Leading change

Directors of Nursing jointly led a Nursing Development Programme at South London Mental Health and Community Partnership (SLP). The SLP is a collaboration between three Mental Health Trusts, Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George’s Mental Health NHS Trust, between them delivering mental health services to a population of more than 3.6 million people. Nurses were also appointed to develop and implement change at each Trust. The programme has improved staff experience and career development as well as improved recruitment and retention rates resulting in better patient outcomes experience and use of resources.

Where to look

The Long Term Plan (2019) identifies that the performance of any healthcare system ultimately depends on its people – the NHS is no exception. The NHS is the biggest employer in Europe and the world’s largest employer of highly skilled professionals. 1.3 million people across the health service in England are devoting their working lives to caring for others. Working in the NHS demands the highest levels of skill and compassion, and the NHS attracts some of the very best people from home and abroad. But, over the past decade, workforce growth has not kept up with need, and the way staff have been supported to work has not kept up with the changing requirements of patients.

Nursing leads at SLP also recognised these challenges.  Unwarranted variation was identified from the data on staff retention rates, agency use and staff turnover levels. These were periodically rising above expected levels across all three organisations. The importance of developing a stable and suitably skilled nursing workforce for a changing, modern mental healthcare was evident. The senior nurses identified they had to address the issues of recruitment, development and retention of highly qualified experienced staff.  This would have the potential to significantly contribute to the SLP aims of continuing to provide improvements in care and access which improve patient experience and outcomes across the system.

What to change

A Nursing Development Programme covering the three Trusts was formed and jointly led by the Directors of Nursing and with Development Nurses appointed on full-time secondments. Identifying what to change was informed by the research findings of an in-depth review of staff views and experience. This helped to gain insight into what would improve nurses’ working lives and were conducted by the Development Nurses leading the implementation at trust level.

A total of 35 face to face interviews were carried out and a detailed questionnaire was designed using a five-point Likert scale. Of those surveyed, 340 responses were received. The questionnaire covered five main domains with sub-segmented questions in each covering: development opportunities, motivation and job satisfaction (including standards of care).

The review findings identified that across the SLP nursing workforce, benchmarking and standardising in many areas was required, including:

• core skills/competencies at each grading band;
• job descriptions;
• clear career development pathways – the research highlighted 46% of colleagues believed there was no clear pathway for nursing staff;
• better flexibility and wider experiences – 55% of colleagues identified opportunities such as rotation and partnerships between the Trusts would help retain them in the south London workforce;
• better training opportunities; and,
• more face-to-face nursing time with patients.

How to change

The Nursing Development Programme team set out to develop and implement change at each Trust, with regular cross-Trust workshops, working and steering groups.

Many staff consultation events were held, which supported the development and launch of new standards, including development of:

• Bands 2-6 career development framework;
• common job descriptions and competencies for Bands 2-6 nursing roles;
• new Band 4 Nursing Associate roles to provide a career development path for existing Band 3 staff and upskill ward teams;
• employee passport enabling quick and easy movement between the Trusts without duplication of background checks or mandatory and statutory training (MAST);
• joint recruitment campaigns and an open day for CAMHS staff including joint panels with senior nurses interviewing and assessing candidates at partner Trusts;
• developing shared Band 7+ development framework and pathways; and,
• funded post-graduate training opportunities.

The Nurse Development Programme is supporting the standardisation of a number of core elements of the nursing workforce skills and competencies across the Trusts building upon successes and highlighting areas of challenge. The programme has also addressed unwarranted variation in recruitment and assessment of performance frameworks across South London.

Adding value

This successful programme is now in its second year and has already delivered positive results. The long-term outcomes will continue to be measured including nursing staff retention/turnover and vacancy rates/use of agency staff.

Better outcomes – Engagement, knowledge and best practice-sharing across the areas has improved which supports staff to deliver high quality care. There are early signs of improved retention rates including increased retention of newly qualified nurses, with a full-year analysis planned. Staff sickness rates have reduced by 1.5% which is positive and has contributed to lesser use of agency staff. All Trusts in the SLP have been rated as ‘good’ by 2018 Care Quality Commission regulator which is positive. More than 70, staff are on the Nursing Associate development programme which is a real sign of success as they go onto develop their skills and confidence and remain retained by the Trusts. 18 nurses are being supported to undertake specific clinical post-graduate courses to develop their skills and competencies.

Better experience – The programme has been well received by staff at the Trusts. An example of this is a Band 4 support worker who undertook the programme and reported:

“I feel confident and empowered to take on extra responsibility. It has been a very positive experience and definitely enhanced my feeling of professionalism. The NHS is evolving, and we can’t stand still. We need to constantly improve our skills and knowledge”

By increasing skill mix into mental health ward teams there is potential to increase time with patients which improves experience for all.

Better use of resources – Having a more consistent ward teams and staffing levels is anticipated to support the wards to achieve consistent standards of patient care across the Trusts including but not limited to best use of resources and retention of staff. A benchmarked and consistent transferable-skilled workforce across South London is being established so patients access consistent high-quality levels of care and staff are kept locally. There have also been cost savings noted in a reduction in agency spend as vacancies for sickness and staff who have left the Trust are reducing in numbers.

SLP is continuing to focus on embedding new ways of working and next steps include broadening opportunities and formal development pathways for nurses at Band 7 and above into clinical, operational and general leadership roles. SLP plans to develop more community-based interventions, therapies, assessment and planning skills.

The Nursing Development Programme has won the Nursing Times Workforce Award for Best Workplace for Learning and Development (over 1500 staff) in 2018 and was shortlisted for the Health Service Journal (HSJ) Awards – Workforce category in 2018.

Challenges and lessons learnt for implementation

• Working across three different Trusts required time and investment in building trust and relationships at all levels. The multiple policies, practices, personalities and cultures had to be considered and a pragmatic approach enabled flexibility to reflect differences.
• It is important to engage with staff to obtain their input, share experiences and challenges and build consensus at every level. Rapport and trust can be built by recognising different leadership styles and supporting one another. It was important to give Development Nurses time to settle into a new role and empower them to focus on delivery.
• A key element to success has been the shared and aligned goals of improved patient care, staff satisfaction and retention in the partnership.

For more information contact

David Rose
Communications and Engagement
South London Mental Health and Community Partnership
david.rose@slam.nhs.uk

Magda Berge
SLP Nursing Development Programme Project Manager
South London Mental Health and Community Partnership
Magda.Berge@swlstg.nhs.uk