From burnout to belief: reflections on reforming the NHS from within

I write this piece not as a distant observer but as someone who walks alongside NHS leaders and teams every day, listening, witnessing and supporting those who hold the system together.

From boardrooms to wards, I have seen the emotional toll caused by a health care service that too often prioritises performance metrics over people. Week in, week out, I see something far deeper than operational strain; I see a moral and spiritual unravelling. A workforce pushed to the edge, not by lack of commitment but by a system that demands everything and gives little back. And the cost? It is not just burnout, but the erosion of care itself. 

Now, with the publication of the 10 Year Health Plan for England, we are presented with a bold opportunity to reimagine care, from hospital to community, from sickness to prevention and from analogue to digital. But these ambitions will remain out of reach unless we address the foundational issue: the wellbeing of the workforce. 

A system breaking its people 

Beneath the visible cracks in patient care lies a deeper workforce crisis: one of burnout, mental exhaustion and systemic neglect. Leadership cultures that prioritise compliance over compassion have turned unrelenting operational demands into a human catastrophe unfolding in real time.  

But I have come to realise that this crisis goes beyond burnout. Fear, relentless pressure and uncertainty have trapped NHS staff in survival mode. Staff are not just overwhelmed, they are firefighting, unable to drive meaningful change. As one leader put it: ‘I’m always on but am I adding any value?’ 

I hear stories like this every week. Exhausted clinicians clinging to purpose while battling impossible workloads; leaders torn between firefighting today and shaping the future; teams stretched so thin that taking sick leave has become a survival strategy.  

While political headlines have framed the NHS as ‘broken’, the real story lies in the hard data and in what it says about the lived experience of those working inside the system. 

Evidence of collapse 

The evidence is stark. 

• The 2024 NHS Staff Survey lays bare the extent of the crisis. Over 41% of NHS staff report feeling unwell due to work-related stress, and burnout remains endemic. Only 34% of staff believe there are enough colleagues to do their job properly, and fewer than half feel able to meet the conflicting demands of their role. 

• A growing body of evidence reveals that many NHS staff, particularly nurses, feel unable to provide the standard of care they aspire to, contributing to emotional exhaustion and a decline in compassion satisfaction. As this emotional fulfilment fades, so too does resilience.  

• A mental health warning: the 2024 Unison survey found that 31% of NHS staff took time off work due to mental health issues in the past year.   

My sense is that this is more than just a staffing issue. It is the warning siren of a system being propped up by exhausted staff questioning whether they can continue. Despite recruitment drives and retention efforts, burnout is widespread. Without change, the exodus will only accelerate, leaving patients to bear the consequences of a system on the brink. 

The 10 Year Health Plan acknowledges this reality and sets out a vision for a workforce that is digitally enabled, community anchored and supported to thrive. But unless wellbeing becomes the foundation of that vision, the system will continue to haemorrhage talent, energy and hope. 

But statistics only scratch the surface. To truly understand the depth of the crisis, we must listen to the voices behind the numbers, the people living it every day. 

The lived reality within 

As senior consultants at The Kings Fund, we see the crushing reality of life inside the NHS at first hand.

Sickness leave as survival  

A senior district nurse admitted that taking sick leave has become a desperate escape, not from illness but from the relentless demands of the job: ‘There is no other way of coping’, they admitted. ‘Our teams can predict who will need to go off sick next.’ The fact that this is normalised is horrifying. 

The hamster wheel of firefighting 

One NHS leader described being ‘trapped on a hamster wheel’, spinning so fast they ‘can’t jump off’, unable to enact meaningful change due to relentless short-term pressures.  

The lost souls of leadership 

A senior NHS director admitted to being ‘constantly on’ and unable to set boundaries. ‘The pandemic’s ‘all-hands-on-deck’ mentality never ended, and exhaustion is now embedded into the job.’ Another national director laid it bare: ‘There is no time to be strategic; it is just an endless battle with the diary. My time is absorbed in activity, not meaningful action.’  

Stress catching up 

A senior HR leader reflected on their own wellbeing, admitting, ‘As someone who works until I can’t work anymore, last year was the first time it caught up with me, leading to health issues.’  

Reaching breaking point  

Another senior NHS director voiced their exhaustion: ‘I’m done. I can’t do anymore. I don’t want to leave the NHS, but the constant change and endless scrutiny grinds you down. We are not just double running; we are quadruple running at least!’ 

Taking the job home 

A distressed ward nurse told us: ‘I go home, and my anxiety remains sky high. Did I administer the right dose? Did I leave a canula in someone’s arm? Did I check on Ms X.’  

This is not a collection of isolated experiences. They are the soundtrack of a workforce stretched to its limits, and a stark reminder of the unsustainable working culture within the NHS. Many staff are experiencing profound moral injury, haunted by the knowledge that, despite their best efforts, they are unable to provide the standard of care their patients deserve. 

These accounts lay bare the human cost of a system under sustained pressure and point to a critical policy imperative: despite these impossible odds, NHS staff continue to show up, make a difference, and create moments of brilliance every day. Without their resilience, persistence and loyalty, the system would simply collapse. 

