Total overhaul of NHS and social care workforce planning needed to tackle staff burnout emergency, say MPs

In a highly critical Report, the Health and Social Care Committee finds that workforce burnout across the NHS and social care has reached an emergency level and poses a risk to the future functioning of both services. Only a total overhaul of workforce planning can provide a solution, say MPs.

Though covid-19 had a huge impact on workforce pressures, the Committee was told of staff shortages across the NHS and social care prior to the pandemic, with such shortages identified as ultimately the biggest driver of workforce burnout. The inquiry heard that NHS workforce planning was at best opaque and at worst was responsible for unacceptable pressure on staff. The Report concludes that available funding was the driver behind planning, rather than the level of demand and staffing capacity needed to service it. It further cites the absence of any ‘accurate, public projection’ of workforce requirements in specialisms over the next five to ten years.

Although the inquiry’s terms of reference included workforce resilience in the NHS and social care, evidence cautioned against a focus on the resilience of individual staff members, advising instead to consider systems and systemic solutions.

Rt Hon Jeremy Hunt MP, Chair of Health and Social Care Committee, said:

“ Workforce burnout across the NHS and care systems now presents an extraordinarily dangerous risk to the future functioning of both services.
“An absence of proper, detailed workforce planning has contributed to this, and was exposed by the pandemic with its many demands on staff. However, staff shortages existed long before covid-19.
“Staff face unacceptable pressure with chronic excessive workload identified as a key driver of workforce burnout. It will simply not be possible to address the backlog caused by the pandemic unless these issues are addressed.
“Achieving a long-term solution demands a complete overhaul of workforce planning. Those plans should be guided by the need to ensure that the long term supply of doctors, nurses and other clinicians is not constrained by short-term deficiencies in the number trained. Failure to address this will lead to not just more burnout but more expenditure on locum doctors and agency nurses.”

ENDS

Report’s key recommendations

• Repeats call for Health Education England to publish objective, transparent and independently audited annual reports on workforce projections covering next five, ten and twenty years, including assessment of whether sufficient numbers are being trained
• Workforce projections should cover social care as well as the NHS
• DHSC should produce a People Plan for social care as a priority, aligned to the ambitions set out in the NHS People Plan

• Level of resources allocated to mental health support for health and care staff should be maintained as and when the NHS and social care return to ‘business as usual’ after the pandemic
• NHS England should review of role of targets across the NHS which seeks to balance the operational grip they undoubtedly deliver to senior managers against the risks of inadvertently creating a culture which deprioritises care of both staff and patients

A full list of conclusions and recommendations can be found in the attached Report

Workforce planning overhaul:

MPs concluded that the level of funding available to health and social care drive workforce planning had been led by the funding envelope available, rather than demand and capacity required to service that demand. The Report notes that a combination of ministerial ‘judgements’ and haggling between Government departments were unsatisfactory substitutes for objective long-term workforce planning for the NHS and care system. It recommends that instead Health Education England should publish annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained.

The absence of a People Plan for social care should be rectified by Government as a matter of urgency, with the adult social care workforce which stepped up to the plate during the pandemic deserving the same care and attention as NHS colleagues.

Causes and scale of workforce burnout:

Evidence cited staff shortages as the most important factor in determining chronic excessive workload,which itself was identified as a key driver as cause of burnout. Excessive workload was also described as the key predictor of staff stress and of their intention to quit, of patient dissatisfaction, and was highly associated with the level of errors. MPs heard evidence that burnout and the poor wellbeing of doctors had major implications for patient outcomes, with the RCN citing analysis that concluded burnout was linked to a decline in patient safety.

In evidence, NHS Providers Chief Executive Chris Hopson identified a mismatch between rising demand and capacity over the previous decade that led to frontline staff being asked to work harder and harder to close the gap, resulting in an impossible and unsustainable workload.

Impact of covid-19:

During the pandemic, the NHS Staff Survey indicated that 44% of respondents reported feeling unwell as a result of work-related stress in the previous 12 months. However, the NHS faced shortages of around "one in 10 or one in 12 staff" in January 2020, before the pandemic fully hit. In adult social care, Skills for Care estimated that 7.3% of roles in adult social care had been vacant during the financial year 2019-20, equivalent to approximately 112,000 vacancies at any one time.

The inquiry heard evidence that the projected NHS workforce gap was likely to double over next five years. Staff shortages were replicated in social care where the situation was described as ‘fragile’.

NHS action:

Giving evidence in October 2020, NHS Chief People Officer Prerana Issar was pressed on the availability of workforce projections and for further information on recommendations made to the HM Treasury by NHS England and Improvement for the Comprehensive Spending Review. Though not able to make public those recommendations, she said they were based on “what staffing is required to deliver the long-term plan”. MPs note that further detail on workforce planning had been expected after the autumn Spending Review but it had not been provided.

Though NHS England and Improvement’s People Plan contained a comprehensive ambition to address the needs and wellbeing of NHS staff and failings in NHS culture, the Committee’s Report concludes that its delivery will depend on adequate funding to achieve its ‘laudable aspirations’.

Workplace culture:

The inquiry heard that the pressure on managers to meet targets risked undermining the development of compassionate leadership in workforce culture. MPs call for a review of the role of targets to consider the risk that they create a culture which deprioritises staff and patient care.

To support a culture of speaking up when things go wrong, the Report recommends that a system of Freedom to Speak Up Guardians, established in the NHS, should be extended to cover social care.

Staff from minority ethnic backgrounds face specific challenges:

Staff from minority ethnic backgrounds faced specific challenges in relation to workplace culture, burnout and resilience, with the BMA reporting evidence that they experienced worse inequalities in the NHS. There was clear evidence that these staff had been disproportionately affected by the pandemic, whilediscrimination was also raised as a factor in burnout. Reports from Public Health England and the BAME Communities Advisory Group had identified a series of actions to address this problem. The Department should now set out how it plans to implement those recommendations within a timeframe, say MPs.