Scotland's Education

The UK parliament issues a report yesterday'Demography of Scotland and the implications for devolution', copy of which is here
It is a sobering read, it highlights many challenges including our ageing population and lower life expectancy - as demonstrated in the report

A substantial part of the report focused in on Scotland's economic sustainability and growth, in particular the need for migration and ensuring that Scotland has a highly trained/skilled workforce in order to grow business and attract investment.

I was shocked to see SNP's Pete Wishart MP tweet in relation to the report

Err - is he really asking that question? shouldn't the Scottish Government have all the answers and a plan that has seen them implementing strategies over the past 9 years they've been in office? -
It would appear not so let me try and point Mr Wishart on what not to do ....

Firstly there is the appalling attainment gap in our primary schools here -

only now have the SNP put a plan together to address it, time will tell whither that strategy will succeed but we are looking at another generation of kids that will fail to achieve.

Then there is high school performance league tables here, which, similar to the primary school tables, shows a clear class divide between the rich and poor, with many schools struggling to get their pupils 5 highers or more which is the amount required for most university places.

Moving up to further education we have seen unprecedented cuts in our colleges here.

I hear students being unable to complete their two year course as they have been kicked off it after one year by the college so that they can offer the place to school leavers in order to ensure youth unemployment figures remain low, thus they are unable to complete their training and gain their certificates.

Last but not least are our Universities.  We have some of the best Universities in the world and rightly they attract a lot of interest from international students. However the number of places for Scots kids are falling as reported here

Free higher education is still available in Scotland.  The Scottish Government however prefer to extend the gift of free University tuition to our European rather than rUK neighbours in the hope it would stimulate migration into the country, the subject of which is mentioned in the report here

Given that it costs c. £93m p.a. to provide free higher education to EU domiciles, one would expect the Scottish Government to show the tax payer a return on their investment, however, as demonstrated in the graph, most come to Scotland to study and leave after graduation and there is little 'pay back' for the tax payer.

In order to get official statistics into University outcomes I sent FOIs to the Higher Education Statistics Agency (HESA), details of which is here (when it came to providing me with the statistical tables HESA preferred to email it to me instead of making it public) and also to the Students Awards Agency for Scotland, details here.

I asked the HESA for all students who receive free university places in all subjects and also extract EU domiciled specific data. I also asked them to break down the stats to give me those who are studying medicine as we have a shortage of doctors in this country as featured in the BMA here

I was interested in knowing how many medical students stayed in Scotland after graduation.  The figures are shocking and would explain why there is a shortage of doctors.

The HESA tables are quite complicated and needed amalgamating in order to get the full picture.

The HESA data shows a huge increase in the number of EU students from 15,930 in 2009/10 to 20,805 in 2014/15. Not all students qualified and in years 2009-2015 the average pass rate was 35%. The average number of students who stayed and worked in Scotland after finishing University was 3.67%.

The figures detailing our medical schools show that very few EU domiciles stayed to work in Scotland after graduating but it also shows the same applies to Scottish/rUK students.

The results of the amalgamated tables:

Data from the Students Awards Agency for Scotland show that EU domiciled students did not require students loans, which suggests its EU middle classes taking advantage of free tuition.

Is it really too difficult for Pete Wishart and his colleagues to join the dots and see where they've went wrong?  It would appear so and I see no evidence that there are coherent plans to put it right.

NHS Scotland Nursing Figures

This post is an update on the NHS Workforce blog published in February.

At First Minister's Questions on the 9th June, Nicola Sturgeon reiterated that the SNP have increased nursing staff by 6% since coming to power; this would gives nursing statistics an increase of over 2000 nursing staff.  One would be forgiven if they interpreted this as our NHS having 2000 qualified nurses working in our wards and our community, as stated by Health secretary Shona Robison. Unfortunately it does not.  I decided to have a closer look at the nursing statistics and raised some questions with ISD, Scotland's equivalent to HSCIC, both organisations responsible for collating, analysing and publishing the statistics relating to the NHS.

I first asked ISD if they could confirm that Nicola Sturgeon was correct in her statement to parliament that there was an increase of 6% - the response was that it was correct

So it looks from this Sturgeon was correct and everything in hunky-dory
however...something's not right; this does not marry up with news headlines

and this

I wanted to look closer at the 43,418 figure. Forget the 29 interns - they are not qualified, so now we are down to 43,388 "qualified nurses".

