Debates about the future of the NHS are often dominated by calls for more investment in new technology to cure its debilitating symptoms. But many of the immediate problems facing front-line workers in the sector are not technological; they are human.
There have been well-documented shortages of nurses, GPs and other clinicians in recent years, exacerbated by factors such as Brexit and a wave of early retirements. This has since combined with the emergence of Covid-related job vacancies across the sector’s wider ecosystem.
Calls for an urgent remedy have attracted billions of pounds in public investment, with the chancellor announcing further capex funding in his October budget. But, given that much of that money has been earmarked for new digital IT and diagnostic equipment, there is a growing belief that the recruitment and retention problem is still being ignored.
Richard Murray, CEO of the King’s Fund, an independent charity working to improve health and social care in England, fears a future in which newly opened NHS facilities need to be mothballed owing to a lack of staff. He believes that successive administrations have ducked several of their responsibilities to the sector.
Murray suggests that the current government has “shown bravery” by increasing taxation to fund NHS investments and a long-term plan to reform social care (see panel, XXXXX).
But he warns: “This all risks coming to nothing for one simple reason: there aren’t enough employees. Even before Covid, the NHS was in the middle of a deep staffing crisis caused by a prolonged funding squeeze, combined with years of weak policy, poor workforce planning and fragmented responsibilities.”
Murray notes that additional funding cannot increase staff numbers by any significant extent, because those extra people simply “don’t exist”, although short-term measures such as an international recruitment drive could help to fill some of the more pressing vacancies.
A detailed workforce plan for expansion is needed, he stresses, explaining that this entails “retaining and motivating as many existing employees as possible and investing in training to deliver the new staff of the future”.
But Murray is unclear as to whether there’s “any money left for such a plan. Tackling the workforce crisis is the biggest challenge by a country mile.”
Rachel Hollis, chair of the Royal College of Nursing’s professional nursing committee, also foresees problems if HR investments aren’t increased.
“In his recent budget, the chancellor set out investments in clinics, hospital beds and technology,” she says. “All are welcome, but they do not replace years of under-investment in workforce planning. Technology will continue to evolve, but patients will benefit only if there are nurses to deploy it.”
Hollis continues: “Nursing is a highly skilled and safety-critical profession, which requires significant investment. Our health service has tens of thousands of nursing vacancies and there are even more in social care. No amount of technology will prevent a knife-edge winter for health and care services. Human resources are the greater priority.”
As CEO of doctor-led campaigning organisation EveryDoctor, Dr Julia Patterson speaks for more than 1,700 members. She believes that the pandemic’s effect on their ability to work effectively in several settings is a grave concern.
Patterson acknowledges that investments in technology are necessary across the NHS, noting that it can sometimes be a struggle simply to find a working printer. But she fears that doctors’ stress levels have become so high during the Covid crisis that their resilience is being tested to the limit. This could exacerbate the sector’s human problem unless there’s a properly funded effort to improve their physical and mental wellbeing.
She would also like to see fairer increases in doctors’ pay to recognise increasing workloads and inflation, plus funding for new nursing bursaries to widen access to the profession.
“What I do get from doctors an awful lot is their sense of exhaustion,” Patterson reports. “Everyone has a level of resilience. It feels as though the government is testing that by pushing and pushing. Humans can absorb only so much pressure. This will definitely have ramifications on the NHS workforce in the longer term.”
She continues: “We’re extremely fortunate in the UK to have excellent training systems for healthcare workers, but losing skilled staff later down the road once they’ve gained expertise will adversely affect patient care. This is going to have a devastating effect on our service.”
Social care addresses its image problem
Social care is also facing its own particular human crisis, with issues such as recruitment from overseas and the introduction of mandatory Covid vaccinations for some employees playing a part in this.
But Richard Adams, CEO of eldercare provider Sears Healthcare, believes that the key contributing factor is the common view that work in the sector is of “low value and low status”.
Adams, who runs three nursing homes in southern England, having started out in the late 1990s as a care assistant, says: “Until caring for older people is seen as a skilled role, recruitment will remain a real challenge. This issue is underpinned by a more deeply held view that health services, particularly hospitals, have greater societal value. This is not only about pay, but also about training, career frameworks and a recognition that caring for people has the same value as healing people.”
Adams believes that more needs to be done to publicise the positive outcomes that high-quality eldercare can achieve. “The more that care is understood, the more value it will have. People should be proud to say that they are a carer or that they work in a care setting,” he says.
Dementia care nursing is another area that’s unable to attract the talent it needs, notes Paul Edwards, director of clinical services at charity Dementia UK. This is not helped by the fact that the specialism’s “unique skill” is often downplayed in universities, he adds.
Perception problems also figure highly in the recruitment challenge, according to Tricia Nicoll, one of the prime movers behind the #socialcarefuture campaign. Low salaries and short care visits play their part too.
Her two autistic children (now adults) have needed help in many areas of their lives over the years, and this now includes their college work and volunteering. Nicoll stresses that the people she employs as care workers for her son and daughter are highly skilled.
“We need to look past formal qualifications to judge skills and knowledge – and we need to routinely pay at least a living wage,” she says.
Shifting public perceptions of work in social care as simply a matter of helping older people to “get up, go to the loo or eat” would also widen the base for recruitment, Nicoll believes.
She recalls how she once helped to create a team of care workers to support people with learning disabilities. They were all former miners with “no experience of working in social care”, Nicoll says. “But their big hearts and no-nonsense attitude made them perfect for the role.”