Mortimer: Waterproofing the NHS workforce

With the NHS facing worker shortages, tight budgets and major recruitment issues, Danny Mortimer, chief executive of NHS Employers, explains how organisations can go about retaining talented staff.

Workforce shortages within the NHS have long dominated the headlines, as concerns over pay and conditions, increasing service requirements and longer working hours continue to be reported.

Recent analysis from the King’s Fund has also shown that the number of nurses employed by the NHS has fallen for the first time on a year-on-year basis since 2013.

While reduced levels of international recruitment are an important supply side factor, the NHS needs to work harder than ever to make sure it is able to retain a talented workforce in the immediate term, as a stable workforce is associated with better patient outcomes, and recruitment and training of new domestically sourced staff will naturally take time.

There have been some significant national steps to support retention with moves to improve the availability of affordable accommodation for NHS staff, and we have been given real hope for an easing of pay restraint following an announcement from Jeremy Hunt in October.

But other national workforce challenges remain – not least the need to reverse the disinvestment we have seen in continuing professional development (CPD) funding.

Our members are clear, however, that while this national support is very welcome, they need to deliver action in their organisations to reduce rates of staff leaving the NHS. With this in mind, NHS Employers recently published a guide to staff retention, aimed at providing clear and succinct information to help trusts to take rapid action.

Knowing your organisation inside out

The guide is the result of work with 92 NHS organisations over the course of 2016 and 2017, and the overarching message is that there is no one-off action that will solve all retention issues; rather, it is a question of finding the right balance from a bundle of best practice for an individual trust.

At the heart of the advice NHS Employers has given is the need to know properly the ins and outs of your own organisation. What is your workforce data telling you? For example, what do staff surveys or appraisals reveal? What needs to be discussed with staff and managers? Is there higher or lower turnover in certain areas? It’s essential to be able to drill down into this information as far as department or staff group.

Having an open dialogue with the workforce and regularly engaging with staff is also extremely important, as it helps employers understand why people choose to remain with an organisation and how they can become an ‘employer of choice.’ Our focus on the importance of CPD funding stems directly from the feedback given to employers by their people and teams.

Of course, some turnover is indeed beneficial, and can help to make organisations more dynamic and better able to support career progression for individuals. The key is in making sure turnover rates do not become unmanageably high, which can in turn affect continuity of care.

It’s not about reinventing the wheel; it’s about making good use of the solutions and supporting resources and best practice that are already available.

For example, when considering the ‘lifecycle’ of an employee, it’s important to start at the very beginning with robust recruitment and induction practices, making sure staff feel supported and secure from the outset so that they are more likely to remain with the organisation for a longer period of time.

Creating a positive environment

The retention guide looks at the work East Kent Hospitals University NHS FT has done in this area. In 2015-16, the trust identified a major issue: a high number of staff were leaving in their first year of employment.

It therefore began work to improve the experience of staff in their first year, including values-based recruitment, increasing focus on attracting the right staff, creating an online portal for new starters to engage with them before they joined, and building a strong local induction programme.

As staff move through their careers, providing solid pathways for development is another way of making them feel valued, supported and professionally fulfilled, alongside good relationships with management, with regular appraisals and one-to-one meetings.

Organisations could follow the example of Buckinghamshire Healthcare NHS Trust, whose work on using data to improve nurse retention saw the creation of a series of 12 focus groups with existing nurses to identify the reasons they were leaving. These included poor line management, poor work/life balance, lack of professional development, and lack of appreciation.

As a result of this work, the trust also created an ‘itchy feet’ programme, making it easier for staff to move around the organisation internally before it advertised a role externally.

Retirement support

There is also a need to support staff at the other end of their employment journey, including the use of flexible retirement options to retain staff and their skills for as long as possible in the final years of their working lives.

Flexible retirement options can support overall workforce planning. Initiatives incorporating these options into flexible working procedures, providing staff with enough information, encouraging them to attend pre-retirement workshops and ensuring line managers are aware of the options can all contribute to strong staff retention.

Another cohort of 30 organisations are receiving more targeted support from NHS Improvement, and their analysis reinforces the importance of the actions identified above.

Fundamentally, of course, strong staff retention comes about as a consequence of creating a positive workplace environment where staff feel appreciated and supported, and where values are well-understood and shared across the organisation.

The upshot is that while the challenges facing employers are numerous and difficult, with the right approach and with some national support too, especially in funding for CPD, the outlook can be improved.




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