United Surrey Talent - Emergent Strategy

Creating opportunity, prosperity, and the health and care workforce for the future

July 2022

The case for change – emergent vision for our Integrated Care System

What strategic decisions need to be made?

Surrey is already one of the healthiest places to live in England. Our services also perform well with most health and care providers rated good or outstanding. Yet there are big differences between what most of us experience and what some of us can expect, with a 12-year gap in life expectancy depending on where you live. And because most people in Surrey are living longer, that means more people living with ill health and conditions such as dementia, social isolation and loneliness. We know that medical care alone will only ever impact about 20% of someone’s health and wellbeing; the rest (the wider determinants of health) is influenced by factors such as education, housing, employment, the environment and personal characteristics, such as race.

As a partnership, we want to create a health and care system that builds on the amazing community spirit we’ve witnessed during the pandemic. One that values the role of the local community, as well as organisations, and enables people to take more control of their health and wellbeing, with easy access to high-quality care when it’s needed. With a focus on prevention and support that’s targeted where it’s most needed, we will reduce the unfairness some people experience in accessing care, so nobody is left behind.  At the same time, we want to take advantage of what we have in Surrey to pursue innovation with business, public sector partners and communities, joining up services for residents and developing digital technologies to create smarter ways of managing health and accessing support.

With an important role in the community as the largest employer, a major purchaser of goods and services and recognising our duty towards addressing climate change, we want to create opportunities for people to work and volunteer with us. Making sure we involve our workforce and local people in co-designing services so that together, we continue to support the people of Surrey Heartlands to live healthier lives.

Summary of the Critical Five

Our system has now agreed the ‘Critical Five’, an overarching framework for bridging short and long-term sustainability through five key ambitions. These will form the foundation of our ICS transformation strategy.

  1. Keeping people well: Preventing citizen/patient deterioration by creating a vibrant Council, community, public health and preventative environment.
  2. Urgent care: Where citizens/patients do deteriorate, they will be able to easily navigate an effective and efficient urgent care pathway.
  3. Safe and effective discharge: Navigating patients more safely through an improved integrated community care environment.
  4. High-risk care management: ‘Wrapping’ care around the most vulnerable citizens/patients so that their care plans and pathways are coordinated and curated.
  5. Effective hospital management: Effective management of hospital resources and patients to ensure safe and efficient ‘flow’ through the hospital, and to deliver high quality care aligned to GIRFT and similar recommendations.
  6. Surrey Heartlands-wide effiencies: diagnostics, cross-system patient management & clinical networks, workforce optimisation, digital innovation, corporate and clinical support service, financial management, estates and facilities.

The Challenge

The health and care systems in England, and in Surrey, are facing the greatest set of challenges in their history:

  • Worsening financial environment for sectors and their staff
  • Higher retirement and exit rates.
  • High witing times and backlogs
  • Declining public satisfaction
  • Falling retention and staff satisfaction
  • Challenging labour market, high living costs and ramifications of European Union exit
  • High expectation from rapidly augmenting digital advancemnet

Underneath all these challenges is fundamentally a people issue: capacity and demand, quality of care, waiting times, high spend on escalation, agency and inefficiency are all addressed through having the right people, with the right skills,
in the right number and in the right place. This must be our biggest area of focus in the future.

Our Surrey Heartlands Partners by Sector

Surrey Heartlands provider sectors are made up of acute hospitals, community services, the Voluntary, Community and Social Enterprise (VCSE) sector, care sector, mental health, local goverment, and primary care networks.

Our Surrey Heartlands places

Surrey Heartlands is made up of four geographical ‘places’, Guildford and Waverly Health and Care Alliance, North West Surrey Alliance, Surrey Downs Health and Care Partnership and East Surrey.

The Opportunity

Surrey Heartlands has a clear vision for the future, which brings direction for the workforce leadership:

  1. Shifting the focus to population health, with more resources and new teams positioned towards ill health prevention and non-acute settings
  2. Creating sustainable and high quality physical and mental health acute and community services
  3. Playing our role in the wider determinants of health – such as employment access, positive working cultures and addressing racism and other forms of exclusion
  4. Joining up teams between organisations to work seamlessly for residents and patients as a united Surrey workforce team
  5. Recognising the contribution and potential energies of VCSE, social care providers, carers and residents themselves as part of that team
  6. Developing the workforce when augmenting digital, data and technology

The above requires a highly organised response and vehicle for change.

