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.
There are few other industries more reliant on the goodwill of their workforce than the health service. It is sadly commonplace for NHS staff to regularly need to work beyond their hours to get the job done, but without the reward of a pay rise or end of year bonus.
Over the last 18 months this has been ratcheted up another level, and although there are parts of the health service that have maintained various staff wellbeing initiatives, many other perks have melted away.
The significant role ‘goodwill’ plays in keeping the NHS running was also raised in the health and social care committee and the science and technology committee’s Coronavirus: Lessons Learned to Date report, published this week.
The report said written evidence submitted to MPs suggested the NHS “had been reliant upon the goodwill of those who staff the system”. It also discussed the “lack of buffer in resources”, including for the workforce.
So, with this in mind the announcement of the Messenger review of NHS leadership, closely followed by a briefing to The Times (£), suggesting trust leaders would be sacked if they fail to reduce their elective backlog, will have eroded the essential goodwill supply even further.
Jon Restell, chief executive of union Managers in Partnership, said that while he believed health and social care secretary Sajid Javid “probably knows” managers have done a good job during covid, working long hours, and going above and beyond, the briefing “undermines their credibility”.
“There is a drip, drip, effect,” Mr Restell said. “Something has happened to some people in the last 18 months and they think ‘I don’t have the energy for this’. It’s the straw that broke the camel’s back.”
In terms of the Messenger review, Mr Restell called for the government to “flip it away from a deficit study” and instead focus on what could be done to support existing leaders and help people into the leadership pipeline.
Mr Restell made clear the “performance” from the health secretary also has a knock-on impact on the managerial pipeline, both clinical and non-clinical.
“It’s about the managers that are more clinical; people who are thinking of going into management,” he said. “They hear those messages, and they hear a lack of respect and risk. Everyone thinks it just [affects] boards. It affects everyone.”
Even for NHS staff who are not considering moving into a management role of whatever rung, the rhetoric could still be damaging.
“If you’re a [healthcare assistant] or a nurse and you hear managers are going to be sacked, you know that is going to be horrible,” Mr Restell said. “That will influence your own perceptions.”
With emergency departments already in crisis, the elective backlog and covid – the ever-present uninvited guest at the party – the government would be well advised not to play the blame game with the people who keep the health service, so dangerously powered by goodwill, running.
Maternity in crisis
The pandemic has shone a light on many fragile services in the NHS. Maternity is undoubtedly one of them.
Just last week board papers published by Northern Lincolnshire and Goole Trust described how there had been an “increase in red flag incidents” because of maternity staffing shortages, delays in inductions of labours, staffing being “less than establishment” and the need to call in the “on-call community midwife” to ensure services are run safely.
To cope with this, the trust has had to recruit midwives directly from Thornbury, an off-framework agency, rather than first go to the cheaper agencies approved by NHS England and Improvement.
NLAG will not be alone facing these challenges in staffing and safely running its maternity services (although the trust has emphasised no patient has come to harm and it has recruited more midwives). The Royal College of Midwives found last year that 83 per cent of its members did not think their trust had enough midwifery staff to ensure safe services.
In a recent interview with HSJ, Mary Ross-Davie, Royal College of Midwives’ UK director for professional midwifery, described how midwives are often drawn away from working in their community patches to cover labour wards.
“Midwives are having to run up and down an escalator,” Dr Ross-Davie said. “You can have many innovations, many new tools, and they can have an impact and they can improve care, but actually the biggest risk of safety in maternity services is a shortage in midwives.”
Much like nurses, and in fact most other healthcare professionals, midwives do not grow on trees, so relying on short-term solutions such as international recruitment will continue to be crucial when plugging those gaps.
Speaking at the Queen’s Nursing Institute annual conference this week, Duncan Burton, one of the deputy chief nursing officers for England, said the NHS’ international recruitment programme has just been extended to midwives, for which a programme is being “worked up”.
This focus is good news for understaffed maternity teams, the community services midwives who have been drawn away from other work and of course the safety of mothers and babies. But with RCM predictions that the NHS is 3,000 midwives short, boosting the domestic training pipeline is also crucial.