Condition critical: Why a lack of quality key worker accommodation is constraining health and care services

9th May 2023

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Condition critical: Why a lack of quality key worker accommodation is constraining health and care services

Amid a cost-of-living crisis, the quality and viability of vital NHS and care services are directly linked to declining housing affordability. How can key worker accommodation provide a vital mechanism to solve this health and care crisis?

Key Takeaways

  1. Stagnating wages and challenging working conditions are driving health and care staff out of the profession in search of better salaries and improved work-life balance.
  2. Climbing house prices and rising rental costs increase the affordability ratio and add to the cost-of-living challenges.
  3. After many months of development work and significant investment, Prime is rolling out its key worker solution, which addresses the issues without impacting NHS finances.

The ability of health and care providers to maintain a robust workforce remains headline news. Recent industrial action and the latest results of the NHS public satisfaction survey, highlighting staff shortages as the reason why satisfaction levels have slumped to 29%, have only brought this challenge into sharper focus. Declining staff morale and pay and rewards dissatisfaction have become ingrained threats for embattled providers and are cited as some of the dominant factors fuelling recruitment and retention challenges.

In their quest to manage these risks, health and care leaders are returning to one critical solution – the availability of affordable and high-quality key worker accommodation.

In this article, we explore how a lack of affordable housing, rising living costs and employee wellbeing are at the root of recruitment and retention challenges, and why part of the solution is within closer reach than many may assume.

Unaffordable becoming the new normal

The UK finds itself in a perfect storm, where wages have stagnated, the cost of goods and services is rising, and house price and rental affordability ratios continue to climb. Average rental costs rose more than 11 per cent in 2022 according to recent analysis by Zoopla,[1] while the number of properties available to rent has fallen by a third.

In some areas, the search for a property has become a ferocious battlefield marred by long queues for viewings and properties disappearing from the market within hours. For NHS and care staff who lack the flexibility to down tools and rush to the next available viewing, the very ability to find a quality property to live in has become a challenge in itself.

Regional disparities are also a critical factor in the recruitment and retention challenge. With some regions of the country becoming rapidly unaffordable, health and care professionals may seek employment where they can afford to live or decide to leave the profession altogether – exacerbating existing staffing shortages and putting greater strain on healthcare systems.

While NHS relocation allowances have helped to boost recruitment in some areas – in remote areas of Scotland, for example – they come at great expense to trusts, with NHS Highland chalking up relocation costs of more than £1.2m in 4 years.[2]

When wellbeing becomes unwell-being

NHS and care staff faced the brunt of the national burden during the COVID-19 pandemic, and unsurprisingly, at the height of the health crisis, almost half of NHS staff in England (44 per cent) reported feeling unwell from work-related stress.[3]

Record high waiting times in urgent and emergency care[4] in the wake of the pandemic have only exacerbated the pressures on NHS staff. A recent report by the NHS revealed that in September 2022, almost 25 per cent of staff absences in the service were due to anxiety, stress, depression or other psychiatric illness – accounting for nearly half a million full-time days lost in a single month.[5]

Long working hours and rising pressure on staff have fuelled chronic staffing shortages, leading to record numbers of NHS staff quitting[6] in search of better pay and greater work-life balance. The same picture is reflected in the adult social care sector, with 10.9 per cent of social care jobs remaining unfilled.[7]

A recent workforce report by NHS Shared Business Services stated that the annual turnover rate for a nurse at a large NHS trust averages 12%,[8] indicating the significant proportion of nurses that are leaving their roles on a regular basis. This turnover rate translates into a considerable cost to the NHS, with each nurse costing approximately £12,000 to recruit.

The wave of recent strike action and demands for better pay and working conditions demonstrates union members’ ongoing frustration and concern about the ongoing staffing crisis within the NHS.

With the situation so critical, how do NHS and care services plug the gap and reverse the tide?

The future of key worker accommodation

Meaningful change and effective solutions take time. Prime’s journey to solving the key worker accommodation problem began years ago when working with Yeovil District Hospital. They sought to identify and solve Yeovil’s operational challenges and recognised they had a role to play in solving the critical risk of recruitment and retention of staff at the hospital.

After investment market testing, Prime leveraged their expertise to secure £21m of funding and develop a new 176-bedroom complex that provides modern, high-quality accommodation and affordable housing to NHS staff and students.

