As we begin to see hospital admissions fall, our attention needs to focus on how we develop our people recovery plan. I am concerned about the impact of the pandemic, but am hopeful that we will be enabled to support the recovery of our teams alongside the significant activity recovery plan that will be needed to enable us to commence the treatments we have had to postpone.
International evidence and public health messaging cited by Williamson et al (2020) indicate that COVID-19 has placed a substantial demand on an overstretched NHS. Bailey and West (2021) have also reflected that we must remember that in January 2020 before the pandemic the NHS was already in the middle of a workforce crisis with the highest ever stress levels, and high staff vacancies and turnover. They say: ‘The system was cracking … and then the pandemic struck.’
According to Williamson et al (2020), it remains unclear to what extent current events will affect frontline keyworker teams, but it is likely that many will experience a degree ‘moral distress’ and some ‘moral injuries’.
‘Moral injury’ has been defined as the profound psychological distress resulting from actions, or the lack of them, that violate one's moral or ethical code (Litz et al, 2009). In Williamson et al's (2020) view, moral injury is a particularly relevant concept in understanding the psychological impact on frontline workers of having to take certain decisions or actions due to the circumstances of the current COVID-19 pandemic.
Bailey and West (2021), in a blog for The King's Fund, identify that, as we plan recovery, the first imperative will be to give staff the space and time to rest and recover. According to Bailey and West (2021), this may take months, rather than days or weeks. In order to inform the support given to frontline workers during and after the COVID-19 pandemic, Williamson et al (2020) have made a number of evidence-based recommendations, both for employers and for clinicians working with workers who have developed mental health problems, which include:
Staff needs
The second imperative identified by Bailey and West (2021) will be to seek to transform the way that health and social care are delivered because the demand for services will be relentless. For this to happen, they suggest that we consider meeting the ABC of core needs of staff.
A: autonomy and control
Here, the desired outcome for staff is to experience both joy and a sense of engagement at work every day, rather than exhaustion and burnout. This is based on the theory that, when teams feel safe and engaged at work, they innovate at scale and pace. This will be achieved by removing unnecessary hierarchies and regulations that prevent innovation. Of significant importance will be the voice of staff and a collective drive to transform working lives by improving basic work conditions, focused on areas such as shift times, rest and a culture that places value on learning, compassion and support rather than values of control, fear and blame.
B: belonging and support
The desired outcomes of teamwork lead to improvements in services and productivity via the innovations that effective teams repeatedly generate. Such teamwork is powerfully protective of staff health and wellbeing and thereby maintaining the quality of care. It is critical, however, that teams must be provided with the time and space so they can meet to reflect and learn.
C: competence or contribution
The desired outcome is that commitment will act as a powerful force for innovation, enabling staff to dispense with unnecessary activities, deploy new technologies, develop new roles and improve team and interteam cooperation.
In discussions that I have been involved in, we have reflected on the work of Bailey and West (2021)—in that we have considered that all leaders must actively model compassionate leadership, which may require shifts in how leaders listen to those they lead, to understand the challenges they face, empathise and support them.
Leaders must have the courage to plan now to ensure that our practice environments enable the energy, skills and motivation of our workforce as we emerge from the worst of the pandemic, But first, and most importantly, we must provide the space and support for our teams to heal.