Agenda item

(indicative timing: 10:05am – 11am)

Sarah Dugan, Chief Executive of Herefordshire and Worcestershire Health and Care Trust (HWHCT) introduced the report and explained she was present in her capacity as Co-Chair of the People Board within the Integrated Care System.

Workforce was a very broad topic, and there were various areas which Committee members may want to explore.

In Worcestershire and Herefordshire around 16,500 people were employed by the NHS, 12,375 of whom in Worcestershire. Regarding vacancy rates and staff turnover, figures in the Agenda report included those who may have moved to other NHS organisations within the NHS family.  COVID had brought incredible challenges and there were some hot spot areas with higher numbers of staff approaching retirement. During the pandemic, use of temporary staff had increased significantly, and it was hoped to reduce use of agency staff, which was expensive. The absolute priority was to attract and importantly, to retain a permanent workforce, for example by trying to be as creative and flexible as possible to make jobs attractive, including international recruitment when needed.

Worcestershire’s Primary Care workforce was fortunately very strong, although there were some hot spots in both primary and secondary care sectors, for example practice nurses, haematology and mental health. Mental Health was an example of an area where there had been recent development resulting in new posts which was positive, but there was not a ready supply of staff, although for mental health this was a short-term problem since there had been a big increase in young people training in this field. The Board was really keen to encourage local people to consider NHS roles, which spanned a huge range of job types.

Workforce pressures within domiciliary care and social care were significant and organisations were trying to work more as a system and look at practical considerations such as transport.

It was important to do as much as possible to mitigate the significant pressure on staff from the cost of living.

The report included the range of solutions in place to address workforce pressures. The People Board comprised 30 people from a range of organisations who all wanted to make a difference and there was a local as well as national People Plan. Following the huge success of the call for people to help the NHS during the pandemic, the reservist programme was a new area of work to develop staff resources from people who may be employed in other jobs but have skills to help the NHS at times.

A Health and Well-being Hub, funded nationally, was available to support staff and was particularly beneficial to smaller organisations.  It was also important to note the ‘game changing’ addition of the Three Counties Medical School.

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

·       Reassurance was sought about the impact of NHS staff being redeployed to the COVID vaccination programme to assist with further rounds of vaccinations, however it was confirmed that all staff had now returned to their usual posts, and the vaccination programme was staffed by new staff who had come froward during the pandemic.

·       The difference between use of bank staff and agency staff was clarified and it was explained that bank staff may already work in NHS roles but be available for extra shifts. Pay was more in line with NHS rates, therefore was more affordable and the scheme was promoted, for example to medical students, although the representatives present were conscious to avoid staff doing too many hours.   Agency staff were expensive and could be from a number of neighbouring areas but provided a fantastic resource when needed.

·       Flexibility was the main reason why staff preferred the bank, nonetheless, permanent roles came with better terms and conditions, which the People Board sought to promote as a priority, for example by providing programmes for people to join the NHS and progress.

·       In terms of what was being done to discourage staff becoming agency workers, the importance of listening to feedback and being creative were highlighted. Figures for the conversion rate of agency staff transferring to permanent workforce would be circulated.

·       A HOSC member asked how stress and anxiety in the workplace were identified and tackled, including the potential for existing NHS staff to work as bank staff during their holiday. Tina Ricketts, Worcestershire Acute Hospital Trust’s Director of People and Culture explained that risk assessments included stress and staff were signposted to appropriate support. Although some staff terms and conditions were set nationally, there was a health and well-being offer to staff and flexibility had been increased to make roles more attractive, as well as access to schemes such as bike to work. It should not be possible for a staff member to work 52 weeks a year, and there were system checks in place and second employments had to be declared; throughout the pandemic staff had been encouraged to take holiday.

·        When asked about plans in place to resolve workforce pressures, the People Board representatives explained that the Board had a clear Strategy which was being systematically addressed against timelines, including recruitment and retention – the Headline Plan of the priorities for Worcestershire in addressing the workforce issues would be circulated.

·        It was worrying that despite all the work going on, a dramatic change had not yet been seen, therefore efforts needed to continue. International recruitment was working well but a more sustainable, long-term solution was the focus.

·       Brexit had led to vacancies in some sectors such as social care but had not led to a noticeable impact on the NHS workforce locally, however the challenging area was healthcare support and administrative workers, who were unsettled at changes and competition in the marketplace.

·       The Chief Executive of HWHCT advised that retirement was the biggest problem for retaining staff in her organisation especially as the workforce was exhausted after the last two years. A programme to attract retired workers back to part-time roles was an area of focus.

·       When asked whether the figures of staffing in primary care masked a crisis, it was explained that although under pressure, figures in Worcestershire were very strong compared to elsewhere.

·       It was acknowledged that innovation played a part in attracting staff to secondary care roles and it was therefore important to continue the momentum of innovative working sparked by the need to work at pace during the pandemic.

·       Regarding the workforce Plan, some positive progress was emerging, for example changes to the national bursary system for mental health and learning disability nurses had led to a 50% increase in people training.

