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.

Charlotte Leslie Foodbanks

Charlotte Leslie MP for Bristol, currently being investigated for accepting cash donations and failing to declare them  has written a blog for 'Conservative Home' titled

"Why government needs to be more like foodbanks"

In this article she describes her visit to a foodbank, she states;

but according to the 'Bristol Northwest Foodbank' (the one Charlotte visited) they state in their winter newsletter  that "Benefit changes and Benefit delay are one of the major contributions to local people needing to use our foodbank".  She does a huge disservice to the staff and users of Bristol Northwest Foodbank by denying that this is the case.   

This main reason is also backed up by figures from the Trussell Trust with delays in receiving benefits accounting for 30.93% of people being referred and 16.97% due to Benefit Changes.

Benefit delays are obviously a huge problem that leaves the claimant without money until the Government process their claim, this results on them having to rely on foodbanks.  It is not only the unemployed that is affected, the disabled and sick are also affected and as this article by the BBC shows this Government's utter contempt for the sick and disabled - leaving them 6 months or more without much needed funds.

Charlotte then goes on to say ...

"cutting through the politicisation" ..she then goes on to shamefully do just that by trying to score political points over Labour in terms of the number of foodbank users when they were in power against that of her own government.

So lets look at the numbers when Labour were in power;

2005-6	2,814
2006-7	9,174
2007-8	13,849
2008-9	25,899
2009-10	40,898

and now under Coalition Government

2010-11	61,469
2011-12	128,697
2012-13	346,992
2013-14	913,138

Its distasteful for Miss Leslie to try and score political points over starving people but even worse when her government is responsible for the huge increase in foodbank users since foodbanks franchises started in 2004.

Interestingly she also states "since the government opened up foodbanks to job centre referrals the rise in numbers attending foodbanks has doubled".  Apart from the disingenuous statement regarding Labour; the DWP have repeatedly denied that JCP refer claimants to foodbanks

http://www.theguardian.com/society/2014/mar/11/food-bank-jobcentre-dwp-referrals-welfare

So thanks to Miss Leslie we now know that the DWP have been in fact referring claimants to foodbanks since 2011.

She then goes on to criticise her own government's model

I am sure Miss Leslie agreed to so this blog in order to deflect blame away from her government's role in the upsurge of food banks but manages not only to highlight the huge rise in foodbank use since the Coalition came to power but also highlights that the DWP were lying when they said they did not refer claimants to foodbanks and lastly criticises her Government's model which exacerbates the need for foodbanks.

So in essence is not that the "Government needs to be more like foodbanks", the Government should be ensuring that they is no need for foodbanks by protecting, not punishing, the most vulnerable in our society.

My advice to Miss Leslie is to keep on blogging, she's an asset to all her political opponents.

Shaun Lintern's analysis of NHS earnings

Its that time of month again whereby I am compelled to write yet another article on Shaun Lintern.  I must point out that when I first decided to write a blog my aim was to write about the misuse of statistics used by the media and politicians, little did I know that the majority of it would be concerning Shaun Lintern.
This is not a deliberate or personal attack on Shaun Lintern per se but to merely set the record straight regarding his misuse of statistics.  Today's blog is not about misuse of statistics but rather his claims to them and the personal smears which accompanied them.
I will always challenge dodgy statistics because I believe the public deserve to know the truth about what is happening in our NHS and we should have the right to question someone who misleads the public without being smeared at.

Today Shaun announced that he had carried out an "analysis" for HSJ.

When further questions where put to Shaun about these figures he could not answer

I did ask for his source and after much to-ing and fro-ing he eventually gave me the link to the spreadsheets from HSCIC.

http://t.co/oiC3VCh2X8

If you download the spreadsheet and turn to table 2b, you will see that in fact HSCIC has done the "analysis" - not Shaun but credit where credit's due Shaun did come up with a pretty picture - unless someone else came up with that as well.

