SUPPLEMENT

N90 Evidence to the Pay Review Body The CSP's Industrial Relations Department undertakes the research and writes much of the evidence to the Pay Revlew Body on behalf of the professions allied to medicine and related grades. Other organisations contribute towards the cost of this work and Phillip Gray, the Society's director of industrial relations, is also the Staff Side Secretary of the PT'A Whitley Council and acts as the chief negotiator for PAM staff in discussions with the Review Body and management.

The professions allied to medicine and related grades (PAMs) consist of physiotherapy; radiography; occupational therapy; chiropody; dietetics; orthoptics; art, music and

THIS is the sixth year that the PT'A' Staff Side has submitted evidence to the Pay Review Body. This year's evidence consisted of three volumes. Paper I is entitled 'Pay, Allowances and Related Issues' and includes the Staff Side's salary proposals for 1990 (see table 1). The second volume, Paper II: 'Demand, Shortages, Recruitment and Retention: Motivation and Morale' includes the results of both last year's manpower survey and a motivation and morale survey carried out by the Staff Side in 1989. The final volume of evidence was compiled by the Institute of Manpower Studies (based at the University of Sussex) and commissioned by the Staff Side. The study 'PAMs into the 1990s - Professions Allied to Medicine: The Wider Labour Market Context' looks at the future demographic trends and in particular the fall in the number of school leavers in the early 1990s and the effects that this will have on recruitment and retention of PAMs to the NHS. Summaries of all three papers are given in this supplement to Physiotherapy.

Joint Staffing Survey with Manpower Planning Advisory Group

For the past five years the CSP has been conducting its own manpower surveys of physiotherapy staffing through District/Area physiotherapists. These surveys have provided much valuable information both for the Pay Review Body and on physiotherapy manpower generally.

In the past the Regional Chairmen's Group has also undertaken limited (and unsuccessful) surveys of vacancies in the PAM professions and last year the Office of Manpower Economics undertook a similar survey on behalf of the Pay Review Body. There has therefore been a considerable duplication of effort.

Following the publication in 1988 of the National Audit Office and Public Accounts Committee Report on the control of NHS professional and technical manpower and the criticisms this contained about the lack of manpower infor- mation on these groups, the Chartered Society and the Manpower Planning Advisory Group (MPAG) of the Department of Health established an initiative to improve the quality and flow of data between the PAM professions, the Department of Health and the NHS.

The CSP and other PAM professions therefore agreed to conduct a joint survey with MPAG starting with 1989. The Society has been commissioned to undertake and analyse

jrama therapy; and helpers and technical instructors. Written evidence is submitted to the Review Body by both

the Staff Side and the Department of Health. Separate oral hearings are held at which the Review Body asks searching questions about the evidence submitted. The Review Body then prepares its report with the assistance of the Office of Manpower Economics. The final report is submitted to the Prime Minister at the beginning of January 1990, along with the separate reports on nursbs and doctors. The Government is committed to making an announcement of acceptance or rejection of the pay recommendations in approximately mid-February 1990.

the surveys for all the PAM professions, with the MPAG paying for the additional costs involved. A joint survey has a number of advantages, the main being that the data would be jointly agreed;and although each side may have differing views and interpretations, there should be no arguments about the facts themselves.

1989 Pay Award

Last year's Pay Review Body award gave rises of 7.7%-7.8% to the professions allied to medicine and related grades. Although the increase was marginally above the inflation rate at the time of the announcement and marginally better than the subsequent awards to most NHS groups, it was disappointing - a view expressed by many members of all the professions. The Review Body appeared to be sitting on the fence awaiting a grading review blocked by management. The Staff Side was particularly concerned because nothing was done to remove the gap between the pay of nurses and PAMs. This gap first opened as a result of the PRB award following the conclusion of the grading review for nurses in 1988. The Staff Side firmly believes that this gap is unjustifiable and was disappointed that it was

Table 1: Salary proposals 1990 ( f 1

Salary indicated by external Final

Current salary comparison proposal to April 1989 1.4.90" 1.4.90

Helper (aged 19+ under supervision) Technical instructor I1 Qualified grade Senior I Superintendent HeadKhief 111 Superintendent HeadKhief I District I Senior teacher Principal 24+

Max 6,790

Max 9,290 Min 8,620

Max 14,025

Max 15,225

Max 18,555 Max 21,220 Max 18,445 Max 22,045

8,600

- 11,020 18,292

20.387

26,923 31,612 22,073 27,032

9,000t

13,750 11,000 18,300

20,100

27,000 31.600 26,000 31,600

*A l l external comparators have been uprated to 10.2% in line with the predicated growth in average earnings to April 1990. (Source: Phillips and Drew)

t Based on estimated April 1990 Low Pay Unit definition of low pay.

physiotherapy, January 1990, vol76, no 1 57

closed by only 1% by the Review Body award in 1989. Our concerns have been put to the Review Body both in the written evidence and in the evidence presented orally at the Staff Side's meetings with the Review Body in October and November 1989.

Recruitment and Retention

Members may be aware that in the 1989 evidence to the Review Body, the Department of Health (DOH) has proposed a pilot flexible pay scheme for the PAMs, similar to the pilots for nurses' Regional pay established last year, setting aside f1.5 million of new money to carry it out. However, the Staff Side is convinced that this scheme could only be divisive and would do nothing to ease the serious recruitment and retention problems being faced by physiotherapists and other PAMs which are set to worsen in the 1990s. Vacancy rates in physiotherapy (10%) and occupational therapy (16.3%) are among the highest in the NHS.

