Analysis of Recruitment in the NHS

Analysis of Recruitment in the NHS CIPD Management Report Utilising E Recruitment Executive Summary This Management report will look at the Recruitment Processes with an NHS Acute Trust and identify if E recruitment can help with the difficulties experienced in the Trust. Alongside a literature review of Recruitment difficulties, Employer Branding, Traditional recruitment and E recruitment, the author has conducted a benchmarking exercise in order to establish best practice in recruitment in local NHS organisations, A Process Mapping exercise to identify current practice and identify any difficulties or hold ups in the current process and a Managers questionnaire to allow the author to identify current perceptions of the recruitment service in the organisation alongside what expectations are. Appendices. Satisfaction Survey Survey results 1.0 Introduction The Pennine Acute Hospitals NHS Trust was established in April 2002 and manages hospitals in Oldham, Rochdale, Bury and North Manchester. Serving a population of approximately 800,000, the Trust is one of the largest in the country and had an operating expenditure of over  £425 million in 2006/07. It runs services across five hospital sites: Fairfield General Hospital, Bury; North Manchester General Hospital; The Royal Oldham Hospital; Rochdale Infirmary and Birch Hill Hospital, Rochdale and employs a staff of approximately 10,000. The Trust has four divisions identified as Surgery, Medicine, Women and Childrens, and Diagnostics and Clinical Support. It also has directorates providing support to clinical services including Human Resources, Facilities, Planning, Finance, Information and Management Technology, Modernisation and Performance, Governance and Research and Development. The local economy in which the Trust is situated is strong, with a great deal of competition from local organisations for staff. There is little competition within the NHS for staff, as Pennine is ‘the only Trust in town, in each of the 4 areas. Transport links to the Trust are generally good, although access to some peripheral sites is difficult, and car parking can be a problem, especially at the Royal Oldham site. The Trust is concerned, as many Trusts in the Greater Manchester area are, that many of its nurses will retire within the next five years and it is trying to develop a programme to get people to stay on after the normal retirement age. It also attempts to recruit as many student nurses as possible, but positions for newly qualified staff have been reduced in the last few years due to reconfiguration of services and redeployment to avoid redundancy. The Trust has a lower proportion of nursing staff from ethnic backgrounds than the local population, when comparing the 2001 Census with its workforce data; but the percentage of staff as a whole from ethnic backgrounds is higher, due to the numbers of medical staff from ethnic minorities within the Trust. The Trust works hard to recruit staff from ethnic minorities/deprived backgrounds. It has an Equality and Diversity Team who work to promote diversity within the Trust, supporting proactive recruitment where there is a concentration of individuals from ethnic or disadvantaged backgrounds. There is a central HR function, with designated HR Managers for each division. Restructuring of this model has taken place in recent years. Recruitment is managed from the North Manchester General Hospital site and provides a central function. With a workforce of over 10,000 people, the average monthly cost of recruitment at Pennine Acute Hospitals NHS Trust is xxxxxx. Added to this is the length of time it takes to place a new employee in post, which is on average 60 days. This estimate is from measured from the advertised positions closing date to offering that position. Recruitment is currently a major issue in the Trust with days lost in the recruitment process costing money and reducing morale and effectiveness. At present the department is receiving a lot of pressure from the rest of the Trust and the reputation of the department is poor. This management report is being undertaken to identify recommendations that will allow the recruitment process to become more efficient and identify whether utilisation of e recruitment is a viable proposal in the Trust and whether its implementation will increase efficiency and save resources. All employers face the challenge of employing the right staff for their organisation and this often falls under a human resource arena. The recruitment and retention of healthcare professionals has been identified as a key challenge facing the NHS (NHS Plan 2002). High on the agenda at local, regional and national levels is the development of strategies and initiatives to attract suitable people to work in the professions, in order to ensure that services are responsive to patient needs. 2.0 Literature Review Recruitment is an extensive subject with many aspects making up the area. A study by Ullman (1966) cited in Breaugh Starke (2000) was one of the first to examine recruitment sources. Finding that new employees who were recruited by means of informal sources (i.e., employee referrals, direct applications) had a lower turnover rate than individuals recruited via formal sources (i.e., newspaper advertisements and employment agencies). Barber (1998) has since concluded that past research has not made a strong case for the importance of source differences. The author is interested in research into the prevalence of the sources used in traditional recruitment, which appears to be research that has not been undertaken significantly. Torrington, Hall and Taylor (2005) identified that employers in the UK recruit over 3 million people each year, in a costly and time consuming exercise to add suitable staff to their organisation. They identify a need to ‘sell jobs to potential employees in order to ensure they can generate an adequate pool of applicants. Organisations are now facing a greater challenge recruiting rather than selecting. (Ployhart 2005) Other researchers having also identified the difficulties organisations have in attracting candidates, identifying selection will only be effective and financially defensible if a sufficient amount of applicants apply to the organisation. (Taylor and Collins, 2000) However according to Barber (1998), It is important that employers do not consider the recruitment process to be completed at this point, It continues during the short listing and interviewing stages and is only deemed as complete when an offer is made. For the purposes of this literature review the author will review thoughts and research on the initial stages of recruitment, that being the attraction of employees and advertisement of vacancies in order to recruit to the organisation, this will allow the author to include the areas of employer branding and e-recruitment in the review. 