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Using e-rostering & software to support flexible working Simon Courage Director of Product Strategy Allocate Software

What is flexible working? March 2014 Mon Tues Weds Thurs Fri Sat Sun

Flexible Working March 2014 Mon Tues Weds Thurs Fri Sat Sun

Inflexible working March 2014 Mon Tues Weds Thurs Fri Sat Sun 08:45-14:30 08:45-14:30 08:45-14:30 08:45-14:30

Why do we have a flexible workforce? Flexible staffing Substantive staffing level

What is the Exam Question?

Meet safe staffing requirements cost effectively whilst having a happy workforce

Current Exam Question

Current Exam Question

Millions Agency Spend Increase 800 700 600 500 400 300 200 100 0 714 485 327 Agency Spend (168 Trusts) 2012-13 2013-14 2014-15 (projected)

Agency Spend Increase 26 trusts are spending five times more in quarter 2 2014-15 than 2 years earlier Only 19 trusts are spending less on agency nurses than 2 years ago

Spend and Care The numbers in this report will make sobering reading for health care leaders and politicians alike. But what they don t show is the cost to patients. Over-reliance on agency staff impacts on continuity of care, and that is bad for patients

Meet safe staffing requirements cost effectively whilst having a happy workforce

It won t will fix itself

But how do we fix it? The only way to reduce the spiralling agency bill is by taking a long-term approach to workforce planning

But we can reduce costs & improve care even if we keep temp staffing levels the same by moving use from agency to bank

Improve OUR flexible workforce (bank) to reduce dependency on Agencies flexible workforce

Benchmark Temp Staff Usage

Benchmark Agency Use: % of Temporary Staffing Hours 2,499 agency hours. If replaced agency with bank at level of best Trust, save 2,487,000 pa with no change in staffing levels or total temp staff usage

Staffing Lifecycle Reduce Temp Staffing Reduce Agency Organisation Staff Unavailability Rostering Bank Agency

Next Steps

Staffing Lifecycle Reduce Temp Staffing Reduce Agency Organisation Staff Unavailability Rostering Bank Agency

Staff with Working Restrictions Understand where staff inflexibility is an issue Review and determine if still appropriate

Reducing Agency Ratio 1. Improve positives bank has over agencies 2. Remove positives agencies have over the bank 3. Increase efficiency of the bank office

Improve positives bank has over agencies

Improve positives bank has over agencies Make it more likely you ll get work if you work on the bank Bank has better choice; bank has earlier choice Virtuous circle

How? Show unfilled bank via Employee Online

Enable Direct Booking Staff love it In control of their working Fast and easy No need to speak to anyone! Safe rules still enforced Bread and butter looks after itself Bank Office focus on hard to fill direct agency impact

Other Communication Techniques: SMS

Making This Work: Bank Lead Time Get gaps to the bank ASAP Bank get first choice; bank gets more choice; Bank gets time to fill Use Integrated e-rostering>bank Makes sending requests as quick & simple as possible Available even if use NHSp Track how well this is working Track Roster Approval timescales Track Bank lead times

Other Communications: Employee Online Give staff control of their working life View bookings Confirm unconfirmed bookings View / direct book into matching gaps Enter availability for targeted SMS or calls Home access is key

Remove positives agencies have over the bank

Remove Positives Agencies have over Bank Weekly payrolls Pay at current payscale Consider tax impact.

Recruitment Recruitment drive for the bank explaining the positives Do you know which substantive staff work agency duties? Are they also on the bank?

