Written evidence submitted by The Department of Health and Social Care (WBR0077)

 

Introduction

This government greatly admires the 3 million people who work across the health and social care system. Their dedication to providing the highest quality of care and support to all those who need it is incredible and the impact of COVID-19 has highlighted their commitment to others. Social care and NHS staff were able to rise to the challenge, adapt to rapidly changing circumstances and continue to provide world class services. It has also tested staff resilience too. On top of the challenges and struggles we all faced as we adapted to lockdown, for health and social care workers, long hours and emotionally draining work added to the strain.

Whilst we began work before the pandemic on staff wellbeing, the pandemic highlighted just how important our work on staff wellbeing is. We have accelerated implementation of much of the work already in development as part of the NHS People Plan programme: from flexible working to improved training for line managers and more comprehensive mental health support; and went further by providing practical support such as free car parking, more rest spaces and food and drink for staff to make doing their jobs easier. We have also seen a wide range of commercial partners step up to support health and social care workers, for example, by providing priority access to supermarkets, offering them free or discounted food, and providing unlimited mobile data. We continue to learn from our experiences during COVID-19 and that is why the recently published We are the NHS: People Plan 2020/21 places health and wellbeing at its core. It focusses on building resilience across the NHS workforce and ensuring staff have the mental and physical wellbeing support they need.

In social care, during the pandemic we also took steps to put in place centrally funded support services for social care staff, including a package of practical resources to support emotional and psychological wellbeing and extension of Samaritans and Hospice UK helplines, and we developed advice and guidance to employers about how they could support their staff in challenging times. We have also launched the CARE brand to increase workforce recognition.

There is strong evidence that staff who feel well supported and engaged with their employer will deliver better care, with improved patient safety and patient satisfaction. We have increased the size of both workforces over the last decade and this growth continues to be a key focus to ensure we meet the rise in demand for health and care services. Ensuring the health and adult social care sectors are well staffed, with colleagues well looked after, to prevent pressures becoming too great, is an absolute top priority for this government.

The government’s commitment to supporting the NHS workforce is demonstrated by the manifesto commitments to deliver 50,000 more nurses and growing the general practice workforce by 6,000 doctors and 26,000 other primary care professionals. We now have a record high intake for medical students and historically high numbers of people entering nursing degrees.

Action to fulfil the manifesto commitments is continuing at pace despite the pandemic with a wide range of actions being taken to improve retention and increase the attractiveness of careers in health and care. Nursing students now receive an additional £5,000 a year to support their living costs, with some students eligible for up to £8,000 a year. In adult social care, the government launched a new national campaign, Care for Others. Make a Difference to increase recruitment into the sector and highlight the rewards of a career in care.

Over the last few years, medical school places have increased by 25% - one of the biggest increases in NHS history with 1,500 more undergraduate medical school places every year by September 2020 – 630 started in 2018, a further 690 in September 2019 and the remaining 180 places being made available in September 2020 – bringing the total entrants to 7,500 per year from 2020. This is one of the biggest ever increases to the medical workforce and includes five brand new medical schools in Sunderland, Lancashire, Canterbury, Lincoln and Chelmsford.

The NHS and social care sector has seen unprecedented levels of public support throughout the pandemic and interest in NHS careers has increased significantly. To capitalise on this increased interest, a cross system approach has been taken to supporting the higher education sector to expand across all health care undergraduate programmes, complementing the comprehensive communications campaign to promote the NHS as a world class employer and the national recruitment campaign in social care. In March, NHS England and NHS Improvement also launched the Bringing Back Staff campaign to ask clinical professionals to return to health and social care work during the COVID-19 pandemic.

However, although workforce growth is essential, on its own it is not enough. We are embedding innovations which allow people to work more effectively and create a more compassionate culture. We commissioned the NHS to develop a comprehensive People Plan in 2019 to underpin delivery of the NHS Long Term Plan. The ongoing People Plan programme of work recognises how fundamental the people working in the NHS are and the importance of looking after them by making the NHS a great place to work. 

This Government recognises that the NHS employment offer is vital in attracting and retaining the compassionate and dedicated staff that our NHS needs. That is why we have accepted in full the recommendations of the Review Body on Doctors’ and Dentists’ Remuneration for a 2.8% pay rise, backdated to April 2020 for consultants, specialty and associate specialist doctors, salaried GPs and dentists. Junior doctor pay scales have increased by 2% in 2020/21, on top of the multi-year deal that we agreed with the BMA. In addition, the Agenda for Change pay and contract reform deal has seen more than 300,000 nurses benefitting from a pay rise with nurses below the top of the pay band receiving a pay rise of at least 9% over the course of the deal. As part of the deal we have increased the starting salary for a newly qualified nurse by over 12% to nearly £25,000 and increased the pay of the lowest paid by over 16%.

Whilst the social care sector is fundamentally different, with over 18,000 separate largely private and independent sector employers commissioned by 151 local authorities, it is for local authorities to ensure there are enough people who want to work in adult social care and employers to make sure they have the terms, conditions and support in place to attract and retain people in the social care sector. However there is an important  role for central government to play in increasing the recognition of the social care workforce by society as a whole and putting in place national programmes of support where it is difficult for individual providers to do so, and we have put more funding in place centrally for workforce and launched the CARE brand to try to bring in more centralised recognition.

