The cost of living crisis is affecting healthcare professionals just as it is their clients. Journalist Anna Scott investigates the impact on the work and personal lives of CPs.
In August and September 2022, NHS Providers surveyed chairs, chief executives, finance, HR, medical and nursing directors of NHS trusts across England for their collective views on the impact of the cost of living crisis on trusts and the health and care sector. What emerged was a damning indictment of how healthcare practitioners have been affected by high inflation and low wage growth.
A majority of NHS executives were ‘extremely concerned’ about employees’ financial wellbeing (95%) and mental wellbeing (78%), and 33% felt the same about the workforce’s physical wellbeing. The knock-on effect on the NHS is clear, with 61% of executives reporting a rise in staff sickness absence due to mental health, and 71% of trusts saying that staff struggling to afford to come to work has a ‘significant’ or ‘severe’ impact (NHS Providers, 2022).
The crisis is causing staff to look for roles elsewhere, with two-thirds (68%) of trusts reporting a ‘significant’ or ‘severe’ impact from staff leaving trusts for other sectors, such as hospitality or retail, where they can earn more. So significant is the problem that more than a quarter (27%) of trusts surveyed in England offer foodbanks for staff and 19% plan to do so. Three-quarters (72%) offer financial advice and education for staff and 10% plan to do so (NHS Providers, 2022).
The picture is similar across the rest of the UK. In November 2022, Scottish health secretary Humza Yousaf and Welsh health minister Eluned Morgan wrote to UK health secretary Steve Barclay calling for an increase in the amount of funding for NHS pay (Welsh Government, 2022). ‘We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable,’ they wrote.
Janet Taylor, chair of the CPHVA Executive and nurse manager, children’s services, South Eastern Health and Social Care Trust in Belfast, points out that nurses and community practitioners (CPs) are using foodbanks. ‘I have a friend who volunteers at a foodbank and she sees nurses with their coats on calling in on the way home after a shift,’ she says. ‘Everybody is affected – staff, members, clients. People who previously have been comfortable – say, both parents working, one a nurse – I tell you they are affected. There are health visitors visiting people who are not far off the same situation themselves.’
It was noted in the November/December 2022 issue of Community Practitioner that the cost of living crisis had ‘stepped up several gears’ over the course of just one year for clients and their families. It’s now increasingly clear that the problem is having a profound impact on CPs themselves, in their work and personal lives. ‘All our members that work in this space are human beings; they have these worries and anxieties in exactly the same way the people they are caring for do,’ says Dave Munday, lead professional officer (mental health) at Unite.
Making ends meet
Janet believes the situation is worsening. ‘We absolutely have CPs who are using foodbanks,’ she says. ‘They may be the only working parent in the house and they need that bit of a boost.’ Struggling to make ends meet means difficulty in getting fresh food too. ‘You can still make a healthy meal on a low budget of course, but sometimes people don’t necessarily have the energy, especially after a long shift,’ Janet adds.
The Healthcare Workers’ Foundation provides support for the physical, mental and day-to-day needs of all healthcare workers (including CPs) and their families. CEO Julie Child points to the fact that some CPs are on temporary or zero-hour contracts, which can result in an irregular salary. ‘Recently we have heard that many healthcare workers are having to rely on payday loans to put food on the table,’ she says. ‘With our hardship fund we have seen many applications for financial support to cover the cost of rent arrears, household repairs and white goods such as washing machines, so that they can wash their uniform and their children’s clothes.’
Even for CPs on permanent contracts, the pay rise equating to 4.5% awarded in 2022 (Department of Health and Social Care, 2022) when the inflation rate at year end was 10.7% (Office for National Statistics, 2022) will not make it easy to pay the bills. ‘There is widespread dissatisfaction with the pay award and a real desire to take action and support improved pay that is paced with the rise in inflation and the cost of living pressures we’re currently facing and will continue to face in the months and years to come,’ Unite’s regional officer South West Nick Bailey told the Unite-CPHVA Annual Professional Conference last October.
Fuel is also an issue. ‘With the cost of living crisis, many are finding that as they need their vehicle for work, that their fuel expenses don’t cover enough of the wear and tear or repairs on the vehicle,’ Julie adds. Janet says that although petrol prices have come down a little, she has had Unite-CPHVA members on the phone explaining the impact of fuel rises on them.
