For the Committee to receive a verbal update from the Director of Public Health on Covid-19 and Director of COVID-19.
Minutes:
6.1 Professor Orchard presented the report which emphasised the importance of recruiting and supporting health staff. NHS staff had been at the forefront of dealing with community transmission and it was not easy to now recall the level of fear and daily challenges of dealing with the pandemic from March 2020 onwards. The swift transmission and progression of the virus in some cases meant that not much time elapsed between admission, intensive care treatment and mortality, with 70% of deaths occurring on acute wards. Having met with staff in across the Trust, and in particular Charing Cross and St Mary’s, Professor Orchard expressed his deep admiration for the resilience of his staff and how they had responded.
6.2 The paper offered three priorities shaped around building a sustainable workforce, improving staff health and wellbeing with a counselling offer and improvements made to catering and rest area facilities. This had been well received by staff and had made a significant difference. Focusing on recruitment and retention it was reported that the vacancy rate was in decline. In terms of the metrics and to add context, it was reported that about 200 nurses had been recruited to deal with increased demand following Covid-19 and the recovery period to address a treatment waiting list backlog of six million people.
6.3 The NHS nationally had been strategically exploring recruitment and retention and how this could be enhanced by local recruitment. It was acknowledged that most staff who left did so within a year of joining and that those who remained, stayed long term. Most importantly, the NHS weakness was around ethnicity, diversity, and inclusion (EDI) need to be addressed. There was an acceptance that although 50% of staff were of Black and Asian ethnicity, this was not reflected at higher levels within the Trust. An inclusive recruitment policy had been implemented to constitute diverse (gender and ethnicity) interview panels, and a follow up letter from the interview panel called “Dear Tim” was required, to justify all senior Band 7 and above appointments. The scheme had achieved modest success but needed to be tested with proper feedback as to how individuals increase their chances for a successful appointment. In addition, it had also been recognised that Black and Asian staff were less likely to apply for study leave or access training opportunities. A new programme would be launched to facilitate improvement through people management to set out clear expectations.
6.4 Co-optee Jim Grealy commended Professor Orchard for the commitment of his staff who continued to work in challenging circumstances and welcomed the report for its combination of analytical rigor, determined to tackle the difficulties inherent in recruitment and retention. He asked if the Trust had considered an age categorisation of staff, referencing the large number of older GPs retiring from practice as an example. He also asked if the staff policies referred to would be rolled out across the wider North West London Integrated Care System (ICS). Councillor Bora Kwon welcomed the focus of the paper on improving the work culture but asked about how staff improvements were perceived by patients what service delivery could look like long term. Carleen Duffy endorsed earlier comments and reported that Healthwatch H&F was working to encourage NHS applications from Black and Asian ethnic minority groups and asked how the Trust was addressing unlearning cultural bias, re-educating staff through, e.g., anti-racist workshops or similar. Clare Caccavone asked if the Trust had addressed the issue of cultural competence in adjusting recruitment practices, and how a sustainable workforce could operationally include more ethnic and gender diversity with the workplace.
Councillor Coleman referred to recent funding awards from the Department for Levelling Up and the NHS to continue progress on these areas. Referring to question 14 of the staff survey included in the report, Councillor Coleman asked about the 10% decline in positive staff perceptions about career progression, between 2019-20. There was a slight increase observed in response to the question about whether staff had personally experienced discrimination at work from patients, service users or their family members. More of a concern was the 4% increase in discrimination at work from a manager or team leader, and specific specialist departments were reporting similar metrics. Councillor Coleman asked how the Trust could tailor and adapt its approach according to the improvements required in different departments. Councillor Lloyd-Harris referred to the departure of staff within a year of joining the NHS and asked if the Trust had undertaken any analysis or research to explore the reasons for this and asked what these might be.
6.5 Professor Orchard Responded to each of the questions and points raised:
· Jim Grealy’s point about age categories was particularly important in respect to staff who were 50+, and who might be reflecting on whether to continue within the NHS, considering retirement or new career pathways, and exploring their options. The Trust was prepared to be flexible to retain experienced senior staff, but this needed to be addressed across the North West London acute trusts as part of the collaborative, and at ICS (Integrated Care System) level.
· At ICS level there was an opportunity to think long term and strategically about the provision of health and social care and how this intersected, and to improve community engagement through patient involvement. He referred to a group of service users at Imperial called the Strategic Lay Forum.
· There had been useful feedback from HaFSON (H&F Save our NHS) with insights into patient views on services and treatment.
· It was recognised that a happy and content workforce offered better quality services and care with a greater focus on the needs of the individual rather than the organisation.
· Clinical outcomes at Imperial were very good and standardised mortality rates were consistently amongst the best nationally.
· There was a desire to improve the patient experience of care and improving staff care was part of this process.
· In response to Carleen Duffy’s point, Professor Orchard was keen to ensure that staff were not racist but to go further and be positively anti-racist, referring to the Trusts white ally’s anti-racist programme.
· There had been a slightly slower but no less active response to addressing disability issues, through the I Can network, a leadership programme for staff with disabilities run by Dr A. Stewart.
· Reasonable adjustments were being made in the workplace and Professor Orchard recognised that there had been varying levels of effectiveness and a central funding repository had been established to ensure that reasonable adjustments were being made to support people with disabilities and neurodiversity.
· Professor Orchard agreed with the point made by Clare Caccavone and acknowledged that the mechanisms to encourage cultural competency might not be in place consistently yet.
· With regards to the staff survey, it was acknowledged that these were not always helpful, but the questions could not be interpreted in isolation. The aim was to get a good number of staff to respond and have a broad perspective, including the clinical workforce. The Sodexho staff had been the first cohort to complete the survey and while they had done an amazing job during the pandemic, many issues still remained and tailored approach was required for different parts of the organisation. Nationally, pulse surveys were also being undertaken to get achieve more granular detail.
· Professor Orchard observed that there was much that had been implemented with a keen focus on the EDI agenda, and that the cycle of surveys, analysis and follow-up would take time to embed and recoup the benefits of this. The EDI results were not atypical for London but there were many positives to focus on which was encouraging.
· In response to Cllr Lloyd-Harris’s question, Professor Orchard confirmed that a series of detailed exit interviews were being undertaken to ensure that the Trust avoided assumptions about why people chose to leave.
6.6 Councillor Richardson asked how the Trust could work with the council as it sought to offer a job brokerage service for inclusive apprenticeships and ensure that residents most in need of work opportunities would be able to access them. Many residents that were neurodiverse or with disabilities were a big source of untapped employment and would work well in the NHS environment. Professor Orchard confirmed that Trust was very keen to engage with the council and develop some initiatives. Engagement with local communities in this way was a positive, supporting health and wellbeing as well as offering financial security. Professor Orchard thanked Cllr Richardson for varying the order of business and was warmly thanked in return for his contribution to the meeting.
RESOLVED
That the report was noted.