Report to: Board of Directors (Public)

Paper number: 4.4

Report for: Monitoring

Report type: Operational Performance

Date: 28 January 2016

Report author: Rachel McGeorge, Workforce Planning Manager and Louise Thomas, Head of HR and BP

Report of: Claire Johnston, Director of Nursing & People

FoI status: Report can be made public

Title: Human Resources and Workforce Performance Report – Q3, 2015/16

Executive Summary

The attached report provides workforce performance data for Q3 2015/16 with regards to the directly employed staff of Camden and Islington NHS Foundation Trust.

The report outlines performance against key workforce indicators and where appropriate, includes trend analyses and changes from Q2 of 2015/16 to Q3 of 2015/16.

The table below summarises the key areas of positive performance against KPIs during Q3.

Measure: Trust Figure:

Q2 to Q3 :

Comment:

Bank & Agency Spend

£2,361,683 Bank and agency spend decreased from

£3,027,563 in Q2.

Bank & Agency % of establishment

11.1% Bank and agency % of total establishment reduced

from 11.9% in Q2.

Turnover (%) 4.8%

Turnover reduced from 5.2% in Q2

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The sickness rate and vacancy rate increased slightly but remained consistent with Q2 as shown below.

Measure: Trust Figure:

Q2 to Q3:

Comment:

Sickness Rate (%) 3.1%

A slight increase in sickness absence from 2.9% in Q2.

Vacancy Rate (%) 10.6%

A slight increase in vacancy rate in Q3 from 9.2% due to an increase in budgeted establishment.

The extensive recruitment campaigns have resulted in a 0.7% qualified nursing vacancy rate. In Q4 we will be attending Kings College Nursing Careers Fair to recruit Band 5 Nurses to any new vacancies and to the Rapid Response Team. There is a focus on recruiting to HCA posts and 20 were recruited in this Quarter after two recruitment campaigns with another post at the shortlisting stage. We received significant interest at the Careers in Health Fair at the Emirates from potential HCA applicants to work at the Trust and an advert has been opened for this purpose.

Fire Safety, Information Governance and Safeguarding have been identified as the areas in need of most improvement. These are areas where training is required on an annual basis. All three can be completed relatively simply; Fire Safety and Safeguarding through completion of a workbook or attendance at that part of the Trust’s Safe and Sound mandatory training session and Information Governance through eLearning. HR will renew reminders to the division by sending out regular information on individual compliance for managers to follow up on alongside clear and concise instructions of how to complete these mandatory trainings.

The Trust’s Staff Survey response rate closed at 52%, a significant increase on last year’s 43%. The first initial results were released on 15th December 2015. The headlines include:

• 18% of respondents are working up to 6 -10 hours of unpaid overtime a week;

• 1 in 5 do not feel able to deliver the care to which we aspire;

• 1 in 5 felt there were issues around discrimination in the workplace which affected career progressions/promotion;

• managers in the trust are valued for team building and being supportive and responsive to staff needs;

• respondents’ appraisals left them feeling their work is valued by the Trust and that their learning needs were thought about; and

• more staff felt secure about raising concerns about unsafe clinical practice.

Further details of the work relating to the Staff Survey can be found on Section 5 Pg. 17.

Recommendation to the Board

The Board of Directors is requested to

receive and accept the report.

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Trust Strategic Priorities Supported by this Paper

Excellence

Continually improve the quality and safety of service delivery, service user experience and improving outcomes.

Delivering the highest level of quality and financial performance.

Innovation

Rapidly adopt best practice and maintain a culture of innovation in service development.

Growth

Seek both organic and inorganic growth opportunities through strategic partnerships and research and development.

Risk Implications

There are no risks directly as a result of this report. The report highlights a number of issues which the Trust is addressing and the associated risks are being mitigated. Any failure to implement good human resource management and workforce planning may adversely affect Trust performance.

Legal and Compliance Implications

Monitoring to ensure compliance with Trust HR policies and procedures. CQC standards also require good HR management practices and workforce planning.

Finance Implications

The majority of Trust expenditure is on staff costs; therefore it is vital the Trust is appraised of the key workforce components, and any issues that could have a financial impact. Failure to ensure good human resource management and workforce planning may adversely affect Trust financial performance

Single Equalities Impact Assessment

This paper does not affect one group less or more favorably on the basis of race/ethnicity, disability, sex/gender, religion/belief, sexual orientation or age.

Requirement of External Assessor/Regulator

This report is not related to any specific requirements of any external assessor or regulator.

Human Resources and Workforce Performance Report

2015/16 Quarter 3

October to December 2015

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Contents

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1. Introduction 3

2. Trust Dashboard and London Benchmarking 4

3. Divisional Overview 7

4. Bank and Agency Analysis 9

5. Recruitment and Retention 11

Starter Analysis 11

Recruitment Activity 12

Vacancy Projections 14

Leaver Analysis 15

Retention Strategies - Developments from Q2 16

6. Learning and Development 17

7. Employee Relations 20

8. Equality and Diversity Monitoring 22

9. Safe Staffing 26

10. Conclusion/Future Plans 27

11. Appendices 28

I. HR Action Plan 28

II. Report Notes/Definitions 29

1. Introduction

This report covers Quarter 3 of 2015/16 (October to December 2015). The report highlights changes and progress from Q2 of 2015/16 and takes into account feedback and actions requested by the Board. It also highlights new initiatives and progress made against key areas in our HR action plan and our response to the wider CQC actions.

KEY POINTS for Q3:

1577 staff directly employed at the end of Q3 this is slightly down from Q2 whilst the establishment has gone up by 14.37FTE thus the vacancy rate has slightly increased from 9.2% in Q2 to 10.6% in Q3. (Headcount excludes trainee clinical psychologists and seconded staff).

The quarterly turnover is down from 5.2% in Q2 to 4.8% in Q3.

Sickness absence rate of 3.1% up from 2.9% in the last quarter (see note on Pg. 4) on Wards.

Continued recruitment activity and 0.7% vacancy rate in qualified nursing.

65 starters (mostly qualified and unqualified nurses and psychologists) and 75 leavers (mostly Corporate staff and non-professionally registered staff in Acute). (Further detail on Pg. 11 and 15).

