Written evidence submitted by Anonymous (RTR0061)

I have been a Consultant Physician since 2007. I, together with three colleagues, have responsibility for the recruitment and development of circa 38 Junior Clinical Fellows, 98% of whom are recruited from abroad. These doctors perform their roles over 18-24 months with most leaving sooner into training posts. I propose a pilot for trialling recruits taking up competitive clinical attachments before being offered posts. This will ensure better quality recruitment to deliver better patient care and quality of care.

• What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?
• What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?

Determine the services in area per population numbers, deprived vs. affluent areas, age demographics and establish services accordingly including numbers of recruits needed matched with public health, social and care needs. Recruitment has to include a plan to ensure continuity and development of services with contracts long enough to ensure overlap for new recruits with leavers. Incentives to stay on in an area must be included to enhance continuity based on quality and progress of individuals. Performance measures for each must be mandatory. Recruits must be fully informed of their contracts and induction should include steps for competitive progression. This has to apply for all tiers of the NHS: cleaners, consultants, porters, nurses etc. Contracts for all must have progressive job plans and not just salaries.

Short-term: Dedicated teachers/assessors and  clinical programmes recruiting with restrictions for recruits moving out of area until standards are met and contracts fulfilled. Ensure standards by recruiting to the U.K offering accommodation (and others?) for the individual/s and then a short clinical attachment culminating in a competitive interview to assess learning, progress, communication skills and suitability for post. The NHS/Government will have to part subsidise this with some payment by the recruited staff.  These programmes must roll until the UK is able to support itself for the medium and long term.

• What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?
• What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

There needs to be medium and long term plans to address balance but we are desperate right now. Offer to exchange national management/clinical guidelines and free conferences/webinars to those countries may be a start but individuals choose (for whatever reasons) to come here.

Please see my answers in bold for the next 4 questions.

• What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors? In particular:
• To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need? NHS recruitment must know
• Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills? YES
• Could the training period for doctors be reduced? Definitely not but apprenticeships without eportfolios for a year for the trainees to discover themselves in the focus of clinical work

Should the cap on the number of medical places offered to international and domestic students be removed? Yes for a time as we are desperate

• What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

An increasing population with increasingly complex medical conditions with increasing social care needs in hospital care settings has trebled workload in the last 5 years including increased mandatory training (own time), increased unplanned meetings, increased governance and complaints all related to poor/worsening quality of care (waits etc.) and poor communication and practice related incidents not least because of understaffed and staff not having the required skills. The burden for senior (and junior) doctors has resulted in burnout matched by perverse pensions and a favoured tax system in other countries. Increased burden to oversee juniors who are recruited without proper skills or who turn out to “fail” in the system. A training system (for doctors) which favours a tick box exercise without the individual having the insight into or confidence of these skills. Run-through training has to be accepted that it does not suit everyone (too draconian) and young doctors cannot decide on their specialty which once agreed ties them in for many years.   A disjointed system from primary to social care. A “pass the problem” culture leaving patients dissatisfied.

An increasingly disrespectful population of their individual entitlement over clinical priority in an overstretched NHS.

Solution: An NHS that is standardised as much as possible in every way.

• Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this? I do not know

• What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff? Seamless quality care

• To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?

Could be much better to demonstrate paths of progression but it is recruitment and interview processes which require more robust processes.

• What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?

I am not sure as the current processes need work.

January 2022