Are we addressing the workforce risks in managing the elective backlog?

To succeed in reducing the waiting list for elective care, we must resolve workforce issues.

NHS Confederation
James Devine
11 June 2021

With emerging concerns about NHS workforce burnout, high vacancy levels (which predate the COVID-19 crisis) and a likely mental health pandemic, the NHS Confederation’s new Acute Network hosted a webinar to ask whether NHS leaders are truly addressing the workforce risks associated with dealing with the elective backlog. James Devine considers what we found.

With what is now thought to be in excess of 5 million patients waiting for surgery or treatment, 

  • high occupancy levels reported in some hospitals, 
  • higher acuity of patients presenting at emergency departments, 
  • and hospitals with clear and expected performance trajectories, 

we asked a panel of experts whether they felt the NHS is doing enough to support a tired workforce.

Running on empty

There is no doubt that both clinical and non-clinical teams across health and care are working tirelessly to see and treat as many patients as possible following the reduction in COVID-19 admissions and the return to elective care. That, coupled with the positive impact of the vaccine, provides some optimism.

But significant concerns were raised over potentially losing current workforce support measures — which need to remain in place over the next 12–24 months — with one panellist warning of a ‘post-COVID-19 mental health pandemic’ affecting health and social care workers.

… with one panellist warning of a ‘post-COVID-19 mental health pandemic’ affecting health and social care workers.

A need for early support, for colleagues to pace themselves and to retain flexible work practices were also key talking points. 

But of concern was the number of attendees (65 per cent) who felt that their trust wasn’t yet doing enough to support a tired workforce.

Committed to the cause

Panel members and attendees alike described wellbeing initiatives aimed at supporting colleagues, many of which have been in place and enhanced over the last 12 months. Some trusts are also expanding this offer to reflect the wider economic impact of the pandemic on the families of those they employ, and supporting the subsequent stress and anxiety this may cause colleagues, regardless of seniority.

The discussion turned to colleagues feeling guilty for taking time off or being unwell, a view corroborated by the most recent NHS Staff Survey, which revealed that almost half of respondents had come to work despite feeling unwell. A statistic that cannot be ignored.

In considering teams, one panel member talked about team resilience and how support offerings should focus on teams as well as individuals — and a fear that high turnover in the coming months could become a reality at those trusts that do not genuinely invest in these areas. 

Moving away from traditional workforce metrics will be critical in understanding turnover; particularly given that, in the main, improvements in attrition rates have been largely due to individuals being committed to the cause, rather than improved retention initiatives.

“Do we really know what our colleagues are carrying in their ‘invisible ruck-sac?” Webinar delegate

Early warning signs

The balance of meeting agreed performance trajectories, capacity and capital challenges and the threat of a future surge of COVID-19 patients further stress the importance of understanding the impact on the workforce (clinical and non-clinical) and a view that trust boards must have better grip and oversight. 

Moving away from traditional workforce data is needed to have early warning signs that performance may be impacted by absence, morale or even poor leadership, and provide evidence that pressures are being taken seriously.

Moving away from traditional workforce data is needed to have early warning signs that performance may be impacted

Taking the long view

Concerns were raised about clinical colleagues in particular using a post-pandemic period as a point of life reflection, and potentially retiring earlier than planned. This puts in to focus whether trusts are doing enough on longer-term workforce planning. 

But to do that, they must better understand the risks of the impact of the pandemic on people and plan for what is genuinely needed based on data, demand, capacity and capital requirements — not using existing financial envelopes as the parameters.

Those points of life reflection will also include how supported colleagues feel during tough times — but also how NHS leadership teams respond to those verbal and non-verbal requests for support. 

With concern of individuals displaying signs of PTSD, it will be vital that leaders are supported in noticing these signs so they can act early.

It is clear that many trusts are doing several great things to support our workforce as we move into a period of focus on elective demand. 

But with many of the risks not yet fully understood or indeed stated at board level, there is a risk that trusts will see increases in turnover, low morale and performance trajectories not being met — with the only course of action being reactive and perhaps more draconian, rather than being proactive now. 

How many boards see detailed and triangulated data on morale, engagement, incidents, performance, turnover by department?

Finally, discussion moved to the vaccination programme, and it was felt that the programme had brought optimism and comfort to individuals, with most being appreciative that they were able to receive their vaccine early on.

The ongoing debate on whether the vaccination should be mandatory for health workers drew, perhaps unsurprisingly, an even split among delegates, with 52 per cent believing it should be mandatory and 48 per cent believing it should not. That debate will, I’m sure, rumble on.

Three takeaways

The webinar yielded three key takeaways to support trusts:

  1. Fully understand and discuss the workforce risks with the same importance at board level as quality, safety and finance.
  2. Improve the focus on longer-term workforce planning across a system, and be unforgiving about what is needed, moving away from the financial envelope being the set parameters.
  3. Continue to support the wellbeing of health and care colleagues — and ensure the same support is there whenever it is needed.

James Devine is network director of the NHS Confederation’s Acute Network

Originally published at

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