Staff Recruitment and Retention at the Hospital - Ministerial Response - 11th May 2016

Findings

Comments

1

Jersey  General  Hospital  faces imminent workforce pressures with many staff approaching retirement age.  This,  combined  with  the difficulties  of  recruiting  and retaining  qualified  staff,  makes current  services  vulnerable  due  to staff shortages.

The age profile of Registered Nurses and Midwives has started to reduce as a result of pre-registration nurse training and proactive recruitment. We do not believe that  current  services  are  vulnerable  today  due  to recruitment and retention issues. Of course this could change  in  the  future  should  new  recruitment  and retention challenges emerge.

From  a  medical  perspective,  this  offers  both  an opportunity and a risk: the opportunity to appoint new individuals who may offer a different scope of practice, but a risk that our more generalist' jobs may not be attractive to individuals who have specialised. However, responses to recent advertisements are encouraging.

2

Evidence  shows  that  the  main reason why clinical staff leave their roles is because they decide to leave the Island.

Staff  leave  for  a  range  of  reasons,  including – promotions elsewhere; opportunities to work within a clinical  specialism  not  provided  in  Jersey;  personal reasons;  older  families  and  carer  responsibilities; marriage breakdown; childcare commitments; childcare costs  for  more  than  one  child;  spouse/partner employment;  lack  of  opportunity  to  own  property; general  cost  of  living;  differences  in  terms  and conditions of service; university fees and means-testing; and general challenges of living within a small Island.

Within nursing, there is also movement across the local labour market.

Consultant and senior medical staff tend not to leave as frequently, but when they do it is almost always due to family circumstances.

Findings

Comments

3

The salary of a nurse is, on its own, insufficient to fund a mortgage for the purchase of a property on the lowest quartile in Jersey.

This  is  accepted,  but  is  also  the  case  for  many professionals in Jersey.

To  buy  here  they  would  probably  need  to  own  a property in the UK that they are able to and want to sell, along with being able to contribute significant equity towards  a  deposit.  It  would  also  be  influenced  by whether they can secure work for a spouse or partner in Jersey.

4

There has been a shift towards two- income families relocating to Jersey instead  of  single  people,  but  the housing  stock  within  the  hospital estate  has  not  reflected  this  shift. Within the current stock a lot more single  accommodation is available than family units.

This is correct. The intention is to undertake an HSSD Housing Survey, which will feed into the SoJ Strategic Housing Unit and Andium Homes plans. HSSD may need to consider extending the deposit on private rental scheme  to  those  moving  into  the  affordable  housing sector, as staff are now reporting they cannot afford to fund  flooring/lighting  and  furnish  the  properties  that have recently been made available for HSSD staff by Andium Homes (also covered in Q5 recommendations).

5

Relocation packages are important when trying to recruit externally as they could be a deciding factor for someone considering applying for a position.  If  relocation  packages elsewhere  are more  generous, this could put Jersey at a disadvantage when  embarking  on  a  recruitment drive.

There is no evidence that the value of our relocation package is a negative factor in recruitment and retention.

In fact, a survey of new recruits (registered nurses and midwives) undertaken at the point the package was put into place from July 2012 reported that the package was really helpful when relocating.

We have not had a consultant or senior doctor turn down a recruitment opportunity due to the relocation package.

6

High  cost  of  accommodation  and unpredictable  employment opportunities for a spouse or partner are likely to be two major hurdles couples face when one applies for a position at the hospital.

Yes this is accepted, as mentioned in 3 above.

7

There  has  been  a  shift  in  the demographic of nurses relocating to Jersey  where  it  is  now  more common for a nurse to relocate with a  family.  However,  the  cost  of  a university education could act as a deterrent  for  this  population  of nurses  because  if  their  teenage children  want  to  attend  university they  will  be  treated  as  overseas students even though they may have spent most of their life in the UK.

Yes this could be a factor.

However, our understanding from Student Finance is that the fees charged for Jersey students are normally the same  as  those  charged  to  UK  students,  with  a  few exceptions –  for  example,  Cambridge  University  and Imperial  College  charge  overseas  fees,  as  do  some conservatoires and art colleges. Of course, the English student loan system does not apply to Jersey.

