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Content ArticleHuge issues are facing the UK’s medical workforce: angst among staff, battles for training opportunities, a lack of basic amenities, discrimination, shortages of posts, roles with no career progression, and a failure to support workers asking for pay reviews. In this BMJ opinion piece, Partha Kar says we need fresh leadership to lead basic changes with support from the royal colleges and unions, and other external organisations need to step up now.
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Content ArticleDespite steps towards closing the gap between mental and physical health services, many people still cannot access services and face long waits for treatment. Addressing workforce challenges in mental health services will be crucial to improving this situation. This report, commissioned and supported by NHS Confederation’s Mental Health Network, takes stock of progress across the country in staffing the single largest profession within the mental health workforce: nurses.
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Content ArticleThe Bucharest Declaration is the outcome of a World Health Organization (WHO) high-level regional meeting on health and care workforce in Europe that took place in Bucharest 22-23 March 2023. It makes 11 statements relating to the workforce crisis facing countries across Europe about retention, recruitment and staff safety.
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Content ArticleHealth and care workers in all parts of Europe are experiencing overwork, with high levels of burnout. This opinion piece in the BMJ looks at the issue of healthcare professionals leaving European health systems to take early retirement or work in other countries where pay and conditions are better. It highlights the causes of this exodus, including increasing patient complexity, salary erosion and work-life balance. It argues that policies should prioritise retaining existing staff, as increased training numbers offer only a partial, long term answer.to the crisis, highlighting potential approaches governments can take to retain highly qualified healthcare staff.
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Content ArticleThis toolkit from NHS Employers aims to support the reduction in turnover of international staff in the NHS by improving their experience at work. It is hoped that this will then enable them to stay, thrive and build lasting careers in the NHS. It is for line managers and employers and should be used alongside the International Recruitment Toolkit and the Improving Staff Retention Guide to support your overall approach to recruiting and retaining international and domestic staff. The good practice principles and examples throughout can be applied to all professions.
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Content ArticleAll countries of the WHO European Region currently face severe challenges related to the health and care workforce (HCWF). This report focuses on identifying effective policy and planning responses to these HCWF challenges across the Region. The report presents an overview of the HCWF situation in the Region (focusing on medical doctors, nurses, midwives, dentists, pharmacists and physiotherapists, for whom data are available) and identifies relevant policy options, their expected benefits and potential facilitators or barriers to successful implementation. Examples of sound evidence-informed practices in countries are also provided. The aim of the report is to describe the data, rather than to analyse. Data supplied by countries have been used, but in many cases these have been incomplete. It is expected that data will grow progressively in future. No data on informal health workers are included.
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Content ArticleMany cross-sectional studies and reviews have demonstrated that higher registered nurse staffing levels are associated with better patient outcomes. The aim of this study was to identify and assess the evidence for an association between nurse staffing levels, including the composition of the nursing team, and patient outcomes in acute care settings from longitudinal studies.
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Content ArticleThis is the first national ambulance volunteering strategy, produced by the Association of Ambulance Chief Executives. It recognises the important role volunteers play in the ambulance service and outlines a national approach to volunteering that will be adopted between January 2023 and May 2024. The strategy covers mission, vision, principles and measures of success.
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Content ArticleOn paper, a GP’s working schedule can look quite inviting: consulting for three and a half hours in the morning, with a coffee break in the middle, then a gap for lunch and home visits before a similar length afternoon surgery. However, this is rarely the reality for NHS GPs. In this BMJ opinion piece, GP Helen Salisbury talks about what working life is really like for GPs and highlights the mismatch between their scheduled hours and tasks and the reality, which often involves them doing much more. She highlights how the unrealistic demands GPs face have been exacerbated by a movement of work from secondary to primary care, and argues that this is contributing to the workforce crisis that general practice faces.
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Content ArticleDespite being the employees who often have the most direct contact with service users, NHS clinical support workers, such as healthcare assistants and maternity support workers, have long experienced a range of barriers to their effective deployment and development. These include a lack of standardised entry requirements, inconsistent task deployment and truncated career progression pathways. These have a detrimental impact on service delivery, including patient satisfaction. The degree to which local employers are able to determine the recruitment, deployment and development of support workers is a key reason why these issues endure; however, this article suggests that a deeper reason is the existence of a segmented labour market in the NHS, with support workers existing in a secondary market. This duality resides in the socio-economic differences between registered and non-registered staff. Recent NHS support workforce strategies present an opportunity to finally address the issues support staff face.
