Meeting and date BOARD OF DIRECTORS – 5 MAY 2016

Title Nurse Recruitment - current progress, plans and mitigating actions

Summary of paper This paper provides the Board with an update on the nursing vacancy position across the Trust, explains contributing factors and actions being taken to ensure safe staffing levels. Actions include local and international recruitment campaigns, skill mix reviews to review the staffing model, use of temporary/agency staff, increased emphasis on workforce planning, return to practice schemes, planned overtime and incentive payments and various retention strategies. Despite a pro-active recruitment and retention strategy, vacancies are projected to continue due to the ongoing national shortage. Gaps in substantive posts are partially filled with temporary staff (bank and agency workers) but approximately 25% remain unfilled. The high patient demand on the organisation since October 2015 has driven increased demand for nursing staff as we have been in full hospital protocol and our nursing staff have demonstrated high levels of resilience and coped extremely well. Our risk score is 16 as mitigating actions are in place but despite international and UK campaigns, a number of vacancies continue. The winter plan for 16/17 which is being submitted to the Trust Board in June 2016 will have a workforce and recruitment plan to support.

Consultation / other committee views

Optimising Nursing & Midwifery Programme Board

Executive Committee

People Strategy Committee

Trust Board

Recommendations/ decisions required

Trust Board are asked to review the Trust’s current and projected vacancy

position and assess the pace and effectiveness of actions being taken locally to

address the national nursing shortage.

Link to Trust Priorities Link to Quality - We will make the patient the centre of

everything we do. - We will innovate and identify new ways of

working. - We will build capacity and capability by

investing in our staff, infrastructure and partnerships.

(1) Safety (staffing, falls, never events, handover, SI, safeguarding, infection control, environment, medicines, equipment)

(2) Effectiveness (HMSR, SHMI, Mortality, Clinical audits, care bundles, deteriorating patient)

(3) Caring (patient experience, patient surveys, friends and family test, patient stories, response to call bells)

(4) Responsiveness (complaints, waiting times, cancelled operations, ambulance stays, translation services, comfort factors – TV and seating)

(5) Well led (staff survey, staffing levels, sickness rates, flu vaccinations rates, board/ward interactions, staff reports, governance and reporting, risk management, financial control)

Risk issues Continued difficulty in recruiting sufficient registered nurses poses a risk to delivering consistently safe staffing.

Risk Register Ref No. 815

Risk Score 16

Resource Implications The recruitment costs for the International Recruitment strategy for 2016/17 is £850,000.

Regulations and legal considerations CQC Fundamental Standards

Mutual Recognition of Professional Qualifications (MRPQ) Directive

NMC Registration Requirements

Quality consideration and impact on patient and carers Staffing is a key determinant of quality of care.

Report Sign Off

Financial Karen Johnson, Director of Finance

Operational Hilary Walker, Chief Nurse

HR Oonagh Fitzgerald, Director of Human Resources

Confidentiality This report does not contain any confidential information.

Equality Impact Assessment Great Western Hospitals NHS Foundation wants its services and opportunities to be as accessible as possible, to as many people as possible, at the first attempt. This report has been assessed against the Trust’s Equality Impact Assessment Tool and there are no proposals or matters which affect any persons with protected characteristics.

Name of Lead Executive Director

Oonagh Fitzgerald, Director of Human Resources

Report Authors Kimberley Sumbler, Head of Human Resources & Workforce Planning Kelly Ody, Senior HR Business Partner

1. National context

1.1 Supply gaps

Ensuring there are enough nursing staff with the right skills to meet the demand for high-quality, safe patient care is essential to the delivery of our services. There is however a national shortage of Registered Nurses with over 50,000 vacant nursing posts across the NHS. Over the last 3 years we have had a vacancy level of 7.83% within qualified nursing. The vacancy rate for qualified nurses for 15/16 increased to 10% due to an increase in our qualified nursing establishment from March 15 to April 15 of 109wte. The current average national vacancy rate is 10%, according to the NHS Registered Nurse Supply and Demand Survey Dec 2015. There are considerable geographical variations in the extent of staff shortfalls with London vacancy rate at 18% and vacancy rates in the North at 7%. The current flow of nursing staff into and out of the NHS is demonstrated below:

(Managing the Supply of NHS Clinical Staff in England, 2016)

Reasons for the current gaps are as a result of 10 years of national and local decision making:

3106 fewer nurse training places in 2014/15 compared with 2004/05. This is a 19% decrease.

