The Ward Round: Back to normal is not good enough

This week HSJ has focused on what restoration of the NHS in a post-covid world could resemble.

Trusts are tentatively looking at how some elective work could be restarted and what should be prioritised, while ensuring infection control remains front and centre.

Attention also needs to be swiftly turned to staffing. It has been a very challenging few months for recruitment – with obvious pressure on overseas recruiting – and although thousands of staff rejoined the NHS, this surge is not predicted to last.

The workforce – in all healthcare settings from acute trusts to pharmacies, care homes and in primary care hot hubs – has been through the ringer over the last two months, to put it lightly. The Ward Round has already covered the huge redeployment of NHS staff across trusts and to the temporary Nightingale Hospitals (at one point it was suggested 16,000 staff would be needed in London alone).

It was remarkable to see quite how many staff chose to rejoin the NHS and also how medical and nursing students signed up to start their NHS employment early. They did this in a climate of PPE fears, pressure on capacity, and a lack of a fully operational national testing system.

“Staff are tired,” one HSJ commenter said this week in the leader article linked above. “They’ll want a break and that is going to have to be managed just as we begin to return to full capacity.”

This will certainly be difficult to manage – but the efforts to make the NHS a better place to work over the last two months absolutely must be prioritised, especially if there is any hope in improving retention.

I have heard from some staff earlier this week working in London that free food provision has been stopped and wellbeing hubs closed down. Free food is understandable – caterers and kitchen staff must be paid, of course – but the creation of hubs to rest with tea and coffee was such a simple improvement and made a lot of difference to the working day.

It was cheering to then hear from trusts – including Milton Keynes and Sherwood Forest – of the things they are continuing to do for staff. This includes free parking, hot drinks, investment in staff rooms, mentoring and virtual exercise.

Making the NHS the best place to work was – and is – a key part of the People Plan. In a very short space of time employers made changes to the working life of their staff, and in lots of cases these changes were overdue.

Ending a culture of discrimination

As my colleague Rebecca Thomas has written this week, this restoration phase must address inequalities in the NHS – and urgently so.

Covid-19 has had a disproportionate impact on black, Asian and minority ethnic people, and of course staff, which was set out in Public Health England’s report last week. This piece of work has been heavily criticised for not properly investigating the inequalities it highlights and then missing out recommendations on how to tackle them.

As well as the effect of discrimination on health outcomes, the NHS must also tackle the prejudice faced by its workforce in day-to-day work and also structural discrimination within the system itself.

According to the most recent NHS Staff Survey, the proportion of BAME staff reporting that they had experienced “bullying, harassment or abuse from patients, relatives or the public” increased to 30.3 per cent – up from 29.7 per cent in 2019 and it is well known BAME staff are over-represented in fitness to practise cases.

This week NHS leaders and the chief executive of NHS England have published open letters about the discrimination faced by BAME communities, with Mr Stevens also calling for “faster action” on “the reality of racism and discrimination experienced by many colleagues across the NHS.”

As well as taking the overdue opportunity to redesign services through, as Mr Stevens put it, an “equalities lens”, the NHS must also diversify its leadership so it properly reflects its workforce.

“We should be much more intelligent, systematic and comprehensive in our approach to assessing whether leaders are truly being inclusive,” Professor Michael West, head of thought leadership at the King’s Fund told me last week. “Those kinds of interventions could really make a difference.”

“It’s about the leadership of organisations at every level – leaders need to say one of the key lessons learnt after covid-19 is the transformation of how we treat people,” Professor West added.

“We need to take responsibility for creating climates of inclusion and make sure everyone understands what the research evidence shows – the evidence is so compelling.”

Going back to normal should therefore not be an option for the NHS when it comes to the treatment of the BAME workforce and the opportunities available to progress within the health service. And if the tragedy of the higher number of BAME colleagues lost during covid-19 pandemic is not enough to kick-start real, tangible change, then it’s hard to see how the NHS will ever become the best place to work for everyone.