2.1 Recruitment Difficulties The Audit Commission (2002) has identified that the UK labour market is highly competitive at present with the rate of unemployment at a historically low level. Employers are openly competing harder to attract and retain staff. This is made more difficult, with reports across the country, of recruitment and retention problems affecting local public services, the NHS being no exception. There have been serious concerns about shortages in staff numbers, and fewer young people being attracted to work for the public sector, meaning there is a potential ‘demographic time bomb. It has been identified that 27 per cent of the public sector workforce are now aged 50 or over. (Gulland (2001), Audit Commission (2002)) Recruitment is also expensive, in a recent survey; CIPD (2007) identified the average cost of recruiting a member of staff is  £4,333; however this increases significantly to  £7750 when organisations are also calculating the associated labour turnover. They identified that eighty four percent of organisations have reported difficulties in filling vacancies in 2006, a rise of 2 percent on the previous year. The key challenges faced by organisations in regard to recruitment have been identified from the survey as; attracting and recruiting key staff to the organisation, reducing recruitment costs, enabling the achievement of the organisations strategic goals and addressing skills shortages. CIPD strongly believes that: ‘effective recruitment is central and crucial to the successful day-to-day functioning of any organisation. stating that ‘successful recruitment depends upon finding people with the necessary skills, expertise and qualifications to deliver organisational objectives and the ability to make a positive contribution to the values and aims of the organisation. The Audit Commissions report (2002) also identified there are concerns about ‘skill shortages, not only in terms of ‘basic skill levels in the workforce, but also in key leadership, management and specialist skills that are required. Previous research from the Audit Commission (2001) has showed that, on average, a new employee will perform at only 60 per cent of their productive potential when they are first appointed, only reaching 100 per cent after being in a post for a year. This makes recruitment in these areas and adequate delivery of services even harder to manage. In their extensive report on public service recruitment, the Audit Commission identifies the way the employers can maximise their recruitment practices. They advised: Informed, quick and professional responses to job advertisement enquiries are essential for maximising applications; routine monitoring of recruitment will ensure that recruitment initiatives are driven by the bigger picture rather than just the latest concern; success in addressing diversity issues are to be achieved through efficient, effective targeted recruitment campaigns based on knowledge of the target community; and any initiative to attract a specific group of staff will benefit from being profession-led and in partnership with HR. Audit Commission (2002) Effective recruitment practices and policies are recognised as making a significant contribution to an organisations success, according to Plumbley (1990). He states it is not simply about placing suitable candidates into jobs, but also about building an adept and flexible workforce in order to meet the organisations changing and demanding needs. The first stage of recruitment and selection is to be able to attract an adequate number of appropriate candidates. Prospective employees do not select the organisation they wish to work for on the foundation of job and organisational characteristics such as location, and organisational structure alone. 2.2 Employee Brand The increased competitiveness in the recruitment market has led to organisations spending more time, effort and resources on developing their recruitment brand and expanding the range of advertising methods used, to try and attract quality applicants from as broad and diverse a pool possible. Almost seven in ten organisations describe themselves as having an employer brand according to CIPD (2007), and studies have shown that an organisations reputation and identity is vital in the fight to attract suitable talented applicants into organisations. (Lievens Highhouse, 2003; Cable Turban, 2001). Identifying that in order for the corporate brand to be more successful at attracting suitable candidates there is an importance in promoting and monitoring that brand. (Slaughter, Zickar, Highhouse, Mohr, 2004) Fombrun, (1996) agrees with this stating the reputation of an organisation has been acknowledged as one of the key factors that can affect the probability of potential applicants choosing to apply to work for it. In the same way, organisation reputation has been found to be an important influence on applicants decisions of whether they fit with an organisation and want to join it (Rynes et al., 1991). This researcher has also showed that applicants utilised information on how informative and the ‘recruiter friendliness as an indicator of how an organisation treated its employees. Fombrun (1996) expands this argument to identify that reputation is of particular concern to applicants seeking employment in knowledge-based institutions, such as universities and hospitals, because of the intangibility of the services these organisations provide. Whilst Turban et al. (1998) also found that applicants perceptions of the specific attributes of a post were influenced by their evaluation of the organisation, even if they had been interviewed and were successful. The importance in private/commercial organisations reputation in relation to the recruitment and retention of staff has been well documented in literature, for example: (Turban, 2001) and Cable and Graham (2000), Gray and Ballmer 1998)), there has however been comparatively little consideration on the impact of reputation for public sector organisations. Most people in the course of their life have a need to use the services the NHS provide, some more than others and health is an important issue, not only on a personal level, also in the political arena. The NHS is the UKs largest employer, so many of the UK population are at present working in it, with a great number more many having done so at some point in their lives. In brief, the NHS has a wide range of different stakeholders, who may feel they have a vested interest in the quality; provision of services and ultimately, the reputation. People have varied, and very personal experiences of the NHS and this could mean image and reputation are therefore difficult to manage. The Audit Commission study (2002) study showed that public sector staff thinks that ‘their image in the eyes of the public would discourage potential recruits from entering the NHS. The study analysed a wide sample of the UKs national press to see if the evidence supported this observation. Analysis of the results showed that plenty of stories are told and coverage given to the NHS is extensive. They concur that the picture of public sector work presented to the reading public is often bleak. Of the former public sector workers surveyed, 68 per cent thought that the image of their former profession would discourage people from entering that job. Only 9 per cent thought the opposite and stated that the image would instead encourage people to enter. The NHS is such a well-known organisation that carries out specific roles in society, that when considering a career in the NHS people often have an idea regarding an occupation they would like to pursue. The GTI (2006) conducted a survey to establish the major determinants that influence applicants in their choice of employer. The results show that for 22% of student nurses and doctors, the reputation of a prospective employer (often influenced by media coverage) is a key factor in determining their aspirations. They identify that ‘word of mouth can be damaging to an employers reputation. If employers get things wrong, it can really affect the way they are viewed by potential employees as over half of the survey respondents have shared their bad experiences with their peers. So for some people the images and reputation of the NHS may be crucial to their decision of whether to work for it. 2.3 Traditional Recruitment Methods Traditional recruitment methods are the way in the past, that an organisation announced a job opportunity to the marketplace, through a classified advertisement, a job fair, an external recruiter, or other media. Any candidate who happened to see the announcement would submit his or her CV, ring the company for an application form or submit a letter of interest. Lievens and Harris (2003) have stated that in