Following the appointment of the new Equality and Diversity Lead, the Trust has undertaken several projects focussing on the experiences of BME staff including focus groups and surveys on staff experience and career aspirations.

Bank and Agency spend is down from a combined total of £3,027,563 in Q2 to £2,361,683 in Q3.

73.3 % Mandatory training compliance, down from 74.3% in Q2 (further detail on Pg. 17).

Formal Investigation case length down to 42 days in Q3 (35 days if 2 outliers excluded) from 69 days in Q2 and 72 days in Q1.

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2. Trust Dashboard

Comment

4

Staff numbers have decreased by 0.8% from 1589 staff to 1577 (excluding Trainee Clinical Psychologists) .

The rolling 12 month turnover has increased since the last report (16.4% to 17%) and the vacancy rate has increased by 1.4 percentage points (9.2% to 10.6%).

Sickness absence has increased since the last quarter at 3.1% from 2.9%. Note: December absence has been derived from Health Roster though incomplete as only 33% of the Trust is rostered. It is then combined with October and November data from ESR to give the quarterly figure.

Bank and Agency spend decreased by £665,880 from Q2 2015/16. Further detailed is provided on Pg. 9. Trust total includes Trainee Clinical Psychologist bank/ agency spend.

Mandatory training has reduced since the last report from 74.3% to 73.3% which is below target. Further detail is provided on Pg. 17.

Appraisal is at 79.4% at the end of December.

Note : ‘Other’ includes Operational Services Management covering Operational Services Management, Education, Research and Development and PWLD.

2. Trust Dashboard - Detail

Establishment vs FTE Bank and Agency Use - % of Establishment

Acute and R&R have the highest staff in post figures.

Directly employed staff coded against LBC and LBI cost centres are included in the staff in post FTE figures. The budgeted FTE for LBC and LBI cost centres are coded to the for the relevant Division.

‘Corporate’ includes the Medical Directorate (junior doctors) in addition to Finance, IT, HR, Estates and Pharmacy departments.

‘Other’ includes Operational Services Management, Education, Research and Development and PWLD.

The highest use of Bank and Agency is in Acute (20.9%), R&R (17.3%) and SAMH (8.7%) Divisions . There is ongoing recruitment activity to reduce bank and agency spend.

Further analysis is provided on Pg. 9.

Sickness Absence Turnover

All other areas apart from Acute, R&R and SMS were within target of 3%.

Of the 3.1% Trust rate, 51.1% (2149.80 FTE days lost) was due to long term absence while 48.9% (2055.46 FTE days lost ) was due to short term absence. (Long term absence = 28 days or more).

90% of open absence cases were managed informally (91 out of 101), an increase from 83.6% in Q2. This indicates that managers are managing cases at an early stage.

The rolling 12 month turnover rate for the Trust was 17% at the end of December 2015, an increase from 16.4% in the last quarter.

Turnover includes end of fixed term contract but excludes rotational staff and TUPE transfers

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2. London Benchmarking

The London Deputy HR Network is capturing benchmarking data on a bi-annual basis which means that there is no updated information available from Q2. This bi-annual report will include a comparison of the following data items:-

• Headcount

• FTE

• Turnover (%)

• Sickness (%)

• Bank and Agency spend (% of total FTE)

• Mandatory training compliance

• Appraisal rate (%)

• Vacancy rate (%)

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3. Divisional Overview

The Division’s vacancy rate is 10.6% (40.45FTE) compared with 8.8% in Q2 and 27% in Q3 2014/15. There was a 10FTE increase in the budgeted establishment due to resilience funding which has contributed to the increased vacancy rate. The Division continues to focus on recruitment and retention of nursing staff and supporting its new nursing staff.

Sickness absence has increased to 5.9% (compared to 4.5% in Q2), and mandatory training compliance has reduced to 71.1% (from 75.4% in Q2). Please see page 18 for detail on mandatory training and the plan to address this. The Division is taking steps to reduce sickness absence through its Treatment Ward Standard Improvement Programme. The Division has also established a “Trauma Pathway” – a collaboration between the Trust’s health and Wellbeing Manager, Psychology & Occupational health which supports staff following traumatic incidents at work. Also, the division’s psychologists are delivering resilience training to Acute staff.

Sickness absence rates are consistently below Trust target at 1% (no change from Q2) with absence being managed rigorously across the Division. Mandatory training compliance has fallen to 68.7% (from 71.8% in Q2). Please see page 18 for detail on mandatory training and the plan to address this. A joint piece of work between Finance and HR is reviewing the establishments in CMH Division due to a reported vacancy rate at -10.3%. This over-establishment is due to external secondments, backfill for employees on maternity leave and short term additional funding for psychology sessions.

The Clinical Health Psychology Service at the Whittington underwent consultation in Q3 and this has now closed. Staff will be confirmed into posts within the new structure in early Q4. Consultation with the Psychotherapy administration staff also took place in Q3 and the new structure is now in place.

Recovery and Rehabilitation (R&R) Services for Ageing Mental Health (SAMH)

Vacancy rates have increased to 17.3%. Divisional management and HR are reviewing this data to ensure it is correct. All known vacancies are being recruited to and a review of the recruitment to band 6 Nurse and OT recruitment is underway as these appear to be hard to recruit to posts.

The management restructure took place in Q3 and is now being implemented. Implementation also means that vacant posts are known and recruitment to these shall commence shortly.

The Highgate Day Centre (HDC) consultation was jointly launched by the FT and LBC in Q2 and the new service was implemented in Q3 (December 2015).

Sickness absence rates have fallen slightly to 3.7% (compared with 3.8% in Q2). Absence is being managed carefully across the Division.

Mandatory training compliance has reduced to 70.3% (compared with 76.1% in Q2). Please see page 18 for detail on mandatory training and the plan to address this.

Vacancy rates are at 14.7% and recruitment activity is ongoing to fill vacancies. The division is finding that vacancies for band 6 nurses for both inpatient and community roles are hard to recruit to and ideas regarding this are being considered.

Sickness absence for Q3 has increased to 3.1% (compared to 1.6% in Q2). All cases in the division are actively being managed and staff are being supported to return to work.

Mandatory training compliance has risen slightly to 78.7% (compared to 77.3% in Q2). Please see page 18 for detail on mandatory training and the plan to address this.

