The National Health Service is a rare point of consensus in British public discourse. That it is free at the point of need and delivery is held up as evidence of the UK’s fair and modern society. Doctors, nurses and support staff are lauded as heroes. So why are so many choosing to leave?
In 2019, research by the Health Foundation think tank found that the rate of personnel leaving the NHS due to excessive stress had nearly trebled over the course of seven years. Between June 2010 and June 2011, 3,689 members of staff, the majority of whom were nurses, cited burnout and a poor worklife balance as key reasons for leaving the NHS in England. That figure was 10,257 for the 12 months to June 2018. According to the most recent NHS Employers report, stress accounts for a third of all sickness absences among staff, costing the service between £300m and £400m per year.
And that was before the pandemic. Covid-19 has been something of a call to arms for the NHS. Staff have acquitted themselves in managing the crisis, working substantial overtime. But with a second wave looming, a perfect storm of exhaustion and disillusionment is brewing across the healthcare sector.
In August, Dr Chaand Nagpaul, chair of the British Medical Association, told the Independent that a second wave of Covid-19 could be accompanied by the “double whammy” of staff shortages and a backlog of postponed operations and treatments from the first wave. Nagpual said the pandemic had led thousands of staff to consider quitting or retiring early. He added that coronavirus restrictions on foreign travel, which would be further complicated by Brexit, will make it even harder to replace those who do leave.
A junior doctor based in Brighton, who prefers not to be named, tells Spotlight that the NHS has become a “far less attractive employer than it was a generation ago”.
“I still love what I do,” he says. “I’m a doctor because I want to help people. But the NHS is only as strong as its staff. And if members of staff are unhappy, overworked or stressed, then that will have a direct effect on the quality of care that the NHS is able to give.”
Though nobody in the medical profession “expects to always clock off at 5pm on the dot”, he adds, this crisis has taken overtime to new levels. But he confirms that staff shortages were a problem even before coronavirus. “It has become almost accepted that every hospital rota is short of doctors. And as those shortages continue, all these targets about patient waiting times and so on are unlikely to be met.”
A nurse practitioner based in Leeds, who also chooses to remain anonymous, says that working during the pandemic has, at times, felt “thankless”.
“The Thursday night applause [when the public was encouraged by the government to clap on doorsteps once a week in recognition of NHS staff] felt hollow to be honest,” she says, noting that platitudes were not matched by policy. “The failure on PPE [personal protective equipment] meant that you had nurses going into work, putting themselves at risk, every day. It made me feel so anxious.”
In July, Chancellor Rishi Sunak announced an above-inflation (between 2.8 and 3.1 per cent) pay rise for nearly 900,000 public sector workers including doctors, teachers and police officers. But the scheme does not extend to nurses, paramedics, social care workers and other NHS support staff, who are tied to a three-year pay deal that does not end until April 2021. Their salaries will not even be eligible for review until next year. This “feels like a kick in the teeth”, says the Leeds-based nurse.
The pay rise also excludes junior doctors, who make up almost half of the total doctor workforce. They are due a 2 per cent pay rise each year of a four-year deal that began in 2019. “It [the public sector pay rise] is just a headline unfortunately,” the junior doctor from Brighton says, “just smoke and mirrors.”
Suzie Bailey, director of leadership and organisation development at The King’s Fund think tank, and a former NHS general manager, says that while pay is undoubtedly a factor, it is not the only issue. “Of course, people need to be properly compensated for the risks they are taking to keep other people safe,” she says. “But we need to look at how work is structured. There is a debate to be had about 12-hour shifts. A lot of staff can see benefits in working three 12-hour shifts in a row to get more time off during the week, but actually, there is evidence to suggest that those longer hours are making burnout more likely.”
Bailey says there are many “cultural” factors contributing to NHS burnout, including how employees are treated by senior staff. “Better management practices are key,” she says. “Staff should feel like they are part of a team, and not hassled constantly to work to certain targets.”
The NHS hero tag is “a bit of a double-edged sword” too. “In painting NHS staff as super-human, you belie the fact that they are, in fact, human.” Bailey points out that the unique pressures of healthcare, namely dealing with potentially traumatic issues, such as patients dying, on a daily basis, can have a profound impact on staff. “And yet there is an expectation that they should become immune to it and just carry on.”
Schwartz Rounds – conversational forums where clinical and non-clinical staff discuss the social and emotional aspects of their work – are one way in which NHS Trusts support employees. Julian Groves, head of staff experience programmes at the Point of Care Foundation, a charity which helps implement these forums, says that the NHS and, indeed, the government have a “moral responsibility” to look after staff. Groves feels many staff stop working for the NHS because many aspects of the system “do not feel ‘human’ at scale, structure or culture”.
Around 1.3 million people work for the NHS. In 2019, the NHS Staff Survey found that 51 per cent of staff were thinking about leaving their current job, while 21 per cent wanted to quit the service altogether. More than three-quarters of respondents felt they were placed under unrealistic time pressures some or all of the time, and nearly six in ten claimed to have done unpaid overtime every week.
mso-border-alt:none windowtext 0cm;padding:0cm”>Ultimately, “it’s not enough,” the junior doctor from Brighton says, “to simply rely on the goodwill of doctors and nurses to keep them in a job. As with any employer, you need to think about how you would attract someone to apply, and how you would convince them to stay.”
Approached for this piece, an NHS spokesperson said: