RCN Employment survey 2013 for Wales

Transcription

1 RCN Employment survey 2013 for Wales January 2014 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 9,754 usable responses across the UK, with 1,365 usable responses from nurses working in Wales. Incomes Data Services was commissioned to administer the survey, but all analysis was undertaken by the RCN. The RCN employment survey has been ongoing since the 1980s and this is the 24th survey in the series. Surveys of RCN membership are broadly representative of the nursing workforce as a whole, thus the results of this survey of members can be taken to reflect the UK nursing workforce more generally. 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 Similarly to recent years, this year s employment survey has been undertaken in a time of uncertainty and flux for the NHS in Wales. The UK financial crisis and economic recession has resulted in the UK Government making considerable cuts in public spending. The Welsh Government has seen its grant from the UK Treasury reduce in real terms since This is set to continue until at least 2016, if the proposed cuts are fully implemented the total block grant will have been reduced by 12.2% 1 As the recent Wales Audit Office 2 states the NHS in Wales has faced significant financial pressures over recent years, which have been more extreme than those faces by the NHS in other parts of the UK. Both the Scottish Government and the UK Government decided to protect NHS spending between 2010 and 2014, and instead chose to makes cuts to local government funding. The Welsh Government however chose to cut the health budget by 8.6% in this time period. The future funding for the NHS looks more positive, in publishing the Welsh Government response to the Francis Inquiry the Minister for Health and Social Care, Mark Drakeford announced that he would be working with the Minister for Finance to review the NHS budget 1 Institute for Fiscal Studies (2013) Scenarios for the Welsh Government Budget to Wales Audit Office (2013) Health Finances and beyond. 1

3 ...to ensure that it reflects the lessons to be learned from Francis, that it acknowledges the additional burdens that face the health service and to ensure that there is a proper match between the quality of care and patient safety issues, and that there are the budgets to support them. 3 The recently announced Welsh Government s budget proposals see an increase in NHS funding of 180m in and 240m in The Welsh Government set out its vision for the NHS in Wales in its policy document Together for Health in 2011 in which the minister for health called for an action from each health board to set out its plan for creating sustainable services for all communities within one year. There are common themes across Wales which emerge from each of the health board plans. The plans propose to increase the volume of care delivered in the community by providing care at or closer to home with the intention of reducing the number of acute and or community hospital beds. The intention is that improvements in primary and community care services will reduce the presumed overuse of hospital beds as there is a widespread belief that many patients in hospital beds don t need to be there. The health board reconfiguration plans have not been well received and the Welsh Government has been asked to review a number of the proposals. Although involved in the South Wales Reconfiguration plans, Cardiff and the Vale Health Board also issued a Section 188 notification in June 2013, which outlined that over two hundred nursing jobs were at risk of redundancy. Of particular note this year is that the nursing profession has been under the public spotlight. In England the Francis Report published the findings of an inquiry into the services provided by the Mid Staffordshire NHS Foundation Trust between January 2005 and March This report and others which followed 4 noted that having too few nurses had an impact on nursing care and patient outcomes. In Wales, Betsi Cadwaladr Health Board has received highly critical reports on its mismanagement of a C. Difficile outbreak by Healthcare Inspectorate Wales (HIW) and the Wales Audit Office (WAO). The Minister for Health and Social Services has commissioned external independent review into the care provided at the Princess of Wales Hospital, Bridgend and Neath Port Talbot Hospital specifically looking at the care of older people. The latest figures available on nursing numbers were published by the Welsh Government in March 2012 and are from September They show that overall nursing numbers have remained broadly stable between 2008 and 2011, and pre registration places continue to rise, albeit slowly. Table 1 Nursing Numbers (from Welsh Government) 3 National Assembly for Wales debate 9 July Keogh B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England:overview report. National Advisory Group on the Safety of Patients in England (2013) Improving the Safety of Patients in England. 2

