Featured, News, Workforce April 16, 2024

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+).

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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.

Rob McDonald, NHS Retention Services manager, NHS Shared Business Services

BMA survey finds widespread concern among doctors over role of physician associates

By Gabriel Blaazer

The BMA calls for immediate pause to recruitment into Medical Associate Professional (MAP) roles and to limit the scope of MAP roles to administrative and low-risk clinical tasks.

A majority of doctors have expressed concern that physician associates (PAs) and anaesthesia associates (AAs) are undertaking tasks beyond their competence, according to a new survey from the BMA.

In the survey of more than 19,000 doctors, nearly 80 per cent reported concerns that MAPs were “occasionally or frequently” working on tasks for which they are underqualified, with 87 per cent believing that the current rules pose a risk to patient safety, some or all of the time.

A majority of doctors also believe that working with PAs and AAs has increased their workloads, according to the survey. Only 21 per cent of respondents reported a decrease in their workloads since the employment of MAPs, while more 55 per cent reported that their workload had instead increased.

Professor Phil Banfield, BMA Chair of Council, said: “NHS England tells us that ‘Physician Associates support doctors in the diagnosis and management of patients,’ supposedly giving doctors more time to deliver the high-quality care only they can give.

“But the reality appears to be the exact opposite – too many doctors are telling us that working with PAs is instead draining their time and energy. The responsibility for signing off prescriptions and ensuring the PAs are working within their proper scope of practice quite rightly falls on the supervising doctor, but also those doctors working alongside them; as scope has inappropriately crept ever further it has made far more work for doctors than it has saved.

86 per cent of doctors also reported concern that the role of MAPs, and the difference between MAPs and fully qualified doctors, is not well understood by the public, and that many patients may wrongly assume they are being seen by a fully trained doctor. 80 per cent said they would support the change of terminology from Associates to ‘Assistants’, as they were known until 2013.

The House of Lords is expected to consider this week the Anaesthesia Associates and Physician Associates Order 2024 statutory instrument, which if passed, will see the GMC appointed as regulator of MAPs. 72 per cent of respondents to the BMA survey expressed their opposition to the move. The BMA itself has called for all legislators to oppose the Order, arguing instead that regulation of MAPs should fall to the Health Care and Professions Council.

Liberal Democrat Peer, Baroness Sal Brinton, has tabled a motion of regret outlining concerns about the regulation of MAPs falling under the remit of the GMC, as well as about the nomenclature applied to MAPs, which the motion states “risks confusion for patients”.

Professor Phil Banfield added: “The House of Lords will soon have a chance to oppose damaging legislation that aids that blurring of lines by regulating PAs under the GMC, the doctors’ regulator rather than the more appropriate Health and Care Professions Council.

“The Government and NHSE should be instead ensuring that PAs return to their original purpose of supporting, not replacing doctors, so that doctors can get on with utilising the diagnostic and treatment skills they have spent so long at medical school gaining their expertise in.  Their scope should be strictly defined and, to ensure patients are not confused, the title returned to the more accurate “physician assistant” – then they can play their valuable role in supporting the delivery of NHS care safely.”

The BMA has made the following recommendations:

There should be an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK, including PAs and AAs on the grounds of patient safety (as called for by the BMA in November 2023). Long term expansion plans for the roles must be paused.
All legislators must oppose the Anaesthesia Associates and Physicians Associate Order 2024. The House of the Lords must vote against it in the days ahead. MAPs should be regulated by the Health Care and Professions Council, as called for by the BMA in response to the original DHSC consultation on regulation in 2017.
The titles should revert to physician assistant and physician assistant (anaesthesia) / anaesthesia assistant to avoid public confusion.
The scope of the roles should be strictly limited to the original intention of supporting doctors with administration tasks and a defined range of low-risk clinical tasks.
The UK has a severe shortage of doctors. This should be urgently addressed by fully funding increased specialty training places and opening Additional Roles Reimbursement Scheme (ARRS) funding to GP recruitment.
Training opportunities for doctors must be protected. Doctors and medical students should be prioritised for all clinical and training opportunities. This means that within a department/practice any procedure, clinic opportunity, or other structured learning event must be offered to doctors first before being offered to non-doctor staff.  The training of physician associates and anaesthesia associates must not compromise the training of current or future doctors
MAPs should not be utilised on any level of doctor rota or perform, train in, or consent to invasive or life-threatening procedures. They should not be receiving any specialty referrals or be in roles requiring them to give specialty advice. They should not make unsupervised treatment decisions or management plans. They must work under direct on-site supervision at a level commensurate with their qualification and not be using on-the-job experience to work beyond their formal level of qualification.

