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Retaining our NHS People
Beyond the Pandemic
Virtual Community Meeting
Wednesday 14th July 4pm
#Caring4NHSpeople # ProjectM
Welcome to the NHS England and NHS Improvement monthly
national community event supporting the health and wellbeing of
our NHS people during the Covid-19 response
Introduce yourself in the chat box
Say:
• Who you are
• Where you are today
• What do you as an
individual, enjoy/appreciate the
most about your current role?
• Send to “all participants”
To join the wellbeing community list, click on
the link at
http://horizonsnhs.com/caring4nhspeople/
To join the mailing list of people who
get the information about this
community:
http://horizonsnhs.com/caring4nhspeople/
#Caring4NHSpeople
#ProjectM
Staying in touch…
#Caring4NHSpeople #ProjectM
For all the wellbeing offers: england.nhs.uk/people
All the #ProjectM offers: https://people.nhs.uk/
Introduce yourself in the chat box
Say:
• Who you are
• Where you are today
• What do you as an individual,
enjoy/appreciate the most about
your current role?
• Send to “all participants”
To join the wellbeing community list, click on
the link at
http://horizonsnhs.com/caring4nhspeople/
Retaining our NHS People
Beyond the Pandemic
Virtual Community Meeting
14th July 4pm
#Caring4NHSpeople # ProjectM
Welcome to the NHS England and NHS Improvement monthly
national community event supporting the health and wellbeing of
our NHS people during the Covid-19 response
Aims of today’s
national health and wellbeing
community event…
• Offer support, ideas, knowledge and wisdom
to those with a role in supporting the health
and wellbeing of our staff
• Share the range of wellbeing support activities
that are available
• Connect with each other and collectively build
our community of those who support the
health and wellbeing of our staff
#Caring4NHSpeople #ProjectM
• 25 virtual meetings of the community with
more than 8,000 participations
• 130,000+ views of the sessions and
materials
• 140,000+ words shared in the chat boxes
during the sessions
• Over 2,500 #Caring4NHSPeople newsletter
subscribers
• Over 30 million Twitter impressions
#Caring4NHSPeople
Led by the People Directorate, NHS England and NHS Improvement
The community of people who support
the health and wellbeing of
#OurNHSPeople
(and those in partner organisations)
Source
of
image:
NHS
North
West
Leadership
Academy
• Welcome – Zoe Lord, Elizabeth Nyawade & John Drew
• Wellbeing overview – Steve Lee
• Looking after our people - Retention programme – Chris Dzikiti
• Should I stay or should I go? – NHS staff retention in a post COVID world – Dr Andrew Weyman
• Supporting Health and Wellbeing: Choosing to Stay at North Bristol Trust – Guy Dickson & Dr
Katie Egan
• Closing Remarks – Zoe Lord & Elizabeth Nyawade
#Caring4NHSpeople #ProjectM
The team today
Zoe Lord
Contributors...
Elizabeth Nyawade
Chat box facilitators
Social Media
YouTube hosts
Paul Woodley
Technical host
#Caring4NHSpeople #ProjectM
Leigh Kendall
Dr Andrew Weyman
Guy Dickson
Chris Dzikiti
Dr Katie Egan
Lynsey
Ogilvie
Michelle Lee
Steve Lee
Laura Flatman
Ian Baines
John Drew
Wellbeing overview
#Caring4NHSpeople #ProjectM
Steve Lee
Interim Head of Health &
Wellbeing, NHSE&I
11 |
An evolution of the NHS staff health and wellbeing offer
It is important that the health and wellbeing offer continues to evolve and our focus will be on three main
areas in the coming year:
• We need to ensure Wellbeing Guardians and Boards are supported and champion health and
wellbeing consistently within organisations – we have worked in collaboration with the Thomas
Ashton Institute to develop a dashboard to help assess HWB performance and inform preventive
interventions
• We need to equip line managers and teams with the tools they need take ownership of health and
wellbeing and that supportive, compassionate, health and wellbeing conversations take place
routinely – we have produced guidance on conversations and are developing further training
materials
• We need to continue to deploy evidence-based interventions on mental health that staff can
access rapidly through mental health hubs; and have a focus on Occupational Health becoming
an integral part of a preventive approach
We believe we need to have a focus on these activities while ensuring that ‘people recovery’ sits at the
heart of what we do.
12 |
• The Wellbeing Guardian is recommended to be a board-level role (NED, or equivalent) that
provides oversight, assurance and support to the organisational senior leadership team to fulfil
their legal responsibility in ensuring and empowering the health and wellbeing of their NHS
people
• Over 75% of Guardians are in place in large acute trusts, ambulance services, community and
mental health trusts
• We are putting in place support to help the Guardians and Boards understand their data and
determine the right interventions for their organisations
Wellbeing Guardians (WBG) in post June 2021
13 |
13 |
The HWB dashboard
14 |
14 |
1. Psychological safety climate - leading positive indicator
• e.g., staff survey: ‘My immediate manager takes a positive interest in my health & wellbeing’
2. Job Demands - leading negative indicator
• e.g., vacancy rate, as a predictor of increased workload
3. Job Resources - leading positive indicator
• e.g., quarterly survey: ‘I am able to make improvements happen in my area of work’
4. Healthy work environment - leading positive indicator
• e.g., staff survey: ‘My immediate manager values my work’
5. Stress / burnout symptoms - lagging negative indicator
• e.g., sickness absence rate
6. Positive health & wellbeing / engagement - leading positive indicator
• e.g., Staff survey: ‘I look forward to going to work’
The domains – lead and lag indicators
15 |
15 |
Enables comparisons with peers
Wellbeing conversations
Support coming soon for wellbeing conversations
Conversations training for line managers - We are now pleased to advise that
we have appointed a supplier to offer a national wellbeing conversation training
programme.
This programme will:
• Be available to all NHS organisations, including secondary care, primary
care, CCGs and national organisations.
• Aimed at line managers and colleagues who would like additional support in
developing the skills to confidently hold a conversation about wellbeing.
• Be rolled out as both a training programme, as well as a Train the Trainer
model that will enable organisations to train internal facilitators for future
sustainability.
