Scaling the workforce to meet MSK demand is unrealistic. We need new solutions

By Finn Stevenson

Digital pathways can transform access to care and ensure that those with the greatest need receive the care their conditions require, writes Finn Stevenson, Co-Founder and CEO of Flok Health.

According to recent projections, more than 7.2 million Brits will be living in chronic pain by 2040. With almost a million people already forced out of work due to musculoskeletal (MSK) issues, the welfare bill for back pain alone currently stands at £1.4 billion a year.

As our population ages and demand for treatment increases, one of the key challenges policymakers face is how to ensure patients can continue to access the care they need. With waiting lists for MSK treatment up 27 per cent from January 2023 to March 2024, we need to do more to deliver timely care to those who need it.

Hiring and training more physiotherapists can help make MSK treatment more accessible. It’s no secret that the workforce as it stands is chronically understaffed, and senior figures from the Chartered Society of Physiotherapy (CSP), along with politicians, have underlined the need to boost training and recruitment in the service. Since coming to power in July, Labour has already announced that it will be publishing a new Long Term Workforce Plan in 2025, with leaders signalling their ambition to go beyond the previous government’s commitments on NHS training and recruitment.

But it’s naive to think that simply hiring more people will be enough to service soaring MSK demand. As it stands, staff are so overstretched that the NHS would need to increase the number of physiotherapy positions in England by at least 7 per cent every year, just to keep up with current demand. Reaching this target seems unfeasible, especially considering the fact that physiotherapist numbers in the NHS increased by just 4 per cent from 2022 to 2023, and by only 0.7 per cent the year before. In fact, data collated by the CSP reveals that the annual rise in staffing levels has consistently fallen short of the required 7 per cent, with the largest increase in NHS physiotherapists across the last seven years standing at just 5.2 per cent, in 2019-2020.

With this in mind, it’s clear that any drive to hire and train more colleagues must come alongside a commitment to find new, innovative ways to improve patients’ access to MSK care.

Digital pathways can transform access to care

In September 2024, there were almost 350,000 people on MSK waiting lists in England, with some being forced to wait months to begin treatment. Not only is this frustrating for patients, it can also exacerbate their health problems. Studies show that longer wait times can lead to worsening pain, increased risk of disability, and a hugely detrimental effect on mental health and quality of life. By integrating novel digital pathways, we can deliver care to these patients as soon as they seek help, reducing the risk of deterioration, and accelerating recovery.

Effective digital pathways are already out there. At Flok Health, for example, we’ve developed the UK’s first AI physiotherapist, delivering at-home MSK appointments in a CQC-approved digital clinic on behalf of the NHS. Our system allows patients to be triaged, assessed and treated through a smartphone app, without ever having to wait for a traditional appointment.

Data from the work we’ve done so far shows that 94 per cent of patients describe their experience using Flok’s automated pathway as being “better” or “the same as” the care they would expect to receive from a human physio, with 88 per cent reporting that their symptoms had improved as a result of AI treatment. Crucially, all of these patients were able to access same-day care, with 24/7 appointment availability.

AI-operated digital pathways can also offer major benefits to clinicians. Managing high volume pathways (like back pain) in an AI clinic frees up capacity in the traditional services, allowing staff to focus on the cases where face-to-face appointments matter most. This alleviates pressure on the workforce and ensures those with the greatest need receive the dedicated time and resources that their conditions require.

Bringing care to the community

Another way to improve patient access to treatment is to extend MSK services out into new community settings. There are examples up and down the country where local Trusts have found innovative ways to meet their patients closer to home.

Sussex MSK Partnership introduced community appointment days (CADs) in non-clinical settings in a bid to deliver more scalable care and improve outcomes. These CADs act as a one-stop shop where patients can discuss their health issues with staff, before accessing a range of clinical solutions and other community services. The results of this programme were hugely encouraging, with 50 per cent of attendees discharged immediately and just one third requiring follow-up appointments. On top of this, waiting times for MSK treatment saw a 5-week cut, while staff morale was boosted as a result of seeing the immediate impact of their work.

Time to embrace change

In most NHS settings today, all patients with MSK conditions are funnelled down the same pathway for face-to-face appointments, leading to enormous backlogs, overburdened staff, and compromised care. Training and recruiting more MSK staff is of course important, but insufficient. Solving these issues will mean offering patients a choice of different care pathways. By running novel services like Flok’s AI clinic and Trust-run CADs alongside traditional pathways, we can transform patient access and outcomes while freeing up capacity in the existing services. These newer forms of care delivery are also significantly more scalable and resource-efficient than traditional models, which in today’s NHS is more important than ever.

Operational management: The invisible backbone of NHS success

By Phil Bottle

Phil Bottle, Managing Director of NHS workforce planning specialists, SARD, discusses the unsung importance of operational management to the NHS, including how effective management can be the remedy for a system straining under the weight of misaligned capacity and demand.

Penny Dash’s recent comments cut straight to the heart of a critical issue within the NHS: the absence of robust operational management. Her observation that adding staff has not translated into the anticipated impact is a stark reminder that people alone, without the right systems and processes, cannot untangle inefficiencies or improve outcomes.

But what exactly is operational management in the NHS context? At its core, it’s about ensuring that the vast resources—people, time, and technology—are strategically aligned to deliver the best care for patients. It’s the art of transforming effort into efficiency, of turning plans into practical, measurable outcomes. It’s also about creating a culture of accountability, where teams understand their roles, adapt to challenges, and continuously seek improvement.

The cost of missing discipline

Operational management is not a glamorous term. It doesn’t grab headlines like breakthroughs in medical research or new funding announcements. Yet its absence is felt every day:

Empty outpatient clinics sitting next to overcrowded ones
Elective surgery lists under-utilised due to inflexible staffing
Temporary fixes taking precedence over sustainable solutions

These aren’t isolated problems; they’re symptoms of a system straining under the weight of misaligned capacity and demand. And they highlight the critical need for something often overlooked in healthcare: discipline.

“Dr Dash’s call for more ‘ops managers’ is a recognition that leadership matters.”

