Juliette Cosgrove, director of nursing, midwifery and therapies at Southport and Ormskirk Hospital NHS Trust, was brought into the organisation a year ago following the publication of a critical inspection report.
“If we were to be a responsible board, we had to do this”
The Care Quality Commission warned that patients were facing “long and unacceptable waits for treatment”, and labelled nurse shortages in the medical division a “risk” and “ongoing challenge”.
While the trust was rated “requires improvement” overall, it has been placed under NHS Improvement’s “challenged provider” scheme, meaning it was deemed at risk of falling into special measures.
When Ms Cosgrove came into position in June 2018, one of her first priorities was to carry out a systematic, evidence-based review of the nursing establishment.
The review found the trust did not have enough nurses to provide effective care to patients in the face of a growing and ageing population.
The shortages were leading to the trust spending a significant amount of money on temporary bank and agency staff to fill the gaps.
“We didn’t have enough people in the right services to meet the needs of patients in a timely way,” Ms Cosgrove told Nursing Times.
“As a result, people weren’t satisfied with the care they were receiving and we weren’t satisfied with what we were delivering.”
Ms Cosgrove made a pitch to the trust board, laying out the number of extra nursing staff she felt were needed to turn the situation around – and she was determined to settle for nothing less.
“I had to be really clear about the evidence base that I was using in order to do that,” she said. “I wanted to get it first time, and I wanted it all.”
The trust has subsequently agreed to commit more than £1m of extra funding to increase the workforce by an additional 54 registered nurses and 59 healthcare assistants during 2019-20.
“When we looked at the numbers it’s a lot of money [but] I was absolutely clear that we had to do this,” Ms Cosgrove said.
“If we were to be a responsible board, we had to do this – it was me then persuading the board that this was an absolute priority investment and that we would deliver improved outcomes for patients, we would deliver better experiences for patients [and] we would provide a better working environment for our staff.”
Ms Cosgrove was clear that the increase was not about simply making staffing “safe”, but to make it “effective” and to have the capacity to improve patient experience and outcomes.
“I have this personal thing about there’s safe staffing, where you just get everything done, you manage, but actually it doesn’t always allow you to be really reflective in practice, having more time to consider the needs of individuals and make sure their plans are very appropriate and individualised to improve outcomes,” she added.
“That’s what I’ve had to describe to people – we achieve safe staffing every day, but it’s not going to deliver the full range of the quality of the service that people want.”
The extra nursing staff will be placed across the trust’s two hospitals – Southport and Formby District General Hospital and Ormskirk and District General Hospital – mostly on wards for older people, who make up a large proportion of the trust’s population.
The money is available thanks to the trust making efficiency savings in order to deliver its budget last year.
Funds have also been committed for extra medical roles and to make improvements to ward facilities, but Ms Cosgrove said the nursing investment was the most significant.
However, with the national nursing shortage, Ms Cosgrove recognised that it was not going be easy to fill the vacancies.
The trust will mainly be focusing on attracting newly qualified nurses from its two local universities – Edge Hill University and University of Central Lancashire – and will also be increasing the number of student placements it offers.
While international recruitment was not on the agenda at present, Ms Cosgrove said the trust was not ruling it out in the future and was considering the merits of teaming up with partner organisations to find nurses from overseas.
“Overseas recruitment isn’t in the plan at the moment, however, we are looking to see if we can work with other organisations to look at overseas recruitment,” she told Nursing Times.
“When you are in small towns, especially coastal towns, they are not necessarily that attractive for overseas, staff tend to want to come to bigger places, so we will be considering this year whether or not that’s something we think would work.”
The trust has also been taking steps over the past year working in collaboration with NHS Improvement to look at retention and what could be done to keep more nurses in the organisation.
“When you are working under pressure it’s really important that you feel you are part of a team”
Ms Cosgrove recognised that nurses had been working under “pressure” and that changes needed to be made to improve the workplace culture.
Stressing that the trust was not an “outlier” in terms of poor retention, she said: “In my view every single individual, registered nurse, particularly, is important and I think sometimes we haven’t valued that generally.”
She said the trust was focusing on understanding why staff members were wanting to leave the organisation and working out what it could offer them to convince them to stay.
“We have done quite a lot of work on the areas where we might have had concerns about retention,” she noted.
“We have done a lot of working in understanding that environment, understanding the factors that are influencing people’s decisions to move and then trying to rectify them, particularly issues around culture really.”
She added: “When you are working under pressure, it’s really important that you feel you are part of a team, so we have been doing a lot of work on improving team relationships, team dynamics – that type of thing. Just trying to really listen.”
As part of efforts to make working life better for nurses, the trust has put aside £600,000 to improve the ward environments, such as equipment storage facilities and staff areas.
The trust will begin hosting recruitment events every four to six weeks.
The first will take place on 30 July, from 5-8pm, at Southport hospital, in the clinical education centre, and will be targeted at band 5 nures and soon-to-qualify student nurses, with flexible working options available.
There will be a separate event to recruit healthcare assistants in August.
Source: Southport and Ormskirk Hospital NHS Trust
Source: Southport and Ormskirk Hospital NHS