Agenda item

Dr Angela Bhan, Managing Director, Bromley CCG, and co-senior responsible officer for workforce for OHSEL, introduced a paper on NHS workforce issues. She confirmed that they were still awaiting a full strategy from NHS England, and were working to the Interim People Plan. The workforce stream in South East London was looking at what could be best done on a collective level, adding value to the work of individual organisations. There were significant challenges in recruitment of nurses and GPs and developing a new type of workforce, with new roles such as Nursing Associates. The delivery plan responded to the challenges of the Long term Plan and the Interim People Plan under five headings -

·  Capacity;

·  Capability;

·  Contracts and governance;

·  Culture; and

·  Collaboration, engagement and enabling. 

In response to a question from Councillor Noakes, Dr Bhan explained that there were many educational providers in the area, and CCGs worked with the Local Workforce Action Board (LWAB), a multi-agency forum which looked at workforce issues, including the training of doctors and nurses, and there were a variety of local schemes involving local schools and colleges. Training slots for mainstream nursing were still all being filled, despite a reduction in applications. More could be done, especially to work more consistently across South East London. Julie Lowe added that the headline turnover rate across South East London was about 12%, much of which was normal and within the area, but this masked some very high turnover in some specialities. The pattern of turnover tended to be different between the inner and outer London acute trusts, and analysis was complicated as nurses moving to GP practice were counted as leaving the service. In terms of the impact of Brexit, the number of European nurses employed within the 46,000 workforce was relatively small, but anecdotally this number could be swelled by those affected by the status of other family members or an atmosphere where foreign staff felt that they were not welcome. 

Councillor James raised the issue of the vital agency staff and ancillary workers in cleaning and catering roles, and whether all staff received at least the London Living Wage. Dr Bhan agreed that these staff were important and included, and stated that although OHSEL did not employ staff the local trusts and their contractors were using responsible employers. Julie Lowe reported that a study had been carried out into whether all employers were paying the London Living Wage. She could not confirm the details, but conditions in London meant that it was usually difficult to recruit staff without paying the London Living Wage. 

Councillor Olisa commented that there would clearly be substantial changes to many people’s jobs, so full consultation was required. She was concerned that there were very significant changes that needed to be discussed with the Trade Unions at an early stage, and that there would be resistance if this was delayed until late in the change process. Dr Bhan agreed and stated that Trade Unions had been involved; she stated that much of the change would be gradual and evolutionary, empowering staff to train and develop, rather than a “big bang.” She added that there was a London-wide forum with the Unions, and that they had organised themselves to ensure that there was proper representation and dialogue in each STP.

Councillor Muldoon asked how many doctors or nurses had to opt out of the Working Time Directive, or routinely breached it, leaving them tired and overworked, and causing safety issues. Dr Bhan accepted that there were still staff breaching the Working Time Directive, but the situation was much improved and staff were more aware of when they were too tired to work effectively. Julie Lowe stated that no-one could be required to opt out of the Working Time Directive, and all junior doctor rotas were compliant. The situation was complicated, as staff worked additional hours for various reasons. Dr Bhan added that there was an individual guardian in each organisation overseeing how junior doctors worked. The situation was now much more flexible for medical professionals.

Councillor Diment commented that, unlike some other industries, there appeared to be little effort to reach out to young people (at 13/14) to inspire them to take up careers in the health service. He was also concerned that with the acute trusts already having vacancy rates of around 11%, and severe shortages of some staff, such as physiotherapists, plans to create thousands of new roles in primary care networks across the country were not realistic. Dr Bhan agreed that this was a challenge - it was estimated that the proportion of the workforce in England working in the health/social care sector would need to rise from 1:12 to 1:8.  She considered that some of this would best be addressed at borough level working with partners and spreading good practice. Julie Lowe added that there were programmes such as Future Nurse reaching out to primary schools, and Healthcare Ambassadors. Some of the primary care network roles would be flexible and offer new opportunities to staff who might otherwise leave the health service.

Julie Lowe clarified that the NHS People Plan had not been published, and indeed there was no publication date yet - only an Interim People Plan 2019/20 was available. There would be a workforce chapter in the Long Term Plan based on the Interim People Plan, but the full People Plan was awaited and she expected to be required to provide a full response based on the full five year scope of the Long Term Plan. Councillor Hunt commented that the NHS decision not to consult meant that the JHOSC could not comment - any JHOSC comments could only to be based on the Interim Plan.

Dr Bhan explained that the people Plan would have strategic changes, but most changes would occur gradually and not overnight. There were lots of individual pieces of work behind this - some of these involved supporting non-clinical practice staff to take on more roles so that clinicians could use their skills more effectively, and utilising social prescribing in PCNs. The changes would be strategic, but would reflect how the workforce and health sector changed over time anyway. The Chairman commented that the timeline was important, and training had to be in place - South East London Colleges would be crucial in this. The public needed to be informed of the new roles and titles.