• Training will likely commence in July/August 2021.
Further guidance and resources – further guidance and resources including case studies, example personal
action plans and a supporting animation can be found here: https://people.nhs.uk/projectm_old_v1/wellbeing-
conversations/
For any questions, please email ournhspeople.hwb@nhs.net
17 |
‘Growing OH’ programme overview
Vision Drivers Enabling project areas
Improving the
health and
wellbeing of our
NHS people by
growing and
developing NHS
Occupational
Health services
and our OH
people to reach
their full
potential as
strategic,
integrated and
proactive
organisational
partners
Enabling OH to be a trusted, strategic,
and integrated organisational partner
Increased OH workforce, capacity and
capability
Supporting system-wide service
innovation and improvement in OH
Effective use of technology to support
service delivery
Equality of access to services that meet
the needs of all our diverse NHS people
Empowered OH leadership, service
improvement and innovation
Enhancing service standards, quality,
measurement, and consistency
Increased focus on proactive and
preventative care
Designing and embracing future models
of multi-disciplinary service delivery
OH service improvement pilots: Enabling a group of system wide OH service improvement pilots to design and
implement future-facing models of systemic multi-disciplinary OH service delivery, and sharing the learning
Community and co-design: Programme of communication, engagement and co-design events with the OH
community and stakeholders to empower them to collaboratively drive the ambitions of the programme
Utilising technology: Deliver a gap-analysis review into how technology can better support OH service delivery,
considering current state, customer requirements, and future drivers
Leadership and transformation skills: Development programmes to empower OH professionals with the
leadership and transformation skills required to enable OH services to reach their full potential
Identifying and sharing best practice: Capturing and sharing the impact of the programme of work and wider
evidence based best practice in OH service delivery
OH service delivery and workforce models: Using co-design and best practice to create a ‘blueprint’ for future-
facing OH strategic and operational services models (i.e. national/system/organisation/ commissioned)
Improving quality standards: Supporting the enhancement and adoption of OH quality service standards in
partnership with the Health at Work network
Long-term programme: Capturing impact evaluation from this year of investment into OH services to scope a
potential plan for longer term investment and service improvement
Creating a trusted brand: Understanding user need, purpose, positive identity, trust and how this can inform the
future branding, identity and positioning of OH services
Co-design,
improvement
and
learning-focused
approach
Workforce data and measuring the impact of OH: Co-design of metrics for quality, future facing OH services
that demonstrate impact and value of the service as a strategic partner, linked to workforce wellbeing data
Growing the strategic OH brand
Growing our OH services
Growing our OH people
Empowering OH to strategically and
operationally support recovery
Growing from the pandemic
3 Ways to join Menti:
1. Click on the the link to the poll which has been shared in
the chat box
2. Scan the QR code below on your phone
3. Go to menti.com and use the code 2188 2406
Q: How high is retention in your
organisations priorities?
How high is retention in
your organisations
priorities?
What’s enjoyable for
you on a personal level
working in the NHS?
What’s one thing your
organisation is doing or
could do to best support
people to stay in the NHS
during these challenging
times?
Looking After Our People - Retention
programme
#Caring4NHSpeople #ProjectM
Chris Dzikiti
Head of Programmes,
Transformation & Delivery,
NHSE&I
@ChrisDzikiti1
People Plan overall outcome: Close the workforce gap through more people, working differently in a compassionate and
inclusive culture to support the delivery of the NHS Long Term Plan.
System level retention
Looking after our people Growing for the future Belonging in the NHS
New ways of working and
delivering care
Looking After Our People – Retention Programme
NHSE/I
strategic
direction
Support systems and
organisations to retain
their most experienced
people and people
early in their careers
Contribute to NHSE/I support
to our staff on flexible
working, health and
wellbeing, equality, diversity
and inclusion, compassionate
and inclusive leadership,
pay and reward
Aim of the retention programme*: to keep people in the NHS and keep them well
Programme
aim
Programme
priority
areas
for
the
next
3
years
Generational perspective/
career stage
Internationally
trained
Staff group/ Sector
or service area
Support systems to
develop and embed
retention at system
level across health and
social care
Support systems and
organisations to
improve the
experiences of
internationally recruited
NHS colleagues
Understand and help to
address specific needs
of different staff groups
and sectors
“Recovery” – operational, financial and what people need over the short, medium and long term to fully recover
ENABLERS
People Promise
areas
Robust data and evidence base
Retention research strategy
Communications and
stakeholder engagement
Team building and L&D
Programme agility & responsiveness
*The retention programme is one of nine interdependent workstreams to deliver the 50,000 ambition. The objective is to retain more Registered
Nurses (RNs) in the NHS in England by slowing the leaver rate of registered nurses employed in NHS trusts, CCGs and general practice.
Achievements: Key milestones the Retention Programme
delivered in 2020/21
24
Launched retention hub
•Dedicated NHSEI webpages and NHS Futures site based on 7 People Promise themes with new case studies,
• retention blogs and programme updates regularly added:
•Access to verified research studies to support retention strategies and interventions
•An easy way for organisations and individuals to contact the national and regional programme teams
•Extending the reach of ideas and positive practice
•Accelerating uptake of new evidence based interventions
•Tangible examples for organisations to build into local workforce plans
•Making case for change for retention initiatives
Delivered intensive pathfinder sites in every region
•Pathfinders cover 7 regions, 10 systems, 77 Trusts
•Building trusting relationships led to deeper understanding and collaboration between national, regional and system colleagues
•QI methodology approved by board level SRO’s as useful mechanism to support local transformation - even within Covid-19 context
•NEY Community of Practice network saw people and organisations accelerate learning from one another
•Enhanced system level maturation and collaboration system wide standardised approaches to flexible working implemented
Developed generational focus for ‘flight risk’ groups
•Identified and met with 12 national exemplar organisations retaining people in early years and/or later years – ideas and solutions shared across the
country at national event
•Held 2 focused national events (with early and later years people) - over 100 participants shared ideas and learning & informed generational
programme
•The support offer includes pension guidance, preceptorship, flexible working, legacy mentoring, support for BAME staff and menopause programme
Designed Retention Dashboard and Model Health System Retention Compartment
•National and regional teams able to track performance against trajectory and early warning indicators at national to organisational level.
