Second Report - Workforce burnout and resilience in the NHS and social care
- HC No.
- HC 22
- Published
- 8 Jun 2021
- Items
- 33
- Response
- Response document linked Read government response ↗
Select Committee · Health and Social Care Committee
Workforce burnout and resilience in the NHS and social care
Status: Closed
Opened: 30 Jul 2020
Closed: 22 Feb 2022
26 recommendations
7 conclusions
1 report
Inquiry scope
This inquiry will focus on workforce burnout and resilience across the NHS and social care. It will look at: burnout, resilience and stress levels before and during the covid-19 pandemic the impact of workforce burnout on service delivery, staff, patients and service users workforce planning and projections the measures set out in the NHS People Plan any further measures required to tackle burnout, including how to achieve parity for the social care workforce. Read the call for evidence for more detail about the inquiry .Reports
Recommendations & Conclusions
Burnout is a widespread reality in today’s NHS and has negative consequences for the mental...
Conclusion · source text
Burnout is a widespread reality in today’s NHS and has negative consequences for the mental health of individual staff, impacting on their colleagues and the patients and service users they care for. There are many causes of burnout, but chronic excessive workload is a key driver and must be tackled as a priority. This will not happen until the service has the right number of people, with the right mix of skills across both the NHS and care system.
Department of Health and Social Care
Understanding the scale and impact of workforce burnout can only be achieved with a metric...
Recommendation · source text
Understanding the scale and impact of workforce burnout can only be achieved with a metric for staff wellbeing and staff mental health that covers both the NHS and social care. We therefore recommend that the Department for Health and Social Care extends the NHS Staff Survey to cover the care sector.
Department of Health and Social Care
We further recommend that the NHS Staff Survey and any social care equivalent includes an...
Recommendation · source text
We further recommend that the NHS Staff Survey and any social care equivalent includes an overall staff wellbeing measure, so that employers and national bodies can better understand staff wellbeing and take action based on that understanding. The Staff Survey already allocates a scale out of 10 for each ‘theme’ it covers, which could provide the starting point for the calculation of such a measure.
Department of Health and Social Care
We welcome the additional support provided to health and care staff during the pandemic.
Recommendation · source text
We welcome the additional support provided to health and care staff during the pandemic. However, we conclude that such additional support will need to be maintained during the recovery period and beyond to stop further staff from leaving. Furthermore simply offering support services, however important, is not on its own enough. The Department and employers need to ensure that those services are accessible to all and used by all who need them. This will require removing barriers to seeking help, and embedding a culture where staff are explicitly given permission and time away from work to seek help when it is needed.
Department of Health and Social Care
We recommend that Integrated Care Systems (ICSs) be required to facilitate access to wellbeing support...
Recommendation · source text
We recommend that Integrated Care Systems (ICSs) be required to facilitate access to wellbeing support for NHS and social care workers across their systems, and that they are accountable for the accessibility and take-up of those services.
Department of Health and Social Care
We further recommend that the level of resources allocated to mental health support for health...
Recommendation · source text
We further recommend that the level of resources allocated to mental health support for health and care staff be maintained as and when the NHS and social care return to ‘business as usual’ after the pandemic; and that the adequacy of resources allocated to that support be monitored on a regular basis. (Paragraph 40) Workplace culture
Department of Health and Social Care
It is imperative staff have the opportunity and the confidence to speak up.
Recommendation · source text
It is imperative staff have the opportunity and the confidence to speak up. However, this needs to be matched with a culture in which organisations demonstrate that they are not just listening to, but also acting on, staff feedback. While NHS organisations have a formal structure to raise concerns through Freedom to Speak Workforce burnout and resilience in the NHS and social care 55 Up Guardians, there is no equivalent for adult social care. We therefore recommend that the Department develops a strategy for the creation of Freedom to Speak Up Guardians in social care.
Department of Health and Social Care
Improvements to workplace culture have been made, but equally, there is more work to be...
Recommendation · source text
Improvements to workplace culture have been made, but equally, there is more work to be done. Embedding and facilitating cultures which support compassionate leadership must be at the heart of that work. There is a strong appetite for that leadership from both managers and staff, but structural barriers remain. The Department, the NHS and individual trusts need to focus on removing those barriers so that their leaders can lead to their full potential. The establishment of statutory Integrated Care Systems provides an opportunity for those systems to lead a transformation of support for NHS leaders in their areas that includes mental health support, development of proper career structures, and a review of targets.
