Getting to grips with healthcare’s staffing problems

Debates about the future of the NHS are often dom­i­nat­ed by calls for more invest­ment in new tech­nol­o­gy to cure its debil­i­tat­ing symp­toms. But many of the imme­di­ate prob­lems fac­ing front-line work­ers in the sec­tor are not tech­no­log­i­cal; they are human.

There have been well-doc­u­ment­ed short­ages of nurs­es, GPs and oth­er clin­i­cians in recent years, exac­er­bat­ed by fac­tors such as Brex­it and a wave of ear­ly retire­ments. This has since com­bined with the emer­gence of Covid-relat­ed job vacan­cies across the sector’s wider ecosys­tem.

Calls for an urgent rem­e­dy have attract­ed bil­lions of pounds in pub­lic invest­ment, with the chan­cel­lor announc­ing fur­ther capex fund­ing in his Octo­ber bud­get. But, giv­en that much of that mon­ey has been ear­marked for new dig­i­tal IT and diag­nos­tic equip­ment, there is a grow­ing belief that the recruit­ment and reten­tion prob­lem is still being ignored.

Richard Mur­ray, CEO of the King’s Fund, an inde­pen­dent char­i­ty work­ing to improve health and social care in Eng­land, fears a future in which new­ly opened NHS facil­i­ties need to be moth­balled owing to a lack of staff. He believes that suc­ces­sive admin­is­tra­tions have ducked sev­er­al of their respon­si­bil­i­ties to the sec­tor.

Mur­ray sug­gests that the cur­rent gov­ern­ment has “shown brav­ery” by increas­ing tax­a­tion to fund NHS invest­ments and a long-term plan to reform social care (see pan­el, XXXXX). 

But he warns: “This all risks com­ing to noth­ing for one sim­ple rea­son: there aren’t enough employ­ees. Even before Covid, the NHS was in the mid­dle of a deep staffing cri­sis caused by a pro­longed fund­ing squeeze, com­bined with years of weak pol­i­cy, poor work­force plan­ning and frag­ment­ed respon­si­bil­i­ties.”

Mur­ray notes that addi­tion­al fund­ing can­not increase staff num­bers by any sig­nif­i­cant extent, because those extra peo­ple sim­ply “don’t exist”, although short-term mea­sures such as an inter­na­tion­al recruit­ment dri­ve could help to fill some of the more press­ing vacan­cies.

A detailed work­force plan for expan­sion is need­ed, he stress­es, explain­ing that this entails “retain­ing and moti­vat­ing as many exist­ing employ­ees as pos­si­ble and invest­ing in train­ing to deliv­er the new staff of the future”.

But Mur­ray is unclear as to whether there’s “any mon­ey left for such a plan. Tack­ling the work­force cri­sis is the biggest chal­lenge by a coun­try mile.” 

Rachel Hol­lis, chair of the Roy­al Col­lege of Nursing’s pro­fes­sion­al nurs­ing com­mit­tee, also fore­sees prob­lems if HR invest­ments aren’t increased. 

“In his recent bud­get, the chan­cel­lor set out invest­ments in clin­ics, hos­pi­tal beds and tech­nol­o­gy,” she says. “All are wel­come, but they do not replace years of under-invest­ment in work­force plan­ning. Tech­nol­o­gy will con­tin­ue to evolve, but patients will ben­e­fit only if there are nurs­es to deploy it.”

Hol­lis con­tin­ues: “Nurs­ing is a high­ly skilled and safe­ty-crit­i­cal pro­fes­sion, which requires sig­nif­i­cant invest­ment. Our health ser­vice has tens of thou­sands of nurs­ing vacan­cies and there are even more in social care. No amount of tech­nol­o­gy will pre­vent a knife-edge win­ter for health and care ser­vices. Human resources are the greater pri­or­i­ty.”

As CEO of doc­tor-led cam­paign­ing organ­i­sa­tion Every­Doc­tor, Dr Julia Pat­ter­son speaks for more than 1,700 mem­bers. She believes that the pandemic’s effect on their abil­i­ty to work effec­tive­ly in sev­er­al set­tings is a grave con­cern.

