Behind the scenes government committees have been busy gathering evidence from stakeholders to produce the 4 following reports that will greatly influence our working lives:
The Workforce burnout and resilience report acknowledges some causes of burnout in the NHS, such as the chronic, excessive, intensive workload, the effect of vacancies, discrimination and culture. The report begins to acknowledge the impact of burnout for individuals and the system, with a nod to the data from the NHS Staff Survey and the BMA on the numbers of staff who plan to leave the NHS, in the near future. The report recommends that the extra support for staff offered in the pandemic should continue beyond the recovery period, with the new Integrated Care Systems being accountable for access to that support. The Covid 19 mental health and wellbeing recovery action plan also recommends NHS staff have access to the ongoing support offers, and yet the free parking, that seemed to have a most beneficial effect on wellbeing for many has gone, and was not mentioned in either report. We owe it to ourselves to report the system level changes that improved our wellbeing in our health and wellbeing conversations, committed to in the NHS People Plan, so they are fed back to organisations by the Wellbeing Guardians, and in turn government, who say they will also be reviewing the ongoing support. The primary interventions that addressed systemic problems like parking prevent the need for secondary interventions like the NHS England and Improvement commissioned 24/7 text support line, or tertiary interventions such as psychology, which are mentioned in the report. It would be good if the compassionate leadership and culture recommended in the reports recognise that primary system level interventions that nurture are better than secondary prevention, which is better than a tertiary cure.
The workforce burnout and resilience report also recommends that a culture is embedded where staff are explicitly given permission and time away from work to seek help when it is needed. I hope this is not interpreted as only when the person is burnt-out. That Work Race Equality Standards were recommended to be part of the indicators used by Integrated Care Systems, whose boards should be representative of the populations they serve, will also improve NHS culture. The report recommends that the Department for Health and social care should have a policy framework around migration, to support workforce planning, and there should be a strategy for recruitment, transition and training for overseas workers, which would greatly improve their wellbeing and desire to stay. I was pleased to see the recommendation that workforce planning should also include time for recovery and hope my colleagues in Occupational Health and Rehabilitation Medicine will be consulted on what is really required to retain a workforce who will need to be able to work into their 70s (1). Costed updates and delivery timelines for the proposals in the NHS People Plan are also sensibly suggested and I hope that NHS work being “flexible by default” is prioritised, so that the gains made during the pandemic are not lost.
To improve the situation in social care, which has no Staff Survey or People Plan, the Workforce burnout report recommends a duty should be included in the Bill for the Secretary of State to publish a 10 year plan with detailed costings. It is also recommended that Health Education England publish annual reports on health and social care staffing requirements for the next 5, 10 and 15 years annually. taking into account shortages and numbers in training. The request in the report for the opportunity cost of not training, employing and retaining sufficient numbers of staff is a worrying one. Data that truly represents the money lost through only being able to operate a reactive health and social care system, rather than a proactive one, will be hard to come by. A recommendation of interest is that the NHS Staff Survey should include an overall wellbeing measure, which hopefully will truly measure wellbeing and not pathology, such as burnout. It would be a great shame if the overall wellbeing of staff is captured with a measure of pathology, as it sends the message that the best we can hope for is to not be unwell, and leaves no opportunity to capture where staff thrive and to learn from this. Our Delphi Study to develop a Core Outcome Set for wellbeing could help inform this measure.
The Covid 19 mental health and wellbeing recovery action plan recommends NHS staff have access to expert support, such as Occupational Health, but the lack of Occupational Health staff is not acknowledged. The Health is everyone’s business report does acknowledge the shortage of nurses and doctors in Occupational Health, but how far away we are from Occupational Health being the “frontline service”, suggested in the NHS People Plan has not been quantified. Many of us do not see Occupational Health even when needed, with 19% of respondents to an anonymous NHS staff survey disclosing a disability, but only 3% doing so on Electronic Staff records. For those of us that do see Occupational Health the Health is everyone’s business report also notes the lack of awareness and understanding of rights and responsibilities under the Equality Act among both employers and employees, in particular around providing reasonable adjustments. This is of particular relevance to the NHS, the UKs biggest employer, who you would imagine should be getting this right given the health expertise, but the BMA reported only 55% of doctors who required reasonable adjustments obtained them (2). The fact that doctors, with the highest levels of education, eloquence and experience in healthcare cannot get reasonable adjustments for themselves to enable them to remain at work, again emphasises the systemic problems of workload, discrimination and culture in the NHS. The Shaping future support Health and Disability Green paper talks about the government commitment to reduce the disability employment gap, and given the number of health and social care staff with Long Covid I hope this is taken seriously in the NHS for staff, who are patients too. We can all help improve things by continuing to speak out and report where we see excessive workloads, discrimination and unhelpful cultures and by remembering that showing each other compassion and civility saves lives.
- Gov UK. State Pension Age Timetable. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/310231/spa-timetable.pdf
- British Medical Association. Disability in the medical profession. Survey findings 2020. Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/disability-in-the-medical-profession