HR Recruitment and Selection in the NHS

Recruitment and Selection Strategies: UK NHS

1. Introduction

The objective of this paper is to review the recruitment strategies of an organisation making
reference to the theoretical underpinnings governing recruitment to determine whether the
strategies employed by the organisation are consistent or in contrast to the theoretical
underpinnings. The organisation adopted for this study is the UK National Health Service, the
NHS. Having identified the objective of the paper, I shall now continue with an overview of
the UK National Health services in section 2 below providing general information about its
history/background, its objectives and prospects for the future; section 3 will look at the
recruitment strategies of the NHS; and section 4 provides some conclusions and
recommendations for best practice.

2. Overview of the UK NHS

The UK National Health Services (NHS) remains one of the largest public sector bodies in
the world and the largest public sector organisation in the United Kingdom. The NHS was
established in 1948 by the post-war labour government and it was the first health system in
any western society to offer free medical care to the entire population. (Goodwin, 2000). Its
objective was to be universal in its coverage and comprehensive in terms of the services to be
provided, available on the basis of clinical need and not based on income. It has been
financed through taxation. (Goodwin, 2000)

Unfortunately, however, funding crises have resulted in the introduction of prescription,

dental and ophthalmic charges. The social conception of health care has lost and two issues
have dominated the UK NHS ever since. These include financial resources and politics.
(Goodwin, 2000).

Major challenges for the NHS include the persistent push for structural reform in state health
provision, within the UK. The NHS operates today in an economic climate that is faced with
escalating costs thus making it difficult for it to meet diverse patient and community needs.
(Hill et al, 2001). According to Chang et al, (2006) other challenges for the UK Health
Services today include: keeping a long-term health and well being perspective as a priority
across all policies; managing and paying for patient and public expectations, planning
workforce issues in the context of social, economic and technical change. Despite large
increases in the NHS’s budget in 2002, only 2.5 to 3% is realised as surplus funding taking
into consideration the increases in costs of goods and services (Chang et al, 2006).  There are
also debates over the impact of the increased funds considering the fact that productivity did
not increase between 1997 and 2003. (Chang et al, 2006).  It is also believed that increases in
health service productivity as evidenced in increased life expectancy, reduced infant
mortality, reduction in circulatory disease, cancers and respiratory diseases are attributed to
other factors and not to efforts by the NHS. (Chang et al, 2006).

3. Recruitment strategies of the NHS

This section provides a discussion of the recruitment and selection strategies of the NHS. In
doing so, reference is made to the theories of best practice in recruitment and selection
strategies. The most important challenge facing human resource managers is the difficulty
entailed in selecting the right applicant for a particular job. The concern of every organisation
is the attraction and selection of the right type of employees. (Schneider, 1976, 1987).
Conventional wisdom dictates that successfully selecting the right applicant can lead to
brilliant performance on the particular job and can lead to the overall success of the
organisation. On the contrary, recruiting the wrong person for a particular job can lead to
poor performance by the particular candidate and the organisation as a whole. A number of
factors determine an organisation’s ability to attract and screen employees. These include the
relative attractiveness of the position, as well as the state of the labour market. (Guin, 1976).
Thus, an organisation such as the NHS needs to be able to attract and retain competent staff.
The big question is how does the NHS go about its recruitment strategies given the ever-
changing business environment which in turn affects the dynamics of the labour market in the
UK?

To better understand the recruitment process of the NHS, this paper considers the guidelines
set out by NHS London. (NHS London, 2007). According to these guidelines, before
advertising a vacant post the manager is required to complete an Establishment Control Form
(ECF) which includes a signed authorisation of the budget holder and internal HR and
Finance Leads. The advert is expected to carry the job description which must include the
following basic elements:

 Include the main terms and conditions of the post.

 Define the role and reporting relationships.
 Define the overall purpose of the job.
 Describe the range of duties.
 Include key organisation policies.
 Comply with the Strategic Health Authority’s (SHA) Equal Opportunities and
 

The advert is also expected to include person specifications which is required to concisely
define the skills, experience and general attributes needed by the candidate to successfully
undertake the post. (NHS London, 2007).

