Evidence based practice

NHS Employers is working with organisations that are researching the theme of age diversity in the workforce. We provide updates on findings and on work in progress on collaborative projects that may be used to inform practice.

At NHS Employers we promote and encourage fresh ideas and innovative approaches to managing and developing the NHS workforce. We believe that well constructed research studies can provide us with helpful pointers to good practice 'on the ground'.

Many researchers have chosen to look at this theme, looking at age; the ageing workforce; recruitment, retention and motivation of older workers; demographic change and employment related issues.

The examples given here are those with which NHS Employers has some direct involvement or interest or has provided practical support in enabling researchers to tap into our networks for the purpose of piloting or field testing.

• Older nurses, midwives and the NHS
• Improving the retention of women in the Primary and Community care workforce after the age of fifty years
• Ageing workers: evidence based risk assessment
• Demography is Destiny and the Employer/Employee Equation
• Young people's attitudes to the NHS as a potential employer
• Intergenerational Portfolio Management

Older nurses, midwives and the NHS

The project, funded by the European Social Fund and undertaken at the University of Hull is building on earlier work undertaken by the Joseph Rowntree Foundation on employment decisions in relation to Nurses over 50: Options, Decisions and Outcomes (Watson et al 2003). This study raised a number of concerns about treatment of older nurses in terms of equal opportunities, including lack of choice, stereotyping and perceived discrimination. In addition, issues relating to ethnicity and ill health or disability are being examined. The main objectives of the project are to:

• Examine employment policy and procedure in relation to the employment of older nurses and midwives
• Identify a range of 'best' practice with regard to support for older nurses and midwives in the workplace
• Provide recommendations to support future practice in this field
• In order to achieve these aims a systematic literature review has been undertaken, and a postal questionnaire survey of older nurses and midwives and a sub-set of younger nurses and midwives in thirteen NHS trusts and PCTs. Statistical analysis is being undertaken.
• Currently, a series of semi-structured interviews with nurses and midwives is being undertaken to further investigate some of the issues highlighted by the questionnaire survey. The project will be completed and final report available at the end of August 2006. for further information please visit the project website at www.hull.ac.uk/ON
• A member of NHS Employers sits on the Expert Panel for this project.

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Improving the retention of women in the Primary and Community care workforce after the age of fifty years

In 2004 the Department of Health funded a two year study to investigate the impact of age on the retention of women in the Primary and Community nursing workforce in England. The study is being conducted in five Primary Care Trusts (PCTs) across England, involving District Nurses, Health Visitors, Practice Nurses, School Nurses and Community Nurses. To date a literature review, a postal survey questionnaire to nurses and telephone interviews with managers have been completed. Face to face interviews with 40 nurses in the NHS and ten who have left the profession have recently been completed, and analysis is about to start. The study will report in June 2006.

Results from the PCT postal survey of nurses across all ages have shown that there are few differences in the views of nurses in the different professional groups. Factors which nurses indicated might improve retention include remuneration that better reflect their experience and skills, and greater promotion opportunities within clinical nursing posts rather than having to move into management posts to increase their pay. Nurses value patient contact which should be appreciated by managers and reflected in work opportunities. Part time working near retirement would encourage nurses to stay, as would recognition from managers that their contribution is valued. Retirement and pensions advice was frequently lacking, particularly amongst practice nurses. However since two thirds of nurses were generally happy in their current role, it is important that this should be maintained throughout their working lives.

Telephone interviews with managers revealed that links between Workforce Development Confederations, Strategic Health Authorities and PCTs were sometimes weak with regard to workforce issues and neighbouring PCTs could be in competition for staff. Policy had changed and managers were of the opinion that nurses were now being actively encouraged to remain in the workforce with numerous strategies identified. Constant change in the NHS made workforce planning problematic. Agenda for Change and Improving Working Lives were seen as key policies for encouraging the retention of older nurses, although their effectiveness has yet to be identified. The final report will provide more in depth findings from interviews with nurses to identify the factors that they feel influence their employment decisions.