ISD sent me the sub tables for nurse/midwifes workforce to examine

The sub tables have drop down menus that allow one to search by categories

The five categories are:

• Hospital
• Community
• Hospital/Community Combined
• Prison (Clinical staff came over to NHS control in 2013)
• Other/Non applicable

Hospital

In this section I found there was an increase in qualified nurses/midwifes; and increase of  255 since 2011 (sub tables only went back to 2011)

Community 


In this section I found an increase of 401

Hospital/Community Combined

This section showed a decrease of 945

Prison 

This showed 196 nursing staff moved over to NHS

Other/Non applicable

This is a strange category and one I had to seek clarity from ISD as to its meaning

It was indeed very helpful! So office staff are included in the nursing figures as their pay in under Agenda for Change Pay Rates

This category shows the biggest increase over the years from 935 in 2011 to 2374 in 2016 - an increase of 1439

Oh dear and I thought the Tories were bad at using dodgy stats!

If we add up all the figures it shows 'real' qualified nurses/midwifes working in our NHS Scotland is 41,013 - lower than 2006 figures!

I shall be sending my findings to the Scottish Parliament - watch this space.

NHS workforce - It ain't rocket science

A stockbroker once said to me "the key to successful stockbroking is not looking at the companies financials/forecasts/market but rather its looking at these in conjunction with whats happening in our world through media reports, this influences the stock market more than individual company performance- it ain't rocket science".

He was demonstrating that statistics on their own are meaningless and in order to gauge the true picture one has to look at external influences and supporting evidence.

A case in point is the NHS workforce, if we are to believe the 'official' statistics, we now have record number of nurses in our NHS - so press headlines would reflect that ...

"Ward accidents increase as nurses falling over each other" 

"Patients complaining that they can't rest as too many nurses caring for them"

said no newspaper ever


Joking aside - we are told we have an increased nursing workforce add to that the huge number of bed closures and add those two together would give us a greater nurse to patient ratio.

BUT if the latter is correct then we would not have headlines like this .... National Health Executive

or this ... The Mirror 

and we certainly wouldn't be seeing the need for this ... The Telegraph 

All external evidence suggests that the government statistics are wrong  ... and they are

but you don't need a degree in mathematics to know when the government is lying about numbers; all you need to do is see if external reports support their statistics.

NHS Scotland Workforce - What the SNP are not telling us

To much fanfare the SNP announced that there are more people working in our NHS Scotland than ever before as stated here  and from Shona Robison (Health Minister) here but the headlines are misleading and some of the claims are false.

Claim 1 - There are more working in our NHS than ever before, with over 10,000 more people

Claim 1 = False 
There are actually 6,633 more people working in the NHS but this figure also include those Health Care Professionals who are working in our prison service,agency nursing and a category classed as 'not assimilated/unknown'.
There are no figures for the amount of HCPs working in prisons so I cant subtract the number from the overall totals but I was able to subtract agency nurses.

Claim 2 - The are over 2,000 additional qualified nurses and midwives

Claim 2 = False 
If we added all staff that are on bands 1-9 then there are an additional 1,873 staff, still nowhere near the "over 2,000" claim. However if we take the actual number of "qualified nurses and midwifes" the total amount comes to 960 , however 70 of these are 'unknown' banding and therefore the figures could be lower if those 70 are >band 5.  I have no idea where the misleading "over 2,000" figure comes from; perhaps the SNP did a 'Lintern' and added the last three months of 2015 to hike up the totals instead of taking the figures from September of each year??

Claim 3 - There are over 2,500 more doctors

Claim 3 = False 
Keeping in mind that GPs are not included in ISD 'overall workforce stats' as they are not NHS 'employees' and therefore not on the HR system, then the total amount of additional doctors is 1,989.

I guess we should be thankful that at least there is an increase rather than a decrease but given that our ageing population has increased by 17% and due to rise to 25% over the coming years there is simply not enough staff or indeed the right kind of specialist staff to cope; under the SNP government we have seen decreases in specialised areas e.g.:

Acute                    ⇓   140 nurses
Geriatric doctors   ⇓  12.4%
Oncology              ⇓  10.1%
Orthopedics         ⇓   7.7%

So there you go folks, the SNP can spin NHS stats just as much as the Tories can.