The recruitment of social workers to Islington vacancies is currently proving difficult due to council processes which is impacting Islington Community Mental Health team.

Following health and safety concerns that were raised by staff via Datix the teams that were previously housed in Hill House are now settled in good quality accommodation at Brewery Road.

Acute Community Mental Health (CMH)

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3. Divisional Overview

SMS Corporate (continued)

Camden and Islington Councils re-tendering process for all of its drugs and alcohol services are now complete and the results known. Consultations for the staff affected are expected to take place in Quarter 4.

Sickness absence has decreased from 3.3% to 2.8% this quarter. Turnover this quarter remains the same as last quarter at 4%.

The Division continues to comply with statutory and mandatory training requirements achieving 85.9% compliance overall which is an increase from 81% of last quarter.

ICT

Turnover has reduced this quarter to 0% from 8% last quarter. There are ongoing challenges in relation to retention of staff as a result of market variations in remuneration packages for roles of this nature and this will continue to be monitored.

The consultation on the structure of the ICT department is now complete and staff have been informed of the outcome. All existing permanent staff have been slotted into roles in the new structure and recruitment to the remaining roles shall commence shortly. The department does have a high vacancy rate and this is partly due to funded posts that were part of this review being added to the department’s budget.

ICT does continue to have a high percentage of temporary staff due to ongoing capital projects.

Sickness absence has further reduced in Q3 to 0.5% from 0.6% in Q2 and 1.5% in Q1. The department achieved a good compliance at 93.3% for statutory and mandatory training.

HR

Sickness absence for the department has increased to 5.5% in Q3 from 2.1% in Q2. This is accounted for by two individuals on long term sick one of which has now left the Trust. The department’s mandatory training compliance has decreased to 74.6% from 88.1% in Q2. Fire training and information governance are the areas in need of improvement. Department wide fire training will take place and all staff will be reminded to complete their information governance training by the deadline of the 31st March 2016.

Pharmacy

The vacancy rates for Pharmacy has increased to 15.9% from 5.4% last quarter due to two leavers.

Sickness absence remains at 2.8% for a second quarter in a row (compared with 4.1% in Q1). Mandatory training compliance has decreased slightly to 88.2% (from 91.2% in Q2).

Please see page 18 for detail on mandatory training and the plan to address this.

Corporate

Finance

Overall Finance are doing well this quarter, whilst sickness absence has increased slightly it remains low at 0.6%. The department’s turnover is at 8.3% as two individuals left the department in Q3 and this shows an increase from 0% in Q2. The department had achieved 95.5% compliance rate for statutory and mandatory training this quarter which is a slight increase from the Q2 figure of 95.1%.

Estates & Facilities (E & F)

The sickness rate has decreased to 0.3% compared to 1.5% in Q2. The department’s turnover remains at 0.0% and the department has achieved 85.9% compliance for statutory and mandatory training which is an increase from the rate of 80.4% in Q2.

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4. Bank and Agency Analysis

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As per the Monitor requirements, the Trust has submitted data each week since the 23rd November of any shifts that have been out of compliance with the rules on the price caps for agency staff. There have been 10 admin and clerical shifts (2 staff members) each week which have been above the price cap. This has now been resolved as of January by reducing the agency rate and one post substantively recruited.

An audit is currently underway to ensure that agency rates will be in line with the reduced price cap from 1 February 2016 and the 1 April 2016. Any agencies that will breach the cap at the planned reduction date will be contacted.

We will also be auditing the use of the protocol to ensure it is being used across all teams. In the Divisions weekly reports on the previous week’s temporary staff use and a forward look to the coming week are being sent to all ADD level managers to ensure that they can manage the use of temporary staff.

The total Nursing Qualified bank and agency spend in Q3 2015/16 was £600,642, this is a significant reduction from £921,878 in Q2 2015/16. The total Nursing Support bank and agency spend (Bands 2-4) was £789,367 an increase from £756,346 in Q2 2015/16.

The graphs overleaf show spend by Division and by staff group. Trends are being closely monitored via performance meetings.

4. Bank and Agency Analysis

Corporate bank and agency spend reduced from £391,693 in Q2 2015/16 to £365,712 in Q3 2015/16.

ICT has the highest spend at £141,841 (an increase from £115,472 in Q2) due to the need for specialist roles.

30.5% of bank & agency spend is within Admin & Managers.

33.4% of bank & agency spend is within Nursing Unqualified.

25.4% of bank % agency spend is within Qualified nursing roles.

Bank and Agency Spend - Corporate Detail

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Total spend on Bank and Agency (including locum) in Q3 2015/16 was £2,361,683. This was an decrease from £3,027,563 from Q2 2015/16.

Acute had a decrease of £217,096 in bank and agency spend from Q2 to Q3. With Corporate spending £206,880 less in Q3 compared to Q2 on bank and agency.

SAMH was the only Division with an increase in bank and agency spend from Q2 to Q3 of £5,441.

Q3 Trend of Spend by Division

Q3 Spend by Staff Group

5.0 Recruitment and Retention

5.1 Starter Analysis

Starters by Month

There were 65 new starters in Q3 (excluding 1 Trainee Doctor and 9 High and Low Intensity Trainees).

Recruitment activity in the previous quarters is reflected in the high starter numbers in Acute (33.8%) and CMH (24.6%).

Starters were mostly Unqualified and Qualified Nursing staff.

26% of new starters were at Band 7 with most of these being Psychology staff and 23% were Band 5 of which most were nurses.

Note: Trainee Doctors and High and Low Intensity Trainees are excluded from the figures above.

Starters by Band

Starters by Staff Group

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We have met the qualified nursing targets against the CQC action plan and are now focussing on HCA recruitment. The largest group of new starters were within Qualified and Unqualified nursing.

The second highest number of starters were within Add Prof and Technical at 30.8%, in Band 6 - Band 8a Psychology roles. The above data excludes trainee Doctors and PWP Trainees (high & low intensity trainees). The majority were inducted in CMH (12).

Starters by Ethnicity

47.7% of new starters across the Trust were BME staff and 49.2% white staff (3.1% of staff did not state their ethnicity). This compares to our overall workforce, of whom 41.2% are BME staff. The greatest concentration of white staff are in more senior posts. In keeping with the Workforce Race Equality Standard (WRES), we have devised a comprehensive implementation plan to address the imbalances.

