Improving staff retention

Foreword

In the NHS People Plan, we set out a key ambition – to have more people, working differently in a compassionate and inclusive culture. This ambition is at the forefront of all our work across the People Directorate and our National Retention Programme, launched in April 2020. Retaining our staff is one of the most important factors for the NHS to deliver care in the forthcoming years. The retention team has worked closely with systems to support them to improve staff experience, retain our NHS people locally and undertake a range of actions to help staff feel valued, through the themes in Our People Promise. I appreciate the pressure that colleagues have felt over the past couple of years. As a nurse I also know that it is the contribution of the whole team that delivers the very best patient outcomes and provides the support for us all to continue to be the best we can be. Whilst the pandemic has seen many colleagues stay, our workforce needs our support more than ever. As line managers and leaders, we play a crucial role in supporting colleagues to not only stay but stay well. That’s why we are proud to be working alongside NHS Employers to publish this guide to support you, so that in turn, you can support your staff. We hope this resource will inspire you to help staff feel happy at work and supported to achieve their individual ambitions in the workplace, while delivering the highest levels of care.

Em Wilkinson-Brice, deputy chief people officer, NHS England

It has been, and continues to be, exceptionally challenging in the NHS. Now more than ever before it is vital that we retain and value our people. As organisations navigate the ongoing impact and fallout of the COVID-19 pandemic, we must focus on strengthening the supply of our highly valued workforce and ensure that both new and existing staff are supported and encouraged to remain in your teams. In partnership with NHS England, NHS Employers has continued to support employers in this area. Together, we have refreshed this retention guide, which is aimed at those with responsibility for improving retention across their organisation. There are two main objectives for this guide: first, ensuring it continues to draw on the latest learning and innovation from the COVID-19 pandemic, which has forced employers to critically re-examine how to retain NHS staff. Second, ensuring it supports the ambitions set out within the NHS People Promise, so that employers can work to make this a lived reality for all our NHS people. To help achieve these objectives, this guide explores the experiences of organisations we have worked with on retention. Ensuring we take positive action to retain our talented and skilled staff will remain a priority for individual employers and local systems, and learning from each other’s experiences is a key part of that endeavour. We look forward to gathering future case studies from teams and organisations that are making a difference to their people and patients.

Danny Mortimer, chief executive, NHS Employers

Not sure where to start?

Shaping organisational culture

Healthy cultures in NHS organisations are crucial to ensuring the delivery of high-quality, safe and effective patient care.

Improving staff retention should be led through an inspiring, forward-looking, and ambitious vision focused on offering high-quality, compassionate care. Good leaders reiterate this at every level to ensure that everyone understands and acts on this commitment.

Understanding how staff perceive culture and want to be treated will help to create and implement a collective leadership strategy and to develop compassionate, fair and inclusive working environments where all staff can thrive. If we create positive, supportive environments for staff, where they share in local decision making, they in turn create caring, supportive environments and deliver high-quality care for patients. Such leadership cultures encourage staff engagement.

Organisational development (OD) practitioners are an invaluable resource in generating and implementing solutions to specific retention challenges you may have. There are many OD models which you can choose to support the development of your retention activities. Change teams, which are groups of people made up of staff, patient representatives and partners, can also carry out the culture and leadership change within an organisation or system. Compassionate and inclusive working environments have a positive impact on staff engagement and can help build an organisational culture which our NHS people enjoy being part of. This will increase the likelihood of staff wanting to stay.

Activity: What does good look like?

Try an activity with your board or leadership teams. Split the team into four groups and ask them to look at ‘what good retention looks like’ from one of the following perspectives: the board, an HR professional, line managers and staff within the organisation. Compare and contrast where there are similarities and differences between the four perspectives. Draw up three to five actions from the activity to take away and work on.

Making this happen

Leaders can:

• Take a look at NHS England's Culture and Leadership programme, which provides opportunities for organisations to understand their own culture and deliver culture change. It has been used in over 40 NHS organisations, who have found it helpful as a way of getting started on their journey of culture change.

Managers can:

• Take a look at the Do OD Team toolkit when working with your staff to help embrace team working and recognise the contribution it can make to the delivery of compassionate patient care, from committed staff working within a common culture.

Case studies

• Find out how Maggie Oldham turned the Isle of Wight NHS Trust around to become one of the NHS Staff Survey’s most improved trusts, and how the NHS England and NHS Improvement Culture and Leadership Programme supported putting compassionate leadership at the heart of change. Read the full case study.
• Watch this video to hear how Mersey Care NHS Foundation Trust engaged all parts of their workforce in implementing a just and learning culture in order to create an environment where staff feel supported and empowered, and able to learn when things do not go as expected, rather than feeling blamed.
• Find out how North East London NHS Foundation Trust achieved an inclusive culture by addressing its staff engagement and cultural awareness, and ensuring its recruitment process was inclusive, and put people first. Read the full case study.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• NHS England’s the future of NHS human resources and organisations development report outlines the ten-year plan to transform HR and OD services in the NHS.
• Do OD is the expert resource on OD for health and care. Do OD’s latest resource, The OD practitioner and culture change handbook, is built around ten culture provocations and ‘what if?’ statements that invite us to examine and challenge our views, and practices.
• Improving NHS Culture tool from the King’s Fund.
• Changing healthcare cultures – through collective leadership.

Understanding your data

Understanding workforce data should be at the centre of an effective retention strategy. Collecting and analysing data and identifying trends will help to identify the starting point for your activities. Understanding the profile of your workforce will help you to assess the risk points and ensure that retention issues affecting particular groups are addressed. For example, are retention issues organisationwide or specific to certain staff groups, demographics, departments or teams? If a specific staff group in your organisation are more likely to leave than others, what are the main reasons and how can you address these issues? An equality analysis will be useful to assess if there are retention issues affecting specific groups.