Internal staff banks help trusts meet 40% rise in demand

By Integrated Care Journal

New analysis has revealed that the number of shifts being successfully filled by internal staff banks has increased over the last year, helping to meet a simultaneous sharp rise in demand for temporary staffing in 2023.

Healthcare staffing specialists Patchwork Health analysed temporary staffing data from 17 NHS trusts that use digital staff banks. The analysis compared shift fill rates from the staff banks between January-September 2022 and January-September 2023.

The data revealed a 40 per cent year-on-year increase in demand for additional staff to fill vacant shifts, as the NHS has grappled with rising patient waiting lists alongside staff sickness and absences.

Despite this significant increase in the number of vacancies being advertised, data from trusts using a digital staff bank showed that shift fill rates were not only maintained in comparison to 2022 levels, but increased. Fill rates rose to 77 per cent in 2023, up from 75 per cent the year before, meaning that more than 3 in 4 vacant shifts advertised were successfully filled by staff registered to internal banks. This demonstrates the ability of a temporary staff bank to help trusts meet a significant rise in demand.

The data from Patchwork Health also showed that during the period for 2023, the top 20 busiest days in terms of demand for additional staff were all strike days, when increased staff absence left the trusts with a higher number of workforce gaps to fill. The strike days accounted for 13 per cent of all temporary staffing demand in the nine-month period.

Trusts that can rely on internal digital staff banks to fill short and long-term vacancies can reduce their over-reliance on (and the costs associated with) sourcing clinical staff through third-party locum agencies. The NHS pays more than £3bn a year to locum agencies to provide doctors and nurses at short notice.

Dr Anas Nader, CEO and Co-Founder of Patchwork Health, commented: “The NHS has faced a significant rise in both patient demand and staff shortages over the past year. A marked increase in the number of temporary staffing vacancies is reflective of just how far this demand has intensified.

“It’s so encouraging to see the shift fill rate from digital staff banks simultaneously rising, helping trusts to effectively tackle and meet this growing challenge, and keep services safely staffed. It’s a promising indication that the consistent use of an effective, dynamic staff bank can help us to remain resilient and weather fluctuating demand, while reducing over-reliance on costly locum agencies to plug staffing gaps.”

Social care system in sustained crisis despite ‘record’ investment, report finds

By Integrated Care Journal

2023 Sector Pulse Check report describes the current situation in social care as “arguably more perilous than ever”.

Unsustainable financial and workforce pressures are forcing adult social care providers to turn down new admissions and close services, as government grants are not reaching the people who need them most, according to a new report commissioned by Care England and the learning disability charity, Hft.

Based on a large-scale survey of adult social care providers, the 2023 Sector Pulse Check report finds that despite the sector receiving a £7.5bn funding boost in Chancellor Jeremy Hunt’s 2022 Autumn Statement, there has been little progress in the key challenges facing social care.

In a statement, Care England described the current social care environment as “arguably more perilous than ever.”

Professor Martin Green OBE, Chief Executive of Care England, commented: “The narrative that social care is under pressure is not a new one. What’s disappointing is that we find ourselves in a worsening crisis amid the Government’s narrative of ‘record investment’ into the sector.

“While the Government did make substantial commitments in the 2022 Autumn Budget, the outcomes have not matched the ambition. The new money into the sector has not led to tangible change or any significant progress towards ‘fixing adult social care’.

The report highlights how headwinds facing the social care sector include rapid and dramatic energy cost increases and unfunded rises in the National Living Wage, which contributed to 40 per cent of adult social care providers ending 2023 in deficit, the report says.

Recent funding initiatives from the government, such as the Market Sustainability and Improvement Fund and the International Recruitment Fund, have failed to mitigate funding concerns for the majority of providers, the report states; 84 per cent of care providers surveyed said that these measures made no difference to their organisation’s overall financial sustainability over the past year.

This has resulted in a reduced capacity for the sector to deliver care across providers, and the report finds that:

43 per cent of providers closed services or handed back contracts;
18 per cent offered care to fewer people;
39 per cent considered exiting the market altogether.

