Embedding Fairer, Faster Recruitment in the NHS: Lessons from Royal Papworth’s Digital Transformation
Recruitment and retention continue to pose significant challenges across the NHS, particularly within nursing and healthcare support roles. High vacancy rates, regional workforce shortages, and a competitive labour market have made it increasingly difficult for trusts to maintain safe staffing levels. These challenges are even more pronounced for specialist providers delivering complex care.
Royal Papworth NHS Foundation Trust is one of the UK’s leading specialist cardiothoracic hospitals, providing advanced heart and lung services, including transplantation, cardiac surgery, and respiratory medicine. As a centre of clinical excellence and innovation, the Trust relies on a highly skilled, multidisciplinary workforce to deliver safe and effective care. In early 2023, workforce pressures were mounting: registered nurse vacancy rates had reached almost 14%, HCSW vacancies exceeded 26%, and nearly half of all new HCSWs left within their first year. Recruitment processes were heavily manual, time-consuming, and lacking in transparency, contributing to both inefficiencies and candidate drop-off.
At the same time, the Trust was increasingly focused on aligning recruitment practices with its organisational values and equity commitments. Embedding fairer, more inclusive recruitment was a key strategic aim, recognising the importance of reducing bias, enhancing transparency, and improving the candidate experience from the first point of contact. This transformation aligned closely with the Trust’s values of compassion, excellence, collaboration, and integrity. These principles underpin not only clinical care but also how the organisation recruits and supports its people.
In response, Royal Papworth initiated a comprehensive transformation of its recruitment model, centred on the implementation of a new Applicant Tracking System (ATS). The goal was to enable more data-driven, candidate-centred, and equitable recruitment practices, while also reducing time-to-hire and improving retention.
This case study explores how Royal Papworth used a digitally enabled, partnership-driven approach to redesign its recruitment processes and improve workforce outcomes, offering lessons for other NHS organisations facing similar challenges.
The Challenge
Despite its national reputation for clinical excellence, Royal Papworth NHS Foundation Trust faced persistent recruitment and retention challenges by early 2023. Staffing gaps were particularly acute in nursing and healthcare support worker (HCSW) roles, placing pressure on clinical teams and increasing reliance on temporary staffing. High early attrition among new HCSWs further exacerbated workforce instability.
These issues were compounded by structural and regional factors. The cost of living in the surrounding area made it difficult to recruit into lower-banded roles, and the Trust was seeing a noticeable decline in applications from newly qualified nurses. These external pressures overlapped with internal limitations; most notably a recruitment system heavily reliant on manual processes, which lacked the capacity to track key metrics or support early candidate engagement.
Without access to real-time data, recruitment efforts were largely reactive. Time-to-hire was difficult to quantify, candidate withdrawals went unexplored, and insights into bottlenecks were anecdotal at best. Managers had limited visibility into recruitment progress, and candidates often experienced long silences between application stages contributing to disengagement and potential drop-off.
Feedback from the NHS Staff Survey also pointed to growing staff concerns around unfilled vacancies and the impact on team morale, further reinforcing the urgency for change.
There was also growing awareness that the Trust’s existing systems did not support its ambitions to embed fairer, more inclusive recruitment practices. Without a digital infrastructure to drive consistency, transparency, and equity, the recruitment process risked reinforcing systemic barriers rather than dismantling them.
Together, these challenges pointed to the need for a strategic, digitally enabled transformation, one that would not only streamline recruitment operations but align more closely with the Trust’s values and workforce goals.
The Solution
In early 2023, Royal Papworth NHS Foundation Trust initiated a formal review of its recruitment systems and processes, with the aim of creating a more proactive, transparent, and equitable approach to workforce planning. Central to this transformation was the procurement and implementation of a new Applicant Tracking System (ATS) that could support both operational efficiency and strategic goals.
The Trust undertook a competitive tender process, evaluating multiple providers including NHS Jobs, a market-leading ATS vendor, and Oleeo. Selection criteria included cost-effectiveness, technological capability, customisability, and the potential for long-term partnership. Oleeo was selected in June 2023 as the preferred supplier, based on its comprehensive functionality, strong value proposition, and capacity to support a modern, data-driven recruitment strategy.
Oleeo’s platform offered significant advantages over previous systems. Key features included the ability to build and manage talent banks, a customer relationship management (CRM) engine to personalise candidate engagement, real-time recruitment dashboards, and a high degree of configurability to meet the Trust’s specific needs. Of particular value was the potential to embed fairer recruitment practices through transparent workflows, standardised decision-making tools, and enhanced candidate communication, therefore directly supporting the Trust’s equity and inclusion goals.
Implementation was managed collaboratively, with project teams from both Royal Papworth and Oleeo working closely to co-design workflows, tailor system features, and define a phased rollout strategy. Initial efforts focused on ensuring a smooth “go-live” in June 2023, while allowing for progressive feature deployment over time. Training was delivered through a “train-the-trainer” model, supported by regular engagement with stakeholders across clinical and corporate services.
Throughout the implementation, emphasis was placed on partnership working. Weekly meetings, feedback loops, and shared development goals enabled continuous adaptation and responsiveness. Where challenges emerged, such as in pre-employment check workflows, these were jointly addressed through escalation, dedicated working groups, and resource reallocation. The Trust’s willingness to engage in system improvement, alongside Oleeo’s openness to feedback, helped shape not just local success but broader improvements for NHS users across the supplier’s client base.