To better understand your data, consider who in your organisation you could work with. Your informatics or data analytics colleagues can help to understand and explore the data, including the NHS leaver rate; demographic data of workforce and leavers; turnover rates and reasons for leaving; sickness rates and retention related staff survey questions. This data can be found in a range of sources including:

Local data sources:

• Locally designed surveys.
• Workforce information from Electronic Staff Record (ESR).
• Staff turnover and stability rates.
• Exit surveys and exit interviews.
• Conversations with existing staff.

National data sources:

• NHS Staff Survey: Research shows that the morale and engagement theme scores from the NHS Staff Survey have a strong correlation and statistical significance with retention. There are specific questions within the NHS Staff Survey that can help to understand staff feedback on whether people are thinking of leaving and various elements of the People Promise such as flexible working or health and wellbeing support.
• National Quarterly Pulse Survey, People Pulse, Model Health System retention compartment and data from national organisations such as NHS Digital can all provide useful insights into retention and related indicators of staff experience.

Things to consider

• What data already exists within the organisation and who has access to it? How can different departments work collaboratively to collect this?
• What information will support the team, directorate and organisational decision-making processes?
• Do you need to introduce new data sources? If so, can you develop and design these with different people and departments within your organisation?
• Could you improve the decision-making process around what data you need, the way you collect it and how you use and present it?
• Does analysis of your data show any key themes or trends? There could be specific issues that affect different staff groups or departments more than others, and these could change over time. Understanding these themes and trends will help you adapt and evaluate your retention strategy.
• How does your organisation compare or benchmark against other local or similar organisations? Can you engage with neighbouring employers and across your ICS area to better understand where you can work collaboratively to address shared issues?
• How will you use your data to evaluate the changes you make? Consider looking at a range of indicators beyond staff turnover, for example, sickness absence or staff engagement.

Making this happen

Leaders can:

• Support a data-led approach to retention across your organisation and support putting methods in place to achieve this.
• Have regular conversations with their staff to improve their understanding of factors affecting retention in their teams.
• Work with HR to understand reasons for leaving raised in exit interviews from staff members in their team.

Managers can:

• Take a data led approach to inform their understanding of factors affecting retention within their organisation.
• Use data to evaluate how effective the organisation’s retention approach has been.
• Implement free tools such as the People Pulse to gather data and ensure you are listening to staff voice.

Case studies

• Bristol North Somerset and South Gloucestershire completed initial data diagnostics to identify patterns, trends, and key areas for focus, as part of a 90-day quality improvement cycle. This helped them to develop a system wide retention improvement action plan that responds to areas identified through data diagnostics.
• Keen to reduce attrition, improve staff engagement, motivation, and retention, West London NHS Trust reviewed its exit interview data in collaboration with GreatwithTalent and developed a new initiative ‘Promotion, praise and promise’. This initiative has recently won a Healthcare People Management Award (HPMA) and saw a nearly 10 per cent drop in early attrition.
• Blackpool Teaching Hospitals NHS Foundation Trust and East Lancashire Hospitals NHS Trust used the People Pulse to listen to staff voice and turn listening into action to improve their overall experience.

Tools and further reading 

• Keep up to date with interventions and practical solutions on NHS England’s website.
• NHS England and NHS Improvement has worked with the NHS Business Services Authority and NHS Wales to refresh the ESR exit interview questionnaire. It is available to all organisations using ESR self-service and allows the employee to self-report their reason for leaving and state what, if anything, would have kept them in the organisation.
• You may need to address retention issues affecting particular groups. Read this guidance to understand the profile of and address retention issues specific to anaesthetists.
• The National GP Retention Scheme is a package of financial and educational support to help doctors, who might otherwise leave the profession to remain.

Communicating with your staff

Seeking and listening to staff views and acting upon results shows we value our people and increases the likelihood of staff staying. Line managers play a key role in supporting engagement at a team level where it will have the most immediate impact. Improved staff engagement can reduce sickness absence levels and increase productivity.

Top tips

✓ Speak with your staff to understand what motivates and drives them, and what makes them want to stay or leave your organisation.

✓ Setting aside time to communicate regularly with staff and direct reports, while recognising competing demands and time pressures, will help with understanding issues in your team and wider workforce.

✓ Work with your communications team so that your team’s work is well represented in internal communications and that any achievements of your colleagues are recognised.

✓ Have conversations, and seek feedback, with your staff and wider workforce to find out what matters to them and involve them in thinking about potential solutions. This could be in focus groups, team meetings or trust-wide staff engagement events or a place online where staff can submit questions and suggestions. 

✓ Ensure staff engagement is a two-way process in your organisation, by providing opportunities for staff to feed in their views, ask questions and contribute to changes and decisions.

✓ Act upon the information you receive and demonstrate that you are listening to staff on the issues that matter the most to them by following through and showing the changes you have made.

Making this happen

Leaders can:

• Be visible and approachable and support a focus on staff engagement at board level.
• Highlight and promote the NHS Staff Survey and ensure action is taken on the issues raised by your colleagues.
• Ensure there is a systematic local approach to collecting and acting on staff feedback alongside the NHS Staff Survey.

Managers can:

• Seek regular feedback from their teams and act on ideas raised, ensuring this is a two-way process.
• Consult staff on planned changes which may affect them.
• Talk to team members who may be thinking of leaving about what interventions might help them stay.