Operational discipline doesn’t mean rigid adherence to plans. It’s about creating the flexibility to respond dynamically to real-world challenges. It’s about having clear, standardised processes that still leave room for human ingenuity. It ensures the right people, in the right roles, supported by the right tools, are empowered to adapt and improve.

It is something clearly missing and sorely needed. Yet as unglamorous as this work may seem, these are the hard yards that need to be made for meaningful progress.

Unlocking potential through workforce planning

Workforce planning is one of the linchpins of effective operational management. Done well, it provides the foundation for aligning capacity with demand. It highlights inefficiencies and opportunities, offering clarity on how resources can best support service delivery.

However, traditional approaches to workforce planning often fall short. Data may be fragmented or inconsistent, job plans may fail to reflect actual service needs, and staff often feel excluded from decision-making. The result? A process that stalls and fails to deliver the needed impact.

What’s needed is a shift in focus:

From fragmentation to integration
Workforce data should tell a cohesive story, not present conflicting narratives. This requires shared frameworks, clear language, and accessible tools that translate data into actionable insights.
From top-down to collaborative
Operational management isn’t a one-person job. It’s a team effort that thrives on engagement at every level—from senior leaders to frontline staff. Collaboration fosters ownership, ensuring that changes are not only implemented but embraced.
From short-term fixes to long-term sustainability
Quick fixes may alleviate immediate pressures, but sustainable operational management looks ahead, anticipating future challenges and building resilience into systems and processes.

Leadership and accountability

Dr Dash’s call for more ‘ops managers’ is a recognition that leadership matters. But perhaps even more critical is focusing on the processes those leaders oversee. Operational management isn’t just about systems; it’s about the people who run them. Effective leaders don’t simply keep the cogs turning—they identify inefficiencies, question the status quo, and work collaboratively to drive meaningful change.

This may mean rethinking whether current processes are fit for purpose or innovating entirely new ways of working. For example, underutilised elective services or ‘dark hours’ in clinical spaces could be addressed by flexing traditional staffing models or introducing creative solutions such as cross-team task-sharing.

Equally, accountability plays a pivotal role. As Paul Corrigan pointed out, the NHS must create environments where success and failure are acknowledged and acted upon. However, accountability should not equate to punitive measures like league tables. Instead, it should foster collaboration between trusts, encouraging the sharing of best practices and lessons learned. Data is crucial here—not as a blunt instrument, but as a tool to illuminate areas of strength and opportunities for growth.

A moment of opportunity

The challenges are clear, but so too are the opportunities. Meeting today’s demand is as critical as planning for the future. Predictive analytics can help model upcoming needs and support proactive decision-making, but current demand models are just as vital. These tools allow teams to allocate resources efficiently, manage capacity in real time, and ensure patients receive timely care. Balancing immediate pressures with future-proofing is the operational challenge of our time—and one that must be tackled head-on.

Operational management is more than a behind-the-scenes function. When strengthened, it unlocks efficiency, empowers teams, and transforms patient care. The time to focus on “ops, ops, ops” isn’t years away; it’s now.

Will NHS England’s medical consultant job planning improvement guide work?

By Phil Bottle

Phil Bottle, Managing Director of NHS workforce planning specialists, SARD, explains how a limited view of workforce data is preventing trusts from workforce planning effectively, and explores whether NHS England’s newly published job planning improvement guide will help solve the problem.

Let me start with a story. Back in 2010, when I was head of learning and development in the NHS, I’d watch our director of workforce in a blind panic every month as they pulled together a board report. The report was simple: who works for the trust, including substantive, part-time, honorary contracts, and temporary staffing costs. So why the panic? Because nobody knew the answers.

Month after month, they scrambled to piece it together. This wasn’t a capability issue — our director of workforce was an excellent leader, and adept in their role. The problem was systemic; nobody had the data, and more concerningly, nobody knew where to look.

This problem existed long before I joined the NHS, and unfortunately, it still exists today. So, when I saw NHS England’s new improvement plan, my initial reaction was, hopefully, a step forward. Workforce planning has been a constant struggle. But the real question is: does this improvement guide truly help solve the underlying issues?

The positives: A step in the right direction

I’ve been around the workforce planning block for almost two decades. I’ve seen countless attempts to kick-start meaningful change. The most notable difference with this guide? It ties job planning directly to patient value, something often overlooked. Too often, job planning has been about capacity without understanding how that capacity impacts patient outcomes. Finally, a patient-centric focus — this is progress.

The plan also discusses some important areas that need addressing; consistency, engagement, utilisation of data-driven insights, leadership focus, capability, process structure, and demand and performance metrics. These are key areas for improvement, and I support these measures.

The familiar oversight

However, here’s the big ‘but’ — this guide, like many before it, focuses too much on procedure, and not enough on resistance, lack of perceived value and inconsistent linkages to demand. These are the familiar hurdles that those doing the job know all too well lead to poor engagement, and the real root causes of 20+ years of subpar workforce planning.

“The data isn’t being utilised effectively, and everyones knows it.”

It’s like telling someone, “just try harder.” No amount of process improvements will solve the underlying barriers unless we address the core issues. As it stands, it feels more like a numbers game. Those who truly understand workforce planning and its relationship with patient safety outcomes and workforce wellbeing know it’s far more complex.

Workforce planning is not as straightforward as finding a round peg for a round hole. It’s more akin to a 1,000-piece puzzle — having the right people, with the right skills, in the right place, at the right time. Without this, a team’s, a department’s, or on a bigger scale, an organisation’s ability to deliver safe services and ensure staff wellbeing can resemble a shaky house of cards ready to tumble.

The root cause of poor job planning

A barrier to improving the consistency of job planning is cultural resistance. This is understandable to a certain degree, as job planning feels incredibly personal, even though it shouldn’t be. There’s a strong resistance to anything perceived as a threat to individual autonomy.

There is also an ambivalence towards the process due to the lack of perceived value. Why should anyone engage in this process if the data isn’t used for anything? The improvement guide talks about triangulating data with HR and Finance, but without demand modelling, it feels empty. The data isn’t being utilised effectively, and everyone knows it.

