NHS staff retention

The NHS staff retention report curated by NHS Digital looks into workforce statistics within NHS England. The scope of the report stretches from September 30, 2009 until February 28, 2023, though it does forecast some data for March 2023 too. This document differs somewhat from the NHS staff burnout report within the NHS staff survey, which looks at the direct causes of stress and anxiety.

The retention document itself is less of a review rather than an index or compilation of related intelligence and information gathered by NHS services about operational performance. Two important documents it does link out to though are the NHS sickness absence rates and the NHS vacancies survey.

The sickness rate document covers December 2023 in this case, though it is a monthly report and more data is available. Within it, the most reported reason for absence was due to anxiety, stress or depression (or other mental illness) – equating to just over 25% of all sickness absences that month. For context we should say it was down around 6% on November 2023, but that’s still high. MentalHealth.org puts the nationwide average at around 15%, and while the NHS is a higher intensity workplace compared to most, the caveat is that staff expect that and go into it willingly; knowing they will be pressured but aiming to thrive in it and do good for the wider population.

In addition, a more recent report from NHS England on discrimination against NHS staff is at record levels. Staff are too busy, short-handed, getting abuse from the public, and turning on each other – it’s no surprise that there are issues with mental and physical health in NHS staff and that there’s a steady trickle of people leaving the service.

The other survey mentioned on NHS staff vacancies reports a vacancy rate at the end of December 2023 of 8.4%; down from 10.7% the previous year. This is an improvement for sure, but is also qualified as not indicating where vacancies are being filled by a temporary workforce and thus might reappear in the near future.

NHS staff vacancies are currently are a tricky subject to cover. The NHS has many vacancies listed and thousands of positions to fill across the country, but in our article on ICB restructures we point out how government pressure to reorganise integrated care boards is resulting in job losses on that front, to the tune of hundreds of roles. The Echo – an Essex newspaper – reported that their local NHS trust has been instructed to cut 600 jobs.

The argument is that this is an efficiency change designed to minimise bureaucracy and maximise funding for frontline clinical employment, but whether you believe that or not it reminds us that these vacancies have a political role as well as a practical one.

The NHS staff survey details why people aren’t staying, so this is the foundation of strategic planning for turning things around, but there are financial incentives to be had as well as the humanitarian impact of better work environments.

Nurses.co.uk give the following breakdown of the costs involved in staff training, replacement, and the financial impacts of service shortfalls:

• £12,000 = the cost of replacing a fully-trained Nurse (NHS)
• £3.6 million = spent each year by each Trust to replace Nurses (NHS)
• £21.7 billion = cost to NHS of not addressing retention (MSI / HWF)
• £6,371.41 = cost of recruiting a Nurse from overseas (NHS)
• £8,477.80 = cost of recruiting 21 Staff Nurses (NHS)
• £100,000 = cost of an agency Nurse each year (BBC)
• £6.2 billion = cost of agency and bank staff 2019-20 (Liason)
• £12 million = paid in 1 year by the five NI Trusts to one agency (BBC)
• £46 = the difference cited in hourly pay between one agency Nurse and an NHS Nurse on the same ward (BBC)
• £1.7 million = cost of sickness absence for an average Trust each year (MSI / HWF)
• £2.4 billion = cost per year to NHS of staff absence due to poor health (NHS)
• £1.9 billion = how much the NHS spent on locums in 3 months 2015 (BBC)

These are huge figures that offer a very clear incentive for the NHS – and by proxy integrated care boards and NHS trusts – to address the problems affecting staff.

This brings us to the NHS staff retention strategy, and how the organisation as a whole can turn the problem of staff retention into a positive with some systematic changes.

There is already an NHS Employers guide to improving staff retention, and an NHS employee benefits scheme in place for staff members, but between April 2022 and December 2023 NHS England held an NHS retention trial to see what changes to management and organisation could be done to support staff better. 23 trusts were included in the trial, and it allowed staff extra flexibility with their working hours, as well as additional personal support to bypass clinical waiting lists for staff members needing a specific type of support, or greater interaction with HR to ensure complaints are properly addressed and acted upon.

Some, like Medway NHS Foundation Trust, have been working with the NHS Shared Business Service (SBS) to utilise workforce analytics to help analyse the historic data of staff leavers over the past five years. The pilot project sought to use statistical modelling to predict employee departures, based on the data trends leading up to previous resignations from the Medway trust. The results were 95% accurate; a huge success rate that means the modelling will be able to work with the Electronic Staff Records (ESR) system used by the trust to flag up warning signs for all employees going forward.

This use of data is great, but it was only possible because of computer software…

NHS staff software

At The Access Group, we don’t shy away from the fact that we’re a software provider. We’re proud to be one, we’re proud to work with the NHS in many instances, and we’re proud of the work we do in producing high quality solutions designed to improve people's health and wellbeing.

Our solutions are popular because they work, and the way that they work is to help clinicians with the burden of modern healthcare. More people means more records, more data, more chance for errors, more duplication across departments or trusts. Solutions like Rio EPR solve that, offering interoperability to connect different organisations and share information – to create a centralised, singular record that is the one source of the truth and the go-to for a patient’s information. That’s just one solution. We have things like Access Patient Flow Manager to help with hospital movement and bed availability, a virtual ward package, Adam Continuing Healthcare, and even Access EarlyPay...

Access EarlyPay

Access EarlyPay is our pay advancement solution, designed to provide workers with flexibility in how they take their pay.

The idea is simple: if you already earned it, you should have instant access to your pay to help with your needs - be they bills, debts, or surprise expenses. The EarlyPay app is a solution that allows you to take a small sum of monthly salary, or multiple incremental sums throughout the month, ahead of schedule when needed.

Within health and care, this is particularly relevant. Many NHS employees and care workers are willing to work overtime IF they are paid quickly. The problem commonly experienced is that due to this inability to pay quickly, many staff members decline to take overtime that would cover staff absences or shortages. This then means more expensive agency hires must come in to provide the care needed, taking spend away from elsewhere in an NHS trust or provider organisation.

The cost of living crisis that has followed on from the tail end of the pandemic. An article from Nursing Notes reported back in 2020 that NHS staff are amongst the most likely to apply for a payday loan. EarlyPay offers financial freedom for staff in a troubled economic climate so they can avoid these high interest loans, and helps via the financial advice and support of 'Thrive' in the EarlyPay app. Businesses benefit from a more engaged workforce, increased staff retention, and boast higher competitivity in the recruitment space. A win-win for employers and employees.

Our conclusion is that the NHS is taking the right steps to address the issue of staff retention and the causes behind it, but more needs to be done and quickly. The NHS is losing staff at a rate it cannot afford – physically or financially – and it’s doubly beneficial for them to onboard software solutions that can optimise both clinical and administrative processes. Freeing up staff members to focus on their duties removes so many of the problems facing them. A fairer workload means less irritated staff, which protects colleague relationships and ensures a harmonious workspace. It also means that more care is being provided and at a better quality, so patients and their families/loved ones are less frustrated with the system and the staff in it, thus reducing the rate of their hostile or abusive behaviour. NHS staff software is the domino that starts the cascade of so many improvements, culminating in a big win for the national health service and everyone who uses it.