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Introduction

5.1 NHS staff are a precious resource. They are what make the NHS tick. A modern NHS must offer staff a better deal in their working lives. It is never an easy life working in the NHS but it can be a better life. This chapter and chapters eight and nine, set out the improvements we will make. Our task is not just to end years of underfunding. It is to end years of low morale.

5.2 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.

5.3 It takes years to train doctors, nurses, therapists and other health professionals. Our ability to expand the NHS workforce is still being constrained by the limited investment made by the previous government in education and training for the future of the NHS. Within these constraints, there will now be an unparalleled increase in the number of key staff over the next four years.

More staff

5.4 Between now and 2004 there will be:

5.5 These are very challenging targets but we must meet them - and, if possible, exceed them - if the NHS is to make the service gains for patients they need. We will achieve them by:

More training places

5.6 By 2004, on current plans, we expect more than 45,000 new nurses and midwives to come out of training and over 13,000 therapists and other health professionals. Now we can go further. There will be further year on year increases in the number of training places available for all health professionals.

5.7 As a result of this NHS Plan there will be:

New medical school places

5.8 1,000 of the 1,100 extra medical school places the Government has already announced are expected to come on stream by 2002. We need to build on this progress with a further major expansion in numbers to be delivered by 2005. As a result of this NHS Plan:

Improved pay for NHS staff

5.9 The public want to see better, fairer rewards for NHS staff. The Government shares this ambition. For the last two years pay awards recommended by the independent pay review bodies have been implemented in full. Since 1997 nurses have had a 15% pay rise. We have agreed, in principle, a new system of intensity payments for consultants to reflect increasing workloads and negotiated a new contract for doctors in training to give more rewards to those working most intensively and doing the most anti-social hours. We have agreed an aboveinflation pay rise for staff outside the Review Body, not just for one year but for three years.

5.10 We are prepared to invest in pay. We also know the current NHS pay system inhibits the modernisation of the service. It has failed to keep pace with changes in NHS practice, and does not recognise that modern forms of healthcare rely on flexible teams of staff working across traditional skill boundaries. The NHS needs a new pay system - one that rewards staff for what they do, for their own particular skills and abilities, rather than simply being based on their job title. We will continue our discussions with the organisations who represent staff on delivering these goals. We will shortly publish a joint document reporting on progress and setting out the future timetable. In the meantime we will make progress on two fronts.

5.11 First, the contribution midwives make to the lives of mothers and babies has long been recognised by the population. It has not been sufficiently recognised within the NHS pay system. As a result of this NHS Plan the Government will act immediately to ensure that midwives with a year's satisfactory service will have access to progression from the top three pay points of Grade E to the top of Grade F without the need for promotion.

5.12 Second, we will move quickly to increase incentives for staff to join or re-join the NHS in those parts of the country where labour shortages are most serious. As part of the current negotiations on pay, the Government is considering a more flexible system capable of responding to different pressures in local labour markets within a national framework. As part of this NHS Plan the Government proposes a new Market Forces Supplement to top up the pay of staff in areas where there are labour market shortages.

5.13 There will be more help with accommodation costs, including the provision of affordable, good quality modern houses and flats for nurses and other staff. We will evaluate the concept of staff hotels to accommodate the significant numbers of staff who travel into city centre hospitals and whose working patterns make travel between work and home difficult. We will provide 2,000 extra units of nurse accommodation in London within the next three years. A detailed analysis of nurse accommodation needs outside London, particularly in the South East, will be completed by the autumn.

Improving Working Lives

5.14 Improving the working lives of staff contributes directly to better patient care through improved recruitment and retention - and because patients want to be treated by well-motivated, fairly rewarded staff. We have shown over the last 18 months that intensive action to bring back professionals into the NHS can succeed. Since February 1999 over 4,000 nurses and midwives have already returned to work in the NHS, and over 2,000 more are preparing to do so. But we have to go further and faster. That means extending the national recruitment campaign to other staff groups and intensifying follow-up action, with more - and more accessible - return to practice courses, a willingness across the board to offer flexible working practices, and effective support and mentoring of newly returned staff.

5.15 As a result of this NHS Plan, for the first time, the way NHS employers treat staff will be part of the core performance measures and linked to the financial resources they receive. Therefore:

5.16 The Improving Working Lives standard means that every member of staff in the NHS is entitled to belong to an organisation which can prove that it is investing in their training and development, tackling discrimination and harassment, improving diversity, applying a zero tolerance on violence against staff, reducing workplace accidents, reducing sick absences, providing better occupational health and counselling services, conducting annual attitude surveys - asking relevant questions and acting on the key messages. Standards and targets have already been established to support these goals. It is now down to NHS employers to deliver them. As a result of the NHS Plan we will give their efforts a further impetus.

5.17 We will ensure more help with personal development and training: by investing an extra £140 million by 2003/04 to ensure that all professional staff are supported in keeping their skills up to date and to provide access to learning for all NHS staff without a professional qualification.

5.18 An extra £9 million - £25,000 for every NHS trust - will be provided immediately, to go into tangible, practical improvements in the working environment for staff and to be spent as staff themselves want - whether on providing a face-lift to staff rooms or improving other basic facilities - based on responses to the local annual staff survey or other means of staff involvement.

5.19 We will invest an additional £6 million in 2001/02 building to £8m in 2003/04, to extend occupational health services, already a requirement in hospitals and community trusts, to GPs and their staff. Standards for occupational health services for NHS staff will be included in the Improving Working Lives standard.

5.20 Under the Improving Working Lives standard every member of staff in the NHS is also entitled to work for an organisation which can demonstrate its commitment to more flexible working conditions: challenging traditional working patterns and giving staff more control over their own time; one which provides team-based employee-led rostering, annual hours arrangements, childcare support, reduced hours options, flexi-time, career support, career breaks and flexible retirement. Staff should themselves be involved in the design and development of better working practices and in decisions which affect their working lives. The standard and the associated performance improvement and monitoring framework means this will no longer be left to chance.

5.21 In addition, to boost childcare arrangements and expand NHS sponsored and on-site nursery provision, we will now earmark extra funding, building up to an additional investment of over £30million by 2004. As a result of the NHS Plan:

International recruitment

5.22 To further boost NHS staff numbers in the short term, the Department of Health will work with the leaders of the professions and with other government departments to recruit additional suitably qualified staff from abroad where this is feasible, meets service priorities and complies with NHS quality standards. The NHS will not actively recruit from developing countries in order not to undermine their efforts to provide local healthcare.

5.23 There will be a targeted, nationally co-ordinated campaign using short-term contracts to boost the number of medical consultants and the overall number of doctors in the next three years. There are surpluses of trained doctors in some European countries. We will also recruit from other developed nations, especially in key specialties such as oncology and cardio-thoracic surgery, where expertise is concentrated. Carefully planned and targeted international recruitment for nursing and midwifery also remains part of our strategy.

Conclusion

5.24 The next few years will see a major expansion in staff numbers in the NHS. This expansion has to be sustained. The increases we are making in training numbers will provide for further staff expansion in future years. Getting the most from these new staff - and from existing staff - will, however, require changes in the way people work in the NHS and changes in the way the NHS is run. As the chapters that follow explain, delivering a patient-centred service requires reform as well as investment.