The Health Departments claim that the ability to award flexible pay in areas where there are staff shortages will solve these problems. The Staff Side has pointed out that unless there are substantial increases in basic salaries and conditions, staff will not be retained in the NHS and non- practising staff will not be encouraged to return. A Regional pay scheme may merely encourage staff from neighbouring areas which do not pay the supplements, to move to the authorities that do, without improving the overall vacancy problems. The Staff Side has asked to see the results of the nurses' pilot experiments this year before any similar pilots are introduced for PAM staff.

In the light of our objections to the introduction of flexible pay, the Pay Review Body asked the Staff Side to suggest alternative uses for the €1.5 million set aside by the DOH. Our response was that a far more effective way of using this money to help solve the problems of recruitment and retention would be to assist with the childcare problems faced by many PAMs. For some time, the DOH has been voicing its support for equal opportunities for the NHS with improved childcare facilities such as creches as one of its objectives. However, despite the good intentions, l itt le or nothing has been done within the NHS to provide such facilities. The PAM Staff Side therefore proposed that a system of childcare vouchers should be introduced as a means of cost compensation for those PAM staff faced with the considerable additional financial burden of having to pay for care facilities for children (which on average cost between f1.75 and f2 per child per hour with a registered child-minder).

Many staff are unable to return to work after having children because of these difficulties. Our proposal is that the sum of €1,000 for those working over 18 hours per week and €500 for those working under 18 hours per week should be provided in childcare vouchers each year for those staff with childcare costs for pre-school-aged children. Companies such as Luncheon Vouchers Limited have now introduced such schemes with vouchers which may be cashed only by recognised carers, such as nannies, registered child-minders, creches and close relatives, but not spouses. We believe that this would help to retain those currently working in the NHS but who are finding the costs of childcare facilities an increasing concern, and would help to encourage back to the NHS many women who have remained at home to care for their children themselves.

This proposal has now been put to the Review Body and we await its response with interest. As with all other issues, we will keep members informed of developments.

London Weighting London Weighting has also been the subject of a major

new initiative. As members are aware, the basic London Weighting allowances for Inner and Outer London and the Fringe have in the past been negotiated by the General Whitley Council London Weighting Consortium (LWC). However, recently these negotiations have reached deadlock and no rise to basic London Weighting has been agreed since July 1987. The current allowances are f1,267 for Inner London; f 757 for Outer London; €149 for Fringe London and Extra Territorially Managed and Contiguous Units.

In recognition of the extra financial difficulties facing the PAMs working in these areas and the severe recruitment and retention problems, the Review Body has awarded London Supplement to these staff since April 1988 which is paid in addition to the basic London Weighting allowance. These rates, as of April 1, 1989, are 5% of basic salary to a maximum of €568 in Inner and Outer London, and 2.5% of salary to a maximum of €284 in Fringe areas.

Following the lack of success of negotiations in the London Weighting Consortium during the past two years, it was agreed in 1989 that the LWC should be dissolved. In future the total London Weighting payments will be referred each year to the Review Body to recommend a rise. NHS groups which do not have review bodies will be referring the issue to their functionat councils.

The PT'A' Staff Side has therefore submitted a claim to the Review Body for rises to London Weighting payments leading to a total payment of €3,000 for Inner London, €2,000 for Outer London and €1,000 for Fringe. In our submission we have stressed the fact that there has been no rise in the London Weighting allowance since July 1987.

We were extremely disappointed and annoyed, however, by the Management Side's evidence. A number of agree- ments were reached in the LWC as a pre-condition to this break-up. These included an assurance from Management Side that it would not argue that the current total London payments should be reduced in any way. Also, that the Staff Side's agreement to withdraw from the LWC in no way suggested that the Staff Side agreed to the omission of an increase to the payment during the previous two years. However, the Management Side is now proposing to the Review Body that there should be no rise at all in London Weighting in this year's award; a move which the Staff Side feels goes completely against the spirit of the assurances given prior to the break-up of the LWC.

We hope that the Review Body will listen sympathetically to our arguments and award a suitable rise to compensate PAM staff properly for the substantial extra financial burdens of working and living in the London area.

Grading Review We have stressed to the Review Body both in our written and oral

evidence that there will be no return to grading negotiations in the foreseeable future The Management Side has been unable to agree to the basic assurances asked by the Staff Side following the confused and unacceptable approach of the Management Side during the unsuccessful negotiations in 1988. We approached the Management Side to try to establish a suitable grading agreement for the April 1990 PRB report, but without success. Both sides have written a joint letter to the Review Body explaining their positions on grading. The Management Side states in the letter a large number of further reasons for its reluctance to resume grading talks, including the White Paper on the NHS; the extension of general management contracts to some PAM managers; the National Council for Vocational Qualifications; the separate studies into the professions' staffing which are in preparation; and the possible implications of self-governing hospitals for PAM staff. That list would guarantee that negotiations could not take place for a long period. We hope that these facts will encourage the Review Body to improve PAM salaries substantially without awaiting a grading review that seems unlikely to happen.

58 physiotherapy, January 1990, vol76, no I

Paper 1: Pay, Allowances and Related Issues Chapter One - 1990 Evidence and Salary Proposals

The Staff Side was disappointed by the Review Body's award of 1989, which did l itt le to change the serious gap in pay between PAM staff and nurses. This has left many PAM staff believing that perhaps their professions have been effectively down-graded - merely, it appears, because they have not been through the process of a grading review, as have the nurses.

