Is a pledge still a pledge when it has an elastic deadline?
In its general election manifesto, the Labour Party quietly extended its NHS plan cut-off point for delivering 20,000 extra nurses by a year to 2005.
What is the baseline year for the new target date? A spokesperson for the Department of Health tells HSJ it is 2001, while a parliamentary written reply in July from health minister John Hutton still refers to 2000.
And will these numbers deliver sufficient capacity to support the ambitious increases in activity promised in the NHS plan? The Royal College of Nursing assumed the target was for 20,000 extra nurses working full-time, but it is now clear that the figures relate to head counts and not whole-time equivalents.
John Stock, senior researcher in employment relations at the Royal College of Nursing, says that using the headcount definition, '20,000 could mean anything from 10,000 to 20,000 whole-timers'.
There has never been an 'underpinning rationale'behind the figure, he says, leaving nurse managers with a major headache.'You can't plan services on head count, but That is what the government has done.'
Belinda Finlayson, research officer for healthcare policy programme at the King's Fund, says 'any nurses we get back are great', but that head count 'is not going to contribute as much to the service as if it was whole-time equivalents'.
Last December the RCN highlighted 22,000 WTE vacancies, she adds.
'The fact is that if they are mostly part-time, we need a lot more to make up for the vacancies We have got.'
According to the DoH spokesperson, 'most nurses are working full-time', but the NHS must give 'nurses and midwives the opportunity to work part-time if they want to'.
How did last year's nurse recruitment campaign fare? By the end of October,2,763 nurses returned to the NHS and 87 to other areas of healthcare, of whom 60 per cent were part-time.Of 713 nurses who came back to the service between April and July this year, three-quarters are working part time, the DoH admits.
Ray Rowden, visiting professor of nursing at York University and a member of the NHS plan taskforce on service quality, says senior professionals are noting 'a lot of returners, but many of them are very much part-time'.
He asks: 'What if you end up with 20,000 extra nurses, but they only add up to 9,000 whole-time equivalents?
That has huge implications for NHS capacity.'
If that is the pessimistic scenario, then 'everything is threatened', he points out.'Look at NHS Direct and walk-in centres.Who's staffing them? If you do not get the equivalent of about 15,000 whole-timers there will be a problem.' Ann McGauran