Written evidence submitted by Dr Paula McFadden1, Dr Patricia Gillen1,2, Dr John Moriarty3, Dr John Mallett1, Dr Heike Schroder3, Dr Jermaine Ravalier4, Professor Jill Manthorpe5, Dr Denise Currie3, Ms Patricia Nicholl1, Ms Susan McGrory1 and Dr Ruth Neill1 (Health and Social Care Workforce) (RTR0039)
1Ulster University; 2Southern Health and Social Care Trust, 3Queen’s University Belfast; 4Bath Spa University; 5King's College London
Funding Statement: This research is funded by the Public Health Agency R&D Division in Northern Ireland and supported by the National Institute for Health Research (NIHR) Policy Research Programme, through the Policy Research Unit in Health and Social Care Workforce, PR-PRU-1217-21202. The views expressed are those of the authors and not necessarily those of the funders, or the NIHR or Department of Health and Social Care.
UK PARLIAMENT - CALL FOR EVIDENCE
Workforce: recruitment, training and retention in health and social care
Brief description of Research Team and contribution to evidence
We are a research team from Ulster University, Queen’s University Belfast, King’s College London and Bath Spa University. We are sending evidence from Phase I of a study that was seed funded by the Northern Ireland Social Care Council and the Southern Health and Social Care Trust in Northern Ireland, and Phases 2-5 (until October 2022) funded by the HSC Public Health Agency Northern Ireland, and support from the NIHR Policy Research Programme grant to the NIHR Policy Research Unit in Health and Social Care Workforce at King’s College London (grant number NIHR PR-PRU-1217-21002). We have expertise in nursing, midwifery, social work, Human Resource Management, quantitative and qualitative research methods and have established networks with stakeholders across the UK. The evidence from our study provides data across five time points of the pandemic (May 2020-October 2022) and includes information about the principal factors that appear to lead to frontline staff leaving the health and social care sector.
Brief Description of the study
Our study focusses on psychological wellbeing, quality of working life, burnout and coping strategies in nurses, midwives, allied health professionals (AHPS), social care workers and social workers from across the UK who are employed in a range of settings such as hospitals, the community, GP practices, care homes, home care and day services. Phase 1 received a total of 3,290 responses, Phase 2 received 3,499 responses and Phase 3 received 2,721 responses. We developed evidence-based recommendations for supporting the workforce not just during the Covid-19 pandemic, but also post-pandemic as services rebuild and in business-as-usual times. Phase 3 results revealed that across UK, a total of 35.1% of respondents (nurses, midwives, allied health professionals, social care workers, social workers) were likely or possibly suffering from depression and/or anxiety and we suggest this will be of major importance in recent and future decisions about staying in frontline health and care work. Respondents from Northern Ireland reported higher wellbeing scores compared to those in England; we do not know why this is but it suggests the value of looking across the UK at workforce trends. Similarly, respondents from Wales reported better quality of working life than all other UK countries and the reasons for this could be explored. Higher wellbeing and higher work-related quality of life were associated with positive coping strategies (e.g. acceptance, emotional support) and lower burnout amongst the workforce. Respondents who indicated they wanted to leave their employer or occupation during the pandemic experienced higher personal, work-related and client related burnout than those who did not intend to leave. These are not unsurprising findings but they do suggest that leaving frontline care (Health and Social Care) is not inevitable but that employers do have a role in mitigating the factors that contribute to difficulties or burnout.
Rationale for submitting evidence:
The Health and Social Workforce study survey can contribute to the Call for Evidence Terms of Reference.
Most pertinent to this call for evidence, is a question posed in Phase 3 of our survey, respondents were asked if, since the start of the pandemic, they had considered changing their employer while staying within their current occupation. Respondents from Wales were the least likely to consider changing their employer with over two thirds answering no they have not considered changing their employer (66.3%) while those in England were more likely to consider leaving their employer (61.0%). Midwives and Social Workers were more likely to consider changing employer during the May-July 2021 period of the pandemic (this may be affected by the shortages in these professions meaning that moving employers is not too difficult). More than a quarter of all respondents (25.8%) reported that their job had been impacting negatively on their health and wellbeing. Other factors which led to respondents considering changing their employer included:
• Limited opportunities in their current work area
• Restructuring of services
• High risk place of work (exposure to COVID-19)
• Being exposed to bullying behaviour in workplace
• Need for more hours of work
• Unmanageable stress
• Family reasons
• Loss of autonomy and flexibility
• No job security – temporary contracts
• Not feeling valued or supported
• Poor work-life balance
• Considering retirement
• Costs of working at home (such as electricity, heating, broadband)
Respondents were also asked if, since the start of the pandemic, they had considered changing their occupation. Respondents from Wales were the least likely to consider changing their occupation (60.1%) while those from England were more likely to consider changing occupations (56.2%) mostly because they found their job was impacting on their health and wellbeing. Midwives were most likely to consider leaving their professions during the pandemic while Allied Health Professionals were more likely to remain in their roles. Respondents reported other factors which led to them considering changing their occupation including:
• Retraining required for redeployment
• Considering retirement
• Job is now too demanding
• Challenges of working for hours at home
• Redeployed with no sign of returning to original role
• Additional family pressures
• Constant stress and work pressures for the foreseeable future
• Lack of organisational support for the occupation
• Wages are too low and staff feel undervalued
• Not wanting to get COVID Vaccine
• Frightened over the pandemic
To address the principal factors driving staff to leave their job/employment in the different health and social care sectors, the survey’s open ended responses and focus groups discussions highlighted some of the key problems and explored how they could be overcome including: a better Home-work interface, recognition and feeling valued, wellbeing support, workplace support, lack of resources, communication in the workplace and building and appreciating relationships.
