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 (

Ten NHS trusts in South West London have launched an online project that
aims to fill 5,000 nursing vacancies in the capital ( 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

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

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

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.

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