COVID-19 AND THE HEALTH AND CARE WORKFORCE SUPPORTING OUR .

COVID-19 AND THEHEALTH AND CAREWORKFORCESUPPORTING OURGREATEST ASSETSupported bySeptember 2020

About NHS ResetCOVID-19 has changed the NHS and social care, precipitating rapidtransformation at a time of immense pressure and personal andprofessional challenge. One message from leaders and cliniciansacross the UK has been clear: we must build on the progress madeto chart a new course. NHS Reset is an NHS Confederation campaignto help shape what the health and care system should look like inthe aftermath of the pandemic.Recognising the sacrifices and achievements of the COVID-19 period,it brings together NHS Confederation members and partners tolook at how we rebuild local systems and reset the way we plan,commission and deliver health and care. NHS Reset is part fundedthrough sponsorship by Novartis Pharmaceuticals UK Limited.Find out more at ww.nhsconfed.org/NHSReset and join theconversation on social media using #NHSResetAbout the NHS ConfederationThe NHS Confederation is the membership body that bringstogether and speaks on behalf of organisations that plan,commission and provide NHS services in England, Northern Irelandand Wales. We represent hospitals, community and mental healthproviders, ambulance trusts, primary care networks, clinicalcommissioning groups and integrated care systems.To find out more, visit www.nhsconfed.org and follow us onTwitter @NHSConfed

Key points3 The pandemic has been without precedent in the demandsit has placed on health and care staff across all settings anddisciplines. It has also magnified long-standing problems, theresponse to which has become more important. Public support for the health and social care sector and itspeople has been remarkable and humbling. The NHS recognisesthe role the public played in supporting the lockdown andunderstanding that some routine treatments would be delayed. Organisations focused on the wellbeing of their staff inresponse to these unique circumstances. This built on longterm practices and programmes but was delivered at a scalethat was not achieved before the pandemic. The challengefor our members, the organisations that plan, commission anddeliver NHS services, is now how to sustain that work given theemotional toll the pandemic has taken on many of their teamsacross all settings. A number of factors, including faster decision-making,lighter-touch regulation and reduced bureaucracy, have beenidentified as supporting the response to the pandemic. Thesereinforce messages previously raised by the NHS Reset campaignregarding collaboration and the enabling (as opposed toperformance management role) of national regulators. The disproportionate impact of the virus on ethnic minoritycommunities was mirrored in the impact on black and minorityethnic (BME) staff. The long-standing differences in treatmentbetween BME staff and their white colleagues was throwninto stark – and challenging – focus by the virus and the killingof George Floyd. Our members know they must, and arecommitted to, addressing these long-standing inequities in theirworkplaces.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

4 Given the impact of the pandemic on teams, members recognisethe steps they must take to support staff and to improveemployment practices and culture. The NHS People Promisebuilds on the lessons learnt through the national retentionprogrammes of recent years and the experience of thepandemic. And members recognise its importance. Fair investment in pay and reward is recognised to be part ofthe response to the immense contribution of health and carestaff during the pandemic, but must not be at the expense ofother priorities, particularly relating to improving workforcesupply. NHS leaders need resources and investment to make sustainedheadway on vacancy levels, especially in areas of highest risk,including mental health and learning disability and some of thesmaller allied health professions. This should be a priority in theforthcoming Comprehensive Spending Review.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

Introduction5Health and care staff and the teams they form are thefundamental component of how the nation delivers healthcare.Over the last six months, colleagues across all parts of the healthsystem have mobilised resources, deployed creativity, worked atpace and applied learning to ensure the immediate challengespresented by the pandemic were managed.In responding to the pandemic, we have seen the commitment,professionalism and compassion of staff shine through. Sacrificeshave been made by many, and public support has been bothuplifting and humbling. This needs to be harnessed in collectiveefforts to improve people’s experience of work and to build theworkforce of the future.Additionally, it is vital to acknowledge and celebrate the collectiveefforts of the volunteers; students; current staff stepping up andinto other roles; leavers offering to return; and corporate andadministrative team colleagues adapting quickly to new ways ofworking. Managers and leaders have worked together withinorganisations and across systems to coordinate and lead theirpeople through new and challenging experiences.‘‘The pandemic has taken an awful toll in loss of life amonghealth and social care staff and the population as a whole.Clare Panniker, Chief Executive, Mid and South Essex NHS Foundation TrustHowever, the long-standing discrimination experienced bymany colleagues has been brought to the fore. As the healthand care sector looks to reset how it operates, it is incumbenton colleagues in every part of the system to address inequalityand discrimination in recruitment, development and peoplemanagement practices. This will need to be through leadershipbehaviour change as well as reviewing transactional processes.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