•Self-service diagnostic tool providing increased system capability.
•Systems and organisations are able to review their own data, track improvement and benchmark against peers to enable them to make informed
decisions.
Embedded research within the national programme
•Set up research workstream to test programme assumptions against latest evidence.
•Literature search and gap analysis of retention research – building in evidence to programme development.
•Evidence from research suggests that different ages and career stages have different expectations and behaviours due to individual needs,
motivations and challenges. (please refer to annex for further research information on why nurses stay)
Should I stay or should I go? – NHS
staff retention in a post COVID
world…
#Caring4NHSpeople #ProjectM
Dr Andrew Weyman
Principal Investigator ESRC
research
University of Bath
Should I stay or should I go?
NHS staff retention in a post-COVID-19 world….
RESEARCH TEAM:
ANDREW WEYMAN & DEBORAH ROY – UNIVERSITY OF BATH
PETER NOLAN – UNIVERSITY OF LEICESTER
JOANNE COSTER – UNIVERSITY OF SHEFFIELD
RICHARD GLENDINNING AND RACHEL O’HARA – CONSULTANTS.
Funder:
Economic & Social Research
Council
Should I stay or should I go?
NHS staff retention in a post-COVID-19
World
Key Research Questions
1. How will the Covid-19 pandemic impact on staffing resources
in the short & longer term?
2. What impact will the legacy of the crisis have on the resolve
& capacity of current NHS employees to remain?
3. Will this be strengthened or weakened by their experiences?
4. Which variables predict exit & what are the employment
destinations of those who leave?
3 Complementary Work Packages
• Social survey Wave 1 - YouGov panel. Sample: 1,962 (Dec 2020 / Jan 2021);
Wave 2 - YouGov panel + RCN + RCM + CSP + UNISON + 8
NHS Trusts. Sample: 2,000 + 5,000 (July – Aug 2021)
• Case studies 6 NHS Trusts (Acute; Ambulance; Mental Health;
Community) – qualitative interviews (June-August 2021)
• 2ndary data UK Labour Force Survey; NHS staff survey (July-Sept 2021)
3 Complementary Work Packages
Integration of evidence
• Social survey – What? Who? Where? and
How many/how much?
• Staff interviews – Why? How? and In
what way?
• Secondary data – Employment
destinations of leavers?
Policy relevance:
Identification of incubating
threats to:
(i) NHS resilience
(ii) Employee well-being &
resilience
Intervention relevant evidence:
(i) What?
(ii) Who?
(iii) Where? and
(iv) How?
Social Survey – Themes explored, include (1):
Workload
Working hours
Staffing & resources
Job satisfaction
Health status
• Mental
• Physical
‘Comparing the period before the emergence of COVID-19 in March 2020 with
the current situation where you work – would you say this has: got better, got
worse or is it unchanged?’
Support
• Colleagues
• Line manager
• Employer
Recognition
• Public
• Employer
• Government
Social Survey – Themes explored, include (2):
• Being redeployed to work with COVID patients?
• Being pressured to receive a COVID vaccination?
• The impact of my work on my mental health?
• The impact of my work on my physical health?
• Being given too much responsibility?
• Bring asked to do work I’ve not been trained for?
• Standards of COVID infection control in my team?
• Not having enough time to do my job properly?
• Making mistakes because of my workload?
• Effectiveness of PPE?
• Abnormally high staff shortages?
• Colleagues lacking necessary skills & competencies?
• Being more vulnerable to COVID due to my ethnicity?
‘To what extent are the following currently a worry for you?’
(Scale 1= Not at all worried – 10 = Extremely worried)
% who raised concerns with line manager?
Social Survey – Themes explored, include (3):
 Talked to colleagues/former colleagues about job opportunities outside the NHS?
 Actively looked at vacancy lists for jobs outside the NHS
 Requested details of a job(s) outside the NHS
 Submitted an application(s) for jobs outside the NHS
 Been interviewed for a job(s) outside the NHS
 Been offered a job outside the NHS
Strength of intention to leave: ‘During the last 6 months have you:’
Social Survey – Themes explored include (4):
.
Staff views on priorities for change?
Ranking push & pull influences
• Reasons why staff in your type of
job leave the NHS?
• What needs to change to encourage
staff in your type of job to remain in
the NHS?
Time pressure
Mental health/stress
Staffing levels
Working hours
Workload (intensity of work)
Pay
Recognition of contribution
Work/home life balance
Occupational group (% of sample)
Wave 1 Survey Sample Profile
0.1%
0.4%
0.5%
1%
2%
2%
3%
6%
6%
7%
12%
15%
15%
30%
0 5 10 15 20 25 30 35
Other
Commissioning Managers
Clinical Management
Social Care
Ancillary&support
Clinical Psychology
Ambulance
Admin Man
Central tech; admin/Corp services
Scientific and technical
Medical/dental
Admin & Clerical (inc Med Sec)
Allied Health
Nursing
Percentage of Sample
Interviews with NHS staff
Sample – 6 case study NHS
organisations.
• Senior managers
• Line managers
• Front line health professionals
• Health care support
• Front line admin & support
Objectives:
Personal accounts of impacts of COVID on
individuals, colleagues & functions.
Detailed insight into how and in what ways
identified variables impact on staff well-
being & leave / remain orientations.
Insight into what might need to change & in
what way(s) to maintain / enhance staff-
well-being & retention.
Secondary data sources
UK Labour Force Survey (2010-20)
◦ Map patterns of migration from the NHS
◦ Employment destinations of leavers
◦ Exit profile e.g. age and rates for different
professions
NHS staff survey (2017-2020)
◦ Explore variables that predict employee
disposition to leave the NHS
All-NHS age profile
Discovering & mapping impacts of COVID19 on NHS
employee well-being and staff retention
.
Analysis - An epidemiological perspective
• Identifying differential impacts
e.g. by profession; grade; type of service; age, experience, gender, ethnicity, region / country
• Identification of vulnerable demographics - groups of employees - who? & where?
• The relative importance of recognised drivers of exit.