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Content ArticleThe nature of patient needs and ward activity is changing. Inpatients tend to be more ill than they used to be, many with complex needs often arising from multiple long-term conditions. At the same time, hospitals face the challenges of a shortage and high turnover of registered nurses. This review presents recent evidence from National Institute for Health Research (NIHR)-funded research, including studies on the number of staff needed, the support workforce and the organisation of care on the wards. While few research studies have explored the similar pressures that occur in community and social care, the learning from hospitals may be useful to decision makers in these areas.
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Content Article
Breaks from operational duty are an important factor in the management of fatigue. But as highly committed and professional operational staff often perform several secondary tasks and activities—inside or outside the ops room—breaks can become a victim. This blog by Chartered Ergonomist and Human Factors Specialist Stephen Shorrock offers some general guidelines about what kinds of tasks add to stress and fatigue and should be avoided during rest breaks. He places break activities into three categories which place different demands on the individual: red, amber and green activities. He also highlights that when it comes to breaks from operational duty, changes in activity are the key to reducing fatigue-related risks. -
News Article
GPs each seeing 15% more patients, BMA says
Patient Safety Learning posted a news article in News
The average number of patients each individual GP is responsible for has increased by 15%, or around 300 people, since 2015, the BMA has said. This is due to the ‘slow but steady haemorrhaging’ of GPs over the last few years, which has led to pressures on services growing ‘even more acute’, it suggested. The Association’s statement comes in response to the latest GP workforce data – published by NHS Digital (10 February) – which showed that 188 FTE GPs left between December 2020 and December 2021. Dr Farah Jameel, chair of the BMA’s GP committee, said the figures are the direct result of an ‘over-stretched’ and ‘under-resourced’ NHS. She said: ‘Family doctors, exhausted and disenchanted, feel as though they have no choice but to leave a profession they love because of chronic pressures now made worse by the pandemic. Workload has dramatically increased, there are fewer staff in practices to meet patient needs.’ Insufficient staffing is particularly concerning as the backlog for care continues to grow, she suggested, with many GPs believing ‘the day job is just no longer safe, sustainable or possible anymore’. The NHS and the Government must work to retain current staff as its ‘immediate priority’ and must urgently refocus on retention strategies as a key enabler for the NHS’ recovery. She said: ‘The Government has repeatedly argued that the number of doctors is growing, but this isn’t the reality for general practice, and it begs the question: how many more have to go before something is finally done about it? Our NHS is the people who work in it, and without them, the entire system and provision of patient care is under threat.’ Read full story Source: Management in Practice, 11 February 2022 -
News Article
Staff on prolonged leave with long covid could be dismissed, says NHSE
Patient Safety Learning posted a news article in News
Staff on prolonged sick leave due to long covid could be dismissed if ‘redeployment is not an option’ and they are unable to fulfil their contract, new NHS England guidance says. The advice was set out in guidance published this month and follows the government’s temporary, non-contractual guidance that was issued in response to the coronavirus pandemic during its first waves. The government’s advice aimed to provide a temporary enhancement of covid sick pay and meant that staff who were absent with covid would remain on full pay, therefore, did not feel pressured to return. However, NHSE’s guidance warned that “while this provision is still available, it is possible that it may change”. The move has been seen as an inevitable step as the guidance was brought in as an emergency measure, while some employers may have been holding off dismissing staff with long covid or covid-related absences due to guidelines in place. NHSE’s new Guidelines for supporting our NHS people affected by long covid said: “According to [the] guidance, periods of covid-19 sick pay would not be counted towards a colleague’s normal sickness entitlements. “However, if a colleague is approaching long-term sickness (for a period of 12 months or more), the employing organisation would be expected to complete a review at 12 months to understand the ongoing need and potential challenges with a return to work. It adds: “Consideration of dismissal due to the colleague being unable to fulfil their contract should only be considered if redeployment is not an option.” Read full story (paywalled) Source: HSJ, 11 February 2022 -
News Article
7,469 research nurses and midwives across the UK and Ireland, new census reveals
Patient Safety Learning posted a news article in News