Tools and further reading

• Northumbria Healthcare NHS Foundation Trust adapted its staff engagement approach during COVID-19 by developing a real time feedback mechanism. The trust did this via a weekly online survey Corona Voice to provide up-to-date data and insight. This informed decision-making and helped sustain motivation during the challenge of the pandemic. The survey included questions on key issues and staff could also share free text comments. This enabled staff to share their feelings and raise issues. Read the full case study.
• Keep up to date with interventions and practical solutions on NHS England’s website. If you are interested in being part of a community of practice in this area please email nhsi.staffsurveyengagement@nhs.net.
• There are a range of resources available on the NHS Employers website to support you with staff engagement, including top tips, guidance and toolkits.
• The People Performance Management toolkit supports NHS managers to talk about all aspects of performance with staff.
• For information on wellbeing conversations, read the health and wellbeing section and for talent conversations, read the development and career planning section of this guide.
• Access a range of staff engagement resources.

Supporting new starters and those moving roles

Placing the candidate experience at the centre of recruitment, selection and onboarding is essential to reducing the turnover of newly employed staff. Developing an engaging and pro-active recruitment and on-boarding experience for new starters allows them to get a realistic picture of the role they are applying for and creates a good first impression of your organisation.

Using recruitment to support retention  
In a competitive labour market, a timely and effective recruitment process helps to ensure that staff with the right knowledge, skills and values join your organisation quickly. Discussions with potential applicants should focus on giving them a realistic insight into the role they’re applying for, and the organisation as a whole. Making sure candidates have realistic expectations of the role will help reduce the likelihood of them leaving the organisation in the first few months.

The NHS Employers Inspire, Attract and Recruit toolkit can help you with the different stages of recruitment and aims to spark ideas for the process of attracting and recruiting new staff.

Supporting retention of staff means enabling staff to move between NHS organisations more easily without the frustrating repetition of form filling, employment checks and statutory and mandatory training.

The NHS England and NHS Improvement Enabling Staff Movement toolkit supports organisations to put in place local workforce sharing agreements, to provide the legal underpinning for staff to safely be moved temporarily between NHS organisations.

The COVID-19 Digital Staff Passport takes this further, helping to speed up the process by providing a modern, digital way for staff to be in control of their own verified information on their smart phone that eliminates unnecessary administration for employers with the legal underpinning agreements automated within it. This is the first phase of NHS England and NHS Improvement’s overall ambition to develop a Digital Staff Passport to support all movements of staff. For further information, email england.enablingstaffmovements@nhs.net

Post offer
Keeping in touch with staff between their offer and their start date can help to reduce postoffer dropouts and is a great way of getting candidates engaged in what’s happening in your organisation. You may wish to consider:

• Providing the candidate with a dedicated email address of a line manager who they can ask any questions of prior to starting.
• Introducing the candidate to some of the key colleagues they will be working with in advance of their start date so they can feel part of the team as soon as they accept their offer.
• Giving access to key information and e-learning as soon as they begin their role, so they feel prepared and valued.

Induction and early years support
A robust induction provides new employees with the support and practical information they need to work effectively and helps them feel part of the team. Regular catch ups or one-to-one meetings will help assess progress and offer support, as well offering new employees additional support through a buddy, or a network with other new starters. Several trusts have implemented supportive approaches to inductions, for example inviting newly qualified nurses to tea with a member of the team or board director. This helps to promote a culture where people feel valued and supported in their new roles.

Legacy mentoring is another approach some organisations have taken, where experienced staff provide mentoring and pastoral support to new employees that can lead to improved attrition in those first few years.

Preceptorships are often offered to newly qualified staff and provide support to those make the transition from study into practice. Having robust and consistently applied preceptorship frameworks, with access to timely support, is key to helping people feel valued and that their development is considered important. Preceptorship schemes are offered to newly qualified nurses, nursing associates, midwives and allied health professionals.

Things to consider

• Has your organisation implemented values-based recruitment and standards of behaviour in employment?
• Could recruitment processes and preemployment checks be streamlined to maintain quality and assurance while moving at pace to improve the candidate experience?
• What do inductions look like in your organisation? Are there areas of good practice which could be rolled out across the organisation?
• Could support be provided to employees beyond induction, for example preceptorships and/or early years support for the first two to three years post-qualifying or joining your organisation?
• Do newly qualified employees benefit from mentoring or pastoral support either from either their peers or from legacy mentors?
• Do all staff have meaningful objectives and development plans?

Making this happen

Leaders can:

• Advocate for continuous professional development and preceptorship (if applicable) for new starters.
• Promote health and wellbeing and resources to support people in new roles.
• Ensure the recruitment process is as streamlined as possible.

Managers can:

• Keep in touch with new starters between appointment and start date.
• Check in with new starters across their induction period, making sure they have the right equipment as soon as they start and have a buddy.
• If applicable, apply the preceptorship scheme in a fair and consistent way, and check in with new employees that it’s meeting their needs.

Case studies

• Barking, Havering and Redbridge NHS Trust implemented legacy nurse mentoring and has now expanded the scheme to provide mentoring and pastoral support to midwives, allied health professionals and healthcare assistants due to its success. They have reported a reduction in both turnover and their vacancy rates.
• Oxford University Hospital Trust introduced a three-tier foundation preceptorship programme where preceptors helped to inform organisational changes through the identification of common themes. New nurses indicated the preceptorship programme had positive value and improved the experience of newly qualified nurses during their first year of clinical practice The Flyer Programme.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• There are a range of resources available on the NHS Employers website.
• Exploring preceptorship programmes: Implications for future design. Taylor et al., 2018.
• Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. Brook et al., 2019.
• Podiatry as a career in the UK - what attracts Generation Z? A qualitative exploration with university and college students. Whitman et al., 2021.

