Staff retention programme to provide bespoke help for NHS trusts

Retaining staff remains a major problem for the NHS. Over the past six years the proportion of nurses leaving the health service has risen by one quarter, to top 10% in 2016.

Retaining staff remains a major problem for the NHS. Over the past six years the proportion of nurses leaving the health service has risen by one quarter, to top 10% in 2016.

With the pay cap in place it is perhaps unsurprising that acute, community and mental healthcare providers are struggling to keep hold of employees.

A support programme is being rolled out across NHS trusts
to control high staff turnover rates. Picture: iStock

But there is more to retention than pay, according to NHS Improvement’s director of nursing for improvement Mark Radford.

Professor Radford, who is spearheading the regulator’s new retention programme, says there is 'strong evidence' to suggest that other factors play a vital part in staff attrition.

Research by his organisation shows that over recent years 'work-life' balance and flexibility have proved to be influential on staff leaving than pay and reward.

1 in 10

nurses left the NHS last year

'Pay is clearly important, as are other factors like the strength of the pound and the policy position on Brexit, and these are things outside our control,' he says.

'But there are plenty of ways the NHS can help retain staff. For example, we know mentoring programmes and preceptorship can support newly registered staff.

Bespoke help

'For those who are further on, we have found that factors such as term-time contracts and flexible working are important. For reaching retirement age, measures can be taken – such as reduced hours and new roles – that can have an impact.'

Mental healthcare and community care have the highest turnover of staff out of all the specialties.

NHS Improvement's retention programme is offering all 53 mental healthcare trusts and 60 acute and community trusts bespoke help. The primary focus is on nurses, although the scheme does cover all clinical staff in these organisations.

The support lasts 90 days and involves NHS Improvement staff working with trusts to identify the most influential factors behind staff leaving and then helping to draw up plans. Examples include buddying them with trusts that have already made progress.

The support is being offered in three waves. The first 40 trusts, 20 mental healthcare providers and 20 acute and community healthcare providers, have begun the programme with another tranche due to start in October, before the final wave gets going by the end of the year.

There is also an offer to all trusts. This involves a series of masterclasses for directors of nursing and human resource directors, an engagement tool to be launched in September to highlight best practice, and case studies, webinars and guidelines that are due to be published later in the year.

'We want to give everyone a chance to improve,' says Professor Radford. 'There are plenty of good examples out there and with a bit of support we hope we can help trusts across the country improve the way they retain staff. But what works in north London is not going to necessarily work in Northumbria. There will be different solutions in different places.'

There will be no overall target for reducing the leaver rate, but Professor Radford is looking for improvement by 2020 among those trusts that have higher rates than others in their region.


NHS trusts will receive bespoke help with retention from NHS Improvement

It is still early days, but those trusts that are currently involved are optimistic that progress will be made.

Retention summit

Solent NHS Trust, based in Southampton, is part of the first wave. Chief nurse Lesley Munro has welcomed the help. The nurse turnover rate is currently just under 17%, although it has been falling since last year, when it was 23%.

She says the trust now plans a retention summit for the end of September to draw up an action plan to make 'even better' progress.

'Our particular focus is on continuing professional development, flexibility and developing strong, integrated teams' she says.

'Retention is obviously important, but it’s also about boosting recruitment, improving morale and paying nursing staff a salary they deserve. Without the right numbers, patient safety is on the line'

Kim Sunley

But others have voiced concern. Royal College of Nursing senior employment relations adviser Kim Sunley says the programme is 'positive' but adds: 'With more than 40,000 vacancies in England alone, we need to look at all the challenges.

'The RCN has repeatedly called for an overarching strategy. Retention is obviously important, but it’s also about boosting recruitment, improving morale and paying nursing staff a salary they deserve. Without the right numbers, patient safety is on the line.'

NHS Providers director of policy and strategy Saffron Cordery agrees: 'Workforce is a top concern for trusts. Until we address the underlying issues driving retention problems, including the pay cap and the unsustainable workplace pressures, these approaches will only have a limited impact.'

Effective measures

Buckinghamshire Healthcare NHS Trust has reduced turnover from just under 17% to 15% over the course of the past year.

The trust carried out a review of why staff were leaving, and identified problems with line management, short-notice transfers, career development and a lack of opportunities for flexible working.

It responded by developing a leadership programme for line managers, offering one-to-ones for staff who have 'itchy feet' to see what can be done to encourage them to commit to staying, and introducing staff awards. It has also introduced targeted action for the over-50s including bespoke training and flexible retirement options.

Sandwell and West Birmingham Hospitals NHS Trust has established a new £1.1 million protected training budget to help staff progress their careers.

An employee benefit scheme with free gym and yoga sessions, childcare vouchers, and discounts on everything from insurance to holidays has also been established. Staff can also borrow bikes for free to encourage cycling to work and attend cooking lessons.


number of vacant nurse posts in England

(Source: RCN)

According to the trust, these measures have reduced nurse turnover by three percentage points over the past year.

Medway NHS Foundation Trust in Kent has focused on retention problems among nurses in its emergency department. A year ago the vacancy rate was 65%; now it is 14%.

Team awaydays

A combination of initiatives has helped, it is said. There is an 18-month preceptorship pathway for newly registered nurses, while the department is split into small teams with new starters distributed across them to help provide day-to-day support. Biannual 'small-team awaydays' are held to ensure clinical and mandatory training is up to date.

There is also a clinical sister or charge nurse development pathway and, for more experienced nurses, a master’s-level programme has been developed in partnership with a local college, under the guidance of the consultant nurse.

Nick Evans is a freelance health writer



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