Published: 26/05/2005, Volume II5, No. 5957 Page 32 33

NHS staff are continuing to leave the capital as they struggle to cope with the high cost of living. Stuart Shepherd finds out how trusts are hoping to stem the flow

The headline in London's Evening Standard on 25 April served as a blunt reminder of the scale of the task facing NHS recruiters in the capital. 'Staff exodus causes nursing crisis' was the bold announcement at the top of a report about Royal College of Nursing statistics claiming as many as 13 per cent of London nurses had left the NHS in the last year.

To many, however, this was not really news. A 2003 report from the King's Fund - In Capital Health? Creative solutions to London's NHS workforce challenges - had already drawn attention to the pressing issues of recruitment and retention.

The key data from that report was updated in the King's Fund working paper Trends in London's NHS workforce , published in March. Co-author John Buchan, visiting research fellow in health policy at the King's Fund and professor in health and social sciences at Edinburgh's Queen Margaret University College, explored those earlier findings against a number of changes since introduced across the NHS.

'None of the challenges have disappeared, ' says Professor Buchan, 'but there has been progress in some areas'.

'Staff numbers have improved and spending on agency staff seems to be down. More applicants for nurse training in London are from those already living in the city and there has been a steady number of professionals returning to practice after breaks in service. Childcare provision is also better.' The working paper goes on to list strategies to underpin this progress and meet the demands of the national agenda.

'The policy shift to creating new services and roles in the community requires further programmes that help staff move between the acute and primary sectors, ' says Professor Buchan.

He also believes recruitment must be better targeted at local minority ethnic groups. 'Workforces should represent the communities they serve. Entry paths for potential candidates could be improved and the NHS better promoted as part of a deliberate strategy to 'grow its own'.

'It is important that the labour issues that make London so distinct are not marginalised by an overriding focus on national priorities [such as Agenda for Change], ' he adds.

At South East London strategic health authority, workforce director Annie Brough is familiar with the challenges outlined in the updated King's Fund paper. And regular meetings with colleagues across the capital give her a good sense of the picture in the four other London SHAs.

'The high cost of living, population growth, staff turnover and the ageing profile of some sectors of the workforce are our most pressing concerns, ' she says.

'There is no problem attracting staff to London for a spell in their career.

Recognising the attraction of the capital's training opportunities is certainly something to play on. But after a few years those staff move out, and this continues in significant numbers. The workforce community know that we need to recruit more Londoners because they are the ones who stay with us.' The success of recruiting and retaining clinical staff from London lies in the quality of the training experience, says Annie.

'Evidence tells us that good placements during training encourage people to stay on and apply for jobs. The past three years have seen huge investment in the role of placement facilitators, who help the trusts and universities in south east London and beyond create supportive learning infrastructures.

'And It is not only the quality that has improved, ' continues Annie. 'Having more placement sites has reduced the number of 'pinch-points' and seen clinical training expand.' Improving Working Lives initiatives also make a difference. An additional 60 nursery places at King's College Hospital trust has helped reduce staff vacancies to 7.3 per cent. And in south-east London up to 130 families have benefited from the government's key worker housing scheme to help public sector workers in London and the South East buy their own home.

Staffing levels have also been bolstered by an 'international recruitment at home' project. 'We recognised that a significant number of people living in our region had nursing qualifications from West African countries. We have started adaptation programmes so that they can practise here, ' explains Annie.

Kingston Hospital faces the same problems as a number of outer London trusts competing for staff with their higher profile inner-London neighbours.

Situated in an area of relative affluence, the challenge is made greater by expensive housing costs.

In March 2004 the trust developed a recruitment and retention strategy to tackle an annual staff turnover rate of 18 per cent. Director of human resources Oonagh Fitzgerald has been particularly pleased with the success of some of the initiatives from the strategy, which has helped cut staff turnover to 14 per cent.

'We introduced online recruitment, with job specifications and application forms posted on our website. Now 50 per cent of all candidates apply through this route, ' says Oonagh. 'In time we intend to recruit for all our vacancies exclusively by this route. The savings on our advertising budget will be enormous.' The trust also introduced a series of 'gold-standard' open days to promote vacancies in its maternity services.

'Scotland is currently producing more midwives than it can use so we developed links with several of their colleges. We help potential candidates with their flight arrangements and lay on a coach from the airport, ' explains Oonagh. 'They stay with us for three days and they meet all the senior staff associated with the department.' Midwifery vacancies are now at a bare minimum.

Another important component of the strategy is the childcare co-ordinator advisory service. 'The co-ordinator helps parents with childcare concerns - such as mothers returning to work after maternity leave. She also liaises with managers for flexible working hours. Last year we had 116 staff go on maternity leave, so It is a valued service.'

Find out more

Trends in London's NHS Work force www. kingsfund. org. uk/pdf/ workforcetrends. pdf


Compliance with the European working-time directive and the NHS Improvement plan prompted the South East London workforce development confederation to create two new roles to complement the work of the direct patient care team - clinical technicians (CTs) and clinical assistant practitioners (CAPs).

At University Hospital Lewisham these posts have been introduced as a response to the changes to junior doctors' hours and enhanced care standards. The entry-level position is technician and, for those wishing to progress, a foundation degree leads to accreditation at practitioner level.

Among the first group of CT recruits to take up training at UHL in March 2003 was Anthony Robertson.

'I was attracted to the job because it gave me the chance to develop indepth clinical skills along an exciting career pathway, ' says Anthony. 'Now I am qualified to take blood, insert cannulas and perform electrocardiograms.' Other core skills include basic observations and rapidresults MRSA screening.

As a senior technician Anthony now provides support to junior colleagues across a number of clinical areas. The team provides 24/7 cover on the wards, while in accident and emergency the service operates from 10am to 10pm.

The CAP foundation degree at South Bank University began in September last year, and Anthony is one of three clinical technicians from University Hospital Lewisham on the course. It teaches students enhanced theory and competencies to be able to plaster, suture and care for wounds.

His previous employment is indicative of the diverse areas from which the scheme hopes to attract new practitioners. 'I was a nurse recruitment consultant and had been a combat medical technician in the Territorial Army, ' says Anthony.

The foundation degree also offers a fast track into nurse training and an entry route onto a medical degree at Guy's, King's and St Thomas' medical school. 'I can definitely see a CAP following this route, ' says Anthony.

'The course is structured around NHS skills frameworks, has national recognition and lots of credibility.'