BOARD – SUMMARY REPORT
Date of Board meeting: 29th September 2009
Title of Report: Recruitment and Retention
Title of Director: Acting Director of Workforce and Organisational
Development
Paper Number: WL1661
Purpose of the report:
To inform the Board on progress and developments in relation to the management of Recruitment
and Retention of staff.
Recommendations to the Board:
The Board is asked to note the progress and developments in relation to the recruitment and
retention of staff.
Action required:
To note progress and developments in relation to the recruitment and retention of staff.
Relationship with the Assurance Framework (Risks, Controls, and Assurance):
CO2 Embody the values of a Foundation Trust
CO4 Ensure staff are equipped to effectively deliver high quality, safe care
CO3 Achieve good or excellent Annual Health Check results
CO1 Continue to develop and ensure safe planning, coordination and delivery of care
Healthcare Standards (Core / Developments):
C11 Ensure that staff concerned with all aspects of the provision of healthcare are
appropriately recruited, trained and qualified for the work they undertake
Summary of Financial and Legal Implications:
Proper workforce utilisation and development is a key component of corporate governance and
financial control.
Appropriate systems and processes for the recruitment and retention of staff will strengthen the
Trust‟s transparency in ensuring equality and diversity for all staff.
1
ENCLOSURE R
Paper WL1661
WEST LONDON MENTAL HEALTH NHS TRUST
RECRUITMENT AND RETENTION
A REPORT FROM THE ACTING DIRECTOR OF WORKFORCE
AND ORGANISATIONAL DEVELOPMENT
The Board is asked to note progress and developments in relation to the recruitment and
retention of staff.
1 INTRODUCTION
1.1 This report follows various regular updates to the Board in relation to the management of the
recruitment and retention of staff, which have included:
Quarterly and Annual Workforce Information Reports reviewing vacancy and turnover
rates, associated recruitment activity, and the measures being pursued to obtain
improvements in this area.
1.2 This paper provides a review of the workforce profile for 2008/09, key recruitment and
retention performance indicators with comparative data over the previous 5 years, and
benchmarking information from London Mental Health Trusts, together with an up-date on
progress and development of recruitment and retention initiatives and services.
2 BACKGROUND
2.1 The NHS Plan heralded a period of rapid workforce growth over the last decade. More
recently the NHS has moved to a more steady state and labour supply is more closely
matched with demand. However there remain shortages in some specialist areas and with
changing workforce demographics, including an ageing workforce, the NHS needs to work
hard to retain its skilled staff and recruit the right people in the future.
2.2 Over the next few years as the economic situation impacts on public sector funding, the
focus will be on productivity and service and role redesign. The future changes in service
emphasis and organisation will require a workforce that is flexible and adaptable. Planning
future workforce requirements will need to recognise this changing environment.
2.3 Over the last few years, largely in response to the Bichard Enquiry, there has been greater
emphasis and higher standards set in relation to employment checks. There are a set of
legal and DH mandatory checks that must be carried out for the appointment and on going
employment of staff. Compliance with these standards now forms part of the Care Quality
Commission‟s Annual Health Check. The Independent Safeguarding Authority will manage
the new vetting and barring scheme that will require all staff working with vulnerable adults
and children to be registered with the scheme by 2015.
2.4 The Trust‟s workforce has increased year on year due to its service modernisation
programme; there has been a total increase of 34% since it formed in 2001. On average
just under 600 new staff commence each year (50 per month) in response to these
developments and turnover.
2
2.5 The Care Quality Commission Report identified concerns regarding recruitment and staffing
levels, with the recommendation that the Trust „must ensure that it has sufficient numbers of
staff, with the right skills, in all staffing groups‟ and this forms part of the Trust Action Plan. It
is imperative that recruitment and retention is a priority for all.
3 RECRUITMENT AND RETENTION KPIs
Workforce Profile
3.1 The workforce profile for 2008/09 is shown in appendix one. It provides the funded
establishment, staff in post, vacancy and turnover rates, starters and leavers and the
diversity profile. Narrative and comparative data is provided below.
Establishment
3.2 At its inception in 2001, the Trust employed 3218 staff. The workforce has increased year on
year and it now employs 4,320 staff, an increase of 34%, making it one of the largest mental
health trusts in the UK.
