Welcome to the new best practice section of our website. Here you will find a searchable, growing database of examples of good practice in healthcare employment in answer to the many people registered with us who told us they want more good practice information. And, with a health service facing significant cutbacks, the time for adopting and adapting ideas that have led to major savings or more efficient patient care has never been more crucial. The website will be updated regularly with new examples and contact details kept up to date as far as possible.
We welcome any feedback or contributions.
Enabling continuous improvement
Every day three people die as they wait for an organ. The organ donation taskforce was set up to tackle this situation, and in January 2008 it called for a 50% increase in organ donation rates by 2013. The taskforce highlighted the need for every UK hospital to identify key clinical staff to champion organ donation within their hospitals, and for these champions to be supported by donation committees. It also directed that people involved in the care of potential organ donors should receive bespoke training for their role....
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Enabling continuous improvement
At Royal Surrey County Hospital FT it was felt that a continuous improvement programme was needed to enable staff to make the frontline changes needed to improve patient care and efficiency. The trust wanted to ensure that it had a supply of experienced patient care, service and quality improvement experts....
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Creating a multiskilled primary care workforce
The practice manager at Avicenna Medical Practice felt that administrative staff were not working to their full potential; she had staff who were extremely experienced in various administrative aspects but were not using these skills in their daily work. This seemed a waste of skills and was also affecting morale as staff felt undervalued, and unable to show initiative and use their skills....
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Using a whole systems approach to widening participation
NHS West Midlands recognised that a more refined approach to the Widening Participation agenda needed to be developed; one that would ensure flexible and accredited pathways of learning, both personal and professional, to enable better transferability of skills and competencies between organisations....
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Developing clinical support staff
The trust decided the best solution was the creation of a band 4 associate practitioner role. This involved the creation of a career framework straddling the traditional unregistered/registered boundary thereby widening access to employment and preregistration training....
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Setting up an apprenticeship scheme
The geographical area in which NHS Birmingham East and North serves covers half of Birmingham. It is an area with one of the highest rates of unemployment within the UK and skill levels below the national average. The trust felt there was a need to engage with the younger population of the local community and to resource new talent....
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Saving temporary staffing costs
With 5,500 staff, University Hospital of South Manchester NHS Foundation Trust (UHSM) is a large, foundation, acute, teaching hospital trust, Prior to 2003, UHSM operated its own internal nursing bank service with widespread use of agency staff. The trust had very limited, paper-based information to help it manage demand or to control usage of expensive agencies. The trust also had difficulty recruiting health care assistants (HCA) from the local health economy....
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Recruiting health visitors
Cornwall's children's directorate was unable to recruit health visitors to its service, and held eight vacancies. Care provision within health visiting focused on crisis management only, which was not a sustainable position. A sustainable and flexible work based learning approach to widen the access to the health visitor role was needed....
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Recruiting and retaining support staff
For some years, Cwm Taf Local Health Board in South Wales had recruited staff who were already in employment to these traditionally hard-to-fill posts. As a result the many, long-term unemployed local residents didn't see working for the NHS as a realistic prospect....
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Developing a therapy assistant role
Whittington Hospital NHS Trust was looking at new roles as part of its requirement to address national initiatives and local financial pressures....
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Radiographer-led breast cancer follow up service
At Velindre Cancer Centre, breast cancer patients were seen in the outpatient environment twice (a year apart) - once to generate the request for imaging and then to receive the results.Tthis resulted in costs incurred for the administration and clerical time as well as the medical consultation, nurse, radiographer and radiologist time. The clinics frequently overran by several hours resulting in stressful situations for patients and staff alike....
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Supported early discharge for stroke patients
It is recognised that early supported discharge to a specialist team in the community, but with a similar level of intensity of care as an inpatient stroke unit, can lower overall costs and reduce long term mortality and institutionalisation rates. However, pre-existing community services for University Hospitals Bristol NHS Foundation Trust were unable to support the specialist multidisciplinary requirements that the early transition of patients from hospital to home require....
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Establishing an orthopaedic physiotherapy practitioner role
At Poole Hospital NHS Trust, the consultant orthopaedic surgeons worked on split sites so only did a formal ward round on a weekly basis. But F1 and F2 doctors lacked confidence to take orthopaedic decisions in between times. This resulted in several instances of delayed discharge as a result of X-rays or investigations not been requested and reviewed in a timely manner, or delays in changes to orthopaedic management plans....
