COUNCIL OF GOVERNORS MEETING Agenda Item: Subject: Workforce Report Date: 18th February 2015 Author: Lauren Tilstone - Workforce Information Manager & Kate Lorenti, Deputy Director of HR

Lead Director: Karen Fisher, Executive Director of Human Resources

Relevant Strategic Objectives (please mark in bold)

Achieve the best patient experience Achieve financial sustainability

Improve patient safety and provide high quality care Build successful relationships with external organisations and regulators

Attract, develop and motivate effective teams

Links to the BAF & Corporate Risk Register

Details of additional risks associated with this paper (may include CQC Essential Standards, NHSLA, NHS Constitution)

All HR policies and procedures are produced in line with CQC standards. Where targets aren’t met, this can provide a risk to quality of care and financial position.

Links to NHS Constitution

Staff – your rights and NHS pledges to you Staff – your responsibilities

Financial Implications/Impact Reporting of staff numbers which have an impact on pay spend.

Legal Implications/Impact Non compliance with mandatory training targets can impact upon litigation cases

Partnership working & Public Engagement Implications/Impact N/A

Committees/groups where this item has been presented N/A

Monitoring and Review

Executive Director of HR monitors performance and actions on a monthly basis. Trust workforce performance is also tracked via a number of performance meetings, specifically the monthly Confirm & Challenge which are chaired by the Deputy HR Director.

Is a QIA required/been completed? N/A

Staff in post numbers continue to increase month on month with an increase of 14.43wte’s in quarter 3. International Nurse recruitment continues and 30 registered nurses commenced employment with the Trust in quarter 3 with a further 32 expected to commence between now and the end of September 2015. At the end of quarter 3 the Trust budgeted establishment increase of 23.03 wte’s. The average vacancy rate has decreased in quarter 3 to 5.55% from 6.28% in quarter 2, this is due to the increase in staff in post and the transaction of CIP’s from divisional budgets. Total Pay increased to £43.60m in quarter 3, an increase of £28k when compared to quarter 2. Central reserves and facilities figures have not been accounted for within these numbers. Fixed pay totalled £37.19m in quarter 3 which was an increased position reflective of the increase in staff in post. Variable pay continues at an unacceptable level at £6.40m compared to £6.83 in quarter 2 a decrease of £427k. Medical and Nursing variable pay continues to impact with a heavy reliance upon agency and locum staff to cover vacancies. and extra staff to meet the increase in capacity during quarter 3. A recruitment brand and marketing strategy is currently being developed in order to support our efforts to attract potential candidates to the Trust. The Recruitment team has supported local recruitment fairs to promote SFH as a local employer for a variety of professions. International recruitment continues to be pursued for Medical staff. Sickness absence during quarter 3 stood at 4.11%, this is an increase of 0.37% from quarter 2. Short term and long term absence has increased in quarter 3 with areas of concern being escalated within the divisions for action. Long term absence is being proactively managed with support from HR. The cost of sickness absence in quarter 3 was £1.08m which brings the year to date total to £3.41m. Appraisal compliance increased by 3% in quarter 3, with Diagnostics and Rehabilitation Division making a significant improvement of 9% in quarter 3. The 98% compliance continues to be driven within the divisions and areas with a high amount of outstanding appraisals are being contacted directly and supported to develop plans to increase their compliance. Mandatory training completion stood at 83% at the end of quarter 3 which was an increase of 3% from quarter 2, the Training & Development department have been working on a number of initiatives such as increased use and access of e-learning resources to help improve compliance rates and the development of a new suite of performance management reports through the ESR system which will assist managers to drive compliance at a local level. Letters have been sent to every member of staff to address compliance rates with individuals directly, this is an exercise that will be undertaken on an annual basis going forward.

Recommendation for Council of Governors:

Note the workforce information presented

Acknowledge the actions being taken to improve performance take note of the information provided in the report.

