The UK healthcare sector has been in the limelight over the past year or so. Workers from across the sector have recently taken industrial action over pay and stressful conditions. Many have blamed the COVID-19 pandemic for creating backlogs within the NHS. Others seem to suggest that cracks in the foundations of the NHS had been developing for some time. We were interested in finding out empirically whether conditions have deteriorated for healthcare workers in the UK over the past decade.
Background
Our study focused on two main areas: job leaving behaviour, and job-related satisfaction. The most common complaints found in the existing literature were about the NHS management structure, poor pay, stressful conditions, and poor work-life balance. There seems to be a belief in some areas of healthcare that staff are not entitled to time or a personal life outside of work. This has generated a large amount of burnout, which significantly increases the likelihood of depression, anxiety, substance abuse, eating and sleep disorders, and suicidal ideation.
However, existing surveys tend to come from non-representative samples. This means that we might only be hearing from staff who had bad experiences. Another problem is that research has almost always been cross-sectional, so it doesn’t say anything about how conditions or leaving patterns have changed over time. This gap in the literature is why we felt there was a strong need for a longitudinal approach, and why we made use of both NHS workforce statistics and Understanding Society data.
NHS workforce data
We initially examined quarterly NHS workforce data. We found that the total number of people leaving NHS jobs has stayed relatively stable over the 2011-2022 period. However, there were two spikes: one in 2012 that coincided with the introduction of the Health and Social Care Act, and another from 2020 onwards due to Covid.
Things get more interesting when we look into why staff are leaving NHS jobs. Even ignoring the upturn from 2020, there has been a gradual increase in the proportion of leavers that resigned voluntarily from 2011 onwards. When we break these voluntary resignations down further, we see that the most rapidly increasing reason for leaving across the entire period was for work-life balance reasons. By 2022, work-life balance had become the number one most specified reason for leaving an NHS job voluntarily.
Understanding Society data and results
NHS data are quite limited in what they can tell us about individual behaviour, because they only provide summary statistics. We wanted to look deeper at the work-life balance and satisfaction of healthcare workers over time at the individual level. Waves 1-11 of Understanding Society cover the time window we are interested in, so we used these data to estimate a number of longitudinal fixed-effects regression models. A regression model allows us to see how an outcome (like job satisfaction) changes when we change independent variables that are likely to influence the outcome (like worker characteristics).
First, we wanted to estimate levels of job related satisfaction for healthcare workers over all 11 waves, and compare this to workers outside the healthcare sector. We focused on four outcome measures: overall job satisfaction, satisfaction with one’s amount of leisure time, satisfaction with income, and satisfaction with health. Each of these was measured on a 7-point scale. We also controlled for standard demographic variables: age, marital status, number of children, education level, income, and employment type.
When we take these demographics into account, we find that estimated healthcare sector satisfaction levels declined more sharply between wave 1 and wave 11 than in the private sector. Most notably, our estimates suggest that satisfaction with amount of leisure time for healthcare workers has fallen by three times the amount that it has fallen for non-healthcare workers between 2010 and 2020. The only area where things might look better for healthcare workers is overall job satisfaction, where it has remained higher than the private sector. However, our estimates suggest that the gap in job satisfaction between the private sector and the healthcare sector has become progressively smaller over time. There has also been a substantial decline in job satisfaction for other public sector workers over the period.
Next, we estimated models that predicted whether a person would be working in healthcare in the following year, based on their satisfaction levels in the current year. We found that current levels of income satisfaction, satisfaction with the amount of leisure, and overall job satisfaction can help to predict the likelihood of someone joining (or staying) in the healthcare sector in the following year.
A healthcare worker in 2020 with the highest levels of satisfaction with their amount of leisure time would only be about 3 percentage points less likely to stay in healthcare in the following year than they would have been in 2010. However, if that worker in 2020 had the lowest levels of satisfaction with their amount of leisure time, they would be about 22 percentage points less likely to stay in healthcare in the following year than they would have been in 2010.
Conclusion
Overall, our results suggest that there are two things happening:
- work-life balance and satisfaction levels for healthcare workers have fallen over the past decade, and to a greater extent than in the private sector
- dissatisfied healthcare workers are becoming more likely over time to leave the sector.
This paints a grim picture, because it means the sector could be heading towards a downward spiral (if it isn’t in one already): worse conditions lead to increased leaving, which leads to a further workload pressures that worsen conditions further, and so on. Therefore, our study suggests that there needs to be a focus on improving working conditions within UK healthcare if we want to prevent a mass exodus of healthcare workers in the near future.
Authors
Neel Ocean
Neel Ocean is Assistant Professor in Behaviour and Wellbeing Science at the University of Warwick
