Last reviewed 28 October 2021

Covid-19 has taken a heavy emotional and physical toll on people working in the health services, together with creating an imposing backlog of tests and treatment in all settings, ongoing demands dealing with the virus, a surge in demand for mental health services and persistent inequalities across the workforce.

The NHS now needs to focus on supporting and nurturing its people in the next phase if it is to minimise an increase in staff turnover and ensure that as many staff as possible who want to return to and stay in work in the long term are supported to do so.

Workforce in crisis

In the NHS Staff Survey 2020, 44% of staff reported feeling unwell as a result of work-related stress in the last 12 months, up from 40% in 2019. But the pre-pandemic survey had already recorded the highest ever levels of stress among NHS staff, more than 100,000 vacancies, and more than a third of GPs intending to leave. In February 2021, the British Medical Association (BMA) reported that 41% of doctors who responded to their Covid-19 tracker survey said they were suffering from depression, anxiety or another mental health condition.

The latest staff survey results showed that in the aftermath there is an urgent need to make progress on bullying, harassment and violence.

There is also a general consensus that addressing unwieldy issues around work overload, long-standing vacancies and systemic workplace discrimination, which were prevalent before Covid-19, is now even more of a priority, and in doing so the wellbeing of staff will be improved in the longer term.

Evidence on improving staff retention

A Skills for Care survey found that good social care employers with a low staff turnover of less than 10% described their main related activities as:

  • investing in learning and development, at 94%

  • embedding the values of their organisation, at 92%

  • celebrating the organisation’s and individual achievements, at 86%

  • involving colleagues in decision making, at 81%.

The independent charity for workforce development found that investment in staff retention helped with “continuity of high-quality care, positive workplace culture, staff wellbeing, time and cost savings, and positive CQC ratings”.

Areas for immediate action

Creating a supportive working environment where people feel valued and have a sense of belonging is a top priority for the NHS. General Medical Council (GMC) Chief Executive Charlie Massey told leaders at a virtual NHS Confederation conference in June that all the data supported this. He added: “That, I think, is one of the most important imperatives for all of us to think about over the months ahead.”

The NHS Confederation’s Putting People First framework has focused on the need for immediate support for staff to recover and re-energise. It said otherwise “the NHS will lose many of the people it needs to help tackle the backlog of care.” It is calling on organisations to use bespoke approaches for individuals and teams to create time to “decompress”, reflect, debrief, take part in supervision and plan for the future, although the idea of taking time to rest has been received with some scepticism from staff who are simply busier than ever before.

There are five main elements in the framework, which describes action at both local and national level to create an effective environment for retaining and sustaining staff in the aftermath of the pandemic:

  • rest and recovery

  • health and wellbeing

  • recognition and reward

  • visible and compassionate leadership

  • creating conditions to enable a reset.

It says local organisations and systems need autonomy and funding to choose the priority wellbeing support that their staff need. Some good news is that the score for staff perception of positive employer action on their wellbeing improved, rising to 33% in 2020 from a previous 29%.

Local organisations will also want to determine the most appropriate forms of recognition and reward for their staff, for example some have offered a “wellbeing day” off. Beyond this, there needs to be a sustainable and funded “reward package” that supports long-term attraction and retention. NHS Employers has guidance on using the NHS Pension Scheme as an incentive to support workforce retention, with information on retire and return. The BMA also has details on the GP Retention Scheme.

The latest staff survey showed falls in some scores for line manager support and a more negative perception on team working. The framework stresses how leaders at all levels will have to listen to staff, remove barriers and administrative burdens, and ensure people have the tools, skills and time to do their job. “Brave” and inclusive leadership is also essential if systemic issues of workforce inequality, magnified by Covid-19, are to be addressed. The King’s Fund explains in its piece, Five Myths of Compassionate Leadership, how leaders who listen, are empathetic and caring, and arrive at a shared understanding of the challenges faced, do not compromise their effective decision-making qualities.

We also recently published an article on the importance of raising Health and Wellbeing Conversations for Primary Care Staff, with tips on how employers should prioritise this.

Creating the conditions to enable a reset

The NHS Confederation added that the following conditions need to be in place to enable a reset for staff in the longer term.

  • A healthy environment with facilities for self-care, relaxation or communal space.

  • Specialist mental health support encompassing trauma, psychological safety and bereavement.

  • The ability to have some control over work, hours and setting, and balancing this with life outside of work.

  • Addressing workload and ensuring the right resources are available.

  • A compassionate culture of equality and inclusion.

  • A culture of learning and connection to one’s team, work and overall purpose.

  • The capacity and environment to think, innovate and deliver change.

Employers can also support the conditions for innovation in staff if they follow the ABC of core needs of staff, of “Autonomy, Belonging and Contribution”, explained by The King’s Fund here.

Government action

The CQC’s State of Care Report 2020-21 highlighted the absence of a comprehensive NHS People Plan. The August 2020 publication contained some measures on wellbeing and discrimination but was seen as a “stop-gap measure” as it only covered seven months and failed to include an implementation plan and targets.

The House of Commons Health and Social Care Select Committee's report on workforce burnout and resilience in the NHS, published May 2021, recommended that the Government instigate a requirement for publishing annual, independent workforce projections, and develop an approach to workforce planning that takes into consideration capacity and demand, and makes clear “the opportunity cost of not training, employing and retaining sufficient numbers of staff”.