Urgent steps needed now to avoid staffing crisis in the NHS

The NHS is facing a staffing crisis which threatens the quality of patient care unless urgent steps are taken now by the Government to help alleviate the mounting pressure on front-line services.

The NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland, is calling for a range of measures to be taken in the NHS in England to support hospitals, ambulance services, mental health and community providers, primary care and social care providers.

These include prioritising access to lateral flow and PCR tests for key workers, including NHS and social care staff; deploying medical students onto wards and other healthcare settings; and continuing to review the self-isolation period to see if it is feasible to halve the period from 10 to five days as they have done in the US and France.

The Confederation believes the measures announced in Tuesday’s Downing Street briefing do not go far enough, including the Prime Minister’s commitment to ensuring 100,000 critical workers across a variety of industries will get direct access to daily lateral flow tests from 10 January.

The actions are recommended in response to Covid infections having risen to unprecedented levels in recent days because of the Omicron variant. Despite indications that the effects of the variant are milder than previous strains of the virus for some people, the NHS is seeing rising hospital admissions, with more than 15,000 patients in hospital in England with Covid and increasing pressure on primary care services.

At the same time, the NHS is experiencing major staff shortages due to Covid infection and other illnesses. Before the pandemic, staff absence during winter was usually around the 5% mark; now it is around 8% and rising. Several NHS trusts have called a ‘critical incident’ due to them not having the staff to run services as effectively as normal. In primary care, staff absence can be as much as 20% to 30%. While in social care, providers in some regions have seen a 10% reduction in their workforce in the last four weeks as staff have left for alternative employment in a recovering economy.

In addition, from 3 February the NHS is poised to start removing from frontline care around 5% of its workforce who have not yet been double vaccinated. This will increase the demands placed on staff and teams.

All of these factors are having a detrimental impact on patient care. One hospital chief executive told us they had 750 staff off sick on Friday due to Covid or for other illnesses, while another said they had 413 staff off with 270 of those absent with Covid-related issues.  This is the situation facing many trusts, leaving them with fewer staff to respond to the increased demand for care.

Matthew Taylor chief executive of the NHS Confederation, said:

“It’s clear that we are facing a staffing crisis in the NHS, with a number of hospitals telling us they have around 10% of their staff in self-isolation or on sick leave for other reasons. This is pushing up the ratio of staff to patients to levels hospitals are extremely concerned about. And we know that several hospitals have had to declare a critical incident because of these widespread staff shortages and rising admissions. The Prime Minister’s attempts to reassure the public that the NHS is not being overwhelmed will not chime with the experience of staff working in some parts of the NHS.

“The government now needs to do all it can to mobilise more staff and other resources for the NHS to get through this extremely challenging period. We are calling for NHS, social care and other key workers to have priority access to testing – the Prime Minister’s announcement yesterday that 100,000 critical workers will get direct access to daily lateral flow tests from 10 January is welcome but does not go far enough. We should not be in this position two years into the pandemic.

“We also think there is merit in continuing to review the self-isolation period to see if the evidence supports a halving of the period to five days. We also need other short-term measures, including deploying medical students on wards and taking other steps to cover rota gaps.

“It seems that the Omicron variant is milder than previous strains, but it is still too early to know how much milder, especially in terms of how it will affect older people.  What we do know is that the combined impact of the sheer volume of Covid cases, rising hospital admissions and widespread staff absence is placing front-line services under enormous strain.

“We urge the government not to allow its optimism to lead to complacency given the rapidly changing situation we are seeing on a daily basis. It is for the Government to review the data to see if further restrictions are needed and we urge Ministers to take the right decisions in light of the emerging evidence.”

The Confederation is calling for six steps to be taken to support the NHS to get through January and beyond:

1. Testing: given the shortage of supply for lateral flow and PCR tests, all key workers, including NHS and social care staff, should be given priority access to tests. Otherwise, the significant staff shortages we are already seeing will be made worse, with more staff having to self-isolate until they can prove that they are not infectious.
2. Deploying students: medical students and trainees should be redeployed onto wards and other healthcare settings to support teams in the face of mounting absence and make sure there are enough people to care for patients.  This would be a short-term measure to help alleviate pressure on hospitals and other services. This approach was taken last winter.
3. Self-isolation period: if you test positive, your self-isolation period includes the day your symptoms started (or the day you had the test, if you did not have symptoms) and the next 10 full days. Individuals can leave self-isolation after seven days if certain conditions are met. In line with the approach taken in other countries, such as the US and France, we believe the self-isolation period should continue to be reviewed to see if it’s feasible to halve the period from 10 to 5 days. Only if the evidence is clear that this poses no risk to patients would we want to see this measure adopted. We would not want a reduction to be counterproductive but if the isolation period could be safely shortened, this would significantly help to reduce the level of staff absence over the rest of the winter.
4. Interim changes in ways of working: given the levels of absence and demand due to omicron, national heads of profession and professional regulators, together with the CQC, should clearly state their recognition of the exceptional circumstances in which our people might find themselves working in the coming weeks. This should include explicit acknowledgment of interim changes in ways of working which mean that staffing numbers are altered or reduced and that clinical tasks might need to be allocated in ways which would not normally be recognised as best practice.
5. Transfers of care: hospitals continue to struggle to move patients out of hospital and into care homes and other settings. This is often due to a lack of capacity and increased levels of COVID-related absence in social care and due to some patients choosing not to leave hospital until they have a social care provider of their choice ready to take them. While this is understandable, it is leading to multiple delayed discharges and those same hospital beds not able to be prioritised for patients who are in greater clinical need. The Government and its national bodies should issue a clearer instruction on what needs to happen in these scenarios. This should include guidance that enables patients to be transferred to a suitable placement from where they can then choose a provider of their choice. The risk otherwise is that more hospital beds will be taken up by patients who are clinically ready to be discharged into the community but unable to be transferred.
6. Clear communication with the public: much of the national focus continues to be on the pressure that hospitals are under. While this is a major concern, there are other parts of the health service that are under extreme pressure too, including primary care services such as GP practices. It is vital that the Government provides clear and consistent advice to the public in terms of what they should do when they experience minor illness to avoid GPs and A&E departments being overwhelmed. That advice should include, as a first step, using the NHS website, visiting local pharmacies or calling 111 and using video or telephone services where possible to reduce the spread of infection.