Recruitment

NHS recruitment: joining the dots

Neal Suchak, policy advisor at the Recruitment and Employment Confederation, analyses the importance of a healthy, transparent recruitment supply chain and the benefits of co-operation in NHS recruitment

The UK has now left the EU – so what does this mean for the future of the NHS workforce? How can the NHS best recruit, train and retain its workforce, and what role does the recruitment industry have to play in supporting the NHS through these unchartered waters? Where are the numbers? Latest NHS figures show that most staff are British – but a sizeable minority are not. Around 153,000 out of 1.2 million staff report their nationality as non-British. This is around 13 per cent of all staff for whom a nationality is known, with around 65,000 (5.5 per cent) being EU nationals; the figures are much higher in London and the South East. Although the UK has officially left the EU and become a ‘third country’, we are currently in a transition period in preparation for the 31 December, where on-the-ground changes will be evident, including a new immigration system.

Nevertheless, even

before these changes occur more than 10,000 EU

nationals have left the NHS

since the Brexit referendum, including almost 5,000 nurses; and on top of that, fewer nurses are arriving. Recent figures From September 2020 all nursing students will receive a payment of at least £5,000 a year, with up to £3,000 further funding available for eligible students

from the Nursing and Midwifery Council show that the number of nurses arriving from the EU dropped by 87 per cent from 6,382 in 2016-17 to 805 in 2017-18. To address these challenges, the Conservative Party has pledged to add 50,000 nurses to the workforce in England by 2024-25. How realistic is this target, particularly given that nurse numbers have gone up by only about 5,000 since 2010?

Early steps With more than 40,000 nursing vacancies, workforce is the main concern for NHS leaders. The current government have said that 14,000 more nurses will be trained with extra placements funded in the NHS. Another 5,000 more nursing staff will come from apprenticeships - which are designed to allow recruits to be trained in the workplace without the need to pay tuition fees and study at university. However, the Nuffield Trust notes that the nurse apprenticeship scheme is relatively new and by the middle of 2018, only 300 people had started.

The government also wants to see 12,500 more nurses recruited from overseas, arguing that halving the cost of the NHS visas will help attract more staff from outside the UK.

Will better retention help? The government says that 18,500 extra nurses can be found by using policies to ensure fewer leave the NHS. NHS England is already addressing this issue by promoting more flexible working, enhancing continuing professional development and encouraging highly qualified staff who have left in

recent years to return. Projections suggest that as many as 20,000 nursing staff who might have otherwise quit could still be working for the NHS in five years’ time.

What do health experts think? Both inside the NHS and among independent health commentators there is agreement that 50,000 more nurses than now will need to be working in the service in five years’ time. The Health Foundation, Nuffield Trust and King’s Fund think tanks, in a joint report, argued that 5,000 nurses will have to be recruited annually from overseas over four years to avoid staff shortages, even if other initiatives are pursued to boost the workforce. That would mean 20,000 more internationally recruited nurses by 2023, considerably more than the Conservative plan.

The Year of the Nurse and Midwife As we enter the Year of the Nurse and Midwife, the Department of Health and Social Care have at least put measures in place. From September 2020 all nursing students will receive a payment of at least £5,000 a year which they will not need to pay back, with up to £3,000 further funding available for eligible students, including for: specialist disciplines that struggle to recruit, including mental health; an additional childcare allowance, on top of the £1,000 already on offer; and areas of the country which have seen a decrease in people accepted on some nursing, midwifery and allied health courses over the past year. The funding will be given to all new and continuing degree-level nursing, midwifery and many allied health students, and it is expected to benefit more than 35,000 students every year.

Given the increased administrative burden for many NHS workers in recent years, it would be better to think of how automation could potentially complement human capacity rather than replace it

Taking a joined-up approach Agency staff have provided a vital lifeline to the NHS for decades. They continue to provide the NHS with the extra support that it needs in times of increased demand, and are crucial in ensuring patient safety. Agency staff have the same skills as substantive staff, often with many years of experience. It is essential that these staff are recognised for their professionalism and contribution, are treated fairly and are valued.

Furthermore, specialist healthcare recruiters are experts in workforce planning, and see first-hand the shortages that it has to contend with. Recruiters are perfectly placed to identify where problems lie and able to offer immediate solutions. They can supply staff up and down the country, often to regions that are less appealing to other workers, as well as offering immediate help in critical situations.

What about AI? Automation has potential to help fill the skills gaps. However, how far this will go is debatable. It’s difficult to believe that most people will be eager to lose their GP, nurse or care worker to automation. These are roles where the human skills of

compassion and empathy are so important. Looking beyond front-line services, the RSA point out that outsourcing decisionmaking in the public sector to computers is also a risk, as it is important that the decisions taken on the services that people rely on maintain a human element.

Given the increased administrative burden for many NHS workers in recent years, it would be better to think of how automation could potentially complement human capacity rather than replace it. There is huge potential for it to minimise administrative elements of the roles.