Now Shaun knows I know what has happened i.e. he tried to pass off someone else's work as his own but instead of owing up he labels me a "troll" in order to deflect from the subject and to smear me.
His tweet tonight - which is frankly so embarrassing for him that I will not post it here; is another ploy to smear and play the victim with some actually falling for it, but as they say you can fool all of the people some of the time and some of the people all the time but you cannot fool all the people all of the time!

Needless to say the figures Shaun quoted are wrong - the HSCIC spreadsheet does carry a warning that they are estimates and "experimental".  I won't embarrass HSCIC by publishing their mistakes but I firmly believe that no professional journalist would take these stats and publish them without checking first their validity but then in order to check their validity one would need to have a degree of maths knowledge which Shaun Lintern clearly does not have.
So my advice is once again to treat any stats that Shaun Lintern produces with extreme caution and if in doubt ask Shaun to produce his math formulas, that should separate the wheat from the shaft!

Shaun Lintern - Nursing Statistics

There has been much debate on twitter over the last couple of days on nursing workforce.  I have written about this in the past, in fact the subject of my first attempt at writing a blog was about Shaun's use of statistics.
I now find myself having to cover this topic again due to Shaun Lintern's continual habit of quoting statistics that are at false and/or misleading.
On Tuesday 18th, Shaun Lintern co-hosted #Nurchat. During that chat Shaun tweeted

Now anyone looking at the graph would think that this graph related to band 5 and band 6 nurses with nearly 174,000 being employed. Whereas it is in fact the same graph Shaun Lintern produced in January, which encompasses all nurses irrespective of grade working in 'Acute, Elderly and General' and has nothing whatsoever to to with nursing bands 5 and 6.

The spreadsheet from which this information is taken from can be found here

You will see in this spreadsheet that there is no mention of 'bands' instead it only records levels in this format;

 Shaun was questioned over his stats and he claims they come from Individual Trust's ESRs

ESR (Electronic Staff Record) is a HR programme that records the following

You will see that it does not record nursing bands yet Shaun is adamant that the ESRs are collected by HSCIC.

Shaun failed to reply to my tweet, so I emailed HSCIC and asked for a copy of the figures from ESRs. Here's their reply:

Therefore Shaun is telling porkies- they are not on the HSCIC website, it is not published, there is no link between pay band and occupational code and therefore would be impossible for Shaun to produce any statistics and graph them!

I personally cannot fathom why a journalist would set out to deceive the public in this way and my advice to all is to treat any statistics that Shaun Lintern produces with extreme caution.

**UPDATE**

Exposing Shaun Lintern's misunderstanding/misuse of stats feels like a full-time job at times *sigh* - There is more to statistical analysis that just rhyming off a line in a spreadsheet and feel any journalist worth their salt would actually analyse the numbers, especially if they are, like Shaun, hell bent on quoting them at every opportunity in order to appear knowledgeable.

but here's another one; 

On the subject of nurses - again - Shaun tweets;

HSCIC in collaboration with the RCN (see above email) undertook a recent study into nursing bands, the datasheet they emailed me states that there are 308,776 "qualified nurses" working in the NHS, of which   245,255 were in bands 5/6.  In Acute, Elderly & General, nursing bands 5/6 amounted to 139,510; nothing near the 174,000 Shaun Lintern is reporting!

The data sheets published on the HSCIC website also includes "unknowns" into the figures. So therefore, the "nursing" figures specified do not mean "qualified nurses"!

As specified in my first blog, nursing levels peak every Autumn due to graduate intake and should level off in December.  I have asked HSCIC to clarify the definition of 'nurses' used in their data because I have a feeling some will include HCAs + HCA Student nurse pilot scheme.  I will update this blog when I receive their response.

*HSCIC state that the nursing stats (bands) are not for general publication - hence why I have not published them in full here but happy to email them to those who have an interest, excluding Shaun Lintern!