Pat­ter­son acknowl­edges that invest­ments in tech­nol­o­gy are nec­es­sary across the NHS, not­ing that it can some­times be a strug­gle sim­ply to find a work­ing print­er. But she fears that doc­tors’ stress lev­els have become so high dur­ing the Covid cri­sis that their resilience is being test­ed to the lim­it. This could exac­er­bate the sector’s human prob­lem unless there’s a prop­er­ly fund­ed effort to improve their phys­i­cal and men­tal well­be­ing. 

She would also like to see fair­er increas­es in doc­tors’ pay to recog­nise increas­ing work­loads and infla­tion, plus fund­ing for new nurs­ing bur­saries to widen access to the pro­fes­sion.

“What I do get from doc­tors an awful lot is their sense of exhaus­tion,” Pat­ter­son reports. “Every­one has a lev­el of resilience. It feels as though the gov­ern­ment is test­ing that by push­ing and push­ing. Humans can absorb only so much pres­sure. This will def­i­nite­ly have ram­i­fi­ca­tions on the NHS work­force in the longer term.”

She con­tin­ues: “We’re extreme­ly for­tu­nate in the UK to have excel­lent train­ing sys­tems for health­care work­ers, but los­ing skilled staff lat­er down the road once they’ve gained exper­tise will adverse­ly affect patient care. This is going to have a dev­as­tat­ing effect on our ser­vice.”

Social care addresses its image problem 

Social care is also fac­ing its own par­tic­u­lar human cri­sis, with issues such as recruit­ment from over­seas and the intro­duc­tion of manda­to­ry Covid vac­ci­na­tions for some employ­ees play­ing a part in this.

But Richard Adams, CEO of elder­care provider Sears Health­care, believes that the key con­tribut­ing fac­tor is the com­mon view that work in the sec­tor is of “low val­ue and low sta­tus”.

Adams, who runs three nurs­ing homes in south­ern Eng­land, hav­ing start­ed out in the late 1990s as a care assis­tant, says: “Until car­ing for old­er peo­ple is seen as a skilled role, recruit­ment will remain a real chal­lenge. This issue is under­pinned by a more deeply held view that health ser­vices, par­tic­u­lar­ly hos­pi­tals, have greater soci­etal val­ue. This is not only about pay, but also about train­ing, career frame­works and a recog­ni­tion that car­ing for peo­ple has the same val­ue as heal­ing peo­ple.”

Adams believes that more needs to be done to pub­li­cise the pos­i­tive out­comes that high-qual­i­ty elder­care can achieve. “The more that care is under­stood, the more val­ue it will have. Peo­ple should be proud to say that they are a car­er or that they work in a care set­ting,” he says.

Demen­tia care nurs­ing is anoth­er area that’s unable to attract the tal­ent it needs, notes Paul Edwards, direc­tor of clin­i­cal ser­vices at char­i­ty Demen­tia UK. This is not helped by the fact that the specialism’s “unique skill” is often down­played in uni­ver­si­ties, he adds.  

Per­cep­tion prob­lems also fig­ure high­ly in the recruit­ment chal­lenge, accord­ing to Tri­cia Nicoll, one of the prime movers behind the #social­care­fu­ture cam­paign. Low salaries and short care vis­its play their part too.

Her two autis­tic chil­dren (now adults) have need­ed help in many areas of their lives over the years, and this now includes their col­lege work and vol­un­teer­ing. Nicoll stress­es that the peo­ple she employs as care work­ers for her son and daugh­ter are high­ly skilled. 

“We need to look past for­mal qual­i­fi­ca­tions to judge skills and knowl­edge – and we need to rou­tine­ly pay at least a liv­ing wage,” she says.

Shift­ing pub­lic per­cep­tions of work in social care as sim­ply a mat­ter of help­ing old­er peo­ple to “get up, go to the loo or eat” would also widen the base for recruit­ment, Nicoll believes. 

She recalls how she once helped to cre­ate a team of care work­ers to sup­port peo­ple with learn­ing dis­abil­i­ties. They were all for­mer min­ers with “no expe­ri­ence of work­ing in social care”, Nicoll says. “But their big hearts and no-non­sense atti­tude made them per­fect for the role.”