the past, job searching was a more time-consuming activity. They identified ‘A candidate who wished to apply for a job would need to first locate a suitable job opportunity, which often involved searching through a newspaper or contacting acquaintances. After locating potentially suitable openings, the candidate would typically have to prepare a cover letter, produce a copy of his or her resume, and mail the package with the appropriate postage. Arboledas, Ferrero and Vidal (2001), presented some examples of recruitment methods that organisations have traditionally used. These were identified as newspaper advertisement, faxed/mailed resumes, recruitment agencies or the use of headhunters. Galanaki (2002) similarly identified all these methods and also defines them as ‘traditional recruitment methods. This idea of traditional methods can also be found quoted in numerous HR texts, which have sections dedicated to recruitment and try to identify best recruitment practices. The authors of such texts include Cole (2004), Rayner and Adam Smith, Armstrong (2007) and Mullins (2005). These texts give a useful overview of the concepts of recruitment but again the best practice and evidence of what is most effective is not present. An IDS study in 2006 reported that to maximise their chances of appointing the best candidate, many organisations have utilised a combination of online and traditional approaches. In 2004 Softworld HR and Payroll identified in a study, that 24% of respondents envisaged e-recruitment entirely replacing all traditional methods of advertising in the future, however 76% of the practitioners surveyed, see it as an additional tool to allow the widest possible range of applicants to be accessed. Traditional methods also identify the use of recruitment agencies in the way of recruiting staff. According to an IES study (2005), recruitment agencies remain confident that the growth in e-recruitment technology will not eliminate their role in the process, as many organisations lack the time and expertise to carry out these tasks. Many organisations, especially smaller ones may also lack the technology to carry out their own recruitment online. They state with the low unemployment rate that currently exists, the task of finding quality candidates will remain challenging and this may prompt organisations to continue to use agencies, in particular, for specialised, senior or difficult to fill positions A Demos report (2007) however has identified difficulties in the recruitment business. They point out that the ‘landscape has changed remarkably over the past decade. And identify the recruitment industry has been growing rapidly, and the talent war has led to an increase in outsourcing and much greater efforts being made to reach candidates through on and offline advertising. They identify that recruiters have had to embrace technology, or be left behind. In the 2007 CIPD recruitment and retention survey, it was identified for the first time in the UK; corporate websites have broken even with local newspapers advertisements as the most common method of recruiting candidates. 2.4 E-recruitment E-Recruitment is identified as ‘the use of Internet technology to make the job of recruiting staff more efficient and effective, when used together with traditional recruitment methods; the benefits derived from e-recruitment can be considerable. (E-recruitment Best Practice Guide 2007) Internet usage in recent years has seen the recruitment process transformed. Online recruitment, internet recruitment, web-based recruiting and e-recruitment are terms used to describe the use of the internet to recruit potential employees, and mediums to conduct other elements of the recruitment process. We will use the terms interchangeably in this report. According to Schreyer McCarter (1998) e-recruitment refers to â€Å"The recruitment process, including placing job advertisements, receiving resumes, and building human resource database with candidates and incumbents E-Recruitment is establishing itself as a significant part of the recruitment strategy in a range of organisations across the UK and the world. This is in addition to becoming a progressively more accepted method for job seekers in searching and applying for jobs. The traditional method of recruitment has been transformed by the appearance of the Internet. In the past few years, the Internet has dramatically changed the face of HR recruitment and the ways organisations think about the recruiting function. There is predicted to be a continued dramatic growth in recruiting and hiring via this medium in future years. (CIPD 2007) A survey by the public appointment service in Ireland in 2006, relating to e-recruitment in Irish organisations, has also identified a high level of current or intended future use of e recruitment, this being identified as an area forming an important part of the Irish recruitment strategy. It would seem that e-recruitment has been implemented in many organisations from small companies to large organisations. These organisations are already using e recruitment to advertise jobs and accept CVs on the Internet, and also to communicate with the applicants by e-mail. In the CIPD Recruitment, retention and turnover 2006 survey it was identified that eighty-four percent of respondents have made greater use of e-mail applications in the last three years. Over seven in ten organisations also said they are actively advertising jobs on their corporate websites and using online recruitment applications. Lievens and Harris (2003) have identified the following methods of using the Internet to attract candidates, acknowledging that approaches are continually changing. †¢ Company websites Advertising posts and providing information to candidates through the company website. The facility to apply online is often also provided. †¢ Job Boards Commercial general purpose recruitment portals, (e.g. Yahoo!, Monster.com) and specific industry job boards. †¢ Online Searching Recruiters searching online sources such as company websites and professional chat sites to identify candidates who may not be actively looking for a position. †¢ Relationship recruiting Using the internet to build and maintain long term relationships with passive candidates, through using internet tools to learn more about web visitors interests and experience and to e-mail regular updates about careers and their fields of interest. Kerrin and Keetley (2005) have suggested that the reasons for many organisations to introduce e recruitment have been recruitment cost reduction, speedier processes, access to a wider pool of applicants and better employer branding. In the CIPD Recruitment, retention and turnover survey 2006,  it was identified that the key drivers for e-recruitment were; reducing recruitment costs (cited by 71%), broadening the selection pool (60%) and increasing the speed of time to hire (47%). It was also noted that : ‘over a third of respondents believed it brought greater flexibility and ease for candidates, and over a quarter believed it strengthened the employer brand. This has been further supported by the IRS Employment review (2007). Reduction in costs E-Recruitment has allowed employers to make reductions in advertising costs and remove their dependency on recruitment agencies. Technology in online recruitment is not expensive and the hours saved in the pre-selection process gives HR staff more time. Administration can be significantly reduced in most organisations. This can prove to be extremely important when recruiting involves high numbers of staff or when receiving high numbers of applications. (DTI 2006, Guertal et al 2007). The IRS 2007 study identified 7 out of 10 organisations say administration is easier to perform when utilising online recruitment services and 8 out 10 identified the e- recruitment process as