2004/05 2005/06 2006/07 2007/08 2008/09
FUNDED FTE 3963.2 4070.5 4155.8 4254.1 4320.4
FUNDED FTE
4400
4300
4200
4100
4000
3900
3800
3700
2004/05 2005/06 2006/07 2007/08 2008/09
Vacancies and Turnover
3.3 The vacancy rate has increased from 12.4% for 2004/05 to 14.8% for 2008/09; it has
remained largely static for the previous 3 years. The turnover rate has shown a variance of
between 11.0% and 12.8% over the last 5 years, and is currently standing at 12.5%.
3.4 Administrative and Clerical, ancillary and unqualified nursing staff groups have had
consistently higher vacancy rates than the Trust average. The recruitment of community
psychiatric nurses and occupational therapists has been challenging as well as staff for
Older People‟s Services, Women‟s Services and DSPD Unit. The growth in establishment
outlined above has created a significant number of new vacancies; this together with a small
year on year increase in turnover has also presented significant challenges to reducing the
vacancy rate.
2004/05 2005/06 2006/07 2007/08 2008/09
VACANCY RATE 12.4% 10.9% 14.7% 14.6% 14.8%
TURNOVER RATE 12.8% 11.0% 11.4% 11.5% 12.5%
3
16.0%
14.0%
12.0%
10.0%
VACANCY RATE
8.0%
TURNOVER RATE
6.0%
4.0%
2.0%
0.0%
2004/05 2005/06 2006/07 2007/08 2008/09
3.5 The table below provides comparative data for vacancy and turnover rates with other Mental
Health Trusts in London. The Trust‟s rates are slightly above the average.
BENCHMARKING DATA 2008/09
London Mental Health Trusts 2008/09
Turnover % Vacancy %
Central & North West London NHS
Foundation Trust 13.0% 13%
South West London & St George‟s
Mental Health NHS Trust 12.0% 18%
East London Hospitals NHS
Foundation Trust 12.0% 8%
Barnet, Enfield & Haringey Mental
Health NHS Trust 12.1% 12.9%
Camden & Islington Foundation NHS
Trust 10.6% 15.8%
South London & Maudsley NHS
Foundation Trust 9.5% 17.5%
West London Mental Health NHS
Trust 12.5% 14.8%
Starters and Leavers
3.6 The number of starters per year has remained static over the last 5 years at just under 600
(with the exception of 2006/07). The number of leavers for each year is at a similar level. In
2008/09 nearly half of leavers had a length of service of between 1 to 5 years – this has
been consistent over the last 5 years and is the norm. 8% of leavers were within their first
year of service; this is a considerable improvement from 2004/05, when this figure sat at
23%.
2004/05 2005/06 2006/07 2007/08 2008/09
Starters 574 597 403 594 584
Leavers 505 490 519 533 604
4
700
600
500
400 Starters
300 Leavers
200
100
0
2004/05 2005/06 2006/07 2007/08 2008/09
3.7 The reasons for leaving are provided below. For voluntary resignations, promotion and
relocation are the most common reasons provided, followed by work life balance and child
dependants. However this needs to be treated with caution as the majority of resignations
provide „other‟ as reason for leaving, indicating that improvements in data collection are
required to obtain a more accurate picture.
Reason for Leaving Headcount
2007/08 2008/09
Voluntary Resignation 314 370
Contract Ended 136 156
Retirement 78 71
Death in Service 5 7
3.8 The number of age retirements has shown a small increase over the last 5 years and this
will continue as the workforce ages, in line with the national trend. In 2008/09 nearly half of
all retirements were in the nursing staff group (qualified and unqualified) and this trend is set
to continue.
RETIREMENTS
2005/06 2006/07 2007/08 2008/09 Average
222 West London Mental Health NHS Trust Retirements
49 66 78 71 66
Staff retired aged under 60
N/A N/A 38 29 33.5
5
RETIREMENTS DURING 2008/09
STAFF GROUP HEADCOUNT
ADMIN & CLERICAL 13
NON CLINICAL SUPPORT STAFF 13
MAINTENANCE & WORKS 2
MEDICAL 5
QUALIFIED NURSING 21
UNQUALIFIED NURSING 13
ALLIED HEALTH PROF 1
SCIENTIFIC, PROF & TECHNICAL 2
SENIOR MANAGERS 1
TRUST TOTAL 71
3.9 17% of Trust staff are aged 55 and over, an increase of 3% from the previous year. This
trend is set to continue; projected figures are provided below.