We are committed to investing in the health and social care workforce and will prioritise their wellbeing during and after COVID-19. We will ensure that support is provided consistently across the NHS, and that social care employers are supported to provide similar support to their teams.


Roles and Responsibilities

Department of Health and Social Care:

NHS England and Improvement:

Health Education England:

Local authorities:

 

Adult social care providers:

NHS

Supporting our workforce through COVID-19

COVID-19 has been a challenging time for NHS staff.  Whilst COVID-19 affected NHS staff working in different settings in different ways, we know that many staff have had to work in environments that put them at greater risk and they have had to manage significant upheaval to services and procedures, including some staff being redeployed to different areas. Staff have worked long hours, spent time away from their families and friends, and sadly loved ones, including colleagues, have been lost.

 

The Government has proactively provided a wide range of support to the NHS during this period. We have listened to the people delivering health and care and put in place changes that supported them to do their jobs well. The national package of support has been well received by staff in the NHS and has been bolstered by many local initiatives led by employers.

 

Throughout the pandemic the Department has worked closely with the NHS, employers and trades unions to prioritise the health and safety of staff. The Social Partnership Forum (SPF), which brings together leaders from the Department, the NHS and trades unions has met weekly throughout the pandemic to prioritise workforce issues, focusing on issues such as access to PPE, testing and the disproportionate impact of Covid-19 on some groups of NHS staff, most notably the BAME workforce. 

 

 

Increased size and flexibility

To boost workforce size, emergency legislation was passed to allow professional regulators to create a temporary “Emergency” register of healthcare professionals.  47,000 former health professionals (doctors, nurses, midwives, allied health professionals and pharmacists) joined this register and made themselves available to the health and social care system.  

 

We ensured that students could graduate early or take up paid clinical placements to support the Covid-19 effort. This has resulted in:   

 

 

 

 

In partnership with the NHS and trades unions, we ensured that the operation of national terms and conditions reflected the unprecedented nature of the pandemic and the reliance on our NHS staff at this difficult time. Temporary guidance was put in place giving staff, leaders and the HR community in the NHS the clarity and flexibility they need to manage issues around pay, pensions, sickness absence and annual leave.

 

NHS England and Improvement (NHSE/I) took steps to ensure that all GP practices were paid at rates that assumed they would continue to perform at the same levels from the beginning of the outbreak. On 4th August 2020 details of the COVID-19 support fund for general practice were also confirmed. The purpose of this fund is to assist with the legitimate additional costs of the response borne by GP practices to the pandemic. This includes costs relating to COVID-19 related absence cover for the period 23rd March to 31st July 2020, where cover was necessary to maintain capacity and staff were offered full pay for COVID-19 related absences. This ensured practices could continue to operate and deliver patient services whilst supporting their staff.

The way in which people accessed general practice services changed during the Covid-19 pandemic to ensure practices could see as many patients as possible, while protecting staff and patients from avoidable risk of infection. Practices introduced “total triage” and offered more telephone and online consultations enabling more patients to access services remotely and staff to work from home (where possible/appropriate). To support this over 22k laptops and 18k headsets were deployed into primary care. NHSE/I estimate that 90% of practices have online consultation capability and 99% have video consultation capability. These changes resulted in decrease footfall in practices, reducing the risk of infection and we heard positive feedback from practice staff on the increased ability to work remotely and more flexibly.

A snapshot survey of 800 GPs, run by Royal college of General Practitioners and published in July 2020 found:

 

 

NHS England committed to almost full remuneration for primary care dentistry during this period even though face to face care was only being required in designated urgent dental centres (UDC). They continue to remunerate in full during the current period when face to face dentistry is restarting in all practices.

 

Enhanced wellbeing support

We recognised at an early stage the need for enhanced wellbeing support for NHS and social care staff. We commissioned NHS England and Improvement to develop a comprehensive emotional, psychological and practical support package for NHS staff, and many elements of the support package were also extended to social care staff (see page 15 for more details on the social care support offer). NHS England and NHS Improvement looked to similar large-scale traumatic events and the impact they had on NHS staff and first responders to inform the development of the support package. Throughout the pandemic, NHS staff have been able to access:

 

 

 

 

Line managers have been given the tools they need to effectively support their teams through COVID-19. For example, mental health conversation training has helped to equip NHS managers, supervisors and those with caring responsibilities for NHS people to confidently hold local supportive and compassionate mental health and wellbeing conversations.

NHS England and NHS Improvement have also launched a new framework, which has enabled employers to buy-in additional occupational health support for their staff.

Health Education England has made available a wide range of free e-learning resources for the health and care workforce through Covid-19, including: 

 

 

 

Protecting vulnerable staff

Ensuring staff feel physically safe is essential to their overall wellbeing. We know that COVID-19 has had a disproportionate impact on BAME staff, their families and friends. The health and social care system is the largest employer of BAME people in the country and takes its responsibility to look after at-risk staff very seriously.

