Staffing challenges are a well-known issue for the NHS in England. As of 2024, the vacancy rate stands at 7.6%, which translates to around 110,0001 full-time equivalent positions unfilled. This is a widespread problem, affecting all regions of the UK. There are notable regional disparities: coastal areas2, for instance, have 15% fewer consultants and 7% fewer nurses per patient compared to inland regions, while deprived areas suffer from a shortage of GPs3. Although some specialities are less affected, a staffing crisis in any particular speciality or sector can quickly worsen. As pressures increase on the remaining staff, their roles may become unsustainable, leading to a downward spiral in staffing levels. The ageing population is an additional and increasingly negative pressure on the ability of staff to maintain appropriate care standards.
The reasons staff leave their jobs in healthcare are well known4: the top three are burnout, lack of work-life balance and low pay. When staff leave, the remaining workers tend to be younger and less experienced, and they are left to shoulder the load. Tasks take longer, and a greater training burden falls on the remaining seniors resulting in even less clinical time for direct patient care. The use of agency and bank staff to fill staff shortages, whilst necessary, is not a good solution. Continuity of care is lost and the cost to the NHS is eye-watering.
Making healthcare careers more attractive leads to stronger staff recruitment and better retention, improved patient care and job satisfaction. This helps to fill vacancies creating an upward recruitment spiral, rather than the current downward trend.
The motivation for recruitment of NHS worker-groups is diverse. There is not a single fix that will resolve the problems for every staffing group. There are common elements of staff retention practice which are attractive to all staff and identifiable in most workplaces. Many of these positive elements don’t adversely impact budgets, and others can usually be funded by savings on current agency staffing costs and improved clinical efficiency.
Job satisfaction is a key ‘reward’ which counts for a lot among healthcare workers. Careers in healthcare are relationship-based (with patients and/or colleagues ), and when many of us feel or develop a vocational draw, we become emotionally invested. We all experience a sense of achievement when we have made a difference. An acceptable level of income for the role is important, as are resourcing, work intensity and a good working environment. Each element will vary in relative importance between individual staff members, depending on age, background and profession.
Staff in demanding jobs benefit from feeling ‘looked after’ by their employer. This can also have a powerful influence on the general culture of the organisation, positively impacting on service quality as well as staff retention. Feeling valued and safe at work, combined with good colleague relationships, creates a positive culture which impacts on patient care in the best organisations. Developmental training opportunities and possibilities for career advancement also help staff feel appreciated and valued5. Good working practices, staffing levels, professional autonomy and empowerment as well as opportunities to use their skills and judgement, all contribute to a sense of wellbeing among staff. Fairness and equality in the workplace are also key.
Staff shortages frequently lead to increased pressure on staff related to patient care, which in turn causes stress and diminishes job satisfaction. These conditions are linked to a rise in clinical errors. Fostering a ‘no blame’ culture that offers learning opportunities from mistakes can distinguish between a unit experiencing high staff turnover and one with strong retention of clinical team members. Unpredictable working hours can be another important retention issue for carers and those with young families or outside commitments. This also tends to be associated with suboptimal staffing levels.
Addressing the NHS staffing problem fundamentally requires compassionate and effective leadership at all levels. Even the most overburdened managers have the potential to make a significant impact. However, without adequate support from the overall NHS organisation, healthcare leaders struggle to support their teams or foster the kind of positive institutional culture that can help retain experienced staff and attract new recruits. The competence of leadership within organisations largely depends on the training, resources, and manageable workloads available to them.
The challenges facing the NHS often lead to a quick attribution of blame towards managers for clinical and patient care shortcomings. However, it’s essential to consider that while managers constitute 9.5% of the UK workforce overall, they make up only 2% of those working in the NHS1. This discrepancy highlights the need to enhance their roles through well-defined career pathways and increased respect from the teams they lead. Developing managerial career pathways and improving the perception and effectiveness of NHS managers are necessary steps.
To foster better accountability in decision-making among medical managers, it is critical to regulate the managerial profession and to recognise and reward those who promote a positive organisational culture. This strategy could play a substantial role in addressing the ongoing recruitment and retention crises in the NHS. Relying solely on pay settlements does not suffice, as NHS staff value strong clinical leadership and a supportive organisational environment, both of which are crucial to maintaining their dedication to the profession.
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