Health Board Report NURSING AND MEDICAL RECRUITMENT UPDATE

Transcription

1 AGENDA ITEM 4.4 Health Board Report NURSING AND MEDICAL RECRUITMENT UPDATE Executive Lead: Director of Workforce and OD Author: Director of Workforce & OD Contact Details for further information: Mrs Joanna Davies on or Purpose of the Health Board Report This report has recently been provided as a presentation to our local Public Fora. It is now presented as a briefing for the Health Board to update on our current medical and nursing workforce recruitment. The Board are asked to note the content and progress, support ongoing and planned initiatives. Governance Link to Health Board Strategic Objective(s) The Board s overarching role is to ensure its Strategy outlined within Cwm Taf Cares 3 Year Integrated Medium Term Plan and the related organisational objectives aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim are being progressed, these in summary are: To improve quality, safety and patient experience. To protect and improve population health. To ensure that the services provided are accessible and sustainable into the future. To provide strong governance and assurance. To ensure good value based care and treatment for our patients in line with the resources made available to the Health Board. This report aims to support all of the strategic objectives. Supporting evidence Engagement Who has been involved in this work? Executive Directors, Workforce & OD, Operational Nursing Teams, Clinical Directors. Nursing & Medical Recruitment Update Page 1 of 10 University Health Board Meeting

2 Health Board Resolution (insert ) To; APPROVE ENDORSE DISCUSS NOTE Recommendation The Health Board is asked to: DISCUSS and NOTE the content of the report. Summarise the Impact of the Executive Board Report Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience All recruitment and selection is in accordance with Equality Legislation. Overseas recruitment is undertaken within legislative requirements. N/A Procedures are in place to ensure all substantive and locum staff are competent. Resources Risks and Assurance Health & Care Standards Locum and agency usage is higher cost. Securing a substantive workforce is the primary aim. Locums will be and are used where staffing levels fall below the required. The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes: Staying Healthy Safe Care Effective Care Dignified Care Timely Care Individual Care Staff & Resources 4/24729_Health%20Standards%20Framework_201 5_E1.pdf Workforce Freedom of Information Status The work reported in this summary and related annexes take into account many of the related quality themes (as applicable) These are detailed within the report. Open Nursing & Medical Recruitment Update Page 2 of 10 University Health Board Meeting

3 NURSING AND MEDICAL RECRUITMENT UPDATE 1. PURPOSE OF REPORT This report has recently been provided as a presentation to our local Public Fora. It is now presented as a briefing for the Health Board to update on our current medical and nursing workforce recruitment. 2. BACKGROUND - OUR CHALLENGING CONTEXT There are national and international labour market shortages in some specialties including nursing, radiography, sonography, medical staff in Accident & Emergency, radiology, pathology, psychiatry and primary care. In addition we have had ongoing local difficulties recruiting medical staff in Trauma & Orthopaedics and Surgery and, more recently, therapy staff in physiotherapy and dietetics. The demand for some staff has been driven up by unforeseen circumstances that were in the main not predictable. These include but are not limited to: The Francis Review (Mid Staffordshire), The Andrews Review (Abertawe Bro Morgannwg University Health Board) and resulting demand for higher qualified nursing levels. The Welsh Government s Nurse Staffing Bill. Labour market changes particularly the rise of premium agency and locum contracts and the apparent shift in attitude about being employed in permanent NHS roles versus accepting more flexible higher paid temporary posts. The South Wales Programme outcome impacted on the Royal Glamorgan Hospital in particular with some destabilization of the workforce concerned about the impact of the changes on careers and job security. This has led to increased turnover at RGH and higher levels of vacancies. The ongoing reduction of training places provided by the Deanery which allocates junior doctors in training to Health Boards and recruits to these posts. The paper primarily focuses on nursing and medical recruitment, but we are actively working on recruitment plans for other areas based on similar work. Nursing & Medical Recruitment Update Page 3 of 10 University Health Board Meeting

4 SETTING THE SCENE - VACANCY LEVELS Nursing Acute and Community Wards Site Specialty Aug 15 Jun-16 Onboarding Predicted vacancy level PCH Surgery Medicine A&E/CDU YCC All Wards RGH Surgery Medicine A&E/ YCR All Wards Radiographers Site Grade Vacancies Site Grade Vacancies PCH Band 5 4 RGH Band 5 4 Band 6 1 Band 6 1 Key Medical Areas Shortage Occupational Areas Specialty Area Paediatrics Accident and Emergency Trauma and Orthopaedics Psychiatry Grade CT CT Employed Locums Agency Locum Vacancies CONSULTANT SENIOR JUNIOR CONSULTANT SENIOR/JUNIOR CONSULTANT SENIOR JUNIOR CONSULTANT SENIOR JUNIOR Nursing & Medical Recruitment Update Page 4 of 10 University Health Board Meeting