Workforce challenges remain widespread

The findings are concerning for a sector already facing deep-rooted and systemic challenges, particularly around workforce retention and recruitment. Despite a recent rise in international recruitment, staffing shortages remain widespread across the sector, with approximately one in 10 posts vacant in 2023/23. Nearly half (44 per cent) of organisations had to turn down admissions due to a lack of staff in 2023, the report finds.

Care England’s statement argues that the government’s approach to mitigate workforce are not working, and cites the recent tightening of overseas care staff and growing concern over the state of local government finances. Hft and Care England are calling on the government to implement immediate measures to support the care sector, including improving commissioning practice, revising VAT arrangements and removing barriers to ethical international recruitment.

Professor Martin Green OBE added: “It’s clear that the way our system is funded needs a rethink. For years, adult social care providers have absorbed increased costs and inflationary pressures without corresponding funding. When money is made available it simply isn’t cutting through. Recent changes to immigration rules and an insufficient Local Government Finance Settlement this year further suggest a government that is heading in the wrong direction. The sector’s needs are now on red alert.

“Our long-term vision remains one of a sustainable sector that is financially viable and an attractive destination for staff. While this may seem a distant reality, there are a range of policies at the Government’s disposal that would help turn the tide and put us on the path towards a sustainable future. As we count down to a general election, the Government must now make good on their promise to fix our sector.”

Steve Veevers, Chief Executive of Hft, said: “It is difficult to offer words of hope and motivation when the past 12 months have seen the adult social care sector engulfed in a sustained state of crisis.

“Despite moving away from the immediate challenges posed by the COVID-19 pandemic, there has been little respite from the fundamental financial and workforce pressures that have faced our sector for many years. The fact that 43% of providers told us they closed a part of their organisation or handed back contracts last year is testament to this.

“Our report provides several realistic, practical and impactful suggestions – including reforming VAT, revisiting the new visa laws for international workers and establishment of national commissioning standards – which we shouldn’t delay in implementing if we want to see real change from the next Government.”

Speaking to ICJ at the launch event, Veevers argued that ICSs, with their remit for joining local services, present an ideal avenue through which to improve access to social care. However, in line with recommendation area four in this year’s Sector Pulse report, he stressed that social care representation on integrated care boards and integrated care partnerships needs to increase in order to adequately reform the sector.

The full 2023 Sector Pulse Check report can be accessed here.

How NHS leaders can ease staffing pressures over winter

By Dr Anas Nader

Dr Anas Nader discusses the steps the NHS can take to deliver sustainable and long-term workforce improvements that benefit staff, systems and patients.

The NHS is bracing for another tough winter. Exacerbated by a record waiting list of almost 8 million and a rise in flu and norovirus hospitalisations, all signs point to an intense period of pressure for an NHS that’s already struggling.

To even begin to tackle the challenges this season will bring, the NHS needs a healthy, well-equipped workforce manning the front lines. But with 84 per cent of healthcare leaders understandably worried about the impact of winter pressures on levels of clinical burnout, there’s never been a more acute need to embrace solutions that will ease workforce pressures and support staff in the short and long-term.

Turn flexibility commitments into tangible offers

Recent years have seen a lot of discussion around flexibility for healthcare professionals. And despite the challenges involved in enabling flexibility in an organisational system as complex as the NHS, we are starting to see this rhetoric translate into action.

There is no better time than now to pick up the pace and drive these efforts forward. Facilitating better work-life balance by accounting for staff preferences when rostering is foundational to a healthy future for the NHS workforce and is key to turning the tide on worrying levels of staff exit.

If we can make it easier for clinicians to balance their personal and professional commitments, while maintaining patient safety, the NHS can become a place where every staff member feels supported and valued in their role.

A genuine flexible workforce puts employee empowerment at the heart of decision making. Crucially, this commitment to flexibility doesn’t necessarily mean staff working fewer hours – but it does mean enabling them to have a say in their rota. This can be achieved in many ways. From rolling-out self-rostering technology and moving from a spreadsheet system to one powered by the latest technology and algorithms, to ending the archaic way in which swaps are handled and ensuring staff can book leave much further in advance.

The NHS Staff Survey brought to light that only half (50.2 per cent) of the NHS workforce felt as though they were involved in decisions about changes affecting their work area or team. Being at the mercy of an impersonal, centralised rota will inevitably lead to frustration for staff and increase the likelihood of burnout. It’s time to empower the NHS workforce so they can remain in their roles without compromising their personal lives.