For more information contact Cr. Brenda Leese, telephone 0113 3431914, email b.leese@leeds.ac.uk or Claire Storey, telephone 0113 343 6967, email h.c.storey@leeds.ac.uk

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Ageing workers: evidence based risk assessment

This cross-sectional study aims to develop a risk based approach to objective decision making on workability and employability of ageing workers. Following the interim report from Sarah Harper, Research Director at the Oxford Institute for Ageing, here is an update on progress.

• The evidence review is progressing and remains scheduled for target completion end of March
• Next advisory board meeting to be held on 16 May. Thus the output from evidence review will still be in good time to, inter alia, inform evidence base re age discrimination legislation
• The Institute's occupational psychologist had an unexpected relocation to Australia late last year. This will not affect the progress of the evidence review. However it will delay future phases by two to three months whilst a replacement is recruited. However the Energy Institute (one of the project funders) is commissioning another piece of work with researchers looking at ergonomic issues and aging workers which fits very well with the BOHRF project, and findings from which have the capability to enhance the physical part of the BOHRF research
• From the range of organisations that are represented, it can be seen that this is a real cross-sector piece of work by the leading research team in its field. So apart from early access to emerging findings, there could be some very good benchmarking opportunities.

For more information contact Brian Kazer, telephone 020 7317 5898, email bohrf@dial.pipex.com

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Demography is Destiny and the Employer/Employee Equation

These two projects were developed by the Concours Group in the USA in partnership with Age Wave and Harris Interactive to look at the implications of the demographic shift in the workforce of the US and Europe. The projects were supported by the Department of Health and the results of the two studies are being taken forward by the National Workforce Projects (NWP) in the UK.

• The Demography is Destiny study highlighted the impact of the demographic changes facing the workforce in the US and Europe.

The Employer/Employee Equation (EEE) is a US based study that has carried out an original piece of research into what staff want from work and has developed a survey based tool to maximise staff engagement.

A UK version of the American survey has now been developed and has been piloted by Birmingham and Black Country SHA. The results of the pilot survey are now being used to develop an in depth study across a range of staff from two volunteer sites. The results of this study will be shared with the wider NHS community in March 2006.

For more information email info@nwpnhs@org.uk

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Young people's attitudes to the NHS as a potential employer

This study has been carried out under the auspices of the NHS Employers Positively Diverse Programme and is based on questionnaire data and focus groups from a mix of agencies and voluntary organisations in the East Midlands. Ages in the groups range from under 16s to 22-24 years, with more than half of the sample in 16-18 age band.

The main findings were that generally the young people had positive perceptions of the NHS as an employers, although they had limited knowledge of the career paths available and generally believed that working in the NHS would involve working in a hospital setting. Careers advice appears to be patchy. What was apparent was the missed opportunity to use NHS staff themselves as ambassadors. With the exception of work as a doctor or surgeon, careers in the NHS were not generally perceived as appropriate to high flyers. Nor were NHS roles seen as aspirational or exciting, but they did score highly on social usefulness and community value. In every focus group, anxieties about the future of the NHS were identified as disincentives to joining the NHS. Generally, the NHS was not perceived as a low wage payer and all the young people felt that they would be able to access at least adequate training and development. In fact, most perceived the NHS as a good provider of training and career development.

For further in formation contact Anthony Nichols email anthony.nichols@nhsemployers.org

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Intergenerational Portfolio Management

Age discrimination legislation on its own will not be sufficient to change employer attitudes and practices. Age diversity programmes are also required. They should promote the benefits of an age-balanced workforce, age-appropriate job design, intergenerational knowledge transfer and the integration of older workers into innovation processes, as well as an ongoing focus on lifelong learning and health promotion. Intergenerational portfolio management is a good example of such an age diversity programme.

Intergenerational portfolio management aims to change perceptions and practices with regard to age and to prepare workers for the prospect of working longer to encourage internal and external mobility and participation in continuing training at mid-career bases on prior acquired competencies and skills

to capitalise on best practices and disseminate these practices into the sector of health services, by publishing them widely on the internet and via other media

This will be realised by country-based pilots in three countries (NL, UK and BE) between training organisations and hospitals, exchange of experiences and material, and re-piloting in other countries (AT, CZ and EE). Dissemination and valorisation will be delegated to involved employers organisations in the health service sector.