NHS recruitment and staff record-keeping are important levers in the push to improve patient safety. Stephen Dangerfield explains

Recruiting safe, qualified employees in a timely and cost-effective manner and maintaining their employment records are challenges for all NHS organisations, particularly in the case of flexible workers.

And these challenges are getting greater as recruitment standards are raised in response to patient safety and data protection concerns, particularly in the following areas:

  • verification of identity checks;

  • right to work checks;

  • registration and qualification checks;

  • employment history and reference checks;

  • criminal record checks;

  • occupational health checks.

In addition, the changes included in the Safeguarding Vulnerable Groups Act, which lays the foundation for the new Independent Safeguarding Authority scheme to be rolled out from 12 October 2009, will introduce the most stringent vetting and barring service yet. This will build on current legislation around pre and post-employment checks to provide a more robust system to prevent unsuitable people from gaining access to vulnerable adults and children.

Records gaps

NHS Professionals is the largest recruiter of flexible workers in the NHS. Even though our core processes include recruitment and file management, there have been times when we have struggled to do this well.

In autumn 2007, we identified a problem with our historic recruitment and file management processes in that a percentage of our pure bank flexible workers had incomplete documentation.

Our flexible worker recruitment and documentation management processes underpin all our services. Once issues were found in these processes, we launched a high-priority effort to assess the situation and implement necessary changes.

As part of this work, we asked the NHS Purchasing and Supply Agency to conduct an audit of our existing processes. This showed that our current processes were thorough and robust and in line with safer recruitment standards for our bank only flexible workers.

Changes we have introduced include:

  • changes to our implementation methodology to ensure we correct imperfect files when we transfer staff from new client trusts under the Transfer of Undertakings (Protection of Employment) Regulations (TUPE);

  • changes to our systems and processes to prevent workers with incomplete or out-of-date documentation from working (for example, qualified staff cannot be booked unless the Nursing and Midwifery Council registration has been checked and is current);

  • a secure electronic scanning and filing system to ensure all documentary evidence is properly indexed and recorded, including regular exception reporting.

Over the past year, we have learned many lessons that can be equally applied to trusts that run their own banks, as well as to processes associated with substantively employed workers:

Establish governance as a leader in quality improvement

We have found that governance must play an important leadership role in the continuous review and improvement of processes, as these processes affect our ability to provide safe, qualified workers to our trusts and ultimately to patients.

Perform regular audits

Audits of processes and worker documentation must be performed at least annually to ensure safer recruitment standards are met. This is especially critical now that the standards are being raised.

Create appropriate organisational focus and investment

Recruitment and employee records management understandably receive less focus than frontline patient care. However, given the increased safety concerns and liabilities associated with workers who do not have proper qualifications, we believe there is a need for increased focus and investment in many trusts. We have put in place an electronic scanning and filing system for all our flexible worker files to ensure documentary evidence is properly secured and maintained with appropriate exception reporting.

Define excellence

It is difficult to assess the performance of a process if excellence is not defined in clear, measurable performance targets. Once these targets are defined, then any gaps can be identified and solutions developed to close the gaps. It is critical to establish a performance monitoring culture that is relentless in its pursuit of excellence.