Report to: Public Trust Board Agenda item: 14 Date of Meeting: 27 March 2013

Transcription

1 Report to: Public Trust Board Agenda item: 14 Date of Meeting: 27 March 2013 Title of Report: Workforce Strategy Status: For Information Board Sponsor: Lynn Vaughan, Director of Human Resources Author: Sue Smith, Deputy Director of Human Resources Appendices: 1: Quarterly Workforce Strategy Update /13 2: Trust HR card 1. Purpose of Report (Including link to objectives) To highlight and describe progress against the main workforce related priorities for the Trust, as outlined within the Workforce Strategy, for this financial year. This report focuses on those areas of the strategy that are not otherwise covered by the remaining papers on the Trust Board public and private agendas. 2. Summary of Key Issues for Discussion The Workforce Strategy, associated policies, people management training, and KPI monitoring, provide an excellent framework within which to manage workforce issues The Trust benchmarks well around a range of KPIs which are monitored through the Strategic Workforce Committee; However, where the balance between activity and staffing fails, there is a knock on effect into a range of HR KPIs e.g. appraisal rates, sickness absence and attendance at mandatory training; Staff engagement is a major concern, primarily linked to pressure of work, the savings agenda, and membership of the South West Pay Consortium over the past year; Staff Survey results clearly indicate that staff feel demoralised in a number of areas; the friends and family test aims to better understand how staff can be supported to deliver excellent patient care in such a complex and dynamic environment. The Workforce Strategy contains a number of key aims and this paper outlines key actions in support of their delivery. Trust Board are asked to note progress to date against these aims and advise on any differing priorities for action as appropriate. 3. Recommendations (Note, Approve, Discuss etc.) Trust Board is asked to note the report and be satisfied that the priorities and actions being taken are both appropriate and necessary to support the Trust in delivering its service objectives. Agenda Item : 14 Page 1 of 18

2 4. Care Quality Commission Regulations (which apply) Outcomes 12,13 and Legal / Regulatory Implications / NHS Constitution (NHSLA / ALE etc.) NHSLA standards 1, 2, 3,5, 6. Risk (Threats or opportunities link to risk on register etc.) Ensure a workforce is in place to deliver a safe service that is fit for purpose. Details of risks and mitigating actions are contained within the main report. 7. NHS Constitution 3a. Staff your rights and NHS pledges to you, 3b. Staff your responsibilities, and NHS values. 8. Resources Implications (Financial / staffing) HR and Finance resources to model and cost creative solutions and negotiate difficult change. 9. Equality and Diversity This strategy supports equitable opportunities for staff across the trust. 10. Communication Shaping the Future Workforce Conference (9 th May 2013). 11. References to previous reports Management Board Strategic Workforce Committee Update (March 2013) 12. Freedom of Information Public. Agenda Item : 14 Page 2 of 18

3 Workforce Strategy Update 2012/13 Appendix 1 1. Introduction 1.1 The purpose of this report is to highlight progress against the main workforce related priorities for the Trust that have been identified and agreed within the Workforce Strategy for 2012/ This report also provides an opportunity to review progress against key performance indicators within the Workforce Strategy, which serve to identify any emerging issues or risks in relation to the key workforce themes which have the potential to impact on our ability to deliver operational services. 2. Background 2.1 Staff are the Trust s most valuable resources, both in terms of the contribution that they make to the delivery and quality of patient care but also in terms of financial investment. As such, the effective management of staff should be the highest priority for all managers and supervisors. 2.2 Through the Workforce Strategy, the Trust Board explicitly directs that all staff should be managed in line with the pledges to staff laid down in the NHS Constitution, Trust values and the RESPECT behaviours. Trust Board members are expected to role model these behaviours and values and personally uphold the pledges. 3. Workforce Aims and Objectives 3.1 Planning effectively for future work Current performance against KPIs A key KPI regarding workforce planning is staff perception of work pressure, as demonstrated by the staff survey results in 2012 which show a below (worse than) average result regarding staff perception of work pressure (KF3): Agenda Item : 14 Page 3 of 18