Increase efficiency of the bank office

Increase Efficiency of the Bank Office Get the bread & butter to look after itself Direct booking 2 Way SMS Ward direct bookings Reduce admin overhead Integrate with e-rostering Integrate with payroll Agency access

Summary Improve your flexible workforce: the bank Reduce agency costs & improve care now No dependency on long term workforce planning Use technology to make bank a more compelling choice Provide a better service to your flexible workforce

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Our Approach to a Recruitment and Retention Strategy A Cinderella Story - Lorissa Page - Associate Director of HR at Brighton and Sussex University Hospital NHS Trust

BSUH Brighton and Sussex University Hospitals is the regional teaching hospital, working across two sites: Brighton and Haywards Heath. We are also the major trauma centre for Sussex and the South East. Specialised and tertiary services - neurosciences, arterial vascular surgery, neonatal, pediatric, cardiac, cancer, renal, infectious diseases and HIV medicine. Serving a population of 500,000. Care for circa 750,000 patients per annum. Employ circa 7000 staff

BSUH Recruitment in 2013 Vacancy rate 11.5% Turnover rate 13.6% c.750 vacancies (12/13) 4.5 WTE Recruitment Administrators Caseload of 85 vacancies each Time to recruit 17 weeks Recruitment process contained 9 stages and 74 steps! IT administrative system Excel spreadsheets

Why do we need a strategy? Recruitment and retention of skilled staff is a continuing challenge and has created a highly competitive market. The Trust need to employ more staff and retain, manage and develop its existing workforce who have the right skills and experience to ensure high quality, safe and effective patient care. The national demographic profile highlights an aging workforce and the demand to increase career and flexible working opportunities make recruitment and retention of staff a major challenge. A fair and diverse representation of the local community in our workforce is essential to how we work. The Trust needs to shows its commitment to working in partnership with its local community and workforce.

Corporate Brand vs. Talent Brand The Corporate Brand influences behaviour about its services, the Talent Brand influences consideration as an employer. The John Lewis Partnership view all applicants as potential customers and its online process aims to make applying an enjoyable experience Companies with a strong Talent Brand benefit by having: A strong pipeline of people willing/desiring to work for a company A large number of employee advocates and employee referrals The ability to attract hard-to-find talent Reduced recruitment costs Improved Retention

What about Retention? Staff feedback Develop a more flexible workforce Sandwich generation Review and develop roles that introduce new and innovative ways of working and delivering care e.g. Physician Associates.

BSUH the Future

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Overseas Test of Competence Tom Kirkbride Assistant Director: Registration Emma Lacy International Team Manager

Overview Why has the process changed The Test of Competence Part 1 Computer Based Test Part 2 - OSCE Process overview To date Questions & Feedback

Why has the process changed As a result of numerous internal/external audits and investigations, recognition of a need to improve the Overseas Registration process and assessments to: Provide a reliable and valid method of testing overseas applicant s competency to access the UK register. Consistency Output rather than input measure (objective test vs. hours of training) Address limitations of ONP

Test of Competence The NMC has established a test of competence for applicants wishing to register in the UK as a midwife or as a nurse in each of the four fields: Adult nursing Children s nursing Learning Disabilities nursing Mental Health nursing

Pre requisites for the test of competence The applicant must: Be an RN or RM in their own country IELTs at the required level of 7.0 Have three years undergraduate nursing or midwifery education. Have 12 months post registration experience Have met the health and fitness to practice requirements

Purpose of the test of competence To ensure those who pass the test of competence are fit for registration in the UK. The test of competence allows nurses and midwives to demonstrate their skills, knowledge and attitudes are at the level required for point of entry to the UK. The skills, knowledge and attitudes covered in the test of competence will be derived from the current pre-registration nursing and midwifery education standards.

Design Overview The test of competence is made up of 2 parts. Part 1 The unseen examination (MCQ) Part 2 The practical examination (OSCE) The midwifery test of competence will follow the same assessment structure.

Part 1: Computer based MCQ Computer based Multiple choice questions Available in a number of countries where IEN&Ms are typically recruited. Provided by Pearson-Vue who are well known and recognised for providing the NCLEX online multiple choice exam which is required for registration in the USA. Essential questions critical areas Developed, written, tested and evaluated by teams of subject matter experts for midwifery and each field of nursing. Tests candidates against the point of entry competence set out in the pre- registration standards and essential skill clusters for nursing and midwifery education

Part 2: The OSCE Scenarios reflect typical patient encounters for each field of nursing and midwifery. Scenarios developed written, tested and evaluated by teams of subject matter experts. Scenarios will allow candidates to demonstrate competence across the domains and essential skills clusters. Each nursing or midwifery practical exam will be made up a number of stations. Candidate will complete all stations and all stations must be passed. Mandatory elements such as informed consent, hand washing, safe medicines management and communication must be effectively demonstrated by candidates.

