As an employer of 1.6 million people in the UK, the NHS has an opportunity and a responsibility to prevent ill health by influencing and improving the wellbeing of its own workforce.
Anya Gopfert is a junior doctor and also a clinical fellow at the Health Foundation, where she focuses on the role of the NHS in prevention and improving health. We spoke to her about how the NHS can develop its role as a healthy employer.
What do we know about the health of people working in the NHS?
The results of the 2018 NHS staff survey were published in February. There are improvements in some areas, but the score for staff health and wellbeing has gone down compared to 2017, with less than a third of staff reporting that their trust takes positive action on health and wellbeing.
While the survey is a barometer of change not a detailed assessment, the indicators suggest that people working in the NHS are facing immense pressure, which is impacting on their physical and mental health. Over half of respondents report going into work in the past three months despite not feeling well enough to perform their duties. There has also been an increase in the proportion of staff who’ve felt unwell as a result of work-related stress (40 per cent) in the last 12 months, the worst result in 5 years.
What are the most important factors impacting on NHS workforce wellbeing?
Low morale, and high levels of burnout and stress among staff are important issues that should be addressed. As a doctor, I can talk from personal experience about the huge job pressures, including long hours, poor environment and rota gaps. I don’t know a single colleague who hasn’t had to work an understaffed shift, or work through without a break.
And that all has an impact. When you work as part of a fully staffed team, you have time to really talk to and care for patients. But after a shift spent firefighting, without proper time to talk to patients, you go home feeling like you didn’t do a good job for them or make best use of your skills.
Staff are also affected by physical health problems. According to the staff survey musculoskeletal injuries are increasing. I’ve spoken to people who’ve injured themselves lifting someone and had to spend time off work waiting for physiotherapy.
There’s also a lot we simply don’t know about the physical health and lifestyle behaviours of people working in the NHS – their diet, smoking and drinking habits, and what other issues they face. (There are some published studies, usually focused on doctors, but in general we know little about those issues across the workforce.)
But I think it’s fair to say that the culture and environment NHS staff are currently working in doesn’t always encourage positive wellbeing.
How do you see the role of the NHS in supporting the health of its staff?
The NHS employs over 1.6 million people in the UK. As such a large employer (whose core business is health), the NHS has the potential to influence the health and wellbeing of a significant proportion of the population, both those it directly employs, and their families and communities.
The NHS Long Term Plan for England refers to the importance of workforce health and wellbeing, and it’s important that this is reflected in the workforce implementation plan that’s currently being drafted. After all, staff wellbeing has a big impact on patient care, on how engaged people are, and whether they stay or look for work elsewhere, which is really important given the current workforce shortages in the health service.
What are some of the main areas NHS organisations can focus on?
In 2018, NHS England produced the Healthy Workplace Framework, which outlines things employers can do to provide a healthy workplace. It has a section on culture and leadership, which includes having a strategy on health and wellbeing for staff, led by a board member. Leadership is key. Ultimately, if people know they are valued, listened to and have a role in decision-making, this can have a real effect on how well they feel at work.
The Health Foundation, Nuffield Trust and The King’s Fund’s recent report on workforce shortages in the NHS makes a range of recommendations linked to improving retention and making the NHS a better place to work. It identifies that people are much more likely to leave the NHS at either end of their career, highlighting that more needs to be done to support newly qualified staff, including providing sufficient funding for continuous professional development and ensuring that staffing levels include adequate numbers of senior staff so that there isn’t an over-reliance on newly qualified staff.
There’s lots of work going on across NHS organisations to try to improve staff wellbeing in small ways. One hospital I worked at made a point of ensuring that all staff, regardless of seniority, were offered somewhere to rest. Adequate rest is essential to ensuring wellbeing, and this simple act made people feel valued.
This same hospital also had lots of green space outside, which was available for staff to use to de-stress during breaks. Access to green space is really important in a health care environment, both for staff and patients. Some studies even show that patients who can see a view of nature from their hospital bed recover more quickly from surgery. The Health Foundation has recently funded the Centre for Sustainable Healthcare to evaluate the impact of green spaces on hospital staff and we’re looking forward to the findings.
Working out what has the most impact on improving workforce wellbeing is a challenge across the NHS and we don’t have huge amounts of evidence yet about what actually works and what the nuances are in different staff groups. But there are some places making inroads, for example the Health Foundation recently funded several projects focused on improving staff experience and wellbeing through its Innovating for Improvement programme.
What’s not in doubt is the massive opportunity to improve the health of our population that comes with focusing on the health and wellbeing of NHS staff across the country.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.