RCN Employment survey 2013 for Scotland

Transcription

1 RCN Employment survey 2013 for Scotland December 2013 Publication code:

2 1. Introduction This report has been produced by the Royal College of Nursing (RCN) based on the results of an online survey sent out to a stratified random sample of the RCN membership. The survey achieved a total of 1,681 usable responses. Incomes Data Services was commissioned to administer the survey, but all analysis was undertaken by the RCN. The results are taken from the 2013 RCN employment survey which is the 24th survey in the series which reports findings from the whole of the UK. A key feature of the series has been the inclusion of many of the same questions over time, in order to measure changes and trends. This year s survey also incorporates some new questions. The full questionnaire can be found in Appendix 1. The survey follows seven key areas: employment status and personal profile pay, grading and career progression pension arrangements training working hours workload and staffing views regarding nursing as a career. 2. Context and background Pressures on the nursing workforce in NHS Scotland Demands on health care are rising and signs of pressure on the NHS were apparent. Some boards missed waiting times targets; vacancies for hospital doctors, nurses and midwives increased; and spending on bank and agency staff and private health care rose. Because boards have to meet annual financial targets, their focus can be on breaking even each year. They need to focus more on long-term financial planning to change the way they deliver services to meet the challenges of population changes, technology advances and decreasing budgets. The Auditor General for Scotland, NHS Financial Performance The most recent official overview of NHS spending in Scotland paints a picture of an NHS which is managing to balance its books, but under heavy pressure to meet increasing demand, government targets and rising costs within tightened budgets. The RCN s own analysis of NHS finances has shown boards repeatedly breaking even by using unsustainable temporary savings, plugging financial gaps with short term funding and, in some cases, relying on loans from Scottish Government. Pay is one of the largest single budgets for NHS boards and nursing is the largest group employed directly by the NHS, comprising 43 per cent of all staff in Scotland. While the nursing workforce is crucial to the delivery of quality care and the success of health and social care reforms currently underway, it is also a prime target for cuts when times are hard. Between September 2009 and June 2012, the number of nursing and midwifery staff in post in NHS Scotland fell by more than 2,240 whole time equivalent (WTE) posts a cut of more than 3.8 per cent

3 There have been many lessons for Scotland to learn over recent months about the impact of reduced staffing and resources on the quality of care including the report of the Francis Inquiry and headlines reflecting the effects of NHS capacity pressures on patients. Some health boards have clearly realised they have cut staff too far, too fast. Over the period June 2012 to June 2013, there was a welcome, if moderate rise in the overall numbers of nursing staff in post. Scotland saw a 1.7 per cent increase in nursing staff over the last year since the low of 56,183.7 WTE in June 2012 however this increase is not replicated across all NHS employers. At 30 June 2013 there were 57,152.7 WTE nursing and midwifery staff in post in NHS Scotland. 2 At the same time as we saw this moderate rise in WTE nursing staff, we also witnessed an increase in the use of bank and expensive agency cover. This suggests that even the rise in the numbers of employed nurses has been insufficient to cope with the strain boards are facing to deliver quality care. An ageing population with increasingly complex needs will require increases in both staff capacity and clinical capability to deliver services across the full, integrated pathway of care including the acute, community, primary, third and independent sectors. Just as the Auditor General (above) has suggested that NHS boards need to focus on longterm financial planning, so Scottish Government and Boards, will need to focus on long term workforce planning to ensure the sustainability of services and avoid the nursing workforce boom and bust of the past. We hope that the recent Scottish Government announcement on mandating the use of the Nursing and Midwifery Workload and Workforce Planning tools will, in practice, support the future stability of the workforce for the NHS, if not for the wider sector. However, Scotland s recent experience of developing a new generation of registered nurses to meet future need has not been wholly positive. Between 2010/11 and 2012/13 pre-registration nursing and midwifery student intake places at commissioned universities in Scotland decreased by 21 per cent, a loss of 630 places. As with WTE employed nursing staff, there has been slight turn around in this situation over the past year with the 2013/14 intake increasing by 100 places (4.1 per cent) to 2,530 preregistration nursing and midwifery students at commissioned universities. However, given the expected rise in demand on services which should be planned for now, there is still much ground to make up. Investment in existing staff is also needed to support nurses and health care support workers to make significant transitions in their skills, competencies and approaches if the Scottish Government s 2020 vision is to be realised safely and effectively. 3 However, the proposed Budget (Scotland) Bill reduces the expected investment in nursing education and training by 11 million. 4 Whilst the government has set out its rationale for ending central funding of the One Year Job Guarantee for newly registered nurses, it has not explained why it has seen fit to relinquish this funding when the need to train the nursing workforce to deliver key policy priorities is high. The RCN has called for a national, strategic approach to support post-graduate education for nurses, much as exists for the medical workforce. 2 All workforce figures from Information Services Division: ISD Scotland

4 The wider financial, social and political context in Scotland All debates on national funding and the future of Scottish public services are now taking place in the heated atmosphere of the run up to a referendum on Scottish independence on 18 September The recently passed Scotland Act will change the responsibilities devolved to Scotland in 2015 if there is a no vote to independence. Whatever the outcome of the referendum vote, the political and financial landscape for Scotland will change. For now, the continued reverberations of the global recession across public sector budgets is being felt in Scotland just as it is being felt across other parts of the UK. Although Scotland has seen small indicators of economic improvement over the past year, Scottish Government figures show an expected real terms cut in the Scottish budget of nearly 11 per cent between and as the longer-term effects of the recession continue to be felt through reductions in available government spending. 5 Given that 23 per cent of Scottish employment was accounted for by the public sector at September 2013 a reduction of 6,000 (one per cent) over the 12 months to this date this forecast for public spending is concerning for the public sector labour market. Private sector employment rose by 3.3 per cent over the same year. 6 Overall, Scottish unemployment figures in the quarter ending August 2013 saw a slight decrease in the latest figures from Office of National Statistics (ONS) (0.2 per cent) over the previous quarter. Just as employment recovery is mixed so is Scotland s progress in tackling its history of poor health and inequalities. Whilst, for example, deaths among men from heart disease and lung cancer have seen significant improvements, pressures on public spending in Scotland are also being felt in areas in which positive progress has not been seen. A recent study looking at trends between 1950 and 2010 showed that Scotland, in 2010, had the highest mortality rate among year olds and deaths from oesophageal cancer in all of Western Europe; chronic liver disease remained at worryingly high levels; lung cancer among women was not declining, and 50 per cent more men committed suicide than in Life expectancy in Scotland, though improving, also highlights significant inequalities still evident across communities. Life expectancy at birth ( ) for men living in Glasgow was 71.6 years, but just a few miles away in East Dunbartonshire this rose to 79.4 years a difference of 7.8 years 8. The Scottish population is expected to increase by 10 per cent between 2010 and Within this headline figure, however, the number of people of pensionable age is anticipated to rise by 26 per cent to and the number of people aged 75 and over will increase by 82 per cent over the same 25 year period. 10 We know that the likelihood of experiencing ill health increases with age. For example, the most recent Scottish Health Survey showed that, 66 per cent of men and 67 per cent of women aged 65 years and over had a long-term health condition compared with 33 per cent of men and 37 per cent of women aged years. The prevalence of long-term conditions increased with age, from 62 per cent in adults aged years to 73 per cent in those aged 85 years and over. 11 According to the Scottish Government, around 51 per cent of the 4.5 billion spent on health and care Not adjusted for changes to the state pension age

5 services for the over 65s in Scotland (2007/08) was spent on emergency and planned hospital care. 12 Without changing how we design and use services, and how we prevent and treat illness, in the face of rapid demographic change, public services operating within reduced budgets will struggle to cope. The Scottish Government has laid new legislation before the Scottish Parliament to integrate health and social care services and, if passed, we expect to see the reforms take place by Whilst the policy intent of this new approach may well support the step change in service redesign and health improvement we will need to manage the future well, the scale of change this will bring, and the changed expectations for the public, will be considerable

6 3. How to use this report This report presents the results of the 2013 RCN employment survey for Scotland across the following chapters: Chapter 4: Chapter 5: Chapter 6: Chapter 7: Chapter 8: Chapter 9: Chapter 10: Employment/respondent profiles Pay, grading and career progression Pension arrangements Training Working hours Workload and staffing Nursing as a career Where appropriate, we explore differences in the findings according to respondents age, place of work and ethnicity. RCN members work across a range of organisations and in some cases, the sample sizes were too small to report all findings. Please contact the RCN if you would like any other results or comparisons from this survey. In most tables and charts, the number of respondents replying to the question is presented. In the case of tick all that apply questions, the sample size stipulated refers to the total respondents answering the question, rather than the total number of responses given. The use of routing questions in the survey also means that sample sizes vary across the results shown. Where percentages from the tables are featured in the text they have been rounded up or down accordingly. Figures containing decimals of 0.5 and above have been rounded up when referenced in the text. This survey uses data from the UK employment survey and for some findings; we report comparisons with the rest of the UK (ie England, Wales and Northern Ireland) and for others we show a breakdown across all four UK countries. The UK report can be found at 5

