NHS sickness absence: let’s talk about mental health

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Sickness absence rates in the NHS are higher than in the rest of the economy. NHS staff sickness rates rose from 3.8 per cent in April 2018 to 4.1 per cent in April 2019. This is the highest level at that time of year in more than a decade, and represents more than 1.4 million full-time equivalent (FTE) days lost in that month alone.

Data on the level of sickness absence in the NHS has been published for several years now, but it is only recently that national data has been published on the reasons why NHS staff are absent. This data shows that anxiety, stress, depression and other psychiatric illnesses account for nearly a quarter of the staff absences in April 2019, far outstripping other reasons for absence (Figure 1).

Source: NHS Digital
Notes: The data presented here is a ratio of absence days as a proportion of all possible FTE working days from all staff directly employed by the NHS, ordered by the absolute number of days taken as absent (in descending order).

The absence rates in two groups of staff are of particular note. The Health Service Journal recently commented on the high levels of absence attributed to psychiatric illnesses among managers – 32.5 per cent among senior managers and 32 per cent for other managers. This isn’t limited to managers though: the percentage of days lost due to anxiety, stress, depression and other psychiatric illnesses has risen steadily over the past seven years among nursing and health visitor staff as well (see Figure 2). Working on the frontline of the NHS is often a difficult and emotional job, but this level of mental health absence deserves greater focus.

Source: NHS Digital
Notes: Annual periods in this chart refer to the period between 1 July and 30 June each year.

It should come as no surprise that the mental health of NHS staff is increasingly under pressure. Workforce shortages are rife, with 96,000 vacant posts in NHS trusts, even as the demand for care continues rises relentlessly each year. This means that existing staff are increasingly stretching themselves thin to provide care for patients. In the 2018 NHS Staff Survey, 56.6 per cent of staff said they had gone to work when ill, and close to 3 in 5 staff were working extra unpaid hours on a weekly basis.

A report by the Department of Health and Social Care highlights the effects of these long hours and difficult shift patterns on the mental health of employees, with 76 per cent of frontline staff experiencing ‘mental distress’ at work. In 2017, The Point of Care Foundation found increased distress enhances sensitivity to further stress and makes employees more likely to ‘burn out.’ This report, along with the Observer and Guardian’s healthcare network survey, suggests that staff absence creates a negative spiral that only increases the pressure on those who are still at work.

So, we clearly need to improve the workplace environment for all NHS staff, but how?

One place we can start is by helping NHS staff prioritise their own health and wellbeing. A stigma still exists that makes it hard for staff to disclose mental health problems to their employer out of fear that they will be treated differently. Many organisations are tackling this by signing up to Time to Change, which supports employees to have conversations around mental health. The NHS Practitioner Health Programme aims to support doctors and dentists with mental health concerns.

The NHS is also taking steps to be a better and more flexible employer – for example, through offering occupational health services and flexible working to support staff. The Interim NHS People Plan aims to make the NHS a better place to work. Published in June, it recommends that every member of staff should feel that they have “voice, control and influence” in their work. It is hoped that the final People Plan will also place a clear focus on better mental health support for staff, in line with government announcements from earlier this year, including a dedicated confidential helpline and greater peer-group support networks.

And no less important is tackling some of the cultural issues that may be contributing to increased sickness absence. This includes acting on the recent staff survey findings that approximately 20 per cent of NHS staff experienced bullying and harassment in the workplace from other colleagues. Making a reality of the commitment in the Interim NHS People Plan to create a more healthy, inclusive and compassionate culture in the NHS will be crucial for giving staff the support they need, particularly given the strong associations that have been found between higher staff engagement and lower levels of sickness absence.

The NHS is one of the few organisations that offer services 24 hours a day for 365 days a year. And the work NHS staff do takes a physical and psychological toll. But that does not mean we should simply accept high sickness absence rates for NHS staff. If the NHS is really going to be the best place to work, these absence rates must be reduced. And a focus on the health and wellbeing of the current workforce across the whole system is ones of the best ways to begin.

