National efforts to stop nurses from leaving their jobs, and in some cases the profession altogether, have seen some employers reduce turnover, but it is still “very early days”, according to a senior nurse at England’s NHS regulator.
Initial results from NHS Improvement’s national retention programme, launched in July 2017 to support employers to retain their staff, have shown clinical staff turnover has reduced by 0.5% over three months among a group of 14 mental health trusts taking part.
“We need to make sure trusts are sustaining this improvement and it’s not just a halo effect”
This has meant the rate at which clinicians – largely nurses – are leaving their trust has dropped from 16.3% in July to 15.8% in September 2017, according to indicative figures from the regulator.
If confirmed, the figures would mean the first time that turnover among this group of trusts has been below 16% since June 2014.
Meanwhile, among 21 acute and community NHS trusts also taking part in the first wave of the programme, the rate at which nurses are leaving their employer has reduced by 0.1% over the same period – from 16.2% to 16.1%.
In an exclusive interview discussing the regulator’s ongoing programme, NHS Improvement’s director of nursing for improvement, Mark Radford, told Nursing Times the data showed “early signs of promise”.
“With the mental health programme, they have improved by about 0.5% – which for three months of the programme is an extremely positive start. We weren’t expecting them to make that early gain,” he said.
NHS Improvement set up the programme last year after health and social care secretary Jeremy Hunt asked the arms’-length body to look into why nurses were leaving their jobs.
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Its initial analysis uncovered a “huge challenge”, according to Professor Radford. The overall number of clinicians leaving trusts in England had been rising over the previous seven years across all staff groups.
NHS Improvement launched the voluntary scheme last summer with the group of mental health trusts, targeting all clinical roles, and another group of acute and community trusts, focussing solely on nurses. They were chosen based on organisations with the highest rates of staff turnover.
It has since started working with a further 76 trusts across England. As part of the programme, employers are provided with direct support by NHS Improvement to come up with plans to stop staff leaving and improve workforce planning.
“Nursing is a phenomenal profession but it is very, very tough out there at the moment”
The ultimate aim is to bring down the number of nurses leaving the profession altogether, said Professor Radford, though he noted figures were not yet available to show if the support programme was having an effect in that area.
However, the turnover rates indicated employers had made a good start, he said, and the regulator was now developing a plan to see if it could extend the support programme to all trusts England over the next 12 months.
“Turnover is the number of people moving between organisations and there is a logical reason for improving that, because the logistics of managing that many people in transition is a problem,” he said.
It is time-consuming and expensive for trusts to recruit – and NHS Improvement recognised excessive turnover can have a negative impact on both morale and patient care.
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Professor Radford said there had been particular successes from the programme that were specifically focused on nursing staff, such as at Tameside and Glossop Integrated Care NHS Foundation Trust.
According to figures shared with Nursing Times, the trust reduced its band 5 turnover from 16.6% to 14.5% between May 2017 and March 2018, and over the same period has seen a reduction in turnover of qualified nurses from 13.1% to 11.2%.
“They have done particularly well – though have some way to improve,” noted Professor Radford.
Since starting the programme, the organisation had introduced “itchy feet” conversations for its nurses – looking at career planning much earlier on, to help identify training they wanted.
It had also been inspired by a scheme run by University College London Hospitals NHS Foundation Trust that allowed nurses to swap jobs without having to go through lengthy recruitment processes.
Professor Mark Radford
A senior nurse had also been appointed to offer independent career advice, especially to nurses in the early part of their career who were often those most likely to leave.
Trusts had been encouraged to come up with their own “bespoke” strategies, because NHS Improvement’s analysis had found distinct differences across areas – and sometimes even in the same city – said Professor Radford.
Asked about the overarching reasons behind nurses leaving organisations across the country, he highlighted that “flexibility is a key issue”.
“Lots of organisations are looking at improving their policies for staff who are carers and also to make them more family-friendly,” he said. “But I think all people are looking for flexibility – not just those two groups.”
That included tailoring rotas to ensure staff could come back into the profession after a period away, but also to fit with everyone’s busy lives, he noted.
The culture among teams, and also additional services on offer to staff – such as counselling, health and wellbeing programmes and musculoskeletal support – was also being looked at by many employers, he added.
“I’m not calling this a success just yet, because we need to make sure the data is absolutely clear”
Career development, and training and education to be able to do that, also needed to be tackled by many trusts, he said. “We are working with organisations on that as they have a responsibility in training and education,” he said.
However, as previously reported by Nursing Times, national continuing professional development funding had been slashed by around 60% in the past two years.
Workforce planning body Health Education England cut its workforce development funding – which is largely used for CPD for nurses, midwives and allied health professionals – from £205m in 2015, to £83.49m in 2017.
It has initially frozen the budget at £83.49m for 2018 – despite a recent inquiry by the health select committee saying the cuts should be reversed.
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Professor Radford said: “We are clearly working with Health Education England after the health select committee discussion about what more can be done to increase the amount of workforce development funding available, so trusts are able to develop their staff further.”
But he noted some employers taking part in the regulator’s programme had brought in improvements regardless of the threat to national funding.
“At Barts Health Trust they have developed an in-house support programme for intensive care nurses which is around developing practice, skills and leadership,” he said. “At Rotherham Doncaster and South Humber Foundation Trust, they have got their staff to co-produce a master’s level accredited preceptorship programme specifically for mental health training.”
Despite the progress made so far, official data provided by NHS Digital to Nursing Times shows one acute trust taking part in the first wave of the programme had annual nurse turnover rates as high as 28% in the 12 months up to January 2018 – compared with 20% the year before.
“This is about recognising organisations have a significant role to play in making sure the culture is right”
Among the remaining 34 NHS trusts in the first cohort, the annual rate of nurses leaving their organisation from January 2017 to January 2018 ranged from between 12% and 24%. Meanwhile, nine of the NHS trusts had seen annual turnover rates worsen compared with the year before.
When asked if the speed at which improvements were taking place was sufficient, Professor Radford reiterated that the programme only started half way through 2017.
“The direction of travel is the right one,” he said. “I’m not calling this a success just yet, purely because we need to make sure the data is absolutely clear and robust. And we need to make sure trusts are sustaining this improvement and it’s not just a halo effect.”
He said NHS Improvement was not setting targets, but that all employers in the first wave of the programme had submitted plans to the regulator in October, detailing their own goals at reducing turnover – which ranged from 0.5% to 4% over the next 12 months.
“We’ve been clear this is very difficult stuff to do and so there is no specific target that we’ve given them,” he said. “We are expecting to see an improvement over a 12-month period as part of being within the programme, but that’s different for each trust depending on issues they have.”
Professor Radford said he recognised there were wider problems affecting NHS staffing, that were outside of the control of employers.
He said the support programme had factored in these elements as far as it could – such as fewer staff coming to the UK due to Brexit, the national shortage of nurses, and recent shrinking of the Nursing and Midwifery Council register.
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But trusts still had to play their part, he suggested. “This is about recognising organisations have a significant role to play in making sure the culture is right, staff feel valued and supported, and all of the appropriate people management structures around rosters and health and wellbeing are all in place,” he said.
“Nursing is still a phenomenal profession but it is very, very tough out there at the moment. This programme is designed to ensure organisations focus on frontline staff feeling supported to deliver the care they wanted to give when they came into the profession,” he said.