The NHS has a stated aspiration to make itself the best employer. This report applies the CPP Good Employer Index to each of England's 223 trusts to assess the NHS's current performance and what it needs to do to meet this aspiration. Download the full report and dataset below.

Population health is a cornerstone of inclusive economic growth. Our year-long 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 March 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 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?

All data analysis referred to in this report relates to NHS institutions in England.

Summary of key findings

1. The NHS ranks 9th out of 26 in CPP’s Good Employer Index. The NHS falls particularly short on social mobility and commitment to the real Living Wage.

2. There are big variations across NHS trusts: four trusts at the top end have similar scores to the top employer in our index (John Lewis) and four at the bottom end have worse scores than the organisation at the bottom of our index (Capita).

3. Trusts that perform well in the index tend to have higher CQC ratings and greater patient satisfaction.They are also more likely to be in financial surplus.

4. The NHS is broadly place-neutral on employment practice

- The NHS’s universal pay scales help to level up pay across the country. Areas that have higher than average median pay for non-NHS employment do pay NHS staff more, but the relationship is less than 1:1. For instance, in an area where local pay is 10% higher than average, NHS staff would expect to earn 5% more than the average median pay across the health service.

- But universal pay scales present a problem. Trusts in areas with higher non-NHS pay (and a higher cost of living) have lower staff satisfaction, lower overall employment scores and higher turnover — with London trusts performing particularly badly.

- There is increasing emphasis on the NHS's wider role as economic anchor particularly within deprived communities where the healthcare sector accounts for a large part of the local economy. However, CPP analysis reveals that trusts in these areas perform no better or worse in terms of employment practice than anywhere else.

5. There are clear differences in employment practice by type of trust:

- 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.

- 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.

- Acute and mental health trusts are mostly in the middle within a moderate range of scores.

Implications for raising NHS employment performance

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.

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