Given the sheer importance of the NHS and Social Care to the UK economy and the population, we have decided to devote this quarterly workforce wellness update to the profound challenges facing the UK healthcare workforce.
In June 2021, the Health and Social Care Select Committee pulled no punches. They described the incidence of burnout and well-being challenges facing the UK healthcare workforce as an “emergency.” Furthermore, in July 2022, the Select Committee asserted that the NHS is facing the greatest workforce crisis in its history driven by staff shortages (which we have discussed in detail in our separate blog this month.”
PERVASIVE PEOPLE PROBLEMS
The Nuffield Trust, in its article (“Fronting up to the problem; what can be done to improve the well-being of NHS staff?”) from July 2022, highlighted the fact that “…many studies have reported increased rates of depression, anxiety and severe stress alongside a range of other serious issues” among the NHS workforce.
It points to the large-scale effects of the pandemic on the stress levels and long-term health and well-being of the workforce, referring to high rates of probable PTSD(36%), probable common mental disorders (51%), and alcohol misuse (18%). While it cautions that “more detailed analysis” reveals actual rates of PTSD of 9%, it should be recalled that this is double the rate amongst the general population.
The Nuffield Trust report showcases that women, younger workers, and nurses have poorer outcomes than other staff. It cites the only longitudinal study of over 2750 workers across more than 25% of Trusts, which found that 21% of health and care workers reported high levels of stress.
This general picture of the well-being landscape is worrying, given the sheer scale of vacancies across both NHS and social care and the broader context of severe shortages across the wider labour market.
ALL OCCUPATION GROUPS IMPACTED
If we examine the data from across various groups within the NHS, there is little doubt that mental health challenges are ubiquitous and challenges of workforce retention paramount.
When we look at the nursing profession, it is instructive to note the findings of the Royal College of Nursing (RCN) membership survey from December 2021. This survey found that almost 6 out of 10 nurses were considering or planning to leave their careers; the main reasons cited for this included feeling “undervalued” and being subject to “too much pressure.” NHS Digital Data supports this thesis in that the leaver rate among nurses and health visitors fell from 9.8% to 8.6% in December 2020 but rose to 10.1% in December 2021.
In the case of medical doctors, the latest General Medical Council (GMC) training survey ( cited by the Health Service Journal in late July 2022) reveals “..a worsening picture of burnout among medical professionals,” according to the HSJ.
The GMC findings are stark indeed, with 2/3 of medical trainees and more than half of trainers reporting either moderate or high risk of burnout; the highest rate since 2018. The trainee group most at risk is those working in emergency medicine. The GMC highlights the link it notes between burnout levels and retention. In response to the findings, Dr. Katherine Henderson (President of the Royal College of Emergency Medicine) has called for a fully funded workforce plan.
In the case of General Practice, it is a similar story of retention challenges fuelled at least in part by the emotional pressures of working in this segment of the healthcare sector. The Kings Fund (“More of the same will not fix General Practice”) in August 2022 shines the light on the fact that staff in general practice are feeling “demoralised and demonised”. It adds that one in seven GP posts stands vacant.
Perhaps as disturbingly is the incidence of negative well-being amongst Freedom to Speak Up (FTSU) Guardians whose role’s raison d’etre is to help provide an emotionally safe space for people to raise issues about working conditions and their experiences within them.
This comes from the National Guardian, Jayne Chidley-Clark, who warned (in July 2022) that there has been an unusual drop in the percentage of staff viewing their organisations as having a positive speak-up culture. In addition, the Report cites the alarming finding that 50% of all guardians said that their FTSU role had reduced their emotional and psychological well-being.
Whilst there are unlikely to be any easy solutions to the broad and perhaps broadening well-being challenge facing the NHS and wider healthcare sector, commentators have highlighted actions that are being taken to tackle this critical issue.
The Nuffield Trust Report referred to above highlights the importance of improving staff experience, including tackling the issue of effective rota planning and providing comprehensive training to ensure there are sufficient staff to ensure that the care delivered is safe.
The report also points out the value of organisations creating impactful options for dealing with stress, including “Providing high quality psychological and well-being services that are evidence-based.”
“ MORAL RESPONSIBILITY “ to be Better Employers
There is also perhaps an imperative to view the issue of staff well-being through a wider lens. The current cost of living crisis is highly pertinent in this regard as inflationary pressures are likely to add to stress and anxiety amongst the lower-paid segments of the workforce especially given Bank of England estimates that inflation could reach 13% in October this year.
This is an issue very close to the heart of Clare Teeney, the Chief People Officer at the University of Leicester Hospitals NHS Trust, who has stated that the leaders at the Trust view it as a “moral responsibility” to be better employers; and to support staff In this cost of the living challenge. The reason is that 29% of all UHL staff earn a low wage, as defined by the Office of National Statistics (ONS).
In its publication (entitled “How Health is Perceived Around the world “)from July 2022, McKinsey argues that discussions about health tend to refer to physical health but exclude other critical components, including social and spiritual health – it defines the latter as including the elements of meaning, purpose, and belonging.
Some commentators are calling for a reimagining of how employers approach questions of well-being and a flourishing workforce. The UK is facing its highest talent shortages in 16 years and growing numbers of workers seeking freedom to choose their working hours. Ariana Huffington, founder and CEO of Thrive, has called this a “…once in a generation opportunity to redefine how we work and live.”
Addressing the central impotence of supporting well-being, she puts a challenge to all employers who one can argue, have a particular understanding of the NHS:
‘’Forward-thinking companies need to do away with the zero-sum idea of work and life reflected in the myth of “work-life” balance by embedding well-being into the workflow itself.”
Whether wider definitions of health are adopted and whether or not NHS leaders begin to see their provision of better working conditions as a moral imperative, it is perhaps clear that addressing the (long-standing and pre-pandemic) issue of workforce vacancies within the NHS is a key lever in reducing pressure on the current workforce. As a result, the call for the Government to produce a clear strategy to tackle this becomes ever louder.
In July of this year, Jeremy Hunt, the `chair of the Health and Social Care Select Committee, was candid:
‘’We now face the greatest workforce crisis in the history of the NHS and social care with still no idea of the number of additional doctors, nurses and other professionals we need.”