There are at least 7,469 research nurses and midwives across the UK and Ireland working within all areas of healthcare, reveals a landmark new census initiated by a group of NIHR 70@70 Senior Nurse & Midwife Research Leaders. The census, incorporating responses from research nurses and midwives across all four UK nations and the Republic of Ireland, reveals nurses and midwives are working at every level in healthcare from Bands 5 – 9 in the UK, and from staff nurse to Directors of Nursing or Midwifery in the Republic of Ireland. This suggests there are opportunities to join the profession at every level, with continued potential for career progression. Clinical research nurses and midwives are a specialist workforce, with knowledge, skills and expertise in both clinical practice and research delivery. The census shows that: 33.7% reported working in joint posts, for example as a clinical research nurse for part of their role as well as a clinical nurse specialist; 72% are working within a single disease/area specialism; 28% reported covering multiple disease areas. NIHR Director of Nursing & Midwifery Professor Ruth Endacott said: “This census reveals the true breadth and depth of our research nursing and midwifery community. We know there are scores of people working incredibly hard day and night helping to bring us new treatments and medicine alongside their healthcare colleagues but we now have a much clearer idea of the size of the workforce. Research nurses and midwives are making a difference to the health of people across the UK and Ireland." Read full story Source: National Institute for Health Research, 9 February 2022 -
News Article
Leak reveals management consultants’ role in recovery plans
Patient Safety Learning posted a news article in News
Consultants will set strategy, provide analytics and help lead the creation of integrated care systems’ elective recovery plans, a leaked document reveals. HSJ reported that seven management consultancy firms would be paid up to £21m to “support” every ICS design its elective recovery plans by April. According to internal NHS documents, leaked to HSJ, the firms will provide “tailored skills and expertise” to help ICS teams develop their plans. The document, shared with ICS and regional chiefs in a presentation by NHS elective care chief Sir Jim Mackey, states the consultancies will work alongside ICS teams to “ensure” the ICS plans achieve many objectives. These objectives include: Delivering or exceeding the expected performance ambitions… and are “triangulated across activity, finance and workforce capacity”; Making “full use of transformational opportunities” to manage demand, increase capacity or improve productivity; Having a clear link to the health inequalities agenda; and Maximising elective activity through all available options including making use of the available independent sector capacity. Read full story (paywalled) Source: HSJ, 10 February 2022 -
News ArticleThe government has promised to build more surgical and community diagnostic hubs in England and to give patients greater control over their healthcare provider as part of its long awaited recovery plan for elective care to reduce the NHS backlog and tackle waiting times. But the targets set out on 8 February will not be met without the staff to run the expanded services, health leaders have warned. Andrew Goddard, president of the Royal College of Physicians, said that the plan depended on the “recovery of urgent and emergency care, as the two are intimately entwined both with respect to workforce and estate.” He added, “We will also need to build on it with a full plan for recruiting enough new staff to meet patient demand and the steps we’ll take to retain existing staff, including flexible and remote working for those returning to practice." Read full story (paywalled) Source: BMJ, 8 February 2022
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News Article
Staff will quit if not given ‘time to recover’, says NHSE director
Patient Safety Learning posted a news article in News
An NHS England director and trust chief says he ‘fears [the NHS] will see increasing numbers of resignations’ unless more is done to ensure burnt-out staff are given sufficient leave to recover mentally and physically. Matthew Winn, NHSE’s director of community health and Cambridgeshire Community Services Trust chief executive, set out his concerns in a paper for discussion at his trust’s board meeting today. While the service is grappling to keep tabs on the number of staff it is losing because of compulsory vaccination plans, the issue of staff leaving because of burnout is harder to quantify, but a huge concern to NHS leaders. Nearly two years of tackling coronavirus has taken a huge emotional and physical toll on a large proportion of the workforce and burnout was a growing issue even before the pandemic. Mr Winn’s paper says: “As the NHS starts to focus on recovering from the current covid pressures, it is vital that the national, regional and local planning must take into consideration that our staff need time to recover and that they cannot (for example) be expected to catch up on the waiting lists that have accrued, without time and resources to support them. “In the absence of such an approach, I fear that we will see increasing numbers of resignations and the care we will be able to provide will be far short of the standards we set ourselves and that the public expects from us.” Read full story (paywalled) Source: HSJ, 26 January 2022 -
News Article
Concern over ‘disgraceful’ nurse staffing levels planned for mini Nightingales
Patient Safety Learning posted a news article in News