being substantially cheaper. Cappeli (2001) calculated that ‘it costs only about one-twentieth as much to hire someone online as to hire that same person through †¦ other traditional methods. This can again, be achieved through significantly reducing advertising costs and by reducing recruitment related administration according to Elkington (2005) An IDS HR Study in April 2006 identified how the Internet now plays a significant role in recruitment activities of employers. The report examined the use of corporate and third party recruitment websites and identified they are being used to reduce advertising costs and tap into a more diverse candidate base. They also identified that technology is streamlining the application process with the encouragement of online applications, linking into sophisticated application tracking systems and allowing organisations to measure the success of attraction methods. IDS state that over 70% of adults utilise the Internet, and employers are using this medium to attract and recruit much more frequently. They identify significant cost savings for employers and reduced time taken to fill vacancies, but are keen to point out the wariness of employees in missing out on potential candidates and feel that traditional recruitment media is set to retain and important role, particularly when recruiting locally or hard to fill jobs. This supports reservations held by IRS (2007) who identified that e recruitment was considered unsuitable for certain kinds of vacancies. Grout and Parrin, authors of the book, ‘recruiting excellence agree with the assessment by IDS. In an article for HR Director (2006), they identify that online recruitment can improve efficiency by the reduction in man hours involved in the process, and help employers reach a wider and larger audience of jobseekers. They also recognise that it can be a valuable part of a recruitment process, in addition to traditional press advertising and the use of agencies (DTI, 2005). Kerrin and Keetley (2005) however, have stated, that the full cost savings are often only realised if the whole recruitment process is carried out online, a view supported by a number of authors. (Demos 2007, IRS 2007) Reducing time-to-hire With e-recruitment the time taken to recruit can be reduced by as much as 75% and allow the recruitment of the most appropriate employees more quickly into the organisation. Time is also saved by spending a reduced amount of time tracking, communicating with and screening the applicants. Online recruitment also allows organisations to the share best practice and improves the consistency of recruitment processes across the organisation. The Public Appointments Service survey showed that a reduction in administrative workload (cited by 49% of respondents), and reduced timescales for hiring (cited by 40% of respondents), were key drivers in the decision to implementing e recruitment. Hogg (2000) stresses a shorter recruitment cycle can be gained by the speed at which several steps of the recruitment process are carried out online. Elkington (2005) supports this and has identified that the immediate posting of jobs online and the effortlessness of completing online application forms and e-mailing CVs to an organisation has made these steps much faster. Moving further into the recruitment process, the short-listing process can be accelerated by routinely aligning applications dependent on prearranged criteria (CIPD 2005). Applications can be progressed within minutes rather than weeks, saving both recruiters and job applicants time. Widening Talent Pool Internet tools that enable employers/recruiters to reach a wider pool of potential applicants and to fill positions faster with less cost to the organisation are obviously advantageous in such a competitive environment. Online advertising opens up a wider candidate pool, by providing 24/7 access to job seekers, at local, national and international locations, thus providing a better chance of finding the right candidate (CIPD 2005a). As job seekers become increasingly more web literate and the growth of broadband makes web surfing easier and cheaper (IRS 2005), the potential for e-recruitment to attract wider candidate pools is increasing. Enhancing Employer brand Increased numbers of candidates are expecting to apply directly online and they routinely make judgements about employers based on their recruitment process. To combat this employers are adopting increasingly dynamic e-recruitment solutions to allow them to distinguish themselves from others and to professionally manage the recruitment process. (Willock, 2005; Paton 2006). E-Recruitment enables an organisation to raise its profile to potential applicants and promote itself as innovative and forward looking, allow visitors to the website to leave with a positive experience. Kerrin and Kettley (2003) in their report ‘e-recruitment is it delivering identified a key factor for organisations in their adoption of e-recruitment, is the desire to increase their profile as an employer of choice amongst potential candidates and to promote their image as a progressive organisation. This is supported by 7 out of 10 organisations also agreeing that the use of online recruitment was more likely to improve reputation (IRS 2007) E-Recruitment can help to build the image of a brand. Barrow (2005) recommends that organisations build their brand identity very carefully however; warning of a need to ensure substance is beneath the clever name, logo or design, as employees once appointed will see through the facade. This is further supported by Gray and Balmers (1998) term, ‘routine interactions. They state that outsiders have a place in shaping image and reputation when they interact with organisations; communications are likely to be received with scepticism when they do not match personal experience. CIPD (2005) also demonstrated that more detailed information can be provided on the organisations website than in a newspaper advertisements and in recruitment agency literature, reinforcing the employer brand, improving the corporate image and profile whilst also giving an indication of the organisations culture The use of the Internet allows organisations to pass far more information in a much more dynamic and consistent fashion to candidates than was the case in the past (Lievens and Harris 2003). Applicants therefore have much more information at their disposal before they even decide to apply for a job than in the past. In addition, candidates can easily and quickly search for independent information about organisations from various sources, such as internet search engines and libraries. Therefore, unlike in the past, a candidate may have applied for a job based on practically no information; todays candidate may have reviewed a substantial amount of information about the organisation before choosing to apply. Disadvantages of e-recruitment The CIPD Recruitment, retention and turnover 2006 survey revealed some concerns that e-recruitment could increase the number of unsuitable applicants and that it could act as a barrier to recruiting older workers. A factor which seems to be discouraging some employers from making more use of online recruitment systems, is a concern, over the level of internet access and levels of accomplishment with technology, of their target audiences. While usage of the Internet does vary by social group there is evidence to suggest that recruiting online results in at least as diverse an applicant group as those recruited through traditional methods (McManus M.A., Ferguson M.W. 2003). Searle (2003) would dispute this however stating that participation in online recruitment is skewed towards ‘white males from higher socio-economic groups. A further concern in relation to access is the suitability of online recruitment methods for candidates with disabilitie