Parliamentary report on workforce burnout and resilience
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1603 (Published 25 June 2021) Cite this as: BMJ 2021;373:n1603
- Suzie Bailey, director of leadership and organisational development
- S.Bailey{at}kingsfund.org.uk
In July 2020 the House of Commons Health and Social Care Committee started an inquiry on workforce burnout and resilience in the NHS and social care. The committee received over 100 written submissions, held oral evidence sessions, and conducted anonymous in-depth interviews with staff. The report was published on 8 June 2021 and found evidence that “burnout is a widespread reality in today’s NHS.”
Although many of the findings may be of little surprise to people working in the system, it raises important concerns about the health and wellbeing of the workforce.1 Commenting on the report, the committee’s chair, Jeremy Hunt, described workforce burnout as “an extraordinarily dangerous risk to the future functioning of both services.”
In declaring burnout widespread even before the pandemic, the report makes an important distinction, given that the past 15 months could be viewed as special cause. It calls out the lack of robust workforce planning and recommends that chronic excessive workloads be tackled as a priority.
Excessive workloads need to be dealt with at every level of the health and care system, requiring courage from leaders and teams. Different ways of working need to be developed, including genuine co-production with staff, service users, and the public.
The report also calls for parity with NHS staff for the social care workforce, including the development of a social care people plan and a staff survey similar to that in the NHS. Ultimately, improving working conditions and pay in social care will require reform of the sector, but these would be welcome steps forward.
Case for change
Healthcare is experiencing a global workforce crisis, with the World Health Organization projecting that an additional 40 million health workers will be needed by 2030.2 Health and care delivery is labour intensive. Around two thirds of NHS providers’ spending is on staff costs, and the total pay bill for NHS trusts is more than £50bn (€58bn; $70bn) annually.3
Multiple warnings have been issued about the need to tackle workforce wellbeing over many years, including in the 2009 independent review by Boorman.4 This showed the relation between the health and wellbeing of NHS staff and organisational performance, and set out the business case for investment—an estimated saving of £555m a year of direct costs. The NHS staff survey 2020 showed that 44% of staff reported feeling unwell owing to work related stress—the highest level since 2016—and ethnic minority staff experienced high levels of bullying, harassment, and discrimination.5 Improving staff health and wellbeing is therefore far from being a “nice to have,” it is a moral, social, and economic priority. The focus must be on tackling the root causes of stress, not on interventions that seek only to manage or mitigate it.
It is encouraging that the committee’s recommendations emphasised the importance of compassionate leadership: “embedding and facilitating cultures that support compassionate leadership must be at the heart” of improvement to workplace culture. But it also acknowledged that “structural barriers” would need to be removed to support this recommendation.
The report also calls for Health Education England to publish independent annual workforce projections covering the next five, 10, and 20 years, including an assessment of whether sufficient numbers are being trained. The Health Foundation, Nuffield Trust, and King’s Fund proposed this amendment to the forthcoming health and care bill.6 In its latest guidance on integrated care systems, NHS England emphasises the role of such systems in workforce planning, asking integrated care systems to “undertake integrated and dynamic workforce, activity, and finance planning based on population need, transformation of care models, and changes in skills and ways of working.”7 This is sensible in theory, but how realistic is it to place new workforce responsibilities on these relatively new structures?
Leadership, investment
The evidence based tools and leadership behaviours required to reduce stress and burnout are already well known, but workforce health and wellbeing has not seemed to be a high priority of policy makers. Will the health and social care committee’s report improve outcomes? In part, it will depend on whether multiple leaders across the health and care system can maintain the current momentum behind workforce and workplace transformation. Progress is already being made,89 and it is also encouraging to see many organisations coming together, committed to play their part.10
Effective workforce planning and purposeful culture change will require sustained political leadership as well as long term investment at a level commensurate with the urgent need for improvement. As the committee concluded: “We are not persuaded that a combination of ministerial judgements and haggling between government departments is a satisfactory substitute for objective long term workforce planning for the NHS and care system.” As Michael West, of the King’s Fund, said in his evidence: without this investment, the NHS People Plan will remain “a very smart looking car” but “without the engine.”1
Footnotes
Competing interests: I have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.