How industry can help deliver the ambitions of the NHS Workforce Plan

By Stephen Jowett

The long-awaited NHS Long Term Workforce Plan (NHS LTWP) was published at the end of June and has been broadly welcomed across the healthcare system.

The NHS in England is under increasing pressure. By 2037, the number of people aged over-85 is estimated to grow by 55 per cent, which means there will be an ageing population who will require more healthcare interventions and more care for long-term conditions and co-morbidities. The NHS currently has the longest waiting times and lowest satisfaction rates ever recorded which has been demotivating for employees and frustrating for patients.

The current NHS workforce challenges have impacted the whole of the healthcare system and can delay people receiving the best treatments available. Once a treatment is approved by the National Institute for Health and Care Excellence (NICE) there needs to be the capacity for it to be rolled out, including any additional training requirements and this will have an impact on industry partners if new treatments are not utilised.

There are examples of fast-paced innovation within cancer treatments, but the adoption is slowed by a stretched and understaffed system – following the long-term impacts of the pandemic – that does not have protected time to embed new approaches. Collaboration between sectors is also crucial to support adoption at scale. If these workforce challenges are not addressed, patients will not be able to access the right healthcare when they need it.

There are three big ambitions laid out in the NHS LTWP:

Recruitment – there is a focus on a big recruitment drive into roles in the NHS and into training places. As there are currently shortfalls in almost every area of the NHS, particularly in frontline care, this needs to be a priority.
Retention – a large number of professionals leave the NHS every year, so focusing on how the NHS keeps the people who are already employed is essential if they are going to meet the increasing demand on the system.
Retraining – there is more to training than getting new people into the workforce – it is also recognising that to make the NHS future proof, more needs to be done to support the current and future workforce to embrace new technology. This needs to address how the whole health system embraces new ways of working and developments in technology. There can’t be fast adoption of new technologies if the training and skills aren’t quickly put into place for the workforce and patients.

Although the NHS LTWP has been broadly welcomed by the healthcare system, there are some very clear omissions that will make it hard to deliver. There is no mention of infrastructure, meaning that capital investment isn’t aligned to the planned workforce investment. Many of the current hospital buildings in use are not fit for purpose and it was recently announced that the target to build 40 new hospitals by 2030 is likely to be missed.

“There is an opportunity for industry to think about how new technologies can address some of these pressures in the system.”

This NHS LTWP does not include social care and is not aligned to a similar reform of our social care system, which is currently suffering from many of the same challenges as the NHS in terms of increased demand on services with a reduced workforce. If the healthcare and social care systems do not receive investment simultaneously, then one will take on the burden of the other, as they are intrinsically linked.

The NHS LTWP talks about innovation in robotics which has dramatically reduced how long patients need to stay in hospital; for example, heart surgery often now requires a shorter stay in hospital due to technological advances. However, these technologies often need to be accommodated in modern facilities, which means new capital investment. Furthermore, without appropriately resourcing the social care system, many patients are not able to move out of hospital when they are ready to.

Many of the ambitions laid out in the NHS LTWP will take time to deliver, so there is an opportunity for industry to think about how new technologies can address some of these pressures in the system. Those in industry can position themselves to make relevant value propositions and be part of the discussions over the coming years.

The education piece in the NHS LTWP is also interesting for industry, as there are plans to accelerate how people are trained, meaning that there could potentially be a role for life sciences to support with this. IQVIA’s work in population health management and service redesign will also continue to help address workforce challenges, especially when aligned and augmented with IQVIA’s clinical services.

This NHS LTWP is highly innovative, but there is no mention about how it is going to be funded, which raises questions around whether it will actually deliver what is needed for the NHS. This is especially true given the current issues within social care, but by working collaboratively with industry, there is an opportunity to bring in experts to look into niche, innovative solutions.

Stephen Jowett is Senior Director and Head of Healthcare Consulting at IQVIA.

Digital innovation will be key to realising ambitions of the Workforce Plan – Richard Stubbs

By Richard Stubbs

Responding to the NHS Workforce Plan, CEO of the Yorkshire & Humber AHSN, Richard Stubbs, argues that plan’s success will depend on the adoption of digital innovation and the creation of a digitally-capable workforce.