• The relative importance of variables that encourage staff to remain
• Intervention relevant insight into what might need to change & in what way(s)
• to maintain / enhance staff well-being
• to maintain / enhance staff retention rates
• whole population (one size fits all) or segmented solutions?
Delivery & reporting
Summary
• Wave 1 UK wide NHS survey – completed Jan 2021
• Wave 2 UK wide NHS staff survey commenced – July 2021
• Case study interviews with NHS staff - commenced – June 2021
• Secondary data analysis – commenced July 2021
Reporting of results,
dissemination of findings
& implications:
• Late Summer / Autumn 2021
Supporting Health and Wellbeing:
Choosing to Stay?
#Caring4NHSpeople #ProjectM
Guy Dickson
Head of People Strategy, North
Bristol NHS Trust
@mrguyd
Dr Katie Egan
Psychotherapist, Staff
Wellbeing Psychology team
Bristol NHS Trust
@nbt_staffpsych @nbtwellbeing
12,000 staff
500,000 outpatients
70,000 inpatients
40,000 operations
100,000 ED visits
A difficult past…
• 2014: 2 hospitals
merged
• 2015 CQC: “Requires
Improvement”; “Plans
not realistic”
• 2015: financial special
measures.
• Command and control
• Then winter 2017/18
Turning point: Winter 2017-18 at North Bristol NHS Trust
Nov 2017: 5th worst survey
result in 116 Acute Trusts for
“my organisation takes action
on health and wellbeing”
A new paradigm:
• Developed programme structured around Mental Health, Physical
Health, and Lifestyle. Wellbeing “Menu”, 5 WTE psychologists, 2
physios, EAP, MHFA,TRiM, Champions, etc.
• Reduction in sickness absence (3,928 WTE days 2017 to 2018)
• Increased engagement (6.8  7.1)
• Improved CQC Rating (requires improvement  good)
• Awards including 2019 Parliamentary Award
• Nov 2020: Ranked 21st best of 128 Acutes for wellbeing
CQC 2019: “with a strong
focus on staff wellbeing,
all staff felt supported and
valued despite the
significant pressures of the
job”
NBT’s
Wellbeing
Approach
• A tiered pathway of support
• Encouraging conversations
• Mirrored in system Mental Health
Hub
• Focusing support on difficult areas:
Covid wards, redeployees,
Facilities etc.
Team
support
I will remember that the
struggles/thoughts I
have had are shared
ones (clinical fellow Dr).
Thank you very much for the time and effort
we received. I think this initiative by NBT
within this period of massive change and
stress will have been invaluable to support
staff and ensure we have the support
mechanisms we need
Request:
• Mental Health First Aid Training? Worried about Junior Docs
Intervention:
• Bespoke package
• Peer to Peer support – more sustainable, all staff included.
• Consulted with ED consultant, ward sister, another Dr, local
Psychologist.
• Developed interactive training for all staff, plus supported staff-led
working group to consider the anonymous feedback received
Outcome:
• Running training 5-6 times per year. The feedback gets reviewed
at the wellbeing working group and they implement changes as a
result.
• Team are checking in & out more with each other and having
more pitstops (see Start Well>End Well )
• More able to check in with colleagues of different professional
groups.
• Staff more aware of other available support in NBT e.g. ACT
courses, trauma focussed 1:1.
Bespoke wellbeing intervention with the
Emergency Department
Case Study
Being more aware of how people
are managing in work and asking
if they are ok. Ensuring people
know I’m happy to listen. (Nurse)
Great session and wish this sort of
awareness/support had been
available years ago – THANK YOU!
(consultant)
If a colleague in NBT was
in need of similar help,
would you recommend
the staff wellbeing
psychology sessions to
them?
100% responded “Yes”
Individual
support
Case Study
Senior Consultant (surgeon)
1:1 Support
Referral:
• Consultant distressed after a patient death. Thought she
might have PTSD. Was signed off work on sick.
• Decision making was really difficult, sleep was poor, her
anxiety was really high, felt concerned she would make more
errors and wasn’t safe.
• Was considering leaving the profession.
Intervention:
• EMDR + formulation i.e. making sense of perfectionistic
tendencies and feelings of ‘not being good enough’ came
from.
Outcome:
• See feedback below.
• Consultant after a phased return has now returned to full time
work and is operating again with confidence and enjoying her
work.
‘Clinical’ levels of
psychological distress
fell in staff from 94% of
staff to 22% following
individual support.
(CORE -10)
Supporting wellbeing informed management
approaches
Me+MyTeam - facilitated 1:1 consultation
session for team leaders and managers to
reflect on the wellbeing of their team, and
practical ways to support team dynamics and
team wellbeing going forwards.
In the last 12 months, we have supported 89
teams with this and other bespoke sessions
Sharing this approach in the coming weeks
through a webinar with NHS England and
NHS improvement: 28 July @ 4pm
I found it useful to attend with colleagues,
and I hope that attending together will
help us apply the learning to our team as
a whole (as well as the smaller teams that
we lead).
• Flu vacc / covid booster: how make a
wellbeing space
• Linking Datix to wellbeing support
• Sir Michael West, Burnout white paper
2021: “I want to be clear about the issue of
excessive workload. The danger is that we do
not see it. It is like the pattern on the
wallpaper that we no longer see, but it is the
No. 1 predictor of staff stress and staff
intention to quit. It is also the No. 1 predictor
of patient dissatisfaction...”
• One NBT Festival: 5 days of wellbeing
showcase and fun 1-5 July: yogalates,
Schwartz Rounds, BBQ, NHS Big Tea,
wellbeing stalls, thank you box, online
music, bird watching, etc.
2021: An Emerging Wellbeing Culture
Thank you
In the chat box…
Share one thing that
you're going to do as a
result of joining the
session today...
Photo by Júnior Ferreira on Unsplash
Very helpful
Not helpful
To what extent has today’s session been useful in
your own role supporting staff health and wellbeing
during and after Covid-19?
