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Doctors call for better leadership to address NHS retention crisis

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Frontline healthcare workers in busy NHS hospitals feel that they are “just rearranging the deckchairs on the Titanic” according to new research into the impact of under-resourced and high-pressure emergency hospital departments in the UK.

Research from the Royal College of Emergency Medicine and University of Bath, led by clinical psychologist Dr Jo Daniels in collaboration with colleagues at UWE Bristol and the University of Bristol, argues that hospitals need better leadership to help change cultures and support people’s basic needs.

Alongside reflections from current frontline doctors, nurses and advanced clinical practitioners, the research also features exclusive interviews with former doctors turned comedians, Adam Kay, Harry Hill and Phil Hammond.

The comics all offer reflections on why they left, and how they hope the NHS can be better managed in the future to avoid others from doing likewise.

Lead author Dr Jo Daniels of the University of Bath, said: “At a time of national crisis in the NHS, with over-stretched resources leading to long waiting times for patients and burnout for staff, our study asked what more could be done to improve the current challenges of staff retention.

“A common thread that emerged across our interviews was the critical importance of leadership in hospitals.

“Those in leadership positions are powerful agents of change, and have pivotal influence over team functioning, staff wellbeing and patient outcomes.

“However, lines of accountability and communication with executive management needs to be clarified, opened up and improved. ”

In February 2023 a University of Bath IPR report found that as many as one in seven healthcare workers were actively trying to leave the NHS.

According to the Royal College of Nursing, nearly 27,000 people left the register in the past year, with more than half leaving earlier than planned citing burnout, workload, and concerns over care quality.

The new study, funded by UKRI and published in the the journal Emergency Medicine Journal, investigated perceived barriers to implementing better working practices and conditions for emergency medicine practitioners in the UK.

Building on previous work from the team looking at the toll of Covid for healthcare workers, the analysis highlights multiple issues associated with poor retention.

These include a culture of blame and negativity in hospitals, untenable working environments, compromised leadership and a perceived general lack of support leading to burnout and low morale.

Across the board, participants reported feeling undervalued, with their basic demands being unmet.

These ranged from ‘sharing toilets with patients’, to poorly functioning IT systems, or the lack of rest spaces and staff rooms.

A lack of private space within hospitals meant many repondents also found it hard to decompress.

When considering how staff continue to work in such difficult conditions for so many years, comedian Harry Hill emphasised the ‘force for good’ that has traditionally motivated NHS staff.

Yet, the comic suggested, after repeated reorganisations and a lack of support, this was wearing thin.

Hill said: “When I was a doctor, doctors…were held in some esteem by society.”

Dr Adrian Boyle, President of the Royal College of Emergency Medicine said: “Working in Emergency Medicine can, by its very nature, be a high pressure and stressful job.

“Our members, and their colleagues, who go above and beyond for their patients day in day out, should not also have to battle a system which is meant to be there to nurture and support them.

“What [the research] reinforces is that the NHS must get better at caring for its workforce – its people are its greatest asset, and everything must be done to ensure their welfare.

“This research will now be shared with policymakers and will form part of the College’s advocacy work to help inform and bring about the cultural shift that is so needed in our A&Es.”

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