Case studies

Why North East London NHS FT turned to its workforce to help solve inherent problems

28 Mar 2019 By Eleanor Whitehouse

The mental health and community trust looked to staff insights to try to reduce sickness absence, staff retention and employee wellbeing

It’s fair to say these are troubling times for the NHS. With 44 per cent of the provider sector (comprising acute, ambulance, community and mental health trusts) ending the last financial year in a deficit totalling £960 million (and an underlying deficit several times greater), a record high of almost 12 per cent of nursing posts going unfilled, and EU staff leaving in their droves due to ongoing Brexit uncertainty, the numbers make for sombre reading.

But it seems, to an extent at least, that one trust in a corner of the capital has been able to buck the trend. When Bob Champion, North East London NHS Foundation Trust’s executive director of workforce and OD, arrived at the organisation in July 2014, it was on a three-month contract to diagnose issues within the HR function, following a period of declining quality and with the board deliberating over whether it needed an HR leader in its ranks. 

Yet almost five years later, he’s still firmly ensconced. He recalls walking into a “misdirected” HR team, where separate transactional and employee relations functions sat in a “crumbling Victorian ruin” and recruitment processes were too long, paperwork got lost and many staff were not paid correctly. The picture across the rest of the organisation was no more positive: it saw sickness absence rates of 6 per cent, an agency staff bill in excess of £40 million a year, and staff turnover rates of more than 15 per cent, all amid concerns over quality of care and a 2016 CQC rating of ‘requires improvement’.

Fixing these multiple issues was not going to happen overnight – especially for an organisation with £350 million turnover and 6,000 staff spread across more than 150 locations – but Champion had to start somewhere. “It was about the people first, not the money,” he says. “If we could get the HR function working to best serve the needs of the organisation and address the issues staff said affected their ability to do their jobs, the rest would follow.” The first step was to introduce a business partnering model, and his team of 110 is now embedded across seven different directorates, with some roles remaining centralised. 

“Rather than the organisation coming to my team, I sent my team out to the organisation,” he says. “There’s now a much closer relationship with the business, instead of just speaking to faceless people on the end of the telephone.” And the new model has reaped rewards – in just two years, the average time to hire reduced by more than half, from over 90 days to around 40.

With the HR function now “firing on all cylinders”, Champion moved on to more ambitious plans. But rather than dictate change from above, he put the ball back in the workforce’s court, issuing a call to arms to staff to make suggestions about potential improvements. “The answers were already within the organisation,” he says. “So I asked for subject matter experts to come forward with bright ideas.” Around 250 employees volunteered to be part of small-scale “think tanks”, each tasked with solving problems in specific areas, including sickness absence, temporary staffing, use of data, retention and wellbeing. The results of the work streams include improved occupational health referrals, stress management programmes, wellbeing initiatives, better onboarding processes, and raising the profile of staff networks for minority groups.

The overall project – dubbed ‘Well Together’ and underpinned by a prolific communications campaign – has been well worth the effort. The trust cut its agency spend by £20,000 in the first two years after the programme’s inception, and its sickness absence rate is now consistently below 5 per cent. 

“We’ve now got over 90 health and wellbeing ambassadors from all over the organisation, as well as many for ethnic minorities, LGBT+ and disabled colleagues” says Champion. “There’s no financial reward, but they’re doing it because they want to.”

Staff wellbeing is not the only area being improved by Champion’s team. After recognising the higher-than-average number of BAME staff in NELFT’s inpatient mental health services were not progressing as quickly as expected, the organisation invested in a two-year coaching and mentoring programme to offer guidance in areas such as personal presentation and persuasiveness. 

One in 10 of those who undertook the programme subsequently achieved a promotion. “BAME staff were very underrepresented in senior roles, but we’ve redressed that balance now,” says Champion. All interview panels for roles at NELFT above a certain level must now have a BAME representative – “so everyone has a voice”, he adds. And it’s work that’s paying dividends. The trust was the first in the country to be fully compliant with all nine NHS Workforce Race Equality Standards, which ensure BAME staff have equal access to career opportunities.

But Champion isn’t stopping there. “My passion is to make sure we’re inclusive across all protected characteristics,” he says. “A big focus now is on disability.” He is already into the third year of a programme that supports staff with disabilities or long-term conditions, as well as educating line managers around reasonable adjustments and discrimination, and is aiming for NELFT to be fully compliant with the new NHS Workforce Disability Equality Standards ahead of their introduction later this year. 

Of course, even an organisation that is paving the way isn’t without its problems. Despite improvements in staff experience, turnover remains relatively high – something Champion describes as an “interesting dichotomy”. There are two key reasons – an ageing workforce with many nearing retirement, and a perceived lack of development opportunities for staff looking to move on from their first roles. “We’re also not in a very sexy location,” admits Champion. “People prefer the bright lights and extra money of the big city.” 

One way the trust is attempting to mitigate turnover issues is via apprenticeships, albeit currently only in non-clinical roles – however, recent reforms in the NHS may change that. “We currently have around 50 apprentices in finance, HR and other support areas, and they’ll go straight into substantive roles afterwards,” says Champion. “We treat them as part of the family.” 

With the trust likely to be less impacted by Brexit than some of its inner-city counterparts, and its position as one of the few London trusts to not be in financial deficit, Champion is optimistic about the next few years. As well as aiming to upgrade the trust’s current CQC rating from ‘good’ to ‘outstanding’, he plans to further upskill line managers to reduce staff turnover, and try to maintain the organisation’s unprecedented levels of engagement. 

“We’re always very clear it’s about our people – whether colleagues or service users – and their experience,” he says. “We don’t get tired of saying it. It’s not just another initiative: it’s what we are.”

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