Hospital Staff Shortage: the Role of the Competitiveness of Pay of Different Groups of Nursing Staff on Staff Shortage. Hospital Staff Shortage: the Role of the Competitiveness of Pay of Different Groups of Nursing Staff on Staff Shortage

International audienceShortages of nursing staff in OECD countries have been a preoccupation for policy makers. Shortages of staff may be the consequence of uncompetitive pay. In the private sector, employers in different regions can offer different pay rates to reflect local amenities and cost of living. Hospitals in the UK however cannot set the pay for their employees, and as a result they might therefore incur staff shortages. Moreover, occupational groups do not operate in isolation. Shortages of staff may also be the consequence of the competitiveness of pay of an alternative group of staff. This is investigated using two distinct groups of nursing staff: assistant nurses and registered nurses working in English hospitals in 2003-5 using national-level data-sets. We find that an increase by 10% of the pay competitiveness of registered nurses decreases the shortage of both the registered nurses and of assistant nurses by 0.6% and 0.4% respectively

What do UK doctors in training value in a post? : A discrete choice experiment

Acknowledgements: our thanks first to the following colleagues (in alphabetical order) for their support: Professor Phillip Cachia, East of Scotland Deanery; Professor Jacky Hayden, CBE, North Western Deanery; Professor Stewart Irvine, NHS Education for Scotland; Dr Namita Kumar, Health Education North East England; Professor Alastair McLellan, West of Scotland Deanery; Professor Gillian Needham, North of Scotland Deanery; Professor William Reid, South East of Scotland Deanery; and Ms Jayne Scott, NHS Education for Scotland. Our thanks also go to the START Core Group: Professor Alastair McLellan, Professor Rowan Parks, Dr Ronald MacVicar and Ms Anne Dickson. We also thank Professor Charlotte Rees and Dr Karen Mattick for their feedback on the project proposal, the project report and the qualitative survey that informed the DCE. Our thanks to John Lemon for his sterling work and endless patience when developing and managing the online surveys. Finally, we would like to thank all the doctors in training who participated in the DCE. Funding: our thanks go to NHS Education for Scotland for funding this programme of work.Peer reviewedPostprin

Won' t you stay just a little bit longer? A discrete choice experiment of UK doctors’ preferences for delaying retirement

Funding Information: The survey instrument and all available data can be obtained by contacting the corresponding author (JC). Our thanks to those friends and colleagues whose discussions about retirement, lifetime allowances and pensions ceilings were the motivation for this study. Thanks to all those who participated in qualitative interviews and in developing, piloting and completing the survey. Thanks also go to BMA Scotland for the distribution of invitations. This study was funded by a grant from the University of Aberdeen Development Trust (UOA Ref: RG14022), and the qualitative data collection (reported separately) was supported by funding from BMA Scotland (UOA Ref: RG14434).Peer reviewedPostprin

Constrained candidacy: exploring different barriers to attaining healthcare access and treatment for long COVID illness by NHS workers in Scotland.

Long COVID (LC) affects 1.2 million people in the UK, including 120,000 NHS workers. LC remains poorly understood, comprising manifold symptoms ranging in severity, disrupting quality of life and work abilities. Emerging qualitative findings suggest attaining healthcare for LC is challenging. This study aims to explore the experiences of NHS workers with LC to understand their illness experiences, conceptualisations of healthcare eligibility, and barriers to attaining healthcare. We apply Candidacy theory, how persons conceptualise eligibility for healthcare, to interpret the findings. Study design was mixed methods, including an online questionnaire and in-depth qualitative interviews, and with follow-up data collection after six months. Participants (n=471) were purposefully sampled for interview following initial questionnaire completion using maximum variation sampling. All interviews were conducted remotely and transcribed verbatim, and data were analysed thematically, inductively and deductively using framework analysis in NVivo software. 50 participants were interviewed in the first phase of interviews, 44 in the second phase. LC caused devastating, long-standing disruptions to many aspects of life as indicated by questionnaires (51% reporting ability to undertake day-to-day activities had been "limited a lot") and interview data collected. Shared in interviews, NHS workers experienced manifold candidacy-driven barriers to health care access including feelings of reluctance to seek help for fears of "overburdening" the NHS, perceptions that LC was not taken seriously or understood by GPs and specialists, and little occupational and healthcare supports existed. Some accessed limited supports via services and work contacts, sought private healthcare, engaged with online support groups and utilised medical experience and knowledge to keep abreast of published LC literatures. NHS workers struggle to access healthcare for LC. Access journeys are complex and inexorably connected to notions of illness candidacy. Feelings of a lack of entitlement to healthcare, a lack of legitimisation of LC illness and participants' expectations of low success when attempting to seek help, which was often driven by past healthcare experiences, constrain access. Professional role and role-identity represented significant components in participants' conceptualising of their eligibility for access and how access was approached. Nuances between professional groups, identity and healthcare access will be discussed in the presentation. The findings of this study are important; giving a voice to those suffering from LC, and highlighting the multiple barriers that prevent and constrain NHS workers from receiving healthcare for LC illness, which ultimately impacts return to work and fulfilment of their functional - and essential - role in the struggling NHS healthcare system

