As long ago as 1997, research showed that 26.8 per cent of NHS staff were suffering damaging levels of stress, compared with 17.8 per cent of the general population. Evidence suggests that little has changed in the intervening 18 years, and health professionals (nurses in particular) have consistently reported the highest rates of work-related stress, depression or anxiety for the past three years. In the last NHS Staff Survey, 39 per cent of NHS staff reported that during the past 12 months they had felt unwell as a result of work-related stress. 65 per cent of staff reported that they had attended work in the previous three months despite not feeling well enough (physically or mentally) to perform their duties. However, only 43 per cent said that their organisation took positive action on health and wellbeing.
We are creating conditions in which the health, wellbeing and quality of life of those who have committed their working lives to the NHS are being profoundly damaged. And stress can kill people.
How should NHS leaders respond? One way is to implement health and wellbeing strategies to help staff take more responsibility for their health (for example, by promoting the ‘five ways to mental wellbeing’). And there are lots of very good health and wellbeing strategies across the NHS. But, to some extent, this is treating the symptoms, not cause – preparing staff to be more resilient in order to send them back into the trenches. And there is a danger that leaders could use a health and wellbeing strategy as a sticking plaster, instead of addressing the underlying and pervasive structural and cultural causes of low staff morale.
We know that stress is a result of a toxic cocktail of high work demands coupled with low levels of control and support. We must address all three elements.
First is the need to reduce work demands. A recent study showed that long shifts are associated with poor patient care and higher levels of errors and it is key to address the culture of long working hours that often characterises NHS organisations.
At a national or regional level, reducing work demands requires there to be sufficient resources in local systems of care to run services effectively and credible workforce strategies which provide a pipeline of staff qualified to work in the areas of care where demand is rising. And it requires we reduce demands by developing credible strategies for preventive health care. This starts in the early years of our lives and needs collaboration between all sectors of health, and education and housing too. At a service level, reducing work demands also involves challenging activities that do not add value to delivering high-quality care for patients.
Second, control. NHS staff are more highly motivated, skilled and experienced than staff in virtually any other industry. Command and control cultures in such a context are unnecessary; the number of levels of hierarchy in NHS organisations is far too high; and we must give frontline staff the autonomy and control to provide care (within safe boundaries) in the way they know is most effective. In effect, we must create shared leadership in teams and cultures of collective leadership.
Third, staff must have support to do their jobs effectively. This includes developing effective team- and inter-teamworking in health care because effective teamworking (where teams have clear objectives, work closely together and meet regularly to review their performance) is associated with better-quality care, staff wellbeing and innovation in improving patient care.
The role of leaders is to create the conditions that enable staff to do what it is they chose to commit their working lives to – offering high-quality, continually improving and compassionate care. And there needs to be the necessary resources, staff and time for the work to be conducted effectively.
Leaders must model compassion in their dealings with staff: paying attention, appraising the situation, having an empathic response and taking intelligent action to support them. Our surveys of culture in the NHS suggest that leaders are not always seen as being compassionate towards staff. Indeed, a shocking 24 per cent of NHS staff report being bullied by colleagues and managers compared with around 16 per cent in some of the worst-offending industries outside health care. This in turn affects how compassionate staff are in relations with patients and service users.
There are good examples across the NHS of organisations that are safeguarding the health, wellbeing and morale of staff. For example, at our forthcoming conference on encouraging staff wellbeing in health and care, we’ll be hearing about the work Northumbria Healthcare NHS Foundation Trust are doing in this area. It may not be easy, particularly in a period of rising demand and diminishing resource, but it is possible for organisations to create environments in which staff are supported rather than damaged. A service focused on delivering high-quality compassionate care must not be damaging to those who deliver that care in the process.
This blog was co-authored by Donna Willis, Programme Director, Collective Leadership.