The Ward Round: A final wake-up call for ministers

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

“I want to apologise to everyone that the experience of working at the trust is so deeply unsatisfactory for so many colleagues.”

This was a message sent from the chair of Liverpool University Hospitals Foundation Trust to all staff this week referring to the NHS staff survey, of which the 2021 edition was published yesterday. Quite a refreshing acknowledgement of just how concerning the results are this year.

By contrast, a Twitter thread posted by NHS acting chief people officer Em Wilkinson-Brice read: “The results give us a number of key areas to focus on and build further.” True, but perhaps she could have done more to acknowledge how dissatisfied the workforce is and how much needs to be done.

HSJ’s analysis of acute trusts in this year’s survey confirmed Liverpool had deteriorated the most in terms of staff recommending the trust as a place to work, but it was by no means alone; only a handful of trusts improved on this key measure when compared to last year.

The ongoing covid pandemic has taken a huge toll on staff morale and satisfaction. Combined with operational pressures and the lack of a pay rise, this makes for an unhappy workforce.

It will also be of no surprise to readers that ambulance trusts are still performing the worst. This was seen in a big way in the responses to the questions relating to staff being happy with the standard of care their organisation provided, being satisfied with the recognition they receive for their work and those who have gone to work despite not feeling well enough to perform their duties.

Worries about staff shortages also come through in this year’s survey. Just 27 per cent of staff who responded agreed staffing was adequate in their organisation, a huge drop of 11 percentage points from the previous year.

Responding to this particular finding, NHS Providers deputy chief executive Saffron Cordery said it was “vital” for the government to come up with a fully costed and funded workforce plan to ensure the NHS has the staff it needs.

Ms Cordery also pointed towards NHS Providers’ recent workforce survey, in which 97 per cent of respondents said staff shortages were having a serious and detrimental impact on services.

With that in mind, it was concerning to see around 30 per cent of all staff are considering leaving the workforce, another measure which has worsened since last year.

“Keeping NHS staff on board and supported is the greatest challenge the NHS faces right now,” said Jessica Morris, a Nuffield Trust fellow.

This year’s British Social Attitudes survey, which has tracked the public’s view of the NHS since 1983, was published on the same day as the staff survey. And workforce shortages are clearly cutting through.

The survey’s results show overall satisfaction with the NHS in 2021 fell 17 points to 36 per cent — the lowest level since 1997.

“Staff shortages remain a key driver of concern, with nearly half of respondents (46 per cent) putting it behind growing dissatisfaction,” Ms Morris added.

Sara Gorton, head of health for Unison, said without an “urgent and significant” wage rise, NHS staff will “simply walk for better pay and less stress elsewhere, which is a disaster for patient care”.

“With household bills going through the roof and staff being hit by hospital parking charges, nurses, porters, paramedics, cleaners, healthcare assistants and all other vital employees will be thinking long and hard about their futures in the NHS,” Ms Gorton stressed.

NHS must act to eliminate equalities

Ms Morris also highlighted that, despite the NHS promising action on diversity and inclusion, reports of discrimination against staff from black and minority ethnic groups has jumped sharply.

HSJ has also explored this in my colleague Nick Kituno’s analysis; he found a greater percentage of ethnic minority staff reported they personally experienced discrimination at work – nearly a fifth of staff reported this – within the last 12 months, compared to the previous year.

A smaller proportion of NHS staff from an ethnic minority background, compared to their white colleagues, believed they are given equal opportunities for career progression. At 44 per cent, this is an improvement on last year, but still a fall since 2017.

Ms Cordery said there are similar concerning trends for staff living with lasting health conditions. “We must find ways to address the large proportion of disabled staff who don’t feel valued,” she said.

“Leaders across the NHS and government must act to address this and work to eliminate inequalities based on race and disability in promotions and career progression, where a large gap has persisted to the detriment of staff with protected characteristics.”

Some might argue in the context of the pandemic and recovery pressures these results are not surprising. But the health service should be surprised – it should be shocked – and ministers and national teams should take note. The public is not satisfied with the NHS, but the NHS does not have the tools to do enough about it.