Note: Trainee Doctors and High and Low Intensity Trainees are excluded from these figures

5. Recruitment and Retention

The final 10 of the 65 newly qualified nurses recruited form the Middlesex University started as scheduled in October and November. A programme of specialist training has been rolled out as part of their induction and the vast majority are now NMC registered (2 awaiting their PIN). Support is being provided locally to progress registration for the minority who have yet to receive their PINs. The successful recruitment drive in 2015 has led to a 0.7% vacancy rate amongst qualified nurses.

In Q4 we will be working with the management team and Middlesex University to plan our 2016 recruitment drive.

The five Middlesex nurses participating in the pilot rotation scheme are enjoying the experience and feedback from managers has been positive. We will be building upon the success of the rotation programme with our next Middlesex cohort.

The virtual team has been rebranded as the Rapid Response Team. It is hoped that this change in name will be better received by applicants and help us achieve the required higher volume of applications. In quarter 3 a further 3 Band 5 nurses were recruited into the team. These recruits will be used to meet demand as and when it arises at HMHC and St Pancras.

Further advertisements for Band 5 Staff Nurses and Band 2 Healthcare Assistants (HCAs) were released in this quarter and are currently at shortlisting stage. Our campaign aimed to re-launch the Rapid Response Team and sell the opportunity to work flexibly with guaranteed employment and an NHS Pension, in order to target agency workers for whom work may be less readily available as a result of the new Monitor targets. This campaign received a high number of applications for the HCA posts but a lower response to the Band 5 Nurse posts. However, it should be noted there is a higher demand for HCA cover.

A joint local media campaign has been planned to take place in Q4 by Acute and SAMH divisions to address their Band 6 vacancies. This advertisement will also seek to address the ongoing Healthcare Assistant vacancies. While our pool of bank staff at this level is sufficient and fill rates good, HCA vacancies currently stand at approximately 30% across in patient wards. Recruitment to these roles remains a challenge but further work is being conducted to address this issue.

A further 20 Healthcare Assistants were recruited in this quarter after two campaigns. These recruits have been shared by Acute, R&R and SAMH divisions. A further advert was placed to fill remaining vacancies in this quarter; this is currently at shortlisting stage. Work has also begun with our local Job Centre Plus in Camden and Islington to assist us with filling our unqualified vacancies and several posts have already been advertised through this route.

The 7th Cohort of Trainee Mental health workers will start with the Trust in Q4. 26 of the 30 Trainee Mental Health Workers recruited in 2015 remain and will complete their programme in Q4. we have been working with the Divisions to identify Band 4 positions for these graduates , with assessments and interviews planned for February.

In Q4 we will be attending the Kings College Nursing Careers Fair to recruit Band 5 Staff nurses. We have also attended the Careers in Health Recruitment Fair at the Emirates Stadium where there was significant interest, particularly amongst potential HCA applicants from the local area, to work with the Trust and an advert is currently open for this purpose. Work is underway to identify other key recruitment fairs that the Trust should have a presence at and application for funding will be made in Q4.

In October 2015, we pledged our commitment to employing more people with learning disabilities. This completes Step One of the guidance to support NHS organisations employ people with learning disabilities. We will now focus on creating an action plan and work with partners to create placements by January 2017, in line with our draft Workforce Strategy.

The chart below gives a summary of recruitment activity at the end of Q3. The number of starters does not include internal movement.

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5.2 Recruitment Activity

5. Recruitment and Retention

All recruitment is now processed using the TRAC system, with integrated electronic DBS checking and the truncated Occupational Health process.

During Q3 the time taken to hire has increased from 33 days to 51 days. This increase is due to several factors; primarily due to the time taken to move the vacancy from creation stage to advertising stage. This is due to delays (compared to Q2): in authorisation of the vacancy; in managers shortlisting; in advertising due to the redeployment process; and in advertising due to an unexpected long term absence within the resourcing team. The team is now back to full capacity for Q4. We are also now piloting a scheme which should resolve delays caused by the redeployment process; vacancies are now permitted to be advertised alongside the redeployment process. In addition we are working with our managers to ensure that authorisation and shortlisting are completed in a timely manner.

The vacancy projections in Section 6.4 reflects the position at the end of December 2015. The estimates are based on previous month’s actual starters and leavers and appropriately factoring in the recent recruitment campaigns and further expected retention activity.

We continue to track internal movements within Divisional performance reports in order to better appreciate the numbers of staff obtaining promotional opportunities as a result of our recruitment drives. We have also sought the support of the TRAC Reports officer to ascertain whether we can use the system to support this work.

5.3 Recruitment Activity

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As part of equal opportunity monitoring under the WRES, the table below shows a snapshot of the number of applications, shortlisted and interviewed in Quarter 3.

The graph below indicates that for Q3:-

• 63.7% of applicants were BME

• 56.8% shortlisted were BME

• 55.2% interviewed were BME

• 47.7% of new starters were BME

The BME data is being reported quarterly at the Performance meeting, it will be presented at the January meeting. The HR Business Partners are working with their Divisional leads to create local plans, and are exploring corporate strategies to address the issues highlighted by the data.

Application activity by Ethnic Group

Other recruitment news

5. Recruitment and Retention

5.4 Vacancy Projections by monthly rate % (excluding internal movements)

R&R

The current vacancy rate in SMS is 4.49FTE (6.4%) which is predicted to steadily increase to 6.53FTE (9.3%) in April 2016. This is based on the average new starters and leavers and the current establishment, however, as detailed on Pg.8 there will be consultations will be taking during Q4 and the vacancy projections will need to be realigned to take in this changing landscape.

The vacancy rate in R&R is projected to decrease due to 31.8FTE new starters that are in the recruitment pipeline to start between February and April 2016.

It is projected that R&R will have a vacancy rate of 9.5% in April 2016.

SMS SAMH

There are a projected 16.2FTE new starters between March and April 2016 that are currently in the recruitment pipeline. It is anticipated that SAMH will have a vacancy rate of 10% in April 2016 based on current information.

Acute

The Acute vacancy rate is projected to decrease due to 11.4FTE starters that are in the recruitment pipeline to start in March 2016.

The budgeted FTE increased by 10FTE in December 2016 due to resilience funding which in turn increased the vacancy rate.

