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:
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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.
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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.
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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.
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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)
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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.
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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.
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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.
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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):
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It was suggested that the strategic role of GP
Federations could be discussed as a topic at a future meeting of
the Committee.
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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.
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The Committee recommended that a
staff representative should be invited to speak at the next
workforce update item provided to the JHOSC.
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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.
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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.