Part 2: The OSCE The focus of nursing and midwifery OSCEs are on the assessment of the holistic and integrated nature of safe and effective nursing or midwifery practice measured against current pre-registration education standards. OSCE Centre University of Northampton

NMC NMC Online Registrant Overseas Registration Process Research & Preparation Registrant withdraws / Reapplies IELTS 7 or above 12 months post-registration practice 3 year (equivalent) nursing programme Self declaration on health and character References available ID documents logged Complete Online Declarations/ Confirm Eligibility Notify of Unsuccessful Application 1 st Fail (re-sit) Part 1 Test Computer Based Pass 2 nd Fail All eligibility criteria evidences/valid References appropriate Fail x 2 Digital ID Documents consistent /accurate retries Initial fee paid Assessment Reject criteria not met Accepted 1 st Fail (re-sit) Part 2 Test - OSCE 2 nd Fail Pass Face to face checks at OSCE centre ID check Original document verification ID and Document Verification Missing/Fraud Confirmed Activate Registration

INTERNATIONAL(non-EU) PROCESS COMPARISON New Overseas Process (Test of Competence Based) Eligibility stage Start Process Online selfdeclaration Auto Confirm CBT stage Min 2 wks Average Prep 4 wks Exam: 0.5 day Timing depends on applicant preference. Document Submission Min 2wks Ave 4 wks Max 6 wks Online submission Verification by post Depends on applicant providing docs and regulators/ universities providing verifications Assessment stage Min 2 wks Average: 6 wks Max 12 wks Depends on volumes being processed by NMC Visa Min 4 wks Average 8 wks Max 14 weeks Depends on Home Office Arrival in UK. OSCE & prep stage Min 4 wks Average: 8 weeks Max 12 wks Includes travel to UK & familiarisation/preparation ID verification at OSCE Dependent on individual and employer decisions Registration Average: 2 days Max 5 days OSCE re-sit (including education/support) Min 4 wks Average: 10 wks Max: 16 wks. TOTAL (Pass 1 st ) Min 14 weeks Average: 31 weeks Max: 49 weeks. TOTAL inc. re-sit Min 18 weeks Average: 41 weeks Max : 65 weeks. Previous Overseas Process (ONP Based) Average 102 weeks for an applicant to register (max 174 weeks) Request Application Average 4 weeks Application Pack Issued Application Returned Timing dependent on applicant. 1 st Stage: Overseas Mandatory Average: 10 weeks Basic Eligibility Check Document Submission Average: 4 weeks Timing dependent on applicant. 2 nd Stage: Overseas assessment Average: 30 weeks NMC Document verification and detailed assessment Overseas Nursing Programme Stage Average: 52 weeks Find University ONP place Complete Placement (3-12 months) Registration stage Average: 6 weeks Final Declaration ID check interview. TOTAL Average: 102 weeks Max: 174 weeks.

Proposed Timeline Awaiting final confirmation from UKVI Visa Application 4-14 weeks Entry 2 W k Sponsorship Familiarisation and Preparation CoS Continued 10 weeks Sponsorship before Support & OSCE Education Employment Confirm eligibility Book CBT Sit CBT Submit Doc Evidence Confirm Evidence Book OSCE Sit OSCE Re-sit if req d Registration 1 Day 1 Day Applicant Choice to Allow for Preparation Applicant Dependent Approx 6 weeks 1 Day Applicant Choice Allow for Visa & Preparation. Can enter 10 weeks before OSCE date 1 Day 5 Days Applicant /Employer Choice up to 16 weeks education /support

