The Ward Round: One step forward, two steps back

It has been a particularly galling week for the NHS workforce. As tweeted by an NHS manager, “…in one breath we’re being clapped, the next shafted.” This is perhaps in reference to news that all NHS workers have been awarded the George Cross — which is given to recognise “acts of the greatest heroism or of the most courage in circumstances of extreme danger” — by the Queen, alongside a thanksgiving service at St Paul’s Cathedral.

But, later on Monday afternoon, Boris Johnson confirmed all covid restrictions would be lifted on 19 July. The messaging was confusing; despite the prime minister announcing the end of a legal requirement to wear a mask, chief medical officer Chris Witty said he would continue to wear one in certain situations. Since then, ministers have said in interviews it is a matter for the public to use their own judgement.

Every NHS employee I’ve spoken to has felt uneasy about this. Concerns were heightened again following new health and social care secretary Sajid Javid’s admission that covid infections could reach beyond 100,000 a day this summer but still stressed the vaccination scheme had weakened the link between infections and hospitalisations.

NHS Providers deputy chief executive Saffron Cordery said that, although this link has been weakened, it has not been broken.

“We urge the government to keep a very close watch on the evidence as it emerges in the coming days, and to be ready to make the right call — whichever way it points — when the real decision day comes round next week,” Ms Cordery said.

It is, of course, a difficult call to make, but regardless, many in the health service will be feeling nervous next week. 

Setting the standard for baby loss support

Birmingham Women’s and Children’s hospital has this week announced a new package of paid leave for staff who experience baby loss or pre-term birth, which is not dependent on the length of the pregnancy or time worked at the trust.

The new policy offers staff who experience this devastating loss up to 10 days paid leave for the person who was pregnant and up to five days for their partner. It includes, but is not limited to miscarriage, stillbirth, abortion, ectopic pregnancy, molar pregnancy and neonatal loss.

Staff will also be offered paid time off for appointments linked to pregnancy loss and requests for flexible working will be treated with “understanding”. 

There are ongoing national campaigns by baby loss charity Tommy’s and others to raise awareness of miscarriage and neonatal death, and calls for those going through this awful experience to be able to take paid time off from work to recover. 

It’s heartening to see an NHS trust leap-frogging much of the private sector and becoming a trailblazer in this area.

How new ICS leaders will ‘set the tone’

This week has also seen the publication of the long-awaited Health and Care Bill, which finally sets out the legislative underpinning for integrated care systems.

The new bill will give ICSs significant local freedoms as to how they will work — they can, for example, develop their own constitution, determine staff pay and raise additional income.

New research from NHS Horizons — a specialist part of NHS England’s improvement directorate — has suggested ICSs’ creation is also an opportunity to go further and rethink how the NHS approaches leadership and focus more on the ‘organisational health’ of their staff.

More than 80 senior health and care leaders working in the NHS and local government took part in the Psychologically Safe Leadership Programme — delivered by NHS Horizons in partnership with Harvard Business School professor of leadership Amy Edmondson, and UK psychological safety expert Rachel Cashman — during England’s second pandemic wave.

“Psychological safety”, a term Professor Edmonson coined in the late nineties, is the belief you won’t be punished or humiliated when speaking up with ideas or concerns within your team.

The research found ICSs could actually heighten the risk of exhaustion and burnout for the workforce, as the “layering” of the different organisational cultures within them could create further complexity for staff.

It has called for ICSs to adopt a different management and leadership style which empowers the workforce to feel safe as a “minority of one”. 

“There are huge opportunities here with the new health secretary and the new NHSE chief executive around the tone of these new organisations,” Ms Cashman told me. “People need to focus on the organisational health of their staff, particularly in the context of the coming winter, with wave three and long covid.”

Ms Cashman highlighted that the high levels of burnout and exhaustion at chief executive level are often just seen as part of the job, and that a big part of senior managers looking after themselves is admitting they themselves are not coping.

“We expect [senior managers] to operate under stretched conditions and there is an expectation that this is good and will enhance performance,” she said. 

She stressed how the new ICS leaders will “set the tone” for the rest of their organisation, when it comes to admitting they need help.

Could the creation of ICSs be the perfect opportunity to reset how leaders lead in the NHS? Potentially. But is there a risk these new organisations could revert to how things have always been done? Ms Cashman says yes, but argues effective ICS leadership will be crucial in reducing risk to staff as the NHS works to recover from covid.