What success means

What success means to Frankie, Community Connector, working for the VCSE sector:

VCSE organisations can help reach people in all walks of life and together we can improve access to jobs and diversify our talented teams. At the same time, VCSE partners can benefit from sharing talent and scaling expertise from the united team approach.

The opportunity in some hard facts

  1.  Central Surrey Health is 100 Whole Time Equivalent
  2. short of Registered Nurses, yet Surrey loses 900 WTE each year.
  3. Although we have 5,700 registered nursing roles, we only recruit to 75 Nursing Associate posts.
  4. Skills for Care forecasts indicate a requirement to grow the workforce by 29% by 2035.
  5. Care sector turnover is around 36.4% with little supported pathways between health and care sectors.
  6. Many Surrey Care Association (SCA) members are small and medium sized businesses, with little or no dedicated HR infrastructure and clinical supervision.
  7. There are 30,000 social care jobs in the local authority and independent sector across Surrey Heartlands (2020/21). 42% of voluntary social care
  8. Organisations are turning down packages of care because they are unable to staff the services. Over 40% reliant on Agency staff
  9. Registered Nurse staffing is challenging but Nursing Support recruitment consistently over-achieves (+14% in 2021/22)
  10. Allied Health Professional (AHP) supply is also challenging but, again, AHP Support roles are popular, growing 23% in 2021/22
  11. 23% of existing care workers are on zero hours contracts and 28% are aged 55 or above.
  12. 62 Surrey Care Association members reported 14% vacancy rate: 20% for home care (SCA Survey October 2021)
  13. Less than 40% of charities have a specialist HR role responsible for recruitment - Voluntary, Community and Social Enterprise (VCSE) Alliance

The above shows many of the answers lie within our gift, if we work differently together.

Our Response

A United Team for the first time with health, VCSE, independent sector and local authority partners are working together. We believe that, for a united Surrey Heartlands workforce, we need a new vehicle entirely focused on developing the health & care workforce and careers across Surrey. This early report represents the current joint thinking of our partners emerging from workshops, conferences and engagement from April to June 2022.

Our Draft Vision

‘To unite Surrey talent across health, care and VCSE which is enabled,
mobile and skilled to serve others during fulfilled careers.

Six Levers for Change

  1. Modernise and Integrate Recruitment: Unite recruitment efforts with talent sharing, top-class labour market analytics, and diverse and effective recruitment channels.
  2. Build New Capabilities: Health & Care Academy for learning and education.  Strategic education and training partnerships.  Focus on values, as well as skills.
  3. Develop fulfilling Careers: Integrated, attractive careers across care and health.  Introduce career guarantees, with 2 job offers in 1.
  4. Establish a Surrey Offer: Level up experience.  Innovation in incentives and retention to build productivity, satisfaction and cost control. 
  5. Enable the United Surrey team: One governance vehicle.  Mobility across partners, systems access and shared spaces to connect. Digital enablement and build our neighbourhood teams.
  6. Build our Expertise: Leading expertise in workforce development and management

1. Modernise and Integrate Recruitment

The Challenges

  • Employers across health, care and VCSE compete for talent.
  • A lot of recruitment is through traditional, siloed, channels – internal websites and NHS Jobs
  • We can be inflexible in appointing talent, sometimes prioritising experience over values/potential.
  • As such, new and external expertise coming into the system is highly limited, causing cost inflation and stagnation.
  • Our understanding of the local employment market is limited, and we don’t adapt our response to market trends.
  • We continue to have wasted/unused apprenticeship levy funds.

The Solutions

  • Coordinate recruitment using Place based hubs and digitised talent sharing.
  • Large, dedicated and responsive recruitment teams providing dedicated visibility and communication.
  • Leading workforce and labour market analytics; understanding the trends and drivers of employment choices and key attraction factors across different roles and demographics.
  • Expanded recruitment channels and tracking their effectiveness, making our roles the most visible across Surrey and surrounding areas.
  • Targeted recruitment activity across towns and areas according to employment need and demographics
  • Focus on skills, experience and values in attraction and selection for wider reach.
  • Streamlined and accelerated onboarding and placement process

Pioneer Example: NW Surrey Place-Based Hub

A joined up, proactive recruitment model which seeks to:

  • Significantly enhance and develop the recruitment capacity to create bandwidth to expand all recruitment activity across the Alliance, also ensuring joint recruitment is in place for integrated roles.
  • Develop strategies to make health and care the first choice for local employment.
  • Explore a range of recruitment strategies including values-based recruitment, joint recruitment activity, new ways of recruiting and attracting a new workforce.
  • Provide co-ordination of regular resourcing activities such as recruitment events, pre-employment and careers activities
  • Explore opportunities for tackling differences in processes, pay and Terms & Conditions between employers and standardising where possible for integrated teams.
  • Develop an attraction strategy and run a series of recruitment campaigns for hard to fill roles e.g., community nursing.