4 (the lower the score the better) Trust score 2012 Average 2012 score for acute Trusts Best 2011 score for acute trusts Scale summary score Risks & Mitigation Low work High work pressure pressure Source: NHS 2012 Staff Survey - Brief Summary of Results (Royal United Hospital Bath) Description of Risk As a result of the failure to achieve workforce reductions the Trust will not achieve its QIPP savings plans. Initial 12 Mitigating Actions QIPP plans included in budget setting 2013/14 and PMO have prioritised 10 projects 2013/14. Current Progress against key objectives Workforce Planning System and Processes: An annual workforce plan is currently under development as part of the 2013/14 business planning process, which will take account of a number of factors: QIPP workforce changes Service changes and developments, linked to the clinical strategies Changes in commissioning Benchmarking information The requirement to make year on year efficiency savings (cost improvement requirements) The year-end forecast for turnover is 8.7%, the top three reasons for leaving being: Voluntary Resignation - Work Life Balance Voluntary Resignation - Relocation Retirement Age Nursing Workforce Plan: The annual plan in support of the Nursing Workforce Strategy, developed and monitored by the Nursing Workforce Planning Group, recognises the internal and external drivers impacting on the nursing workforce, skill mix and role development, internal and external training, and the need for a more flexible workforce, as outlined within the Temporary Nursing Workforce Strategy. Opportunities have been identified to enhance the nursing workforce with mental health nursing skills and to review the establishment linked to increasing acuity. Agenda Item : 14 Page 4 of 18

5 Flexible Workforce: The achievement - 0.1% vacancy factor in February against funded beds, now provides the opportunity to begin to scope exactly what we require from a flexible workforce in support of escalation areas and challenges associated with the operational gap i.e. the totality of the gap caused by vacancies, sickness and maternity leave etc. E Rostering: The project team is undertaking a pilot in the following two areas: William Budd Ward and ITU. The pilot is specifically looking at how the data sharing interfaces between RPC and ESR can: enable pay enhancements to be paid directly against time worked record employee sickness and absence with increased precision deploy the Costing and Management Dashboard modules This pilot will also support a new Roster Policy and Procedure for Nursing Staff which will address in detail the use of e-rostering to maintain and improve safe and effective patient care delivery through effective rostering of the substantive nursing workforce. Efficiencies and cost-savings derived from e-rostering will be generated by: evaluation of staff management decisions in real-time against service requirements and staffing budgets challenging and improving workforce management practices automating rostering and payroll tasks increasing the proportion of work time available to deliver direct patient care/ clinical supervision reducing unnecessary spending on Bank/Agency backfill Description of Risk Initial Mitigating Actions Current A Copy of RUH Data contained in the RPC e-rostering bank software is required to go off site to the software company ( SMART) in order to fix a serious issue with the absence interface. SMART have previously refused to sign RUH documents regarding safeguarding of RUH data. The risk is if SMART do not hold our data securely, the trust will breach NHS information governance guidelines. 12 Meeting taken place with Information Governance lead and risk discussed at Strategic Workforce Committee. Meeting scheduled for April to review contractual implications for continued use of system if company continue to refuse to adhere to NHS information governance guidelines. 12 Agenda Item : 14 Page 5 of 18