‘One man who works in community primary healthcare, a Band 3, said his petrol cost him more than his mortgage,’ Janet says. ‘I know some trusts have maybe bought a few electric cars but people aren’t sure. Members are thinking, “That’s a car I don’t know, how do I book a car, go and get the car and start the car when I have to be out of the house at half eight.” I know trusts are making an attempt to help, but it hasn’t quite gelled yet.’
As well as the effect on their own finances, the cost of living crisis is having an impact on the everyday, practical side of CPs’ work. ‘Low staffing levels, inability to retain and recruit staff, low pay and rewards and zero-hour contracts means CPs are using personal vehicles to travel through community and rural areas which can cover substantial boundaries within health boards and councils,’ Julie says.
The shortfall of HVs across England (estimated at around 5000, as Janet highlighted at conference) increases the pressures on CPs in some areas. ‘Workers in general are having their workloads increased, especially in the community,’ Julie says. ‘Some are expected to administer meds as part of their role. There is also a delay in support packages so some CPs are supporting people midway through approval for care plans, meaning their needs have increased but their package of care is sometimes behind their needs.’
‘We have seen many applications for financial support to cover the cost of rent arrears, household repairs and white goods’
As clients’ needs change during the cost of living crisis, CPs’ roles begin to change too. Client needs are complex and roles can become reactive, rather than preventative. Dave says the immense pressure CPs have been put under during the past two and a half years has changed how they work.
‘If you are able to take a really preventative public health approach, you will be thinking about ways to support families when it comes to money, not just in terms of accessing appropriate support when things are going wrong, but in developing healthy processes,’ he says. ‘But if CPs are in a situation where there is one person doing the job of four people then obviously that kind of innovative, preventative public health work is really difficult.’
‘Keep talking, don’t isolate yourself – no one will be judging you as many are experiencing similar difficulties’
‘If we had one school nurse in every secondary school, imagine the work they could be doing with young people in terms of their health, making sure they have got a home that is supportive and safe for them,’ he adds. ‘But the reality is that they have got a load of child protection work that they have to get on with.’
The knock-on effect of these pressures on professionals is on their physical and mental health. ‘Levels of anxiety, levels of depression, people are having physical manifestations because they’re so stressed. We’ve just come out of the Covid-19 pandemic,’ Janet says.
Source: DHSC, 2022; NHS Employers, 2022; OBR, 2022; ONS, 2022.
‘You’re always conscious about balancing cost’
One health visitor works in Scotland, covering a town and sometimes visiting clients in rural areas. Tracy* doesn’t drive enough miles a year for work to qualify for a leased car so uses her own car, and receives 54p per mile of fuel. ‘Our fuel bill is ridiculous. It has definitely increased, which is a worry because you think, “Can you afford to do your job, going out and about all the time?”,’ she says.
‘I suppose we are lucky now because all our meetings are over Microsoft Teams and occasionally you can work from home, but then I am putting the heating on at home and the electricity bill is going up. If I go into work there is heating and tea and coffee there too. All those little things. You’re just always conscious about balancing the cost of going to work or working from home,’ she adds.
Tracy hasn’t had to use food or heat banks but a colleague has. ‘It’s sad because you’re used to this with your families on your caseload, not your colleagues. We’re definitely referring clients to foodbanks more. We have a service here called Tweed Togs where we can refer for children’s clothing – families just can’t afford to clothe their kids. We’re encouraging parents to send their kids to nursery as much as they can so that they are getting food and snacks. We’re noticing the shift across the board.’
Like many others in the profession, Tracy has considered leaving, given the possibility of receiving at least equal pay in retail, for example, and she has put her name forward for extra nursing night shifts. ‘It’s pretty crazy how with your weekly shopping going up, your weekly fuel costs going up – but your wage hasn’t gone up, so you need to do something to make ends meet.’
One positive is that Tracy’s caseload has not gone up as her health board has recruited quite well over the last few years to cover retirement and long-term sickness. ‘But with the ageing health visitor population, I think over the next three or four years we’ll become short-staffed again,’ she says.
