Press Release: Big differences in NHS employment practices puts patients and local economies at risk

The Centre for Progressive Policy today launches a new NHS employer index, which ranks the employment practices of all English NHS trusts and compares them to the country’s largest employers.

The NHS is the nation’s largest employer and CPP analysis reveals how the health of its patients and the wellbeing of its staff go hand in hand - trusts ranking as better employers report higher patient satisfaction and are more likely to be in financial surplus.

Despite the importance of good employment, the index reveals many trusts are falling behind:

  • The average NHS trust would rank 9th out of the UK’s 26 largest employers with it falling short on social mobility and commitment to paying the real Living Wage.
  • Four trusts at the top end of the index have similar scores to the top employer in the index (John Lewis) while four at the bottom end have worse scores than the organisation at the bottom of the index (Capita).
  • One in ten trusts have a gender pay gap of over 20p, whilst 1 in 4 trusts manage a smaller gap of less than 5p.

With increasing emphasis on the NHS’s wider role as economic anchor within deprived communities, CPP analysis shows that trusts in poorer places are no better or worse employers than anywhere else. For the term anchor to mean anything, these trusts must become exemplar employers.

In the context of troubling staff shortages, the index also reveals how some trusts are consistently better than others:

  • All ten ambulance trusts are in the bottom 11. Ambulance trusts scored particularly poorly for work-life balance, reporting high levels of overtime while staff also gave poor ratings for career opportunities and training.
  • Community trusts are mostly, but not exclusively, ranked towards the top of the index. They are more likely to be signed up to schemes such as being a Disability Confident employer, or the real Living Wage, and have a lower gender pay gap.
  • Acute and mental health trusts are mostly in the middle within a moderate range of scores.

To improve, CPP are calling on the NHS to:

  • Focus on social mobility and paying the real Living Wage to improve on its employment practices and play its part in creating inclusive economies.
  • Address the poor performance of ambulance trusts. Recommended key steps are the implementation of the 2018 Carter Review as well as extending the National Retention Programme to ambulance staff.
  • Set up a national Employer Vanguard which would bring together the very best NHS employers in order to construct best practice pathways for different types of trusts. Such approaches are already being tried and tested in order to standardise clinical practice (such as the Cancer Vanguard).
  • Build on emerging formal models of collaboration such as the Acute Care Collaboration Vanguards. Good employment practice should be increasingly ingrained into these new models, especially as the NHS transitions towards more integrated local health and care systems.

On publishing the index, Ben Franklin, Head of Research, Centre for Progressive Policy, said,

“With the government focused on the dual challenges of improving the health service and levelling-up the economy, now is a good time to explore how the NHS could become a better employer.

Sitting at the heart of many communities, the NHS can be both a force for better health and stronger local economies. In some places, the health and social care sector accounts for upwards of 15% of local economic output. Local health institutions should use their sizeable economic weight to support better pay, higher skills and career progression in these areas, which would also address a key social determinant of poor health – low quality work”.

CPP Good Employer Index for the NHS and the UK’s 25 largest employers

Notes to the editor:

  1. The report can be downloaded here
  2. Find the ranking of all NHS trusts attached to this email.
  3. About this report: Population health is a cornerstone of inclusive economic growth. Our yearlong inquiry into the future of health underlined the reciprocal relationship between health and the economy and explored the importance and limitations of the NHS in delivering better health nationwide. The beating heart of the NHS is its workforce, and in February this year, the NHS will publish its People Plan to outline how it will meet ambitious recruitment and retention targets in the face of rising demand and uncertainty about its post-Brexit labour supply. Against this background, this report examines the role of the health service as an employer and provider of good jobs — utilising the CPP’s Good Employer Index to rank all 223 NHS trusts. This allows us to comprehensively answer the following key questions: To what extent is the NHS a good employer relative to other large employers? How and why does employment practice vary across the NHS? How is the NHS a force for ‘levelling up’ pay and employment practices across the country?
  4. About CPP: The Centre for Progressive Policy is a think tank committed to making inclusive economic growth a reality. By working with national and local partners, our aim is to devise effective, pragmatic policy solutions to drive productivity and shared prosperity in the UK. Inclusive growth is one of the most urgent questions facing advanced economies where stagnant real wages are squeezing living standards and wealth is increasingly concentrated. CPP believes that a new approach to growth is needed, harnessing the best of central and local government to shape the national economic environment and build on the assets and opportunities of place. The Centre for Progressive Policy is fully funded by Lord David Sainsbury, as part of his work on public policy.
  5. For more information on the Centre for Progressive Policy, please see or follow @CentreProPolicy
  6. For interview requests contact Thomas Hauschildt, Communications Manager, Centre for Progressive Policy:, 020 7070 3370