Tackling the NHS retention crisis

Ahead of the general election, all three of the main political parties have committed in some shape or form to the integration of health and social care. However, we are yet to see any real detail or analysis of the workforce that will be needed to deliver this change.

Contingent labour plays an important role, enabling cover for last‑minute absences, maternity cover and supplying extra resources during periods of peak demand. Agencies provide a service to ensure that hospitals can maintain safe staffing levels and meet patient needs. Yet few people are asking what role contingent and flexible labour will need to play in the upcoming integration of health and social care services.

Contingent labour
As NHS England’s Five Year Forward View acknowledged, care will need to be delivered locally, and organised to support people with multiple, complex and chronic health conditions. A new flexible workforce will be needed – one capable of delivering personalised care across a variety of settings so that patients receive a consistent level of care whether they are on a ward or at home. The NHS will have to manage this flexible workforce. Surely staffing suppliers who are used to delivering consistent, high quality care across a variety of settings, used to working hard to secure access to CPD, vetting and performance feedback for such a peripatetic, flexible workforce can offer some key insights.
A lot of the debate so far with regards to contingent labour in the NHS has focused on the increasing use of and spend on agency staff, and how this reflects the current retention crisis hitting the NHS. The REC/KPMG Report on Jobs, featuring original survey data which provides a picture of recruitment, employment, staff availability and employee earnings trends, has shown an increase in the amount of health and social care vacancies being passed to recruiters for permanent roles. But we know that advertising for more permanent roles doesn’t mean that there will be enough candidates willing to fill them; hence the recent overseas recruitment drives.
Demand for agency workers is stronger than ever. Our members tell us that they took lots of calls after Christmas from nurses who had got to the end of their tether and wanted to move into temporary work instead. Indeed, a majority of agency nurses have either had long careers as permanent employees in the NHS, or are combining temporary assignments with permanent roles as a means to develop experience in specialisms that they wish to transfer into full time.
However, because of dissatisfaction with management, inflexible shifts and long hours, many of these highly skilled, experienced, caring people have made a decision to quit permanent NHS jobs completely. Last year we surveyed nurses who had made this switch and they said they preferred to work that way as it meant they can exert more personal choice over what wards they work in and how often they have to switch between day and night shifts.

Perhaps, therefore, the transfer away from ward politics and set institutional settings, as promised in The Five Year Forward View, will help ameliorate the current recruitment and retention crisis hitting the NHS. In the interim however, we are missing out if we do not reach out to agencies and their candidates to learn more about what motivates and guarantees the delivery of good quality compassionate care.

A good staff experience
The NHS National Quality Board recently released its framework ‘Improving experiences of care: Our shared understanding and ambition’, published in collaboration with NHS Improving Quality and the Health and Social Care Information Centre. It is one of a few initiatives that has emphasised how critical a focus on workforce leadership, management and wellbeing is to the delivery of compassionate care.
Evidence included in the framework shows that organisations which deliver good experiences of care have workforces with higher levels of wellbeing as well as more satisfied patients and service users. One of its many recommendations is that organisations should “use the potential of their staff and focus on supporting staff to deliver a good experience”. So why are we not inviting the one section of the workforce – contingent labour – that has attracted so much attention in the press to the table?
The use of flexible labour in the NHS looks set to stay, be it the continuing need for agency workers to cover gaps and fluctuations in demand or, more fundamentally, the likelihood that this way of working is the only solution to tackling the retention crisis and delivering personalised 21st century care throughout a variety of community settings.

Learning lessons
The immediate lessons for now? A focus on HR processes such as induction, appraisal, prioritising staff engagement and morale, have all been strongly linked to improving people’s experiences of care. In terms of specific lessons to be learnt from the contingent labour workforce, take a lesson from the REC’s Chain Reaction report published in association with CIPS and the CIPD, which examined the effect supply chains have on recruitment and how HR, procurement and recruitment professionals develop more strategic working relationships to improve efficiency and quality in recruitment. The research revealed the organisational benefit to prioritising candidate experience and satisfaction – and indeed recommended that it is positioned as a contractual obligation between clients and their staffing suppliers.
HR departments across the NHS should certainly be encouraged to be more assertive about the quality of the hire, the induction and integration processes they institute rather than seeing agency workers as merely cost units on a spreadsheet to be managed and ultimately minimised. There is also still a need for those using managed service providers to really extend their line sight and scrutiny beyond the first tier to SME specialist suppliers. This is to benefit from their frontline knowledge and insights on recruitment and retention challenges and trends within each labour market, as well as the likely capacity of the local talent pipeline to deliver the new visions of integration and compassionate care. Part of this will necessarily involve NHS Trusts and suppliers collaborating to manage contingent staffing spend. The challenge is to guarantee that procurement agreements are an attractive and financially viable option for specialist SMEs. Therefore, the Department of Health needs to step up its investment in training for HR and procurement professionals beyond self-help toolkits to ensure effective, efficient and equitable contract management. 

Recognising the staff
The NHS is its staff. As clichéd as its sounds, it bears repeating. Not only do staffing costs make up over 70 per cent of the NHS’ £110 billion annual budget, raising standards across health and social care in the future will depend on so much more than safe staff to patient ratios, or the creation of thousands of new training places. While there is certainly an urgent need for investment in national workforce planning, NHS trusts need to start recognising the role of contingent labour as an invaluable resource in building a sustainable NHS labour market.

Further information

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