NHS Nursing - The brain drain

I was hoping that I could leave this topic behind given that the statistics provided by HSCIC are, I believe, unreliable as identified in my previous blogs here and here.  It goes against my all my training to analysis figures I have no confidence in but given Saturdays article in the Mirror and viewing several twitter conversations on the topic:

After seeing this I decided another article was necessary. The problem with the Mirror's figures is that they made the same mistakes as Shaun Lintern as described here, essentially they do not take year by year comparative figures, quoting May 2010 figures and comparing them to August 2014 figures distort the figures.  However the general premise of the Mirror article is correct.

First of all I want to look at the Acute, Elderly and General Nursing

I have removed 1st level nursing from this graph as its difficult to plot while allowing you to see the trends for the minority, but highly skilled nurses, as will be demonstrated later.

This graph shows that the total number of nurses in these categories have decreased.

Modern Matron 

August 2010 /11 = 35,418

August 2011/12 = 33,031 down 2,387

August 2012/13 = 31,320 down 1,711

August 2013/14 = 30,498 down 822

Ending August 2014 with a decrease of 4,920 from 2010

Managers

August 2010 /11 = 43,019

August 2011/12 = 30,031 down 12,988

August 2012/13 = 39,518 up 9,487

August 2013/14 = 42,248 up 2,730

Ending August 2014 with a decrease of 771 from 2010

Children's Nurse

August 2010/11 = 4,325

August 2011/12 = 7840 up 3,515

August 2012/13 = 3,335 down 4,505

August 2013/14 = 3,438 up 103

Ending August 2014 with a decrease of 887 from 2010

Other 2nd Level > Bands 6-8

August 2010/11 = 28,069

August 2011/12 = 24,408 down 3,661

August 2012/13 = 23,525 down 883

August 2013/14 = 19,851 down 3,674

Ending August 2014 with a decrease of 8,218 from 2010

Which gives a total decrease of senior nurses by 14,796 since 2010

Looking at Level 1 nurses - now we know from HSCIC that these also include bands below band 5 (qualified nurse) and therefore this is an area of contention for me as not all in this category are qualified nurses. However when I put these into the graph it is plain to see that the Mirror's article is highlighting the problems this creates as "senior nurses play a vital role in patients safety". Don't think many would disagree with Andy Burnham when he states “Nurse losses on this scale risk threatening standards of patient care. Half of nurses say their ward is dangerously understaffed as hospitals shed ­experienced nurses in a crude attempt to save money".

You can see quite clearly that the lower nursing grades overshadow the more qualified nursing grades. There is only 1 senior nurse (2nd Level) to every 78 junior nurses (1st Level).

In other disciplines we see a similar pattern with more staff losses:

Maternity

The total decrease of these categories from 2010-2014 is 3328

Paediatrics

The total decrease of these categories from 2010-2014 is 378

Other Psychiatry

The total decrease of these categories from 2010-2014 is 2982

Community Psychiatry lost a total of 690 nurses between 2010-2014

I have no idea where the Mirror got its figures from; "Britain’s total nursing staff plummeted alarmingly from 280,765 in June to 278,924 in August, according to the ­latest official figures"

According to the HSCIC there were 313,752 nurses in June compared with 311,670 in August so the total number of nurses lost in that period is 2,082. 

So the points made by the Mirror and Andy Burnham are valid.  Jeremy Hunt claims that the article is misleading and that the number of nurses falling is due to "seasonal variation" and that there is always a temporary dip in the summer months.  It appears that the "summer months" in England start in April.

Dont you just love politicians.

Hospital safe staffing levels

From April 1^st 2014 it became a national requirement for all hospitals to publish information about staffing levels on wards, including the percentage of shifts meeting their agreed staffing levels. This initiative is part of the NHS response to the Francis report which called for greater openness and transparency in the health service.  

NHS choices website has a feature that allows you to check how your hospital is performing here. Unfortunately it does not offer much in the way of detail:

So to get behind the headers one has to dig a little deeper.

If we look first at University Hospital of North Staffordshire (UHNS) found here

Selecting June’s statistics we can, if we look closely enough, see the departments that did not reach the minimum safe staffing levels. 

Difficult to see from this spreadsheet what is actually going on across the hospital but put into a 'traffic lights' system we can see more clearly how this hospital is performing in relation to their ward staffing:

Only 1 out of 41 wards had continuous levels of appropriate safe staffing over the month of June and worryingly the trend appears to be the majority of these wards are heavy reliant upon health care assistants. In one ward, 'critical care medicine', they only managed to reach an average day rate care of 52% of qualified staff - yikes !

