HR Recruitment and Selection in the NHS – 2500 words

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.


  1. 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).


  1. 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.


  1. 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.





Brown A. K., Barrick M. R., Franke M. (2002). Applicant Impression Management: Dispositional Influences and Consequences for Recruiter Perceptions of Fit and Similarity. Journal of Management, vol. 28, No. 1, pp. 27-46


Caldwell D. F., Burger J. M. (1998).  Personality characteristics of job applicants and success in screening interviews. Personnel Psychology, vol. 51, pp. 119-136.


Guion, R. M. (1976) Recruiting, selection, and job placement. In M.D. Dunnette (Ed.), Handbook of industrial and organizational psychology, 777-828. Chicago, Rand-McNally.


Jeanquart- Barone, S.,  Peluchette J. V. (1999) Examining the Impact of the Cultural Dimension of Uncertainty Avoidance on Staffing Decisions: A Look at US and German Firms. Cross Cultural Management, Volume 6 Number 3



Lin, Y., Kleiner, B. H. (1999) How To Hire Employees Effectively, Management Re search News, Volume 22 Number 9.


May, D.,  Askham, P. (2005) Recruitment and retention of estates and facilities staff in the NHS Facilities vol. 23 No. 9/10, pp. 426-437; Emerald Group Publishing Limited; 0263-2772; DOI 10.1108/02632770510602360


NHS London (2007) Recruitment and selection Guidelines. Available online at:


Rosse J. G., Stecher M. D., Miller J. L., Levin R. A. (1998). The Impact of Response Distortion on Preemployment Personality Testing and Hiring Decisions Journal of Applied Psychology vol. 83, No. 4, pp. 634-644


Ryan A. M., Polyhart R.E. (2000). Applicants’ perceptions of Selection Procedures and Decisions: A critical review and agenda for the future. Journal of Management, vol. 26, No. 3, pp. 565-606.


Schneider, B. (1976) Staffing organizations. Santa Monica: Goodyear.


Schneider, B. (1987) The people make the place. Personnel Psychology, 40, 437-454.