 

NHS England and NHS Improvement have set up five workstreams to support their BAME staff after learning that COVID-19 was having a disproportionate effect on them. These workstreams were made available throughout the response:

 

 

 

 

 

 

The NHS has worked with employers to ensure robust risk assessments are in place as well as training and compliance on the use of PPE.  NHS England and Improvement are asking organisations to publish metrics from their staff reviews until fully compliant. These metrics include number of BAME staff risk assessments completed, and percentage of total risk assessments completed and of whole workforce.

Engagement with BAME networks has been stepped up to ensure they are informed, supported and represented in decision making.

 

Life assurance scheme

We have set up a COVID-19 Life Assurance Scheme for NHS and social care workers in England who are at the forefront of the pandemic response. The scheme is non-contributory and pays a tax-free lump sum of £60,000 to families of NHS and social care staff who die having contracted coronavirus disease in the course of their frontline work. The scheme recognises the increased risks faced by NHS and social care staff who work in environments where direct personal care is provided to people who have or are suspected to have coronavirus. It provides a safety net for families who have no life assurance cover provided by their employer or a pension scheme. For those who do, it provides an extra level of financial protection paid in addition to the death in service benefits that they have bought through their pension scheme. 

 

Practical support

Practical support to staff is also vitally important. By making it easy for people to do their jobs we can reduce some of the lower level pressures, ensure they feel respected and their needs properly looked after.  We have made free car parking available to staff throughout the pandemic and have ensured that staff have access to free food and drink. The NHS has also received many offers from corporate partners, with companies donating food, enabling priority access to services and discounts for key workers. 

 

New ways of delivering care

During the COVID peak (from 25th March to 7th June 2020) all face to face NHS dentistry was suspended by NHS England except for designated urgent dental centres (UDC). Over 600 of these were set up to provide urgent care. In order to protect staff, patients and reduce the risk of infection, all practices holding an NHS contract were required to provide telephone triage for their patients referring those who needed to be seen urgently to UDCs and in other cases prescribing pain relief and antibiotics, as needed. Dentists and their staff were also asked to redeploy as needed to other parts of the NHS directly dealing with COVID as needed in services such as NHS111. Detailed guidance has been provided to practices on safe provision of care including best practice for those who are particularly vulnerable to COVID-19.

In order to support NHS dental contract holders, NHS England continued to fully fund NHS dental contracts, despite all routine dentistry being suspended. During the restart period, which began on 8th June, full funding continues with activity requirements suspended.

NHS England suspended all routine sight tests during the COVID peak. Practices, however, were able to offer to offer telephone triage and some remote services in order to protect staff and patients and reduce the risk of infection.  A minority of contract holders were also able to continue providing urgent face to face care. In order to support NHS contract holders during that period and during the immediate restart period NHS England continued to pay contractors their average monthly earnings from the NHS.

 

 


Strengthening our workforce for the future

Although Covid-19 has put the health and social care system under incredible pressure, we have seen many changes that have enhanced patient care and staff wellbeing that we want to embed for the future. Leaders across the system have adapted to make the best use of the skills and experience they have available. We have seen more collaborative and flexible working. Established practices and beliefs have been challenged and overcome, allowing greater innovation and productivity throughout the system. This, in turn, has empowered staff across all professions. Hierarchies have been flattened, enabling leaders, including our clinical leaders, to develop solutions and efficiencies within the system. We need to build on this momentum as we look to grow and transform the workforce for the future.

‘We are the NHS: People Plan 2020/21’, published on 30 July 2020, is an important step forward in supporting the NHS workforce. It focuses on strengthening resilience, embedding the positive changes that staff saw during COVID-19 and building on these good things.

The plan sets out a clear strategy for supporting the NHS and requires employers across the NHS to:

Invest in physical health and wellbeing, with:

 

 

 

 

Make flexible working a priority by:

 

 

 

Create an inclusive and diverse workplace, with:

 

 

 

Maximise opportunities for multi-professional working and developing new skills, with:

 

 

 

 

 

 

 

Create time and space for education and training, with:

 

 

 

 

As part of the national “Looking After Our People” retention programme, NHS England and Improvement launched three local pathfinder regions on 1 September. The pathfinders will be used to test assumptions about how best to empower the whole workforce to feel valued, safe, productive and supported, giving regions the opportunity to try new things and share learning about best practice. The programme will use continuous quality improvement methodology to evaluate the impact of its interventions and enable system wide change and learning. Supporting and retaining our existing workforce is incredibly important, but we also need to continue to make progress in recruiting across many professions.

We have committed to delivering 50,000 more nurses in this Parliament.  The Minister of State for Care, Helen Whately MP, is chairing the programme board to oversee and assure the delivery of this commitment. We have also committed to delivering an extra 50m appointments in general practice a year by growing the general practice workforce by 6,000 more doctors and 26,000 more primary care professionals. The Parliamentary Under Secretary of State (Minister for Prevention, Public Health and Primary Care), Jo Churchill, is chairing the programme board to oversee and assure the delivery of these commitments. 

The government has already put in place a new financial support package for new or continuing students on nursing, midwifery and many allied health pre-registration courses at English universities to increase nurse numbers. This financial support will start from September this year. Each eligible pre-registration student will benefit from at least £5,000 per year which they will not need to pay back, with additional non-repayable funding of up to £3,000 for some students in regions or specialisms struggling to recruit and to help students cover childcare costs.

