This study

1. This study Did the NHS Agenda for Change reform succeed in reducing the leaving intentions of nurses? John Hill, Economics

2. Agenda 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.

3. Agenda for change The 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.

4. Agenda for change

5. Agenda for change 2 ) 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.

6. Agenda for change - Goals

7. Global ‘crisis’ in nursing Nurse 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)

8. British Context The NHS has had a nursing shortage for the past two decades. - Between 1990 and 2000, around 170 000 nurses left the nursing register (Buchan and Seccombe, 2005). - Between 2000 and 2005, nearly one-in-ten nurses completely left the NHS each year. Leaving at a time when there is an increasing demand for their services. -Inpatient admissions are increasing by an average of 1.4% per year and outpatient referrals by 1% per year (NHS Staff Council, 2005).

9. Problems in the NHS Shortage 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).

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

11. Introductory summary The 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

12. Data: national NHS staff survey An 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.

13. The 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:

14. The Model An ordered logit model. The dependent variable:

15. Dependent Variable

16. Model: 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

17. 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 estimationmethods 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.

18. Results: Agenda for change

19. Results (continued): Agenda for change

20. Results: Discussion Receiving 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.

21. What next Deals 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

22. The End! Thanks for Listening!