Leverage your data

Our ability to access and analyse data has never been greater. In the NHS, we are collecting reams of data constantly. But not every organisation has access to the necessary tools to put it to good use. Developing ways to leverage organisational data to spot staffing trends can be a game-changer.

Data is the perfect tool for optimising human decision-making. Analysing workforce activity, costs and performance metrics to improve judgements is vital to boosting cost efficiency and growth when it comes to staffing. If we are able to systematically match demand for care with the supply of staff, we can more easily identify hotspots of pressure and redeploy staff appropriately.

This gives managers actionable insights and saves precious decision-making time. Weaving up-to-date data into decision-making also allows teams to be anticipatory – modelling staffing solutions in response to emerging trends, instead of simply firefighting. If we can reliably predict which shifts might be understaffed, we can try and reduce the impact on those working, equipping them with the right support in advance.

A data-first culture also facilitates transparency and accountability on multiple levels. Staff are more likely to unite around decisions informed by, and tailored to, data that matches their reality. And once new initiatives have been put into motion, data has the unique ability to illuminate their successes and setbacks in granular detail, ensuring that no opportunities are missed.

It’s critical that NHS leaders take time now to engage with data, employing it to drive their decisions and empower staff as demand intensifies this winter.

Prioritise collaboration

In order to unlock vital resources in particularly pressured times, regional collaboration can help. Pooling resources across organisations and within integrated care systems (ICSs) can be made to work effectively; enabling staff to safely move in line with demand.

The North West Doctors in Training Collaborative Bank (NWCB), for example, is the largest of its kind in the UK. It has acted as a staffing safety net for the 24 participating trusts since its creation in 2020. The bank has allowed thousands of approved clinical trainees to work shifts outside of their host organisation, reducing the need for extra paperwork which previously restricted movement. The initiative is just one example of how collaboration can grant staff more autonomy when choosing shifts whilst also helping managers plug staffing gaps in line with patient demand.

With the formal introduction of ICSs last year, NHS leaders have the perfect opportunity to make collaborating a priority, in the hopes of delivering more joined up care for patients, but also as a necessary shift towards more sustainable staffing solutions and a healthier workforce.

The root cause of the pressure on NHS workers is often buried beneath the backlog of patients waiting for treatment – in reality, it’s the rigidity of schedules and lack of sufficient staff and resources supporting them, which leads to burnout.

By prioritising flexibility, data-driven decision making and collaboration over the coming months, NHS leaders can drive forward improvements which are tailored and genuinely effective for the clinicians and managers feeling the winter strain.

*Dr Anas Nader, Co-Founder and CEO of Patchwork Health*

New endoscopy staff bank to boost NHS capacity in Cheshire and Merseyside

By Gabriel Blaazer

NHS Cheshire and Merseyside Integrated Care System (ICS) has established a new endoscopy staff bank to help boost local capacity and give endoscopy staff greater flexibility over when and where they work.

Developed in partnership with Mersey and West Lancashire Teaching Hospitals NHS Trust as lead employer, a new collaborative staffing bank for endoscopy staff will enable local trusts to pool their individual networks of temporary workers and adjust staffing levels according to demand. A total of seven trusts, which provide endoscopy services at 10 hospital sites and are part of the Cheshire and Merseyside Endoscopy Network, are participating.

The new bank is available to all NHS staff who specialise in endoscopy across the seven trusts taking part, including clinical, administrative, nursing and medical staff, and it is hoped that greater flexibility for staff will help boost staff retention. The bank will enable staff to pick up additional shifts as and where they wish, allowing them to view and select shifts at any of the 10 hospital sites via a mobile app, connected to a new digital platform built in partnership with workforce solutions provider Patchwork Health.

Participating trusts will be able to manage and approve payments through the platform, as well as gain access to a data reporting tool providing key staffing insights from across the collaborative bank, including staffing levels, pay rates and shift fill rates at the 10 hospitals. Workers joining the staff bank will be engaged through Mersey and West Lancashire Teaching Hospitals’ (MWL’s) Lead Employer team and added to their workforce and payroll systems.

Much of the information required on staff will be imported automatically from their existing NHS employment, reducing ‘time to hire’ and avoiding the duplication of checks including pre-employment screening and mandatory training. The new bank will also mean staff do not need honorarium contracts, which were previously required when staff worked for trusts other than their primary employer.

