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Case Study – Royal Free London NHS Foundation Trust

NHS Trust’s streamlining employment checks leading on a review of NHS Employers’ Employment Check Standards reducing the average time to hire by over six weeks, fast-tracking workforce development plans and improving patient care and services

Royal Free London NHS Foundation Trust was one of the trusts leading on a review of the NHS Employers‘ Employment Check Standards. The project has reduced the average time to hire by over six weeks. The Royal Free London NHS Foundation Trust (Royal Free) is based in north London and offers an exceptionally wide range of local and specialist services, providing over 880,000 episodes in an average year. The Trust expanded considerably through the acquisition of much of the Barnet and Chase Farm Hospitals NHS Trust, making it one of the largest trusts in London.

Royal Free was involved in the Streamlining Programme from the very beginning. It was instrumental in helping HR directors across London to realise how the fragmented processes and procedures that each trust had in place were letting down not only junior doctors on rotation but all staff whenever they moved. For two years, Gareth Jones, the Associate Director of Workforce for Royal Free, participated in meetings with a small group of like-minded individuals from trusts across London, looking at how these processes could be improved. Having sought legal advice and completed a great deal of analysis, it became clear that the NHS Employers Employment Checks Guidance could be amended so that the quality of pre-employment checks could be improved, while the time taken to complete them could also be dramatically reduced.

This led to a period of lobbying of NHS Employers, the Care Quality Commission (CQC), the NHS Resolution, and other bodies, including the Department of Health and Social Care and NHS Protect (part of the NHS Business Services Authority). Once these organisations understood trusts’ desire and ability to make significant improvements in both quality and productivity, the programme was invited to help redraft the NHS Employers’ Employment Checks Standards. This process took approximately six months to get right.

The Royal Free worked alongside ten other London trusts and the Streamlining Programme team to go through hundreds of pages of guidance, while at the same time producing very detailed standard operating procedures that all trusts could follow. This served to not only meet the minimum requirements set out in the guidance but to reach the highest possible standards found along the way.

Executive support within the trust was essential and a case for change was presented to the committee and unanimously approved. New policies were drafted in line with the new guidance and these were approved via the appropriate committees.

The implementation of the programme was broken down into relevant milestones and tasks, for people across HR and recruitment to get involved in. However, this was phased to ensure changes had a minimal negative impact on the day-to-day operational demands. These changes included:

  • Engaging with the trusts external recruitment supplier Health Jobs UK, which very quickly amended its software, so that the new processes could be automated and accurate reports could be produced to measure the improvements. The recruitment software provider also updated its system to reflect the new guidance in the confirmation of employment templates
  • Purchasing and installing identity document scanning equipment to identify potential fake IDs. The use of the equipment has been mandatory for all starters (this includes external candidates as well as internally appointed employees whose ID and right to work documentation had never been scanned before)
  • Allowing staff recruited from other NHS trusts to start work if evidence could be provided that an acceptable Disclosure and Barring Service (DBS) check had been completed by another NHS trust within an agreed timeframe
  • Shortening their occupational health assessment questionnaire to the new standard, saving new applicants and the OH department time, as only those who needed advice and support were referred
  • Issuing and requesting factual references to replace the old style subjective references, improving the assurance around new hires and also shortening the reference chasing process
  • Confirmation of employment is now being sought by the HR department for the HR department, within the trusts which signed up to the Streamlining Programme, where it has been agreed to turn around the confirmation of employment responses within three working days


  • Average time from conditional offer to unconditional offer has dramatically dropped from 41 working days average in June 2013, to 13 days in November 2013 and eight days in December 2013
  • It is estimated that this time saving is worth £1,200 per vacancy in lower agency spend and with over 40 vacancies per month, this equates to approx. £50,000 per month saving
  • New recruits to Royal Free no longer have to wait as long to start their new job
  • Royal Free is now much now less exposed to legal risk from issuing inaccurate or potentially discriminatory references and from employing staff with fraudulent references
  • The new NHS Employers Employment Checks Guidance has been thoroughly revised with extensive inputs from recruitment managers from a number of London trusts to benefit trusts across the rest of the UK
  • Most importantly, the new guidance works in practice and is flexible enough to allow for local variations
  • The case for change developed by the programme provides any trust board with a great summary of why changes are needed and what the benefits of implementing them are. Set up an internal project team to be involved in designing and implementing improvements in a way that will work on the ground
  • Plan change in a phased way to minimise the negative impact on day-today operational demands
  • Involving all relevant external stakeholders such as NHS bodies, recruitment suppliers, and other trusts will give the project more clout and ensure changes that are needed outside your trust can be made alongside internal change
  • Reach the highest possible standards