View our resources: www.nhsemployers.org

View our resources: www.nhsemployers.org

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View our resources: www.nhsemployers.org

Simon Courage

Director of Product Strategy

Allocate Software

Using e-rostering & software to support flexible working

What is flexible working?

March 2014

Mon Tues Weds Thurs Fri Sat Sun

Flexible Working

March 2014

Mon Tues Weds Thurs Fri Sat Sun

Inflexible working

March 2014

Mon Tues Weds Thurs Fri Sat Sun

08:45 -14:30

08:45 -14:30

08:45 -14:30

08:45 -14:30

Flexible

staffing

Substantive

staffing level

Why do we have a flexible workforce?

What is the Exam Question?

Meet safe staffing requirements cost effectivelywhilst having a happy workforce

Current Exam Question

Current Exam Question

Agency Spend Increase

327

485

714

0

100

200

300

400

500

600

700

800

Agency Spend (168 Trusts)

Mill

ion

s

2012-13 2013-14 2014-15 (projected)

26 trusts are spending five times more in quarter 2 2014-15 than 2 years earlier

Only 19 trusts are spending less on agency nurses than 2 years ago

Agency Spend Increase

“The numbers in this report will make sobering reading for health care leaders and politicians alike. But what they don’t show is the cost to patients. Over-reliance on agency staff impacts on continuity of care, and that is bad for patients”

Spend and Care

Meet safe staffing requirements cost effectivelywhilst having a happy workforce

It won’t will fix itself

“The only way to reduce the spiralling agency bill is by taking a long-term approach to workforce planning”

But how do we fix it?

…But we can reduce costs & improve care even if we keep temp staffing levels the same by moving use from agency to bank

Improve OUR flexible workforce (bank)

to reduce dependency on Agencies’ flexible workforce

Benchmark – Temp Staff Usage

Benchmark Agency Use: % of Temporary Staffing Hours

2,499 agency hours. If replaced agency with bank at level of best Trust, save £2,487,000 pa with no change in staffing levels or total temp staff usage

Reduce Agency

Staffing Lifecycle

Reduce Temp Staffing

Staff BankRosteringUnavailabilityOrganisation Agency

Next Steps

Reduce Agency

Staffing Lifecycle

Reduce Temp Staffing

Staff BankRosteringUnavailabilityOrganisation Agency

Staff with Working Restrictions

Understand where staff inflexibility is an issue…Review and determine if still appropriate

1. Improve positives bank has over agencies

2. Remove positives agencies have over the bank

3. Increase efficiency of the bank office

Reducing Agency Ratio

Improve positives bank has over agencies

Make it more likely you’ll get work if you work on the bank

Bank has better choice; bank has earlier choice

Virtuous circle

Improve positives bank has over agencies

How? Show unfilled bank via Employee Online

Staff love it

In control of their working

Fast and easy

No need to speak to anyone!

Safe – rules still enforced

‘Bread and butter’ looks after itself

Bank Office focus on ‘hard to fill’ – direct agency impact

Enable Direct Booking

Other Communication Techniques: SMS

Get gaps to the bank ASAPBank get first choice; bank gets more choice;

Bank gets time to fill

Use Integrated e-rostering>bankMakes sending requests as quick & simple as possible

Available even if use NHSp

Track how well this is workingTrack Roster Approval timescales

Track Bank lead times

Making This Work: Bank Lead Time

Other Communications: Employee Online

Give staff control of their working lifeView bookings

Confirm unconfirmed bookings

View / direct book into matching gaps

Enter availability for targeted SMS or calls

Home access is key

Remove positives agencies have over the bank

Weekly payrolls

Pay at current payscale

Consider tax impact

….

Remove Positives Agencies’ have over Bank

Recruitment drive for the bank –explaining the positives

Do you know which substantive staff work agency duties? Are they also on the bank?

Recruitment

Increase efficiency of the bank office

Get the ‘bread & butter’ to look after itself

Direct booking

2 Way SMS

Ward direct bookings

Reduce admin overhead

Integrate with e-Rostering

Integrate with payroll

Agency access

Increase Efficiency of the Bank Office

Improve your flexible workforce: the bank

Reduce agency costs & improve care – now

No dependency on long term workforce planning

Use technology to make bank a more compelling choice

Provide a better service to your flexible workforce

Summary

View our resources: www.nhsemployers.org

Our Approach to a Recruitment and Retention Strategy

A Cinderella Story

- Lorissa Page -Associate Director of HR at Brighton and Sussex University

Hospital NHS Trust

Brighton and Sussex University Hospitals is the regional teaching hospital, working across two sites: Brighton and Haywards Heath.

