Agenda item

Present for this Item:

Herefordshire and Worcestershire Integrated Care Board

Katie Hartwright, Director of People and Workforce

Karen Paynton, Head of Primary Care

Worcestershire Acute Hospitals NHS Trust:

Tina Ricketts, Director of People and Culture

Herefordshire and Worcestershire Health and Care NHS Trust

Elaine Clough, Director of People and Organisational Development

Worcestershire County Council:

Mark Fitton, Strategic Director for People

Rebecca Wassell, Assistant Director for Commissioning

Voluntary, Community or Social Enterprise Sector:

Carole Cumino

The update on workforce pressures was introduced by Herefordshire and Worcestershire Integrated Care Board’s (ICB) Director of People and Workforce Pressures, who reminded the Health Overview and Scrutiny Committee (HOSC) that workforce was being looked at collectively as a system.  Workforce remained a challenge nationally as well as locally, with some specialist and social care roles being especially hard to fill.  The situation was not helped by factors such as media coverage and industrial action, however staff turnover had decreased slightly, which was testament to the huge effort involved.

The Primary Care workforce was in a good position, and the Herefordshire and Worcestershire (H&W) GP to patient ratio was one of the best in the country. However social care workforce pressures remained a challenge.

The Chairman invited discussion and the following main points were raised:

·         A Member questioned the number of staff that the increase in workforce numbers of 1200 equated to since the previous HOSC discussion.

·         Several members expressed concern about the amount of spend on agency staff and felt that measures should be introduced to limit this. The ICB Director agreed that agency use remained an issue for the system as a whole, and advised that currently, just under 10% of substantive pay was on agency staff (including Wye Valley Trust in Herefordshire). Every area had a programme in place to reduce use of agency staff, and the national target was 3.7%, although an outcome of 6% was more likely for H&W. Reasons for agency staff use were complex and many, involving decisions about wards, cover and strike action.

·         The Worcestershire Acute Hospitals NHS Trust (the Acute Trust) representative referred to the Trust’s quite high reliance on agency staff, although this had reduced the previous month to 12%. Successful recruitment levels this year was very positive and would make a difference to reliance on a temporary workforce. Measures to increase recruitment included international recruitment and welcoming CVs to aid the application process, as well as wider recruitment and retention work. Career progression paths and apprenticeships were also being developed for hard to recruit roles. The Herefordshire and Worcestershire Health and Care NHS Trust (the Health and Care Trust) representative referred to other work including getting teams to think critically about use of agency staff and to focus on fostering a robust staff base.

·         A member sought clarification about the actual difference in cost for an agency member of staff as opposed to a permanent employee, taking into account factors such as holiday pay, sick pay, and was advised that pay rates could be £25 an hour but £50 an hour for hard to fill roles; there was a range depending on the nature of the shift and how hard it was to fill, which was often nights and weekends. The ongoing focus on recruitment and retention would reduce agency use. The Acute Trust representative explained that the approach was to use its own staff where possible, followed by bank staff (Acute Trust staff who chose to work additional hours), with agency staff being the last step.  The induction and welcome to agency staff was important as some may then opt to join the permanent workforce.

·         A member acknowledged the enhanced flexibility for agency staff but asked what impact their presence had on permanent staff morale, and was advised that in general staff feedback indicated a preference for working with their own colleagues and teams and a dislike of having to work in other areas.

·         In terms of safety considerations when using agency staff, the Acute Trust representative explained that they worked with NHS Professionals to ensure staff had the right training and checks.

·         The Chairman enquired about agency staff use within the Council’s People Directorate and the Strategic Director pointed out that in general the Council had its own workforce and used agency staff only when absolutely needed. The vast majority of social care staff were employed by the independent sector, therefore the Council’s role was different. Nationally, morale in social care was not good and there were efforts at national level to promote the sector, and in general staff retention was better where employers valued their staff.

·         The H&C Trust representative pointed out the importance of promoting the non monetary benefits of working for the health sector including progression and training, which were being worked on across the system.

·         A HOSC member asked the representatives what their sectors were doing to regulate and control use of agency staff and whether any representation had been made to Government to suggest introducing restrictions. The ICB Director acknowledged the detrimental impact of higher paid agency staff working alongside other staff and stressed that the sector was working to make substantive roles the best possible, which was such an area of focus both at local and national level. While there was no national directive, locally, various strategies were in place, such as not using the most expensive agencies, however where patient safety was concerned, staff gaps had to be filled, which was an inevitable pressure. However the Director would raise this point again at a regional meeting she was attending that week.

·         In respect of Adult Services’ staffing, the Council’s Strategic Director explained that some use of agency staff was necessary to fill gaps in teams for example where higher pay rates elsewhere hindered recruitment, however the new Social Work Academy was helping attract local staff. A consultation exercise was also underway to look at reducing over reliance on agencies within children and families social care.

·         In terms of help from the Government to reduce use of agency staff, there was a framework to ensure only appropriate agencies were used.

·         Regarding the reduction in vacancy numbers across the two secondary care trusts from 1200 to 900, this related to support staff recruitment, rather than medical.

