Leading with compassion: supporting the health and wellbeing of NHS staff

Key:
I:     Sally Warren (Interviewer)
AL:     Annie Laverty 
SN:      Steve Ned 

I:    Hello and welcome to the King's Fund Podcast where we talk about the big issues and ideas in health and care.  My name is Sally Warren and I'm the Director of Policy here at the King's Fund.  In this episode we're going to be exploring the results of the latest NHS staff survey, what they tell us about how NHS staff are experiencing their workplaces and the practical steps leaders can take to address the issues raised and for this episode I'm joined by two expert guests, Annie Laverty who is currently Northumbria Foundation Trust's Chief Experience Officer and will be soon moving to a new role as the Chief People Officer for the North East and North Cumbria Integrated Care System, and Steve Ned, the Director of Workforce of both Rotherham and Barnsley Foundation Trusts.  Annie, Steve, welcome and thank you for joining me on this episode. 

AL:    Hi Sally. 

SN:     Nice to be here Sally.  

I:    Before we get started, can I ask you to briefly introduce yourselves to our listeners and tell them a little bit more about what you do? 

AL:    I'm Annie Laverty, I've been with Northumbria a very long time, 30 years in fact, joined the NHS in 1990 and my role essentially is about integrating patient and staff experience and how we can use that information and feedback to drive improvement in the organisation. 

I:    Thank you, so fantastic to be joined by 30 years of experience, Annie, really looking forward to what you have to say later, and Steven? 

SN:     Yes, thank you Sally.  Steve Ned, I'm Director of Workforce at Rotherham and Barnsley.  I've been at Rotherham and Barnsley now, it's a joint role which I think sort of pre-empted some of the conversations about collaborations for the two organisations who are looking to work more collaboratively together.  At the risk of one upmanship, 35 years in the NHS in and around South Yorkshire and Bassetlaw.  So lots of experience, some will be good some less good and most of it people related and it's about … again similar to Annie, about how do we harness the skills and talents of our workforce whether … and my experience has been in most acute organisations in South Yorkshire, how do we connect the workforce to the mission of the organisation in terms of driving the quality of patient care? 

I:    Great, thank you, Steve.  It's fantastic to have you and your 35 years of experience with us.  I know we're going to learn a lot throughout this episode.  So it's fair to say that the latest NHS staff survey results paint a concerning picture of staff under intense and systematic pressure.  Steve, what was your take on the national results?  Were they what you were expecting? 

SN:     Yes, I think … Sally, I think the word I've used a couple of times when I've been presenting these to board in terms of our organisational results and the national picture, is sobering.  So I think we anticipated nationally that as chief people officers, as workforce professionals, that 18 months into a pandemic we just knowing from our staff what their experiences were, that they were tired, they’ve been through a lot in the last 18 months.  So we weren't hopeful particularly of excellent staff survey results which I think have been borne out in the national staff survey results and I think some of that was to be expected, I think some of it is more disappointing than others if you look at the experience of some of our black and minority ethnic staff in terms of their experiences in the workplace, we're going in the wrong direction.  This is not just a chief people officer or a director of workforce challenge, this is a whole system, a whole organisational challenge about, how do we address some of those concerns?  So we locally, nationally, need to focus on some of those areas of concern around health and wellbeing, around the experience of some of our minority staff and how do we address that challenge knowing that the world that we're going into is not going to be any easier for a range of different reasons.

I:    Annie, your organisation Northumbria Healthcare NHS Foundation Trust was one of the top performing Trusts across the country, but when you saw the national results, how did that make you feel? 

AL:    So yes, I think I'd agree with Steve, I don't think the results were surprising given the context of the last couple of years in particular, but I think nonetheless we'd all share that the results are concerning when we consider the first hand impact of the significant pressures on the NHS and how that manifests itself in terms of morale of our health workers.  We see more and more staff becoming sick with work related stress, people having concerns about gaps in rotas, less confident that their friends and family would be happy to get the care they would receive and then Steve's point about despite the NHS promising action on diversity and inclusion, we still see the reports of discrimination against staff from black and minority ethnic groups and seen that jump sharply.  I think overall my main emotion was recognition of a general worsening across most questions from 2020 to 2021, noticeable increases in work pressure, negative staff experience and a decline in health and wellbeing measures and, as I say, while we might not be surprised on that, the fact that those results were then published on the day that we also hear that there's been the biggest ever drop and fall in public satisfaction with the NHS, I think seeing those two survey results side by side extremely concerning really.

