Narrow Health Service? Approach to solving the NHS staffing problem from an HR point of view

The National Health Service (NHS) of the United Kingdom faces many problems in the last years: The number of patients is increasing every year, whereas the existing staff cannot cope with this emergence. According to NHS Digital, the NHS has treated more than 1,4 million patients every 24 hours – only in England (NHS, 2019).  However, only around 1,1 million people[1] worked for the NHS in September 2018 (NHS Digital, 2018a).

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 Therefore, the NHS needs to recruit new employees to withstand the high amount of work. However, it is already not possible to fill all vacancies: Latest studies assume there is a 11% vacancy rate only for nurses within the health care system, which equals a total number of 36000 (House of Commons, 2018, p. 6). At the same time, approximately 22000 people graduate from a bachelor’s degree in Nursing in the UK yearly. Although the NHS already implemented new strategies to deal with this issue, for example through Fast Track Schemes, it is vitally important to find an effective way to recruit these nurses properly to find the best candidates for vacant positions (House of Commons, 2018, p. 19)

 Furthermore, the NHS has to deal with a high turnover rate: In the second quartal of the financial year 2018/2019, 71291 employees left the organisation and almost half of them[2] left voluntary. The most common reasons are a bad work-life-balance[3], better reward packages[4],  and the lack of opportunities[5] (NHS Digital, 2018b).

 To keep the NHS viable, it is important to create sustainable strategies which will solve the issues of unsuccessful recruitment and high turnover. This essay provides recommendations for these two main problems within NHS’s HR work and discusses their possible limitation. Based on theoretical frameworks, a new employer branding and retention strategies like increasing the learning and development possibilities, remodeling the reward system, as well as creating a work-life-balance-empowering environment will be introduced and their limitations will be discussed.

To ensure that used recruiting tools are actually working, it is necessary to create an attractive employer brand. According to Backhaus and Tikoo (2004, p. 502), employer branding points out what makes an employer unique and makes the purpose of the organisation clear. This specific kind of marketing is especially useful in tight labour markets as in the health industry where potential employees are rare. Having an accurate employer brand leads to higher employer attraction and higher person-organisation-fit, which reduces turnover intentions (Backhaus & Tikoo, 2004, p. 507ff; Kristof-Brown, Zimmerman, & Johnson, 2005). To create a unique employer brand, NHS should focus on its own purpose and the reason why people decide to work for them – helping people. A marketing campaign “I AM NHS. YOU ARE NHS. WE ARE NHS” with pictures and stories of real employees and why they decided to work for the NHS can help future candidates to identify with the organisation and its employees, as well as creating an organisational citizenship behaviour for the existing staff. This is seen as causally linked with job engagement (Newton & LePine, 2018, p. 47).

But not only having some feeling of belonging will keep the current staff, as well as not only recruiting new people will solve current issues if they will basically not stay with the organisation. The NHS needs to focus on getting a higher job engagement first through fixing the main reasons why employees are leaving the company as well.

 According to Kahn (1990, p. 700), people who enjoy their job are more likely to stay in the role they are occupying. Therefore, a high job engagement should lead to less turnover intentions, higher motivation and higher quality of work (Roberts & Davenport, 2002, p. 21). As stated before, the main issues of leaving were lack of opportunity, better reward systems at conquering organisations and the work-life-balance. To actually enhance job engagement, motivation and the overall satisfaction of its employees, the NHS should take actions to solve these problems.

The feeling of lack of opportunities often comes from being in the same position over a long period of time. In order to solve this issue, the learning and development possibilities should be increased. Investing in employees’ human capital is not only beneficial for the organisation itself as it ensures a competitive advantage (Birasnav, Rangnekar, & Dalpati, 2011; Schultz, 1961). It also increases the intrinsic motivation of workers. According to Herzberg’s 2-Factor-Theory (1993), motivation can be influenced extrinsically through money or working conditions, as well as intrinsically through recognition or self-development. Encouraging the intrinsic motivation through additional learning and development offers through advanced education or social skill courses could therefore have a positive impact on job engagement of each employee (Egan, Yang, & Bartlett, 2004, p. 295).