Looking forward To attract more people into the NHS, it’s important to think of what new generations of workers will be looking for in their jobs. ‘Purpose’ is often cited as having increasing importance in why people choose their career paths. This is something that the NHS has lots of, and playing on this strength makes sense. Something else frequently cited as increasing in importance in career choices is having more job flexibility. Workers are increasingly expecting to see flexible working patterns offered as the norm. There are challenges with increasing flexibility for some healthcare jobs, but finding solutions to achieving this is important if the NHS is going to compete with the private sector on modern working practices.

With the decline of ‘jobs for life’ and more people leaving the health sector early in their career, it’s also important to think of ways to attract people from the private sector. The NHS ‘We Are the NHS, We Are Nurses’ campaign, backed by the Health Secretary, targets teenagers who are about to choose their degrees as well as career switchers considering going into nursing. The measures are part of the NHS People Plan, which will set out work to reduce vacancies across the NHS and secure the staff needed for the future.

Recruit, train and retain Deep problems remain within NHS recruitment and there are no quick fixes, but consistent and determined action from the government and employers can deliver results. Government needs to work hard at retaining its existing workforce, as well as adopting a joined-up approach to workforce planning with specialist recruitment agencies. Patient safety always has to come first, and getting the workforce right is the single biggest factor that policy makers and NHS leaders need to be focussing on to achieve that. L

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Hiring to better serve your trust

The NHS is the UK’s biggest employer, with 1.5 million employees, and is one of the largest employers globally, ranking fifth behind McDonalds, Walmart, the People’s Liberation Army China, and the US Department of Defense

Even with its 1.5 million strong workforce, the NHS does not have enough staff to meet demand. The majority of NHS staff work in ‘hospital and community services’ (HCHS) as direct employees of NHS trusts; providing ambulance, mental health, and community and hospital services. The NHS workforce is made up of direct and indirect employees.

Direct employees count for 319,740 staff members in support to clinical staff, 306,996 nurses and midwives, 171,282 working in NHS infrastructure support, 139,241 scientific, therapeutic, and technical staff, 111,247 HCHS doctors, 78,684 in GP support and admin roles, 34,534 GPs, 20,951 ambulance staff, 16,276 practice nurses, and 4,752 counting for other staff, as of September 2018. In addition to direct staff, NHS organisations have indirectly employed staff through a paying company to provide services such as laundry, cleaning and catering, corporate function and estate management.

Current hiring demands In NHS hospitals, community, and primary care settings, there are approximately 150,000 doctors and over 320,000 nurses and midwives. These two groups make up just over one third of the total workforce.

Given the multidisciplinary nature of the NHS, finding staff that meet hiring demands is always going to be tough.

Between July and September 2018, there were almost 94,000 full-time equivalent advertised vacancies in hospital and community services alone, equating to an estimated shortfall of eight per cent. These shortages were unevenly distributed across the country. The lowest were found in the North East & Yorkshire and Humber areas, at 4.5% and 5.6% respectively. Further South, at 9.9% and 11.5%, Kent, Surrey & Sussex and Thames Valley were the highest in the country.

The lowest staff shortages within hospitals and community health services were healthcare scientists, estates and ancillary staffing groups. In a 3 month period both were around 2,500. This is particularly concerning since the latter group are often responsible for ensuring that hospitals are maintained and fit for purpose. When it comes to recruitment, the first port of call is usually advertising vacancies through different platforms, or internally within NHS organisations. In the short term, this approach to recruitment is cost effective, and makes sense considering current financial constraints. A permanent recruitment cycle takes on average 47 days. However, when you factor in time to short list candidates and submit applications this process can be pushed past ten weeks. If unsuccessful the clock resets.

The impact of this challenging recruitment process is that jobs are left vacant, or unqualified staff are taken on. This is a risky approach to take as a lack of resources often means that there is not enough oversight of under-skilled staff, so problems may often go unnoticed or ignored until they pose a serious risk. For existing staff, this can result in elevated stress levels and ultimately lead to burnout. Some organisations look at solutions that rely on support from service providers and consultancies to fulfil a client side role.

The cost of these services is often magnitudes higher than it would be for internal staff, creating a false economy, and these service providers do not always necessarily represent the trust’s best interests. Meeting hiring demands Apprenticeships are a great tool to add to your succession planning. Any method that helps unskilled workers gain valuable experience within the sector should be paramount for any staffing strategy.

It has been troubling to see that UK trusts are sitting on £200 million of unused funds for apprentices. These funds collected though the apprenticeship levy, will be clawed back by the government if unused. However, according to a government spokesperson speaking in October 2019, new flexibilities have been introduced, ‘to help employers spend their levy funds. It means employers now have 24 months to spend their levy funds and large employers are able to transfer up to 25 per cent of their funds to other businesses’. Hopefully this initiative will enable employers to use their money to invest properly and ensure that apprenticeships play a role in solving the staffing crisis.

