Cost-of-living: employer workshops

• Our first meeting was held in person, and gave the group a chance to meet each other, share key issues and begin the planning process for the series of workshops.
• The themes that were identified as the biggest frustrations were: in-work progression, flexible working, stigma and culture change, systems working and population health, all with the aim to create long term solutions to support employers with the cost of living.
• From the first session the team went away and began to prepare the agendas for the remaining networks. Working with the feedback from the group and the biggest frustration, these are then used as the main topic for each session.
• During the workshops we will also invite external speakers who are experts in this area.

Ruth Lowe from NHS Confederation discussed strategic approaches and population health impacts and shared examples of how organisations can support employers:

• Work towards living wage accreditation, including supply chains.
• Increase percentages of pay for the lowest paid staff.
• Provide financial literacy support.
• Ensure that your organisation offers savings advice.
• Involve Credit unions and Citizens advice bureau links.
• Provide cheap and healthy meals. These should also be open to public as well as staff (this relates to population health, looking after our community

West London NHS Trust discussed a data driven approach to reward. A survey was published asking how staff were and what would make a difference to them, rather than assuming. They had a great response rate and have implemented many approaches to support staff.

Milton Keynes shared that it is currently piloting the any hour’s approach to support flexible work. The trust reiterated the importance of bravery in this space and how we need to consider long-term solutions despite short term pressures.

Above is a visual timeline that captured our latest meeting on supporting NHS people with the current cost of living crisis:

The group aimed to:

• connect with other people
• provocation of thought and how we maximise partnerships
• highlight issues and find tangible solutions
• be a force for lobbying and change
• understand what the outcomes can be.

The ambitions of the meeting:

• Generate ideas and approaches to support staff with the rising cost of living.
• Create a supportive community of people.

“Explore and look at the longer-term strategic impacts and their sustainability.” Jen Gardner

Changing the mindset from short- to long-term solutions

The group highlighted short-term ambitions as:

• freebies, discounts and vouchers
• short-term financial solutions
• subsidised food.

By being strategic and changing mindset these can help to achieve long-term ambitions, such as:

• in-work progression
• financial education and wellbeing
• tackling the stigma around money
• sustainable reward offers
• embedding a culture of flexible working
• getting the basics of wellbeing right
• working in partnerships at a system level.

What our speakers said

Ali Webster looked into the data driven approach to reward:

• developing a plan
• leading the way
• opening up
• measuring success
• listening and engaging.

Speaker Kate Jarman explored flexible working. By focusing on the basics of working conditions and being brave it would be possible to:

• help people manage costs
• create affordable and accessible childcare
• embrace an ‘any hours’ way of working
• achieve parity, while understanding some jobs are easier to make flexible then others.

Speaker Ruth Lowe explored a sustainable and strategic approach while asking the fundamental question how do we help staff help themselves? This led to why we should act:

• cost of living
• poverty
• poverty related health conditions
• health inequalities
• demand in the NHS and social care
• impacts on workforce.

This can be achieved by:

• being both responsive and proactive to futureproof
• educating managers on what’s available.

What we have tried since the last session

• Adoption of real living wage.
• Meal deals.
• Staff hardship fund.
• Exceptional support fund for students.
• Focus on partnerships.

“Don’t make assumptions about the solutions.”

Scenarios

 We then looked at scenarios and how to apply what we have discussed to each.

Childcare costs and flexible learning

• Thinking about what resources would be beneficial (for example survey questions).
• Managers feeling comfortable with having conversations and conducting staff surveys.
• Adopt a test and learn mindset and flexibility for the future.

In-work progression

• Make job descriptions and person specification easy to understand.
• Utilising apprenticeship levy and promote in-house training.

Students and apprentices

• Paying for training time.
• Ringfencing study time.
• Using charitable arms.
• Welfare meetings.
• Promoting health and wellbeing champions.
• Empowering to do more and support trusts to do more.

 Stigma and financial wellbeing

• Health needs and assessments for medics:
  • emotional
  • physical
  • social
  • financial
• Creating board-level champions for wellbeing.
• Remembering ‘it’s okay not to be okay’.

Enablers

We then looked at the enablers to this:

1. Evaluation and measuring the impact of success.
2. Communication and reach (for example digital inclusion).
3. Working in partnership.
4. Investment and upskilling line managers. This includes:

• being fluent in having financial wellbeing conversations with staff
• difficult conversations training
• reallocating resources and funding to meet priorities.

“Have the courage to change what can be changed.”

Themes

Themes we have heard:

• Decisions based on staff feedback.
• Our work is changing so roles need to too.
• Carers respite and back up care.

