Through collaboration, flexibility, and compassion we can retain our NHS staff

The NHS workforce is facing a ‘perfect storm’, a phrase somewhat overused during the pandemic but nonetheless true. Every day, exhausted and demoralised staff are being confronted with increasing backlogs and patients presenting with more and more complex conditions.

Understaffed hospitals are not new. As a consultant anaesthetist, I know there are rota gaps and high caseloads across the NHS, and this has been the case for many years.

We would need to see a significant increase in the NHS workforce just to meet pre-pandemic demand, let alone to tackle the elective care crisis that covid-19 has left in its wake. Any recovery is likely to take years longer than expected, and patients need to be prepared for waiting lists to keep rising.

Education

There is one obvious solution to this problem, the government needs to provide funding to train more health and care staff. Which is why the Royal College of Anaesthetists has called on the government to fund 100 additional higher anaesthetic training places per year for the next four years.

I mean it is hardly a secret that the lack of long-term workforce planning and funding has led to staffing gaps that create higher workloads, that impact the welfare and morale of staff, and that then ultimately lower retention rates. This is a vicious cycle that we are unlikely to resolve unless the NHS’ staffing capacity is increased.

However, while the college and others work with the government, Health Education England and their devolved nation equivalents to address long-term workforce shortages, a comprehensive plan is a long way off. Even if a workforce plan were to be implemented tomorrow, it takes five years to train someone to be a doctor and a further seven years to train them to become an anaesthetist.

We cannot wait that long for extra capacity. With more than 5.6 million patients waiting for surgery, covid admissions across UK hospitals averaging over 700 patients per day, and the winter flu season nearly upon us, there is an urgent need to keep our NHS staff happy, healthy and in work now.

Respondents to a recent RCoA survey on retention told us that one in four consultant anaesthetists plan to leave the NHS within the next five years. Work-life balance, lack of support, job inflexibility and perverse incentives around pensions often emerge as key factors affecting career decisions in anaesthesia.

Many senior consultants and SAS anaesthetists want to stay but end up leaving out of frustration due to the rigidity of terms and conditions of employment, and because it may no longer make good financial sense to work the number of hours expected.

The fundamental challenges NHS staff face cannot be cured with a yoga class or a mindfulness app. To deliver genuinely impactful wellbeing, it is necessary to address the underlying stresses of the job

While it is easy to place blame for poor retention at the feet of government - not entirely without cause when it comes to workforce capacity and pension policy - it is clear from the survey results that maintaining staffing levels is not just a role for one group: everyone from NHS leadership through hospital management to individuals involved have a part to play.

Speaking to those on the ground, it is clear that during the pandemic the idea of being kind to yourself and others became a theme in some hospitals. The mental health concerns of NHS colleagues became increasingly recognised, and the offer of wellbeing resources became more common.

While these are positive steps, the fundamental challenges NHS staff face cannot be cured with a yoga class or a mindfulness app. To deliver genuinely impactful wellbeing, it is necessary to address the underlying stresses of the job and to provide staff with adequate time to rest and recuperate.

Culture and leadership

While some NHS HR departments and managers have acknowledged the stigma surrounding time off and flexible working, we are still waiting for many to follow their lead.

At a roundtable discussion on retention recently held by the RCoA, the chief executive of NHS Employers Danny Mortimer hit the nail on the head: “All too often we have valued people in the NHS who have worked in an unhealthy way or celebrated those who gave every waking hour to their hospital and their patients. Although I am immensely proud of the members of our specialty who have repeatedly gone the extra mile to provide effective care to the sickest patients, there is a limit to what people can do before they reach breaking point. We do not always see the damage this causes behind the scenes, to physical and mental health, personal lives and ultimately the sustainability of the NHS, as staff leave medicine or take early retirement. This is fundamentally an issue of culture: we need to value the teams that support flexibility, show compassion to our colleagues’ needs and champion those who want to stay and contribute to the work in a measured way that safeguards their wellbeing.”

This is however not a one-way street. Every action has an equal and opposite reaction, and adjustments to one colleague’s working patterns will have an impact on the rest of the team.

There needs to be a common sense of purpose in agreeing job plans that work for individuals, departments and systems alike. For me, that common purpose has to be to provide the best possible care for our patients while safeguarding the mental and physical wellbeing of our workforce, but I am all too well aware that achieving that balance is far from easy.

Managers have a clear role in shaping the culture in departments and fostering respect, but at operational level they are also best placed to facilitate discussions with individuals and teams. Succession planning takes time, and career conversations need to be offered early and regularly as part of yearly reviews of job plans to inform workforce planning in departments.

Once a member of staff has decided to leave or retire it becomes very difficult to bring in the adjustments required to keep them in work.

The pandemic has shown the NHS can be a collaborative, flexible, and compassionate place to work. While there is no silver bullet when it comes to retention and the reasons people stay and go are complex, it is clear that we can achieve far more together than we will alone.