Board of Directors Meeting Report 27 May 2015 Agenda item 53/15 (i) Title Recruitment Update Sponsoring Director Director of Human Resources and OD Author Sarah Daniel, Interim Associate Director of Human Resources Purpose To provide the Board with an update on progress Previously considered at Board Meeting September 2014 Executive Summary: The Trust has a total of 221 vacancies, a reduction of almost 50% since the September 2014 report to the Board of Directors, when 432 vacancies were outstanding. This equates to a vacancy rate of 5.6%, a reduction which is ahead of plan, (268) which is a significant achievement and provides a strong level of positive assurance of the overall reduction in vacancies. There are still challenges in recruiting into some specialist nursing and consultant and other professional groups highlighted in this report. The action plan is attached as Appendix 1 continues to be implemented to reduce the vacancy rate which includes measures to improve our marketing to potential applicants, recruitment and retention incentives, improvements to the recruitment process to remove any avoidable delays, increasing our partnering with specialist agencies to source applicants for hard to fill roles, creating new roles as a response to hard to fill roles, developing our staff for hard to fill roles and provide career development and actions to continue to reduce the staff turnover rate, which now stands at 12.35%. This paper does not include the action plan for retention; this will be covered in a Board Report in August. The Trust has also recently joined the East of England Recruitment Streamlining project. The trajectories which predict our progress in reducing the vacancy gap both overall and for specific occupational groups remain unchanged, despite being ahead of target, as the action plan is to be reviewed at which point the trajectories will be revised. Moving forward our next key focus will be high value recruitment, some of the details of which are contained within the body of the report. Corporate Objective 1 Patient Focus keep Related Trust Objective getting better. Risk 1,2,3 Corporate Objective 2 Staff feel proud to work
here and keep making a difference. Risk 1 & 2. Related Risk See above Legal implications / regulatory requirements Quality impact assessment Equality impact assessment Action required by the Board The Board is asked to note the update and action plan. NHS England and our regulators expect organisations to ensure that staffing capacity and capability are appropriately funded, monitored and maintained. The CQC will monitor how well staffing requirements are met as part of their inspection programme. Permanent staffing levels need to be at an adequate level to provide safe nursing care. Monitoring recruitment levels will enable us to understand the impact of any permanent staffing deficit on care including patients with protected characteristics. 2
High Risk Recruitment Trajectories Introduction This report provides the Board with an update regarding the current level of staff vacancies and the actions that are being taken to reduce the gap between the approved staffing establishment and the number of staff in post. In order to provide continuity of safe and effective patient care the Trust engages workers from its own Bank or from agencies to cover relevant vacant posts. However, the cost of agency staff is a significant financial pressure to the Trust and patient care is best served by a stable staffing situation. Current Position Turnover notes: Due to the recent transfer of Pathology services, the turnover (WTE %) Excluding Jnr Doctors figure would appear inflated. In order to reflect this, an additional line has been added to the turnover graph. This line includes voluntary leavers and excludes Junior Doctors, TUPE transfers, End of Fixed Term Contracts, Mutual Agreed Resignations and Redundancies. Excellent progress has been made, ahead of target, to move toward the target of 4% vacancy rate - this has been achieved through the implementation of a range of actions. A reminder of some of the key actions taken to reach this point is as follows: 3
Reviewed the recruitment process for general recruitment and agreed changes to the process at the Corporate Management Team which are being implemented Reviewed the recruitment process for Medical Staff Implemented a recruitment and retention allowance on a targeted basis for qualified nursing staff in the Emergency Department Reserved additional dates for Consultant recruitment panels Initiated a review to identify trainee doctor posts where it is anticipated that Deaneries will be unable to fill and to commence local recruitment to avoid the use of agency staff. Golden hello offer to over 40 newly qualified nurses to help close the vacancy gap The exit interview process with a targeted focus on areas where turnover is significant. The new process will be discussed at the Board. Hard to Fill Posts Although the general labour market for NHS staff is challenging, there are some roles with an acknowledged national skills shortage. These are requiring us to pursue national and international recruitment initiatives and campaigns and to work with business units for alternative solutions such as establishing new roles (e.g. Advanced Care Practitioners in the Emergency Department) and how we develop our own staff into shortage roles. Hard to fill roles include: Operating Department Practitioner Speech and Language Therapist Nurses (including Paediatric Nurses) Consultants in a range of specialties current challenges include