4 No. of nursing staff (includes HCSW) 32,124 33,021 33,012 32,787 WTE nursing staff (includes (HCSW) 27,806 28,199 28,168 27,999 No. of registered nurses 24,636 25,374 25,436 25,351 WTE registered nurses 21,461 21,790 21,823 21,737 Student nurse (pre-registration) commissioning figures 1,093 1,179 1,070 1,115 This is clearly good news and the RCN would hope that this picture remains constant for the next few years, however the RCN maintains that the current numbers of registered nurses and healthcare support workers in the NHS may be not be sufficient to ensure quality of care for the volume of work they are expected to deliver. Figures obtained by the RCN show that health boards (bar one) have spent over 161,500,000 on bank, agency and overtime payments on nursing staff over the past three years. 3

5 3 How to use this report This report presents the results of the 2013 RCN employment survey for Wales 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, country of work, 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 (i.e. England, Scotland and Northern Ireland) and for others we show a breakdown across all four UK countries. The UK report can be found at 4

6 4 Employment/respondent profiles This section summarises the main characteristics of respondents to the RCN s 2013 employment survey for Wales. 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 (90 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 Main employer and location of work Table 2 shows that just over three quarters reported that they work for the NHS (excluding GP practices) including for NHS authorities and boards, for NHS Bank or NHS 24. Seven per cent work in GP practices and six per cent work for independent/private health care providers. Other employers include private companies, charities/voluntary sector, further and higher education institutions, nursing agencies, 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 (19 per cent), outpatients/day care (5 per cent) or another hospital setting (2 per cent). A further 18 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 Student Unemployed Fully retired Self-employed Not currently working Total 1,

7 Table 2: Who is the employer for your main job? No. % NHS (excluding GP practices) Other NHS employer (eg Health Board) NHS Bank NHS 24/helpline GP practice Independent/private health care provider Private company Charity/voluntary group Further/higher education Nursing agency Local authority/other public body Self-employed Criminal justice Industry/workplace Not currently working Student Retired Total 1,

8 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 GP practice Care home Office/research/education setting Various (across organisation/s) Further/higher education Industry/workplace Hospice School Call centre Prison service Private clinic/hospital Ambulance trust Not currently working Student Total 1,

9 4.1.3 Main job title and area of practice Just over one third of respondents (36 per cent) identified their main job title as staff nurse. Senior nurses (including sisters, charge nurses, ward managers, matrons and nurse managers) make up almost 16 per cent of survey respondents. Table 4: Which one of the following job titles best describes your main job? No. % Staff nurse Clinical nurse specialist Sister/charge nurse/ward manager Community nurse Nurse practitioner Senior nurse/matron/nurse manager Practice nurse District nurse Manager/director Researcher/lecturer/tutor Occupational health nurse Health care assistant/nursing auxiliary Community psychiatric nurse Health visitor/scphn Quality assurance/risk Educator School nurse Midwife Public health practitioner Commissioning Consultant nurse Student Non-nursing job/work Retired Not currently working Total 1, In terms of area of practice, 26 per cent of respondents reported acute and urgent care as their main area of practice and 15 per cent work in primary and community care. 8

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 Mental health Older people Long-term conditions Children and young people Adult general/medical/surgical Learning disabilities Cancer care Palliative care Management/leadership Public health Workplace and environmental health Women s health Surgery/operating theatre Quality improvement and research Education School nursing Outpatients Neonatal e-health/telecare Non-nursing Midwifery Various Student Retired Not currently working Total 1, 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. Half of all respondents have been with their current employer for over 10 years and a quarter (24 per cent) between five and ten years. In terms of time in post, just over half (52 per cent) have been in their current post for over five years. 9

11 Chart 1: Length of service with current employer and time in current post Over 10 years Over 5 years, up to 10 years Over 2 years, up to 5 years Over 1 year, up to 2 years Less than 1 year % How long have you been in your current post? How long have you worked for your current employer? Chart 2 shows that respondents working in the NHS and for GP practices are more likely to have worked for the same employer for a longer period of time than those in the independent/voluntary sectors. Over half (55 per cent) working in NHS hospitals, six in ten (59 per cent) working in the community for the NHS and half of those working for a GP practice have worked for the same employer for 10 years or more, compared with 16 per cent of those working in the independent sector. For length of time in current post, general practice stands out with a higher proportion of nursing staff having worked in the same post for five years or more (69 per cent) compared to other sectors including NHS hospitals (55 per cent), NHS community (55 per cent) and the independent/voluntary sector (25 per cent). 10