This People Plan 2020/21 is just the start of the learning from COVID-19 and the actions that will be put in place to take forward work to support NHS staff. The next phase will focus on workforce growth and ensuring we have the right skills mix in place for a flexible and modern NHS.

In general practice, there is now an opportunity for the government, the NHS and professional representatives to ensure the innovations introduced during the Covid-19 pandemic can be adapted into a sustainable model for the future, which provides the best quality of care and ease of access for patients as well as offering an attractive career option for doctors and other health professionals. Remote working has not been seriously considered pre COVID in dentistry as an assessment of oral health is key to treatment but careful consideration is being given to whether this can in some form be introduced to the benefit of patients and staff going forward.

In order to support staff it is important to know how they are feeling and take responsive action to tackle the root causes of stress. NHS England and NHS Improvement have recently launched the ‘NHS People Pulse’ for all NHS and provider organisations, to understand the varied experiences of staff through COVID-19 and recovery. To build on this NHS England and Improvement will:

 

 

 

Adult Social Care

Supporting our workforce through COVID-19

In our Action Plan for Adult Social Care, published in April, we made clear our commitment to supporting the vital adult social care workforce, ensuring that we have the staff we need, and that those in the sector feel both supported and valued for the crucial role they continue to play in our national effort to respond to COVID-19. The social care workforce has shown remarkable resilience during COVID-19 and risen to the challenges presented by operating in these difficult circumstances. However, it is without doubt that this has been a demanding time for adult social care workers. 

The role of the care worker has fundamentally changed during the pandemic: frontline staff have taken on additional clinical responsibilities; staff have provided additional support for individuals who have lost access to day services or been isolated from family and friends; an increased number may have had to cope with bereavement both at work and in their personal lives; they have had to manage new infection prevention and control measures; many have worked more flexibly than before; and some have not seen their own families to reduce rates of transmission of COVID-19.

We know there are real concerns within the sector about resilience and wellbeing among care workers, who in many cases have been operating in an intense environment, sometimes without respite (for example for shared lives or live in carers, or for those who have   moved into residential settings). While many care workers have recognised the value of their role during this time, and the outpouring of public support for frontline workers has been welcome, there are also some who fear the increased risk of COVID-19 that their work might place on themselves and their families. 

 

Support Offer

In order to support the wellbeing of social care workers, and working with the NHS and other organisations, we have developed a package of emotional, psychological and practical resources for the workforce. Wherever possible we have ensured the same offer is in place for all social care staff as is in place for their colleagues in the NHS. As part of this package of support:

 

 

 

 

 

 

 

 

So far some of these services have had limited take up from the social care workforce and we have increased communications activity to ensure social care workers know where to turn if they need additional support. We know that for some, the emotional impact of their COVID-19 experience will come later, so we are continuing to promote these wellbeing services to ensure that people know what support is available when they need it most.

 

Addressing Issues Affecting Morale

Identity and recognition

 

We are in no doubt that our social care staff have played and continue to play a vital role in our national effort to respond to the outbreak. As the Secretary of State has made clear the weekly Clap for carers was every bit as much a recognition of our social care workforce as it was for those working in the NHS. 

 

In the early stages of the pandemic, some social care staff found it difficult to access the special supportive arrangements – such as priority shopping hours – that businesses had put in place for key workers. This was partly because before the pandemic there was no clear and visual inclusive brand for the adult social care sector, contrasting with the strong and recognisable NHS brand.

In April, ownership of the CARE brand was transferred to the Secretary of State for Health and Social Care from the CARE Badge Community Interest Company. The extension by the Government of the CARE brand identity will give, much-deserved unified recognition to the social care workforce which will last long beyond COVID-19. As part of the plan to promote the CARE brand, CARE badges are currently being distributed at no cost to social care providers and members of the workforce so that care workers can wear them with pride and be recognised for their hard work during the pandemic. Easy visual recognition of care workers allows businesses to show them the same appreciation as they show other key workers.

Safety

 

Ensuring the safety of the workforce is vital for improving stress levels and morale and we have worked hard to address workforce safety concerns quickly when they have arisen during the pandemic.

We know that PPE has been a concern in social care, particularly at the outbreak of the pandemic, and we have worked tirelessly to ensure those working in social care are receiving the PPE they need. This is a sector where we have seen a significant spike in demand for PPE. To address this, the Government stepped in to support the supply and distribution of PPE to the care sector. We have focused on ensuring there is an emergency supply in place, whilst building a longer-term solution for emergency distribution to the sector.

Action has also been taken in response to concerns about the impact of COVID-19 on vulnerable workers, including BAME staff. DHSC published a COVID-19 adult social care workforce risk reduction framework to support employers to sensitively discuss and manage specific risks to their staff – this includes risk by ethnicity, but also age, sex and underlying health conditions. 

With the advice for clinically extremely vulnerable people to shield now suspended in most parts of the country, in August, we wrote to the sector setting out guiding principles for employers and employees to consider when deciding if it is safe for an employee to work.

