Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.
“The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.”
The health and social care committee’s latest report on workforce burnout is clear: the NHS workforce was in no fit state to cope with pre-pandemic demand, let alone what it has had to endure over the latest 15 months.
The extensive report is the accumulation of evidence from numerous staff groups and other organisations either representing or with an interest in the workforce. It makes for bleak, but unsurprising, reading.
Quite striking evidence given by The King’s Fund stated that NHS staff were 50 per cent more likely to experience high levels of work-related stress, when compared with the general working population. This was likely to damage their health and affect care quality and was also associated with patient satisfaction, financial performance, absenteeism, and organisational performance, the think-tank said.
Michael West, professor of work and organisational psychology at Lancaster University, and senior fellow at the King’s Fund, stressed the relationship between excessive workload and burnout and described it, rather aptly, as the “number one predictor of staff stress and intention to quit… it is also the number one predictor of patient dissatisfaction”.
The report rightly describes workforce shortages as the “biggest driver of burnout” and makes clear measures brought in during the pandemic to boost staff wellbeing must be maintained to stop staff from leaving – it calls for these measures to be extended and all staff given “explicit permission” to take time away from work. But as we all know, in reality, permission doesn’t always result in action in the NHS.
The NHS People Plan: A “smart-looking care without an engine”
The committee described the ambitions of the People Plan, published last summer, as “laudable”, but is clear its delivery depends on the level of resourcing allocated.
Much of the evidence submitted to the committee was also critical of the plan’s failure to include more detail, tackle longer-term issues or even cost any of its recommendations.
Professor West described it as a “smart-looking car without an engine”, and the NHS Confederation warned “too many investment decisions have been postponed or clarity has not been forthcoming”.
The HSCC therefore calls on the government to publish regular, costed updates along with delivery timelines for all of the proposals in the People Plan. It also goes a step further and highlights the absence of a People Plan for social care, which “serves only to widen the disparity in recognition and support for the social care components of health and social care”.
“The adult social care workforce has stepped up to the plate during the pandemic. They deserve the same care and attention that the People Plan pledges to NHS colleagues,” it said.
Bringing in social care
This report stresses it is no longer acceptable to separate health and social care staff; their work is intertwined and the wellbeing and robustness of one affects the other.
It argues that in order to understand the scale and impact of workforce burnout, a single metric for staff wellbeing and mental health is needed for both NHS and social care staff.
It also sets out the need for adult social care to have its own People Plan, which should include parallel commitments to those in the NHS document on diversity and inclusion.
An interesting recommendation, that conjured visions of Matt Hancock’s ‘bureaucracy busting barnacle’ speech at the launch of the People Plan, was the need for NHS England and Improvement to undertake a review of targets across the NHS.
It said it should seek to balance the “operational grip they undoubtedly deliver to senior managers against the risks of inadvertently creating a culture which deprioritises care of both staff and patients”.
However, it falls short of naming which targets should be scrapped, or changed, and in the context of recovery where targets to catch up are more prevalent than ever, this seems unlikely.
Although it must be stressed the HSCC is made up of numerous MPs, it is chaired by former health secretary Jeremy Hunt. There are echoes in this report of his repeated call and campaign for Health Education England to publish “objective, transparent and independently audited annual reports on workforce projections that cover the next five, ten and twenty years”.
When reading the report, it is hard not to wonder if the workforce could be in a better state if Mr Hunt had campaigned this tirelessly during his own tenure. Although the longest serving health secretary, his record on workforce was not glowing – and although promised – a long-term workforce strategy, one was never published.
However, this report is one of the punchiest reads on the challenges facing the NHS – and social care – workforce I have read.
A particular quote, again from Professor West, stands out: the excessive workload in the NHS “is like the pattern on the wallpaper that we no longer see”. But this report has ensured it is in plain sight – the extensive evidence that fed into this report cannot be ignored or glossed over.
The perpetual and extremely damaging argument that working in the NHS is a vocation, a job done by those who want to care for others with no want for themselves, must be extinguished and replaced with proper, costed and rigorous long-term planning – and fair reward.