No-one gets left behind: NHS Staff and Learners’ Mental Wellbeing Commission

Source: NHE March/April 2019

Professor Simon Gregory, Health Education England’s (HEE) primary care lead, discusses the NHS Staff and Learners’ Mental Wellbeing Commission final report.

There are 1.4 million people in the NHS taking care of the health needs of patients up and down the country, and their physical and mental health is key to patient welfare. With this in mind, the HEE draft Health and Care Workforce Strategy for England to 2027 – Facing the Facts, Shaping the Future – announced a new commission on the mental wellbeing of NHS staff and learners, led by Sir Keith Pearson, former chair of HEE, and Professor Simon Gregory, director and dean of education and quality, Midlands and East, as programme clinical director.

The NHS Staff and Learners’ Mental Wellbeing Commission published its final report with the aim of enabling an NHS where staff and learners are happy and feel fulfilled in their work, where they look forward to going to work, and are proud of the care they provide to their patients. There is good evidence that happy staff are more compassionate and provide safer care. The key to this is ensuring a well-led, supportive environment with a manageable workload and rewarding careers.

The commission’s findings underline the need for urgent action. It found that doctors, nurses, allied health professionals such as paramedics, management and staff, including those in training, can face increased pressure, with complaints, fear of investigation, blame, or even prosecution. Stress and burnout can significantly affect patient safety. All of these need to be addressed.

Increased pressures during education and early career have led to a recent rise in distress among health professionals and young learners. In the most tragic cases, this can lead to people taking their own lives.

We have seen evidence from primary care that interventions can really make a difference, with reports suggesting that self-care support approaches can improve job satisfaction, quality of life, and compassion. Other studies have revealed that interventions can also reduce symptoms of stress.

With the vast majority of NHS patient contact being in general practice, demand for GPs is not only increasing, but also diversifying. While the importance of the GP to the health of local communities remains undiminished, general practice is feeling the pressure of demand, with a population that is living longer with increasingly complex conditions. While the role of the GP is ever-changing, it still remains at the forefront of modern medicine and is the bedrock of the success of the NHS. The issues of workload, work intensity, bureaucracy (including indemnity), and finance – as Simon Stevens himself has acknowledged – are very much there. In the report, we make recommendations about how GPs can support measures to give early access to fast-tracked mental health referrals for NHS employees, ensuring that the role of the GP as the family physician is not undermined.

We need to remember that health professionals in primary care can themselves need support, so we have put forward a series of recommendations to bring about change, including the introduction of a Wellbeing Guardian in every community trust and care setting in the country (to be determined if CCG or PCN level).

I am particularly delighted that the work HEE has been leading on, such as our Enhancing Junior Doctors’ Working Lives programme, has also been recognised by the review, which recommends that it should be fully implemented and applied to all postgraduate trainees, not just doctors. We also suggest that every student and post-graduate trainee has access to personal wellbeing support that is not linked into their education and assessment – a really important distinction that has not been addressed before.

This will help us to tackle some of the many issues faced by staff and learners alike, and ensure that no-one gets left behind. We need to change cultures, remove the stigma that is attached to talking about mental health, and encourage open discussion.

Danny Mortimer, chief executive of NHS Employers (who writes on page 46), said: “Clearly, our teams must need some respite from the ever-greater demands placed on them. The NHS Long-Term Plan and the delivery of the social care Green Paper must go some way to helping with this.

“At the same time, employers understand that there is more they have to do to improve support to their people, particularly as we all become more open about our mental health and wellbeing.

“Sir Keith’s recommendations are therefore a timely and important contribution.”

Here are some key facts and figures which highlight the impact that poor mental wellbeing has on the NHS:

  • The cost of poor mental health in the NHS workforce equates to £1,794 - £2,174 per employee per year;
  • A survey of 3,500 doctors showed that 73% would choose to disclose mental ill health to family or friends rather than a healthcare professional;
  • One in three of the NHS workforce have felt unwell due to work-related stress, and half of staff members have attended work despite feeling unwell because they felt pressure from their manager, colleagues, or themselves;
  • Compared to 10 years ago, students entering higher education are now five times more likely to disclose a mental health issue;
  • Half of lifetime mental illness starts by the age of 14;
  • Suicide is one of the three most common causes of death in young people – and is rising;
  • Approximately 25% to 35% of young people requiring mental health or wellbeing support are not accessing services;
  • Three-quarters of mental health problems are established by the age of 24.


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