6 Consultant Job Planning: All jobs are due for review on the Zircadian job planning system. Additional support has been identified within the Medical Workforce team to ensure both Divisions have dedicated support with this process and all Clinical Leads are asked to maintain the momentum. Shaping the Future Workforce Conference: This conference will offer service line management teams the opportunity to share learning and knowledge regarding strategies to deliver 24/7 working. The conference is planned for 9 th May Recruiting the Best Staff Current performance against KPIs Safer Recruitment Checks Blank ESR entries % Compliance CRB Disclosure 0 100% Children & Adults Barred List Checks 0 100% Occupational Health Clearance 0 100% Visa & Work Permit 0 100% Professional Registration 0 100% Source: ESR Risks & Mitigation None identified at present Progress against key objectives Streamlining Recruitment: Employment checks have been both refined to reflect best practice changes from NHS Employers with regard to external applicants, and streamlined for those moving internally, including into bank posts, as part of the Every Patient Matters transformation project. These changes have been reflected in the revised Pre & Post Employment Checks and Temporary Staffing policies which were ratified in November Increasing Management Capability: Recruiting the Best Staff training is now available into This classroom based session works in partnership with the Recruiting Manager s Handbook which is provided to every recruiting manager and is designed to take them through the process on a step by step basis. Attracting the Best Candidates: The Recruitment Manager is currently reviewing the total reward information provided to applicants as well as the Proud to be a Nurse umbrella branding for nurse recruitment, in support of hard to recruit areas such as Cleaners and Health Care Assistants and retention issues associated with these staff groups. Agenda Item : 14 Page 6 of 18

7 3.3 Developing our Workforce for Success Current performance against KPIs Risks & Mitigation Source: ESR Description of Risk As a result of the new SHA CPD contract with Capita not being ready to deliver, staff have had very little training during There is a risk that nursing staff have not been kept up to date with specialist knowledge and expertise therefore leading to patients not receiving the most up to date evidence based care. Initial 12 Mitigating Actions Training needs analysis to assess the CPD gap undertaken as part of the business planning process; identify a resource to meet CPD gaps. Current 12 As a result of low attendance at core skills training for all and insufficient reporting of compliance with other mandatory training there is a risk that staff are not competent to carry out their roles safely which may result in harm to staff and patients and risks the Trust's continued registration with the Care Quality Commission (CQC) Essential Standards of Quality & Safety. 15 Options discussed at learning & Development team meeting. Project plan produced. Exploring possibility of using an external provider to develop and host a solution. 6 As a result of insufficient time set aside for doctors in training to participate in an ever increasing amount of mandatory training due to requirements laid down in the Learning and Development Agenda Item : 14 Page 7 of 18 9 An e-learning system has been commissioned, which covers key mandatory subjects as part of the induction process. This approach will be implemented with the August 2013 junior doctor take. 6

8 Agreement (section 3.55) with the SHA, NHSLA, CQC, NPSA, there is a risk that doctors in training do not have the knowledge required to undertake their roles safely. This may result in sub-optimum patient care and low performance ratings when the trust is assessed by external organisations e.g. NHSLA, CQC, Health & Safety Executive. Staff, patients and the trust's reputation is at risk Progress against key objectives Appraisal: 85% appraisal target has been met, which is an 20% improvement on the previous year. The Appraisal Policy will now be reviewed in light of the changes to Agenda for Change terms and conditions of employment. Medical Revalidation: The trust has identified 223 doctors who have a prescribed connection to the RUH, 55 of these doctors will revalidate in 2013/14. To date the trust has trained 45 doctors as Medical Appraisers. A new Medical Appraisal Policy has been ratified. Mandatory training: The subject specific mandatory training roll out plan is on schedule and is shared with the Strategic Workforce Committee quarterly. The reports have enabled Subject Matter Experts to access detailed information about who has and has not attended mandatory training by department. This in turn has enabled them to identify any areas of risk to the trust. For example, incidents involving violence and aggression against staff have been analysed so that areas of high risk can be identified. Staff in these areas have been specifically targeted and prioritised onto Conflict Resolution Training. The reporting demonstrates significant improvement in compliance in high risk areas over the past 12 months. This progress has been commented on positively by NHS Protect. The Q3 subject specific mandatory training compliance report has identified gaps in specific areas which have resulted in the development of actions to address. A new reporting tool has been developed with BIU; this will be launched in Q1 of 2013/14 and will be accessible by all members of staff. This will ensure that managers and individuals are able to monitor mandatory training compliance and take actions to improve. 3.4 Staff as Stakeholders for Success A wide range of activities impact on staff engagement e.g. the Every Patient Matters events and the Staff Governor role. However, this particular report focuses on activities delivered by the HR Directorate. Agenda Item : 14 Page 8 of 18