The result was a recruitment infrastructure that was not only more efficient, but better aligned to organisational values and workforce priorities, capable of supporting data-driven decision-making, improved candidate experience, and long-term workforce sustainability.
The Results
Royal Papworth has seen demonstrable improvements across a range of recruitment performance indicators. These outcomes reflect not only operational gains, but also a shift in culture toward more transparent, data-driven, and candidate-focused practices. As of March 2025:
– Nursing vacancy rates have decreased from 13.79% to 1.77%
– HCSW vacancies have dropped from 26.82% to 11.01%
– The overall Trust vacancy rate has fallen from 14.33% to 6.01%
This improvement has directly supported service continuity and reduced reliance on agency staffing with positive implications for both patient care and workforce morale.
Time-to-hire performance has also improved significantly. Prior to the implementation of the system, actual time-to-hire figures often exceeded the 48-day KPI, fluctuating between 40 and 60 days without a clear trend. Post-implementation data shows a steady reduction in time-to-hire, with performance becoming more consistent and better aligned to targets. The system now enables the Trust to isolate exceptional cases, offering a more accurate picture of baseline efficiency and areas for improvement.
The quality and visibility of candidate data has also transformed. Royal Papworth is able to track candidate withdrawals in detail including both the stage at which they occur and the reasons. Between June 2023 and March 2025, 127 candidate withdrawals were recorded, with 46.5% attributed to a general loss of interest in the role. This insight has informed improvements to candidate communications, onboarding content, and recruitment web pages, helping to maintain engagement throughout the process.
Importantly, the candidate experience has improved markedly. Through integrated feedback mechanisms, 726 candidates rated their recruitment experience between June 2023 and March 2025. Of these, 79.4% rated their experience as “Excellent” or “Very Good”, with only 2.6% reporting a negative experience. In the most recent 12-month period, positive ratings increased to 80.9% and negative feedback dropped to just 1.5%.
Beyond the data, there has been a measurable increase in manager engagement and ownership of the recruitment process. The new system’s visibility tools have enabled hiring managers to track candidate progress in real time, reducing administrative delays and encouraging more active participation.
The partnership with Oleeo has also supported the development of new onboarding tools, reference-checking workflows, and early engagement features such as the Talent Engagement Engine, all designed to further reduce attrition and enhance candidate connection to the Trust.
The implementation of the new ATS also enabled Royal Papworth to capture and analyse equality, diversity, and inclusion (EDI) data more effectively across the recruitment process. For the first time, the Trust was able to identify where in the process different groups of candidates were being disproportionately filtered out. One key finding was that while a high proportion of candidates from Black and minority ethnic (BME) backgrounds were applying for roles, comparatively few were being shortlisted. In response, the recruitment team developed targeted candidate support materials, including guides on how to complete NHS application forms and interview preparation sessions. These resources were promoted both internally and externally and have been well received. Early feedback suggests they have improved candidate confidence and application quality, while also contributing to more equitable shortlisting outcomes.
Together, these results demonstrate the value of a well-structured digital transformation, supported by strong supplier collaboration and a clear focus on values-based and inclusive recruitment. The improvements seen at Royal Papworth offer a practical model for other NHS organisations seeking to modernise recruitment, reduce inequality, and improve workforce stability.
Lessons Learned & Implications
The success of the recruitment transformation at Royal Papworth NHS Foundation Trust highlights several key lessons for NHS organisations seeking to modernise workforce strategies and reduce vacancy rates.
The importance of partnership working cannot be understated. Working with a supplier that aligned with the Trust’s values and demonstrated a genuine commitment to co-design was critical. The ability to adapt the system to local needs, coupled with responsive support and shared problem-solving, created a platform for sustainable change.
The richness of data has driven improvement. The introduction of a system capable of tracking real-time metrics, from time-to-hire to candidate withdrawals and EDI outcomes, shifted recruitment from a reactive process to a strategic function. This visibility enabled targeted interventions, more effective decision-making, and a stronger focus on equity and experience.
Cultural change as much as technology drove success. While the technical infrastructure was essential, the increased engagement across the organisation pushed the transformation. Hiring managers gained ownership of the process, candidates reported improved experiences, and recruitment is being reframed as a shared responsibility rather than a back-office function.
Finally, values-based recruitment can be strengthened by the right digital tools. With greater transparency, structured decision-making, and proactive candidate engagement, the Trust was able to move toward a more inclusive and fair recruitment process — one that both reflects and reinforces its commitment to equity.
The results achieved at Royal Papworth demonstrate what is possible when digital innovation is combined with strategic intent and collaborative implementation. As NHS organisations continue to face workforce pressures, this case study offers a practical model for embedding fairer, smarter, and more sustainable recruitment systems across the health service.
The Conclusion
The transformation of Royal Papworth’s recruitment approach has delivered measurable improvements in vacancy rates, candidate experience, and process efficiency. More than a technological upgrade, the implementation of a modern ATS enabled a fundamental cultural shift toward more transparent, inclusive, and values-led recruitment practices.
Through data-driven insight, collaborative implementation, and a commitment to continuous improvement, the Trust was able to address longstanding challenges and build a more resilient workforce pipeline. The use of candidate feedback, EDI tracking, and targeted support interventions demonstrates how digital tools can be leveraged to improve both outcomes and equity in NHS recruitment.
As workforce pressures persist across the health service, this case study offers a practical and replicable model for trusts seeking to modernise their recruitment strategies. The experience at Royal Papworth highlights the value of investing not just in systems, but in partnerships, people, and the principles that underpin fair and effective recruitment.
