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The Royal College of Physicians reported (13th Jan) that over 69% of Physicians had reported being ‘overwhelmed’ at work at over the Christmas period.
Dr Andrew Goddard, the president of the RCP stated,
"Staff are feeling as low as ever before. The conversations I have with colleagues every day, lead me to sense a real shift in how well people feel they are able to cope. We need to keep this in mind because while we may see some light at the end of the COVID-19 tunnel, we have a long way to go before we are through the current pressures and have even further to go to clear the backlog."
News reports of this type are becoming very familiar, too familiar in fact — at the risk of becoming background noise.
It begs the question, what happens if we keep pushing on medical teams to meet demand?
A worrying trend
8 months ago the government produced its NHS report on workforce burnout and resilience. This being the situation for staff before COVID had taken its full effects on the NHS. In it, they state;
NHS staff were 50% more likely to experience high levels of work related stress compared with the general working population. This was likely to damage their health and affect care quality, and was associated with patient satisfaction, financial performance, absenteeism and organisational performance. Poor staff health and wellbeing was also linked with turnover and intention to quit, along with higher levels of patient mortality in the acute sector.
At this time, the nation were regularly standing on their doorsteps clapping for the NHS, whilst NHS staff endurance and wellbeing was being flagged as an organisational and national concern. This wasn’t a new situation for NHS staff, as wellbeing, burnout and stress had been long term issues with years of government policy circling the issue without much measurable positive impact.
8 months on, now, and we are seeing the impact of an already stressed and worn out team trying to meet a national pandemic and to support escalating patient demand.
The outcome?
The worrying predictions in that report have come true but 10–100 fold more than was likely predicted, obviously exaggerated by COVID. We are fast approaching (or in reality have already past) a point where we need to make some critical decisions about NHS staff capacity — with a priority decision needed on how much of staff energy is spent dealing with overload vs how much do is spent on rebuilding staff resilience, wellbeing and coping.
A Wellbeing call to Action
There is an increasingly desperate need to call for healthcare staff to spend time, at work, with space to reflect, recover and recharge — at the level of organisational change, rather than personal commitment. We need the system to design this into job roles if we can hope to see the NHS survive. We need the public to be educated on the importance of this need.
To me it sounds logical, but hits the same kick-back in reality. How can a medic drop an hour when their patient list is already packed to the brim with 100s waiting? How does a nurse sit down when 30% of her nursing team are already off sick and patient numbers are up? How does a receptionist take time away from her desk when the phone never stops ringing? Many of these staff answer these questions by never asking them, they just push on and the demand gets ever bigger despite their effort.
There are emotional challenges with this too, from us, the patients. We are increasingly frustrated, anxious, afraid and, it seems, angry when we are not getting our health needs met. NHS staff are reporting a tidal wave of difficult conversations through to actual abuse and threats, so much so that the NHS is campaigning hard for the public to be nice to the staff!
How absurd, we went from clapping to swearing in under a year. We can perhaps empathise and make sense of the abuse as emotionally charged when we think of things at the level of personal emotions and fear, but when we consider the NHS as a place where people are paid to work — we have to worry about how many people might quit and take a nice job where people smile and say thanks rather than hearing patients sign off with sentiments such as hoping that the receptionist’s “kids and family die of COVID” because there are no appointments available (a recent disclosure from a GP practice manager I work with).
Patients feel staff are failing them.
Staff feel that they are failing the patients.
The government makes promises the NHS can’t meet.
The media reports these failures.
Who wins?
Well, we all lose.
Staff exodus / collapse
I spoke with a GP practice recently, where the staff have all been working 60+ hour days for almost 18 months with varying sickness levels. After this period, the practice manager quit — she was totally burnt out. The impact was incredible, as the entire team started to collapse. The loss of this one person, who is pivotal to the team, meant that the entire team struggled to cope. More staff went off sick, patient waiting went sky high and the whole team felt stressed and overwhelmed.
This is not uncommon. I am told that 4 such managers have quit recently in the last few months in our county alone. These managers take years to replace and to become proficient in their roles. But it’s not just managers, we are hearing the same about GPs, nurses… across the entire NHS. We are losing the people we need, at an increasing pace.
They are sensibly realising that they need to self-care and to be in the lives of their own families, so quitting their jobs. Or they are just incapable of giving any more. Either way, my heart breaks for them — as they leave a job they likely worked hard to get in a less than positive end.