NHS and Social Care Coronavirus Life Assurance Scheme

 

In April, the Government announced a new NHS and Social Care Coronavirus Life Assurance Scheme for frontline health and social care workers during the coronavirus pandemic. Families of eligible social care workers who have died from coronavirus in the course of their frontline essential work will receive a £60,000 payment. The scheme recognises the increased risks faced by social care workers during the crisis and provides a safety net for their families. Social care workers are unlikely to have access to occupational life assurance.

Recruitment, returners and deployment

The Government acted quickly to support the sector to accelerate the recruitment of additional staff in order to alleviate pressure on the workforce, build resilience and improve capacity.

Recruitment and training

 

In order to attract people to the sector, in April we launched a new national recruitment campaign, Care for Others. Make a Difference, to run across broadcast, digital, and social media, as well as a new online platform, Join Social Care, to fast-track recruitment into the sector. The campaign highlighted the vital role of the social care workforce in the pandemic, along with the longer-term opportunity of working in care.

Although staffing needs are a problem for many social care providers, the administration and time taken in finding new staff can be an additional issue. In order to help support providers to bring new people in quickly through the Covid-19 response, the Department allocated funding from its Workforce Development Fund (WDF) to commission Skills for Care to develop rapid response training. This is fully funded (and therefore free for providers), helping them induct new recruits and volunteers into their services through this period. We are continuing to monitor uptake of this training through the year in order to continue this support.

Returners

 

We are committed to ensuring nurses are deployed where local systems need them the most, including social care. In March, NHS England and NHS Improvement launched the Bringing Back Staff campaign to ask clinical professionals to return to work during the COVID-19 pandemic, including registered nurses. The nurse returners programme provided an important additional recruitment option for employers to help with nursing shortages as a result of COVID-19. Despite there being limited deployment of nurses into social care through the first phase of the initiative, Skills for Care will continue to lead for social care, to continue development to improve social care providers’ access to nurses who register to be redeployed.

We continue to support the temporary re-registration of 8,000 former social workers who have left the profession in the last two years, allowing them to fill vital roles in the community. Together with DfE, the Local Government Association and Social Work England, we have developed the Social Work Together platform which connects social workers looking to return to work with local authorities and other employers. Although few social workers have been deployed so far, we are keen to retain and support social workers who wish to return and support employers to make best use of the platform.

Deployment

 

We have also published guidance for the sector on redeploying workers and involving volunteers in delivering services – where it is safe to do so.

 

Strengthening our workforce for the future

Looking to the future, it will be important that we learn lessons from the pandemic to ensure that the system is staffed by a united, supported, stable and productive workforce. There will be challenges ahead, particularly in managing the longer-term effects of COVID-19 on workforce resilience, stress and burnout, and we must work with providers to support the workforce and prioritise wellbeing.

People working in adult social care need a comprehensive wellbeing offer to ensure they can access much needed support. We will work closely with the sector to improve the occupational health offer for social care workers, support mental health interventions where needed, and ensure staff have access to practical support and advice. 

There is much more to do in order to establish parity of esteem between adult social care workers and their NHS counterparts. However, we have begun to act in this area to improve workforce recognition - both through our ownership of the CARE brand and creation of the CARE workforce website and app - and we will continue our work to improve morale across the workforce.

In order to tackle and mitigate against ongoing burnout and impacts for social workers specifically, the Chief Social Worker’s Office are putting together a series of development programmes for Principal Social Workers (PSWs) to equip key professionals with practical skills and support sharing of best practice. This will encourage the driving of good outcomes which includes better management oversight, with PSWs passing on learning within their management teams.  The timelines for these programmes have been delayed due to Covid-10 pressures, but the intention is to resume planning and scheduling as soon as possible.

 

 

 


Annex A: NHS Long Term Workforce Trends

This section summarises the various data sources which are available to understand workforce challenges, including measures of staff experience, workforce growth, vacancies, sickness absence, and retention.

NHS Staff Survey

Each year the NHS Staff Survey[1] asks over 1.1m NHS Employees across 300 organisations in England to answer questions about their experience of working in the NHS. It is one of the largest staff surveys in the world and provides useful insights on NHS staff health and well-being.

Staff Engagement is a typical headline measure. It is derived based on questions surrounding motivation, contributing to improvements and recommending their place of work.

Staff Engagement has been relatively unchanged for the last 5 years with most benchmark groups scoring close to the national average. Whilst engagement is consistently high in Acute Specialist Trusts, Ambulance trusts have always achieved the lowest score despite gradual improvements since 2015.

Health and Wellbeing is another headline theme which is derived based on questions surrounding flexible working, actions taken and physical and mental wellbeing.

The overall score for health and wellbeing was 5.9 in 2019; the same as 2018 and slightly lower than 2015 to 2017.

•          28.6% believed their Organisation promoted Health and Wellbeing (-3% from last year)

•          27.6% had suffered Musculoskeletal issues in the past year (this has been increasing since 2015)

•          Almost 40% reported feeling unwell due to stress.

However, there were improvements in the question that relates to organisational action on health and wellbeing.

•          29.3% reported positive action on health and wellbeing by their employer up from 28.6% in 2018.