It is clear that there is no prospect of grading review for PAM staff being carried out in the foreseeable future. We therefore urge the Review Body to award a substantial increase in pay to PAM staff in 1990. This would lessen the gap between PAMs and nurses; improve morale greatly; and help to ease the problems of recruitment and retention which have been affecting PAM staff even worse than nurses and which are likely to grow more serious in the early 1990s as a result of the dramatic fall in the number of school leavers.

Chapter Two - Economic Indicators

We stress the difficulties that we have experienced in predicting economic trends seven months ahead of the April 1, 1990, implementation date, particularly since the economic position has changed considerably over the past year and does not yet appear to have stabilised.

Predictions of inflation by both the Government and commentators have been below actual levels and many commentators are predicting continuing high inflation in 1990. The underlying increase in average earnings fell only slightly to 9% by June 1989, but the figure does not take into account several recent pay settlements.

Pay settlements are rising, and those which occurred over the late spring and early summer of 1989 have made the 7.7% Review Body award to PAMs from April 1, 1989, look low.

Another factor to consider is the rapid rise in house prices, and the high level of mortgage interest rates. These are important points to consider since most PAMs will be looking towards buying their own homes and many will find their salaries inadequate to enable them to do so.

It is therefore essential that PAM salaries remain competitive when compared both to the salaries of other graduate careers and to the general economic situation as a whole.

Chapter Three - Current Pay Issues

We ask the Review Body to ensure that the 1990 pay award re-evaluates the worth of the professions and related grades, particularly when compared to the salaries of nurses and similar professions outside the NHS, before the present serious problems of recruitment and retention worsen.

We have asked the Review Body to change the current London Weighting and London Supplement payments into a single, increased payment of €3,000 pa for Inner London; €2,000 for Outer London; and €1,000 for the Fringe Areas. These are consistent with the London Weighting payments made by a large number of other employers. We show how the current rates of London Weighting allowances, particularly in Inner London, remain low when compared with

other organisations and the cost of housing. This clearly plays a part in the current serious problems of recuitment and retention among PAM staff and related grades in this area.

We noted that the Management Side did not have any direct discussions with us last year concerning the intro- duction of Regional and local pay variations for PAMs and related grades. We discuss in this, chapter the arguments about Regional pay variations using recent academic research. We are still very sceptical that such a scheme will ease the problem of recruitment and retention for these grades and wish to see the result of such experiments for nurses.

Chapter Four - Starting and Clinical Salaries

One of the most important issues to be considered is that the already serious problems of recruitment and retention for PAM staff are likely to get worse in the 1990s as the effects of the 25% drop in the number of school leavers are felt. All employers will be facing fierce competition to attract these school leavers to their companies - particularly those with good qualifications. These alternative careers appear to be attracting newly qualified PAM staff since, in some of the professions, as many as 50% of the output in any year either do not take up posts in the NHS after qualifying or leave again shortly afterwards. The low starting salaries and poor career prospects for PAMs in the NHS are obviously at least part of the reason for this.

The entry and training requirements for PAM courses are equivalent to those for university and polytechnic degree courses and the PAM courses themselves are either degree or degree equivalent courses. The various surveys we quote show that the market for graduates is highly competitive and all firms expect to face recruitment difficulties in the near future. The average starting salary for graduates in 1989 was at least €10,000, considerably higher than that for PAMs.

We believe these points to be of such serious concern that we are undertaking further research into the impact of the 1990s demographic changes on PAM staff.

Comparisons of the starting salaries of NHS PAMs with equivalent posts in the public sector also show a marked difference. When compared with earnings in industry the differences are large and help to explain the continued loss of PAM staff from the NHS.

Chapter Five - Career Progression and Differentials

We continue to argue that internal differentials in PAM grades have been compressed too far. This is contrary to the current situation in the economy as a whole where higher salary increases at higher grades are stretching differentials further. The Review Body argued in 1988 that it did not wish to alter the current differentials in view of the impending grading review. We stress that since this is now unlikely to happen in the foreseeable future, we ask the Review Body to take action immediately. It is essential for the concertina of differentials to be pulled out as part of a substantial increase in salaries for all grades to encourage PAMs to progress up the career structure. We also ask for action to

Wsiotherapy, January 1990, vol76, no 1 59

be taken to introduce a logical progression in the size of increments between the higher grades to replace the present anomalous variations in increments.

We continue to express our concern that there is a widening gap in pay between nurses and PAMs and stress that there is no evidence to justify paying the PAM professions less than nurses. We suggest there are reasonable grounds to pay PAMs more than nurses. We give detailed comparisons between the work ,of nurses and PAMs but emphasise that we are not requesting direct comparability and links with nurses.

We also use examples of other NHS groups such as dentists, pharmacists, biochemists, physicists and optometrists and show how there are significant differentials between these groups and PAMs, which we do not believe to be justified. We give detailed comparisons between PAMs and other graduate level careers within the general economy, both in the private and public sectors, which again show that PAMs do not compare favourably.

Once again we stress that a substantial improvement to salaries is essential in order to attract and retain PAMs within the NHS by restoring internal differentials and comparability with other competing careers.

