As the 10-Year Workforce Plan fast approaches, staff mental health is back in the spotlight. Recent figures from Unison paint a worrying, yet painfully familiar picture of an NHS workforce at breaking point. These figures came just weeks after a separate report from the Nuffield Trust highlighted mental ill-health as the leading cause for nurses leaving the service. As Union's head of health, Helga Pile, powerfully put it: ‘Staff who care for others are being pushed to the point that they're becoming unwell themselves.'
None of us began our career in healthcare expecting it to be easy. Long shifts, unsociable hours and a demanding workload are part of the job. But for too many NHS workers, the additional pressures of inconsistent scheduling, understaffing and a chronic lack of flexibility make it altogether unsustainable.
I've lived this reality. Within two years of qualifying, the cumulative toll of an unsustainable system had quietly eroded my ability to keep going full time. I loved caring for patients and I worked alongside some truly incredible colleagues, but our efforts were constantly undermined by a fundamentally broken system. Irregular shift patterns left no room for life outside work and I was repeatedly unable to book the annual leave I was entitled to, even when requesting it months in advance. Eventually, it became apparent I was trying to strike an impossible balance and decided to step back from my full-time role.
The natural response to reports like Unison's is to call for greater wellbeing support for staff on the frontline. This is absolutely necessary. But if we're serious about creating real change and boosting retention, NHS staff need more. We need tangible, structural measures to repair the system that's pushing so many clinicians like me to breaking point in the first place. Sticking plaster solutions aren't cutting it. To move the dial, we must take a more flexible, sustainable approach to workforce management.
From retroactive support to proactive prevention
While readily accessible wellbeing support is essential in any workplace, not least one as demanding as the health service, it is by its very nature treatment for a symptom. It doesn't tackle the problem at source.
We know one of the key forces driving record numbers of NHS staff to leave the workforce every year is stress, fuelled in large part by a severe lack of flexibility and work-life balance. Retroactive support, delivered only once staff reach breaking point, does nothing to address the structural problems that are causing their stress in the first place. Sticking to this approach will not break the burnout cycle.
Rather than backing on retroactive treatment to clear up the mess, we need more proactive prevention and a workforce structure that supports healthcare staff to continue delivering outstanding care, without compromising their own wellbeing.
Turning intent into action
Intent isn't the issue. NHS organisations across the UK are working tirelessly to overcome workforce challenges and ease shortages, all while under pressure to cut costs and drive down waiting lists. But too many workforce teams, however well-meaning, are being hamstrung by decades-old tools that simply cannot accommodate the level of flexibility and co-ordination needed to deliver fair and sustainable rotas.
As a result, workforce inflexibility and chronic staff shortages become baked into the system, leading to increased frustration for both clinicians and managers. As a doctor, I've heard countless stories from colleagues of missed weddings and birthdays, or holidays cancelled at the last minute. I've also seen how damaging it can be to keep missing out on the little moments - regular family dinners, a weekly dance class, children's sports matches. For most people, looking forward to these moments is what gets you through a tough working week. For too many clinicians, they feel like a pipedream.
But the technology we need to deliver more flexible shift patterns - ones that incorporate clinicians' individual preferences, while balancing service needs - exists. With the right support and collaboration, these tools can be effectively deployed to transform healthcare staffing from the ground up.
Since stepping back from full-time clinical practice and taking up my role at Patchwork Health, I've seen first-hand the work NHS trusts up and down the country are doing to deliver fair and sustainable staffing. When it's embedded in workforce planning and supported by the right digital infrastructure, flexible, preference-based rostering can have an incredible positive impact on clinicians' wellbeing. It's not a quick fix. Digital transformation in the NHS is a complex and slow-moving beast. But if we want to prevent this pattern from repeating and retain more clinicians in our health service, it's a shift we have to make.
For clinicians, it means having the flexibility and work-life balance to manage the demands of the role while maintaining their own wellbeing. For workforce management teams, it means fewer staffing gaps and more efficient shift planning, making it easier to maintain safe staffing levels and preventing the need for third-party agency staff to plug gaps.
Looking ahead
Tackling the NHS workforce crisis requires more than retroactive wellbeing support for staff. To truly address these challenges, we have to dig deeper and start delivering the targeted, structural changes that will prevent staff being pushed to the brink in the first place.
We cannot wait for yet another report telling us how many clinicians are at breaking point. The focus has to shift, and fast. As we approach the 10-Year Workforce Plan, my hope is that it moves the NHS beyond sticking plaster policies and delivers concrete plans for proactive, structural reform and the digital transformation needed to enable it. At a minimum, that means a statutory commitment to flexible rostering, funded digital infrastructure for workforce planning and a measurable target for reducing unplanned staff absence linked to burnout.
