Surgical solutions

How can the NHS solve its recruitment problems? And how effective is HR at coming up with new ways of attracting and hiring staff? Rob McLuhan takes a look at four big ideas helping to bring key staff into the sector.

1 Recruiting Overseas

Increasingly, NHS trusts are turning their attention to foreign countries, where a surplus of trained doctors and nurses is often to be found. The Government is actively promoting this channel, signing agreements with willing countries and providing guidance on where to look.

South Tyneside Healthcare Trust recently acquired three consultant anaesthetists and one orthopaedic surgeon from Germany and Austria - all vacancies that had been causing some concern. It also brought in two pharmacists from Spain. Lewisham Hospital NHS Trust has recruited from Germany, Sweden and Spain, and several others have found nurses in the Philippines, India, and other Commonwealth countries.

Trusts advertise vacancies in foreign journals, where doctors are being sought and will visit target areas to meet prospective candidates. Foreign consultants can also apply through a UK government fellowship for a one or two-year posting.

However, overseas recruitment holds snags, as some trusts have been finding. In South Tyneside, doctors initially found the idea of filling vacancies with foreign consultants quite alarming, and they needed to be reassured that this would not compromise quality. The doubts were laid to rest when the doctors started work.

"They were excellent candidates, so it's not as though we are having to make do," says Ian Frame, director of organisational development for South Tyneside Healthcare Trust.

Recruiters also found differences in the way German doctors go about seeking work, for instance preferring to make appointments rather than dropping in for a chat, which it would have been useful to know beforehand. And candidates often needed considerable help in preparing CVs, since there are important differences in the presentation and quantity of information required in the UK and other countries.

On the other hand, South Tyneside has not found the process more expensive, paying around £10,000 to fill the four posts. As an incentive, the trust offers free accommodation for up to a year, as well as two flights home for staff and their families.

The number of foreign nurses coming to the UK has more than doubled over the past year, and there are now 60,000 foreign nurses working in the health service. Around 19,000 are from the Philippines, which trains nurses for export with skills closely compatible with UK standards.

Dartford and Gravesham NHS Trust has been recruiting from the Philippines and is also starting to look at India. Director of personnel Colin Moore says relatively little extra training is required and it takes only around three months to adapt skills. "The main difference is that English nurses are clearly accountable for what they do, whereas in the Philippines the doctor is the preferred authority," he says.

Kings College Hospital NHS Trust has recruited about 100 nurses from the Philippines through a three-month supervised practice programme. That lowered a 20 per cent vacancy rate to 7.5 per cent in a year, and the trust hopes to reduce it still further.

'We haven't lost any nurses yet and they are making a useful contribution,' says staff resourcing manager Peter Absalom. The nurses are on two- or three-year contracts, which could be renewed and some are expected to stay longer. The trust has had applications from Australia, New Zealand, South Africa, and Canada.

2 Online recruitment

Private firms have been recruiting online for some years, but the public sector is starting to catch up. A recent study by Enhance Media showed that almost a third of online jobseekers have successfully found employment using the internet, so this is a channel that recruiters cannot afford to ignore.

Many trusts now have their own recruitment sites or are included in those run by local councils, and there also online agencies such as NHS Professionals, which recruits temporary staff (www.nhsprofessionals.nhs.uk ).

Ten NHS trusts in South West London have launched an online project that aims to fill 5,000 nursing vacancies in the capital (www.swlwdc.org ). The project is being carried out by the NHS South West London Workforce Development Confederation and will advertise about 250 jobs at a time, from consultants to hospital porters.

Jobseekers can register online and receive regular e-mail updates of jobs that interest them, although eventually they will be able to apply directly online. The trusts will be able to match available skills to current vacancies for medical and care staff as they arise. For the moment recruiters rely on the site management for access to the website, but will soon have direct access so they can use it to handle every aspect of the recruitment process.

"Trusts have their own preferences as to where they feel they get the best exposure, and this is not meant to replace other methods," says Sally Lissenburgh, communications and operations manager at the confederation. "The advantage of using a single pool is to share costs and compete on equal terms with private firms."

Over the past 12 months, Dartford and Gravesham NHS Trust has established a website that lists all its current vacancies, including clerical and technical staff. "Letting applicants download information at home is better than sending out expensive packs, and can speed things up," says Moore. The trust has also produced a seven-minute video for prospective candidates, which conveys a much fuller impression than a written document.

Jobseekers are showing a lot of interest in the system, Moore adds, although nurses may be somewhat less quick to use it than clerical workers, having less access to computers. However the aim has been to make the process quick and easy, so that people can log on in a few minutes at an internet café as well as taking their time at home.

Other trusts are benefiting from initiatives by local authorities. Surrey County Council is developing a public services websites that will include job advertisements for the NHS throughout the county, as well as universities, local authorities, the police and other services. David Thomas, HR director at Runnymede Borough Council, says the aim is to reduce the cost of recruiting staff and try to retain staff in the public sector in Surrey. At a later stage the site will co-ordinate opportunities for secondment, mentoring and career development. That is expected to aid retention of individuals in the public sector in Surrey, rather than losing them to other parts of the country.