It is the word, ‘jobs’, that the public in their rage sometimes forget. The anger is being directed at a person who is paid to support us, but can leave and probably should leave if their work-life is ruining their health, personal life and ability to actually perform their role. How many of us would take jobs that had those effects?
Whilst recognising this ‘jobs’ concept, also we need to not forget that NHS staff are people who also rely on the health system. I’m recently aware of an anxious nurse working on the ward who herself is long overdue tests her own suspicious breast lump, a working manager who is on a long waiting list for bereavement counselling and a worrying number of medical staff who are feeling depressed and exhausted, but still at work. We need to remember that the system overload issues effect the NHS team too, who also patients of the same NHS they work for.
I feel extraordinary appreciation for staff at present that I know is shared by many, and wonder how we can translate this into a culture of wellbeing.
No time for self-care
I perhaps have an unusual insight into NHS staff needs , as the founder and CEO of a national nonprofit that provides burnout support to 1,000s of NHS staff a year, www.project5.org. It is free to any staff that need it and is regularly attended. I also lead a service that supports NHS teams and leaders, with a big focus on wellbeing and sustainability (www.aimyourteam.com). My work brings me into contact with the large scale picture as a service lead and the very close quarters stories, emotions and efforts of staff and teams as NHS teams orientated Clinical Psychologist.
I am noticing a worrying trend, that no matter what we offer to help staff and how appealing we make it, they can’t find the time to attend outside of home life — where they are already exhausted and struggling to thrive. Even when we suggest support to working staff at the scale of 50 minutes per month, staff feel that taking 50 minutes would be impossible. The same staff who quite often have given up on lunch breaks at work. The staff we do see refer to the challenging experience of work. We support them as individuals, patch up their battered resilience and then send them back.
The race for capacity to meet demand is blindly driving without sight of the wall that is fast approaching, the potential collapse or exit of our much needed staff. We need to down gear and realise that capacity is not going to meet demand for a while and there are more urgent needs, like the survival of the system itself. There is no point relentlessly driving as fast as you can from A to B, whilst B gets further away and you can hear the wheels starting to fall off the car!
We need to create a culture of change where staff work includes staff recovery time. Currently, this space for staff becomes available when staff become ill or teams fracture, which is arguably too late. For those who become sick, take therapy or sick leave, the evidence shows that their problems very quickly return when they return to work, if their coping problems stemmed from the system the work in. Not rocket science really, depleting places make depleted people. They also exaggerate the darkest sides of us, as mass burnout and extensive pressure brings increased target driven management styles, reports of bullying and a loss of personal autonomy in our roles. A recipe for low job satisfaction, for all of us.
I am aware that the NHS is creating wellbeing hubs and increased wellbeing support for individual staff, but the emerging story is pointing to a broader need. The need for entire teams to access the space to meet and work together to support each other, to creatively meet challenges and to feel united. To achieve this we collectively need to envision staff wellbeing as a target for the NHS alongside rates of care provision, to enable staff to drop tools now and then so that the NHS can catch a break on every level. We need this, as the evidence suggests it works and the current situation is signalling a raft of risks, threats and care quality issues.
When I refer to ‘we’ in reference to building this culture, I see a united role for NHS leaders, the public, the media and the government:
We need to legitimise and quasi-mandate (strongly encourage) recharge space as a form of scaffolding to help staff stand up. Not just for sick staff, but for all staff and for teams as whole entities.
We need to educate patients that NHS staff are almost all working with less than they need at present.
Our media need to celebrate that staff are still around rather than hitting them hard every week on patient let downs (we need a lot of birthday wishes to make this last one a reality!).
We need to stop hearing government promises that patients will get longer access hours and face to face contact when they want it and let services work out how best to meet demand with the challenges each team faces.
How could such an approach not hurt patients, we may fear?
The answer comes from trusting NHS staff and valuing them even when we feel we are not getting what we expect. Space to recharge, space to unite and space to be creative will create capacity in ways mandated target driven innovation has never been seen to. Humans solve amazing problems when they have the space to solve them, right now staff need this space and time.
To achieve this, we all need to lead NHS staff towards this way of being as it will feel new. Staff are in a crisis mode after years of being overworked and need to be shown / taught / supported to calibrate energy expenditure… sometimes on patient care and sometimes on personal wellbeing.
This is what it really means to create a culture of wellbeing and we are way past the exit sign that points to it.
For NHS staff that need support now — go to www.project5.org, we are ‘here for healthcare’!
Craig
Multi-award winning Health Innovator, Clinical Psychologist & Leadership Coach. Founder of www.aim-you.com, www.uxcgroup.com & www.project5.org