Analysis of Recruitment in the NHS Analysis of Recruitment in the NHS CIPD Management Report Utilising E Recruitment Executive Summary This Management report will look at the Recruitment Processes with an NHS Acute Trust and identify if E recruitment can help with the difficulties experienced in the Trust. Alongside a literature review of Recruitment difficulties, Employer Branding, Traditional recruitment and E recruitment, the author has conducted a benchmarking exercise in order to establish best practice in recruitment in local NHS organisations, A Process Mapping exercise to identify current practice and identify any difficulties or hold ups in the current process and a Managers questionnaire to allow the author to identify current perceptions of the recruitment service in the organisation alongside what expectations are. Appendices. Satisfaction Survey Survey results 1.0 Introduction The Pennine Acute Hospitals NHS Trust was established in April 2002 and manages hospitals in Oldham, Rochdale, Bury and North Manchester. Serving a population of approximately 800,000, the Trust is one of the largest in the country and had an operating expenditure of over  £425 million in 2006/07. It runs services across five hospital sites: Fairfield General Hospital, Bury; North Manchester General Hospital; The Royal Oldham Hospital; Rochdale Infirmary and Birch Hill Hospital, Rochdale and employs a staff of approximately 10,000. The Trust has four divisions identified as Surgery, Medicine, Women and Childrens, and Diagnostics and Clinical Support. It also has directorates providing support to clinical services including Human Resources, Facilities, Planning, Finance, Information and Management Technology, Modernisation and Performance, Governance and Research and Development. The local economy in which the Trust is situated is strong, with a great deal of competition from local organisations for staff. There is little competition within the NHS for staff, as Pennine is ‘the only Trust in town, in each of the 4 areas. Transport links to the Trust are generally good, although access to some peripheral sites is difficult, and car parking can be a problem, especially at the Royal Oldham site. The Trust is concerned, as many Trusts in the Greater Manchester area are, that many of its nurses will retire within the next five years and it is trying to develop a programme to get people to stay on after the normal retirement age. It also attempts to recruit as many student nurses as possible, but positions for newly qualified staff have been reduced in the last few years due to reconfiguration of services and redeployment to avoid redundancy. The Trust has a lower proportion of nursing staff from ethnic backgrounds than the local population, when comparing the 2001 Census with its workforce data; but the percentage of staff as a whole from ethnic backgrounds is higher, due to the numbers of medical staff from ethnic minorities within the Trust. The Trust works hard to recruit staff from ethnic minorities/deprived backgrounds. It has an Equality and Diversity Team who work to promote diversity within the Trust, supporting proactive recruitment where there is a concentration of individuals from ethnic or disadvantaged backgrounds. There is a central HR function, with designated HR Managers for each division. Restructuring of this model has taken place in recent years. Recruitment is managed from the North Manchester General Hospital site and provides a central function. With a workforce of over 10,000 people, the average monthly cost of recruitment at Pennine Acute Hospitals NHS Trust is xxxxxx. Added to this is the length of time it takes to place a new employee in post, which is on average 60 days. This estimate is from measured from the advertised positions closing date to offering that position. Recruitment is currently a major issue in the Trust with days lost in the recruitment process costing money and reducing morale and effectiveness. At present the department is receiving a lot of pressure from the rest of the Trust and the reputation of the department is poor. This management report is being undertaken to identify recommendations that will allow the recruitment process to become more efficient and identify whether utilisation of e recruitment is a viable proposal in the Trust and whether its implementation will increase efficiency and save resources. All employers face the challenge of employing the right staff for their organisation and this often falls under a human resource arena. The recruitment and retention of healthcare professionals has been identified as a key challenge facing the NHS (NHS Plan 2002). High on the agenda at local, regional and national levels is the development of strategies and initiatives to attract suitable people to work in the professions, in order to ensure that services are responsive to patient needs. 2.0 Literature Review Recruitment is an extensive subject with many aspects making up the area. A study by Ullman (1966) cited in Breaugh Starke (2000) was one of the first to examine recruitment sources. Finding that new employees who were recruited by means of informal sources (i.e., employee referrals, direct applications) had a lower turnover rate than individuals recruited via formal sources (i.e., newspaper advertisements and employment agencies). Barber (1998) has since concluded that past research has not made a strong case for the importance of source differences. The author is interested in research into the prevalence of the sources used in traditional recruitment, which appears to be research that has not been undertaken significantly. Torrington, Hall and Taylor (2005) identified that employers in the UK recruit over 3 million people each year, in a costly and time consuming exercise to add suitable staff to their organisation. They identify a need to ‘sell jobs to potential employees in order to ensure they can generate an adequate pool of applicants. Organisations are now facing a greater challenge recruiting rather than selecting. (Ployhart 2005) Other researchers having also identified the difficulties organisations have in attracting candidates, identifying selection will only be effective and financially defensible if a sufficient amount of applicants apply to the organisation. (Taylor and Collins, 2000) However according to Barber (1998), It is important that employers do not consider the recruitment process to be completed at this point, It continues during the short listing and interviewing stages and is only deemed as complete when an offer is made. For the purposes of this literature review the author will review thoughts and research on the initial stages of recruitment, that being the attraction of employees and advertisement of vacancies in order to recruit to the organisation, this will allow the author to include the areas of employer branding and e-recruitment in the review. 