Background
Norfolk Community Health and Care NHS Trust provides community-based NHS health and care across Norfolk, serving a population of nearly 900,000 people. The trust's ambition is to provide 'seamless health and care that creates healthier futures for everyone across Norfolk and Waveney'.
The trust is rated 'outstanding' by the Care Quality Commission and has been commended for its compassionate, inclusive and effective leadership at all levels, and its commitment to the development of staff. The trust received positive NHS Staff Survey results in 2023, with 76% of staff either agreeing or strongly agreeing that they would recommend their trust as a place to work, an increase of 4.4% since 2022.
The state of play in Norfolk
Norfolk Community Health and Care NHS Trust (NCH&C) operates in a challenging local environment, delivering services across a mix of urban and rural locations for an ageing population.
Historically, recruitment has been difficult for the trust, particularly in more remote areas where house prices are high, and where travel is required. The trust also operates alongside three acute hospitals in their system, which can contribute to competition for staff. Recognising this, NCH&C has undertaken significant work over the past ten years to improve recruitment and retention within the organisation.
A particular focus for the organisation has been to engage with staff to ensure they can see a career pathway and ultimately ensure they stay within the sector.
Engage to retain
A focus on staff engagement is firmly embedded throughout the organisation. Leading from the top, the chief executive of the trust, Matthew Winn, emphasises the importance of improving staff engagement and the role this can have in supporting wider organisational performance. Reflecting this, the trust has a well-established dedicated staff engagement role and sets responsibilities for senior managers to embed this culture throughout the organisation.
As part of this, the trust is exploring the findings from the 2023 NHS Staff Survey to ensure there is an accurate representation of staff views, which can be used to support retention throughout the trust. This includes taking the time to carefully consider various breakdowns of the findings, coding responses in line with the NHS People Promise. This has helped provide a clearer understanding of staff experiences across the diverse range of services that are provided by the trust, recognising that different roles have their own unique challenges and opportunities. Staff are also given protected time to complete the survey and are encouraged to be involved in its development.
The value of 'growing your own'
In addition to the work on staff engagement, the people directorate at NCH&C have been working with local communities to encourage people to take up a career in the community sector. They have been working hard to demonstrate the value of working in a community provider, emphasising the role the sector has in creating a sustainable health and care system for the future, and outlining the various career pathways available.
Given the physical geography the trust operates in, which covers a largely rural area with limited numbers of people moving to the area, leaders recognise the importance of growing their own pipeline of staff locally. The trust is currently running approximately 100 apprenticeships within the organisation to support recruitment, with a view to retaining staff at the end of their course, demonstrating their role as an anchor institution.
Barriers to success
Although the last decade has seen a significant improvement in recruitment and retention for NCH&C, there remain a number of barriers to progressing this work.
The trust faces challenges recruiting into specific community roles, including clinical support workers. These members of staff see patients every day and are often pivotal in identifying issues early on, which in turn supports admission avoidance. However, these roles often exist at the lower end of the NHS pay scale, meaning that remuneration does not always feel competitive or attractive, especially in the context of cost-of-living pressures. These roles also require extensive travel which places additional financial burden on staff. Employment in industries such as hospitality and retail often offers similar pay and less pressure, further contributing to challenges around recruitment.
Leaders at the trust also cite the national focus on acute services as a key factor contributing to the challenges around recruitment into community providers. NCH&C believes staff working in community settings do not receive the same parity of esteem as those in acute trusts. This may reflect a lack of understanding around the skills needed to work in the community, which is often portrayed as a 'lesser skilled' career option. In reality, working in the community sector is demanding, technically advancing and clinically challenging, as well as being highly rewarding.
The trust would like to see national policymakers shift the current narrative, raising the profile of working in the community and demonstrating the vital role the community workforce plays in the future of the NHS.