Workforce pressures remain one of the greatest challenges facing the health and care system, with ever-increasing and diversifying demands of the population driving the need for greater system capacity. It is implausible to imagine that we will continue to expand our workforce to meet future demand in a sustainable way. As well as supporting and championing our workforce, we need to also explore new ways of working by unlocking the power of digital, introducing new models for delivering services which will enable our staff to spend more time on activities that directly benefit patient care.

These ambitions are reinforced by the recently published NHS Long Term Workforce Plan, majoring on training and retaining our healthcare workforce, alongside the need to reform our ways of working and workforce training offer.

Digital technology, data, AI, and robotics offer numerous opportunities to address system capacity challenges and enable patients to receive timely, high-quality care. For example, the PinPoint blood test optimises NHS urgent cancer referral pathways so patients in greatest need are seen first, whereas the Digibete online platform supports better management of young people with diabetes and helps prevent unplanned hospital admissions.

These innovations will never replace care delivered by people and the specialist skills of our health and care workforce, nor is it an alternative to safe levels of staffing. Instead, it should be an integral part of a modern health and care system’s approach to coping with increasing demand. However, as around 22 per cent of the UK population lack basic digital skills, digital technology needs to be introduced in a way which doesn’t exacerbate existing inequalities. As the Digital Divide report I supported in conjunction with Public Policy Projects recommended, we need to avoid a ‘digital-by-default’ approach, and instead, ensure that adoption of digital technology is sensitive to the needs and challenges of different population groups.

As the Long Term Workforce Plan acknowledges, adoption of digital technology needs to take place alongside digital skills training for the workforce, enabling them to continue providing high quality care aided by digital technology. The linkages between digital technology and health inequalities should also be further highlighted within the workforce, helping mitigate inequalities caused by future introduction of ‘digital by default’ services.

“ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities.”

ICSs have a critical role in delivering the Long Term Workforce Plan and mitigating current workforce challenges by bringing together workforce, clinical, and service planning and implementing digital solutions which unlock system capacity and deliver patient and system benefits. ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities. The fifteen Academic Health Science Networks also have a role to play in supporting ICSs to match local need with evidence-backed innovations and supporting equitable adoption and spread of innovation across services.

We can only fundamentally address our current workforce challenges by reimagining the way we deliver health and care. Digital and tech transformation has been the journey for almost all non-health sectors over the last few decades. ICSs and AHSNs will be fundamental in driving this transformation, ensuring digital technology is adopted in a way which supports our workforce, meets local demand and reduces inequalities in access to services.

Richard Stubbs is CEO of the Yorkshire & Humber AHSN, an organisation that connects NHS and academic organisations, local authorities, the third sector and industry to facilitate change across health and social care economies. Prior to becoming CEO, Richard was AHSN’s Commercial Director.

Damaging NHS disputes hindering progress on productivity, finds survey

By Integrated Care Journal

Trusts making progress on NHS targets and taking steps to boost productivity but concern mounting about staff morale and burnout as operational pressures take their toll.

Ongoing industrial action presents a major operational and financial challenge for NHS trusts, and is hindering all trusts’ ability to recover productivity, according to a new survey carried out NHS Providers. It highlights the scale of the task ahead for the NHS, as it simultaneously grapples with increasing numbers of patients with complex conditions staying in hospital for longer, emergency care pressures and limited bed capacity, exacerbated by the crisis-hit social care sector.

Trusts across hospital, community, mental health and ambulance services have made significant early progress towards meeting care backlogs for urgent and emergency care, cancer tests, long waits and diagnostic services as they strive to deliver better outcomes for patients, say NHS Providers.

They have introduced a range of measures to boost productivity in the NHS – delivering more care with existing resources – including targeted initiatives to improve staff health, wellbeing and retention alongside efforts to help discharge patients faster and adapting their buildings to treat more patients.

But trusts are now warning that eight consecutive months of industrial action across the NHS are taking their toll on efforts to cut waiting lists, with more than 651,000 routine procedures and appointments rescheduled so far and many tens of thousands more likely to be delayed as the health service faces back-to-back walkouts by junior doctors, consultants and radiographers in the coming days.

“Increasingly hard to improve productivity”

The new survey by NHS Providers, Stretched to the limit: tackling the NHS productivity challenge, outlines the scale and complexity of the challenge ahead, particularly as trust leaders count the cost of industrial action given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

The Chief Executive of NHS Providers, Sir Julian Hartley, said: “Leaders and staff are working flat-out to cut waiting lists and to see patients as quickly as possible in the face of major obstacles.