7 4 Employment/respondent profiles This section summarises the main characteristics of respondents to the RCN s 2013 employment survey for Scotland. Information requested by this year s survey includes: current employment situation job title main area of practice length of service with current employer age range gender country of work qualifications ethnicity disability. 4.1 Employment information Current employment situation The majority of respondents (93 per cent) describe their current employment situation as employed and working. Other respondents described themselves as being employed on either sick or maternity, retired, students, self-employed, unemployed or not currently working. (Table 1) Main employer and location of work Table 2 shows that nearly 80 per cent reported that they work for the NHS (excluding GP practices) including for NHS boards, for NHS Bank or NHS 24. Six per cent work for independent/private health care providers and almost six per cent work in GP practices. Other employers include charities, social enterprises, further and higher education (FE/HE) institutions, schools, local authorities and other public sector bodies, and non-health care private industry. With regard to the main location of work, 56 per cent are employed in hospitals, including hospital wards (23 per cent), specialist units (17 per cent), outpatients/day care (6 per cent) or another hospital setting (two per cent). A further 19 per cent of respondents work in a community-based setting. Table 1: Which one of the following best describes your current employment situation? No. % Employed and working 1, Employed, but currently on sick leave Retired, but still in paid employment Employed, but currently on maternity leave Fully retired Self-employed Not currently working Unemployed Student Total 1, Table 2: Who is the employer for your main job? 6

8 No. % NHS (excluding GP practices) 1, Other NHS employer (eg Health Board) NHS Bank NHS 24/help-line Independent/private health care provider GP practice Private company Charity/voluntary group Further/higher education Local authority/other public body Nursing agency Self-employed School Retired Not currently working Student Other Total 1, Table 3: Where do you currently spend most of the time in your main job? No. % Hospital ward Hospital unit (eg A&E, ITU specialist unit) Across different hospital departments/settings Hospital outpatients/day care Other hospital setting All hospital settings Community Care home GP practice Office/research/education setting Various (across organisation/s) Industry/workplace Hospice Further/higher education School Call centre Prison service Private clinic/hospital Student Total 1,

9 4.1.3 Main job title and area of practice 39 per cent of respondents identified their main job title as staff nurse. Senior nurses (including sisters, charge nurses, ward managers, matrons and nurse managers) make up just over 15 per cent of survey respondents. 29 per cent of respondents reported acute and urgent care as their main area of practice and 13 per cent work in primary and community care. Table 4: Which one of the following job titles best describes your main job? No. % Staff nurse Sister/charge nurse/ward manager Clinical nurse specialist Nurse practitioner Community nurse Senior nurse/matron/nurse manager Practice nurse District nurse Manager/director Occupational health nurse Researcher/lecturer/tutor Health care assistant/nursing auxiliary Health visitor/scphn Community psychiatric nurse Educator School nurse Quality assurance/risk Consultant nurse Assistant practitioner Midwife Public health practitioner Commissioning Non-nursing job/work Retired Not currently working Student Other Total 1,

10 Table 5: Which one of the following best describes the area of practice in your main job? No. % Acute and urgent care Primary and community care Older people Mental health Children and young people Long-term conditions Adult general/medical/surgical Cancer care Palliative care Public health Learning disabilities Management/leadership Workplace and environmental health Quality improvement and research Education School nursing Women s health Surgery/operating theatre Outpatients e-health/telecare Neonatal Various Non-nursing Midwifery Aesthetics Retired Student Not currently working Total 1,

11 4.1.4 Length of service with current employer and time in current post Respondents were asked how long they have been employed both with their current employer and in their current post. 55 per cent of respondents have been with their current employer for over 10 years and 21 per cent between two and five years. 59 per cent have been in their current post for over five years (Chart 1). Chart 1: Length of service with current employer and time in current post (n=1,627) Chart 2 shows that respondents working in the NHS are more likely to have worked for the same employer for a longer period of time than others, including GP practices and independent and voluntary sector providers. 58 per cent working in NHS hospitals and 70 per cent working in the community for the NHS have worked for the same employer for 10 years or more, compared with 49 per cent in GP practices, and 28 percent of those working in the independent sector and charities/voluntary sector (30 per cent). General practice stands out with a higher proportion of nursing staff having worked in the same post for five years or more (78 per cent) compared to other sectors including NHS hospitals (61 per cent), NHS community (59 per cent), charities/voluntary sector (52 per cent) and the independent sector (39 per cent). 10

12 Chart 2: Length of service by type of employer Chart 3: Time in current post by type of employer 11

13 4.2 Respondent profile Gender, age, ethnicity and disability Eighty nine per cent of respondents are female and the majority of respondents are aged 45 or over, with 46 per cent in the age range 45 to 54 and 20 per cent aged 55 or over (Chart 4). In addition, 77 (5%) respondents reported that they have a disability. Chart 4: Age breakdown of respondents (n=1,620) 97 per cent of respondents identified their ethnic group as white, with less than two per cent identified black or another ethnic minority background. Table 6: Analysis of survey respondents by ethnic group No. % White 1, Black/African/Caribbean Asian/Asian British Mixed/multiple ethnic groups Prefer not to say Total 1,

14 4.2.2 Qualifications held Survey respondents were asked about the types of registration and qualifications held. 75 per cent) have completed their first-level registration nursing qualifications and nine per cent hold second level registration. In addition, 48 per cent hold a nursing degree and 27 per cent hold a diploma. Table 7: Nursing qualifications held* No. % First level registration 1, Second level registration Nursing degree Nursing diploma Masters/PhD NVQ 2, 3 or * Other specialist registrations or qualifications are held, including health visiting, school nursing, occupational health, family health, public health, mental health, district nursing and learning disabilities. 13

15 5 Pay, grading and career progression This chapter looks at respondents current pay and grading arrangements and whether they are on Agenda for Change (AfC), clinical or other pay scales and whether they receive unsocial hours payments. The chapter also covers questions asked about whether respondents think their current pay, grade or band is appropriate and whether they are coping financially. Main findings 82 per cent of all respondents in Scotland are paid on Agenda for Change pay bands; four per cent are on clinical grades and the remainder on organisational pay systems. 51 per cent receive unsocial hours payments (when the standard working week includes evenings, early mornings, weekends, bank holidays and nights); with the highest use in the NHS. 42 per cent view their pay band or grade as appropriate in view of their roles and responsibilities; 44 per cent view it as inappropriate. Over half of survey respondents (56 per cent) are the main or sole earner in their household. There is a high level of financial anxiety, with 85 per cent of all respondents experiencing static or decreasing household incomes while 88 per cent say their expenditure is increasing. Primary concerns are increasing fuel and transport costs, food costs and other household bills while others point to worries about cuts to their income and increased pension contributions. There are also high levels of employment anxiety, with 40 per cent stating they are increasingly worried about job cuts or redundancy; this is a particular concern for nursing staff working for the NHS and in social enterprises regardless of the fact that there is a no compulsory redundancy agreement in NHS Scotland. 5.1 Pay and grading arrangements Excluding students, those not currently working, retired or self employed, 82 per cent of respondents are currently on an Agenda for Change (AfC) pay band, 4 per cent are on clinical grades and 13 per cent are on other, organisational pay systems. For those respondents paid according to AfC pay bands, most are likely to be on band 5 (43 per cent), followed by band 6 (28 per cent) and band 7 (23 per cent). 14

16 Chart 5: Agenda for Change pay bands (n=1,363) Almost all respondents working in the NHS and the majority of respondents working for NHS 24 (94 per cent), NHS Boards (86 per cent) and NHS Bank (74 per cent) are employed on AfC terms and conditions. Chart 6 also shows that around 34 per cent of charity/voluntary sector employees are on contracts which pay AfC rates. Clinical grades are used mostly in GP practices, where 40 per cent of respondents report being employed on these grades. Meanwhile Chart 8 shows that organisational pay systems are the norm for FE/HE employees (96 per cent), where they are likely to be paid on university or college grading systems, for the independent sector (78 per cent) and charities/voluntary sector groups (66 per cent). 15

17 Chart 6: Use of Agenda for Change by sector Chart 7: Use of clinical grades by sector 16

18 Chart 8: Use of organisational pay systems by sector For those respondents not paid on AfC or clinical grades, we asked them to indicate their hourly or annual pay levels. A very small number of respondents (three per cent) are paid at 2012 national minimum wage levels ( 6.19 per hour or 12,103 annual equivalent). Around four per cent are paid below Living Wage levels ( 7.45 per hour or 14,567 annual equivalent). The majority (81 per cent) earn 25,000 per year or more. 17

19 Chart 9: Levels of pay for respondents on organisational pay systems (n=211) 5.2 Unsocial hours payments Respondents were asked whether they received additional payments for unsocial hours. Around half (51 per cent) stated that they receive these payments, with highest response among NHS 24, bank/agency, and NHS hospital workers. Unsocial hours payments are enhancements to staff whose standard working week can include evenings, early mornings, weekends, bank holidays and nights. 18

