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Who cares for the carers?

June 23, 2017

Nurse-rubbing-her-forehead-in-hospital

It was timely and appropriate to hear at last week’s NHS Confederation Conference from staff involved in the immediate response to last month’s bomb attack in Manchester. The stories of the commitment of NHS staff in responding to the needs of those were affected by the blast were truly inspiring.  It was also important to reflect on the psychological and emotional strains which such events place on staff and to recognise what we need to do support them.

However I was also struck that this story was not one just about exceptional events such as the Manchester bombing, but had much greater significance in reminding us about the underlying nature of clinical work and how we address what is needed to promote staff wellbeing and resilience.

We have two reasons for needing to do so. First the values of the NHS should reinforce in us a strong commitment to looking after our staff, as we always say our most valuable resource and one which is doing, day in day out, a difficult and psychologically challenging job.  The work of clinicians and others who are involved in directly supporting patients work in constant proximity to distress, suffering and death.  Inevitably this has an emotional cost, particularly when combined with the sense of responsibility which staff will feel about the impact of their own actions on what happens to patients. We need to recognise this much more explicitly in our public discourse about the delivery of healthcare.  We are not making widgets.

The second reason, is, as researchers like Michael West have clearly demonstrated, that there is a close correlation between staff engagement and wellbeing and the quality and effectiveness of care. His analysis of the results of the staff survey shows clearly that Trusts with better scores for staff engagement also do better in relation to patient satisfaction and for certain measures of clinical quality.  Poor engagement correlates with burn out and we should all be concerned at the finding in the latest staff survey that 37% of staff report having taken a period of absence in the last 12 months due to work related stress.

These issues matter all the more in the context of the very significant pressures we face on workforce and staffing. Whatever our efforts the pipeline for new supply of clinical staff will not address easily the likely gaps we will face across a range of clinical disciplines over the next 5 years, gaps which Brexit and other factors are only likely to worse. Initiatives around retention will be key if we are to find a way through.

Pay will be a key issue and I welcomed the suggestion made by the Secretary of State at the conference to argue the case for lifting pay restraint for NHS staff. The worsening differential between NHS staff and workers in other parts of the economy must be a serious concern and without some attempt to address this, our workforce problems will only get worse.  It goes to say, of course, that any increase must be fully funded and not add to the financial problems of providers.

However alongside pay we must also prioritise the agenda of staff wellbeing. The question of the psychological dynamics of clinical work has long been an area of interest for my Trust.  This starts, as I highlighted earlier, with a recognition of the psychological and emotional wear and tear of caring roles and the need to invest in approaches which help staff feel supported.

Michael West sees good engagement underpinned by two ingredients: job resources such as the degree of control staff feel over their work, systems of reward and recognition and the extent to which staff supported by their organisation and personal resources around individual’s resilience and ability to process stress and distress.

There is a long established tradition of work discussion groups which provide a safe, confidential, multidisciplinary and non-hierarchical forums for staff to come together and deal with the issues they encounter in their day to day clinical practice. A number of models exist, Schwartz Rounds and Balint Groups being amongst the most well-known and there is a good body of knowledge about how they support staff wellbeing and engagement.

At the heart of both approaches is the issue of empathy and compassion, the ingredients which above all others distinguish excellent care. The ability, in the words of Ken Schwartz, whose legacy led to the creation of Schwartz rounds, to deliver the small acts of kindness which make the unbearable, bearable for patients and their families. Such approaches are followed in many NHS organisations but should, I would argue, become mainstream.

At a time when our NHS faces unprecedented demands what is, in the scheme of things, relatively modest investment in protecting the wellbeing and engagement of our staff must be a top priority for leaders. Without them we have little chance of meeting the challenges ahead.

 

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