Staff shortages have been a perennial issue within the NHS for years now. As of March 2024, the NHS vacancy rate in England was 6.9%. And whilst this is not a new problem, the rather complex nature of the issue has evolved since the pandemic.
COVID-19 offered a unique set of challenges for every sector across the globe. However, it’s fair to say that healthcare was impacted the most, both in the short and long term – with the effects still proving problematic today. The NHS experienced numerous people forced into or opting for early retirement. At the same time, other NHS staff decided to change their working arrangements and adjusting their clinical commitments, especially if they were frontline staff. At least in part because of this, the NHS has struggled to deliver the clinical care needed – particularly in high-demand areas, highlighting the mismatch between the supply and demand in the workforce. Naturally, this means the areas with the highest demand now face the greatest challenges in catching up on workforce supply, which is no easy task due to the issue of attracting staff into these highly complex and pressurised environments.
Dr Chandu Wickramarachchi, Chief Clinical Informatics Officer at Epro, outlines the task at hand and gives his advice on how the NHS might take steps to mitigate these challenges.
The task at hand for the UK government?
Drawing from the Labour manifesto, the new government has pledged to hire 8,500 additional staff specifically for mental health care – which is certainly an area of need. This is a significant commitment, given the vast differences in best practices and the care currently delivered, particularly for acute mental health issues in A&E and for those in the community with chronic mental health conditions.
While the influx of 8,500 staff will undoubtedly be beneficial, it’s essential to consider the training required and workforce alignment with the systematic framework for mental health services within the NHS. The current shortage is inextricably linked to the pipelines through which most staff are trained. There is an 8 to 9-year lag for doctors being trained in the NHS; similarly, nurses have an extended training period, including their degree and dedicated time for specialisation. Policy effects often differ markedly from what we see a few years later in terms of how these staff are deployed and whether the initial intentions are realised in practice. Therefore, an emphasis on training pathways with built-in flexibility for the individual, alongside scope for enhancing a generalist professional skillset, would mitigate against the uncertainty of workforce deployment needs down the road.
Additionally, the manifesto pledges an additional 40,000 appointments every week, which would require significant increases in staffing across multiple domains of the health system. Balancing the dynamic service provision and educational requirements for NHS staff, the reality of implementing this would necessitate a considerable shift in management priorities and resource allocation. It’s not just about having enough staff and infrastructure for offering more appointments, but also about how Trusts’ management hierarchies work alongside neighbouring organisations to pool and re-prioritise growing waiting lists whilst ensuring that staff are placed and empowered effectively with the knowledge and tools to deliver on this manifesto promise.
Addressing workforce incentives and satisfaction
The NHS must proactively overcome barriers in the high-demand areas experiencing the most significant lack of resources. Many healthcare staff in these domains have been chronically dissatisfied with their day-to-day working lives, leading to demotivation, moral injury, burnout, and, ultimately, the erosion of services.
The obvious solution here is to improve the incentives holistically for healthcare staff. By doing so, we would cultivate a happier and healthier workforce, which could not only retain current staff but also attract new talent into the NHS. Nursing, in particular, needs to be valued and recognised with a greater sense of purpose towards changing healthcare for the better: this includes diversifying opportunities for career advancement (such as advanced nurse practitioner roles), promoting nursing input within organisational change management, and wider multidisciplinary participation in the uptake of new clinical tools and technology – all these play a part in transforming how modern healthcare is delivered.
However, improving such incentives alone will be insufficient to address the issue at scale. Through the appropriate management structures and resource allocation processes, senior leadership must take accountability for the two root causes underlying the majority of healthcare staff dissatisfaction: pay and working conditions. The public deserves a sustainable and productive workforce fit for delivering 21st Century healthcare – and to meet that need in the long-term, commitment to significant change in the government’s healthcare budget is required to guarantee fair and reasonable pay alongside safe and equitable working conditions to bring the best out of the NHS’s employees.
Education and career flexibility
Addressing issues in our nation’s education system, particularly the mismatch of potential between secondary and tertiary education, is crucial. We have a significant pool of young talent in the UK that is underserved by the available opportunities beyond school. The difficult bridge between secondary and tertiary education stems from universities not fully equipping themselves for this new decade’s need for cross-disciplinary education. This generation of students, even within the rather traditional rails of healthcare, are not just learning for a vocation anymore; they are actively learning to become the next generation of change-makers. Naturally, they should play an ever-increasing role in determining how their skills will be used rather than having this pre-determined for them by academic ideals or by an industry prone to outdated management principles.
A more open-minded approach, similar to the liberal arts system in the US, could prevent specialisation too early in an individual’s developing career aptitude – and allow valuable breathing space for medical, nursing, and AHP students to mindfully forge their career paths in alignment with systemic needs. A few extra years of exposure and reflection can thus prevent the premature pigeonholing of developing talent (including missed opportunities in adjacent fields) and thereby also mitigate against the risk of disenfranchisement and / or mid-to-late career disillusionment. So, these two components – providing more flexibility in healthcare education and allowing individuals more autonomy in determining their career paths – are crucial.
And finally…
Addressing staff shortages within the NHS requires a multifaceted approach, including better alignment of training programs with current needs, strategic workforce management, and comprehensive policy implementation. So, while the proposed increases in staffing for mental healthcare and additional appointments are steps in the right direction, they must be supported by robust education, incentives and change management to be truly effective. In 2024 and beyond, Labour’s recommitment to strategic frameworks such as the NHS Long Term Workforce Plan will play a crucial role in addressing these factors across the board. By outlining clear strategies for recruitment, retention, and development, these frameworks aim to create a sustainable workforce capable of meeting the growing demands of the health service. Successful implementation will, of course, require substantial investment, responsive leadership, and a collaborative approach involving all levels of the NHS.
