Agenda item

To provide an update on workforce issues in NCL.

Dr Jo Sauvage, Chief Medical Officer at NCL ICB, and Kate Gardiner, Nursing Workforce Programme Director, introduced the report on this item. Dr Sauvage commented that the aim of Integrated Care Partnerships was to manage population health improvement with a focus on outcomes and on inequalities in a way that used resources appropriately and was embedded in local communities. She acknowledged that the NHS had not been as good as it could be on local workforce planning and there was an opportunity to develop different ways of working in the ICS by thinking about transformation and the planning and development of existing staff. There were existing challenges on recruitment, retention, staff wellbeing, agency pay and the impact of the cost of living crisis. There were also issues with the retention of GPs and on recruitment and retention in the care sector.

Kate Gardiner added that, from a clinical perspective, the biggest challenge was on staff retention with a large number of nurses now leaving the profession. Across the NCL area there were now around 200 more nurses than there were in 2021 but this was the result of a large effort on securing pathways into nursing, retention and international recruitment.

Dr Jo Sauvage and Kate Gardiner then responded to questions from the Committee:

• Cllr Connor observed that, from people that she knew in the nursing profession, some key concerns of theirs were that it was too stressful on the wards with not enough staff to cope with demand and also pay issues. She asked what more could be done in these two areas as these were specific concerns driving people to consider leaving the profession. Kate Gardiner responded that one of the issues was that patients on the wards often now had more complex needs when compared to years ago and so, to tackle this, it was important to understand the nursing workforce that was required. Organisations went through a process each year to assess and sign off safe staffing requirements using evidence-based tools about the clinical needs of patients. Over the last couple of years, the delivery of care on the units had changed and so there was an opportunity to reset and make sure that the reviews were in place to understand the workforce that was needed, to fill vacancies and retain staff. This included looking after staff on wards, securing their professional knowledge and qualifications, their enjoyment of coming into work and the teamwork on the wards.
• Cllr Atolagbe said that she received feedback from BAME nursing staff who reported that, despite obtaining training and qualifications as well as relevant experience, they felt that they were not achieving the career progression that they ought to. Kate Gardiner acknowledged that this was a problem across the NHS with a high level of diversity across Bands 1-5 but a reduced level at the higher Bands. There was a drive for diversity on recruitment panels in some organisations. Dr Sauvage added that it was important to ensure that clinical leadership reflected the population that the NHS serves across a diverse set of boroughs and that this was mirrored through every level of the system. An equality standards questionnaire had recently been distributed in NHS organisations in the London area. She also noted that the UCL provider alliance had begun to work on a developmental offer so that people from differing backgrounds were more able to take advantage of learning opportunities including the development of leadership skills.
• Cllr Clarke asked what the international recruitment target was and how those recruits were supported to cope with the cost of living in London. Kate Gardiner said that the target for the current year (Jan 2022 to Dec 2022) was for 732 internationally recruited nurses in NCL with 403 having arrived so far. Part of the offer to them in London was that they receive 2-3 weeks of accommodation paid for them when they arrive. However, they were not paid for their examinations and higher levels of experience were not yet recognised. These kinds of initiatives were being implemented outside of London though so the nursing consortium in NCL had provided a challenge on this on how this offer could be improved. This was being considered along with other ways of supporting them and helping them to progress.
• Cllr Hutton queried the ethical implications of internationally recruited nurses given that their countries of origin may also be in need of their services. Kate Gardiner explained that international nurse recruitment was undertaken by a consortium and that nurses were only recruited from countries that already had more than they needed. However, she acknowledged that it was not sustainable to rely on this type of recruitment in the long-term and that an attractive pathway into nursing for people who already live here was also required. This included expanding the number of university placements and helping to address the high cost of living for people working to obtain nursing qualifications. Asked by Cllr Hutton about the payment of the London Living Wage, including through agencies, Dr Sauvage said that this was being actively looked at with a review currently taking place. Cllr Connor requested that information about the outcome of the review be provided to the Committee when it had been completed. (ACTION)
• Cllr Anolue expressed concerns about the number of nurses choosing to leave the country to work elsewhere due to concerns about stress, pay and lack of career progression. Dr Sauvage agreed that there was further work to do to support people to develop and enable education and training. She added that the recent ability to look at a wider range of data in a more transparent way was making a real difference as was the Race Equality Standard which was relatively recent. Kate Gardiner added that there was a nurse ambassador group which helped to communicate concerns on key issues, including opportunities for career progression, by attending steering groups and operational groups. Cllr Atolagbe added that exit interviews for staff could also be an important source of information about staff concerns.
• Cllr Iyngkaran observed that workforce issues had long been a concern in the NHS but were now becoming more acute and expressed that there was a need for an NCL wide strategic approach on this to develop a unified workforce. Kate Gardiner agreed with this and said that this was one of the key programmes of work at ICB level and that all NHS organisations in NCL had been asked to look at their own retention plans. NHS Trusts would be brought together in November to look at common workforce issues across NCL and identify what was already in place and what more could be done together to address these.
• Referring to the retention issue with GPs, Cllr Clarke expressed concerns about organisations such as Operose filling the vacuum and how control would be maintained across GP networks. Dr Sauvage explained that a GP Provider Alliance had recently been developed in NCL which had enabled GP Practices to be brought together and to speak and respond to service requirements in a more unified way. In each area, the GP Practices were brought together in Primary Care Networks (PCN) and each PCN had a Clinical Director who were linked into the Federation and the GP provider alliance leading to a networked approach. This provided greater opportunities to improve integrated working, local understanding and continuity of care.
• Cllr Atolagbe expressed concerns about patients from some parts of the community being unable to access GP services at all, meaning that they would often have to attend A&E units for treatment. Dr Sauvage said that all patients should be able to access GP services although demand was recognised to be very high currently. GP practices had therefore had to triage patients according to need in some circumstances.

The Committee than discussed recommendations on workforce issues based on the information received (ACTION):

• It was suggested that the strategic role of GP Federations could be discussed as a topic at a future meeting of the Committee.
• The Committee raised concerns about the lack of BAME representation at higher pay bands and management levels. Whilst welcoming the initiatives described in this area such as the equality standards questionnaire, the Committee asked whether further information/data was available to help understand what was happening in practice. For example, where there were specific complaints or issues that had been identified, what measures were put in place to address this and/or provide greater support to staff.
• The Committee recommended that a staff representative should be invited to speak at the next workforce update item provided to the JHOSC.
• The Committee suggested that there needed to be greater understanding of the ongoing support and training provided to staff from overseas, particularly in relation to the cost of living and the concerns about some staff having to take on second jobs in order to be able to pay their bills.
• The Committee emphasised that there needed to be a strong understanding at senior level of the realities on hospital wards where there are staff shortages and whether sufficient safety levels were being met for staff and patients. The Committee proposed that this could be examined in greater detail at the next workforce update item provided to the JHOSC.