The national retention programme: two years on

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This article outlines the retention programme’s progress and key actions on retention in the interim NHS People Plan. It will give you an insight into trusts' initiatives to achieve sustained improvements in their turnover rates.

Two years have now passed since we started the National Retention Programme, in partnership with NHS Employers. We have provided a range of intensive support to trusts to improve staff retention and are delighted with the progress – national turnover rates for nursing and clinical mental health staff are at their lowest in five years.

Context

In 2017, the Secretary of State for Health asked us to deliver a programme of support around improving nursing turnover rates in all trusts, and turnover rates for clinical staff in mental health trusts. This was against a backdrop of rising turnover rates over the previous five years.

Our programme offers trusts a range of support, which now forms an essential part of delivering the interim NHS People Plan and the NHS Long Term Plan. Many actions trusts are taking make the NHS a better place to work – such as more support for new starters, better utilising the expertise of their experienced workforce and improving flexibility and career development. These actions and their impact on nursing retention will play an important part in achieving another key aim of the interim NHS People Plan – addressing urgent nursing workforce shortages. 

The programme so far

The data highlights that the programme has been a major step forward in giving trusts the tools, knowledge and expertise they need to develop initiatives that will encourage staff to stay working for the NHS. The intensive support programme has included:

Direct support programme

Targeted, clinically-led support focusing on nursing and clinical staff turnover rates. We support trusts intensively for 90 days to develop retention improvement plans, which must aim to improve turnover rates in 12 months. Plans have included initiatives around:

  • improving inductions
  • extending preceptorships
  • increasing flexible working opportunities.

We initially focused on trusts with the highest turnover rates and have now completed four cohorts comprising 140 trusts. They are now implementing and refining their plans as they achieve the ambitions within them.

We continue to monitor and support the first four cohorts. Each trust was partnered with one of our workforce and clinical leads to develop its plan, continuing to:

  • advise trusts
  • review updated plans
  • share best practice
  • connect trusts with peers tackling similar challenges.

Retention masterclasses

To facilitate sharing of ideas between trusts, we regularly run retention masterclasses aimed at HR nursing leaders, where trusts talk about their own experience of what works.

The latest series were held in early June 2019. We have had more than 1,000 delegates attend these sessions.

Retention hub

Both we and NHS Employers continue to publish resources, case studies and retention guides for trusts. This is in response to trusts wanting to understand what others are doing to improve retention and what works. The online retention hub is a platform for trusts to share initiatives and resources and to implement best practice, while #NHSRetention has been effective in sharing ideas between trusts on social media. The response has been positive, with over 12,000 views of the retention hub and 5,500 uses of the NHS Retention tag. Resources for the following themes are currently available on our hub:

Facilitated networks

NHS Employers has facilitated networks to collaborate on key issues affecting retention such as flexible working, supporting new starters and older workers, and development and career planning, over several events throughout 2018/19.

Additional support

We provide additional support on recruitment and retention in specialised areas where the need is greatest, including high secure hospitals and 15-20 emergency departments. 

The positive impact to date

    Since the beginning of the retention programme in June 2017, national nursing staff turnover rates have fallen from 12.5% to 11.9%, and mental health clinical staff turnover rates have fallen from 14.3% to 13.4%.


    These reductions now mean both national nursing staff turnover rates and clinical mental health staff turnover rates are the lowest they have been for five years (since July 2014). This equates to 1,100 clinical staff opting to stay in their jobs working for the NHS after action by their trust, since the start of the programme.

    These improvements have been largely driven by the superb performance of trusts in the early cohorts of the direct support programme.