Chapter Six - Managers

We ask the Review Body to improve substantially the rewards for PAM managers since this is an important way to attract new members into the professions within the NHS and avoid the loss of NHS staff to outside organisations and abroad. Good career prospects and salaries are important to ensure that school leavers are persuaded to consider these professions among their options when choosing a future career.

It is therefore important that PAM managers' salaries compare favourably with outside organisations. The work and responsibilities of PAM managers within the NHS are continuing to grow with the development of quality assurance; the problems of staff shortages; deployment of resources and the issues of recruitment and retention and return. The immense size of the NHS as an organisation also increases the pressures faced by NHS managers.

As in previous years we have used the survey by the British Institute of Management (BIM) of managers employed in various companies in the year to January 1989. We believe that the duties and responsibilities of PAM managers equate to certain specific levels of the managers covered in the BIM survey.

The BIM survey shows that differentials for management are continuing to widen with an increase in management earnings of 10.5% compared to an increase in average earnings in the economy generally of 8.7%. The survey forecasts an increase in management earnings of 11.5% for 1990, compared with the 7.7% basic increase awarded by the Review Body from April 1, 1989.

Once other factors are taken into account as well as the comparison of salary levels (such as the provision of company cars and free petrol), our arguments are further strengthened for a substantial improvement to PAM managers' salaries. Members of the PAMs are of graduate level and therefore the professions need to offer salaries of a competitive level to those available to graduates and graduate managers in the economy as a whole.

Chapter Seven - Teachers We ask the Review Body to consider the Staff Side's evidence

of 1989 which compared the conditions of service of PAM teachers in the NHS to those employed within higher and further education and universities.

This year we also ask the Review Body to pay attention to the fact that there is no difference in educational responsibilities or in the teaching qualifications of PAM teachers and grade 2 nursing teachers. However, the PAM courses are of the level of higher education, whereas the nursing teachers may be teaching a course at a level that is considerably less demanding academically. We

would therefore expect this difference to be reflected in the pay of PAM teachers, whereas nursing teachers in grade 2 now earn significantly more than PAM teachers in the main g!ade. We also ask the Review Body to resolve not only this anomaly but also that between the pay of PAM senior teachers and nursing teachers in grade 3 which again we consider directly relevant. We also suggest comparisons between PAM principals and some nurse teaching grades although we accept that such comparisons are far more difficult to judge.

Chapter Eight - Staff in Related Grades Recent changes in both'the NHS and the demographic situation

are having increasing effects upon these staff. The role of PAM staff in the related grades has changed dramatically in recent years, particularly in view of the policy to develop care in the community and the national shortage of qualified PAM staff. The increase in the number of elderly people within the population will also increase the demand for the skills of these staff, since the majority of helpers work with elderly and mentally ill patients.

We ask the Review Body to increase the salaries of staff to combat the problems of low pay and low morale and in order to recruit and retain the right calibre of staff. Otherwise, they will be attracted to move outside the NHS, as can already be seen from a comparison of the salaries offered to occupational therapists by the NHS and those on offer by local authorities.

We therefore ask the Review Body to increase the salaries of staff to combat the problems of low pay and low morale and in order to recruit and retain the right calibre of staff. We also ask the Review Body to increase the number of increments in the occupational therapy technical instructor TI/III and TI/I scales. Finally we ask that the parity between the TI/I scale and the occupational therapy senior II scales be restored.

Chapter Nine - Allowances We express our disappointment that all allowances, other than

student training allowances, were increased in 1989 by less than the increase in basic salaries, thereby eroding their value and incentive effect. It is essential that the incentive these allowances offer staff to work extra (and usually unsocial) hours, or to undertake additional responsibilities, is retained and improved. We explain the importance of the role of the on-call and stand-by payments in meeting the needs o f patient care and providing an efficient and effective service.

We also use some external comparisons of the levels of allowances paid to workers who undertake out-of-hours emergency work, such as those in British Gas and the water and electricity supply industries. These figures show how poorly the amounts paid to PAMs compare.

We therefore ask the Review Body not only to increase the allowances substantially this year, but also, in the future, to increase them annually in line with salaries.

Chapter Ten - Managing on PAM Salaries This year the Staff Side has conducted a survey of members of

different professions and grades within the PAMs to discover how they are managing on their current salaries. We have asked those involved in the survey to record their income and average expenditure for the month of June 1989. We stress that we do not claim that this survey is a large sample of the professions, and is more useful as a descriptive 'snapshot' of how these members manage. However. we are confident that it is typical of the problems faced by members of these professions. Some of the problems of living on low salaries revealed in the survey are distressing.

From the detailed accounts and comments made by these members it becomes clear that many PAMs are having great difficulties managing on their salaries. It is clear that the lower salary levels are not able to meet the demands of even the smallest mortgages and mean that many are unable to make regular savings or take annual holidays. This appears an unreasonable situation for highly skilled, highly trained professionals to find themselves in. Many even have to rely on State benefits or get themselves into severe debt to obtain the simple necessities of life. These problems must appear particularly frustrating for those PAMs who compare their current status with that of their friends with similar qualifications who have not chosen to pursue this career. It will act as a severe disincentive to future recruitment if action is not taken to improve salaries.

Therefore, we believe that the information contained within this chapter does give some reflection of the problems faced by PAMs and the great necessity for a substantial improvement to PAM salaries.

