The national economic situation, COVID-19 recovery and NHS pay negotiations have had an impact on hospice recruitment and retention across the whole country. Peace Hospice Care experienced some extra challenges:
A significant proportion of the clinical workforce are aged over 50, which means more staff are nearing retirement age and there are fewer younger people to take over roles.
There are several hospices and palliative care providers in the local area, which gives jobseekers a lot of choice. It is not uncommon for people to accept a role, then pull out because they got a better offer.
The proximity of the hospice to London means that people don’t have to go very far to get London weighting on their salary.
If staff are coming from the NHS, they are required to give three months’ notice (however outgoing hospice staff only need to give one month). This means that even if a post is filled quickly, there will be a staffing gap.
The hospice needed to act before staff shortages had too much of a negative impact on safe staffing levels, morale and wellbeing.
Outcomes
Peace Hospice developed new roles to help solve the staffing problems. These included:
Nurse associates
Nurse consultants
Clinical Fellowship
Head of Pharmacy
Assistant Allied Health Practitioners.
They set up a Palliative Care Response Team, led by a virtual ward sister and including paramedics, to work with the local Macmillan community nurses.
Facilitators, challenges and advice
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Key facilitators
The hospice has a good relationship with the West Hertfordshire Hospital Trust, who have a good international recruitment programme. Peace has now gained a Home Office licence to employ international candidates. This really opened up the recruitment pool.
Peace worked with two agencies to fill staffing gaps. They trained a group of nurses to work in the hospice, knowing they were likely to return over time. This helped make sure the quality of care was always high, but also gave the hospice a level of flexibility over staffing patterns.
The merger with Rennie Grove Hospice, along with the development of several new posts, has helped create a clear career development path for staff. It is now possible to join the team as a Healthcare Assistant and progress to Director!
The hospice carries out weekly monitoring for safe staffing levels. If staffing goes below 80%, this now triggers an automatic reaction (this might be recruitment, employing temporary agency staff, etc). This helps ensure the staffing situation does not escalate.
Challenges
Working with the local Acute Hospital Trust, the hospice developed a system of rotational posts for nurses. This was very successful – so much so that, when they finished their rotation in the hospice, nurses wanted to stay! Unfortunately, this meant that the hospital decided to stop promoting the programme.
While it is positive that a number of new staff have joined the hospice, this has resulted in a loss of ‘organisational memory’. Processes have not always been cascaded.
Tips and advice
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Make sure you fully understand the problem and take appropriate action in response. If a team is overstretched, is this because they need more staff, or because they are receiving inappropriate referrals?
When recruiting and on-boarding new staff, move fast! Keep in contact with candidates and sell your hospice!
If you are recruiting internationally, you might find that some candidates come from a country that has a different model of palliative and end of life care to the UK. It is helpful if international candidates understand hospice care.
Listen to your staff and make changes to help retain them.
