Examination of Witnesses (Questions 60-79)
WEDNESDAY 4 APRIL 2001
SIR JOHN BOURN, KCB, MR GLENN HULL, MR NIGEL CRISP AND SIR BRIAN FENDER
60. I know you alluded to the point that Simon Burns was making. Clearly nurses do not have to repay the money they have invested in their qualifications. I presume that is partly because the level of salaries they get is not as much as other graduate recruits. Is that a reasonable thing to say?
(Sir Brian Fender) They are funded in a different regime and given bursaries so there is not the same issue as there is for other students who of course have to pay fees if they are not relieved of those fees because of their financial circumstances.
61. On this very narrow point about paying for immigrants that Simon Burns was going on about, is there a relationship whereby, for instance if we take Swedish nurses over here, we pay back the Swedish Government the cost of the investment in their training?
(Sir Brian Fender) No.
62. There is not a reciprocal relationship. Have you got any data that shows we are net gainers in this process of importing/exporting trained nurses? It might be the case, contrary to Mr Burn's presumption, that we are making a bit of a killing on this. Do you know?
(Sir Brian Fender) I have not got any information on this. If the student comes from within the EU they are entitled to study in this country just as British students are entitled to study in other EU countries.
Mr Davies: Thank you very much.
Chairman: Mr Nigel Griffiths?
63. Why was training cut in the early 1990s?
(Mr Crisp) I guess that is to me. As the document makes clear, there has been a process of planning numbers which has changed over the last 15 years from a planning process that was very central to a planning process that was then much more local and which was planned primarily by the employers during the early 1990s, and now we are moving away from that to one that is partly central and partly local.
64. Let me get this right. What you are saying is that as it went local they decided that they would cut training whereas nationally the government knew better how to plan globally in Britain to train people but locally they did not notice there were shortages as a result of cuts in their training?
(Mr Crisp) If I have misled you I am sorry, that was not what I was intending to say. I was trying to give you a bit of background about how the decision-making changed. It was not quite as simple as that because when it was planned nationally it was not particularly accurate. Workforce planning is an enormously difficult thing to do, to plan where you are going to be in the future. What was happening at that point when the numbers went down was that the workforces were, by and large, being planned through trusts, through the local employers, and at that point it looked as if the numbers that were going to be required were lower. There were a number of justifications for that including very significant changes in practice. The other thing that happened very significantly in the early 1990s was the change from in-patient to day patient activity and there was a considerable drive towards care in the community and a whole set of other policies which pointed in the direction of lower workforce numbers during that period. That is where that planning process led us.
65. What was the budget like at that time?
(Mr Crisp) I think the budget followed the planning process.
(Mr Crisp) I am sure it must have done if we were planning lower numbers.
67. So the simple answer to why training was cut in the early 1990s was that funding was cut?
(Mr Crisp) No, projections about what was needed is what happened. People went through a workforce planning process and because of very significant changes in people's expectations about the future requirements of the NHS we ended up with too few nurses coming into training at the end of the 1990s.
68. What we had was health planning experts and politicians making a big mistake in their projections. How do we know politicians and health experts today are not making the same big mistake in projections?
(Mr Crisp) Let me go back to my first point which is that we started off with an over-centralised process, we went to an over-localised process, and we have now got, as this document makes clear, a move towards bringing everyone we think can help us inform that together into these new confederations. For the first time it includes higher education institutes as well as the planning we get from a national perspective as well as the local employers. The other important thing about these new confederations is we are not planning for nurses in isolation. The significant thing here is that we are looking at the whole workforce and not just for individual professional streams because again one of the thoughts earlier and one of the things that is happening is that bits of work that are done within the Health Service are moving between professions.
69. What was the impact of the training cut in the early 1990s on waiting lists and waiting times?
(Mr Crisp) I do not think we can do a direct correlation. I think the impact on it was that we were unable to recruit as many nurses as we wanted to in the late 1990s. How that plays through into service levels I do not think it is easy to define. It is more complex than that.
70. What is the maximum length of training time for these professions?
(Mr Crisp) If we take nurses, there is a two-year diploma course and a three-year degree course. I cannot honestly tell you exactly how long some of the other courses are, but two or three years.
71. If we look at more recent trend, trends of the past five years for instance, I see that £705 million was spent in 1999-00 from the report on training places and student bursaries. What was the figure in 1996-97?
(Mr Crisp) I can let you have that. I have got the numbers that were brought in but I do not have the financial figures.
72. The numbers?
(Mr Crisp) If we are talking about nursing and midwifery training commissions, in 1996-97 the number of funded nursing and midwifery training commissions was 14,984. Last year, if that is the one you would like as the comparison, it was 18,707.
73. You mentioned earlier the "Return to Practice" programme. Can you check-list for me the reasons professionals have come back to the various branches of nursing and other health care professions? What have they said has brought them back as a result of that?
(Mr Crisp) I think the overwhelming issue is giving people a more family-friendly and a more flexible approach. I think there are other things like asking them. They have been approached and invited back which kind of helps.
74. So how successful is this scheme?
(Mr Crisp) Again let me find the numbers which I have got here. We regard it as successful enough for us to keep doing it. I can give you the numbers for one region just to give you an illustration. In one region the number of people attracted back was 270. If there are eight regions we are looking at somewhere between 1,500 and 2,000 in a year.
75. Are you saying that almost none of those would have been attracted back otherwise?
(Mr Crisp) I certainly do not have that information here and I would have to take advice on that and let you know what information we do have. Certainly that is a scheme which has been successful and which we are still running in terms of getting people back.
76. The Government's aim is to train 50 per cent more cardiologists and oncologists.
(Mr Crisp) Yes.
77. Are you training enough nurses and other support staff to back them up?
(Mr Crisp) The calculations we did last year were based on the amount of additional service we believed we needed to do and, therefore, against that model this was the workforce model of additional staff we needed to do that. The first point is that our calculations, as of last summer, were precisely intended to make the balance between the amount of work, the number of doctors, the number of nurses and so on. As I have already mentioned though some of the boundaries of what people do change over time so nurses may take on some of the things which doctors may traditionally have done. That set of figures needs to keep being kept under review. Certainly the last point, that was precisely the intention, to get them in balance.
78. Paragraph 1.5 gives the 50 per cent increase in the number of entrants to nursing and midwifery pre-registration education and training schemes. What are the figures for each year? I see it is a 50 per cent increase.
(Mr Crisp) Sorry, I missed which paragraph?
79. It is 1.5, it is the 50 per cent increase in the number of entrants to nursing and midwifery pre-registration education and training programmes. Page 9.
(Mr Crisp) Page 9, right, thank you. 1.5 there says that we have seen this big increase, yes. I am sorry, could you tell me the question again?
5 Note by Witness: The diploma course is for three years, not two years. Back
6 Note by Witness: Most courses are in fact, for three years. Back