DME, Stroke and Radiology Middle grades in Emergency Medicine and medical specialties There have been some notable recent successes with medical recruitment through the use of agencies for middle grades in A&E and Oncology. We are also planning further overseas recruitment campaigns for nursing staff including paediatric nurses. Although we have provisionally identified countries to recruit from, the arrangements will be finalised once the Trust has confirmation from the Nursing and Midwifery Council (NMC) of its review of the compatibility of other countries with the registration requirements for nursing in England and Wales. Next Steps Consultant Recruitment We will continue to innovate and replicate success from the action plan to achieve the trust target of 4%. An additional focus will also be to review and develop our consultant recruitment process: The current consultant recruitment process is currently not designed to ensure the best candidate is appointed on the day of the interview with just a 40 minute interview. Additional elements under consideration to enhance the current process include:. Pre-screening filter questions to be used on NHS jobs. 4
Job descriptions to be more succinct and relevant with any Trust information uploaded onto NHS jobs as an attachment. Recruitment and selection skills training and Equality and Diversity training for all internal AAC members. This would involve Learning and Development designing a training programme for this purpose. The AAC should consist of a maximum of 6 members. Prior to the AAC there should be an on-line psychometric test to ensure behaviours are explored at this stage using the Keil Centre. The results of this test will be fed back to the members of the AAC at the end of the formal interview. The cost for this is being explored. On the morning of the AAC the candidates would be required to give a presentation on a given topic to members of the multi-disciplinary team. The clinical lead would be required to provide details to the person responsible for arranging the AAC to invite members to the presentation. A proforma would be completed by each team member and feedback would again be given to the AAC by the clinical lead/clinical director. At the AAC ensure probing questions are asked using a clinical scenario where the situation is deteriorating. Instead of just requiring the candidate to respond with the relevant clinical solution the probing would need to be about behaviours asking questions like How did that make you feel? Have an agreed bank of suitable questions. 10 minutes before coming into the interview the candidate could be given a topic to present to the panel and would only have a flip chart and marker to use. A simulation suite could be used where a doctors skills can be tested and also an opportunity for the MDT to assess how they interact with a patient or relative in a difficult situation. The AAC should be advisory and not decision making with the final decision made by the Trust Executives at their regular meetings. A full induction to the Department and the Trust and then a formal meeting with the Medical Director after six months for a review meeting. Develop a mentorship programme. The mentor would not have to be from the same department but could be a Consultant from another specialty with excellent leadership skills or a Consultant from a neighbouring Trust.. 5
Overall Risks and Mitigations The labour market remains very competitive and a risk is that we will be unable to sustain our success in attracting sufficient suitably qualified staff to fill all vacancies, or that we will be able to replicate our success across all the hard to recruit to roles. There is currently a restructure paper being consulted on with the HR team which proposes changes to the recruitment teams, in particular integrating the medical, bank and general recruitment teams. Actions are being taken to mitigate any issues linked to retention and continuity. The situation will be kept under constant review. 6
Appendix 1 Over Arching Objectives To recruit the right people at the right time in order to provide high quality patient care and improve the patient experience To promote the Trust as an organisation that is recognised as a quality employer in respect of working environment, leadership and creativity, thereby attracting and retaining quality, high performing staff. Action Plan KPI Target Date Ensure that the recruitment team has a balanced skills and experience mix in order to HR Reorganisation completed 10/15 deliver an integrated recruitment service Ensure the recruitment process minimises the time to hire Reduce the time to hire by 10% 05/16 Develop a recruitment media strategy in order to attract a broader range of candidates and develop the brand of the Trust Agreed post advertise on LinkedIn 09/15 Establish a recruitment user group to receive direct feedback from hiring managers. At least one user group organised 11/15 Ensure reduction in hard to recruit vacancies through specialist campaigns and where appropriate engagements in International Recruitment Campaign achieves its target Develop an apprenticeship scheme 60 Apprentices recruited 12/16 Introduce value based recruitment for consultants and nursing posts Pilot carried out in consultants recruitment Develop a talent pipeline Apprenticeship scheme introduced Work experience scheme introduced Recruit a diverse workforce which reflects the diversity of the local population Become a two ticks employer Attend careers fairs and other community based events On going 07/15 08/15 01/16 01/16 06/16 7