CHILDCARE: For many parents, work is only possible once childcare has been resolved. So the NHS is wise to invest in more nursery places, says Claire Laurent

For Marie Sinclair, the chance of a workplace nursery for her 13-month-old son, Nile, makes the difference between being able to work and not.

'Many people have family close by to help out, but we didn't have that option. And speaking to other new mothers near us, a lot of nurseries do not offer anything until the child is over two - or there are long waiting lists.'

Mrs Sinclair, a renal technician at Barts and the London trust, works three full days a week. As her job is fairly hard to recruit to, she scored highly on the points system the trust runs for places at the nursery. As a returner from maternity leave, she also scored highly.

But even so, she had to spend an extra four unpaid months on maternity leave until a place became available.

She has nothing but praise for the nursery and staff.

Although subsidised, it still costs her£27 a day. The 50-place nursery is on the Royal London hospital site and has been open 18 months. A 44-place nursery is planned for the Bart's site, along with a nine-place extension to the present site.

Trust human resources business manager Judith Aldridge says the existing nursery cost£308,000.

'We didn't have to acquire land, but that covered everything else from clearing the land to soil testing and from building to supplying mattresses, desks and chairs.'

The nursery was funded by the trust's special trustees, but the one planned for the Bart's site will come from£300,000 of government funding. Its running is contracted out to Childcare Partners, which operates under the name of Buffer Bear.

Childcare Partners started out 10 years ago, running nurseries at commuter rail stations. It also runs the nursery at Mayday University Hospital, Croydon, and the Children's Trust, Surrey, formerly Tadworth Court.

Managing director Kay Turner says: 'All those organisations want to provide facilities for their staff. They have recruitment needs and they are using them to aid recruitment and retention of staff.'

Bart's operates an allocation policy so childcare places are targeted at those in jobs most difficult to recruit to, and the ages most difficult to find nursery places for (0-2 years).

The cost of each place is subsidised on a sliding scale, according to parents' personal circumstances.

NHS childcare strategy coordinator Dr Tig Calvert says:

'The provision of good-quality, accessible and affordable childcare for parents working in the NHS is an essential part of improving the recruitment and retention of staff.'

The NHS has commissioned the Daycare Trust to support the early stages of the NHS childcare strategy.

Its support will include developing recruitment packs to help appoint childcare co-ordinators and toolkits for providing information about childcare options and examples of good practice.

Twelve trusts have been identified as 'pilot' sites for developing 50-place on-site nurseries and given capital funding of£300,000, plus revenue of around£78,000 a year to subsidise each place by up to£30 a week.

Dr Calvert says: 'The money is from the centre for the first three years and will then go onto health authority baselines. It is not ring-fenced after that, but it is secure.'

A further£15m has been allocated this year to build about 40 more on-site nurseries.

Royal United Hospital trust, Bath, is one of 12 trusts identified by the Department of Health to develop childcare provision.

The trust already has an on-site nursery and aims to build a second one. Director of facilities Stephen Holt says:

'We are looking at whether we can combine the two and give ourselves 75-80 places.

'The hours of the one currently running suit office staff and some nursing staff.

This new one will serve staff out-of-hours. It will start earlier in the morning and finish later in the evening.'

He says the trust could fill the proposed new nursery 'tomorrow', but hopes it will also attract staff to the hospital.

'House prices in Bath are such that people have to travel to work and so childcare becomes a bigger problem.'

The money in the present childcare strategy is for on-site nurseries. However, finding childcare for school-age children can be a bigger headache than pre-school. Here, the childcare co-ordinators, which every trust is required to have in place by 2003, will come into their own.

'They should be able to sort out things like childminding networks so there are childminders around the clock, ' says Dr Calvert.

'We are encouraging trusts to set up after-school clubs and holiday play schemes.'

Trusts are being urged to collaborate with their local communities. Many Royal London Hospital staff live locally so the trust is extending its nursery with part funding from the local early-years development and childcare partnership.

Derriford Hospital in Plymouth has had an on-site nursery for 12 years, run by Busy Bees, which is open to both NHS and non-NHS staff.

Its current hours are suitable for office staff, but as places become available the trust is looking to extend the hours gradually. The trust operates a corporate childcare scheme which means parents do not pay tax or national insurance on their childcare costs.

'We really want the childcare strategy to make a difference to people's lives so they can work the shifts they want while their children have good-quality childcare' says Dr Calvert. 'Some criticism we get is people saying 'you just want to put children in nurseries for 12 hours a day'.

Children do come first but parents come second and if they need to work, we want to help them to work.'