The NHS faces a bleak midwinter as its staffing crisis hits home
Here we go again. As Omicron scythes through the population, many of us despair at the resumption of uncertainty and anxiety. For those working in our hospitals, the situation looks bleaker still. Even if Omicron proves relatively benign, the NHS is bracing to handle staff sickness and additional patients. It feels as though the health service is on the brink of a mass exodus of staff which will be unstoppable, unless action is taken now. And unforgivable, because the problem has been staring us in the face for years.
In the past few weeks, three senior people in the NHS have told me that the fear of this exodus is keeping them awake at night. Staff, not money, is now the limiting factor. There are 93,000 vacancies across the NHS, and shortages in every major speciality. Our hospitals are under huge pressure from the unvaccinated, the backlog of non-Covid cases, and the decision to divert GPs and nurses into giving booster shots.
You might have thought those in charge would have spent the past 18 months building up critical care capacity, improving recruitment and retention, and creating a dedicated vaccination service of volunteers and new trainees. But none of that has happened.
Instead, the system is its own worst enemy. An army of retired medics who offered to give jabs earlier this year were put off by absurdly onerous requirements. Now, the Royal College of Physicians tells me that many of its recently retired members are unable to come back because their hospital trusts “have either been unwilling to allow this or have stipulated unreasonable conditions”. And while the government has made welcome noises about expanding training, it has still not even set this year’s budget for the training body Health Education England.
For years, the NHS’s annual staff surveys have shown levels of bullying and abuse which would be unacceptable in most organisations. More than £6bn is spent every year on locum doctors and agency nurses. The agencies have us over a barrel right now, one senior nurse told me this week. She is struggling to persuade staff to do more overtime because they don’t trust management to protect them against unexpected tax bills.
Pay is not the whole explanation as to why 60 per cent of junior doctors and 55 per cent of nurses are contemplating leaving the NHS, according to one survey. International studies show that healthcare workers can become burnt out by the “moral distress” that comes from being unable to care for patients as they believe they should in resource-constrained environments.
One coruscating paper by two highly respected think-tanks, The Health Foundation and The King’s Fund, concluded bluntly that the NHS needs to become a “better employer”. Rigid rota systems and a lack of management support for staff at key stages in their career make people more likely to leave, the paper said. The think-tanks also accused the NHS of having “failed” on equality, with a quarter of black and ethnic minority staff reporting they did not have equal opportunities to progress.
Would any other organisation of this size survive if it was so poorly managed? I understand why insiders bristle at comparisons. The NHS is England’s biggest employer. It is not M&S, as the retailer’s chair Sir Stuart Rose admitted when he was appointed to lead an inquiry in 2014. But he did point out that “leadership, motivating staff and creating a culture where people are empowered to do things differently” were crucial to the success of any operation. He was also aghast at how often underperforming senior managers would be paid off from one hospital, only to appear in another.
When I conducted an independent review of junior nursing staff some years ago, I asked whether 12-hour shifts made sense given the intense emotional strain of the work. I was told that many nurses preferred these longer shifts because they had got used to organising their lives around them and some did outside work on their days off. There was no interest in the impact this might have on their mental health. Today, frontline nurses still face incredibly rigid rostering systems. This might explain why a lack of work-life balance is now cited as a reason by 26 per cent of those leaving the NHS.
“The little things can make a big difference to morale” says Dr Andrew Goddard, a gastroenterologist who heads the RCP. He recently visited a hospital where trainees told him that a vending machine providing food for overnight shifts hadn’t been stocked for weeks. Elsewhere, nurses are fighting to be allowed even to drink water on the ward. What kind of system treats people like this?
The huge variation in staff turnover between different hospitals suggests that good leadership can make the difference. Yeovil District hospital in Somerset cut its nursing turnover from 23 per cent to 17 per cent in one year by actively helping its overseas nurses settle in. The hospital says it was “determined to become a more conscientious and caring recruiter”. In the NHS, that makes it stand out.
In the first Covid wave, there was a fanfare about the creation of “wellbeing hubs” to give staff psychological support. This week I discovered that many have since been closed or scaled down: a small but depressing sign that despite the spur of the pandemic, too little has changed.