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NHS sickness absence: let's talk about mental health

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    Annabel Copeland

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).

Chart showing the most common reasons for absence among NHS staff

Source:  NHS Digital
Notes: The data presented here is a ration 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.

Chart showing percentage of days lost due to anxiety, stress, depression and other psychiatric illnesses among nurses and health visitors

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.