Community providers innovating to tackle workforce crisis

Background 

Wirral Community Health and Care NHS Foundation Trust provides a range of community health care services, including sexual health, urgent community response and health visiting, supporting people throughout their lives both at and close to home. 

The trust employs around 1,850 members of staff, 90 per cent of whom directly support patients and service users. The workforce represented 76 per cent of the trust’s expenditure in 2022/23 and is the most important and valued resource. Investment in the workforce is core to the ethos of the organisation. 

The state of play in the Wirral 

Over the past few years, Wirral Community Health and Care NHS Foundation Trust (WCHC) has worked hard to improve recruitment and retention across the organisation. Reflecting on the results of the 2023 NHS Staff Survey, the trust saw its highest level of engagement and their best results to date following an intensive programme of activity which included a dedicated staff engagement plan to encourage staff and managers to have their say. Staff turnover rates also fell from 14.6 per cent in September 2022 to 9.5 per cent  in June 2024. Members of the team say progress has been supported by work to improve retention and staff engagement. 

The role of Wirral Community Health and Care NHS Foundation Trust as an anchor institution 

Leaders at WCHC are very proud of the work the trust is doing to support local people, particularly those from disadvantaged backgrounds, to start a career in the health and social care sector. The trust works closely with system partners and local schools to carry out community engagement, targeting people living in areas with high levels of long-term unemployment. 

This involves building career pathways with entry level opportunities based on skills and potential, breaking down the barriers to employment and supporting people from all backgrounds to start a career in health and care. The trust is building career pathways from entry level through to registration and beyond. These are aligned to national apprenticeships and the trust is supporting apprentices to obtain the necessary qualifications on that journey. 

WCHC is also leading the way in the roll out of the NHS Cadets Programme, in partnership with NHS England and St John’s Ambulance, which encourages young people, often from deprived families, to get involved in the health and social care sector. The cadets programme provides an insight into the various opportunities available within the sector, including what it is like to volunteer and work in the NHS. More broadly, it can support participants to develop their confidence and life skills, including around leadership and first aid awareness. The programme is now in its fourth year and is going from strength to strength. 

One cadet said: 

“My confidence has improved massively. I’ve learnt my own personal skill sets and found my strengths with the help of the staff. I can talk confidently and proudly of many different roles in the NHS. I am very passionate about my future career choice.”

The importance of career development and skills mix 

As well as supporting local recruitment into the sector, WCHC recognises the importance of learning and development for existing staff within the organisation. The trust therefore works hard to retain staff in various ways, including by providing development opportunities where possible; this may be through formal apprenticeships or training, or through on-the-job learning. 

Ensuring the trust has the right skill mix to deliver timely and high-quality care for local communities is also vital. WCHC is therefore considering the composition and size of their workforce against expected future demographics in the area. Current projections suggest there are insufficient numbers of registered nurses to meet anticipated demand. The trust is therefore thinking differently about how staff can work with partners to proactively identify people at highest risk and best utilise their shared skills to optimise hospital avoidance, ensuring that the highly skilled community resource is allocated appropriately to address need and support a reduction in health inequalities.   

Enablers to success

The trust leadership team is positive about the improvements made in workforce recruitment and retention, with less than 10 per cent staff turnover in 2024, down from 14 per cent in April 2023, and agency staff usage down to 1.3 per cent. The various recruitment and retention initiatives described above and the strong emphasis on the value of staff are viewed as key enablers to reducing the use of agency staff.

The trust was recently successful in securing funding for a 12-month people promise manager position. The successful candidate has previous experience as a clinical team leader. Her experience with practical frontline issues is crucial on the journey of identifying the appropriate level of resource to ensure the trust has the right number and mix of staff to deliver sustainable care both now and in the future. The fact that the people promise manager has frontline clinical experience provides invaluable insights supporting the trust’s community nursing transformation programme. 

Background 

Livewell Southwest provides integrated health and social care services across South Hampshire, West Devon and Plymouth. Livewell Southwest is one of the largest independent social enterprises in England, with a workforce of approximately 2,800 people, of which 750 are nurses. 

The workforce is made up of a range of health and care professionals, reflecting the diverse services required to support an ageing population with increasingly complex health and social care needs. Leaders at Livewell Southwest deeply value their staff and are keen for everyone to achieve their full potential – offering a range of development opportunities from apprenticeships to clinical training. 