“With waiting lists at a record high, trusts are keenly aware of the need to carry out more operations, treatments and scans. They are doing everything they can to see more patients more quickly and to deliver better quality care, including introducing virtual wards and new initiatives to speed up hospital discharge and offer more care at home.

“However, it is increasingly hard to improve productivity because of staff burnout, high turnover, vacancies, a rising number of patients with more complex conditions, stretched community and social care capacity, and fewer hospital beds per person than comparable countries.

Trusts are also warning that it will be very difficult to deliver the government’s overall demands in terms of performance while delivering unprecedented efficiencies, seeking to protect quality of care for patients.

The survey finds that:

Almost nine in ten (89 per cent) trust leaders said the scale of the efficiency task is more challenging than it was last year.
Almost three in four (73 per cent) did not think they had access to sufficient capital funding over 2023/24 to cover the costs of vital repairs to buildings and equipment.
Nearly two thirds (61 per cent) were not confident that they and their system partners would hit targets to reduce long waits for mental health care.
Fewer than half (43 per cent) expect to meet an interim recovery target of 76 per cent of A&E attendances to be seen within four hours during 2023/24.

The findings reveal widespread worry among trusts about having to deliver more for less as budgets, staff and resources are stretched to the limit, leaving trust leaders facing increasingly difficult dilemmas about how to sustain services in the future.

Despite an overall increase in workforce numbers and the welcome promise of more staff in the future through the new long-term workforce plan, rising concerns about staff morale and burnout also continue to play heavily on trust leaders’ minds. They are contending with 112,000 vacancies across the health service in England with staffing numbers and skill mix failing to keep pace with growing and changing demand.

This is piling on the pressure, with trust leaders identifying discharge delays, relentless demand on emergency care, a lack of investment in social care and a dependency on agency staff as the biggest barriers to returning to pre-pandemic levels of productivity.

They are clear that capital investment in the NHS estate is also key to boosting productivity. This would allow trusts to expand bed capacity and community provision, deliver digital transformation, bear down on care backlogs and eliminate the persistent inefficiencies created by creaking buildings and equipment.

But with the NHS capital maintenance backlog now exceeding £10bn, and only a handful of trusts benefitting from much-needed investment through the New Hospital Programme, a great many more need urgent major capital investment to overhaul their ageing estates to achieve better – and safer – outcomes for patients.

Sir Julian Harley added: “Industrial action also poses a significant financial risk to trusts, given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

“The new long-term workforce plan with its focus on recruitment, training and retention could finally put the NHS workforce on a sustainable footing if commitments are made to keep it updated and funded. But the benefits of that plan can only be reaped with a wider focus on productivity and its enablers, many of which we explore in this report, such as investment in management capacity and capital.

“If we are to ramp up productivity across the NHS, we need a step change in capital investment to provide more beds, more community care, a digital revolution, a safe and comfortable therapeutic environment, and appropriate support for social care.”

Poor work/life balance driving NHS exodus

By Integrated Care Journal

As vacancies hit record levels, doctors and nurses want more flexible work arrangements to carry on working in healthcare, study from Deloitte finds.

Poor work-life balance is a key driver of job dissatisfaction for healthcare workers, and improvements are within the power of employers, according to new research from Deloitte’s Centre for Health Solutions.

The findings come from the report, Time to Change: Sustaining the UK’s clinical workforce, which looked at the experience and resilience of front-line clinicians, based on a survey of 1,286 UK public healthcare workers. The study examines how attitudes within the profession have changed since 2017, when a similar piece of research was conducted, and includes input from doctors, nurses and other clinical staff working in primary, community and secondary care.

Having a ‘sense of fulfilment/making a difference’ (42 per cent) and a good ‘work-life balance’ (41 per cent) are the top two drivers of job satisfaction for healthcare workers, the study found. By contrast, pay (60 per cent) and having a poor work-life balance (42 per cent) were found be the two main drivers of job dissatisfaction within the professions.

The high ranking of work-life balance for job satisfaction and dissatisfaction is in stark contrast to five years ago, when work-life balance was the fifth-biggest driver of job satisfaction, according to Deloitte’s 2017 study.

When asked how their feelings on job satisfaction and dissatisfaction has affected career intentions, the most common response, among 53 per cent of all respondents and 59 per cent of doctors, was to reduce hours and move to part-time working in healthcare. In addition, 40 per cent of clinicians overall, including 35 per cent of doctors and half of nurses and midwives had considered leaving the profession and changing career.

