Cultivating compassion: who cares for NHS staff?
5 Jul 2018
This month the NHS turns 70, in the same year as IES’ 50th anniversary celebrations. On a personal level these milestones have provoked me to think about my role as both a user of NHS services, and a researcher interested in the way it operates. I have been fortunate not to have been in regular need of NHS services, but when I have, the difference a compassionate approach has made is immeasurable. Even if we have youth and health on our side, we also want to feel our older relatives will always be treated with dignity and respect.
So how can the NHS ensure it continues to deliver caring and high-quality treatment, and how can researchers work with them to help them achieve that?
As the social care and health sector, including the NHS, accounts for 13 per cent of all jobs, there is also a need for a national strategy on how to support this number of employees. Last year, in advance of the NHS’s birthday, Health Education England (HEE) launched a national consultation on a health and care workforce strategy for England to 2027 - the results of which are expected imminently.
Recruitment and retention
One key observation made in the HEE consultation is that the NHS workforce will need to increase by 190,000 posts from now to 2027 to deal with the forecast growth in demand.
Alongside ambitious recruitment aims, it also addresses the retention and care of existing staff. It recognises increasing pressures on the NHS and its workforce due to longer working hours, a lack of salary increases, and a shortfall in recruitment. These conditions have led the leader of one Trust to state that ‘the NHS is significantly dependent on the heroic efforts of clinical and non-clinical colleagues’.
A 2017 King’s Fund report also pointed to increasing admissions and decreasing nurse numbers: it highlights the risk of overstretching nurses both in hospitals and in the community. IES has also contributed to this evidence base, through a study of the impact of Brexit on the nursing workforce and in our survey of nurses on behalf of the Royal College of Nursing.
The reasons why NHS staff choose to leave the health service are complex, but the HEE strategy demonstrates that the NHS already has some knowledge of what makes staff happy, and what helps to recruit and retain staff.The list of such factors includes resources on culture and leadership such as NHSI Culture Tools, strategies, methods of staff consultation and wellbeing incentives.
The demanding nature of healthcare jobs brings its own health risks, and the NHS cannot grow or indeed retain its current workforce if employees on the frontline of care and treatment provision feel unwell physically and/or mentally. One of the reasons they may feel unwell is compassion fatigue.
Compassion fatigue can be characterised by emotional and physical exhaustion, a decrease in the ability to empathise and nurture others. It features largely (though not exclusively) in the caring professions, and can be differentiated from the related state of burn-out in the fact that it can arrive suddenly.
The evidence for the benefit of engaged, compassionate and mentally-healthy care-givers was highlighted by Department of Health’s (2012) Compassion in Practice strategy document for nursing, midwifery and care staff. Compassion is also given as a key tenet of the proposed NHS workforce strategy:
‘Good health and social care relies upon easy, dependable access to staff who know what they are doing, have the time to do it and treat us with respect and compassion.'
Agreeing a definition of compassion and and identifying adequate ways of measuring it are not straightforward. Equally evaluating whether interventions designed to enhance compassion are effective is a complex task. Most of the compassion literature to date has focused on wellbeing and stress reduction, with much less published about compassion as an organisational development (OD) or change intervention. The feasibility of compassionate organisations as an idea and the means by which a compassionate culture can be fostered among healthcare staff is also an ongoing area of work for IES.
It is encouraging to see that compassion is recognised by public bodies such as HEE as a crucial part of employee self-care, as well as something that impacts on organisational culture and patient care.
‘Looking after those who look after you’
One of the objectives of the NHS 70th birthday celebrations is to ‘thank NHS staff for their hard work and commitment, profiling their skills, experience and successes and celebrating their diversity, whilst recognising the challenges they face’. To meet this aim, the specific measures recommended in the HEE report include targeted retention schemes to encourage staff to continue working in healthcare, and steps to make the NHS a more inclusive, ‘family-friendly’ employer.
The importance of wellbeing and effective occupational health support for frontline health service staff also features prominently in the HEE strategy in terms of prioritising measures aimed at preventing ill-health (both physical and mental) and promoting wellbeing. Actions include the NHSE Healthy Workforce programme, which has been working with a group of Trusts to determine standard interventions to offer staff on health and wellbeing. This task is not just the role of public health, and NHS occupational health providers might play a bigger role here as well as departmental leaders and line managers.
This issue of responsibility raises the wider question of who should look after the health workforce? Some would argue that managers should take better care of their frontline teams, but they are often under pressure too and need support in turn, with appropriate expert occupational health referrals where needed. Training can help both employees and managers look after themselves and recognise early signs of stress, compassion fatigue and burnout, which may lead to them leaving the NHS if not addressed.
IES research can help shed light on meeting these challenges set out in the HEE draft strategy; both through illuminating ‘bottom-up’ patient and staff experience, and by exploring top-down perspectives of the NHS as an employer.
Understanding the challenge
To retain staff the NHS needs to be able to understand their diverse needs and experiences, and ensure they continue to deliver a high-quality compassionate service.
For more than 20 years IES has advised on measuring employee engagement and identified actions to foster engagement among NHS personnel by, for example, undertaking regular staff engagement surveys on behalf of NHS Employers. In a recent evaluation of a pre-degree pilot for aspiring paramedics commissioned by HEE, IES took an in-depth approach to explore the attitudes, experiences and career intentions of participants, providing insight into NHS staff experiences of issues such as stress and burnout. This work adds to evaluations IES has carried out for Mind focusing on the mental health and occupational stressors experienced by emergency services personnel, and potential mechanisms for supporting them.
The consultation phase of the HEE strategy has now closed. The feedback received will help inform the first comprehensive health and care workforce strategy in over 25 years (to be published later in 2018). As the Chief Executive of Health Education England Professor Ian Cumming stated; 'as the NHS heads into its 70th year, more than ever, patients deserve nothing less than safe, high quality and compassionate care'. As has been recognised, the central way to ‘future proof’ the workforce is to look after it. In its 50th year, IES research can play a key role in helping to understand how this might be done.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.