How can the NHS resolve its current staff crisis?

The latest NHS statistics are worrying. Last month, a record high of accident and emergency (A&E) patients had to wait for more than four hours to be seen, according to recent statistics from NHS England. 

Alarmingly, the figures show that 275 526 A&E patients were seen after waiting for more than four hours – the target time – compared with 208 083 in July 2018, which is an increase of almost a third (32.4%). This represents the highest number of delays for July since the current records began in August 2010. Within this figure it was revealed that 436 A&E patients waited more than 12 hours to be seen. 

Going some way to explain the exceptional delays, the figures also show that admissions at A&E departments have hit records levels in England – rising 6 per cent in a year to reach 2.27 million last month. A record number of people are also waiting for routine operations.

Alongside the increased demand for services, the delays seem to be the cumulative result of numerous adverse factors that have created a ‘perfect storm’ for the retention and recruitment of clinical staff within the NHS. These include significant rota gaps in hospitals, together with difficulty in recruiting GP partners, the infamous pension taper crisis and Brexit-related uncertainty for our European colleagues, all of which result in a pronounced loss of morale.

What can be done to resolve this deteriorating situation? Matt Hancock’s offer of a 3% per annum pay increase to junior doctors over the next three years hardly seems adequate when the private sector is seeing much higher rates of salary increase.

Sajid Javid has promised ‘pension flexibilities’ to avoid the punitive tax charges that are discouraging doctors from doing overtime and incentivising them to take early retirement. Perhaps the creation of an AI Lab, which will bring together the industry’s best academics, specialists and technology companies to work on some of the biggest challenges in healthcare, including earlier cancer detection, new dementia treatments and more personalised care, will help? This lab will sit within NHSX, the new organisation that will oversee the digitisation of the health and care system, in partnership with the Accelerated Access Collaborative. Potentially, at least AI can play an important role, giving staff of the future the ‘gift of time’, as outlined in the Topol Review, to care for more patients with time-saving support from AI, but this is all some way off.

There is an upcoming event on NHS recruitment and retention that will seek top address some of these issues for anyone interested in attending. 

What recommendations do you have to encourage high quality staff to join and stay within the NHS? All suggestions welcome!

Comments (16) Add yours ↓
  1. Nitin Shrotri Consultant Urologist &FTSUG

    1. Take Consultants 55+ off the on call rota. They will work for more years
    2. Offer seniors more Academic contracts, thereby less punitive work
    3. Increase respect for all senior doctors, black, brown or white
    4. Make up for the lost years of no increments
    5. Make junior doctors lives better with no rubbish duties and ensure they are treated with respect
    6.Pay junior doctors attractive salaries
    7. Ministers who destroyed the medical professions morale should be held to account.
    8. Consultants should look after their juniors better instead of running after money/targets. This will make them feel valued. We have lost the art of doing this.

    August 14, 2019 Reply
  2. Sophie Rintoul-Hoad ST5 Urology trainee

    The state of waiting times (both lists and in A&E) and busy departments can be really demotivating. However it is not a simple case of having more staff.

    Why are more people coming to A&E – do they have options to see a doctor/ experienced health care professional elsewhere?
    Is the 4hour target meaningless – some problems take longer to solve – some patients need to see more than one professional.

    People don’t generally go into healthcare professions expecting huge salaries, but of course being paid for the volume of work done, being paid fairly for anti-social hours and being recognised for good work (and thanked if you do extra) goes a long way to ensure people feel valued.

    Similarly opportunities to learn, be trained, attend courses and having time to study give greater satisfaction. BSoT (BAUS Section of Trainees) and ASiT (Association of Surgeons in Training) work hard to help trainees and address issues on a National and Local level.

    Support and encouragement from senior colleagues is invaluable. Indeed the teamwork and camaraderie, that I’ve been fortunate to experience in bucket loads, can make any busy day that bit more bearable.

    The junior doctors contract fiasco has dented morale significantly and I see UK trained doctors having a far better time of it working abroad… what can we learn from them? Similarly what can we learn from other industries – graduate schemes do not expect their candidates to pay for their own exams e.g. in accountancy.

    Sometimes the grass does look greener elsewhere; but being a doctor and working in the health sector is a brilliant job – perhaps we can all work together to make it even better.

