Beating burnout in the NHS

The NHS Staff Survey 2022 results indicate that Burnout is more prevalent amongst staff in certain occupations, with staff in clinical roles more likely to report burnout, and around half of staff in ambulance (operational) roles claiming to have felt burnt out because of their work this year (49.3%). On this measure, burnout is at a similar level or slightly lower than in 2021 across many occupation groups*. However, the proportion of medical and dental staff reporting feeling burnt out because of their work has increased by 2.2 percentage points to 35.3%

The Burnout Report, 2024 by Mental Health UK found that nine in ten UK adults experienced high or extreme stress in the past year. Almost a quarter of UK adults felt unable to manage stress and pressure in their lives. While 35 per cent of respondents did not feel comfortable talking about mental health with managers and senior leaders at work.

Research by The King's Fund shows that NHS staff are 50 per cent more likely to experience chronic stress, a known contributor to burnout. Factors such as staff shortages, high workload, and pressures to maintain high quality patient care all contribute to burnout in NHS staff. According to the British Medical Journal (BMJ), burnout significantly impacts the retention of our highly valued NHS workforce, with more staff thinking about leaving the NHS.

Although burnout is a long-standing issue, the pandemic placed further burdens on NHS staff and exacerbated the problem. The Long Term Workforce Plan has emphasised the importance of retaining our valued NHS workforce and while there are factors beyond our control, such as increasing demands on the service, employers must act quickly and effectively to tackle burnout by facilitating a supportive, compassionate and positive experience that prioritises the experience and wellbeing of staff.

This guidance intends to support leaders in the NHS, including health and wellbeing leads and managers, who all play an important role in beating staff burnout.

What is the impact of burnout?

• Employee wellbeing - Burnout can negatively impact both mental and physical health, and often results in presenteeism and absenteeism. Organisations have a moral and legal obligation to look after the wellbeing of their staff.
• Financial cost to the organisation - The cost of absenteeism and presenteeism can be detrimental to organisations. Although we are no longer in the pandemic, the long-term negative effects of issues such as long COVID and patient waiting-list backlogs are likely to remain.
• Patient care - How staff are feeling can impact on the quality of care provided to patients. Staff who have constant exposure to traumatic events associated with caring responsibilities, can often experience compassion fatigue.
• Retention - Reports show that nearly a third of NHS staff have recently inquired about jobs outside the NHS and only one in four NHS nurses would recommend working for the NHS to others.
   

Top tips for NHS organisations

We have outlined several practical tips that can help you support your staff:

• Ensure optimum staffing levels where possible.
• Shift towards a culture of prevention and early intervention.
• Overcome the stigma of mental health conversations at work.
• Recognise pressures of maintaining a ‘hero identity’.
• Upskill staff to understand burnout symptoms.
• Upskill managers to support staff effectively.
• Encourage compassionate leadership.
• Build organisational resilience.

Beating burnout in practice

Optimum staffing levels

Rising sickness absence levels, poor retention, and unsuccessful recruitment campaigns have been major contributors to staff shortages. Whilst there are often financial and practical barriers to achieving optimum staffing levels, employers can work to boost retention, strengthen recruitment efforts, and support those staff off work to return to the workplace. See some resources below to help you:

• The improving staff retention guide for line managers and employers in the NHS.
• Our sickness absence toolkit details how you can support your staff and help them return to work.
• The NHS Staff Council’s guidance on the management of long COVID sickness absences.
• The NHS Staff Council's musculoskeletal guidance, helping you keep your workforce healthy and safe.
• Watch the NHS Staff Council's Health Safety and Wellbeing Group webinar to support employers to ensure measures are in place to keep their workforce healthy and safe.
• The inspire, recruit and attract toolkit provides resources and guidance to support your workforce supply.
• Our case study on how Wye Valley NHS Trust filled some of its hard to fill vacancies through upscaling and improving its international recruitment campaign.
   

Supportive organisational culture

Mental Health UK outlines the strong relationship between burnout and poor mental health. It is therefore crucial to create a healthy and supportive working environment, where mental health conversations are encouraged and not stigmatised. Read more about how you can raise awareness of mental ill health, upskill your managers and put supportive initiatives in place on our mental health in the workplace web page. In addition, organisations can:

• ensure your managers hold regular and ongoing wellbeing conversations with their staff, and staff are enabled to seek support when needed. Read our guidance on embedding effective health and wellbeing conversations.
• encourage senior leaders to share honest personal experiences to inspire others to do the same and get help. This can reinforce that NHS staff should not feel under pressure to constantly maintain a ‘hero-identity’. Listen to our podcast with Deborah Lee on mental health: leading the way and tackling the stigma.
• create safe spaces for discussion, where staff can openly share views and experiences. Use these conversations to better understand the problems staff are facing, and to shape local health and wellbeing initiatives.
• ensure your initiatives are inclusive. Provide alternative routes for staff to share thoughts if they are not comfortable with open discussions.

