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% 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% reduction to running cost allowance (RCA) by 2024/5. 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%) 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 post-holder 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.
Trust leaders at DCHS are keen to see support for equality, diversity and inclusion (EDI) roles from senior NHS decision makers to push forward a positive and inclusive culture across the NHS. These roles are a strategic investment that pay dividends in the form of better patient care, a more inclusive work environment that supports retention, and ultimately, the reduction of health inequalities. EDI roles are also valuable in providing resource to respond to the various regulatory frameworks associated with staff inclusion.