“Workforce planning… it’s failing because trusts don’t have the time and capacity to make it work.”

The inconsistent link to demand makes it feel like an afterthought. Demand should be at the core of job planning — ‘this is the demand on my service, and here’s the capacity to meet it’, not the other way around.

As a result, people don’t engage in job planning as it is seen as a process that doesn’t improve wellbeing, workloads, service objectives, or patient outcomes. The same applies to safe staffing, reducing backlogs, or achieving service goals.

The biggest issues: Time and capacity

Here’s the crux: workforce planning isn’t failing because of systems, leadership, or metrics. It’s failing because trusts don’t have the time and capacity to make it work. The process is complicated and labour-intensive, requiring significant hours from multiple people to be truly effective.

Until we address this fundamental issue — the lack of time and capacity — job planning, and therefore workforce planning, will continue to fall short.

Familiar solutions, same old problems

I’m not saying the challenges are easy to fix, but they are solvable. We need to think outside the box, beyond risk aversion, regulations, and procurement rules, and focus on what will add real, tangible value. Solutions that flatten the landscape by dealing with all the root problems holistically, rather than manage the hill. Solutions that tackle data analysis, engagement, expertise, tools, and training and provide tangible outcomes like better quality management information, not simply enabling more input methods.

This improvement guide offers procedural fixes, but it doesn’t tackle the deeper, systemic issues that have prevented job planning from being effective for so long. Real change will only happen when we address the root causes that are holding workforce planning back.

A People Powered NHS – A call to all health leaders

By Dr Allison Smith

Dr Allison E Smith, Director of Research & Insight at the Royal Voluntary Service discusses the key role that volunteers can play in delivering on core NHS goals.

The Prime Minister’s speech on 11th September 2024 pledged that this would be the ‘biggest reimagining of the NHS since its birth’. Hence, as we reflect on the plan for the future, we should challenge ourselves to think differently and work in ways which prioritise patient care and staff wellbeing. We should be bold and ambitious as the founders of NHS were in 1948.

In the original blueprint of the NHS, it was always intended to be a partnership between the state, the citizen and their communities. Public participation in the NHS e.g. via volunteering, informal carers and patient groups, has always played a vital role in the delivery of better health care. But in many ways, public involvement is a postcode lottery – a few areas do it really well, some do it (not well), and others have nothing. From the perspective of a volunteer-involving charity like Royal Voluntary Service – who have been supporting the NHS since before it was even founded – it is hard to get volunteering truly embedded in healthcare delivery. It still feels as if we are on the outside looking in or ‘pushing water uphill’. The purview of ‘integration’ appears largely limited to that of the NHS with social care.

With the public consultation on the 10-Year Health Plan, now is the time to rethink how the NHS – and wider healthcare system – works collaboratively with the public for the common good. System leaders need to stop putting up barriers to public participation and think ‘how can I build inclusive blended teams of staff and volunteers?’. Leaders should be embracing and nurturing the public interest and love for the NHS; 66 per cent of those signing up for the NHS and Care Volunteer Responders programme do so because they ‘want to support the NHS’.¹

The business case – in terms of the impact of volunteers on the NHS and wider healthcare system – we feel has been made.² The NHS and Care Volunteer Responders (NHSCVR) programme – first launched during the pandemic – has continuously proved its effectiveness, from driving system efficiencies to better patient care, workforce recruitment, and staff morale. For system leaders and frontline staff that embed NHSCVR within their local delivery there are big gains to be had.

For those unfamiliar with NHSCVR, this programme is a unique partnership between a charity (Royal Voluntary Service), a public service (NHSE) and a tech company (GoodSAM). It can match, via an App in real-time, requests for support from staff or patients with members of the public that can lend a hand. The programme is a key auxiliary service supporting the NHS and patients to expedite patient discharge, provide practical support to patients at home, deliver equipment for virtual wards, and provide support to ambulance crews waiting outside A&E. It is a free resource for local areas, is NHS approved, and can provide a critical safety net to mobilise volunteers at scale at times of high demand on the system.

In the past four years the programme has achieved significant scale; more than 2.6 million activities have been delivered in support of patients and the NHS, 221,000 individuals have been supported, and over 1 million members of the public responded. And while these numbers are indeed impressive, on the ground in local areas the programme delivers significant benefits for the system, staff, and patients – see table below.

The data also finds that those who volunteer report higher wellbeing. In a 2021 study by the London School of Economics, those that volunteered experienced statistically significant higher wellbeing compared to those who did not volunteer, and this wellbeing impact lasted for at least 3 months.⁶

This article is a call to all NHS system leaders; the breadth of impact – from this programme – plus others (see Helpforce) surely warrant the immediate integration of volunteers in NHS ‘BAU’, and centre stage in our reimagining of the NHS over the next 10 years.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum in London on the 5th November.

For more information or to connect with a member of our team, please reach out to your Regional Relationship Manager. Contact details are available at nhscarevolunteerresponders.org.

References

¹ NHSCVR baseline survey, n=8481)

² See King’s Fund 2018 Views from the Frontline, Helpforce, 2020, Volunteer Innovators Programme

³ Programme data & Volunteer Annual Survey March, n=6302

⁴ Staff Annual Survey October 2024, n=345

⁵ Client/Patient Survey June/July 2024, n=687

⁶ https://blogs.lse.ac.uk/covid19/2021/06/02/happy-to-help-how-a-uk-micro-volunteering-programme-increased-peoples-wellbeing/

How EDI can support NHS staff by creating a psychologically safe environment

By Dr Melissa Carr

In the face of increasing pressures, equality, diversity and inclusion offers NHS managers a pathway to foster supportive, inclusive environments that allow healthcare workers to thrive and patients to receive better care, writes Dr Melissa Carr for ICJ.

An ageing population with complex needs. Long waiting lists and over-stretched services. Disengaged and demotivated staff. The recent Darzi report highlighted in grim detail the challenges facing the NHS.

With healthcare workers on the front line under huge pressure, it’s unsurprising to see high rates of burnout, stress and staff turnover.

With the Long Term Workforce Plan predicting a potential shortfall of between 260,000 and 360,000 NHS staff by 2036/37, retaining an engaged workforce is an organisational priority.

