Read our introduction and executive summary below, or download the full report in English or in Welsh.
This report is a workforce profile for Wales, supported by the Royal College of Paediatrics and Child Health (RCPCH) workforce census 2017, and other data on the paediatric workforce and services collected by the College. It follows on from the Workforce Census 2017 Overview Report1 that provides a UK-wide analysis of the census data, and is part of a series of reports focusing on the four UK nations in turn. Further reports will focus on safeguarding provision, the workforce in paediatric specialties and Specialty and Associate Specialist (SAS) doctors.
This report makes recommendations specific to Wales in five key areas:
- Planning the child health workforce
- Recruiting, training and retaining more paediatricians
- Incentivising the paediatric workforce
- Planning for and expanding the non-medical workforce
- Expand the primary care workforce
The reports are supported by the following census resources:
- An interactive dashboard of paediatric workforce data which allows users to apply filters and customise for their own use and interest
- A set of detailed tables in Excel format for those who wish to see further breakdowns of the census data
- An explanation of how we arrived at our estimate of consultant workforce demand and supply of trained doctors
- The census data collection methodology and response rate
Wales has seven Health Boards providing a range of paediatric services. Tertiary paediatric services are primarily concentrated at University Hospital of Wales in Cardiff and Vale University Health Board (UHB), and acute services in across South Wales are generally in large urban centres. However, elsewhere (in West Wales for example), services are based in more rural and remote areas with access and staffing problems. All health boards provide community child health services. There are particular concerns in Wales about workforce provision in remote and rural areas. As in the rest of the health service, remote and rural areas face higher costs2 , and paediatrics faces issues of recruitment and retention and a reliance fewer of paediatricians in smaller centres.
Health Education and Improvement Wales (HEIW) was established on 1st October 2018. It is a special health authority created within NHS Wales which brings together three key organisations for health: The Wales Deanery; NHS Wales Workforce Education and Development Services (WEDS); and the Wales Centre for Pharmacy Professional Education (WCPPE). HEIW’s key functions include: education and training, workforce development and modernisation, leadership development, strategic workforce planning, workforce intelligence, careers, and widening access, therefore many of the findings and recommendations in this report are directed towards the new organisation with whom the RCPCH looks forward to having a fruitful and co-operative relationship in the future.
Paediatric consultant whole time equivalent (WTE) growth in Wales between 2015 and 2017 was 2.9%, the lowest of all the UK nations: lower than the England growth of 6.4% and the UK growth of 6.7% over the same period. To meet the RCPCH standards set out in Facing the Future3 and other service standards, there needs to be an additional 73.7 whole time equivalent consultants: from 175.7 WTE to 249.4 WTE. This would be an expansion of the current consultant workforce of 42.0%.
Rates of less than full time consultant working in Wales are lower than the other UK nations and medical paediatrics has a trainee workforce which increasingly wishes to work less than full time (LTFT)4 . In Wales, GMC data show that LTFT for trainees working in Wales has gone from 16.4% in 2012 to 19.7% in 2018 . Modelling needs to consider how the shift towards even greater LTFT in trainees may extend into consultant LTFT working patterns in future. This could lead to a potential dramatic fall in the whole time equivalent (WTE) workforce in Wales unless there is an increase in the headcount of doctors in training.
There is political emphasis on preventative health measures, as seen in A Healthier Wales5 , which the College welcomes as an approach to child health. However, the increased burden on Community Child Health (CCH) services must be recognised and corresponding resources provided. CCH is facing difficulties as workload and demand expand without the corresponding expansion in workforce6 . The whole of the NHS workforce is facing a recruitment and retention crisis7 , and shortfalls of other non-paediatric health professionals, such as educational psychologists and speech and language therapists, impact on the multidisciplinary teams in Community Child Health (CCH) services. The Health, Social Care and Sports Committee of the National Assembly for Wales recommended an increase in medical student places8 , a call that the RCPCH supports.