£3.3 billion spent by Trusts on agency staff in 2014/15 compared with £2.2 billion in 2009/10.

699 overseas nurse entrants to the UK from Europe in 2014/15 - a decrease from 11,359 in 2004/05.

1000 former nurses returned to practice each year between 2010 and 2014, compared with 3700 each a decade earlier.

Historically, the supply of nursing staff within the NHS was not managed centrally and lacked a holistic view of workforce requirements. In recognition of this, the Department of Health set up Health Education England in 2013 with the aim of ensuring that the NHS had a workforce fit for the future. The National Audit Office has reviewed workforce planning and their report indicates that Trusts’ workforce plans are often driven by financial plans which are focused on reducing the pay bill. By focusing on efficiency targets when balancing financial sustainability and service requirements, the NAO’s view is that Trust’s risk understating their true staff needs. This in turn could result in Health Education England commissioning too few places to train new staff. Over the past 10 years there has been a 19% decrease in the number of training places being offered across the country and very little change regarding the distribution of placements regardless of the different regional requirements. 1.2 Changes in Demand In addition to these challenges over the past few years, there has been an increased focus on quality and safety pre and post the Francis enquiry that has increased the demand for nurses. The impact of this drive was that in 2014, acute hospital Trusts estimated they would need 24,000 more nursing staff than they had forecast two years earlier in 2012, which would cost around an extra £1 billion. Alongside this, the National Institute for Health and Care Excellence (NICE) published guidelines on minimum staffing levels for adult nursing which also increased the demand for nurses. As a result of the increased demand for nurses in the NHS and a decreased supply, the amount of temporary nurses utilised also increased to fill this gap.

1.3 National constraints 1.3.1 Changes to bursary system from September 2017 It was announced in the Comprehensive Spending Review in November 2015 that nurses, midwives and allied health professional students will not receive grants and bursaries from September 2017 but will move onto the standard student loans system. Surveys conducted by Unions have indicated that this will have a significant impact on the number of people choosing to join these professions as they will need to fund their studies themselves. To date 160,874 people have signed a national petition to ask the Government to review this policy. Under the current system, the Trust is restricted to working with only select Universities; however the removal of the current bursary system will allow the Trust to extend to working with more providers which may increase the number of student placements. However, the student support system within Swindon is limited (eg accommodation) with regards to the number of students it is able to work with, without compromising the standard of training and mentorship. 1.3.2 Immigration policy The Migration Advisory Committee (MAC) has recommended nursing is entered onto the shortage occupation list and the government accepted their recommendation on 24

th March 2016. Nurses were placed temporarily

on the list on 15th October 15 pending a review. This means that nurses from non-EU countries will no longer

run the risk of having their visa’s rejected while non-EU nurses earning less than £35,000 per year that have been in the UK for six years will not have to leave the country from April 16. There will be an immigration skills charge payable by the employer of £1000 per year, for each Tier 2 visa holder (non-EU) from April 2017. 1.3.3 Agency caps Agency caps were introduced by NHS England on 23

rd November 2015 to drive down spend on agency staff.

1.3.4 Mutual Recognition of Professional Qualifications Directive The EU introduced a new test on 19

th Jan 2016 which has impacted on EU Nurses and Midwives. In order to

achieve registration with the NMC, individuals will also be required to evidence that they have the necessary knowledge of the English language. The IELTS test is set at Level 7 which is a Masters level qualification. 2. Our local nursing establishment and vacancy rates Changes to our establishment Our qualified nursing establishment was 1,588wte in April 2013. Following skill mix reviews that financial year agreed by Trust Board to increase the nursing establishment, we ended the year with 1,709wte. During 14/15 153 midwives TUPE’d to the RUH and with other changes including in community nursing we ended the financial year with 1,572wte. An additional 109wte were added as a result of the introduction of 20 community staff commissioned by the CCG, approval of the Gastroenterology business case, the permanent establishment of Teal Ward as a medical ward and additional funding for the Paediatric Emergency Department. Our qualified nursing establishment as at March 16 was 1,652wte as 30 posts were converted from band 5’s to assistant practitioners (band 4s). These variations in our establishment are reflected in the table below:

Our recruitment strategy has therefore needed to be very pro-active as we have been increasing our establishment during a time of national shortage. Our qualified nursing vacancy rates are at 10.23% which equates to 169wte vacancies. Our band 5 vacancy rates are currently 107wte which equates to a vacancy rate of 13%. Local intelligence tells us that the band 5 vacancy rate in our neighbouring Trusts (March 16 data) is as follows:

3. Recruitment Strategy 3.1 International Recruitment In June 2013, the Trust went into partnership with TTM Health Care to launch our first International Recruitment Campaign. Since then, a number of campaigns have taken place with 135 overseas nurses joining the Trust from Italy, Spain, Portugal and Ireland over the past three years as set out below;

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

1450

1500

1550

1600

1650

1700

1750

% V

acan

cy

Bu

dge

t W

TE

Qualified Nursing - Budget WTE vs Vacancy % Rate

Budget WTE

% Vacancy

0

5

10

15

20

25

Sep

-13

Oct

-13

No

v-1

3

De

c-1

3

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Number of New Starters

Trust Band 5 Vacancy Rate

Great Western Hospital NHS Foundation Trust 13%

Royal United Hospital Bath 10%

Gloucestershire NHS Foundation Trust 14.7%

Salisbury NHS Foundation Trust 16.4%

FY13/14 FY14/156

FY15/16

In 2013/14, a total of 76 nurses were recruited. In the following year, the Trust continued this strategy by recruiting a further 51 nurses from Europe. In the last financial year 2015/16 the Trust agreed to source 35 nurses from Spain and Portugal in September 2015 but only 8 nurses were recruited due to economic changes in the EU, a saturated competitive market and the use of Skype rather than visiting the EU country. To date, 52 (39%) of these international nurses that have been recruited since September 2013 remain in post. The average length of service of the 81 leavers was 332 days. In September 2015, a paper was submitted and approved by Executive Committee to recruit 35 nurses from Spain & Portugal via skype. In October 2015, a paper was submitted to the Executive Committee and approved outlining a requirement for further international recruitment campaigns given the experience of the changing EU market and intelligence from our agency TTM that only 5% of EU nurses would pass the new Mutual Recognition of Professional Qualifications (MRPQ) test that was due to take effect from Jan 2016. Approval was received for 70wte nurses via ongoing campaigns in Europe and also a Non-EU campaign. A further paper, outlining the Trust’s International Recruitment Strategy for 2016/17 was approved at Trust Board in January 2016 which would see 110 nurses recruited across two campaigns:

3.1.1 Changes between October and January 2016 – the evolving International Recruitment Market Europe From 19

th January 2016 in order to be a registered nurse working in the UK, individuals must now complete

the International English Language Test System (IELTS) and achieve a score of 7 (which is equivalent of a master’s level). As a result of this the Trust has adapted its approach to European recruitment by recruiting nurses at pre-registration level and supporting them to achieve IELTS 7.

It is anticipated that it will take between 3 to 6 months for the Pre-Registered Nurses recruited to achieve IELTS 7 and become fully registered with the NMC. This is significantly less time should they stay in their home country. The Trust should also be aware that some of Pre Registered Nurses who join the Trust on the training programme may not reach the required level within 6 months and will therefore be required to return home. The cost of recruiting a nurse from the EU is currently £3,575 and therefore the cost of the EU campaign will be £125,125. Non EU timeline from decision making to mobilisation When the International Recruitment Strategy was approved by Trust Board and Monitor on 25

th January 2016,

it was agreed that the Trust would target the Philippines for the Non EU campaign as the Trust has an existing Filipino workforce and would aim to visit in March/April 2016. Following an analysis of the Non EU market during February, it became apparent that the Philippines was becoming a much more saturated market with many more Trusts scheduled to visit. This was mainly because so many Trusts successfully recruited nurses from the Philippines back in 2000 (including GWH). This is demonstrated in the chart below which indicates the countries that Trusts are targeting for recruitment campaigns in the next 12 months.

Month Proposed Campaign Number of Recruits Target Start Date

April Non EU Recruitment 70 September 2016 – March 2017

May EU Recruitment 40 June 2016 - December 2016

With so many Trusts’ recruiting from the Philippines, it became evident in February 2016 that the number of nurses successfully achieving IELTS Level 7 was lower compared to other Non EU countries such as India. The Trust therefore changed the destination of its April campaign on 29

th February 2016 to India. The team of

4 nurses and a member of the recruitment team left the Trust for India on 23rd

April 2016. Between 29

th February 2016 and 23

rd April 2016 the following activities were undertaken to ensure the trip

was mobilised and a success: Between the paper being approved in January and the location being changed to India in February the HR team were undertaking actions to prepare for a trip to the Philippines. The requirements for entering the Philippines for recruitment are different from India and therefore when the destination changed this process had to start again. In order to achieve the number of nurses sought TTM require a minimum 4 weeks lead time from approval to visit the country to the event taking place. The team of 5 nurses and a member of the recruitment team therefore travelled to India on 23

rd April 2016.