What success means

What success means to Marcus, Future Applicant

Applying through a recruitment hub could mean that I would only have to apply once for multiple opportunities across Surrey Heartlands- a one stop shop! The recruitment team would help find the right role for me and the process would be seamless, with regular contact between us for a fast start.

2. Build New Capabilities

The Challenges

  • Despite our aspirations for integrated health & care, workforce education, learning and design are siloed.
  • National training pipeline is insufficient to meet our demands.
  • Our links with universities and educational institutions are at a foundational level and need to develop.
  • We rely heavily on out of area clinical training programmes making attraction more challenging.
  • We focus too much on traditional roles in rigid career structures, which are increasingly out-dated for new models of care and modern workplace aspirations.
  • We have fragmented presence at school and college level to promote care and health career choices.
  • There is a lack of national professional standards for the social care workforce.
  • Funding for apprenticeships is becoming increasingly challenging, resulting in apprenticeships for key clinical roles being turned down.

The Solutions

  • Develop a united Health & Care Academy to integrate workforce planning, education and learning.
  • Shared competency frameworks across health and care to underpin both physical and virtual work settings.
  • Build strategic partnerships with universities and education providers to guarantee the right influx of staff in key roles into our sectors.
  • Undertake a comprehensive assessment of workforce competency need, with a baseline position and rolling 5-year projections.
  • Expanded ‘Grow your own’ programmes working directly with students and school and college level to inspire, and vastly increase direct school/college leaver direct uptake.
  • Professionalising the social care sector workforce
  • Working together to find new funding solutions among partners organisations.

Pioneer Example: Health and Social Care Academy

Long term ambitions and early priorities include

  • Improving access to learning and work
  • Locally relevant delivery but with standardisation and consistency enabled across system.
  • Developing a workforce tailored to local population needs through joined up commissioning.
  • Relevant to emerging new roles for new models of care.
  • Competency development as a basis for flexible careers & mobility across system
  • Solid relationships with education partners, including schools and colleges.
  • Digital platform for sharing and signposting current training across system
  • Linked up training calendars and prospectus.
  • Collaboration on apprenticeships, placements, rotations, T&Cs
  • Removal of inconsistencies in roles, statutory and mandatory training, levy etc

What success means

What success means to Imogen, Care Assistant, Woodview Care Home:

I would love to know what development opportunities are available to me so that I can start to think about my future and see the career that I could have ahead of me. Clear career pathways and funding support would help me to develop professionally, to enhance my skills to care for our residents, and help me plan my long-term future in health and care.

3. Develop fulfilling careers

The Challenges

  • We lose significant numbers of staff who choose to pursue opportunities outside the area and outside ICS partner organisations.
  • There is a lack of rotational working across sectors which results in isolated silos and a lack of understanding across care settings.
  • Priority areas of our business often lack a career development pathway in particular, primary care and the care sector.
  • Significant investment into Additional Roles Reimbursement Scheme roles but no model for progression and attraction is behind plan.
  • Negative image associated with working in social care - seen as a dead end in Surrey.

The Solutions

  • Single approach to career planning across sectors
  • Compelling career pathways communicated to potential applicants.
  • Introduction of a career guarantee – offering 2 jobs in advance for key pathways
  • Rotations offered to new joiners through a centrally coordinated programme across organisations.
  • Empower care workers to deliver more health care – enhancing their job satisfaction and augmenting community capacity. Enable more clinical supervision and reflective practice in social care.
  • Single database of opportunities with everyone leaving Surrey offered a competing role as standard.
  • Talent development programmes for leadership and specialised roles

Pioneer Examples:

Examlpe 1:

  • St David’s Family Practice, New Roles Development: St David’s family practice in Staines is growing and developing new roles for staff as part of the Additional Roles Reimbursement Scheme. This not only helps improve access in primary care, but it also provides new career opportunities for local neighbourhoods.

