BOARD – SUMMARY REPORT Date of Board meeting: Title of Report: Title of Director: 29th September 2009 Recruitment and Retention Acting Director of Workforce and Organisational Development WL1661
Paper Number: 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.
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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 1.1 INTRODUCTION 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. BACKGROUND 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. 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. 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. 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 2.1
2.2
2.3
2.4
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. RECRUITMENT AND RETENTION KPIs Workforce Profile
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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 FUNDED FTE 3963.2
2005/06 4070.5
2006/07 4155.8
FUNDED FTE
2007/08 4254.1
2008/09 4320.4
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%. 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.
3.4
VACANCY RATE TURNOVER RATE
2004/05 12.4% 12.8%
2005/06 10.9% 11.0%
2006/07 14.7% 11.4%
2007/08 14.6% 11.5%
2008/09 14.8% 12.5%
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16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2004/05 2005/06 2006/07 2007/08 2008/09 VACANCY RATE TURNOVER RATE
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 Central & North West London NHS Foundation Trust South West London & St George‟s Mental Health NHS Trust East London Hospitals NHS Foundation Trust Barnet, Enfield & Haringey Mental Health NHS Trust Camden & Islington Foundation NHS Trust South London & Maudsley NHS Foundation Trust West London Mental Health NHS Trust 2008/09 Turnover % 13.0% 12.0% 12.0% 12.1% 10.6% 9.5% 12.5%
Vacancy % 13% 18% 8% 12.9% 15.8% 17.5% 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 Starters Leavers 574 505
2005/06 597 490
2006/07 403 519
2007/08 594 533
2008/09 584 604
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700 600 500 400 300 200 100 0 2004/05 2005/06 2006/07 2007/08 2008/09 Starters Leavers
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 Voluntary Resignation Contract Ended Retirement Death in Service
Headcount 2007/08 314 136 78 5
2008/09 370 156 71 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
222 West London Mental Health NHS Trust Retirements 49 Staff retired aged under 60 N/A N/A 38 29 33.5 66 78 71 66
2006/07
2007/08
2008/09
Average
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RETIREMENTS DURING 2008/09 STAFF GROUP ADMIN & CLERICAL NON CLINICAL SUPPORT STAFF MAINTENANCE & WORKS MEDICAL QUALIFIED NURSING UNQUALIFIED NURSING ALLIED HEALTH PROF SCIENTIFIC, PROF & TECHNICAL SENIOR MANAGERS TRUST TOTAL HEADCOUNT 13 13 2 5 21 13 1 2 1 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
Projected number of staff aged 55 and over. No allowances made for joiners or leavers 551 652 743 852 936
2008/09
2009/10
2010/11
2011/12
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.
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RECRUITMENT DATA
Internal and External Applicants Recruitment Campaigns Average no of applicants per campaign Applicants Shortlisted Appointed
Additional Clinical Services Professional Scientific & Technical Administrative & Clerical Allied Health Professionals Estates & Ancillary Medical & Dental Nursing & Midwifery
61 65 97 62 25 31 185
47 15 42 7 39 5 27
2864 963 4048 418 979 156 5076
619 301 632 156 188 45 1830
167 50 121 45 46 18 397
Grand Total 4 4.1
526
28
14504
3771
844
PLANNING THE FUTURE WORKFORCE 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. 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. 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. RECRUITMENT FRAMEWORK AND RETENTION STRATEGY, POLICY AND SERVICE
4.2
4.3
5
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.
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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. Euro RSCG Riley are the Trust‟s single Advertising Agency to support the operational and strategic delivery of recruitment activity. Recruitment and Retention Strategy
5.3
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. 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
5.5
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. 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. 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
5.7
5.8
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.
