Our NHS, in its 75th year, the people who it serves and the people who serve in it, are not in good health. The unrelenting pressures on our NHS are seen as the main cause of a rise in staff illness. This situation will not be remedied any time soon. It is only when our NHS has enough nurses (and other NHS employees), that sickness levels will stop going up. If there is to be a healthy NHS, then what is needed first is a healthy workforce. There has been much focus on recruitment, but there is an urgent need to improve the working conditions of current staff and to protect them from illness, including mental ill health and, in so doing, retain staff.
Last year in England the NHS staff sickness rate was at new high (this is not exclusive to NHS England, other public sector organisations and the NHS in Wales and Scotland are also reporting similar increases in sickness absence). The rate of sickness last year was higher than it was at the height of the COVID-19 pandemic. This record high last year resulted in the health service losing almost 75 000 staff to illness, estimated at 27 million days on average across 2022, equating to around 74 500 full-time equivalent staff, including 20 400 nurses and 2900 doctors (Palmer and Rolewicz, 2023).
Analysis by the Nuffield Trust of NHS Digital data (Palmer and Rolewicz, 2023), demonstrates that mental health problems, such as anxiety, stress and depression, were the most common cause of illness, which had increased by 26% between 2019 and 2022. This was followed by cold, flu or other infectious diseases. The NHS sickness rate is higher than during the pandemic years of 2020 and 2021; this is a 29% rise on the 2019 rate.
The high sickness absence in the NHS is harmful for NHS staff, it is bad for providers of health care in relation to costs and results in disruption to patient care, as well as being expensive for the taxpayer. The increasing numbers of employees taking time away from work leads to an unsustainable vicious circle of increased work for those left, leading to burnout, with more staff then choosing to leave the service.
Our health service has a chronic staffing crisis, with one in 10 NHS jobs currently vacant. The danger of leaving this problem unsolved should not be underestimated: by 2036, England could be 570 000 healthcare workers short (Campbell, 2023).
The recently published Workforce Plan (NHS England, 2023) is welcome, it is also overdue. But the document should not be mistaken for a solution. The challenges posed by ageing populations are global and the UK is not immune to these. How illness is changing, including the number of people with multimorbidity, is a public policy challenge. Key determinants of health such as poverty, inequality and poor housing also need to be addressed.
Ignoring pay and conditions for staff has the real potential to scupper the Workforce Plan. If nothing is done retention will become even more of an issue.
More effort must be made to improve the working conditions of our existing staff and to protect them from illness. The NHS has a duty to protect the physical and mental health of its staff, in so doing this can benefit the whole workforce and current and future patients. The metaphor based on the aeroplane instruction to ‘put your own oxygen mask on first’ before helping others is important for nurses because they need to be taken care of if they are to care for others.
As the General Medical Council (2023) notes, when employers and policymakers understand the positive consequences that feeling supported, valued and having a sense of belonging can have on job satisfaction, retention and patient safety, this will highlight specific areas of workplace conditions that are ripe for improvement.