UK: How Willing And Able Are NHS Employees During Times Of Crisis?

Last Updated: 17 September 2015
Article by Sara Ulrich and Lorna Riddle

Most Read Contributor in UK, August 2017

Earlier this year an innovative public-private research partnership between Deloitte, King's College London and Public Health England published findings from novel research exploring the topic of employee responses to extreme events. Their report, Willing and Able: Building a crisis resilient workforce, focused on the core question: if employees are able to report to work during an extreme event, would they be willing to do so?1 Subsequently, given the critical role of the NHS workforce in maintaining a fully functioning healthcare delivery system at times of crisis, the project team reviewed their research findings supplemented by published research on the willingness of healthcare staff to work during extreme events. This week's blog presents some of the project's key findings and recommendations.

While there is plenty of anecdotal evidence indicating that healthcare workers will go to great lengths to fulfil their roles during times of crisis, to what extent are these anecdotes supported by evidence? Do healthcare workers feel a duty to continue to work under any circumstance?

There are a number of published research articles that compare healthcare workers' willingness to report to work during different hypothetical scenarios. One such study found that 78 per cent of frontline health staff in Australia said they would be willing to work in a weather related event compared to 67 per cent in an influenza pandemic and 52 per cent in a bioterrorism event.2 Similarly, research in the US found that healthcare workers were most willing to report to work for a mass casualty incident (86 per cent), an environmental disaster (84 per cent) or a snow storm (80 per cent) and least likely to report to work for a chemical event (68 per cent), a smallpox epidemic (61 per cent), a radiological event (57 per cent) or an outbreak of SARS (47 per cent).3 This demonstrates that threats that could impact the direct health of the individual or their family could make healthcare workers less willing to come to work.

The recent Ebola outbreak in West Africa has provided further evidence. One study, examining UK healthcare workers' attitudes on volunteering to help with the Ebola outbreak in West Africa, found that the primary barrier to volunteering was insufficient information on which to base the decision. Other barriers were uncertainty about what their role would be, fear of catching Ebola, family considerations and partner concerns.4

The above research highlights a number of factors that motivate or facilitate an individual healthcare worker to report to work during a major public health emergency. These include:

  • Perceptions of duty/professional obligations
  • Feeling important to the overall public health response
  • Communication and information from their employer
  • Positive perceptions of workplace health and safety.

A series of employee focus groups from various national infrastructure sectors (including the health sector), conducted as part of the Willing and Able research, revealed further insights. In one example, where the focus groups were based around a hypothetical bioterrorism scenario, the discussions revealed an overall willingness amongst health sector workers to report to work during a potential high risk situation.

Employees were motivated by a desire to help, both with the organisation's response and the UK's ability to recover from such a serious public health incident:

"I guess we would feel a duty because of what our roles are. As a scientist you feel like you should...well if we all went home then who would do it? Nobody, because there would be nobody here. Somebody has to find the cure."

However, some health sector workers also discussed their fears and how the actions of their organisations could affect their decision:

"If things were really that bad I don't think I would want to go home to spread it to my family, I would probably want a little room at work to stay over in.... I would want to stay there rather than risk spreading it."5

So what can employers in the health sector do to motivate their staff to report to work during incidents that might pose a perceived risk to their health? The findings of the above research, which also included a systematic literature review, interviews with business continuity professionals and an employee web survey, were used to develop a series of recommendations for organisations, these include:

  • Make sure all staff (including those in non-clinical positions) are aware how important they are to the overall public health response
  • Emphasise the organisation's focus on staff health and safety, both before and during an incident
  • Where appropriate, provide access to diagnostic assessments and medical treatment for those employees most at risk and consider also whether this could be given to their families'
  • Consider providing temporary accommodation for essential employees who may perceive that going home at the end of a shift could put their loved ones at risk
  • When communicating with staff about the potential risks of coming to work during a public health incident, provide the relevant scientific/technical information to allow individuals to perform their own personal risk assessments. Do not try to hide information as this may cause trust issues in the future.


1 Details about the methodology and findings for the thought piece "Willing & Able: Building a crisis resilient workforce" can be found on this link: This PhD funded research was recently recognised by the UK Resilience CIR Award 2015 for Initiative of the Year.

2 Kristy Hope et al., 'Willingness of Frontline Health Care Workers to Work During a Public Health Emergency', The Australian Journal of Emergency Management 25, no. 3 (July 2010): 39–47.

3 Robyn R. M. Gershon et al., 'Factors Associated with the Ability and Willingness of Essential Workers to Report to Duty during a Pandemic', Journal of Occupational and Environmental Medicine 52, no. 10 (October 2010): 995–1003.

4 L. Turtle et al., 'A Survey of UK Healthcare Workers' Attitudes on Volunteering to Help with the Ebola Outbreak in West Africa.', PloS One 10, no. 3 (March 2015).


The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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