 

Workforce Growth

Staffing levels in NHS are at record levels. Over the last 6-7 years the NHS workforce has grown at about 1.5% pa and the long-term funding settlement will enable further growth and the government to deliver on its workforce manifesto commitments to increase the number of nurses, doctors and primary care professionals working in the NHS.

As at May 2020, there are a total of almost 1.2 million full time equivalent (FTE) NHS Hospital and Community Health Service (HCHS) staff working in NHS Trusts and CCGs in England[2]. Compared to May 2010 there are almost 148,700 (14.7%) more staff and including:

•          Over 76,600 (14.4%) more professionally qualified clinical staff, of which there are:

•          Over 26,500 (28.0%) more doctors

•          Over 22,500 (8.3%) more nurses

Despite record numbers of staff, a challenge remains in ensuring sufficient workforce capacity to meet increased demand. Demand for workforce continues to grow due to increasing demand for NHS services; this is a result of increased pressures from a growing and ageing population, unmet health needs and increasing possibilities of medical science and innovation[3].

 

Response to Covid-19

During the pandemic, the Bringing Back Staff Programme supported the NHS to bring in additional workforce capacity through temporary re-registration of healthcare professionals, early deployment of students into front line clinical placements and a “volunteers call to arms”.

The professional regulators for doctors, nurses and midwives, pharmacists and pharmacy technicians, and allied health professionals contacted over 65,000 former clinicians who had been out of practice for the last three years to invite them to join their temporary registers to support the NHS during the pandemic.

 

At the time of publishing, the ‘We are the NHS: People Plan for 2020/2021 – action for us all’[4] reported that:

Health Education England[5] also reported that, as of 17 July 2020, 28,108 nursing and midwifery students, and 7,896 Allied Health Professional students had opted in to paid placement as part of the COVID-19 call to arms and were being allocated to NHS and social care settings.

In April 2020, additional source of recruitment fields were added to the Electronic Staff Record[6] to record new entrants to the workforce in response to the Covid-19 pandemic. These codes were to help account for staff returning to the workforce as part of the NHS ‘Bringing Staff Back’ scheme and fast-tracked students joining the NHS.

 

•          May 2020 figures reported as part of the NHS Workforce Statistics[7] show that 592 ‘Returners’ were identified through the ‘Return to NHS – Covid-19’ code. Of which, there are 102 doctors and 157 nurses and health visitors.

•          Figures for fast-tracked students show that 9,264 staff had been recorded as having joined the workforce using the ‘Students – Covid-19’ code. Of this number, 8,039 (86.8%) are classified in the Support to doctors, nurses & midwives staff group.

 

However, the numbers recorded in under these fields are likely to be an underestimate for both groups of staff.

•          The return to NHS COVID 19 code excludes staff that may have returned on different contracts, for example Honorary or Bank contracts. Many are also likely to have been employed via NHS Professionals.

•          'Education / Training' as a source of recruitment shows an increase of over 1,200 staff in the workforce through this route compared to the previous month and may indicate some organisations recording students this way as opposed to the 'Students - Covid-19' code.

 

Vacancies

NHS Digital publish vacancy management information, on behalf on NHS EI, based on the full-time equivalent number of posts which are not filled by a substantive member of staff.  

Carrying vacancies does not mean that work is not being carried out, as bank and agency staff are used to cover vacancies, as well as short and long-term sickness absence and maternity leave.

The total number of vacancies in the NHS has decreased since last year; in quarter 1 2020/21 there were almost 83,600 vacancies overall (6.7% of the workforce) and over 6,400 (14%) fewer nursing and midwifery vacancies than last year.

 

Staff Absence

Data on the level of sickness absence in the NHS is published monthly by NHS Digital. This shows that anxiety, stress, depression and other psychiatric illnesses accounted for over 25% of the sickness absences in February 2020, far outstripping other reasons for absence[8].

The sickness absence data presented here reflects the situation before the start of the Covid-19 pandemic, rather than the latest data.

Staff absences and absence rates were also high during the peak of the Covid-19 pandemic[9]. At the peak in April 2020, staff absence was almost 3 times the expected level for time of year. However, this was mostly driven by sickness or self-isolation related to Covid-19.

 

Retention

Analysis of the NHS Workforce Statistics suggests the leavers rate for nurses and health visitors has fallen from 10.5% in 2016/17 to 9.7% in 2018/19[10].

However, in the 2019 NHS Staff Survey, almost 30% of all staff in the NHS have said that they have considered leaving their current organisation[11]. The ambulance sector in particular had the highest proportion of staff who agreed or strongly agreed that they have considered leaving their current job at almost 40%.

 

 

 

 

 

 


Annex B General Practice Long Term Workforce Trends

Workforce Growth

The total General Practice workforce has seen an increasing trend since September 2015.

FTE

Sep 2015

Sep 2016

Sep 2017

Sep 2018

Sep 2019

GPs

34,429

35,229

34,653

34,534

34,862

Nurses

        15,241

        15,793

        16,030

        16,276

        16,573

Direct patient care staff

        10,883

        11,636

        11,901

        12,555

        13,565

Admin/non-clinical staff

        63,069

        65,341

        64,551

        66,129

        67,952

Total staff

123,621

127,999

127,135

129,494

132,951

Total clinical staff

60,553

62,658

62,584

63,366

65,000

 

Source: NHS Digital

In order to provide a longer timeseries, September figures are presented. Due to a number of methodological changes to the workforce data collection in September 15, figures are not comparable to those published earlier.