2.1 Recruitment Difficulties The Audit Commission (2002) has identified that the UK labour market is highly competitive at present with the rate of unemployment at a historically low level. Employers are openly competing harder to attract and retain staff. This is made more difficult, with reports across the country, of recruitment and retention problems affecting local public services, the NHS being no exception. There have been serious concerns about shortages in staff numbers, and fewer young people being attracted to work for the public sector, meaning there is a potential ‘demographic time bomb. It has been identified that 27 per cent of the public sector workforce are now aged 50 or over. (Gulland (2001), Audit Commission (2002)) Recruitment is also expensive, in a recent survey; CIPD (2007) identified the average cost of recruiting a member of staff is  £4,333; however this increases significantly to  £7750 when organisations are also calculating the associated labour turnover. They identified that eighty four percent of organisations have reported difficulties in filling vacancies in 2006, a rise of 2 percent on the previous year. The key challenges faced by organisations in regard to recruitment have been identified from the survey as; attracting and recruiting key staff to the organisation, reducing recruitment costs, enabling the achievement of the organisations strategic goals and addressing skills shortages. CIPD strongly believes that: ‘effective recruitment is central and crucial to the successful day-to-day functioning of any organisation. stating that ‘successful recruitment depends upon finding people with the necessary skills, expertise and qualifications to deliver organisational objectives and the ability to make a positive contribution to the values and aims of the organisation. The Audit Commissions report (2002) also identified there are concerns about ‘skill shortages, not only in terms of ‘basic skill levels in the workforce, but also in key leadership, management and specialist skills that are required. Previous research from the Audit Commission (2001) has showed that, on average, a new employee will perform at only 60 per cent of their productive potential when they are first appointed, only reaching 100 per cent after being in a post for a year. This makes recruitment in these areas and adequate delivery of services even harder to manage. In their extensive report on public service recruitment, the Audit Commission identifies the way the employers can maximise their recruitment practices. They advised: Informed, quick and professional responses to job advertisement enquiries are essential for maximising applications; routine monitoring of recruitment will ensure that recruitment initiatives are driven by the bigger picture rather than just the latest concern; success in addressing diversity issues are to be achieved through efficient, effective targeted recruitment campaigns based on knowledge of the target community; and any initiative to attract a specific group of staff will benefit from being profession-led and in partnership with HR. Audit Commission (2002) Effective recruitment practices and policies are recognised as making a significant contribution to an organisations success, according to Plumbley (1990). He states it is not simply about placing suitable candidates into jobs, but also about building an adept and flexible workforce in order to meet the organisations changing and demanding needs. The first stage of recruitment and selection is to be able to attract an adequate number of appropriate candidates. Prospective employees do not select the organisation they wish to work for on the foundation of job and organisational characteristics such as location, and organisational structure alone. 2.2 Employee Brand The increased competitiveness in the recruitment market has led to organisations spending more time, effort and resources on developing their recruitment brand and expanding the range of advertising methods used, to try and attract quality applicants from as broad and diverse a pool possible. Almost seven in ten organisations describe themselves as having an employer brand according to CIPD (2007), and studies have shown that an organisations reputation and identity is vital in the fight to attract suitable talented applicants into organisations. (Lievens Highhouse, 2003; Cable Turban, 2001). Identifying that in order for the corporate brand to be more successful at attracting suitable candidates there is an importance in promoting and monitoring that brand. (Slaughter, Zickar, Highhouse, Mohr, 2004) Fombrun, (1996) agrees with this stating the reputation of an organisation has been acknowledged as one of the key factors that can affect the probability of potential applicants choosing to apply to work for it. In the same way, organisation reputation has been found to be an important influence on applicants decisions of whether they fit with an organisation and want to join it (Rynes et al., 1991). This researcher has also showed that applicants utilised information on how informative and the ‘recruiter friendliness as an indicator of how an organisation treated its employees. Fombrun (1996) expands this argument to identify that reputation is of particular concern to applicants seeking employment in knowledge-based institutions, such as universities and hospitals, because of the intangibility of the services these organisations provide. Whilst Turban et al. (1998) also found that applicants perceptions of the specific attributes of a post were influenced by their evaluation of the organisation, even if they had been interviewed and were successful. The importance in private/commercial organisations reputation in relation to the recruitment and retention of staff has been well documented in literature, for example: (Turban, 2001) and Cable and Graham (2000), Gray and Ballmer 1998)), there has however been comparatively little consideration on the impact of reputation for public sector organisations. Most people in the course of their life have a need to use the services the NHS provide, some more than others and health is an important issue, not only on a personal level, also in the political arena. The NHS is the UKs largest employer, so many of the UK population are at present working in it, with a great number more many having done so at some point in their lives. In brief, the NHS has a wide range of different stakeholders, who may feel they have a vested interest in the quality; provision of services and ultimately, the reputation. People have varied, and very personal experiences of the NHS and this could mean image and reputation are therefore difficult to manage. The Audit Commission study (2002) study showed that public sector staff thinks that ‘their image in the eyes of the public would discourage potential recruits from entering the NHS. The study analysed a wide sample of the UKs national press to see if the evidence supported this observation. Analysis of the results showed that plenty of stories are told and coverage given to the NHS is extensive. They concur that the picture of public sector work presented to the reading public is often bleak. Of the former public sector workers surveyed, 68 per cent thought that the image of their former profession would discourage people from entering that job. Only 9 per cent thought the opposite and stated that the image would instead encourage people to enter. The NHS is such a well-known organisation that carries out specific roles in society, that when considering a career in the NHS people often have an idea regarding an occupation they would like to pursue. The GTI (2006) conducted a survey to establish the major determinants that influence applicants in their choice of employer. The results show that for 22% of student nurses and doctors, the reputation of a prospective employer (often influenced by media coverage) is a key factor in determining their aspirations. They identify that ‘word of mouth can be damaging to an employers reputation. If employers get things wrong, it can really affect the way they are viewed by potential employees as over half of the survey respondents have shared their bad experiences with their peers. So for some people the images and reputation of the NHS may be crucial to their decision of whether to work for it. 2.3 Traditional Recruitment Methods Traditional recruitment methods are the way in the past, that an organisation announced a job opportunity to the marketplace, through a classified advertisement, a job fair, an external recruiter, or other media. Any candidate who happened to see the announcement would submit his or her CV, ring the company for an application form or submit a letter of interest. Lievens and Harris (2003) have stated that in