6The recently published NHS People Plan for 2020/21 and the PeoplePromise have a focus on creating an environment and underpinningemployment practices which create open and inclusive workplaces;improve staff wellbeing, provide development opportunity andflexibility in working arrangements; and continually improve theexperience our people have at work.They reinforce and build on the interim plan published in 2019, butfail to fully address the long-standing supply and vacancy problemsfacing our members – the organisations that plan, commission andprovide NHS services in England. But the plan does help to cementthe focus on people at the heart of how we collectively reset.The biggest single risk to delivering the aspirations outlined in theNHS People Plan is workforce shortage. With finite funding, it iscritical to prioritise investment decisions that enable: an increase in the number and diversity of people we trainand employ improvements to the environment in which people work improvements in the technology and digital infrastructureto better enable people to do their jobs or access learningopportunities differently delivery of a funded, modern total reward package offer for thewhole workforce, that encompasses all areas of pay, reward,pensions, benefits and staff recognition.Collectively, these actions will help employers with the attraction,recruitment and retention of staff and support delivery of thePeople Plan aspirations beyond 2020/21. There has been concernthat the NHS People Plan still needs to go further to bring togetherhealth and social care workforce planning.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

7It is accepted by our members that national action and investmentis only part of the response. They understand now more thanever that they must sustain the focus on people within their ownorganisations. They also better appreciate that collaboration withtheir neighbours is a vital ingredient in delivering that focus onpeople.This report draws on feedback from members to identify bestpractice and to prioritise further supportive actions for nationalorganisations and government. These will help employers to deliverthe actions on the People Plan and will go some way to addressinghistoric disinvestment in NHS workforce supply across primary,community, mental health and acute care settings. It also highlightsthe importance members attach to looking at the workforce issuesacross health and social care, not just the NHS.We focus on three areas within the report, which form the basis forthe recommendations we identify:1. Workforce inequality2. Staff experience3. Workforce supplyBefore the detailed discussion of these three areas, we will focusfurther on the reflections and feedback of members regarding thekey workforce policy issues arising from the pandemic.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

Reflection andlearning8Across our membership, organisations have highlighted thefollowing key reflections on the pandemic based on theexperience for their organisations, systems, teams and people.WellbeingCaring and supporting staff formed a central plank to theapproach to dealing with the pandemic in every organisation.There have been significant changes to the way in which peoplework, additional demands placed on staff and the prospect of achallenging few months ahead.Spotlight: Supporting workforce wellbeingImperial College NHS Foundation Trust developed acomprehensive and stepped approach to supporting workforcewellbeing throughout the pandemic, during recovery and beyond.Focusing on practical support in the initial critical phase, the trustquickly pooled expertise to create a multi-modal offer to cover a12-month period which will continue to support all staff throughthe longer-term recovery phase. Additional specific resources areavailable for managers and teams.1ImpactThe unprecedented and rapid changes health and social careorganisations have gone through since March have taken a tollon the health and care workforce. Whether caring directly forthe sickest COVID-19 positive patients or moving to a new way ofworking, leaders observe a strain on their people. This has beenexacerbated across teams by the problems with the availability ofpersonal protective equipment (PPE) and testing in the first half of thepandemic response.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET

9A new NHS Confederation member survey of over 250 healthcareleaders revealed that nine out of ten are concerned about thelong-term impact of COVID-19 on the wellbeing of their staff.‘‘Now is not the time to pack away the wellbeing supportavailable to those across health and care services. Nowis the time to redouble our efforts and expand thesupport, because we should expect unresolved mentalhealth issues are likely to continue to come to the foreover forthcoming months. There is the risk of moralinjury to those working in health and care duringthe pandemic and the long-term impact of this giventhe number reporting impact to both emotional andphysical wellbeing.Samantha Allen, Chief Executive of Sussex Partnership NHS FoundationTrust and Chair of the NHS Confederation’s Health and Care WomenLeaders NetworkCollaborationWhen the climate and conditions are right, individual employerswork together to address shared workforce challenges andpriorities. As has been seen, cross-team working has flourishedwithin organisations and across traditional boundaries. Andcollaborations within integrated care systems (ICSs) have providedmutual aid with both equipment and skills.Members report that moving beyond the transactionalelements of these collaborations requires a fundamental shiftin relationships and ways of working. If we are to deliver onintegrated health and social care delivery, the health and caresystem needs to retain and build on the foundations createdthrough crisis management.COVID-19 AND THE HEALTH AND CARE WORKFORCE: SUPPORTING OUR GREATEST ASSET