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Skill mix leads to dramatic waiting list cuts in speech and language therapy
A shortage of speech and language therapists with a dysphagia qualification at bands 6 and 7 was leading to problems with waiting times for dysphagia services. Conversely, there was a national shortage of posts for newly-qualified band 5 therapists....
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Peripatetic OT cuts locum spending
Calderdale and Huddersfield NHS Foundation Trust found that gaps in staffing caused by the recruitment process and special leave circumstances such as illness, bereavement or maternity were often hard to cover, even using a bank OT system, as bank staff did not always wish to work at a given period. There was also a very flat career structure, which meant that there was a ceiling on the career structure at band 6....
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Developing a universal supervision policy
Southern Health and Social Care Trust set up a project to develop and implement a supervision policy for nutrition & dietetics, occupational therapy, orthoptics, physiotherapy, podiatry, radiography and speech & language therapy....
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Leading as Peers
With the current challenges facing the NHS, chief executives need to be able to work with other leaders across their patch. This is completely different from traditional notions of leadership, but it is assumed chief executives can work collaboratively just because they are highly able even though there is no specific guidance for them....
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Setting up a centre of excellence for training
Cervical cytology screeners training in the three regions was provided by two training schools located within the cytology departments of Leeds and Sheffield Teaching Hospitals. Training facilities and resources in both trusts were inadequate and indeed training accreditation in one centre was under threat due to low staffing and service priorities taking precedence although the enthusiasm and commitment to training demonstrated by the scientists within those trusts was commendable....
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Setting up a training course
The stroke team developed a programme based on educational needs which encompassed the breadth of the patient care pathway. The Understanding Stroke training course is accredited via OCN at level 2 and aims to improve the knowledge and skills of health and social care staff. The educational programme aims to bring all existing staff up-to-date with evidence-based best practice and to ensure that all new staff are competent in the necessary skills....
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Combining research and clinical work
Clinical research expertise in the allied health professions (AHPs) has developed around a very small number of active researchers, a niche and ad hoc approach which limits career options for the brightest new graduates. While some AHP research leaders have built excellent research profiles, unlike in the medical training model, succession planning has been minimal and there is a lack of early entry points into a clinical research career for the most outstanding young clinicians....
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Cutting back on agency costs
Norfolk and Waveney Mental Health NHS Foundation Trust covered a large area and each location had local temporary working practices and its own individual banks, with shift demand largely uncontrolled. Outside of urban areas, bank shift fill was typically very poor, resulting in excessive agency spend....
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Reducing overtime rates and agency demand
Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) found that many of the rural areas it covered had no bank service and depended on the goodwill of substantive nursing staff supported by expensive agencies. This resulted in excessively high overtime rates across the trust and high costs....
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Cutting back agency staff costs
Central Manchester University Hospitals was using up to 22 different staffing agencies, operated numerous different processes and procedures, and temporary staff spend was increasing at an average of GBP1 million p.a. The increased leave entitlement under AfC in 2006/07 created an unfunded nurse and midwifery spend of over GBP2million while the18-week wait target the following year created an additional spend of GBP0.34million....
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Reducing use of agency staff
Since 2005, shift demand at King's College Hospital has increased by 50% and because London Trusts by nature tend to have a very transient workforce, ensuring sufficient cover is a constant challenge plus processing the vast flow of timesheets involved is a huge task....
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Cutting agency staffing costs
South London and Maudsley NHS Foundation Trust (SLaM) has a high number of short-notice requests for temporary cover as a patient's condition can change very quickly, suddenly requiring one-to-one, two-to-one or even three-to-one supervision. This results in a high shift demand and high temporary staff usage - over 120,000 hours in January 2010. Also the skills and competencies of its nursing & care support worker (CSW) staff and even admin & clerical workers are specialised....
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Cutting agency staff costs
In 2004 Newham University Hospitals NHS Trust was facing a high agency spend, recruitment difficulties and rising demand for flexible staff. The percentage of temporary vacancy demand handled by agencies was significant - between 25% and 30% per month. The cost of such high usage was also substantial - nearly GBP2m in 2004/05....
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Cutting agency staffing costs
In addition, a nearby trust increasing its agency use to meet targets has had a knock-on effect on agency staff use....