 Other reflections

• There is a lot we don’t know about.
• We found project planning helpful.
• We don’t need to over complicate.

• Michelle Wayt from NHS Employers shared how recruiting locally (or growing your own) has a positive effect on the local economy and community. Michelle shared some programmes that can support recruitment: the Prince's Trust and Step into Health programme.

• Medway Trusts shared its in-house programmes which support staff who are wanting to progress in their career, while learning on the job and earning a wage.

• The key themes that came from the workshop were:
  • The need to focus on making substantive roles more flexible so we can move staff off the bank.
  • Ensure there is education available about the different flexible working arrangements available to staff. Flexible working doesn’t just mean part time or working from home.
  • Systems working is vital and working together is key, we should be sharing our work more.
  • We need to work together at a systems level to raise the profile of financial wellbeing and support.

Ruth Lowe from NHS Confederation attended the session to talk about the effect that the cost of living has had on employers. Ruth shared:

• Healthcare leaders are increasingly worried about the impact of the cost-of-living crisis on the health of communities, healthcare staff, and patients.
• The NHS is already working flat out to eliminate long waiting lists caused by the pandemic, hindered by a lack of capital investment that shows itself in crumbling buildings and outdated estate and 130,000 vacancies. Put simply, the NHS can ill afford spikes in demand caused by this crisis.
• We hear from members that they are doing all they can to support staff, service users, patients and local communities from the worst effects of this crisis. For example, hardship grants, food banks, subsidised travel.
• The integrated care system, which is responsible for running all the services, is made up of two key bodies: 

  • Integrated care partnership: links in with all the wider partners including the voluntary sector, employment, health at place level. Through discussion with those partners, the partnership uses the information about the local population to create a strategy for helping everyone who lives in the system area to live healthily. 

  • Integrated care board​: Secretary of State is in charge of the NHS money and making sure the services are in place to make the strategy become a reality on the ground. 

• The principles of system working:
  • Curiosity and appreciating difference.
  • Sharing priorities and building a network.
  • Agreeing shared goals.
  • Flattening hierarchies.
  • Venturing into a brave new world – collaboration over competition.

Midlands Partnership shared how working at a system level has supported her trust.

• The organisation has a wellbeing approach called SOOTHE. This is an empowering framework to individual, team and organisational approach to wellbeing. It includes a set of wellbeing resources/ support available, including wellbeing conversations.
• The approach is developed with staff to ensure the offer is inclusive. There are also ambitions to grow the offer further.
• In recognition of the increasing cost of living, Midlands Partnership NHS Foundation Trust has agreed a financial wellbeing charter and package of measures to support colleagues in the most need. The charter aims to promote financial wellbeing for all staff and provide mechanisms of support, working collaboratively with agencies best placed to provide specialist and expert support.
• The charter proposes three basic principles:
  • We will support you to improve your financial wellbeing and where possible help to address financial hardship.
  • We will focus on the costs it takes you to do your job.
  • We will seek to support any other elements of hardship that you may face.

Joseph Rowntree Foundation (JRF) shared a presentation around the cost of living and what JRF has done to support organisations.

• JRF's key work:
  • Understanding the trends in in-work poverty.
  • Co-designing solutions to make jobs better.
  • Researching the cost-of-living crisis and its impact.
  • Making recommendations for government and employers.
  • A new project focused specifically on stigma.
• JRF has also created an employer briefing which includes:
  • key analysis
  • business arguments for taking action
  • practical recommendations
  • signposting to other experts.
• The scale of the cost-of-living crisis is creating huge financial worry and pressure for millions of households. For all low-income households in the bottom 40 per cent of incomes, JRF's research has found that:
  • 7.2 million households (62 per cent) are going without essentials. This means that they have reported going hungry or cutting down the size of meals or skipping meals in the last 30 days or going without basics like showers or adequate clothing since June.
  • 4.7 million households (41 per cent) are in arrears with at least one household bill and the average level of arrears remains above £1,600.
  • 4.3 million (37 per cent) are going without essentials and are in arrears with at least one household bill
  • Over three million households (28 per cent) have not been able to keep their home warm since June because they couldn’t afford to.
• ​​​Employers can take action to support employees by creating and investing in a workplace culture which is caring and compassionate, enables people to talk about worries, signposts people to specialist support, and treats people with dignity and respect.

