It's been over a year since COVID-19 arrived in the UK, and the whole country feels exhausted – no one more so than NHS staff. The pandemic has brought about a deluge of new urgent priorities in health care delivery, trumping previously laid plans and projects across the board. The NHS has consistently risen to meet near-impossible asks, but the effects on the delivery of care and the wellbeing of staff cannot be understated, with a care backlog and an exhausted workforce.
As much as we want, and indeed need, to plan for a future beyond the pandemic, the way that we approach the coming months in the NHS will be critical.Policy Advisor (Workforce)
As much as we want, and indeed need, to plan for a future beyond the pandemic, the way that we approach the coming months in the NHS will be critical. "Normal" is going to look very different in order to set a sustainable course for the NHS. Giving staff time to decompress and recover will be among the most important priorities, as it is neither reasonable nor realistic to expect the NHS to operate under such sustained pressure.
The potential tension between the very real need to catch up with the care backlog (by ensuring patients whose treatment has been delayed for any reason are offered the care they need,) and protecting a limited staff base from even greater strain will be challenging to navigate. For example, we know that demand for mental health support has risen sharply, and by the beginning of December 2020, there were 224,205 people waiting more than 52 weeks to start hospital treatment in England – compared to just 1,467 the year before. In fact, in addition to catching up on the care backlog, the NHS will need to meet previous and newly emerging priorities. From reducing A&E waiting times to meeting the needs of long-COVID patients and addressing the longer-term impact of COVID-19 on health inequalities, the demands on staff are not going to abate for a very long time.
There is a clear and very welcome awareness within the British public of the extraordinary efforts of NHS staff over the past 12 months.Policy Advisor (Workforce)
There is a clear and very welcome awareness within the British public of the extraordinary efforts of NHS staff over the past 12 months. Donations to NHS charities, clapping on Thursdays, and dedications in windows have all emphasised tremendous support for frontline workers. The trauma of caring for critically ill patients, long hours working in burdensome personal protective equipment (PPE), cancelled leave, redeployment, and new ways of working have all required huge levels of personal resilience.
This struggle has extended far beyond those in critical care roles. In ambulance, community, mental health and acute services, medical and nursing directors, infection prevention control teams, and HR managers have had to bring about a raft of new changes, on top of their usual roles, with limited additional resource. Porters and cleaners have been busier than ever, procurement managers have worked flat-out to secure PPE, and communications teams wrestled with highly emotive, ever-changing information. We all owe a debt of gratitude to the wide-ranging teams in health and social care and must bear this in mind moving forwards.
Staff wellbeing is at the forefront of trust leaders' minds. NHS Providers conducted a survey of trust chairs and executive directors in August 2020, which found that 99% of respondents were concerned about the level of burnout across the workforce, even before the second wave hit. The People Plan 2020/21, published in July 2020, also recognised the growing issue of staff burnout, but stopped short of offering a comprehensive, multi-tiered approach to protect mental wellbeing backed by significant government funding.
NHS England and NHS Improvement's wellbeing resource hub has proved helpful to trusts, but many local organisations have run the extra mile, at pace, to provide additional support to staff. Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust set up a COVID-19 Emotional Wellbeing Team; Sherwood Forest Hospital NHS Foundation Trust held staff listening exercises, to ensure they were meeting the right needs; Lincolnshire Community Health Services NHS Trust launched a local wellbeing helpline; and Kettering General Hospital NHS Foundation Trust set up a CareCafe, where staff could take some time out of their day to decompress. Wonderful provisions have been made, but these initiatives desperately need steady funding to continue longer term, and to ensure the inclusion of pastoral care staff, and post-traumatic stress disorder support.
Following the longest and deepest financial squeeze in its history, the NHS entered the pandemic with 100,000 workforce vacancies in the trust sector alone.Policy Advisor (Workforce)
It is not only issues of staff wellbeing arising from the pandemic which need to be addressed, but also those that were prevalent prior to it. For too long, an unsustainable level of discretionary additional effort has been required by staff in the delivery of patient care. Following the longest and deepest financial squeeze in its history, the NHS entered the pandemic with 100,000 workforce vacancies in the trust sector alone. There has been a longstanding, and growing, mismatch between demand and capacity for some time, only exacerbated over the past year.
Research has repeatedly shown that workload is a central determinant of stress at work and, ultimately, burnout for staff. It is understandable, then, that trust leaders are keenly aware and anxious of the fact that large numbers of burnt-out staff may have to take long term leave, or exit the NHS altogether, following the relentless pressure of the pandemic. This will leave the NHS in a very tight spot, and is the reason why allowing staff to recover will be so vital in the coming months.
A fully costed and funded workforce plan is absolutely key to making this a reality for the NHS.Policy Advisor (Workforce)
To protect the wellbeing of the NHS workforce in the long term, and thereby enable the NHS to offer the public the service they expect and deserve, it's painfully clear that enough additional staff are needed not only to cover existing workforce gaps, but also to build flexibility into the system. Wellbeing is often spoken of at an individual staff level, but by building a resilient system, workforce wellbeing will be far better protected by realistic workloads, more regular and reliable breaks, and a better work life balance. A fully costed and funded workforce plan is absolutely key to making this a reality for the NHS.
Whilst the economic effects of the pandemic are palpable, the question of affordability in making the NHS sustainable will be one of political choice. The NHS relies principally on its staff to look after the people it serves, so whilst the current situation is undeniably bleak, it can be turned around with the right policy and funding decisions. NHS staff, and the people that they care for, deserve decisions which look after them.
This blog was first published by Public Sector Focus.