The government recognises whilst the overall general practice workforce has grown, the number of patients registered in general practice have also increased. There were 59,996,728 patients registered in September 2019, an increase of 14% compared to 52,527,737 patients in September 2004. The government has committed to growing the general practice workforce by 6,000 more doctors and 26,000 more primary care professionals including pharmacists and social prescribers.

 

 

GP Worklife Survey

General practice staff are not currently included within the NHS staff survey. The 2020/21 NHS People Plan committed to exploring options to implement this survey in primary care in the Autumn. Ahead of that data source becoming available, The GP Worklife Survey, provides an important source of information on GPs and is independent research commissioned by the department of Health and Social Care and carried out by Manchester University on behalf of the Policy Research Unit in commissioning and Healthcare System (PRUComm). The ninth, and most recent survey was published in May 2018 and was based on surveys completed by a sample (approx. 1,000) of GPs in 2017.

The top three job stressors in the sample of GPs in 2017 were found to be:

There were relatively little differences in stressors found between 2015 and 2017.

In 2017, when questioned about job attributes, the top 3 statements GPs were most likely to agree/strongly agree with were:

On job satisfaction, in 2017 of the GPs sampled, 49.9% reported being satisfied with their job (20.9% neutral, 29.2% dissatisfied) with the lowest levels of satisfaction attributed to “Your hours of work” and “Your remuneration” and highest for “Your colleagues and fellow workers” and “Physical working conditions”.

Overall satisfaction increased slightly between 2015 and 2017, although it was not statistically significant. The satisfaction levels in 2015 were the lowest since 2001.

Publication of the latest GP Worklife survey was delayed as a result of COVID-19 and is expected later this year.

 

Recruitment and retention

We recognise that general practice is under pressure, that is why the government has taken action to address this, including the plans set out in the NHS Long Term Plan (2019), the five year GP contract framework (2019, and update in 2020) and the NHS People Plan. The contract framework saw billions of pounds of additional investment to improve access to general practice services, deliver the ambitions set out in the NHS Long Term Plan and address the reasons GPs cite as reducing job satisfaction including workload, bureaucracy and indemnity.

 

To address workload, the 2019/20 GP contract framework set out plans to make funding available towards for up to 20,000 additional staff across five roles in primary Care Networks (PCN) by 2023/24. The 2020/21 update to the five year GP contract significantly enhanced the offer for PCNs with additional investment to recruit a further 6,000 Primary Care Professionals and increased the reimbursement for all the roles available to PCNs from 70 to 100%. The number of roles PCNs could choose from was also expanded from four to ten in 2020/21 with mental health professionals to be added in 2021/22 alongside the expected expansion to community paramedics.

 

The update also included a series of recruitment and retention schemes and a commitment to a NHSE&I and DHSC review into the impact of bureaucracy in general practice. This review is focusing on what improvements can be made to a range of bureaucratic and administrative requirements including appraisals, revalidation, reporting, the interface with secondary care, certification, and requests for medical evidence. The aim is to simplify processes, remove duplication, make better use of digital and ensure the right professional is completing tasks, with the review aiming to conclude by the end of 2020.

 

HEE has also continued to make good progress towards increasing the number of GP trainees with 3,441 recruited against a target of 3,500 in round one (August 2020 start), a 15% increase compared to 2019 round one, with round 2 (February 2021 start) now open. Plans are in place to increase trainee numbers to 4,000 in 2021/22 and increase the proportion of time GP trainees spend in general practice placements from 18 to 24 months of their three year training. We expect this to support a more balanced distribution of trainees across the NHS as well as better training for GPs.

 

We will continue to monitor the impact of these actions and take further steps to support general practice as needed.

 

 

 

 

 

 

 

Annex C General Dental Practitioners/Opticians Long Term Workforce Trends

 

General Dental Practitioners

24,545 dentists delivered some NHS care in 24,545. Numbers of dentists working in the NHS has been stable or slightly increasing over the last 5 years.

Year

2013/14

2014/15

2015/16

2016/17

2017/18

2018/19

GDPs

23,723

23,947

24,089

24,007

24,308

24,545

*Headcount only data held not FTE

Source: NHS Digital

Optometrists

The table below shows the workforce providing General Ophthalmic Services via high-street opticians. In England there were 14,280 ophthalmic practitioners. This is an increase of 594 (4.3 per cent) since 2018 and have been increasing since 2013/14.

Optometrists

2013/2014

2014/2015

2015/2016

2016/2017

2017/2018

2018/2019

Total

11,827

12,136

12,458

13,141

13,686

14,280

Source: NHS Digital

Primary Care Dentistry pre-Covid

Primary care dentistry is directly commissioned by NHS England and delivered through high street dental practices supported by some community dental services. As with other primary care independent contractor services NHS England lets contracts with an agreed level of service to be delivered per year. The dentist holding the contract then subcontracts with other dentists (unless a single hander) and directly employs other dental clinicians (therapists and hygienists etc) and any administrative staff. The Doctors and Dentists review body makes recommendations annually on dentists pay for all other staff pay and conditions are a matter for the contract holder.