We are also the major trauma centre for Sussex and the South East.

Specialised and tertiary services - neurosciences, arterial vascular surgery, neonatal, pediatric, cardiac, cancer, renal, infectious diseases and HIV medicine.

Serving a population of 500,000.

Care for circa 750,000 patients per annum.

Employ circa 7000 staff

BSUH

Vacancy rate 11.5%

Turnover rate 13.6%

c.750 vacancies (12/13)

4.5 WTE Recruitment Administrators

Caseload of 85 vacancies each

Time to recruit 17 weeks

Recruitment process contained 9 stages and 74 steps!

IT administrative system – Excel spreadsheets

BSUH Recruitment in 2013

Why do we need a strategy?

• Recruitment and retention of skilled staff is a continuing challenge and has created a highly competitive market.

• The Trust need to employ more staff and retain, manage and develop its existing workforce who have the right skills and experience to ensure high quality, safe and effective patient care.

• The national demographic profile highlights an aging workforce and the demand to increase career and flexible working opportunities make recruitment and retention of staff a major challenge.

• A fair and diverse representation of the local community in our workforce is essential to how we work. The Trust needs to shows its commitment to working in partnership with its local community and workforce.

Corporate Brand vs. Talent Brand

The Corporate Brand influences behaviourabout its services, the Talent Brand influences consideration as an employer.

The John Lewis Partnership view all applicants as potential customers and its online process aims to make applying an enjoyable experience

Companies with a strong Talent Brand benefit by having:

A strong pipeline of people willing/desiring to work for a companyA large number of employee advocates and employee referrals The ability to attract hard-to-find talentReduced recruitment costsImproved Retention

What about Retention?

• Staff feedback

• Develop a more flexible workforce – Sandwich generation

• Review and develop roles that introduce new and innovative ways of working and delivering care e.g. Physician Associates .

BSUH the Future

Connect on Linkedin

View our resources: www.nhsemployers.org

View our resources: www.nhsemployers.org

Overseas Test of Competence

Tom Kirkbride – Assistant Director: Registration Emma Lacy – International Team Manager

Overview

• Why has the process changed

• The Test of Competence

• Part 1 – Computer Based Test

• Part 2 - OSCE

• Process overview

• To date

• Questions & Feedback

Why has the process changed

As a result of numerous internal/external audits and investigations,

recognition of a need to improve the Overseas Registration process

and assessments to:

• Provide a reliable and valid method of testing overseas

applicant’s competency to access the UK register.

• Consistency

• Output rather than input measure (objective test vs. hours of

training)

• Address limitations of ONP

Test of Competence

• The NMC has established a test of competence for applicants

wishing to register in the UK as a midwife or as a nurse in each

of the four fields:

• Adult nursing

• Children’s nursing

• Learning Disabilities nursing

• Mental Health nursing

Pre requisites for the test of competence

• The applicant must:

• Be an RN or RM in their own country

• IELTs at the required level of 7.0

• Have three years undergraduate nursing or midwifery education.

• Have 12 months post registration experience

• Have met the health and fitness to practice requirements

Purpose of the test of competence

• To ensure those who pass the test of competence are fit for registration in the UK.

• The test of competence allows nurses and midwives to demonstrate their skills, knowledge and attitudes are at the level required for point of entry to the UK.

• The skills, knowledge and attitudes covered in the test of competence will be derived from the current pre-registration nursing and midwifery education standards.

Design Overview

• The test of competence is made up of 2 parts.

• Part 1 The unseen examination (MCQ)

• Part 2 The practical examination (OSCE)

• The midwifery test of competence will follow the same assessment structure.

Part 1: Computer based MCQ

• Computer based Multiple choice questions

• Available in a number of countries where IEN&Ms are typically recruited.

• Provided by Pearson-Vue who are well known and recognised for providing the NCLEX online multiple choice exam which is required for registration in the USA.

• Essential questions – critical areas

• Developed, written, tested and evaluated by teams of subject matter experts for midwifery and each field of nursing.

• Tests candidates against the point of entry competence set out in the pre- registration standards and essential skill clusters for nursing and midwifery education

Part 2: The OSCE

• Scenarios reflect typical patient encounters for each field of nursing and midwifery.

• Scenarios developed written, tested and evaluated by teams of subject matter experts.

• Scenarios will allow candidates to demonstrate competence across the domains and essential skills clusters.

• Each nursing or midwifery practical exam will be made up a number of stations.

• Candidate will complete all stations and all stations must be passed.

• Mandatory elements such as informed consent, hand washing, safe medicines management and communication must be effectively demonstrated by candidates.

