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Tackling low workforce morale in the NHS

Academy of Medical Royal Colleges

Carrie MacEwen

Tuesday, 06 November 2018

AdobeStock_135258057_morale.jpgIn his first speech as Secretary of State for Health and Social Care Matt Hancock stated that he was horrified that NHS staff feel ‘undervalued’. He is not alone. Nor is it new – affecting all staff groups working in the health and social care sectors. Low morale has been repeatedly reported as a major factor leading to doctors failing to apply for run through training, taking career breaks, moving to different countries or professions and, later in life, giving priority to early retirement. Feeling undervalued is a key component of low morale – other factors include high volumes of work, lack of control over professional and personal life, poor sense of support and inclusion and lastly, inadequate reward. All these factors were picked up as issues during the junior doctors’ contract negotiations.

In essence, low morale has been identified as both being caused by, and contributing to, the NHS medical workforce crisis. Attracting and retaining staff requires a positive working environment. Failure to address this will put patient safety at risk as rotas remain undermanned, patients wait longer for treatment and professionalism becomes threatened by impossible demands.

Junior doctors face specific problems due to frequent changes in location, conflicts between training and working, long hours, rigidity of training pathways and lack of continuity of either patient care or working relationships. The Working group for Enhancing Junior Doctors Working Lives has, or is, addressing many of these and the review of the 2016 contract is underway, with a number of commitments secured ahead of negotiations to ensure more flexibility, clearer timely information about rotas and induction and patient safety.

Workforce problems stretch further to include most, but not all, groups who work in health and care and, for his part, the new SoS has launched a new digital platform called ‘TalkHealthandCare’, to request challenges, questions and ideas from staff about their roles and workplace. Feedback and suggestions regarding issues such as ways to improve shift patterns, training and development needs and opportunities, the better use of technology and ways to reduce bullying and harassment will be welcomed as these are common themes.

The problems are largely known and are beginning to be addressed – NHS Employers are introducing fast-access systems for mental health support and physiotherapy for all staff while Simon Stevens recently announced widening of NHS Practitioner Health Programme to include all areas of England. However, as with medical conditions – prevention is better than cure and the emphasis needs to be placed in this domain if the NHS is to become a desirable employer. This means that all staff need to:

  • Feel supported, respected and trusted to do their jobs without over regulation or fear of a blame culture
  • Enjoy work because of a reasonable work/life balance
  • Deliver and learn from continuity of patient care and to celebrate good patient outcomes
  • Be part of a recognisable team
  • Feel empowered to achieve their full potential through access to training and development
  • And confidently work without fear of bullying, violence or discrimination.

Author's Image

Carrie MacEwen

Professor Caroline (Carrie) MacEwen is Chair of the Academy of Medical Royal Colleges (2017–2020) and a Consultant Ophthalmologist at Ninewells Hospital, Dundee. She holds a Honorary Chair as Head of the Department of Ophthalmology at the University of Dundee, is Ophthalmology Specialty Adviser to the Scottish Government, and is leading the National Ophthalmology Workstream in Scotland. She has published more than 150 papers and written and contributed to several textbooks for both undergraduate students and qualified doctors. Her blogs can be found on the Academy of Medical Royal Colleges website.
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