Holding back the tide - extending working lives in the NHS

It is increasingly likely that the NHS will experience unprecedented staff shortages over the next ten years. This has serious implications for service provision and the wellbeing of the staff that remain. The abolishment of the mandatory retirement age and changes to the UK state pension age (currently 67) means that people are now having to work for longer. Nonetheless, despite the staff shortages, there has been a surge in applications for retirement from the NHS in the last few years – many from people who are in their 50s who could be working considerably longer. It is therefore crucial to identify the 'push and pull' factors that encourage and discourage people to remain working for the NHS. 

The Medical Research Council has funded a four-year project to examine the implications of extending working lives in the NHS and to identify ways to retain an ageing workforce. Two linked studies from this research programme were presented, drawing on data from people working in six NHS trusts and professional bodies and trade unions, together with the secondary analysis of a UK-wide NHS employee questionnaire and the Labour Force Survey.

The first study, presented by Deborah Roy from the University of Bath, considered the role played by job demands and job commitment to the NHS in predicting intentions to quit in Allied Healthcare Professionals (AHPs). Dr Roy explained that a strong commitment to the values of the NHS and the deeply satisfying nature of patient care means that staff are prepared to work above and beyond the call of duty. There are concerns, however, that growing demands and fundamental changes to the structure of the NHS (such as the franchising of services) are reducing staff commitment and satisfaction, with serious implications for retention. 

More than 1,000 staff completed questionnaires that assessed psychosocial aspects of work (such as job demands, resources and flexibility), together with levels of job satisfaction and NHS commitment. Participants were also asked whether they wished to leave or remain and to provide the reasons for this. Age, job demands and satisfaction were found to be the key predictors of intention to quit within 12 months, but high commitment and satisfaction offset the negative effects of job demands and encouraged people to remain. A particularly powerful message from this study was that AHPs were 3.5 times more likely to wish to leave the NHS in the next 12 months when they were working under conditions of high demand. They were six times more likely to plan to remain for every unit increase in NHS commitment.

The second talk, presented by Andrew Weyman (also from the University of Bath), considered the factors that push health professionals towards leaving the NHS. Over 1600 staff from different functions identified the most important factors that motivate people in their profession quit. Options included time pressure, working hours, shortages of staff and resources, mental and physical demands, lack of flexibility, low pay, bureaucracy and a lack of recognition for effort. A paired comparisons method was used to consider the relative importance of these factors to quitting. Regardless of job type, staff shortages, job demands and time pressure were the key factors thought to drive an early exit. Pay and working hours were generally considered to be less important. Few age differences were found; as Dr Weyman observed: 'if you can cope with the pressures early on, then you are likely to remain'.

The demand for healthcare staff is currently exceeding supply. There are serious concerns that rising job demands and poor resourcing will encourage many more staff to leave the NHS over the next few years with serious implications for the quality of healthcare. Cuts to nursing and other training bursaries and concerns about the implications of Brexit for recruiting staff from other countries are likely to compound these pressures. The findings of this research suggest that that further privatisation in the face of growing demand might erode commitment to the NHS and encourage a mass exodus. A further threat to commitment and satisfaction appears to be the change in pensionable age and the decreased value of an NHS pension, which is something that staff see as a reward for many years of hard work and dedication to the welfare of patients. The speakers recommended that, in order to improve retention, staff need reassurance that core NHS values of fairness, altruism, universality and collectivism will be adhered to in the future and that the age will not be extended further. 

- Look out for much more coverage from the Conference here over the coming weeks, and in the July print edition.