Example 2:

  • Guildford and Waverley Career Guarantee: As part of the career guarantee, Guildford and Waverley will test the intention to offer two roles at the same time along a career pathway.

What success means

What success means to Julie, Physiotherapist:

With opportunities to rotate across all Surrey Heartlands organisations, I could begin to understand how everyone in the system works together and grow professionally. I would gain rich experiences and really make a difference to my patients. A “career guarantee” where I could be offered an unconditional offer for one role and a conditional offer for a second role at the same time would show a real commitment from Surrey!

4. Establish a core Surrey Offer

The Challenges

  • Retention rates and staff satisfaction are falling.
  • Significant operational pressure is increasing the number of people leaving the sectors; this then intensifies the capacity/demand gap leading to greater pressure and greater dissatisfaction.
  • We operate reward and recognition structures largely separately across organisations leading to internal competition and driving rising costs.
  • Pay and conditions in the care market, in particular, are not always competitive and reduce care capacity.
  • Cost of living and access to affordable accommodation are placed in the “too hard” box but are central to our problems.
  • Myths and negative perceptions by staff about working in new settings.

The solutions

  • Identify what’s important to a Surrey health and care employment brand.
  • Explore a minimum set of terms and conditions across health and care.
  • Address pay parity across health and care.
  • Much greater intelligence gathered through a structured exit process; providing a collated insight into why people leave.
  • Develop, coordinate and market a broader benefits and wellbeing offer for health and care staff.
  • Develop and test new simplified and comprehensive access to affordable accommodation solutions with partners.
  • Enable minimum support requirements across all staff - such as wide access to Speak-Up and occupational health facilities.
  • Establish ways to measure, capture and use staff experience data, so we can be clear nobody is being left behind. 

Pioneer Examples:

Example 1: Surrey Care Association, Role Evaluation for Social Care Roles

  • The SCA will develop a validated job evaluation process for current and future social care roles, including the development of a pay and grading structure for social care that reflects the NHS Agenda for Change and/or Local Authority pay bands. This will need to consider wider terms and conditions as well as pay. This will take time to introduce across the sector but would help inform commissioning and improve the narrative of values-based and valuable roles in social care.

Example 2. East Surrey Place, Discharge to Recover Workforce model.

  • Development of a new workforce team to enhance the current Home First and reablement model. The team will deliver a health and care offer that meets a broad range of need without the need for multiple agencies to support patients on discharge from home. The focus will be delivering intensive support at home for a defined cohort with an emphasis on constant assessment and review to enable patients to move to their next care destination as quickly as possible.

What success means

What success means to Matt, Student Nurse:

Working for Surrey Heartlands means that I will have better access to support, no matter which health or care organisation I am employed by. The Homestay pilot will assist me in finding suitable and affordable accommodation – enabling me to stay in Surrey!

5. Enable the United Surrey Team

The Challenges

  • Health and care partnership working is voluntary and fragile.
  • Traditional organisational silos and role structures are barriers to integrating health and care.
  • Team development is not seen as important, but the future will increasingly rely on shared teams – from system leadership to neighbourhood levels.
  • Working between organisations and settings is cumbersome, fraught with risk and frustrating for staff and managers.
  • There is no coordination or sharing of temporary labour market – pay competition is driving up costs and supply is variable.
  • Lack of recognition for changing attitudes to work and desire for more flexibility.

The Solutions

  • Build and enable new teams, at neighbourhood, Place and ICS levels. 
  • Focus and investment in OD support for building team effectiveness across settings and levels.
  • Surrey talent to be afforded suitable and easy access to systems and premises.
  • Shared physical spaces for teams to connect and innovate to be well designed and available.
  • Digital passporting for a fully mobile workforce and single source of assurance.  Shared statutory and mandatory training requirements.
  • Through a collaborative employment model, develop improved access and experience for our valued flexible workforce, better internal deployment, controls processes and fair rates of pay.

Pioneer Example: The FBOBSH* Temporary Staffing Collaboration Model

  • Develop a shared and agile temporary workforce which can be adaptively deployed to deliver care in response to demand.Greater equity and access to opportunities for both workforce and organisations through standardisation and effective collaboration.
  • Recognise the value of temporary workers and drive improvements in staff experience, satisfaction and engagement, improving
  • workforce productivity.
  • Collective grip, control and monitoring over temporary staff usage and a reduction in agency and breached spend.
  • Establish and join up good workforce data for planning, decision making and measurement at neighbourhood, Place and ICS levels. 