20 Chart 10: Unsocial hours payments by sector Chart 11 indicates that of those receiving unsocial hours payments, 74 per cent receive higher rates, 22 per cent receive normal rates and 3 per cent receive lower rates. Chart 11: How unsocial hours are paid (all respondents receiving unsocial hours payments, n=847) 5.3 Views about current pay band or grade Respondents were asked whether they thought that their current pay band or grade was appropriate in view of their roles and responsibilities. Chart 12 shows that 42 per cent thought their pay band/grade was appropriate, compared with 32 per cent who regarded it as inappropriate. These figures are broadly similar to those from the 2011 survey when 44 per cent stated their pay band or grade was appropriate. 19

21 I feel it was [appropriate] three to four years ago, I see more minor illness, self manage, extended nursing role, manage a small team that can be challenging. We are also expected to keep up to date, do more while pays are frozen. Even a rise in line with cost of living would be more appropriate. Nurse practitioner, GP practice, AfC band 7 In general I feel that nursing is an underpaid profession compared to other professions requiring university level education, which often involve less responsibility. Staff nurse, NHS Bank, AfC band 5 I believe nurses should be paid more due to the duties and responsibilities of their job and the amount of training they are required to have to undertake these roles. Staff nurse, NHS community outpatients, AfC band 5 Chart 12: How appropriate do you consider your current pay band/grade to be given your role and responsibilities? (n=1,666) Below we set out some of the specific concerns made by health care assistants/support workers, band 5 staff nurses, GP practice nurses and those employed in independent sector care homes. Nursing staff employed on bands 1-4 often compare themselves to other colleagues level of pay and responsibility, or their own cost of living, and deem their pay to be insufficient. Meanwhile, a common issue raised by Agenda for Change band 5 nurses is a judgment that the pay band does not reflect their level of responsibility and that there is little prospect of promotion. Practice nurses paid on local pay rates often feel underpaid in 20

22 comparison to colleagues paid on Agenda for Change rates. Among the varied concerns identified by respondents working in independent sector care homes, a commonly voiced issue was underpayment for unsocial hours. Agenda for Change bands 1-4 I am a lone worker, I carry a pager, I do cannulation, venepuncture and ECGs. I believe that this should have been band 4. Health care assistant, NHS hospital ward, AfC band 3 I and the rest of the HCAs/nursing auxiliaries are on band 2 the same as a porter/domestic yet we have more responsibilities and skill levels. Health care assistant, NHS hospital ward, AfC band 2 Agenda for Change band 5 I work in a high dependency unit with specialist skills in endoscopy procedures. The level of constant responsibility is not reflected in the pay. Staff nurse, NHS hospital unit, AfC band 5 We currently have many extended roles. These roles can vary vastly from ward to ward and there is no incentive within the banding system to learn other clinical skills. We are often asked to go to other wards to perform certain tasks but these skills are not taken into account in our pay band. Staff nurse, NHS hospital ward, AfC band 5 We are at the front line for the hospital, with potential risk of harm in this unpredictable day and age. Staff nurse, NHS hospital unit, AfC band 5 GP practice nurses There is no scale for practice nursing. I have all required certificates and feel am underpaid for service given. Salary range 25,001-35,000 Working at an advanced level with extended prescribing and some triage. Equivalent trained nurses I have met on courses say they are top band 6 or 7. Salary range 21,001-25,000 Not on Agenda for Change GP practices can pay you what they want. Salary range 21,001-25,000 Independent sector care homes Working night shift, only qualified nurse on duty for 50 clients, do not get extra for working unsocial hours. Sister, salary range 25,000-35,000 21

23 I work nights but don t get paid for working unsocial hours. Staff nurse, salary range 21,000-25,000 Full responsibility on shift, for both residents and staff. Manager only works 9-5, although is available on-call. Work night-shift and weekends without any enhancements. No pay rise or well under inflation pay rise every year, pay has not risen with cost of living expenses. Staff nurse, salary range 21,000-25, Reasons for dissatisfaction with pay and grading The main reason given for feeling that the level of pay or grade is inappropriate is that it is not felt to match the level of responsibility, autonomy and intensity of the job. Similar reasons that the pay or grade does not match the individual s knowledge and skills held or level of experience are also frequently cited reasons. Other respondents compare themselves to other professions and deem nursing to be poorly paid. Other explanations show how many nursing staff feel they are working to a level unrecognised by their pay band or grade due to increased workload or expanded role while others feel stuck in their pay band with no room for progression. 22

24 Figure 1: Main reasons given for judging pay band/grade as inappropriate 23

25 Pay does not sufficiently match the levels of responsibility, autonomy and intensity of the job I have the responsibility level of senior charge nurse but do not get paid the same as a hospital-based senior charge nurse despite being a lone worker, team leader/manager, innovative practitioner. District nurse, AfC band 6 My responsibilities and work load expectations far outweigh the original job description for which my community nursing role was graded for. Community nurse, AfC band 5 I have a very autonomous role and solely make decisions regarding patient care, yet despite having most patient contact, I am the least paid in my team. I review patients at home, on the ward, and run a nurse led clinic. Clinical nurse specialist, NHS hospital unit, AfC band 7 Banding does not reflect the often highly technical, specialist knowledge and skills held, whether in a clinical, research or teaching role I am specialist trained to first assist surgeons skills but this is not reflected in payband. Nurse practitioner, NHS hospital unit AFC band 6 I work within a specialist team providing expert advice to staff and the public. This job, due to the autonomy and high level decision making that is required warrants a higher pay scale. Health protection nurse specialist, AfC band 6 The technical skills involved are greater than that of a band 5 nurse. Staff nurse, NHS hospital unit, AfC band 5 High level of responsibility related to child protection work. Autonomous work, responsibility for caseload of 300 cases. Health visitor, AfC band 6 24

26 Pay does not sufficiently reflect or compensate the workload Caseload/role has expanded, and pay level does not sufficiently reward this Pay grade is in no way near to the ever increasing workload. It does not take into account unpaid breaks that are never taken, extra work after shift completed or staff attending training/work unpaid in their own time. Staff nurse, independent sector care home, Salary range 21,000-25,000 My workload has increased. My skills have developed, my pay does not fairly represent this (and will not in the future) Staff nurse, NHS hospital ward, AfC band 5 We have had no pay increase for two years and we have been told there will be none in the foreseeable future but are given more and more responsibilities. Staff nurse, independent sector care home, Salary range 21,000-25,000 We have no band 6 now. I have to make decisions on a daily basis because there is no-one who clinically leads the team. Increased stress. NHS community nurse, AfC band 5 The responsibility is more than before since qualified staff reduced in number, doing additional duties that we all have had to take on and acting more as supervisors of HCWs, so should be band 6. Staff nurse, NHS hospital outpatients, AfC band 5 The nurse s role is extending all the time, as is paperwork. We are constantly short staffed so we are doing the work of one and half nurses. Staff nurse, NHS hospital ward, AfC band 5 25

27 Pay grade does not adequately reward or reflect experience in nursing With my experience, qualifications and working at a high level, a band 8 would be more appropriate, but they are kept for management. The top of band 7 is the ceiling unless I wanted to go into management. Nursing is losing staff and not rewarding experience where staff want to remain in the clinical setting. Our medical colleagues seem to be able to achieve this with very attractive salaries. Nursing seems to turn its back on expertise and vast experience. Sister/ charge nurse/ward manager, NHS acute/urgent care AfC band 7 The level of responsibility and educational and practical experience to reach this grade dealing autonomously with complex patients is not reflected in the salary. Clinical nurse specialist, AfC band 7 Comparisons made to other professions, or the market rate judging that nursing salaries are lower/comparatively poorly paid The training, responsibilities, continued learning and ongoing courses and long hours. Teachers and police are well paid for the job they do. The nursing service is not an attractive place to work anymore. Low morale, reduced staff, increased sickness due to stress and poor pay. Manager, hospice, AfC band 5 The pay scales should be reviewed. As a staff nurse with one year s experience I don't feel that nursing is paid fairly in relation to other professions. Staff nurse, NHS hospital ward, AfC band 5 26

28 Stuck in current pay band/grade with few opportunities for progression Pay or grade does not adequately reflect role following a restructuring or redeployment I work beyond pay grade 5 but management will not upgrade to 6 due to salary costs. Clinical nurse specialist, NHS hospital ward, AfC band 5, I work to a band 6 but don't get paid for it as there are no band 6 posts to apply for. Staff nurse, NHS hospital unit, AfC band 5 I am the most senior nurse on duty most days with the most responsibility and working with junior staff earning same rate of pay as I have been on top increment for years with no scope to progress. Staff nurse, NHS hospital unit, AfC band 5 We are working at a higher level than we are being paid. Higher banded posts are not being replaced like for like. More of the higher banded work is being placed on existing and remaining staff members. Staff nurse, NHS hospital unit, AfC band 5, The role is autonomous with limited on site support and facilities. It was always a minimum band 6 role but as people have retired they have been replaced with band 5 nurses despite the role now requiring you to have extended skills as well as being a non-medical prescriber. Staff nurse, NHS hospital unit, AfC band Management responsibilities in the NHS From the comments given by respondents, we identified a particular concern over pay and grading among NHS nursing staff with management responsibilities. General concerns about their level of responsibility appear to be directed into expressions of dissatisfaction with their pay and grading. There is a specific concern that colleagues employed on lower AfC bands can receive comparable or even higher take-home pay after working unsocial hours. Managerial responsibilities Band 6 nurses and band 5 nurses are paid more monthly as unsocial hours gives them a boost to their salary. Sister/charge nurse/ward manager, NHS hospital ward, AfC band 7 Working in ICU in a clinical and managerial post. Have 120 staff in my remit. Advanced nurse practitioners are being paid band 7 in this area with far fewer responsibilities. Sister/charge nurse/ward manager, NHS hospital unit, AfC band Pay and effects on household income Respondents were asked to indicate the proportion of total household income that their earnings represent. Chart 13 shows that 31 per cent reported that their earnings represent more than half of total household income and for 25 per cent, earnings represent all 27