5 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES BUILDING OUR BRAND AND RAISING OUR PROFILE Regular adverts are placed across several jobs boards, including NHS Jobs, LinkedIn and Indeed.com as part of our efforts to market Cwm Taf. We have engaged with an advertising agency to develop a national recruitment campaign to attract nurses to Cwm Taf from other parts of the UK which is due to launch July. We have included materials to promote our Health Board s innovative service changes and new roles alongside testimonial and video diaries. The campaign will target nurses further afield in the UK to relocate to Cwm Taf. The Multi media campaign includes the following components: Social media Catch up TV Press Adverts London Underground A dedicated recruitment microsite containing Cwm Taf case studies and news stories, information about local housing and promoting the quality of living and Careers in Cwm Taf. A key element is the video diaries of a number of our NHS staff. Whilst the microsite is initially being used for the Nursing campaign this will be available for more general recruitment use and other occupational groups going forward. SUPPORTING ACTIVITY We are introducing New Nurse Bank Software to manage temporary workforce supply to fill shift demand. This will give our substantive and bank staff the ability to commit to work available shifts as and when additional hours become available. These shifts will be visible through an online app, which will allow the individuals to view, request and have confirmation of their shifts on their PC / Tablet / Mobile Device remotely. It will also allow Managers and Bank staff quicker access to the requests and visibility of shifts being filled. We have also introduced New Recruitment software (Trac) that links to the main NHS Jobs site to streamline and reduce the administration burden that sits behind the recruitment process. By automating processes and making these visible on line this will speed up the pre employment checks and routine processes taken to get candidates who have been offered a job post interview into employment. This went live at the end of April and we are beginning to see the improvements. Nursing & Medical Recruitment Update Page 5 of 10 University Health Board Meeting

6 NURSING RECRUITMENT - OUR GRADUATES ARE OUR FUTURE We have built strong links with the University of South Wales and Cardiff University to develop recruitment for future graduates who complete their qualification twice yearly. We are working with Practice Facilitators to encourage graduates to join Cwm Taf, and encouraging students to join our nurse bank at the onset of their training. This will allow them to develop practical care skills and provide financial support whilst studying. We are continually engaging with the local University students through social media, s and face to face sessions. This September s cohort of graduates is consolidating their learning in their preferred areas now with a view to securing in permanent employment in these areas. We are offering the option to name their top three choices with a view to matching them to these areas where possible. We have developed a clinical skills training programme to support their practice which involves a period of a month when they join us as supernumerary to consolidate their learning. Progress to date 30 graduates joined us across April and May, with a further 3 joining over summer. 43 students are currently in line to join us at the end of September (although we are looking to increase this). Students from the 2017 cohorts are already seeking employment with us on completion of training. We are also working with international nursing students at University of South Wales with 1 (so far) planning to join us once she has completed her OSCE. Our Graduates are a key part of our ongoing Nursing Supply. OTHER NURSE RECRUITMENT ACTIVITY In October 2015, the Home Secretary added nursing professions to the UK s Shortage Occupation List; this means that the UK Government has recognized that there are not enough resident workers to fill vacancies. The Migration Advisory Committee regularly reviews this list, and at the latest review agreed to continue to include nursing professions. Doing this means that the Health Board can now actively recruit for staff from outside the European Economic Area and issue a Tier 2 Certificate of Sponsorship without the need to demonstrate that a resident labour market test has been carried out. The Health Board had been actively recruiting from the European Economic Area and is now in the process of recruiting from the Philippines. This is a major undertaking for the Health Board and for the individuals involved, and to maximize our preparedness for their arrival, a task and finish group is looking at an induction and adaptation programme to support resettlement, encourage integration to the local community and ensure skills are aligned with Health Board standards of practice. Nursing & Medical Recruitment Update Page 6 of 10 University Health Board Meeting

7 Part of this process will be to build links and develop peer support groups via social media prior to arrival, with a Facebook group being established to share news and support before, during and after arrival. This will also be used to build connections to the Health Board s existing Filipino community. For UK activity we have also attended jobs fairs in Birmingham, London and Bristol, and we have rolling adverts in place on NHS Jobs. Progress to date 4 EU nurses joined us in recent months 44 Filipino nurses due to join us at the end of 2016/early Filipino nurses due to join us around April 2017 Local Recruitment Activity continues to deliver steady flow of candidates MEDICAL RECRUITMENT The Health Board has continued to build the strong links with the All Wales Deanery, with the twice yearly pathway of Core Medical trainee doctor rotations. Despite the challenging position across Wales, the Health Board maintains a very strong position with an improved fill rate to core medical trainee posts. Regular adverts are placed across a number of jobs boards, including NHS Jobs, the British Medical Journal (BMJ), LinkedIn and indeed.com. Medical Recruitment representatives have also recently attended the national jobs fairs in Birmingham and London. Medacs Permanent Recruitment Agency are also sourcing candidates from across the globe, with recent campaigns in Canada, Australia and the Middle East. There is also ongoing collaborative work with the Welsh Assembly Government, Welsh Deanery and other Health Board to improve the Medical Recruitment position and market Wales as a location of choice. A coordinated recruitment campaign for medical staff is under development with the aim of being launched later in the summer. Progress to date Recent permanent successful Consultant recruitment exercises: o 2 Haematologists o 2 Acute Physicians o 3 Anaesthetists o 1 Paediatrician o 1 Ophthalmologist In the last 12 months, an additional 5 Consultant posts in Pathology - Haematology, Microbiology and Histopathology, 2 Anaesthetists, 7 Physicians, 6 Surgeons (covers General Surgery, Trauma and Orthopaedics, Urology and Health and Neck), 1 Psychiatrist, 1 Obstetrician Gynaecologist and 4 Radiologists. Specialty Doctors 23 recruited across Medical specialties, plus 10 appointed to Primary Care. Nursing & Medical Recruitment Update Page 7 of 10 University Health Board Meeting