International Process (non-eu) Operation to Date Introduced with effect 1 October 2014 Two Stage Test of Competence (CBT & OSCE) Stage 1 - Computer Based Test (CBT) 60% score overall and patient safety related essential questions correct to pass Adult RN1 Pass Rate % 100 90 80 70 60 50 40 30 20 10 0 Other pathways 6% Nov (95) 14% Dec (109) Jan (133) For Midwifery, Mental Health and Child Nurse - 10 candidates in total. Monitoring Stage 2 OSCE University of Northampton 84% After slow start CBT settling in Refined critical questions based on feedback Improved structure of guidance materials based on feedback Anecdotal evidence early candidates insufficiently prepared Added additional question set Continue to closely monitor University ready and waiting for applicants none yet at that stage. Several currently submitting their documents for assessment/confirmation

How you can assist Advise NMC of recruitment drives - currently not told of OS recruitment Employer Helpline: International.recruitment@nmc-uk.org 020 7681 5954 Fully understand the application process mistakes are repeated. We have guidance on most common mistakes. Preparation, preparation, preparation.

Thank you Questions and Feedback

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ecruitment and Induction of overseas staff to ACCU Timothy Kuhn Senior Charge Nurse Royal London Hospital Adult Critical Care Unit Practice Development Team

Background Overseas recruitment x 2 Spain and Italy/UK interviews PDN Team 3 Band 7 PDNs and 1 Seconded Band 6 Band 6 Secondment (Recruitment/induction) The unknown..

The Adult Critical Care Unit 44 beds 16 HDU 4F 28 ITU 4E Trauma/Neurosurgical/General Surgical/Medical/ Max fax/renal Approximately 200 bedside Nursing Staff

Cohorts of new staff Cohort 1 = 16 Staff July Cohort 2 = 12 Staff August Cohort 3 = 22 Staff September Cohort 4 = 7 Staff October Cohort 5 = 7 Staff November Cohort 6 = 5 Staff January 2015 Cohort 7 = 6 Staff March 2015 12 Jordan Nurse observers September 1 week induction 4 weeks supernumerary (Band 6s)

Inductions 2-4 days Cohort specific Not just work, work, work!! Not just ACCU The other stuff. Continuous evaluation Clinical Study Day and meeting at week 4

Supernumerary period 4 weeks Extension periods NMC registration Supernumerary passport/domains IV competencies Anxiety

Training Technician training During Induction Haemosafe During induction Pump training / IV study day Equipment training PCA and Epidural Study day Band 5 development course

Communication Differing levels of English Impacts on time management Communication specific objectives English assessments English classes (now trust wide) Communication sessions Use of other resources within the department

NMC registrations - Staff Without NMC registration - Replacement documents - Impact on staff development - Impact on staffing - Impact on living (Band 3) - 5 staff currently without NMC registration

Lessons learnt/tips English language Cultural differences Consider current staff Integrate current staff External training Documentation Competencies NMC delays HR process It gets easier!

QUESTIONS? Timothy.kuhn@bartshealth.nhs.uk 020 359 40331

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Feb 2015 The nursing workforce.. Stevens_jan Janice Stevens CBE

A perfect Storm NICE guidance Safe Staffing Mid-Staffordshire & Francis Report 5 year Forward View Activity and service changes Investment Commissioning Workforce planning www.hee.nhs.uk

Growing nursing workforce multifaceted challenge Train Retain Recruit Remain www.hee.nhs.uk

Create a reliable process Employed on the frontline Recruited Attend Trust Induction Complete Statutory and Mandatory Training Preceptorship Flexible working options Clinical supervision www.hee.nhs.uk 106

Return to Practice Mature nurses who bring a wealth of experience are likely to remain continually employed until retirement RTP courses have low attrition rates More cost effective returning nurses to the workforce

www.hee.nhs.uk

Impact The campaign has reached 1.2mil users on Twitter since launch. Cost 2000 per nurse Over 1000 nurses recruited to programmes Phase II Campaign launces in next 2 weeks Your role Get involved - promote Recruiting work with HEI Placements & support where nurse may wish to work Offer HCA role before & during Don t duplicate HR practices Challenge thinking on flexible working. www.hee.nhs.uk

Prevent people leaving Create more flexible working options Clear career options progression & development Start and end of career www.hee.nhs.uk Healthy workplace, reduce stress & burnout Preceptorship & Support

Stevens_jan ANY QUESTIONS?