Angela O’Donnell

Committed to excellence 

Facing the future 

,,,,:;j

Frimley Health 
NHS  Foundation Trust 

Frimley  Park Hospital 
Portsmouth  Road 
Frimley 
Surrey 
GU16 7UJ 

17th  December 2021 

Mrs Heid i J  Connor 
Senior Coroner 
County of Berkshire 

Private & Confidential 

Dear Mrs Connor 

Response to Regulation 28 Report following the Inquest into the death of Mrs A O'Donnell 

I am writing to set out the Trust's response to the Regulation 28: Report to Prevent Future Deaths, dated 
3 November 2021, wh ich was issued following the inquest into the death of Mrs Angela O'Donnell. 

I would  like  to  begin  by  extending  our deepest  condolences  to  the  family  of Mrs  O'Donnell.  We  fully 
appreciate that this has been, and will remain, an extremely difficult time. 

Whilst we appreciate that you make clear in your report that your enquiry did  not find  that there were 
any fai lings which had  a causative impact on  Mrs  O'Donnell's death, we do appreciate that the issues 
raised will  be a concern to the family of Mrs O'Donnell.  I hope that our response provides assurance to 
both  you and Mrs O'Donnell's family that the Trust is looking seriously at how to address these issues. 

You summarise your concerns arising out of the evidence you heard at the inquest as follows: 

'Wexham Park Hospital, along with  many hospitals nationally,  has a serious problem 
with  staffing  shortages  in  many areas,  including  nursing.  As such,  they have  little 
choice but to use large numbers of agency nurses to  fill those gaps in  the short term. 
This is a picture which is reflected up  and down the country .... 

This is a complex and national issue, but it is the important responsibility of coroners 
to highlight matters of concern, where we  believe there is a risk of future deaths. 

Concern about the use of agency staff is by no means new information.  This report does not tell the 
hospital anything they do not already know.  It is difficult even for the senior managers within the trust 
to identify the cause or 

v~f.  ~ INVESTORS 
8  IN  PEOPLE 
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In partnership with the Ministry of Defence 

Frimley Health incorporates Frimley  Park Hospital, Heatherwood Hospital and Wexham Park Hospital 

 
 
 
 
 causes of these national shortages.  Coroners are under a duty to flag up concerns 
where there is a risk of future deaths - even where the solution to that concern is not 
clear. 

I have heard in  evidence on more than one occasion that recruiting more nurses is 
difficult - not because the trusts are not trying to recruit them,  but simply because 
there are insufficient nurses out there to recruit. 

Given the fact that this issue is a national one, and the root cause of it is nursing 
staff shortages,  I have considered it necessary to include the Secretary of State for 
Health and Social Care,  to add my voice to this ever-increasing national concern. 

The  MATTERS OF CONCERN are as follows.  -

(1)  Is the trust able to carry out any steps to reduce  their reliance on agency nursing 
staff - for instance, by using nurses from  a smaller pool of their own bank staff who 
receive the same training as permanent staff,  or any other similar measures? This 
question is for the hospital trust. 

(2) What plans are there nationally to reduce the shortage of nursing staff going 
forward? This question is for the Secretary of State.' 

I recognise the point you have made about the reliance on agency staffing being a national issue for the 
NHS and that you have also directed your concerns to the Secretary of State for Health. It would not be 
appropriate for me to seek to address or comment on the national issue in this  response,  but I hope to 
set out what Frimley Health NHS Foundation Trust is doing to address your first concern  listed above. 

I will  explain  how we are aiming to reduce our reliance on agency nursing staff by: 

a)  Working  to increase the recruitment of nursing staff and, 
b)  Encouraging our substantive staff to undertake bank shifts. 

I will also address how grateful the Trust is for the flexible resource which  agency staff provide us with 
in  assisting  with  patient  care  when  we  do  have  unavoidable  gaps  in  our  staffing  and  how  we  are 
improving the way in which we work with our agency staff to ensure the safety of our patients. 

1.  Our nursing recruitment 

The Trust is constantly undertaking a range of initiatives to recruit nurses and has been successful in 
reducing the nursing vacancy rate over the past two years from 13.7% in April 2019 to 8.9% in 
October 2021. 

The Trust advertises vacancies through a combination of targeted  and specific advertising , alongside 
generic campaigns, open days,  virtual events,  and attraction campaigns using social and digital media 
and professional publications. 

We also look to increase our student placement capacity year on year to  increase the number of 
nursing staff in training . It is the intended aim that these nurses will then continue in  substantive roles 
within the Trust upon qualification. 

We offer various training routes into registered nursing through Trainee Nursing Associate (TNA) and 
Degree Apprenticeship  routes. Over the last few years we have successfully supported 50 Care 
Assistants through their Nursing Associate (NA) training and currently have a further 57 staff on their 
TNA programme.  These programmes have continued to grow each year and it is hoped that this will 
help stabilise our substantive nursing workforce over the next three years and reduce our reliance on 
temporary staffing . 

International recruitment forms a large part of our nursing recruitment activity, with  172 international 
nurses recruited  in 2019120 and around 200 so far in  2020/21 . We have an  ambition to increase our 
international nurse recruitment to around 400 nurses throughout 2022, with additional funding from 
NHSE/1  to support this. 