One crucial solution lies in the training and development of NHS managers who are equipped to lead teams within this challenging environment.

By using Equality, Diversity and Inclusion (EDI) practices, managers can create psychologically safe environments where team members can ask questions, raise concerns, admit mistakes and suggest improvements without fear of negative consequences.

How a culture of psychological safety can improve outcomes for staff and patients

Think back to a time when you worked in a team where finger-pointing and blame was the default. How would you have felt about reporting a mistake? Or suggesting a better way to do something?

Creating a safe workplace where colleagues can raise issues and share best practice is essential within any healthcare setting. As previous failings of care, and the inquiries that followed them show, toxic cultures can silence legitimate concerns.

EDI practices enhance and enable psychological safety in teams. The NHS equality, diversity and improvement plan highlights the importance of managers that can model inclusive leadership behaviours, guard against workplace bullying and discrimination, and create channels through which staff can speak up and highlight problems.

What research into psychological safety tells us about failure

More than 20 years of research has found that organisations with higher levels of psychological safety, often achieved through the implementation of EDI practices, consistently achieve better outcomes.

They don’t just protect staff from discrimination, stress and burnout. They can also have a transformative effect on how teams function.

Professor Amy Edmonson, who pioneered the idea of team psychological safety in the 1990s, discovered something interesting during her early research. Edmonson examined the relationship between error making and teamwork in hospitals but, rather than showing that more effective teams made fewer mistakes, the results found the opposite. Teams who reported better teamwork apparently experienced more errors.

A dive into the data explained why. It established that more effective teams reported more mistakes because they talked openly about them. It can feel challenging to hold your failures up to the light, but it’s the most effective way to troubleshoot systematic errors and drive positive change.

As a practical guide to improving patient safety culture published by the NHS in 2023 confirmed, team environments that allow for ‘intelligent failures’ which lead to reflection and improvement usually achieve the best patient safety outcomes. Psychological safety provides the environment in which this can work effectively.

As Amy Edmonson says: “Psychological safety is not about being nice. It’s about giving candid feedback, openly admitting mistakes, and learning from each other.”¹

How integrated care systems can support safer workplaces

Within a culture of robust psychological safety and leaders trained in EDI processes, teams can openly challenge the status quo and flag fixable mistakes. Importantly, they are also empowered to suggest innovations that can improve the systems they work within.

One of the key functions of integrated care systems (ICSs) is to identify pockets of best practice across services and provide a platform where they can be widely shared. The repository of case studies on the NHS England website is a treasure trove of success stories – from social prescribing initiatives to fast-tracking cancer diagnoses by using AI.

ICS leaders must continue to create open channels for feedback. These help to foster team collaboration and trust, encouraging a no-blame culture, and shared aims and ambitions.

In a culture of collaboration rather than competition, this focus on knowledge-sharing encourages learning and improvement at all levels.

Using EDI practices to ensure psychological safety

Individual managers can make a big difference to their immediate teams but change on a larger scale can’t happen without clear organisational frameworks.

Equality, diversity and inclusion practices go hand in hand with psychologically safe workspaces. They provide the safety nets and support networks which allow people of all ages, ethnicities, sexualities and genders to share their lived experiences and raise concerns. They also work to erase the bullying and discrimination that makes workplaces fundamentally unsafe and silence the voices of staff.

In an organisation as multi-layered, complex and hierarchical as the NHS, inclusivity must be prized as highly as productivity. This means that everyone is given a platform to speak up, no matter their discipline, experience level or pay grade.

EDI frameworks aren’t a silver bullet for the complex issues facing the NHS. But they can tackle the significant problem of staff disengagement and enable a culture where diversity of thought is prized.

Empowering managers to lead teams

Psychologically safe workplace are as important to staff wellbeing as they are to patient safety. When employees feel valued, supported and – crucially – listened to, they experience lower levels of stress and burnout.

At Henley, we recognise that inspiring leaders can make a huge difference. That’s why we’ve partnered with NHS England to launch the first cohort for NHS colleagues pursuing careers in EDI.

Professionals at the beginning of their leadership journey, with no more than three years of experience within a management role, will learn the skills to create positive, inclusive and transparent working environments for their teams.

Dr Melissa Carr, Director of EDI at Henley’s World of Work Institute

Pandemic reflections: What we’ve learned from professional South Asian women in the NHS

By Dr Saleema Kauser and Dr Ana-Paula Figueiredo

Women from the BAME (Black, Asian, and Minority Ethnic) communities working in the NHS faced unique challenges and risks during the pandemic. Dr Saleema Kauser and Dr Ana-Paula Figueiredo interviewed women working in the NHS to hear the challenges they faced.

Ethnic minorities in the NHS encountered unique challenges during the pandemic, underscoring significant systemic issues within the NHS. Indeed, the pandemic served as a magnifying glass, revealing the vulnerabilities of healthcare systems across the world and the particular pressures faced by ethnic minorities within these systems.

For Asian women in the NHS, these pressures included not only the health risks from being on the front line. Their critical role in the healthcare response also positioned them at the intersection of race, gender, and professional risk.

This demanded focused research to dissect these overlapping vulnerabilities, and that is precisely what this project has been doing – researching the key insights and pivotal lessons that can be learned by interviewing professional South Asian women working in the NHS. Our research broke down into seven key areas of insight:

Preparedness and resilience

Many respondents noted that while the pandemic was challenging for everyone, it was particularly severe for ethnic minority women. A key issue highlighted was the inadequate distribution of personal protective equipment (PPE), which disproportionately affected these women, often leaving them on the front lines without adequate protection.

This lack of resources was compounded by delayed responses from management, who were slow to implement necessary safety measures. These delays not only heightened the risk of virus transmission but also highlighted a failure in crisis management that left staff feeling vulnerable and undervalued. Nearly all of our participants underlined the need for more proactive planning, robust health systems preparedness, resilience planning and the immediate provision of adequate resources like PPE.

