Clinical support workers are crucial to the NHS, often spending more time than doctors and nurses with patients and their families, so it is hugely disappointing to find they still feel invisible and undervalued. These staff are an underutilised resource, that if invested in, could significantly contribute to addressing the capacity and capability issues that the NHS faces. The opportunity was missed in 2013. It should not be missed again.
Lead author Professor Richard Griffin, Professor of Healthcare Management at King’s Business School
23 July 2024
Crucial NHS staff still undervalued and 'invisible', report finds
Clinical support staff are crucial to the NHS but still feel undervalued and ‘invisible’ 10 years after a government-commissioned review highlighted ways to improve working practices, a new report has found.
Working in roles such as healthcare assistants, cancer support workers and physiotherapy assistants, clinical support staff make up 28 percent of the NHS workforce and are often the staff who have the most direct contact with patients and their families. Today there are 389,000 in the NHS in England with another 204,000 needed by 2037 to meet demand.
However, a new report produced by researchers at King's Business School has revealed little progress in the decade since The Cavendish Review highlighted workforce issues that limit opportunities for support staff. As a result, most in these roles continue to feel undervalued and ‘invisible’ – just one in five think the NHS values them and more than a quarter regularly consider leaving their job.
The authors say action is needed now and set out recommendations to address the recruitment, management and career development issues support workers face. They stress this would improve patient care, workloads, productivity, safety and patient satisfaction.
The Government commissioned The Cavendish Review in 2013 in the wake of events at Mid Staffordshire NHS Foundation Trust. It found a range of workplace issues that prevented nursing health and social care support workers from fully using their skills and progressing their careers. It warned this was a waste of resources and patient care was not always as effective, nor as safe, as possible.
The new report, The Cavendish Review: ten years on, by Professor Richard Griffin and Professor Ian Kessler from King’s Business School and Dr Abi Hall of the University of Exeter, widened its scope to all patient-facing support workers in the NHS in England, and found many of the same issues remain around recruitment, management and career development.
It is frustrating to see that so many of the issues and challenges I identified 10 years ago still remain. When the NHS faces acute backlogs and staff shortages, it is vital to maximise the potential of all staff.
Camilla Cavendish, who led the original Cavendish Review and contributed a foreword to the new report
The report included a survey of 5,255 NHS support staff in England which found only 26% think their ‘pay banding’ or grade is fair. More than a quarter (28%) regularly think about leaving and just over half (53%) would recommend being a support worker to their friends and family. When asked if support staff were still ‘invisible’ in the NHS – something highlighted in The Cavendish Review – only 27% thought that they were not.
The NHS would simply collapse without the hundreds of thousands of its unsung workers who give vital care. “It’s clear their contribution still goes unrecognised. Many aren’t paid fairly for the duties they perform, often way beyond their wage band. Ensuring staff are properly valued is key to solving the workforce crisis.
Christina McAnea, UNISON General Secretary
The report said most of those surveyed were enthusiastic about the work that they did (75%), felt proud of it (85%) and that they made a difference to patients (83%). They also thought they could contribute more if they had greater access to occupationally relevant education, time off for study and funding for professional development.
One in 10 said they had not been able to access any formal training in their whole career with the NHS. Nearly a third strongly aspired to become registered professionals but wanted more support to do so and currently said they face a lack of information about developmental routes and have little support from their managers, poor quality appraisals and Personal Development Plans.
Those surveyed felt strongly that workforce practices need changing to address the issues they face, supporting ideas such as representation of support workers at board level, support to access pre-registration degrees, better quality appraisals, review of pay banding and a national support staff workforce plan.
The report, which also included a literature review, did find there had been some progress since 2013, such as on the quality of supervision and the clarity around scope of practice. However overall, it found many issues remained unaddressed and pointed out many of the interventions supported by the surveyed staff are not addressed by the NHS Long Term Workforce Plan published by NHS England last year.
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Professor of Healthcare Management