Part 2: The OSCE

• The focus of nursing and midwifery OSCEs are on the assessment of the holistic and integrated nature of safe and effective nursing or midwifery practice measured against current pre-registration education standards.

• OSCE Centre – University of Northampton

Part 1 Test –

Computer Based

ID and Document

Verification

Activate

Registration

Fail x 2

retries

2nd

Fail

Reject – criteria not met

2nd

Fail

Missing/Fraud

Notify of

Unsuccessful

Application

Re

gis

trant

NM

C O

nlin

eN

MC

IELTS 7 or above

12 months post-registration practice

3 year (equivalent) nursing programme

Self declaration on health and character

References available

ID documents logged

All eligibility criteria evidences/valid

References appropriate

Digital ID Documents consistent /accurate

Initial fee paid

Face to face checks – at OSCE centre

ID check

Original document verification

Accepted

Pass

Confirmed

Pass

Registrant

withdraws /

Reapplies

Overseas Registration ProcessResearch &

Preparation

Complete

Online

Declarations/

Confirm Eligibility

Assessment

Part 2 Test -

OSCE

1st Fail

(re-sit)

1st Fail

(re-sit)

Dependent on individual and employer decisions

Eligibility stage

Start ProcessOnline self-declaration

Auto Confirm

Assessment stage

Min 2 wksAverage: 6 wks

Max 12 wks

OSCE & prep stageMin 4 wks

Average: 8 weeksMax 12 wks

Includes travel to UK & familiarisation/preparationID verification at OSCE

RegistrationAverage: 2 days

Max 5 daysCBT stageMin 2 wksAverage

Prep 4 wksExam: 0.5

day

TOTAL (Pass 1st)Min 14 weeks

Average: 31 weeksMax: 49 weeks.

Document SubmissionMin 2wksAve 4 wksMax 6 wks

Online submissionVerification by post

VisaMin 4 wks

Average 8 wks

Max 14 weeks

Arrival in UK .

TOTAL inc. re-sitMin 18 weeks

Average: 41 weeksMax : 65 weeks.

OSCE re-sit (including education/support)Min 4 wks

Average: 10 wksMax: 16 wks

.

INTERNATIONAL(non-EU) PROCESS

COMPARISON

Previous Overseas Process (ONP Based)Average 102 weeks for an applicant to register (max 174 weeks)

New Overseas Process (Test of Competence Based)

1st Stage: Overseas Mandatory

Average: 10 weeks

Basic Eligibility Check

2nd Stage: Overseas assessment

Average: 30 weeks

NMC Document verification and detailed assessment

Overseas Nursing Programme Stage

Average: 52 weeks

Find University ONP placeComplete Placement (3-12 months)

Registration stage

Average: 6 weeks

Final DeclarationID check interview.

Request Application

Average 4 weeks

Application Pack IssuedApplication Returned

Document Submission

Average: 4 weeks

TOTAL

Average: 102 weeksMax: 174 weeks.

Timing depends on applicant preference.

Depends on applicant providing docs and regulators/ universities providing verifications

Depends on volumes being processed by NMC

Depends on Home Office

Timing dependent on applicant .

Timing dependent on applicant .

Proposed Timeline

Confirm

eligibility

Book

CBTSit CBT

Submit

Doc

Evidence

Confirm

Evidence

Book

OSCESit

OSCERe-sit if

req’d

Sponsorship

Visa

Application

4-14 weeks

Registration

1 Day

Applicant

Choice – to

Allow for

Preparation

1 Day

Applicant

Dependent

Approx

6 weeks1 Day

Applicant Choice

Allow for Visa &

Preparation. Can

enter 10 weeks

before OSCE

date

CoS

10 weeks

before

OSCE

2

W

k

Entry

Familiarisation

and Preparation

Continued

Sponsorship

Support &

Education

Applicant

/Employer

Choice – up

to 16 weeks

education

/support

1 Day 5 Days

Employment

Awaiting final confirmation

from UKVI

International Process (non-EU) Operation to Date

• Introduced with effect 1 October 2014

• Two Stage Test of Competence (CBT & OSCE)

Stage 1 - Computer Based Test (CBT) – 60% score overall and patient safety related essential questions correct to pass

Other pathways

For Midwifery, Mental Health and Child Nurse - 10 candidates in total. Monitoring

Stage 2 – OSCE – University of Northampton

University ready and waiting for applicants – none yet at that stage. Several currently submitting their documents for assessment/confirmation

• After slow start CBT settling in

• Refined critical questions based on

feedback

• Improved structure of guidance

materials based on feedback

• Anecdotal evidence early candidates

insufficiently prepared

• Added additional question set

• Continue to closely monitor

Pass

Rate

Nov(95)

Dec(109)

Jan(133)

100

90

80

70

60

50

40

30

20

10

0

%

6%

14%

84%

Adult RN1

• Advise NMC of recruitment drives - currently not told of OS

recruitment

• Employer Helpline:

• International.recruitment@nmc-uk.org

• 020 7681 5954

• Fully understand the application process – mistakes are

repeated. We have guidance on most common mistakes.