12 Chart 2: Length of service with current employer by type of employer % NHS hospital NHS community Chart 3: Time in current post by type of employer 50 GP Independent/ voluntary sector Less than 1 year Over 1 year, up to 5 years Over 5 years, up to 10 years Over 10 years % NHS hospital NHS community GP Independent/ voluntary sector Less than 1 year Over 1 year, up to 5 years Over 5 years, up to 10 years Over 10 years

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 22 per cent aged 55 or over (Chart 4). In addition, 90 (7 per cent) respondents reported that they have a disability. Chart 4: Age breakdown of respondents (n=1,362) % By ethnic group, 95 per cent of respondents identified their ethnic group as white, with three per cent identified as black or another ethnic minority background. Table 6: Analysis of survey respondents by ethnic group n % White 1, Asian/Asian British Black/African/Caribbean Mixed/multiple ethnic groups Prefer not to say Total 1, Qualifications held Survey respondents were asked about the types of registration and qualifications held. Two thirds (67 per cent) have completed their first-level registration nursing qualifications and 12 per cent hold second level registration. In addition, two fifths hold a nursing degree (43 per cent) slightly fewer hold a diploma (37 per cent). 12

14 Table 7: Nursing qualifications held n % First level registration 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 Wales are paid on Agenda for Change pay bands; 6 per cent are on clinical grades and the remainder on local or organisational pay systems. Half (52 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. Half (49 per cent) view their pay band or grade as appropriate in view of their roles and responsibilities; 37 per cent view it as inappropriate. Over half of survey respondents (57 per cent) are the main or sole breadwinner in their household. There is a high level of financial anxiety, with 83 per cent of all respondents experiencing static or decreasing household incomes while 86 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 half 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. 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, 6 per cent are on clinical grades and the remainder are on other, organisational pay systems. For those respondents paid according to AfC pay bands, most are likely to be on band 5 (41 per cent), followed by band 6 (27 per cent) and band 7 (22 per cent). 14

16 Chart 5: Agenda for Change pay bands (n=1,088) % Almost all respondents working in the NHS and the majority of respondents working for NHS Boards (92 per cent) are employed on AfC terms and conditions. Chart 6 also shows that around a third of charity/voluntary sector employees (32per cent) are on contracts which pay AfC rates. Clinical grades are most used in GP practices, where two fifths (44 per cent) of respondents report being employed on these grades. Meanwhile Chart 8 shows that organisational pay systems are the norm for the independent sector (74 per cent). 15

17 Chart 6: Use of Agenda for Change by sector Independent sector 9.2 GP 18.0 Charity/voluntary sector 32.0 Bank/agency 62.5 NHS Board NHS All % Chart 7: Use of clinical grades by sector NHS 0.5 NHS Board 6.2 Bank/agency 9.4 Independent sector 17.1 Charity/voluntary sector 24.0 GP 43.8 All % 16

18 Chart 8: Use of organisational pay systems by sector Bank/agency 28.1 GP 38.2 Charity/voluntary sector 44.0 Independent sector 73.7 All % 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 (2 per cent) are paid at 2012 national minimum wage levels ( 6.19 per hour or 12,103 annual equivalent). Around 3 per cent are paid below Living Wage levels ( 7.45 per hour or 14,567 annual equivalent). The majority (72 per cent) earn 25,000 per year or more. 17