9 3.4.1 Risks & Mitigation Description of Risk Failure to improve the NHS Staff Survey results year on year incrementally will result in a negative CQC Quality Risk Profile for the RUH Outcome 13. This may result in a CQC inspection. Initial 12 Current Mitigating Actions Staff Engagement Group established. Aims of group agreed and Staff Engagement action plan under development for 2013/ Progress against key objectives People Management Training: Staff engagement is an intrinsic element of the Trust s People Management programme, comprising local update training to support line managers in dealing effectively with Conduct, Performance, Sickness & Flexible Working issues, as well as centralised Training on Management skills & techniques to support Appraisal, Performance Management & effective Recruitment. Additional one-to-one coaching is also provided for managers by the HR Directorate team on an on-going basis. Review of the NHS Constitution: A consultation on proposals to strengthen the NHS Constitution has commenced, and employers are asked to share their views in relation to changes to the existing staff pledges and amendments to the current pledge on access to training. This work will be undertaken in partnership through TCNC as part of the staff engagement programme. Partnership Working: The trust strives to work in partnership with staff side to roll out the management of change agenda, in particular the Local Medical Negotiating Committee (LMNC) and Trust Consultative Negotiating Committee (TCNC), albeit that recent initiatives around terms and conditions and pension reform makes this a challenging agenda. The March TCNC specifically raised the challenges arising from the recent national agreement regarding terms and conditions of employment for Agenda for Change staff. 3.5 Valuing a Diverse Workforce Please refer to the annual Equality Objectives report for further details Current performance against KPIs The staff survey results in 2012 demonstrated an above average result for the percentage of staff having equality and diversity training in the last 12 months (KF26): Agenda Item : 14 Page 9 of 18

10 (the higher the score the better) Trust score for 2012 Trust score 2011 Average 2012 score for acute Trusts Best 2012 score for acute trusts Percentage score 58% 55% 55% 89% Source: NHS 2012 Staff Survey - Brief Summary of Results (Royal United Hospital Bath) In contrast, employee belief that the trust provides equal opportunities for career progression and promotion are slightly below average (KF27): (the higher the score the better) Trust score for 2012 Trust score 2011 Average 2012 score for acute Trusts Best 2012 score for acute trusts Percentage score 86% 88% 88% 97% Source: NHS 2012 Staff Survey - Brief Summary of Results (Royal United Hospital Bath) In the last twelve months, the Trust formally investigated 5 cases of alleged discrimination; one related to bullying behaviour, three were raised as part of an appeal process, and one case is linked to an Employment Tribunal claim, which was successfully defended in January Maintaining a Healthy Workforce Current performance against KPIs The graph below shows the Trust s sickness absence benchmarked against medium acute trust within the NHS South region. Agenda Item : 14 Page 10 of 18

11 Source: NHS iview (Benchmark - Medium Acute Trust, South), ESR (Royal United Hospital Bath) The graph below shows the rolling 12 month average Trust sickness absence rate which is currently 3.8%, compared to the planned reductions in absence rate of 3.4%. There are multiple factors that contribute to sickness absence, one of the key reasons being work pressure felt by staff. The Safer Staff Group monitor the top two reasons for absence, namely Back and Other musculoskeletal problems and Anxiety/stress/depression/other psychiatric illnesses. Source: ESR Agenda Item : 14 Page 11 of 18

