Much has been (and will continue to be) written on the NHS workforce crisis; which is really a knot of overlapping crises, some long-standing, others more recent, that grows more intractable with the passing of time. It’s important to say that much of this knot is a consequence of political choices, there’s nothing inevitable about it. But until different choices are made the challenges in the health and care workforce will continue to fall to the workforce to manage and solve.
'This is a human crisis of chronic excessive workloads, exhaustion and burnout, guilt, sickness, absence and – in some places – the unprocessed traumas and moral injuries delivered by the pandemic.'
Training, recruiting and attracting enough of the right staff, assuring their targeted and equitable distribution across the system and retaining them: this is a technical description of (part of) the crisis. But it’s a description that misses the human distress that sits, unfolding, behind it. This is a human crisis of chronic excessive workloads, exhaustion and burnout, guilt, sickness, absence and – in some places – the unprocessed traumas and moral injuries delivered by the pandemic. It’s compounded by various forms of institutional bullying and discrimination, financial insecurity and a rising cost of living that is driving many health care staff to food banks, (some of them run by the NHS). And that also makes the workforce crisis a crisis for the families and friends of health care staff, and for the patients, service users and carers whose experience of receiving care is being undermined by all this.
The 2021 NHS Staff Survey revealed 38 per cent of respondents often or always find work emotionally exhausting, while 47 per cent said they had felt unwell as a result of work-related stress in the past 12 months. We must not allow these figures to be normalised, they are awful. And we must disabuse the notion (common across public service) that staff goodwill and fidelity to the vocation of caregiving will see us right.
So what is there left to say or do that hasn’t already been said or done by the very many good people in the health and care system working to protect, support and improve staff health and wellbeing in this context? This was the question we posed when our own experience of working across the system through the pandemic moved us to want to make a helpful contribution. To answer it we went back to first principles and talked to health care staff in a variety of roles, bringing them together and listening carefully to their experiences and the feelings they attached to them.
We heard that it was important to ‘tell the truth’ about what is happening. An overly appreciative tone, and/or a focus on individual remedies serves to obscure the full picture and the roots of the crisis. We were told that the NHS is great at reaching for solutions that centre individual self-care and resilience (or ‘endurance’ as someone put it), but, to paraphrase the philosopher Jidda Krishnamurti ‘it is no measure of health to be well adjusted to a profoundly sick system’. To tell the truth then is to name candidly the systemic challenges and forces that shape staff health and wellbeing, and the choices individuals feel able to exercise.
But ‘telling the truth’ doesn’t have to mean doom-mongering, which can strip individuals of their agency and responsibility for the things they can control and influence. For example, the NHS Staff Survey in 2021 also revealed that 68 per cent of respondents felt their line manager took a positive interest in their health and wellbeing. This is cause for hope because we know that one of the most influential factors determining employee health, wellbeing and engagement – despite all the systemic challenges – is good line management.
Our question evolved and became ‘how can we help managers and leaders in the NHS to line manage and lead well?’ Part of the answer we settled on – and have tested with health care staff over the summer – is a free, self-directed course we have called ‘Leading well for staff health and wellbeing in the NHS’.
In our conversations with staff through the spring we were told there is often a rush in the NHS to solve problems before properly understanding them; a pull to action that is itself a feature of a heavily pressured operating environment. Our intention with this course then is to offer anyone in (or aspiring to be in) a management or leadership role in the NHS a flexible space to consider the challenge of workplace health and wellbeing more deeply, holistically and honestly. And to offer some ideas about the priorities and skills that will help you to take wiser, more effective action.
'The course we have designed purposefully centres the lived and learned experiences, insights and wisdom of NHS staff.'
Don’t just take our word for any of this either. The course we have designed purposefully centres the lived and learned experiences, insights and wisdom of NHS staff. We chose to present the work in this collective way to highlight the complexity of the issues and shared nature of the challenge. And because, in the end, in the absence of those political choices that would make a material difference, we believe the answer to this problem cannot continue to be greater personal resilience or more good will. Right now, for the people who make up the NHS workforce, the answer to this problem is each other.
With sincerest thanks to all those NHS staff who gave their time and energy (around otherwise busy lives) to help us design and create this course.
Develop your understanding of your own health and wellbeing and learn to better lead and support your colleagues in our free, online course.