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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,
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underpinned by values and behaviours that promote respect, value diversity and cooperation. 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 6.1 TEMPORARY STAFFING 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 coordinate 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. 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. 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 Requested 18767 Filled by Bank 17523 % Filled by Bank 93.37% Filled by Agency 630 % Filled by agency 3.36% Unfilled Shifts 614 % Unfilled Shifts 3.27%
6.2
6.3
Quarter one
2008 - 2009 Shifts Requested Quarter One Quarter Two Quarter Three Quarter Four 19350 20704 18288 21382 Filled by Bank 19253 20119 17477 19635 % Filled by Bank 99.50% 97.17% 95.57% 91.83% Filled by Agency 78 170 173 658 % Filled by Agency 0.40% 0.82% 0.95% 3.08% Unfilled Shifts 19 415 638 1089 % Unfilled Shifts 0.10% 2.00% 3.49% 5.09%
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.
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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. 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. CONCLUSION 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.
6.6
7 7.1
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. RECOMMENDATION The Board is asked to note the progress and on-going developments in relation to the recruitment and retention of staff.
8 8.1
Linda Dyson Acting Director of Workforce & Operational Development September 2009
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RECRUITMENT AND RETENTION KPIs Activity – recruitment, vacancies, starters, leavers, turnover – hotspots
WORKFORCE PROFILE BY OCCUPATIONAL GROUPS Stability Index (%)
APPENDIX 1
WLMHT
Establishment
In post
Vacancies
Starters (headcount)
Leavers (headcount)
Turnover (%)
Gender
Working Pattern
Disability
Ethnic Origin % Black/ Minority Ethnic 34.0%
STAFF GROUPS ADMIN & CLERICAL NON CLINICAL SUPPORT STAFF MAINTENANCE & WORKS MEDICAL DOCTORS ON ROTATION QUALIFIED NURSING UNQUALIFIED NURSING TOTAL NURSING ALLIED HEALTH PROF SCIENTIFIC, PROF & TECHNICAL SENIOR MANAGERS TRUST TOTAL 08/09 (07/08)
Establishment (fte) 622.2
fte 525.6
headcount 528
Current Rate (%) 15.5%
2008/09 65
2008/09 61
2008/09 11.5%
2008/09 87.9%
% Male 18%
% Female 82%
% Part Time 21%
% 1.3%
% White British/Irish 64.0%
% Not Known 1.3%
365.3 65.5 298.9
274.4 55.0 250.2
323 55 254
24.9% 16.0% 16.3%
46 3 1 121
50 6 17 115 167 103 270 38
14.8% 10.4% 15.0%
86.7% 94.5% 99.0%
45% 96% 54%
55% 4% 46%
17% 4% 25%
0.0% 0.0% 0.0%
55.0% 85.0% 32.0%
41.0% 8.0% 57.0%
4.0% 7.0% 11.0%
1416.8 837.8 2254.6 275.9
1285.0 699.8 1984.8 235.2
1305 730 2035 255
9.3% 16.5% 12.0% 14.8%
129 112 241 33
12.7% 13.8% 13.1% 14.7%
90.2% 90.1% 90.1% 88.2%
46% 48% 47% 43%
54% 52% 53% 57%
4% 10% 6% 22%
0.2% 0.4% 0.3% 2.0%
27.0% 37.0% 32.0% 75.0%
68.0% 58.0% 63.0% 19.0%
5.0% 5.0% 5.0% 3.0%
259.4
231.1
277
10.9%
64
34
13.4%
76.9%
24%
76%
37%
0.7%
69.0%
28.0%
3.0%
178.6 4320.4 (4254.1)
123.2 3679.5 (3633.2)
125 3852 (3838)
31.0% 14.8% (14.6%)
10 584 (594)
13 604 (533)
11.1% 12.5% (11.5%)
92.0% 87.5% (91.9%)
50% 42.0% (43.0%)
50% 58.0% (57.0%)
9% 13.0% 14.00%
0.0% 0.5% N/A
72.0% 45.0% 52.00%
27.0% 50.0% (41.0%)
1.0% 5.0% (7.0%)
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