Behind the row about nurses’ pay lies a sickness in the NHS workforce

NHS nurses took a historic step this month, voting to strike in their first ballot on industrial action since the Royal College of Nursing was founded more than 100 years ago. When my girlfriend, who works for a central London trust, received her ballot paper in October, she filled it out in an instant.

Never mind that many accident and emergency nurses like her will still have to work through any strike. Or that some hospital departments are already operating with staffing levels below the minimum legal requirements for strike days. Returning her vote felt like a rare victory in her struggle with an institution that she fears is slowly consuming itself, and her with it.

Discussion of the ballots has mostly focused on pay. With annual inflation above 10 per cent, the government’s offer of a £1,400 pay increase for the average nurse means a devastating cut in real terms. But nurses’ frustrations are likely to have had more to do with their wider wellbeing than money alone. A real-terms pay drop means less disposable income to do things that improve wellbeing and make a difficult job feel worthwhile.

An increasingly important factor in nurses’ decisions may be how their work is affecting their health. Frontline NHS work is almost perfectly designed to create illness: it is physically and mentally draining, shifts are long and hours unsociable, putting pressure on relationships and making it hard to maintain healthy routines. Last year’s survey of NHS staff found that nearly half felt unwell and a third suffered musculoskeletal injury due to work.

My partner is on a list of over 1mn people across the country — NHS staff and others — waiting for mental health support. The causes are complex, but have been exacerbated by work, while the irregular nature of her job adds to the challenge of battling NHS bureaucracy to get care. She knows better than most that services are stretched. But private care is prohibitively expensive; she’s still paying off debts from studying for her nursing licence.

Anxiety, stress, depression and other psychiatric illnesses are the leading cause of absence among NHS staff — far more than Covid. In June 2022 alone, they lost the NHS the equivalent of 476,000 days. Most trusts have neither dedicated staff psychiatrists nor give staff priority to see specialists — yet reducing absence and improving wellbeing would boost NHS productivity and outcomes, according to the King’s Fund think-tank. That would help address waiting lists and reduce the drag of ill health on the wider economy.

Since the start of the pandemic, some other sectors have moved to greater working flexibility, but NHS arrangements remain archaic. With little to no say over when they work, many staff are finding they would rather switch to agency or NHS bank work to gain some autonomy. My girlfriend has had to cut her contracted hours and take up bank shifts which she can control more easily.

This is a lose-lose situation: less job security for nurses and more staffing uncertainty for the trust, which has to use costlier temporary workers. The Commons health and social care committee recently called for NHS employers to give all staff access to flexible work patterns, though this will mean raising overall numbers.

Meanwhile, it is little wonder nurses are leaving at the highest level in a decade, driven by younger ones who are not prepared to sacrifice their own wellbeing for their job. Retail and hospitality both offer better pay and conditions. Chancellor Jeremy Hunt, a former health secretary, is well aware of NHS staff shortages — he admitted in the summer to having helped create them. He did increase NHS funding in his Autumn Statement, but he needs to go further to ensure there are the resources to introduce working practices fit for the 21st century.

The risk now is that the NHS begins to devour itself in a spiral of ill, overstretched staff needing treatment from an ill, overstretched service. My girlfriend loves the NHS, and does not want to leave it. After we dropped her ballot in the post box, we discussed whether acknowledgment of the pressures in the health service would help her feel better about her work. “I guess,” she replied hesitantly. “I just want to feel well again.”

joseph.bambridge@ft.com