A challenging context

The NHS is at a crossroads and that means its workforce is too. The ongoing COVID-19 pandemic has presented the biggest challenge in the history of the service, requiring staff to work at increased risk and in vastly different ways. This overhaul in priorities and ways of working, coupled with growing service demand and a care backlog requiring theNHS to run just to stand still, has led to understandably high rates of staff burnout, early retirement, and sickness absence. 48% of trust leaders report having seen these effects on staff in their organisations.

But, as vast as these challenges are, there are also opportunities for change and improvement. Trusts across the country are continuing to push themselves to do the best for their staff, with innovative and future-facing approaches to workforce planning, management, and deployment. This report aims to collate best practice examples in these areas, identifying the common enablers and obstacles so that other organisations can consider this in their own work. It also gives an overview of the national context behind initiatives to recruit, retain, and sustain NHS staff.

Delivering the People Plan

The case studies in this report are each focused on a central theme from the national People Plan 2020/21. The plan, from NHS England and NHS Improvement and Health Education England, expands on the strategic priorities for – and approaches to – NHS workforce management which were set out in the 2019 Interim People Plan. The five themes from the People Plan 2020/21 are: growing for the future, new ways of working and delivering care, supporting our NHS people for the long term, looking after our people, and belonging in the NHS.

Local response to national change

Growing for the future

There is significant legislative change on the horizon for the NHS. The upcoming Health and Care Bill seeks to add clarity and transparency on roles and responsibilities within the NHS for workforce planning. This is a real challenge, as unsustainable workloads are placing far too much pressure on a workforce facing severe staff and skills shortages. While we await this legislation, trusts are developing future facing approaches to recruitment, such as Sussex Partnership NHS Foundation Trust. They have overhauled their recruitment practices, investing in a dedicated recruitment team and establishing workforce pipelines among the local community by working in collaboration with Greater Brighton Metropolitan College, and are seeing excellent results.

New ways of working and delivering care

The North East Ambulance Service NHS Foundation Trust has also been collaborating with local partners. Their initiative to provide paramedics to primary care services on a rotational basis has garnered great feedback from patients and staff (regarding the positive effect this offers their professional development and job satisfaction), as well as relieving some of the pressures which primary care services currently face.

The national move towards Integrated Care System (ICS) working has been evolving over the course of several years, and trusts have been focused on building effective working relationships with local partners. Our last Providers Deliver report went into detail on how this is being done, and it is heartening to see the continued development of excellent work in this area. This is another key focus in the Health and Care Bill, which intends to codify the integration of health and care services.

The Midlands Partnership NHS Foundation Trust has also been enabling new ways of working and delivering care, ensuring that their staff and services remain adaptable by providing excellent development and training opportunities. These opportunities are rooted in staff feedback regarding which areas and skills they want or need to develop. This provision of continual professional development has improved retention rates, as well as the experiences of service users.

Supporting our NHS people for the long term

Another consideration for the way in which trusts approach retention is that increasingly, people want to work differently. We are seeing divergent working preferences between generations within the workforce, between geographical areas, and even between staff groups. The University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) have improved their staff retention by focusing on these preferences and structuring management approaches accordingly. Their case study expands upon their work for newly qualified nurses, and nurses approaching retirement.

Looking after our people

UHDB's case study also expound their management solutions to support flexible working options in areas which have traditionally been unable to facilitate this. The People Plan 2020/21 sets flexible working options as a key aim for the NHS. Of course, there is a way to go in this area, particularly given the limiting factor of staff vacancies, but the innovation in the way that trusts are creating more options within current constraints is commendable.

Looking after staff has also been a priority for Mid Yorkshire Hospitals NHS Trust – like so many trusts, they scaled up their staff wellbeing offer during pandemic, and have since been developing it to ensure useful, continuing support for their workforce. They have seen significant upswing in staff accessing the offer and discuss the scope which they see for it going forwards.

Belonging in the NHS

The People Plan 2020/21 also gives important focus to addressing race inequalities within the NHS workforce – an area in which Dorset County Hospital NHS Foundation Trust has key learning to share, with a tangible commitment from executive level down to face this head on. The treatment of staff from minority groups in the workplace often falls short of expectations, hindering the NHS in closing gaps on health inequalities or achieving all of the service changes that are necessary for population health improvement. The pandemic has also had a disproportionate impact on people from minority backgrounds, older people, men, those with obesity, and those with a disability or long-term condition.

The NHS workforce is large and diverse and as such reflects wider society. NHS staff face the same inequalities as the broader population, and the importance of truly understanding and acting upon this, to improve staff experience and to benefit patient care, cannot be overstated.

Addressing issues of workplace culture more widely is another key tenet of the People Plan. Solent NHS Trust has focused on creating a truly values-led speaking up culture, leading to improvements in staff engagement alongside a drop in staff turnover as a result. Another facet of how to improve organisational culture is Berkshire Healthcare NHS Foundation Trust's approach to empowering staff to be part of change within their trust, grounded in a thorough approach to management training. The importance of both freedom to speak up and excellent, consistent management are two central outcomes highlighted in the Kark review, and restated in the People Plan. It is crucial to the retention of staff that they feel safe, supported, and engaged by their workplace culture. Trusts recognise this and are continually developing their approaches in order to best facilitate a positive culture.

Enablers and barriers

We are seeing excellent examples of trusts harnessing existing funding and talent to make truly remarkable improvements for their workforce. The willingness of health and care organisations to pool resources and work together remains encouraging, and the results from increased collaboration are consistently positive. Additional funding for new roles – as was made available for nursing apprenticeships last summer – has also supported workforce management more widely.

However, to improve the recruitment, retention, and wellbeing of the NHS workforce in the long term, it’s clear that more staff are needed not only to cover existing workforce gaps, but to build additional capacity in the system. Wellbeing is often spoken of at an individual staff level, but by building a resilient system, workforce wellbeing and patient experience will be far better protected by realistic workloads, more regular and reliable breaks, and a better work life balance. A fully costed and funded workforce plan, alongside increased long-term investment in workforce expansion, education and training, is absolutely key to making this a reality for the NHS.

Why Providers deliver?

The importance of adaptable approaches to workforce planning and management is key, as we anticipate future service delivery requirements against the context of intense pressures, increasing demand, and national policy change. The strategic challenges that the NHS is currently facing therefore also present strategic opportunities. We hope that this report gives a positive view of just some of the excellent responses from trusts across the country, and an inspiring look at what could be next.