• Nine in 10 NHS leaders of services provided in the community are either extremely or moderately concerned about their organisation's ability to deliver all services due to staff shortages related to recent increases in the cost of fuel.
  
  
• Over two-thirds of NHS community health services leaders are extremely concerned about the impact of increased fuel costs on their organisation's ability to recruit new staff and retain existing staff.
  
  
• Without a nationally agreed uplift to reimbursement rates, NHS leaders who responded to the survey estimate on average that 8% of their organisation's staff could leave in the next year.

Patients are at risk of waiting longer for their at-home appointments, such as caring for wounds or helping with their rehabilitation, or going into hospital when care at home would be more appropriate, due to recent increases in fuel prices which are exacerbating staff shortages among NHS community providers.

In response to an NHS Confederation and NHS Providers survey, nine in 10 NHS leaders of services provided out of hospital and closer to where people live, such as podiatry, specialist nursing care for diabetes or heart failure and physiotherapy, said they were either extremely or moderately concerned about their organisation's ability to deliver all services due to staff shortages.

NHS leaders have reported having to delay home visits or make them less frequent as a result, highlighting that not all patients will be able to attend clinics.

They say the staff shortages they are experiencing are being made worse by recent increases in fuel prices. High fuel costs are particularly worrying for community providers, and their staff, as many travel long distances daily by car to deliver vital care in people's homes or other community settings, often covering large rural areas.

Over two-thirds of the 103 NHS leaders who responded to the survey said they are extremely concerned about the impact of recent increases in fuel costs on their organisation's ability to recruit new staff and retain existing staff. Many NHS leaders said community-based staff have turned down offers of community sector jobs in favour of roles nearer to home or without the need for travel, including outside of the NHS in other sectors such as retail. Staff are also turning down extra shifts, which will reduce the community sector's capacity to tackle backlogs of care and support safe and timely discharge from hospital.

One community provider leader reported that some of their staff have been paying an additional £200 a month on travel costs to visit patients. While another said that 750 staff in their organisation have applied for financial help with their bills in the past three months.

An NHS community leader said: "We are concerned about the number of staff who are putting this down as their main reason for leaving and moving into an acute or a setting closer to home. [We] have now had to assist some staff with advances on salary to help them fuel their cars to come to work. We know sickness has gone up as a way of deflecting from the problem as people do not want to be honest about their financial issue and not being able to fund their car."

NHS community provider leaders are concerned about all roles, but say there will be significant pressure over the next year on district nurses, who provide care to housebound patients through regular visits; urgent community response teams, who provide urgent care to older people and adults with complex needs in their own homes to help them stay out of hospital and live well in the community; and health visitors, who work with children from birth to the age of five. They are also concerned about the impact that staff shortages are likely to have on the delivery of children and young people's services, which are already facing concerning backlogs of care.

As a result, the NHS Confederation and NHS Providers are calling for urgent national action to tackle the impact of recent increases to fuel costs on NHS community services. This includes an agreed national approach to reimbursement for staff, and the cap on fuel costs they receive. There must also be a national uplift in reimbursement rates and a change in the HMRC tax free mileage rate to ensure that staff benefit from any uplift. Without a nationally agreed uplift to reimbursement rates, the majority of survey respondents estimate that on average 8% of their organisation's staff could leave in the next 12 months.

It comes as the NHS is managing with more than 105,000 vacancies and preparing for what could be its busiest winter in memory. Strong community provision is necessary in part to reduce hospital bed occupancy and pressure on ambulances and A&E departments and GP services. To help reduce pressure, the NHS is expected to increase its use of virtual wards by an additional 2,500 beds, which will require more staff on the ground to visit patients at home.

Saffron Cordery, the interim chief executive of NHS Providers, said:

"Rocketing prices at the petrol pumps mean that staff who drive long distances to see patients in their homes are spending a small fortune to do their vital jobs – especially in rural areas.

"Vacancies for health visitors and district nurses are high already, and soaring fuel costs risk driving away staff we can ill afford to lose. Without community staff keeping people well in the community, more demand will be placed on other parts of the health and care system which are already under pressure at a level never seen before.

"Many local NHS community service providers have taken the lead to support staff, including funding increased mileage rates from their own already stretched budgets. But this is only a temporary sticking plaster; the problem needs a national, properly funded and coordinated solution."

Matthew Taylor, the chief executive of the NHS Confederation, said:

"If NHS staff working in the community can't afford to fill their tanks, then they cannot make important house calls and check in on some of the most vulnerable and poorly patients in our communities. This in turn will have a knock-on effect on other services, with increasing numbers of patients needing to use ambulances, go to A&E or their local GP practice when they could otherwise be cared for at home.

"This has been a problem for months but is getting to a critical state and we need to see urgent action from the government on the costs of fuel to help avoid more staff leaving these vital roles in the community. Ultimately, NHS staff shouldn't find themselves out of pocket and unable to pay their bills just for doing their jobs."

Siobhan Melia, the chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, said: 

"The cost of fuel is putting a huge amount of stress on community staff, who are being put off taking extra shifts or working in rural locations, and those on the lowest salaries are being hardest hit. As NHS leaders we are already struggling to keep staff or recruit new people to fill vacancies.

"Our community teams are caring for some of the most vulnerable adults, children and families in our local communities, and staff shortages threaten to undermine service delivery for people most at risk of poor health outcomes if they cannot access treatment in the community. These staff should simply not be out of pocket for doing their job."

Background information

The cost of petrol is around £1.75 per litre – 41p higher than August 2021. The current mileage reimbursement rate for health staff on standard NHS employment contracts is set by HM Treasury in agreement with trade unions bodies and NHS Employers and reviewed twice a year, or when there is a 20% increase or decrease in motoring or fuel costs over a 12-month average.

As it stands if NHS staff travel in their cars for work, most can claim taxable expenses of 56p per mile up to 3,500 miles per year and 20p for any miles driven over that, a rate that has remained static since 2014.
Many community providers have already put in place measures locally to support frontline staff with the issue of recent increases to fuel costs:

• 66% of respondents have increased the reimbursement rate from their existing budgets.
• 39% have scrapped a 3,500-mile cap at which higher rates are paid
• 29% have invested in employer-owned pool cars.

A number of providers have also had to significantly increase agency spending to fill vacancies. However, these interventions are not sustainable in the long-term, particularly given the further squeeze on NHS budgets as a result of inflation.