THE NHS RECRUITMENT GAP: a special investigation - Part One: Recruiting at Great Western Hospital is not just about bringing nurses from overseas

Written by Tony Millett.

At the end of December, Great Western Hospitals Foundation Trust (GWH) employed 1,964 nurses - that was 161 more than they were employing in April 2013.  But they still have 125 nursing vacancies in the main Swindon hospital, in community hospitals (including Savernake), in clinics in Swindon, and in their new and expanding community nursing teams for adults.

Recruiting the right nurses for the specific vacancies is not a simple matter.  As Oonagh Ftitzgerald, GWH's director of workforce and education, told Marlborough News Online, two years ago, before the Francis report on the Mid Staffs scandal set new patient-nurses ratios, GWH did an audit of its nursing skills and committed £1.3 million to augment its nursing staff.

Wherever you look in the NHS you find people worrying about shortages of staff.  At the recent meeting of the Wiltshire Clinical Commissioning Group's board, staff shortages and recruitment were highlighted as "One of our biggest risks as regards delivery."

The recruitment gap is hurting the NHS and this series of articles looks at three aspects of the problem.  This first article looks at the way GWH has been seeking to boost its recruitment of nurses.  The second article will look at the government's 2011 pledge to recruit 4,200 more health visitors by March 2015.  The third article looks at the nursing numbers game and its place in the political football around the NHS.

Oonagh Fitzgerald, GWH's Direcor of Workforce & EducationOonagh Fitzgerald, GWH's Direcor of Workforce & EducationKeeping on top of GWH's nursing intake is a year-round job for Oonagh Fitzgerald and her team.  After all, like everyone else, nurses do retire.  Or they get fed up with low pay and no pay rises and they leave.  Or they leave the NHS for a commercial health provider.  Or, like many doctors, they find a better way of life abroad.  They can also switch between health care roles to enhance their careers.  And the needs of the hospital can change.

GWH has a firm relationship with Oxford Brookes University's department of clinical health care in Swindon.  Students do their practice placements at GWH and Oonagh Fitzgerald aims to recruit 90 per cent of the 75 nursing graduates who emerge from Oxford Brookes each year.  Their great advantage of these graduates is that many of them are local to the area.

But GWH's recruitment work starts well before that.  Nurses go to St John's Academy each year to talk to six formers. "Our staff," says Oonagh, "really enjoy it, they get a lot out of it - showing people that health care is a fantastic career."

They can explain Oxford Brookes' application forms and do practice interviews for sixth formers who may want to be nurses, pharmacists or doctors.

There are many other recruitment tools GWH use.  They held a three-day  "Dare to nurse course" which attracted seventeen 17 year-olds from schools for an in depth discovery process about nursing, seeing the hospital in action and meeting staff.   Quite an effort for 17 prospective nurses - but still worthwhile.

GWH has a 'return to practice' scheme for nurses who have left to start a family or moved to other jobs and want to come back to some area of health care.  They provide bursaries (£1,000 for nurses and £500 for midwives and health visitors) to do a refresher course run by the University of the West of England.  

They also target working nurses who may want to return to acute care.  To suit their lifestyle, they may have gone into part-time work perhaps in a care home or as a GPs' receptionist.  In six months GWH has successfully brought 42 nurses back to acute care working.

They have an active (and prizewinning) Twitter account that helps keep young people interested in working at GWH.  And they target special areas with recruitment days like the one to be held at Savernake Hospital on February 27.

The number of nursing vacancies matters financially as most vacancies have to be filled in with expensive agency nurses.  At the moment GWH's nursing budget for 2014-2015 is overspent by £3million.

That overspend is not just about agency costs.  There is, of course, the increased post-Francis Report concern about patient safety and nurse to patient ratios.  But a major secondary factor is the growing number of patients who are older with much more complex conditions.

Oonagh Fitzgerald says GWH is seeing "more and more" patients who need one-on-one 24/7 close nursing support.  They may have dementia and wander, or be liable to fall - or be abusive.  "That is a very expensive but essential option for us."

Then there is the recruitment of nurses from the EU.  Oonagh Fitzgerald stresses that this is nothing new in the NHS.  In earlier times, the NHS has recruited from the Philippines, from India and from the West Indies: "Part of what makes the NHS such a lovely place to work is its diverse workforce."

In 2014 GWH recruited 114 nurses from Spain and Portugal, countries where  training to be a nurse is a year longer than in the UK and where English language skills are good.  

GWH uses an agency that knows exactly the kind of recruits GWH is looking for to do essential checks with the local police, on English language skills and on academic achievements.  Then a team of three senior GWH nurses travels to interview them face-to-face.

Oonagh Fitzgerald gets a report from Chris Bull, Matron overseeing Site Management and Patient FlowOonagh Fitzgerald gets a report from Chris Bull, Matron overseeing Site Management and Patient Flow


They cannot all be brought over at once.  As Oonagh says "It wouldn't to be safe for our patients if we brought 114 in one go."  When they arrive they need accommodation - often in groups of friends (flats on bus routes are the mainstay) - and are interviewed again for specific jobs and roles with GWH: "My team have been amazing - working above and beyond to make them feel welcome."

In March and April they are going back to Spain and Portugal for 20 more recruits.  And this time they are going to Italy as well looking for six paediatric nurses to help support their new children's emergency department (or A&E.)   In Italy they place great store by paediatric training.

Oonagh Fitzgerald's job is not just about nurses, but about recruiting doctors, pharmacists, specialists and also about providing further education so nurses can increase their skills and knowledge, get promotion and so be encouraged to stick with the GWH.

Keeping the recruitment pipeline flowing is a permanent challenge.  For instance, the serious dip in training numbers earlier in the decade (which we will come back to in the third article of this series) will have an impact next year and the year after - reducing the numbers of available British trained nurses.

GWH cannot order more training places for nurses, but they can influence Health Education England who oversee training numbers and control training places.  "Do they listen to you?" "They are now."  So in future the pipeline may, repeat may, flow more efficiently.