The vacancy rate in Acute is projected to be under 10% in March 2016 (at 8.4%).

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5. Recruitment and Retention

5.6 Leaver Analysis

Leavers by Reason

There were 30 leavers in October, 19 in November and 26 in December. These exclude trainee doctors and rotational psychologists.

There were higher numbers of leavers recorded in the Acute Division as compared to others. Of the 20 leavers in the Acute Division, 10 were Band 2/3/4 HCAs/Assistant Practitioners and 7 were Band 5 and Band 6 Nurses.

The next highest area was corporate areas which accounted for 14 leavers in Q3

Aside from 21.3% of leavers who did not clarify their leaving destinations, the next largest group of leavers left to due to promotion (38.7%), end of fixed term contracts (8%) and work life balance (6.7%).

Note : Trainee doctors and rotational staff are excluded from these numbers and consequent turnover figures.

The majority of leavers were within Additional Clinical Services (20) and Nursing (20).

The highest number of leavers were band 5 and band 6 with a leaving reason of Voluntary Resignation (VR) – Promotion, Retirement, VR – child dependents, VR – Health, VR – work life balance and VR – other/ not known.

The majority of leavers left between 1-2 years and under (as per Q1 and 2). This indicates that staff, particularly HCAs, leave relatively early in their employment with the trust. Getting the right exit questionnaire process is key to understanding the reasons for this (see p.16 for an update).

Note: Trainee Doctors and rotational psychologists are excluded from the figures above

Leavers Staff Group and Band Leavers by Staff Group and Length of Service

Leavers by Month

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5. Recruitment and Retention

Exit Questionnaire

A revised exit questionnaire process was launched in Q2. However, this did not achieve the aim of improving the response rates. Therefore, in Q4 we are implementing a different technique to capture the data using a variety of options for staff, including using an online survey. A link will be sent to leavers requesting that they complete the online survey. A communication will be sent to all managers notifying them of the change. This will enable us to ask more questions and therefore analyse trends in more detail. The termination form has been changed to include personal email addresses to which a link can be sent both pre- and post-termination, so that staff can complete the survey either at work or home, wherever, they are most comfortable providing their answers. The new termination form and process will be launched in Q4.

Retention Strategies

Our 2015 nurse recruitment campaign has been very successful. However, it is key that we retain all the nurses that we have recruited, particularly the newly qualified staff. Post-registration can be a challenging period for all newly qualified nurses; all the more so in the context of a large proportion of our inpatient staff being new.

A bespoke programme of training and support for newly-qualified nurses has been set up in partnership with Middlesex University This has entailed:

• Additional training opportunities for nurses to enhance their skill-set

• Participation opportunities in a wide range of clinical research programmes

• A mentorship and support programme for new nursing staff

• The ability to move around the Trust and its satellite sites to gain experience in a wide range of roles

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5.7 Retention Strategies – Developments from Q1

Retention

In addition, we are using the Recruitment and Retention group, membership for which is drawn from a wide group of stakeholders, to develop clinical career structures.

The R&R Group will also shortly be meeting to discuss how we improve feedback from our newly qualified nurses, the improvements we can make to our programme of support for the 2016 cohort and identify any further interventions that will further enhance the support and retention of the 2015 cohort.

In the Acute Division, we are launching a secondment programme in partnership with the Whittington as part of our plans to enhance RGN capability within the Trust.

Staff Benefits

Following the feasibility study, a decision was made by the Workforce Committee, to delay the introduction of the buying and selling of annual leave due to further work required to ensure that staff are taking adequate leave. Our work to further expand flexible working and support for working parents will continue, as we know that this is one of the reasons our staff leave.

As agreed with Finance and Procurement, a new staff benefits portal will be implemented which will include two new staff benefit schemes; technology and cycle to work salary sacrifice. This is due to launch in March.

We have decided not to pursue staff accommodation with One Housing Group as a survey of staff found insufficient interest in accommodation due to the rental costs. Further work will be taken to advertise in agreement with local organisations, student accommodation which may be beneficial for staff in the short term as well as continuing to work with Islington Council on their Key Worker Housing Scheme.

5. Recruitment and Retention

5.7 Retention Strategies – Developments from Q1

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Staff Survey

In order to drive up participation rates, second reminders for staff survey returns were hand delivered to staff across the trust. The positive upshot of this activity was that the Trust’s response rate closed at 52%, which is a significant improvement on last year’s 43%.

The first review of responses was released to the trust early on 15 December 2015. This rough cut of the material compares our data with the official sample data from all trusts of our type for whom Quality Health ran the survey for in 2015, and gives a comparison with our 2014 staff survey data.

The headlines form this data are:

• 18% of respondents are working up to 6 -10 hours of unpaid overtime a week.

• 1 in 5 do not feel able to deliver the care to which we aspire.

• 1 in 5 felt there were issues around discrimination in the workplace which affected career progressions/promotion.

• Managers in the trust are valued for team building and being supportive and responsive to staff needs.

• Respondents’ appraisals left them feeling their work is valued by the Trust and that their learning needs were thought about.

• More staff felt secure about raising concerns about unsafe clinical practice.

We will be having conversations with our staff side partners, to gauge the views of our trade unions – and to look at how we might work jointly to address the issues that come out of the survey. We have set up two events in January, open to all staff, where we can reflect on the issues raised in the staff survey and think about creating solutions together.

Our data will be uploaded to the National Staff Survey Co-ordination Centre, as part of the NHS-wide staff survey exercise. This will allow for more detailed comparative work in terms of our position relative to other Mental Health Trusts.

Quality Health will produce a management report for the trust at the end of January and will present that material at the Senior Leaders Team Meeting on 27 January 2016.

Given that this is a national exercise, the data is embargoed until 23 February 2016, when the national results are published.

Raising concerns at Work Policy

Discussions with staffside have continued and we are now in a position to formally re-launch the Raising Concerns at Work Policy (formerly Whistleblowing Policy) in January 2016, following a comprehensive communication strategy, which will include reminders of the 24/7 external hotline, which went live in August 2015.

Staff Friends’ and Family Test

At a national level, there is a consultative exercise being undertaken into Staff FFT, encompassing among other things whether the questions are appropriate in the current exercise. In light of this activity, it is likely that there will be changes to Staff FFT.