Department of Health and Social Care
We recommend that NHS England undertake a review of the role of targets across the...
Recommendation · source text
We recommend that NHS England undertake a review of the role of targets across the NHS which seeks to balance the operational grip they undoubtedly deliver to senior managers against the risks of inadvertently creating a culture which deprioritises care of both staff and patients.
Department of Health and Social Care
We further recommend that the Department of Health and Social Care work with stakeholders to...
Recommendation · source text
We further recommend that the Department of Health and Social Care work with stakeholders to develop staff wellbeing indicators, on which NHS bodies can be judged.
Department of Health and Social Care
The Committee welcomes the Workforce Race Equality Standard (WRES), along with the People Plan, as...
Recommendation · source text
The Committee welcomes the Workforce Race Equality Standard (WRES), along with the People Plan, as an important step towards an NHS which offers equal opportunities to all its staff. We were pleased to hear in our oral evidence session that work had begun to provide similar information to the WRES in social care. This year’s WRES report concludes that ‘now is the time to translate the data to actions.’ We agree. Part of this must be to ensure that the boards of the new ICSs appropriately represent the populations they serve.
Department of Health and Social Care
We therefore recommend that WRES data be made part of the ‘balanced basket of indicators’...
Recommendation · source text
We therefore recommend that WRES data be made part of the ‘balanced basket of indicators’ we suggest for Integrated Care Systems, with the result that they become accountable for progress across their domains. As part of this process, organisations should set themselves ambitious yet achievable targets that include timings.
Department of Health and Social Care
We heard that colleagues from Black, Asian and minority ethnic backgrounds across the NHS and...
Conclusion · source text
We heard that colleagues from Black, Asian and minority ethnic backgrounds across the NHS and social care continue to face additional challenges. As stated above, we welcome the commitments of the People Plan to a truly inclusive workforce, and the accountability brought by the WRES. But the People Plan does not include social care, which means there are no plans in place to tackle discrimination in a workforce of over 1.6 million people.
Department of Health and Social Care
We recommend that adult social care have its own People Plan, which includes parallel commitments...
Recommendation · source text
We recommend that adult social care have its own People Plan, which includes parallel commitments to those for the NHS on diversity and inclusion.
Department of Health and Social Care
Staff from overseas play a key role in enabling the NHS and social care to...
Recommendation · source text
Staff from overseas play a key role in enabling the NHS and social care to function. Whatever role overseas staff will play in the long-term, they are essential to the health and social care system in the short-term and medium-long term because any 56 Workforce burnout and resilience in the NHS and social care move to shift to more domestic supply is likely to take time. Workforce planning, in both the NHS and social care therefore will need to include strategies for the recruitment, transition, and training of overseas workers in the health and care sector.
Department of Health and Social Care
We recommend that the Department develops an NHS and social care national policy framework around...
Recommendation · source text
We recommend that the Department develops an NHS and social care national policy framework around migration to support national and local workforce planning and identify the balance between domestic and international recruitment in the short, medium and long-term. (Paragraph 91) The impact of covid-19 on burnout
Department of Health and Social Care
Covid-19 has exacerbated existing problems with staff welfare, but also brought some benefits, including higher...
Conclusion · source text
Covid-19 has exacerbated existing problems with staff welfare, but also brought some benefits, including higher levels of recognition and different ways of working. While enhanced recognition of the work of health and care staff is welcome, adequate and holistic support for their mental health and wellbeing is of primary importance. That support was not just needed during the waves of covid-19: it will be needed through the recovery as the health and care sector returns to ‘business as usual’.
Department of Health and Social Care
We recommend that national bodies must continue to monitor the impact of covid-19 on the...
Recommendation · source text
We recommend that national bodies must continue to monitor the impact of covid-19 on the NHS and adult social care workforce and ensure that workforce planning builds in time for recovery after the pandemic is over.
Department of Health and Social Care
We recommend that the Department of Health and Social Care, the national bodies, and individual...
Recommendation · source text
We recommend that the Department of Health and Social Care, the national bodies, and individual organisations across the NHS and social care commit to capturing and disseminating the innovations—in particular giving greater levels of autonomy to staff and new forms of integrated working—during the pandemic so that they can be embedded in organisations as they return to ‘business as usual’.
