New ways of working

Have you seen NHS Emeritus, this new way for retired and semi-retired consultants to work flexibly to see outpatients? To me, it makes a huge amount of sense. We've all seen the headlines and that 6.37 million people are on an NHS waiting list (at December 2023). The vast majority - around 80% of people on an elective waiting list in the NHS, so over 5 million people - are waiting for an outpatient consultation or diagnostics, not an operation.

To use tech to pair up surgeons and other consultants with patients to be seen on an outpatient basis is a cracking idea. It gets people seen by relevant experts, gets waits down and offers an attractive and home-based way for senior, experienced doctors to use their clinical skills working in the NHS for longer.

There is more on the Emeritus programme here and do pass onto people in your network who could be interested.

https://www.nhsemeritusconsultants.org/

By coincidence, I had been having a parallel thought, when I read the fascinating analysis on the menopause and the NHS by the Strategy Unit.

The NHS is the biggest employer of women in Europe with over one million women employed, the largest single professional group being nurses. Based on Nuffield Trust analysis the proportion of female NHS staff who are nurses is just over half (52%) - that’s 520,000 female nurses employed by the NHS.?

Menopause and the NHS workforce - The Strategy Unit

Expertise Drain

The Strategy Unit work tells us that one fifth of all NHS employees - over 260,000 people - are of menopausal age (which they define as between 45-54) and the vast majority of these work in acute and mental health services. They warn that there is a serious “expertise drain” going on and that the NHS should do more to support staff who otherwise may leave the NHS entirely.?

“The NHS is a provider of health and care services; our analysis finds that nine of the ten women who are NHS employees of menopausal age, work in acute or mental health trusts. […]. Therefore, many of those in front-line operational, clinical, medical, scientific, therapeutic or technical roles have limited options to work from home.”

There are 3 findings and recommendations made, and number 3 is?-

“Finding: There is a significant financial cost associated with the menopause for the NHS as an employer of clinical and medical staff. In parallel there are individual health and wellbeing costs for those in front-line roles navigating their symptoms

Recommendation: The NHS as an employer should address the skills and expertise drain associated with the menopause, examining both employer and personal costs”?

Their research suggests “one in 85 NHS employees may leave their NHS roles and one in 48 may reduce their hours because of the severity of their menopausal symptoms”.?They found that 16,110 women in this age bracket a year leave employment with the NHS and a further 28,790 reduce their hours.

8,377

Based on 52% of these being nurses that would be 8,377 nurses leaving the NHS each year - just in this age group - and almost 15,000 reducing their hours.

The cost of training one nurse in the UK is assessed as being ￡67,000; the cost of training these 8,000 plus nurses who leave each year, during the menopause period, is half a billion pounds or ￡561,260,000, to be precise.?What if we used a tiny fraction of this to run creative schemes to help them stay in the NHS?

We also lose lots of nurses every year from the NHS across all age groups. The Strategy Unit work demonstrates that in the "over 54 year old" group, early retirement increases the proportion leaving to above 10%. We also lose a number pretty early career, in their late 20s and early 30s when bringing up children and shift work can be a very challenging combination, in fact the "under 35" group sees 11.7% leaving the NHS, which is the second highest proportion, after the "over 64s". Is there not something we could do to keep these nurses within the NHS for longer?

An NHS Emeritus for Nurses

Wouldn’t it be fantastic if, before any nurse left the NHS, at any age, they were offered an opportunity to join a similar scheme to the consultants - a national bank of nurses who could, for example, support virtual wards. And the exact same offer to be made at the point of retirement, and - as with consultants post retirement - so that anyone who wanted to continue to make a clinical contribution, could do so on a part-time basis and help care for people recovering at home.

It could be an NHS Emeritus scheme for nurses and indeed AHPs and clinicians of all varieties. So that anyone who really wanted to continue to use their clinical skills but needed - for whatever reason - greater flexibility and to be home-based, could be matched with a service that could make fantastic use of those skills.?Where the consultants are running remote outpatient clinics, the nurses and other clinicians would provide video consultations in the home and review remote monitoring results. They would join an existing team providing ongoing supervision to people on virtual wards and having remote monitoring for long term conditions.

Instead, many thousands of nurses, with not only training but with 20 even 30 years of hands-on clinical experience are leaving the NHS. Some are working in different areas, such as retail, some stopping work altogether. Rather than losing trained, experienced, compassionate and skilled nurses, pharmacists, paramedics and physiotherapists to jobs at Amazon, shouldn’t we try to offer them something clinical, that fits with the strategy to increase NHS capacity through more digital home care, where the patient feedback is phenomenally positive and their role is likely to reward them every day??

Of course, NHS organisations should do their level best to offer flexibility and be imaginative in order to keep staff who want to remain at work, this idea doesn’t let anyone off the hook. I have benefited from hugely enlightened bosses that enabled me to work at a senior level part-time when my kids were small. With shout outs to Sir Robert Naylor Sir David Sloman Andrew Riley and Trevor Campbell Davis as this made a huge difference to my career progress and my family life. I've done the same for people working for me and what I have found is that if you offer people some flexibility, you get it back in spades.

I was appointed to my first CEO role while on maternity leave and while it’s not at all unusual for new dads to get a big promotion, it remains much rarer for women. If every employer was as family friendly as my NHS experience has been, it would be incredibly beneficial, and it is particularly important given NHS staff are 75% female. Kate Jarman is a great one to follow if you want to see what excellence in this area in the NHS looks like.?

It would also be terrific to see employers coming up with roles that are a mix of hands on and remote clinical, to provide more options for staff and greater flexibility. So, to repeat, no-one is remotely "off the hook", but once internal avenues are exhausted, this offer, just as with consultant medical staff, would be an attractive way to keep clinicians working within the NHS for many more years.?

I reckon this is well worth a go. It could use the exact same cloud based platform and recruiting structure as the one for consultants and Trusts can post roles in support of their virtual ward or remote monitoring programme, while any nurse at risk of an early departure from the NHS can be encouraged to view it.?

NHS Emeritus is described as a pilot scheme with the initial phase running to September 2024. As part of the evaluation it will consider

"extending the scope to other programmes, professions and grades".

I think this would be a perfect way to extend the scope while linking to a strategic imperative for the NHS, and meet the twin challenges facing all advanced health care systems - those of capacity and workforce.