 Our International Educated Nurses (IEN) are supported from day 1 in the organisation with preparation 
for their UK exam to enter the Nursing Midwifery Council register.  Following successful entry onto the 
register, all  lEN's then enter a preceptorship period where they are supported and developed 
alongside our newly qualified nurses from the UK.  Pastoral care for our international staff is a priority 
as we recognise the importance of ensuring that all of our workforce is valued, and that they feel 
integrated as part of our community. 

Our registered  nursing workforce is also supported by  healthcare support workers.  The Trust regularly 
undertakes recruitment drives to meet the national target of zero healthcare support worker vacancies. 
This is again supported by offering additional training through apprenticeship routes and the Care 
Certificate, with additional funding currently being  provided by  NHSE/I to support this initiative.  209 
care assistants have started in  the Trust over the last 12 months with a further 93  having been 
recruited who are currently completing their pre-employment checks. 

The Trust recognises that there needs to be a continued focus on  recruitment and is always looking at 
all options to improve our vacancy  rate. We  recognise that patient care is best provided by a 
consistent, and substantive nursing staff team and recruitment of nursing staff will continue to be a 
main priority for us as an  organisation. 

2.  Encouraging our substantive staff to  undertake bank shifts and  increasing the number of 'bank 

nurses' we employ 

To supplement and support our substantive nursing teams the Trust runs its own Staff Bank, this 
provides a team of bank nurses who provide cover for planned and  unplanned shortfalls in  staffing, 
covering vacancies and absences. This flexible resource is invaluable across all  NHS organisations. 

When employed on a permanent contract with the Trust,  all our staff are automatically registered with 
a 'bank contract' and are encouraged to undertake any additional shifts they can work. 

Furthermore,  the Trust recognise that staff who leave permanent roles within the Trust do so for a 
variety of reasons.  Staff leaving permanent contracts with the Trust are actively encouraged to remain 
on  the bank register, thus allowing them to return to work shifts at the hospital  under a bank only 
contract. 

3.  Staff retention and wellbeing. 

The Trust recognises the importance of retaining staff as well as recruitment,  this is vital to achieving a 
safe and sustainable workforce. We understand that retention of nursing  staff is a recognised 
challenge nationally and we are working hard to improve staff wellbeing as a cornerstone of this issue. 

We have recently been allocated funding from NHSE/I  for two posts which will  be  actively recruited to 
in early 2022 to support the 'NHS People Promise'. One post will be held within the Trust as a People 
Promise Manager and the second within our Integrated Care System (ICS) as a Retention Lead. 
These roles will support the Trust and the wider ICS to ensure our workforce: 

Feel recognised and rewarded,  and feel that they have a voice that counts, 
Feel safe and healthy, 

•  Are compassionate and inclusive, 
• 
• 
•  Are always learning, 
•  Are able to work flexibly. 

This will enhance the work already in  place as we have a range of initiatives to support the retention of 
staff including: 

•  Comprehensive educational and career development pathways 
•  Preceptorship programme for newly qualified nursing staff 
•  A dedicated 24hr Employee Assistance Programme (available via free call or free app with  live 

chat or email options) 

 •  Access to  rapid mental health support via our NHS resilience hubs,  provided by  our local 

Mental Health Trusts, and offering  1: 1 support and rapid access to IAPT as well as bespoke 
workshops and support for teams 

•  Mental Health First Aid training with our in-house MHFA instructors 
•  Ongoing refurbishment programme of staff rest areas 
•  Executive listening events, where our executive team have dedicated time set aside to listen 

to any concerns raised  by staff 

•  Staff benefits, including salary sacrifice schemes,  a lease care scheme and a cycle to work 

scheme 
Flexible working  and flexible retirement options 

• 
•  Reward and recognition programmes such as ViP (Values into Practice) awards, extra annual 

leave day given to all staff in recognition  for work during the pandemic. 

4.  Induction training for agency  and  bank staff 

Agency staff are utilised to provide an additional flexible workforce outside of our own bank workers. 

The Trust recognises that it is much better for patient care if we can  use agency staff who are familiar 
with  our hospitals and our policies. We work hard with our agency providers to ensure that, wherever 
possible, we are provided with agency staff who have worked in our organisation previously. 

Wherever possible Frimley Health NHS Foundation Trust appoints agency staff through suppliers who 
are party to the Framework Agreement with the  NHS Workforce Alliance. This agreement sets out that 
agencies providing temporary workers to NHS Trusts under this agreement will ensure: 

'that the  Temporary Worker is fully trained,  compliant with any professional registration 

• 
required for the role' (para 8.12 of the Framework agreement) and. 

'that Temporary Workers are fully trained in accordance with the UK Core Skills Training 

• 
Framework Agreement.' (para 8.13 of the  Framework agreement) 

http://www. skillsforhealth. org. uk/services/item/146-core-skills-training-F ramework Agreement. 

The Trust has also recently relaunched the induction training for all  staff including agency and  bank 
staff. There is now an induction  programme which is delivered to all new bank nurses and Health Care 
Assistants before they can  book on to a vacant shift and there is also a local induction provided to any 
new staff member working on a ward provided by  the  nurse in  charge of the ward. Through this 
induction we will ensure that all agency staff are aware of how to find all  policies and key training 
updates on our Trust intranet. 

I hope that the information provided within this response is helpful to set the context of the actions 
being taken  by Frimley Health Foundation Trust in  the face of the national challenge around nurse 
recruitment and staffing of clinical areas. 

Chief Executive