Written evidence submitted by The British Association of Endocrine and Thyroid Surgeons (WBR0059)

Please note that this is from the perspective of an organisation representing Consultants and Trainees in Endocrine and Thyroid Surgery, and is therefore representative of this group of secondary and tertiary care surgeons.

• 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?
  
  The Covid-19 pandemic has demonstrated short term resilience when confronting challenges – but at the expense of worsening burn out and stress in sections of the workforce. in the medium term.

• 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?  

Within the hospital sector, clinicians worked well with managers to bring about rapid operational change within hospitals required to look after COVID-19 patients.

We are now seeing a slowing of this process as hospitals try to return to normal working. This has resulted in frustration amongst the clinical workforce, including trainees, and poor patient experience due to longer waiting times and late diagnosis. Trust NHS managerial teams, who we work with closely, sometimes lack the skills needed to operationalise rapid change and avoid seemingly endless meetings where quick decisions and actions are required to return to more normal working.

The needs of surgical trainees are often forgotten – surgical training has been very severely impacted by the pandemic, and training is all too often not seen as a priority within NHS management teams.

• 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? 

Hospital doctors and other hospital clinical staff have been impacted in different ways by the pandemic. In some cases, more remote working has allowed a better work life balance, whilst in others there has been significant trauma (including PTSD) from caring from sick and dying patients.  Rapid changes in timetables have often been imposed without regard to home care responsibilities and work-life balance.

The reduction in elective work during the Covid-19 pandemic had both positive and negative effects; on the one hand training rotas were combined which meant fewer rota gaps – a major source of burnout and worry amongst trainees, and their supervising consultants.

However, trainees in surgery were particularly negatively impacted by the lack of surgical elective training during this time and this will need to be addressed if the next generation of Consultants are to achieve their full training potential.

• What are the impacts of workforce burnout on service delivery, staff, patients and service users across the NHS and social care sectors?  

Workforce burnout leads to increased short notice ill health leave, with resulting poor patient experience and increased stress on remaining staff members. Some NHS employers continue to insist on 8-weeks notice of taking leave – 6-weeks is more commonly applied, 8-weeks can seem a long time for someone who just needs a few days off to recuperate and can result in individuals taking sick leave instead.
 

• What long term projections for the future health and social care workforce are available, and how many more staff are required so that burnout and pressure on the frontline are reduced? To what extent are staff establishments in line with current and future resilience requirements? 

The devolved nations have different approaches to workforce planning, despite the trained clinical workforce being mobile across the UK. There are areas of shortage both nationally and, more worryingly locally. A 10% shortage nationally of fully trained consultants in a particular specialty would be manageable if spread equally across the UK, but is instead often reflected in much more severe shortages in geographical areas where it is less likely that professionals will choose to work, leading to poor service provision and stress and burnout for the remaining specialists working in those geographical areas.

Our organisation represents surgeons mainly form two parent specialities – General Surgery, where currently there is a reasonable workforce balance, and Otolaryngology (ENT) where there is a national shortage with no current plans to properly address this. Workforce planning needs to much more dynamic - for instance some Trusts would be willing to fund training posts in shortage specialties but are prevented from doing so by the current HEE workforce planning arrangements.

Rota gaps in training lead to stress, poor training and early years doctors leaving the profession. Perhaps the NHS is trying to do too much with the current available workforce?

• 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?  
  
  This is partly answered in the question above, Decisions regarding workforce for our Consultants are made by HEE and the devolved nations. They do take into account Royal College advice, but in an ‘arms length’ way which means that the reality ‘on the ground’ is not always reflected in national planning. The HEE team dealing with workforce is small and under resourced, and also works to seemingly inflexible criteria – all of which hamper dynamic changes to identify and act upon over and under supply of relevant specialists.

• Will the measures announced in the People Plan so far be enough to increase resilience, improve working life and productivity, and reduce the risk of workforce burnout across the NHS, both now and in the future?  
  
  The People Plan does have many positive ideas. It does not however sufficiently address the problems surgical trainees face (including rota gaps) and does not adequately address the need for more dynamic workforce planning for hospital doctors to deal with shortages based upon speciality and/or geographical location.

Another area not addressed which contributes significantly to stress and burnout amongst more senior hospital doctors is the potential imbalance in medicolegal practice. Whilst it is of course imperative that the highest possible clinical standards are maintained, the number of medicolegal cases has greatly increased and this is both time consuming, particularly for senior doctors, and adds to the stress of the work.

• What further measures will be required to tackle and mitigate the causes of workforce stress and burnout, and what should be put in place to achieve parity for the social care workforce? 
   

Greater recognition of the importance of surgical training

More dynamic workforce planning, looking at novel ways of identifying and addressing workforce shortages (and oversupply).

Review of the UK medicolegal system to rebalance in a manner which is more supportive of clinicians whilst continuing to protect patients

Sept 2020