work in Nursing Homes as carers as theirregistration is not recognised by the NMC.Recruitment of nurses from overseas is limited due toregisterable qualifications. The Nursing and MidwiferyCouncil (NMC) should review those countries, take intoaccount not just training experience, but additionalexperience and qualification gained, and length ofactual time practicing.Miscellaneous (other ideas)Continue with leadership development.Reducing cost of agency workers.More proactive involvement in workforce planningregionally.A local workforce forecasting tool.Region-wide initiatives to reduce use of agencies inlocal areas.Assistance to co-ordinate a regional approach andreduce competition within the NHS for the limitedsupply.Supply information covering the West Midlands tosupport workforce planning and resource planning.More intelligence about potential nurse supply innon-NHS organisations.Support from the commissioners and primary care tofurther support discharge of patients from the Acutehospitals will mean less staff in acute areas andpossibly more beds and staff in the community withdifferent skills.That the NMC improves the time it takes to registernewly qualified nurses.Greater visibility of workforce planning at all levelsorganisation – regional – national level.More emphasis from professional bodies and leadson competency, so that the issue around supply is notabout qualifications but competencies. Competenciesare more in the control of organisations,qualifications are not.It would help if newly qualified nurses that aresubsequently taken on at the Trust did not have togo through all their safer recruitment checks. Thesehave already been carried out by the University inquestion and should be transferred to the new postautomatically.28 May 2014NHS Qualified Nurse Supply and Demand Survey – findings

SummaryThe survey has provided data and analysis on aspects of supply and demandlevels and trends amongst the NHS qualified nurse workforce in England.Report authorNHS EmployersContact: NHS Employers, 2 Brewery Wharf, Kendell Street, Leeds, LS10 1JR0113 306 3000Date of issueMay 2014May 2014 29NHS Qualified Nurse Supply and Demand Survey – findings

NHS EmployersThe NHS Employers organisation is the voice of employers in the NHS, supporting them toput patients first. Our vision is to be the authoritative voice of workforce leaders, experts inHR, negotiating fairly to get the best deal for patients.We help employers make sense of current and emerging healthcare issues to ensure thattheir voice is front and centre of health policy and practice. We keep them up to date with thelatest workforce thinking and expert opinion, providing practical advice and information, andgenerating opportunities to network and share knowledge and best practice.We work with employers in the NHS to reflect their views and act on their behalf in fourpriority areas:• pay and negotiations• recruitment and planning the workforce• healthy and productive workplaces• employment policy and practice.The NHS Employers organisation is part of the NHS Confederation.Contact usFor more information on how to get involved in our work,email getinvolved@nhsemployers.orgwww.nhsemployers.orgenquiries@nhsemployers.org@nhsemployersNHS Employerswww.youtube.com/nhsemployersNHS Employers2 Brewery WharfKendell StreetLeeds LS10 1JRThis publication was produced by the NHS Confederation publications team:publications@nhsconfed.orgThis document is available in pdf format at www.nhsemployers.org/publicationsPublished May 2014. © NHS Employers 2014.This document may not be reproduced in whole or in part without permission.The NHS Confederation (Employers) Company Ltd. Registered in England.Company limited by guarantee: number 5252407Ref: EINF36001