    August 16, 2019 Reply
  3. Hannah Warren Core trainee

    The rising waiting times in A&E simply stem from a year-on-year rise in demand without a matching rise in resources. Hospitals have relatively fixed numbers of hospital beds and staff, and while they have been coming up with ingeneous ways for patient flow to circumvent the emergency department (ambulatory services for example) the demand is simply outpacing the supply.

    I think there is a commonly held belief that many A&E attendees could have been managed by community services, but having worked in a busy A&E department for 4 months over winter there were only 2 patients that I recall seeing that I felt really didn’t need emergency care. From that number I have excluded the sorry population of London’s homeless – often with very real health issues (victims of random acts of violence, deep vein thromboses from sleeping in a seated position night after night, and mental health issues), albeit the health issue in question had usually been saved up for a particularly bitter, cold night.

    It is easy to blame years of austerity for this issue, both for creating the demand (the vulnerable homeless being a case in point), and with the supply issues of staff outline above.

    So how can we retain talented staff? Based on some of the high and lowlights of my career so far I think these would be key points:
    1. Removal of ‘box-ticking’ exercises to be undertaken in one’s precious free time – mandatory e-learning and complex ePortfolios I’m looking at you.
    2. Socialise with colleagues outside of work. It is so much more enjoyable to work with people you also consider to be friends. The loss of firm structure has eroded this somewhat (remnants still exist in surgery which is part of the draw for me, but this is not so in other specialties). Include your juniors in this – particularly those on the disorienting merry-go-round of 4 monthly rotations
    3. And the simplest of all – recognise achievement and give thanks where it’s due. Free and simple but goes a long way to making colleagues feel valued, satisfied and contented.

    August 16, 2019 Reply
  4. Christian Brown Urologist

    The NHS is good but not great. It hasn’t moved with the times and the staff that work within it feel underpaid, under valued and much of the time stressed and over worked.

    The systems currently within the NHS to retain and recruit are old fashioned and over bureaucratic taking months to replace secretaries and clinical fellows where existing budget exists. Outsourcing to HR companies who are negligently slow and inefficient seems now normal and that’s a worry.

    We also cannot escape the salary issue. Although as said before we don’t go into medicine to make money, we also should be recognised for our training, dedication and self investment financially to get to where we are. Currently this is not the case. Salary freezes, little or no opportunity for awards for the masses and now the inability to boost salary with overtime or additional work is not good.

    I predict a different type of working in the future with many senior clinicians retiring early or working less in the NHS and more in the private sector either as independent practitioners or for the ever growing group of large private hospitals that are offering salaried posts.

    August 20, 2019 Reply
  5. Peter Rimington Consultant Urologist

    The saddest thing about the current state of the NHS is that it was avoidable. So many of the “innovations” brought down upon us by Ministerial reforms were doomed to fail. The planning was and is extremely short term, based entirely on fighting fires instead of planning the long term eradication of firewood.

    One of the best examples was the new GP contract offering loss of out of hours work at the same time instituting the 4 hour waiting time for A&E visits. Where did the y think patients were going to go if there were no GPs available?

    The lack of response to advise given by their own QUANGOs is another bone of contention. GIRFT long published its findings that most Urology consultants think the 62day targets for prostate cancer patients are not necessary and are confusing for patients. But nothing has been done.

    How many “Alliances, Networks etc” have we seen come and go and achieve very little. I am reminded of Jim Hacker asking Sir Humphry whether the purpose of a hospital was not to have patients in it? Sir Humphry relies sweetly, “No no no Minister. It is to employ adminstrators!” Ruefully funny.

    And I do not know how to fix this problem. The NHS used to be able to employ young enthusiastic well trained young doctors from far flung countries as the opportunities in the NHS were seen as attractive. This is no longer thecase. In fact the opposite is happening. The amount of paperwork needed to employ a foreign graduate for just one year is mind boggling. The NHS treats its staff appallingly asking and expecting them to always do more and more for little thanks and no real money due to ridiculous unthought through tax schemes.The work environment outside of the Tertiary large hospitals is decrepit, poorly maintained and badly equipped.

    This is indeed a perfect storm and I can offer nothing but the deepest sympathy to those who have more than 5 years to go in what used to be a noble and respected calling for a professional person.