Culture, leadership and behaviour

Many participants discussed a lack of cultural competence in healthcare provision and in managing ethnic minority staff. They called for more diversity in leadership roles within the NHS to provide insights into the lived experiences of different communities and to facilitate fair treatment and prevention strategies.

There is a clear need to integrate cultural competence training across all levels of the NHS. This training should target not only clinical staff but also management teams to ensure that decision-making reflects an understanding of the diverse cultural backgrounds of both patients and staff. The women also emphasised the need for regular assessments and feedback mechanisms to ensure that the needs and views of ethnic minority staff are being met.

Empowerment through awareness and advocacy

Women spoke about how enhancing advocacy could have led to significant improvements in addressing workplace inequalities and ensuring that all staff, particularly ethnic minorities, had the knowledge and tools to advocate for safer and more equitable working conditions.

Many participants emphasised how understanding their legal and organisational protections during the pandemic empowered them to advocate more effectively for themselves and their colleagues, and expressed a desire for more channels to raise their concerns. Some participants also felt there was a need to promote leadership roles for ethnic minorities specifically through leadership development programmes that target ethnic minority groups. This would help diversify the voices in NHS decision-making processes.

Transparent communication and focus on EDI

Clear, consistent, and transparent communication from healthcare leadership is critical during a crisis. The pandemic exposed a number of deficiencies in communication that often left women staff feeling confused and fearful. Many suggested that future strategies should focus on improving lines of communication, addressing staff concerns with empathy, and providing clear guidance on safety measures and operational changes, especially for those in high-risk roles.

Many participants expressed that information often did not reach them in a timely fashion or was not fully accessible, was only selectively shared or, in some cases, not shared at all in instances where white managers did not see BAME colleagues as full team members. They also felt excluded from decision-making processes, particularly those decisions that affected their work conditions directly during the pandemic.

Workforce support and sustainability

The dual burden of professional duties and domestic responsibilities was evident during the pandemic, especially for working mothers. It is crucial for healthcare systems to create and maintain support structures that help women manage this balance without compromising their health and well-being. Recognising and actively supporting the work-life balance during crises is essential in reducing burnout and maintaining high levels of care. Those in high-exposure areas such as COVID-19 wards faced intense pressure to manage work risks and family health.

Providing mental health support systems that are robust during and after crises is also essential. The women in our sample faced increased psychological impacts due to systemic biases and high-pressure roles during the pandemic.

Recognition and response to systemic inequities

Our data highlighted a deeply entrenched lack of recognition and systemic inequities towards South Asian women during the pandemic. The most significant was the systemic inequity around the distribution of PPE and critical resources. Participants often found themselves on the front lines without adequate protection, highlighting a stark neglect in the safeguarding of these workers compared to their white counterparts. Such disparities were not only a matter of resource allocation but also reflected deeper racial prejudices and a failure to recognise the equal worth and rights of ethnic minority workers.

Government and NHS coordination

Many participants discussed the need for a well-coordinated response between the government and NHS, which they felt was lacking. The lack of unity in their responses was a significant concern.

The general view was that in the long-term, healthcare policy reforms should focus on making the system fairer and more inclusive, especially in light of the inequalities exposed by the pandemic. This involves re-evaluating existing policies to ensure they truly serve and protect all healthcare workers, with extra attention given to those who are most at risk or disadvantaged.

Our data indicates that the disparities revealed during the pandemic demonstrated that the normal way of doing things wasn’t effective or fair for everyone, particularly minority women healthcare workers who often faced greater risks and fewer protections.

Our work highlighted the urgent need for systemic changes that promote equity, cultural competence, effective communication, and empowerment. By addressing these key areas, the NHS—and healthcare systems worldwide—can not only better prepare for future crises but also create a more just and supportive environment for all healthcare professionals.

The pandemic underlined the importance of the health and social care workforce, who faced extreme pressures. Ensuring the wellbeing, adequate staffing, and continuous professional development of healthcare workers is vital for sustaining health services during and beyond and future crisis.

*Dr Ana-Paula Figueiredo, Researcher, Alliance Manchester Business School*

*Dr Saleema Kauser, Senior Lecturer and Associate Professor in Business Ethics and Strategy, Alliance Manchester Business School*

News, Workforce September 25, 2024

Staff urged to sign up for course co-produced with autistic people to improve mental health care

By Integrated Care Journal

November marks the deadline to sign up to the ‘Train the Trainer’ course, to support staff to provide workplace training to improve support for autistic people.

Staff working in mental health services in England are being urged to sign up for a ‘ground-breaking’ series of courses that provide training to improve care for autistic people as it reaches its final months.

The National Autism Trainer Programme (NATP) is delivered by Anna Freud, a mental health charity for children and young people, in partnership with AT-Autism, a non-profit UK autism training, clinical services and consultancy provider, for NHS England. Both organisations share a commitment to creating lasting positive change for autistic people, as well as their families and staff working with them.

The programme – which closes in November – supports staff to deliver training within their own workplaces to improve support of autistic people.

Staff working in mental health and other settings can sign up for NATP here.

Research indicates s even out of 10 autistic people develop a mental health condition such as anxiety, depression, or obsessive-compulsive disorder (OCD). They are more likely to require mental health services than non-autistic people, but they don’t always get appropriate care. For example:

Mental health problems are often misdiagnosed among autistic adults, who are more likely to be given a sequence of diagnoses for their mental health problems and to disagree with the diagnosis they receive.
On average, autistic adults spend about 5 years within inpatient mental health services once admitted, compared with 39 days for non-autistic people.
Autistic people are up to seven times more likely to die by suicide than non-autistic people.

Since launching in 2023, more than 4,000 professionals across England have been trained through NATP and more than 600 are registered for the remaining places so far. 

The programme has been co-designed, co-produced and co-delivered with more than 110 autistic people to improve the knowledge, skills and confidence of professionals within mental health services in supporting autistic individuals. This includes challenging stereotypes about autism, building understanding of mental health conditions in autistic people and developing neurodiversity and trauma-informed and experience-sensitive approaches to their care.

Staff working in mental health and other settings can sign up for NATP here.