Lived experience of long COVID in health workers in Scotland (LoCH study).

This is the final project report for project COV/LTE/20/32 ("Lived Experience of Long-Term COVID-19 on NHS Workers in Health Care Settings in Scotland: a Longitudinal Mixed Methods Study"). The Long COVID in health workers (LoCH) study investigated the lived experience of the longer term effects of COVID-19 (long COVID) on professional and ancillary staff employed in the NHS across Scotland. These staff were asked about: their symptoms of long COVID; health and wellbeing; use of healthcare and self management strategies; working in the NHS; and personal and household finances. The report outlines the methodology and results of the study, and identifies key findings and potential impacts

Towards resilience: examining complex and hybridised coping strategies used by NHS workers experiencing long COVID illness.

NHS workers faced an increased risk of contracting COVID-19 during the pandemic and many now experience long COVID (LC). Over 10,000 NHS workers are estimated absent from work due to LC. LC represents a complex, dynamic and often serious condition, for which exist an unclear case-definition and diagnostic criteria. Common LC symptoms - such as fatigue, brain-fog and breathlessness - are debilitating, unpredictable and can significantly impact life and ability to work. Understanding factors supporting positive coping with LC are important for informing successful workplace supports. This study draws on two phases of longitudinal qualitative interviews, conducted six–months apart, with a range of NHS workers from Scotland with LC (50 interviews at first interview and 44 at follow-up). A structured, mixed inductive-deductive thematic analysis revealed that workers engaged in complex, iterative and multi-faceted strategies to approach coming to terms and coping with LC illness; intertwining processes of "illness work" and "emotional work" to generate novel conceptualisations of resilience. Strategies included: reframing LC as long-lasting but temporary; "accepting" LC recovery as "a journey", with "highs", "lows" and often frequent "setbacks"; and "letting go" of past established (pre-LC) benchmarks of health and wellness. Corbin and Strauss' notions of Illness Trajectory Theory are applied as a sociological framework, to interrogate linkages between participants' reimagining of LC illness and their journeys towards developing coping and resilience. Some meaningful outcomes for structuring workplace supports are presented, drawing on participants' narratives of "what works". Pathways are also spotlighted for advancing theory and further scholarship within this important research domain

Understanding and supporting NHS employees with long COVID return to and remain in work: key barriers and facilitators.

Long COVID (LC) is a debilitating illness with complex and dynamic symptoms, affecting all aspects of personal and work life. The process and implications of returning to work following chronic illness have been considered across various conditions; however, published literature exploring LC is sparse. Person-environment fit (PEF) theory has been used to unpick the employer-worker dynamic in the process of returning to work, providing an analytical framework that offers both an understanding of and practical means for supporting this process with a view towards a positive outcome for both parties. We apply this framework to NHS workers suffering LC, utilising PEF theory as a lens through which to provide a sociological perspective for interrogating experiences of returning to and remaining at work, while experiencing symptoms that are often fluctuating, complex and debilitating. Findings are based on a longitudinal, in-depth interview study, exploring impacts of LC on 50 NHS Scotland workers in clinical or ancillary roles. This study highlights the importance and interplay of key factors facilitating successful return to work: improvements in symptoms; specific supports and understanding; workplace flexibility; and considerations around professional role and identity. Understanding and addressing these factors is imperative, as around 10,000 NHS employees in UK are off work because of their LC, at a time of acute crisis in the NHS with understaffing and unprecedented demand. Key outcomes around how workplaces must adapt to facilitate reintegration of workers experiencing LC are discussed, and some additions to theory are proposed to allow for further application to understanding the impact of LC upon return to work

Living with long COVID: the problem of lack of legitimation.