Royal College of Nursing guidance9 states that every organisation should have a children’s champion at executive board level, a view with which RCPCH agrees. However, in Wales, three out of seven (42.9%) of the organisations did not have a Board level lead/champion for children’s services. Initiatives such as children’s champions must be prioritised to ensure the voice of the child is heard.
The number of paediatric trainees and consultants are unlikely to rise by the amount needed to meet demand in the immediate future, especially as a 2018 report found that only 6% of foundation year 1 (F1) doctors consider specialising in paediatrics10 . Therefore, workforce planners need to develop appropriately trained non-medical workforces such as advanced nurse practitioners and physician associates and see their potential in helping paediatric services meet standards and demand.
The general paediatric workload is shifting, and we report a year-on-year upwards trend of admissions11 . A more effective way of working across primary and secondary care, as described in Facing the Future Together for Child Health12 , is needed to keep up with this surge in admissions. The RCPCH are conducting a Paediatric 2040 project13 . The purpose of the project is to develop a shared understanding of what the key issues are likely to be for paediatricians as a discipline and to better understand what the future may hold for paediatricians in the UK in 2040.
We urge Health Education and Improvement in Wales to not emulate the mistakes of other nation’s workforce planners. Wales is desperately short of paediatricians, by around 74 consultants. There are particular challenges in relation to the geography, demography and location of the population centres. Alongside trends towards less than full time working, planners must consider technology requiring more staff, traveling times and the effect that using consultants in either out of hours or resident working has on their availability during the week. Young doctors looking at choices between paediatrics and other specialities may view rota gaps and poor work life balance as disincentives to this otherwise deeply rewarding career.
Improving the health of the nation’s children, aside from being a moral imperative, is an investment in the national economy. Healthy children have more school days, this leads to better education, better employment of healthier adults, who can work and pay tax back into the system until the longer retirement ages being expected of all of us.
- 1. Royal College of Paediatrics and Child Health, 2017 workforce census overview. 2019: www.rcpch. ac.uk/resources/workforce-census-2017-overview-report
- 2Nuffield Trust, Rural health care: A rapid review of the impact of rurality on the costs of delivering health care. 2019: www.nuffieldtrust.org.uk/research/rural-health-care
- 3. Royal College of Paediatrics and Child Health, Facing the Future: Standards for Paediatric Services. 2010
- 4General Medical Council, The state of medical education and practice in the UK 2018. 2018: www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk
- 5Welsh Assembly Government, A Healthier Wales: our Plan for Health and Social Care. 2018: www.basw.co.uk/system/files/resources/180608healthier-wales-mainen.pdf
- 6Royal College of Paediatrics and Child Health and British Association for Community Child Health, Covering all bases - Community Child Health: A paediatric workforce guide. 2017: www.rcpch.ac.uk/resources/covering-all-bases-community-child-health-paediatric-workforce-guide
- 7The Health Foundation, The King's Fund, and Nuffield Trust, Closing the gap: Key areas for action on the health and care workforce. 2019: www.kingsfund.org.uk/sites/default/files/2019-03/closing-thegap-health-care-workforce-full-report.pdf
- 8National Assembly for Wales: Health, Social Care and Sport Committee, Medical recruitment 2017
- 9Royal College of Nursing, The role of children and young people’s nurses in commissioning and planning services. 2014
- 10UK Foundation Programme Office, F2 Career Destinations Report 2018. 2018
- 11Patient Episode Database for Wales (PEDW), Wales admissions by health board and specialty. accessed 2018: www.infoandstats.wales.nhs.uk/page.cfm?orgid=869&pid=40977
- 12Royal College of Paediatrics and Child Health, Royal College of General Paediatrics, and Royal College of Nursing, Facing the Future: Together for Child Health. 2015: www.rcpch.ac.uk/resources/facing-future-together-child-health
- 13. Cushing, J. Shaping the future of paediatric care - introducing Paediatrics 2040. 2018; Available from: www.rcpch.ac.uk/news-events/news/shaping-future-paediatric-care-introducing-paediatrics-2040