the past, job searching was a more time-consuming activity. They identified ‘A candidate who wished to apply for a job would need to first locate a suitable job opportunity, which often involved searching through a newspaper or contacting acquaintances. After locating potentially suitable openings, the candidate would typically have to prepare a cover letter, produce a copy of his or her resume, and mail the package with the appropriate postage. Arboledas, Ferrero and Vidal (2001), presented some examples of recruitment methods that organisations have traditionally used. These were identified as newspaper advertisement, faxed/mailed resumes, recruitment agencies or the use of headhunters. Galanaki (2002) similarly identified all these methods and also defines them as ‘traditional recruitment methods. This idea of traditional methods can also be found quoted in numerous HR texts, which have sections dedicated to recruitment and try to identify best recruitment practices. The authors of such texts include Cole (2004), Rayner and Adam Smith, Armstrong (2007) and Mullins (2005). These texts give a useful overview of the concepts of recruitment but again the best practice and evidence of what is most effective is not present. An IDS study in 2006 reported that to maximise their chances of appointing the best candidate, many organisations have utilised a combination of online and traditional approaches. In 2004 Softworld HR and Payroll identified in a study, that 24% of respondents envisaged e-recruitment entirely replacing all traditional methods of advertising in the future, however 76% of the practitioners surveyed, see it as an additional tool to allow the widest possible range of applicants to be accessed. Traditional methods also identify the use of recruitment agencies in the way of recruiting staff. According to an IES study (2005), recruitment agencies remain confident that the growth in e-recruitment technology will not eliminate their role in the process, as many organisations lack the time and expertise to carry out these tasks. Many organisations, especially smaller ones may also lack the technology to carry out their own recruitment online. They state with the low unemployment rate that currently exists, the task of finding quality candidates will remain challenging and this may prompt organisations to continue to use agencies, in particular, for specialised, senior or difficult to fill positions A Demos report (2007) however has identified difficulties in the recruitment business. They point out that the ‘landscape has changed remarkably over the past decade. And identify the recruitment industry has been growing rapidly, and the talent war has led to an increase in outsourcing and much greater efforts being made to reach candidates through on and offline advertising. They identify that recruiters have had to embrace technology, or be left behind. In the 2007 CIPD recruitment and retention survey, it was identified for the first time in the UK; corporate websites have broken even with local newspapers advertisements as the most common method of recruiting candidates. 2.4 E-recruitment E-Recruitment is identified as ‘the use of Internet technology to make the job of recruiting staff more efficient and effective, when used together with traditional recruitment methods; the benefits derived from e-recruitment can be considerable. (E-recruitment Best Practice Guide 2007) Internet usage in recent years has seen the recruitment process transformed. Online recruitment, internet recruitment, web-based recruiting and e-recruitment are terms used to describe the use of the internet to recruit potential employees, and mediums to conduct other elements of the recruitment process. We will use the terms interchangeably in this report. According to Schreyer McCarter (1998) e-recruitment refers to â€Å"The recruitment process, including placing job advertisements, receiving resumes, and building human resource database with candidates and incumbents E-Recruitment is establishing itself as a significant part of the recruitment strategy in a range of organisations across the UK and the world. This is in addition to becoming a progressively more accepted method for job seekers in searching and applying for jobs. The traditional method of recruitment has been transformed by the appearance of the Internet. In the past few years, the Internet has dramatically changed the face of HR recruitment and the ways organisations think about the recruiting function. There is predicted to be a continued dramatic growth in recruiting and hiring via this medium in future years. (CIPD 2007) A survey by the public appointment service in Ireland in 2006, relating to e-recruitment in Irish organisations, has also identified a high level of current or intended future use of e recruitment, this being identified as an area forming an important part of the Irish recruitment strategy. It would seem that e-recruitment has been implemented in many organisations from small companies to large organisations. These organisations are already using e recruitment to advertise jobs and accept CVs on the Internet, and also to communicate with the applicants by e-mail. In the CIPD Recruitment, retention and turnover 2006 survey it was identified that eighty-four percent of respondents have made greater use of e-mail applications in the last three years. Over seven in ten organisations also said they are actively advertising jobs on their corporate websites and using online recruitment applications. Lievens and Harris (2003) have identified the following methods of using the Internet to attract candidates, acknowledging that approaches are continually changing. †¢ Company websites Advertising posts and providing information to candidates through the company website. The facility to apply online is often also provided. †¢ Job Boards Commercial general purpose recruitment portals, (e.g. Yahoo!, Monster.com) and specific industry job boards. †¢ Online Searching Recruiters searching online sources such as company websites and professional chat sites to identify candidates who may not be actively looking for a position. †¢ Relationship recruiting Using the internet to build and maintain long term relationships with passive candidates, through using internet tools to learn more about web visitors interests and experience and to e-mail regular updates about careers and their fields of interest. Kerrin and Keetley (2005) have suggested that the reasons for many organisations to introduce e recruitment have been recruitment cost reduction, speedier processes, access to a wider pool of applicants and better employer branding. In the CIPD Recruitment, retention and turnover survey 2006,  it was identified that the key drivers for e-recruitment were; reducing recruitment costs (cited by 71%), broadening the selection pool (60%) and increasing the speed of time to hire (47%). It was also noted that : ‘over a third of respondents believed it brought greater flexibility and ease for candidates, and over a quarter believed it strengthened the employer brand. This has been further supported by the IRS Employment review (2007). Reduction in costs E-Recruitment has allowed employers to make reductions in advertising costs and remove their dependency on recruitment agencies. Technology in online recruitment is not expensive and the hours saved in the pre-selection process gives HR staff more time. Administration can be significantly reduced in most organisations. This can prove to be extremely important when recruiting involves high numbers of staff or when receiving high numbers of applications. (DTI 2006, Guertal et al 2007). The IRS 2007 study identified 7 out of 10 organisations say administration is easier to perform when utilising online recruitment services and 8 out 10 identified the e- recruitment process as