Helping NHS staff survive the covid storm

We are in unprecedented times during this covid-19 pandemic. The NHS is under a level of pressure that it has not experienced since its inception.

An enduringly healthy and resilient workforce is needed to deal with the current pandemic and for the health needs of the population in the aftermath.

During this pandemic, our frontline healthcare workers are treating very ill patients and are encountering a level of stress and strain that they rarely normally experience. This includes working in high risk environments, changing job roles, working patterns and exhaustingly intense workload combined with a restricted ability to carry out their usual compassionate roles towards patients and their families. The physical demands of patient care, supporting colleagues and protecting their own loved ones in these extraordinarily difficult circumstances is causing an enormous emotional level of stress.

Research from the Hubei province in China shows the effects on the mental health of the workforce during the pandemic. The clinical staff, if not adequately supported are at higher risk of experiencing moral injury and developing mental health conditions such as depression, anxiety and post traumatic stress disorder.

“I felt like I was the only one who felt this way. I couldn’t make simple decisions at home”

– ITU consultant

“The world is like a horror film at the moment and I still have to go to work and be professional”

– Emergency department nurse

“I worry about my family a lot and am finding coming into work very stressful”

– Staff nurse

With these stark facts in front of us the board of The NHS Clinical Leaders Network commissioned a piece of work to look at what “good” would look like if the NHS and its organisations were to effectively help its workforce survive this storm.

Expert Steering Advisory Group

On 3 April 2020 the CLN held its first videoconference meeting with all the members of the Advisory Steering Group. Three days earlier, emerging clinical leader consultant psychiatrist Dr Cecil Kullu was approached by the CLN chief clinical officer, on behalf of the CLN board, and was asked to write a document for the CLN looking at the subject of enhancing the mental health resilience of our NHS healthcare workforce and advising on the expected mental health provider capacity requirements to treat the impending mental health morbidity. He willingly agreed and was pleased to be supported by the Advisory Steering Group.

The expert Advisory Steering Group that contributed to the development of this paper was made up of senior clinicians and managers from many organisation’s across provision, commissioning, public health, academic university and the CLN. Notable individuals include Professor Sir Cary Cooper, Professor Clare Gerada MBE, Professor Jane Cummings CBE and Dr Joe Rafferty CBE.

The paper Enhancing mental health resilience and anticipating treatment provision of mental health conditions for frontline Healthcare workers involved in caring for patients during the COVID-19 Pandemic – A call for action was finished by 22 April after an amazing effort by all. The CLN then updated the paper on 29 April to incorporate the latest findings surveys undertaken by the British Medical Association and Nursing Times.

The paper considers how organisations and individuals should enhance mental health resilience of the workforce and urges the healthcare system to prepare for the potential mental health impact that coronavirus will have on all our frontline health and care staff. Its ultimate aim being to provide support and guidance to the NHS and care system in order to reduce mental health morbidities in our clinical, carer and front line managerial workforce, which is likely to occur over the coming months and beyond.

The call for action paper also supports the work that NHS England and NHS Improvement has already prepared around Virtual Common Rooms, help and support for family relationships, help and support for any vulnerable ethnic groups and also the development of mental health pathways.

Publication

The NHS CLN intends to publish this document in journals and magazines and also submit it to the Royal Colleges and British societies. It will also be made available on the NHS CLN website and accessible through social media.

Action Learning Sets

The NHS Clinical Leaders Network will utilise the information from within the paper to lead and engage their clinical members, who are leaders at all levels within the system and within all professional modalities. They will proactively support the government’s and NHSE’ actions to enhance the mental health resilience within our frontline workforce.

This is already underway in the North West where the CLN has established Digital Action Learning Sets that meet frequently at the moment. They are informed by regularly organised webinars to keep them abreast of the continual cascade of useful information and guidance.

Health and wellbeing cells

The NHS CLN is pleased to say that it is working in partnership with NHSE and NHSI Health and Wellbeing Cells and the CLN Call to Action paper is seen as recommended useful information/document by all the regions’ Health and Wellbeing Cells.

Evaluation

The NHS CLN board from the inception of this idea felt that anything that was put in place because of this paper, which focused on the mental wellbeing of our frontline healthcare staff should be evaluated. First, to determine whether the suggested actions actually did reduce the expected level of mental illness morbidity but also second, to inform future pandemic preparedness plans as there was very little in our previous plans.

The NHS CLN exists with the purpose of developing shared leadership between clinicians and managers in order to meet the NHS strategic vision, whilst embracing quality provision and clinical commissioning. It has many benefits with the hope that together, the network can bring about real change and improvement to patient/staff experience and service delivery at local, regional and national levels.