19 Chart 9: Levels of pay for respondents on organisational pay systems (n=147) 50,001 or more ,001 50, ,001 40, ,001 35, ,001 25, ,001 21, ,718 17,597 16,300 16,717 14,568 16,229 12,104 14,078 Up to 12, % 5.2 Unsocial hours payments Respondents were asked whether they received additional payments for unsocial hours. Around half (52 per cent) stated that they receive these payments, with highest usage among 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 Independent sector 15.8 Charity/voluntary 30.8 NHS community 47.8 NHS hospital 70.4 Bank/agency 79.4 All Chart 11 indicates that of those receiving unsocial hours payments, almost three-quarters (71 per cent) receive higher rates, a fifth (22 per cent) receive normal rates and 5 per cent receive lower rates. Chart 11: How are unsocial hours paid (all respondents receiving unsocial hours payments, n=696) % 5.0% 1.3% 22.3% Paid at a higher rate Paid at a normal rate Paid at a lower rate Other 71.4% 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 two fifths (44 per cent) thought their pay band/grade was appropriate, compared with 40 per cent who regarded it as inappropriate. These figures are broadly similar to those from the 2011 survey when 45 per cent stated their pay band or grade was appropriate. 19

21 Chart 12: How appropriate do you consider your current pay band/grade to be given your role and responsibilities? (n=1,348) % 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. 20

22 Figure 6: Main reasons given for judging pay band/grade as inappropriate Pay does not sufficiently match the levels of responsibility, autonomy and intensity of the job Banding does not reflect the often highly technical, specialist knowledge and skills held, whether in a clinical, research or teaching role Pay does not sufficiently reflect or compensate for the workload Caseload/role has expanded, and pay level does not sufficiently reward this Pay grade does not adequately reward or reflect experience in nursing Comparisons made to other professions, judging that nursing salaries are lower/comparatively poorly paid Stuck in current pay band/grade with few opportunities for progression Role had undergone a review and there is dissatisfaction with the progress or outcome of this review Pay or grade does not adequately reflect role following a restructuring or redeployment Told their post could not be reviewed or that they could not be promoted due to lack of funding 21

23 Pay does not sufficiently match the levels of responsibility, autonomy and intensity of the job Increased responsibility and autonomy (independent prescriber, nurse led clinics), take home pay is not significantly different to band 5 nurse with a few unsocial hours Clinical nurse specialist, NHS outpatients, Agenda for Change band 6 I work autonomously at times without a GP on site. I carry out telephone triage consultations but am paid an E grade for this. I believe that in secondary care I would be being paid Band 6 / 7 GP practice nurse, clinical grade E The responsibility and the potential risks in mental health nursing are extremely high and the pay does not reflect this at all. It is an incredibly undervalued role and yet utterly important - but this isn't recognised by 'management' or by our pay. On a night shift I am the only qualified nurse, managing a ward of 12 very unwell people with two HCAs Banding does not reflect the often highly technical, specialist knowledge and skills held, whether in a clinical, research or teaching role I have an equivalent role to a consultant, but get paid a band 7. Consultants, GPs and AHPs refer patients to me for my specialist advice and treatment. I also teach in addition to this. Clinical nurse specialist, NHS outpatients, Agenda for Change band 7 I have specialist nurse qualifications, but there has been no change in pay in many years compared to hospital nurses who have incremental increases despite updating courses and increase in responsibilities. If I didn t love the job I certainly would not be doing it for the money! I will not be taking on any extra work now or courses as GPs are very reluctant to pay despite new skills learned. No career structure at all. GP practice nurse, salary range 25,000-35,000 Staff nurse, NHS hospital unit, Agenda for Change band 5 22

24 Pay does not sufficiently reflect or compensate the workload Caseload/role has expanded, and pay level does not sufficiently reward this Weekend and evening working stopped for band 7, monthly car allowance for maintenance of a working car being stopped, no pay rise in two years. More complex patients requiring care in the community, workload increasing and always work over to ensure patient care maintained. District nursing team leader, Agenda for Change band 7 We work long hours, with very short staff. The workloads are increasing all the time. I work extra hours with no benefits, no pay increase. Staff nurse, NHS hospital unit, Agenda for Change band 5 Role and responsibility changed greatly over past 12 months. Paid only 500 more than team I manage and have responsibility for. Also now no Group OH manager in the team therefore taken on clinical responsibility along with other manager Private sector Occupational Health Manager, Salary scale 35,000-40,000 I do a very similar job to our current band 6. Our roles have expanded significantly, we have been trained to do tasks that an SHO would once do, expected to take on more responsibility etc, but at top band 5 unless I apply for a band 6 job elsewhere, (very scarce as are band 5 posts), I have to continue as I am. Staff nurse, NHS hospital unit, AfC band 5 23