In the meantime, the Staff FFT will continue as normal with the Q4 survey launching on 9th February until 31st March 2016. An online survey will be used again with a series of messages being circulated via the Communications Department to support the campaign.

Improving Staff Experience and Data

6. Learning and Development

Mandatory Training – by Division

The introduction of the WIRED reporting system is delayed while the L&D Team work with Skills for Health to address systems issues.

Fire Safety, Information Governance and Safeguarding have been identified as the areas in need of most improvement. These are areas where training is required on an annual basis. All three can be completed relatively simply; Fire Safety and Safeguarding through completion of a workbook or attendance at that part of the Trust’s Safe and Sound mandatory training session and Information Governance through eLearning. HR will renew reminders to the division by sending out regular information on individual compliance for managers to follow up on alongside clear and concise instructions of how to complete these mandatory trainings.

In addition to using our compliance data to support staff and managers to access suitable means of updating in these areas, we will work with the subject matter experts to support them in their endeavours to attain required compliance levels through advice and guidance on content and delivery of this training. Work is already underway with the Head of Social Care to address safeguarding training.

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The L&D Team continues to offer an extensive range of opportunities – in terms of skills, CPD and management and leadership development – to all staff in the trust. For example, 10 of our existing Band 2 to 4 staff recently enrolled on Modern Apprenticeships in Business Administration: this offer will be extended to more staff, including those keen to undertake a vocational qualification in Care.

It has been agreed that the Developing our People initiative regarding a radically revised approach to appraisal will be trialled in April 2016 in the SMS Division and Corporate Departments, in order to allow the trust to assess the new approach systematically prior to full roll-out in April 2017.

Specific statistics for learning activity in Q3 are detailed below with further improvements built into the HR Action Plan.

CCG KPIS

Our training bundled together safeguarding for both children and adults and hence generated one compliance figure. The trust adopted the Intercollegiate Document competences for Safeguarding Children last year which necessitated a separation of those streams and affected levels of competence for different groups of staff, which adversely impacted our figures. We are currently working with the Head of Social Care using a system of workbooks, which are received and marked by L&D, to raise compliance in terms of Safeguarding Children; the Head of Social Care as the subject lead is identifying providers able to offer Safeguarding Adults training, in order to sustain and improve compliance in that area as well.

Mandatory Training - by subject

6. Learning and Development

CPD Uptake by Division CDP Uptake by Band and Ethnicity

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CPD course uptake reported includes all attendance at learning events recorded on ESR centrally other than mandatory training but excludes locally monitored training days.

The graph demonstrates staff participation in such events by division compared to Headcount figures in Q3. In line with their strategic intentions, the workforce development funding from HE NCEL has reduced by 34% in 2015-16, so greater attention is being paid to identifying

business-critical learning needs and prioritising those across the trust. Of staff who took up CPD training 43.2% were BME staff as compared to 55.5% White staff (1.3% of staff did not state their ethnicity). The data does not include CPD training for doctors.

Appraisals

In 2015/16, the window system has been reintroduced. In light of the return to the status quo ante, that window was extended backwards to include appraisals undertaken from January 2015 and the closing date for completion was extended to December 2015.

We continue to work closely with operations managers to collect data on completed appraisals, although we are now fast approaching the new appraisal year. In 2016-17, a new approach to appraisal will be piloted in the SMS Division and Corporate Departments; all other areas of the trust will follow the traditional approach to appraisal, which will need to be completed for all staff between 1 April and 30 June 2016.

7. Employee Relations

The chart below provides details of recorded ER activity across the Trust in the stated categories for September to December 2015 with movement from the last quarter and comparative trends from Q2 to Q3. Overall there were 155 cases in the quarter of which 75 were new cases. Acute had the highest number of cases with the majority being sickness absence cases (Acute has the highest sickness rates in the Trust at 5.9%). The number of new disciplinary cases within R&R remains the highest, this could be attributed to 3 separate cases which involved more than one staff member being investigated. This is being comprehensively managed. The length of time to complete formal investigations has improved in Q3 to 42 days which meets the Amber KPI, there were 2 exceptionally long cases (101 and 105 days each) which if these outliers are removed brings the average case length to 35 days. This is an improvement from Q2 and Q1 which was 69 days and 72 days respectively. The delays which caused the exceptionally long cases included sickness of a key witness,

investigation manager and union representative availability, disputed evidence and an investigation manger on sick leave due to an injury at work.

There were 2 active employment tribunals in Q3. 1 case was settled in Q3 via a non financial agreement it is expected that the remaining case will be concluded in Q4. There was 1 new cases around raising concerns at work. There are currently no suspensions to report.

In order to reduce the length of time taken to resolve cases we have reviewed our current ways of working. We have also considered models used within other NHS organisations and their effectiveness. As a result there are proposals underway to re-vamp the current processes for HR investigations which includes, adopting a commissioning manager approach and the introduction of a standalone HR Investigation Policy and Procedure which would be applied to all HR investigations e.g. Disciplinary, Grievance, Bullying and Harassment and Raising Concerns at Work Policy. Additionally a managers toolkit has also been proposed to provide managers with further support whilst carrying out investigations.

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7. Employee Relations

Disciplinary

57% of cases were new to the quarter (16 out of 28)

28% of cases were managed informally (8 out of 28)

55% of formal cases were referred to hearing (11 out of 20). Of those cases 4 hearings have taken place. 25% (1 out of 4) resulted in dismissal. 50% (2 out of 4) resulted in written warnings. Of those outcomes 2 appeals were received, 1 withdrew and the other upheld the decision of the disciplinary chair.

14% of all cases resulted in suspension (4 out of 28) and 21% of all cases resulted in a restriction of duties (6 out of 28).

61% of cases related to clinical issues (17 out of 28) e.g. medication errors.

15% of cases concluded under 28 days. 55% of cases took between 29-49 days to conclude. 25% took over 50 days to conclude which is a reduction of 23% from the previous quarter. Of the 5 cases which took over 50 days to conclude, 2 were carried over from the last quarter due to appeal. Reasons for new cases going over 50 days include: Investigation manager sickness absence, employee’s annual leave and employee under investigation failing to engage with the process.

There were 4 suspensions active , 2 of which were new to Q3. All 4 suspensions were concluded before the end of Q3.

