The NHS workforce is at something of a crossroads. Pre-existing staff issues have been exacerbated by the circumstances of the past 18 months. Not only through the huge physical, emotional, and logistical challenges of delivering care during the COVID-19 pandemic, but also the resulting levels of staff fatigue coupled with sharply increasing service demand and a care backlog which has the NHS running just to stand still. Trust leaders know how much all of their staff have given, and are continuing to give, at work. There is real concern about increases in staff attrition, with 48% of trust leaders seeing staff leaving their organisation due to early retirement, burnout, or other effects from working in the pandemic. Given that the NHS entered the pandemic with over 100,000 vacancies – and service demand has only increased since then – this is extremely worrying.
However, as turbulent as the present landscape is, there is much to be hopeful about. For a long time, trusts have been innovating locally to recruit, retain, and sustain their staff, and the current climate has only energised such work. Across the country, there are examples of wellbeing offers being expanded, workplace culture being openly evaluated and improved, new ways of working being implemented to improve both patient care and staff experience, and initiatives around recruitment and retention being revamped to futureproof the service.
It is not only impressive, but important that this has been done in the face of the most challenging 18 months that NHS staff have ever seen. Ensuring that people know they are valued and being invested in is key to any workforce initiative, whether it is intended to address issues in the short, medium, or long term. NHS Providers' new report, Providers Deliver: Recruiting, retaining, and sustaining the NHS workforce, provides a snapshot of just some of the excellent work being done across the country in this regard, and how it is acting as a springboard for driving further change and innovation.
Much of this work is framed or supported by national policy. The People Plan 2020/21 from NHS England and NHS Improvement sets flexible working offers as a key aspiration for the NHS. Even prior to the plan's publication, trusts like the University Hospitals of Derby and Burton NHS Foundation Trust have been implementing inspired approaches to workforce management to enable this, working creatively to overcome constraints in capacity and resource. The People Plan also emphasises the importance of addressing inequalities within the NHS workforce – an area in which Dorset County Hospital NHS Foundation Trust has key learning to share, with a tangible commitment from executive level down to face this head on. The NHS workforce is large and diverse, and as such reflects wider society. The importance of truly understanding and acting upon this to implement the best workplace culture and patient care possible, cannot be overstated.
Addressing wider issues of workplace culture is another key tenet of the People Plan. It is no surprise that a healthy, happy, and inclusive workforce leads to better patient care and outcomes, critical for attaining integrated care systems (ICS) ambitions. Solent NHS Trust has worked diligently to create a culture which is values-led and empowers staff to speak up, and as a result they have seen both a reduction in staff turnover, and improvements in staff engagement. Similarly, Berkshire Healthcare NHS Foundation Trust have worked across several years to empower their staff to be part of change within their workplace, centred in a thorough approach to management training. Freedom to speak up and excellent, consistent management are two central issues which the Kark report brought to the fore in 2019, and which are restated in the 2020/21 People Plan.
Good culture is foundational to enabling the continuing moves towards system working in the NHS.Policy Advisor (Workforce)
Good culture is foundational to enabling the continuing moves towards system working in the NHS, with the with the establishment of ICSs as statutory bodies expected in the coming months as part of the Health and Care Bill. Trusts like the North East Ambulance Service have been working cross-organisationally for some time – for example in their initiative to provide paramedics in primary care services on a rotational basis. This has been hugely beneficial to the GP practices involved, relieving some of the pressure which they are currently facing, and has also garnered good feedback from staff on the positive effect this offers their professional development. NHS Providers' last Providers Deliver report focussed on collaboration across systems, and it is heartening to see how excellent work in this area is continuing and benefitting the workforce and patients.
Sussex Partnership NHS Foundation Trust also exemplify collaboration with other organisations through their Learning Academy Partnership, enabling local students from Greater Brighton Metropolitan College to shadow staff. This is part of the trust's wider programme to overhaul traditional recruitment practices, with a new, dedicated recruitment team establishing workforce pipelines in the local community. Midlands Partnership Foundation Trust have also made creative changes to their training offers, and the resultant focus on ensuring continuing professional development for the workforce has improved retention rates. Investing in support for staff for the journey from prospective application to career development has also been a priority for Mid Yorkshire Hospitals NHS Trust. Like many trusts, they scaled up their staff wellbeing offer during the pandemic, and have since been developing it to ensure useful, continuing support for their workforce.
Staffing is the biggest challenge currently facing the NHS, as unsustainable workloads place far too much pressure on a workforce short on staff and skills.Policy Advisor (Workforce)
Staffing is the biggest challenge currently facing the NHS, as unsustainable workloads place far too much pressure on a workforce short on staff and skills. The backbone of the NHS is the people who work for it. Trust leaders know this, and that is why there is such a plethora of excellent work to support them. However, as commendable as initiatives such as those detailed in NHS Providers report are, they can only go so far.
To safeguard the recruitment, retention, and wellbeing of the NHS workforce in the long term, it's painfully clear that enough additional staff are needed not only to cover existing workforce gaps, but also to bring additional capacity into the system. A fully costed and funded workforce plan, alongside increased long-term investment in workforce expansion, education and training, is absolutely crucial to making this a reality for the NHS.
NHS Providers are continuing to call for this, as are many other organisations, as a matter of absolute priority. But, as we wait, it is good to reflect on the brilliant work being done locally to make real differences to the lives of people working in our health service. There is hope to be had in excellent initiatives from trusts across the country, and inspiration to be taken from what they could do next.
This blog was first published by HSJ.