5. Supporting our current NHS staff

4.35. People are proud to work in the NHS. Three-quarters of respondents to the 2017 staff survey reported they are enthusiastic about their job, and nine in 10 agreed their role makes a difference to patients and service users. However, the leaver rate for nurses was 8% in 2017 – up from 6.8% in 2013. Growing the NHS workforce will partly depend on retaining the staff we have. Training lead-times mean new investment in staff  will  not  deliver  additional supply for at least three years. This means concerted action to support employers in retaining staff is an urgent priority now and will remain a necessity throughout the next decade.

4.36. NHS Improvement’s Retention Collaborative has already delivered substantial measurable improvements through targeted support for trusts with high turnover. We will extend this support to all NHS employers, and NHS Improvement is committed to improving staff retention by at least 2% by 2025, the equivalent of 12,400 additional nurses.

4.37. One of the top reasons for people leaving is that they do not receive the development and career progression that they need. CPD − or more specifically workforce development – has the potential to deliver a high return on investment. It offers staff career progression that motivates them to stay within the NHS and, just as importantly, equips them with the skills to operate at advanced levels of professional practice and to meet patients’ needs of the future. HEE has committed to increase the proportion of its total budget spent on workforce development in the short-term, with a focus on primary care and community Support from employers is also key – in particular ensuring that staff are given the time out to develop their skills. Following agreement of the HEE training budget in this year’s Government Spending Review, we will expect to increase investment in CPD over the next five years.

4.38. We will expand multi-professional credentialing to enable clinicians to develop new capabilities formally recognised in specific areas of competence. This will allow clinicians to shift or expand their scope of practice to other areas more easily, creating a more adaptable workforce. With partners, we have already developed several credentials, for example the Royal College of Nursing’s Advanced Level Nurse Practitioner credentialing scheme and the Royal College of Emergency Medicine’s credentialing for Emergency Care Advanced Clinical Practitioners. We will accelerate development of credentials for mental health, cardiovascular disease, ageing population, preventing harm and cancer, with the intention of publishing standards in 2020.

4.39. Inflexible and unpredictable working patterns make it harder for people to balance their work and personal life obligations. To make the NHS a consistently great place to work, we will seek to shape a modern employment culture for the NHS – promoting flexibility, wellbeing and career development, and redoubling our efforts to address discrimination, violence, bullying and harassment. Many of the building blocks for this work are already in place in parts of the The Social Partnership Forum has set out an important programme on bullying and harassment.

4.40. It is unacceptable that a quarter of staff experienced harassment, bullying or abuse from other staff in the last 12 months. The workforce implementation plan will aim to shape a new deal for frontline staff. It is an opportunity to work with staff, employers and trade unions to build a modern working culture where all staff feel supported, valued and respected for what they do. And where the values we seek to achieve for our patients – kindness, compassion, professionalism – are the same values we demonstrate towards one another.

4.41. The NHS has recently launched a new programme to tackle violence. This includes working with the police and Crown Prosecution Service to secure swift prosecutions, improved training for staff to deal with violence and prompt mental health support for staff who have been victims of violence. As part of our action on violence in the NHS, we will pilot and evaluate the use of body worn cameras by paramedics. We will not tolerate violence against NHS staff and, where justified, will always seek to prosecute incidents of verbal and physical abuse. We will invest up to £2 million a year from 2019/20 in these programmes to reduce violence, bullying and harassment for our staff. We will invest a further £8 million by 2023/24 to pilot the use of body cameras to keep our staff safe.

4.42. Respect, equality and diversity will be central to changing the culture and will be at the heart of the workforce implementation plan. The NHS draws on a remarkably rich diversity of people to provide care to our patients. But we fall short in valuing their contributions and ensuring fair treatment and respect. Through the Workforce Race Equality Standard, we are making progress in addressing these issues from the perspective of BAME staff. However, two years is not long enough to achieve the necessary change and so NHS England will invest an extra £1 million a year to extend its work to 2025. Each NHS organisation will set its own target for BAME representation across its leadership team and broader workforce by 2021/22. This will ensure senior teams and Boards more closely represent the diversity of the local communities they serve. We will also develop a new Workforce Disability Equality Standard with the aim of the NHS becoming a model employer in this regard.

4.43. We need to ensure equality for women, who make up three quarters of our workforce. The review of the Gender Pay Gap for doctors will contribute to gender equality in the NHS. However, the issue is broader and more complex and, in addition, concerns about the experiences of LGBT+ staff are highlighted by the staff survey. To strengthen our existing programme to support equality and diversity in the NHS, the new Chief People Officer will consider what more we need to do involving the Social Partnership Forum, NHS Employers, and members of the NHS Equality and Diversity Council.

4.44. The best solutions come from staff themselves. Talk Health and Care allows staff to post ideas, questions and challenges, and is already providing useful insights into the experiences of our people. NHS England is also backing #ProjectA, a 12-month, staff-led engagement exercise with 2,000 staff across all 10 ambulance trusts in England. Teams of ambulance staff and patients identified six priorities to be implemented across the country, including how to reduce stress and isolation for frontline staff.

4.45. An expanded Practitioner Health Programme will help all NHS doctors access specialist mental health support, providing a safe, confidential non-stigmatising service to turn to when they are struggling and need help. This means the NHS will have the most comprehensive national mental health support offer to doctors of any health system in the world [167].

4.46. The NHS Chief People Officer, working with the national workforce group will take action for all NHS staff to:

  • improve health and wellbeing, building on the NHS Health and Wellbeing Framework that includes recommendations from the Stevenson/Farmer review of mental health and employers, and to support improved health and wellbeing of staff and management of sickness absence;
  • support flexible working, including clarity on the proportion of roles to be advertised as flexible; and the ability to express preferences about shifts further in advance enabled by e-rostering technology introduced over the next year and associated applications;
  • clarify expectations on induction and other mandatory training;
  • enable staff to more easily move from one NHS employer to another;
  • set expectations for the practical help and support our staff should receive to raise concerns, or inappropriate behaviours, confidentially.


167. NHS England (2018) NHS to prioritise doctors’ mental health. Available from: https://www.england.nhs.uk/2018/10/nhs-to-prioritise-doctors-mental-health/