The course is open to eligible NHS England staff who currently work or may work with autistic people, including those without a diagnosis, in inpatient and community mental health services.8 Staff from residential special schools and colleges, and children and young people health and justice services, can also sign up.

Full details on training dates and available settings are on Anna Freud’s website. The charity, which has been supporting children and young people for 70 years, is working to close the gap in children and young people’s mental health. NATP is helping to achieve this ambition by closing the gaps in the skills and knowledge needed to support autistic people of all ages within mental health settings.

Dr Georgia Pavlopoulou, NATP Strategic Co-Lead and Programme Director at Anna Freud and Associate Professor at University College London, said: “Without counting those not formally diagnosed, autistic people are massively overrepresented in mental health services, yet many don’t receive appropriate care. This ground-breaking programme was established to help spread a new understanding of autism across the country. We are training staff within mental health settings to better support and recognise autistic people through experience-sensitive and person-centred care.

“Seeing the changes that the thousands of staff trained through NATP so far have implemented in their own workplaces has been a joy. From recognising and making adjustments for sensory and communication differences to developing environments where autistic voices are listened to and respected, so many working cultures have become more neurodiversity-informed and inclusive.

“After we deliver the final set of NATP courses, we will work closely with experts by experience, NHS England and partners to provide recommendations for a sustainable national model that promotes neurodiversity-informed practices within mental health services.”

Alexis Quinn is an autistic campaigner and author who, after attempting to seek mental health support following the birth of her daughter and death of her brother, was detained in 2012 under the Mental Health Act for almost four years. Alexis – who is also a content developer for NATP – said: “After major life changes, my mental health declined, and troubling autistic sensory seeking and cognitive needs arose. I couldn’t sleep, and I was more sensitive to touch, light and sounds. I also found I needed to move around all the time and became fixated on researching death processes. People around me became worried and I went to my GP for help. I thought I would be able to find somewhere to share my experiences and distress and have these supported.

“Instead, I faced countless barriers to accessing health care services. Some of these were environmental and some were caused by staff not understanding me. For example, I found the GP’s waiting area noisy and tried to move around to cope, but I was told I needed to sit down or leave. On one occasion, the police were called, and I was so overwhelmed, I had a meltdown. Not long after, I was sectioned and labelled mentally ill. I was given medications that caused scary and severe side effects, all of which compounded the distress I was experiencing.

“None of this needed to happen. If you understand autistic people, you can make reasonable adjustments such as providing a double appointment. You can also listen beyond the observation of autistic ‘symptoms’ by truly getting to know the person and their needs. That’s why NATP is so important. The course offers a neurodivergent-friendly approach to thinking about and supporting autistic people. Designed and delivered by the population it seeks to serve, it trains staff to recognise, understand and empathise with difference, and adapt care for neurodiverse people accordingly.”

Ellie Tidy, Child Wellbeing Practitioner at Islington Child and Adolescent Mental Health Service (CAMHS) was trained through NATP. She said: “The training provided incredible insights into the experiences of autistic people, including helping us understand the importance of an experience-sensitive approach. We now have a box of sensory tools for face-to-face sessions that young people can access during therapeutic sessions to feel more comfortable, and we have developed a form where they can share sensory and social needs before appointments.

“We have also adapted some resources, including our adolescent anxiety interventions, to better reflect the potential cognitive styles of young people. To achieve this, we incorporated learnings from NATP, including on masking – a strategy used by some autistic people consciously or unconsciously to appear non-autistic – and alexithymia, when a person has difficulty experiencing, identifying, and expressing emotions. We are also expanding and improving our way of working with neurodivergent children and young people beyond the clinic, including advocating for better adaptations in other settings such as at home and in school.

“In the future, we aim to focus more on co-production. We’re currently working with autistic young people and their families in the service to gather feedback and find out which adaptations work well and what could be changed. Listening to the voices of autistic young people will help us to better support them.”

Staff working in mental health and other settings can sign up for NATP here.  

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Labour urged to support and protect NHS’ temporary healthcare workforce

By Integrated Care Journal

The UK’s temporary healthcare workforce needs championing and protecting, suggests the Recruitment and Employment Confederation (REC), as it launches its people-first ‘Voice of the Worker’ campaign.

The Recruitment and Employment Confederation (REC) is urging the government to champion the UK’s temporary healthcare workforce, with the launch of it’s people-first ‘Voice of the Worker’ campaign.

The campaign comes as the new government is pushing on with its Employment Rights Bill within its first 100 days in power.

The move has sparked robust debate regarding recruitment and employment, because highly regulated agency work already offers employment rights and in-work progression. There are fears that anticipated changes to employment rules could put the temporary worker market at risk.

Further, the new government’s launch of Skills England will also create more opportunities for temporary and contract workers to upskill as the Apprenticeship Levy is reformed. Although not confirmed, the government is expected to expand the Apprenticeship Levy into a ‘Growth and Skills Levy’, allowing companies to use 50 per cent of their levy contributions to fund training via routes other than apprenticeships.

Temporary healthcare work is key in helping the NHS deal with disparate and fluctuating demand, and with the right regulations in place, enable workers greater flexibility in work and control over their work-life balance.

Neil Carberry, REC Chief Executive, said: “Flexibility at work is something to feel optimistic about. It is working for millions of people. Individual choice and employers’ need for a versatile workforce can be brought together to deliver better careers and higher productivity. The government must ensure new rules support temps and that means having a real understanding of their lives.”

REC’s campaign aims to show how and why temping can work for many individuals by placing the real-life stories of temps, including those working in healthcare, at its heart. The campaign urges government, employers and unions to collaborate more closely to support the UK’s growing temporary workforce.

For the campaign, REC commissioned Whitestone Insight to interview 520 temp agency workers across different sectors – not just health – in Britain in June 2024, to hear their thoughts about agency work and why it matters to them. Polling found:

Almost eight in 10 temp agency workers (79 per cent) said their work provides an important need for flexibility.
More than two thirds of temp agency workers (68 per cent) said that their work provides a greater work-life balance.
More than half of temp agency workers (53 per cent) believed that this is the right kind of role for their current stage in life – an active choice.