12 3.6.2 Risks & Mitigation Description of Risk As a result of the failure to match staffing levels required to workload and / or the size of the change agenda, there is a risk that staff will experience work related stress or burnout which is not being appropriately managed and could result in adverse external scrutiny. Initial 15 Mitigating Actions The Stress management Policy has been refreshed and is NHSLA 1 complaint. Pilots of the stress risk assessment process are underway in Theatres and Day Surgery. Current Progress against key objectives Stress: A revised approach to Stress Audits has been agreed through the Safer Staff Group. The approach incorporates an initial risk assessment, with local stakeholders, followed by an audit based on the questionnaire developed by the Health & Safety Executive, administered by the Health & Safety team. The line manager will then be supported to convert the findings of that audit into a targeted action plan with key stakeholders from the department. Action plans will be monitored for progress by the Safer Staff Group. Two areas have been identified to pilot this approach, Theatres & Day Surgery. Occupational Health Service: The Safer Staff Group is overseeing the tendering process to manage the Occupational Health Service at the Trust with another service. This will provide greater sustainability and improve Governance. 3.7 Valuing all, rewarding excellence Current performance against KPIs The staff survey results in 2012 demonstrated a significant improvement regarding staff job satisfaction (KF23): Agenda Item : 14 Page 12 of 18

13 (the higher the score the better) Trust score 2012 Trust score 2011 Average 2012 score for acute Trusts Best 2012 score for acute trusts Scale summary score Dissatisfied Satisfied staff staff Source: NHS 2012 Staff Survey - Brief Summary of Results (Royal United Hospital Bath) Risks & Mitigation Description of Risk Following the failure of NHS Employers to negotiate a national agreement for remuneration for work completed out of hours / on call, there is a risk that staff currently providing out of hours cover for remuneration in line with Agenda for Change will raise an equal pay claim. Initial 15 Mitigating Actions Consultations for on call work remunerated other than AFC to be completed 31/03/2013. Consultations for groups altering out of hours provisions Radiology and Physiotherapy were agreed in March and their consultations will now commence. The consultation in support of pathology out of hours working has been deferred to allow further costings to take place but discussed & agreed in principle. Current 12 Failure to improve the NHS Staff Survey results year on year incrementally will result in a negative CQC Quality Risk Profile for the RUH. This may result in a CQC inspection. 9 Staff Engagement Steering group established. Aims of group agreed and action plan under development for 2013/ Progress against key objectives South West Pay Consortium: The Consortium has now been disbanded and HR Directors are encouraged to consider what optimisers might be taken forward to deliver savings in this area, through their respective Boards. A separate paper has been tabled to this effect. Terms and Conditions for staff on Agenda for Change Contracts: NHS Employers have now published the new pay rates for staff on Agenda for Change contracts, effective from 1 April 2013, which incorporate a 1% increase in basic pay. Agenda Item : 14 Page 13 of 18

14 Other changes will come into effect from 1 st April 2013, summarised as follows:. Pay during sickness absence will be paid at basic salary level - not including any allowance or payments linked to working patterns or additional work commitments. This change will not apply to staff who are paid on spine points 1-8 of AfC, or to those whose absence is due to work-related injury or disease. The removal of accelerated pay progression associated with preceptorship for staff joining pay band 5 as new entrants; Progression through all incremental pay points in all pay bands to be conditional on individuals demonstrating that they meet locally agreed performance requirements in line with a proposed new Annex addition to the handbook; For staff in bands 8C, 8D and 9, pay progression into the last two points in a band will become annually earned, and only retained where the appropriate local level of performance is reached in a given year; The scope to put in place alternative, non-afc, pay arrangements for band 8C and above; New guidance on the principles to be followed regarding workforce reprofiling, including the need to follow the processes set out in the NHS Job Evaluation Handbook, and the application of local organisational change policies to protect staff in cases of staff redeployment into lower grade posts; In addition, from 1 July 2013 new conditions regarding staff expenses are to be introduced. Reward: Applications for the 2012 / 2013 round of Employer Based Clinical Excellence Awards closed on 8 th November The Trust received 56 applications. Employer Based Awards are designed to reward consultants who have made an exceptional contribution to the Trust s objectives in year. A total of 27 Consultants have been awarded points this year; the anonymised details of successful applications are now available on the intranet site for all Consultants to view. Harmonisation: A Trust wide approach to remuneration for on call has been agreed and is in the process of being implemented across the organisation. The principles of this approach are in line with the Agenda for Change principles, previously referred to as the interim arrangement. Pathology is now the only area yet to harmonise their out of hours working and proposals Agenda Item : 14 Page 14 of 18