60 physiotherapy, January 1990, vol76, no 1

Paper 11: Demand, Shortages, R Retention: Motivation and Mora

wruitment d and .e

Demand, Shortages, Recruitment and Retention As explained above, for the first time the Staff Side and the

Department of Health submitted jointly agreed manpower data to the Review Body. The survey data show that the number of new PAM posts created continues to grow at a far higher rate of demand than any other groups in the NHS. The increased demand for the PAM professions and related grades stems from NHS policies such as care in the community; the expansion in the numbers of elderly people in the population; mammography screening; preventive medicine; and the increased pressure for a more rapid throughput of patients in NHS hospitals towards which the PAM professions make important contributions.

Demand Demand for PAM staff throughout the NHS continued to grow

during 1988/89, which was not matched by the overall growth in the number of qualified PAMs. The percentage change in the number of qualified PAMs ranges from an increase of 6.7% in orthoptics to -0.1% in chiropody, with physiotherapy showing an increase of 3.1%. The numbers of helpers have continued to decline by 1.3%.

Changes in funded establishments show-an overall increase of 3.2% for the PAM professions from March 31, 1988 to March 31, 1989 with an increase of 3.0% for physiotherapy during this period. However, this increase is lower than for any of the three previous periods. Although the Staff Side believes that funded establishments are one measure of demand, they may well be underestimated by health authorities since they are affected by available funding and judgements on the likely availability of staff. The survey also questions District heads of service on the extent to which they estimated their funded establishments at March 31, 1989, were inadequate to meet current workload. There was on overall estimated shortfall of 27.9% for the PAM professions with a 28% shortfall for physiotherapy. In absolute terms physiotherapy had the greatest estimated shortfall of around 3,400 whole-time equivalent posts.

20

18

16

14

12

10

8

0 ln ._

i

Profession Fig 1: Vacancies as percentage of funded establishment on March 31, 1989

Vacancies The survey also provided detailed data on vacancies. This

information is shown in the form of 'on the day' vacancies at March 31, 1989, and by long-term vacancies, which are vacancies over three months. The 'on the day' vacancies were 8.7% of funded establishment for the PAM professions and 4.3% for the related grades. Occupational therapy has the highest vacancy rate followed by physiotherapy at 9.3%. The vacancies for physiotherapy helpers were 2.8% (fig 1).

Although the Pay Review Body in its 1989 report noted the considerable length of time that it takes to advertise a post, interview

Table 2: Vacancies on March 31, 1989, as a percentage of funded estalishment by profession and Region

Art and music Chiropody Dietetics Occupational Orthoptics Physio- Radiography therapy therapy therapy Diagnostic Therapeutic

Northern Yorkshire Trent E Anglian NW Thames NE Thames SE Thames SW Thames Wessex Oxford S Western W Midlands Mersey N Western SHAs

0.0 0.0 0.0 7.4 2.3 4.1

12.1 1.5 0.0 0.0

12.6 4.4 0.0 0.0 0.0

3.0 2.9 3.0 1.2 6.6 4.6 5.0 4.7 8.4 9.2 6.1 4.2 8.8 7.0

10.4 1.4 3.1 4.5 5.2 1.8 4.6 6.3 3.1 3.2 4.1 3.9 2.0 1.4 0.0 0.0

23.9 17.8 16.7 15.9 23.9 29.0 24.5 18.9 17.2 17.9 13.1 17.1 17.2 17.3 22.9

0.0 4.8 2.2 0.0 8.8 1.8 1.5 9.9 3.2 0.0 10.4 0.8 3.0 11.2 3.9 9.7 15.2 7.1 2.8 10.0 5.2 1.9 9.9 4.7 4.7 7.9 1.9 0.3 12.2 4.0 2.8 6.8 1.2 1.9 9.3 2.6 3.7 7.9 1.8 1.7 11.3 1.4 0.0 4.3 8.9

0.0 2.3 4.1 0.0 5.4 3.7 3.4 0.0 4.9 0.0 3.3 2.8 0.0 0.0 5.9

~~

England 5.0 5.0 4.0 19.1 2.3 9.8 3.1 2.9

Wales 46.7 3.2 3.0 24.3 0.0 8.7 0.8 4.2 Scotland 0.0 2.7 2.9 13.0 4.5 6.3 1.0 0.0

Great Britain 6.8 4.5 3.8 18.8 2.5 9.3 2.9 2.9

Source: Joint National Professional Manpower lnitative 1989. Form 1 & 4

Wte have been rounded to the nearest whole number, percentages have been calculated on unrounded figures, totals do not equal sum of components because of rounding.

Vacancies included only those posts for which funding was available to fill them immediately. ----

Wsiotherapv, Januaw 1990, vol76, no 1 61

applicants and appoint a candidate, the Staff Side still views the 'on the day' vacancies as being of great importance. At least 40% of the movements of PAM staff take place totally within the NHS which results in the filling of one vacancy creating another almost immediately. The long-term.vacancy position identifies only those vacancies which are especially difficult to fill. Vacancies of over three months stood at 4.7% for the PAM professions and 2.2% for related grades. The highest rate was in occupational therapy followed by physiotherapy at 4.9%. However, in our survey questions on long- term vacancies we asked respondents to note on the form the specific date on which the post fell vacant rather than asking how long a post had been vacant. Unfortunately some respondents found it difficult to complete this part of the form and left these vacancies unspecified. However, if all the unspecified vacancies in physio- therapy were found to be over three months in future local discussions with the respondents, the three-month vacancy rate for physiotherapy would be around 3.9%.