·         In response to a concern raised about the potential impact on staff such as nurses using their leave to work additional hours through the staff bank, the representatives advised that all staff were encouraged to take their leave as it was important to have rest from a demanding job. The hours of permanent and bank staff were monitored and followed up with conversations where appropriate.

·         Acknowledging a member’s point that course fees may be a barrier to residents entering the health profession, the ICB representative referred to ongoing conversations across the system to support and enable people to enter and progress careers, in particular for local residents, for example looking at apprenticeships, degrees and social work and recruitment days in localities with interviews on the day. When advertising vacancies, managers were encouraged to review roles to consider whether they could be delivered differently which could help recruitment.

·         A follow up question was asked to find out how the Government could help restrict high agency fees and the Acute Trust representative said she would be very grateful for support in asking the Government to reduce the complexity of recruiting consultants since non foundation trusts were bound by more requirements than foundation trusts – it would be helpful if requirements were the same across the board.

·         The Chairman invited comment from the Voluntary and Community or Social Enterprise Sector (VCSE) representative, who highlighted the importance of being represented at a HOSC meeting, which was a step change. She acknowledged the workforce challenges for all the organisations represented but explained that the VCSE sector picked up some staff from the health and social care workforce, perhaps who wanted more flexibility or who wanted additional opportunities alongside their existing roles. She referred to the new ICS Academy which included a VCSE faculty which would be a really interesting provision.

·         The Council’s Strategic Director emphasised the need to think wider than the paid workforce, since unpaid carers contributed enormously.

·         A HOSC member highlighted the massive contribution to the local economy from the 18,000 full time equivalent health and social care workforce.

·         When asked about awareness of GPs about the workforce agenda in particular the important role of community pharmacies, the ICB Director advised that GPs were relatively comfortable about pharmacy support. Recent emphasis on pharmacies was acknowledged and the ICB was working with the Pharmacy Committee and liaising with the local Medical School about attracting more pharmacists to the area. The ICS Academy included a Pharmacy Faculty, and there was potential for a Pharmacy School at the University of Worcester.  The ICB was looking to bring together local and national work in this respect.

·         The ICS Academy was described as a system-wide one stop shop, with a website, and was a virtual place to bring together several faculties such as social care and nursing, with training available to the whole system. The ability for people to have a varied career and move around the system was important.

·         The HOSC looked forward to hearing progress with the Academy.

·         When asked about equality and inclusion and how this was extended to internationally recruited staff, the ICB Director explained that the aim was for the system wide Equality, Diversity and Inclusion Strategy to enhance those of each separate organisation. The health trust representatives explained that EDI work benefitted the wider staff base. The Trusts only worked with ethical companies for international recruitment and they acknowledged the importance of pastoral care and communication in retaining staff – which included accommodation support, and signposting to relevant community groups, religious leaders and food shops.

·         The main issue raised by staff recruited from overseas was a struggle with accommodation after the first three months’ provision.

·         In terms of how Worcestershire benchmarked against other areas on workforce pressures, the HOSC was advised that each trust completed monthly reports on a number of measures. For Adult Services, the Council’s Strategic Director advised that benchmarking data was reported to the Association for Directors of Adult Social Services (ADASS). Worcestershire performed better for sickness rates and was in the lowest quartile for use of bank staff, and for most indicators performance was comparable with other areas.

·         Support for staff mental health had been increased and was provided by the Health and Care Trust in the form of individual and team sessions and was well used. Mental health was the biggest reason for absence and had increased since the Covid pandemic, however currently there was no funding for the additional support beyond July, which was a concern.

·         The representatives were asked what they would want highlighted to local MPs, and the ICB Director highlighted the need for positive portrayal of careers in the sector, with emphasis on the moral and substantive rewards The sector could offer a breadth of exciting, lifelong careers. The VCSE representative’s plea would be to remember social care, which was so often forgotten.

·         The Council’s Strategic Director referred to the plethora of staff wellbeing events being held for council staff that week.

·         The Cabinet Member with Responsibility (CMR) for Health and Wellbeing stressed the importance of a positive narrative to encourage people to come to Worcestershire which was a phenomenal place to live and work.

·         When asked about the quality of staff cover, the extent of shortfalls and the impact on things such as waiting lists, the ICM representative explained that regular conversations took place to develop short-term and medium to long-term solutions for fragile areas and medical roles where expertise took time to grow. This involved working with the University of Worcester and enabling split roles with other providers so that post holders could spend time at a Surgery Centre, which the Worcestershire Acute Trust lacked. Roles were reviewed to see what could be changed, for example could an advanced clinical practitioner take on aspects of a consultants’ role – although at times agency staff were needed. Waiting lists were impacted, however were monitored and use was made of other providers.

·         In terms of pressure points, recruitment of acute nurses did not tend to be a problem, however consultant posts were more difficult, and the health trusts tried to look at the skills mix of a role and how to overcome barriers to recruitment, for example enabling home working and options for part-time working.

·         The CMR commented on the importance of preventative work and factors such as having a good home and taking exercise, which were a collective responsibility.

The Chairman thanked the representatives for their information. A further Update would be scheduled on this important area.