Mersey Care also shared with the group how the trust is supporting staff with financial wellbeing:

• Citizen’s advice bureau: commissioned Citizens Advice to provide a verified referral pathway, offering 1:1 appointments for our workforce. Virtually or in-person as needed. All appointments allocated in 24 hours.
• Financial education webinars: These are being delivered by a local financial advisory service, Storeton Rose Financial Planning. A series of webinars that are free to access (budgeting, saving, managing debt, utility costs) with lunchtime and evening opportunities to join. Free 30 minute 1:1s.
• Salad Money: collaborated with Salad Money, which provides small loans and free financial education as a not-for-profit social enterprise.
• Benefits Calculator: the benefits calculator asks colleagues questions about their circumstances, household and finances. Then, it will search across all the benefits and grants that staff can claim, calculate how much they can get and what they have to do to receive the benefits they are entitled to.
• Support with travel expenses: the trust has looked at how it can help support colleagues during this difficult period and have agreed that they will provide a payment in advance based on the last three months average of a colleagues travel claims. This can then be paid back over a six month period starting in October 2022 pay.
• Workplace charter to support gambling: working in partnership with the Beacons Counselling Trust’s workplace charter that is designed to help organisations identify and support any gambling related issues within their workforce and to offer appropriate training for colleagues.
• Gambling workshops and therapeutic support: delivered online virtual sessions to support colleagues and their families who may have gambling concerns. The trust also has a dedicated web page for staff, and is also signposting the workforce who are predominantly women to GemCare- a national provider of free information, advice and support for anyone affected by problem gambling.
• Utility Warehouse: signpost colleagues to Utility Warehouse (UW) which can consolidate all colleague’s utility outgoings into one, simple, bill helping reduce colleague’s monthly outgoings (average saving £508 per year)​​​​​​

• The trust also shared what its working on:
  • Health needs assessment (FNA org diagnostic).
  • Loan shark awareness sessions.
  • Building closer relationships with new charitable funds service - Crisis Food vouchers etc.
  • Internal ‘Too Good To Go’ -campaign that tackles food waste and poverty.

As this is the final workshop our aims for the session were:

• Sharing and celebrating work to date to address the cost-of-living crisis.
• Building on knowledge sharing, learning and collaboration
• Space to reflect.
• Thinking about next steps, ways of influencing and bringing people with you.

Sussex Community NHS Foundation Trust: shared an insight on board buy in to the group and shared the key points:

• It shouldn’t be a fight to get what’s right.
• You need sponsorship, who on your board is the most invested in this topic.
• Have a ‘shopping list’ prepared for when you’re approached to spend money. You need to be ready as this process moves quickly.
• Speak with an analyst and understand the data you’re presenting.
• Create opportunities:
  • Go to the meetings.
  • Get in front of the right people.
  • Get on the agenda.
  • Bring your ideas to life.
  • Be brave.
• Understand finance and where to find it.
  • Use your hospital charity.
  • Speak with NHS England as they have pots of money available for wellbeing.
  • Gain a contact in your ICB.
  • Is there any assigned money you can repurpose eg travel.

West London NHS Trust: shared a presentation on supporting the financial wellbeing of our workforce. Understanding the issues and managing expectations, estates and facilities free breakfast provision update.

• Prepared confidential survey to understand the impact of financial wellbeing on our staff and what would help them the most.
• We shouldn’t assume we know which areas of our workforce will have financial concerns and assume they are not telling us. This will depend on demographics, salary and other factors so we need evidence of where to focus.
• The survey was launched on 11 May and closed on 31 May 2022 via Great with Talent which supported engagement and buy-in in addition to providing detailed reports.
• 45 per cent completed the survey (1934) eight per cent asked for immediate support and were referred to NWL Keeping Well Service. 15 per cent agreed to be part of dedicated focus groups.

32 per cent of responders from E&F highlighted they were skipping meals/considering skipping meals due to their financial situation. Ali shared that they have been granted another six months of funding at £20,000 to cover the breakfast provision for estates and facilities staff.

Ali also shared that they have a recognition platform called praise which has been very popular. The systems is based on peer to peer recognition where you can send thank you, birthday and long services cards to celebrate.

King's College Hospital: shared a project around flexible working and understanding managers beliefs around flexible working at King’s College Hospital. Four managers were surveyed across two of the Kings' college sites, this consisted of two clinical and two non-clinical managers to:

• understand the barriers and drivers to managers approving and rejecting flexible working requests.
• gain understanding of manager’s experience around flexible working.
• understand what support managers need around flexible working.