Department of Health and Social Care
It is clear from the evidence collected by Government, the NHS and other organisations that...
Recommendation · source text
It is clear from the evidence collected by Government, the NHS and other organisations that staff from Black, Asian and minority ethnic groups have been disproportionately affected by the pandemic in a way that has shone a light on deeply worrying divisions in society. Both the Public Health England and BAME Communities Advisory Group reports set out a series of actions to address this problem. We recommend that the Department set out how it plans to implement those recommendations, with a corresponding timeframe.
Department of Health and Social Care
We further recommend that Integrated Care Systems have a duty to report on progress made...
Recommendation · source text
We further recommend that Integrated Care Systems have a duty to report on progress made against those recommendations made to improve the support for their staff from Black, Asian and minority ethnic backgrounds. (Paragraph 134) Workforce planning
Department of Health and Social Care
It is clear from our witnesses that although the People Plan presents comprehensive ambition to...
Conclusion · source text
It is clear from our witnesses that although the People Plan presents comprehensive ambition to address the failings in the culture of the NHS, and address the needs and wellbeing of NHS staff, its delivery will depend on the level of resourcing allocated to these priorities. Without adequate funding the laudable aspirations of the People Plan will not become reality. (Paragraph 161) Workforce burnout and resilience in the NHS and social care 57
Department of Health and Social Care
We recommend that the Department published regular, costed updates along with delivery timelines for all...
Recommendation · source text
We recommend that the Department published regular, costed updates along with delivery timelines for all of the proposals in the People Plan.
Department of Health and Social Care
The absence of a People Plan for social care serves only to widen the disparity...
Recommendation · source text
The absence of a People Plan for social care serves only to widen the disparity in recognition and support for the social care components of health and social care. The Government should rectify this as a matter of urgency in their upcoming work to reform the social care sector; and it is essential that it is included in the social care reforms promised this year. The adult social care workforce has stepped up to the plate during the pandemic. They deserve the same care and attention that the People Plan pledges to NHS colleagues.
Department of Health and Social Care
We therefore recommend that, as a priority, the Department produces a People Plan for social...
Recommendation · source text
We therefore recommend that, as a priority, the Department produces a People Plan for social care that is aligned to the ambitions set out in the NHS People Plan.
Department of Health and Social Care
We have made recommendations to the Department on the reform and funding of social care...
Conclusion · source text
We have made recommendations to the Department on the reform and funding of social care in previous Reports. We believe that they are worth restating. Those recommendations are as follow:
Department of Health and Social Care
(a) Alongside […] a long term funding settlement we strongly believe the Government should publish...
Recommendation · source text
(a) Alongside […] a long term funding settlement we strongly believe the Government should publish a 10 year plan for the social care sector as it has done for the NHS. The two systems are increasingly linked and it makes no sense to put in place long term plans for one without the other. Failure to do so is also likely to inhibit reform and lead to higher costs as workforce shortages become more pronounced with higher dependency on agency staff. Reducing the 30% turnover rates typical in the sector will also require a long term, strategic approach to social care pay and conditions. (Social care: funding and workforce, Third Report of Session 2019–21, Paragraph 37).
Department of Health and Social Care
(b) The social care sector needs reassurance that both the structural and financial problems it...
Recommendation · source text
(b) The social care sector needs reassurance that both the structural and financial problems it faces will be tackled by the Government in a timely way. For that reason, we recommend that a duty is included in the Bill for the Secretary of State to publish a 10-year plan with detailed costings within six months of the Bill receiving Royal Assent. (The Government’s White Paper proposals for the reform of Health and Social Care, First Report of Session 2021–22, paragraph 65). (Paragraph 167) Conclusion: Bringing together the post-pandemic response with better workforce planning
Department of Health and Social Care
The emergency that workforce burnout has become will not be solved without a total overhaul...
Conclusion · source text
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.
Department of Health and Social Care
The way that the NHS does workforce planning is at best opaque and at worst...
Conclusion · source text
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. (Paragraph 183) 58 Workforce burnout and resilience in the NHS and social care
Department of Health and Social Care
It is clear that workforce planning has been led by the funding envelope available to...
Recommendation · source text
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.
Department of Health and Social Care
We recommend again, that Health Education England publish objective, transparent and independently-audited annual reports on...
Recommendation · source text
We recommend again, that Health Education England publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained. We further recommend that such workforce projections cover social care as well as the NHS given the close links between the two systems.