• Preparation, preparation, preparation …….

How you can assist

Thank you

Questions and Feedback

View our resources: www.nhsemployers.org

Timothy Kuhn

Senior Charge Nurse

Royal London Hospital

Adult Critical Care Unit

Practice Development Team

Recruitment and Induction of

overseas staff to ACCU

Background

• Overseas recruitment x 2 – Spain

and Italy/UK interviews

• PDN Team – 3 Band 7 PDNs and 1

Seconded Band 6

• Band 6 Secondment

(Recruitment/induction)

• The unknown…..

The Adult Critical Care Unit

• 44 beds

• 16 HDU – 4F

• 28 ITU – 4E

• Trauma/Neurosurgical/General

Surgical/Medical/ Max fax/Renal

• Approximately 200 bedside Nursing

Staff

Cohorts of new staff

• Cohort 1 = 16 Staff – July

• Cohort 2 = 12 Staff – August

• Cohort 3 = 22 Staff – September

• Cohort 4 = 7 Staff – October

• Cohort 5 = 7 Staff – November

• Cohort 6 = 5 Staff – January 2015

• Cohort 7 = 6 Staff – March 2015

• 12 Jordan Nurse observers – September

• 1 week induction

• 4 weeks supernumerary (Band 6s)

Inductions

• 2-4 days

• Cohort specific

• Not just work, work, work!!

• Not just ACCU

• The other stuff…….

• Continuous evaluation

• Clinical Study Day and meeting at week 4

Supernumerary period

• 4 weeks

• Extension periods

• NMC registration

• Supernumerary passport/domains

• IV competencies

• Anxiety

Training

• Technician training – During Induction

• Haemosafe – During induction

• Pump training / IV study day

• Equipment training

• PCA and Epidural Study day

• Band 5 development course

Communication

• Differing levels of English

• Impacts on time management

• Communication specific objectives

• English assessments

• English classes (now trust wide)

• Communication sessions

• Use of other resources within the department

NMC registrations

- Staff Without NMC registration

- Replacement documents

- Impact on staff development

- Impact on staffing

- Impact on living (Band 3)

- 5 staff currently without NMC registration

Lessons learnt/Tips• English language

• Cultural differences

• Consider current staff

• Integrate current staff

• External training

• Documentation

• Competencies

• NMC delays

• HR process

• It gets easier!

QUESTIONS?

Timothy.kuhn@bartshealth.nhs.uk

020 359 40331

View our resources: www.nhsemployers.org

Feb 2015

The nursing

workforce..

Janice Stevens CBE

Stevens_jan

www.hee.nhs.ukwww.hee.nhs.uk

A perfect Storm…Mid-Staffordshire & Francis Report

NICE guidanceSafe Staffing

CommissioningWorkforce planning

Investment

Activity and service changes

5 year Forward View

www.hee.nhs.ukwww.hee.nhs.uk

Growing nursing workforce multifaceted challenge…

Train Retain Recruit Remain

www.hee.nhs.ukwww.hee.nhs.uk

Create a reliable process

106

Recruited• Attend Trust Induction• Complete Statutory and• Mandatory Training• Preceptorship• Flexible working options• Clinical supervision

Employed on the frontline

Return to Practice

Mature nurses who bring a

wealth of experience

are likely to remain

continually employed until

retirement

RTP courses have low

attrition rates

More cost effective

returning nurses to the

workforce

www.hee.nhs.ukwww.hee.nhs.uk

www.hee.nhs.ukwww.hee.nhs.uk

Impact

• The campaign has reached 1.2milusers on Twitter since launch.

• Cost £2000 per nurse

• Over 1000 nurses recruited to programmes

• Phase II Campaign launces in next 2 weeks

Your role

• Get involved - promote

• Recruiting – work with HEI

• Placements & support – where nurse may wish to work

• Offer HCA role before & during

• Don’t duplicate HR practices

• Challenge thinking on flexible working….

www.hee.nhs.ukwww.hee.nhs.uk

Create more flexible working options

Preceptorship & Support

Start and end of career

Clear career options

progression & development

Healthy workplace ,

reduce stress & burnout

Prevent people leaving…

ANY QUESTIONS?

Stevens_jan