Trust Board Meeting in Public: Wednesday 9th November 2016 Title Quarterly Report on Organisational Development and Workforce Performance Q2 2016/17 Status For noting History Workforce Committee, 25 November 2016 Board Lead(s) Director of Organisational Development and Workforce Key purpose Strategy Assurance Policy Performance WF & OD Performance Q2 2016/17 Page 1 of 10
EXECUTIVE SUMMARY 1. The report provides summary information relating to OD and Workforce Performance for the Q2 period, 1 July to 30 September 2016 and comments upon a number of key OD and Workforce priority activities. 2. Further planned increases in substantive workforce capacity were achieved within medical, allied health and clinical support roles. The gap between the budgeted workforce establishment and actual staff in post was 6.3%, representing a reduction of 0.6% against the Q1 position. Despite an uplift in the overall budgeted establishment, effected in April, the underlying vacancy rate continues to decrease. 3. Agency expenditure was maintained at a level substantially below the imposed ceiling, and the Q2 out-turn performance reflected a reduction of 50% compared to last year s Month 6 position. Maintaining controls on the use of agency staff, and further reducing the level of expenditure remains a key priority. 4. Despite the increase in substantive workforce capacity and a further reduction in the overall vacancy rate, staff turnover remained at 14.5%, against a target level of 10.5%. The Trust continues to face challenges associated with turnover within the allied health professions and band 5 nurse staff groups. Actions are being taken to improve staff retention and details relating to the implementation and cost-benefits of further proposed initiatives (outlined to the Trust Board in September) will be presented to the Trust Management Executive in November. 5. Staff sickness absence continued to fall and Q2 performance was marginally above the 3.2% Trust target. 6. Compliance with the completion of statutory and mandatory training, and non-medical annual appraisal did not meet the Trust target of 90%. The report summarises the principal actions being taken to improve these areas of under-performance, which is a priority for Q3. 7. The report provides an update on a number of other key OD and Workforce actions and initiatives relating to: education, learning and development; junior doctor contract implementation; staff engagement and recognition; and staff health and wellbeing. 8. The Trust Board is asked to note the summary information presented within the report. WF & OD performance report Q2 Page 2 of 10
1. INTRODUCTION 1.1 This report provides summary information relating to Organisational Development (OD) and Workforce Performance for the Quarter 2 (Q2) period, 1 July to 30 September 2016. 1.2 The Trust-level information associated with principal key performance indicators (KPIs) is replicated in greater detail within the Divisional dashboard data produced for the respective Divisional management teams, by the OD and Workforce Directorate, on a monthly basis. More granular data, at specialty and departmental level, is also provided. 1.3 The report also includes summary information relating to current OD and Workforce priority activities. 2. PERFORMANCE AGAINST PRINCIPAL WORKFORCE KPIs Substantive Workforce Capacity 2.1 Between Q1 and Q2, the number of substantive staff in post increased by c.80 full time equivalent (FTE). This planned increase is attributable to the recruitment to substantive posts in the medical, clinical support and allied health professional staff groups. 2.2 Against the net increase in substantive staff capacity, there was no significant change in nursing and midwifery numbers. 2.3 Since the end of Q2 the substantive workforce further increased by 90 FTE staff transferring from their employment with the Oxford Health NHS Foundation Trust reablement services to the OUH home assessment and reablement team (HART). 2.4 When compared to the Trust s total budgeted establishment, substantive workforce capacity in Q2 reflected a vacancy rate (gap) of 6.3%. This represented a reduction of 0.6% against the Q1 out-turn vacancy rate. As a consequence of an uplift in the overall budgeted establishment at the beginning of Q1, the 2015/16 outturn vacancy rate increased by over 3%. The Q2 performance is consistent with a continued downward trend in the underlying vacancy rate since Q1 2014/15. 2.5 In recruiting to budgeted establishment levels across all staff groups, the most challenging areas are associated with nursing, the allied health professions, and clinical support worker roles. Workforce Costs 2.6 Total pay expenditure for Q2 remained 1.5m below plan, continuing the positive year to date trend. 2.7 Consistent with the Q1 out-turn performance, total expenditure on agency staff remained well within the ceiling established by the Regulator. The six months WF & OD performance report Q2 Page 3 of 10
