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We should remain focused on the likelihood that worker shortages in health and social care will get worse before they get better, writes Yerin Seo, senior campaigns advisor at the Recruitment and Employment Confederation
It’s hard to describe what the past 18 months have been like for workers across the healthcare sector. The pandemic has been challenging for all of us but it was extraordinarily demanding and testing for those working in the NHS and the social care system, especially those in frontline positions. Staff have risked, and in some cases lost their lives to save others, in the most difficult circumstances.
Even before the pandemic, the health and social care workforce was already seriously depleted. In 2019, there were over 200,000 vacancies across the NHS and the care sector. A large number of nurses and doctors even returned from or postponed their retirement to provide much-needed help during the pandemic.
Now, a year and a half later, there is urgent planning work to be done around how we live with the virus and shift the focus of the sector to resuming elective care and routine services. We also need a comprehensive review to address the wellbeing and robustness of everyone in our healthcare workforce - permanent, agency and bank staff - and ensure that we can maintain a well-functioning health system in the years to come.
Shortages pose a major problem
Staff shortages have been a chronic problem across the NHS and social care even before Covid. Although worker shortages across other sectors of the UK economy have been a dominating headline in recent months, we should remain focused on the likelihood that worker shortages in health and social care will get worse before they get better.
With the UK now in recovery mode, a large number of healthcare workers are looking to leave the industry or reduce their hours – either because they delayed or returned from retirement to help during the pandemic, or due to the strain of the past year and a half. The care industry already has one of the highest staff turnover rates of any sector.
As the world is gradually vaccinated and more countries open their borders, there is also a real concern about the UK losing healthcare workers to other countries, especially Australia and New Zealand where pay and working conditions are better than in the UK.
Burnout is a widespread reality
The incredible difficulties of the past 18 months and these staff shortages mean that nurses, doctors and carers have been pushed to the very edge in many cases, and staff burnout is a worrying reality. In June 2020, the Health and Social Care Select Committee published a report on staff burnout and resilience, saying that burnout is ‘a widespread reality in today’s NHS’. According to an NHS staff survey as part of the report, an ‘unacceptably high proportion of NHS staff experience negative impacts as a result of stress in the workplace’ which results in negative consequences and potential safety issues for patients.
The report also revealed that 44 per cent of respondents to the survey reported feeling unwell as a result of work-related stress in the last year, an increase of 3.7 per cent from the year before. A large number of healthcare workers and nine out of ten industry leaders are also reporting mental health and wellbeing as areas of concerns. Needless to say, the pandemic has added to the situation. There is an acute need to improve staff satisfaction and workers’ mental health to try and halt a potential exodus from the industry.
Demand is still increasing
The high number of hospital admissions due to Covid-19 and growing NHS waiting lists are only exacerbating the demand on the health service. NHS England’s waiting list stands at a staggering 5.45 million, the highest number since records began. And after the UK lifted all restrictions and fully re-opened the economy, hospital admissions have risen again and started to overwhelm a number of trusts. The Prime Minister’s recent announcement to increase National Insurance to invest in the NHS to clear the backlog will help, but it will take some time to take effect - and even longer for this to turn into the social care levy it was initially billed as.
And these are only the short-term pressures. The UK has an ageing population which will require an increasing amount of healthcare provision in the coming decades. It will be vital for the health of the entire country that we maintain a healthy and happy workforce in the health and social care system if we are to provide the care that everybody needs in both the short and long term.
Time for a comprehensive review
In order to do this, a comprehensive workforce review is essential. The current workforce blueprint does not meet either the UK’s current or future healthcare needs. At government level, there needs to be a thorough and extensive review into the healthcare and social care staff needed, with a view to producing a long-term strategy for workforce planning.
This should be done in partnership with the NHS, but also with healthcare staffing agencies, which are an important part of the sector. There will always be a need for temporary workers in healthcare, and thousands of them filled crucial vacancies during the pandemic. This is the perfect time for a reset of the relationship between the Department for Health and Social Care, the NHS and staffing agencies, based on delivering the best care at the best value for everyone.
This workforce review should examine all disciplines, identifying transferrable skills that will be critical for a long-term and forward-looking strategy that maximises workforce efficiency and deploys the right skillsets across the right disciplines at the most effective level. While inspecting transferrable skills, the review should also consider opening up a route for retired clinicians to return to practice with a simple re-registration process which could help ease the immediate pressure of worker shortages.
Invest in staff to improve retention
Alongside this workforce review, there needs to be significant investment put into improving staff satisfaction and working conditions. The REC recently held a series of conversations with medical recruitment agencies on the topic of labour and skills shortages. One thing that was repeated over and over during these discussions was the poor satisfaction levels among nurses and carers. At the end of the day, the environment for health and social care workers must be improved if we are to increase staffing levels and retention.
The Royal College of Nursing are asking for a 12.5 per cent pay increase for nurses, as they argue salaries have not gone up in the last decade. In social care, homes will say they are competing for staff with jobs in retail and hospitality - as they all attract similar rates of pay but provide very different working environments and stress levels. But there are many other things that could also be done to help here - in addition to looking at pay rates. Flexible hours, better facilities and access to training can also be very important to many workers. We hear time and again that people choose to become agency nurses not for the pay rates but because they want to select their shifts to suit their family or other responsibilities outside of work, or they want the opportunity to build up experience in multiple trusts, or on different wards.
A healthcare setting is always going to be a stressful working environment due to the nature of the work. Medical services are in demand 24/7 and emergency situations are of course often unpredictable. But that doesn’t mean that it is impossible to roll out more flexible working for both substantive and temporary healthcare workers. Part-time working, flexi-time contracts, compressed hours, job-shares or term-time workings are all great options that all employers should consider. This would help provide a healthier work-life balance for employees and their families. Flexible working arrangements are one of the key recommendations from medical recruitment agencies that the REC has spoken to, and giving staff the option to work more flexibly could help improve job satisfaction levels significantly.
Through all of this, collaboration between all parties in the health sector will be indispensable. These are not short-term issues, and will take time and effort to solve. But it is vital that we work together on a strategic workforce plan to help the UK’s health and care service be the best it can be - the pandemic has provided a unique opportunity to make it happen. We would like some leadership from the Department of Health and Social Care to coordinate a joined-up taskforce to do this work, which the recruitment industry would be a vital part of.
James Feindt, Marck Aghnatios and Alistair Fleming look at the opportunities of migrating care from hospital to the home environment, as well as the challenges it creates