The challenge of culture change

The Interim NHS people plan places an important focus on making the NHS a better place to work, but shifting the culture to where it needs to be a challenge. This event provides an opportunity to come together and gain practical guidance on how to make this change a reality.

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Comments

Chris Hand

Position
Retired NHS Library Manager,
Comment date
02 October 2019

I worked in a Community Care Trust for 10 years from 2003, and over that time with major changes in the ethos and structure of the NHS the anxiety levels were raised due to mergers of Trusts in the area. Anxiety and stress levels over losing jobs, new management structures and reorganization after reorganization, it was a nightmare. Politicians meddle to much in the running of the NHS. At last Simon Stevens has been allowed to greatly influence the latest 10 year plan, sorry to say the huge damage has been done as so many staff have left. It a great plan but I fear it's 10 years too late.

Raj Matharu

Position
Chief Officer,
Organisation
Chair Pharmacy London
Comment date
04 October 2019

The plight of Community Pharmacists across the country is not being highlighted, we are under extreme pressure to complete the necessary compliance for CPCF, CMCS, PQS, CPPE, HLP and not to mention SSP001, SSP002 & SSP003. Hopefully, reading the last sentence as a non Pharmacist would have left you feeling perplexed and rather confused! Imagine having to implement it within a few weeks and you will realise the crazy workload involved at a time when the NHS management is shirking again!

I have been at the PSNC Conference & roadshow, Pharmacy Awards Conference and NPA Forum meeting in the past few days and conversation with colleagues leaves me really concerned for the mental health of the Pharmacy teams and the stress they are under at present.

The added problem of stock shortages are causing real concerns over patient safety which just adds to the stress levels. You know that we have an issue when the tabloid newspapers are reporting medicine shortages!

And this goes to the heart of the problem, the NHS is utilising human capital across all sectors not only Community Pharmacy. There is a disconnect between commissioning funding and the expectation of service delivery and that gap is bridged by the people working within the NHS. I sometimes feel that the NHS doesn't realise the effect this has on individuals.

I'm not ashamed to admit I am also feeling the pressure. And I know the old adage applies "if you can't stand the heat...." but surly the NHS has a duty to look after our mental health, otherwise all the intentions expressed around mental health are meaningless.

We need to talk about work pressures and the impact on our personal health, I don't want to burden the NHS with my ill health which is caused by working in the NHS!

Certainly are crazy times we're living in!

Anonymous

Position
Ex NHS Nurse,
Comment date
04 October 2019

I truley wish some research into bullying by Senior nurses up to DONs/Chief Nurses is explored as a factor in causing mental health issues and a cause as to why nurses are leaving. The nurses I know who were bullied often in a covert way is in double figures. The psychological chipping away by senior nurses needs to be explored as a reason why nurses are leaving. It’s often too late to fight back and the psychological damage which builds up over time means staff are even more vulnerable and unable to fight. I would question support from a popular union who’s advice ‘well most nurses just put up with it and do what they are told’ ‘what do you want’ is shocking bearing in mind why nurses pay into them. I genuinely think this is a factor in why nurses are leaving.

Dr Steve Boorman CBE

Position
Director Employee Health,
Organisation
Empactis
Comment date
06 October 2019

It is disappointing that almost ten years on from work commissioned by the Health Secretary that highlighted the strong association between NHS Staff health and well being, patient outcomes, organizational efficiency and success against Regulatory targets - that we continue to see many NHS organizations not taking this issue more seriously. Transforming the NHS requires a workplace cultural change that prioritizes staff health to enable future care.

Anonymous

Comment date
09 October 2019

Working in a diagnostic service with a waiting list over 2 years has taken its toll on my own mental health. I am passionate about what I do and wish we could provide better services - this is not sustainable

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