In September 2019 NHS England announced that, after successful piloting, it was going to roll out NHS staff passports. This was one of the aims of the NHS Long Term Plan (NHS England and NHS Improvement (NHSI), 2019). The aim of the passports is to allow various grades of healthcare staff, and especially nurses, to work more freely in hospitals across the NHS at short notice without the need for mandatory 2-day inductions. Such inductions are expensive to implement and result in delays in the employment of staff. Electronic NHS passports are intended to help speed up the whole process of employing staff, and especially those who are bank or agency nurses (NHS England, 2019).
The primary aim of the passport initiative is to offer NHS staff opportunities to move to permanent or temporary positions without delays in starting duties. Ironically, it is these delays in the employment processes that can exacerbate the use of costly agency staff. Passport use seeks to offer NHS staff greater flexibility in allowing them to move as required from one organisation to another. Elements of staff employment that can slow down the process of hiring the right person include pre-employment checks, ascertaining whether mandatory and statutory training (MAST) is up-to-date, and the maintenance of an individual's appraisal and performance record to facilitate non-interruption of development pathways. If implemented well, the passport scheme should allow staff to move jobs within the NHS seamlessly. This will be helpful for those staff who operate as bank or agency nurses, for example, and for those who have rotational roles, such as trainee doctors.
Background
Hospital passports have been used for a number of years for certain patient groups and are designed to give hospital staff helpful information about patients who have frequent admissions to hospital. The aim is to make care more personalised and appropriate. For example, Blair (2011) discussed the use of passports for children with learning disabilities, which are often used by hospitals for this group of patients because they can be annotated to provide useful information, such as the child's likes and dislikes and how they express pain (Glasper, 2017). Similarly, Dijkstra et al (2005) have outlined how passports can be used for patents with specific medical conditions, such as diabetes.
One of the elements of the current induction process for new starters to an NHS hospital is ensuring that these members of staff have received the appropriate MAST that is commensurate with the hospital's duty to ensure patient safety. Although a registered nurse might have completed all of the NHS MAST preparation in a previous or indeed current job, ensuring the consistent compatibility of this training from one NHS organisation to another has proved difficult. This should not be problematical as many trusts across the NHS have now adopted the electronic staff record (ESR) system, which allows accurate record keeping of an individual staff member's compliance with MAST requirements (NHSI, 2019). However, recording and sharing information about an individual's level of competency is challenging and the new passport scheme aims to overcome this.
MAST education is primarily designed to reduce organisational risks to individual NHS trusts and to comply with local or national policies and government guidelines and embrace statutory training. This is a legal obligation of trusts to ensure that staff members are compliant with, for example, the Health and Safety at Work Act 1974. This type of statutory training ensures that nurses and others have the knowledge to maintain a healthy and safe working environment for themselves and their colleagues.
Other types of statutory training offered to nurses include, among others, awareness of the control of substances hazardous to health (COSHH) regulations. Despite the existence of such staff training, serious incidents still occur in NHS trusts. In one hospital, an elderly patient died after drinking floor cleaner, which had been inadvertently put into a water jug and left by the bedside (Mohdin, 2018).
Mandatory training, unlike statutory training that is given to meet legislative duties, is an NHS organisational requirement to limit risk to patients and maintain safe working practice. Mandatory training for nurses covers a wide range of topics, some of which are offered face to face and some via electronic or e-learning packages. The Royal College of Nursing (RCN) (2019a) lists 23 mandatory training topics in which nurses should achieve competency. These include:
Although the health care regulator, the Care Quality Commission (CQC), does not list the specific types of mandatory training that healthcare staff such as nurses must undertake, the Health and Social Care Act 2008 (regulated activities) regulation 18 specifies explicitly that staff must receive the support, training, professional development, supervision and appraisals that are necessary for them to carry out their role and responsibilities (CQC, 2019).
Hence, during any hospital inspection, CQC inspectors and their specialist advisers will check MAST compliance data provided by the trust against the ESRs of the individual nurses they interview.
Ensuring the record of compliance of individual staff members with trust mandatory training targets is accurate and up-to-date is a significant organisational undertaking requiring both long-term planning and the co-operation of ward managers, among others. Most NHS trusts have an education department and often it is the practice educators—usually senior nurses—who liaise between the education department and individual ward mangers to ensure that MAST training is fully implemented across the nursing and healthcare assistant workforce. It is usual for trusts to employ practice educators within individual core services such as surgery or the emergency department and it is their job to facilitate and help staff avail themselves of the right opportunities to maintain not only their clinical competence but also their mandatory and statutory training. Organising MAST training and the maintenance of an individual nurse's appraisal and performance record is a highly complex and a logistical challenge.
This challenge is exacerbated when processing and dealing with new starter staff and bank or agency nurses—who frequently work across a number of separate NHS trusts. Under current arrangements it is difficult to validate previous MAST and other training that has been completed by staff in another NHS organisation. This obligates the new employing trust to give these staff members the same MAST and other training, which in many cases is an unnecessary and expensive belt-and-braces approach.
Avoiding training repetition
As well as avoiding unnecessary, time-consuming and expensive 2-day inductions, this strategy would also facilitate changes in skill mix that might be challenging during periods such as the winter months where staff shortages might threaten the delivery of optimum patient care.
NHS passports have been successfully piloted in a range of NHS trusts, including the South London Mental Health and Community Partnership, which allowed staff to move more quickly and effectively to roles across participating trusts. (NHSI, 2018)
A significant advantage of employing a registered nurse or nursing associate is the flexibility and work experience the roles can offer. Many nurses have embraced either bank or agency nursing not only to enhance income but also to provide employment flexibility. However this flexibility is currently adversely affected by the necessity of undertaking MAST training, even when completed before. Hence, for bank and agency staff, the new passport scheme should be invaluable and should also offer employing trusts the reassurance that new starters are up to date and ready to deliver hands-on care.
The employment passports will be transferred between trusts online. It is envisaged that the new scheme will allow staff to move into roles in other institutions at short notice, allowing core services within trusts such as medicine or elderly care to fill vacancies within the rota, especially during emergencies. The RCN (2019b) has developed guidance on safe nurse staffing levels in the UK, but currently there is no compulsion for healthcare providers to follow these when planning service off-duty rotas. The new employment passport scheme will make it easier for managers within core services to fill vacancies on the staffing rota.
Conclusion
If this new scheme to give NHS staff electronic employment passports is well implemented it could pave the way for removing induction bottlenecks in the employment of nurses and other frontline staff from other healthcare institutions. The reciprocal passport arrangements will enable staff to move seamlessly across different NHS sites to provide care for a range of patient specialties. This will be eminently suitable for bank and agency nursing staff who already work across NHS trusts. The innovation will go some way in helping to create a sustainable workforce as envisaged in the NHS Long Term Plan. The passport scheme should reduce competition among local trusts to recruit staff and give them better opportunities to develop and expand their skillset. Furthermore, NHS England has stated that implementing the scheme should help improve workforce retention. However, the passport initiative is not without its critics. The British Medical Association has aired concerns that some employers might expand the scheme to move junior doctors in training to clinical areas outside their areas of confidence and competence at short notice and without appropriate induction. (Mahase, 2019).
Despite these fears, the introduction of the new employment passport should make it easier for nursing staff to move between NHS trusts without undergoing tedious repetitive pre-employment checks and facilitate the electronic transfer of individual nurse statutory and mandatory training competencies.