Agenda item

Terry Roberts (Chief People Officer, Oxford University Hospitals NHSFT) has been invited to present a report on the Oxford University Hospital’s NHSFT People’s Plan.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

PLEASE NOTE: There are THREE documents attached to this item:

1.    The main report submitted for this item providing an update on Oxford University Hospital’s People Plan.

2.    The Oxford University Hospital People’s Plan Document.

3.    A summary of the Engagements undertaken by Oxford University Hospitals as part of developing the People Plan.

Terry Roberts (Chief People Officer, Oxford University Hospitals NHS Foundation Trust) was invited to present a report on the Oxford University Hospital’s NHSFT People’s Plan. Dan Leveson (BOB ICB Place Director, Oxfordshire) was also in attendance.

The Committee asked for clarification on the Oxford University Hospitals NHS Foundation Trust (OUH) vacancy freeze and whether an impact assessment had been completed to assess its effect. The Chief People Officer clarified that it was not a vacancy freeze, but a vacancy pause. This measure was implemented following instructions from the Integrated Care Board and NHS England, with the aim of balancing their financial books. The pause affected both clinical and non-clinical posts that were Band 8C and above, which included senior roles like managers with a salary of £70,000. Administrative and clerical roles were also paused. OUH still actively recruited to Band 5 and Band 6 nursing vacancies, healthcare support workers, and other direct healthcare roles. The primary goal of this action was to ensure financial stability. A quality impact assessment was conducted not only for the overall programme but also for each post under consideration. Recruitment to posts was not undertaken unless they were fully aware of the potential impact on patient care and their ability to meet constitutional standards.

The Chief People Officer added that OUH was directed to implement these measures. They had been striving to increase productivity and had a significant productivity programme in place for the entire previous year. It was noted that at the end of 2023/24, they finished with a deficit of £10 million. However, this was in the context of achieving £90 million in efficiency savings during the same period.

The Chief People Officer clarified that they did not want to pause the posts, as they were not extra and were indeed needed. However, they had been instructed to review them, a task not unique to Oxford University hospitals. They acknowledged the difficulty of the situation, particularly the administrative burden placed on staff due to the thorough quality impact assessment. They highlighted the financial constraints they were operating under, with a finite budget and a requirement to balance their books. They emphasised that unless key changes were made and tough decisions taken, they would not be able to fund investments to improve both patient and staff experience, as highlighted in the people plan.

The Committee enquired about the effect this could have on staff that were already under strain. The Chief People Officer stated that they were aware of the initiative's impact on their staff. They were constantly monitoring the staff's mood through quarterly staff surveys, a large annual staff survey, retention questionnaires, and regular people plan listening events where they heard directly from the staff. These methods helped them understand the feelings of their staff and were instrumental in developing the people plan.

The BOB ICB Place Director, Oxfordshire acknowledged that their costs, like many systems across the country, had exceeded the allocated funds. The proportion of money spent on staff, was typically between 75% and 80%. They emphasised their responsibility to deliver a balanced budget and considered it absurd to do so without considering how they spent the major proportion of their money. In financially challenging circumstances, one of the first actions they took was vacancy control, as it was something they could control. They ensured that people were still able to staff safely. While doing so, they saw an opportunity to explore different care models that could deliver better value and outcomes at lower costs. They were introducing new integrated models for better value and were considering the introduction of technology. However, they acknowledged the difficulty of these tasks, given the growing cost of care and health demands beyond their resources. Vacancy control was a normal and understandable first action when demonstrating financial control and responsible stewardship of public funds.

The Committee asked how the NHS People Plan influenced the OUH People Plan, and whether the OUH People plan was sufficiently tailored toward any potential specificities for Oxfordshire. The Chief People Officer stated that they had a specific Oxfordshire remit, part of which involved attracting and retaining people from Oxfordshire. They had a scheme to recruit locally for their apprenticeships. They worked on the health inequalities agenda for Oxfordshire and were part of the Anchor Institute. Their goal was to reduce health inequalities and recruit people from local communities into their organization. When they first developed this, they looked at the NHS plan and the ICB people plan, integrating all the key elements from the NHS plan. They conducted extensive engagement to hear what their people thought. Over 75% of the people who worked for them came from Oxfordshire, so they heard what was important for them to live and thrive.