NHS high street optical services

NHS high street optical services provide free sight tests to those who qualify for an NHS sight test. NHS optical services are estimated to make up around 15% of optical businesses activity but this varies between providers. Providers are remunerated per sight test provided. All staff are employed by the optical practice not the NHS.


Annex D: Adult Social Care Long Term Workforce Trends

The Department funds Skills for Care to collate and analyse data for the sector through the Adult Social Care Workforce Data Set (ASC-WDS). The information is used to assess trends in staffing levels within social care, including by job role and geography. Skills for Care produce two annual reports (The size and structure of the adult social care sector and workforce in England and The state of the adult social care sector and workforce in England). The Department uses these resources to help respond to trends within the sector’s workforce.

 

Workforce Growth

The number of adult social care jobs was estimated to have increased by around 1% (17,000 jobs) between 2018/19 and 2019/20. This is slightly below the 1.2% (19,000 jobs) between 2017/18 and 2018/19. Skills for Care’s projections state that if the adult social care workforce grows proportionally to the projected number of people aged 65 and over in the population, then the number of adult social care jobs will increase by 32% (520,000 jobs) to around 2.17 million jobs by 2035. If the workforce continues to increase at the rate seen between 2017/18 and 2019/20 it will not be enough to meet the levels of demand projected by Skills for Care.

 

Recruitment and retention

Recruitment and retention already represent significant challenges: the staff vacancy rate of employers updating ASC-WDS data during COVID-19 (to July 2020) was 6.7%. This figure was lower than before COVID-19 when the rate was around 8.1%. A reduction in the demand for services is likely to be a contributing factor for this decrease in vacancies. Skills for Care survey data in May 2020 found that 46% of responding employers were experiencing a decrease in demand, alongside evidence of falling occupancy rates in care homes.

 

It is important to note that demand is likely to recover, and this may result in the vacancy rate being pushed up again. However, the speed at which this happens will be determined by other factors. For example, higher unemployment is a factor that may mean it is easier for adult social care sector to recruit people in, meaning that vacancy rates may not rise as quickly as they might otherwise have done.

 

Turnover is high at 30.8% in 2018/19. We do not yet know how COVID-19 has impacted on this. It is likely that it has reduced in line with vacancies. However, the same concerns for vacancies increasing again are relevant for turnover as the labour market recovers.

 

Social workers

From Skills for Care data, we know that turnover for social workers specifically was 13.7% in 2018/19. We do not yet know how this has changed since or been impacted by Covid-19, but we know that turnover in social work can be linked to high caseloads, which has a direct link to stress and burnout. We support the measure of targeted training to encourage fast track processing of new recruits and volunteers, to ease the overall burden. 

 

Training

There is no central control for Adult Social Care over the training of regulated professions. Nurse and Occupational Therapist training numbers are planned by HEE. Social Worker training is somewhat limited by the current number of bursaries available, but training can still take place without one. There are no regulated qualification requirements for direct care roles, which means that the workforce is subject to labour market economics.

 

Unlike the NHS where career progression is linked to nationally agreed Agenda for Change pay scales, the diversity of the adult social care sector, with a workforce of 1.5 million covering over 18,000 independent organisations, has meant there is less clarity about the skills and knowledge required in social care roles at different levels. Whilst career pathways do exist within social care, they are generally informal and dependent on several factors, including quality of the training offer and employers’ commitment to fund staff development.

 

Staff Absence

The percentage of days lost to sickness during COVID-19 (up to July 2020) was 8.0%, compared with 2.6% pre-COVID. However, depending on a provider’s sickness pay policy, workers may be disincentivised to take sick leave and reduce their income.

 

 

 

 

 

[1] NHS Staff Survey, 2019: http://www.nhsstaffsurveyresults.com/

[2] NHS Workforce Statistics, May 2020: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/may-2020

[3] NHS Long Term Plan: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

[4] We are the NHS: People Plan for 2020/2021 – action for us all, 2020: https://www.england.nhs.uk/publication/we-are-the-nhs-people-plan-for-2020-21-action-for-us-all/

[5] HEE COVID-19 student data collections to support paid placement deployment, 2020: https://www.hee.nhs.uk/coronavirus-covid-19/hee-covid-19-student-data-collections-support-paid-placement-deployment

[6] Electronic Staff Record – the HR and Payroll system used by NHS Trusts, CCGs and other Central Bodies

[7] NHS Workforce Statistics, May 2020: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/may-2020

[8] NHS Sickness Absence Rates: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness-absence-rates/april-2020-provisional-statistics

[9] Absence rates have been calculated by DHSC using; Numerator: Absences and Coivd-19 Related absences as published in the Covid-19 Hospital Activity publication https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospital-activity/ Denominator: NHS Workforce Statistics headcount figures , as the latest NHS Workforce Statistics are for May 2020, the denominator for June, July and August refers to May figures.

[10] NHS Workforce Statistics: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/

[11] NHS Staff Survey, 2019: http://www.nhsstaffsurveyresults.com/