NHS leaders have raised concerns over the “new mini Nightingales” as hospitals draw up plans for use with “minimal” nursing levels, The Independent has learned. In December the NHS announced it would be launching eight “surge” hubs dubbed “mini Nightingales” to help hospitals manage increased admissions amid the Omicron wave. These facilities would be able to admit about 100 patients and have been set up as temporary sites across eight NHS hospitals. Details around the safety requirements and required staffing levels have yet to be published, however several NHS sources have said some hubs are planning to use a “low” ratio of 1:15 nurses to patients within the units. One trust chief has called the staffing models a “disgrace” and says the hospitals should never be used. Senior sources have questioned the safety of using a 1:15 ratio, although they said the risk would depend on how ill the patients being sent to the units are and whether there would be sufficient health care assistant support. However, sources have said the staffing models have yet to be finalised and so could change. Read full story Source: The Independent, 20 January 2022 -
News Article
Health department warning over vaccine mandate for NHS staff in England
Patient Safety Learning posted a news article in News
Ministers have been issued with a stark warning over mandatory Covid vaccines for NHS workers in England, with a leaked document saying growing evidence on the Omicron variant casts doubts over the new law’s “rationality” and “proportionality”. Two jabs will become compulsory for frontline NHS staff from 1 April after MPs voted on the legislation last month. But the document, drawn up by Department of Health and Social Care (DHSC) officials and seen by the Guardian, said the evidence base on which MPs voted “has changed”, creating a higher chance of objections and judicial review. The effectiveness of only two vaccine doses against Omicron, and the lower likelihood of hospitalisations from the milder variant, are cited. More than 70,000 NHS staff – 4.9% – could remain unvaccinated by 1 April, the document says. NHS trusts in England are preparing to start sending dismissal letters from 3 February to any member of staff who has not had their first dose by then. Amid significant pressures on the NHS, last week groups including the Royal College of Nursing urged Sajid Javid, the health secretary, to delay the legislation, known as “vaccination as a condition of deployment” (VCOD2). On Tuesday the Royal College of Nursing said the leaked memo should prompt ministers to call a halt to the imposition of compulsory jabs, which it called “reckless”. “The government should now instigate a major rethink”, said Patricia Marquis, the RCN’s England director. “Mandation is not the answer and sacking valued nursing staff during a workforce crisis is reckless.” Read full story Source: The Guardian, 18 January 2022- Posted
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News ArticleNHS organisations have been told to prepare for redeploying or dismissing thousands of unvaccinated staff without an exit payment, and to raise the alarm about services which may be rendered unsafe. NHS England today issued guidance on ‘phase two’ of the government’s “vaccination as a condition of deployment”, which requires all patient-facing staff to have had two covid vaccinations by 1 April. Tens of thousands of staff are believed to still be unvaccinated, and the cut off for having a first dose is 3 February. The guidance said efforts should be made to adjust roles or redeploy staff, but added: “From 4 February 2022, staff who remain unvaccinated (excluding those who are exempt) should be invited to a formal meeting chaired by an appropriate manager, in which they are notified that a potential outcome of the meeting may be dismissal.” It continued: “Whilst organisations are encouraged to explore deployment, the general principles which apply in a redundancy exercise are not applicable here, and it is important that managers are aware of this.” Employers will “not be concerned with finding ‘suitable alternative employment’ and there will be no redundancy entitlements, including payments, whether statutory or contractual, triggered by this process”. Trusts also do not have to “collectively consult” with staff being dismissed — as they would with a restructure — although this is “ultimately a decision for each organisation to take”. Read full story (paywalled) Source: HSJ, 14 January 2022
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News ArticleA trust has warned it could be forced to restrict maternity services due to a high midwife vacancy rate, and large numbers unvaccinated among the current staff. The government has mandated that all patient-facing NHS staff must have had two covid vaccination doses from 1 April — meaning they will need to have received their first dose by 3 February. If not, they can be redeployed to non patient-facing roles, or face dismissal. Barking, Havering and Redbridge University Hospitals Trust’s board heard on Tuesday that the current numbers pose a “significant operational problem” amid efforts to encourage more staff to get both covid jabs before the government’s deadline. The board meeting was told that, of the trust’s 7,550 staff, approximately 1,300 workers – or 17.4% – do not have a vaccination recorded against them, with the areas of greatest concern being women’s and children’s health, geriatric services, the emergency departments and some clinical support services. At the board meeting, BHRUHT chief executive Matthew Trainer said: “The vacancy rate, plus the unvaccinated rate, would put us in quite a serious position. “At the minute, for example, the Queen’s Birth Centre [at Queen’s Hospital in Romford, east London], I don’t think, has been open since I got here. I couldn’t see any circumstances in which it would reopen if we lost another chunk of midwives, for the foreseeable future certainly, in terms of vaccination. “I think it would leave us in a position where we’d have to look at constraining services and focusing in on core [services], establishment being focused on the labour ward, looking at complex births and making sure we’re doing everything we possibly can to manage it as safely as possible.” Read full story (paywalled) Source: HSJ, 12 January 2022
