Effective workforce planning ensures appropriate levels of staff are available to deliver safe, high quality care to patients and service users. Creating an effective workforce requires an evidence-based workforce plan, integrated with finance, activity and performance plans. This must directly involve matrons and managers of the service.
Matrons should use their organisation’s workforce planning and resource management systems and processes to support their wards, departments and services: for example, by helping staff implement policies and procedures on sickness, leave, flexible working and other human resources matters.
- Operational workforce planning: a self-assessment tool: this helps trusts carry out an organisational diagnosis and identify areas for workforce improvements.
- Case studies from trusts that have implemented workforce planning processes, new roles and new ways of working to tackle some of the workforce challenges they face.
The matron should assess every day whether staffing is appropriate to meet patient needs. This should include:
- analysing training needs and reviewing skill mix to ensure safe, high quality care within financial constraints
- ensuring staff reflect on what occurs in the clinical environment at the point of care delivery and the impact on staffing management
- planning succession, ensuring enough capacity to develop the workforce effectively
- contributing to implementing the NHS Long Term Plan and the Interim NHS People Plan locally to address staff shortages and develop additional clinical roles to close skills gaps while advancing equality and addressing the inequality.
Retaining staff is a key component of workforce planning. Matrons should use the national retention support programmes to reduce their staff turnover rates.
The NHS retention improvement guide outlines key steps to improving retention of clinical staff, which matrons can use locally. These include:
- developing a retention strategy
- effective use of data and diagnostics
- supporting new starters and newly qualified staff
- flexible working to support work-life balance
- supporting the experienced workforce
- career planning and development
- health and wellbeing, rewards and benefits
- staff engagement and communication.
These themes have been distilled from the expert advice of human resources directors, directors of nursing and medical directors, reflecting and complementing the themes explored by NHS Employers in Improving staff retention: a guide for employers. The matron should use these resources in supporting staff retention locally.
Increasing demand for services, an ageing population, financial constraints and workforce supply and retention issues across many healthcare professions are likely to remain in the NHS for the foreseeable future. These pressures have led to the development of new roles that include the assistant practitioner, physician assistant, physician associate, pharmacy support role and nursing associate. All these roles are designed to support more highly qualified staff such as the registered nurse or doctor.
The matron plays an important part in deploying and monitoring the impact of these roles. Matrons should be fully conversant with all of them and understand how they can support and enhance care. The National Quality Board (NQB) has developed a nursing associate improvement resource to help deploy this role safely and effectively. Although it focuses on the nursing associate, the principles can be equally applied to other new roles.
Building a diverse workforce
Senior leaders are responsible and accountable for ensuring the diverse workforce has equal opportunities to develop, regardless of their race, age, disability, gender reassignment, marriage or civil partnership, pregnancy and maternity, religion and belief, and sexual orientation. Approximately 19% of NHS staff in England are from a black, Asian and minority ethnic (BAME) background. But BAME nurses and midwives are significantly underrepresented in senior pay bands. The matron should lead in understanding and meeting the diverse workforce’s needs in their area of responsibility.
Diversity depends on organisations having fair recruitment and development processes to fit the right person to the right job. All staff, including ward, department and service leaders, should be trained in the importance of diversity and recognising unconscious bias. The matron should liaise with human resources to ensure the recruitment process and interview panel respect diversity.
Interview panels should be diverse: for example, they could include an appropriately senior staff member from a BAME background or a staff member who is registered as disabled. An executive board member should be responsible for key performance indicators for staff recruitment and the Workforce Race Equality Standard (WRES) action plan. BAME staff, and staff with any protected characteristic, should have equal opportunities to undertake development courses, leadership programmes, secondments and internal promotion through succession planning in their organisations.
Enabling staff development that is equitable
It is well recognised that BAME staff face a ‘glass ceiling’ in healthcare, and other sectors, and this hampers their career progression compared to their white counterparts. Candidates from a BAME background remain statistically less likely to be appointed to senior roles. Many with an MSc or PhD in addition to their nursing degree do not have a senior job, according to WRES data. Enrolling BAME staff on a training and development programme or finding them secondments is only the first step: the real test is the support they receive to secure a post they aspire to when they return to their organisation.
The matron as a senior leader should raise awareness across their workforce of the challenges that diversity brings and the inequalities that exist within their area of responsibility. They should lead on strategies to support equitable staff development by having an effective talent management, development and succession planning programme that identifies staff from any background for roles they are qualified to fill. Systems and processes should reduce the risk of unconscious bias and ensure, for example, that BAME staff are as fairly selected for opportunities as their white counterparts.
An appreciative enquiry into enabling BAME staff to progress into senior leadership positions recommended producing an action plan for improvement. Matrons should implement these in the areas for which they are responsible.
These strategies help identify how to support BAME staff to progress into senior roles through to executive nurse level. At the beginning of 2019, 10 out of 156 executive nurses in NHS trusts came from a BAME background, which is just over 5%; BAME staff comprise approximately 40% of frontline NHS staff.
Other ways matrons can support, engage, develop and progress BAME staff include:
- using affirmative action to solve BAME issues
- introducing talent management and succession planning to get the right staff in the right roles
- expecting staff to develop and progress; managerial support is needed for this
- encouraging all senior BAME staff to support their BAME colleagues, sharing their experience of how they progressed to a senior level
- having systems and processes that support BAME staff and include support from senior and executive-level BAME and white staff.
Although the appreciative enquiry focused on BAME staff, these actions apply equally to all staff, including any with a protected characteristic.
Matron’s Handbook – next sections
- Patient experience and reducing health inequalities
- Performance and operational oversight
- Digital and technology
- Education, training and development
- Research and development
- Collaborative working and clinical effectiveness
- Service improvement and transformation
- Appendix: The matron’s developmental framework and competencies