Written evidence submitted by the Association of Anaesthetists (WBR0028)
As the professional membership organisation for over 11,000 anaesthetists in the UK, Republic of Ireland and internationally, the Association of Anaesthetists promotes patient care and safety, and advances anaesthesia through education, publications, research and international work. Our members have been actively involved in the response to the COVID-19 pandemic. Anaesthetists are the largest medical speciality in the NHS.
Our Fight Fatigue campaign (https://anaesthetists.org/Home/Wellbeing-support/Fatigue/Help-Fight-Fatigue) showed the high levels of fatigue amongst this group prior to the pandemic. A 2017 survey of trainee anaesthetists showed nearly three quarters of respondents saying that fatigue had a negative effect on their physical health or psychological well-being while 91% of consultant anaesthetists surveyed in 2019 reported experiencing work-related fatigue and 50% of them reported this had a moderate or severe impact on health, wellbeing, work and home life.
How resilient was the NHS and social care workforce under pre-COVID-19 operating conditions, and how might that resilience be strengthened in the future?
Resilience across the NHS was variable and depended upon staffing levels primarily but was also affected by workload pressures and lack of funding/resources. The ability of anaesthetists to adapt their skills supported the critical care response and was key to the resilience displayed across the acute sector. The knock-on effect of redeployed anaesthetists of all grades on anaesthesia workload in the aftermath of the pandemic is creating a new workload pressure amidst a chronic shortage of anaesthesia workforce. Ensuring the sustainability of the transferrable critical care skills will be critical as anaesthesia and intensive care gradually move further apart in terms of training and service delivery.
The involvement of clinical psychologists who understand the work being done and the pressures has strengthened resilience. This is demonstrated in some maternity units where clinical psychologists skilled in handling complex birthing issues worked with doctors and midwives in maternity units during the pandemic. Similar examples can be found in intensive care units. This type of group and self-reflective support requires significant commitment of time and funding. Further support could be achieved by training healthcare workers in psychological first aid. Funding for psychological support of this kind represents good value for money.
What has the impact of the COVID-19 pandemic been on resilience, levels of workforce stress, and burnout across the NHS and social care sectors?
Resilience was challenged by staff shortages and workload pressures. Stress levels were increased due to staff shortages, workload pressures, confusion around PPE guidance and the uncertainty of PPE availability as well as the increased risk of contracting COVID-19 and subsequently transmitting the infection to colleagues, family members and patients.
In the aftermath of the surge, the inability to return to pre-COVID-19 levels of activity is causing increased stress and anxiety and is adversely affecting quality of care. Limits in testing staff and patients for coronavirus and the difficulty in providing robust COVID and non-COVID care pathways are two major stumbling points. There is a real risk that remaining unheard these stresses will lead to further complacency and burnout.
What is the current scale of workforce burnout across NHS and social care? How does it manifest, how is it assessed, and what are its causes and contributing factors? To what extent are NHS and care staff able to balance their working and personal lives?
Levels of burnout are thought to be high and are manifest in many ways. Some examples include: reduced thinking capacity, poorer communication, less flexibility, deliver of poor care, inefficiency at work, low morale and disengagement, increased sickness rates, increased numbers leaving the workforce either as retirees or earlier, unwillingness to take on extra roles. Assessment is usually undertaken by voluntary anonymous survey.
Causes are multiple and include, staffing levels, inability to get the job done, increased out of hours working leading to tiredness and fatigue, high demand for ‘catch-up’ on elective work without adequate time (annual and study leave) to recover, increasing sense of isolation as individuals are encouraged to work from home when possible. Virus testing facility is thought to be inadequate to support delivery of timely and safe care.
Balancing work and personal lives has been difficult for many but particularly for those working long hours and delivering out of hours cover. This has led to some leaving the profession altogether and retiring early. Other lockdown measures have impacted on home life significantly ranging from school closure and childcare issues to empty shop shelves as seen at the beginning of the pandemic. The ability to undertake supporting professional activities from home is a double-edged sword in that professional exchange is limited to virtual communication.
What are the impacts of workforce burnout on service delivery, staff, patients and service users across the NHS and social care sectors?
Care delivered by people who are burned out is of poorer quality, less empathically delivered, less well thought out, and is delivered with more errors. Efficiency is reduced, sickness rates increase, enthusiasm for new and extra work is reduced and all these impact on waiting lists.
To what extent are there sufficient numbers of NHS and social care professionals in training for service and resilience planning? On what basis are decisions made about the supply and demand for professionals in training?
Anaesthesia and intensive care have significant workforce shortage with predictions pre-COVID-19 of an increasing shortfall – as high as 25%. Accounts of poor working conditions adversely affect recruitment. Anaesthesia has to date maintained good levels of trainee recruitment but reports of over working and stressful conditions are likely to have an adverse effect. Oversupply of trainees creates competition for consultant posts which helps to keep posts filled and drives standards up.
Staffing numbers are determined by the workload the NHS anticipates it will need to deliver. NHS Trusts / Boards Chief Executives complete annual assessments of service requirements. Funding is made available to meet this anticipated need (HEE in England and NES in Scotland). Training numbers are calculated to meet consultant vacancy plus any expansion. With a finite number of medical graduates fuelling the workforce pipeline, government decides employment priorities e.g. psychiatry and general practice are current priorities. With limited funding and limited numbers, the service demand will always outstrip the workforce supply. Both sides of this equation need urgent attention. Recruitment of new staff and retention of the older workforce should demand equal attention if the workforce is to be maintained never mind increased.