Supporting international staff

It is important that systems and organisations work collaboratively to support retention of international colleagues and work to understand how to help international colleagues to feel recognised and valued, build their careers and feel a sense of true belonging within the NHS.

Ethical international recruitment remains a workforce priority with plans to recruit in the NHS at scale over coming years as set out in both the NHS Long Term Plan and the NHS People Plan. This may mean refocusing efforts to ensure you understand the specific needs of all your NHS people in order to truly create the conditions that enable international colleagues to stay and thrive in the NHS.

Things to consider

• What additional support can be offered to international colleagues who will be learning how to work in the NHS alongside potentially living in England for the first time
• Understanding the reasons and motivations your international colleagues may have for moving to work in the NHS, and are these being met?
• What is the best use of your international colleagues’ experience and skills?
• What support is there for international colleagues outside of work and how could you offer support if they are missing home or are feeling lonely?
• Do your international colleagues feel included and that they belong?
• Do international colleagues with the same first languages have opportunities to interact with one another?
• Do your international colleagues have the same access to predictable and flexible working patterns as other colleagues?

Making this happen

Leaders can:

• Improve understanding and support international colleagues by learning about different dialects, colloquialisms and cultures.
• Foster cultures that champion the voice of international colleagues through the development of international communities via staff networks, shared lived experiences and inclusive pastoral support.

Managers can:

• Take part in cultural awareness training to help support international colleagues to better integrate both in and out of the workplace.
• Acknowledge the richness of experience that international colleagues bring and build this into career and talent management conversations.
• Provide a safe space where international colleagues can raise concerns and speak up.

Case studies

• Watch this video to see how Newcastle upon Tyne Hospitals NHS Foundation Trust supported their internationally recruited staff with dedicated training within their trust.
• West Suffolk NHS Foundation Trust are establishing a ‘safe spaces’ programme which will proactively reach out to overseas colleagues and facilitate and nurture confidential spaces where they will feel confident to speak up.
• Hertfordshire and West Essex ICS are in collaboration with the local community to facilitate networks for internationally recruited nurses, where volunteers help people with accommodation, group activities, access to local services and the provision of digital champions.

Tools and further reading

• NHS England and Improvement support on international recruitment can be found on the NHS Futures platform.
• Keep up to date with interventions and practical solutions on NHS England’s website.
• NHS Employers international recruitment toolkit help you plan your approach to overseas recruitment activity.
• NHS England has developed an interactive and practical Civility and Respect toolkit with a framework for organisations to use.
• Mersey Care NHS Foundation Trust has developed online learning modules on establishing a just and learning culture.

Development and career planning

Supporting staff through career development opportunities is important across an employee’s whole career and should be based on each individual’s preferences and career aspirations.

Building a strong induction programme, regular appraisals and one-to-one meetings between managers and staff should be a key part of any retention strategy. These meetings are an opportunity to discuss and agree development needs that can support the delivery of patient care and staff career development.

Discuss and agree development needs during your induction programmes, regular appraisal and 1-2-1 meetings.

There are many learning and development opportunities which can be offered to staff including apprenticeships, continuous professional development, secondments, shadowing, mentoring and coaching. There could also be opportunities to provide internal transfers, rotational posts across departments, sites or organisations across the ICS. These can all support career development and enable individuals to progress through career pathways.

Organisations may need to consider how their policies encourage development and career planning, and what support line managers require to be able to implement this. Managers should be aware of the support that the organisation offers and be knowledgeable about how they can support their staff to develop and career plan while continually learning.

Things to consider:

• What development and career opportunities are your staff looking for? Are there patterns in what is required?
• What opportunities for training and development already exist in your organisation and across your ICS?
• Are development opportunities available for people from under-represented groups?
• How are staff supported across their career, from newly qualified to experienced staff?
• What opportunities do staff have to move roles in the same band or across different teams?
• Could the skills and knowledge of experienced staff be used to support others, for example through coaching or mentoring or in career conversations?
• Can existing funding for training, such as the apprenticeship levy, be used to support the development of your teams?
• Are there already qualified coaches or career experts in your organisation you can utilise?
• Are there any free training and development opportunities you could take advantage of?
• How would a careers service support your careers offer for your staff? What would work or already exists for your staff, organisation or system? A telephone helpline, online advice or face to face meetings?

Making this happen

Leaders can:

• Develop a culture of work-based learning and lead by example by sharing their own development stories.
• Commit to investing in staff development and education.
• Advocate for, and commit to, leadership development programmes to support diversity and inclusion. Join a leadership and lifelong learning course to grow as a leader.
• Hold regular career conversations with staff to understand their aspiration and potential; identify their needs and development opportunities, in order to retain and develop people in organisations and ICSs.

Managers can:

• Provide staff with opportunities to learn and develop in a work-based setting and release staff to develop themselves professionally and personally.
• Share opportunities within the team for development.
• Connect, share and learn with other leaders and managers in health and care via #ProjectM – Our NHS People.
• Encourage shadowing opportunities and cross team/cross profession working to stretch and develop skill-sets, broaden skills and leadership capabilities and increase knowledge to support career progression.

Case studies

In this video, Adewale Abimbola talks about his experience of the Elizabeth Garrett Anderson programme experience.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• Access a range of resources and guidance that will support your existing and future workforce.
• New career development tool for Allied Health Professions (dchs.nhs.uk).
• NHS Leadership Academy’s Talent Management toolkit is designed to support organisations to develop and embed inclusive, sustainable approaches to talent management for staff at all levels.

