Cidália finds common ground in Oluwaseun’s poem from our ‘Gradients’ issue and contemplates a path forward to save our broken healthcare system and those within it.

In the Autumn 2021 issue of the Keppel Health Review, Oluwaseun reflected on her clinical experience working in the National Health Service (NHS). Her piece drew out memories of those I also care for and of the tireless frustration of caring when no one else seems to.

“Why are we still here?”

I wish I could explain to managers and policymakers that it is because we care. Evidence of the benefits in improving the working experience of healthcare professionals is abundant. But any delusions I once had of getting through to them might as well be labelled ‘biohazard’ and left in the disposal bin ready for your annual ward foray. If I confronted them with all the extra hours we put in, and all the breaks we do not take, perhaps they might start to see.

“We don’t get paid overtime, you know”

The result of this way of working is dangerous, scalpel sharp. In an already overstretched health system, COVID-19 has expanded workloads. Our mental health has suffered, with anxiety, PTSD, and other mental health issues increasing. Overstretched and burnt out, we end up taking risks in order to care. 

Perhaps it is attempting to care for others while wading through a sea of personal neuroses that is causing one third of healthcare workers to leave the profession.

Caregiving constantly feels undone, unfinished. The lack of capacity to respond to demands and provide the best care needed is debilitating. As healthcare professionals, the knowledge that avoidable mortality is likely rising is heart-breaking.

These feelings of ours are merely symptoms of more insidious and structural problems, such as glaring gaps in the governance of the health workforce. Omissions result in limited policymaker accountability and understanding of the pandemic, with threats to long-term care that affect the NHS’s efficiency and sustainability. Will we be able to respond to the evolving needs of citizens, patients, and healthcare professionals to guarantee a future-proof healthcare system? 

Probably not.

Healthcare workforce retention is not a new challenge, but it remains overlooked in policy efforts across the world. In the United Kingdom, despite recent efforts to amend the Health and Care Bill, the government rejected it. This rejection sends a clear message to us healthcare professionals. 

Reliance on healthcare professionals trained abroad should not be the main strategy, as this does not provide a sustainable, equitable, and ethical long-term solution. I truly believe that sustainable investment in workforce planning and retention is the best way forward; otherwise, the predictable increases in temporary agency staff, litigation, and care costs will become unmanageable and prevent us from thriving in a healthy society.

We need political will to implement policies that protect the health and care workforce. Until then, we must take small steps to support our resilience and continue to do what we do best: care for others. We should empower each other to take individual actions in the hope of further accountability from politicians. 

To healthcare professionals:

• Allow yourself to take breaks. Do not feel guilty about leaving clinical care if it’s what you wish to do—you can always return.

• Learn to negotiate and calculate your salary. You should not tolerate being one band forever with extensive years of experience. 

• If your employers do not see your value, look for other opportunities.

To policy-makers:

• If you want to improve staff retention, invest in clinical careers at the bedside and learn to value clinical experience and expertise. This investment is crucial to guarantee safety of care.

To NHS Trusts:

• Measure your return on investments when you retain staff versus hiring temporary staff. Not only could this amount to considerable financial savings, but importantly, to improvements in the quality and safety of care.

The wellbeing and safety of both healthcare professionals and patients is dependent on sustained investment in the health and care workforce. Health workers are a fundamental societal building block, and without proper recognition, tangible economic and health returns remain unrealisable. Until our importance is recognised, we remain shadows to policymakers, in a healthcare system waiting to collapse. 

Disclosure: This piece offers Cidália’s personal views and does not represent the views of her employer.