Lessons from UK

What makes the National Health Service the pride of a developed nation?

Recruitment and retention of the optimum workforce is a challenge for every healthcare system in the world. The NHS (National Health Service) is one of the largest employers in the world with a workforce of 1.6 million. There are more than 350 different careers available within the NHS. As a well-respected employer in the UK, the NHS strongly believes that compassionate care comes from the staff who are well looked after. With up to 70 per cent of annual budget spent on staffing, the NHS workforce is the primary driver of health costs. Given the scale of this challenge, it is essential that the NHS invest in making the best use of staff to ensure that they can deliver the care required by patients in the future.

The NHS has a fair pay structure for various staff groups. It aims at maintaining a quality workforce with the right number of staff required to deliver high-quality care. The pay structures are broadly divided into medical staff, non-medical staff and very senior management roles. The terms and conditions for pay and rewards are nationally agreed upon. This provides an element of portability for staff when moving between employers. Pay enhancements reward out of hours work, shifts, overtime and on calls.

Provided the appropriate level of performance and delivery has been achieved during the review period, individuals will progress to their next pay point on their pay step date.

Everyone in the NHS has an annual personal development review and plan to support their career aspirations. There are development opportunities and access to training courses. There has been a significant focus in the NHS on advanced practice and skill enhancement. In addition to addressing medical staffing shortages, it provides opportunities for career progression as well as enhanced job satisfaction for non-medical staff.

All staff is entitled to the NHS pension scheme on joining the service. Pension costs are shared between staff and employers with employee contributions ranging from 5 percent to 14.5 percent of the salary. This is topped up by an employer contribution of 14.3 percent. Owing to on-going national financial pressures, recently there have been significant changes to NHS pension scheme. These have seen an increase in pension age from 60 years to 67 years, an increase in contributions and a reduction in final pension amount. Compared to other private pensions both in the UK and worldwide, the NHS offers a good pension scheme that is very competitive with a generous employer contribution. It includes both a lump sum and death-in-service benefits.

The NHS pension benefits are in addition to state pension every eligible person gets at the age of 67. Regardless of how long one has been working in the NHS, all pregnant staff are entitled to one-year maternity leave. It is illegal for the employer to fire them during this time. Fathers are entitled to two weeks’ paternity leave. There is also an option of shared parental leave. Depending upon their length of service, staff is also entitled to maternity pay.

All staff is entitled to sick leave based on the length of their service. It ranges from one month’s full pay and two months’ half pay during the first year of service to six months’ full pay and six months’ half pay after completing five years of service. Sick days are not deducted from the annual leave. If someone unfortunately gets sick during their annual leave, they are able to claim it later.

Full time working hours do not suit everyone as people have other commitments in life, childcare and other caring responsibilities etc. The NHS offers a range of flexible working conditions to its staff. Some examples of flexible working include first, part-time work, where a person works to a pattern and number of hours by mutual agreement; second, job sharing, where two or more people share the responsibilities of one or more full-time job(s), dividing the hours, duties and pay between them; third, flexi-time, where employees can choose their own start and finish time around fixed core hours. Also, there are annual-hours contracts, where people work a specific number of hours each year, with the hours being unevenly distributed throughout the year. In addition there are flexible rosters, using periods of work of differing lengths within an agreed overall period. Lastly, compressed hours, where employees work their total number of agreed hours over fewer working days for example compressing a five day working week into four days.

Based on their training needs, staff is given paid study leave to avail external training. For example, medical staff is typically entitled to 10 days’ study leave a year with a study leave budget ranging from £600-£1,000 a year. A confidential staff survey is carried out annually. Senior leadership in every organisation is expected to respond to review and act on staff survey results to improve staff wellbeing.

Around a million women work for the NHS in England, making it one of the largest employers for women in the world. The NHS has recently invested focus on its equality and diversity agenda, which aims at making it a good experience for everyone without any discrimination because of gender, ethnic background, religion, or other protected attributes.

Although every healthcare system is unique in its service delivery model and workforce systems, there are a number of good practices in the NHS. These include, pay, reward and working conditions that can be studied by healthcare systems in Pakistan with a view to incorporate into local practice. To name a few lessons, Pakistan could take from the NHS: NHS pension scheme, sickness benefits, maternity and paternity leave, flexible working hours, study leave and study leave funding. In addition to this, Pakistan should also take precedence from the NHS pay enhancements to reward extra work, staff survey, annual appraisal, equality and diversity.

The King Fund in 2019 summed up the need for meeting workplace health requirements in the following statement, “Humans have three core needs and it is particularly important these are met in the workplace. They are the needs for belonging, competence and autonomy. When these needs are met in the workplace, people are more intrinsically motivated and have better health and wellbeing”.

The writer is a consultant histopathologist and clinical chair for Diagnostics &Outpatients Division at the Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK

Lessons from UK