year to date agency expenditure totalled 7.9m, which was 2.2m below the Month 6 ceiling level. This compares with expenditure on agency staff totalling 15.6m at the same point last year (i.e. a reduction of 7.7m; 50%). 2.8 With the maintenance of current agency staff authorisation restrictions, combined with the application of additional control and reporting mechanisms recently mandated for all trusts by the Regulator, this positive trend is forecast to continue during Q3 and Q4. Staff Turnover 2.8 Overall staff turnover remained largely unchanged, at 14.7%. Consistent with the previous reporting period, the highest levels of turnover were recorded within the clinical support, and administrative and clerical staff groups. Members of staff within these groups occupy the lower NHS pay bands and the prevailing turnover rates are thought to be significantly influenced by the strength of the local economy and its low levels of unemployment. 2.9 Amongst the professional staff groups, the higher levels of turnover are associated with allied health professionals and band 5 nurses. 2.10 The Q2 position represents an increase in overall staff turnover of 0.9% when compared to the same period last financial year, and is consistent with the average rate of turnover for the Shelford Group of trusts. Sickness Absence 2.11 Sickness absence continues to reduce and the current rate of 3.3% is marginally above the 3.2% Trust target. This continued downward trajectory is a consequence of the maintained focus on sickness absence management by line managers, Divisional HR teams and the Occupational Health and Wellbeing Service, combined with the benefits afforded by the investment in both the FirstCare management system and Employee Assistance Portal. Trust-level performance compares well against a national average rate of 4.1% and an average of 3.7% across the Shelford Group of trusts. 2.12 At an operational level, the Children s and Women s Division is experiencing a sickness absence rate of 3.9 %, which is an improvement on the previous reporting period. Within the respective staff groups, the highest level of absence (5.9%) is reported against clinical support staff. Table 3, below, details the rolling 12 month sickness absence rate and projection for the remainder of the current year. Statutory and Mandatory Training 2.13 At the end of Q2, the overall statutory and mandatory training compliance rate was 85.3% against a target of 90%. This represents a marginal improvement of 0.2% when compared to the previous reporting period. Performance at a Divisional level is highlighted in Table 1, overleaf. 2.14 In the interests of increasing compliance levels, and following feedback sought from the operational Divisions, changes have been made to update the WF & OD performance report Q2 Page 4 of 10
Trust s Statutory and Mandatory Policy, which is now being consulted upon. The main changes are summarised, as follows: The ability to passport between organisations using the Skills for Health Framework. Future compliance to be reported at two levels, namely: Compliance - this will be reported quarterly against the Skills for Health core skills framework, which represents the minimum data set for the NHS and includes those competencies which can be passported between organisations aligned to the Framework. This provides an external benchmark against which to measure compliance. OUH Enhanced Compliance - in addition to the core skills framework, this also includes additional locally-determined competencies, informed by a riskbased approach. Examples of additional local competencies include: basic dementia awareness for administrative and clerical staff; pressure ulcer prevention; essentials of diabetes care; back care facilitation, and fire marshal responsibilities. 2.15 Once the Policy is endorsed and implemented, a further targeted effort will be made to engage with those who have outstanding competencies. Where there is clear evidence of a persistent failure to undertake training, then the provisions of the recently introduced Linking Pay Progression and Performance Policy will be applied. Table 1: Statutory and Mandatory Compliance Rates by Division Q1/Q2 Division/ Function Q1 (2016/17) Q2 (2016/17) Clinical Support Services 91.4% 91.0% Children s and Women s 86.8% 86.4% Medicine, Rehabilitation and Cardiac 81.5% 80.7% Neurosciences, Orthopaedics, Trauma and Specialist Surgery 86.2% 86.0% Surgery and Oncology 89.6% 88.8% Corporate Services 87.8% 88.6% Research and Development 70.4% 73.1% Overall Trust Compliance 85.1% 85.3% Non-Medical Annual Appraisal Compliance 2.16 During the reporting period, annual appraisal compliance improved within all Divisions, but remains an area of under-performance (i.e. 70% against a Trust target of 90%). Compliance by main Division and function is detailed in Table 2, overleaf. WF & OD performance report Q2 Page 5 of 10
