Saying goodbye to outdated shift scheduling will prevent NHS burnout

As featured in Personnel Today

Another pandemic could be about to hit the NHS – staff burnout. Dr Anas Nader explains how embracing flexible working practices and modernising shift scheduling would ease the burden on stretched healthcare workers.

At long last, the UK is emerging from its lockdown hibernation. Within our hospitals, doctors’ surgeries and clinics, a sense of collective pride hangs in the air, like that among warriors returning victorious from battle.

But among the doctors, nurses, porters, pharmacists and frontline managers who worked tirelessly throughout the Covid-19 pandemic, any joy at the prospect of a return to normality is tempered by exhaustion and anticipation of the difficult months which lie ahead.

An understanding of their experience, built from my own years spent as a doctor in London’s hospitals and from the accounts of my friends and colleagues within the health service, causes me to fear that a second pandemic is poised to strike the health service from within.

I’m not referring to the rumoured second wave, or even to an approaching winter flu, but rather the phenomenon of burnout – a potentially incapacitating and dangerous condition which affects over half a million adults in the UK each year.

Burnout – defined by the World Health Organization as “feelings of energy depletion, reduced professional efficacy, and negative feelings related to one’s job” – is known to be a result of chronic mismanagement of stress in the workplace. Sufferers may exhibit emotional overwhelm, weakened immunity, and a propensity to make errors of judgement in the workplace.

In June the British Medical Association released the results of a tracker survey in which 41% of respondents (NHS doctors) considered themselves to be “currently suffering from any of depression, anxiety, stress, burnout, emotional distress or other mental health condition relating to, or made worse by, your work”, with 29% of respondents acknowledging that their condition has worsened since the start of the pandemic. These statistics, shocking as they are, mask the many doctors who are fast-approaching the point of burnout, or who have not yet self-diagnosed.

This condition has the potential to pose significant danger to the sufferer, their colleagues, and, in this case, their patients. But can we really be surprised that the rate of burnout among medics is spiralling out of control?

Firstly, those who exhibit dedication and commitment to their work – as many of those in caring professions do – are generally at higher risk of reaching burnout point. Secondly, NHS staff are experiencing extended exposure to stress, risk and fear. My NHS colleagues likened the act of going to work during the early spring of this year to heading into battle with an invisible and powerful enemy – but in this instance they went without armour, and risked bringing the danger home to their families every evening.

Now, despite a significant drop in Covid-19 infections, it is the mountainous backlog of missed routine appointments and treatments which are piling the pressure on NHS staff. Most will, out of a genuine sense of loyalty and duty, continue to prioritise their patients and colleagues over their own wellbeing, but I believe it’s high time we called a halt on the NHS’s unsustainable working norms.

Decision makers must seize this opportunity to fix the cracked foundations, before the impending risk of large-scale staff burnout causes the whole structure to collapse.

I remain optimistic that, although much damage has already been done, opportunities remain to control the escalation.

We must start by delivering empowerment to clinical and non-clinical staff alike. By this I mean handing back control over shift scheduling; trusting individuals to self-manage their time and workloads in a way which best suits their unique needs, and ending the unpredictable tyranny of the centralised rota. Flexible working has been embraced by most employment sectors in the UK, so why have NHS staff been denied the same benefits?

The transition will by no means be easy – the current outdated staffing systems are deeply embedded – but the payoffs would vastly outweigh the costs. Imagine a system in which doctors can forestall burnout by temporarily cutting down their shifts, where nurses could take time off to process a family bereavement, safe in the knowledge that their shifts would be quickly filled by a colleague and that they could easily re-adjust their schedules again in the future.

This might sound counterintuitive at a time when services are stretched wafer-thin, but it makes sense when you remember that without this enhanced flexibility, many staff will be forced to leave the workforce permanently.

By embracing simple technologies and digital platforms, this scenario could quickly become a reality. This means making investments in digital innovations which can facilitate flexible work scheduling, seamless staff recruitment and redeployment, and a reduction of the energy-sapping time clinicians spend on admin.

However, if we want to see real, lasting, meaningful changes to protect the NHS for decades to come, actions and initiatives will need to be developed with and around the people they are intended to support. NHS staff may be heroes, but they’re not superhuman. There’s no more time to waste – let’s begin meaningful action to reform working norms and make our NHS even greater.