    August 20, 2019 Reply
  6. Roger Kirby Professor of Urology

    A view from the Kings Fund: “The staff working in the NHS are its greatest asset and are key to delivering high-quality care. However, a prolonged funding squeeze combined with years of poor workforce planning, weak policy and fragmented responsibilities have resulted in a workforce crisis. Staff are working under  enormous strain  as services struggle to recruit, train and retain enough staff. Without urgent action to address this, the aspirations of the NHS long-term plan will not be met, and quality of health and care will deteriorate.

    In the short term, the immediate workforce shortfall is so severe that it can only realistically be managed by recruiting staff from overseas, including ethically recruiting 5,000 nurses a year. This cannot be achieved without a supportive immigration policy, which should include the government accepting the recommendations of the Migration Advisory Committee to make it easier to recruit staff from outside the UK.

    To create a sustainable workforce in the longer term, more staff need to be trained domestically. This will require additional investment or resources being diverted from other budgets, recognising the consequences that this would have on the ambitions to improve (or even sustain) existing services.

    It is also important to improve the retention of staff already working in the service. To do this, the NHS must focus on becoming a better employer, for example by tackling discrimination and inequality, providing an attractive employment offer including more opportunities for flexible working and embedding collective leadership across the NHS that is compassionate and inclusive to create cultures in which staff want to work and build their careers.”

    August 30, 2019 Reply
  7. Roger Kirby Professor Of Urology

    Hospital patients’ safety is being put at risk by fires, floods and crumbling, overcrowded buildings caused by a £4bn government squeeze on capital funding, NHS bosses are warning.
    Hospitals say they do not have the funding to replace outdated scanners, fix leaking roofs and boilers, or remove ligature points that suicidal patients may attempt to use to try to end their lives.
    Four out of five (82%) chief executives and chief finance officers at NHS trusts in England fear the lack of capital funding poses a medium or high risk to patient safety.

    August 30, 2019 Reply
  8. Roger Kirby Professor of Urology

    About half of all cancer patients in England failed to be diagnosed with cancer in its early stages in one year, a charity has said, sounding the alarm that NHS staff shortages are contributing to a loss of life.
    Some 115,000 people in England were diagnosed with late-stage cancer in 2017, significantly hurting their chances of survival and leaving them with fewer treatment options, according to figures released by Public Health England and analysed by Cancer Research UK.
    Of those, some 67,000 were diagnosed with stage 4 cancer, the most advanced stage. The figure could even be larger as for 19 per cent of patients there is no record of what stage their cancer was diagnosed.
    Cancer Research UK said many factors were causing late diagnoses, but it said a “desperate shortage” of staff was a large contributor and government inaction was “crippling” the NHS. “There just aren’t enough of the right staff available on the ground now, and there are no plans to significantly increase the numbers.”

    September 2, 2019 Reply
  9. Roger Kirby Professor of Urology

    The rise in hospital nurses in England has been dwarfed by a jump in patients, a recent study suggests.
    The Royal College of Nursing research points to data showing the nurse workforce has increased by 4.6% in five years.
    But hospital admissions have jumped by 12.3% – nearly three times the rate.
    The union says this shows more needs to be done to ensure safe staffing.
    Currently it is estimated that one in nine nursing posts are vacant in the NHS in England.

    September 17, 2019 Reply
  10. Roger Kirby Professor of Urology

    The number of GP appointments in England has risen to an estimated 30.8m in October – the highest ever recorded in a single month – according to official data.

    At the same time, the number of fully qualified full-time equivalent GPs in the country has dropped by 339 in the past year.

    The BMA said the figures show that general practice is set for an ‘unprecedented’ winter in terms of demand and supply.

    The latest statistics from NHS Digital show that in October, practices in England delivered a total of 29.7m appointments (and an estimated 30.8m), 17% higher than the previous month.

    November 29, 2019 Reply
  11. Roger Kirby Professor of Urology

    Community nurses are being forced to delay patient care on a daily basis as health leaders warn the government’s plans for the NHS are undeliverable without significant investment. New data has revealed district nurses, who deliver complex care in people’s homes to help them recover and stay out of hospital, are being forced to work an extra day of unpaid overtime every week to try to meet the relentless demand for their services.
    Three-quarters of teams have vacancies and recruitment freezes and the number of NHS district nurses has dropped from more than 7,000 to just over 4,000 in the past 10 years. The problem is now becoming so severe NHS bosses have been told their plans to transform the way the NHS works by caring for more patients at home will fail without the number of district nurses in training being doubled.

