A build-up in staff shortages in both the NHS and social care due to mistakes made over the previous decade by the Conservative government has now led to such high levels of burn-out rates and staff turnover that the services are in danger of not working properly, a cross-party committee of MPs has been told. 


The burn-out resulting from chronic workplace stress results in some to take time off sick, others to reduce their working hours, resign or take early retirement, which in turn makes the situation worse for those left. 


Dr David Wrigley, the British Medical Association’s wellbeing lead, told the Health and Social Care select committee: “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.”


Burn-out is a widespread reality in today’s NHS, noted the committee; burn-out damages the health of staff, and affects care safety and quality. It is linked with high turnover and intention to quit, along with higher levels of patient mortality in the acute sector. 


A major driver of burn-out is “chronic excessive workload” and the key to tackling it is having the right number of people, with the right mix of skills across both the NHS and care system – good workforce planning.


The committee was told that there were an estimated 85,000 vacancies in the NHS in England and 112,000 unfilled posts in social care before the pandemic struck.  All predictions show that this is set to get worse:


The Health Foundation has predicted that the NHS in England is likely to require workforce growth of 3.2% a year over the next 15 years, which “implies a requirement of a projected 179,000 additional FTE staff by 2023–24, rising to 639,000 additional FTE staff by 2033/34”. 


The health thinktank The King’s Fund told the committee the current approach to workforce planning, was “incoherent” and that funding for education and training was “inadequate” with a “reliance on overseas recruitment”. In written evidence the King’s Fund noted that since the 2012 Health and Social Care Act responsibilities for workforce planning had been fragmented and there has been “a lack of clarity” at a national level. More recently a number of policy decisions (on, for example, immigration, English language testing and student bursaries) made “improvement harder rather than easier.”


The Government has for many years based workforce planning on the funds available rather than on the demand and the capacity needed to cope with that demand. This has been a fundamental error that has led to the high number of vacancies. 


The Royal College of Nursing is warning that NHS trusts are now recruiting people without the right qualifications to act as registered nurses, despite the risk to patients; another outcome of poor workforce planning over the past decade that has left the country with a shortage of nurses.


“Filling registered nurse vacancies with those who are not registered nurses is not filling those vacancies,” said RCN Acting General Secretary & Chief Executive Pat Cullen. “Acting in this way not only leads to vacancies elsewhere but also carries a risk to patient care.”


Although using a deeply flawed approach, long-term workforce planning has at least been attempted in the NHS, the latest being the June 2019, the Interim NHS People Plan, in social care there has been no such approach. 


The social care workforce is “if anything even more fragile than the NHS” the King’s Fund told the Committee. The staff turnover rate was estimated to be 30.8% by the organisation Skills for Care in 2018/19. Skills for Care estimates that if the adult social care workforce grows at the same rate as the projected number of people aged 65 and over in the population, then the number of adult social care jobs will increase by 32% (or by 520,000 jobs), to around 2.17 million jobs by 2035.


What is now urgently needed, the committee concluded, is a comprehensive 10-year plan for social care, however the committee noted that it had called for such a plan from the government previously, as has the Care Quality Commission (CQC), and those in the private and voluntary sector of social care, all to no avail.  


In his oral evidence to the committee Professor Martin Green of Care England, called for a 10- year plan for social care that was “aligned on every level” with the NHS People Plan and included workforce issues, skills mix, support for staff and how to ensure that “we retain as well as recruit the right people”.


For both the NHS People Plan and, if forthcoming a plan for social care, it was made very clear to the committee, that however ambitious the plans to address workforce issues are, nothing will come of them unless they are funded sufficiently. 


The most recent NHS People Plan was widely criticised for the lack of detail and the lack of funding attached to the plan.  The King’s Fund described the People Plan as “another stop-gap that falls a long way short of the workforce strategy needed”, and the NHS Confederation said that “too many investment decisions have been postponed or clarity has not been forthcoming, especially with the longstanding need to address vacancies”.


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