25 Pay grade does not adequately reward or reflect experience in nursing Our ward consists of band 5 and 6 nurses plus ward sisters at bands 6 and 7. The department stopped recruiting band 6 nurses a few years ago and no longer promote band 5s to be band 6s. I have 9 years experience now and no chance of going up to a band 6. Despite 9 years of experience I am stuck as a band 5 and therefore unable to progress. Staff nurse, NHS hospital unit, Agenda for Change band 5 The workload & caseload is heavy & payband does not reflect responsibility, experience, decision making skills needed to give patients the highest possible standards of care. District nurse, Agenda for Change band 5 Comparisons made to other professions, or the market rate judging that nursing salaries are lower/comparatively poorly paid The responsibility of a ward manager is comparable to other professions who earn a considerable amount more than nurses. Ward manager, NHS hospital ward, Agenda for Change band 7 Pay not adequate in regards to the roles and responsibilities of a staff nurse, in comparison to some less skilled careers. Staff nurse, NHS hospital ward, Agenda for Change band 5 The job comes enormous responsibility, as well as physical and mental pressures. Nursing in general is low paid compared with other professions that may not encounter such stress and responsibility in their day to day roles. Staff nurse, NHS hospital unit, Agenda for Change band 5 24

26 Stuck in current pay band/grade with few opportunities for progression Pay or grade does not adequately reflect role following a restructuring or redeployment Working in critical care environment for past 14 years. Have been paid at band 6 for rotational post for a year, but despite having sufficient competencies for the post there is no prospect of further promotion in the area. Therefore reverted back to band 5 status. NHS staff nurse, hospital unit, AfC band 5 There is no career progression or recognition for those band 5 nurses who remain in the ward area you have to go into ward management or specialist nursing roles the backbone of the nursing profession is not recognised. Working as band 7 until recent reorganisation. No change in work responsibilities, but downgrading applied. NHS health visitor, AfC Band 6 We are being rebanded to band 6 in a few week s time despite how much our role has changed and how many demands are placed upon health visitors. Health visitor, AfC band 7 Staff nurse, NHS hospital ward, 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 Some of my junior colleagues, who have no managerial responsibilities, take home more money than me as a band 7 can only work Monday-Friday. I have no enhancements, no weekends. Band 5 and 6 take more money that a band 7 and lot more responsibilities and paperwork. Sister/charge nurse/ward manager, NHS hospital unit, AfC band 7 A band 5 can take home more at the end of the month than a band 7. Although this happens only occasionally mainly due to unsocial hours payments, it should never happen. Band 6's nearly always take home more pay monthly. This is not acceptable given the responsibility a ward manager has for her unit. I would have been much better of remaining as a band 6, more money with much less hassle and responsibility. I am often contacted outsides working hours at home especially during the weekend. I receive no extra pay for this. Sister/charge nurse/ward manager, NHS hospital unit, AfC band 7 25

27 5.4 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 just under one-third (32 per cent) reported that their earnings represent more than half of total household income and for 26 per cent, earnings represent all household income. We can see therefore that well over half (58 per cent) of survey respondents are the main or sole breadwinner in their households. This is compared with 57 per cent of all UK respondents. Four per cent of all respondents in Wales stated they are in receipt of Working Tax Credits, compared to 10 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=1,333) 25.5% 32.3% 19.8% 22.4% Less than half About half More than half All of it 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 87 per cent of cases, while income levels have remained the same for around half (54 per cent) and fallen for just under one-third (32 per cent). In line with these findings, almost two thirds of respondents (62 per cent) 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 one-third of respondents and remained the same for 59 per cent. When asked about their major concerns over the coming year, the most common were fuel and transport costs (61 per cent) increased food costs (45 per cent) and other household bills (43 per cent). A further quarter (27 per cent) said that increased pension contributions and cuts to their income (23 per cent) were pressing concerns for the next 12 months In addition, 50 per cent of nurses said that worries about job cuts and the threat of redundancy have increased in the last year. A third (33 per cent) said their own job security 26