29 household income. We can see therefore that 56 per cent of survey respondents are the main or sole earner in their households. Three per cent of all respondents in Scotland stated they are in receipt of Working Tax Credits, compared to six per cent in Four per cent of all UK respondents stated they received Working Tax Credits in this year s survey. Chart 13: Approximately what proportion of your TOTAL household income do your earnings represent? (n=1,664) Respondents were also asked about changes to their household income and expenditure over the previous year. Chart 14 shows that household expenditure has increased in over 88 per cent of cases, while income levels have remained the same for 54 per cent and fallen for 32 per cent. In line with these findings, 64 per cent of respondents said they are now more concerned about their financial situation compared with 12 months ago, while concerns about levels of personal debt have increased for 33 per cent of respondents and remained the same for almost 60 per cent. When asked about their major concerns over the coming year, among the most the common concerns were fuel and transport costs (59 per cent) increased food costs (45 per cent) and other household bills (42 per cent). A further 23 per cent said that cuts to their income and increased pension contributions were pressing concerns for the next 12 months. Over 40 per cent of nursing staff said that worries about job cuts and the threat of redundancy have increased in the last year. 25 per cent said their own job security was their most pressing concern for the near future while 21 per cent are worried about their partners job security. Work night-shift and weekends without any enhancements. No pay rise or well under inflation pay rise every year, pay has not risen with cost of living expenses. Staff nurse, independent sector care home 28

30 Having qualified at degree level I find that although the work is what I wanted to do the pay is poor for a graduate position. Also having had the pay freeze for the last few years I have in effect been taking a pay cut year on year. Staff nurse, NHS hospital unit, AfC band 5 Chart 14: Household income, expenditure and concerns about finances Table 8 looks in detail at patterns in household expenditure by country. Results for Scotland are broadly similar to those for the rest of the UK, yet concerns about job cuts and the threat of redundancy are markedly higher in the other UK countries than in Scotland. This is likely to reflect the Scottish Government s policy to avoid compulsory redundancies in the NHS and central government. 29

31 Table 8: Changes in financial situation over the last 12 months (by country) England Scotland Cymru/ Wales Northern Ireland Total Household income level (eg money coming in) has... Increased No ,364 % Stayed the No. 2, ,187 same % Decreased No. 1, ,535 % Total No. 4,415 1,666 1, ,086 % Household expenditure (eg outgoings) has... Increased No. 3,763 1,462 1, ,963 Stayed the same Decreased % No % No % % 2.5 Total No. 4,391 1,664 1, ,055 % Concerns about my financial situation have... Increased Stayed the same Decreased No. 2,698 1, ,005 % No. 1, ,727 % No % Total No. 4,374 1,652 1, ,022 % Concerns about my level of personal debt have... Increased Stayed the same Decreased No. 1, ,596 % No. 2, ,622 % No % Total No. 4,319 1,631 1, ,918 % Worries about job cuts and the threat of redundancy have... Increased Stayed the same Decreased No. 2, ,892 % No. 1, ,731 % No % Total No. 4,361 1,652 1, ,998 %

32 Analysis by age (Table 9) reveals that respondents aged 54 and under are most likely to be concerned about their financial situation, personal debt and job security than older respondents. Respondents in the youngest age group (18-25) are most likely to be starting out in their first job, often as newly registered nurses. The findings suggest that while paid employment immediately boosts their income, younger respondents are no less likely to feel the pressure of rising cost of living and job security. 31

33 Table 9: Changes in financial situation over the last 12 months (by age) Total Household income level (eg money coming in) has... Increased No % Stayed the same No % Decreased No % Total No ,657 % Household expenditure (eg outgoings) has... Increased No ,456 % Stayed the same No % Decreased No % Total No ,655 % Concerns about my financial situation have... Increased No ,052 % Stayed the same No % Decreased No % Total No ,643 % Concerns about my level of personal debt have... Increased No % Stayed the same No % Decreased No % Total No ,622 % Worries about job cuts and the threat of redundancy have... Increased No % Stayed the same No % Decreased No % Total No ,643 %

34 Looking just at worries about job cuts and the threat of redundancy, Chart 15 shows that those working for charities/voluntary sector groups (47 per cent) and NHS hospitals (42 per cent) were most likely to express anxiety even though there is a no compulsory redundancy agreement in NHS Scotland. Those working for GP practices (17 per cent) were least likely to be worried about job security. Chart 15: Worries about job security and the threat of redundancy have increased over the previous 12 months 5.5 Changing jobs This year s survey asked whether respondents had applied for a job at a higher grade or band over the previous 12 months, to examine the extent of career progression. In total, 13 per cent had applied and of these, 35 per cent were successful. 20 per cent of these successful applications involved a change of employer. In addition to those respondents having applied for a job at a higher grade or band, a further nine per cent had changed jobs in the previous 12 months and of this number, 39 per cent had also changed employer. The main reason for seeking a new job was a positive one, as nursing staff looked to gain different experience or skills (42 per cent). However, the next two reasons were more negative as 27 per cent stated they were dissatisfied with their previous job and 18 per cent cited stress or workload. Analysis of the findings showed little variation in whether respondents had applied for a job at a higher grade according to which sector they worked in or their age. 33

35 Chart 16: What are the main reasons you changed jobs and/or employer?* (n=234) *Respondents were asked to tick all that apply 34

36 6 Pension arrangements This chapter looks at current pension arrangements among survey respondents and attitudes to increased pension ages. Key findings There is almost full membership of the NHS pension scheme among those working in the NHS. Outside the NHS, 55 per cent of respondents working in the independent sector have no pension at all. From 2015 the retirement age for NHS staff will be linked to the state pension age, which is set to increase to 66 by 2020, 67 by 2036 and 68 by The majority (83 per cent) would not feel capable of working until 68, with only nine per cent stating they would feel capable. 91 per cent of those with a disability and 77 per cent of those with no disability stated they would not feel capable of working until the age of Current pension arrangements In respect of current pension arrangements, 85 per cent of all respondents belong to the NHS pension scheme, while 8 per cent have no pension at all. Chart 17: Which pension scheme do you belong to? (All respondents, n=1,677) Table 10 shows that the majority of members working in the NHS, for NHS Bank, NHS 24 and NHS Boards have an NHS pension, with the lowest incidence of take up of the scheme being among NHS Bank workers (90 per cent). 35

37 Table 10: Which pension scheme do you belong to? (All respondents working in the NHS) NHS pension scheme Other scheme None Total NHS hospital No % NHS community No % NHS24 No % NHS Bank No % NHS Board No % Total No. 1, ,221 % Table 11 shows that outside of the NHS, a high number of respondents working for independent sector providers (55 per cent) have no pension at all. This table also shows that membership of the NHS pension scheme is relatively high among respondents working for GP practices (99 per cent). Respondents working in FE/HE institutions are most likely to belong to another pension scheme usually a teaching or university public sector scheme. Table 11: Which pension scheme do you belong to? (Respondents working outside the NHS) NHS Private Personal Other None Total pension scheme scheme pension Independent No sector provider % GP No Charity/ voluntary sector % No % FE/HE No Total % No %

38 6.2 Working to age 68 From 2015 the retirement age for NHS staff will be linked to the state pension age, which is set to increase to 66 by 2020, 67 by 2036 and 68 by We asked respondents across all health care sectors about their attitudes to working until 68 to assess whether they think they would be able to cope with the nursing role at this age. Chart 18 shows that the majority (83 per cent) stated that they would not feel capable of doing so, with only nine per cent stating they would feel capable. In addition, 91 per cent of those respondents who indicated they have a disability stated that they would not feel capable of working beyond 68. Chart 18: In my current role, I would feel capable of working until the age of 68 (n=1,673) 37