The study follows a slew of unwelcome news in recent days, including (now-confirmed) speculation that the government’s long-awaited NHS workforce plan (due to be published Tuesday 30th May) is to be delayed as it is considered too costly and the admission from the Health Secretary, Steve Barclay, that the 40 new hospitals will now not be built by 2030 – in contravention of the Conservative government’s flagship pledge.

Additionally, NHS vacancies remain at record levels as the health service continues to struggle to attract and retain staff. One-fifth of all nursing posts in England are estimated as vacant, and NHS trusts fear that the situation will not change until the government sets out a fully-costed workforce plan.

Karen Taylor, Director and Head of Research at Deloitte Centre for Health Solutions, said: “The problem has worsened over the past few years and our findings mirror recent staff surveys from the industry. There is a clear need to address the physical and mental health needs of staff if employers are to build a resilient workforce.

“Many solutions are in the hands of local health organisations to address and several have implemented effective solutions, just not at the scale needed.”

Sara Siegel, Partner and UK and Global Head of Health at Deloitte, said: “The most vital asset in healthcare is its workforce. Our study shows that the availability, accessibility and quality of care available to patients depend on having the right professionals, with the right skills, in the right place, at the right time.

“Healthcare leaders have a real opportunity to make a long-lasting impact in this crucial area. Those that have adopted new ways of working and technologies, have already realised the benefits to empower their workers. Not only will this help patients, but it will have a positive impact on job satisfaction that supports individuals to build rewarding, long-term careers in healthcare.”

Implications for physical and mental health

The study also revealed that 87 per cent of clinicians had experienced an increase in their workloads since March 2020, including 90 per cent of nurses and midwives and 84 per cent of doctors, with serious mental health and wellbeing implications for those staff affected; 46 per cent of clinical staff reported experiencing a negative impact on their physical health, including 50 per cent of hospital doctors and 45 per cent of hospital nurses. The study also found 57 per cent disclose a negative impact on their mental health, including 58 per cent of hospital doctors and 59 per cent of hospital nurses.

This contrasts with the 2017 study, in which 30 per cent of hospital doctors and 32 per cent of hospital nurses said that their workload had a negative effect on their physical health; and 23 per cent of hospital doctors and 33 per cent of hospital nurses said that it affected their mental health.

Digitisation will help – eventually

Numerous policy documents and reports, including the NHS Long Term plan, have identified the importance of adopting technology across healthcare. Deloitte’s study therefore asked healthcare workers which technologies they think are helping to improve the quality of patient care. The top five technologies included Electronic Health Records (EHR) (87 per cent), e-prescribing (78 per cent), patient apps (73 per cent), at-home diagnostics (70 per cent) and remote consultations (70 per cent).

Adoption remains low, however, and only 64 per cent of clinicians said they are using EHRs, while fewer than half of respondents have adopted e-prescribing (46 per cent), patient apps (33 per cent), at-home diagnostics (22 per cent) and remote consultations (39 per cent). Likewise, automation of human resource and occupational development services is lagging behind other industries and the study points out the crucial need to modernise these areas.

Dr Karen Kirkham, partner and Chief Medical Officer at Deloitte added: “While healthcare workers know that technology-enabled care models, systems and processes can improve outcomes and safety for patients, simplify tasks and reduce the significant administrative burden for clinicians, adoption remains fragmented.

“Healthcare leaders need to modernise and unlock better ways of working that improve the employee – and employer – experience. More efficient HR and people policies that focus on equality, diversity and inclusion, investing in leadership and professional development, and accelerating the digitalisation of healthcare infrastructure, will go a long way towards developing new ways of working that release time to care.”

News, Workforce May 23, 2023

NHS must seize upon growth in physiotherapist numbers

By The Chartered Society of Physiotherapy

Growth in the physiotherapy workforce should be the solution to the workforce crises in the NHS community rehabilitation services.

The physiotherapy workforce is ripe for expansion, which is good news for the public, policy makers and service providers. But this good news is not resulting in a high-quality rehabilitation service for all with a well-resourced physiotherapy workforce.

Many people do not know what good quality rehabilitation should look like, and there exists a growing unmet population need, combined with historic understaffing of community services, particularly of rehabilitation services.

At present, nearly a third of people in England has a long-term health condition. People with long-term conditions are being pushed into the most expensive and overburdened parts of health and care because they are not being supported in the community to manage their conditions effectively.

