A horizon scanning exercise to explore retention policies for international and minoritised NHS Trust staff in England: what are the current pledges and where are the gaps?

backgroundThe NHS has pledged to reduce staff attrition to address its widening workforce gap, which has been exacerbated by understaffing and the COVID-19 pandemic. Evidence suggests that staff from some minoritised groups may be at greater risk of attrition post-pandemic. However, a gap in the literature means there is no clear overview of current organisation-level NHS staff retention policies aimed at addressing this problem. We sought to address this with a horizon scanning exercise undertaken as part of a wider study aiming to support the development of policies to improve retention of NHS staff from minoritised groups. The study draws on three key occupational psychology theories, each of which provides different insight into the mechanisms underlying staff turnover and its major contributing factors of sickness and satisfaction.

methodsThe sampling frame was all 215 NHS Trusts in England. Within each region we sampled NHS Trusts with numbers of minoritised or international staff above the regional median and rates of staff retention (stability) below the regional median, based on publicly available NHS statistics. We sourced retention policies directly from Trust staff or their public facing websites. We also sourced policy documents that focused on induction or Equality, Diversity and Inclusion in case they contained relevant content. We extracted and analysed the contents of documents based on preselected aspects of work known to influence staff attrition, developed from the underpinning theories. We used Framework Analysis to make comparisons within and between documents and Trusts.

resultsDocuments were sent to us by 13% of the sampled Trusts. We found other documents by searching Trust websites. We obtained and screened 128 documents from 56 Trusts and analysed 99 that met our inclusion criteria. Trusts were considering staff retention, and many of them had actionable strategies. Most Trusts had enshrined some workplace matters in policy that may be particularly relevant to international and minoritised staff. Examples were anti-discrimination and bullying procedures and inclusive line management which may improve retention by reducing job demands and work stress. However, other matters that may influence retention of international and minoritised staff were rarely addressed. Notably lacking was consideration of the range of factors that contribute to creating and maintaining a sense of belonging and trust such as provided by induction, onboarding and effective staff networks.

conclusionTo our knowledge this is the first study to collect and analyse current Trust level NHS staff retention policies in England. The results are important because they reveal that while some factors that may influence retention of minoritised and international staff were comprehensively addressed by the sampled Trusts' policy documents, many others were absent. The documents are reflective of organisations with social and institutional awareness of staff-wide retention drivers but not necessarily cognisant of specific additional drivers of attrition for international and minoritised staff. We recommend that policy makers reframe generic statements regarding attrition and retention as concrete procedures with specified measurable outcomes. Our findings will now contribute to the co-creation of a suite of retention policy interventions in collaboration with our stakeholder groups.