8 MEDICAL TRAINING INITIATIVE Medical Training Initiative (MTI) is designed to enable a small number of International Medical and Dental Graduates to enter the UK to experience training and development in the NHS for up to two years before returning to their home country. Training capacity not required for planned UK/EEA training numbers is made available for overseas doctors who meet the required eligibility criteria, including obtaining registration with the GMC. Doctors in the MTI scheme are always obtained via a professional sponsorship scheme with the relevant Medical Royal College. The placements filled by doctors in the MTI scheme are approved by the local Deanery/Local Education & Training Board (LETB) and may also need to be approved by the relevant Royal College. The Academy of Medical Royal Colleges acts as the UK Visa Sponsor to enable participants to apply for a Tier 5 Visa. Cwm Taf University Health Board has one MTI in Obstetrics and Gynaecology and is currently processing another 3 MTIs for Medicine via the RCP. We are looking to increase our use of MTIs through local work with overseas universities and Royal Colleges and also through a coordinated Wales wide initiative. LOCUM COVER Gaps in permanent vacancies continue to be covered by Locums with the Medacs Vantage Framework solution sourcing locums in the UK and overseas. Where Locums are require, long term locums are employed wherever possible, and where it is possible these are converted to permanent posts. This latter work has recently been presented to the Audit Committee, Finance, Performance and Workforce Committee. The Executive Board is provided with regular oversight of the Locum position and costs. Progress to date Improved success rates in filling difficult vacancies Position remains challenging - we are making progress both in recruiting permanently to posts and in reducing the spend on high cost locum usage. RECRUITING NEW SERVICES Recruiting staff to the Health Board s future service design underpins their success. Major recent development have been the establishment and development of the Acute Medicine Model and the GP Out of Hours service. Nursing & Medical Recruitment Update Page 8 of 10 University Health Board Meeting

9 Acute Medicine Model - to support the new model we have recruited: 6 additional Advanced Nurse Practitioners, taking the total to 12 WTE. The Critical Care Outreach team now provides 24/7 cover to support the Medical Model and this team of nurses has been expanded from 3 to 6 WTE. The Medical Model requires 7 Acute Care Physicians, plus 3 General Internal Medicine Physicians to support this new way of working we have appointed 5.2 of the 7 (with our staff picking up extra shifts for the shortfall) plus 2 General Internal Medicine Physicians. GP Out of Hours Focus remains on recruitment and retention of the GP workforce. A shift bundle system has been created to attract higher rates of pay for those shifts difficult to fill. Shift fill rate is currently at 93% fill rate. GP Skill mix review is being undertaken to focus on the future sustainability of the service. Work is being undertaken to look at implementing roles such as Advanced Nurse Practitioners and Advanced Paramedics to support the service. OTHER INITIATIVES The Health Board is always seeking ways to develop existing staff in parallel to developing services to ensure future sustainability. A number of initiatives are being undertaken: Exploring alternative new roles e.g. development of Advanced Practitioners Emergency Nurse Practitioners and Advanced Nurse Practitioners are being developed in house as part of the new acute medicine service and will be used in some of the rotas currently covered by junior medical staff Development of support staff and Health Care Support Workers Examples include primary care Health Care Support Workers are working to support health checks, midwifery assistants, Medical Technical Assistants undertaking phlebotomy, ward clerks releasing specialist nurses to more clinical work etc Development of Health Care Support Worker working with University of South Wales to develop more flexible routes to become registered and widen the pathways to employment Working with local job centres and schools to offer work experience as a route into NHS careers. CONCLUSION The Health Board is sustaining activity around recruitment to key areas to ensure stability and safety of services and maintain high standards of patient care. Nursing & Medical Recruitment Update Page 9 of 10 University Health Board Meeting

10 4. RECOMMENDATION The Health Board is asked to: DISCUSS and NOTE the content of the report. Freedom of Information Status Open Nursing & Medical Recruitment Update Page 10 of 10 University Health Board Meeting