The Ward Round: ‘It feels explosive’

Winter is never easy in the NHS. Last year, with the winter 20-21 covid wave under way, it would have felt to many that things couldn’t get much worse.

But this year, although there is the welcome protection of a largely vaccinated population, health services around the country are reporting their busiest days ever, ambulance services are warning of harm being caused by long delays and the elective backlog is ever growing.

Along with this pressure, further requirements are being piled on staff and employers; last week the government announced its booster acceleration campaign intended to dampen the impact of the Omicron variant.

In a letter sent from NHS England to ICS leaders last week, it confirmed “all national NHS organisations have now been asked to deploy their registered healthcare professionals into vaccination services”.

Clinical students were also asked to work bank shifts to help the effort, NHS Professionals have been asked to recruit more vaccinators and a new volunteer drive has been launched.

The letter itself admits that workforce is a “rate-limiting factor for increasing capacity, particularly in rural areas”, but points to other measures – including military support – which it suggests will help.

Despite this, calling on NHS organisations to free up registered healthcare professionals to join the vaccination effort is a monumental ask. When talking to healthcare leaders, there is a sense of ‘we’ve done it once, we can do it again’, but also real concern about where these staff will come from.

One GP described how they were “haemorrhaging staff” at all roles and levels, and criticised the bureaucracy bound up with the vaccination campaign, describing it as simply “not sustainable”.

“It feels as if we’re reaching the end,” they said. “It feels explosive.”

And along with this, trust leaders may also be anxiously thinking about the target to have all patient-facing staff vaccinated by April 2022, with further guidance published on Monday suggesting employers should start planning for potential redeployment of unvaccinated staff.

“Thanks government for giving us an ever more complex workforce issue to navigate. We all had plenty of spare time this winter…” said one HSJ reader below our report on this.

However, when speaking to senior workforce leaders about the potential redeployment challenge, they stressed trusts and other organisations should be focusing their attention on “engagement and education” rather than worrying too much about redeploying staff this side of February.

NHS Providers chief executive Chris Hopson has also this week called on the government to “acknowledge the scale of workforce problems”.

“This level of pressure on our workforce is totally unsustainable and it cannot go on much longer. It’s now risking patient safety, quality of care and staff health and wellbeing. We can’t keep trying to cover the mismatch between NHS capacity and demand for care by asking our staff to work harder and harder,” Mr Hopson said.

But what should be done about this mismatch?

Mr Hopson has called for the Health and Care Bill to be amended to provide a “rigorous long-term approach” to working planning, which every two years will set out what the workforce needs in the short, medium and long term. NHS Providers also calls for Health Education England’s training budget to be increased.

This echoes Lord Simon Steven’s maiden speech in the House of Lords yesterday, in which he supported an amendment to the Health Bill proposed by House of Commons Health and Social Care Committee chair Jeremy Hunt, which would force the government to publish independent workforce projections biennially.

Lord Stevens said he supported the insertion of a similar measure by the Lords into the bill and described the “resilience of the workforce” as the major challenge facing health and social care.

“For many years now, we’ve been promised a detailed, funded and properly thought through workforce plan… and yet when that detailed plan is about to be produced, it’s muzzled [by HMT],” Lord Stevens said.

HSJ reported last month on the failure of the government to announce a settlement for HEE and workforce education and training, and it is understood the merger of HEE and NHSE was a trade off to enable an agreement to be reached. However, we understand negotiations remain ongoing.

This settlement will of course be looking to the future. The only way to plug immediate workforce vacancies is to try to persuade existing staff to take on additional bank shifts – an even tougher ask than usual this winter.

But with warnings from trust leaders that its becoming increasingly hard to maintain safe staffing levels –  Nottingham University Hospitals spoke honestly with staff last week about the extraordinary challenges they are facing at the moment – warm words about the workforce are no longer enough. The workforce is not only a rate-limiting factor for the vaccination campaign, but the resilience of the health service overall.