I:    Let's build on your point about this is a trend that's happening.  So this is a second staff survey to have taken place since the start of the COVID-19 pandemic, and we know in that time staff wellbeing has deteriorated as you've both so articulately said with nearly half of NHS staff are feeling ill with work related stress in the past year, but we know the rate of stress related illness was increasing before the pandemic struck as well and whilst COVID-19 has accelerated it, it's important for us and our listeners to understand these results are part of that longer term trend.  So Annie, in your view, how did we get here?  What's behind that long term trend?

AL:    It's clearly a challenge that people are reporting in relation to the pressure that they experience at work, the investment, long term investment in workforce supply, attention being paid to the health and wellbeing of NHS colleagues.  None of those findings were new.  Certainly if you look at the results just in 2019 some of the figures from there were concerning enough in their own right even without any of the influence of COVID.  I think what we need to pay particular attention to is the sharp decline or the significant decline for the first time in staff engagement and certainly in Michael West's research would be reminding us that engagement is the number one predictor of organisational performance.  So seeing staff engagement and staff morale decline in the way that they have and the worsening of those two categories with an increase in staff who are considering leaving the NHS permanently … so that was as high as 10% or 11% every single year in 2019 pre-COVID, but it's got worse and that impact also of the advocacy element, a decline in staff being able to recommend the NHS both as a place to work and as a place to receive care, both things that I think we should be paying particular attention to, we have to acknowledge that behind this feedback is years and years of staff shortages, a lack of a workforce strategy, people feeling overstretched, intolerable pressure on staff and then the pandemic has added so much more on top of that.  So the journey to recover services and waiting times will be long and difficult.  So keeping staff on board and supported I believe is the greatest challenge that the NHS faces right now. 

I:    Steve and Annie, you've both already reflected on some of the different experiences that different staff groups have had through this survey and the latest results show that 17% of staff from Black, Asian and Minority Ethnic groups experience discrimination from their managers or colleagues, an increase from 14.5% back in 2019.  Steve, what's the picture like in the organisations you work for and what steps have been taken to address these issues? 

SN:     Yes, I think the picture in both organisations where I work reflects the national  picture which is an increasingly worrying trend towards staff from a black or minority ethnic background reporting a negative experience compared to the colleagues who don't share that protected characteristic.  I do hesitate and worry that it becomes an episodic conversation.  So there were lots of discussions in both organisations and I think nationally around the time of the George Floyd murder and Black Lives Matter etc, but that's got to be a continuing narrative.  It's got to be a continuing discussion about how we alter the experience for black and minority ethnic staff.  I think from a practical point of view, I don't think we're doing anything earth shattering that I think other colleagues are doing in other organisations.  We've got staff networks which we're trying to actively engage in terms of experience at work, we've got reverse mentoring schemes which are operating in both organisations which I think are really positive, but we've got to address the perceived treatment that black and minority I think staff are getting. 

I:    And Annie, does this echo the picture in Northumbria?

AL:    Yes, I think well we've committed to measuring staff experience all year round and because of really good engagement to those surveys, we're able to analyse that data against all groups represented by protected characteristics and I think it's really, really important that we have a constant focus on any difference in experience and changes.  We devise specific surveys around belonging and inclusion and understanding how that feels across our organisation for all of our workforce because whilst it's absolutely clear from the latest results that there is so much more that needs to be done to change the experience of black and ethnic minority staff, it is also clear that when monitoring targets are set and evidence based actions are pursued, it is possible to shift that staff experience.  So I think I would want to have a message of hope that there are actions that we can take locally.  For me it's about that understanding that you need a constant focus on this, you need to absolutely strengthen the voice and influence in the organisation of a staff network and there needs to be an absolute zero tolerance, and zero tolerance meaning that, and that's for all staff experiencing it from all groups. 

I:    So we've outlined the problems that the staff survey are highlighting, and I want to talk about some of the solutions and some of the practical steps that leaders at every level in the NHS can take to tackle some of the issues that we've discussed, I think it's really important that we recognise behind all of these numbers there are people who are really struggling and many of our listeners may themselves be feeling burnt out or they will know colleagues who are feeling really overwhelmed at work.  So Steve, if someone walks into your office and says that they're feeling stressed or burnt out from work, what's the first thing you do? 

SN:    The first thing I'd do is listen.  That sounds like an obvious response, but I had several conversations in the last couple of years where having listened, the feedback I get is thank you for listening, because I think people sometimes feel as if they have problems they take them to certain parts of the organisation and don't come away feeling as if they're listened to.  So I think there's a real role for leaders across the NHS and not just workforce directors, it's a leadership issue, it's that we do need to listen and actively listen to our staff and the concerns that they've got.

I:    Annie? 