POLL
If you are on YouTube or the poll doesn’t work for you on Zoom, write your number in the chatbox
Here are the key points made about staff retention in the NHS:- Retention is a major challenge, especially given the pressure on the NHS from the pandemic. High staff turnover is costly and impacts quality of care. - Factors influencing retention include workload, burnout, wellbeing support, career development opportunities, feeling valued by managers and the organization. The pandemic has exacerbated some of these challenges.- Initiatives to improve retention include focusing on health and wellbeing, reducing demands on staff, improving psychological safety, ensuring compassionate management, and developing people's skills and careers. - Organizations are looking at retention holistically rather than just focusing on pay. It's about creating a positive work environment where people

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Here are the key points made about staff retention in the NHS:- Retention is a major challenge, especially given the pressure on the NHS from the pandemic. High staff turnover is costly and impacts quality of care. - Factors influencing retention include workload, burnout, wellbeing support, career development opportunities, feeling valued by managers and the organization. The pandemic has exacerbated some of these challenges.- Initiatives to improve retention include focusing on health and wellbeing, reducing demands on staff, improving psychological safety, ensuring compassionate management, and developing people's skills and careers. - Organizations are looking at retention holistically rather than just focusing on pay. It's about creating a positive work environment where people

  • 1. Retaining our NHS People Beyond the Pandemic Virtual Community Meeting Wednesday 14th July 4pm #Caring4NHSpeople # ProjectM Welcome to the NHS England and NHS Improvement monthly national community event supporting the health and wellbeing of our NHS people during the Covid-19 response
  • 2. Introduce yourself in the chat box Say: • Who you are • Where you are today • What do you as an individual, enjoy/appreciate the most about your current role? • Send to “all participants” To join the wellbeing community list, click on the link at http://horizonsnhs.com/caring4nhspeople/
  • 3. To join the mailing list of people who get the information about this community: http://horizonsnhs.com/caring4nhspeople/ #Caring4NHSpeople #ProjectM Staying in touch… #Caring4NHSpeople #ProjectM For all the wellbeing offers: england.nhs.uk/people All the #ProjectM offers: https://people.nhs.uk/
  • 4. Introduce yourself in the chat box Say: • Who you are • Where you are today • What do you as an individual, enjoy/appreciate the most about your current role? • Send to “all participants” To join the wellbeing community list, click on the link at http://horizonsnhs.com/caring4nhspeople/
  • 5. Retaining our NHS People Beyond the Pandemic Virtual Community Meeting 14th July 4pm #Caring4NHSpeople # ProjectM Welcome to the NHS England and NHS Improvement monthly national community event supporting the health and wellbeing of our NHS people during the Covid-19 response
  • 6. Aims of today’s national health and wellbeing community event… • Offer support, ideas, knowledge and wisdom to those with a role in supporting the health and wellbeing of our staff • Share the range of wellbeing support activities that are available • Connect with each other and collectively build our community of those who support the health and wellbeing of our staff #Caring4NHSpeople #ProjectM
  • 7. • 25 virtual meetings of the community with more than 8,000 participations • 130,000+ views of the sessions and materials • 140,000+ words shared in the chat boxes during the sessions • Over 2,500 #Caring4NHSPeople newsletter subscribers • Over 30 million Twitter impressions #Caring4NHSPeople Led by the People Directorate, NHS England and NHS Improvement The community of people who support the health and wellbeing of #OurNHSPeople (and those in partner organisations) Source of image: NHS North West Leadership Academy
  • 8. • Welcome – Zoe Lord, Elizabeth Nyawade & John Drew • Wellbeing overview – Steve Lee • Looking after our people - Retention programme – Chris Dzikiti • Should I stay or should I go? – NHS staff retention in a post COVID world – Dr Andrew Weyman • Supporting Health and Wellbeing: Choosing to Stay at North Bristol Trust – Guy Dickson & Dr Katie Egan • Closing Remarks – Zoe Lord & Elizabeth Nyawade #Caring4NHSpeople #ProjectM
  • 9. The team today Zoe Lord Contributors... Elizabeth Nyawade Chat box facilitators Social Media YouTube hosts Paul Woodley Technical host #Caring4NHSpeople #ProjectM Leigh Kendall Dr Andrew Weyman Guy Dickson Chris Dzikiti Dr Katie Egan Lynsey Ogilvie Michelle Lee Steve Lee Laura Flatman Ian Baines John Drew
  • 10. Wellbeing overview #Caring4NHSpeople #ProjectM Steve Lee Interim Head of Health & Wellbeing, NHSE&I
  • 11. 11 | An evolution of the NHS staff health and wellbeing offer It is important that the health and wellbeing offer continues to evolve and our focus will be on three main areas in the coming year: • We need to ensure Wellbeing Guardians and Boards are supported and champion health and wellbeing consistently within organisations – we have worked in collaboration with the Thomas Ashton Institute to develop a dashboard to help assess HWB performance and inform preventive interventions • We need to equip line managers and teams with the tools they need take ownership of health and wellbeing and that supportive, compassionate, health and wellbeing conversations take place routinely – we have produced guidance on conversations and are developing further training materials • We need to continue to deploy evidence-based interventions on mental health that staff can access rapidly through mental health hubs; and have a focus on Occupational Health becoming an integral part of a preventive approach We believe we need to have a focus on these activities while ensuring that ‘people recovery’ sits at the heart of what we do.
