Caring for our carers: what can COVID-19 teach us about NHS staff wellbeing?

If, like me, you took part in the weekly ‘Clap for Carers’, you probably experienced a range of feelings over the ten weeks of clapping. I wasn’t prepared for how emotional I felt that first Thursday, overwhelmed by the enormity of what we were about to ask of our health and care staff, and indeed all key workers up and down the country. 

Over time, the gratitude remained. But as stories emerged of the daily reality for staff working under such intense pressure – the shortage of PPE, the disproportionate impact of COVID-19 on staff from black, Asian and minority ethnic communities, and the many tragic deaths of colleagues – the gratitude was mixed with concern. What impact would this experience have on the physical and mental wellbeing of staff, long after the weekly demonstrations of public support had stopped? 

Caring for our carers

On the positive side, the pandemic has led to a massive focus on the need to look after the wellbeing of staff. NHS organisations and national bodies mobilised quickly, often supported by generous contributions from the public, voluntary sector and private organisations. 

In a recent Zoom call hosted by the Q community to discuss changes to practice during COVID-19, by far the most reported activities related to staff wellbeing. Many of these measures were about providing practical support: free meals; parking; rooms for staff to take a break; access to foodbanks, helplines and free mindfulness apps.

This support is incredibly important, particularly in times of crisis and stress, and can go a long way to making sure that staff feel valued and looked after. The challenge is how to build on this energy and commitment to ensure staff wellbeing remains a top priority in the period beyond the immediate crisis. This is likely to be a critical time in terms of determining the psychological wellbeing of staff. 

Clearly, achieving sustainable improvements in staff wellbeing requires action on a much wider set of issues than just meeting practical needs for food and rest, critical as these are. The 2019 NHS staff survey results, released a month before the UK went into lockdown, revealed the impact of excessive workloads and staff shortages. The results showed high levels of stress and sickness absence amongst staff, as well as entrenched issues relating to career opportunities, bullying and discrimination, all impacting on staff wellbeing.  

Prioritising staff wellbeing work in three areas

A focus on staff engagement and wellbeing forms part of the Health Foundation’s COVID-19 response. We are supporting work in three areas we believe are important to prioritise if the NHS is to effectively support staff wellbeing during the recovery from COVID-19 and beyond. 

1.    Ensuring staff experience drives improvement 

Northumbria Healthcare NHS Foundation Trust has demonstrated the benefits of investing time and resources in capturing and learning from staff experience. When the pandemic struck, they were able to build on their Health Foundation funded project using real-time staff experience data for improvement, to develop Corona Voice, a short weekly survey of staff across all of their sites as well as staff currently at home (self-isolating or shielding). 

Corona Voice has surfaced a broad range of issues from concerns about shortages of personal protective equipment (PPE), to feelings of isolation and the pressures of working directly on COVID-19 wards. It has also highlighted factors that staff find helpful, including maintaining connections and team support and having someone to talk to. 

Data from almost 8,000 survey responses to date has been used by leaders at the trust to inform their COVID-19 decision making, helping them adapt and tailor their support to staff based on what people have told them matters most. This led to concrete actions, including the trust being proactive in procuring PPE and improving staff testing, as well as initiating welfare calls to staff at home due to COVID-19 who were feeling isolated and often guilty for not being on the front line with their colleagues.

Being able to see the data for staff in different locations has allowed the trust to identify particular issues for different staff rather than adopting a ‘one size fits all’ response. Understanding the varied experiences of staff is particularly important in ensuring that measures to improve staff experience and wellbeing don’t inadvertently widen inequalities. 

Northumbria has a long history of developing improvement capability and focusing on staff and patient experience, which has undoubtedly helped the organisation respond effectively in this current crisis. However, their learning highlights a number of factors – listening to staff, valuing insights and using data for improvement – that are likely to be relevant to many organisations, regardless of where they are on their journey to improved staff wellbeing. 

We will be publishing more insights from the team over coming months to help others think about how they can ensure that staff experience is heard and used for improvement. 

2.    Increasing opportunities for reflective practice 

It can be difficult in the busy world of health care for staff to find the time to come together to share experiences and reflect on their work. The pandemic has made this even harder, with teams sometimes dispersed and the need for social distancing making it difficult for staff to meet in person. It’s ironic that just as the ability to do this has decreased, the need can hardly be greater. 

The Royal College of Psychiatrists has identified opportunities for reflection as a key factor in helping staff to recover from the trauma and impact of COVID-19, and the Scottish Government has included reflective practice as one of the key strands of its health services’ COVID-19 recovery plan. 

The Point of Care Foundation, with support from the Health Foundation, has developed Team Time, an online version of its Schwartz rounds, enabling clinical and non-clinical staff to come together virtually to reflect on their social and emotional response to their work. Slightly different from Schwartz rounds, which traditionally connect people across organisations, Team Time is focused on bringing together existing teams, and creating a safe space to share and support each other. 

Over 400 people have taken part in Team Time so far and learning from the initial pilot is encouraging. It suggests that these virtual sessions could potentially have similar benefits to in-person Schwartz rounds, including reducing stress and isolation and making staff feel more supported in their jobs. 

3.    Valuing supportive and compassionate leadership 

Finally, the quality of leadership and management during times of crisis and uncertainty is so important and can have a big bearing on staff experience and wellbeing. 

Instinctively, it might feel that ‘command and control’ is needed in this situation and that more relational aspects of leadership must wait until the immediate crisis has been dealt with. However while decisiveness and clear communication are essential, it is important to avoid the misconception that strong leadership cannot also be kind and compassionate. It is encouraging, therefore, to hear that staff working in the NHS report that they are finding their leaders to be more supportive, appreciative and collaborative during the crisis.

Of course, this style of leadership doesn’t just happen, it needs conscious effort. Leaders need support as well as time to reflect and learn from their experiences. Working with Hult Ashridge Executive Education, we are supporting action research with up to 60 leaders who have taken part in our GenerationQ programme to allow them to reflect and to capture their insights on leading teams through COVID-19. We want to know what they are learning about what ‘good leadership’ and team support looks like during a period of sudden transformational change, and what feels important to sustain in the future. 

Looking to the long term

It’s likely the working lives of NHS staff will be affected by coronavirus for months or even years ahead, with other challenges appearing as we open services back up with huge waiting lists and deal with the wider effects of lockdown on people’s health. 

NHS staff will continue to quietly respond to these challenges, away from the media spotlight and long after the public shows of appreciation fade. That’s why it’s so important that the positive changes prompted by this pandemic relating to how staff are supported, can be turned into learning that improves working life and wellbeing for people working in the NHS in the long term.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.