The notion of the "sick role" (Parsons, 1951), where affected individuals are exempt from certain normative expectations and responsibilities (e.g. work) in line with societal judgements, rests heavily on the 'legitimation' of illness, principally through a formal diagnosis. Whilst extensively critiqued in later work (Frank, 2016; Vassiley, et al, 2017), and particularly in relation to chronic illness (Segall, 1976; Radley, 1994), it can be argued that critical aspects of the theory are still useful in understanding illness experiences today (Williams, 2005; Varul, 2010; Hallowell et al., 2015). Here, the sick role theory is applied to the context of long COVID, offering an understanding around the problem of the lack of legitimation of this condition amongst the medical profession. This is based on the findings of a longitudinal, qualitative study looking at the impact of long COVID on 50 NHS workers across Scotland. Presenting with a constellation of common and often debilitating symptoms, the impacts of long COVID are wide-ranging, very often necessitating suspension of normal social responsibilities, including paid work. Yet, as a relatively new condition with few visible symptoms, a lack of evidence base, and poor understanding around the condition, long COVID is generally not legitimised in the same way as other chronic conditions. Many individuals report a sense of not being 'believed', having their needs unrecognised, misdiagnosed, barriers in accessing healthcare, a lack of support at work, emotional burdens and a need for validation of their symptoms and experiences

The GP can't help me, there's no point bothering them: exploring the complex healthcare journeys of NHS workers in Scotland suffering from long COVID: a longitudinal study.

Globally, Long COVID (LC) affects around 40% of people infected with COVID-19 (Chen et al, 2022). Despite high prevalence, symptoms are variable, and no clear healthcare pathway models exist for diagnosis and treatment. The Candidacy Framework describes how individuals conceptualise their eligibility for accessing healthcare services and legitimise service engagement (Dixon-Woods et al., 2006). Anticipation of poor communication with healthcare professionals, and poor expectations of knowledge and advice, deter healthcare engagement. Conversely, positive beliefs regarding accessing clear illness information facilitate healthcare interactions. Determining factors are complicated in the context of LC, where candidacy domains such as Professional Adjudication are conflated with the high demand for NHS services and lack of knowledge surrounding diagnosis, classification and management of LC symptoms. We apply the Candidacy Framework to make sense of the often difficult and challenging healthcare journeys of NHS workers suffering from LC as they negotiate access to healthcare services. Online qualitative interviews were conducted with 50 NHS workers who reported symptoms of LC and came from a range of healthcare disciplines. Analysis identified themes of uncertainty regarding available healthcare supports, self-management and feeling abandoned. GP access was often difficult, with mixed responses surrounding LC legitimacy and diagnosis. Referrals were negotiated (i.e. cardiology consult) but often addressed single fluctuating symptoms, which impacted candidacy. Findings are used to advance three existing Candidacy Framework domains in new directions, highlighting how uncertainties surrounding LC, illness presentation, legitimacy and available recovery pathways systemically constrain health seeking behaviours in healthcare workers suffering LC in Scotland

Disrupted candidacy: a longitudinal examination of the constrained healthcare-access journeys of National Health Service workers in Scotland seeking supports for Long COVID illness.

Evidence examines how persons experiencing Long COVID (LC) struggle to secure healthcare for symptoms; however, few studies examine healthcare workers experiencing LC, nor the complex and multiple difficulties faced when seeking and receiving healthcare. This study is based upon two phases of longitudinally conducted qualitative interviews, six-months apart, with NHS (National Health Service) workers experiencing LC, from different occupational roles at NHS locales in Scotland (first interviews n=50, second interviews n=44). Multiple factors restricted healthcare-access, including worries of pressuring the NHS and concerns over LC being legitimised. When healthcare was sought, workers struggled to secure supports, referrals and treatment. Reasons included: 1) Context - the restrictive pandemic healthcare context; 2) Illness Climate - low GP knowledge surrounding LC and how this could be treated, trends for ascribing symptoms to other causes, and reluctance to diagnose LC; 3) Sense-making of LC, healthcare availability linked to occupational role-identity. To visualise and examine healthcare barriers, candidacy theory is applied, drawing inferences between healthcare context, illness climate, sense-making and identities. The study concluded that NHS workers' complex journeys represent Disrupted Candidacy: intersecting challenges across candidacy domains, restricting seeking and receive LC healthcare. Findings provide insights into why NHS workers resisted and withdrew from healthcare-seeking, and barriers faced when later attempting to secure LC supports. A pathway for future LC illness research to make use of a modified candidacy theory framework is presented. This research focusses on amplifying and learning from lived experiences; the voices of NHS workers in Scotland experiencing Long COVID. Interviews represent primary data for this study, therefore participants and their healthcare journeys are centred in this research and all aspects of production, reporting and output. Explicit discussions of stakeholder group involvement are highlighted in the methods section