A few years ago I was a non-executive at a large NHS Trust. At my final Board meeting I was struck by the symmetry of my time on the Board. At my first meeting, we had had a discussion on the nursing workforce and the challenge of recruiting and retaining staff. At my final Board meeting some four years later we were discussing the same issue. This wasn’t unique to us. Staff recruitment and retention is a challenge for the NHS across the country. But one thing that did make this conversation particularly poignant was that we were based in a part of the country with high long-term unemployment.
This experience came back to me when the Health Foundation was exploring the role of the NHS as an anchor institution. In many towns and cities, two of the institutions with the greatest longevity are the NHS and, sadly, the Job Centre. Given the constant challenge of filling vacancies in the NHS, it made me think: What if the NHS set out to put the job centre out of business?
There are lots of reasons why the NHS could be focusing more attention on recruiting from its local community. First, it needs the staff. A recent Health Foundation report shows that the primary and community care sector, in particular, are facing shortages. The number of GPs has fallen by 1.6% – 450 full time equivalent (FTE) staff – over the year in September 2018, moving further away from the government's pledge to find 5,000 extra GPs by 2020. Similarly, the numbers of nurses and health visitors working in community health services have continued their long-term decline, falling by 1.2% (540 FTE staff) in July 2018 compared to a year before.
The steady decline in the workforce is also exacerbated by more recent challenges in recruiting from outside the UK. Health Foundation analysis of the latest Nursing and Midwifery Council data shows that the number of new nurses from EU coming to work in the UK has dropped by 87% from 6,382 in 2016/17 to 805 in 2017/18.
But a strategy for more local recruitment shouldn’t be viewed simply as a fix for current workforce challenges. It needs to be viewed more holistically in terms of the wider value that can be generated by the NHS working more purposefully to employ people from its local community – particularly those that are from communities that face significant disadvantage. A local recruitment strategy would need to be viewed over the longer term, it would require relationships to be developed between local NHS organisations and local schools and colleges. Starting by increasing contact between young people and the NHS at an early stage, such a strategy could create opportunities for young people to visit, volunteer and do work experience. All of which can help young people see the range of roles and career paths that an organisation as complex as the NHS has to offer. However, creating these opportunities wouldn’t just increase the chances of young people considering a career in the NHS, they can also help young people build self confidence, inter-personal skills and networks. The Health Foundation’s inquiry into young people’s future health prospects has found that building these skills and attributes are important in helping young people make a successful transition to employment – a core foundation of a healthy life.
Drawing from the local workforce has wider benefits for the NHS than simply filling posts. It creates roots into the local community. Creating a more porous boundary that can enable the NHS to have more awareness of the wider opportunities that exist to support patients in the wider social aspects of healing – community groups, arts space, walking clubs etc. It will also enhance the understanding of local factors that may be impeding people’s ability to live a healthy life.
We welcome the CPP’s report calling to establish the NHS as an anchor institution. However, while the opportunities and value of the NHS viewing itself as an anchor institution and looking for stronger links with its local communities may be evident, the shift in culture this requires shouldn’t be underestimated. The Health Foundation has been working with the Centre for Local Economic Strategies and the Democracy Collaborative to build more insight into how this potential can be realised. It goes beyond the opportunities of it being an employer of over 1.5 million people nationally and includes the social value that can be created by exercising its purchasing power of some £27bn annually, its stewardship of 6,500 hectares of land across more than 8000 sites and addressing its 40% share of the public sector carbon footprint.
Exercising a wider role in creating value will be essential if the NHS is to move away from treating and managing disease when it occurs to creating to conditions for people to live healthy lives. This will require the NHS to change its relationships with local communities and work in much closer partnership with local authorities. This won’t always be easy given the NHS’s history of ‘looking up rather than looking out’ but the benefits of doing so will be repaid several times over as it helps to address some of its own challenges short term and the health of the population long term.
Jo Bibby is Director of Health at The Health Foundation, where she leads the Healthy Lives Strategy. She has worked in health care at local and national level for 25 years, including 10 years at the Department of Health. Previously Jo was Head of NHS Performance where she oversaw the policy agenda set out in the NHS Plan. At the NHS Modernisation Agency, Jo led an international quality improvement initiative – Pursuing Perfection. She was the Director for the Calderdale and Kirklees Integrated Service Strategy, as well as serving as a non-executive director of Salford Royal NHS Foundation Trust.