Between 29

th February and 23

rd April the following activities were undertaken to ensure the trip was a

success:

Protector of Emigrants (POE) clearance was required from the Indian Authorities in order to travel to India to recruit. It is illegal to recruit in India without POE and therefore the project is unable to start until this clearance had been achieved.

To apply for POE the Trust had to send the following documents signed by the Chief Nurse: Sponsor Licence, Certificate of Sponsorship and a Visa Guarantee Letter, Employment Contract, Authorisation Letter and Demand Letter. A POE must be completed for each Region visited in India. POE clearance was received from the India authorities on 4

th April 2016. The Trust had been advised by TTM that PEO approval is usually

granted within 2 weeks. On this occasion is took 5 weeks due to some recent illegal recruitment activity in India and this therefore impacted on the arrangements which had been put in place.

As a result of the above the original dates of the trip had to change from 20th April to 23

rd April. This

meant that one member of the originally travelling party could no longer attend and an alternative person had to be identified.

Once the travelling party had been confirmed, alongside POE, TTM arranged for a letter of invitation to be sent to the High Commission of India requesting that they grant Business Visas for each of the travelling party members.

Following receipt of the letters of invitation each member of the travelling party had to complete a visa application form which was submitted along with 2 passport photos, a signed letter from the Trust, proof of 2 years residency in the UK and the appropriate application fee.

The visa applications and supporting documents were then couriered from GWH to the India Embassy in London to gain fast tracked visas in time for the trip on 23

rd April.

A pre meet with the team took place on 19th April in preparation for the trip the following week.

On average nurses recruited from India stay in post significantly longer than nurses recruited from within the EU. In addition, the visa stipulations restrict the individual to working for the Trust who sponsored their visa for a period of 3 years. Therefore the Trust is only likely to lose Indian nurses recruited if they return back to India.

Due to the stability of this workforce once recruited, the number of nurses that the Trust seeks to recruit in April 2016 has been increased by a further 50 nurses following delegated authority from Trust Board in March 2016. However, it is important to note that the pre and post recruitment process for Indian nurses is far more complex and time consuming and therefore the lead time for such events is considerably longer than EU trips as is the time it takes for nurses recruited to arrive with the Trust. The total cost per recruit to the Trust is £6,000. Therefore the revised India campaign taking place in April 2016 will now cost £720,000. There will also be additional costs incurred for both campaigns for Trust travel expenses and vaccinations. The total combined cost of the proposed international campaigns will therefore be £850,000 for 16/17 and the Board has given delegated authority for this to be approved. 3.2 UK Recruitment Strategy The Trust’s UK Recruitment Strategy includes a number of successful projects aimed at attracting nurses to join the Trust. These include;

Oxford Brookes University An important part of our recruitment strategy has been to recruit local nursing students. Oxford Brookes University currently based at Ferndale, Swindon but moving to Delta Business Park in the Summer is a key part of our recruitment pipeline. Placement numbers for the Trust have remained consistent at 80/90 students each year for the last 10 years. This was increased in 2015 to 130 as a result of the local workforce plans submitted to HEE. Historically, the providers have filled 100% of placements, however since the increase in the number of placements available, 23% have remained unfilled. Intelligence from our providers suggest that there are two main reasons for this; a lack of local student accommodation and the fact that Swindon is not a large city surrounded by vibrant cities which are more attractive to students. Following representations from the Trust, the unfilled placements were reallocated to the Open University for the eight places. Students on the degree nursing course come to the Trust on placement and we recruit approximately 85% of graduates each year. The Trust is highlighted in student evaluations as an area with excellent training support and won placement of the year last year with Oxford Brookes University. The placement support has led to consistently lower attrition from the programme that in Oxford and by aligning career aspiration to placement opportunities the Trust has secured the vast majority of newly qualified nurses who are trained for the whole Swindon and north Wiltshire healthcare system.