15 are under discussion and awaiting final costing prior to the harmonisation Group meeting in April. 3.8 Enabling the HR Directorate to deliver the strategy Current performance against KPIs A detailed HR card is reviewed by the Strategic Workforce Committee on a monthly basis. HR scorecards are also circulated to all divisional / directorate management teams, in addition to individual performance management reports to each cost centre manager (Appendix 2). Updated KPI s for 13/14 have been agreed by the Strategic Workforce Committee Risks & Mitigation Description of Risk There is a risk that information regarding an employee is located in potentially four different places i.e. within their leavers file(s), a substantive employee file, a bank file and an informal departmental file held within the employee's place of work by their manager, thus contravening the Corporate Records Policy and also potentially resulting in a situation where the current manager (either substantive or interim) is unaware of the need to manage any on-going performance issues effectively and therefore potentially creating a risk to safe patient care. Initial 6 Mitigating Actions Review of current practice undertaken in line with Data Protection Act 1998 and the Employment Practices Code, published by the Information Commissioners Office; response made to Coroner and outline action plan agreed with the Corporate Records Management Group (February 2013); action plan developed for implementation Senior Workforce Analyst. Current Progress against key objectives Business Planning: The HR Directorate has identified key priorities as part of its business planning process for 2013/14. Occupational Health: Capacity within the Occupational Health team has been severely compromised following the resignation of a number of nursing post-holders within the team. Additional nursing support has been sourced from Bradford-On-Avon Occupational Health Services. Agenda Item : 14 Page 15 of 18

16 4. Recommendation 4.1 The Trust Board is asked to note the contents of this report and be satisfied that the priorities and actions being taken are both appropriate and necessary to support the Trust in delivering its service objectives. Agenda Item : 14 Page 16 of 18

17 Trust HR card Appendix 2 KPI Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Headcount Budget (WTE) Contracted (WTE) Actual (WTE) Sickness (%) In Month Data N/A Sickness (%) Rolling Vs Quarter 3.4% A Sickness (%) Year End Forecast 3.4% Other Absence (%) Data N/A Vacancy Rate (%) 4.5% G Bank, Overtime, Agency (%) Data N/A Operational Gap (%) Data N/A Bank (WTE) Data N/A Overtime (WTE) Data N/A Agency (WTE) Cost of Bank 489, , , , , , , , , , ,419 Data N/A Cost of Agency 379, , , , , , , , , , , ,778 Turnover (%) In Month Turnover (%) Cumulative 8.3% G Turnover (%) Year End Forecast 8.3% Appraisal Rate (%) 85.0% G Appraisal Rate (%) Year End Forecast 85.0% Trust Other Absence (%) = Unauthorised Absence, Maternity Leave & Special Leave Bank, Overtime, Agency (%) = Bank (WTE) + Overtime (WTE) + Agency (WTE) / Bank (WTE) + Overtime (WTE) + Agency (WTE) + Contracted (WTE) Agenda Item : 14 Page 17 of 18 This is any absence recorded on ESR that is not Sickness Absence. This shows bank, overtime & agency as a percentage of the total available workforce as WTE.

18 Operational Gap (%) = Vacancies (WTE) + Sickness (WTE) + Other Absence (WTE) / Budget (WTE) This shows the percentage of WTE that is lost from the budget. Agenda Item : 14 Page 18 of 18