Many have asked what NHS Charities Together—the national charity supporting the NHS, for which Captain Sir Tom Moore raised £33 million—has funded. This week we heard that a bid led by my Trust's Clinical Director for Psychological Medicine, Dr Simon Pangnell, had been successful in obtaining a grant. Our proposal was simple: to ‘address the psychological wellbeing of the workforce’.
I have previously discussed interventions to support the recovery of our people following the response during the COVID-19 pandemic. The programme put forward here is important as it goes way beyond the pandemic response, and addresses concerns that I have that the NHS might rush an ‘in the moment’, quick fix solution and not consider the long-term investment needs for staff wellbeing. Before the pandemic, the prevalence of mental health problems such as anxiety, depression and post-traumatic stress disorder (PTSD) in healthcare staff was already well documented. Within my Trust, mental health-related reasons were among the most common reported causes of sickness absence. Mental health accounted for 20% of all sickness absence in 2019/2020 with a total of 21 053 lost working days. Aside from the personal effect on our staff, this has a substantial economic impact—the total cost of those lost days in my Trust was £1 035 014.
Typically, for staff experiencing mental health difficulties, access to specialist assessment and treatment often includes long waiting times to access specialist psychological therapies. In the community, for example it is not uncommon for waiting times of 18 months to access treatment for PTSD. The NHS Employee Assistance Programme (EAP) provides access to telephone-based counselling support. It does not provide face-to-face psychological assessment and treatment, nor does it provide treatment for conditions such as PTSD. Colleagues report that return to work anxiety is emerging as a significant problem across the workforce, especially those in the high risk and most vulnerable groups, and this is not an area that EAP is able to support.
My Trust, like others, lacks any systematic measurement of staff wellbeing, burnout levels and stress levels. This impacts on our ability to respond proactively to support pockets of staff experiencing difficulties and assess issues in a proportionate manner. The provision of psychological support at an organisational, service and individual level has been central to our plan, which was pump-primed by our hospital charity in the hope that the national charity bid would be successful. This three-part plan aims to provide a co-ordinated, evidence-based Trust-wide response:
The first element is the Support for Teams programme. The psychological medicine team created a network of over 100 wellbeing leads. Each wellbeing lead was allocated to a clinician from the psychological medicine team. Frequency, duration and the nature of the contact with wellbeing leads has varied according to need and has included video hosted staff support groups, weekly telephone contact and a series of webinars on topics such as: panic; coronavirus and sleep; and managing anxiety. One wellbeing lead said:
‘The support from the psychologists has been invaluable in putting the whole wellbeing project on a professional footing. Without them, it feels like a group of well-meaning amateurs. They have provided support to us in the form of the facts, the talks and the evidence base.’
Wellbeing leads highlighted practical support (eg, access to resources, information about how to support colleagues from black, Asian and minority ethnic (BAME) backgrounds) and relational support (eg reassurance, being listened to, regular and flexible contact) as especially valuable.
The second aspect is dedicated support for COVID and critical care wards. An enhanced level of direct support was provided to critical care services through clinicians already integrated in those services together with additional staff whose routine work had been suspended. This included direct work with staff teams, with patients and supporting relatives.
The third part is rapid access to specialist assessment and treatment through the occupational health service. Throughout the pandemic, the psychological medicine department has worked in partnership with occupational health to develop and implement a dedicated pathway for staff experiencing psychological distress. The pathway included early triage of referrals by psychological medicine clinicians followed by direct provision of support or signposting to specialist mental health services.
An evaluation strategy to assess the quality of the support provided through the wellbeing network has been implemented. This includes feedback measures from the teams receiving support and the clinicians delivering the support such as standardised mood assessment questionnaires to evaluate direct intervention; measuring staff sickness days lost due to mental health reasons and bank and agency spend due to sickness absence; rating scales completed by clinicians and staff.
We hope that the benefits that this service can offer can be scaled up across many organisations, and substantively funded, with a desire that this is not just a ‘post-COVID’ initiative—with huge thanks to the charity for support as we develop a longer-term NHS-funded business case.