This studyThis study

Did the NHS Agenda for Change reform succeed in reducing the leaving intentions of nurses?

John Hill, Economics

Agenda for changeAgenda for change Implemented in December 2004, the objective of

the Agenda for Change programme was to reform and standardise the pay and conditions of around 1.1 million staff in the NHS in England.

Mainly focused staff pay. An annual earnings increase of 5.2 per cent for an NHS employee covered by Agenda for Change

The annual cost of employing staff on Agenda for Change in the NHS (England) rose by £7.4 billion (36 per cent) from £20.8 billion in 2003‑04 to £28.2 billion in 2007-08.

Agenda for changeAgenda for changeThe pay modernisation programme was

made up of two main elements: 1) New harmonised terms and

conditions and a simplified single pay spine.

Previously, different roles in the NHS were subject to different pay scales which had built up over time. In addition some NHS trusts had developed local terms and conditions for particular groups of staff.

Agenda for changeAgenda for change

Agenda for changeAgenda for change2 ) The introduction of a competency

based staff development framework   -involved the creation of an outline for each

post of the knowledge and skills required; -an annual review to assess each post

holder’s knowledge and skills against the outline

- and an agreed personal development plan for each employee based on skills gaps identified at the annual review.

Agenda for change - GoalsAgenda for change - Goals

Global ‘crisis’ in nursingGlobal ‘crisis’ in nursingNurse supply shortages seriously threaten health care

systems around the world (OECD – Human Resources for Health Care Project, 2003).

Retaining trained nurses is a major concern for policy-makers in most Western countries, including Australia, Canada, Norway, the UK and US (Shields, 2004)

Few new entrants into nursing. Trained nurses are demoralised - linked to increased workloads, excessive working hours and poor pay. (Shields 2001)

  British ContextBritish Context

Problems in the NHSProblems in the NHSShortage of trained nurses is recognised

as a major limitation to NHS modernisation plans (Buchan and Seccombe, 2003).

Low nurse staffing ratios are linked to:-Higher patient mortality-A higher incidence of respiratory, wound and urinary tract infections -An increased number of patient falls

-An increased number of general medical ‘errors’ (West et al., 2004).

This studyThis study

Uses a national cross sectional survey to investigate the determinants of NHS nurses quitting intentions- In particular, evaluating the Agenda for Change reforms.

Introductory summaryIntroductory summaryThe data is the national NHS staff survey.An ordered logit model with an ITQ question as

a dependent variable.Principle component factor analysis was used

to remove multicollinearity by reducing the number of explanatory variables .

Parsimonious model specification (Bayesian estimation).

Results suggest that the factors that contribute towards the ITQ of UK nurses (post AFC) mostly coincide with those in the empirical literature

DData: national NHS staff surveyata: national NHS staff surveyAn annual workplace questionnaire collecting the

views and experiences of staff that work in local NHS trusts.

Trusts administer the survey, the minimum sample size is determined by the size of the trust (number of employees).

The sample is randomly drawn from a single list of all eligible staff.

The 2006 wave is the only year that has questions about the Agenda for Change reforms.

The sampleThe sample 341 NHS trusts took part (326 in England) and 48,365

NHS nurses responded (survey response rate of 53.6%).

The self reported reasons to leave work from this sample of nurses:

The ModelThe ModelAn ordered logit model. The dependent variable:

Dependent VariableDependent Variable

Model: Independent variablesModel: Independent variables This is the first study to use the national NHS staff

survey- a much richer dataset than in previous studies.

Trust level: Work-life balance; Appraisals & Personal Development Plans; Training, Learning and Development ; Trust Leaderhsip; Organisational Climate; Equal opportunities; Whistle-blowing; Harassment, Bullying and Violence; Agenda for Change

Ward level: Team Working; Errors and Incidents; Questions about respondents’ jobs (including involvement in decision making, work pressure, job satisfaction); Immediate Management and Supervision

Individual: Gender, Age, Has a dependent, temporary or fulltime employed

Methods:Methods:

Factor analysis: Principle component factor analysis was used to summarise relationships among similar variables into a single factor.

The model appeared to be over specified so Bayesian estimation methods were used to form a parsimonious model. The following criteria was applied: If there is a 95-100% probability that removing an explanatory variable increases the (BIC) likelihood of the success of the model - then that variable is removed.

ResultsResults: Agenda for change: Agenda for change

Results (continued)Results (continued): Agenda for : Agenda for changechange

Results: DiscussionResults: DiscussionReceiving a rebranding is not significant

neither having agreed a personal development plan – the two core features of AFC

Receiving a ‘fair’ grading on the new Agenda for Change pay system is strongly associated with a reduction in nurses’ quitting intentions, as was perceived ‘successful’ implementation of Agenda for Change by the local Trust.

Suggests that it is not the AFC changes as such that affects quitting intentions, but rather the received treatment of an individual under this new system.

What nextWhat nextDeals with association between

intentions to quit and self reported quitting intentions.

Casual impact of Agenda for change:

- Panel-Data Techniques - Control Groups

Deeper issues- Qualitative Interviews with NHS nurses

The End!The End!

Thanks for Listening!