STAFF AGED 55 AND OVER
2007/08 2008/09 2009/10 2010/11 2011/12
Projected number of staff aged 55 and over. No
allowances made for joiners or leavers
551 652 743 852 936
Recruitment Activity
3.10 The table below provides the overall picture for recruitment activity for the year 2008/09 as
recorded on NHS Jobs. 526 campaigns were managed during the year, with 14,504
applications received and from these 844 appointments made. The „quality of candidate per
division‟ is therefore 5.8% or 17 applicants to 1 hire. Although there is no data available from
previous years, this ratio is comparable with other NHS employers and is regarded as a
satisfactory return.
3.11 Administrative and Clerical roles have the worse „quality‟ or suitability of candidates at 3%
(33.5 applicants to 1 hire) due to the fact that such roles attract high volume applications,
particularly in the current economic climate; professional roles having a higher quality at, on
average, 10% (9.5 applicants to 1 hire). Again this is comparable with other Trusts.
3.12 All jobs are posted on NHS Jobs, which provides a cost effective approach to recruitment
advertising and is the leading online recruitment service in the UK with consistently more
visits (4.5 million per month) than other commercial job boards such as Monster or
Totaljobs. All posts advertised at Agenda for Change bands one to five also feature in the
local Jobcentre Plus.
3.13 The advertising spend for 2008/09 was £205,585. This presents a significant reduction on
expenditure prior to the introduction of NHS Jobs, which for 2005/06 was £654,108. The
main areas of current spend are local media for ancillary posts, professional journals and
national media for senior posts.
6
RECRUITMENT DATA
Internal and External Applicants Recruitment Average Applicants Shortlisted Appointed
Campaigns no of
applicants
per
campaign
Additional Clinical Services 61 47 2864 619 167
Professional Scientific & Technical 65 15 963 301 50
Administrative & Clerical 97 42 4048 632 121
Allied Health Professionals 62 7 418 156 45
Estates & Ancillary 25 39 979 188 46
Medical & Dental 31 5 156 45 18
Nursing & Midwifery 185 27 5076 1830 397
Grand Total 526 28 14504 3771 844
4 PLANNING THE FUTURE WORKFORCE
4.1 The Trust recognises that the key to sustaining its business plans and service development
aspirations across the spectrum of patient care is through successfully recruiting and
retaining a suitably skilled workforce. The first bedrock of this is the creation of an
integrated workforce plan. The Trust Workforce Plan provides the current workforce
baseline in terms of occupational category skills and deployment, maps future staffing needs
to meet turnover, retirement and other recurrent trends, and service developments, and
estimates future workforce requirements.
4.2 This integrated workforce plan is a holistic view for the totality of the Trust workforce for the
future. It has also been used to provide the basis for developing an integrated recruitment
strategy as the two are inextricably linked. The workforce plan recognises that it must take
account of the whole of the demographic features in the workforce (age and gender profiles,
skill sets etc) but also must take account of local, regional and national trends for developing
the workforce and “growing our own”. This approach has been adopted for individual service
developments, for example DSPD and Broadmoor modernisation. It starts with a concept of
a service model and the skills that will be required to fulfil this service need including all
aspects of the clinical pathway and the patient experience, and allows for the development
of appropriate skills/occupational mix, and the opportunity to develop new roles.
4.3 The current plan shows the demand up to April 2010. The plan will need to be refreshed for
2010/11 onwards to reflect local service plans, the implications of the Next Stage Review
and the impact of reduced NHS funding over the next few years.
5 RECRUITMENT AND RETENTION STRATEGY, POLICY AND SERVICE
FRAMEWORK
Recruitment Service
5.1 Recruitment and Retention is one of the Trust‟s top priorities and the establishment of an
infrastructure to lead and support this activity has been essential. The post of Head of
Staffing Solutions was created to provide a focus for the development and implementation of
a resourcing strategy for the Trust. The Trust wide centralised Recruitment Service has
been in place for five years. The service and associated systems and processes are subject
to regular review to reflect increased recruitment activity, service changes and customer
feedback. Although the service is Ealing based, outreach clinics are provided on the
Broadmoor site and regular meetings are held on the other main sites.
