Take the menopause seriously or face a crisis of clinical experience

Menopause: A biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Usually it is defined as having occurred when a woman has not had a period for 12 consecutive months (for women reaching menopause naturally). The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone.

There are also a number of women that will experience a clinically induced and/or early menopause as a result of conditions such as cancer and interventions such as hysterectomy.

I wrote in October 2019 that consideration of menopause in the workplace is an important factor in both addressing the gaps in staffing, but also to contain costs of recruitment. The NHS reports around 100,000 staff vacancies, approximately 38,000 of which are nursing gaps, staff turnover is huge; one in five staff left a post between 2017-18.

Changes in funding training places has done little to address the shortfall. Data also shows that many qualified nurses having been recruited from the EU are turning away from the NHS. We can see that the largest groups affected are nurses with an 8.5 per cent reduction and midwives reduced by over 3 per cent since 2016.

Set alongside this context, we have to manage the complexities of fishing in a changed recruitment pool; leaving the EU and a changed immigration system. To maintain a focus on recruitment is critical to attract staff into existing professional gaps.

Reinforcing right recruitment

Without this emphasis we will undoubtedly fail to build a workforce to lead us into future years. However, just as we cannot merely focus the “front door” when planning and delivering care, we cannot ignore the “brain drain” we face from the loss of our most experienced, most trained potential mentors and coaches at the other end of the cycle.

Without the equal focus on those staff who intend to leave the NHS, we risk a huge challenge as we go forward with gaps in experience and the inability to support any students and new starters that we do manage to attract.

We are proud of the comprehensive and professional training we provide for students. However, this has to be seen as only part of the rounded education of a student. Unlike those undertaking non-clinical degree courses, our students are faced with challenging, competing and often complex, moral issues that require guidance, support and care to navigate.

Just as we cannot merely focus the ‘front door’ when planning and delivering care, we cannot ignore the ‘brain drain’ we face from the loss of our most experienced, most trained potential mentors and coaches at the other end of the cycle

It is in this contextual and unique space that formal learning cannot replicate and, in this space, that the experience and patience from senior leaders and coaches support.

This surely underlines the need to think differently? I mentioned in my previous article that approximately 77 per cent of the NHS workforce are women – nearly half of which are between 45 and 64 years; the most common age at which (non-clinically induced) menopause symptoms appear.

Of these, perhaps 25 per cent will experience problematic symptoms which will impact on wellbeing at work. There are wider, societal issues alongside the unique NHS environment which affect women; there are more women working than ever, around one in four have additional caring responsibilities and more of those will have to work longer before they can retire.

Scope for strategies

Set against little awareness or recognition of menopause in the workplace, often-inflexible shift systems, relentless demand of winter which now extends all year, and limitations to training and educational opportunities, many staff appear to be reconsidering. It is reported that around 10 per cent of nurses intend to leave the NHS – a large proportion of which are near retirement.

With such significant numbers of staff affected by menopause, added to the high turnover and attrition rates of those nearing retirement, surely, we are working to nationally shore up the gap? Should we expect a nationally-led strategy akin to the recruitment campaign to redress the balance, to underline the value we place on this well-trained cohort of staff, to hold services firm as we attempt to support them with new recruits?

I would argue that without such a campaign we are facing a crisis of clinical experience, which will likely grow beyond the gaps we are trying to fill with new recruits at the “front door”.

There are strategies we can employ – and there are many small pockets of innovation and support.

• Menopause policies that facilitate open discussions, a culture of awareness and support to maximise wellbeing in the workplace
• Flexible working, self-rostering; could you support staff to work differently
• Regular opportunities for access to a menopause ambassador, coach or menopause café to embed ongoing support, info sharing and knowledge building
• Ask staff what matters. Regular NHS staff discussions can offer some insight and help to structure an approach relevant in your own organisation.

If we cannot retain the experience we have, then who will mentor and train those new recruits we have worked hard to attract? Without the support and mentorship they need at the start of their career, will we retain them?

The NHS England/Improvement Menopause Group has worked extensively with the Cross Govt Menopause Group to champion the development of workplace guidelines and a toolkit for managers and staff. Available on request.