    • trusts in our nursing cohort 1 saw on average a 1.4 percentage point improvement in turnover of nursing staff
    • trusts in mental health cohorts 1 and 2 saw a 1.0 and a 0.9 percentage point improvement respectively in turnover of all clinical mental health staff
    • 14 out of 35 trusts in cohort 1 saw an improvement of more than two percentage points in turnover in the 15 months since they started the programme. 
    Please see below for examples of trusts that made great progress in improving their turnover rates and how they have achieved this. The improved performance by NHS organisations is particularly notable considering the recently published Office for National Statistics paper reported that the nursing profession already had one of the highest levels of retention before we started the programme, when compared to other public sector professions.

    Chelsea and Westminster Hospital NHS Foundation Trust Essex Partnership University NHS Foundation Trust
    Problem The trust had one of the highest turnover rates in London for registered nursing staff and different retention challenges at its different sites. The trust experienced a challenge driving improvements in turnover during a period of significant merger in 2017.
    Solution Establish overall aim and identify key drivers to deliver improvement:
    • improve understanding of why staff leaving via improved joiner and leaver surveys and exit and stay questionnaires
    • increasing awareness of wider staff benefits offer that the trust has developed
    • improving training and development opportunities, including extending preceptorship programme and new internal transfer scheme.
    Establish overall aim and identify key drivers to deliver improvement:
    • in-depth root cause analysis of why staff leave
    • work-life balance focus, including flexible working tool and incentive to buy and sell annual leave
    • focus on retire and return policy
    • develop promotion opportunities to encourage internal staff development.
    Results Nursing turnover rates have fallen by 2.5 percentage points since the trust started on cohort 1 of the direct support programme. Clinical staff turnover rates have fallen by over 6 percentage points since the trust started on cohort 2 of the direct support programme.

    Find out more about Essex Partnership University NHS Foundation Trust stabilising retention during change and flexible working.

    Next steps for the programme

    Based on these promising results, we will launch a fifth cohort in September 2019, covering all remaining trusts that have not yet received direct support. Once completed, the national retention programme will have directly interacted with every NHS trust in England.

    We will continue to monitor and intensively support cohorts 1 to 4, with each trust continuing to be partnered with an NHS England and NHS Improvement workforce and clinical lead. We will also provide trusts with detailed retention data diagnostic packs every quarter to aid the ongoing implementation of their plans.

    We will work with primary care to extend the national retention programme into general practice, in addition to incentives to join or return to general practice nursing.

    We will continue to work in partnership with NHS Employers to ensure that collectively there is a coherent and joined-up approach to improving retention. During 2019/20, NHS Employers will work on the factors that make a difference to implementing flexible working practices for nurses. The outputs from this work will be available for everyone to access and will be shared through the direct support programme communication routes.  

    We will continue to facilitate idea and resource sharing across trusts via social media and the retention hub, and continue to provide additional support in specialised areas including high secure hospitals and support to 15-20 emergency departments on recruitment and retention.

    What we know about tackling retention

    We all have a responsibility to act now to support and retain our existing clinical staff, as the interim NHS People Plan emphasises. This is critical to making the NHS the best place to work and addressing the urgent workforce shortages in nursing.

    There is no single solution to improving retention, as all organisations face varying issues and needs. But there are actions all organisations can take, which begin with understanding their workforce picture through leaver data. 

    Once trusts understand why staff stay or leave their organisation and know what requires attention, this should form the basis of a people-centred, inclusive workforce and retention strategy that empowers and engages their highly committed and dedicated NHS staff. 

    We know that many trusts have already undertaken this work and, through working directly with trusts and via an assessment of the retention plans of those involved in the direct support programme, we have identified key themes that consistently appear as trusts’ priorities in their retention strategies. These appear in the document below and are linked to the interim NHS People Plan’s key themes. We hope this provides insight into what has been most effective in improving retention in the trusts we have worked with.

    Trend in nursing turnover rates PNG, 46.6 KB

    Overall nursing turnover rates have fallen from 12.5% to 11.9% since the start of the programme.

    Trend in mental health turnover rates PNG, 51.7 KB

    Overall mental health clinical turnover rates have fallen from 14.3% to 13.4% since the start of the programme.

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