  • 12. 12 | • The Wellbeing Guardian is recommended to be a board-level role (NED, or equivalent) that provides oversight, assurance and support to the organisational senior leadership team to fulfil their legal responsibility in ensuring and empowering the health and wellbeing of their NHS people • Over 75% of Guardians are in place in large acute trusts, ambulance services, community and mental health trusts • We are putting in place support to help the Guardians and Boards understand their data and determine the right interventions for their organisations Wellbeing Guardians (WBG) in post June 2021
  • 13. 13 | 13 | The HWB dashboard
  • 14. 14 | 14 | 1. Psychological safety climate - leading positive indicator • e.g., staff survey: ‘My immediate manager takes a positive interest in my health & wellbeing’ 2. Job Demands - leading negative indicator • e.g., vacancy rate, as a predictor of increased workload 3. Job Resources - leading positive indicator • e.g., quarterly survey: ‘I am able to make improvements happen in my area of work’ 4. Healthy work environment - leading positive indicator • e.g., staff survey: ‘My immediate manager values my work’ 5. Stress / burnout symptoms - lagging negative indicator • e.g., sickness absence rate 6. Positive health & wellbeing / engagement - leading positive indicator • e.g., Staff survey: ‘I look forward to going to work’ The domains – lead and lag indicators
  • 15. 15 | 15 | Enables comparisons with peers
  • 16. Wellbeing conversations Support coming soon for wellbeing conversations Conversations training for line managers - We are now pleased to advise that we have appointed a supplier to offer a national wellbeing conversation training programme. This programme will: • Be available to all NHS organisations, including secondary care, primary care, CCGs and national organisations. • Aimed at line managers and colleagues who would like additional support in developing the skills to confidently hold a conversation about wellbeing. • Be rolled out as both a training programme, as well as a Train the Trainer model that will enable organisations to train internal facilitators for future sustainability. • Training will likely commence in July/August 2021. Further guidance and resources – further guidance and resources including case studies, example personal action plans and a supporting animation can be found here: https://people.nhs.uk/projectm_old_v1/wellbeing- conversations/ For any questions, please email ournhspeople.hwb@nhs.net
  • 17. 17 | ‘Growing OH’ programme overview Vision Drivers Enabling project areas Improving the health and wellbeing of our NHS people by growing and developing NHS Occupational Health services and our OH people to reach their full potential as strategic, integrated and proactive organisational partners Enabling OH to be a trusted, strategic, and integrated organisational partner Increased OH workforce, capacity and capability Supporting system-wide service innovation and improvement in OH Effective use of technology to support service delivery Equality of access to services that meet the needs of all our diverse NHS people Empowered OH leadership, service improvement and innovation Enhancing service standards, quality, measurement, and consistency Increased focus on proactive and preventative care Designing and embracing future models of multi-disciplinary service delivery OH service improvement pilots: Enabling a group of system wide OH service improvement pilots to design and implement future-facing models of systemic multi-disciplinary OH service delivery, and sharing the learning Community and co-design: Programme of communication, engagement and co-design events with the OH community and stakeholders to empower them to collaboratively drive the ambitions of the programme Utilising technology: Deliver a gap-analysis review into how technology can better support OH service delivery, considering current state, customer requirements, and future drivers Leadership and transformation skills: Development programmes to empower OH professionals with the leadership and transformation skills required to enable OH services to reach their full potential Identifying and sharing best practice: Capturing and sharing the impact of the programme of work and wider evidence based best practice in OH service delivery OH service delivery and workforce models: Using co-design and best practice to create a ‘blueprint’ for future- facing OH strategic and operational services models (i.e. national/system/organisation/ commissioned) Improving quality standards: Supporting the enhancement and adoption of OH quality service standards in partnership with the Health at Work network Long-term programme: Capturing impact evaluation from this year of investment into OH services to scope a potential plan for longer term investment and service improvement Creating a trusted brand: Understanding user need, purpose, positive identity, trust and how this can inform the future branding, identity and positioning of OH services Co-design, improvement and learning-focused approach Workforce data and measuring the impact of OH: Co-design of metrics for quality, future facing OH services that demonstrate impact and value of the service as a strategic partner, linked to workforce wellbeing data Growing the strategic OH brand Growing our OH services Growing our OH people Empowering OH to strategically and operationally support recovery Growing from the pandemic
  • 18. 3 Ways to join Menti: 1. Click on the the link to the poll which has been shared in the chat box 2. Scan the QR code below on your phone 3. Go to menti.com and use the code 2188 2406 Q: How high is retention in your organisations priorities?
  • 19. How high is retention in your organisations priorities?
  • 20. What’s enjoyable for you on a personal level working in the NHS?
  • 21. What’s one thing your organisation is doing or could do to best support people to stay in the NHS during these challenging times?
  • 22. Looking After Our People - Retention programme #Caring4NHSpeople #ProjectM Chris Dzikiti Head of Programmes, Transformation & Delivery, NHSE&I @ChrisDzikiti1
  • 23. People Plan overall outcome: Close the workforce gap through more people, working differently in a compassionate and inclusive culture to support the delivery of the NHS Long Term Plan. System level retention Looking after our people Growing for the future Belonging in the NHS New ways of working and delivering care Looking After Our People – Retention Programme NHSE/I strategic direction Support systems and organisations to retain their most experienced people and people early in their careers Contribute to NHSE/I support to our staff on flexible working, health and wellbeing, equality, diversity and inclusion, compassionate and inclusive leadership, pay and reward Aim of the retention programme*: to keep people in the NHS and keep them well Programme aim Programme priority areas for the next 3 years Generational perspective/ career stage Internationally trained Staff group/ Sector or service area Support systems to develop and embed retention at system level across health and social care Support systems and organisations to improve the experiences of internationally recruited NHS colleagues Understand and help to address specific needs of different staff groups and sectors “Recovery” – operational, financial and what people need over the short, medium and long term to fully recover ENABLERS People Promise areas Robust data and evidence base Retention research strategy Communications and stakeholder engagement Team building and L&D Programme agility & responsiveness *The retention programme is one of nine interdependent workstreams to deliver the 50,000 ambition. The objective is to retain more Registered Nurses (RNs) in the NHS in England by slowing the leaver rate of registered nurses employed in NHS trusts, CCGs and general practice.