Centralised Recruitment A centralised approach has been adopted to managing the recruitment of local and UK nurses with a rolling fortnightly programme agreed for 2016/17.

Recruitment Events The Trust attends national career fairs, national conferences and hosts recruitment open days on a Trust wide basis or ward/area specific basis.

Recruitment Premiums A proposal to pay a recruitment and retention premium to appropriate hard to fill posts is being developed with a view of implementing within Q1. This proposal will be presented to Executive Committee in May 2016.

Rotational Posts

The development of a Rotational Programme across all nursing groups both internal and with external partners, including educational pathways and development plan to enhance career development.

Returning to the Profession Attendees at Return to Acute Setting courses in the Academy have remained an important part of our pipeline with 22 in 13/14, 17 in 14/15 and 11 in 15/16. The Academy has achieved national recognition for these programmes and 50% of attendees seek employment in the Trust, the remaining in the local healthcare market. Return to Practice attendees have included 6 in 13/14, 8 in 14/15 and 16 still on the programme at UWE in 15/16. The Academy has achieved national recognition for these programmes and 50% of attendees seek employment in the Trust.

Advertising Strategy – our offer The Recruitment Team is currently designing a recruitment advertising plan for 2016/17 which will include a revised branding approach focusing on the key highlights from our Staff Survey Results. The internet and intranet are currently being redeveloped to ensure that candidates receive all the information possible to promote GWH as an employer of choice.

Skill Mix Reviews - Developing alternative roles and reviewing the staffing model In response to the national shortage of Registered Nurses, the Trust has developed and introduced a new Assistant Practitioner role. This is a non-registered role which has been accessed by our talented health care support workforce who undertake a 2 year foundation Degree and across the nation has been successful in supporting quality of care by learning skills that have traditionally been executed by a Registered Nurse – a total of 30 are being trained in 15/16 and a further 35 ear marked for 16/17. The Trust is also currently planning to support placements for Physicians Assistant students – a role which undertakes many aspects traditionally undertaken by Junior Doctors.

Become a nurse without leaving your job campaign Nursing Assistants across the Trust have been offered the opportunity to train as a qualified nurse, whilst remaining a Trust employee and being salary supported with funding secured from Health Education England. GWH is only one of two Trusts in the South West working in partnership with the Open University. Nursing assistants are able to undertake a part time BSc Nursing course with the minimum NMC qualification requirements whilst still working for us part time. This gives opportunity to our experienced Nursing Assistants with proven values and attitudes to access nursing that traditional routes do not. Our Assistant Practitioners, who have achieved a Foundation Degree, also have accessed sponsorship for their nursing Degree with Oxford Brookes University, which is offered to them over a shorten two year period in acknowledgement of their prior knowledge and skills.

Recruiting foreign nationals from within the UK A proposal to offer an Overseas Training Nursing Programme is currently being developed which aims to attract foreign nationals living in the UK with nursing qualifications, live registration overseas and IELTS level 7. Successful candidates will take part in a training programme which will prepare them for their NMC examinations which will be funded by the Trust. Once completed, they will receive a permanent contract as a Band 5 Nurse.

Increase in Temporary Staffing - Developing the Bank offer Our policy has been to treat our bank only staff the same as permanent staff. We are therefore supporting bank staff (who may only work one shift a month) with their revalidation and they have access to courses within the Academy. They also receive incentive payments for hard to fill shifts that have been in place since 2013/14. From 1

st April 2016, bank pay is paid weekly and not monthly. This will act as a key incentive for both

internal and external nurses to join the bank and will encourage permanent nurses to undertake extra shifts. Once the rosters have been signed off by the ward manager and matron, they are submitted to the bank office to see if bank staff are available for gaps in shifts. Demand for temporary staff over the winter period has increased significantly as the Trust has been in full hospital protocol. In total 5,022

shift requests for cover were received by the Bank office in March 16. As a benchmark for April 2015, the bank office received 3,636 shift requests. The average qualified nursing wte per month that work from the bank is ICHD 22wte, Planned Care 15wte and Unscheduled Care 35wte. This totals 72wte temporary staffing cover per month. The average wte from qualified agency nursing staff October 15 to March 16 is ICHD 3.6wte, Planned Care 18wte and Unscheduled Care 41wte which totals 62.6wte. Temporary staffing provides an important component in our ability to flex our staffing to meet demands. In December 2015 for example, we spent 207k on qualified nurse bank hours and overtime to support gaps in nursing.