3 Recruiting the unemployed

Besides doctors and nurses, the NHS requires a small army of clinical and administrative staff, as well as cleaners, porters, and maintenance technicians. In a period of almost full employment, filling this type of vacancy can be one of the biggest headaches for trusts.

Hospitals are major employers in their community and maintain links with job centres, local authorities and training organisations to keep up a flow of qualified personnel. But some trusts have been going further, setting up ambitious 'employability' schemes that provide a training pathway for the unemployed and disadvantaged in their area.

Some of these target specific groups. For instance, Kings College Hospital NHS Trust is running a programme aimed at the over-50s, as well as a work experience project for helping young mothers into work. The trust is also involved with the Cross River Partnership, a government project for sharing expertise across central London.

One of the biggest schemes is being run by the Leeds Teaching Hospitals Trust to confront serious problems with recruitment and retention. The scheme has been running for the past three years in partnership with the city council and other local organisations. As well as recruiting to specific jobs the scheme also provides training programmes that can lead to employment, either in the trust itself or elsewhere.

Of the 351 people who have started on the programme, 308 have gained employment with a 98 per cent retention rate, compared with 86 per cent for staff recruited through other channels. The areas recruited into include clerical, ward housekeeping, transport and porters.

Impressed by this success, the Northern Lincolnshire and Goole Hospitals NHS Trust recently started a pilot programme for hospitals in Grimsby and Scunthorpe.

Opportunities for basic training in a variety of posts are circulated via Job Centres and adult guidance centres, to reach people who are out of work and eligible for government funding. This funding is provided by the Government's Workbased Learning for Adults scheme, and the trust is also considering applying for funding for three year courses under the Modern Apprenticeships programme. Candidates are screened for aptitude and motivation, and if they are thought to be suitable invited for an interview and a look around.

"That gives them a chance to ask questions and decide whether the NHS is the right sort of employer," says Simon Dunn, employability manager for Northern Lincolnshire and Goole Hospitals NHS Trust. The trust also provides help with interview techniques and application forms. If they are successful, applicants are given training, which can lead to an NVQ.

"We can't guarantee a post at the end, but we can say to people they will be the best candidates if a position comes up," says Dunn. In some cases the training can be a fast-track to a job. One woman who had repeatedly failed to be considered as a healthcare assistant was offered a post within two weeks of starting training.

Out of 110 applicants since July, 40 adult learners are now training on site. Five have used their new skills to find work elsewhere, and another eight are now working for the trust. Development opportunities will also be made available they can progress up the career ladder if they wish.

4 Recruiting returners

Many NHS workers move into other jobs or leave to start families, and encouraging them to return is a major priority.

Two years ago the Government launched its 'returners' campaign, offering 'golden hellos' to GPs, doctors and consultants coming back into the NHS, and this has now been raised from £10,000 to £12,000. Those thinking of returning can also receive advice, training and support, including childcare and mentoring.

One of the biggest issues here is the need for flexibility. According to the Royal College of GPs, around 16 per cent of all UK GPs work part-time, and of these three quarters are female. Under the new programme, doctors will be able to spread their hours to enable them to fit in with school holidays, for instance.

That applies equally to nurses, who will return to the profession as long as the conditions are right. Local workforce development federations have working programmes for nurses, and the number of returners is expected to grow as the government's Improving Work in Lives initiative helps trusts to find the most appropriate working pattern.

"Many of them have had children and need assistance to get work and life balance," says Absalom of Kings College Hospital NHS Trust. The trust has been particularly successful in attracting and keeping returning nurses, which Absalom puts down to the effort it has put into providing a flexible working scheme over the past two years. It is now sought after by other trusts for advice and guidance.

One advantage of returning nurses is that they offer a lower attrition rate. "We often find that people returning from a break in nursing may well stay with us longer than others," says Absalom. "Those in their early twenties will tend to move on as they wish to build up their CVs."

Lewisham Hospital NHS Trust, however, has reservations about returners. "We are very keen on them, but in practice there are limitations on how many people are willing to return and on our ability to provide the flexibility they require," says director of personnel David High.

In 1999, Burnley Healthcare NHS Trust carried out a return-to-practice campaign with support from the local workforce development confederation. Its success was clear, bringing average nursing vacancies down to only seven by the following year.

The trust had recognised the need for flexibility, but there were problems it had not anticipated. One was the question of personal development. "We thought it would be a question of simply updating skills, but nursing has moved on," says Lesley Doherty, director of nursing and quality. The returners had been out of practice for an average of 13 years, and it took longer than expected to get up to speed.

One difficulty was trying to re-train nurses who held more than one post, for instance, spending one day in day care and another in an operating theatre. The trust got around this by implementing a 'buddy' system, providing individuals with on-the-job support instead of formal instruction.

Another unexpected problem was that the older nurses were used to a much slower pace. "Ten or 15 years ago they might have experienced a rate of admissions of four or five a day," Doherty says. 'But now it's 60 a day and average occupancy is almost 100 per cent, which is much more pressured.'

On the other hand returners tended to have more of the traditional skills of good patient communications. "That was a bonus and something that they gave back to us," Doherty says.