Department of Health and Social Care
We further recommend that those projections: • Are informed by the future shape of services...
Recommendation · source text
We further recommend that those projections: • Are informed by the future shape of services and anticipated demand. • Take into account the labour market as a whole. • Make clear the opportunity cost of not training, employing and retaining sufficient numbers of staff. (Paragraph 186) Workforce burnout and resilience in the NHS and social care 59
Department of Health and Social Care
Oral evidence sessions
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| Date | Session and witnesses | Source |
|---|---|---|
| 24 Feb 2021 | Anita Charlesworth · Health Foundation, Helen Whately MP · Department of Health and Social Care, Oonagh Smyth · Skills for Care, Prerana Issar · NHS England and NHS Improvement, Rob Smith · Health Education England | View ↗ |
| 12 Jan 2021 | Chris Hopson · NHS England, Dr Henrietta Hughes, National Guardian, Helené Donnelly OBE · Midlands Partnership NHS, Lord Victor Adebowale · NHS Confederation, Professor Jeremy Dawson · Sheffield University, Shilpa Ross · The King's Fund, Tricia Pereira · London Borough of Merton | View ↗ |
| 17 Nov 2020 | Denise Crouch, Macmillan Lead Cancer Nurse, Dr Adrian James · The Royal College of Psychiatrists, Dr Chaand Nagpaul · Council of the British Medical Association, Paul Farmer · Mind - on behalf of Our Frontline, Professor Dame Clare Gerada · NHS Practitioner Health, Vic Rayner · National Care Forum | View ↗ |
| 20 Oct 2020 | Bernie Miller · Lancashire Teaching Hospitals NHS Foundation Trust, Caroline Waterfield · NHS Employers, Claire Murdoch · NHS England, Jo Da Silva · Agincare, Prerana Issar · NHS England and NHS Improvement, Professor Martin Green · Care England, Professor Michael West · The King's Fund | View ↗ |
Written evidence
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| Reference | Date | Submitter |
|---|---|---|
| WBR0112 | 24 May 2021 | Helene Donnelly, Midlands Partnership NHS |
| WBR0081 | 12 May 2021 | London South Bank University |
| WBR0111 | 11 May 2021 | Transcript of interviews with health and care workers |
| WBR0110 | 13 Apr 2021 | NHS England and NHS Improvement |
| WBR0109 | 13 Apr 2021 | Hft |
| WBR0108 | 25 Feb 2021 | Anita Charlesworth, Health Foundation |
| WBR0087 | 15 Dec 2020 | Nuance Communications |
| WBR0107 | 15 Dec 2020 | Ann Paul, Doctors in Distress |
| WBR0106 | 25 Nov 2020 | Jane Cox, MHA (Methodist Homes) |
| WBR0105 | 25 Nov 2020 | Hannah Collins, Boundless |
| WBR0104 | 25 Nov 2020 | Mr Peter Hand, The Working Group of the APPG on Adult Social Care |
| WBR0103 | 25 Nov 2020 | WPI Strategy |
| WBR0100 | 25 Nov 2020 | Professor Jill Maben, University of Surrey |
| WBR0099 | 25 Nov 2020 | Royal College of Anaesthetists |
| WBR0098 | 25 Nov 2020 | The College of Podiatry |
| WBR0096 | 25 Nov 2020 | Medical and Dental Defence Union of Scotland (MDDUS) |
| WBR0095 | 25 Nov 2020 | Mrs Lucy Johnston, Edinburgh Napier University |
| WBR0094 | 25 Nov 2020 | Bliss |
| WBR0093 | 25 Nov 2020 | British Association of Social Workers |
| WBR0092 | 25 Nov 2020 | St John Ambulance |
| WBR0091 | 25 Nov 2020 | Sacred Space Foundation |
| WBR0089 | 25 Nov 2020 | Pharmaceutical Services Negotiating Committee |
| WBR0088 | 25 Nov 2020 | OxfamGB |
| WBR0086 | 25 Nov 2020 | Mesothelioma UK Research Centre Sheffield |
| WBR0085 | 25 Nov 2020 | Adult Social Care Taskforce Workforce Advisory Group & National Care Forum |
| WBR0083 | 25 Nov 2020 | The Disabilities Trust |
| WBR0082 | 25 Nov 2020 | Dr Daniele Carrieri, University of Exeter |
