The Ward Round: A summer of ‘pressure, stress and anxiety’

The image, tweeted out by Radio Cornwall yesterday, showed an over-turned football goal, three umbrellas and some tarpaulin used as a makeshift shelter for an 87-year-old man, who was waiting 15 hours for an ambulance.

HSJ also reported this week that ambulances in the same county are taking more than three hours to respond to a heart attack, thought to be the worst reported system-level performance so far this year.

These latest awful examples of this summer’s emergency care and ambulance crisis are deeply shocking, but sadly for many working in the NHS they will not be surprising.

Performance like this has a dreadful – and deadly – impact on patients, but it is also incredibly difficult for the NHS staff involved, too. BBC Radio Cornwall added in a second tweet to say that, according to the 87-year-old man’s daughter, the paramedics arrived and were “very apologetic and very cross, feeling helpless at the situation”.

This helplessness will surely only further contribute to the feeling of burnout among NHS workers and heighten the risk of moral injury – where persistent psychological distress leads to long-term psychological harm.

Although usually associated with the military, over the course of the pandemic this term has frequently been used when describing the experiences of NHS staff. Although the pandemic’s peak has passed, many staff are still experiencing, as West Midlands Ambulance Service University Foundation Trust put it in recent board papers, “pressure, stress, and anxiety”.

According to absence management company GoodShape, this is consistently reflected in their data: “mental health absences” have consistently been the second top reason for absence from work over the last three years. The company estimates that between 1 January 2020 and 30 June 2022 the number of working days “lost” in the NHS due to mental health reasons was around 6.8 million, and, in June 2022 alone, more than 200,000 working days were lost.

“People who work in the provision of healthcare are arguably those who need wellbeing support the most,” Amanda Manser, chief experience officer at GoodShape, told The Ward Round. She also stressed mental health-related absences are longer – at around 16 days on average – than those linked to physical health.

NHS Employers has this week set out how leaders and line managers can help reduce the risk of moral injury among NHS workers. Among their recommendations include encouraging managers to organise “reflective practice sessions” talking about the impact of the event, rather than what went right and wrong, and also ensuring risk assessments are done on work-related stress.

It has also directed leaders to the national mental health hubs, set up in the wake of the pandemic. However, as reported by my colleague Emily Townsend earlier this year, staff take-up of the services the hubs offer has been lower than expected. Criticism has also been levied at them, with HSJ readers describing them as a “tick box exercise” and others suggesting the hubs’ offer cannot cut through the high level of stress and anxiety experienced by the workforce.

Health Education England has also today encouraged all A-level students to visit the NHS careers website and explore their options. But considering the recent pay deal, cost of living and lack of a basic requirement for psychological safety at work, it’s hard to see a compelling reason to embark on a career in the NHS this summer.

The wrong direction

UCAS figures published today have, according to the Royal College of Nursing general secretary and chief executive Pat Cullen, “headed in the wrong direction”.

This year, there were 21,130 students accepted on to nursing courses, representing a fall of 1,560 (or 7 per cent) from 2021.

“The impact of this drop in acceptances to nursing courses, along with the drop in applications this year, must not be underestimated. It will only add to the growing nursing workforce crisis,” Ms Cullen said.

This was foreshadowed by the reduction in applicants to nursing courses this year, too – where there was an 8 per cent decrease in nursing applications falling from 56,630 in June 2021 to 52,150 in the same month this year.

In the government’s midway report on reaching 50,000 more nurses by 2024, one of the key risks was domestic recruitment – if this drop in new students continues next year and beyond, this target will surely be impossible to meet.

Out of context tea bag

Worcestershire Acute Hospitals Trust has been in the headlines for the wrong reasons this week; a picture of a teabag apparently gifted as a “treat” to staff has been doing the rounds on social media.

It reminds me of the snack box Kent and Medway Clinical Commissioning Group offered as a thank you for their staff’s hard work during the pandemic – but Worcestershire’s chief executive Matthew Hopkins told The Independent the tea bag was taken “out of context”.

Mr Hopkins said it was part of a gift box given to staff on International Day of the Midwife and International Nurses’ Day, earlier in the spring and designed to encourage them to take a break.