In March 2020, 45 London NHS Chief Executive Officer’s signed an memorandum of understanding (MOU) that allowed staff to be redeployed rapidly across sites during the Level 4 emergency incident. They included all London ICSs, NHS England – London Region, Health Education England London Region, the London Ambulance Service, Higher Education Institutes, and NHS Blood and Transport. The agreement has been so successful in facilitating agile working that it has been extended and strengthened to support recovery.

With the first Nightingale Hospital set to open and London intensive care units (ICUs) filling up with first wave COVID-19 patients, it was clear a mechanism was needed to share staff rapidly, safely and legally across sites. While well-established protocols exist to move patients between Trusts during a major incident, no such arrangements existed to move staff.

“Moving skilled specialist staff is much more difficult than moving patients,” says Cheryl Samuels, NHSEI Deputy Director of Workforce Transformation. “We needed to ensure compliance with governance and safety checks without trusts having to negotiate secondment agreements and contracts, which take weeks. A small number of trusts were piloting digital staff passports, but they weren’t ready to roll out across London.”

Crafting a temporary agreement

So the first London Staff Movement Agreement (LSMA) was born, to address the urgent workforce challenges. A set of guiding principles was quickly agreed with all key stakeholders and template documents prepared for employing and receiving bodies. “I led this work initially to support elective recovery after the first wave,” says Manjit Mahal, London’s Deputy Chief People Officer, “but we realised we also needed to support any future COVID response needs.”

Under the agreement, NHS staff could be deployed at speed into the Nightingale Hospital or other trust, but remained employed and paid by their own trusts. Trusts collaborated locally, for example to align cancer services and paediatrics emergency services and perform urgent surgery. In one trust alone, the Royal National Orthopaedic Hospital released staff to cover over 100 shifts at other trusts in the North Central London, in response to emergency requests.

“One challenge was that this was a voluntary agreement. We needed to engage every CEO and their team,” comments Deborah Tarrant, Lead Director London Temporary Staffing and Wellbeing Programmes for NHSEI. “Initially Trusts limited the agreement to the crisis, but once it proved its value there was support for extending it.”

Extending and strengthening the LSMA

The team moved the process forward through careful consultation. A discover, design and deliver process took place in June 2020, with questionnaires to all London HR Directors and unions followed by 1:1 and small group conversations.

In August, Manjit facilitated task and finish workshops with senior HR colleagues from all five London ICSs, following a review of other ICS-wide MOUs and legal advice on future use of the LSMA. In October, these efforts paid off when all 45 organisations signed a revised agreement covering elective recovery, transformation plans and new surgical hubs across London.

In February 2021 a requirement to capture staff deployment data was added, to give a full picture of cross-trust workforce movements. “This is not just an agreement for clinical staff,” stresses Deborah. “We’re also moving management and support staff around to ensure we properly support people doing difficult jobs in new locations.”

A tool for transformation

It is clear that an agreement created at speed to resolve workforce challenges during an emergency is now seen as a strategic tool to transform services across London.  “This is ground breaking,” confirms Cheryl. “We took away the bureaucracy and barriers to staff movement and innovated at scale through sharing and collaboration.”

“We want that to continue,“ Manjit concurs: “We’re developing processes to ensure workforce planning conversations occur, and to help managers track and support their staff so wellbeing and working time regulations are not compromised.”

Many staff feel they have benefited from the shake-up, despite the stresses of the pandemic. “Staff are telling us that they feel enriched by their experiences of working with different organisations,” says Cheryl. “Some might have worked in the same team for years. Redeployment gives them opportunities to expand their networks and to cross-fertilise skills and knowledge, which will stay with them forever.”

Deborah agrees: “All HR people agree that movement is good for careers and skills, and for the wider NHS. The LSMA provides an infrastructure to work in agile ways and give our staff more choice. Now we’re putting our energies into building on what worked and ensuring it stays useful and relevant going forward.”

For more information please contact cherylsamuels@nhs.net.