39 7 Training and continuing professional development This chapter looks at training and continuing professional development (CPD), the nature and amount of training received in the previous 12 months, whether RCN members in Scotland have current training and development plans, and the use of appraisals/development reviews with line managers. Key findings: participation in mandatory training has increased slightly since 2011 respondents in Scotland are less likely to receive most types of mandatory training than colleagues in the rest of the UK particularly England most mandatory training is completed in work time, but a significant proportion (41 per cent) of respondents report completing their last training session either in their own time or split between work and their own time 38 per cent of mandatory training is conducted through face-to-face learning, 39 per cent is delivered through e-learning and 23 per cent through a mixture of face-to-face and e-learning 41 per cent received no CPD provided or paid for by their employer, compared to 30 per cent in per cent have a personal training and development plan and 59 per cent have had an appraisal/development review in the previous 12 months. 7.1 Mandatory training Respondents were asked first to report on the nature of mandatory training received in the last year. Across all respondents, fire safety was the most prevalent mandatory training sessions given, having been undertaken by 74 per cent in the last 12 months, followed by moving and handling (56 per cent) and cardio-pulmonary training (55 per cent). A small number (nine per cent) said they have received no mandatory training in the last year. Chart 19 shows that slightly higher numbers of respondents reported receiving almost all types of mandatory training than two years ago. 38

40 Chart 19: Mandatory training received in 2013 compared to 2011 Involvement in mandatory training is lower for respondents in Scotland than colleagues in the rest of the UK across all categories, with the widest gaps for infection control, health and safety and equipment training. 39

41 Chart 20: Mandatory training received in 2013, Scotland compared to rest of the UK Table 12 provides a comparison of findings with the 2011 survey and appears to show that the incidence of training reported by members working in the independent and voluntary sectors has increased across all types of training. Findings for NHS respondents, however, appear to be broadly similar. 40

42 Table 12: Comparison of mandatory training with 2011 employment survey NHS excluding GP practices (n=578) NHS excluding GP practices (n=1,271) Independent & voluntary sector (n=135) Independent & voluntary sector (n=68) % % % % Fire safety Health and safety Moving and handling Infection control Equipment training CPR None Other Chart 21 shows that 59 per cent of all respondents completed their last mandatory training session in normal working time; 23 per cent completed in their own time with the remainder (19 per cent) spreading the training over working and personal time. Respondents in NHS community and hospital settings are most likely to report being able to complete their training in work time, while bank/agency and independent sector care home employees are most likely to report undertaking training in their own time. I do most of my mandatory online training in my own time because it s difficult to find time to do this at work. Staff nurse, NHS mental health unit, AfC band 5 41

43 Chart 21: When did you complete your last mandatory training session? 38 per cent of respondents stated that their last training session was delivered on a face-toface basis, with 39 per cent stating it was delivered through e-learning and 23 per cent stating it was delivered through a mixture of face-to-face and e-learning. Respondents working in GP practices and charities/voluntary sector are most likely to report undertaking face-to-face training, while e-learning is most reported by those in NHS community and hospital settings. 42

44 Chart 22: How did you complete your last mandatory training session? 7.2 Continuing professional development We asked respondents about the amount of CPD or non-mandatory training received in the last 12 months. In total, 59 per cent of all respondents have received training that has been provided or paid for by their employer, lasting from a minimum of one day to more than two months in duration. 41 per cent received no CPD provided or paid for by their employer, compared to 30 per cent in per cent of respondents working in NHS hospital settings, 32 per cent in NHS community settings, and 34 per cent in the independent sector received no training in the last 12 months, compared to just 12 per cent of those working in GP practices. Most respondents across all sectors received between one and six days training. 43

45 Table 13: Length of continuing professional development (by sector) NHS hospit al NHS community GP practice Independent sector Charity/ voluntary sector Total None No % days No % days No weeks 3-4 weeks Over 1 month % No % No % No % Total No ,381 While there is very little difference across the four UK countries in the provision and length of CPD training undertaken, Table 14 shows there is some variation in Scotland according to age of respondent, with the youngest nursing staff most likely not to receive any training at all, with 53 per cent of year olds having received none, compared to 39 per cent of year olds. Table 14: Length of continuing professional development (by age) Total None No % days No % days No % weeks No % weeks No % More than 2 No months % Total No ,657 Chart 23 shows the proportion of CPD provided and paid for by the employer compared to 2011, suggesting that respondents are less likely to have received funding for learning and 44

46 development than two years ago, with just 59 per cent having received any CPD, compared with 70 per cent in Chart 24 goes on to show that when CPD has been undertaken, respondents are just as likely to receive all of it paid for by their employer as in 2011, with over 80 per cent stating that the employer covers the whole cost. Chart 23: CPD provided/paid for by employer over the past year (2013 compared to 2011) 45

47 Chart 24: Proportion of training paid for by employer Chart 25 shows that while 45 per cent of respondents in Scotland report that the amount of CPD undertaken in the previous year is about the same as the previous year, 33 per cent state that is has decreased. These figures are almost identical to those for the rest of the UK. 46

48 Chart 25: Amount of CPD undertaken in 2013 (Scotland compared to the rest of the UK) 7.3 Personal training and development plans and appraisals Chart 26 shows that overall Scotland fares better than the rest of the UK for numbers receiving a personal training and development plan (PTDP) over the previous 12 months. 74 per cent reported having a PTDP in Scotland compared to 57 per cent in the rest of the UK. In particular, NHS and charity/voluntary sector respondents are more likely to have received a PTDP than colleagues in the rest of the UK. However, Charts 27 and 28 both paint a slightly different picture. Of those respondents with a PTDP, 69 per cent reported that their line manager was actively involved in drawing up the plan, compared with 76 per cent in the rest of the UK. Moreover, 59 per cent of respondents in Scotland stated they had had an appraisal or development check with their line manager in the previous 12 months, compared to 67 per cent in the UK. These figures suggest that overall, respondents in Scotland are more likely to have a personal training and development plan than colleagues working elsewhere in the UK, but that their appraisal and development exercise is more likely to be a meaningful one than for Scotland respondents. 47

49 Chart 26: Do you currently have a personal training and development plan? By sector (Scotland compared to rest of UK) Chart 27: Has your line manager been actively involved in drawing up this plan? By sector (Scotland compared to rest of UK) 48

50 Chart 28: Have you had an appraisal/development review with your line manager in the last 12 months? By sector (Scotland compared to rest of UK) 49

51 8 Working hours This chapter covers patterns of work, frequency of additional hours worked and how the extra hours are paid. Key findings Once again, we find a high frequency of overtime working, and that the overtime is usually unpaid. 54 per cent of respondents work extra hours on every shift or several shifts a week while among those working extra hours, 62 per cent are working over 2 hours overtime every week. 11 per cent of all respondents provide on call evening or weekend cover, with this arrangement most prevalent in charities/voluntary sector groups, nursing agencies and independent sector care homes. 18 per cent have additional paid work on top of their main job, with the most popular choices being bank nursing working for the same employer. Under 35s are most likely to have additional jobs in order to provide additional income. Workload and stress are the main personal concerns for nursing staff, ranked above all other concerns about their and their families health, their own job security and that of their partner or household income and expenditure. This work pressure is also leading to high levels of presenteeism, with nursing staff going to work when they are really too ill or unfit to work productively. Half of all respondents have worked on at least two occasions in the previous 12 months despite not feeling well enough to do so. Worries about working hours and work pressure are most acute among respondents working in the NHS and independent sector care homes, while they are least severe for those working for charities/voluntary sector groups and GP practices. The survey clearly demonstrates that work pressure means that nursing staff feel unable to give the level of care they would like to. And this chapter shows the vicious circle nursing staff find themselves trapped in high workloads are putting pressure on nursing staff, leading to worries about the the quality of care they feel able to provide; this in turn leads to even more stress onto the nursing workforce as they work increasingly levels of unpaid overtime and when they are not well enough to do so productively. 8.1 Patterns of work Chart 29 shows that 67 per cent of all respondents stated that they currently work full-time, 30 per cent work part-time and almost three per cent work occasional hours. 50

52 Chart 29: Working pattern in main job Analysis by age shows that the proportion of nursing staff working part-time rises markedly after respondents reach the age of 35 as individuals adjust their work-life balance. Table 15: Working pattern in main job (by age) Full-time Part-time Occasional/ various hours Total No ,119 % No % No % Total No ,659 %

53 8.2 Contractual and additional hours worked Chart 30 indicates that 71 per cent of respondents have a normal working week of between 30 and 37.5 hours a week and around 8 per cent work more than 37.5 hours. 13 Chart 31 presents data for bank and agency staff only, with 30 per cent working between 30 and 37.5 hours a week, 12 per cent working over 37.5 hours and 49 per cent working 29 hours a week or under. Chart 30: Normal hours worked all respondents Chart 31: Normal hours worked - bank/agency staff 13 In 2011, 65 per cent reported they had a normal working week of between 30 and 37.5 hours a week and 13 per cent work more than 37.5 hours. 52

54 Chart 32 shows that 35 per cent of all respondents state that they work in excess of their contracted hours several times a week (compared to 43 per cent in 2011) and 18 per cent work in excess of their contracted hours on every shift (compared to 13 per cent in 2011). Just 10 per cent of all respondents report never working additional hours. Chart 33 shows that of those who reported working excess hours, 38 per cent work up to 2 hours a week, and 30 per cent work between two and four hours per week. A further 12 per cent of respondents work an additional eight hours each week. Chart 32: How often do you work in excess of your contracted hours? (2013 compared to 2011) Chart 33: Number of additional hours worked on average each week (2013 compared to 2011) 53

