Why wellbeing matters: the importance of supporting community health staff

NHS community work is diverse, with a varied range of activities. It is also demanding, with more than 200,000 patient contacts taking place each day. Working outside of a hospital setting means that staff need to travel to clinics and patients’ homes and be equipped to manage a range of health care and welfare demands from the patients they are supporting. Community staff are also essential to ensuring that patients who are well enough to be discharged from an acute setting can either return to their homes or to a step-down setting. Due to the responsibilities involved in community work, the age profile of community staff tends to be older than those who work in acute care.

Research into the health and wellbeing of NHS staff, particularly following the pandemic, has focused on those staff who work in acute settings, mainly due to the number and severity of patients who are treated in these settings, as well as a belief that once discharged contact with health services finishes. What the research has not focused on, though, is the impact on those staff who were discharging patients back into the community during the pandemic to free up capacity for those more unwell. The pandemic meant a huge increased reliance on community providers to manage both an increase in acuity and volume of patient care. However, although the pandemic conditions have decreased, the demand for community services appears to have remained consistent.

Although there has been an ongoing narrative about the need to prioritise community settings in order that the service can build the capacity and capability to better meet patient needs, funding to match community demand is yet to be realised.

The Neighbourhood Health Service – envisaged as part of the new government’s health strategy – looks to centralise community services, enabling funding to be directed towards primary and community services. While this focus on much-needed improvement to both funding and delivery is welcome, the wellbeing data for community providers from the NHS staff survey provides stark reading, and reveals that we are overlooking the needs of a mature workforce who are more likely to be working in the community and who need to remain active and mobile to deliver this work well. The community workforce’s ability to reduce the demand on acute settings is clear, but the recruitment and retention of staff is not easy. Community settings are just as challenged as the acute sector in the number of staff wanting to join them, with an increased reliance on international colleagues joining the workforce.

A deep dive into one community provider that offers medical, nursing and allied health professional services reveals what over 500 staff members think about their professional quality of life. The type of work undertaken (nursing or care) appears less likely to have a negative impact on staff members than the demands of the work and the organisational conditions that staff work in. This demonstrates the importance of establishing a compassionate culture where people can feel valued, respected and cared for.

The level of compassion satisfaction (pleasure from delivering a caring role) that staff experience is crucial to mitigating stress and burnout. In this study, the feelings of satisfaction and pleasure derived from caring for others were at a lower level than previous studies in acute settings. The pleasure derived from a role is inextricably linked to the relationship that staff have with their line manager. The demands on community staff to deliver when they already feel under pressure compromises the pleasure they gain from their work and leads to increased vulnerability.

Although the deep dive study results indicated positive levels of compassion satisfaction, as is usual within NHS staff cohorts, it is significantly less than previous levels within the NHS workforce and is not universal across participants. This is a concern. Staff in the health and care sector undertake difficult and challenging jobs, but the enjoyment they gain from their work gives them some protection from these challenges. Organisations across the NHS need to pay attention to the pleasure that staff experience in their roles to reduce the risk of job abandonment, which means staff leaving the profession entirely, as well as not being able to attract new people into these roles.

The provision of health and wellbeing services needs to be considered throughout the employment life cycle and in a way that recognises the changing needs of staff over time. Paying attention to the services being offered to ensure staff can remain well and engage with work in a flexible way while meeting the needs of the service is crucial to ensuring that the health service continues to attract and retain staff who want to work in the community.