Findings

Comments

8

Professional  indemnity  insurance has  become  a  major  issue  for hospital consultants in Jersey due to an  increase  in  premiums.  The necessity of having to pay and the uncertainty of what contribution the Health  and  Social  Services Department  makes  could  act  as  a deterrent for consultants elsewhere who might be considering applying for a position in Jersey.

There is no evidence that this has ever been a deciding factor  in  recruitment  or  retention.  All  prospective consultant  candidates  have  this  discussed  with  them before  they  are  interviewed.  The  only  uncertainty surrounds the premium changes that the medical defence unions  may  make  each  year,  which  is  outwith  our control. Doctors here or in the UK have to take out indemnity cover for their private work as dictated by the GMC.  It  is  a  contractual  requirement  in  Jersey  for doctors  to  have  continuous  medical  indemnity insurance,  this  is  supported  by  the  GMC.  Doctors without current cover are not able to practise. HSSD either pays all of their premium, if they earn <10% of their total income from private practice or 50% of their premium if they earn more than >10% of their total income from private work. No-one pays more than 50% of their premium. The vast majority are satisfied with this arrangement.

9

In  the  UK,  nurses  are  entitled  to more annual leave than is currently provided in Jersey. The disparity of annual  leave  entitlement  between the  UK  and  Jersey  could  be  a deterrent  for  a  nurse  considering relocating to Jersey.

This may be a consideration, but unlikely to be the main one (see answer to Q2 above).

10

Other  jurisdictions  offer  financial incentives such as  award schemes and high cost of living allowances. There are no similar incentives in Jersey and the higher remuneration rates  here  are  not  necessarily  an incentive  to  attract  staff  from outside the Island.

Our  pay-scales  reflect  the  London  cost  of  living allowance when we benchmark, so it is not paid as a separate allowance, but is already reflected in our pay- scales.

The Consultant pay-scale mimics the UK scale for the first few years, then goes beyond the UK scale to a significantly  higher  level  (£40k  higher).  This  is  to recognise that Jersey does not have access to Clinical Excellence Awards.

11

The  Health  and  Social  Services Department has been successful in training  nurses  and  midwives locally.

Yes this  is  true – 12 students  moved  into  staff nurse posts in October 2015. A further 12 are due to move into post from September 2016, 8 are due in 2017 and a further 12 in 2018.

12

In  2014,  the  Health  and  Social Services  Department  successfully offered a Return to Practice course for  nurses  wishing  to  return  to nursing  after  a  career  break. However,  a  course  has  not  been offered subsequently.

A press release announced the last Return to Practice programme in 2014 and it was advertised in the Jersey Evening Post. However, the take-up was minimal, with 4 staff starting the programme and 3 completing it. This was not cost-effective, and due to competing demands on  the  lecturers'  time,  a  decision  was  made  not  to advertise in 2015. There are plans to advertise again in May 2016 with a similar press release and advert in the JEP, plus additional exposure on local TV and radio.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

Negotiations should continue in order to resolve the disparities between terms and conditions and employment mechanisms in Jersey and Guernsey so that collaborative work within the medical profession can take place between the two Islands.

HSS

Reject

No  negotiations  are  underway  or planned to harmonise Jersey consultant T&Cs with the Guernsey medical staff. The 2 departments have very different contractual approaches to the provision of medical services.

Jersey aligns itself much more closely to the UK contract and T&Cs for good reasons. Firstly, all doctors in Jersey have  to  be  GMC  registered  and, therefore,  being  in  line  with  UK standards  and  practices  is  hugely beneficial; secondly, we appoint most doctors  from  the  UK,  so  having  a similar  contract  makes  Jersey  more attractive  and  secure;  thirdly,  the system in Guernsey would not offer us the  same  clinical  input  that  we currently enjoy.

Notwithstanding  the  above,  the differences  should  not  prevent collaborative  working  by  clinicians, and indeed this is already happening in Ophthalmology  and  Urology.  Should doctors wish to practise in each other's jurisdiction, then they would be subject to  all  of  our  recruitment  safeguards around pre-employment checks: Royal Court  registration,  references,  health checks,  etc.,  and  would  require  an honorary or paid contract. This process should  never  be  compromised,  as  it provides  the  appropriate  governance assurance.