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Absence

47% of cases were new to the quarter ( 47 out of 101).

90% of cases were managed informally ( 91 out of 101).

2 cases is currently at the final stage of the procedure.

Capability

30% of cases were new to the quarter (3 out of 10).

40% of cases were managed informally without requiring formal action (4 out of 10). Out of the 6 formal cases, 2 cases have concluded with satisfactory performance, 1 case resulted in redeployment, 1 case concluded with retirement.

100% of cases were related to clinical staff.

80% of the cases related to junior employees (below band 7).

53.3% (80) of all ER cases, in Quarter 3, were BME staff as compared to 44% (66) White staff. (4 did not have ethnicity stated). This compares badly to our overall staff in post, of whom 41.2% are BME staff.

69% of staff who have been involved in Disciplinary cases in the Quarter were BME staff, slightly lower than the average for last year (70%) and one of the indicators monitored under the WRES. There is further analysis being carried out to investigate this. Unconscious bias training is currently being scoped with external providers. A series of appeal reviews is being planned in partnership with staffside to ensure that decisions relating to investigations of an employee relations nature are appropriate and fair. Following the success of two BME Staff Forum events at the end of October, the HR department are liaising with the Equalities Lead to explore how best to establish a permanent forum for BME staff in the trust.

Disciplinary

Ethnicity Monitoring

Grievance and Bullying & Harassment Sickness Absence and Capability

Grievance

75% of cases were new to the quarter (3 out of 4).

75% of cases were managed informally (3 out of 4).

Only one investigation required investigation. This case has not yet concluded and the number of days taken to investigate has exceeded the KPI target of 28 days. The reasons for delay are due to the availability of witnesses.

Bullying and Harassment

57% of cases were new in the quarter (4 out of 7).

86% of cases were raised under the formal stage of the procedure (6 out of 7).

29% of the cases were withdrawn by the complainant and required no investigation (2 out of 7).

29% cases carried over from quarter 2 due to appeal (2 out of 7). 1 case has not yet started due to the long term absence of the complainant. Of the 2 new cases during the quarter none met the KPI target of 28 days. The reasons for the delays include: A large numbers of witnesses to meet during investigation (12 witnesses) and the availability of witnesses.

8. Equality and Diversity Monitoring

WRES Update

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In response to the Improving Staff Experience pledge on Equality & Diversity, two Diversity Forums were held in October 2015 and facilitated by the Director of Challenge Consultancy, and external organisation specialising in exploring and improving the experiences of BME staff. Paul Calaminus and Claire Johnston were also in attendance.

A total of 21 BME staff members participated in the forums and an additional 64 completed an online survey. The key recommendations outlined by Challenge Consultancy are below:

1.The setting up of a BME support group should become a priority.

2.Development of internal events aimed at BME staff on improving career development.

3.Consider introducing the secondment scheme so that staff can be seconded into senior posts

4.Ensure sufficient time between advertising posts internally and then externally to allow internal candidates time to complete paperwork

5.Review mandatory training programmes for managers and staff and ensure that they are fit for purpose. This is especially important in relation to training for managers in all aspects of performance management.

6.Training for managers in cultural awareness and/or unconscious bias

7.Set up a support forum where managers can come together and look at the broader issues. This could be done through the instigation of Action Learning Sets for managers.

The Equality and Diversity Lead has drafted an action plan to take forward recommendations 1 and 2. We are looking to set up a BME staff network by March 2016 with an Equality and Diversity Task and Finish Group to be set up and meet in January 2016. The Annual Equality and Diversity Report will be published in January. The Valuing Diversity Policy is currently being discussed and updated in partnership with staffside.

In addition, the Head of L&OD is currently undertaking a management and leadership development learning needs analysis among BME staff. This will underpin the action plan in terms of training and support provided to BME staff to progress in their careers.

8. Equality and Diversity Monitoring

Staff Profile by Band and Ethnicity

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The statistics below present the wider workforce profile status at the end of Q3 in comparison to local population statistics in the areas of ethnicity, age, gender, disability, marital status religion and sexual orientation. The Trust figures exclude Trainee Clinical Psychologists who are hosted on the C&I payroll.

The data above shows that :

In our workforce, 41.2% are BME staff as compared to 56.4% White staff (2.3% not stated).

In our workforce, 15.6% of our staff in bands 8 and above are BME staff (including medical staff) as compared to 78.4% White (6% not stated).

Majority of staff in Band 1-5 are BME staff (58.2%) while majority of staff in Bands 6-9 are White staff 70.6%

32.8% of the local population are of black and ethnic minorities while 67.2% are white.

It follows that the Trust overall has a higher representation of BME staff as compared to the local population but a lower representation of BME staff in higher bands, Executive and Board level.

We are taking forward a comprehensive Workforce Race Equality Standard implementation plan to address these imbalances.

8. Equality and Diversity Monitoring

Staff Profile by Disability Staff Profile by Sexual Orientation

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With 7.5 % of the local population declaring a disability that hinders day to day life and a further 7% indicating they have long term conditions the Trust ‘s figure of 3.4% appears low.

There is a high percentage of staff without a declared disability status . In January a data gathering exercise was launched to improve disability and all E&D data accuracy. The updated information will be shared in the Q4 2015/16 report.

Highest numbers of staff are in their 30s (29.9%)

There are high proportions of staff in the their 50s and 60s (25.8%)

Age groups in the local population are well represented in the Trust except for the 70 year group. The proportion of 20 and 60 year groups is also lower in the Trust compared to the local population.

There are a higher number of females as compared to males. (69% vs 30.5%)

Males are under represented when compared to the local population where there is a higher ratio of males to females 49% vs 51%

Majority of C&I staff are heterosexual which follows the trend of the local population.

The Trust is high on representation on bisexual and gay and lesbian categories as compared to the wider population.

*Note : detailed population statistics for this category are currently not broken down to borough level. The benchmark used is data at national level. Our understanding is that further analysis at local level is ongoing.

8. Equality and Diversity Monitoring

Religious Belief Marital Status

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Majority of staff are Christian (35.5% vs 37% as compared to the local population).

Atheism is the second highest category (14.5% vs 27.7% of the local population).

About 17% of staff have not defined religious belief. Data gathering exercises are planned to resolve this.