The value of ‘growing your own’ workforce 

In order to keep a sustainable balance between international and national recruitment, leaders at Livewell Southwest have heavily invested in ‘growing their own’ workforce, working closely with local communities to encourage more people to enter the health and care sector. Leaders at Livewell Southwest were particularly keen to engage people from traditionally seldom-heard groups, including people who are long-term unemployed, people struggling with their mental health and single parents. 

To support this, the people directorate started looking at the barriers to recruitment within their local communities and found that it can be very difficult to access the opportunities on offer. The organisation has therefore removed the requirement to have previous experience for all band 2 roles, instead opting for a values-based recruitment process. From this, the organisation has developed a pathway that allows people to automatically progress from band 2 to band 3 after six months without the need for an interview, thus breaking down barriers to progression. 

Livewell Southwest has also started a project with local schools to recruit school leavers to a nursing associate development programme. Individuals are recruited onto an early development programme for three months before carrying out a nursing associate course, which is fully funded by the organisation. Staff are paid a salary by the trust while undertaking the training. Livewell Southwest has also worked with Plymouth Marjon University to develop a bridging module, allowing nursing associates to access degree courses without any prior qualifications, opening up opportunities to become qualified nurses. 

The importance of learning and professional development

As well as developing the programme to recruit new starters into the organisation, Livewell Southwest are supporting retention for existing staff through a number of initiatives. As part of a new development pathway, band 5 staff can automatically progress to band 6 once they have achieved key competencies. Removing barriers to progression can reduce the number of staff looking for role development opportunities elsewhere. Livewell Southwest also has apprenticeship programmes for administrative and support staff to allow people develop no matter their current role. 

To support learning and development with the organisation, Livewell Southwest has secured ringfenced funding from a local university, which can be used for continuing professional development (CPD) and scholarship pathways. Given that community interest companies and social enterprises have not historically had access to national CPD funding, leaders at the organisation have had to think innovatively about how they can generate income to support learning and development. Despite financial constraints, leaders at Livewell Southwest are committed to protecting development and education programmes. They recognise this is key to bolstering recruitment and retention within their organisation. 

Supporting retention within the organisation

As well as their commitment to supporting learning and development, embedding a positive working culture is also vital within the organisation. Livewell Southwest has a number of staff networks. These groups can help people feel supported, both professionally and personally, at work. There is also a wellbeing fund to support suggestions that would improve staff experience. For example, staff asked for outdoor benches to give them the opportunity to eat lunch outside. This has been successful in improving staff wellbeing. 

Leaders at Livewell Southwest are proud of the work they have done to support new recruits within the organisation. The organisation has a dedicated ‘people experience’ team that provides support for new starters in their first few months. New starters can approach the team to raise queries about a range of topics, from parking to wellbeing. Having this support is hugely valued by new starters and helps develop a sense of community, supporting retention within the organisation. 

Livewell Southwest has also developed an initiative which supports staff to transfer between roles internally. So, if an individual is not satisfied with their current role, they can apply for an internal transfer and managers will look to support them to move to a different team within the organisation. This supports retention by helping to match people to suitable roles. 

Enablers to progress

Leaders at Livewell Southwest are clear that having access to funding for CPD is vital to support staff retention. This year was the first year that NHS England provided funding for CPD to community interest companies and social enterprises. This is a positive step, and the team at Livewell Southwest would like to see recurrent funding for CPD available to community interest companies and social enterprises. 

Developing a strong relationship with the local integrated care systems (ICSs), One Devon, is another enabler to supporting recruitment and retention. Leaders at Livewell Southwest have been working at system-level to share learning on their recruitment and retention programmes. This has ensured the organisation is included and involved in recruitment and retention projects that the ICS is carrying out. Leaders at Livewell Southwest believe it is vital for systems to understand the role of the local social enterprise sector and how it can support care provision for local communities. 

Going further, faster 

In order to increase recruitment and retention to the community sector, both for social enterprises and the NHS, leaders at Livewell Southwest believe more funding for and a greater focus on implementation of CPD programmes is vital. Staff want to grow and develop in their careers and must be supported to do so through learning and development opportunities. Without the ability to progress, there is a risk that nursing and clinical staff see their time in health as a stop gap rather than as a long-term career. 

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 per cent of staff either agreeing or strongly agreeing that they would recommend their trust as a place to work, an increase of 4.4 per cent 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. 

When reviewing the survey results, senior leaders at the trust carefully consider the responses and use it to inform a small number of priorities to progress. The trust has invested in tools such as Power BI to really understand the staff survey data. Over the last three years, the trust has thoroughly interrogated responses question by question, and examined qualitative data from the survey. This is important because, in a previous year, leaders noticed positive quantitative data masked growing dissatisfaction expressed in open text questions. Although this approach can be labour intensive, senior leaders see the value in carefully examining the results in order to retain staff. Once the results have been analysed, staff are encouraged to focus on one or two things in the action plan to drive improvements. 