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News Article
Absences hit 120,000 as military sends 200 staff to help hospitals
Patient Safety Learning posted a news article in News
The government has announced 200 military personnel are being deployed to “support the NHS in London amid staff shortages due to COVID-19”. The 200 figure is equivalent to about 1.8% of the covid-related absences in acute trusts in the capital on Wednesday, and 0.2% of the national all-trust total of 120,000. The Ministry of Defence will provide 40 defence medics and 160 general duty personnel, it said. The first were deployed this week, including in Whipps Cross in east London. According to the minutes of an internal meeting held by senior leadership at the hospital, 10 general duty military personnel have been deployed. They do not have clinical training so cannot take blood, but will undertake general duties, such as feeding patients and communication with teams and relatives. Staff absences from NHS trusts hit nearly 120,000 on Wednesday after another increase, HSJ has learned. Figures due to be published by NHS England are expected to show there were total absences across acute trusts of just over 80,000 on 2 January, down from more than 85,000 on 30 December. However, figures seen by HSJ show that, after the end of the new year bank holiday period, this acute trusts figure leapt to more than 92,000 by Wednesday (5 January). Read full story (paywalled) Source: HSJ, 7 January 2022 -
News Article
Fix NHS staffing crisis to tackle waiting lists backlog, warn MPs
Patient Safety Learning posted a news article in News
A long-term plan to fix the staffing crisis in the NHS is needed to cut record waiting lists for treatment, the government is being warned. Currently, nearly six million people in England are waiting for routine operations and procedures - many of whom are in pain. A report from MPs says the government needs to address staff shortages - or NHS workers will quit. There have been repeated warnings over the length of hospital waiting lists in England. As of September 2021, a record 5.8 million patients were waiting for surgery - such as hip or knee replacements - with 300,000 waiting more than a year compared with just 1,600 before the pandemic. In the autumn Budget, the government announced an extra £5.9bn for the NHS in England to help clear the backlog. This was on top of another funding package in September to create an extra nine million checks, scans and operations. But in its report published today, the Commons health and social care select committee said the health service was hugely understaffed and was facing an "unquantifiable challenge" in tackling the backlog. Jeremy Hunt, the former health secretary who now chairs the committee, said the NHS was short of 93,000 workers and there was "no sign of any plan to address this". He described the staffing crisis as "entirely predictable", adding: "The current wave of Omicron is exacerbating the problem, but we already had a serious staffing crisis, with a burnt-out workforce." "Far from tackling the backlog, the NHS will be able to deliver little more than day-to-day firefighting unless the government wakes up to the scale of the staffing crisis facing the NHS." Read full story Source: BBC News, 6 January 2022 -
News Article
NHS unable to treat every child with eating disorder as cases soar
Patient Safety Learning posted a news article in News
The NHS can no longer treat every child with an eating disorder, a leading psychiatrist has warned, as “worrying” figures reveal hospital admissions have risen 41% in a year. A dramatic surge in cases during the pandemic has left already struggling community services overstretched with many unable to care for everyone who requires help, experts said. NHS Digital data for England shows a sharp rise in admissions in every area of the country. The provisional data for April to October 2021 – the most recent available – shows there were 4,238 hospital admissions for children aged 17 and under, up 41% from 3,005 in the same period the year before. Charities said the fast rising number of hospital admissions was “only the tip of the iceberg”, with thousands more children needing support for eating disorders. Dr Agnes Ayton, the chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “The hidden epidemic of eating disorders has surged during the pandemic, with many community services now overstretched and unable to treat the sheer number of people needing help. We are at the point where we cannot afford to let this go on any longer." “Early intervention is key to recovery and to preventing serious illness, which is why it’s crucial that the money announced by government urgently reaches the frontline. The government must also deliver a workforce plan to tackle the shortages in eating disorder services so that they have enough staff to treat everyone who needs help.” Read full story Source: The Guardian, 4 January 2021