·       The Council’s Director of People explained that the pandemic had highlighted the difficult nature of care work which was now exacerbated by the cost of living crisis and all representatives present shared the consensus that working together was the way forward.

·       Apprenticeships were also important, although progress on this and a number of areas was difficult to assess during the pandemic therefore a further update would hopefully demonstrate more established patterns of progress.

·       In terms of additional pay for agency staff, the Acute Trust representative advised that approximately 7% of staff in March were agency, although across the board there would be hotspots with much higher levels.  Reassurance was given that because of the higher cost, permanent staff were the real focus, and agency staff would only be used if cover could not be found internally. 

·       A member expressed concern about the figures for social care staffing for example that one quarter were employed on zero hours contracts and the Council’s representative explained that although the Council tried to influence this, much of the social care workforce were commissioned through external employers. Contracts stated pay should not be below the national minimum wage. However, nationally there was a drive to make this sector more attractive and the national Cost of Care exercise required the Councill to engage with providers and the marketplace.

·       When asked what the Council was doing to attract staff, and whether pay was an issue, initiatives such around welfare and wellbeing were given as examples and promoting the overall rewards including flexible working. 

·       The representatives present acknowledged that higher pay would be desirable, however it was not the biggest issue raised, with more focus currently on living costs. NHS salary ranges were determined nationally.

·       Union representation and involvement on the People Board was strong.

·       Increasing fuel costs against mileage rates was a big issue, and it was explained that NHS rates were set nationally twice a year but had not been increased at the most recent review in April, which impacted in particular on staff doing a lot of miles. The HWHCT Chief Executive supported national negotiation of rates rather than at local level, however the issue was growing and the Trust was looking at how to support staff.

The Council’s representatives advised that the domiciliary care workforce was most affected, in particular those working over 35 hours. Staff were paid a rate for care time, a lower rate for travel time and were reimbursed for travel costs. During market engagement, Officers had suggested a differentiated rate within fees for more rural areas but interestingly this was not wanted by providers, however the forthcoming Fair Cost of Care exercise would provide a further opportunity; increasing fuel costs was going to cause significant problems and a potentially difficult situation.

·        Regarding the secondary care workforce, some specialist areas were a challenge, such as haematology, orthodontics, cancer, neurology and stroke services and the People Board was looking at increasing flexibility and appealing roles, early contact with those due to complete training, offering recruitment premiums as well as using international recruitment. A positive training experience often prompted individuals to return to Worcestershire at a later point in their career. Alongside traditional means such as school fayres and the NHS Jobs website, there was increasing use of targeted digital and social media channels.

·       Staff feedback was generated and captured through a variety of ways including at senior recruitment level.

·       When asked to what extent Worcestershire was considered a ‘state of the art’ place to work, the representatives believed it did well from a technology viewpoint and while effort was made to promote innovation, there was more to do.

·       When asked why Worcestershire was not always seen as an attractive destination for mental health nurses, it was explained that this was for similar reasons as for more specialist roles and while Worcestershire provided a range of specialisms, bigger Trusts such as Birmingham provided more. Another factor was that students often chose to remain where they had trained.

·       Worcestershire was in the fantastic position of being part of transformation investment for mental health, which had created many new posts, however as a result staff had moved around with vacancies opening up in other areas.

·       It was difficult to know when the workforce pressures would settle, as staff were heavily involved in restoration of services and had been working remotely from their teams which had a big impact – now that teams were getting back together it was hoped the situation would improve.

·       Significant turnover figures in social care were acknowledged, which reflected a lot of change during the pandemic including mandatory vaccines and opportunities to work in easier jobs for example supermarkets, for more pay. However it was interesting that the vacancy rate had remained relatively static, around 7% and the Council had worked hard  to promote care work as a career, which Scrutiny had also been involved with.

·       In response to a question about whether transport to and from work at early/late hours could be a factor for staff, it was explained that ways of working were being looked at, for example location of work in certain geographies as well as childcare voucher schemes, pool cars etc.

·       HOSC members were keen to be kept up to date with initiatives so that they could promote employment in their role as local members.

·       It was confirmed that the staff passport to enable mandatory training records to be ported across sectors applied to all hospitals and staff.

·       Support such as helping international staff find housing, was provided and general NHS staff terms and conditions were good in terms of pay and holiday, and there was a little flexibility with incentives for more specialist staff – the People Board representatives were wary of starting bidding wars between areas.

·       The Council had decided to apply market forces to attract some staff such as social workers.

·       Details about staff speciality roles with highest vacancy rates including pay rates for both permanent and agency, would be circulated.

·       Staff usually maintained continuing professional development (CPD) through joining schemes such as NHS Professionals.

·       Aware that healthcare had always attracted an international workforce and students, a member asked how this was enabled to fill gaps and also how councillors could help as community representatives to support cultural diversity, and it was acknowledged that the international workforce played an important contribution. Staff visas could be applied for certain categories of staff, for example a recent cohort from India, and the offer of support was appreciated.

The Chairman thanked everyone for the information provided on an area which was of considerable concern and interest to the Committee – therefore a further update in six months’ time was requested.