The needs of people with long-term physical conditions account for half of all GP consultations, 70 per cent of bed days in hospital and 70 per cent of total health and social care spending, while more than 60 per cent of patients admitted to hospital as an emergency have one or more long-term conditions.

Lack of access to high quality rehabilitation services

Narrowing the gap in healthy life expectancy will only happen with better access to quality community and primary care services for people with long-term conditions and for these services to be integrated around their needs.

NHS community rehabilitation services have been developed in a piecemeal way, often siloed by medical condition, with varying criteria for access. Furthermore, poor access to rehabilitation is particularly concentrated in areas of deprivation and among marginalised groups, resulting in more demand for GP appointments, increased A&E attendance and admissions.

Delivery plans for NHS policies have been also undermined by the lack of calculations on the additional staff capacity needed. For example, policies on urgent community response and discharge to assess have been implemented at the expense of rehabilitation, because they are delivered by the same group of staff. This has meant the policies have failed to reduce emergency admissions or the harm from delayed discharge.

However, for the last five years, additional roles in primary care have improved access to expert advice and diagnosis within primary care.

The value of Musculoskeletal first contact physiotherapist roles

An example of this is the establishment of the role of the Musculoskeletal first contact physiotherapist (MSK FCPs). MSK FCPs are improving patient outcomes, reducing demands on GPs, cutting medicine prescribing and reducing unnecessary onward referrals and tests.

The initial target provided in the Interim People Plan 2019 was stated as 5000 MSK FCPs, but currently there are only 1376 posts covering many GP surgeries and population sizes several times more than originally modelled. Due to these issues, GPs report that they don’t feel the impact of MSK FCPs, and issues of MSK FCPs retention are emerging.

This dynamic undermines implementation and has slowed down the evolution of the MSK FCP role which would support integration with community services.

How can we expand the physiotherapy workforce?

Community rehabilitation services are experiencing difficulties with recruitment and retention, but even greater issues are a lack of established posts and gaps in provision. 15 per cent of physiotherapy staff are leaving the NHS each year and almost half of them are leaving within the first five years of qualifying.

Many are moving to the private sector, but some newly qualified physiotherapists are seeking positions in low-skilled roles in the commercial sector citing less stress, flexible working hours and better pay. There is also the worrying issue of support workers retiring; a 2019 CSP survey of support workers shows that approximately 24 per cent of the current physiotherapy support worker workforce are over 55 years of age.

To compound this, a recent CSP staffing survey, showed that 93 per cent of physiotherapy managers reported that there were insufficient staffing numbers to meet patient needs and 39 per cent of physiotherapy staff reported that this was something they were very concerned about. CSP members also reported having less time to spend with patients, longer waiting times and a lack of available time to improve services, while issues around staff retention and an inability to fill vacant posts were also highlighted by members as contributing factors to insufficient staffing levels.

In the UK, there are currently nine registered physiotherapists for every 10,000 people compared to Denmark, where there are 26.8 physiotherapists for every 10,000 people and Norway, where there are 25.3 physiotherapists for every 10,000 people.

What are the solutions?

Over the years, the NHS has not grasped that, if done well, an increase in physiotherapy provision can help to meet patient needs and reduce pressures on the most overstretched parts of the system.

Insufficient staffing levels are contributing to recruitment and retention problems, which has led to a vicious cycle of high workloads and too few staff.

Change can happen but this requires increased staffing as well as doing more to attract and retain the physiotherapy workforce. The growth in the numbers of registered physiotherapists is increasing, but a sustainable and long-term workforce solution is urgently needed.

The NHSE Long Term Plan must support integrated workforce planning, with targets across primary and community sectors based not on the status quo but on Government and system policy objectives to improve provision to meet population need.

Support workers also have a vital role to play – they need expanding in number and should be upskilled through Rehab Assistant Practitioner apprenticeships to take on greater responsibility, making it possible to safely expand the support worker workforce as a proportion of the workforce overall.

As well as addressing under-staffing, community services also need more strategic leadership, consistency of provision and visibility within the NHS. The lack of leadership in community services is worrying; where Trusts have Chief AHPs at a senior level, community service leadership is strengthened, improving visibility. As well as ensuring this is the case within all Trusts, there need to be more clinical therapy roles within the community working at an advanced practice or consultant level to drive up consistency in standards, lead integration across pathways and partnership working with primary care.

