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Wednesday, 21 February, 2001, 15:47 GMT
Staffing in the NHS
There are too few doctors and nurses in the NHS, but opinion over how to solve the problem, and whose fault it is, are divided.
Health is a devolved matter dealt with domestically by the Scottish Parliament, and the Welsh and Northern Ireland assemblies. Westminster retains UK-wide powers over medical regulation and safety.
The government's blueprint for the NHS, the NHS Plan, published in July 2000, spelt out how important staff were to the health service:
"The biggest constraint the NHS faces today is no longer shortage of financial resources. It is shortage of human resources - the doctors, nurses, therapists and other health professionals who keep the NHS going day-in and day-out."
Staffing levels in the NHS are at the centre of political debates over how to improve the service.
Politicians and health workers' leaders agree there are too few staff in the NHS - but they cannot agree how many extra are needed.
How to recruit more doctors, nurses and other staff, and how to keep them is perhaps the most crucial question for the health service.
Better pay would help says the profession, but doctors and nurses also call for more family friendly and flexible working, and targeted initiatives, such as help with accommodation in expensive areas.
The government has made some moves to address the problem, including staff hotels and a "market forces supplement" aimed at helping nurses living in areas where housing costs are high.
The shortage of nurses has led to an increase in spending on agency nurses, who are not tied to one ward or even hospital.
Spending on agency nurses in the NHS has increased from £190m in 1997/8 to £344m in 1999/2000.
But doctors leaders have said the additional responsibilities spelt out for GPs in the NHS Plan means the health service will need an 10,000 GPs, a third more than the NHS has now.
Overseas nurses have been recruited in order to fill the gap until UK nurses can complete their three years of training.
Most come from the European Union, South Africa and Australia.
In November last year, the government signed a high profile agreement with Spain to employ 5,000 Spanish nurses to help fill the shortfall in the NHS. China has also been approached.
The medical profession is also warning that the impending retirement of many GPs who trained overseas and who work in needy inner-city areas will leave the family doctor service well short of the numbers it needs.
The latest official figures, from the NHS vacancy survey carried out in March 2000, suggest the health service needs an extra 22,000 nurses.
The same survey said just under 10,000 posts had been vacant for more than three months.
Labour in government set a target in the NHS Plan of attracting an additional 20,000 nurses into the NHS by 2004.
But the Royal College of Nursing said last December that if current rates of retirement and loss of nurses continues, the NHS will actually need another 110,000 nurses.
A lack of nurses is the key issue which governs how many patients the NHS can deal with.
There is an untapped pool of around 70,000 people on the UK's nursing register who are not nursing.
Nursing is an ageing profession, with between 4,000-5,000 retiring every year. Almost a third of nurses and midwives in the NHS now are over 45.
Many women also leave the NHS when they have children, saying they find it difficult to combine family life and working in the NHS.
The number of training places for nurses across the UK fell in the early 1990s, but has increased since the late 1990s.
Over the last decade, Wales and Northern Ireland were worst affected by a fall in the numbers who registered as nurses after training.
Doctors and dentists
By 2004, there should be an additional 2,000 GPs in the NHS, according to Labour.
They claim many younger GPs, both men and women, are choosing to work part-time. So even though the number of GPs has remained roughly the same in recent years, they provide fewer hours. And fewer trainee doctors are choosing general practice - numbers are at a 15 year low.
The British Dental Association estimates the NHS has lost the equivalent of 1,800 dentists to the private sector in recent years - which it says equals the amount of treatment provided by all the dentists in Scotland.
It adds that without action, the government will not achieve its aim of providing NHS dental care for all who want it.
Salaries for NHS staff are an ongoing problem.
Doctors feel they have slipped well behind comparable professions such as lawyers. In the pay awards for April 2001, announced in December, all doctors received a 3.9% increase. A GPs average pay in 2000 - 2001 was £54,220.
Nurses pay is perhaps more of a thorn in government's side, as they carry a lot of public sympathy for what is perceived as low pay.
In the 2001 pay award, they received an increase of 3.7%. Senior nurses received 5%.
In previous years, the Labour government had targeted specific grades - experienced staff nurses in 2000, and a boost to newly qualified nurses' salaries in 1999.
Dentists also received a 3.9% increase, which the professions' leaders said would not help overcome the shortage in the NHS.
The majority of GPs work independently and have a contract with the health authority to provide a range of services called "General Medical Services."
But the Labour government has extended a policy of its Conservative predecessor by developing the concept of services tailored to local need in what are called a "Personal Medical Services".
It is proposed that a third of GPs will work under these contracts by 2002.
The plan also says there will be a revised national contract and special contractual quality standards for single-handed GPs.
Consultants' contracts are also being revamped and Labour pledged to make consultants work solely for the NHS for the first seven years after they qualify.
In government, Labour pledged to increase all areas of staffing in the NHS.
The Plan promised that by 2004, there would be:
A thousand specialist GPs are promised by 2004.
Expansion of staff numbers is planned to continue until 2010.
An extra 11% will be put into the training budget for NHS staff next year.
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