The Health and Social Care Select Committee’s new report from its inquiry into workforce burnout and resilience in the NHS and social care makes clear that burnout is a “widespread reality” and has negative effects on staff mental health, impacting staff and patients.
Against a backdrop of workforce shortages, funding pressures and reconfiguration of services, concerns about the morale of the NHS and social care workforce are not new. The report cites that prior to the pandemic, one third of the doctors who responded to a survey published by the BMJ in January 2020 were described as burntout.
The size of the problem
The report finds that workforce burnout across the NHS and social care has reached an “emergency” level and poses an “extraordinary dangerous risk” to the future functioning of both services. Only a total overhaul of workforce planning can provide a solution. Planning to date has been led by the funding available to both health and social care rather than by demand and the capacity required to service demand.
The report explains that there is “no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism” and without that level of detail, the shortages in the health and care workforce will endure to the “detriment” of both the service provision and the staff who currently work in the sector. It said that moving to annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.
Key recommendations from the report
Understanding the scale and impact of workforce burnout in the NHS and social care
• DHSC extends the NHS Staff Survey to cover the care sector – and in addition, the NHS Staff Survey and any social care equivalent includes an overall staff wellbeing measure, so that employers and national bodies can better understand staff wellbeing and take action based on that understanding.
• Integrated Care Systems (ICSs) be required to facilitate access to wellbeing support for NHS and social care workers across their systems, and that they are accountable for the accessibility and take-up of those services.
• The level of resources allocated to mental health support for health and care staff be maintained as and when the NHS and social care return to ‘business as usual’ after the pandemic; and that the adequacy of resources allocated to that support be monitored on a regular basis.
• DHSC develops a strategy for the creation of Freedom to Speak Up Guardians in social care.
• NHS England undertake a review of the role of targets across the NHS which seeks to balance the operational grip and the risks of inadvertently creating a culture which deprioritises care of both staff and patients.
• DHSC work with stakeholders to develop staff wellbeing indicators, on which NHS bodies can be judged.
• WRES data be made part of the ‘balanced basket of indicators’ we suggest for Integrated Care Systems, with the result that they become accountable for progress across their domains.
• Adult social care have its own People Plan, which includes parallel commitments to those for the NHS on diversity and inclusion.
• The Department develops an NHS and social care national policy framework around migration to support national and local workforce planning, and identify the balance between domestic and international recruitment in the short, medium and long-term.
Bringing together the post-pandemic response with better workforce planning
• Health Education England publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained. And importantly that such workforce projections cover social care as well as the NHS given the close links between the two systems.
Commenting on the report, the Rt Hon Jeremy Hunt MP, Chair of Health and Social Care Committee, said:
“An absence of proper, detailed workforce planning has contributed to this, and was exposed by the pandemic with its many demands on staff. However, staff shortages existed long before covid-19.”
“Staff face unacceptable pressure with chronic excessive workload identified as a key driver of workforce burnout. It will simply not be possible to address the backlog caused by the pandemic unless these issues are addressed.”
“Achieving a long-term solution demands a complete overhaul of workforce planning. Those plans should be guided by the need to ensure that the long term supply of doctors, nurses and other clinicians is not constrained by short-term deficiencies in the number trained. Failure to address this will lead to not just more burnout but more expenditure on locum doctors and agency nurses.”