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Cutting costs of using agency care support workers
Stockport NHS Foundation Trust was keen to reduce the cost of care support worker (CSW) recruitment as it was under pressure to make savings....
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Improving employee health and wellbeing
Faced with a quarterly absence rate of 5.13%, York Hospitals NHS Foundation Trust realised action was needed. Furthermore, the average referral time to occupational health (OH) for a member of staff on long-term sick leave was 15 weeks and the estimated cost of absence was GBP3.7 million....
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Pacesetter Disability Workforce Project
NHS Gloucestershire discovered that the quality of the data on their electronic staff records (ESR) system was suspect. Records showed that 0.4% of staff on ESR were listed as 'disabled'; however, 12% of staff in the 2007 NHS staff survey identified themselves as 'having a long-standing illness, health problem or disability'....
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Health and well-being programme
A 3.7% sickness absence rate was costing Nuffield Orthopaedic Centre NHS Trust GBP5,000 per day - not including temporary staffing cover costs. There was also little focus for employee health and wellbeing and funding was going towards dealing with sickness absence rather than supporting staff to take early and preventative measures. There were also high levels of stress and bullying....
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Reducing musculoskeletal injuries through ergonomics
In March 2009, the occupational health and safety (OH&S) team at Great Western Hospitals NHS Foundation Trust was set an objective to work towards reducing the 600 days per month lost due to 66 staff (on average) sustaining a musculoskeletal injury of back, neck, shoulders or arms/hands. This absence equated to nearly 20% of the total absence....
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Sexual Orientation Equality Scheme (SOES)
NHS 24 faces particular challenges in understanding the barriers that might be encountered by people from the lesbian, gay and bisexual (LGB) community when accessing their services, and deciding how these could be identified and removed. Evidence shows that gay, lesbian and bisexual people have disproportionately higher risk levels of suicide, alcohol and drug abuse, and self-harm....
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Dignity at work
In November 2008, Nottingham University Hospitals NHS Trust decided to re-launch Improving Working Lives. One of the reasons for this was that their 2007 staff survey highlighted that 23% of staff had experienced bullying and harassment....
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Unleashing Talent Passport
Research has suggested that up to 18% of the Northern Ireland Health &Social Care (H&SC) workforce has essential skills support needs, and that up to 20,000 staff lack level 2 qualifications. Support staff make up over 40% of the total workforce and Belfast Health and Social Care Trust itself employs about 8,300 support staff (Bands 1-4). There was a high turnover of these staff, negatively impacting recruitment spend. In addition essential skills gaps was having a further impact on potential for supervisor appointments from within...
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Maths for healthcare staff
The Welsh Assembly has set targets to improve the literacy and numeracy skills of working age adults. However, within health and social care, 56% of workers have literacy skills at Level 1 or below and 72% of workers have numeracy skills at Level 1 or below, which is equivalent to the level of an average 11 year old....
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Improved induction programme
Results of a staff survey at NHS Greater Glasgow & Clyde indicated that an unacceptably low number of staff - 54% - had received an effective induction. In addition, there was dissatisfaction with the 'old-style' classroom approach that was used. Retention of information and application of knowledge in the workplace also fell below required standards....
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Day case service transformation
In 2007/08, Alder Hey Children's Hospital NHS Foundation Trust found itself facing a number of key challenges including a potential deficit of GBP13.5m, increasing financial and service delivery pressures and the need to improve its financial and governance performance to become a foundation trust....
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Sickness reporting using the ESR
Heart of Birmingham Teaching Primary Care Trust (HOBTPCT) recognised that it was 'information poor', particulary on sickness reporting. The hurdles involved in the paper-based process resulted in a reported sickness rate that was significantly lower than the NHS average....
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Using the Oracle Learning Module
To ensure they had accurate and up-to-date staff training records - in particular mandatory and statutory training - West Middlesex University Hospital NHS Trust decided to see whether the Oracle Learning Module (OLM) could solve the problems of attendance not being recorded against individuals' names and not being able to see who needed to attend training....