28 was their most pressing concern for the near future while 19 per cent are worried about their partners job security. I think the basic frozen pay, considering the huge responsibility and requirements of the job, and considering how much living costs have gone up recently, is now too low. Only unsocial hours enhancements help to boost up pay to a living wage. Staff nurse, NHS hospital unit, AfC band 5 Chart 14: Household income, expenditure and concerns about finances 100 % Household income Household expenditure Concerns about my level of personal debt Concerns about my financial situation Worries about job cuts and threat of redundancy Increased Stayed the same Decreased Table 8 looks in detail at patterns in household expenditure by country. Results for Wales are broadly similar to those for the rest of the UK, yet concerns about job cuts and the threat of redundancy are markedly higher for both Wales and England than in Scotland and Northern Ireland. 27

29 Table 8: Changes in financial situation over the last 12 months (by country) England Scotland Cymru/ Wales Northern Ireland Total Household income level (e.g. 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 (e.g. 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 %

30 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 qualified nurses. The findings suggest that while paid employment immediately boosts their income, younger nurses are no less likely to feel the pressure of rising cost of living and job security. 29

31 Table 9: Changes in financial situation over the last 12 months (by age) Total Household income level (e.g. money coming in) has... Increased No % Stayed the same No % Decreased No % Total No ,348 % Household expenditure (e.g. outgoings) has... Increased No ,179 % Stayed the same No Decreased % No % Total No ,348 % Concerns about my financial situation have... Increased Stayed the same Decreased No % No % No % Total No ,344 % Concerns about my level of personal debt has... Increased Stayed the same Decreased No % No % No % Total No ,321 % Worries about job cuts and the threat of redundancy have... Increased No % Stayed the same No % Decreased No % Total No ,333 % Looking just at worries about job cuts and the threat of redundancy, Chart 15 shows that those working for NHS hospitals (54 per cent) and in NHS community settings (53 per cent) were most likely to express anxiety. Those working for GP practices (26 per cent) were least likely to be worried about job security. 30

32 Chart 15: Worries about job security and the threat of redundancy have increased over the previous 12 months GP Charity/voluntary Independent/private health care provider NHS community NHS hospital Increased Stayed the same Decreased % 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, 14 per cent had applied and of these, 40 per cent were successful. Just over a quarter (28 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 12 per cent had changed jobs in the previous 12 months and of this number, a third (35 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 (40 per cent). However, the next two reasons were more negative as 32 per cent stated they were dissatisfied with their previous job and 28 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. 31

33 Chart 16: What are the main reasons you changed jobs and/or employer?* *Respondents were asked to tick all that apply Redundancy/place of work closed Redundancy/service reconfiguration Semi retirement Terms and conditions/pension issues Health problems Personal/family reasons/moving area/care of dependent Training reasons Distance to work Distress caused by bullying/harassment from colleagues/managers Better pay Promotion Working hours/work life balance Better prospects Dissatisfied with previous job Stress/workload in previous job To gain different experience/skills % 32

34 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, six in ten (59 per cent) of all 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 (77 per cent) would not feel capable of working until 68, with only 12 per cent stating they would feel capable. 80 per cent of those with a disability stated they would not feel capable until the age of 68 and 76 per cent of those with no disability stated they would not be capable. 6.1 Current pension arrangements In respect of current pension arrangements, 86 per cent of all respondents belong to the NHS pension scheme, while 7 per cent have no pension at all. Chart 17: Which pension scheme do you belong to? (All respondents, n=1,362) % NHS pension scheme No pension Other non NHS pension Other public sector pension Personal pension Not sure/do not know Table 11 shows that the majority of respondents working in the NHS (98 per cent) belong to the NHS pension scheme. Outside the NHS, a high number of respondents working for independent sector providers (59 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 (93 per cent). 33