It therefore appears evident that these data present little if any evidenoe of improvement in the vacancy positions for any of the PAM professions which started the year with high vacancy rates. The 'on the day' vacancy rate compared with March 31, 1988, has grown marginally and there is still a large number of long-term vacancies. The situation has clearly worsened when the information on the related grades is considered. The highest level of vacancy IS found in the lowest grade at 12.3% followed by senior II at 8.8% and senior I at 7.9%. Approximately 90% of all vacancies in the PAM professions occur in the first three grades.

We also studied the rates of vacancies on March 31, 1989, by Region for the PAM professions. North East Thames showed the highest percentage of vacancies at 14% while the other Thames Regions and Oxford showed vacancies of over 10%. Northern and South Western Regions and Scotland showed the lowest levels but even these were well over 5%. The vacancy rates for the related grades were highest in the North East and South West Thames Regions and the Special Health Authorities and lowest in East Anglia, South Western and Scotland. In physiotherapy the lowest vacancy rates were found in the Special Health Authorities (4.3%) and Northern Region (4.8%), while the highest vacancies were found in the North East Thames (15.2%), Oxford (12.2%) and North Western (11.3%) Regions. (table 2.)

The vacancy rates for physiotherapy helpers were considerably lower although there was still cause for concern in many areas. Among the worst affected Regions were Oxford (8.2%), North West Thames (7.5%) and North East Thames (4.6%).

Staff Turnover We were also concerned by the high percentage of staff leaving

posts in health authorities in the PAM professions as a whole which was 16.8%. The highest turnover rate was in occupational therapy at 20.9%, followed by physiotherapy at 20.5%. The turnover rate for physiotherapy helpers was 12.5%. These figures were very similar to those found in last year's survey. The overall turnover rates have remained high compared to other UK business or organisations and should be a cause for concern. A certain level of staff turnover is inevitable for professional development, but excessive turnover may be damaging to the continuity of patient care.

Leavers The Staff Side also asked detailed questions about the destin-

ations of leavers. During 1988/89, a total of 5,069 of PAMs in the professions left their posts in health authorities for destin- ations outside the NHS or for posts in other health authorities. Approximately 2,000 (39.6%) were known to have left for posts within the NHS, a further 1,200 (23.5%) were known to have gone to non-NHS employment, and the remainder to other destinations, not involving employment, outside the NHS (such as maternity leave, retirement, or ceasing employment). The figures were similar for the related grades with only 3.8% known to have gone to posts within the NHS and 44.8% known to have gone to other non- employed destinations outside the NHS (fig 2).

We then looked in detail at the destinations of staff known to have left the NHS during 1988/89. A total of 41.3% of these staff were known to have gone to employment outside the NHS. This figure included a total of 524 physiotherapists (41.1%). A substantial number of these staff particularly in physiotherapy (over half) and radiography are known to have left to take up jobs abroad. Among NHS leavers who are known no longer to be working, by far the highest proportion left for reasons relating to maternity and other domestic commitments. This category represented over 25% of the total whole-time equivalent (wte) staff known to have left the NHS.

PAM Professions I ' h l Related Grades 1 % )

17.60 30.20

:Filar employment in ~ ;~ t ; f~xed- te rm

[173 "riYiY$; emgioyment

0 Different employment

69 Maternity/other No longer working domestic commitments

Fk?;;;ment/ill health/ Unspecified I!!! (not visible on pie chart1

Fig 2: Destinations of staff leaving the NHS during 1988/89

Staff Recruited We also questioned where the 5,986 wte staff in the PAM

professions.who were recruited to health authorities during 1988/89 came from. Of these, 38.5% were newly qualified and 22% were recruited from outside the NHS. The pattern of recruitment in the related grades is completely different from that in the professions. The vast majority of their recruitment is from outside the NHS (nearly 87%) and there is only a small amount of recruitment from within the NHS (6.5%) (fig 3). These figures are similar for physiotherapy helpers at 88.3% and 7% respectively. In summary we can say that physiotherapy has a high turnover with a major source of recruitment from within the NHS and above average recruitment from outside the NHS at 22.89/0.

PAM Professions ( % I - Related Grades (901

n

R Newly qualified

[113 Recruited from within NHS

0 Recruited from outside NHS

I[pp Unspecified

Fig 3: Staff recruited to health authorities 1988/89

Loss of Newly Qualified Staff We were very concerned to draw the Review Body's attention

to the major difference between the numbers of PAM professionals qualifying from schools in 1988 and the numbers of newk qualified known to have been recruited to the NHS in 1988/89 (eg 40% less in dietetics; 27% in radiography; 18.5% in occupational therapy). However, while the survey shows that figures are as high as 52% loss of newly qualified staff in orthoptics, the figure for physiotherapy is very low at 5%. Even this loss is a cause for concern when the cost of training newly qualified staff is considered.

Implications for Pay of Recruitment and Retention Problems Starting Salaries

There is a clear need for NHS salaries to be competitive in order to attract enough staff into training and to ensure that once qualified, most of them can be attracted to the NHS. Given the demographic changes ahead it will be vital to m intain the output of schools at least at current levels. It should be%ted that a large

62

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physiotherapy, January 1990, vd 76, no 1

proportion of PAM vacancies are in the entry grade (although in physiotherapy, vacancies in senior II and senior I grades are growing a t a faster rate). The Staff Side believes that the starting and early career salaries in the professions are too low to attract newly qualified graduates and degree equivalent PAM professions to take up the large number of vacant jobs in the professions. If there is not to be a continued waste of public funds on training, salaries must be increased to make them attractive to encourage newly qualified staff to seek employment and remain in the NHS.