The Committee asked whether there was still a heavy reliance on agency and bank staff and whether cheaper housing for staff would help attract the workforce. The Chief People Officer responded that there was a reliance on agencies due to existing vacancies and a national shortage of trained nurses and doctors. They had not only depended on agencies and banks but also on overseas recruitment due to the poor supply of trained medical professionals. They had a target to reduce their reliance on banking agencies by 700 whole time equivalents that year and were exploring different ways to achieve this. The cost of living was a factor that made it difficult for people to afford living in Oxford. They had been working with outside agencies to secure cheaper accommodation for their staff, an effort that was ongoing. They appreciated any support that could help them offer low-cost accommodation to their people and key workers. They were also considering the introduction of an Oxford Weighting, similar to the London Weighting received by hospitals in London, given that the cost of living in Oxford was not much lower than in London. They expressed appreciation for any assistance that could be provided in this regard.

The Committee enquired whether there was any extensive collaboration underway with Oxford University to help support the recruitment of young and talented individuals for employment roles within the trust? The Chief People Officer stated that they regularly met with the university, and they had been exploring creating joint initiatives and developing a joint office. This joint office would focus on joint recruitment for both the university and OUH. This was an ongoing effort that they had been working on for a year but competing demands had prevented an early resolution.

The Committee asked about the protection of staff from abuse and violence and whether there was a whistleblowing policy in place. The Chief People Officer stated that addressing abuse towards their staff was a high priority due to an increase in such incidents. They had a specific group focused on supporting staff in relation to violence, aggression, and sexual harassment. Several initiatives were in place, including body cams for Emergency Department staff, psychological support from their Psychological Medicine service, a poster campaign, and a revisited policy about violence and aggression. They had strengthened their warning system for aggressive or violent patients. They were also encouraging staff not to tolerate abuse, which had sometimes led to staff leaving their jobs. They were working to lower staff tolerance of violence and aggression, even when it came from patients with dementia or other illnesses. They wanted staff to report incidents so they could take action, and were even willing to deliver final warnings to patients at an executive level. They were making progress on this significant agenda, but not as quickly as they would have liked.

The Chief People Officer had confirmed that the majority of the issues were from patients. Upon reviewing the data and staff survey results, they found that incidents involving staff-on-staff were less than half of those involving patients-on-staff.

The Chief People Officer stated that they had a whistleblowing policy encouragement to speak up, however, they believed more needed to be done. As part of their action plan, they were exploring ways to provide psychological safety for people to voice their concerns. They were seeking charity funding to establish an external whistleblowing system, assuring that it would be anonymous and allow people to raise their concerns without fear of being traced. This was aimed at addressing these concerns effectively.

The Committee asked how OUH would be evaluating and measuring the overall effectiveness of the Plan and its tangible outcomes and delivery. The Chief People Officer had responded that they had 15 metrics in their report, that they believed were crucial to measure. The end of Year Three of the People Pan, which was also the end of the financial year, was the time they would measure against all the metrics such as bullying and harassment, time to hire, and vacancy rates. An annual evaluation was conducted to assess their position, and for the second year, they had met the majority of the metrics. The areas they identified as having the most significant gaps were some of the equality and diversity metrics. They also noted the importance of employees taking the majority of their annual leave throughout the year, as it was crucial for rest and recovery. Another concern was the number of people leaving within a year of starting, particularly among admin and clerical and healthcare support workers. This indicated issues with the work environment and the selection process. They found that sometimes, people did not realise the nature of the job they were taking on; and with admin and clerical staff, they could earn the same or more working at Amazon or Tesco. Therefore, they were considering how they paid and how they marketed their non-monetary benefits. These were the key areas they planned to focus on in their third year.

The Committee emphasised the quality of the report and the presentation, and commended the comprehensive metrics and creative solutions being produced.

The Committee AGREED to issue the following recommendations to Oxford University Hospitals NHS Foundation Trust:

1. For Oxford University Hospitals NHSFT to provide the Committee with a written briefing around the reasoning behind the pause in recruitment of certain OUH staff, as well as around any risk assessments that have been conducted around the recruitment pause.

2. To ensure that there is ongoing engagement with staff and key stakeholders around the continuing design and delivery of the OUH People Plan.

3. To continue to secure the necessary levels of resources required to deliver on the key objectives of the People Plan.

4. To explore avenues of improving pay for staff in line with the increases in financial hardships generated by the Cost-Of-Living Crisis. It is recommended that the Trust works with relevant system partners to explore the prospect of achieving an Oxford Weighting.

5. To continue to develop clear processes through which to evaluate and measure the effectiveness of the People Plan and its delivery.