  • 24. Achievements: Key milestones the Retention Programme delivered in 2020/21 24 Launched retention hub •Dedicated NHSEI webpages and NHS Futures site based on 7 People Promise themes with new case studies, • retention blogs and programme updates regularly added: •Access to verified research studies to support retention strategies and interventions •An easy way for organisations and individuals to contact the national and regional programme teams •Extending the reach of ideas and positive practice •Accelerating uptake of new evidence based interventions •Tangible examples for organisations to build into local workforce plans •Making case for change for retention initiatives Delivered intensive pathfinder sites in every region •Pathfinders cover 7 regions, 10 systems, 77 Trusts •Building trusting relationships led to deeper understanding and collaboration between national, regional and system colleagues •QI methodology approved by board level SRO’s as useful mechanism to support local transformation - even within Covid-19 context •NEY Community of Practice network saw people and organisations accelerate learning from one another •Enhanced system level maturation and collaboration system wide standardised approaches to flexible working implemented Developed generational focus for ‘flight risk’ groups •Identified and met with 12 national exemplar organisations retaining people in early years and/or later years – ideas and solutions shared across the country at national event •Held 2 focused national events (with early and later years people) - over 100 participants shared ideas and learning & informed generational programme •The support offer includes pension guidance, preceptorship, flexible working, legacy mentoring, support for BAME staff and menopause programme Designed Retention Dashboard and Model Health System Retention Compartment •National and regional teams able to track performance against trajectory and early warning indicators at national to organisational level. •Self-service diagnostic tool providing increased system capability. •Systems and organisations are able to review their own data, track improvement and benchmark against peers to enable them to make informed decisions. Embedded research within the national programme •Set up research workstream to test programme assumptions against latest evidence. •Literature search and gap analysis of retention research – building in evidence to programme development. •Evidence from research suggests that different ages and career stages have different expectations and behaviours due to individual needs, motivations and challenges. (please refer to annex for further research information on why nurses stay)
  • 25. Should I stay or should I go? – NHS staff retention in a post COVID world… #Caring4NHSpeople #ProjectM Dr Andrew Weyman Principal Investigator ESRC research University of Bath
  • 26. Should I stay or should I go? NHS staff retention in a post-COVID-19 world…. RESEARCH TEAM: ANDREW WEYMAN & DEBORAH ROY – UNIVERSITY OF BATH PETER NOLAN – UNIVERSITY OF LEICESTER JOANNE COSTER – UNIVERSITY OF SHEFFIELD RICHARD GLENDINNING AND RACHEL O’HARA – CONSULTANTS. Funder: Economic & Social Research Council
  • 27. Should I stay or should I go? NHS staff retention in a post-COVID-19 World Key Research Questions 1. How will the Covid-19 pandemic impact on staffing resources in the short & longer term? 2. What impact will the legacy of the crisis have on the resolve & capacity of current NHS employees to remain? 3. Will this be strengthened or weakened by their experiences? 4. Which variables predict exit & what are the employment destinations of those who leave?
  • 28. 3 Complementary Work Packages • Social survey Wave 1 - YouGov panel. Sample: 1,962 (Dec 2020 / Jan 2021); Wave 2 - YouGov panel + RCN + RCM + CSP + UNISON + 8 NHS Trusts. Sample: 2,000 + 5,000 (July – Aug 2021) • Case studies 6 NHS Trusts (Acute; Ambulance; Mental Health; Community) – qualitative interviews (June-August 2021) • 2ndary data UK Labour Force Survey; NHS staff survey (July-Sept 2021)
  • 29. 3 Complementary Work Packages Integration of evidence • Social survey – What? Who? Where? and How many/how much? • Staff interviews – Why? How? and In what way? • Secondary data – Employment destinations of leavers? Policy relevance: Identification of incubating threats to: (i) NHS resilience (ii) Employee well-being & resilience Intervention relevant evidence: (i) What? (ii) Who? (iii) Where? and (iv) How?
  • 30. Social Survey – Themes explored, include (1): Workload Working hours Staffing & resources Job satisfaction Health status • Mental • Physical ‘Comparing the period before the emergence of COVID-19 in March 2020 with the current situation where you work – would you say this has: got better, got worse or is it unchanged?’ Support • Colleagues • Line manager • Employer Recognition • Public • Employer • Government
  • 31. Social Survey – Themes explored, include (2): • Being redeployed to work with COVID patients? • Being pressured to receive a COVID vaccination? • The impact of my work on my mental health? • The impact of my work on my physical health? • Being given too much responsibility? • Bring asked to do work I’ve not been trained for? • Standards of COVID infection control in my team? • Not having enough time to do my job properly? • Making mistakes because of my workload? • Effectiveness of PPE? • Abnormally high staff shortages? • Colleagues lacking necessary skills & competencies? • Being more vulnerable to COVID due to my ethnicity? ‘To what extent are the following currently a worry for you?’ (Scale 1= Not at all worried – 10 = Extremely worried) % who raised concerns with line manager?
  • 32. Social Survey – Themes explored, include (3):  Talked to colleagues/former colleagues about job opportunities outside the NHS?  Actively looked at vacancy lists for jobs outside the NHS  Requested details of a job(s) outside the NHS  Submitted an application(s) for jobs outside the NHS  Been interviewed for a job(s) outside the NHS  Been offered a job outside the NHS Strength of intention to leave: ‘During the last 6 months have you:’
  • 33. Social Survey – Themes explored include (4): . Staff views on priorities for change? Ranking push & pull influences • Reasons why staff in your type of job leave the NHS? • What needs to change to encourage staff in your type of job to remain in the NHS? Time pressure Mental health/stress Staffing levels Working hours Workload (intensity of work) Pay Recognition of contribution Work/home life balance
  • 34. Occupational group (% of sample) Wave 1 Survey Sample Profile 0.1% 0.4% 0.5% 1% 2% 2% 3% 6% 6% 7% 12% 15% 15% 30% 0 5 10 15 20 25 30 35 Other Commissioning Managers Clinical Management Social Care Ancillary&support Clinical Psychology Ambulance Admin Man Central tech; admin/Corp services Scientific and technical Medical/dental Admin & Clerical (inc Med Sec) Allied Health Nursing Percentage of Sample
  • 35. Interviews with NHS staff Sample – 6 case study NHS organisations. • Senior managers • Line managers • Front line health professionals • Health care support • Front line admin & support Objectives: Personal accounts of impacts of COVID on individuals, colleagues & functions. Detailed insight into how and in what ways identified variables impact on staff well- being & leave / remain orientations. Insight into what might need to change & in what way(s) to maintain / enhance staff- well-being & retention.