The lived experience of staff, however, must inform a systemic response that enables leaders and their teams to shape, not just survive, the environments they are part of. 

Leadership at every level of the system 

The 10 Year Health Plan calls for a new kind of leadership: one that is bold, relational and grounded in purpose.  

But even the most capable leaders cannot thrive in a system that undermines their agency and erodes their humanity. Too often, what I witness is a culture that prioritises task completion over thoughtfulness and control over compassion, stretching leaders beyond human limits.  

We need to move beyond this culture of task completion towards one that values reflection, compassion and connection. That means protecting time for leadership, not just management. It means embedding wellbeing into leadership development, and recognising that leadership is not a title, it is a practice that needs nurturing.  

Politicians and national bodies can either fuel a culture of fear or foster one of trust. The real power of politics lies in enabling a culture that restores trust, removes unnecessary scrutiny and prioritises staff sustainability. Striking the right balance by urgently tackling pressures such as waiting times while safeguarding staff wellbeing is not a soft option. It is the foundation for sustainable leadership at every level. 

Bold, compassionate leadership is the least our NHS staff deserve. To honour the unbending contribution of our staff, we must act decisively. 

A call to action; stop the bleeding now 

In my role as a senior consultant, I do more than consult; I listen deeply, observe carefully, intervene thoughtfully and help facilitate meaningful change. Here is what I know: if we are to reverse the current trajectory of poor wellbeing and widespread burnout in the NHS, we must act, boldly, and without delay. The Wellbeing II report makes it clear: staff wellbeing is not a peripheral concern; it is the keystone of care. The NHS cannot performance manage its way out of exhaustion. What is needed is a renewed focus on the deeper architecture of care, relationships, culture and the capacity to think. To move forward, the NHS must act now on four critical fronts. 

Make staff wellbeing the foundation of reform, not just a footnote 

• From hospital to community: wellbeing must be the golden thread running through the neighbourhood health model. That means embedding wellbeing into the design and delivery of community-based services and supporting community-based teams with the resources, autonomy and psychological safety that they need to thrive. It also requires tackling of the systemic drivers of poor health and burnout: excessive workloads, toxic hierarchies and rigid shift patterns. The voices of staff captured through the Change NHS exercise must shape this transformation, ensuring that the shift from hospital to community is not just a structural change but a cultural one, rooted in compassion, trust and care for those who deserve it. 

• From sickness to prevention: the 10 Year Health Plan sets a clear ambition to reduce NHS sickness absence to its lowest recorded level and reduce agency spend. But this won’t be achieved through performance targets alone. It requires a cultural shift, where wellbeing is not seen as a cost but a strategic investment. It also means recognising that staff wellbeing is a form of prevention, one that reduces sickness absence, improves retention and enhances care. The evidence is clear: healthier staff deliver better care, stay longer and cost less.  

• From analogue to digital: the NHS App is being reimagined as a ‘doctor in your pocket’ for patients. Why not for staff, too? And can it have features built in that support mental health, track stress and connect peers? There is much to explore about digital tools and how they can support wellbeing, but these tools must be designed with, not just for, the workforce. 

Reinforce the importance of compassionate leadership  

As operational and financial pressures intensify, leaders are being pulled in every direction. But leadership that ignores the human dimension will fail. It is important to recognise the importance of devoting time to leadership, protecting space for reflection and relational leadership and releasing leaders from bureaucratic overload. Make it possible for leaders to lead, not just survive. 

Devolve responsibility and enable greater autonomy 

As integrated care boards step back from performance managing providers, we have a rare opportunity to reimagine accountability. To review and reduce central demands on local systems. Place-based partnerships and provider collaboratives can take the lead, including holding each other to account rather than battling with a traditional top–down line of accountability. This will create greater freedom to collaborate across organisational boundaries and for more enabling cultures to emerge. Local solutions, shaped by those closest to delivery, offer the best route to recovery.  

Provide stability, not just reform 

The NHS has long been caught in a cycle of structural upheaval, with reform often arriving faster than systems can absorb. This has left staff fatigued and uncertain, undermining morale and the ability to plan for the long term. The publication of the 10 Year Health Plan marks a critical opportunity to break this cycle, not by halting change but by embedding it within a stable, long-term vision that staff can trust and work towards. This means creating the conditions for services to plan ahead with confidence, reducing the churn of short-term initiatives and ensuring that reform is not experienced as disruption. The plan’s emphasis on earned autonomy, local innovation and devolving power to providers and communities is a welcome step in this direction. 

We are out of time 

The NHS crisis of burnout, mental exhaustion and systemic neglect is not hidden. It is screaming at us from wards, GP practices and ambulance services across the country. This is no longer a slow-moving crisis; it is unfolding in real time. Every week I hear more people questioning whether they can stay. And every week the system loses more of the belief it needs to hold itself together. 

We know what helps. We have the evidence. We have the insight. What we need now is resolve. 

So let’s stop the bleeding and start the healing before the damage becomes irreversible.