Its not the only one however, we can take a look at several other hospitals and perform the same analysis.

Nottingham University Hospitals Trust:

Only 4 out of 47 wards achieving expected levels of safe staffing.

West Hertfordshire Hospitals Trust:

Only 3 out of 33 wards managing to have a consistent safe level of staffing throughout June.

It was difficult to carry out a full analysis of all hospitals as some hospitals presented their data rather differently and, in my opinion, a little less transparent than they ought to be, Central Manchester here, North Bristol here ...hmmm

Not surprisingly however I did find a Trust that had a good record on safe staffing, not 100% perfect, but better than the rest that I had seen, ironic given that this Government is hell bent in ensuring its demise.

Over to Midstaffordshire Foundation Trust (MSFT) found here

and again using the 'traffic lights'

A much healthier picture with only Orthopaedics at Cannock Chase failing to continuously meet safe staffing requirements.

Stafford has 9 out of 17 wards having continuous safe staffing levels. 

Comparing MSFT to UHNS; it would be false to claim that the people of Stafford would be safer transferring to UHNS for treatment as Stafford outperforms UHNS in safe staffing percentages.

Looking overall at the the 'safe staffing' tables of NHS trusts I can find no evidence of the so called "Francis Effect" nor any evidence that would suggest that this Government has invested in extra nurses.  I have seen nursing staff ratios ranging from 1:8 right up to 1:13.  What is clear is that hospitals do not have enough nursing staff and that the majority of hospital wards rely too heavily on health care assistants to deliver care - this of course puts a considerable strain on the front line and something that the Francis report highlighted as one of the main issues at Midstaffs - something this Government continues to ignore!

NHS nurses workforce - what lies behind the statistics

Last week Jeremy Hunt quoted the number of NHS workforce statistics in a House Of Commons debate on Wednesday 16th July.  The Hansard report can be found here.

He states there are 6,200 more nurses on our wards

as the debate goes on it is reduced to 6000 more nurses

and then finally we have 4000 new nurses

So there we have it 2,200 nurses made redundant in the space of an hour.

Joking aside, there is much debate about the number of nurses and the politicians, press and so called 'health' journalists jump on them in order to spin these statistics into whatever shape suits their agenda.  So what is the true number of nurses?  its not an easy question to answer due to the way these statistics are collected and formulated.
To understand why its so difficult is down to a couple of things 1) the system the NHS use to collate these figures 2) the quality of data held within the system.

Lets look at the first point.  This NHS workforce statistics come from a NHS HR system called the ESR which stands for Electronic Staff Record, as previously blogged here , the ESR system does not link NHS staff pay bands with their occupation code, what this mean is that the only way to check the grade to see if that member of staff is a qualified nurse is for it to be done manually.
Now for point 2 - the quality of the data - the data in the system will include non-qualified staff and is open to abuse as HR can 'up' their nursing figures by including unqualified nurses, so HSCIC statistical header "qualified" nurses is a misnomer.  To be fair to HSCIC they do have caveats to the figures produced and have issued guidance that these figures are 'estimates' - something our politicians and press appear to ignore as they present them as fact!

So we are using stats that really should be taken with a huge pinch of salt and to be honest I don't think we will get a handle on these stats any time soon.  I have had some interesting email exchanges with HSCIC in order to get some background information on the stats as its naive to believe everything you read is true; now call me a cynic but where the Tories are involved I always suspect foul play - so delving a little further I asked HSCIC if there had been a change in the way the NHS workforce statistics are collected since 2010  and lo and behold there was:

So the figures prior to 2010, under a Labour government, were collected manually and therefore grades could be checked and proper statistics given, however under the Tories we have it all coming from a system that is not fit for statistical purposes, not manually checked for quality assurance and open to abuse.
So next time you hear a politician or journalist quote nursing statistics - send them my way :)


The big question here is what is the NHS England workforce? Does HSCIC statistics give the right type of information needed to manage and plan the workforce?
Compare HSCIC statistics to NHS Scotland's statistical information (sorry to rub salt in the wounds); I can break NHS workforce statistics down to nursing grades:

by age:

and even by gender/contract type

and also by region/health board and trends - but I won't bore you with that.  However you can see my point, HSCIC statistics just doesn't cut it. How NHS England, The NMC and the DH can know what is happening with nursing in England is beyond me, they simply do not have the tools to manage that aspect or any other aspect of the NHS workforce.