55 Overtime working appears to be most intense in England with around 60 per cent reporting they work in excess of contracted hours either several times a week or every shift, compared to 54 per cent in Scotland. Of those who reported working overtime, 68 per cent of England respondents reported that they work over two hours on average per week, compared to between 62 per cent and 65 per cent in Scotland, Wales and Northern Ireland. Table 16: How often do you work in excess of your contracted hours? (by country) England Scotland Cymru/ Northern Total Wales Ireland Every shift No ,526 % Several times a No. 1, ,036 week % Once a week No ,262 % Less than once a No ,503 week % Never No % No. 4,392 1,657 1, ,890 % Table 17: Number of additional hours worked on average each week (by country) England Scotland Cymru/ Northern Total Wales Ireland Up to 2 hours No. 1, ,973 % Over 2 and up to 4 No ,790 hours % Over 4 and up to 6 No hours % Over 6 and up to 8 No hours % Over 8 hours No % Total No. 3,295 1, ,815 % per cent reported that they usually receive time off in lieu for overtime and just seven per cent are paid at normal rates. Over half all respondents (59 per cent) reported that their additional hours are usually not paid, thus revealing the huge reliance on nursing staff working unpaid overtime. This has increased from 54 per cent in

56 If I work an extra day then this is paid at my normal rate however I regularly also work between 30 mins to one hour extra each [on] of my usual work days and this is not paid. NHS Quality Assurance manager, AfC band 7 Members frequently told us about budget restrictions, meaning that controls were placed on overtime payments. Continually ask for it to be paid but told that if not agreed by line manager prior to doing it will not get additional hours paid. Sister/charge nurse/ward manager, NHS hospital ward, AfC band 7 A large proportion of members explained to us that workloads and staffing levels meant that it was often difficult for them to take time off in lieu. Extra hours are unpaid. Supposed to get time back in lieu but unable to get time back due to being seriously understaffed. Staff nurse, NHS hospital ward, AfC band 5 Meant to be time off in lieu...but due to shortage of staff and time limits put on how long you have to take them 9 times out of 10 you only manage a few hours back and lose the rest. GP practice nurse, AfC band 6 Chart 34: How additional hours are paid all respondents who work additional hours (2013 compared to 2011) 55

57 Table 18: How additional hours are paid (by country) England Scotland Cymru/ Wales Northern Ireland Total Not paid No ,127 % Time-off-in-lieu No ,711 % Paid at a No normal rate % Bank work No % Paid at a higher No rate % Combination No % Paid at a lower No rate % Total No. 3,291 1, ,801 % Working on call We asked respondents whether they worked on call, providing evening and weekend cover. Chart 35 shows that overall 11 per cent work on call, with members working in the independent sector or for charities/voluntary sector (mostly hospices), most likely to work this system. Chart 35: Do you work on call arrangements (by sector) n= 1,660 Most respondents who work on call arrangements (77 percent) work from home, a further 17 per cent do so from their place of work, and a small number have sleep-ins (2 per cent) from their workplace. 56

58 Chart 36: On call arrangements (all respondents working on call, n=173) 8.4 Additional paid work Around 18 per cent of all respondents undertake other paid work in addition to their main job (almost the same finding as in 2011). Of these respondents, 54 per cent report undertaking bank nursing with the same employer, a further 13 per cent undertake bank nursing with a different employer and 5 per cent work through a nursing agency. Respondents aged under 35 were most likely to undertake extra paid work to provide additional income, with 29 per cent taking other jobs (Chart 37). The most likely reason given by respondents given for doing additional paid work was to provide additional income (71 per cent) and this is particularly the case for younger respondents. A further 9 per cent said they wanted to maintain particular nursing skills. Table 19: Other jobs undertaken in addition to main job No. % Bank nursing with the same employer Bank nursing with a different employer Agency nursing Other non NHS nursing work NHS nursing management Care nursing home Non-NHS hospital Non-nursing work Other work

59 Chart 37: Do you have other paid work in addition to your main job (by age) 8.5 Views about working hours The data shows that 58 per cent of nursing respondents in Scotland report being under too much pressure at work and 62 per cent feel that too much of their time is spent on nonnursing duties both higher figures than found in 2011 and The impact of this is that 55 per cent of nursing staff feel unable to give the level of care they would like to. Another finding from this survey shows that workload and stress came top of members personal concerns for the near future, with 62 per cent rating it as their biggest worry, above job security, financial problems and their and their families health. 58

60 Chart 38: Views about working hours (2013 compared to 2011 and 2009) Charts 39 and 40 show respondents views about working hours, work pressure and work-life balance according to sector. Respondents working in the independent sector, NHS hospitals and NHS community settings consistently report lower satisfaction ratings than colleagues working in GP practices and charities/voluntary sector. 59

61 Chart 39: Views about working hours and working pressure (by sector) 60

62 Chart 40: Views about shifts and work-life balance (by sector) Chart 41 shows that 27 per cent of respondents stated that their working hours and domestic commitment frequently or always conflicted with each other and 50 per cent said they occasionally conflicted, with similar overall results to those in the 2011 employment survey. Chart 41: Do your hours of work conflict with domestic commitments? 61

63 8.6 Presenteeism Presenteeism has been a growing problem in the UK over the last few years, with employees feeling pressure to attend work despite feeling unfit or unwell. The 2012 Chartered Institute of Personnel and Development (CIPD) Sickness Absence Survey found that 30 per cent of employers responding to their survey reported an increase in the number of people coming to work ill in the previous 12 months, a slight increase on previous years. This figure has risen from 23 per cent in The CIPD states that the increase in presenteeism is in a large part due to the threat of redundancies and concerns over job security The CIPD warns that presenteeism is also a sign of anxiety and that failure by organisations to address employees concerns is likely to impact on morale and commitment and may lead to stress or mental health problems, with costly longer-term consequences. It goes on to state that organisations who have noted an increase in presenteeism over the past year are more likely to report an increase in stress-related absence over the same period. Chart 42 presents survey data on presenteeism and shows similar findings between Scotland and the rest of the UK with nearly 50 per cent of all respondents stating they had attended work two or more times in the previous 12 months despite not feeling well enough to do so. Chart 42: Over the previous 12 months, have you gone to work despite feeling that you really should have taken sick leave due to your state of health? Chart 43 shows that respondents working in in NHS hospitals or community settings and the indpendent sector are most likely to work despite being unwelll or unfit; while those working for GP practices and charities/voluntary sector groups are least likely to do so. 14 CIPD Annual Survey Report 2012: Absence Management 62

64 Chart 43: Over the previous 12 months, have you gone to work despite feeling that you really should have taken sick leave due to your state of health? (By sector) 63

65 9 Workload and staffing levels In the previous chapter, we reported on working hours and work-life balance, finding a workforce feeling under too much pressure, dissatisfied with their working hours and with their work-life balance. We found that in the main, this pressure stems from heavy workloads, work pressure and low staffing levels. Key findings: 54 per cent report a drop in the level of registered nurses over the previous 12 months 37 per cent report a drop in the level of health care assistants/support workers over the previous 12 months 30 per cent report a drop in the level of both registered nurses and health care assistants/support workers respondents working in NHS hospital, NHS community, independent sector hospitals and those working as bank or agency staff are most likely to report a decrease in the level of registered nurses and health care assistants in their workplace in the NHS, staffing levels are being managed by recruitment freezes (reported by 49 per cent), skill mix changes (38 per cent), the redistribution/redeployment of staff (28 per cent) and cuts to posts (23 per cent) 35 per cent of respondents working in the NHS report that changes in staffing levels are leading to increased patient/client caseloads. 9.1 Staffing levels Table 20 shows that across all respondents, 54 per cent reported that the levels of registered nurses had decreased and 37 per cent stated that levels had fallen for HCAs. This appears to be a continued trend, with a decrease in staffing levels also reported in Table 20: Changes in staffing levels Staffing levels have decreased Staffing levels have increased Registered nurses Health care assistants/ Health care support workers No. % No. % No. % No. % No change Not sure/don t know Total , , Charts 44 and 45 indicate that in general, reductions in staffing levels are most common among respondents working in the NHS. 64

66 Of all respondents reporting a change in staffing levels, 30 per cent told us that staffing levels for both types of nursing staff had decreased, suggesting an overall reduction in nursing staff within a large number of workplaces. The sectors where respondents were most likely to report a drop in overall staffing levels for both registered nurses and HCAs are: NHS hospitals (39 per cent) Independent sector (21 per cent) NHS community (23 per cent) By contrast, the least likely to report overall staffing level reductions are respondents working for GP practices (5 per cent). Chart 44: Changes in staffing levels of registered nurses by sector (all respondents) 65