* Name has been changed
So what support is out there for CPs to try to mitigate some of the impacts?
Unite lead professional officer (health) Gavin Fergie says that the same advice CPs have been sharing with their clients for many months may now be applicable to them. ‘Simply, it is about seeking support from wherever it can be found in your area,’ he adds. ‘Provision for those in need differs, depending on where you live and work. It is very much a case of local solutions for local needs.’
CPs should ensure they are accessing all state assistance they can draw on. ‘If you find that paying for housing costs, fuel bills and other fixed items is becoming difficult, initiate discussions with the providers, banks and council to see what support they can provide,’ says Gavin. ‘Keep talking, don’t isolate yourself – no one will be judging you as many are experiencing similar difficulties.’
The Queen’s Nursing Institute (QNI) has been gathering examples of how community NHS organisations have improved processes and reimbursement rates for nurses who rely on cars to reach patients. Some NHS organisations have increased temporarily what people can claim for work-related travel, or paid forward money directly to staff who need to drive their cars for work (see Resources).
‘We would encourage anyone who is struggling to reach out for help, and also talk to your employer in confidence to make them aware as they may also be able to offer additional support,’ says Matthew Bradby, head of communications at the QNI. ‘All employers have a duty of care towards employees and they will be aware that some people are struggling with rising living costs at this time.’
Unite is leading the campaign to ensure health sector members are paid a salary that can offset the increasing demands on a members income. ‘This is a longer term solution, but in the shorter term if you are having difficulties in meeting your costs, contact your local Unite office to discuss your membership,’ adds Gavin. ‘Your local office may also have local connections that they can advise you of, places and organisations that may be able to help. Although it is a difficult time for many, Unite can offer an empathetic ear, especially in such straightened times.’
- Take a look at what help is available to NHS staff from the NHS itself. Your trust might have changed its fuel policy, for example. Ask your manager or HR for advice on policy changes.
- Various charities have funds to assist NHS employees who are struggling. The Queen’s Nursing Institute and the Healthcare Workers’ Foundation are two examples (see Resources).
- Find out what financial wellbeing benefits and education your trust offers. There may be discounts with retailers or vouchers available.
- Contact your local Unite office to see how they can assist.
- Your local Unite office – find details at unitetheunion.org/contact-us and keep up to date with the latest issues on Twitter @UniteInHealth @Unite_CPHVA
- Counselling and financial support of up to £1000 to people working in healthcare in the UK from the Healthcare Workers Foundation healthcareworkersfoundation.org/financial-support
- Financial assistance to community nurses in need from the Queen’s Nursing Institute qni.org.uk/support-for-nurses/financial-help
- Phone listening service from the QNI that can signpost to other services qni.org.uk/support-for-nurses/talktous
- How NHS organisations are helping community nurses with the cost of fuel qni.org.uk/support-for-nurses/fuel-support
- An NHS Employers’ guide on how to support staff with the rising cost of living bit.ly/NHS_Employers_rising_costs
- NHS England guidance on supporting staff to help money go further bit.ly/NHSE_financial_support
- How some NHS trusts in the UK are helping staff with food poverty and fuel insecurity nhsconfed.org/topic/cost-living
- Tips from NHS Eileanan Siar Western Isles for helping employees bit.ly/NHS_cost_of_living_advice
Department of Health and Social Care. (2022) NHS staff to receive pay rise. See:
gov.uk/government/news/nhs-staff-to-receive-pay-rise (accessed 22 December 2022).
NHS Providers. (2022) Rising living costs: the impact on NHS, staff and patients. See: https://nhsproviders.org/rising-living-costs-the-impact-on-nhs-staff-and-patients/key-messages (accessed 5 December 2022).
OBR. (2022) Economic and fiscal outlook – November 2022. See: obr.uk/efo/economic-and-fiscal-outlook-november-2022 (accessed 5 December 2022).
ONS. (2022) Consumer price inflation, UK: November 2022. See:
ons.gov.uk/economy/inflationandpriceindices/bulletins/consumerpriceinflation/november2022 (accessed 15 December 2022).
Welsh Government. (2022) Call for more funding for NHS pay. See: gov.wales/call-for-more-funding-for-nhs-pay (accessed 5 December 2022)
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