West Country Chronicle: How an ICB became the best place to work (again)

This year’s NHS Staff Survey results made for much improved reading as far as the South West region was concerned.

The region was at the right end of the table for several of the survey’s (arguably) most important questions, such as recommending your organisation as a place to work (2^nd place) and morale (1^st place).

These results were a notable improvement on the previous two years, and made all the more impressive given the fact that the region still contains some of the most challenged NHS providers when measured against key performance targets.

Last year’s Chronicle analysis of the staff survey focused on the region’s providers, but this year’s results saw one particular NHS body stand out.

Second year of success

That organisation is Gloucestershire Integrated Care Board, which topped the table of 42 ICBs for staff recommending their organisation as a place to work.

Making it all the more impressive is the fact it was the second year in a row the ICB claimed top spot for this crucial cultural indicator.

The ICB’s result dropped from 80.6 per cent (of staff either strongly agreeing or agreeing with the statement) in 2022 to 74.8 per cent in 2023, but all except three ICBs saw a reduction on this indicator amid steep cuts in running costs and internal restructures.

In fact, Gloucestershire’s 2023 score was 6.6 per cent higher than the next best ICB (Lincolnshire). Dorset ICB was third and Somerset ICB tenth, while the South West’s remaining four ICBs all were in the bottom half of the 42-strong table. 

Mary Hutton, Gloucestershire ICB’s chief executive, told the Chronicle there was “no magic answer” to how the ICB had obtained such strong results from its staff over the last two years.

Reflecting on the achievement, she highlighted several circumstances that have helped the ICB remain relatively stable as an organisation.

These included the ICB and its previous organisational forms being co-terminus with the local authority and the fact that the area was chosen as a second-wave integrated care system by NHS England back in 2018, meaning clinical commissioning group staff have had a smoother path.

(Gloucestershire, along with the other strong performers Somerset and Dorset, are also relatively small in terms of population, and co-terminous with predecessor CCGs — so have seen less painful upheaval than many others — although this formula hasn’t worked for everyone).

The turnover of very senior managers at the organisation has been relatively low – Ms Hutton said.

“It’s more pleasant when people know each other and you feel like you’re working for the benefit of one population – there’s a nice feeling about that,” she said.

Distributed leadership 

Ms Hutton herself has led commissioning in Gloucestershire since 2013, when she was appointed accountable officer of Gloucestershire Clinical Commissioning Group.

She highlighted “distributed leadership” as one important factor, which sees leaders across the ICS take responsibility for different areas such as inequalities and diagnostics on behalf of the system.

This encourages cross-organisational partnerships and strengthens relationships between staff, she said.

Asked if the ICB has implemented any particular staff wellbeing initiatives, Ms Hutton said it was focused on providing health checks for staff – including support around smoking, blood pressure and musculoskeletal issues (given the desk-based nature of most roles).

The ICB also takes a “flexible” approach to home-working, with staff expected to only come into the office one day per week. However, a significant number of staff still choose to come in up to four days, and they are encouraged to spend one day working closely with their teams, either in person or online. NHS England recently imposed a two-day office policy on its staff.

In return for looking after them, the ICB gets significant “discretionary effort” from its employees, Ms Hutton said.

“It’s a really good return on investment and we don’t need to spend much money on this,” she added.

“I would hate anyone to think that we’ve nailed it or we think we’re the best – we’ve got a lot more to do.

“I think people need to have time to settle into new structures and we’ve had that opportunity ourselves as a second-wave ICS.

“For everyone, the most important thing you can do is listen to your staff, and sometimes small adjustments can make an enormous difference.”