Another main complain of former employees are better reward packages of other competitors. As the NHS is mainly funded by taxes, its possibilities regarding financial benefits is highly limited (Hawe & Cockcroft, 2013, p. 50). However, money is an important factor for motivation, but may not be the biggest one (Rynes, Gerhart, & Minette, 2004, p. 391). Although empirical studies like Brown and Sturman (2003), Fernie and Metcalf (1999) or Kerr (1975) show the impact of performance-based pay schemes on high performers, it might not be the best reward system for the health care system. Even if team-based bonuses for each ward would be paid, it is hard to quantify what should be rewarded: How quickly a patient leaves the hospital again? How many operations or births could be done in a certain amount of time? This might be a reasonable option;

However, it should not be forgotten that the NHS is working in the health sector. Patients could lose their trust in doctors and nurses as they could fear the staff only wants to treat them quickly, not qualitatively. An alternative would be “compensation perks” like a free travel card for public transport or even a new learning and development section within the organisation with courses not related to organisational human capital, like languages or computer skills.

But most importantly, a healthy work-life-balance seems to be the biggest complain former workers had about the NHS. Work-life-balance, as defined by Kalliath and Brough, simply means that individuals should see their work and private life in harmony and meet their current needs (Kalliath & Brough, 2008, p. 326). As not enough people are working for the NHS, it is assumable that employees have to work more and therefore have to cut their personal life drastically.

This issue makes it the hardest point to change as well, as it is not possible to simply work less or use a different form of working, for example home office. However, it is important to take this point seriously and actually reward employees for their overtime work, either financially or with days off as it will lower the risk of a psychological contract breach between employer and employee. The psychological contract is an unwritten agreement between employer and employee, which involves subjective things that are important for each side’s satisfaction (Rousseau, 1995, p. 9).

Breaches of these unwritten and often unknown wishes and needs lower organisational commitment and job satisfaction in general. Not rewarding overtime work will be seen as a breach and therefore increase turnover intention (Zhao, Wayne, Glibkowski, & Bravo, 2007, p. 663). Withal, showing employees that they are actually valued for their work and acknowledging their engagement will fulfil their need of recognition according to Herzberg’s 2-Factor Theory, which has an impact on people’s motivation and therefore job engagement (Herzberg, Mausner, & Snyderman, 1993).

But as much theoretically underpinned and empirically proven all these actions might be, the biggest limitation of them all is the cost factor: Be it more learning and development possibilities, a unique employer branding campaign, implementing new reward schemes or rewarding extra hours to ensure a healthy work-life balance, every action needs a certain budget, which the NHS apparently does not have as it is already facing immerse cost cuts.

However, the NHS should not only focus on the short-term costs, but rather on the long-term outcomes of such arrangements: Current processes and strategies do not seem to work, therefore new ideas should be implemented to ensure effective recruitment of new staff, and keeping the existing employees through enhancing their motivation at the same time.

Summarising, it can be said that the NHS’s main mission should be to increase people’s job engagement through taking care of their actual needs on a personal, as well as organisational level. To do that, four main actions should take place:

Firstly, the NHS has to come up with a new employer branding which points out what makes the NHS unique and what its main purpose is: its staff and their will to help others. Creating this employer brand will help attracting the right candidates on the one hand, and keeping the current staff through building an organisational citizenship behaviour on the other hand. Secondly, learning and development facilities should be implemented to fulfil the employees’ need for self-development. This can be part of an attractive new reward system to motivate high performers as well. Lastly, the NHS has to ensure its employees feel valued for the extra work they do, both financially and through positively acknowledging their commitment. Although these actions might seem costly first, they should be seen as investments in the preservation of the organisation. Without all the nurses and doctors, the NHS simply cannot sustain and should therefore invest in its most valuable resource – its employees.

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