News Tuesday, January 5th

Revealed - the struggles of Wye Valley NHS Trust to recruit and keep staff

Latest figures show some 359 whole time equivalent (WTE) posts are currently going through recruitment processes at Wye Valley NHS Trust (WVT).

The trust acknowledges that on-going struggles to recruit and retain staff have been hampered by its “special measures” status and financial difficulties.

But there is evidence, too, that salaries on offer aren’t seen as enough to overcome perceptions of the county’s rural nature.

A re-assessment of the trust’s special measures status - imposed by the Care Quality Commission in October 2014 - is due as soon as this month.

Vacancy figures for October last year - the latest publically accessible - indicate the position the trust finds itself in trying to recruit some 359 whole time equivalent (WTE)  posts.

This equates to approximately 14% of the workforce, with bank recruitment additional to these numbers.

Against this, there was an increase of 7.84% WTE in the substantive workforce, with an overall increase in bank and agency workers of 44.76% WTE over the month.

Temporary staffing comprised of 8.7% of the total workforce as of October, up 7.23% on the previous month with agency workers accounting for 5.51%.

As a comparison, the sickness absence rate in October rose to 5.02% from 4.78% the previous month – with all the service units reporting sickness absence as well above their targets and a total of 485 staff absent.

Long term sickness, however, dropped from to 66 staff in October from 71 the previous month.

But just 15 of the 66 have returned to work days planned.

October saw an increase in six out of the eight staff groups for sickness absence with clinical services staff the highest at 7.81% followed by scientific, therapeutic and technical staff at 7.38% .


WVT acknowledges long-term difficulty in recruiting and retaining nursing and medical staff, citing perceptions of the rural nature of the county, salaries, the imposition of special measures on the trust and the financial difficulties it faces as key reasons.

This is evidenced by candidates withdrawing from interviews and job offers, reduced applications to advertised vacancies, and the attrition of existing staff - all of which are acknowledged by the trust as occurring at greater than expected average rates.

An emerging factor in both recruitment and retention are the acknowledged increased workloads and pressures on existing staff to cover the staff shortfalls.

As of October,  this can be evidenced in further existing staff leaving the trust, and, again, the number of new candidates withdrawing from interviews  and job offers, a reduction in applications received in response to job adverts, and difficulty in vacancies being substantively recruited.

Operationally, this manifested in reduced capacity for service provision and patient care, cancelled procedures and appointments, loss of service provision related income, breaches in NHS national targets, and - as acknowledged by the trust - deteriorating reputation.

The cost of filling gaps with temporary / bank and agency staff is increasing to be a key contributory factor in the trust’s overall £19m operating deficit.


Policies in place cover the conducting of exit interviews within two working days to understand why staff leave and follow-up phone conversations with applicants who have withdrawn.

The trust acknowledges “limited data” emerging from reports from exit interviews and recognises manager responsiveness to progressing applications, shortlisting, recruiting etc. as slow and “needing work – with some applicants lost as a result.

As of last month (December), the trust was specifically looking to cease its use of agency staff, with an emphasis placed on overseas recruitment.

Overseas recruitment has seen positions appointed, these will be phased in from this month (January) subject to immigration checks.

Issues are already apparent in relation to immigration rules and nurses passing an English exam.

These have resulted in a reduction in numbers arriving, to the extent that the trust has had to put personnel plans in place to consider impact.

The trust is working with an agency on recruitment initiatives and is looking to release staff to significantly reduce the use of face to face statutory and mandatory training

The number of staff undertaking face to face training is decreasing.


With medical aspects, the trust is experiencing recruitment issues to consultants posts with a continuing high use of agency locums to cover on-going vacancies.

The trust continues to use the British Medical Journal (BMJ) to advertise and promote consultant posts through a marketing campaign.

Identified actions to mitigate risks include:

• Early decision making in relation to managed service provider contracts and/or the implementation of VAT relief schemes.

• Recruitment strategy and action plan – medical recruitment strategy to be developed by July.

• Review of alternative options to agency doctors.

• Exploring the use of International Medical Trainees (IMT) doctors.


The trust has recently had 15 Certificates of Sponsorship approved by the Home Office and expects to have eight Filipino nurses in place by January.

This recruitment avenue may be made easier by the recent Home Office confirmation of nursing being on the shortage occupation list – so nurses from outside the EU will have their applications prioritised.

The trust had planned to go to Italy in October but due to reduced interest decided to interview via Skype and has offered five nurse posts with two due to start this month, another two in January and one in March.

Trust recruiters also travelled to Athens in September and Spain in October to appoint another 16 nurses – all of which should be in place by February.

Another five nurses were found during a recruitment trip to Turin, with the trust “hopeful” that all five will accept appointments.

The trust has so far appointed 33 overseas registered nurses now training to become assistant practitioners.

In terms of UK recruitment, seven nurses were due to join the trust under the NHS Return to Practice scheme – through which nurses who have left or taken a break from the profession can come back – with a further 12 expected as of October.

Overall, the trust is acknowledged as under establishment by 293.92 FTE - a vacancy rate of 10.38% for October.