Table 2: Annual Appraisal Compliance Q2 Division/Function Compliance (%) Corporate 61 Children s and Women's 58 Neuroscience, Orthopaedics Trauma and Specialist Surgery 76 Medicine, Rehabilitation and Cardiac 66 Surgery and Oncology 77 Clinical Support Services 79 Operations, Service and Improvement 75 Research and Development 29 2.17 Over the past six months, and in response to feedback from staff and consultation with line managers, improvements have been made to the Trust s online appraisal documentation. These improvements have aimed to simplify the appraisal process as far as is practicable. Nevertheless, a persistent problem impacting upon the reporting of annual appraisal compliance is the accuracy of recording, and qualitative information confirms that a significant number of completed appraisals are not entered on the central data base in a timely manner and, in many cases, not at all. 2.18 In response to this continued under-performance, the learning and education team is working with Divisional management teams and department leads to validate any paper-based appraisal documentation that is recorded locally, rather than centrally. Furthermore, Divisional HR Business Partners have been tasked with prioritising the completion of outstanding appraisals within their respective Divisions during Q3. 3. KEY OD AND WORKFORCE ACTIVITY Staff Retention 3.1 A principal concern, and therefore focus of activity, for the OD and Workforce Directorate is the provision of support to improve staff retention. As highlighted above, particular challenges persist in the retention of nursing staff at band 5 level, staff within the allied health professions, and staff occupying clinical support roles. At its previous meeting in private, the Trust Board received a detailed report which explained the main pressures, both national and local, influencing staff retention, together with a summary of the actions that have been taken, and are being pursued, in response. The report also outlined a number of additional proposed initiatives particularly targeted at improving retention amongst nurses and allied health professionals at bands 5 and 6, where attrition rates are highest. 3.2 Advocated by Divisional management teams and clinical leaders, these proposals aim to assist the Trust in being better able to meet the expectations of younger members of staff within non-medical clinical roles, with respect to professional development and career progression. The proposals, if adopted, would represent a significant level of financial investment which will need to be considered as part of the 2017/18 budget setting activity. A further paper detailing the worked-up WF & OD performance report Q2 Page 6 of 10
financial implications and associated cost benefit analysis will be presented for consideration by the Trust Management Executive in November. 3.3 In the interim, the centralised approach to recruiting newly qualified band 5 nurses, introduced earlier in the year, continues to deliver positive results. Improvements have included the establishment of monthly fast-track assessment days, where technical and values based interviews, maths and English testing, and full documentation checking (including portfolio review) is completed within a few hours. Successful candidates are then immediately provided with confirmed, written job offers. In response to the popularity and success of this initiative, it is now being replicated for other key staff groups, including the allied health professions. 3.4 The implementation of more clinical rotation programmes has also proved to be popular with staff and is considered an effective means by which to attract and retain nurse graduates. Since March 2016, when all ward based rotations were standardised to eight months duration, and centrally co-ordinated by the OD and Workforce Directorate (via the dedicated Recruitment and Retention Nurse Advisor), a total of 34 rotation appointments have been made, and the first cohort of newly qualified nurses began their rotation programmes in September. 