REC says it hopes its ‘Voice of the Worker’ campaign will prompt far more discussion about reform of the public sector, with public services clearly struggling with demand. Temporary workers are critical in enabling the NHS to deliver services, helping to retain skilled people in the workforce and provide solutions to NHS trusts. But NHS policies for frameworks and banks have reduced the attraction of working for the NHS for medical staff – and forced trusts to use more and more emergency shifts. By reforming frameworks, their rates and the approach taken to permanent staffing, the new government could reduce costs and get better results for patients and the Treasury. But a proper partnership is needed to achieve this, the REC argues.

Neil Carberry added: “Government has repeatedly made the same mistakes in NHS staffing for almost a decade – trying to pay agency staff less year-on-year than they pay substantive staff. And pretending that Banks are cheaper to the exchequer. The result of this is that there are more emergency shifts as medics reject shifts, and spending overall has gone up. Moving on from demonising agency nurses and doctors and other clinicians – and the agencies that supply them – and working in partnership with the sector on a new approach to procurement will give the new government a unique opportunity to build a sustainable supply of short-term staff, at high quality and value for both patient and taxpayer.

“Good and lasting workforce changes that are effective for workers and employers, happen when employers and government work together to determine what works for everyone. Our case studies show the difference talented agency and contract staff are already making in our health service.”

This autumn, the REC will highlight video and written case studies of temporary workers, in which they explain the reasons for wanting flexibility and the benefits of temp working, across a variety of sectors.

New data reveals mental health toll on NHS staff

By Integrated Care Journal

Despite challenges facing the service, the NHS remains one of the UK’s most loved institutions, says survey data, as NHS Charities Together launches new campaign urging public to continue supporting NHS and its staff.

More than three quarters (76 per cent) of NHS staff surveyed said they have experienced a mental health condition in the last year, according to new data collected by NHS Charities Together. Conducted by YouGov on behalf of the charity, the survey of more than 1000* NHS professionals also found that 52 per cent reported experiencing anxiety and 51 per cent reported struggling with low mood.

More than two-fifths of respondents (42 per cent) said they had experienced exhaustion in the last year, while three in five (60 per cent) reported feeling concerned for the mental health of colleagues.

Despite these challenges, however, 79 per cent of respondents said they feel proud to work for the NHS and 68 per cent said that they are unlikely to leave within the next 12 months.

The survey reveals the impact of increasing pressure on NHS staff, who are now subject to ‘winter pressures’ throughout the year, and are increasingly facing high workloads, long and unsociable hours and exposure to traumatic, stressful events. 96 per cent of those surveyed said they believe that overall pressure on NHS services is growing, and 69 per cent said that morale is the lowest they have ever experienced. A similar number (70 per cent) said that work-related stress has negatively impacted their mental health in the last year.

The release of these findings comes alongside the launch of a new campaign from NHS Charities Together called Support Goes Both Ways, which aims to raise awareness of need to continue to support NHS staff, so that they can best support the public.

Commenting on the findings, Ellie Orton OBE, CEO of NHS Charities Together, said: “Staff working within the NHS do a hugely challenging job every day, often dealing with traumatic events most of us would never encounter. The majority of NHS staff love doing the job they do, and both NHS staff and the general public feel proud of our NHS. But the nature of the work can have a detrimental impact on their mental health, and stigma can prevent them talking about it.

“Many NHS Trusts are already doing what they can to prioritise the mental health and wellbeing of our NHS staff, but it doesn’t go far enough. We will continue to work closely with NHS England and across the UK to ensure the additional support we provide for NHS staff has the most impact.”

In a separate survey, also carried out by YouGov on behalf of NHS Charities Together, more than 2,000 members of the public were invited to give their opinion on the NHS. Despite the challenges facing the NHS, the 2024 survey revealed that almost four in five (78 per cent) agreed that the NHS is one of the UK’s most loved institutions, compared to three in five (60 per cent) of the 2,000 respondents surveyed in 2022 who stated that the NHS is the best thing about the UK.

The proportion of respondents saying that they would consider a role working for the NHS if they were starting their career again, has risen slightly, from just over one in four (28 per cent) in 2021 to three in 10 (30 per cent) in 2024**.

Author, comedian and former doctor, Adam Kay, whose number-one bestselling book and multi-BAFTA-winning TV show, This is Going to Hurt, provided an insight into the often funny but harrowing daily life of a junior doctor, said: “These figures sadly come as no surprise at all. I know from my own experience just how hard NHS staff work, day-in, day-out, and the mental toll that routinely takes. We are uniquely privileged to have the NHS and should be proud of the wonderful people who sacrifice so much and go so far beyond the call of duty to look after us when we need it. But they desperately need support too, which is why I’m very proud to get behind NHS Charities Together’s Support Goes Both Ways campaign.”

Pat Chambers, Charity Development Manager, County Durham and Darlington NHS Trust Charity, said: “During the pandemic, many staff were affected mentally and emotionally. The extra support from NHS Charities Together enabled us to fund wellbeing spaces, equipment and food and drink for staff, who were working exhausting shifts in the constraints of PPE.

“We also received funding for the Trauma Risk Management (TRiM) project. TRiM is a trauma-focused peer support system helping to prevent extreme trauma and PTSD – similar to interventions delivered for service personnel returning from conflict zones. Funding enabled us to recruit 53 staff volunteers to be trained in providing peer support and interventions. We also funded a staff choir, which was a great outlet for staff and even saw us recording a single during lockdown, which hugely boosted morale.

“The unique challenges of the job means many NHS staff still face mental health challenges today, and the extra support is still needed, allowing us to promote wellbeing across our workforce and therefore ultimately continue to support the delivery of safe, compassionate and quality patient care.”

Hannah Canning is the Health and Wellbeing Coordinator at North West Anglia NHS Foundation Trust. Her role is fully funded by NHS Charities Together, through the North West Anglia Hospitals’ Charity, and was created to support frontline workers in the hospital. She said: “Thanks to the funding from NHS Charities Together, I’m able to support the wellbeing and mental health of staff in the hospital. I’m focusing on individual and team wellbeing and encouraging breaks and rest – considering all things that affect staff while they are on shift. Using this funding, we are able to go ‘over and above’ to support our staff.”

