Cost of living hits patients, staff and trusts

The vast majority of trust leaders (95%) said that the cost of living had significantly or severely worsened health inequalities in their local area. And with housing, energy and food costs rising, trusts expect to see more people pushed into poverty and the health consequences that go with it. Trusts are already reporting an increase in demand due to the cost of living, with more than 70% seeing an increase in mental health presentations due to stress, debt and poverty.

According to the survey, trusts were all concerned about the mental, physical and financial wellbeing of their own staff as a result of cost-of-living pressures. More than 60% reported a rise in staff sickness absence due to mental health. Below-inflation pay rises had left staff worse off in real terms with some staff struggling to afford to travel to work. According to one trust leader: ‘For some staff this is the final straw psychologically after two years of Covid.’

While trusts also faced significant cost rises from soaring inflation, the cost-of-living crisis was also increasing staffing pressures. There are already 132,000 vacancies across trusts, but the rising cost of living was making recruitment and retention harder. Two out of three trust leaders reported a significant or severe impact from staff leaving to work in sectors such as hospitality and retail, which could offer competitive rates.

The impact is greatest in lower paid roles, such as porters, cleaners and healthcare assistants. However, trusts also reported recruitment challenges in areas such as IT, human resources and facilities, where there was direct competition for skills with other sectors.

Miriam Deakin (pictured), director of policy and strategy at NHS Providers, said trust leaders believed they had reached a tipping point for the workforce. ‘Trusts are vital hubs at the heart of their communities, ‘go to’ institutions where people seek help in difficult times, and are doing everything they can to support staff, patients and the public,’ she said. ‘But the cost-of-living pressures are too big and wide-ranging to be left to local NHS trusts to solve on top of everything else they are grappling with.’

She called for realism from government and national leaders, and recognition of the scale of the challenge. ‘The rising cost of living is adding to pressures as the NHS seeks to reduce care backlogs and trust leaders fear it will have long lasting impacts on the health of the most deprived communities,’ she added.

Analysis by the Nuffield Trust this week revealed that more than 40,000 nurses in England left active service in the year to June. This is a peak in absolute terms for the last decade (6,100 more leavers than the previous high five years ago) and relative to the whole workforce, with a leaver rate of 11.5%.

The analysis, undertaken by senior fellow Billy Palmer (pictured) and researcher Lucina Rolewicz, said the trend on nurses leaving the NHS was even more stark in Scotland. The latest leaver rate of 10.6% was 2.9 percentage points higher than the previous peak in the year to March 2018.

The record leaving rate is not good news for the government, which made a manifesto commitment in 2019 to increase the number of nurses by 50,000 by March 2024. The target includes nurses in NHS providers and GP settings. According to the Nuffield Trust, the number of full-time equivalent nurses has increased by 24,190 in 31 months (the government uses a slightly earlier starting point in its definition of the target).

In separate analysis, the Royal College of Nursing in Wales this week said there were 2,900 registered nurse vacancies in Wales, up from 1,719 in 2021. Releasing its annual nursing workforce report – Nursing in numbers – RCN Wales director Helen Whyley said nurses were exhausted and under pressure with waiting lists rising. ‘These vacancy numbers are deeply troubling and show that nurses are being pushed to the exit and are leaving the NHS,’ she said. ‘The Welsh government needs to act now to safeguard patients and support the nursing workforce. It must address nurse staffing levels to ensure environments where patients receive care are safe.’