3.5 Preparations have been made for the staff transfer bureau to launch in December. Managed by the Recruitment and Retention Nurse Advisor, the purpose of the bureau is to: provide advice and support to nursing and midwifery staff who wish to transfer between areas, specialties, roles or bands; assist with arranging taster sessions in other clinical areas; provide a link to other functions that can assist with staff retention, including education and training, and the accommodation bureau; advise on and facilitate retire and return options. Education, Learning and Development Post Graduate Certificate for Nursing and Midwifery Staff 3.6 Education and training provision plays a vital role in the recruitment, development and retention of staff, and the learning and education team continues to implement the work programmes associated with the Trust s Education, Learning and Development Strategy. Good progress has been made in the development and implementation of an in-house accredited Post Graduate Certificate in Leading Compassionate Excellence in Nursing and Midwifery, which is accredited by the University of Northampton. Designed and delivered by Trust faculty, the content and structure of the programme was highly commended by the validation panel. The current cohort consists of 24 band 7 nursing and midwifery staff and a further 25 participants will commence the programme in January 2017. Places are in high demand and it is anticipated that the programme will support the retention of more senior non-medical clinical staff. The programme is also receiving national interest through the UK Magnet Alliance (led by the Trust) and external candidates will join from the third cohort onwards in 2017. WF & OD performance report Q2 Page 7 of 10
Mentorship, and Foundation/Preceptorship Programmes 3.7 Plans are currently in place and work groups established to deliver perioperative, neuroscience and mentorship programmes later in 2017. Again, these programmes will be academically accredited by a University partner and delivered by the Trust s own staff. 3.8 The Foundation/Preceptorship programme continues to expand to include all non-medical newly registered staff joining the Trust. The programme is designed to benefit nurses, midwives, operating department practitioners, occupational therapists, physiotherapists and therapeutic radiographers. An aim is to achieve validation for the programme by the American Nurses Credentialing Centre, in January 2017. If successful, the programme will be the only one if its kind which is accredited outside of the United States, thereby significantly enhancing the Trust s Magnet journey. To date a total of 145 staff have completed the programme and a further 150 are enrolled. Expansion of the programme will support greater numbers of participants from Q3 onwards. Of note, in recognition of work being undertaken locally, OUH was successful in being nominated as a case study site for the national Health Education England Reducing Pre-registration Attrition and Improving Retention (RePAIR) project, the focus of which is supporting the development and retention of staff in all branches of nursing and therapies. Promotion of Apprenticeship Opportunities 3.9 The learning and development team, in partnership with HR colleagues, is supporting the aspiration for the Trust to become a recognised Employer Provider for Apprenticeships in 2017, following the introduction of the national Apprenticeship Levy (which will apply to all organisations in all sectors). OUH is taking a leading role in supporting the development of apprenticeships across the region s Sustainability and Transformation Plan (STP) geography. The aspiration is for the Trust, over the coming year, to become a lead provider for the regional healthcare system and co-ordinator lead for a proposed health and social care apprenticeship rotation programme. Support Worker Academy 3.10 The Support Worker Academy is enjoying continued growth in its education provision and is currently developing an in-house Community Care Certificate Programme specifically to support the HART service. Following a successful external examiner assessment visit by Edexcel, the Academy is now able to deliver a health screening qualification. This complements the provision of maths, English and IT training, and short courses in time management, note-taking, and food hygiene for support staff occupying bands 2 to 4. Training Needs Analysis 3.11 Work has commenced towards completing a Trust-wide training needs analysis (TNA), capturing all non-medical staff groups, in order to identify continuing professional development (CPD) needs for 2017/18. The TNA will aim to ensure CPD is appropriately prioritised and efficiently delivered. WF & OD performance report Q2 Page 8 of 10
Junior Doctor Contract Implementation 3.12 In September, the Trust Board received a paper detailing the local actions being taken in preparation for the implementation of revised terms and conditions of employment, under a new contract for junior doctors. The paper confirmed that an appropriate governance framework has been established to manage and oversee the implementation of new contractual arrangements for the Trust s junior doctor workforce (which totals c.1,500 individuals) in accordance with the nationally prescribed timescale. The introduction of the new contract represents an important and substantial programme of work, which requires that all existing medical rotas (almost 100 in total) are tested for future suitability and, where required, adapted to ensure they are fully consistent with the new contract provisions. 