Supporting staff in late career

Approximately a third of the workforce in the NHS are in the late stages of their career and should feel valued and supported to work in a way that meets their individual ambitions and needs.

What people want from their career may change over time and with people choosing to work for longer, it is even more important that in the later stages of their career, our people are supported to continue working for the NHS in a way that supports these changes.

Colleagues should be able to continually access development opportunities that meet their career aspirations, as well as be supported to think about how they can use their skills, experience and knowledge in different ways, recognising that some people often have the most challenging and exciting roles late on in their career. Organisations should consider what flexible options and opportunities they can offer.

Staff late in their career may want to use their experience to lead or support colleagues, potentially work in a less intensive role and/ or inspire newer staff and pass on their knowledge, leaving a legacy for those following in their footsteps. Although not exclusive to those who are in late career stages, we know that at this point many people will be affected by the menopause, which can impact on people’s working and home lives, both directly and indirectly. There are resources available to raise awareness of the menopause, including how to improve workplace environments and how line managers can support people to look after themselves.

Things to consider

• Are there opportunities to utilise your most experienced colleagues to provide mentoring or pastoral support to newly qualified colleagues? For example, legacy mentoring can support those staff in early and later stages of career.
• Are there any system wide opportunities via the integrated care system for developing and supporting staff in the later stages of their career?
• How can more and different flexible working or retirement opportunities be introduced in your organisation to help encourage people to stay for longer?
• How can you raise awareness that NHS staff are managing the menopause at work and best support staff experiencing the menopause?

Top tips

✓ Share easy to understand information on NHS Pensions to support staff to make informed decisions about continuing to work or planning their retirement. Dedicated advice is available to help employers deliver the NHS Pensions Scheme effectively for their organisation.

✓ Encourage and support people to actively think about and plan for the later stages of their career so that at an earlier stage people can identify the ways of working which suits their individual ambitions, circumstances and needs.

✓ Menopause has a very broad range of symptoms and can impact on people’s working and home lives and people may need additional support during this time. See practical guidance for employers on how to improve workplace environments.

Making this happen

Leaders can:

• Make sure that there are a range of career pathways and options available for later career stages.
• Offer flexible retirement and flexible working opportunities, across the organisation and ICS, and signpost to how staff can be supported with understanding their pension.
• Raise awareness of the menopause so more people talk openly about it and there are clear expectations of the support that will be provided.

Managers can:

• Hold career conversations to identify people’s needs and development opportunities, to retain people in the organisation and ICS.
• Develop understanding about the pension scheme and its benefits to help inform people and support them appropriately.
• Raise awareness of menopause including holding menopause conversations and ensuring menopause related absence is recorded in ESR.

Case studies

• Over 12 months Sherwood Forest Hospital Foundation Trust carried out a research intervention study and expertise from menopause clinical colleagues to develop action plans to educate line managers. Read the full case study.
• North Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group’s Healthier Together developed an ‘itchy feet’ approach across the system to encourage individuals to talk through their career aspirations or concerns with an impartial trained coach in the first instance.
• Nottingham University Hospitals launched a ‘Late Career Hub’ hosted by the innovative Care4Notts platform to support staff across the ICS. The platform provides resources for late career healthcare professionals, their managers and mentors.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• Support for people in the later stages of their career in the NHS.
• We are recognised and rewarded.
• Later careers: Stemming the drain of expertise and skills from the profession | RCP London.
• Essentials for later career and retired GPs | RCGP.
• Menopause and the workplace.

Flexible working

Flexible working supports staff to have greater choice in where, when and how they work and should help them achieve a better work-life balance. The COVID-19 pandemic has provided an unexpected catalyst for different ways of working across the NHS workforce. Now is a great opportunity for organisations to challenge the traditional ideology of how work has previously been delivered and support our NHS people and managers to explore flexible working options.

This gives everyone an opportunity to achieve a work-life balance that suits them and their organisation, and in turn supports workforce retention. Understanding what type of flexible working your staff require is key to developing your approach to supporting them.

Now is a great opportunity for organisations to challenge the traditional ideology of how work has previously been delivered and support our NHS people and managers to explore flexible working options.

Why is flexible working important?

• People are increasingly seeking roles that offer a good work-life balance. Flexible working will help the NHS remain an employer of choice, as well as acting as part of the solution in addressing the current workforce shortages in the NHS, by attracting new joiners, returnees and better retaining current staff.
• People require flexible working for a wide variety of reasons to achieve a better work life balance and value having this choice. For some, it is necessary in order to be able to work at all.
• Flexible working can positively impact on staff attendance, morale and job satisfaction leading to engaged staff delivering the best patient care.

Things to consider

• How open is your organisation to facilitating different working arrangements?
• Do you proactively advertise roles with flexibility, offer it post-recruitment or only when a member of staff requests it?
• Could you work with your senior leaders to facilitate a cultural change that challenges myths and negative perceptions about flexible working?
• When you offer flexible working, how creative are you in your approach and in suggesting support relevant to staff in different stages of their lives and careers?
• Could implementing an e-rostering system support flexible working or team-based rostering in your organisation?
• How often do you share examples of where flexible working works well and could these examples help implement change across the organisation?
• Aligning your flexible working policy to the recent revisions to Section 33 of the NHS Terms and Conditions of Service that provide for a contractual right to request flexible working from day one of employment and by default. How might you support staff not covered by these terms?
• Being responsive and agile to flexible working requests when received and measuring flexibility across your organisation.

Making this happen

Leaders can:

• Become a board level champion for flexible working by ensuring flexibility remains a strategic priority for their organisation and by role modelling effective flexible working practices.
• Identify the cultural norms and negative perceptions that are blocking flexible working in your organisation and proactively dispel them.
• Adopt a ‘test and learn’ mindset for flexible working that is open to change and experimenting with new ideas.