Ellie Orton OBE, CEO of NHS Charities Together, added: “NHS Charities Together already funds extra support such as counselling, green spaces, helplines and wellbeing zones and we’re launching Our Support Goes Both Ways campaign to raise awareness that while those who work for the NHS have a duty to care and protect us all, we all have a responsibility to make sure those who work for the NHS are looked after too.”

Steph Gorman is an intensive care nurse at Guys and St Thomas’s Hospital in London. She said: “I’m passionate about my work as a nurse. It’s hard, and I’ve had my struggles, but despite everything, it’s still one of the best jobs in the world. In the past, I’ve needed to seek help and started one-to-one counselling sessions at the hospital, which was really beneficial.

“Working as a nurse is still incredibly challenging. It’s so vital that we continue to invest in NHS staff mental health. NHS Charities Together have funded wellbeing zones at the hospital, just one example of the types of measures that really help make a difference.”

*Healthcare Professional sample: Total sample size was 1078 NHS staff. Fieldwork was undertaken between 13th – 19th February 2024. The survey was carried out online. The figures have been weighted and are representative of all NHS staff by occupational group.

**GB/UK Omnibus: Total sample size was 2068 adults. Fieldwork was undertaken between 16th – 18th February 2024. In 2022, total sample size was 2132 adults. Fieldwork was undertaken between 13th – 14th January 2022. For the 2021 survey, total sample size was 2120 adults and fieldwork was undertaken between 11th – 12th March 2021. The surveys were carried out online. The figures have been weighted and are representative of all UK adults (aged 18+) while for the 2022 survey, the figures are representative of all GB adults (aged 18+).

Is the push for collaboration causing a retention crisis?

By Rob McDonald

Rob McDonald, NHS Retention Services Manager at NHS Shared Business Services, asks whether exit interviews could hold the key to boosting NHS retention – a key goal of the NHS Long Term Workforce Plan.

Collaboration has been an NHS mantra for years now. According to all sources, no matter what the problem, collaboration (oh, and technology) will solve it.

But is that true? Intriguingly, my experience is that – far from being a panacea – the move towards collaboration might be exacerbating the NHS’s staffing problems.

Don’t get me wrong. I’m a fan of collaboration. It helps to spread good practice. It reduces or eliminates inconsistencies. It enables organisations to pool their resources and benefit from economies of scale. So it’s perhaps not surprising that the entire NHS has been reorganised to encourage (or mandate) partnerships, exemplified by system-wide reorganisations like the establishment of ICSs two years ago.

The drive for productivity is resulting in mergers as services are scaled. The changes affect all organisations – from acute providers to community, mental health and learning disability services and Community Interest Companies. These TUPE transfers (Transfers of Undertakings (Protection of Employment), affecting many thousands of front-line staff every year, are frequently seen by senior managers as routine or benign. After all, the individual’s terms of employment are protected – so what is there to worry about?

The reality is that the changes are often poorly managed, can be unsettling and – I believe – are contributing so much to staff turnover that they’re having a significant impact on patient care.

What does it feel like if you’re one of those staff?

Thankfully, that’s a question we can answer. NHS Shared Business Services provides an exit interview service, which I am privileged to run. We’ve done more exit interviews in the past three years than most people do in a lifetime. I say that as a statement of fact, not a boast!

One of the questions we’ve started to ask leavers is whether uncertainty around, or the impact of, mergers has influenced their decision.

The answer is yes. We’re finding that nurses in particular often cite service mergers as contributing to their desire to leave, frequently in combination with other factors, such as general stresses of the job.

It goes without saying that this is a problem. The NHS’s long-term workforce plan highlights the need for up to 190,000 additional nurses by 2037, requiring retention rates to improve by around 15 per cent over the course of the plan. Losing nurses has knock-on effects way beyond the immediate impact on patient care. The cost of recruitment to backfill; the cost and time of additional training; the stress on team members who have to provide cover and the cost of overtime – all of these erode both money and goodwill.

The recently published NHS staff survey confirms this. Although most of the People Promise indicators showed a modest improvement, many of the numbers are still concerning. Some 30 per cent of respondents said that they felt burnt out by their work, and 34 per cent found it emotionally exhausting, yet only around half said they felt able to make improvements happen or be involved in change.

The good news is that this can be fixed. Mergers and reorganisations do not need to make staff feel disempowered and uncertain. In fact, when handled well, they can have the opposite effect.

To do this takes time, care, and skill – I’ve provided a few hints below, based on the feedback we’ve been getting.

Uncertainty about a merger is often more damaging than the merger itself, so communication really is key. People subconsciously “triangulate” information – that is, they won’t absorb or believe it until they’ve heard it from three different sources. So think about what level of communication you might need, then triple it.

Identify flight risks. This is something we’ve done for years at NHS SBS; we even have an algorithm that predicts people at risk of leaving. Then take proactive action to address their concerns and bring them further into the fold. Leavers often tell us their manager knew they were thinking of leaving; managers, by contrast, tell us the resignation came as a surprise.

Conduct exit interviews – and use the data you collect. I may be biased, but I think exit interviews are possibly the most important conversation you can ever have – more important even than recruitment interviews. Yet, remarkably, the standard approach is for an automated tick box survey to be sent to leavers upon resignation. The response rate is usually around 30 per cent and the greatest reason for leaving is ‘unknown’ – in other words, the path of least resistance to complete the survey without discussing any real issues.

Finally, remember – a resignation doesn’t have to result in a leaver. Is there a feeling that once resignation is given, the horse has already bolted? I think there is. Yet when I ask leavers whether they would have stayed if somebody had done something differently, the answer is often yes.

Resignations can be withdrawn. And sometimes, a conversation is all it takes to retain a valued and valuable member of staff.

Given that the magic roundabout of change in the NHS is unlikely to slow down any time soon, learning to support and empower staff through periods of uncertainty is critical.

I’d love to hear from readers about their experiences of change – particularly the impact of service mergers on retention and how you use exit interviews. Contact me at Rob.McDonald1@nhs.net.