After the advert has been made and sufficient applications have been received within the
deadline specified in the advert, the next stage is the recruitment and selection of the
appropriate candidates. This stage requires the shortlisting of candidates for interview. In
doing so the NHS London discourages all forms of discrimination and favouritism. It also
carters for the needs of people with disabilities and ensures that all applicants with disabilities
who meet the minimum/essential requirements for a job vacancy are interviewed.  (NHS
London, 2007). After shortlisting, the next stage is the interview which aims at determining
how successful the candidate would perform in the job. The guidelines require that the
selection process should include a make it clear that applicants with reasonable dietary
requirements are not disadvantaged by the process or venue. in addition to the interview, the
selection process may as well include tests to assess the candidates’ skills in specific areas of
the persons specifications or in the case of more senior staff, there may be circumstances
where it is appropriate to run assessment centres to allow for a more in depth assessment of
the candidates’ skills. It is also required that the questions asked during the interview should
be job-related and candidates should be given the opportunity to take notes during the
interview and to ask questions at the end of the interview. (NHS London, 2007).

After the interview, references are sought from previous employers. The decision to recruit is
based on the interview and references provided. Successful candidates are expected undergo
an occupational health clearance if the post is for duration of more than three months. In
addition, non-EU or non-EEA national are expected to provide have a valid work permit to
work in the UK. However, the HR Team can apply for a work permit on a candidate’s behalf
on condition that the following are met: (i) the post requires a recognised professional
qualification; (ii) The vacancy has been advertised nationally; and (iii) it has not been
possible to recruit a suitably qualified person who is a permanent resident of the EU. (NHS
London, 2007).  All successful candidates must also undergo a Criminal Records Bureau
(CRB) check most often when the post involves working with children or vulnerable adults.
Once the above conditions have been satisfied, a formal (unconditional) offer of employment
is made to the selected candidate(s). During the first day of work, the employee is required to
meet with the HR Team to complete documentation for payroll/HR purposes. After this the
employee is offered a formal contract of employment (three copies) detailing the Main Terms
and Conditions of Employment. The Contract is to be issued within 8 weeks from the time
that the employee starts work. One copy is issued to the manager and two to the employee
who is required to sign and return one copy to the HR Team. The final stage in the
recruitment and selection process is the induction phase. The induction process covers the
NHS London’s values, goals, working practices and corporate policies. Managers are also
expected to go through arrangements with new employees to ensure that they are clear with
their individual roles, objectives and working relationships. (NHS London, 2007).

 
In addition to the guidelines set out above for the recruitment and selection of NHS London,
this paper employs the results of a study conducted by May and Askham (2005) to determine
the process of recruitment employed by a number of NHS Trusts in recruiting and retaining
estates and facilities staff. The study summarises and presents data collected from focus
groups under a number of different categories. May and Askham (2005) notes that the
recruitment and selection process at NHS Trusts is characterised by delays. They note that the
process is characterised by a number of bureaucracies that tend to increase the length of time
taken to finalise the recruitment process. Some of the issues that make it difficult for the
process to move faster and smoothly are the fact that applicants are often expected to provide
criminal records, and good references from previous employers. These processes are usually
time consuming and result in unnecessary delays. Some applicants are often put off by these
delays and as such are forced to seek for employment elsewhere. In addition, May and
Askam (2005) note that the process lacks flexibility. For example, some NHS Trusts are not
authorised to advertise and recruit speculatively so that potential recruits could be held on file
until a suitable position becomes available. This means that it become difficult for the trust to
quickly fill vacancies given that the vacancy is only advertised when it becomes available and
applications are only sought during this period. in addition, there are a number of forms,
signatures and approvals required before the vacancy can be advertised a process that only
goes a long way to increase delays in the recruitment process.

Another problem observed is the fact that there is lack of flexibility in the induction period
for staff. This is particularly evident for staff recruited to evening, part-time positions. For
example, housekeepers or domestics recruited for a 20hour evening shift are still required to
attend the Trust induction over a two weeks period, Monday-Friday, 9am-5pm.