N/A

2

The Panel is encouraged that the Health and Social Services Department is reviewing whether consultants should travel to Jersey to see several patients, rather than sending patients off-Island. The Panel recommend that the findings of this piece of

HSS

Accept

All  off-Island  activity  is  being reviewed  and,  where  appropriate, visiting  consultants  will  be  sourced rather  than  patients  visiting  the  UK. Indeed,  this  already  occurs  and currently  there  are  approximately  30 visiting consultants. However, for the majority of our patients this will not be a  viable  option,  as  they  require specialist  facilities  or  investigations not  available  on-Island,  or  we  have insufficient  demand  to  cohort  a

Ongoing

Recommendations

To

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Comments

Target date of action/ completion

work should be shared with the Medical Directors Group and reported back to the States Assembly before the end of 2016.

number  of  patients  together  in  a reasonable timescale in order for them to be seen by a visiting consultant.

Assuming  that  the  term  Medical Directors  Group'  means  the  Clinical Directors in HSS, then this is the group that will be making the decisions about on- and off-Island activity. This work is  constantly  ongoing,  and  while  an update  can  be  given  by  the  end  of 2016, it will not be a formal report or complete  piece  of  work,  as negotiations  and  contract  variations occur continuously.

3

The Health and Social Services Department should investigate and maintain a record of the factors which lead to its hospital staff deciding to leave the Island. This will enable the Department to ensure its employment practices encourage better retention of staff.

HSS

Accept

For some time we have recorded the reasons  for  leaving,  and  we  will continue to do so.

We offer and carry out exit interviews, but they are not compulsory.

Ongoing

4

The Panel is encouraged that consideration has been given to recruiting from Portugal, Madeira and Poland. The Panel recommend that research into recruitment from these jurisdictions is continued and that relationships are established between the Department and their health authorities so that recruitment and exchange of staff can be made to work in the interests of all parties.

HSS

Accept

Best practice is for a health and social care  provider's  workforce  to  be proportionally  representative  of  the local population, and we will continue to seek to ensure this is the case.

Ongoing

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5

The Minister for Health and Social Services and the Minister for Housing should pursue discussions with Andium Homes with a view to providing appropriate accommodation for health staff to rent or purchase. The outcome of these discussions should be shared with the Scrutiny Panel in September 2016.

HSS

Accept

A  survey  of  the  housing  needs  of HSSD staff is due to be undertaken, which  will  feed  into  the  States  of Jersey's strategic housing plans.

Until a more formal process is in place, Andium  Homes'  accommodation availability for HSSD staff is sent out via  the  accommodation  office  and HSSD Communications unit.

September 2016

6

The Health and Social Services Department should ensure that the Jersey relocation package is competitive with other jurisdictions.

HSS

Accept

There is no evidence to suggest that the  current  relocation  package  is adversely affecting recruitment.

Benchmarking  against  other jurisdictions is constantly undertaken. Any  uplift  would  have  to  be considered  along  with  all  other  cost pressures facing HSSD.

Ongoing

7

The Panel recommend that there should be discretionary powers under the Control of Housing and Work (Jersey) Law 2012 to grant "Entitled to Work" status to a partner of a medical professional moving to Jersey provided that partner can demonstrate the settled long-term nature of their relationship.

HSS

Accept

This is not within the gift of the Health and  Social  Services  Department; however,  any  moves  that  assisted  a non-married  partner  of  a  medical professional  into  employment  would be welcomed by HSSD.

N/A

8

Clinical staff considering moving to Jersey with a family should be made aware, via written communication, that Jersey-based students are treated as overseas

HSS

Accept

Medical  staff  moving  to  the  Island have pre-interview conversations about living and working in Jersey with HR and with existing employees, and this is raised then. The SoJ website could add  this  and  could  suggest  to applicants  that  they  contact  Student Finance if they have specific questions.

N/A

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students when applying for university places in England and therefore are liable for increased fees.

However,  our  understanding  from Student  Finance  is  that  in  terms  of university fees, Jersey students are not generally classed as overseas students, with  some  exceptions  in  terms  of certain  universities  and  courses  (see Finding 7  above).  Of  course,  the English student loan system does not operate here in Jersey.

9

The Panel recommend that the uncertainty regarding professional indemnity insurance for consultants is brought to an end and that the Minister for Health and Social Services expedites a decision concerning the contribution of premium reimbursed for their public practice by the end of 2016.

