Three years ago, patients in West Sussex needing an x-ray faced a four-month wait. Staff shortages spelled misery, but waiting times have now been cut so that no one need wait longer than four weeks, thanks to a new working pattern where staff share roles.
This turnaround by West Sussex NHS trust was recognised earlier this month in an awards ceremony for human resources staff. The trust was named overall winner in the Excellence in Strategic Human Resources Management Awards 2003, run by NHSP (formerly NHS Personnel) and the Association of Healthcare Human Resources Management (AHHRM) in association with the Guardian.
Judges heard how, in 2000, a shortage of radiologists and radiographers meant long delays in treatment and a failure to meet national targets. Services to patients improved only after the trust tore down barriers between health professionals and ancillary staff. The move had the backing of staff, and of Portsmouth University, which agreed to carry out extra training.
Now, walk-in patients needing an x-ray or scan are no longer examined by radiographers but by specially trained support workers.
This has allowed radiographers to concentrate on more complex cases. At the same time, a group of advanced practitioners - specially trained radiographers - have been taught to carry out work traditionally undertaken by radiologists, who have been freed to concentrate on the most ill patients.
Such a radical shift in working has led to dramatic results: waits for CT scans have gone down from 15 to seven weeks, and the trust is, for the first time, meeting the national cancer two-week referral target.
The primary care category of the awards highlighted the problem many GP surgeries face trying to recruit receptionists.
In Hounslow, west London, low pay, combined with poor job prospects, led to several vacancies. "We realised we had to do something," says Linda Graves, head of organisational development for Hounslow primary care trust (PCT). "We were worried that staff at the frontline were being placed under unnecessary pressure."
Liaising with the local workforce development confederation (WDC) and learning and skills council, the PCT developed an accredited programme designed to develop receptionists' skills.
Targeted mainly at parents returning to work, the flexible 10-week foundation course included dealing with prescriptions, medical terminology, patients' rights and access to other services. Trainees spend eight weeks on placements and eight half days in one-to-one sessions.
"We were amazed at how much interest there was in the course," says Graves. "Twelve of those chosen for the course have taken up permanent jobs and two have gone on to take degrees."
The scheme won the HR development in primary care category and is now being developed to attract refugees and people from the ethnic minority community.
Some miles away, in south London, when Bernadette Hennigan started her new job as acting chief nurse at South West London and St George's mental health trust, she saw a hospital struggling to cope with a staff exodus.
More than 350 nursing employees had left and the hospital was at crisis point. Managers were forced to bring in scores of temporary staff who did not know how the hospital was run. Patient care suffered as a result. Faced with the challenge of filling 350 vacancies, Hennigan set up a nurse retention group to examine ways of making nurses stay in the job. That was three years ago. Today, the trust has one of the best staff retention rates in the capital, and for its efforts received the recruitment and retention HRM award, sponsored by the Guardian.
The solutions led to a drop in the vacancy rate from 23% to 10%. A nurse transfer scheme was introduced, allowing nurses to switch to other specialities on their nursing grade without the need for a formal interview. With nine clinical directorates providing mental health services for adults and children, the initiative meant staff could develop their careers without leaving the trust.
"This made a real difference," says Hennigan. "The trust operates across five boroughs in south London and people were free to change their jobs as their circumstances changed."
But things did not stop there. Mental health student nurses at the hospital are now guaranteed a job at the end of their three-year training if they pass all their assessments.
Managers recognised also that efforts were needed to retain healthcare assistants. "Without them we would not be able to provide many of the services we do," says Hennigan.
Their experience was developed through a certificate in community mental health care that is now recognised as an entry qualification for those who want to train as registered mental health nurses. Nurses seeking to return to work after a career break, meanwhile, can sign up for a six-month refresher course during which they are paid as a healthcare assistant.
In Manchester, too, excellence has been recognised. NHS recruitment staff were shocked to discover, 18 months ago, that local health organisations would need 2,000 new workers by 2005. It seemed an impossible target. The answer was to create a new role of assistant practitioner - an all-round health worker able to carry out some nursing duties, physiotherapy and basic counselling. Discussions led to the creation of a foundation degree.
Christine Mullen, project director of Greater Manchester WDC, which won the Excellence in Strategic HRM strategic partnership award, says partnerships were forged with health and social services organisations and talks held with the local job centre and Sure Start - the government scheme supporting families in poor areas.
There are now about 500 trainees spread across 14 sites. Eight more sites are due to open next year, when there will be two further intakes of trainees.
It is imaginative ways of working such as these that lie at the heart of the Excellence in Strategic HRM awards. Organisers say growing numbers of trusts recognise that human resource management is a critical factor in securing high-quality patient care. The competition, which has 11 categories, attracted more than 100 entries.
Excellence choices
King's College hospital NHS trust, for improving doctors' working lives by developing a clinical facilitator to support pre-registration house officers who may struggle to make the transition from student to doctor. The facilitator ensures administrative work is delegated, doctors leave on time and provides clinical advice when needed.
The Royal Hospitals HSS trust, Belfast, for developing a consultant appraisal scheme.
Great Ormond Street hospital for children NHS trust, for its recruitment advertising campaign "No Know it Alls", aimed at tackling barriers to nurses joining the London-based trust.
Gwent Healthcare for taking an e-learning approach to fire safety training that prevented taking staff away from patient care.
Queen Elizabeth hospital NHS trust, south London, for developing new lead clinician roles along with a set of leadership competences.
Good Hope hospital NHS trust, West Midlands, for improving staff morale by creating a self-rostering system for nursing staff to give them a greater control over work-life balance.
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