Jonathan Higman became chief executive of Yeovil District Hospital NHS Foundation Trust in March 2018, and has over 20 years’ experience working across the NHS in the south west and south east of England. With over 100,000 vacancies in the NHS, here Jonathan discusses how his trust has been able to eradicate ward-based nurse vacancies in the hopes that other NHS trusts find the story useful and are able to follow suit.
The first step in tackling the workforce challenge within a trust is to dispense with the notion that it is inevitable and unavoidable. True, it is a complex problem and much of the cause lies beyond our control, but there is still much that we can do at a trust level to recruit creatively, and make ourselves supportive, nurturing employers.
As with many other trusts, our historic nursing vacancy issue was driving substantial agency expense, affecting operational effectiveness, and diminishing staff morale. In 2016, our nursing shortages were peaking at 82 vacancies, with a forecast of 150 by 2018. For us in Yeovil Hospital, the short-term solution to our nursing workforce issue started with treating the overseas as a primary market, rather than one which simply enhanced or bolstered our domestic recruitment activities.
In establishing our dedicated overseas recruitment team we ensured that the levels of commitment and investment – both in capacity and funding – were commensurate to the scale of the problems we were addressing. Our recent recruitment activities in Dubai and the Philippines, with our experiences of alternative recruitment models, had proved that visibility and accessibility are crucial when entering into a new overseas market. Therefore, not only did we ensure that our senior nurses were involved in the recruitment process, alongside HR staff, but we also sent our own teams abroad for prolonged periods to conduct intensive recruitment programmes, aiming for several hundred recruits at a time.
For recruits, being able to meet and establish a relationship with an employee of our organisation during an interview is the first step to creating a relationship with our hospital. Maintaining this investment in the individual throughout the vetting, travel, arrival and training process is just as vital – not only in supporting their retention but also to help ensure their clinical effectiveness as a Yeovil Hospital team-member in the long-term; getting the basics right and supporting new recruits through every step of their relocation is a key success factor.
The results speak for themselves. Our ward based nurse vacancies have now been eradicated and our in-house OSCE (practical examination) training programme is delivering a 100% pass rate. Nursing sickness has also now dropped to 2.2% (below the national average of 4.4%) and agency spending has significantly dropped from £250,000 a month to £33,000, releasing resources that can be more efficiently utilised in other areas of need.
However, all the success of creative, collaborative recruitment can be immediately undone if you don’t give retention the same level of attention. In 2017, our hospital had a poor nursing and midwifery turnover rate at 22.8%, putting pressure on both staff and finances. A working group, led by our deputy director of nursing, took a multi-faceted approach to addressing the problem with the hope of strengthening staff morale and ensuring a positive workplace culture. This included reducing the reliance on exit-questionnaires, which we found to be of limited value and something of an ‘after the horse has bolted’ activity; an increase in the number of pre-emptive, proactive career guidance conversations with staff identified as likely to leave, led by senior leaders and our head of education; an increase in the profile and accessibility of opportunities for internal promotion, progression, and training; and the launch of our health and wellbeing programme, which offers a wide range of activities and events aimed to increase mental and physical staff wellbeing and promote cohesion amongst the workforce. This led to us achieving the country’s best results for staff health and wellbeing in the latest NHS staff survey and the current highest ranking in the south west for staff recommending us as a place to work through the staff friends and family test.
As a trust with a primary care operating arm – Symphony Healthcare Services – we are also in the privileged position of being able to develop portfolio contracts for staff interested in working across acute and primary care settings. Additionally, the creation of a staff ‘transfer window’ enables staff to move across departments and wards in a planned and coordinated way. Turnover for these roles dropped significantly and now stands at 15% overall, and even lower for overseas nurses.
With a stable and successful model in place for our own nursing workforce, we are now recruiting on behalf of 15 other trusts to help them address their own nurse recruitment challenges. We are also now affording the same level of attention to addressing our own medical shortages, where arguably the challenge is more nuanced and the prize is equally as significant.
Beyond our trust, we are spreading the message of how we are addressing our workforce shortages in the hopes that other NHS trusts find our story useful and are able to follow suit. Speaking at the NHS Providers’ annual conference, I appeared on a panel alongside Martyn Dicker, director of people at Unicef UK, and Beverley Murphy, nursing director for South London and Maudsley NHS Foundation Trust where we explored turning ambitions for workforce into reality. Martyn discussed the driving forces of employee engagement, such as encouraging people to innovate and express their creativity. Meanwhile, Beverley discussed the importance of working collaboratively – engaging with our workforce to better understand their needs, working together to create solutions and simply getting the basics right.
Participating in this conference reinforced my view that the NHS is at its best and most resilient when we tackle our challenges collectively, and when we put the person – be it patient or staff member – at the centre of our solutions.