being substantially cheaper. Cappeli (2001) calculated that ‘it costs only about one-twentieth as much to hire someone online as to hire that same person through †¦ other traditional methods. This can again, be achieved through significantly reducing advertising costs and by reducing recruitment related administration according to Elkington (2005) An IDS HR Study in April 2006 identified how the Internet now plays a significant role in recruitment activities of employers. The report examined the use of corporate and third party recruitment websites and identified they are being used to reduce advertising costs and tap into a more diverse candidate base. They also identified that technology is streamlining the application process with the encouragement of online applications, linking into sophisticated application tracking systems and allowing organisations to measure the success of attraction methods. IDS state that over 70% of adults utilise the Internet, and employers are using this medium to attract and recruit much more frequently. They identify significant cost savings for employers and reduced time taken to fill vacancies, but are keen to point out the wariness of employees in missing out on potential candidates and feel that traditional recruitment media is set to retain and important role, particularly when recruiting locally or hard to fill jobs. This supports reservations held by IRS (2007) who identified that e recruitment was considered unsuitable for certain kinds of vacancies. Grout and Parrin, authors of the book, ‘recruiting excellence agree with the assessment by IDS. In an article for HR Director (2006), they identify that online recruitment can improve efficiency by the reduction in man hours involved in the process, and help employers reach a wider and larger audience of jobseekers. They also recognise that it can be a valuable part of a recruitment process, in addition to traditional press advertising and the use of agencies (DTI, 2005). Kerrin and Keetley (2005) however, have stated, that the full cost savings are often only realised if the whole recruitment process is carried out online, a view supported by a number of authors. (Demos 2007, IRS 2007) Reducing time-to-hire With e-recruitment the time taken to recruit can be reduced by as much as 75% and allow the recruitment of the most appropriate employees more quickly into the organisation. Time is also saved by spending a reduced amount of time tracking, communicating with and screening the applicants. Online recruitment also allows organisations to the share best practice and improves the consistency of recruitment processes across the organisation. The Public Appointments Service survey showed that a reduction in administrative workload (cited by 49% of respondents), and reduced timescales for hiring (cited by 40% of respondents), were key drivers in the decision to implementing e recruitment. Hogg (2000) stresses a shorter recruitment cycle can be gained by the speed at which several steps of the recruitment process are carried out online. Elkington (2005) supports this and has identified that the immediate posting of jobs online and the effortlessness of completing online application forms and e-mailing CVs to an organisation has made these steps much faster. Moving further into the recruitment process, the short-listing process can be accelerated by routinely aligning applications dependent on prearranged criteria (CIPD 2005). Applications can be progressed within minutes rather than weeks, saving both recruiters and job applicants time. Widening Talent Pool Internet tools that enable employers/recruiters to reach a wider pool of potential applicants and to fill positions faster with less cost to the organisation are obviously advantageous in such a competitive environment. Online advertising opens up a wider candidate pool, by providing 24/7 access to job seekers, at local, national and international locations, thus providing a better chance of finding the right candidate (CIPD 2005a). As job seekers become increasingly more web literate and the growth of broadband makes web surfing easier and cheaper (IRS 2005), the potential for e-recruitment to attract wider candidate pools is increasing. Enhancing Employer brand Increased numbers of candidates are expecting to apply directly online and they routinely make judgements about employers based on their recruitment process. To combat this employers are adopting increasingly dynamic e-recruitment solutions to allow them to distinguish themselves from others and to professionally manage the recruitment process. (Willock, 2005; Paton 2006). E-Recruitment enables an organisation to raise its profile to potential applicants and promote itself as innovative and forward looking, allow visitors to the website to leave with a positive experience. Kerrin and Kettley (2003) in their report ‘e-recruitment is it delivering identified a key factor for organisations in their adoption of e-recruitment, is the desire to increase their profile as an employer of choice amongst potential candidates and to promote their image as a progressive organisation. This is supported by 7 out of 10 organisations also agreeing that the use of online recruitment was more likely to improve reputation (IRS 2007) E-Recruitment can help to build the image of a brand. Barrow (2005) recommends that organisations build their brand identity very carefully however; warning of a need to ensure substance is beneath the clever name, logo or design, as employees once appointed will see through the facade. This is further supported by Gray and Balmers (1998) term, ‘routine interactions. They state that outsiders have a place in shaping image and reputation when they interact with organisations; communications are likely to be received with scepticism when they do not match personal experience. CIPD (2005) also demonstrated that more detailed information can be provided on the organisations website than in a newspaper advertisements and in recruitment agency literature, reinforcing the employer brand, improving the corporate image and profile whilst also giving an indication of the organisations culture The use of the Internet allows organisations to pass far more information in a much more dynamic and consistent fashion to candidates than was the case in the past (Lievens and Harris 2003). Applicants therefore have much more information at their disposal before they even decide to apply for a job than in the past. In addition, candidates can easily and quickly search for independent information about organisations from various sources, such as internet search engines and libraries. Therefore, unlike in the past, a candidate may have applied for a job based on practically no information; todays candidate may have reviewed a substantial amount of information about the organisation before choosing to apply. Disadvantages of e-recruitment The CIPD Recruitment, retention and turnover 2006 survey revealed some concerns that e-recruitment could increase the number of unsuitable applicants and that it could act as a barrier to recruiting older workers. A factor which seems to be discouraging some employers from making more use of online recruitment systems, is a concern, over the level of internet access and levels of accomplishment with technology, of their target audiences. While usage of the Internet does vary by social group there is evidence to suggest that recruiting online results in at least as diverse an applicant group as those recruited through traditional methods (McManus M.A., Ferguson M.W. 2003). Searle (2003) would dispute this however stating that participation in online recruitment is skewed towards ‘white males from higher socio-economic groups. A further concern in relation to access is the suitability of online recruitment methods for candidates with disabilitie