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.
It started in an interview with Bloomberg Businessweek last spring. Anthony Klotz, a psychologist and professor of business at Texas A&M University, told the publication that when there’s uncertainty people stay put, resulting in “pent-up resignations”. The number of people leaving their jobs is then later inflated by what Professor Klotz described as “pandemic-related epiphanies”.
He coined the term “The Great Resignation”, which has prompted an increasing number of articles advising firms on how to tackle this pesky new trend.
This phenomenon is of course not unique to the private sector. The latest NHS workforce data has shown the health service is going through its own “Great Resignation” too. Although the current data only goes up to December 2022, it shows almost 70,000 NHS staff voluntarily resigned last year – this is around 5,000 more than you might expect, taking into account the “pent-up” element identified by Professor Klotz.
NHS employers have limited resources at their disposal to try to stem this terrible leak. Most staff cite “work-life balance” as their reason for leaving, but systemic workforce shortages and consistent winter-style pressures make fast improvements next to impossible. Also, working flexible hours, or working from home, is simply not an option for many frontline staff.
Commenting on the data, Kate Jarman, the director of corporate affairs at Milton Keynes University Hospital Foundation Trust, who has set up a group to promote flexible working for those who are able, said it “demonstrates the enduring importance of focusing on flexibility and worklife balance to retain staff”.
“Without this, no amount of recruitment will ever be enough,” she added.
Although, more optimistically, the workforce has grown over the last two years (as it consistently does) it would still be dangerous to ignore the growing trend of leavers. Trusts with similar priorities to Milton Keynes, who are proactively trying to retain their staff, are an important part of the answer, but so is a national strategy.
Just this week the Lords Public Services Committee questioned Department of Health and Social Care officials on this issue.
Gavin Larner, director of workforce planning for the DHSC, said although the department worries about retention, compared to other sectors it’s “relatively good”.
“People are driven by a sense of purpose that makes them more sticky than other industries,” he said.
He described how the focus on retention has changed since the pandemic, as the “exhaustion” of staff has emphasised the need to focus more on mental health support, as well as improving culture and making the NHS a more modern place to work.
But even if retention has remained stable, demand has increased. Not only does this mean the NHS needs to further reduce churn to keep on top of it, increased workplace pressures could make it more likely staff might look for work elsewhere.
Perhaps the “sense of purpose” won’t be enough to make people stay.
In line with plans to rapidly roll out virtual wards, NHS England has published more guidance for integrated care system leads.
Virtual wards, which enable patients to be treated at home rather than in hospital, are seen as a way to relieve pressure on trusts and deliver financial savings. There are ambitious national targets to have at least 40 virtual beds per 100,000 population by December 2023.
However, as raised again this week by Alison Leary, professor of healthcare and workforce modelling at London South Bank University, there appears to be no workforce impact assessment in this latest guidance document.
Last year, Professor Leary and Elaine Maxwell, visiting professor at Southbank University, discussed in HSJ the unnecessary safety risks caused by London’s virtual wards. In the piece they also warned about the wider impact on community services, referring to emerging evidence that models not offering 24-hour cover are shifting work on to other workers, such as overburdened district nurses and primary care staff.
These concerns have arguably intensified following news of plans to bring in private providers to speed up this rollout.
Professor Leary said: “There are different interpretations of virtual wards. The pre-covid model of a full multidisciplinary team out of hospital with district nursing at its heart shows real benefits.
“However, more recent models that rely more on technology and remote monitoring of a lot of people, provided by a hospital for a limited number of hours per day, is anecdotally increasing workloads for community teams, particularly out of hours.”
Responding to concerns about the lack of an impact assessment and the need to provide 24/7 patient monitoring, Matthew Winn, director of community health for NHS England, said the expectation is virtual wards would “grow from and with community health teams”.
He said: “It will be failure if the schemes are set up in solo and not integrated into how care is currently delivered. The intent is quite clear in the document about this. We will find out in June when all the detailed system returns come in… workforce will be the key determinant of plans being signed off and funding released.”
This is how it should be – but different parts of the NHS not communicating brilliantly with each other is not unusual. The safety risk in leaving already stretched community teams to pick up the out of hours work is too dangerous to ignore.