    December 27, 2019 Reply
  12. Roger Kirby Professor of Urology

    Britain’s busiest ambulance service has had its safety rating downgraded by the care watchdog over fears it does not have enough staff to answer 999 calls consistently.
    Inspectors from the Care Quality Commission (CQC) were told workers at London Ambulance Service‘s two emergency operations centres (EOC) were concerned about staffing levels, struggled to get clinical advice and could not always send out enough paramedics because of demands on the service.
    Overall, the CQC rated the ambulance trust, which responded to nearly one million callouts in 2017-18, as good. But its report, published today, found that in March 2019, only 70 per cent of shifts in the emergency operations centre were filled, the CQC said while the ambulance service as a whole had a turnover of 18 per cent.

    January 3, 2020 Reply
  13. Roger Kirby Professor of Urology

    The Health and Safety Executive (HSE) has said 25 NHS trusts are in breach of rules designed to make sure they manage risks to their staff from violent patients or members of the public. This follows 38 inspections by the regulator since April 2018.
    The Health Service Journal revealed the inspections were prompted by increasing numbers of assaults on NHS staff, including three killings by patients in the last five years.
    The government stopped collecting data on assaults against NHS staff in 2016, but research by Unison estimated there were more than 56,435 physical assaults on NHS staff in 2016-17.
    The HSE said it was carrying out the inspections because it was concerned at the scale of the problem compared to other industries.
    It said: “In terms of violence and aggression, in the last five years, out of six fatal accidents in this sector, three of those were due to physical assault. Approximately 22 per cent of non-fatal injuries … between 2015 and 2018 in health and social care were attributed to acts of violence, which is three times as high as in all industries.”

    January 7, 2020 Reply
  14. Roger Kirby Professor of Urology

    Last month a Times newspaper investigation into some of the most understaffed GP practices in the country revealed the extent to which the national shortage of GPs is affecting patients’ quality of care. Families registered with the worst-hit practices, some of which have more than six times the average number of patients per GP, reported having to wait nine weeks for appointments, and some surgeries have been left with one permanent doctor caring for 11,000 patients — the national average in September was 1,721.

    January 25, 2020 Reply
  15. Roger Kirby Professor of Urology

    Boris Johnson’s pledge to deliver 50,000 more nurses to the NHS has been thrown into doubt after a leaked email revealed civil servants have concerns over the PM’s “weak” plans. The Department of Health and Social Care (DHSC) has demanded more “robust” details from NHS England on how exactly it will keep nurses working in the NHS after civil servants expressed “concerns” about the current plans.
    The leaked email, obtained by Health Service Journal, exposes the difficulty the NHS has in meeting the government’s key manifesto pledge of 50,000 more nurses by 2024-25. The pledge is primarily based on improving working conditions so that 18,500 nurses who already work in the NHS do not leave.
    In the emai from the DHSC’s director of workforce, Gavin Larner, to the NHS England chief people officer, Prerana Issar, Mr Larner said in relation to plans to deliver on the 50,000 nurses: “Unlike the other delivery plans received, this does not include either trajectories or milestones.” He added: “We will be providing detailed feedback to workstream leads on all the plans today, but we do have particular concerns about the retention one, so wanted to flag this early.”

    February 21, 2020 Reply
  16. Roger Kirby Professor Roger Kirby

    The Royal College of Surgeons of England and Faculty of Dental Surgery have joined forces with nine other health bodies in a letter to new Chancellor, Rishi Sunak, urging him to use the Budget to provide a long-term solution to the pension taxation crisis. The letter makes clear that clinicians must be able to do the extra work required to reduce waiting times, without fearing extra pension tax bills.

    Quoted in the Daily Mail and on iNews, we say, “We are past the point when significant action should have been taken,” … “The NHS is amid a workforce crisis, with rising waiting times for cancer and routine surgery. A&E performance is at its worst since records began and 11 million patients are experiencing unacceptable waiting times for GP appointments.”

    February 28, 2020 Reply

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