67 Chart 45: Changes in staffing levels of HCAs by sector (all respondents) Tables 21 and 22 show that reduced staffing levels for both registered nurses and HCAs were slightly more likely to be reported by respondents working in England, Scotland and Wales than Northern Ireland. Table 21: Changes in staffing levels in the last 12 months registered nurses (by country) Yes, staffing levels have decreased Yes, staffing levels have increased There has been no change in staffing levels Not sure/do not know England Scotland Cymru/ Wales Northern Ireland Total No. 2, ,218 % No % No. 1, % No % Total No. 4,303 1,622 1, ,865 %

68 Table 22: Changes in staffing levels in the last 12 months HCAs/HSWs (By country) England Scotland Cymru/ Wales Northern Ireland Total Yes, staffing levels No. 1, ,266 have decreased % Yes, staffing levels No ,028 have increased % There has been no No. 1, ,527 change in staffing levels % Not sure/do not know No % Total No. 3,486 1,302 1, , Eight per cent reported that staffing levels had increased for registered nurses and 14 per cent that HCAs numbers had risen. The box below provides some of the reasons given by respondents for recent increase in workforce numbers; in some case staffing numbers have risen following previous cuts which had led to difficulties. Increased staffing numbers We have been understaffed with job freezes until very recently when 250 extra theatre staff [were announced] to help with the HUGE waiting list! Staff nurse, NHS hospital, AfC band 5 Use of workload tools regarding patient needs had shown more trained staff were required. Staff nurse, NHS hospital unit, AfC band The impact of sickness absence and maternity leave In many cases we heard that while staffing numbers had not decreased, high levels of sickness absence and non-coverage of maternity leave mean that staffing levels were put under increased pressure. Staff on sick leave and no backfill. Existing team having to absorb workload. Clinical nurse specialist, voluntary sector organisation, AfC band 6 Nurse practitioners within the team on maternity/sick leave and career breaks. Posts unable to be covered due to lack of suitably trained persons. NHS Nurse practitioner, AfC band 7 Two maternity leave and long term sick leave with little availability of qualified bank staff. Sister/charge nurse/ward manager, NHS hospital unit, AfC band 7 67

69 9.3 Staffing levels and workplace change in the NHS The previous section of this chapter showed a high number of respondents reporting reduced staffing numbers for both registered nurses and health care assistants. This section looks at the impact of falling workforce numbers in the NHS and how staffing levels are being managed. Recruitment freezes and reductions in staffing levels Vacancies not being filled. Continual issues with staffing levels for past few years. Sister, NHS hospital unit, AfC band 7 Staff have retired/left for other jobs in NHS and their posts have not been filled. Staff nurse, NHS hospital ward, AfC band 5 In a similar finding to the 2011 survey, we once again find a high proportion of respondents (49 per cent) stating that their workplace had instigated recruitment freezes with posts left unfilled (52 per cent in 2011). Staffing levels are also being managed by skill mix changes (38 per cent compared to 28 per cent in 2011), the redistribution or redeployment of staff (28 per cent in 2013; 26 per cent in 2011) and bans on the use of bank or agency staff (15 per cent). Skill mix changes and redistribution/redeployment of staff I was seconded elsewhere for nine months and my duties were redistributed among the team. Sister/charge nurse/ward manager, NHS outpatients, AfC band 7 Previously we had three practice nurses, now only me employed and two health care assistants now being trained to replace registered nurses. GP practice nurse, salary range 21,000-25,000 Respondents reported that changes to staffing levels are leading to an increase in patient or client caseload (35 per cent compared to 26 per cent in 2011). A further 18 per cent stated that services or wards have been merged or restructured and 11 per cent that wards or beds have been closed. Increase in patient/client caseload, merger/closure/restructuring of wards and services Juggling of the figures. Increase in high dependency patients with same levels of staff Staff nurse, NHS hospital ward, AfC band 6 Clinical activity has increased and we now operate electively 7/7. We also have introduced night duty and twilight shifts but only very recently have more staff been employed. Staff nurse, NHS hospital unit, AfC band 5. 68

70 Chart 46: If there has been a change in staffing levels, what changes have occurred in the last 12 months? Table 23 compares these findings with the other UK countries, with overall similar results across all four countries, particularly with regard to recruitment freezes with vacancies unfilled in their workplace. 69

71 Table 23: If there has been a change in staffing levels, what changes have occurred in the last 12 months? (By country) Recruitment freezes with vacancies unfilled England n=3,152 Scotland n=1,123 Wales/ Cymru n=943 Northern Ireland n=405 No. % No. % No. % No. % 1, Reduced staffing levels 1, Increase in patient/client caseload/beds Skill mix change within your area of work Redistribution/redeployment of staff Role expansion eg senior staff cover wider areas 1, , Posts cut Fewer opportunities for access to clinical supervision/mentoring Services/wards merged or restructured Bank or agency ban Ward/bed closures Other changes in last 12 months Redundancies Respondents in the NHS were asked to comment on their own workplace experiences over the past 12 months in relation to nine key areas (including downbanding and moving to a new role), and their expectations for the same nine areas over the next 12 months. Chart 47 shows the results for NHS respondents, and while changes in shift pattern or a move to a new role can occur under any circumstances other findings show more significant changes to working conditions, such as transfer within the NHS to a different organisation (experienced by four per cent and expected by another six per cent), cuts to terms and conditions (experienced by eight per cent in the last 12 months and expected by 13 per cent), and downbanding (experienced by three per cent). 70

72 Chart 47: Changes over last 12 months and expected in next 12 months, NHS respondents only 71

73 Looking at workplace change according to UK country in Table 24, we find that respondents working in Scotland are generally affected less than colleagues in other countries, particularly in England. Table 24: Changes over last 12 months by country (NHS respondents only) England n=2,402 Scotland n=913 Wales/ Cymru n=737 Northern Ireland n=294 No. % No. % No. % No. % Changes in shift patterns Move to new role Cuts to pay, terms or conditions Downbanding Reduced hours Retirement Redundancy Transfer within the NHS to another NHS organisation Transfer out of the NHS to another employer (eg social enterprise/ independent sector) Other transfer to a different organisation

74 Table 25: Changes expected in next 12 months by country (NHS respondents only) England n=2,402 Scotland n=913 Wales/ Cymru n=737 Northern Ireland n=294 No. % No. % No. % No. % Changes in shift patterns Cuts to pay, terms or conditions Move to new role Downbanding Reduced hours Redundancy Retirement Transfer within the NHS to another NHS organisation Transfer out of the NHS to another employer (eg social enterprise/ independent sector) Other transfer to a different organisation

75 10. Nursing as a career The last chapter looks at responses to statements about working in nursing, designed to evaluate levels of morale and motivation among the nursing workforce. Many of the statements have remained unchanged in the series of RCN employment surveys and where possible, we have displayed previous findings and in many cases, we are able to show ten-year trend data. Nursing is a rewarding career: 65 per cent (70 per cent in 2011). I would recommend nursing as a career: 38 per cent (47 per cent in 2011). I regret choosing nursing as a career: 14 per cent. Most days I am enthusiastic about my job: 65 per cent (71 per cent in 2011). Nursing will continue to offer me a secure job in years to come: 36 per cent (34 per cent in 2011). I would not like to work outside nursing: 35 per cent (41 per cent in 2011). I have considered leaving my job in the past 12 months: 60 per cent. It will be difficult for me to progress from my current grade: 76 per cent (70 per cent in 2011). My manager provides me with opportunities to keep up with new development related to my job: 43 per cent (51 per cent in 2011). I am unable to take time off for training: 37 per cent. 73 per cent are under increased stress and 81 per cent have increased workloads compared to 12 months previously. Compared to 12 months ago, I have fewer opportunities to work flexibly: 47 per cent. Compared to 12 months ago, my job is more stimulating or interesting: 24 per cent. This chapter looks at some key indicators of organisational culture including bullying and harassment, management support and occupational health provision. The survey finds a high number of respondents with recent, personal experience of bullying and harassment: 31 per cent report they have been bullied or harassed by a team member or manager in the previous 12 months and 41 per cent have experienced harassment or violence from a patient/client or a patient/client s relative. Disabled respondents were both more likely to report bullying and harassment than non-disabled respondents and they would not be confident that these cases would be dealt with fairly. Similarly, black and minority ethnic (BME) respondents were more likely to report bullying and harassment than white colleagues Views about nursing as a career Chart 48 shows a downward trend in members views about nursing as a career since the survey was undertaken in While 65 per cent believe nursing is a rewarding career (compared with 70 per cent in 2011 and 80 per cent in 2009), just 38 per cent would recommend nursing as a career to other people (40 per cent in 2011 and 58 per cent in 2009). Considering these findings above, it is somewhat encouraging to note that only 14 per cent actually regret choosing nursing as a career. It is also encouraging that 65 per cent remain enthusiastic about their job, albeit that this proportion has fallen from 80 per cent in 2009). 74

76 While there has been a small improvement in the proportion of respondents stating that nursing would offer job security in the future, the figure has fallen by 46 per cent since 2009, with just 36 per cent stating that nursing would continue to offer a secure job in years to come. In addition, 35 per cent of respondents agreed that they would not want to work outside nursing, compared to 52 per cent in Chart 48: Views about nursing as a career (2013 compared to 2011 and 2009) Chart 49 compares figures regarding nursing as a career for Scotland respondents with the rest of the UK and suggests that broadly similar views are held across the whole of the UK, and, if anything, that nursing staff in Scotland are slightly more pessimistic than colleages working elsewhere. 75