The good news is that the number of registered physiotherapists is growing, alongside a supply of students. Now is the time for the NHS to utilise this rise in numbers. Doing so will go a great way towards tackling the current workforce crisis in NHS community rehabilitation services.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Manchester, this Thursday 25th May. The event is free to attend for relevant healthcare professionals, so come and say hello!

All news

Workplace discrimination and equality concerns driving NHS acute staff exodus

By Integrated Care Journal and Gabriel Blaazer

Almost a quarter of surveyed staff working for NHS England acute trusts stated in their 2022 Staff Survey that they intend to leave their role in the next 12 months.

Workplace discrimination and equality concerns are the most significant factors driving acute staff to leave the NHS, according to analysis of the 2022 NHS Staff Survey conducted by consultancy firm Lane Clark & Peacock (LCP).

In a workforce already plagued by burnout, stalling pay and low morale, the findings will come as concern for policymakers seeking to staunch and reverse the flow of acute staff leaving the NHS. The acute sector employs more than 850,000 full-time equivalent staff, 25 per cent of whom are Asian, black or another minority ethnicity, compared to 13 per cent of all working-age adults in the UK.

Among the diversity and equality issues highlighted in the NHS Staff Survey were: a lack of fairness in career progression and promotion (reported by one in eight respondents); discrimination from managers or other colleagues (nearly one in ten); discrimination from patients, their relatives, or members of the public (more than one in twelve); and a lack of respect for individual differences (almost one in twelve).

There was variation in staff responses based on their ethnic background. In particular, 17.2 per cent of staff from ethnic minority backgrounds reported experiencing discrimination from their manager or colleagues, compared to 6.8 per cent of white staff members. These findings are notable in light of recent reports documenting a pattern of racism and discrimination in the NHS.

LCP also looked at all the acute trusts across England to identify which areas most struggle with the diversity and equality issues named above. London and the East of England are the worst-performing regions, but the problem is widespread.

Source: LCP. Data source: 2022 NHS Staff Survey. Diversity and equality score is reported on a 0-10 point scale and is based on responses to four contributing questions. Acute trust catchment boundaries adopted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Hotspots for staff dissatisfaction

There is a stark geographical contrast across England when it comes to staff planning to leave the NHS. Trusts with the highest percentages of staff intending to leave are overwhelmingly located in London and the East of England, while trusts with the lowest percentages of staff intending to leave are concentrated in the North West and North East and Yorkshire.

Source: LCP. Data source: 2022 NHS Staff Survey. Acute trust catchment boundaries adapted from the Office for Health Improvement & Disparities. (Click to enlarge.)

Natalie Tikhonovsky, Analyst in LCP’s Health Analytics team, said: “Our analysis reveals a grim picture of low satisfaction levels and higher staff turnover rates currently facing the NHS acute sector. Understanding what is driving this will be key to the success of the government’s new workforce plan and to the overall aim of reducing steadily increasing wait lists.”

Catrin Treharne, Principal in LCP’s Health Analytics team, also commented: “The next steps for improving the NHS’s organisational health could include addressing disparities in staff satisfaction levels between trusts and investing in diversity and equality efforts to foster inclusive workplace environments. By understanding the root cause of NHS workforce challenges and designing solutions to properly address these, we can improve not only workforce satisfaction in the NHS but also patient satisfaction and outcomes.”

Majority of clinicians want more training on health inequalities, says RCP report

By Integrated Care Journal

A recent study conducted by the Royal College of Physicians (RCP) finds that most clinicians feel they haven’t received enough training on health inequalities and would like more as part of their medical education.

The study, led by Dr Ash Birtles, RCP Clinical Fellow in health inequalities, looked at clinicians’ confidence in talking about and understanding health inequalities – avoidable, unfair and systematic differences in health between different groups of people.

Of the almost 1,000 clinicians surveyed, 67 per cent of respondents reported that they had not received any teaching or training in health inequalities within a training programme or as part of their degree. 31 per cent said they felt confident in their ability to talk to patients about the impact of inequality on their health, however only 26 per cent felt confident in their ability to reduce the impact of health inequalities in their medical practice.

In two self-selecting focus groups following the survey, all participants were keen to access further education on health inequalities, specifically in understanding how they could help to reduce them in practice. They felt that better understanding the needs and experiences of marginalised groups would help them in a healthcare setting. They were also interested in education on wider aspects of health and wellbeing, including the impact of sustainability and climate change on health.

