Medical staff are seen at the NHS Nightingale Hospital at the ExCel Centre as the spread of COVID-19 continues, in London, Britain, April 14, 2020, photo by John Sibley/Reuters

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(The RAND Blog)

Looking After Those Who Look After Us—How COVID-19 May Affect NHS Staff

Medical staff are seen at the NHS Nightingale Hospital at the ExCel Centre as the spread of COVID-19 continues, in London, Britain, April 14, 2020

Photo by John Sibley/Reuters

by Christian Van Stolk

April 15, 2020

COVID-19 is spreading across the globe quickly. In badly affected regions, health services, especially those parts of the system looking after acute cases, risk being overwhelmed. Healthcare staff will be significantly affected by the increased pressures. Many will have to work longer and harder to manage the demand and will likely be exposed to the virus while looking after sick patients. This has both an impact on individual staff as well as the quality of care as fewer staff may be available to look after patients.

Concern for the health and well-being of staff is not new. RAND Europe's seminal work on the health and well-being of National Health Service (NHS) staff in the UK goes back to Steve Boorman's independent review for the Department of Health in 2009. Boorman's review highlighted associations between employee health and well-being and quality of care and financial performance in the NHS. It also suggested concrete steps that NHS organisations could take to improve employee health and well-being.

The NHS in England has been under severe budgetary pressure since the financial crisis of 2008. In this climate, it has proved challenging to make substantial progress on the employee experience in the service. Some initiatives have tried to move the debate forward. The Five Year Forward View, published by NHS England in 2014, underscores the importance of staff health and well-being as a crucial factor in improving the performance of the NHS. This led to guidance and frameworks developed by NHS Improvement and NHS England being rolled out across NHS health organisations. The NHS Constitution makes a commitment to staff and a NHS People Plan is nearly ready for publication.

Despite these efforts, the NHS may not be entering the current crisis in the best shape. RAND Europe research on NHS staff across 35 hospital trusts in 2018 suggested significant health and well-being challenges in many parts of the NHS. The research showed especially high levels of obesity and poor mental health among nursing and healthcare assistants, social care workers, and ambulance staff compared to other NHS workers. Over 80 percent of NHS staff reported at least one dimension of work-related stress. Twelve per cent of NHS staff reported being bullied at least some of the time and four percent experienced violence over the previous year. For some, suboptimal working conditions and poor well-being have become the norm in parts of the service. It seems obvious that NHS staff have been feeling the strain for quite some time.

There is no doubt that NHS staff will step up to the challenge and society will rally around them during the current crisis. However, goodwill is not enough. Concern for the well-being of NHS workers tends to be crowded out by other pressures such as waiting times, finances and political priorities. We need to ensure that NHS organisations provide significant support for healthcare workers and specifically for certain employee groups most at risk. This may be challenging at a time of unprecedented demand for health services but absolutely necessary. COVID-19 may leave a long legacy of poor health and well-being in the health workforce. This could impact both quality of care going forward, but also the financial performance of the system. Ultimately, a healthy NHS workforce is needed to look after the health of all of us.


Christian van Stolk is executive vice president and director of the innovation, health and science research group at the not-for-profit research organisation RAND Europe.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.