Managers can:

• Support their teams to work more flexibly to suit individual worklife needs, whilst maintaining safe and effective services.
• Have supportive conversations with colleagues about flexible working and explore possibilities.
• Undertake training to improve awareness and equip themselves to deal effectively with flexible working requests.

Case studies

• The FlexNHS movement was established to create a supportive, encouraging, and resourceful network to promote and enable flexible working in the NHS for every profession, role and grade. It is available to everyone, helping to generate more conversations about the benefits of flexible working and dispel any myths. Since Milton Keynes University Hospital has implemented FlexNHS, the organisation has halved their turnover and have been able to retain a significant percentage of staff. Find out more about the #FlexNHS campaign on Twitter @FlexNHS.
• The Oldham Care organisation has developed a job description and role profile for a band six midwife working six hours a week. This offers increased flexibility to midwives that might otherwise not have considered taking on a substantive post.
• North Central London ICS is delivering e-rostering and flexible working programme to ensure predictable working that better meets the needs of their people.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• Enablers to flexible working: top 10 enablers to creating a culture that promotes effective flexible working practices.
• Making flexible working requests flowchart: this flowchart provides information on the steps managers and staff in the NHS should take when making a request for flexible working.
• Pensions and flexible working in your later career.
• The line manager guide offers support and highlights pathways to successfully lead a flexible team, helping managers and leaders put structures and processes into place so flexible working is an option for all.  
• The guide for individuals supports our NHS people to preparing for positive conversations around flexible working requests. It can support the best chance of finding a solution that works for them, their team, and their organisations. 

Flexible retirement

Flexible retirement allows people choice over when they retire and allows them to continue working in a different way. By offering flexible retirement, your organisation can retain the valuable skills and knowledge staff have developed over their careers. Retired staff can also register for the staff bank, increasing the amount of bank staff available to cover high demand periods.

Understanding what motivates your employees and what their priorities are will mean that you can help them approach retirement in the best way for them. Ensuring staff are informed of their retirement options, and can have open discussions about their plans, will help challenge misconceptions and help you retain people.

Flexible retirement provides an opportunity to support staff while retaining valuable experience within the workforce. They allow flexibility for organisations and staff around:

• The age at which staff retire
• The length of time a staff member takes to retire
• The nature and pattern of work in the lead up to final retirement

The NHS Employers flexible retirement page has information to help you support flexible retirement in your organisation.

Available flexibilities

Some of these flexibilities are available dependent on the scheme your employee is enrolled in. See the different types on the NHS Employers retirement flexibilities poster.

• Step down – staff can step down to a different role to reduce the level of responsibility while remaining in NHS employment.
• Wind down – staff can wind down to retirement by remaining in their current post but reduce the number of hours or days they work.
• Retire and return – members of the NHS Pension Scheme can request to retire, claim their pension benefits and then return to NHS employment. NHS Employers has published guidance to help employers put policies in place.
• Draw down – members of the NHS Pension Scheme can take part of their pension benefits and continue in NHS employment.
• Late retirement enhancement – members can retire later than their normal pension age and have their pension benefits increased.
• Early retirement reduction buy out – members or employers can pay additional contributions to buy out the reduction applied to the member’s pension if they retire before their normal pension age. 

Things to consider

• When your staff will reach their voluntary or normal pension age.
• Whether your existing policies include retirement flexibilities.
• Incorporating flexible retirement and retirement planning into appraisal discussions.
• Supporting staff who manage individuals or teams to have retirement planning discussions with their teams.
• How do you evaluate and manage requests for flexible retirement?

Making this happen

Leaders can:

• Support line managers to have retirement planning discussions.
• Look at your existing policies – do they include retirement flexibilities?
• Look at your workforce plan – does it incorporate retirement flexibilities?

Managers can:

• Have conversations with staff about the flexible retirement options available to them. This could be incorporated into appraisal discussions.
• Think about how you evaluate and manage requests for flexible retirement.
• Signpost colleagues to where they can find further information about pensions and learn more about pensions themselves.

Case studies

• University Hospitals of Derby and Burton NHS Foundation Trust developed a ‘working for longer’ project, to support its staff to stay in work for longer. Over 15 months the workforce transformation team, which oversees the project, has introduced several initiatives to support the retention of older workers and how flexible retirement can aid workers for longer. Read the full case study.
• Chelsea and Westminster Hospital NHS Foundation Trust is raising awareness of flexible retirement options and promoting the NHS Pension Scheme. Read the full article for more information.
• Norfolk and Waveney Health and Care Partnership piloted a Legacy Nurse programme aimed at retaining potential nurse retirees so they return or remain in practice and share invaluable knowledge and skills plus provide pastoral support, professional advice and guidance to colleagues.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• NHS Employers promoting the value of NHS Pension Scheme videos and presentations.
• NHS Business Services Authority - Manager hub Employer hub | NHSBSA.
• NHS England and NHS Improvement’s Generational Retention Programme web pages.

Health and wellbeing

While the importance of supporting our NHS colleagues has long been recognised, the COVID-19 pandemic has shone a light on the importance of people looking after their physical and mental wellbeing. Now more than ever, supporting health and wellbeing should not be just a ’nice to do’ and should be integral to your organisation’s retention strategy.

Enhancing the experience of our staff, and helping people to stay well, means that our highly valued NHS workforce will stay at work for longer. Health and wellbeing is an organisational responsibility and taking a collaborative and multi-disciplinary approach will maximise the reach and success of your approach. There is no one-size-fits-all approach to supporting workforce wellbeing. It is important to listen to your staff and understand their specific needs as they emerge and change.

