Second Report - Workforce burnout and resilience in the NHS and social care

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

We recommend that adult social care have its own People Plan, which includes parallel commitments to those for the NHS on diversity and inclusion.

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.

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

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’.

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.

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’.

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.

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

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

We recommend that the Department published regular, costed updates along with delivery timelines for all of the proposals in the People Plan.

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.

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.

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:

(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).

(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

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.

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

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.

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.

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