Majority of staff are single staff as compared to the local population (54.2% vs 54.4%).

28% of staff are married compared to 25.4% of the local population.

13.3% of Trust staff have not disclosed their marital status.

9. Safer Staffing

The Trust provided monthly returns to NHS England for October, November and December 2015.

The returns show the Trust’s performance against National benchmarks showing staffing at ward level detailing Day and Night staff fill per staff group (registered nurse/midwives and care Staff)

The shift fill rate is calculated by amalgamating the shifts filled by Trust staff and NHSP/agency workers.

The overstaffing at night in additional care staff as a result of the need to secure additional cover to support increased levels of patients on heightened observation levels in order to meet clinical needs.

The below narrative gives a high level summary of the December report which falls at the end of Q3.

Acute

Nurse day shifts:-

• Overstaffed slightly – Amber Ward (111.8) and Coral (112.2%)

• All other Nurse day shifts had a Green RAG rating

Nurse night shifts:-

• All Acute Nurse night shifts had a Green RAG rating

Care staff day shifts:-

• Understaffed – Amber (85.7%)

• Overstaffed slightly – Coral (117.6%),

• More than 30% overstaffed – Jasper (269.6%)

• All other Care staff day shifts had a green RAG rating.

Care staff night shifts

• Overstaffed slightly – Jade (111.3%)

• More than 30% overstaffed – Coral (206.2%), Dunkley (130.5%), Jasper (293.9%), opal (134.8%), Rosewood (172.3%), Sapphire (184%) and Topaz (152.8%).

• All other Care staff night shifts had a green RAG rating.

SAMH

• Garnet had Green RAG ratings for all their shifts.

• Pearl was overstaffed slightly (113%) on nursing day shifts and understaffed on nurse night shifts (89.4%). Pearl was more than 30% overstaffed on Care Staff shifts.

R&R

• Malachite was understaffed on Care Staff day shifts (73.4%).

• Sutherland was overstaffed for the Care staff night shifts at 120.6% and more than 30% overstaffed for Care staff day shifts (148.4%).

• All other shifts had Green RAG Ratings.

Explanation Key

understaffed 90% or less

good staffing 90% to 110%

over staffed slightly 111% to 130%

more than 30% overstaffed 130% or more

Overall Trust Status for Q3 Comments by Divisional Area

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10. Conclusion

The Trust has maintained a relatively stable position in the majority of its Workforce Key Performance Indicators since Q2.

Key work undertaken in Q3 includes:-

• Equality & Diversity recommendations and actions as outlined in Section 8 (Pg.22) of this report.

• The ongoing recruitment work and the reduction of qualified nursing vacancies to 0.7% and our comparative performance against other London Trust’s can be found on Pg.6.

• Reduction in formal ER investigation length.

• Reduction in bank and agency spend by approximately £700k.

• Local recruitment campaigns in partnership with the local job centre and our pledge to recruit more people with learning disabilities.

It is expected that further improvement will be reported in Q4 of 2015/16.

There is still ongoing work from actions identified in Q4 and Q1 and new actions identified in Q2.

The Action Plan in Appendix 1 details progress made against key deliverables and timescales for completion of those still in progress.

Key actions for Q4 include:

Continued recruitment and retention initiatives including attendance at local recruitment events and working with the local job centres.

ESR Data cleanse activity to provide a better baseline for workforce planning and gather equalities data where it is lacking.

To establish BME staff network by end of March 2016.

Equality and Diversity Task and Finish Group will meet.

Publish the Annual Equality & Diversity Report by end of January 16.

Continued Learning and Development activity and reporting.

Monitoring performance against imposed agency target

Re-launch of the Raising Concerns Policy.

Analysis of and engagement with the workforce regarding the Staff Survey Results.

Future Plans

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11. Appendices

I. HR Action Plan

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Key - RAG Status

Green Completed

Amber In progress

Red Not started

11. Appendices

III. Report Notes and Definitions

FTE – (Full-Time Equivalent) : Number of full time positions. A member of staff working full time will have a FTE of 1.00.

Establishment (FTE) : Budgeted full time equivalent of established posts.

Staff In Post (FTE and headcount) : Number of staff employed at the end of the quarter (full-time equivalent and headcount).

Vacancy Rate : The vacancy rate is a measure of the difference between established posts and actual staff in post.

i.e. (Established FTE – Actual FTE) / Established FTE x 100.

Staff Turnover: The percentage (rate) of people leaving the Trust over the 3 monthly period.

i.e. Number of leavers over the 3 month period (headcount) /

average staff in post over period (headcount) x 100

Note : excludes rotational staff (Junior Doctors) and staff that have transferred to another organisation as part of TUPE or internal movements.

Sickness Absence Rate: The percentage rate of sickness absence calculated in days lost.

i.e. (FTE days lost through absence/FTE days contracted in period) x 100.

Salary Based Sickness Absence Cost (£) - The basic salary amount paid to staff whilst absent due to sickness (excludes London weighting and any allowances).

Bank Use (% of funded establishment) - Bank use expressed as a percentage of funded establishment.

i.e. (Bank use (FTE) / Establishment (FTE)) x 100

Mandatory Training (%) - Number of staff attended courses/ Number of that should have attended x 100.

KPI RAG rating

The RAG rating for mandatory training has been altered following discussions with the Executive to bring them in line with other organisations. Trust targets to reduce both sickness absence and bank use are reflected in the scoring parameters set for both these areas. Vacancy rate RAG ratings have been set at a level that takes account of the need to keep some vacancies open for potential redeployments from organisational change, whilst safely running services.

Measure Green Amber Red

Vacancy Rate <10% 10%-15% >15% or <0%

Bank Use (% of funded establishment) <10% 10%-14% >14%

Sickness Absence Rate <3% 3%-3.5% >3.6%

Staff Turnover (annual) <16% 16%-20% >20%

Mandatory Training >80% 68%-79% <68%

Appraisals >80% 68%-79% <68%

Item Data Source

Establishment (FTE) Finance Ledger

Staff in Post (Headcount & FTE) ESR

Bank Use (FTE) Finance Ledger

Bank & Agency Spend (£) Finance Ledger

Sickness Absence (% and £) ESR and Healthroster

Turnover % (Leavers and Headcount) ESR

Mandatory Training ESR/ OLM

Data Sources

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