NHS staff wellbeing: the financial impact and actions for improvement

The pandemic has demanded an extraordinary response from NHS staff. And while this has highlighted their vital role as key workers, it has also emphasised the issue of staff wellbeing and created an opportunity for meaningful change. 

Commissioned by The International Public Policy Observatory (IPPO), a recent rapid evidence review and economic analysis has now been published looking at the financial impact of poor NHS staff mental health and wellbeing, and what can be done to improve it.

IPPO’s Sarah O’Meara takes us through the review’s findings and what they could mean for researchers and policymakers. 

Through a narrative review of the state of mental health and wellbeing of NHS staff – including a review of the impact on patient and organisational outcomes – the IPPO, The University of East Anglia and RAND Europe showed that: 

• 47% of employees felt unwell as a result of work-related stress in the previous twelve months (data collected between September and November 2021)
• overall sickness absence increased to 5.7% in October 2021
• there are high vacancy and turnover rates in some Trusts
• patient care can be affected by staff wellbeing, with poor NHS staff health and wellbeing associated with reduced quality of care, financial performance, and patient satisfaction

The review estimates the cost of poor staff mental health and wellbeing to the NHS might amount to £12.1 billion per year with:

• presenteeism = £6.07 billion
• staff absence =  £3.79 billion
• use of bank/agency staff = £2.24 billion

As part of the report, a rapid systematic evidence review of organisational and management interventions showed that: 

• Actions focused on systemic/culture change, how working schedules are managed and improving aspects of the physical working environment have positive effects on staff wellbeing. 
• Actions focused on improving social support, automating processes and virtual working also have positive effects, at least for some people. 
• Actions focused on improving the psychosocial work environment were less likely to result in improved wellbeing. 
• Several of these actions have some evidence on cost-effectiveness and suggest a positive return on the initial investment made.

What can be done?

By tackling poor mental health and wellbeing, and reducing the number of people voluntarily leaving, the NHS could save up to £1 billion under some of the scenarios modelled by the review. 

Based on these findings, the IPPO team’s key recommendations include: 

• Putting the protection of NHS staff health at the core of operational plans, governance, and strategies. This could happen as part of the NHS People Plan, the NHS Long Term Plan and the NHS Five Year Forward View.
• Making staff wellbeing a core focus in inspections and reviews by regulators such as the Care Quality Commission, the General Medical Council and the Nursing and Midwifery Council. 
• Improving NHS governance principles as applied to the wellbeing of NHS staff, so that accountability for workforce health is clearly defined and well understood. 
• Introducing shorter, more frequent and operationally-focused tools to monitor the wellbeing and mental health of staff on a regular basis, in addition to the NHS Staff Survey. An example to follow would be the British military, which conducts longitudinal monitoring of personnel through an agency funded by, but independent of, the organisation itself. 

What’s next?

We know that interventions which are part of an organisation-wide approach are more likely to be effective at improving wellbeing than ad hoc measures, and the finding’s recommendations chime with this.

We need to know more about which interventions work at scale in healthcare settings in the UK, their cost-benefits, and their interconnectedness with wider contexts.

Given the unique structure and size of the NHS, we also need to understand the challenges in staff locality and organisation in order to address the specific health and wellbeing issues they face.