4. Vacancy trajectory Based on the implementation of our recruitment strategy, it is predicted that the Trust’s vacancy position will be significantly reduced by March 2017. This is on the assumption that no additional nursing posts are approved.

Note - this chart excludes nurse vacancies within the Corporate Division however includes vacancies within the Trust’s outpatient areas.

The chart above shows the recruitment trajectory for Registered Nurse vacancies for this financial year. This trajectory includes the additional staffing requirements for ED following the CQC recommendations from April 2016. In addition, it takes into account the additional turnover the Trust should except to see, particularly from nurses recruited from within the EU. The chart also takes into account the time it will take an EU Pre Registration Nurses to pass IELTS at level 7 and therefore only counts them on the trajectory from the predicted time that they will become a Registered Nurse. However, our modelling suggests that in October 2016, as the Trust goes into the winter period; there will be 76.27wte band 5 nursing vacancies across the organisation. In order to mitigate this vacancy position, a number of actions are underway and these will be quantified further in the June 2016 Winter plan which will include a workforce and recruitment plan. They include:-

Impact of non-ward based review

Impact of introduction of 35 assistant practitioners (band 4) to ward establishment

Further development of the (temporary staffing) bank offer to improve bank fill rate

Recruitment premia for hard to fill posts/wards

In order to sustain this position, a rolling international recruitment programme will be required until 2020 when the number of nurses within the UK is expected to match demand. 5. Retention Strategies To maintain safe staffing levels, we must continually predict and replace our leavers. This includes those who retire, go to work for a non-NHS employer or leave their profession altogether. Nationally, the number of nurses leaving the NHS in 2010/11 was 6.8%, this has increased to 9.2% in 2014/15. The Trust’s average turnover for this staff group is currently 13% which equates to 20 nurses leaving the Trust every month. Our turnover rates have increased in the last 3 years for qualified nurses due to the high turnover rates of the EU nurses. Benchmark information from the NHS Registered Nurse Supply and Demand Survey Findings (December 2015) attached below demonstrates that turnover for the majority of Trusts is between 9-14%.

To reduce this level of turnover, work is underway on the following:

Introduction of 12 hour shift patterns across Maternity, Unscheduled Care and Planned Care during 14/15 and 15/16.

Ring fenced training budget for certain posts.

Introduction of Trainee Ward Manager & Trainee Matron posts across the Trust with a 12-18 month training/mentoring programme available.

Fast track band 5 to 6 innovative training & development programme for internal candidates.

Fast track new recruit programme for specialist roles (for example; elderly care)

Further develop and promote flexible working options available to staff including part time worker, flexible contracts of employment and career breaks

Develop and implement the Trust’s Wellbeing Strategy

Promote Swindon as a place to live and work through developing partnerships and links with external organisations (for example; key worker housing)

To further develop the clinical supervision roles to ensure newly qualified staff feel supported and developed.

Cross agency working including Oxford Brookes University to develop our pipelines from schools and further education into careers in healthcare

The further development of our in-house CPD/ training portfolio, which has proved a popular option for our nurses this year – with over 150 nurses accessing courses over the last year that have been designed with nurses to ensure that their specific needs and skills requirements are met.

The scoping of fixed term split research and development/ ward or department based roles for areas with high turnover rates to reduce stress and avoid ‘burn out’.

6. Governance, oversight and scrutiny In response to nursing recruitment and retention challenges, Optimising Nursing and Midwifery Programme Board was established in July 2013. Its purpose is to develop and monitor nurse recruitment plans, monitor forecasts and oversee mitigating actions. The Monthly Workforce Report is submitted to Executive Committee and also highlights our vacancy position, hot spots and activities to improve safe staffing levels. People Strategy Committee oversees alignment and delivery of the People Strategy 2014-2019 and Trust Board receives a six monthly progress report on delivery of the People Strategy as well as monthly safe staffing reports at each Board meeting. 7. Conclusion The actions set out within this paper will go some way towards addressing the challenges we have faced and continue to face with regards to nurse recruitment. HESW have suggested that we will continue to face these challenges until 2020 and therefore it is important that the Trust acknowledges that the national shortage of nurses will not be resolved for some time. There may be further challenges ahead that will impact on the workforce as a whole depending on the outcome of the EU referendum and restrictions enforced by the Government in relation to Tier 2 visas.