Feature

Nurses up, managers down?

What’s happening to nurses? The Radical Statistics Health Group have the latest figures

In August 1996 the Department of Health published NHS hospital and community health service workforce statistics for England, based on a census taken on 30 September 1995.¹ The statistics are the first analysed using a new occupational classification introduced in April 1995, which aims to classify people according to the work they do rather than, as its predecessor did, according to their pay scale.

The main reason for this change was the move towards local pay bargaining, which means that increasing numbers of staff are not on national pay scales. The second reason is that ‘the NHS Executive no longer required information on staff numbers at the level of detail previously collected’.¹ As a result the new classification has only 300 occupational codes, compared with 1300 in the old system.

What effect has this had on the statistics? When the change was announced, there were suspicions that it was designed to reduce the numbers of people counted as managers. The statistics are all given in terms of ‘whole time equivalents’ (WTEs), in which hours worked by part time staff are counted as a proportion of full time hours. The numbers of people counted as general or senior managers had risen from none in 1984 when the pay scale was first introduced, to 9,680 WTEs in 1990 and to 22,950 in 1994. Although the growth in bureaucracy arising from the introduction of the internal market undoubtedly contributed to the increase in the early 1990s, it is not the whole story. Considerable numbers of existing senior administrative, clinical and technical staff were transferred to management pay scales—but the actual numbers who transferred were not counted.

The new classification does not show managers as a separate main category. More detailed data about whole time equivalent administrative, estates and nursing staff published in the statistical bulletin shows 6,430 senior managers, 13,620 other managers and 4,280 nurse managers, a total of 24,330 WTEs. The numbers of scientific, therapeutic and technical staff who were managers are not shown separately, and nor does a separate bulletin of figures about medical and dental staff show how many of them were working as managers.²

The census of non-medical staff also attempted to group staff according to the previous classification, at least for those organisations who still submitted data based on national pay scales. A footnote advised caution in interpreting these data. The table suggested a slight drop by 400, compared with 1994, in the numbers of managers, although the commentary suggested interpreting this simply as ‘a levelling off’. The figures suggested a larger drop, by 4,860, in the numbers of nursing and midwifery staff, slightly offset by an increase by 1,490 in the numbers of WTE agency staff.

Under the new classification there were 330,440 WTE directly employed nurses and midwives in 1995, compared with 343,830 under the old classification, a difference of 13,390. On the other hand a new category, healthcare assistants, accounted for a further 13,090 WTEs, so the overall numbers of qualified and unqualified staff combined differed by very little under the two classifications.

The bulletin also contains a separate analysis of all qualified and unqualified nursing and midwifery staff working in England. It comments that between 1990 and 1995, the numbers of qualified nurses and midwives in the NHS and the private sector increased by about 6 per cent. But this is not the whole story, as the figure (based on data in Table B of the bulletin and corresponding data for earlier years) shows. Between 1990 and 1995, the total numbers of WTE nurses in the NHS increased by only 50 overall. An increase in practice nurses by 2,330 WTEs was offset by a fall of 2,180 WTE nurses in the hospital and community health services.

In sharp contrast to the NHS, the numbers of nurses in the private sector rose by 18,040 WTEs. Overall it seems that the new classification has had little impact on the reported numbers of nurses and managers in the NHS. The more important issue is that the employment of nurses is rising rapidly in private sector, while remaining static in the NHS—and that ministerial statements which do not distinguish the two are likely to create a misleading impression.