Organisations could do well in identifying weaknesses within their departments, for example, which areas are under-resourced, or failing to recruit? Develop your strategy to address these weaknesses. When it comes to a hiring strategy, organisations need to be flexible and not follow a rigid process. Be clear with deadliness and interview dates. Applications should be monitored two-three times a week and not left for a hiring manager to sift through after a closing date. Too often candidates slip through the net because there is already a rigid interview process in place that doesn’t accommodate their needs. In a market with a shortage of candidates, it needs to be a two way street, and organisations need to actively promote themselves throughout the hiring process.

A personal touch makes all the difference, and any contact should be made over the phone as opposed to via email.

It would be of benefit to an organisation to engage with fewer agencies, rather than more. Crown Commercial Service (CCS), for example, enables you to identify specialist agencies for critical posts. More time could be invested in speaking with fewer agencies about where a shortfall might exist within a resourcing team, ultimately resulting in a higher quality of candidate and service. Specialist agencies tend to have a greater understanding of the market and will take the time to filter suitable candidates rather than bombarding clients with CV’s with the hope that something will stick. This might mean that some positions will cost more in the short term, but the long-term savings, such as time, overall cost and staff retention will certainly outweigh this initial cost. Recruiting for the NHS will likely continue to be tough for the foreseeable future and the best solution is one that encourages trusts to diversify their hiring strategy and leverage key relationships internally and externally. L

A healthy approach to building design

The rapid growth in smart technology means building engineers can now deliver far more sophisticated HVAC solutions, according to Daikin Applied UK

Wireless systems and greater connectivity in buildings means it is now much easier to accurately match system performance to user requirements and optimise energy efficiency. It also gives engineers a route to tackling the individual pieces of equipment that consume the most energy, such as fans and chillers. This is an increasingly important consideration for NHS estates procurers, who are under pressure to reduce running costs and increase efficiency, while also maintaining good quality indoor environments. It also means Building Services Designers have more tools available to address one of the biggest challenges of our age - the issue of poor indoor air quality (IAQ). Air pollution is a huge problem and has been labelled a ‘public health emergency’ by World Health Organisation (WHO). The British Lung Foundation identified a particular threat to hospitals and healthcare facilities in its 2018 report entitled Toxic Air at the Door of the NHS. This revealed that more than 2,000 GP surgeries and 248 hospitals in the UK are in locations where air pollution is above WHO recommended contamination limits. The WHO is also concerned that outdoor air continues to be used as supply air for ventilation systems despite heavy contamination by particulates and other outdoor pollutants. It has called for much more effective use of air filters and room air purifiers, particularly in buildings with vulnerable occupants like care homes and hospitals.

Protection Healthcare facilities pose a unique design challenge for heating, ventilation, and air conditioning system engineers. These systems fulfil a broad range of ventilation requirements and provide protection from airborne hazards, but controlling HVAC systems can be complex, particularly in a highly mixed use environment like a hospital. However, these challenges can often be overcome if good control logic and optimum system sizing based on closely matching demand to the system’s capacity and performance are used. It is also important to use the technology to continuously monitor critical plant remotely once it is installed and up and running. This will prove increasingly valuable for the NHS because – with summer temperatures staying higher for longer in the UK – continuous monitoring allows facilities managers to spot early warnings. They can see if the cooling system is not achieving its design capacity or efficiency, which could be due to low refrigerant charge or high operating pressures. This allows potential breakdowns to be avoided and any drop in performance to be addressed before it causes serious problems. At Daikin Applied (DAPUK), we focus on providing a fully integrated HVAC solution. We have worked on 311 UK hospitals since 2002, delivering solutions worth more than £43 million. This extensive experience has allowed us to build up a team of highly trained mechanical engineers who understand the particular requirements of a healthcare environment. Our engineering team focuses on the full lifecycle operation of our solutions, which means we have a good handle on operating costs and will always argue for a long-term focus that will deliver a good return on investment – in terms of both finance and human health.

Dainkin Applied’s HTM compliant service and maintenance packages include continuous remote monitoring of site conditions and can be tailored precisely for the healthcare facility in question combined with excellent air filter technology produced by our sister company AAF, which provides clean air solutions for patient rooms, medical procedure areas, operating rooms, dentist offices, research centres, morgues, and cafeterias. When it comes to air filtration, the control of viable and non-viable particles is crucial in many process applications in the life science industry. Protection of people from hazardous or potent compounds is equally important and there is a wide variety of supply, exhaust and recirculated air housings and filter types to address each application. AAF offers a wide range of solutions including HEPA (High-Efficiency Particulate Air), ULPA (Ultra Low Particulate Air) filters and chemical gas-phase filtration. HEPA and ULPA filters are used in isolation rooms, protective environment rooms, organ transplant areas, and other applications requiring ultra-clean air. This allows DAPUK to deliver high care/clean room technology solutions with the necessary sterile environment and our full system approach includes delivering solutions to control air pressure, temperature and moisture. It is an important consideration for any HVAC specialist supplier to understand both the operational parameters of the equipment it supplies and the impact of its designs on indoor operating environments. The extra bonus we now have, thanks to the growing sophistication of digital systems, is that we can continue to monitor and adjust those systems throughout their operating life on behalf of our clients. L

FURTHER INFORMATION

www.daikinapplied.co.uk