Key to the door

A public-private partnership to build key worker housing in Surrey was successful enough to win the HSJ recruitment and retention award. Mary-Louise Harding r

eports On the surface, there is nothing that marks out Ashford and St Peter's Hospital trust's recruitment and retention 'issues'.

However, if you add its Surrey location to the mix - the most expensive UK housing market outside of London - you begin to understand the extra strain the trust faces in keeping a full complement of permanent staff.

The unusual way in which the trust tackled its key worker housing crisis was a large factor in the judges' decision to award it the highly contested recruitment and retention category at last month's HSJ Awards.

Provision of affordable housing for nurses and other key health workers by hospitals is nothing new. But the trust took an unusual step when, after discovering it would not be eligible for government subsidy for new builds, it partnered a private sector developer. It also agreed to shoulder partial financial responsibility for any empty units.

The decision to take on the responsibility was widely regarded with scepticism by the construction industry. But the stakes were high: in the trust's own words, 'new access to highquality, affordable accommodation is paramount to ensure delivery of services'.

For the period January-March 2003, the average house price in Surrey, at£267,215, was 7.3 times the average income in the county.

This means a newly qualified nurse would need 15.5 times their starting salary to buy an averagepriced house, or eight times for a one-bed flat, priced around£150,000 on average in the area.

Ashford and St Peter's vacancy rate for qualified nursing and midwifery staff stands at 19.54 per cent - equivalent to over 194 fulltime members of staff.Meanwhile, the vacancy rate for allied health professionals is 20.43 per cent, or 48 vacancies. 'The trust is simply unable to recruit the staff we need locally, ' says housing co-ordinator Caroline Tindall. 'Therefore, access to affordable housing is a pre-requisite to successful recruitment of people from other areas of the country or from overseas.'

Working without subsidy, the idea of procuring a private developer to take on the design and build of new homes for key workers by offering a no-risk deal was hatched by the trust's chief executive and Runnymede district council in early 2002.

Essentially, the trust had access to demand, and the local authority knew of a vacant brownfield site within walking distance of St Peter's Hospital.

The owner of the site - Berkeley Strategic Land - was subsequently brought into the partnership via its sister company, affordable housing developer Berkeley College Homes. 'The land was subject to a covenant that stipulated it should be used for health purposes.

There was a desire by the owners of the land to develop the site, but there had to be a link to health - the provision of accommodation for health workers provided the link and the partnership was formed, ' says Ms Tindall.

The council's role was to provide independent stipulation of obligations for the development under a 'section 106 agreement' - negotiated between local authorities and developers in the context of granting planning consent - ensuring affordable rents and setting criteria for who would be offered the homes.

Meanwhile, the trust set about making contact with local primary care trusts and mental health trust to form a joint provision partnership and, crucially, a joint financial liability agreement. Pavilion Housing Association was brought on board by Berkeley as preferred bidder to purchase the lease and run the development, while Homewood Housing Association was subcontracted to provide day-to-day management.

Sandgates - the resulting 83unit new-build development exclusively for health workers employed by Ashford and St Peter's, Surrey PCT, Woking Area PCT and North West Surrey Mental Health trust - was opened by health minister John Hutton in June. It was hailed as a unique and remarkable achievement, and an example to other organisations.

Working across such a broad partnership was quite a challenge - and key to success - says Ms Tindall: 'We just worked hard to achieve effective communication between each party.

'We had to ensure comprehensive understanding of what each wanted to achieve and their parameters.'

Runnymede district council's support of the development was a vital ingredient to its success, according to Berkeley College Homes managing director Matthew Biddle. 'We worked closely with Runnymede, who were extremely positive because they could see the desperate need, ' he says. 'It certainly helps when a local authority comes on board and promotes a development.'

Mr Biddle adds that many observers - particularly construction industry insiders - doubted that a 100 per cent affordable housing development would be viable.

'Sandgates is the start of a significant growth area for our business. It has proved we were right to invest in sites that were close to hospitals, for example, and that public-private partnerships on large-scale affordable developments can work to the benefit of all.'

The involvement of the private sector in such an unprecedented way also raised suspicions among the local health worker community.Ms Tindall explains that she has learnt a valuable lesson in managing staff expectations. 'Because existing accommodation provided by the trust is at a lower level, many staff expected that similar rent levels would apply at Sandgates.My job - and my biggest challenge - was to manage these expectations by explaining that it was a new build, with better facilities and so on, which meant the affordable rate set would be higher than they expected, but still be within reasonable limits.'

With the trust sharing financial liability for the development, Ms Tindall says she also discovered the importance of marketing. 'There is a need to do promotion early, and have a show flat as soon possible.

People need to see what's on offer if you're to establish commitment from them.'

According to the latest figures, St Peter's says it can pinpoint certain staff - seven qualified nurses, one radiographer, two biochemists and an estate technician - who shelved plans to leave and move to cheaper areas. It also says the housing has proved attractive when recruiting, although this is more difficult to quantify.

More than half of the Sandgates units are single studio flats, with 17 comprising two-bedroom flats, and 18 'cluster' flats (bedsits with shared kitchen and living facilities). The challenge now, says Ms Tindall, is to build on lessons learnt at Sandgates to find affordable means of providing more family accommodation.

However, Ms Tindall says working in such a way is not a catch-all solution for the future:

'Achieving Sandgates without a subsidy has been a fantastic success, but government-subsidised schemes need to maintain the backbone of provision now and in the future. This can't be the only option.' l