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Darzi fellowships in clinical leadership
NHS London/London Post Graduate Medical and Dental Deanery wanted to ensure they met the vision in the Next Steps Review final report High Quality Care for All which emphasised the importance of clinicians' engagement in shaping services effective, safe, personalised, fair and locally accountable. The report highlighted the importance of clinicians having a range of non-clinical skills including leadership, team working management and teaching. If the service is to change to meet needs of patients more completely, then it is clear that the education and training of clinicians needs to be enhanced so that not only are they equipped to work in a new environment but they are also able to shape, develop and implement effective change...
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Improving workforce information systems
In April 2007, Portsmouth City PCT realised action was needed to improve their workforce information system, which was hard to use, gave inconsistent information, and couldn't identify any trends in the data or good and poor performance. The objective was to develop a system that would resolve these problems and enable managers to access the relevant information, without the need for help from the workforce team....
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Learn:Lead education strategy
Feeling increasingly dissatisfied with the impact of educational investment on individual and organisational performance, the Heart of England NHS Foundation Trust decided the way forward was a new learning and development strategy....
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Wellbeing at work project
Moray Community Health & Social Care Partnership (MCHSCP) assessed its sickness absence levels and found that they were high. The real reason for the absences was not always identified because staff were wary of disclosing mental health problems for fear of being stigmatised. The trust wanted to give its staff practical help which would support and maintain good mental health and wellbeing....
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The LINC peer support scheme
London Ambulance Service NHS Trust wanted to improve the way it helped its staff deal with the demanding physical and psychosocial needs of patients and their families....
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Making the difference that makes the difference
In Cardiff and Vale University Local Health Board two directorates of a large teaching hospital, involving over 750 staff in total, were displaying consistently above average sickness absence rates with consequent high human and salary-based costs....
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One team @ St George's
St George's Healthcare NHS Trust aimed to build esteem and capability among band 1 to 4 staff to deliver high level customer service to colleagues and patients/carers....
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Healthcare Careers and Skills Academy
Unemployment is a major problem in the West Midlands, with more people out of work than in any other English region. The number of job seekers in the area has doubled since August 2008 with many of the region's major employers forced to make cutbacks....
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Embedding equality and diversity
In January 2009 Royal Devon & Exeter NHS Foundation Trust decided to employ an equality and diversity specialist to raise the profile of equality and diversity. The resulting training strategy has so far reached over 3,000 staff....
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Our Manor: better together
Walsall Hospitals NHS Trust recognised that to achieve their strategic vision, it was critical to engage their staff in the transformation programme, so in April 2009 they embarked on a staff engagement campaign, entitled Our Manor: better together....
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Big Staff Conversation - change agenda
When Barnet and Chase Farm Hospitals NHS Trust decided to implement a major new clinical services strategy they wanted to ensure all staff were engaged with the plans including those in hard-to-reach groups, such as night workers, part-time staff and those working in isolation....
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Consultant recruitment, induction and development
After some costly mistakes, York Hospitals NHS Foundation Trust decided that a new process was needed....
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Listening into action
Sandwell and West Birmingham Hospitals NHS Trust wanted staff to identify with the organisation's goals, secure service improvements and better outcomes for patients, and improve working lives for staff....
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Exciting futures
Bradford District Care Trust provides mental health and learning disability services. It trains a large number of employees in various competencies, however, the development was piecemeal, uncoordinated and did not create skilled leaders with the right behaviours. It was clear that development was not competency-based and there was no agreement about what good leadership was....
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North West Rostering (NWR)
The reduction in hours from the European Working Regulations as well as other pressures such as falling training doctor numbers and changes to immigration have meant that doctor vacancies have led to long-term 'gaps' that place significant pressure on services. In addition, current methods of training have come under strain when the trainee has a reduced number of hours and supervision in which to train....
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SAS Doctors' Project
Staff grade and associate specialist (SAS) doctors represent 20% of the NHS hospital workforce. But due to high service commitment, their continuing professional development needs have been neglected....
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ASPIRE TO - developing shared values after a merger
Imperial College Healthcare NHS Trust was formed from the merger of Hammersmith Hospitals NHS Trust and St Mary's Hospital NHS Trust in October 2007. To ensure it functioned successfully as one organisation, a project was designed - the 'Aspire to' project - to capture staff and patient views in defining the organisational values....
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Service standards
In 2003/04 South Buckinghamshire and Stoke Mandeville Trusts merged which left the new organisation facng some challenging issues such as a major C. difficile problem and poor levels of staff satisfaction and engagement....
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