Taking a strategic and flexible approach will enable you to develop and implement a comprehensive and robust health and wellbeing support offer that will enable retention of staff in the longer term.

See NHS England and NHS Improvement’s web page for information on the 2021 edition of the NHS Health and Wellbeing Framework to support you in creating a wellbeing culture in your organisation and also information on support now, programmes and guides. NHS Employers’ health and wellbeing web pages also have a variety of supportive materials around wellbeing.

Top tips

✓ Review your health and wellbeing strategy so that it aligns with and drives your overall retention plan.

✓ Get the basics of health and wellbeing right and ensure that staff have access to suitable rest spaces, are able to take regular breaks and have access to appropriate toilet, changing facilities and water.

✓ The health and wellbeing agenda needs to be championed from the top. Introducing wellbeing guardians will help your organisation to question and challenge decisions that may impact the health and wellbeing of staff. Download NHS Employers’ digital resources which share how to effectively gain buy-in from senior leaders to support your health and wellbeing strategy.

✓ Provide line managers with the skills, guidance, and training so that they understand their role in supporting staff health and wellbeing, can effectively lead their teams compassionately, and can signpost their staff to the appropriate support. See NHS Employers’ health and wellbeing top tips for supporting line managers.

✓ Build health and wellbeing into everyday conversations by fostering a culture that promotes and enables regular open discussions about wellbeing in the workplace.

✓ Ensure your health and wellbeing activities meet the needs of all staff including those with disabilities, those from BME or LGTBQ+ communities or who may identify with other protected characteristics. For guidance on how you can make reasonable adjustments to support disabled staff in their roles, visit the Workforce Disability Equality Standard. For information on creating equal access to career opportunities and fair treatment in the workplace, visit the Workforce Race Equality Standard web pages.

✓ Use health and wellbeing champions and advocates in your organisation to spread key health and wellbeing messages.

✓ Develop a robust communications strategy to effectively promote your wellbeing support offer to all staff, cascading across several channels to target hard to reach staff.

✓ Download free health and wellbeing templates to help promote your wellbeing offer within your organisation.

✓ Use the NHS Health and Wellbeing Framework and complete the diagnostic tool to understand key enablers to wellbeing and find more information about the interventions you can make.

✓ Link with trade union representatives within the trust to ensure staff and management views are included when implementing health and wellbeing initiatives.

Making this happen

Leaders can:

• Lead the way in setting and cultivating a culture that promotes open discussion of health and wellbeing at work.
• Empower and enable managers to prioritise wellbeing by incorporating health and wellbeing into leadership training as part of staff development.
• Engage with your Wellbeing Guardian to ensure workforce wellbeing is at the forefront of your organisation’s strategic priorities at board level.

Managers can:

• Have regular supportive wellbeing conversations with their staff and ensure that there is a focus on health and wellbeing in team meetings to encourage peer support.
• Signpost staff to the health and wellbeing support they need.
• Undertake training so they have the skills and tools needed to effectively support the wellbeing of their team.

Case studies

• North Bristol NHS Foundation Trust made a bold statement to their colleagues that ‘your health is as important as our patients’. The organisation created a comprehensive wellbeing programme based around the NHS Employers Health and Wellbeing Framework. After a year, this had a real impact on staff reducing their sickness by 3,923 days saving the organisation £301,015 a year in sickness costs. The trust also introduced 100 wellbeing champions and focused their support on developing good psychological wellbeing practice for managers and within teams. Read the full case study.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• How are you feeling NHS? toolkit.
• Evaluating your health and wellbeing programme.
• NHS England » Looking after your team.
• NHS England » Looking after you too.

Recognising and rewarding your staff

Meaningful recognition can help to motivate and retain our NHS people. Setting in place a holistic reward package, which is relevant to staff needs, can be key to ensuring your organisation, and the wider NHS, retains its staff.

With continued pay restraint, and public sector pension reforms, it’s more important than ever that our NHS people understand the overall reward package they receive for working in their organisation and in the NHS. Many employees are often not aware of the rewards and benefits offered by their employer. This means that they cannot take advantage of these benefits or compare the value of their overall package when looking to move to a new job.

By taking a strategic approach to reward, you will be able to clearly demonstrate the entire scope and value of your employment package. In addition to tangible rewards, NHS people also benefit from other positive factors from being part of the NHS such as a proven commitment to diversity and inclusion. Employers should make sure their reward package reflects the diverse workforce as well as the organisation’s diversity and inclusion goals.

Recognising staff for the work they do every day can be as important as any formal recognition. This can be done in a variety of ways, perhaps through celebrating significant career milestones, acknowledging those who have spent a long time in the service, commending those who receive excellent feedback from patients or by encouraging peer nominations to help thank colleagues.

It is important to understand how your staff feel about recognition and we know that one size does not fit all. As the NHS People Promise says, being recognised and rewarded is ‘a simple thank you for our day-to-day work, formal recognition for our dedication, and fair salary for our contribution’.

For more information see NHS Employers reward pages and NHS England and NHS Improvement’s We are recognised and rewarded page on the retention hub.

Making this happen

Leaders can:

• Find the time and opportunities to thank colleagues and recognise everyone’s contribution.
• Support and commit to ensuring you have a clear approach to reward and help engage senior leaders across your organisation.
• Create a reward strategy with a researched, planned and monitored approach, making sure it has the intended maximum impact. Use the NHS Employers business case for reward web page to help with this.