Salaries for Experienced Staff It is also vital to retain more PAM staff in the NHS, particularly

those who leave for employment outside the NHS and those who leave because of maternity and other domestic commitments. This requires both competitive pay and innovative management measures. It becomes less worth while for a member of staff to take up a job if it involves disproportionate expenditure on childcare

It is clear from both the vacancy and turnover data that the NHS is not sufficiently attractive to qualified staff in the PAM professions nor to staff who want to work in the related grades. Pay levels must be raised to a level which will improve the situation and not perpetuate the problems.

1989 Motivation and Morale Survey A total of 3,506 PAM staff in the United Kingdom, selected on

a structured basis, were surveyed with the return rate of 66.3%. Unfortunately the return rate for related grades was only 18%, but for physiotherapy it was 90% (over 1,000 physiotherapists of all grades). The survey was the first on motivation and morale since a short survey undertaken by the ‘Staff Side in 1986. Although this survey contains considerably more detailed questions, parallels have been drawn with the 1986 survey where possible.

The results indicate that the majority of staff have experienced a decrease in their morale over the last year with very few feeling that it has increased (fig 4). There is an even higher perception (5790) of the deterioration of morale of colleagues. We believe that this may reflect the finding that 74% of PAM staff believe that their workload has increased in the last year and 5890 feel that the level of responsibility required from them has also increased.

The survey was undertaken after the 1989 Review Body report was published and the salary increases contained in it implemented. The survey indicates the dissatisfaction with relative pay levels which we found elsewhere. Only 4.2% felt that salaries had improved compared to the 36% who felt that they had deteriorated and the 55% who felt that they were unchanged.

Further concerns were expressed about insufficient professionals, helpers and clerical staff. This was reflected by reports of delays in treatment; insufficient time to undertake assessments; and an increasing amount of time being taken up by paperwork. Forty-two per cent of physiotherapists felt that their area did not have enough helpers/Tls to meet the workload, which shows the demand for increased numbers of helpers. Over 50% of PAMs felt that they did not have an adequate level of clerical/auxiliary support staff available in their work area.

Some of these problems were further exacerbated by increasing demands upon the PAM staff for data collection which was having an adverse impact on the time available for patient care. Over 60% of staff felt that they did not have enough time to complete paperwork and patient records during normal working hours. It seems likely that the requirements from the Government’s White Paper on the NHS, which proposes a vastly increased range of data collection, will magnify this pattern quite substantially. Views on this issue were also requested, with 68% of staff stating that they were fairly pessimistic or very pessimistic about the future in the light of the White Paper.

Overall, the survey showed that staff felt they were providing the best care they could in the circumstances, with 68% stating that they were able to provide a satisfactory level of treatment/ examination to their patients. However, 60% reported that they had to delay treatment or examination due to circumstances beyond their control. In physiotherapy 56.390 felt that they and their staff did

Respondents Colleagues

36.30 w v.70& 32.30

Decreased 0 Increased Stayed the same Unspecified

Fig 4: Morale (changes over the last year)

Stress Workload

73.90

L Decreased 0 Increased Stayed the same a Unspecified

Fig 5: Stress at work (changes over the last year)

Fig 6: Respondent‘s own workload (changes over the last year)

not have time to assess and plan treatment properly for all patients. These figures show that PAM professions are highly motivated to provide the best possible care for patients. However, this does not prevent morale from being low - particularly if staff feel that an unfair advantage is being taken of their motivation and commitment to patients.

We would not claim that pay is the sole factor affecting motivation and morale. However, it is a very important factor which the Review Body is able to influence.

The survey also asked about PAM staff’s feelings about the future in the light of the Government’s proposals in the NHS White Paper. A very large majority (68%) were fairly or very pessimistic about the future. Only 7.5% felt either very or fairly opt.mistic about the future of the NHS.

Questions on relative pay over the last year showed that the 1989 increases in pay were perceived at best to have prevented things getting any worse (55%) or were perceived as contributing to a further decline (36%) over the previous year. These views were held particularly strongly by physiotherapists with 42.3% feeling that their pay had decreased when compared with similar responsibilities and experience.

The Staff Side therefore believes that a boost in PAM salaries would give a boost to morale; help to strengthen the existing motivation; make it economically worth while for non-practising members of the professions and related grades to return to the NHS; and help to retain the scarce resource of the professions in the NHS. It is an investment in the future of the PAMs which we feel will provide considerable benefit to health authorities and patient care in the NHS. (A more detailed analysis of the physiotherapists‘ views from this survey will be reported in a future article in the Journal.)

Physiotherapy, Januaw 1990, vol76, no I 63

PAMs 'into the l990s - The Wider Labour Market Context

This report, commissioned by the Staff Side of the Professional and Technical 'A' Whitley Council, was prepared by the Institute of Manpower Studies, an independent research institute with a long-standing programme of research into the Health Service and in other professional and qualified labour markets.

The report states that the key characteristics of the workforce in each of the professions are the comparatively young age profile, and the numerical dominance of female employees. Their study shows that between one-third and one-half of this workforce is aged less than 30 years, with a further third aged between 31 and 39. This means that it is likely that there will be an increasing demand by these staff for career breaks and for returns to career at less than full-time conditions over the next decade.