Health inequalities have become a focal point of the health service in recent years. In 2021, NHS England launched a new approach to tackle health inequalities – Core20PLUS5. Its three components are: a focus on the 20 per cent of the population who constitute the lowest quintile of deprivation (the ‘Core20’); “an additional focus on local inequalities” (the ‘PLUS’); and the five key clinical areas of focus as defined in the NHS Long Term Plan (the ‘5’) – maternity care, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case finding.

Insights gathered during ICJ’s ICS Roadshow in autumn 2022 make clear that ICS leaders are broadly supportive of the Core20PLUS5 approach, specifically the clarity it provides to systems over their role in reducing health inequalities. The RCP study appears suggest that more nuanced and detailed training should now be made available to the frontline clinicians who are to deliver on the strategy.

When asked during qualitative interviews what the RCP could do to enhance practice in addressing health inequalities, more than half of respondents (55 per cent) said that e-learning resources would be helpful. The RCP has therefore committed to develop bitesize audiovisual educational resources on various aspects of health inequalities alongside an e-learning package.

The RCP will also be using insights from the survey to develop further educational tools and resources to support clinicians with practical ideas on reducing healthcare inequalities in their workplace. The survey was sponsored by Novartis Pharmaceuticals, who provided funding but had no input.

Dr Ash Birtles, RCP Clinical Fellow in health inequalities, and leader of the study, said: “This survey has allowed us to capture a snapshot of current practice in the UK and to engage clinicians in a meaningful dialogue about the education they feel is needed to help reduce health inequalities in practice.

“I was shocked at the lack of training many had received in health inequalities, but we’re now equipped with the insight needed to create useful and practical training in a way that clinicians feel is most helpful to them.”

The full report can be accessed here.

Negotiations at an impasse as further industrial action looms

By Gabriel Blaazer

Almost 9,000 ambulance workers were on strike yesterday (Monday 6th February), with the GMB and Unite also striking across 9 regions in England – the most NHS settings ever affected by a single day of industrial action.

Following Monday’s unprecedented strike action, nurses with the RCN are striking today (7th February), with the Chartered Society of Physiotherapy striking on 9th February and the ambulance union, Unison, striking on 10th February. This means that Wednesday (8th February) will be the only day this week on which no strike action is taking place.

Official figures show that more than 88,000 appointments have been postponed already this winter due to industrial action, yet unions have accused the government of intransigence over the disputes, which centre largely around pay and conditions and a perceived lack of investment in recruitment and retention.

Despite claims that comparatively low pay and high levels of in-work stress are contributing to the difficulty in recruiting and retaining health and care professionals, unions say that the government is in effect refusing to discuss improvements to pay and conditions. There are more than 130,000 vacancies across the NHS in England alone, and a worrying number of health and care professionals plan to leave their jobs in the coming years, citing burnout, anxiety and working in a system that has reached its breaking point.

Further, a recent analysis of official figures has shown that burnout and stress among health staff has led to more NHS staff absence than the Covid-19 pandemic. NHS sickness figures show that more than 15 million working days have been lost since March 2020, more than double were list to Covid infections and self-isolation.

A government spokesperson has claimed that Health Secretary, Steve Barclay, is ready to resume talks with unions, and said that “the Health and Social Care Secretary has held constructive talks with unions on pay and affordability.” This was disputed by the General Secretary of Unite, Sharon Graham, who said that no such discussions were taking place. On the negotiations, she added: “In 30 years of negotiating, I’ve never seen such an abdication of responsibility. Categorically…there have been no conversations on pay whatsoever with Rishi Sunak or Steven Barclay about this dispute in any way, shape, or form.”

Pat Cullen, General Secretary of the RCN, today accused the government of ‘punishing’ nurses for their stance, after Maria Caulfield, (the minister for mental health and women’s health strategy, herself a nurse and RCN member), said that nurses’ pay would be discussed, “but only [for] next year’s deal.” However, all 14 health unions have declined to continue talks on this basis, saying that they would only negotiate a settlement that covers the 2022-23 pay deal.

Hope remains for a breakthrough, however, with the new Chief Executive of NHS Providers, Sir Julian Hartley pointing out that industrial action in Wales and Scotland have been suspended following fresh pay offers.

