Two casualties of the old NHS are ironically now assisting hospitals in their quest to recruit and retain staff by establishing on-site nursery provision. Ex-nursing sisters Barbara Baker and Catherine Griffin felt forced to leave their profession when they started families because there was no childcare to cover their working hours. Twelve years on and they have used their knowledge to build up a chain of nurseries primarily providing childcare for NHS hospitals. By next year TLC will have contracts with 11 NHS trusts and it is thought it will then be the largest provider of hospital childcare.
'I'd worked in South Africa and every hospital over there had a creche, but at that time the NHS was not a family-orientated employer so we approached Walsgrave Hospital in Coventry about providing childcare. We were invited to talk about it and we ended up doing it ourselves,' explains Ms Baker, TLC managing director. 'That was 12 years ago and our original nursery is still operating. So the business all happened by default and we are effectively two casualties of the NHS.
'Now we have been approached voraciously by trusts because we have a first-hand understanding of the shift systems and other issues directly related to hospitals.'
TLC currently owns six nurseries, four of which are based at hospitals, but contracts, supported by funding from Aberdeen Murray Johnstone and Bank of Scotland, will double the chain's nurseries.
Such rapid growth is the result of increased demand from trusts following the NHS Childcare Strategy which aims to provide affordable, high quality childcare to cover hospital staff's work hours. Through the strategy funding more than 70m has been allocated to build around 150 new on-site nurseries in the next three years. As set out in the NHS Childcare Toolkit, capital funding is available to hospital trusts to build new nursery facilities or extend present ones. Each hospital can access up to 300,000 to provide 50 new places and revenue funding is available to subsidise the places at an average of 30 per place, per week. The provision of on-site nursery facilities is also being built into all plans for new NHS hospitals.
Chains providing NHS childcare benefit from getting a site that is often in a central location free of charge. 'All the hospital grounds are different but they are often in nice settings,' says Amanda Gilbert, general manager of For Under Fives that operates three NHS nurseries. 'At our Grimsby site there are lots of grassed areas and conker trees.'
Michael Thompson, director of Child Base which has six hospital nurseries plus two in the planning stage, says that another benefit is that NHS nurseries tend to fill up quicker because of the localised demand - at John Radcliffe Hospital, Oxford, Child Base's first NHS nursery, there are 5,500 people on-site and out of those around 70 per cent are women with 60 per cent estimated to be of child-bearing age. All 52 places are taken by hospital staff.
'The flow of customers is more dense because they are already in place which means we do not have to actively go out and look for business,' says Ms Gilbert. 'When the trust advertises vacancies within the hospital it says there is an on-site nursery. In our Grimsby nursery 80 per cent of the children are from the health authority. There is also always a great demand for baby places as staff return from maternity leave.'
Barbara Baker adds, 'Hospital workplace sites are guaranteed income during a recession - it is not like providing childcare for the manufacturing industry. There is always going to be a demand for healthcare.'
Along with helping hospitals with their recruitment problems, Dr Kay Turner, managing director of Childcare Partners, has noticed their hospital nurseries have fewer problems with recruiting nursery staff. 'I don't know why this is but maybe because the people who really enjoy working in nurseries enjoy working for the hospital because they are also in the caring profession. We also often get staff in our nurseries wanting to transfer to the hospital sites,' she says. Childcare Partners has at least two hospital nurseries, but Dr Turner declined to comment on the exact number.
Hospital nurseries have lower development costs because there is no land to purchase but that benefit is offset against there being no freehold. 'We design and build the nursery buildings so we need a strong contract because the land will never be ours. The contract is often a difficult and drawn-out process. At first we negotiated contracts for around five years, but now it is often for 40 years plus. With it costing 500,000 to build an on-site nursery we need a long lease to recoup the money,' says TLC's Barbara Baker.
There is also the disadvantage of having to meet criteria set by the hospital trust. 'It is more of a challenge to make the nurseries work because we need to deliver for their business needs and meet the hospital shift system,' says Dr Turner. 'Sometimes we need to operate in different ways because we need to meet the needs of the trust and that can make it more complicated. But if we wanted an easy life we would not go for these nurseries.'
Michael Thompson has noticed that over the past ten years trusts have got more demanding. 'The trusts are trying to be more commercial with the nurseries but I think they often miss the point because higher rents or longer opening hours get passed on to the end user and that is their employees.'
The nurseries need to be affordable for the hospital employees and fees are often indirectly subsidised by the trust through the ground rent rates and lease that the chains negotiate. Barbara Baker has found making the nurseries affordable can be a problem because a lot of the hospital staff are lower paid - it's not just surgeons or consultants who use the nurseries. At Guy's Hospital nursery this has been tackled by introducing a sliding scale with nursery fees depending on salaries.
The NHS Childcare Toolkit suggests hospital nurseries should provide demand-led accessibility including extended opening hours, weekend and bank holiday provision and flexible opening hours to accommodate shift work. Amanda Gilbert says their hospital nurseries do tend to have slightly longer opening hours than the other For Under Fives nurseries and they are considering opening at weekends. 'When both parents come from abroad or out of the area they have no family to back them up,' she says. 'Quite a high percentage of the parents both work within the hospital so we have to work with the trust to meet their needs.'
Busy Bees has gone one step further to meeting the needs of hospital staff at Hallamshire Hospital, Sheffield by providing Childcare Vouchers that cover registered childcare including childminders and out-of-school provision. 'We offer the vouchers to trusts and employees are taxed but do not pay national insurance. Our vouchers cover registered childcare - there's a raft of childcare needs to cover as a health trust and only one of them is nursery provision,' says Busy Bees director John Woodward.
Michael Thompson is concerned about the effects of extended opening hours on the children. 'There has been some pressure from trusts for us to open for longer but we have resisted that because it is not good to have children in the nursery late at night,' he says. 'The nursery is there to provide care through day cover and outside those hours the trust should seek to be flexible with working parents' needs. I also feel it is wrong to be open at weekends but we do offer a core service to meet the majority of needs.'
To avoid the increasing demands of trusts some chains are establishing nurseries just outside hospital grounds which they can develop to meet hospital staff's needs on the chain's terms. Busy Bees operates one NHS nursery and two on sites near hospitals, with imminent plans to open five more. Mr Woodward says, 'In the future few hospitals will want to run their own nursery. Therefore we can provide capital for a nursery, develop and run it and the hospital can contract places. If other trusts say they want provision then we have the capital.'
The NHS Childcare Toolkit by Daycare Trust is available free from the Department of Health, PO Box 777, London SE1 6XH, NHS Response Line on 08701 555 455, or www.doh.gov.uk/childcaretoolkit
