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The Ward Round: Leaders’ ‘moral’ duty on the cost of living crisis

Published on: 4 Aug 2022

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.

The last edition of The Ward Round discussed the government’s public sector pay announcement, which saw most of the NHS workforce receive a real-terms pay cut.

After it was published, I received messages from NHS staff who made clear their intention was sadly – but understandably – not to fight, but instead to leave.

One divisional manager, who wished to remain anonymous described the 1.3 to 2.6 per cent pay rise given to Agenda for Change band 8 and band 9 staff as an “insult [and they] were voting to walk”, as retirement beckoned, after 30 years in the NHS.

Others talked about how they were considering applying for lower band roles or weighing up their options in the private sector.

And of course, staff in lower bands also received a below inflation pay rise and are more likely to suffer from the cost-of-living increases, with inflation expected to hit “astronomical” levels over the next year. Many NHS employers are acutely aware of this and are trying to come up with new and creative ways in which they can support staff.

Darren Tidmarsh, chief people officer and deputy chief executive at Derbyshire Community Health Services Foundation Trust, said the trust was working hard to try and remove the stigma that is associated with experiencing financial difficulties.

He said: “We are encouraging people to reach out and we’ve got a range of graduated support offers, from making the pound go further to helping staff apply for a £500 Citizens Advice cost of living grant.”

Mr Tidmarsh said the trust was particularly concerned about the impact the cost rise in fuel was having on staff, and so the trust had enabled staff to apply for and draw down a £100 advance from their salary to spend on fuel.

“It prevents them having to pay for the fuel and then claim it back,” Mr Tidmarsh said. “We’ve also increased the fuel mileage rate as well as a

Derbyshire System and we are tracking the fuel cost up and down.”

NHS has “moral responsibility” to support staff

Clare Teeney, chief people officer at University Hospitals of Leicester, said the trust’s leaders view it as their “moral responsibility” to be a better employer and support their staff, as 29 per cent of all UHL staff earn a low wage, according to the ONS data.

Ms Teeney told The Ward Round how UHL had focussed on five key themes: food, transport, energy, children and hardship.

Among the measures introduced – which include food banks, discounted public transport and school uniforms provided to children – the trust is also offering free facilities on site for staff to wash and dry clothes, as this accounts for a high proportion of energy spend at home.

As reported this week by my colleague James Illman, Cambridge University Hospitals FT has a slightly different take and has recognised in recent board papers the impact rising housing costs are having on staff.

The trust is in the middle of converting former offices into accommodation for staff – available to anyone who needs it including staff on-call – and is hoping to open 60 additional rooms over the next six months.

CUH also acknowledged the Cambridge housing market was “very competitive” and has said it is making more plans and talking to local agents within and around the city.

However, it also acknowledged that “directly-provided accommodation could only be made available for a relatively short period of time”, so is a short-term sticking plaster, rather than long-term fix.

Trusts have said they are focusing on what is in their control when it comes to helping ease the pressure on staff, rather than worrying too much about the national pay award.

But the leaders I’ve spoken to are clear: they believe the NHS has a moral obligation to support staff as inflation starts to bite.

If you or your employer is doing something unusual to help staff during this difficult time, do get in touch on

Details emerge on NHSE restructure

In an email to staff last week, NHS England delivery officer Mark Cubbon provided an update on the major job cuts and merger with Health Education England and NHS Digital announced by Amanda Pritchard earlier this month.

Mr Cubbon said the combined vacancy rate of the three organisations was more than 15 per cent in June 2022, and he expected a “proportion of our vacancies can contribute to our overall reduction”, but also said NHSE needed to be “rigorous” about what it does in its new form.

“As the detailed design becomes clearer, we will share what this may mean for re-deployment,” he said.

He also described “clear themes” that have already come through in staff feedback, such as requests for further detail on size, recruitment controls, and particularly how equality, diversity and inclusion would be put at the centre of this work.

Mr Cubbon set out a number of things NHSE was doing, including developing a single equality, diversion and inclusion strategy and equality impact assessment but made clear there was no further detail on how the changes would affect individuals.

Mixed messages

However, Nora Colton, director of the UCL global business school for health, said there were “a lot of contradictions” in plans announced to drastically cut the number of staff working for NHSE, and the Messenger Review on leadership published just a month earlier, which focused on how transforming culture could drive change and improve performance.

Professor Colton described the signals being sent out as “concerning, at a time when we really need people, we really need good leaders, and we need people coming up with solutions”.

“We tend to undervalue leadership and management until something goes wrong,” Professor Colton warned.