It is hoped that this will benefit staff by introducing greater flexibility to respond to personal circumstances, thereby boosting staff retention.

The ability to allocate workforce and resources within a region according to real-time need has long been touted as a potential strength of ICSs. Cheshire and Merseyside ICS hope that the establishment of the staffing bank will help to reduce reliance on agency staff, cutting costs and leading to shorter waiting times for patients. Visibility of staffing data will help teams across Cheshire and Merseyside Acute and Specialist Trusts (CMAST) – the provider collaborative which covers the ten hospital sites – to monitor staffing trends and identify areas for improvement, supporting them to meet rising patient demand.

The Cheshire and Merseyside endoscopy staff bank is the second major collaborative staffing initiative launched by lead employer, MWL Teaching Hospitals NHS Trust. In 2020, it launched the North West Doctors in Training Collaborative Staff Bank, the largest initiative of its kind in the UK, which brings together 24 trusts across the North West and has helped retain an estimated £6 million within the NHS to date.

The seven trusts, which provide endoscopy at 10 hospital sites and are all part of Cheshire and Merseyside Endoscopy Network, are:

Countess of Chester Hospital NHS Foundation Trust;
Mid Cheshire Hospitals NHS Foundation Trust – Leighton hospital;
East Cheshire NHS Trust – Macclesfield hospital;
Mersey and West Lancashire Teaching Hospitals NHS Trust – including Whiston, St Helens and Ormskirk hospital sites;
Warrington and Halton Teaching Hospitals NHS Foundation Trust – Warrington hospital;
Liverpool University Hospitals NHS Foundation Trust – including Liverpool Royal and Aintree hospital sites; and
Wirral University Teaching Hospital NHS Foundation Trust – Arrowe Park hospital.

Tracey Cole, Diagnostics Programme Director, Cheshire and Merseyside, said: “We are delighted to be able to offer this new way of flexible working so that staff can select where and when they want to work to ensure that all our patients are seen with the shortest possible waiting time.

“Each trust across Cheshire and Merseyside can access this secondary bank in addition to their own internal bank, which means that there will be less reliance on agencies when additional capacity is required.

“Staff are able to work and earn in addition to their substantive employment and share learning and best practice with their peers.”

Dr Anas Nader, CEO and Co-Founder at Patchwork Health, said: “It’s a privilege to be working with Cheshire and Merseyside and lead employer Mersey and West Lancashire Teaching Hospitals NHS Trust to expand access to collaborative staffing in the region through the new ‘Diagnostics Collaborative Bank’.

“By connecting workforces from across the region, it is helping to increase flexibility for staff and workforce teams alike. This is especially important as services face unprecedented demand; more flexible, collaborative workforce planning is making it easier for staff to be deployed in line with patient need.

“We’re excited to continue growing this initiative as we onboard more staff and support them to work flexibly through the collaborative staff bank. By doing so, we hope to help support retention, boost collaboration and ease staffing pressures across the region, empowering services to work together to facilitate more sustainable staffing.”

Anyone interested in joining can apply via the following link:

Number of nurses experiencing suicidal thoughts up 98%, RCN finds

By Gabriel Blaazer

The findings have been described as a “frightening wake-up call”, with mental health support for nursing staff declining amid increased pressures.

The number of nurses experiencing suicidal thoughts has risen by 98 per cent compared to the same period last year, according to new data released by the Royal College of Nursing (RCN).

Calls to the RCN’s Advice Line in October found that an equivalent of one person each working day was reporting suffering from suicidal ideation in their initial call, compared to just one per week in October 2021. In response to its findings, the college has commissioned research to understand in greater detail the reasons behind poor wellbeing among members, and to discern whether or not marginalised groups are being impacted disproportionately.

The RCN has previously highlighted the “failure of [the] UK government’s promise to recruit 50,000 nurses”, and points to a 12 per cent fall in the number of people expected to take up nursing courses in England this year as evidence that the nursing workforce is facing “dangerous staff shortages”, which are proving harmful to staff morale and patient care.

The RCN is renewing its call on the government to invest in dedicated mental health support for nurses who are suffering from “persistent understaffing, intolerable pressures at work and financial insecurity at home”. Despite these pressures, one third of the 41 mental health hubs established by NHS England have closed, including seven specialist hubs established during the Covid-19 pandemic. A further seven reported in May 2023 that they had less than a year’s funding to stay open.

