I am very much aware of pressures being experienced by some staff on a daily basis. We know there are hotspots in a number of staff groups, and in a number of specialties and will be having wider conversations about what we are doing to address staffing challenges. This initial update is centred around some of the nursing challenges that have arisen.
We continue to see a sustained high level of demand on our services, combined with increasing complexities associated with the needs of our patients. At the same time, shortages in the supply of clinical staff locally, but also nationally, are causing significant challenges and impacting on our ability to fill staff vacancies and achieve our planned establishment levels across a number of specialties and departments. The problem is most acute within our wards, where the turnover of staff, particularly at band 5 level, is highest.
Across the NHS there are growing gaps in certain sectors of the workforce, and again most notably amongst adult care nurses. This gap between workforce demand and supply has occurred partly as a result of a historical disconnect between service planning, financial planning and workforce planning, but also because of a marked rise in the numbers of clinical staff leaving the NHS before retirement age. Our current levels of staff turnover and vacancies are no worse than most other acute trusts, and are in fact better than many within the south east region.
This situation is unlikely to improve in the short to medium term, so we must do all we can to ensure we are best placed to be able to attract new staff, but also to retain our existing staff. This requires us to think differently about the roles people undertake, how care is delivered, and how we can maintain a supportive environment, where people’s health and wellbeing is an important consideration. There is no quick or easy fix, but the Board recognises this to be a key priority, and I am personally committed to exploring all opportunities to improve upon the current difficult situation.
Below is a summary of steps being taken and initiatives being pursued to help the situation. However we would like to hear any thoughts you have on action we could take. Please contact Rebecca Kopecek, Deputy Director of Workforce and Organisational Development, at Rebecca.firstname.lastname@example.org or Theresa Murphy, Chief Nurse at Theresa.Murphy@porthosp.nhs.uk who will feed back your views.
We are one of twenty trusts nationwide that are part of a major programme identifying ‘high impact’ interventions that will improve staff retention. Already, members of staff who work in our ten wards with the highest levels of turnover have been consulted to help us understand the main contributory factors. Ward managers in the same ten wards have also been interviewed to gather information on their understanding of the issues influencing staff retention, potential opportunities for improvement, their leadership challenges and development needs. The Chief Nurse is leading on a ward stabilisation programme which commenced in September 2018.
We have also contacted a number of band 5 Registered Nurses who have recently left our Trust to take up work elsewhere, in order to discuss their reasons for doing so.
From information gained so far and discussions with ward managers from all specialties, we have identified a clear need to improve our local induction processes for new staff, to review current shift patterns and flexible working arrangements and to establish a development programme for aspiring, newly appointed and existing ward managers. The programme will include effective local induction, people and financial management and team development.
National data shows that ward-based band 5 Registered Nurse vacancies are high in all provider trusts, and we are no exception. We have a dedicated HR Recruitment Advisor for nursing and their focus has been on increasing national and international recruitment. We are offering interviews within 24 hours of receipt of an application, increasing support provided by specialist agencies and extending our recruitment overseas (i.e. outside of the EU), particularly in India and the Philippines. We are also increasing our recruitment of nursing support roles, such as Associate Practitioners to supplement the recruitment pipeline and improve ward skill mixes.
A detailed workforce plan has been developed, based on predicted leavers and starters. Performance against this plan is monitored weekly by the Trust Leadership Team and the Workforce Steering Group.
We have seen an increase in the number of leavers in some areas. We are working to understand the reasons for this and action we need to take to address this.
Meanwhile 62 nurses at bands 3, 4 and 5 are due to join the Trust in the next few weeks, and more new recruits are due to start later this year.
We are actively working with local apprenticeship providers to enable development opportunities for our staff and ultimately a new career path for college graduates and new recruits. We are part of the initial national pilot for Nursing Associates that requires two years of training at foundation degree level and will be registered with and regulated by the NMC. We have nine members of staff who will graduate next March and a further 16 are currently on programme in their first year. This role aims to bridge the gap between Registered Nurses and Health Care Support Workers and has extended scope to include medicines administration. Locally known as a band 4 role, our Nursing Associates will join our existing Assistant Practitioners (Nursing) in areas such as MOPRS and MSK to support Registered Nurses in the delivery of patient care. We will again be offering access to Nursing Associate training from next April and expanding the role across all ward areas.
Training to become a Registered Nurse is also to be made available via an apprenticeship programme and we are working with the Open University and University of Portsmouth to enable staff to access this opportunity. We are fully committed to apprenticeships and will maximise the number of staff we can support in this training role. We will be actively recruiting soon and are working in partnership with local colleges to enable a route into different roles within healthcare, starting with our harder to recruit professions.
The Chief Nurse is working on a four-year plan for nursing recruitment, which commenced in September 2018.
New Temporary Staffing Provider
Whilst it is important that we continue to safely reduce our reliance on high cost agency staff, people who offer their services via the Staff Bank are a vital component of our overall workforce capacity. Therefore, it is critical that we maximise the timely provision of suitably skilled Bank staff to cover gaps in rotas and vacancies. Following the outcome of a contract tendering process, we are changing our temporary staff provider. The new Portsmouth Staff Bank will be run by Bank Partners, who will work closely with us to recruit more people to the Bank, increase our fill rates and improve the way shifts are approved, booked and managed.
The Bank Partners team will officially take over the service from our current provider, NHS Professionals, on 5 November, but will be on site from 10 September to ensure there is a smooth transition period, during which our valued existing bank workers will automatically transfer.
Bank Partners is a market-leading independent provider of Staff Bank management solutions. The new Bank service will be based on site, with a dedicated, high profile team that will support all our staff groups.
New E-Rostering System
The efficient co-ordination and support of ward-based staff is difficult to achieve without the benefit of a sophisticated and comprehensive e-rostering system. Our current system is no longer fit for purpose, so we are engaged in a procurement process to purchase a replacement platform, which we aim to implement next January. A new system that interfaces with our Staff Bank provider will bring many advantages and, in preparation, a significant amount of work is currently being undertaken by our Nursing, HR and Finance teams to ensure ward establishments are accurate, appropriate and fully understood by those who are responsible for their management.
We are also looking at introducing an app which will enable us to improve access for booking shifts, among other benefits.
Please be assured that recruitment and retention is a key priority. Within the local and national context, we are doing everything we can to understand and address this issue to attract and retain more staff. Both myself and Theresa Murphy, Chief Nurse, who is leading this, are keen to maintain a dialogue with everyone and to consider all ideas and suggestions you may have to help meet our challenges.
We will be holding a staff briefing session in the coming weeks where you will be able to find out more, and further details will follow.
Thank you for everything you do, every day, to put our patients first.