The value of ‘growing your own’

In addition to the work on staff engagement, the people directorate at NCH&C has 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. 

Background 

Derbyshire Community Health Services NHS Foundation Trust is one of the largest providers of specialist community health services in the country, employing approximately 4,400 people, and serving a patient population of more than 1.1 million people. The trust delivers care for patients across a wide range of services and locations.

The trust was rated ‘outstanding’ by the Care Quality Commission in September 2019 and in 2022 was voted the third best nationally in ‘Britain’s healthiest workplaces’ survey. This year, the trust received positive staff survey results, with 74 per cent of staff agreeing they would recommend their trust as a place to work, reflecting the trust’s commitment to supporting staff and embedding a positive culture across the organisation. 

Recruitment and retention in Derbyshire Community Health Services NHS Foundation Trust 

Integrated care boards (ICBs) have been asked by NHS England to make a 30 per cent reduction to running cost allowance (RCA) by 2024/25. To support these ambitions, organisations have been asked to reduce staffing costs and develop tight workforce plans to manage this. 

This applies to Derbyshire Community Health Services NHS Foundation Trust (DCHS). However, the trust has recently worked with the local council to move approximately 130 homecare support staff from the council into the community trust. The partnership with the local authority is underpinned by a Section 75 agreement, and the pooling of resources.

The use of a Section 75 agreement has given the trust the flexibility to work innovatively to boost capacity across the health and care workforce. This is a strategic priority for the trust and supports the delivery of more joined-up, holistic care for individuals. It will reduce the risk of duplication by different health and care professionals, allowing homecare staff to upskill to deliver more care for patients. It will also support patient flow throughout the system by allowing more people to receive care at home and support timely discharge from both acute and community settings.  

The value of culture

Embedding a positive staff culture is a priority for leaders at DCHS, and there is a focus on modelling this throughout the organisation. In recent years, the trust has explored the importance of kindness and the impact this has both on staff wellbeing and patient outcomes. This has surfaced issues around how staff are able to constructively discuss performance.

The trust is also undertaking active bystander training as part of their equality, diversity and inclusion programme. The training aims to empower staff across the trust to challenge poor behaviours and bring about change through the reinforcement of messages defining the boundaries of unacceptable behaviour. The trust is working with an external organisation to ‘train the trainer’, ensuring that managers and staff have the tools to stand up to discrimination and abuse when they see it. This is particularly important given that the majority of staff (93 per cent) in their workforce are white. It is therefore vital that staff from ethnic minorities are not isolated within the workforce and feel fully supported by colleagues at work and in the community. 

Earlier this year, the trust re-launched their staff forum to promote staff engagement. Use of the forum had been gradually declining, but it has now been refreshed and takes place face to face, which trust leaders believe has drastically improved the level of engagement. The forum is available for staff across the organisation, with the trust board sitting on the forum. This gives staff the opportunity to raise issues with senior leaders directly, in a constructive and meaningful way. 

Innovate to retain

DCHS has recently joined the NHS People Promise exemplar programme. As part of the programme, which was first initiated in 2022, NHS England works with NHS organisations to deliver all elements of the people promise in one place at the same time, with the aim of achieving improved outcomes and optimum staff satisfaction and retention. 

The trust will receive funding to instate a dedicated People Promise post, with retention being the key focus for the postholder over the next 12 months. Although the turnover rate at the trust is comparable to similar organisations, leaders are keen to better understand the data on leavers, and the reasons behind this. A key challenge is around staff leaving within the first 12 months of employment, which can be costly in terms of training. Evidence suggests that if people stay more than two years at the trust, they are more likely to stay long-term. 

Enablers to success

This impact of the funding through the NHS exemplar programme is valued by leaders at the trust in taking forward their People Promise programme addressing key workforce issues such as staff turnover. Although DCHS is already working hard to develop a positive culture to support staff retention and wellbeing, further dedicated funding and national level support is needed to ensure there is adequate resource to accelerate this work across the whole of the NHS. 

The trust also sees an important role for apprenticeships as an alternative pathway to entering the community workforce and boosting capacity for much needed community roles, such as allied health professionals. However, further national support is needed to overcome operational barriers to delivering apprenticeships, including a lack of funding and flexibility to backfill roles.