7
5.2 The Trust uses the Exchange, ESR and NHS Jobs as the IT platform for recruitment to
support improved efficiency of the recruitment process, enhanced e-recruitment activity, and
improved monitoring and reporting facilities for managers. The on line tool for all recruitment
processes was launched earlier this year.
5.3 Euro RSCG Riley are the Trust‟s single Advertising Agency to support the operational and
strategic delivery of recruitment activity.
Recruitment and Retention Strategy
5.4 The Recruitment and Retention Strategy was developed in partnership with local managers
and professional leads. It is closely aligned to service developments and identifies the
specific challenges for each staff group, recommending a multi-faceted approach to
attracting and retaining staff. This will be subject to review with the production of the new
Workforce Plan.
5.5 In this respect, the Trust has run a number of highly successful recruitment campaigns,
including the opening of the DSPD, Wells and Orchard Units; CPNs for Ealing, a hard to
recruit area; nursing staff for West London Forensic, a high volume requirement; and the
new IAPT (Improved Access to Psychological Therapies) programme for Ealing and
Hammersmith and Fulham.
Recruitment and Selection Policy, Procedure and Standards
5.6 The Trust Recruitment and Selection Policy and Procedural Framework is in place to ensure
a process based on the principles of fairness, equity and transparency, and setting
acceptable and consistent standards for each stage of the process. These standards comply
with the Care Quality Commission (CQC) core standards. There is regular review of
recruitment standards to ensure compliance with legal and Department of Health
requirements, but also to ensure staff are recruited in an effective and timely way to meet
service needs.
5.7 The length of the recruitment process was raised in the CQC Report and is a concern often
raised by managers; specifically this relates to the pre-employment mandatory checks in
respect of CRB and references. A local exemption process has been introduced in response
to this, allowing staff to commence prior to completion of all checks, but clearly this is not
appropriate for all appointments. The delay in completion of CRB checks has been raised
regularly with the CRB service. Currently we are informed that the delays are a particular
problem in London and due to capacity issues within the Metropolitan Police.
5.8 The involvement of Service Users in the recruitment and selection of staff is an important
element of the Trust‟s policy, and a framework has been developed to encourage and
support this involvement. To enable Service Users to understand the process and their role
within it and have the necessary skills to actively participate, a bespoke training programme
is provided. Recruitment and Selection training is also offered to managers through the
Leadership and Management Development Programme and as a bespoke course.
Recruitment and Retention Forum
5.9 The Recruitment and Retention Forum has been reinstated this year to enable a strategic
and planned approach to ensure the Trust meets its current and future workforce
requirements. The current work programme for the next 12 months includes:
The development of a new integrated Workforce Plan to inform future recruitment,
retention and training activity.
8
The development of a recruitment strategy for the next 12 months to include
planned generic and bespoke recruitment campaigns; participation in recruitment
fairs and conferences; and developing links with key partners such as local schools
and colleges, the local community and Jobcentre Plus.
The campaign for the Broadmoor Modernisation is well advanced in this respect, with
recruitment campaigns designed for both local papers and radio and open days
arranged. The first Open Day, held at the beginning of September, was very
successful.
Working in partnership with Euro Riley to develop more proactive and innovative
approaches to recruitment.
The establish of targets to reduce vacancy rates across all SDUs, with local action
plans to support delivery and regular monitoring through the forum.
The development of fast track processes for students, and rotation and transfer
schemes.
A review of existing retention strategies.
A review of existing recruitment and selection processes and systems to maximise
efficiency and effectiveness.
Retaining the right staff
5.10 Although the focus initially for the Recruitment and Retention Forum is on recruitment –
improving the system and processes and reducing vacancy rates - a review of retention
strategies is a key piece of work. Retention initiatives can also act as a positive recruitment
incentive. Some of the key retention strands are:
5.11 Fair pay and reward – the Trust has successfully implemented the national pay
modernisation agenda (Agenda for Change, Consultant Contract and Specialty doctor
contract), which provides a platform to support effective recruitment and retention.
5.12 Improving access to flexible working and other worklife options for all Trust employees. A
Worklife Options Policy was launched in 2004 embedding the Trust‟s approach to childcare,
support for carers, flexible working, special leave, maternity provisions and flexible
retirement options. This was relaunched at the beginning of the year to reaffirm the Trust
commitment to worklife balance and raise awareness of the provisions available.