The report notes that the overall growth in the number of staff has been comparatively consistent over the years 1982-87 at 3%-5%. This has been as a result of the growth in demand for the services of PAM staff because of increased patient throughput, increased number of elderly patients being treated and new developments and techniques in the provision of care, both generally in the Health Service and specifically by the professions.

The report notes the difficulties of accurately assessing unmet demands for PAMs. There are no accepted figures for ratios of patients:staff or staff:population. However, a 1986 National Audit Office Report on professional and technical manpower noted that there were shortages of occupational therapists and physiotherapists in spite of a large increase in the number of staff employed. An indication of unmet demand can be deduced from health authorities' statistics of vacancy rates on establishment levels. However, these figures need to be treated with care since they do not accurately reflect all vacancies such as those filled by under-qualified staff.

One factor in the supply and demand problems is the intake to training schools. The report states that between 1982 and 1986 intakes declined significantly for radiography and also for orthoptics, increased for chiropody and remained comparatively static in dietetics, physiotherapy and occupational therapy. However, applications have also been falling in physiotherapy, chiropody, radiography, orthoptics and occupational therapy.

The report then studies the effects on the PAM professions of the decline in the number of school leavers in the early 1990s. The severity of the problem is reflected in the decline in the number of births registered in the United Kingdom from 1,015,000 in 1964 to 730,000 in 1984. The number of school leavers entering the labour market will decline from 657,000 in 1983 to 428,000 in 1993. The high standards of qualifications needed for entry into PAM training schools (five 0-level and four A-level points, or two or three A-levels), means that the professions are drawing their supply from a restricted number of this population. Although girls remain in education longer than boys and perform better, in general terms, through to the age of 18, higher proportions of men achieve three A-levels at higher grades - an important factor when the higher proportion of female PAMs is taken into account.

Many employers are now revising their recruitment strategies for those leaving school or higher education. Not only will there be a decline in the number of school leavers with appropriate A-level qualifications, but unemployment among graduates is reducing steadily from 13% in 1982 to 6% in 1988. The graduate labour market has now become highly competitive with salaries from certain sectors increasing quickly and further competition rising from European recruiters. The Association of Graduate Recruiters' 1989 survey reported that approximately half of the major graduate recruiters were reporting unfilled vacancies in 1988 as job opportunities grew. Private sector employers are able to offer far more flexible and attractive recruitment packages than public sector services such as the NHS.

The Wider Labour Market The above predictions emphasise the importance of employers

turning to non-traditional sources of recruitment if they are to prevent a major gap between supply and demand arising. Employment Gazette, April 1989, projected an overall increase of 1,000,000 in employment over and above the mid-1988 level by the year 2000, brought about by a fall of 1.3m in the number of employees aged 25 or less and an increase of 2.3m in the employed population aged 25-54. Of this increase, 90% is likely to be accounted for by an increase in female employment. It will therefore be necessary for employers to change their employment strategies in order to recruit from this pool of the population.

The IMS notes the conclusions of various studies which have been carried out on changing recruitment strategies by NEDOlTC (1988), Conroy and Stidston (1988) and Atkinson (1989). These included attracting more school leavers by improving training and career opportunities, pay and benefits and widening qualification requirements for women.

Other strategies for overcoming these recruitment problems include drawing from different pools of workers not ordinarily targeted by the employers, such as older workers (particularly mature women), ethnic minorities, and re-entrants, and encouraging men and women to take up jobs ordinarily dominated by the opposite sex. Once recruited, it will be important for the employers to retain these staff by raising relative pay and benefits, improving career prospects, reducing workloads, and implementing managed career breaks and 'keep in touch' schemes.

More emphasis will also need to be placed on improving training and re-training, deployment and the role of part-timers. Research shows that the more popular initiatives being set up by employers to facilitate recruitment and retention of female employees include job-sharing schemes, and career breaks or childcaring facilities. The survey shows that many employers are already beginning to improve their recruitment strategies in many various ways to ensure that they are able to meet their future employment demands. The survey then goes on to study which of these options are likely to be most effective to ensure the continued supply of sufficient numbers of PAM staff.

The report suggests that the most direct approach to improving the recruitment of new school leaver recruits to the PAM professions is significantly to enhance relative pay rates. This will be against a background of increasing wage competition from other employers, both in the private and public sectors. Training and career prospects will have to be improved, possibly within a future more flexible grading structure. Another effective strategy may be to use alternative sources of recruits such as more mature entrants. This would necessitate specialised recruitment and training, but would be particularly useful in encouraging back staff who have left NHS employment.

Flexible hours and the provision of childcare facilities are important factors in such a strategy. Such improvements would also help to retain PAMs and prevent the loss of trained staff from the NHS to the private sector and abroad. A changing attitude to part-time staff to recognise that they too display the career commitment required to work in more senior posts would improve the utilisation of staff currently employed.

--- Conclusion

The Society and the PT'A' Staff Side have this year put on an enormous amount of detailed, reasoned and factually- based evidence to the Review Body. We are asking for a substantial boost to salaries, improved differentials, revised London Weighting, allowances and the introduction of childcare vouchers. We now await the final report of the PRB and the Government's decision on its recommendations in the second half of February 1990. Any increases awarded should be effective from April 1, 1990.

64 Physiotherapy, January 1990, vol 76, no 1