Participants from earlier nationwide studies on predictors of internship match were contacted 7-10 years after obtaining their doctoral degree to gather additional data concerning their attained early career competencies and benchmarks (e.g., scores on the national licensing exam). In this sample (N = 190), licensure exam scores were significantly positively associated with scores obtained on the Graduate Record Examination (GRE), family of origin socioeconomic status, and student debt load. However, obtained licensure scores were not found to be significantly associated with any pre-doctoral training variables (e.g., intervention/ assessment hours, number of integrated reports, number of publications, rank order of matched internship site) or most post-doctoral early career activities. Weak positive associations between licensures scores and engaging in teaching / supervision / consultation services were observed. Few self-reported early career competencies were found to be weakly positively associated with scores on the national licensing exam (i.e., integrity, seeking supervision, scientific mindedness, evidence-based practice). Significantly inverse associations were found between national licensing exam scores and self-reported competencies in the areas of management and systems change. Findings are discussed and implications for the national licensing exam considered.

Yes / This article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife.

No / NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.

No / The NHS needs to make real term cost savings whilst maintaining and, where possible, enhancing the quality of essential services. The performance of maternity services is seen as a touchstone of whether the NHS is delivering quality health services in general. Recent events in relation to increased infant and maternal mortalities demonstrate the necessity of the benefits of continued improved patient safety. The pressing issues which maternity services face are financial, quality and safety.

No / Jayne Donaldson, Bryan McIntosh and Simon Jones argue that England can learn from Scotland's approaches to the nature of hospital capacity and the workforce's delivery of service.

No / Postnatal care is an area for serious concern, with readmission of women and infants following discharge having increased significantly over the past decade. A reduction in average postnatal stays together with care delivered by many members of a fragmented multidisciplinary team disallowing full timely assessments of health needs, are reasons cited for this. There is a disjuncture between process, policy and health outcomes in maternity and neonatal outcomes. While there is evidence indicating what needs to be done to reduce mortality and morbidity and improve outcomes, more is required in relation to how this is done; central to this is innovation. Currently, the NHS does not have sufficient useful data on the extent to which frontline workers are delivering needed interventions, or their short and long-term impacts. Unscheduled maternity and neonatal admissions are supposedly a key indicator of the quality of maternity care. An understanding of why these incidents occur could generate significant cost reductions at a time of severe austerity and enhance the quality of care and safety for women and their infants.

No / The recently commissioned review of international healthcare systems by the Centre for Workforce Intelligence has a profound significance for healthcare management and the delivery of nursing and medicine within the UK (Cookson, 2012). This review will analyse and compare contrasting international healthcare systems of different providers across the UK—identifying the key factors affecting the delivery of healthcare. This commission must be viewed in relation to the ‘Nicholson Challenge’ (Hawkes, 2012), which requires savings of £21 billion to fund increased demand over the next four years. These efficiency savings are required to be found through better ways of working within current NHS law and regulation (Department of Health (DoH), 2010a; DoH, 2010b; Hawkes, 2012). The main agenda will be staff substitution —substitution of a higher graded practitioner by a lower graded practitioner. However, the greater opportunity is for healthcare assistants (HCAs) to become more professionally empowered.

No / The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.

No / Clinical and corporate governance have been an area of ongoing concerns in the NHS. Since the Bristol Royal Infirmary scandal of the 1990s and the events concerning Sir Jimmy Savile there has been a dilemma of its true nature and relationship. Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management.

No / The National Health Service (NHS) has historically undertaken initiatives to promote equality in employment as well programmes to develop and promote Black and Minority Ethnic (BME) staff. However, discrimination remains a feature of NHS employment practices and may help to explain the lack of BME staff at senior levels in the service. Despite having many initiatives BME staff are underrepresented in NHS senior management and at the top of each organisation, the management is almost always white. This paper will present findings from a case study on the experiences of corrective action by BME staff in senior/middle management positions. The paper will outline key messages and good practice to inform policy and practice.