35 Table 11: Which pension scheme do you belong to? NHS Private Personal Other None Total pension scheme scheme pension NHS No. 1, ,058 % Independent No sector provider % GP No Charity/ voluntary sector Total % No % No. 1, ,295 % I have no pension. If I worked for a supermarket I would have a better pay and a pension plan, but why should I change my job when I love to know that I m helping people. Health care assistant, nursing home, salary range 12,104-14,078, I have a pension from my current employer, but as private sector I have several small pensions which will not provide a good long term pension. Sister, independent sector hospital unit, AfC band 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 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 (77 per cent) stated that they would not feel capable of doing so, with only 12 per cent stating they would feel capable. In addition, 80 per cent of those respondents who indicated they have a disability stated they would not feel capable of working beyond

36 Chart 18: In my current role, I would feel capable of working until the age of 68 (n=1,354) % Strongly agree Agree Neither agree/disagree 30.5 Disagree 46.0 Strongly disagree 35

37 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 Wales have current training and development plans and the use of appraisals/development reviews with line managers. Key findings respondents in Wales are less likely to receive most types of mandatory training than colleagues in the rest of the UK. most mandatory training is completed in work time, but a significant proportion (32 per cent) of respondents report completing their last training session either in their own time or split between work and their own time. 64 per cent of mandatory training is conducted through face-to-face learning, 20 per cent is delivered through e-learning and the rest through a mixture of face-to-face and e-learning. two fifths (42 per cent) received no CPD provided or paid for by their employer, compared to 25 per cent in 2011 and 11 per cent in older nurses (aged 55 and over) are less likely to receive CPD than younger colleagues. just over half (52 per cent) have a personal training and development plan and 57 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, having been undertaken by 63 per cent in the last 12 months, followed by moving and handling (54 per cent) and cardio-pulmonary training (52 per cent), a smaller proportion reported receiving these forms of training than in the 2011 survey. A small number (10 per cent) said they have received no mandatory training in the last year. 36

38 Chart 19: Mandatory training received in the last year, compared to % No mandatory training Other Equipment training Health & safety Infection control Cardiopulmonary Moving & handling Fire safety Chart 20 suggests that involvement in mandatory training is lower for respondents in Wales than colleagues in the rest of the UK across all categories, with the widest gaps for infection control, health and safety and fire safety training. 37

39 Chart 20: Mandatory training received in the last year, Wales compared to rest of the UK % None Other Equipment training Health & safety Infection control Cardiopulmonary Moving & handling Fire safety Wales Rest of 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 between the two surveys. 38

40 Table 12: Comparison of mandatory training with 2011 employment survey NHS excluding GP practices NHS excluding GP practices Independent & voluntary sector Independent & voluntary sector Fire safety Health & Safety Moving & handling Infection control CPR Equipment training None Other Chart 21 shows that 53 per cent of all respondents completed their last mandatory training session in normal working time; 32 per cent completed in their own time with the remainder (15 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, independent and voluntary sector employees are most likely to report undertaking training in their own time. During my unpaid break time at work over a number of shifts as it is the only time available and the e-learning is not available outside of the trust intranet. Study days are in own time but supposed to get time back, however we don't very often due to service constraints. Staff nurse, hospital unit, AfC band 6 39

41 Chart 21: When did you complete your last mandatory training session? Independent sector GP NHS hospital NHS community All % In normal working time In my own time Spread over normal working time and my own time Two thirds (64 per cent) of all respondents stated that their last training session was delivered on a face-to-face basis, with 21 per cent stating it was delivered through e-learning 15 per cent stating it was delivered through a mixture of face-to-face and e-learning. Respondents working in GP practices are most likely to report undertaking face-to-face training, while e-learning is most reported by those in NHS hospital settings. 40

42 Chart 22: How did you complete your last mandatory training session? Independent/voluntary sector GP NHS community NHS hospital All E learning Face to face Blended % 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, 58 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. Just over two-fifths (43 per cent) received no CPD provided or paid for by their employer, compared to 25 per cent in 2011, suggesting a significant fall in CPD provision in the last two years. By sector, 49 per cent of respondents working in NHS hospital settings, 38 per cent in NHS community settings, and 24 per cent in the independent/voluntary sector received no training in the last 12 months. Most respondents across all sectors received between one and six days training. 41