‘Workforce burnout’ is on a large scale in the NHS – warns MPs report

NHS staff demonstrating outside St Thomas’ Hospital in central London, hold up posters of government ministers, Hancock, Johnson and Gove showing them with blood on their hands

A CRITICAL report by MPs on the House of Commons Health and Social Care Committee has warned of large scale ‘workforce burnout’ in the NHS and social care.

Their report published on Tuesday states: ‘In our report, Delivering core NHS and care services during the pandemic and beyond, we set out our concerns that:

‘Some NHS and care staff are suffering from fatigue, exhaustion and a general feeling of being “burnt out” and that the wellbeing of staff (particularly their mental health) is at significant risk.

‘We therefore recommended that NHS England and Improvement:

‘Develop a full and comprehensive definition of “workforce burnout”, and set out how the wellbeing of all NHS staff is being monitored and assessed … by the middle of October 2020.

‘We further recommended that NHS England and Improvement:

‘Set out in detail what further specific steps it would like to take over the coming years to support the mental and physical wellbeing of all staff and a plan to deal with the specific issue of sustained workplace pressure due to the current pandemic and backlog associated with the coronavirus.’

Responding to the report’s findings, Royal College of Nursing (RCN) Acting General Secretary & Chief Executive Pat Cullen said: ‘The unprecedented demand on nursing staff during the pandemic has had a huge impact on their own wellbeing.

‘But, as this report shows, the cracks in the systems designed to look after nursing staff appeared years ago.

‘The Department of Health and Social Care needs to prevent more nursing staff “burning out” or leaving the profession entirely by boosting recruitment and retention.’

The RCN added: ‘The committee’s report echoes our calls for the government to publish workforce projections for both the NHS and social care, covering the next five, 10 and 20 years, including an assessment of whether sufficient numbers of staff are being trained.

‘It also recommends that the level of resources allocated to mental health support for health and care staff be maintained after the pandemic, a position we strongly support in our principles for return to service.

‘In our submission, we stressed the importance of fair pay to attract and retain nursing staff, insisting the government commits to a 12.5% pay increase for all nursing staff covered by Agenda for Change terms, as part of a one-year deal that applies equally to all pay bands.’

Dr Rosemary Leonard said it felt like her GP surgery had been ‘under siege’ since the end of lockdown as people were coming in with ‘shopping lists of problems and we just don’t have the manpower to deal with it’.

She said everybody in primary care was working ‘incredibly long days’ and was under ‘huge, huge pressure’. Asked what would help alleviate the stress, she said: ‘It really is manpower’.

Royal College of GPs Chairman Prof Martin Marshall, said: ‘We simply don’t have enough GPs or other members of the practice team to meet demand and general practice is only set to get busier as we support our communities’ recovery from the pandemic.’

Dr David Wrigley from the British Medical Association said: ‘Health and care staff suffered stress and work-related anxiety before the pandemic but it is now far more serious and we believe the current level of staff burnout and stress presents a worrying risk to the future functioning of the health and care system and safe patient care.

‘There’s an urgent need to address the severe workforce crisis facing health and care services, and – as called for by the BMA and others – the report also calls for continuous and transparent assessments of workforce shortages and future staffing requirements.’

The Health and Social Care Committee report states:

‘The NHS Staff Survey has suggested that an unacceptably high proportion of NHS staff experience negative impacts as a result of stress in the workplace and that the proportion of staff suffering from stress is on an upward trend.

The 2019 survey found that 40.3% of respondents reported feeling unwell as a result of work-related stress in the last 12 months, up from 36.8% in 2016. The most recent iteration of the survey, where fieldwork took place during the pandemic, indicated that 44% of respondents have now reported feeling unwell as a result of work-related stress in the last 12 months.

The latest survey also found that 46.4% of staff said that they had gone to work in the last three months despite not feeling well enough to perform their duties – although this was ‘notably fewer’ than in previous years.

In his submission, Professor Tom Bourne told us that the level of burnout among hospital doctors in the UK was ‘very high and particularly so amongst trainees,’ with over 40% of trainees affected.

Unfortunately, as the King’s Fund highlighted to us, data comparable to the NHS Staff Survey is not available for social care workers.

In oral evidence, Professor Martin Green OBE, Chief Executive, Care England confirmed to us the absence of comparative data for the care sector:

Unfortunately, the problem in social care is that we do not have comprehensive datasets. We do not have things like the staff survey in a uniform way, although there is some work being done by Skills for Care to try to make sure that we have some understanding of what is going on in social care. One of our challenges is that it is a very fragmented system.

Work-related stress has a wide range of consequences.

The King’s Fund’s written submission stated that NHS staff were 50% more likely to experience high levels of work-related stress compared with the general working population.

This was likely to damage their health and affect care quality, and was associated with patient satisfaction, financial performance, absenteeism and organisational performance.

Poor staff health and wellbeing was also linked with turnover and intention to quit, along with higher levels of patient mortality in the acute sector.

Chronic excessive workload

Chronic excessive workload has been identified as a key factor of burnout and staff shortages were identified as ‘the most important factor in determining chronic excessive workload’, with shortages of around ‘one in 10 or one in 12 staff’ in the NHS in January 2020, before the pandemic fully hit.

In his oral evidence, Professor West explained the relationship between excessive workload and burnout, saying:  ‘I want to be clear about the issue of excessive workload. The danger is that we do not see it. It is like the pattern on the wallpaper that we no longer see, but it is the No. 1 predictor of staff stress and staff intention to quit. It is also the No. 1 predictor of patient dissatisfaction. It is highly associated with the level of errors.

He explained that the risks of excessive workload could not be tackled without a comprehensive strategy: ‘Unless we have a well worked-out plan for how we can fill all the vacancies and reduce the attrition rate of staff in the NHS (…) we are going to be in trouble’.

Effect of vacancies in the health and care sector

A number of written submissions to our inquiry also highlighted the link between shortages in the health and care workforce and burnout, along with the scale and impact of vacancies across the NHS and social care workforce.

For example, the Royal College of Nursing (RCN) noted that prior to the onset of the pandemic there were 50,000 nursing vacancies in the NHS across the UK.

Intensity of workload

While staff numbers are crucial, we also heard that intensity of workload was a factor in causing burnout.

Professor West said that staff could ‘deal’ with ‘episodic, transient demands’ but it became a problem when that demand became ‘chronic.’

Pay and reward

Low pay is a particular issue in the social care workforce, while it is estimated that 56% of NHS staff work unpaid additional hours on top of their contract.

For the Local Government Association (LGA), pay was not the only area of reward discrepancy between the social care and NHS workforces, with less favourable sick pay and pension arrangements likely where social care workers are employed in the independent sector rather than by a local authority. It also pointed out that NHS workers were also more likely to have access to retail and other discounts, although this was beginning to change.

Conclusion: Bringing together the post-pandemic response with better workforce planning

The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning.

After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout.

We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.

‘The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.

It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism.

Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.’