How can the NHS become the best employer?

It’s never been more important for the NHS to be a great employer. Growing demand for services, due to population ageing and widening health inequalities, combined with a challenging environment for recruitment and retention have left a burgeoning workforce shortage of more than 100,000 vacancies. Without action, this could reasonably rise to 350,000 by the end of the decade.

To at least maintain the current quality of care, the NHS needs to retain the talent it secures and, in the face of Brexit, be prepared to recruit from other sectors. This is why the NHS’ forthcoming People Plan will prioritise the NHS being the best employer as its core goal — its future survival may depend on it.

But the NHS is falling short. Our new report reveals employment practices across 223 NHS trusts and compares them to the practices of other large UK employers. The report finds:

• The average NHS trust would rank ninth out of 26 on the Centre for Progressive Policy’s Good Employer Index. It falls particularly short on social mobility and paying the real living wage;
• There are big variations across NHS trusts — four trusts at the top end of the index have similar scores to the top employer in the index (John Lewis) while four at the bottom end have worse scores than the organisation at the bottom of the index (Capita); and
• All 10 ambulance trusts rank in the bottom 11, while community trusts are mostly ranked towards the top of the index.

For the NHS, being a good employer is not just important for maintaining and growing the workforce — patients’ lives depend on it. Our research shows trusts that rank as better employers also report higher levels of patient satisfaction and a better financial position. As ever, the heartbeat of the health service starts and stops with its staff.

What can the NHS do about poor employment?

1. It’s a no brainer that there needs to be more focus on improving ambulance trusts, which rank the worst and have long reported low levels of staff satisfaction. As an initial step, the NHS and Health Education England should fully implement the workforce recommendations from Lord Carter’s Review — particularly those relating to improvements in management support and training. In addition, the National Retention Programme should be extended to support ambulance staff.
2. There should be increased formal and informal exchange of knowledge, support and resource between exemplar and low-ranking trusts. For instance, trusts that are exemplar employers could pair up with poorer performing trusts in similar geographic areas to magnify their positive impact on healthcare, employment and the local economy.
3. Partnerships between local trusts should build on emerging formal models of collaboration, such as the acute care collaboration vanguards. Good employment practice should be increasingly ingrained into these new models, especially as the NHS transitions towards more integrated local health and care systems.
4. The NHS should create a new national employer vanguard to bring together the very best NHS employers to construct best practice pathways for different types of trusts. Such approaches are already being tried and tested to standardise clinical practice (such as the cancer vanguard). The same could apply to employment practice.
5. Community trusts can continue to lead the way. Alongside the additional funding for community health services announced in the long-term plan, there is an opportunity for community trusts to leverage and promote their position as good employers to improve their recruitment and retention.

The NHS must become a national leader in employment practice if it is to support a step change in the flatlining health of the nation. Reducing variation in clinical practice has historically been a large focus of health system improvement. Given the linkages we identify between good employment, patient outcomes and financial position, good employment must form a focal point of overall service improvement. Otherwise the consequences could be terminal.