3.13 Local implementation is being managed within the context of the continued general dissatisfaction of junior doctors, nationally, towards the introduction of revised terms and conditions. This is well recognised by the Trust and every effort is being made to ensure the junior doctor body is fully engaged in the process and adequately informed, throughout. An important development in this respect is the appointment of a local Guardian of Safe Working Hours and the establishment of a Junior Doctors Forum, which will be supported by the Trust Executive. The first cohort of 94 Foundation Year 1 and Foundation Year 2 doctors will transition to the new contract in December: Phased transition will then continue until October 2017. Staff Engagement and Recognition 3.14 Whilst, via the regular Staff Friends and Family survey, the majority of the Trust s employees confirm that they would recommend the organisation for care and treatment, just two thirds would recommend it to friends and family as a place to work. Although this local advocacy is comparable with the acute sector average, it is disappointing and of concern (N.B: the same advocacy questions are included within the annual NHS Staff Survey, which is being conducted during October and November). Whilst the data received via the quarterly Staff Friends and Family Test is useful, it does not provide for any deeper analysis of the key factors impacting upon staff engagement and motivation. Therefore, it is of limited benefit in informing those interventions and actions which are likely to deliver improvements. In response, the OD team is developing a pragmatic intervention through which to better understand the causes and effects of local staff engagement, produce regular trend analysis which can be quickly acted upon, and provide clear and practical recommendations to improve staff motivation. 3.15 Building upon and complementing the work of the Trust s Listening into Action and Values into Action initiatives, the scheme establishes a simple model based upon a framework of nine recognised enablers of engagement, namely: influence; clarity; work relationships; perceived fairness; recognition; personal development; mindset; resources, and trust. The scheme will pilot the scheme with a number of clinical and non-clinical teams in Q4. 3.16 The annual Staff Recognition Awards event is to be held in early December, where the winners of each of the Award categories will be publicly recognised and celebrated. The Awards evening also provides an opportunity to give recognition to the work and achievements of specially chosen teams and, for the first time, this WF & OD performance report Q2 Page 9 of 10
year s event will include the presentation of the Patients Choice Award. Staff nominations for this Award were received by patients and their families, and the winning submissions chosen by a panel consisting of patient representatives. This year has seen the highest number of nominations made, across all nine Award categories, since the recognition scheme was implemented in 2012. Staff Health and Wellbeing 3.17 The NHS Healthy Workforce Programme is focused on improving the health and wellbeing of staff in order to help reduce sickness absence, and improve patient and staff experience. All trusts are expected to deliver improvements in three specific areas, namely: provision of support across musculoskeletal health, mental health and physical activities; the uptake of flu vaccinations by frontline healthcare workers; and ensuring the food and drink sold on NHS premises promotes healthy choices. Commissioning for Quality and Innovation (CQUIN) payments are linked to these initiatives, and the Trust s occupational health and wellbeing team is fully supporting the local delivery of the Healthy Workforce Programme. 3.18 The Centre for Occupational Health and Wellbeing already offers an extensive range of health and wellbeing initiatives and support programmes for staff. Additional initiatives aimed at achieving the CQUIN criteria include: physiotherapy support to fast track staff for treatment and advice; extending the number and range of interventions offered to staff to improve mental health; improving referral times to the Centre for staff with mental health issues, and increasing the provision of managing stress and building resilience workshops. This year s flu vaccination programme started in late September and the Centre is supporting the aim to administer vaccinations to 75% of the Trust s frontline (i.e. patient-facing) workforce. 4. RECOMMENDATION 4.1 The Trust Board is asked to note the contents of this Summary Report. Author: Mark Power, Director of OD and Workforce Contributors: Subject matter leads within the OD and Workforce Directorate WF & OD performance report Q2 Page 10 of 10