  • 36. Secondary data sources UK Labour Force Survey (2010-20) ◦ Map patterns of migration from the NHS ◦ Employment destinations of leavers ◦ Exit profile e.g. age and rates for different professions NHS staff survey (2017-2020) ◦ Explore variables that predict employee disposition to leave the NHS All-NHS age profile
  • 37. Discovering & mapping impacts of COVID19 on NHS employee well-being and staff retention . Analysis - An epidemiological perspective • Identifying differential impacts e.g. by profession; grade; type of service; age, experience, gender, ethnicity, region / country • Identification of vulnerable demographics - groups of employees - who? & where? • The relative importance of recognised drivers of exit. • The relative importance of variables that encourage staff to remain • Intervention relevant insight into what might need to change & in what way(s) • to maintain / enhance staff well-being • to maintain / enhance staff retention rates • whole population (one size fits all) or segmented solutions?
  • 38. Delivery & reporting Summary • Wave 1 UK wide NHS survey – completed Jan 2021 • Wave 2 UK wide NHS staff survey commenced – July 2021 • Case study interviews with NHS staff - commenced – June 2021 • Secondary data analysis – commenced July 2021 Reporting of results, dissemination of findings & implications: • Late Summer / Autumn 2021
  • 39. Supporting Health and Wellbeing: Choosing to Stay? #Caring4NHSpeople #ProjectM Guy Dickson Head of People Strategy, North Bristol NHS Trust @mrguyd Dr Katie Egan Psychotherapist, Staff Wellbeing Psychology team Bristol NHS Trust @nbt_staffpsych @nbtwellbeing
  • 40. 12,000 staff 500,000 outpatients 70,000 inpatients 40,000 operations 100,000 ED visits
  • 41. A difficult past… • 2014: 2 hospitals merged • 2015 CQC: “Requires Improvement”; “Plans not realistic” • 2015: financial special measures. • Command and control • Then winter 2017/18
  • 42. Turning point: Winter 2017-18 at North Bristol NHS Trust Nov 2017: 5th worst survey result in 116 Acute Trusts for “my organisation takes action on health and wellbeing”
  • 43. A new paradigm: • Developed programme structured around Mental Health, Physical Health, and Lifestyle. Wellbeing “Menu”, 5 WTE psychologists, 2 physios, EAP, MHFA,TRiM, Champions, etc. • Reduction in sickness absence (3,928 WTE days 2017 to 2018) • Increased engagement (6.8  7.1) • Improved CQC Rating (requires improvement  good) • Awards including 2019 Parliamentary Award • Nov 2020: Ranked 21st best of 128 Acutes for wellbeing CQC 2019: “with a strong focus on staff wellbeing, all staff felt supported and valued despite the significant pressures of the job”
  • 44. NBT’s Wellbeing Approach • A tiered pathway of support • Encouraging conversations • Mirrored in system Mental Health Hub • Focusing support on difficult areas: Covid wards, redeployees, Facilities etc.
  • 45. Team support I will remember that the struggles/thoughts I have had are shared ones (clinical fellow Dr). Thank you very much for the time and effort we received. I think this initiative by NBT within this period of massive change and stress will have been invaluable to support staff and ensure we have the support mechanisms we need Request: • Mental Health First Aid Training? Worried about Junior Docs Intervention: • Bespoke package • Peer to Peer support – more sustainable, all staff included. • Consulted with ED consultant, ward sister, another Dr, local Psychologist. • Developed interactive training for all staff, plus supported staff-led working group to consider the anonymous feedback received Outcome: • Running training 5-6 times per year. The feedback gets reviewed at the wellbeing working group and they implement changes as a result. • Team are checking in & out more with each other and having more pitstops (see Start Well>End Well ) • More able to check in with colleagues of different professional groups. • Staff more aware of other available support in NBT e.g. ACT courses, trauma focussed 1:1. Bespoke wellbeing intervention with the Emergency Department Case Study Being more aware of how people are managing in work and asking if they are ok. Ensuring people know I’m happy to listen. (Nurse) Great session and wish this sort of awareness/support had been available years ago – THANK YOU! (consultant)
  • 46. If a colleague in NBT was in need of similar help, would you recommend the staff wellbeing psychology sessions to them? 100% responded “Yes” Individual support Case Study Senior Consultant (surgeon) 1:1 Support Referral: • Consultant distressed after a patient death. Thought she might have PTSD. Was signed off work on sick. • Decision making was really difficult, sleep was poor, her anxiety was really high, felt concerned she would make more errors and wasn’t safe. • Was considering leaving the profession. Intervention: • EMDR + formulation i.e. making sense of perfectionistic tendencies and feelings of ‘not being good enough’ came from. Outcome: • See feedback below. • Consultant after a phased return has now returned to full time work and is operating again with confidence and enjoying her work. ‘Clinical’ levels of psychological distress fell in staff from 94% of staff to 22% following individual support. (CORE -10)
  • 47. Supporting wellbeing informed management approaches Me+MyTeam - facilitated 1:1 consultation session for team leaders and managers to reflect on the wellbeing of their team, and practical ways to support team dynamics and team wellbeing going forwards. In the last 12 months, we have supported 89 teams with this and other bespoke sessions Sharing this approach in the coming weeks through a webinar with NHS England and NHS improvement: 28 July @ 4pm I found it useful to attend with colleagues, and I hope that attending together will help us apply the learning to our team as a whole (as well as the smaller teams that we lead).
  • 48. • Flu vacc / covid booster: how make a wellbeing space • Linking Datix to wellbeing support • Sir Michael West, Burnout white paper 2021: “I want to be clear about the issue of excessive workload. The danger is that we do not see it. It is like the pattern on the wallpaper that we no longer see, but it is the No. 1 predictor of staff stress and staff intention to quit. It is also the No. 1 predictor of patient dissatisfaction...” • One NBT Festival: 5 days of wellbeing showcase and fun 1-5 July: yogalates, Schwartz Rounds, BBQ, NHS Big Tea, wellbeing stalls, thank you box, online music, bird watching, etc. 2021: An Emerging Wellbeing Culture
  • 50. In the chat box… Share one thing that you're going to do as a result of joining the session today... Photo by Júnior Ferreira on Unsplash
  • 51. Very helpful Not helpful To what extent has today’s session been useful in your own role supporting staff health and wellbeing during and after Covid-19? POLL If you are on YouTube or the poll doesn’t work for you on Zoom, write your number in the chatbox