• There is one WTE Consultant per 7784 annual attendances, considerably less than the RCEM recommended figure of 1:4000.
• Of these 101 consultants, 19 are planning to retire in the next six years – a fifth of the consultant workforce.
• There were 90 gaps in the consultant rota, 33 in the middle grade rota and eight in the junior rota. Inability to recruit was the primary reason for rota gaps.
• This is leading to departments in Wales not meeting RCEM best practice recommendations of having an EM consultant presence for at least 16 hours a day in all medium and large systems.
• When asked for future staffing needs, departments across Wales reported needing an increase of 75% consultants, 120% increase in the ACP/ANP/PA workforce, 44% increase in the ENP workforce, 30% increase in the Higher Specialist Trainees/ Non-consultant Senior Decision Maker and a 50% increase in Junior Doctors in the next six years.

The census also found that junior doctors were also being overstretched:

• At the time of collection there were 52 trainees in the ST1-6 programme as well as 95 non- Emergency Medicine trainees working in EDs across Wales
• Junior doctors work one weekend every three weekends, consultants work one weekend every 6.2 weekends.
• Junior doctors in training also do the most night shifts with an average of 52 per year.

What are the implications for continuity of care, staff experience and outcomes? Is the idea of ‘top of the licence’ working a reason for concern in terms of burnout, the fragmentation of care or is it an unavoidable response to the workforce crisis?

• Chair: Nigel Edwards, Chief Executive, Nuffield Trust
• Prof Alison Leary, Chair of Healthcare and Workforce Modelling, London South Bank University
• Dr Louella Vaughan, Senior Clinical Fellow, Nuffield Trust

Some trusts have been very open about the measures they are being forced to resort to just to keep things running. The University Hospitals of North Midlands Trust confirmed corridor care has been officially brought back and risk-assessed, with staff recruited specifically to look after patients in corridors.

The trust has been clear – it does not want to treat patients in this way, but has no choice. There is a risk to patients and to the staff who care for them.

Helen Hughes, chief executive of charity Patient Safety Learning, said it would be valuable for trusts to have clear guidance and examples of good practice of corridor care that “prioritise patient safety”.

However, she stressed this should be a temporary measure and not be normalised. But many frontline staff would argued this has already happened – they have had to contend with corridor care off and on for the last decade.

Ms Hughes also stressed the negative impact caring for patients in corridors and other areas has on healthcare professionals themselves, “raising the risk of moral injury if they are unable to provide the appropriate level of care”.

A Royal College of Radiologists’ survey found 41% of clinical radiologists do not have the equipment they need to deliver a safe and effective service.

There is insufficient equipment in place to process scans quickly. The UK has fewer scanners than most comparable countries in the OECD. This equipment is also outdated. 10% of CT scanners to diagnose pulmonary embolisms are over 10 years old.

The Royal College of Radiologists’ Workforce Census found that there is a shortfall of clinical radiology consultants specialising in chest & lung:

• There are 28 vacancies for this specialism in England; this is a vacancy rate of 8%.
• 50% of these vacancies have been unfilled for 1 year or more, demonstrating the shortage of these specialists and the challenges trusts are finding in recruiting full time staff.
• The worst-off areas are the East and West Midlands with only 0.4 chest & lung specialists per 100,000 people.
• 25% of the current clinical radiology consultants specialising in chest & lung are forecast to retire in the next 5 years, by which point demand will have increased.
• The Royal College of Radiologists forecasts that demand for complex imaging, such as CTPAs, will only increase in the coming years. For example, England could see a 7% year on year rise over the next five years.
• Since it takes at least 5 years to train a new generation of clinical radiologists, the Government must continue to fund the expansion of trainee places year on year if the NHS is to keep up with demand.

Read the full briefing by opening the attached document.

• 90% of National Nurses Associations (NNAs) are somewhat or extremely concerned that heavy workloads, and insufficient resourcing, burnout and stress related to the pandemic response are the drivers resulting in increased numbers of nurses who have left the profession, and increased reported rates of intention to leave this year and when the pandemic is over. 
• 20% of NNAs reported an increased rate of nurses leaving the profession in 2020 and studies from associations around the world have consistently highlighted increased intention to leave rates.
• More than 70% of NNAs report that their countries are committed to increase the number of nursing students, but highlight that when this happens there will still be a three-to-four-year gap before new graduate nurses are ready to enter the workforce. During that time, they fear an exodus of experienced nurses.
• Due to existing nursing shortages, the ageing of the nursing workforce and the growing COVID-19 effect, ICN estimates up to 13 million of nurses will be needed to fill the global nurse shortage gap in the future.
• It is imperative that governments act now to mitigate the risk of increased turnover among nurses and improve nurse retention.

The research provides an overview of migration journeys from the initial idea through to moving abroad. It details common triggers points, steps involved, and the factors influencing decisions along the way. The report sets out what is typical and where variation exists.

Analysis of the research interviews led to the emergence of different groups of migrating doctors based on common characteristics, contexts and factors influencing migration decisions:

• Burnt-out GPs: while many doctors in our study mentioned experiencing burnout, there were some specific issues in primary care driving GPs to migrate. 
• Career-limited doctors: international mid-career doctors who felt that they had exhausted all possible career opportunities in the UK. 
• Disheartened EU and international doctors: doctors in their mid-career, often with young families, who recounted negative experiences at work, directly or indirectly, in relation to their identity as a foreign national living and working in the UK. 
• Disillusioned doctors: mostly UK-trained doctors in their mid to late career who were driven to migrate due to frustrations with the health system in the UK.
• Internationally mobile doctors: consultants in their mid-career who had plenty of previous experience abroad, working in different countries whenever the opportunity allowed or when administrative or visa issues determined. 
• Older explorers: older doctors who had spent most of their career working within the NHS, seeking adventure, a new professional experience or a challenge. 
• Salary seekers: typically made up of men in their 40s who had come to a point within their career when they realised that their current salary and future salary prospects were not sufficient to sustain the quality of life they desired. 
• Young explorers: this group was made up of early-career, UK-trained doctors who typically had travel in mind from medical school, seeking fun and adventure.

• Planning for the workforce
• Building a skilled workforce
• Wellbeing at work

The Expert Panel found that the overall rating across all the commitments it examined was 'inadequate'. More detail on ratings for specific policy areas can be found in the attached document.

• Annabelle Collins, Senior Correspondent at Health Service Journal
• Alison Leary, Professor of Healthcare and Workforce Modelling at London South Bank University
• Suzie Bailey, Director of Leadership and Organisational Development at The Kings Fund
• Mark Pearson, Deputy Director of Employment, Labour and Social Affairs at the OECD,
• Nigel Edwards, Chief Executive of the Nuffield Trust.

• Differences in leaving rates between men and women in the same staff group are larger than the differences between those in different job roles of the same gender.
• Male consultants and nurses and midwives had almost the same leaving rate up to the age of 55, before rising substantially for those over 55. Male HCAs, unlike their female counterparts, also had very high leaving rates in their 20s.
• There were large differences in leaving rates by nationality, holding all other factors, including age, gender and tenure, constant.
• For consultants, non-British consultants were substantially more likely to leave the acute sector than their British counterparts. 
• For nurses and midwives, the pattern is more complicated. EU staff were 43% more likely to leave than their British counterparts, while non-EU nurses and midwives were 28% less likely to leave.
• Previous sickness absences are strongly correlated with future exits from the NHS acute sector for both consultants and nurses and midwives.
• Regions with higher unemployment rates have lower leaving rates of nurses and midwives and HCAs.
• Better reported ‘staff engagement’ for nurses and midwives is associated with lower leaving rates.