Comment

Watching over workforce wellbeing in the NHS

Professor Lisa Bayliss-Pratt, chief nurse at Health Education England (HEE) and lead on HEE’s mental health programme of work, believes HEE’s new framework will help to raise awareness of stress and resilience in the workplace and encourage employers to adopt a new approach to supporting staff.

One of the biggest challenges facing the NHS is workforce resilience, capacity and wellbeing. It is important to acknowledge that the nature of the work done by anyone working in a caring profession can be challenging to their wellbeing, and their employing organisation has a substantial role to play in supporting the workforce. 

HEE is responding to the challenge of supporting and enhancing the wellbeing of NHS staff with the launch of the ‘Workforce Stress and the Supportive Organisation Framework’ – a framework for improvement through reflection, curiosity and change, aimed at changing our thinking about stress and resilience in the workplace.

What can NHS organisations do to sustain the health, wellbeing and productivity of our staff, boost their morale and improve retention?

I believe our newly-launched framework, commissioned from the National Workforce Skills Development Unit (NWSDU) situated within the Tavistock and Portman NHS Foundation Trust, provides us with some important answers, emphasising the need for an organisational approach rather than focusing on the resilience of individuals working in health and care services.

We all recognise that staff are the NHS’s greatest asset, but, given the size and complexity of the workforce, there is no simple answer to how we best care for and support them. The NHS Long-Term Plan stresses the importance of the health and wellbeing of the workforce and, in support of this, our NHS Staff and Learners’ Mental Wellbeing Commission (February 2019) offers a series of recommendations for consideration by the arms-length bodies of the Department of Health and Social Care.

It highlights the need for changes to working conditions and how a stronger culture of engagement and wellbeing would help boost morale and staff retention. One of the biggest challenges facing the NHS is workforce resilience, capacity and wellbeing, which in turn has an impact on the recruitment and retention of staff. This in turn will support our ultimate objective of enabling the NHS to provide better care for patients and service users.

I cannot claim that there is one single approach that will improve retention – but we know that workplace stress is a major reason for staff leaving the NHS. So, promoting systemic resilience alongside other actions would go some way towards this improvement.

Research we commissioned in 2017 to explore the topic of trauma in the workforce identified that the organisation has a substantial role to play in supporting the workforce to undertake what is an inherently psychologically demanding role; that is, caring for and treating people. Although in recent years we’ve had a plentiful supply of tools, techniques and potential providers to support enhanced resilience in the workplace, most have either not been adopted or poorly employed. The NHS Health and Wellbeing Review also recognised the inconsistent and, in some cases, inadequate occupational health services being offered to NHS staff.

Nor has enough attention been paid to the impact poor psychological wellbeing and stress can have on organisational success. So, following the production of the draft framework last year by the NWSDU, we asked that a proof of concept exercise was carried out to ensure what we would be asking of NHS organisations had robust foundations.

The ideas and practicalities were explored in a series of national workshops, alongside surveys and other forms of engagement, representing a good cross-section of NHS organisations. There was an overwhelmingly positive response to the idea of organisations taking a step back and making the time to think. Participants felt that the framework was timely and appreciated its approach of moving away from a focus on individual resilience.

Two other important messages consistently emerged from this exercise. First, that the approach needs to be owned at board level so that there is accountability for implementing it. And second, that organisations would like further support with practical ideas for implementing the framework – otherwise there is a danger that this will be seen as just another reflective practice document.

One respondent thought it was “great that resilience is a systemic approach and doesn’t just sit at the door of wellbeing services.” And supporting the importance of organisational ownership, another participant said: “I think it enables the right conversation at a strategic and operational level.”

On the practical issues of implementing this approach, another respondent felt that “the way the framework breaks down into the five pillars makes what appears to be a very daunting task seems much more realistic and understandable.”

An initiative closer to home which supports the framework’s approach is some work HEE is planning with frontline staff in emergency services. They do such fantastic work responding to life threatening, distressing and traumatic incidents, and it’s important that they also get the support they need in the aftermath of such exposure. So, HEE is planning a roundtable event this summer with ‘blue light’ services to understand what training and support is available across the country, what staff really need, and where the gaps are.

Next steps

In line with the spirit of reflection recommended in the framework, HEE is now considering the next steps and how to best support its spread and adoption. Most organisations involved in the testing phase were keen to see the work continuing, and some offered to implement parts of it in their own organisations, to continue the testing.

And in response to feedback from the test phase, we will be looking at developing more practical guidance and collecting and sharing examples and case studies of how people are using the framework.

HEE and the NWSDU are also looking at how the framework approaches might feed into the competency frameworks of the board-level NHS Workforce Wellbeing Guardians outlined by the NHS Staff and Learners’ Mental Wellbeing Commission.