Access to good quality employment and fair pay is a key determinant of health. The Good Work Plan, published by the government in December 2018, set out five foundational principles of quality work: satisfaction, fair pay, participation and progression, well-being, safety and security, and voice and autonomy. These principles offer a framework for trusts to assess their employment offer and ensure conditions for their workforce support health.
As one of the largest employers in the world, employing over 1.2 million people, and the largest employer of people from ethnic minority backgrounds in England, the NHS can also play an important role in widening access to quality work for communities facing barriers to the labour market and other inequalities in their social and economic wellbeing. They can also reduce the health impacts of insecure and unhealthy work by improving terms and conditions, including working towards living wage accreditation.
There are substantial inequalities in people's experience of work, particularly among ethnic minority communities. Recent data shows the UK unemployment rate was 3.8% in July–September 2022. However this rose to 6.9% for people from ethnic minority backgrounds and there is substantial variation between different ethnic minority groups. The latest NHS workforce race equality standard (WRES) published by NHS England (NHSE) in April 2022, showed only 44.4% of ethnic minority staff believe that their trust provides equal opportunities for career progression or promotion, compared to 58.7% of white staff. Black, Asian and minority ethnic staff also remain less likely to access Continuing Professional Development (CPD) and non mandatory training.
An important step in addressing these inequalities and improving the NHS's positive contribution to its workforce's health is to understand staff and local communities, and then work to better meet their needs as an employer, tackling discrimination within their organisations and recognising the social and environmental factors which can present as a barrier to good work for some communities.
Leeds Teaching Hospitals NHS Trust is engaging with populations in the community experiencing higher rates of unemployment, and is taking steps to remove barriers to health and care careers for people living in the most deprived areas in Leeds.
Case study
Leeds Teaching Hospitals NHS Trust
Communities in Leeds experience high levels of inequalities, with 26% of the population among the most deprived 10% nationally. Leeds Teaching Hospitals NHS Trust is a member of the Leeds Anchor Network, bringing together some of the city’s biggest organisations to drive positive change for their population.
The trust worked with the Joseph Rowntree Foundation (JRF) to understand the impact of poverty on health, and then worked with JRF and other partners to develop the Leeds anchor framework. Following this, the network was established alongside other organisations, including Leeds City Council and Leeds Beckett University.
As part of its contribution to the network and following engagement with staff, Leeds Teaching Hospitals NHS Trust has been working to recruit people from deprived communities. Using the council's Priority Neighbourhoods programme, which supports those who fall into the 1% most deprived communities in the country based on indices of multiple deprivation (IMD), they identified 12 communities across Leeds that fell into this group.
The trust is focusing on understanding the needs and aspirations of those communities and linking them up to opportunities, taking an 'asset based' approach. One of these neighbourhoods is Lincoln Green, an area surrounding one of the trust's main sites, St James' hospital. Lincoln Green is an area of significant diversity and deprivation with a high population of people who have recently migrated to the UK, and an above-average rate of unemployment and people seeking work. In collaboration with the trust's human resources department and Employment and Skills Leeds, the trust and council designed an initial pilot project with the aim of attracting people into good quality health and care careers.
The programme team carried out community outreach to raise awareness of health and care careers and reduce barriers for people trying to access a career in healthcare. They hosted career days in a local community centre where people could find out about a wide range of careers in health, access support for English as a second language (ESL), and enrol in employability courses with a guaranteed interview for people who completed them.
In the first phase, 127 people engaged with the pilot, with 60 completing a pre-employment programme and 49 people ultimately being recruited into roles in the trust, from estates and facilities, support roles, as well as assisting those with healthcare qualifications from their country of origin to progress into roles in the NHS.
Leeds Beckett University evaluated the pilot through the health and care academy initiative. The academy is funded by the trust and other partners, bringing together health and care workforce development for the city. It found that the collaborative nature of the programme enabled a system-wide approach to tackling inequalities with much greater reach and impact. The Leeds Health and Care Academy then looked at how they could scale up their approach to increasing employment opportunities for marginalised communities. This resulted in the 'connecting communities with health and care careers' programme. This programme applied the learning from the pilot to a wider range of communities and employment opportunities across the Leeds health and care sector. It aimed to remove barriers to recruitment and employment and provide the support that people needed to succeed, 65 people received conditional offers of employment and 49 people achieving an accredited qualification as a result of the project. Leeds Teaching Hospitals NHS Trust continues to recognise the importance of system-wide collaboration in widening access to health and care careers and is committed to increasing the benefit to local communities through the Health and Care Academy.