The RCN’s Interim Head of Nursing Practice, Stephen Jones, has described the findings as a “frightening wake-up call”, adding: “Nursing staff contribute so much to our society, but working in an inherently stressful job can come at an enormous personal cost. Yet we see support services cut when we should be seeing greater investment in looking after those who care for us.

“The increasing burden on nursing staff, as they try to help clear the excessive backlog in care, has created intolerable working conditions on every shift. Coupled with nursing pay not keeping up with the cost-of-living, we’re alarmed by this growing mental health crisis among nursing staff.
“The UK government must understand that cuts to mental health support for nursing staff can’t continue – when you invest in the health of nursing staff you also invest in the health of patients.”

Saffron Cordery, Deputy Chief Executive at NHS Providers, said that: “The RCN is right to highlight the impact of escalating pressure on nurses’ mental health due to increased demand and staff shortages. We need urgent action to tackle this situation, which has led to an alarming rise in suicidal thoughts among nursing staff.

“Nurses play a vital role in our society but cannot be expected to meet such high demand without proper national support for, and investment in, frontline services.”

Recognising the value and impact of AHP support workers within healthcare

By Integrated Care Journal

This week the Chartered Society of Physiotherapy, along with a coalition of 13 other allied health professional (AHP) bodies, is celebrating Support Worker Awareness Week.

AHP support workers are an integral part of multidisciplinary teams. They are relied upon for the transformative role they have to play across many different services, including physiotherapy. They work within their scope of practice to carry out a wide range of tasks and are supervised by a registered healthcare professional who retains responsibility for patient care.

The value of support workers cannot be underestimated. The contribution to services by support workers, both in the NHS and the independent sector, enhances patient outcomes, improves patient experience and increases service efficiency. They also provide immeasurable guidance and support to the wider health and care team.

Currently, we see increasing numbers of support workers playing a vital role in facilitating education by supporting physiotherapy students with their learning. By supporting physiotherapy students with practice-based learning during their placements, support workers offer a safe and supportive space, and contribute to the growth of the profession.

During the pandemic, support workers demonstrated great flexibility and brought new skills to the role. Their responsibilities increased and elements of their practice developed to meet the extraordinary pressures on the system.

Need for more support workers

More physiotherapy support workers are needed within the NHS, but this demand can’t be met by increasing the registered workforce alone. With ever-increasing physiotherapy waiting lists, an ageing population and more patients living with multiple conditions, more support workers are needed to fulfil population, patient and service delivery needs in safe, effective ways.

The CSP has recently conducted a physiotherapy workforce review in England and is calling for 6,500 additional non-registered physio posts in the NHS over the next five years. Additionally, the recent NHSE intermediate care framework recommends maximising the use of skilled support workers. If utilised at the right points in intermediate care pathways, their skills and expertise will improve access to high quality rehab that is timely, safe and person-centred.

In Northern Ireland, we want to see the implementation of the recommendations outlined in the Physiotherapy Workforce Review Report published in 2020, including the establishment of apprenticeships for physiotherapy support workers. In Scotland, we are calling for funded ‘earn and learn’ routes to be established and in Wales, the expansion of the level 4 apprenticeship scheme for support workers.

The support worker role is evolving, with increased opportunity to carry out additional responsibilities in practice. Higher-level support workers have additional responsibilities across the four pillars of practice. These roles are important to provide a positive impact on patient flow, quality of patient care and to meet new national policy developments.

What support workers need

Support workers need clear opportunities and pathways to develop capabilities and pursue career development. Each UK country should have a programme of work to develop support worker roles including those at higher level. This should both develop CPD opportunities, a greater consistency in levels of practice, capabilities and governance arrangements.

Higher-level support worker roles are one example of career development and provide opportunity for managers to think creatively about the skills mix within their teams.

With the right systems and support in place, support workers can do so much more.

Looking to the future

With the opening of the National Rehabilitation Centre (NRC) in East Midlands planned in early 2025, there is a new pioneering role.

The centre will offer a foundation degree apprenticeship for a rehab assistant practitioner role (band 4 equivalent). The rehab assistant practitioner will work across OT, physio and nursing with an evidence and training base behind them.

The NRC plans to offer around three to four hours a day of rehab as opposed to the 30-40 mins per day rehab normally offered in the NHS. Rehab Assistant Practitioners will be key in meeting these ambitious targets.