The COVID-19 guidelines from the UK government at the time of the focus groups in June 2021, advised that everyone who can work from home should still continue to do so. Employers had been asked to be as flexible as possible. Respondents in the focus groups highlighted that working from home had a number of benefits reporting that their productivity increased and the flexibility provided a good work/life balance and a feeling that their employer/manager trusted them to get on with their work with less scrutiny and oversight than before. The use of technology for virtual meetings meant that teams could meet frequently without the need for travel time. Respondents to the survey noted that flexible working patterns such as changes in working hours or the ability to work from home when possible were important factors to consider. Improving work-life interface by having more flexibility could help prevent staff from leaving the health and social care sector. While, this time and location flexibility was noted as a possible important part of staff retention, consultation and discussion are needed between staff and employers. The advantages of more flexibility in employment across individual, organisational and policy levels need to be maintained where possible and if outcomes are good as services rebuild and services adopt new flexible approaches to care delivery.
Peer support was reported to be vital during the pandemic, helping respondents to overcome the challenges in changes to their normal working practices. Having peer support provided people to talk with and a support system/informal network, albeit remotely for some of our respondent groups. However, we found increasing levels of anxiety and depression with declines in wellbeing and work-related quality of life during Phase 3 of the study (May-July 2021) in comparison to Phase 1 (May-July 2020). This may impact staff willingness to go back to workplaces full time, be in the same office space with a larger group of people and attend in person meetings. Human Resources staff will need to support managers in addressing a positive return of being physically present at work where necessary but also to recognise that too great pressure may be counterproductive. On an organisational level signposting employees to support services such as counselling, mentoring or occupational health services was noted by respondents as reasons as possibly helping them to stay in their roles. (https://www.hscworkforcestudy.co.uk/reports-publications).
We found different staff supports were implemented to varying success as staff became more stressed as the pandemic continued. While exercise programmes, counselling services, mindfulness and psychology services were made available across the different sectors and by some employers, several respondents felt these could be more widespread and some suggested they would give them more reason to stay in their current occupation or within their current sector. Several respondents felt that the promotion of positive wellbeing programmes introduced as the pandemic continued focussed on the work day which made these programmes inaccessible to some.
Recognition and feeling valued
Many respondents highlighted that working during the pandemic has been difficult but that they had continued to work hard and had gone beyond their normal job roles to help their clients and service users. Frontline respondents in particular highlighted the need for managers to be visible (either remotely or in person) and to acknowledge the work they had been doing during the pandemic. Recognition and making sure workers feel valued were considered vital. However respondents also recognised that managers had also been working hard and under pressure and that they too needed positive feedback and acknowledgement. Those respondents who were managers sometimes reported feeling unsupported.
Communication in the workplace
Respondents indicated that as the COVID-19 pandemic continued that communication between managers, employees and colleagues for the most part improved. It was acknowledged that it was important to help improve staff’s understanding of what they needed to do during these periods and what safety measures or working procedures were necessary, according to local COVID -19 guidance. Communication is a key to connection and clearer targeted two-way communication pathways are required between employers, management and frontline staff in the health and social care sector. Supportive supervision was also seen as an important way to help addresses concerns that employees may have about their practice, particularly in relation to changes in frequency and nature of contact with patients/clients.
Building and appreciating relationships
The COVID-19 pandemic has presented an opportunity to improve relationships, and develop innovative ways to foster and maintain connections between employees, employers, stakeholder organisations, government departments and patients/service users. Moving out of the pandemic it should be acknowledged that maintaining these connections is important and could prevent staff leaving the health and social care sector.
The lack of resources has frequently been noted as contributing to increased pressures on the health and social care workforce. Most of our survey and focus group respondents observed that not having enough resources, including but not exclusively sufficient staff, causes a great deal of stress and makes the increased workload less manageable. Respondents acknowledged that even when the pandemic subsides, the stress is not just going to disappear in health and social care as the workload looks set to increase with efforts to reduce backlogs in hospital lists and respond to more people seeking support from social care/social work. Therefore, innovative ways to increase the level of resources available to this workforce, in the forms of more administration and technological support, training and development opportunities, and increasing the pool of staff within the sector are important in helping decrease intention to leave and high staff turnover rates.
Good practice recommendations were reported in the Phase 3 study report which can be found at www.hscworkforcestudy.co.uk
We hope the above has been of assistance to the Committee in its deliberations.