| WBR0079 | 25 Nov 2020 | Professor Tom Bourne, Imperial College London |
| WBR0080 | 6 Oct 2020 | Nursing and Midwifery Council |
| WBR0078 | 22 Sep 2020 | General Dental Council |
| WBR0077 | 22 Sep 2020 | Department of Health and Social Care |
| WBR0076 | 22 Sep 2020 | Royal College of GPs |
| WBR0015 | 15 Sep 2020 | FirstCare |
| WBR0014 | 15 Sep 2020 | Carers Trust |
| WBR0012 | 15 Sep 2020 | Care England |
| WBR0011 | 15 Sep 2020 | Paediatric Intensive Care Society |
| WBR0010 | 15 Sep 2020 | LGA |
| WBR0009 | 15 Sep 2020 | Academy of Medical Royal Colleges |
| WBR0008 | 15 Sep 2020 | "Don't ever call us unskilled again! Learning from the experience of support workers during Covid-19 Sally Warren, Paradigm Training and Development Agency and the Gr8 Support Movement |
| WBR0007 | 15 Sep 2020 | NHS Providers |
| WBR0006 | 15 Sep 2020 | Dr Clifford Lisk, Barnet hospital, Royal Free Hospital NHS foundation trust |
| WBR0030 | 15 Sep 2020 | Diocese of Rochester |
| WBR0029 | 15 Sep 2020 | Anchor Hanover |
| WBR0028 | 15 Sep 2020 | Association of Anaesthetists |
| WBR0027 | 15 Sep 2020 | UNISON |
| WBR0026 | 15 Sep 2020 | Bournemouth University |
| WBR0025 | 15 Sep 2020 | Royal College of Midwives |
| WBR0023 | 15 Sep 2020 | Royal College of Physicians |
| WBR0022 | 15 Sep 2020 | Sue Ryder |
| WBR0021 | 15 Sep 2020 | CLIC Sargent |
Who gave evidence
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| Witness | Organisation | Sessions |
|---|---|---|
| Prerana Issar · Chief People Officer | NHS England and NHS Improvement | 2 |
| Anita Charlesworth · Senior Economic Adviser | Health Foundation | 1 |
| Bernie Miller · Clinical Lead, Discharge Lounge | Lancashire Teaching Hospitals NHS Foundation Trust | 1 |
| Caroline Waterfield · Director of Development and Employment | NHS Employers | 1 |
| Chris Hopson · Chief Strategy Officer | NHS England | 1 |
| Claire Murdoch · National Director for Mental Health | NHS England | 1 |
| Denise Crouch, Macmillan Lead Cancer Nurse | — | 1 |
| Dr Adrian James · President | The Royal College of Psychiatrists | 1 |
| Dr Chaand Nagpaul · Chair | Council of the British Medical Association | 1 |
| Dr Henrietta Hughes, National Guardian | — | 1 |
| Helen Whately MP · Minister of State | Department of Health and Social Care | 1 |
| Helené Donnelly OBE · Ambassador for Cultural Change / Lead Freedom to Speak Up Guardian | Midlands Partnership NHS | 1 |
| Jo Da Silva · Care Worker | Agincare | 1 |
| Lord Victor Adebowale · Chair | NHS Confederation | 1 |
| Oonagh Smyth · Chief Executive Officer | Skills for Care | 1 |
| Paul Farmer · Chief Executive | Mind - on behalf of Our Frontline | 1 |
| Professor Dame Clare Gerada · Medical Director | NHS Practitioner Health | 1 |
| Professor Jeremy Dawson · Professor of Health Management | Sheffield University | 1 |
| Professor Martin Green · Chief Executive | Care England | 1 |
| Professor Michael West · Senior Visiting Fellow | The King's Fund | 1 |
| Rob Smith · Workforce Planning and Intelligence Director | Health Education England | 1 |
| Shilpa Ross · Policy Fellow | The King's Fund | 1 |
| Tricia Pereira · Head of Operations Adults Social Care & Adult Safeguarding | London Borough of Merton | 1 |
| Vic Rayner · Executive Director | National Care Forum | 1 |
Correspondence
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| Published | Direction | Letter |
|---|---|---|
| 16 Mar 2021 | To committee | Letter from the Minister of State for Care on improving accountability across adult social care |
| 22 Oct 2020 | From committee | Letter to the Chief People Officer on Workforce projections |