Abstract
Background: High rates of poor mental health in healthcare staff threatens the quality and sustainability of healthcare delivery. Multi-factorial causes include the nature and structure of work. We conducted a critical review of UK NHS (England) data pertaining to: doctors, nurses, midwives
and paramedics.
Sources of data: Key demographic, service architecture (structural features of work) and wellbeing indicators were identified and reviewed by a stakeholder group. Data searching prioritised NHS whole workforce sources (focusing on hospital and community health services staff), which were rated according to strength of evidence.
Findings: Key differences between professions were: (i) Demographics: gender (nursing and midwifery female-dominated, doctors and paramedics more balanced); age (professions other than doctors had ageing workforces); ethnicity (greater diversity among doctors and nurses); (ii) Service architecture: despite net staffing growth, turnover and retention were problematic in all professions; 41.5% doctors were consultants but smaller proportions held high grade/band roles in
other professions; salaries were higher for doctors; (iii) Wellbeing: all reported high job stress, particularly midwives and paramedics; sickness absence rates for nurses, midwives and paramedics were three times those of doctors, and presenteeism nearly double.
Growing points: Socio-cultural factors known to increase risk of poor mental health may explain some of the differences reported between professions. These factors and differences in service architecture are vital considerations when designing strategies to improve wellbeing.
Areas timely for developing research: Multi-level systems approaches to wellbeing are required that consider intersectionality and structural differences between professions; together with interprofessional national databases to facilitate monitoring.