STAFFING ISSUES BY WARD AND DEPARTMENT (figures relevant to October)


Present nurse to patient ratio is 1 to 7 with identified recruitment acknowledged as “difficult to achieve”.

The trust wants to explore the potential for introducing an advanced practitioner (AP) - a role that frees nurses to focus on advanced practice – that could push the nurse patient ratio to 1 to 8.5 without compromising patient safety and nursing care.


A review shows the current establishment slightly over by one WTE.

As of October, the ward had 4.75 WTE vacancies and a nurse-patient ratio of 1 to 7.

A continuing high vacancy rate and an increase in medical outliers are acknowledged as having an impact on the clinical area with high drug errors (8) and slips, trips and falls (10) over the six month review period.


A six month review revealed the staff establishment as being under although the nurse to patent ratio was 1 to 6 .

High acuity is explained by an increase in “level  one” patients.

The vacancy rate is low at 3.5 nurses, but two nurses are on long term sick.

Again, the trust is exploring the AP option to change the nurse to patient ratio to 1 to 7.


A six month review showed establishment as slightly over with a  nurse to patient ratio of 1 to 6 .

Scope to increase the nurse to patient ratio has been recognised with four Aps employed to support the nursing workload .

Relatively high rates of slips, trips and falls are explained by the patient profile of the ward with many post orthopaedic surgery mobilising for the first time.


Nurse patient ratio is 1 to 4 with an establishment of 44.66 WTE nurses.

AAU is an admissions ward and falls outside the traditional 1 to 8 ratio due to higher acuity and high patient turnover.

The recommended ratio is 1 to 4 with a review showing nurse establishment should be 38.11 WTE.

That 1 to 4 ratio reflects the number of non-invasive ventilation (NIV) patients and high patient turnover of patients.

NIV has since moved to Arrow ward.

The trust says many of the tasks undertaken by the nurses could be safely undertaken by alternatives - thus reducing reliance.

But a small proportion of patients will specifically require nursing intervention - along with quicker than average patient turnover - which would suggest a smaller nurse to patient ratio. 

A new nurse patient ratio of 1 to 6 has been agreed with options for role conversion to support the nursing workload .

The total WTE posts converted would be six once APs  are in place.


Nurse to patient ratio is 1 to 6 excluding the recently relocated four bed NIV bay.

A review shows the current situation as over that required with work underway towards a ratio of 1 to 8 for the 21 bedded section of the ward and a 1 to 2 ratio for the NIV bay.

Arrow still has a vacancy rate of 8.1 WTE and will receive some of the newly recruited nurses.


A dedicated stroke ward since April last year with an up lift of staff to meet the increased acuity of the patients.

Nurse to patient ratio is 1 to 4 in line with that recommended for a Stroke ward.

Arrow also has a hyper acute stroke bay with a 1 to 2 nurse to patient ratio. 

Some care is acknowledged as suitable for supervision by a nurse with options employed to support this, raising the ratio to 1 to 6.

Wye continues to have a high nurse vacancy rate and a number of newly recruited nurses have been allocated there.


Continues to see a significantly high vacancy rate.

To resolve this in the short term the trust has blocked book agency nurses and seconded nurses from other clinical areas as support.


A new 16 bedded acute frailty admissions unit that opened last month as 2 x 7 single sexed bays and 2 x side rooms increasing the trust’s bed base by 16.

Establishment was set at 13.5 nurses allowing for two trained staff on every shift giving a nurse to patient ratio of 1 to 8.

In the short term the trust acknowledged a substantive staff nurse on each shift plus the a second nurse provided by bank/agency nurses.

These shifts were out for block booking to further mitigate the risk. 

This equates to 21 shifts per week that will require bank/agency to ensure the unit is safe.


Hillside and Ross were recruiting as of October, with Leominster waiting on final clearance for two return to practice nurses.

Bromyard was seeing its vacancy rate improving after “difficulties” over the summer when controls - including a bed space reduction - were put in place to ensure patient safety.

A pool of health care assistants is being developed for short notice deployment to the community hospitals.   



Critical care had two WTE vacancies and 5 WTE on long term sick and maternity leave, theatres had 14.5 vacant posts with the role of an AP being explored

In Midwifery the birth to midwife ratio was  1 to 28 with the funded WTE establishment 77.49 Midwives and the vacancy rate running at 2.35 WTE.

There are also 1.6 midwives on long term sick.

A business plan is being developed to both increase and backfill the workforce.

Another project is looking at options to put midwifery work into the community.

Vacancies also exist in Women’s Health and the Special Care Baby Unit.

The Children’s Ward was at full establishment as of October ahead of an expected increase in admissions over winter.

This increase is acknowledged as not accounted for in the establishment - which may mean more bank and agency staff are needed to cover the load.

Paediatrics is also undertaking work with emergency care department to scope how children can be better supported there.

The emergency department itself had just over 14 WTE vacancies and was subject to an ongoing recruitment campaign.

 The Clinical Assessment Unit had three WTE vacancies and the Coronary Care Unit was at full establishment. 

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