Case studies

How three south London trusts came together to combat the NHS staffing crisis

25 Apr 2019 By Eleanor Whitehouse

Rather than competing for staff, neighbouring organisations joined forces to overcome their hiring challenges

As the saying goes, if you can’t beat them, join them. And that happens to be equally true of NHS trusts.

Beset by a host of workforce issues, including a 15 per cent vacancy rate for mental health nurses in the area; turnover among children and young people’s mental health nurses standing at 30 per cent; and spending on agency staff frequently exceeding expected levels, three south London mental health trusts – Oxleas; South London and Maudsley (SLaM); and South West London and St George’s (SWLSTG) – realised that rather than competing against each other for staff, their efforts would be better rewarded if they joined forces. 

The result was the South London Mental Health and Community Partnership – established to help the three trusts work together to offer better mental health services across their combined population of more than 3.6 million people. “We’ve all got the same challenges, so it made more sense to work together,” says Mary Foulkes, joint HR director for SLaM and SWLSTG (pictured).

Although only in post since November 2018, Foulkes is no stranger to leading large-scale collaboration projects. Having previously held HR director roles at Ford, HSBC and Timberland, she first joined the NHS in 2008 and spent 18 months as HR director for Southend, Basildon and Mid Essex Acute Hospitals – an initiative that saw three local hospitals work together to improve patient care.

With the creation of the SLP providing the infrastructure to help address the challenges in recruiting and retaining mental health nurses, and more than 30 consultation events with frontline staff highlighting that the nurses themselves wanted more time with patients, better training and clearer career pathways, it launched a nursing development programme jointly led by the three trusts’ directors of nursing, as well as a small number of senior development nurses. 

Preliminary research had identified that 46 per cent of staff believed there was no clear career pathway for nurses, so the team introduced a mapped career ladder across the three organisations – from Band 2 healthcare assistants up to Band 6 senior nurses – which included consistent competencies, job descriptions and L&D pathways, as well as a new Band 4 nursing associate role to offer additional development opportunities for Band 3 staff.

But improved progression for the workforce brought with it a raft of challenges for HR across the three trusts. As well as ensuring uniformity across three sets of job descriptions, development frameworks and assessment standards, the team also introduced an ‘employment passport’ which would see Oxleas, SLaM and SWLSTG recognising each other’s pre-employment checks, mandatory training and appraisal records, in an attempt to combat delays experienced by staff moving between roles. 

“A long wait to start a new role isn’t uncommon, but it affects continuity of care for patients,” says Foulkes. “Aligning three sets of policies was a challenge, but the culture is a barrier too. Each ward, department and trust has its own personality, so you can’t have a vanilla culture everywhere – we have to make sure people who move feel welcome.”

Although the nursing development programme has only just hit its first birthday, it’s already paying dividends. It’s now 75 per cent quicker for staff to move between trusts, and there are early indicators of reduced attrition and sickness absence. “But we’re interested in the qualitative evidence just as much,” says Foulkes. “And staff have told us they feel more confident to take on extra responsibility – that will have a hugely positive effect on patient care.”

The scheme is already being recognised for its work – it won the Best workplace for learning and development (over 1,500 nursing staff) prize at last year’s Nursing Times Workforce Awards, and was shortlisted in the Workforce category at the HSJ Awards. But this is just the beginning for Foulkes’ plans. “I don’t think it’ll ever be the finished article,” she says. “But we’re demonstrating that you don’t need a full merger to get the benefits.”

As joint HR director for two trusts, Foulkes admits it can be “challenging”, but says the most important part of her job is being visible. “When I come to both trusts I spend very little time in my office,” she says. “I do ward visits and network with different functions.” 

And with less than six months in the role under her belt, Foulkes has ambitious plans for her HR teams. “I haven’t got the infrastructure I need at the moment because both teams work quite differently, but I hope to eventually have two deputy directors covering both trusts, split between OD, engagement and more transactional work, plus a joint recruitment manager” she says. “So we’ll be able to have more joint policies.”

There are plans to develop the trusts’ use of the apprenticeship levy, which would see SLaM become a training provider and potentially run the schemes on behalf of the three SLP organisations to mitigate the fact that all are “struggling” to deliver the scheme effectively due to capacity. And Foulkes and her two heads of nursing are also looking to develop a ‘retire and return’ scheme to alleviate the consequences of an ageing workforce. “Some people nearing retirement think we don’t value them, and that’s just not true,” she says. “Many would prefer to work part-time, or mentor junior staff, instead of leaving completely. If we can use those people more creatively, it’ll be a huge benefit.”

But with her ideas now firmly in motion, Foulkes is mindful not to lose sight of the real reason for the hard work. “The HR team’s role is to make sure staff are happy so they can give great care,” she says. “You don’t make service changes unless they're going to benefit patients – that’s one of the main drivers.”

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