WORK FORCE I S SUE S
Let me expand on the three key questions that need to be addressed in critical care in the UK: 1. How do we rectify inadequate critical care staffing provision and continue to meet multi-professional standards of care?
2. How do we increase critical care capacity to meet the increasing demands engendered by an ageing population with multiple co-morbidities?
3. How do we provide an effective buffer to peak surges in critical care demand such that in future other secondary health services are not so negatively impacted; evident now, for example, by huge increases in elective surgical waiting lists?
Prior to the pandemic, in an effort to increase and look after critical care staff, the Faculty of Intensive Care Medicine initiated a three-part series: ‘Critical Staffing’.2
The
series brings together well-recognised, practical best practice frameworks on staffing. It provides an invaluable resource to help address those three key questions. These frameworks should help guide commissioners, hospital management and critical care teams. Furthermore, they provide a resource for individuals from across the multi-disciplinary critical care workforce as to what they might reasonably expect from their directorate and employer. The first in the series covers ‘Safe and effective critical care staffing’, the second ‘Wellbeing and sustainable working’, and the third, ‘Returning to work’. Working in critical care does have significant positives for individuals. Many people find working as part of a functional multi-disciplinary team to be the most rewarding part of the job, but other reasons include a wide range of clinical interests,
emotional rewards, and academic and research opportunities. Conversely, the downsides are the relentless nature of the work, which in some cases leads to burnout, the frequent lack of beds leading to poor morale, and poor work life balance negatively impacting home life. The frequency of being on-call also impacts our families and our own health. The challenges to intensive care medical staff recruitment are in essence two-fold. First, we need to have sufficient training posts to recruit into and, second, we need sufficient numbers of applicants to fill these posts. The good news is that despite the pandemic, applications for National Training Number (NTNs) posts in Intensive Care Medicine (ICM) have remained high. Since 2020, there have been more than two applicants for every ICM NTN. The specialty, however, needs more allocated NTNs. Control for NTN specialty numbers lies with Health Education England and its counterparts in Scotland, Wales and Northern Ireland. Increasing UK critical care capacity requires a significant expansion in ICM trainees, translating into an increase in future ICM consultants. The Faculty of Intensive Care Medicine, the Royal College of Anaesthetists and other key organisations have advocated strongly in favour of this expansion. In ‘Safe and effective critical care staffing’, the focus is on helping local recruitment. It emphasises the need to proactively manage rotas, night work and on-calls, to improve career-long job satisfaction. Recruitment of more critical care staff without addressing retention is very inefficient. More can be done structurally to ensure that our careers remain sufficiently rewarding to continue in the specialty until retirement. For example,
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WWW.CLINICALSERVICESJOURNAL.COM JANUARY 2023
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