Retention, recruitment and morale It's time to address the key challenges facing our NHS and social care workforce

19 May 2017

Anna Starling

There are few things that all political parties agree on in this general election. The need to focus on the health and social care workforce appears to be one of them. The past few years have laid bare challenges in workforce, which threaten the ability for the health and social care system to function effectively now and in the future.

As an operational manager in the NHS I lived with this reality. Filling medical rotas often proved fraught due to the shortage of staff available. A particularly exhausting experience for myself and a consultant colleague was six months of being four doctors short on one rota. It meant we had to make constant pleading phone calls to our own medical team to take extra shifts, and the quotes from the medical recruitment agencies to supply staff to cover shifts became more and more eyebrow raising. We struggled to release our training doctors for their essential medical education sessions, which meant our education lead wasn’t happy with us either. The vacancies placed pressure on clinical teams, and impacted negatively on the trust’s financial position due to our high agency spend. Ultimately, it wasn’t good for patient care.

What’s more, we knew that these problems weren’t confined to our trust or to medical recruitment. As our new briefing
A sustainable workforce – the lifeblood of the NHS and social care discusses, there are currently staff shortages across the health and social care system. Within hospitals, nurses and clinical support staff are in short supply, which has implications for consultant productivity. There are also major problems in non-acute services including community and district nursing, as well as in social care. The Office for National Statistics (ONS) reported that in 2016 health and social work accounted for 15% (118,000) of vacancies in the whole UK economy.

Staff morale and stress is also a concern. The recent NHS staff survey found that nearly two in five staff reported that they had been ill in the past 12 months due to work related stress (37%). This has troubling implications for future staff retention and is almost certainly in part linked to staff shortage issues. As one clinical colleague put it, 'The more gaps there are in rotas the worse your job is, and the more likely you are to think about leaving it altogether.'

These issues have been born from a longstanding piecemeal approach to workforce planning and a policy architecture that, according to our report Fit For Purpose?, is 'large, complicated and opaque – a loose association of organisations more than a system.'  In its recent inquiry into health and social care, the House of Lords’ Select Committee on the Long-Term Sustainability of the NHS concluded that the absence of a comprehensive, national strategy for the health and care workforce over the next 10-15 years was the biggest internal threat to the sustainability of the NHS. There is an urgent need for a nationally-led workforce strategy that sets out how we plan, train, regulate, pay and support health and care staff in the short and longer term.

But any national strategy must build on the work of frontline leaders who have responded to the chaotic nature of national workforce planning by devising their own local strategies to improve the experience of staff and patients.

When my colleagues and I experienced these vacancy issues, it forced us to come up with a longer term solution. Eventually we managed to decrease our rota gaps by redesigning the job role to improve its attractiveness to the limited number of potential recruits. This included teaming up with other departments (so that doctors in these posts could have a greater diversity of clinical experiences) and remodelling the rota to provide a more varied mix of shifts. We were aware, however, that our success in attracting these doctors meant that others in the system would now be in the position we had previously found ourselves in.

There are great examples across the country of leaders in health and social care who have carved out the time to take new, innovative approaches to workforce. The piloting of the Buurtzorg model for nursing staff, the development of new ways of health and social care multidisciplinary team working in new care models, and the introduction of Schwartz rounds to improve emotional wellbeing of staff are all notable examples. Those designing a national workforce strategy must take time not only to learn about such work, but also to ensure that any national actions actively encourage local innovations.  

There is an urgent requirement for the next government to design and implement an effective health and social care workforce policy that focuses on achieving workforce sustainability. An essential part of this process is engaging with the local leaders and workforce that the strategy will aim to support. We know that health and social care staff are committed to providing quality care to patients. Rewarding that commitment with jobs that are desirable, and people want to stay in, must be a national priority.

Anna Starling (@annastarling) is a Policy Fellow at the Health Foundation

Further reading


Election briefing: A sustainable workforce

May 2017

The third and final Health Foundation briefing ahead of the 2017 General Election considers the...

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