* Frimley, Buckinghamshire, Oxfordshire, Berkshire West, Surrey Heartlands

What success means

What success mean to Eve Nurse and new mum:

A united Surrey Heartlands team would mean I have the opportunity to balance my time between my work and my family to suit me.  I now have the choice between a supported career pathway when/if I want one and the need for access to good work, at fair pay with all the support my other colleagues enjoy right now.

6. Build our expertise

The Challenges

  • Our specialist workforce and people expertise are highly stretched with the demands of running large complex organisations.
  • Critical areas of under-investment include workforce planning and digital workforce readiness.
  • Some partners lack scale to invest in specialist talent and systems.
  • We source key expertise in areas like facilitation, OD, leadership development, legal etc, separately across organisations, increasing costs.
  • We don’t always have access to enough capacity in key areas like workforce analytics and planning.

The Solutions

  • Create a joint vehicle across health and care for transformation investment and delivery.
  • Develop material internal capability across core professional services that can then be delivered across partner organisations in areas like OD, workforce planning, digital literacy and analytics.
  • Where not practical to develop expertise internally, secure partnerships at greater economies of scale to reduce system costs, e.g., leadership development programmes, complex consultancy etc.
  • Identify transactional people services best delivered at scale, e.g., pre-employment screening, occupational health, policy development, SAM training, legal services.
  • Provide bespoke professional services and consultancy support into partner organisations at subsidised costs and externally as a supplementary revenue stream.
  • Joint procurement of one-platform digital systems

Our Vehicle for Change

Delivering the fundamental step-change of this nature will require considerable scale and expertise. Consideration for the right type of vehicle for our collective efforts is key. Our essential parts of our change vehicle are.

  • Recruitment and Onboarding
  • Workforce and Market Analytics
  • Education and Training
  • Employment Coordination
  • Retention and Talent Development
  • Joint ICS/SCC funding agreed.
  • ICS and Place partenrships
  • Education Partnerships
    • University of Surrey
    • Royal Holloway University of London
    • Nescot College
    • Bourne Education Trust

What success means

What success means for Duncan, Care Network Director:

I need to build integrated teams in my neighbourhood. By addressing the issues of access to learning and support for all, including pay parity and occupational health as examples, all health and care staff can feel they are part of the team.

Year 1 Mobilisation

We must first mobilise our strategy by building system architecture, bolstering Integrated Care Board Programme Support, pump priming Place Pioneers and developing our System Buniness Intellegnace and Workforce Planning.

Our Year 1 Mobilisation Approach will be to:

  • Engage on and agree vision and objectives for each workstream.
  • Agree leading pioneers in each area who adopt agile and QI approaches to development.
  • Make use of networks and events to share, learn and test together.
  • Invite pioneers to draw down innovation funding to resource their developments.
  • Have oversight by the People Committee and build a vision for the long-term architecture required.

Key Performance Measures - a work in progress and under-pinning the Critical Five

Lever 1: Modernise and Integrate Recruitment

  • Decrease in Place Hubs/Alliance overall vacancy rates.
  • Increase diversity of new recruits
  • Measure and improve stay-rates of new recruits.
  • Lower cost per hire

Lever 2: Build New Capabilities

  • Percentage increase number of student placements
  • Percentage increase conversion from learning to job take up.
  • Increased number of apprenticeships
  • Increased number of learning rotations

Lever 3: Develop Fulfilling Careers

  • Increase in number of 2 in 1 unconditional and conditional offers.
  • Percentage increase in number of new joiner rotations
  • Percentage increase in number of specialist and leadership talent development roles
  • Evidence of joined up job data systems.

Lever 4: Establish a Core Surrey Offer

  • Increase in number of homestays offers and % uptake.
  • Improved retention rates
  • Percentage decrease in sector leaver rates
  • Percentage decrease in voluntary turnover outside Surrey

Lever 5: Enable the United Surrey Team

  • Reduced escalation capacity in Acute Hospitals
  • Report benefits realisation from Workforce Innovation Fund investments
  • Financial savings from Collaborative Bank and Agency model
  • Increased access and mobility through digital passporting
  • More shared estate
  • Participation of Care and VSCE in Surrey 500

Lever 6: Build Our Expertise

  • Consolidation to one source of truth workforce Buisness Imtelligance
  • Improved Operational Planning process and outcomes.
  • Joint Procurement of Single Digital Platforms
  • Professional and Consultancy core services support to more partner organisations