AL:    Yes, we took a decision early on, in the fact the weekend before lockdown, to change and quickly escalate a real time mechanism for tuning in to the emotions of our staff and that's not an easy decision to take.  It's quite hard to go large to an organisation and ask staff how they're feeling in the middle of a pandemic when fear is perhaps at its peak and when you're not necessarily confident as senior leaders that you're going to have the solutions to some of the challenges that people are presenting you with, but Steve's point about listening I think is really, really important.  Part of my work in Northumbria along with colleagues has been around integrating patient and staff experience and I think continuingly listening, gaining feedback, understanding how people are and then acting on it, is an intervention in its own right.  So we were able to create a platform, we launched it on 6 April, within the first three months we'd had 10,000 responses from our staff about that was a place they could go and vent, it was a place they could talk about frustration, if they were working in community services and didn't have the right access to kit or laptops to work remotely we could solve that.  We were hearing that feedback on a weekly basis, could feed it through goals, could feed it through our health and wellbeing committees, around the things that were frustrating and disappointing staff, also the things that they feeling good about so we could do more of it.  But in that analysis of the comments that we received in those early months, we formally analysed all of that free text data and seven core needs emerged in that data forming and if I can just share them with you now, they are listen to me, care about me, keep me safe, keep me connected, lead me, keep me going, and then finally notice me on my work and I don't think those needs are confined to Northumbria, I don't also think they confine necessarily to the context of a pandemic.  I think they are core needs of our workforce and would inform any leadership frameworks in a way.  So I think it was really, really helpful for us to just have this thread of information and I think what it signalled to our workforce was we were listening, we did care, we might not always have the solutions but we were with them and in it with them and I think it's when that measurement acts as a form of care, so an opportunity at an organisational level, to demonstrate compassion.

I:    Were going to take a quick break now and we'll hear more from our guests in a moment.

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Welcome back.

You've both naturally brought up compassionate leadership and leading with compassion and that's where I wanted to turn our attention to next because this was the first year that compassionate leadership featured as a theme in the NHS staff survey with questions such as, does my manager work with me to come to an understanding of problems?  Are they interested in listening to the problems I describe?  Do they care about my concerns?  So echoing a lot of what you've both reflected on already, but few of them, one third of the survey respondents said they experience compassion in this way from their immediate manager.  So Annie, how can this kind of leadership tackle some of the issues we've discussed that our staff groups are experiencing? 

AL:    The modelling of leadership right from the very top.  So it's the behaviours, actions, beliefs, with senior leaders pay attention to that shapes the real culture of organisations.  I think it can be around really, really small gestures and then some big ones that signal something fundamental.  So if I can cite examples from my own organisation, when Christmas [passed] everybody got a brown package from Northumbria with love.  It was a brown paper package tied up with string.  It was just a few of a little treats for Christmas.  There were ice cream vans that connected our eleven hospital sites in the summer, there was a recycle bag reminding people to take a break.  Some of that funded by our charity.  None of it particularly expensive, but the fact that everybody got one was a message that we're with you, we understand you are still working hard, we understand this is taking its toll, but nonetheless take a break.  It's important to do that.  Recover and restore.  Or it can be really, really big gestures that require the skills and experience and talent of leadership.  So I think about fundamental aspects of running out of PPE, our staff feeling very, very unsafe in those early months of COVID and the organisation taking the decision to build a factory of their own and create that PPE and be able to work and supply other organisations across the north in particular, that was a really big gesture for our staff that signalled something about taking back control and not feeling powerless, not feeling hopeless, but it was the skills of leadership that enabled that to happen; but always in that, that compassionate leadership, the humility to think we won't all have the answers, the courage to actually ask the questions and the ability to frame some of those solutions in the context of the challenges that staff themselves are describing. 

I:    And Steve from your perspective, what are some of the really practical things you can do to help leaders at different levels recognise the importance of leading with compassion and equip them with the skills to be able to do that? 

SN:    I think one of the things that we've started to do is actually talk about it.  So when leaders come through in the system, it makes a difference in different parts of the system, I don't think there are any conversations around what it means to be a compassionate leader and I think we need to have more of those conversations as a system, as organisations.  I think there's a psychology around the NHS that what gets measured gets done.  So what are the stories in organisations that lead people to believe that that's what helps you succeed?  So we talk a lot about performance, we talk a lot about delivery, we talk about quality of patient care which is right and proper, but I think we need to start having more of a conversation about compassionate leadership and all that means and what does it mean for me as an individual in terms of the conversations I have with people.  I don't think they're mutually exclusive, so I think we can still have a performance culture but still be a compassionate leader and I think there are examples of that around the NHS and the wider sectors.  So I think we need to be having more conversations about what compassionate leadership means, what does it mean for me as a leader and how do we enact that in the NHS because I think times are not getting easier, so if we move as … as we're moving into recovery we’re hopefully coming out of the pandemic, we know what the staff survey results are saying to us, we've got a lot to do as leaders to harness the power of our people. 