77 Chart 49: Views about nursing as a career (Scotland compared to the rest of the UK). Chart 50 breaks down views about nursing according to the sector of work. In general, nursing staff working in GP practices, the independent sector and charities/voluntary sector are the most positive about nursing as a career. 76

78 Chart 50: Views about nursing as a career (by sector) Chart 51 demonstrates that 60 per cent of respondents stated they had considered leaving their job, with the highest proportion among independent sector staff (77 per cent). Chart 52 shows that respondents aged were most likely to have considered leaving their job in the previous 12 months (65 per cent). Chart 51: In the last 12 months, I have considered leaving my job (by sector) 77

79 Chart 52: In the last 12 months, I have considered leaving my job (by age) 10.2 Career progression and professional development Chart 53 suggests that respondents are increasingly despondent about opportunities for career progression and professional development. 76 per cent stated it will be very difficult to progress from their current grade, an improvement since 2009 (65 per cent), but a slight decrease since 2011 (81 per cent). Moreover, 43 per cent believe that their employer provides sufficient opportunities to keep up with new, job-related developments (compared to 56 per cent in 2011 and 57 per cent in 2009) and 37 per cent stated they cannot take time off for training (compared to 33 per cent in 2011 and 35 per cent in 2009). 78

80 Chart 53: Views about career progression and professional development (2013 compared to 2011 and 2009) 79

81 Chart 54: Views about career progression and professional development (by sector) 10.3 Views about working hours, workload and stress Chart 55 shows that in total 73 per cent of all respondents stated they felt under increased stress now than they did 12 months previously with levels highest among those working within the NHS and independent sector, while all respondents have experienced increased workloads over this period. Looking at different age groups in Chart 56, there is a small dip in reported levels of stress and workloads among respondents aged 55 and above, but the majority of respondents report increased individual stress and workloads. 80

82 Chart 55: Compared to 12 months ago, I am under increased stress/my individual workload has increased (by sector) Chart 56: Compared to 12 months ago, I am under increased stress/my individual workload has increased (by age) 81

83 Chart 57 shows that 47 per cent of all respondents stated that there were fewer opportunities for flexible working compared to 12 months ago, with nursing staff working in NHS hospitals most likely to state that opportunities had been reduced (53 per cent). Respondents in older age groups were slightly less likely to report having reduced flexible working opportunities. Job satisfaction against the measure of whether jobs are more interesting/stimulating is highest among younger respondents, with 47 per cent of year olds confirming that their job is more interesting or simulating, compared with just a quarter (25 per cent) of year olds. Chart 57: Compared to 12 months ago, I have fewer opportunities for flexible working/my job is now more interesting/stimulating (by sector) 82

84 Chart 58: Compared to 12 months ago, I have fewer opportunities for flexible working/my job is now more interesting/stimulating (by age) We asked respondents about their professional and personal concerns, and once again as shown in Chart 59 workload and stress are two of the main sources of anxiety among nursing staff. 62 per cent of respondents in Scotland and similarly across the rest of the UK cite workload and stress as a major concern. Other main sources of worry relate to income and expenditure, including fuel and transport costs (63 per cent), food costs (47 per cent) and other household bills (43 per cent) as well as increased pension contributions (37 per cent). 31 per cent are concerned about changes to their own job description or role and 25 per cent expressed concerns about their own job security and health. 83

85 Chart 59: Main concerns facing respondents (Scotland compared to rest of UK) 10.5 Staff wellbeing and support A study led by the National Nursing Research Unit at King s College London explored the links between patients experiences of health care and staff experiences at work, including staff motivation and wellbeing. 15 The authors state that wellbeing at work includes physical wellbeing but also covers an individual s subjective experience and functioning at work, including job satisfaction and motivation. The study found several factors that are linked to 15 Maben J, et al (2012) Exploring the relationship between patients experiences of care and the influence of staff motivation, affect and wellbeing. National Institute for Health Research 84

86 good patient-reported experience including team support, organisational climate and management support. We are under significant pressures to meet targets of times allowed for calls and bullied into reducing time talking/listening to patients. Yet we are expected to take full responsibility for the calls and ensuring patient safety. Now being expected to supervise non-clinical staff to make decisions of a clinical nature Clinical nurse specialist, NHS24, AfC band Bullying and harassment In this section we look at key indicators of organisational culture: bullying and harassment; management support and occupational health provision. We find a high level of bullying and harassment from team members or managers and a high level of harassment and violence from patients/clients or members of their family. Disabled members are the least confident that these incidents will be dealt with fairly. 52 per cent of all respondents agreed that their manager provided support when needed, and a similar proportion agreed that their employer provides good occupational health support for staff, thus presenting a pessimistic overall picture of organisational culture in health care. Looking first at the extent of bullying and harassment in the workplace, Chart 60 shows that just under a third (31 per cent) of all respondents reported having personally experienced bullying or harassment from a team member or manager in the previous 12 months while two fifths (41 per cent) reported having personally experienced harassment or violence from a patient/client or their family. In the RCN employment survey in 2011 for Scotland, 32 per cent reported bullying or harassment from a team member or manager and 38 per cent reported harassment or violence from a patient/client or their family. The findings are almost identical to this year s figures for the rest of the UK with 31 per cent reporting bullying or harassment from a team member or manager and 38 per cent reported harassment or violence from a patient/client or their family. The incidence of harassment or violence is markedly higher among respondents working in the independent sector with 58 per cent reporting harassment or violence from a patient/client or their family and 33 per cent reporting bullying or harassment from a team member or manager. The proportion of respondents in NHS hospitals reporting harassment or violence from a patient/client or their family was also particularly high, with 50 per cent stating they had personal experience of this from the previous 12 months (Chart 60). 85

87 Chart 60: In the last 12 months, I have personally experienced bullying or harassment from a team member or manager/ I have personally experienced harassment or violence from a patient/client or their family (by sector) Chart 61 shows the data on bullying, harassment and violence according to respondents age, with youngest respondents (aged 18-25) least likely to report having personal experience of either bullying and harassment by team members and managers or harassment and violence from patients/clients or their families. 86

88 Chart 61: In the last 12 months, I have personally experienced bullying, harassment or violence (by age) Respondents with a disability are much more likely to report having experienced bullying or harassment from a team member or manager in the previous 12 months than those with no disability. 52 per cent of those with a disability reported bullying or harassment compared with 30 per cent of those without a disability. In contrast, there was no difference in the incidence of harassment or violence from patients/clients or their families. We looked at the issue of bullying and harassment in wider context and asked respondents whether this was a general problem in their own workplace and whether they or their colleagues would get treated fairly if they reported it. 41 per cent of all respondents stated that bullying and harassment is not a problem in their workplace, falling from 55 per cent in 2009 and 43 per cent in There has also been a drop in the proportion of respondents stating they would feel confident that they would be treated fairly if they reported being bullied or harassed by a colleague (from 50 per cent in 2009 to 44 per cent in 2013). This year, 43 per cent reported they would feel confident that colleagues would be treated fairly if they reported being harassed at work by another member of staff. Respondents working in GP practices (66 per cent) are most likely to state that bullying and harassment is not a problem within their workplace, while those working in NHS hospitals (34 per cent) are the least likely. Respondents working in GP practices are most likely to state they felt confident that they or they colleagues would be treated fairly if they reported being harrassed at work by another member of staff, and respondents working for NHS hospitals are the least likely. 87

89 Chart 62: Views about bullying, harassment and violence (by sector) A much smaller proportion of disabled respondents see their workplace as having a problem with bullying and harassment than non-disabled respondents, with 24 per cent stating it was not a problem in their workplace compared to 42 per cent of non-disabled respondents 16. Confidence is much lower among disabled respondents that they or their colleagues would be dealt with fairly in the case of bullying or harassment than non-disabled staff. Among disabled respondents 28 per cent stated that they were confident that they would be treated fairly if they reported harassment by a colleague and 25 per cent said they were confident their colleagues would be treated fairly if they reported bullying or harassment; this is compared to 45 per cent of non-disabled respondents for both questions respondents reported they had a disability. 88

90 Employer support in the workplace 52 per cent agreed that their manager provided support when needed, (a decrease since the 2009 response of 59 per cent) and a slightly higher number (56 per cent) stated that their employer provides good occupational health support for staff, (compared to 59 per cent in 2011). A follow up question about occupational health asked about the ability to self refer to services, with 82 per cent stating they could access occupational health services. The highest scores for managers support to staff are among respondents from GP practices (59 per cent) and charities/voluntary sector. Meanwhile, the lowest scores were among those working in the independent sector (42 per cent). Respondents working in NHS community settings (63 per cent) and NHS hospitals (60 per cent) are most likely to state that staff had good occupational health support, while those working in the independent sector (22 per cent) and GP practices (38 per cent) were least likely to state that support was good. Chart 63: Views about management support (by sector) 89