It is clearly time to recognise and shine a spotlight on the vital role of support workers but also most crucially to invest in their pathway and career opportunities.

Addressing whistleblower concerns in the NHS

By Chancelle Blakey

Building a culture of transparency and accountability will be essential steps to encourage and protect whistleblowers in the speak-up system.

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press over the last week with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes.

This demonstrates the need for an independent reporting line for employees across the organisation. NHS employees must have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

Whistleblowers within the NHS have often faced challenges, making them hesitant to report wrongdoing due to fears of retaliation and detrimental treatment. Despite these obstacles, 2023-23 saw a significant increase in NHS whistleblowers coming forward compared to the previous year, highlighting the urgent need for reform in the whistleblowing process.

In fact, a record 25,000 plus NHS whistleblowers came forward last year. Of these cases, as has been reported by Freedom to Speak Up Guardians office, the most common reports were of inappropriate behaviours and attitudes (30 per cent), followed by worker safety and wellbeing (27 per cent) and bullying and harassment (22 per cent).

Reports indicate that NHS employees are lacking confidence in the current speak -up system, with many feeling labelled as troublemakers when they raise concerns. This detrimental culture not only deters individuals from speaking up but also hinders the NHS’s ability to identify and address wrongdoing, potentially endangering both patients and employees. And that’s before the damage to the NHS’s reputation is considered.

Improving the speak-up system

For optimal trust and confidence in a speak-up system, employees must feel that their concerns will be taken seriously and investigated appropriately.

Unfortunately, this most recent case is the most extreme example of that not happening, with Dr Stephen Brearey stating that if hospital executives had acted on concerns about nurse Lucy Letby earlier, lives may have been saved.

To address these pressing issues, steps need to be taken to: improve employee confidence; identify and combat wrongdoing; and protect those who come forward to report concerns.

One crucial measure is to review and audit the NHS’s whistleblowing policy, processes, and operations to understand the reasons for the breakdown of trust. Identifying and holding accountable those responsible for retaliating against whistleblowers is essential to foster a culture of transparency and accountability.

Providing whistleblowing training to both employees and managers is another critical step to improve the speak-up culture. When employees are aware of how to raise concerns, and the legal protections they have under the Public Interest Disclosure Act (PIDA), they are more likely to come forward without fear of retribution. Additionally, providing training to managers on how to receive and handle disclosures appropriately can help deter misconduct.

The current Freedom to Speak Up (FTSU) Guardian scheme, while a positive step towards improving whistleblowing culture, appears to lack confidence among NHS employees, with many remaining hesitant to report serious concerns through an internal system due to doubts about confidentiality and impartiality. One worker told the FTSU Guardians that “the Guardian was excellent, but nothing has been resolved”. The Guardians themselves have said that managers need to be trained about their obligations once they receive a report.

Taking affirmative action to instil trust

To build trust, the NHS can consider offering an alternative means of disclosure, such as a dedicated, outsourced whistleblowing hotline provider, ensuring true anonymity and independence in the reporting process. Safecall already works alongside several NHS Trusts helping make their processes more robust and transparent. Employees are much more confident speaking to, and reporting through, a third party.

It is vital that the investigation procedure is handled in a fair and balanced fashion, and not conducted in a way that undermines the whistleblowers’ concerns. To instil confidence in the reporting process, investigations should be conducted in an independent and confidential manner. Outsourcing the investigation process or ensuring that internal investigators undergo proper training and possess the necessary experience can help safeguard employees’ wellbeing and protect the NHS’s reputation.

It is paramount for the NHS to take affirmative action in protecting whistleblowers and fostering a culture of transparency and accountability. No healthcare professional should face detrimental treatment for raising concerns that may impact patient safety. To achieve this, the NHS must review its systems, provide comprehensive training, and offer reliable and independent reporting avenues.

The NHS must strive to offer confidentiality, impartiality, and independence when receiving and investigating concerns. These efforts should be continuous and consistent to create effective and sustainable change within the organisation.

In conclusion, addressing whistleblowing concerns in the NHS is crucial for promoting a culture of transparency and accountability. By taking proactive steps, such as reviewing policies, providing comprehensive training, and ensuring independent investigations, the NHS can create an environment where employees feel confident and protected when speaking up against wrongdoing.

Fostering a culture that values whistleblowers and their contributions will not only strengthen the NHS internally but also enhance its reputation and commitment to patient care.