I:    I wanted to move us on a little, so we've been talking a lot about some of the challenges that the staff survey results have highlighted, but we should also say that despite some of that negative overview that the headline figures provide, there are of course examples of brilliant practice out there across the NHS.  So Steve, what good practice are you seeing that we could share with our listeners? 

SN:    I think I would point to certainly in our organisations and I guess it's the same across others, and it's a big piece for me around health and wellbeing, whilst the staff survey … I think the question in the staff survey is slightly at disconnect with the reality in terms of what … so I would say in our … in my two organisations, we've never had as wide and as deep a health and wellbeing offer in the last two years than we've had previously and when we talked to staff they're grateful for it.  I think the challenge for us then is if you look at the questions in staff surveys about conversations with my manager about health and wellbeing, and I think where we've got to try and focus that conversation is about that one to one connection.  So it's less about the organisation wide offers which I think we're doing really well at, so we've got everything, Pilates class, last night we launched our crochet club, we've got all sorts of psychological wellbeing offerings that we give to our staff, which are appreciated and are being accessed, but I guess coming back to that theme of compassionate leadership, it's about how do we build that into the everyday conversations.  It's not … health and wellbeing is not something that the organisation does, it's something that's done on a day to day basis and I think there's a load of scope for us as organisations as leaders within organisations to build on that.  So I am quite optimistic around the health and wellbeing agenda.

I:    Great, thanks Steve.  Annie, I wanted to come to you partly to hear your reflections on what Steve has just said, but also what initiatives have you seen that can make a really positive difference to how staff feel at work?

AL:    So I think there are also … we should acknowledge that there are some positives in the survey too and I think things that have been strengthened by the challenges of the pandemic, perhaps team working, camaraderie, it's survived the pandemic.  Team working in the NHS remains strong.  I would encourage people to really measure well, to understand your organisation.  Don't wait for an annual survey to know where you are at the end of the year, when you've got an opportunity to stay close to the views of your staff all year round and respond quickly in the moment to what those concerns are and then think that connection between really truly integrating the voice of patients and the voice of staff is something that I think is critically important.  Our teams have missed that dramatically.  We've been able to resurrect our real time patient experience programme, but in the early months of COVID they were denied that feedback and it was amazing how much people missed that connection with what patients were feeling about care and how important that is. So I mean in a summary I think measure well, measure often, act on the advice.  Don't measure without improvement.  It's quite disrespectful to do that for those that are given feedback, but above all have a go with hope that actually by attempting and starting you are more likely to make a difference and see some shift in that data.  When we committed to our staff experience program and just chose eight things to focus on in terms of staff engagement, all eight of them were statistically better within twelve months and it wasn't from a low baseline, it showed us that good could get better.  So I think there are lots to be hopeful about and encourage that, but the focus and attention and belief of senior leaders needs to be on this all the time.  

I:    Thanks Annie.  Annie and Steve, you've both throughout this conversation highlighted really good examples of organisations tackling challenging issues, making improvements.  I'm interested Steve how good do you think the NHS is at sharing those ideas across organisations? 

SN:    Getting better I think would be my initial summary.  So again past experiences, and I think there is a move towards at a system level or collaboration, and I think that's to be encouraged and I think we're getting better.  Certainly as HR professionals in my patch, and I think the pandemic helped with this and never waste a good crisis because it was a situation that we all found ourselves in for the first time and we spent a lot of time not reinventing the wheel, whether that's devising vaccination programmes, health and wellbeing initiatives etc etc.  So we were starting and have started to become a lot more collaborative in my patch in the NHS around sharing good ideas and steal with pride.  I think there are lots of good examples across the country where … and I know context will be different so not every organisation is the same, but we've learnt a lot from other different organisations.  So a good example will be the work that's been done in Mersey Care around just culture.  We've been across to talk to them about what they did, how they did it and again our organisations are different, where we've come from is different and our background is different, but actually the fundamental principles of what they're doing we're now introducing into our organisations and we're pushing at an open door because staff site representatives are really keen for us to have that approach which is again I guess embarrassing that compassionate leadership approach in terms of addressing issues and challenges which there will always be in the NHS.  So I think we're getting better at sharing good practice across the NHS. 

I:    Thanks Steve.  It's been so fascinating having a conversation with both of you Annie and Steve, so much insight and I wish we had much longer to be able to delve into some of the issues not least one of the things I would have liked to have talked about is how you as senior leaders look after your own wellbeing as well because we're talking about NHS staff but that includes you as well, but unfortunately that's all the time we've got for today.  So thank you Steve Ned and Annie Laverty for joining me on this episode.

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