“I have worked in the NHS for 45 years and never have I seen so many staff work under such pressure for so long.”
These are plain speaking words of a trust chief executive talking about the workforce situation in their organisation. The language is bold and direct. There is a welcome clarity.
If we’re to deliver the high quality patient care we all want, we must change our approach to NHS workforce so that we have the right number of staff, with the right skills, in the right place.
If we’re to deliver the high quality patient care we all want, we must change our approach to NHS workforce so that we have the right number of staff, with the right skills, in the right place.
director of policy and strategy
In our report "There for us: a better future for the NHS workforce" we diagnose the problems and challenges facing the NHS workforce and then offer some solutions.
Demand is growing fast
First. More people than ever are using NHS services provided by hospitals, mental health trusts, community services and ambulances. Demand for services is very high and growing fast. The simple fact is we need more staff than we have to meet that need: emergency admissions are up 10%, ambulance calls are up 15% and diagnostic tests up 19%. The workforce has grown by 6% since 2014.
The simple fact is we need more staff than we have to meet growing need.
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This means there is a gap, and it’s one that is growing and is increasingly hard to fill. Recruiting new staff and keeping existing staff is more difficult because jobs on the frontline are getting harder and more pressurised.
Another trust leader told us: “In particular services people are leaving because the pressure is so great they are unable to cope.”
Alongside this we can’t get away from the fact that money really is an issue. Many staff have not received a pay rise for many years, despite having seen their jobs become more demanding and working longer hours. And funding is an issue more generally because even if the workforce were available many trusts cannot afford to recruit more. Although the Government is shifting on public sector pay, it does need to be delivered with out strings attached and with additional money so that trusts themselves aren’t footing the bill.
Although the Government is shifting on public sector pay, it does need to be delivered with out strings attached and with additional money so that trusts themselves aren’t footing the bill.
director of policy and strategy
Closing the NHS pay gap
Second. It’s imperative that we close this gap. Right now “the NHS is significantly dependent on the ‘heroic’ efforts of clinical and non-clinical colleagues” (NHS trust leader). Relying on discretionary effort is not sustainable. Indeed 59% of NHS staff, for example, said in the last NHS staff survey that they are working unpaid overtime each week. It’s finally been recognised we need to grow the domestic workforce, and the government has plans to expand medical education, boost the number of nurses and look at apprenticeships, for example. However we don’t know if this is enough, and it won’t happen tomorrow. So it’s certainly not a quick fix.
In the meantime we must acknowledge that we rely on staff from beyond our shores. Thirteen per cent of NHS staff are from outside the UK. They make a very welcome contribution and are helping to plug that gap, and we need them to continue to do so. However the uncertainty created by Brexit and issues such as language testing and immigration policy is making this much, much harder. As one leader put it “We would not be able to maintain high quality care for the people we serve without our diverse workforce. The current lack of progress in the Brexit negotiations is creating unhelpful uncertainty in an already challenging environment.”
“We would not be able to maintain high quality care for the people we serve without our diverse workforce. The current lack of progress in the Brexit negotiations is creating unhelpful uncertainty in an already challenging environment.”
Something that is in trusts’ gift is to make their organisations, and the NHS generally, a great place to work. That means going all out to creating positive cultures and environment, improving the day to day experience for black and minority ethnic staff and adopting a zero tolerance approach to bullying and harassment. Obviously external pressures cut across this, but there is still much that trusts themselves can do.
Impact on staff morale
Third, and finally, we need everyone in government and the many other national organisations with responsibility for the NHS to acknowledge the scale of the challenge we are facing in terms of all the issues about pay, recruitment, retention, rising demand and the impact of pressurised working conditions on frontline morale. As one trust leader put it. “Staff are the most important factor in delivery and sustainable staffing is the greatest challenge facing my organisation. I have no real sense that the scale of the challenge is truly understood nationally.”
And, even more importantly, they must speak clearly, with one voice, about how to overcome it. It may surprise many to know that there is no single, workforce strategy for the NHS, despite its strategic importance.
It may surprise many to know that there is no single, workforce strategy for the NHS, despite its strategic importance.
director of policy and strategy
There is hope and much of it lies in recognising that whilst they cannot solve things alone, if local organisations had more control and greater room for manoeuvre they could get on with the task in hand, backed up by greater support from the centre.
However, to go back to the nub of the issue - having enough staff is central to the NHS, which cannot function without them. The final words go to a trust leader who sums up the impact of this:
“…the consequent pressure on the remaining workforce and the impacts on their health and wellbeing and the quality of care they provide give me great cause for concern.”
This article was first published by the Guardian Healthcare Network on 7 November 2017
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