Leighton Chumbley, Prime’s Chief Executive, explains why in working to solve the recruitment and retention challenge, Prime had to place people’s primary needs at the centre of their solutions:

At Prime, we recognise that you can’t deliver real and lasting change without people, and you can’t do that without motivated, committed, happy and healthy people. While we can’t recruit or train nurses, what we can do is deliver affordable and high-quality accommodation close to hospital sites that improve the wellbeing, safety and living conditions of hard-working health and care staff. Because people who care for the health and wellbeing of their community deserve to live in a place they’re proud to call home.

Twelve months after moving into their new homes, key workers in Yeovil were surveyed to assess the impact the new dwellings had on their lives:

  • 54 per cent are happier in themselves and at home since moving into the accommodation.
  • 48 per cent say their physical health has improved since moving into the accommodation.
  • 43 per cent of tenants say their mental health has improved since moving into the accommodation.
  • 53 per cent say they are happier in their work since moving into the accommodation.

In response to the success of the Yeovil project, and subsequent changes to accounting standards and NHS policies, Prime got to work creating a key worker accommodation commercial model that they could replicate across the UK. Having invested extensive resources and expertise, Prime is now delivering affordable, high quality accommodation that is not a drain on CDEL.

Using NHS land or locations close to NHS sites, Prime has created a model to develop, fund, and build one, two, three and cluster bedroom key worker accommodation to meet the needs of local health and care systems.

Once the building is completed, ‘Hyve by Prime’ becomes the accommodation operator. Hyve is a not-for-profit company that is dedicated to providing and managing high-quality accommodation for health and care workers – improving their living standards and giving them a sense of place and community. Hyve rents the accommodation directly to the tenants – so, with no leases, nomination agreements or guarantees required from the NHS, the demand risk sits with Hyve, removing any burden from NHS balance sheets.

Some might be curious why a commercial organisation would ever consider creating a not-for-profit organisation but as Leighton explains, this was the only logical choice for projects that are centred on the wellbeing of key workers:

We’ve deliberately set up Hyve as a not-for-profit organisation because we feel that an operating company providing homes for key workers is best focussed on affordable high  quality outcomes for key worker residents.”

Igniting positive change

Following the success at Yeovil, Prime refined its new key worker commercial model at Dorset County Hospital. With the hospital’s existing shared/student-style accommodation fully occupied by junior doctors and medical students, the Trust had no room for other critical key workers. However, an opportunity containing 63 new apartments (mainly single person) was identified.

The apartments are of a high quality and meet national space standards. They are fitted out to include fitted kitchens and bathrooms. Hyve has also included the main fixtures and fittings including tables, sofas, beds, wardrobes etc. The Trust’s partnership with Prime exemplifies the potential of working together to tackle complex and time-critical challenges in the healthcare sector. By providing suitable and affordable housing to key workers, the Trust can retain and attract the essential workforce required to deliver outstanding patient care.

After considerable investment in research development, Prime is ready to roll out its solution to help other trusts proactively address their recruitment and retention challenges.

While the subject of salaries for health and care workers remains on the table, Hyve by Prime has a role to play in helping to solve the cost-of-living challenges. At the same time, access to comfortable, safe and convenient living spaces can positively improve the wellbeing of vital NHS staff.

With Prime taking on all of the risks for trusts, this project is a true partnership that places a collective objective at its core: helping to solve the recruitment and retention crisis which is holding back our health and care services – and at pace.

For more information about Hyve by Prime visit

[1] Rental market report: what’s happening to rents? Zoopla, March 2023

[2] NHS Highland says housing shortage affecting its ability to hire staff, The Press & Journal, March 2023

[3] NHS staff’s stress levels rose last year as covid pandemic took its toll, BMJ, March 2021

[4] New NHS record as more than 54,000 patients wait 12 hours to get into A&E, Independent, January 2023

[5] NHS staff cried in safety interviews, says watchdog, BBC News, February 2023

[6] Record levels of NHS staff resign as nurses say they are ‘broken’, Independent, January, 2023

[7] Carers struggle to find support for loved ones amid ‘enormous’ staff shortage in adult care sector, Sky News, March 2023

[8] Workforce Analytics, NHS SBS

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