5.13 Staff involvement, engagement and recognition - a comprehensive staff partnership
and engagement framework has been established, which includes a Partnership
Agreement, three full time Staff side Convenors, a seat at the Trust Board for the Staff side
Chair, and a Trust Partnership Forum with five locally based forums. The trust employs a
number of methods to facilitate staff involvement and two way communication, including the
Exchange, weekly information sheets on key issues and training matters, a monthly briefing
sheet for managers, an electronic „post-box‟, a bi-monthly magazine, the Chief Executive
blog, notice boards and regular Staff Forums. The annual Quality Awards event provides an
opportunity to celebrate the success of individual staff and teams; the event is hugely
successful and valued by staff.
5.14 The Trust‟s Learning and Development Strategy is another important strand in the
recruitment and retention of staff. The focus includes embedding a process of continuous
learning; ensuring staff have access to supervision, PDR and the training and development
activities they need to perform at their best; and promoting best management practice,
9
underpinned by values and behaviours that promote respect, value diversity and co-
operation.
5.15 Promoting a healthy workplace through the provision of a comprehensive Occupational
Health and Staff Counselling and Support Service; by working to reduce accidents and
incidents and levels of sickness absence; and tackling work related stress and bullying and
harassment in the Trust.
6 TEMPORARY STAFFING
6.1 Whilst the Trust is working to reduce its reliance on bank and, in particular, agency staff, it
recognises that this element of the workforce is essential and provides necessary flexibility.
The Trust has an in-house Temporary Staffing Service, established 4 years ago, to co-
ordinate the temporary workforce requirements and to improve the standards and processes
for the procurement of bank and agency staff. This service is managed through the Head of
Staffing Solutions.
6.2 A Call Centre approach is in place, using an IT platform to enable the booking and tracking
of temporary staff and supported by an agreed protocol to improve management and
monitoring processes. The service has 1200 members on its register and provides, on
average, 95% of the Trust‟s nursing temporary staffing requirements. Whilst the principal
growth area has been nursing, the service continues to be developed to include other staff
groups such as Allied Health Professionals, Facilities Staff and Administrative and Clerical
Staff.
6.3 Demand for bank staff has increased year on year since the service was established, with a
total increase of 42%; in the year 2008/09 79,724 shifts were requested, with, on average, a
95% fill rate. Detailed information is provided in the table below. The main reasons provided
for bank usage are vacancies, sickness and special observations. Regular recruitment
campaigns are undertaken to maintain and, where possible, increase the number of
members on the Bank Register.
Shift Fill Performance Report Quarterly Summary
Nursing Trust wide
2009 - 2010
Shifts Filled by % Filled Filled by % Filled by Unfilled % Unfilled
Requested Bank by Bank Agency agency Shifts Shifts
Quarter one 18767 17523 93.37% 630 3.36% 614 3.27%
2008 - 2009
Shifts Filled % Filled Filled by % Filled Unfilled % Unfilled
Requested by by Bank Agency by Shifts Shifts
Bank Agency
Quarter One 19350 19253 99.50% 78 0.40% 19 0.10%
Quarter Two 20704 20119 97.17% 170 0.82% 415 2.00%
Quarter
18288 17477 95.57% 173 0.95% 638 3.49%
Three
Quarter
21382 19635 91.83% 658 3.08% 1089 5.09%
Four
6.4 The development of the in-house service resulted in the migration from agency staff usage
to bank staff (as reflected in the figures above), and savings on the previous trend of
expenditure, but more importantly continuity of care for patients and familiarity with the
Trust, patients and polices and procedures.
10
6.5 However the last year has seen an increase in agency expenditure. The key reasons
include an increase in agency usage due to increased demand for temporary staffing whilst
at the same time reduced bank capacity with the enforcement of maximum hours‟ limits and
the recruitment of bank staff to permanent posts; and the use of agency staff in hard to
recruit areas such as CPNs, Older Peoples Services, OTs, staff grade doctors, and pockets
of administrative and clerical posts. Over the last year, agency staff have also been used to
provide key escorts to support the capital projects at St Bernards; recruitment to substantive
posts is now taking place. The cost of medical locums has also increased following the
implementation of a new PASA framework.