The trust wanted to look into flexible working due to its exit data. Out of 268 free text responses received for King’s employee’s main leaving reason, there were 18 responses that cited flexible working. Work-life balance is the highest reason listed for the nursing and midwifery and clerical and admin staff groups when leaving the trust. The survey found that:

• All managers believe the trust supports flexible working.
• Two out of four managers were aware that employees can make flexible working requests from day one.
• All managers had approved flexible working arrangements in their areas.
• All managers were aware of the correct processes to reviewing a flexible working request.
• All managers felt ‘somewhat confident’ or ‘extremely confident’ in reviewing flexible working requests.
• Two out of four managers said that training on flexible working requests would increase their confidence in making decisions.

The next steps for the trust are too:

• Address any gaps of knowledge base identified from survey results.
• Provide an education session for each manager.
• Re-survey managers to assess impact of education session.

Roll-out to wider organisation on approval:

• Review current flexible working policy to ensure it is updated.
• Identify agreed arrangements for flexible working, that can be implemented, as an organisation, in each clinical and non-clinical area.
• Look at how formal flexible working arrangements can be recorded and monitored.
• Support middle-managers in education around flexible working.
• Promote retiring flexibly.
• Support carers working flexibly.
• Look at how we promote and communicate flexible working to staff.

Leeds Teaching Hospital: shared that Leeds sends out a 'let’s talk money' email with support for staff and useful resources to access. There is also emergency support available for those in greatest need. It has also really pushed the comms and visibility around this so that all staff have access. Anna shared that adding this information to emails and intranet, isn’t sufficient. There needs to be other ways they can share this information with staff.

Leeds trust also sent a booklet to all staff home address containing the full wellbeing offer at a cost of £20,000. The organisation has also introduced money buddy which provides support through staff via phone calls and onsite meetings to go through bills and discuss debt consolidation. Leeds has also commissioned the Defence Medical Welfare Service which trains and employs welfare officers to go out into organisations to support staff.

Oxford University Hospitals NHS Foundation Trust: shared how Oxford introduced a £250 transport voucher for staff in the trust, whether this be for petrol or towards a bus pass, all staff received the voucher. They also have a financial hub which signposts to available support.

Oxford is also putting in a bid to its board to continue with the transport vouchers, extending its citizens advice support and its breakfast provision.

Sussex Community NHS Foundation Trust: shared that her goal to take forward is developing job descriptions to be one page. The trust recognised that job descriptions can be very lengthy with a lot of text on that may not be necessary at the early recruitment stage. This is an ongoing project which will take time but the organisation is very committed to this and will be seconding one member of staff to support with the development.

The trust is also going to begin tracking postcodes of applicants to find out areas where people are and aren’t applying, they will then target these areas for future recruitment drives.

Above is a visual timeline that captured our latest meeting on supporting NHS people with the current cost of living crisis.

Project aims

• Identify ideas and approaches that can support NHS staff with the rising cost of living and create a supportive community of people committed to working together to make change happen.

Today we will

• Celebrate the work done and learn from each other.
• Thank you for being engaged sharing stories.

What is in your gift

• Building a learning community.
• Igniting collaboration.
• Spreading innovation.
• Growing networks.

How to achieve board buy in

• Create sponsorship (execs as alies).
• Create opportunities to have a conversation (raise the profile and spread the message).
• Personal commitment and resilience (be brave and be bold).
• Understand money and where to find it (become best friends with finance).
• Make the case for change (evidence, data, money).

Leadership and influence

• Set yourself up right from the beginning.
• What data do we need to get ahead of our workplace challenge.
• Draw attention to think – make issues visible.
• Communication – make the process work for you.
• Governance – wats the risk if you don’t act.

Learning journey

West London NHS Trust

32 per cent of people were skipping breakfast, so we:

• lead the way
• used data
• removed stigma and put breakfast on for estates and facilities staff.

The outcomes of this have been:

• 75 per cent increase in morale.
• Staff came in early to have breakfast together.

Oxford university hospital NHS Foundation Trust

• Introduced £250 transport scheme.
• Created an educational financial hub.
• Porridge for staff.

Sussex community NHS Foundation Trust

• Introducing job description on a page.
• Will track postcodes to understand poverty and track social mobility.
• Think about how we interview, on boarding and recruitment for refugees.

Leeds teaching hospitals

• Will push comms and visibility (lets talk about money email).
• Unstable work and risks (overtime and bank).
• 1 in 23 staff have had health and wellbeing training.
• How do we ask our staff what we actually need?

Reflections

• The importance of evaluation.
• Ability to be open and honest.
• Knowing you’re not alone.
• How do we spread what we’ve done.
• How do we measure?
• You’re not on your own.
• Do less, do it better.
• It take time to see the impact of change.
• Learning something new through people is my favourite way to learn.