In an opinion piece on the website of the Faculty of Medical Leadership and Management (FMLM) in February 2016, Peter Lees, their Chief Executive and Medical Director, brought together some facts and observations from key studies and reports from recent years. He brought attention to the fact that the NHS in England alone could reportedly have saved £3.3bn between 2009 and 2015 simply by reducing absence due to staff sickness. He quoted Dr Steve Boorman’s report from 2009 that ‘healthier and happier staff are likely to be more productive and more motivated to remain with their employer, so reducing recruitment and associated costs’.
Political turmoil, disputes and negative press have a direct impact on morale. Unhappy people are more likely to have unplanned absence. This puts additional pressure on their colleagues who have to increase their workload to cover this which in turn makes them unhappy too. The principle of this vicious circle is well accepted across all sectors.
The Department of Health’s 2015 report ‘Productivity in the NHS’ by Lord Carter includes the statement ‘Evidence from other industries has shown that good staff wellbeing leads to increased productivity, so we need to improve’. This was in response to the fact that:
- The average sickness absence level in acute trusts was at least 4% and possibly as high as 6% – higher than levels in healthcare systems in other countries
- There are wide variations from one trust to another and between different staff groups
- The average for the public sector is 2.9%
- The average for the private sector is just 1.8% in the UK
Clearly this becomes an increased issue for top level leadership, given the current status of the dispute. Yet there is also a link to everyday local leadership which is a probable factor in the broad variation in these figures. In his FMLM opinion piece, Mr Lees also drew attention to a 2012 report which concluded that only 59% of junior doctors felt valued by their consultants. To quote the conclusion of that report:
‘Doctors in training have a desire and perceived ability to contribute to improvement in the NHS but do not perceive their working environment as receptive to their skills. Junior doctors who attend leadership training report higher levels of desire and ability to express these skills. This study suggests junior doctors are an untapped NHS resource and that they and their organisations would benefit from more formalised provision of training in leadership.’
In the words of Sir Bruce Keogh “trainees feel undervalued and disenfranchised by the organisations in which they work. This feeling discourages them from engaging enthusiastically with others to change the way NHS organisations deliver services.” So this is not only about absence.
A vicious circle develops where the very people who can make a difference disengage and where they see the problems but feel detached from them. The more people who feel this way the worse it becomes – a culture of idle bystanders rather than engaged leaders. We should also bear in mind that leadership in the modern NHS is the responsibility of all doctors, regardless of their level. The FY1 needs to feel valued and supported by more experienced colleagues in specialist training; the CT1 requires the same from the ST4 and so on.
Frustration, disenchantment and detachment are one level of problem. Data exists which indicates that rates of depression and even suicides are significantly higher for doctors than for the general population and the morale challenges cannot be helping.
How do you ensure that your junior colleagues feel valued?
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