HSS

Reject

There is no evidence that this has ever been a deciding factor in recruitment or retention. All prospective consultant candidates  have  this  discussed  with them before they are interviewed. The only  uncertainty  surrounds  the premium  changes  that  the  medical defence unions may make each year. Doctors here or in the UK have to take out indemnity cover for their  private work as dictated by the GMC. It is a contractual  requirement  in  Jersey  for doctors  to  have  continuous  medical indemnity insurance, and this position is  supported  by  the  GMC.  Doctors without current cover are not able to practise. HSSD either pays all of their premium  if  they  earn  <10%  of  their total income from private practice, or 50%  of  their  premium  if  they  earn more than >10% of their total income from private work. No-one pays more than 50% of their premium. The vast majority  are  satisfied  with  this arrangement.

N/A

10

The Health and Social Services Department should increase holiday entitlement for nurses in Jersey to bring it closer to that in the UK

HSS

Accept

However, in practice, any such move is not  within  the  gift  of  HSSD.  Any increase would be part of the States of Jersey  workforce  modernisation proposals,  overseen  by  the  States Employment Board (SEB). Any such increase  is  likely  to  be  modest  and apply to all staff, not just nurses.

2017

11

The Health and Social Services Department should explore the feasibility of introducing financial

HSS

Reject

The introduction of a retention bonus has  been  previously  considered  and raised  with  SEB  as  an  option. However, the actual reasons for staff leaving  within  a  short  period  of

N/A

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incentives in order to attract more clinical staff from elsewhere. In particular, the Department should consider the introduction of a retention bonus after a period of service.

employment (less than 2 years) have, in general, meant that this would not have impacted on their decision.

Guernsey  has  adopted  such  an approach, but we are not aware that it has been effective. It has a very high percentage  of  nursing  vacancies  and has struggled to retain staff over the years.

One  of  the  disadvantages  of recruitment  and  retention  bonuses  is that staff will shop around for the best deal rather than a real commitment to remain  in  post,  which  affects continuity and patient care.

We understand many UK NHS Trusts have  trialled  and  abandoned  this approach.

12

The overall price level for consumer goods and services in Jersey is 20% greater than the UK average. If the Health and Social Services Department is to resolve recruitment issues, the issue of pay levels that are appropriate to higher costs of living in Jersey must be addressed.

HSS

Accept

This will be addressed as part of the States  of  Jersey  workforce modernisation  programme,  overseen by the States Employment Board, and therefore is not under the sole control of HSSD.

The  2012–14  public  sector  pay settlement  saw  higher  increases  for nurses,  recognising  the  work  being undertaken on providing equal pay for work  of  equal  value  and  addressing recruitment and retention issues.

2017

13

The Health and Social Services Department should maintain its training programme and, if possible, enhance it in order to attract more students to remain on-Island once qualified.

HSS

Accept

A nursing degree programme has been taught on-Island since 2000, partnering with  the  University  of  Southampton and, more recently, the University of Chester.

Registered  nurses  and  midwives  can access  a  range  of  professional development  activities  on-Island. e.g. in-house  conferences  and  study days.

Staff are supported to access specialist training off-Island or to attend subject- specific conferences off-Island if it is identified as a need to support services and staff development.

Ongoing

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Since 2013, nurses and midwives have been  able  to  access  post-graduate Masters degrees, which enables staff to take  on  advanced  practitioner  roles, e.g.  in  the  cardiac  and  colorectal services.  All students  who  study  on- Island have access to all of the above initiatives,  and  we  now  have  former students who are managing wards and departments,  and  developing  the services they manage.

14

The Health and Social Services Department should undertake a public awareness campaign regularly to try and attract nurses back into the profession. The Department should also contact former members of staff living in Jersey to ascertain the reasons why they left the nursing profession and what might attract them to return.

HSS

Accept

This  exercise  has  already  been undertaken  on  2 occasions.  However, the number applying and completing a return to practice programme has been negligible,  and  requires  significant one-to-one  lecturer/mentor  support. The next exercise is planned for early 2017, with a campaign led by the Head of  Nursing  and  Head  of  Midwifery Education.

A  public  awareness  campaign highlighting  graduate  Mental  Health Nurse  programmes  and  a  BSc  in Operating Department Practice would be  a  more  cost-effective  use  of advertising funds.

2017