It’s nearly 70 years since then-health minister Nye Bevan’s dream of a tax-funded healthcare system that’s free at the point of use became a reality. The NHS has come a long way since its humble beginnings in 1948 – life expectancy in the UK has risen from 66 to 79 for men, and from 71 to 83 for women. Its annual drug budget has also massively increased, from £31.7m back then to today’s £15.5bn and counting.
It’s also no secret that the NHS is facing one of the toughest periods in its history. With an ageing population and cuts to social services, demand is at a record high and patient numbers continue to increase. But just when hospitals need more staff to treat the influx of people coming through their doors without compromising patient safety, the opposite is happening.
Figures from NHS Digital, the NHS’s statistical arm, reveal that in the financial year 2016-17, for the first time, the number of nurses leaving the NHS was higher (3,000 higher, in fact) than the number joining. One in 10 of all nurses now quit every year, and from July to September 2017 only one nursing vacancy in seven was successfully filled. With EU medics, nurses and allied health professionals also heading back to the continent in droves because of uncertainty over Brexit, trusts are increasingly looking further afield for suitable staff.
But what can NHS HR teams do to not only make sure enough staff are filling the wards, theatres, laboratories and clinic rooms, but also to keep them there?
Employees leave and join constantly, so HR departments should regularly forecast their workforce’s comings and goings to make sure supply is going to meet demand. This includes estimating how many are likely to leave, and identifying where new recruits will come from and how many are expected.
“We always have a workforce plan in place for the next five years,” says Janet King, director of HR and corporate services at Frimley Health NHS Foundation Trust. “It’s useful to look at how many students are graduating and might join us as newly qualified staff. We also look at historical data and estimate how many people are likely to leave, compared to the number we expect to hire. In the case of nurses, we also recruit a proportion of these from overseas, as the demand for nurses in the UK is greater than supply.”
With rota gaps fast becoming the norm, along with the constraints on using agency staff, it’s up to HR to think creatively when normal methods of recruitment aren’t enough.
“It’s important to realise when your usual hiring channels aren’t delivering, and to think of a way around it,” says King. “For example, if we have medical vacancies we can’t fill, we look at upskilling nurses to become nurse consultants or advanced nurse practitioners, which bridges the gap between nursing and medicine and alleviates some of the pressure.”
As 12 per cent of the NHS workforce hails from outside the UK, overseas recruitment has a huge part to play in NHS HR’s remit, with many trusts already running dedicated schemes to bring in staff from India, the Philippines and Australia, among others.
And with organisations already starting to feel the effects of the UK’s exit from the EU, this is only going to increase in the years to come: in a survey of 80 NHS trusts conducted by NHS Employers between April and June 2017, 18 per cent said they had changed their overseas hiring plans as a direct result of Brexit, compared with only 6 per cent between July and September 2016.
“We’re speaking with organisations about the impact the EU referendum vote is having on them,” says Sue Covill, director of development and employment at NHS Employers. “None have so far reported a mass exodus of staff, but employers are telling us that their EU employees are concerned about their future.”
Make hiring simple
Many trusts are beginning to make improvements to their onboarding process, during which new recruits undergo pre-employment checks, are assessed by occupational health and complete paperwork before they start.
By condensing this process into as short a period as possible, HR can make sure employees’ time with their organisation begins positively, and get them into their role (and the vacancy filled) quicker.
After undertaking an eight-month project to improve the efficiency of its hiring process, Newcastle upon Tyne Hospitals NHS Foundation Trust managed to save 25,000 working days in six months – 16,000 of which were nursing. “Our recruitment process used to take up to 24 weeks, and had 127 separate steps. By getting input from staff, improving communication and streamlining pre-employment checks, we’ve more than halved the time it takes to get new employees into post,” says Ed Hindle, head of staff engagement.
Look after your staff
Of the 205,395 employees who left a role in the NHS between 1 October 2016 and 30 September 2017, 21 per cent cited a better reward package, a lack of opportunities, getting a promotion, moving into further education/training or poor work-life balance as their reason for quitting.
But HR-led initiatives can easily help to improve the happiness of an NHS workforce and make them more likely to stay. “Staff need to feel looked after,” says King. “At Frimley Health we organise social events for employees, like theatre trips, quiz nights and sports competitions. The extra effort we put in is definitely worth it for our staff.”
Upskill the workforce
Supporting staff in their professional development is equally important for HR teams, to make sure employees feel their career is progressing and to prevent them leaving for opportunities elsewhere. An increasing number of trusts are setting up ‘transfer window’ schemes for nursing staff to move more easily between specialties and gain experience in a different area, as an alternative to lengthy application processes or moving trusts altogether.
One such scheme started at King’s College Hospital NHS Foundation Trust in September 2016, and accepts applications during three ‘windows’ per year. The first 12 months saw 48 nurses transfer to a different specialty, and in October 2017 46 of those were still working at the trust. “Thanks to the transfer window, we’ve kept 46 nurses in the trust who would probably otherwise have left,” says Alexandra Nikolaou, head of recruitment. “We’re hoping to extend the scheme to other roles in the future.”