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Council of Governors – February 2015 Workforce Report – Quarter 3 Position

1.0 Staff in Post, Budgeted Establishment, Vacancies: Source ESR, Financial Ledger The Trust monitors establishment and staff in post numbers in line with the Trust’s Annual Plan. The table below reports on substantive workforce numbers as compared to the annual plan and excludes Medirest staff as they are within a hosted service.

1.1 Budgeted Establishment v Staff in Post v Vacancies

Budgeted Establishment

At the end of quarter 3 the budgeted establishment was 3902.03 wte’s an increase of 23.03 wte’s in the quarter.

Staff in Post

Staff in post was 3672.99 wte’s, an increase of 14.43 wte’s in quarter 3

9.65 wte’s attributable to an increase in Registered Nurses which reflects the continued work being undertaken to vacanct posts.

Vacancies • The vacancy rate at the end of quarter 3 was 5.87% with 229.04 wte vacancies at the end of December, this compared to 5.68% at the end of quarter 2. The increased position is due to an increase in establishments.

There are 32 Registered Nurses in the recruitment process due to start between now and the end of September 2015.

Medical & Dental vacancies have reduced to 14.53 wte’s during quarter 3, there are a number of recruitment initiatives taking place to fill medical vacancies that are currently being funded from variable pay. Work is being undertaken to transfer this to fixed pay.

The Ancillary vacancies are showing as a minus figure as there is work to be undertaken to recode staff within ESR and the financial ledger.

Admin & Clerical 5.14% 47.78

Allied Health Professionals 0.20% 0.36

Ancillary -19.41% -7.81

Medical & Dental 3.31% 14.53

Registered Nurse 6.38% 80.80

Scientific & Professional 5.97% 12.34

Technical & Other 1.90% 4.74

Unregistered Nurse 12.98% 76.31

Grand Total 5.87% 229.04

Vacancy Rate - Number of Vacancies Compared to Budgeted

Establishment per Staff Group

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1.2 Recruitment Update – Source NHS Jobs 1.3 Recruitment Benchmarking – Source Health & Social Care Information Centre

2.0 Pay Spend – Source – Financial Ledger

Premium rate VP – Agency, locum, overtime, waiting lists Other VP – Additional hours, extra sessions, pool & bank

Pay spend totalled £43.60m in quarter 3, this compared to a £43.57m spend in quarter 2, an increase of £28k.

Pay budget for quarter 3 was £40.70m, this meant a £2.9m overspend which compared to a £2.61m overspend in quarter 2.

Fixed pay spend increased in quarter 3 to £37.19m compared to £36.75m spend in quarter 2, this position is reflective of the increased staff in post..

Variable pay spend decreased to £6.40m in quarter 3 which compared to £6.83m in quarter 2 a £427k decrease.

*** Please note that these figures exclude reserve funding and

Facilities (Medirest)

Please note that figures include

junior doctors for starters and

leavers

The graph shows information from the Health & Social Care Information Centre (HSCIC) in joiners per Acute Medium Trust in the period between November 2013 and October 2014. The average joiner rate for the 12 month period was 685 headcount for Acute Medium Trusts, SFH had 490 joiners in the same period. This reflects some of the difficulties the Trust faces with recruitment

There above graph shows that a small junior doctor changeover took place in December 2014, as a result there are 4 Medical vacancies currently out to advert. The number of Registered Nurse starters and leavers were comparable in each month during November and December.

There are difficulties in recruiting to A&E, Stroke, Geriatric and Radiology Medics. To address this Trust is working closely with specialised recruitment agencies to fill Medical vacancies to recruit to posts locally, nationally and internationally.

20 Registered Nurses commenced employment in January 2015, 10 being international recruits

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3.0 Sickness Absence – Target 3.50% - Source - ESR

Medical VP – Totalled £2.76m in quarter 3, a decrease of £328k. There are currently 15 Medical vacancies are being funded by VP, as these posts are recruited to the budget will transfer to fixed pay.

Nursing VP – Totalled £2.38m in quarter 3 which was a decrease of £269k, this is an expected decrease due to the large intake of newly qualified nurses in quarter 2. There was an increase in variable nursing pay in December in order to manage flow issues at the Trust.