This five-minute video case study shows how Well_Lab worked with Barts Health NHS Trust’s non-emergency patient transport team, demonstrating how you can quickly experiment with solutions in your workplace.  

Well_Lab also presented at our staff experience conference in December 2022, sharing research and evidence-based recommendations on how trusts can practically address the impact of workplace burnout in the NHS. Read the session slides for more information.
 

Focus on prevention

Most members of staff will have some element of mental health needs. They will therefore require some form of mental health interventions regularly to help prevent burnout. Below is a list of interventions we recommend you consider:

• Challenge perceptions of ‘wellbeing hubs’ so it is no longer a place to go only when struggling with mental health, but a space to help maintain good mental health.
• Embed preventative wellbeing initiatives into all aspects of the employee lifecycle. You could start as early as your induction programme and continue to hold regular mandatory mental health maintenance sessions.
• Prioritise meeting basic staff needs. This includes ensuring staff can get adequate rest and good quality food when on shift. Read how Sherwood Forest Hospital Foundation Trust effectively coordinated and agreed staff break times at the start of their shifts to ensure they were taken. 
• Download our NHS staff wellbeing needs poster and read the supporting the wellbeing needs of NHS staff article to see how you can make great health and wellbeing a lived reality.
• Promote wellbeing and the importance of self-care through highly visible senior role models. This will help a culture of wellbeing filter down to the rest of the organisation.
• Make your health and wellbeing offer and useful resources relevant, accessible and that they are regularly promoted through various channels. Read how you can implement health and wellbeing champions into your organisation to support you with this.
   

Early recognition and intervention

Recognising burnout symptoms and providing the right support early on can help prevent problems from escalating, and reduce the chances of staff absences. Research by Maslach & Leiter identified energy depletion, reduced efficiency and depersonalisation or cynicism as key symptoms. To combat this, organisations should consider the following:

• Train managers and staff to spot symptoms of burnout, and signpost to appropriate interventions. Embed burnout into wellbeing conversations, encouraging a compassionate and personalised approach as there is no one-size-fits-all solution.
• Introduce a rapid access service for staff to access therapies and counselling to address symptoms of burnout early.
• Read our case study to learn how Cambridgeshire and Peterborough NHS Foundation Trust created a rapid-access mental health service to support its staff.
• Ensure your interventions target a range of symptoms, as staff may be affected from burnout in different ways. For example, initiatives that moderate workload demands can help address energy depletion. However, interventions that target workplace civility through ensuring staff are treated with dignity and respect are more effective in decreasing cynicism.
   

Supportive and compassionate culture  

Embedding compassion and support into organisational culture enables staff to seek help when they need it. Organisations should:

• Ensure leaders and managers seek to understand the challenges that staff face through continuous dialogue and ensure that staff wellbeing is a priority in all aspects of organisational strategy. Read our guidance on how health and wellbeing guardians can help influence your leaders at board level to implement a culture of wellbeing.
• Ensure staff have access to the right equipment, training and development to ensure they feel able to do their jobs to the best of their abilities. Listen to Michael West’s blog on recovery and renewal and how to implement compassionate and inclusive leadership.
• Support your teams by working closely with them to harmonise working relationships. Identify and resolve barriers to effective communication and collaboration. Follow up with team building exercises to strengthen relationships, this helps optimise ways of working and builds psychological safety amongst team members. 
   

Compassionate leadership

Compassionate leadership helps staff feel supported, understood, and able to perform their job effectively. Encourage leaders to model positive behaviours and promote their visibility and accessibility to staff so everyone’s voices can be heard. 
 

Upskill managers to offer the right support  

Workplace and external pressures can both contribute to burnout. Upskill your managers to have effective wellbeing conversations with their teams and provide the right support for any pressures staff may experience. These can include:

• The rise in of cost of living. Read how you can support the financial health of your staff on our cost of living hub.
• Caring responsibilities outside the workplace. They could be caring for disabled, elderly, and children. Flexible working opportunities can ease this pressure and allow staff the time to care for loved ones, increase productivity and reduce the chances of compassion fatigue. Read more about how you can implement flexible and agile working practices into your organisation in our flexible working - enablers for change web page.
• Physical or mental ill health. Signposting staff to the right support in a timely fashion can help prevent these issues from getting worse or hindering recovery.

Further resources

• Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. 
• Burnout in healthcare: risk factors and solutions.
• Burnout in healthcare: the case for organisational change.
• New research findings on burnout and exhaustion in nursing staff.
• The Burnout Report 2024, Mental Health UK.
• Working Minds campaign, Health and Safety Executive.
• Unmind is offering free access to NHS staff until 31 December 2024.
• Headspace is offering free access to NHS staff with an NHS email address until 31 March 2025.