Saffron Cordery, who until 1st February was interim Chief Executive of NHS Providers, said: “For many trusts, Monday [6 February] will be the toughest challenge they’ve ever had as nurses and ambulance staff strike together for the first time, and in more places than before. Leaders are doing everything they can to prepare by putting plans in place to minimise effects on patients and making sure they can provide high-quality, timely care where possible. But without a resolution, disruption is inevitable.

“We need to do everything we can to ensure industrial action doesn’t become the new normal. The government has the power to end this disruption right now by talking to the unions about working conditions and, crucially, pay for this financial year. Their reluctance to do so is getting in the way of efforts to tackle elective recovery for patients.”

Rachel Harrison, National Secretary of the GMB said: “It’s been almost a month since the Government engaged in any meaningful dialogue – instead, they’ve wasted time attempting to smear ambulance workers. The NHS is crumbling; people are dying and this Government is dithering.”

Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

Support through the menopause is a necessity, not a luxury

By Professor Dame Jane Dacre

‘The only matter where a woman can take time off for her reproductive health that is widely accepted is pregnancy – that’s the reality’.

These are not my words but those of one of the doctors in the UK that responded to a recent survey by the Medical Protection Society (MPS).

It is a sentiment that many women will recognise. But the medical community surely can, and must, do better than this in 2022.

Every day initiatives are announced to support healthcare professionals’ wellbeing and to enable those of us further along in our careers to continue working. I would argue that support for healthcare professionals experiencing menopause has to be a top consideration as part of this work.

NHS Digital data tells us that women make up more than 75 per cent of the NHS workforce, and that there are more women in medicine than ever before. However, looking at the split of doctors on the GMC register, there is quite a dramatic reduction in the number of women over 45. Under the age of 45, female doctors form the majority of the profession. There will be many reasons for this, including the extent to which women entering medical schools have outnumbered men in recent years.

However, the lack of support for those going through the menopause could be a factor in the reduction of female doctors over the age of 45 on the register. Better recognition of the impact of the menopause on some women’s medical careers could help to keep them in practice for longer.

Some of the most common physical menopause symptoms include hot flushes, night sweats, menorrhagia or a change to the menstrual cycle. Migraines and other headaches are also frequently reported, as well as joint and muscle pain, heart palpitations, urinary incontinence, vaginal dryness, genitourinary infections, and an adverse effect on an individual’s sex life, which can affect relationships and overall wellbeing.

Mental health symptoms reported include anxiety, mood swings, panic attacks and depression. Other reported symptoms include fatigue, poor concentration, brain fog, dizziness and insomnia.

These symptoms can of course have a negative effect on a person’s work performance. The UK’s Faculty of Occupational Medicine and the Chartered Institute for Personnel and Development state that 25 per cent of women say they have considered leaving their job and 1 in 10 do end up quitting as a result of menopause and a lack of available support.

Healthcare professionals will know more about the menopause than others, but this does not mean we are immune from these pressures or that we get the support we need.

A recent survey of 261 doctors in the UK conducted by MPS found that just 14 per cent of female doctors who have experienced the menopause report feeling supported by their employer/workplace and only 7 per cent feel supported by their line manager, with most (76 per cent) feeling supported by their family and friends. 28 per cent feel supported by colleagues, yet 17 per cent say colleagues have been dismissive of their menopause symptoms. 19 per cent said they have considered early retirement due to the menopause.

While the sample size is small, these findings suggest more needs to be done to help doctors experiencing menopause continue to perform at their best and stay in the workforce for longer. A work culture that destigmatises menopause and other factors that impact on a doctor’s wellbeing is much needed to reduce the continued exodus of doctors. Creating an environment that promotes wellbeing is a necessity, rather than a luxury, as the impact of engaged and content clinical staff on patient safety should not be underestimated.

There is a crisis in the medical workforce, due to understaffing, which needs to be addressed urgently, so that we can continue to provide the highest quality of care to our patients. Recognising the potential difficulties faced specifically by women doctors, and addressing them compassionately will help reduce attrition, and will benefit the medical workforce overall, and ultimately, patients too.

MPS, of which I am President, offers support to members including making our 24/7 confidential counselling service available for those struggling with the menopause and other wellbeing concerns.

A much broader approach is needed by the wider system however to ensure better mental wellbeing support and greater awareness from leaders. This is why MPS, in its paper Supporting doctors through menopause, is calling for better training and education around the menopause and its symptoms for managers and senior leaders, and asking healthcare organisations to consider flexible working arrangements to support female doctors to stay in the workforce for longer.