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NHS Highland submission of 15 February 2022

PE1890/D - Find solutions to recruitment and training challenges for rural healthcare in Scotland

National shortages of qualified staff

It is well reported that there is a shortage of qualified nurses, doctors, allied health professionals and specialist consultants in many fields across Scotland and the UK.  NHS Highland with its remote and rural geography has the additional challenge that working for us is not commutable from the central belt of Scotland, and so relocation is required. 

We have been successful in attracting a number of experienced candidates for specialist and leadership roles from across the UK and beyond, especially following Covid when many people wish to find a better work life balance and spend more time outdoors.  However, this has tended to be more successful in the higher paid roles such as senior managers and consultants, than our core nursing, AHP and other roles, due to accommodation shortages and cost of living, both in large population centres like Inverness, Fort William and Oban, but also in areas such as Skye and the North West coast with huge demand for tourist accommodation.  

We also struggle to attract people into social care roles across the board area, which is a critical part of our health and care infrastructure, but there is a national challenge around pay, status and in our geography, people can earn more working in the tourism sector.  In rural areas, the geography covered is also a challenge and access to a car or at least a driving licence is critical.

Accommodation

NHS Highland are currently part of a working group that includes Highland Council and Scottish Government to look at opportunities for future development of affordable housing needs in our most challenging areas.  This is a key priority as there is a long term lack of affordable properties available for long term letting and purchase across the board area, which needs to be addressed in order that plans for wider access to careers are successful.

International Recruitment

NHS Highland are working with Scottish Government and boards across Scotland to develop our international recruitment pipeline to specialist roles.  This is a key part of our sustainable service delivery model, as the timescales to increase the numbers in training across Scotland are much longer term.  However, we work only with countries which are approved by the World Health Organisation as having sufficient staff for their own requirements.

Attracting the Young Workforce

We are working with Skills Development Scotland and other agencies to develop wider access to careers across the NHS.  We have new programmes underway, including foundation apprenticeships and are working with local education providers to establish additional pathways to our core roles through modern apprenticeship programmes, of which we already have many in place, including business and administration, engineering, finance,  IT and digital marketing and digital applications.

Retaining our older workforce

We have an aging workforce across Scotland and the demands of roles in the NHS especially since Covid has made more people consider retiring at 55, we are developing more flexible approaches to make it easier for colleagues to retire from full time, front line working but to return on a part time basis and to retain their skills and experience.

Workforce Board – Attraction, Recruitment and Retention Strategy

Our workforce board is attended by colleagues across the organisation, covering a wide sector of our geography and professions and is overseeing our long term strategy and plan to improve all aspects of attraction, recruitment and retention across the Board.

Job Design and Planning

We are working on integrated service based workforce plans, rather than traditional profession based plans, to ensure that we design our workforce of the future around what is available and think creatively about how our teams work together, making enhanced use of both advanced practice roles and of support roles. This will help inform our conversations with the university and higher education sector about demand and future course design.

Integrated Staff Bank

The Integrated Staff Bank is our internal temporary staffing process, which along with agencies we use to fill gaps in our rotas.  We advertise and recruits Nursing, Midwifery and Allied Health professional Undergraduate Students from UHI and Scottish Universities, in September of each year as well as ongoing wider recruitment drives.  Bank interviews are now held on Teams, and this has increased access for relocating applicants.

There has been a significant increase in interest and applications from Registered Nurses relocating or returning to the Highlands.   Issues experienced with recruitment include the transport network to remote and rural locations for example the flights to Wick airport have stopped completely - this has impacted also on Agency staff willing to travel to cover shifts, travel and accommodation for temporary staff especially in peak season is often prohibitively expensive or just not available.

Working with Schools, Colleges and Universities

We work closely with our local schools and are active participants in the Developing the Young Workforce programme.   The University of the Highlands and Islands has a seat on our board and work in partnership with us to develop and design courses that will fill our talent pipeline. This included a highly successful shortened midwifery programme, which led to a significant number of recruits but was not continued, which was a big loss to us.  We have students on the Midwifery conversion course which is running for the first time this year, training registered nurses to become midwives.  

We also work with the Open University and the University of the West of Scotland on many programmes.   All nursing and midwifery students who complete their training successfully at UHI are guaranteed a position at NHS Highland, should they wish to take it.  In 2021, this was 70 nurses plus a number of midwives, and over 50 in 2020.

Scottish Rural Medicines Collaborative

NHS Highland is a major participant and supporter of the work of the SRMC, and our Chief Executive Pam Dudek is the current chair and heavily involved in promoting and supporting recruitment and retention.   This year’s Rethinking Remote conference being held in Aviemore and will be looking at sustainable pipelines for remote and rural healthcare, including attracting GPs, which is a major area of challenge in our board and others.

Highland Public Sector leaders forum

Our Chief Executive is also part of this forum which meets fortnightly bringing together leaders across the public sector in Highland, working to develop collaborative working and joint initiatives in areas of most need.