In addition, the tests given to some employees are not related to the job. That is, they lack
validity. May and Askham (2005) reports that some low paid workers complained that
assessment tests given to them were not necessary and even helped to deter some potential
recruits from applying. For example, one of the NHS Trust’s HR departments required a 45-
minute interview accompanied by separate aptitude tests. Many workers considered this
intimidating and off putting for the type of candidates concerned.

Another problem faced by the Trusts in attracting candidates was the fact that qualifications
and competence were declining thus reducing the ability of the Trusts to attract high calibre
candidates. The foregoing has resulted to an increase in the supervisory requirements of
senior staff thus damaging the profile of the facilities/estates departments. (May and Askham,
2005).

While the recruitment strategies of the NHS seem to be in line with best practice. For
example the process follows the process outline in Lin and Kleiner (1999). The NHS London
for example employs the interview as a job analysis tool. Lin and Kleiner (1999) suggest that
the interview can be used to gather information about the applicant by asking them to
describe in their own words what they do on their jobs. However, the NHS relies so much on
the interview but it is well known that the interview can be subjective and lead to the
selection of the wrong candidate. For example, empirical evidence suggest that applicants use
a variety of impression management (IM) tactics spontaneously during interview and that
these tactics predict positive interview evaluations. (Brown et al, 2002; Rosse et al, 1998).
This implies that an applicant who is low in a desired attribute may work hard to develop that
particular attribute and perform well during interview. This in turn renders the interview
questionable given that it fails to identify a candidate who has used IM tactics to portray a
positive self image. According to Caldwell and Burger (1998) the only trait that can be
measured reliably at interview stage extraversion the kinds of behaviours that are being
displayed during interview are reflected by the extent to which the applicant is extraverted.
(Caldwell and Burger, 1998). The way applicants perceive the selection process may have an
effect on the applicants’ views about the organisation particularly on issues concerning their
decisions to join the organisation. (Ryan and Polyhart, 2000). Applicants’ subsequent
behaviours in relation to the organisation’s products and services may also be affected by
their perception of the selection systems employed by the organisation.

In the guidelines outlined above, nothing is discussed concerning culture despite the
importance of culture in today’s global village. Jenaquart-Barone and Pelluchette (1999)
suggest that human resource management strategy must be aligned with the cultures
surrounding the organisation. The UK is a multicultural society and any recruitment and
selection strategy such as that of the NHS must take this into account.

Finally as outlined in May and Askham (2005) the recruitment strategies employed the
various NHS Trusts under their study employ very time consuming procedures which deters
potential candidates from applying to available positions. The process is also considered very
complex and bureaucratic. Moreover some of the selection tools employed such as aptitude
tests are often not relevant to the job and also serve as a deterrent to qualified applicants.

4. Conclusions and Recommendations

Based on the foregoing discussion, the paper concludes that the recruitment strategies by the
various NHS Trusts and the NHS London are in line with best practice. However, certain
aspects are not in line with best practice. For example, the impact of culture needs to be
emphasised more. In addition, a multiple number of selection criteria need to be employed in
selecting the right candidate rather than the interview alone. It is obvious that success at
certain jobs may not be determined at the interview stage. Some candidates who may perform
well at the job may not express these traits very well during the interview stage. Likewise,
some candidates who can sell themselves well during interview but who will normally not
perform well in the job can be hired at the expense of those who cannot sell themselves well
but who would normally perform better in the job. Evidence suggests that some interviewees
tend to favour applicants based on first impression at the interview stage. Although first
impressions may determine a candidate’s future performance, this may not always be the
case; some of these judgements are subjective. Best practice is to use the interview in line
with other selection tools, such as aptitude tests, that are directly related to the job; and
perhaps assessment seminars to determine how the applicant can perform on the job. For
example, if a candidate claims that he can perform multiple tasks using excel, the best
approach is to test this ability by giving the candidate an exercise to perform in excel. This
cannot be measured using the interview alone. Thus, a holistic, multi-dimensional approach
would seem to be most productive.

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