6.6 There were also concerns last year regarding adherence to the protocols for bank and
agency usage; these have been reinforced, with improved monitoring through the
Temporary Staffing Service. The service is now managing all bookings for the locum
doctors. This remains an important area of work and will be monitored via the Recruitment
and Retention forum.
7 CONCLUSION
7.1 There has been a wide range of developments over the last few years to improve the
recruitment and retention of staff in the Trust. There is a comprehensive policy, resource
and service framework to support managers to proactively recruit and retain a productive
workforce. The key tenants of the Recruitment and Retention Strategy are:
High quality recruitment with high levels of retention;
An integrated and flexible internal temporary staffing system with minimised
use of agency and locums;
Staff engagement and recognition;
Flexible and imaginative working patterns and conditions;
Healthy and safe workplace;
Pay strategy;
Learning and development.
7.2 This remains a priority for all, with action required (as detailed in the CQC Action Plan) to
reduce vacancy and turnover rates to ensure there are sufficient numbers of staff with the
right skills to deliver high quality care to patients.
8 RECOMMENDATION
8.1 The Board is asked to note the progress and on-going developments in relation to the
recruitment and retention of staff.
Linda Dyson
Acting Director of Workforce & Operational Development
September 2009
11
RECRUITMENT AND RETENTION KPIs APPENDIX 1
Activity – recruitment, vacancies, starters, leavers, turnover – hotspots
WORKFORCE PROFILE BY OCCUPATIONAL GROUPS
Stability
Starters Leavers Turnover Index Working
WLMHT Establishment In post Vacancies (headcount) (headcount) (%) (%) Gender Pattern Disability Ethnic Origin
%
Black/
STAFF Establishment Current % % Part % White Minority % Not
GROUPS (fte) fte headcount Rate (%) 2008/09 2008/09 2008/09 2008/09 % Male Female Time % British/Irish Ethnic Known
ADMIN &
CLERICAL 622.2 525.6 528 15.5% 65 61 11.5% 87.9% 18% 82% 21% 1.3% 64.0% 34.0% 1.3%
NON CLINICAL
SUPPORT
STAFF 365.3 274.4 323 24.9% 46 50 14.8% 86.7% 45% 55% 17% 0.0% 55.0% 41.0% 4.0%
MAINTENANCE
& WORKS 65.5 55.0 55 16.0% 3 6 10.4% 94.5% 96% 4% 4% 0.0% 85.0% 8.0% 7.0%
MEDICAL 298.9 250.2 254 16.3% 1 17 15.0% 99.0% 54% 46% 25% 0.0% 32.0% 57.0% 11.0%
DOCTORS ON
ROTATION 121 115
QUALIFIED
NURSING 1416.8 1285.0 1305 9.3% 129 167 12.7% 90.2% 46% 54% 4% 0.2% 27.0% 68.0% 5.0%
UNQUALIFIED
NURSING 837.8 699.8 730 16.5% 112 103 13.8% 90.1% 48% 52% 10% 0.4% 37.0% 58.0% 5.0%
TOTAL
NURSING 2254.6 1984.8 2035 12.0% 241 270 13.1% 90.1% 47% 53% 6% 0.3% 32.0% 63.0% 5.0%
ALLIED
HEALTH PROF 275.9 235.2 255 14.8% 33 38 14.7% 88.2% 43% 57% 22% 2.0% 75.0% 19.0% 3.0%
SCIENTIFIC,
PROF &
TECHNICAL 259.4 231.1 277 10.9% 64 34 13.4% 76.9% 24% 76% 37% 0.7% 69.0% 28.0% 3.0%
SENIOR
MANAGERS 178.6 123.2 125 31.0% 10 13 11.1% 92.0% 50% 50% 9% 0.0% 72.0% 27.0% 1.0%
TRUST TOTAL
08/09 - 4320.4 3679.5 3852 14.8% 584 604 12.5% 87.5% 42.0% 58.0% 13.0% 0.5% 45.0% 50.0% 5.0%
(07/08)
(4254.1) (3633.2) (3838) (14.6%) (594) (533) (11.5%) (91.9%) (43.0%) (57.0%) 14.00% N/A 52.00% (41.0%) (7.0%)
12