University Hospitals of Derby and Burton NHS Foundation Trust

Key focus:

Supporting our NHS people for the long term

• Retention
• Approaching retirement 

Looking after our people

• Flexible working 

Background

Like many trusts, University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) faces an on-going challenge to recruit and retain staff across a number of shortage occupations, including nursing, allied health professional roles, and medical staff. In the face of this challenge, UHDB have been pursuing a range of retention initiatives that are transferable to the wider workforce and align to the People Strategy as well as the trust's underpinning workforce plans (such as health and wellbeing, leadership and management, and inclusion and belonging). This case study details UHDB's approach to retention both pre and post COVID-19 pandemic.

Retention results

The trust joined the NHS England and NHS Improvement (NHSE/I) retention support programme in 2017 and won the NHSE/I Burdett award for retention team of the year in 2019. The structure of UHDB's people services improvement team was key to supporting the innovative approaches to retention which won the trust this award, as a small team of four colleagues who focus solely on a range of project work.

In particular, the trust was commended for its work in retaining nursing staff, achieving one of the best retention figures in the region with a turnover of just 8.84% in 2018/19. This achievement was in spite of major organisational change in 2018, after UHDB was formed from the merging of Derby Teaching Hospitals NHS Foundation Trust, and Burton Hospitals NHS Foundation Trust. Often, significant change such as this can be a contributing factor to staff leaving an organisation. The 8.84% turnover rate was the equivalent of 43 more Registered Nurses and 36 more HCAs remaining with the Trust than in previous years, with 11 further registered nurses returning to practice rather than taking retirement. This marked an improvement of 15% on the previous years' figures.

The award also came after a period of ongoing vacancy challenges for the trust, across a number of shortage occupations including nursing. In response to this, the trust formed a multi-disciplinary working group to refocus its efforts on retention as well as recruitment, which included representatives from senior nursing, occupational health and wellbeing, workforce systems, people services and the communication team.

Exploring the issues

The journey to improve UHDB's staff retention began with a focus on baseline data, with the trust collating feedback on the most common reasons for leaving from ESR and leaver interviews, as well as looking at staff experience data from staff surveys. The findings were interesting and varied widely across staff groups. For example, newly qualified nurses often wanted to test out different clinical specialities, so were more likely than other staff groups to move jobs after only a year in post.

The nursing optimisation group undertook deeper analysis into these results and established that the trust’s nursing workforce is an ageing one, with 53% of staff in this group aged over 50.

Supporting an ageing workforce

UHDB then commissioned a working for longer group, focused on addressing the most pressing issues for older staff members. The group ran a specific survey for colleagues over 50 years old, to investigate their experiences at work, with 537 responses. The findings were split into five main recurrent themes: retirement, flexible working, menopause, complex conditions and wellbeing plans. UHDB then ran a conference for managers, to equip them with tools and information to support staff in these areas.

UHDB simultaneously recognised that there was an issue with retire and return options being applied differently across the newly merged organisation, which results in some areas having a lower uptake of retire and return. The decision was therefore taken to apply the guidelines consistently across all UHDB sites to allow staff to return to a similar role and retain their previous pay increment, annual leave allowance, and occupational sick pay.

As a result, this led to a significant increase in the uptake of retire and return, from 38% to 53% of retirees. To promote this change of approach, an event was held which attracted attendance from over 500 colleagues. In order to reach all sites, the trust ran a series of roadshows to promote 'working for us' initiatives, wellbeing, and to enable the pension team available to explain retire and return options to staff directly.

The workforce team also produced a UHDB staff handbook and ran poster campaigns which showcased the various staff benefits that the trust offers, including pension options for the workforce. UHDB retains a small team of pension experts, which has been in place for over 20 years, and staff find this specialist service invaluable given the complexities around NHS pensions. As well as providing advice, the pension team also support the families of deceased colleagues to claim their loved one's pension benefits following a death in service.

Supporting younger staff

When considering the retention of younger staff, qualitative feedback showed that newly qualified nurses at UHDB preferred to test out which specialty they want to work in longer term, and many plan to only stay for a year in roles at the beginning of their careers. The size and location of each clinical division within UHDB affects the available exposure which a newly qualified nurse might have to different specialties and career development options. UHDB was aware that several trusts in London (including the Royal Free and Great Ormond Street) had put in place a transfer programme, and so contacted them for details.

UHDB then initiated a similar internal transfer programme, in order to retain their younger nursing staff. This was following the trial of an external transfer programme between neighbouring trusts which had limited success. The internal programme had a much bigger impact on both retention and wider workforce wellbeing. Staff working in busy departments (such as respiratory medicine or surgery) could access the transfer programme, which offered them the opportunity to move to different ward or clinical specialty in order to share their skills and develop learning. For some staff, this offered a degree of respite from areas of high activity, while still retaining them within the service. The programme proved successful and resulted in upwards of 40 transfers both within and across sites. The trust saw a corresponding reduction in leavers for colleagues under 35 years old, from 38% of all leavers down to 26%.

Staff could access the internal transfer programme through an expression of interest form in the first instance. This was then followed up through a collaboration between corporate nursing and the people services team, who liaised with the managers of the clinical specialties to facilitate the transfer as smoothly as possible, including consideration for the staff member’s preference of shifts and flexible hours.

Next steps

UHDB is now signed up to NHS England and NHS Improvement’s 'flex for the future' programme and are planning to build elements of the transfer programme into this work by exploring how colleagues can be transferred to other areas where their flexible requests can be accommodated.

There is a clear opportunity in this work for a more informal approach to flexible working requests. If a request is unsupportable in the first instance in a discreet area, a new iteration of the transfer programme could be used as an alternative escalation process for these flexible working requests, which would help to retain staff of all ages and in all roles, in a flexible way across the whole organisation.

Moving forward, the challenge for the people services team lies in developing an appropriate system of recording and monitoring requests for flexible working, that managers can operate easily.

Key learning

The key learning points from the trust's work on retention are as follows:

• Colleagues need to be made aware of their personal options, such as pension benefits. This information can be the difference between staff leaving and/or returning to the trust.
• Change may not happen first time around, and you must be prepared to take stock and try different approaches – such as the external transfer programme having more success when it was adapted to be internal.
• Consider engaging the workforce by holding an event which gives focus and direction to key areas such as mid-career planning, retire and return options, and menopause guidance.
• Identifying the workplace conditions that support job satisfaction and retention for different generations in the workplace is key to the development of successful retention initiatives. Conducting regular conversations with staff to understand why they may want to leave the trust are vital in order to explore available opportunities to retain skills and experience within a workforce.
• Putting wraparound support in place for staff who work for longer or return to work post retirement is a clear way to demonstrate the value of an ageing workforce.