Non Clinical VP – Totalled £895k in quarter 3, an increase of £175k, the areas of increase were Service Improvement £172k increase, utilised agency staff to cover vacancies that have now been recruited to; PAS Benefits £54k increase, spend was attributable to the implementation of Medway PAS where overtime costs were incurred; Executive Directors £144k increase, where variable pay costs were due to interim Director level posts.

Other Clinical VP– Variable pay spend overall decreased by £5k in month. Agency spend has been mainly utilised within Cardiorespiratory & Radiology. Cardiorespiratory has now implemented an on call rota to provide services out of hours and also has two Band 7 gaps. Radiology has utilised agency particularly within Ultrasound.

Total sickness absence in Q3 stood at 4.11% this compares to Q2 which was 3.74%.

The highest sickness absence reason for the quarter was anxiety/stress/depression related illnesses, losing 1884 working days within the quarter, this was a decrease of 741 working days when compared to quarter 2.

The Trust has lost 11.10 working days per whole time equivalent from April to December 2014. In the same period of 2013/2014 12.24 working days were lost per whole time equivalent.

There has been a month on month increase from September 2014, this is consistent with 2013/2014 trend excluding December 2014, where previous years have seen a decrease and this year saw an increase. Work is being undertaken to understand the reasons for increase.

HR Business Partners and Occupational Health are meeting with managers where there are high numbers of staff on long term sickness to understand underlying factors and develop actions.

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4.0 Agenda for Change Appraisal Compliance – Target 98% - Source – ESR & Manager Returns 5.0 Mandatory Training Compliance – Target 90% - Source ES

6.0 Staffing Mix & Bed Ratios – Information taken from the Nurse Staffing Report December 2014

Appraisal compliance improved by the end of quarter 3 by 3%, closing at 85% at the end of the quarter.

The Diagnostics & Rehab division has made the most significant improvement in quarter 3 increasing compliance by 9%.

Actions for Improvement - All outstanding appraisals are being reviewed by Assistant HRBP’s and being discussed with line managers at Confirm & Challenge.

Compliance by Division –Quarter 3 Trust – 83% (increased by 3%)

Corporate – 82% (increased by 2%) Diagnostics & Rehab - 79% (increased by 1%)

Emergency Care & Medicine - 83% (increased by 2%) Newark Hospitals - 86% (increased by 13%)

Planned Care & Surgery – 83% (increased by 6%)

During December a total of six inpatient areas reported a fill rate of less than 90%. There were no areas reported as below 80%

Additional Health Care Assistant shifts on night duty have increased to meet the continued demand for enhanced observations across the organisation which has predominately been with the Emergency Care & Medical Division.

During December additional bed capacity was opened across a number of areas on a temporary basis in order to address an increase in non-elective activity / admissions to the trust. In addition to this nursing resources were increased across a number of key areas most notably ED and EAU to effectively manage patient flow and patient safety within respective departments.

During December a total of 99 clinical incidents relating to falls, pressure ulcers and medication errors were recorded across all clinical ward environments. Of those recorded 23 were logged against wards that had fallen below the 90% fill rate threshold. The remaining 76 incidents reported were from wards that had achieved or exceeded the required staffing thresholds.

The inpatient wards, in particular medicine are particularly reliant on the use of bank and agency nurses to bridge gaps. This risk is managed consistently by the ward sisters and matrons to ensure staffing risks are mitigated. On-going recruitment to posts is continuing at pace

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7.0 Staff Survey

The below outlines data that has been published by Quality Health and the comparisons against other Acute Trusts are from those who used Quality Health to undertake their survey. The national results will be released in February 2015.There were 89 questions asked of staff within the survey for 2014. Out of those 89 questions:

31 questions demonstrated improvement

37 questions showed deterioration

14 questions results remained the same.

7 questions were either new questions and therefore no comparison available, or questions where improvements/deterioration could not be measured.