Managers can:

• Help by clearly communicating your organisation’s reward benefits to staff.
• Be involved in developing your reward strategy with your staff in mind.
• Have regular conversations with your staff about your reward package and frequently review and update it to meet the evolving needs of staff. Visit NHS Employers total reward web page for more information.

Case studies

• West London NHS Trust reviewed its exit interview data in collaboration with GreatwithTalent and developed a new initiative they called ‘promotion, praise and promise’ which won a Healthcare People Management Award. Read the full case study.
• Leaders at Dartford & Gravesham NHS Trust have a STAR award programme where patients and visitors can nominate a member of staff to say thank you to. The winners are selected and presented with certificates by a member of the executive team and their achievements are acknowledged on the trust’s social media channels.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• Total Reward Engagement Network (TREN) brings together colleagues from across the NHS with an interest to develop, share knowledge and experiences.
• Learn how to communicate your reward package to staff.

Making improvement and change

As part of the planning stage of your retention activities, and to help create an environment where change programmes deliver transformational, sustainable change, you may wish to consider the Change Model framework. The model provides a useful organising framework for sustainable change and transformation that delivers real benefits for patients and the public.

Things to consider

• What constraints in your organisation prevent line managers and teams becoming involved in retention activities?
• Could line managers and teams help to break down their activities into smaller short-term actions which are more manageable and together lead into a long- term vision? This may also help build trust and minimise concerns by helping line managers and teams to break the long-term vision into shorter-term actions for making change.
• How can information and stories be used to connect in a diverse way to get line managers and teams appropriately engaged? Use examples of issues that are currently minor and explain how they can become major challenges for teams in the future if left unresolved.
• Encourage managers to create the vision for their team or department. The process is as important as the vision itself, as it gives everyone time to consider the change, what it means for them, and to voice any concerns.
• Where the change may be perceived as negative, talk openly about it to build trust. Also value your sceptics as they may help identify things you may have missed.

The Improvement Capability Building and Delivery team, which is part of NHS England’s improvement directorate, helps build capability in teams, organisations and systems to improve services to enhance patient care, driven by evidence-based, policy-aligned improvement capability building. A dedicated improvement hub sets out a wealth of improvement knowledge, information and tools to support the delivery of sustainable service improvement.

NHS England provides direct support to ICSs as part of the national retention programme. This support helps the ICSs to work through a 90-day improvement cycle, with 30, 60 and 90 day check-ins. It also supports development of a retention plan. This approach has resulted in retention improvement plans being developed in our ‘pathfinder organisations’ – North East and Yorkshire region, Bristol, North Somerset and South Gloucestershire ICS and North Central London ICS. For further information, please get in touch with your regional retention manager.

Top tips

✓ Speak with your improvement lead about ways you can work together to improve workforce retention.

✓ Consider the different improvement tools that are available and answer the questions set out here to help inform your thinking around the planned change.

✓ Continue the dialogue over time so that line managers and teams stay engaged and up to date with changes, and continue to see the benefits to them.

✓ Role model both the values and behaviours needed to create transformational change within your organisation.

✓ Taking time to slow down and observe what is going on in your departments will give you the opportunity to gain real insights into what is happening for staff and patients on the shop floor.

Tools and further reading

• Keep up to date with interventions and practical solutions on NHS England’s website.
• A driver diagram is a visual activity for tackling complex issues like retention and can be used to plan improvement project activities.
• NHS England's Leading Large Scale change and Change Model Framework.
• East London NHS Foundation Trust’s quality improvement hub.

Next steps

Now you’ve read this guide you may want to go back and complete the traffic light tool if you haven’t already done so. Look at the areas you rated red and amber and begin by focusing on actions against each of these areas.

Things to consider:

• Are your targets SMART?
• Do you have robust evidence to suggest your action should be an action?
• Can you focus your attention on two or three key areas of improvement rather than trying to tackle everything at once?
• Are the timescales you have set realistic?
• When setting your actions, have you considered the personal, team and organisational behaviours that may block your progress?
• Have you identified the best person to take each action forward and worked with them to get them onboard?
• How regularly will you check-in to ensure the actions are completed on time?
• How do these actions fit in with the retention priorities of your ICS?

Action:

Create your own action plan using the template that can be found on page 38 of the PDF version of this guide.

Evaluating impact

When planning your retention strategy, consider how you are going to evaluate the impact of the changes you intend to make.

Being clear about what you want to achieve at the outset and making time to regularly review your activities will help you to assess how successful your strategy has been and whether any changes need to be made.

Evaluating your activities will also help into better communicating what your organisation is doing around retention and the value it has. It will also help identify any risks and issues and recognise where you have done good work. The following evaluation process will help you to think through how you will measure the impact of your retention activities from the start.

Evaluating impact by:

1. Define your objectives Make sure they are clear, measurable, and relevant to your staff groups, team or organisation. Getting your objectives right at the beginning will make it easier to measure them throughout.
    
2. Identify your stakeholders This will be all the people who will be affected by your retention initiatives. Consider who you can work with collaboratively to deliver your retention activities, such as your improvement team and OD leads, and identify the benefits you hope to achieve.
    
3. Map tasks and activities Think about what activities you will carry out to meet your objectives and how each of these will help influence the behaviour of your stakeholders.
    
4. Define your performance measures To assess performance against retention activity objectives, you will need to identify which elements of the activities worked well and which worked less well. Think about impact and outcomes as well as financial or staff turnover targets.
    
5. Identify data sources Identify, for each performance measure, what data you will use and how you will source it. Make use of tools, such as the electronic staff record (ESR), exit interviews and feedback from staff.
    
6. Identify risks and constraints These will include financial risks and resources, and the time and capacity of staff you’re asking to support your retention activities.