Why NHS staff wellbeing is key to caring for patients

This article was authored by All.Can UK, a multi-stakeholder initiative involving patient groups and industry experts, and has been fully funded by the All.Can UK funding partners – Bristol Myers Squibb (primary sponsor) and MSD (supporting sponsor). Together the All.Can UK membership defined the focus of the article which was developed in collaboration with HSJ. Bristol Myers Squibb and MSD do not intend to encourage the use, or advocate the promotion of their products through this article and it does not include discussion of specific treatments or products. The audience for the article is predominantly comprised of commissioners, healthcare providers, those involved in commissioning and those working in healthcare in the private sector.

Even before the COVID-19 pandemic struck, one of the biggest challenges facing the NHS was workforce resilience and wellbeing - with more than a third of NHS staff saying they felt unwell due to work-related stress in 2017.[i]

Evidence shows there is a clear relationship between staff wellbeing, staff-reported patient care performance, and patient-reported patient experience.[ii] In short, when staff wellbeing is higher, there is a positive impact upon patient experience; with a virtuous circle linking the two.[iii]

Concerns about wellbeing were prevalent pre-pandemic, but an already fraught situation has since been exacerbated by the increased pressures placed on NHS staff. [iv]

A recent Nursing Times survey from March 2021 (n: 1,196) revealed that 84% of nurses felt more stressed than they did before the pandemic, while 62% said the mental health support available nationally was inadequate.[v] Even more worryingly, the Laura Hyde Foundation reported that at least 226 nurses in the UK attempted to end their own lives between 1 April 2020 and 30 April 2021.[vi]

Another survey (n: c.2000) published by Unison found that seven in 10 NHS and social care staff had been so overwhelmed by work-related stress they felt unable to cope, and over half (54%) had considered quitting the NHS or social care altogether due to the pressures experienced over the past year.[vii]

This forms part of a larger picture, with patients themselves also struggling to access psychological support. In December 2020 All.Can UK published a report titled Placing the psychological wellbeing of people with cancer on equal footing to physical health. The report considered some of the reasons why some people with cancer were not receiving adequate care for the mental health impact of their disease.

It found that many psychosocial oncology departments are understaffed, under-funded and uncoordinated and this could be why it is not uncommon for healthcare professionals to fail to inform patients of services available to them despite them showing signs of needing support.[viii] To resolve this, All.Can UK’s report recommended steps to improve awareness of the important role that the third sector and health charities play in supporting patients’ mental health needs.[ix] All.Can UK have subsequently begun developing a tool to map the psychosocial support services provided by its patient group members, making it easier for NHS staff to signpost cancer patients to psychosocial support services from day one of their diagnosis.

But it is not just patients who can benefit from the psychosocial services offered by the third sector.[x] To ensure the virtuous circle is maintained, organisations like Point of Care Foundation are working to support the NHS workforce.

Through their Schwartz Rounds, Point of Care Foundation provide a structured forum where all staff, clinical and non-clinical, come together regularly to discuss the emotional and social aspects of working in healthcare.

Rounds can help staff feel more supported in their jobs, allowing them the time and space to reflect on their roles. Evidence shows that staff who attend Rounds feel less stressed and isolated, with increased insight and appreciation for each other’s roles.[xi] One healthcare professional benefitting from the service said:

“The discussions were emotional, relatable and human. They connected us all in our own way and enabled us to empathise with one another. Solidifying that, although we are caring for people, we need to ensure we care for ourselves. It was a privilege to listen to the speakers’ experiences in order to reflect on my own”.

Supporting staff wellbeing better equips them to deliver care for patients. Given the pressures of both the cancer backlog and the coming winter seasonal impacts upon those working in the NHS, the immediate term focus should be ensuring adequate resourcing and investment to improve staff mental health.

Other simple steps which can be taken at a local and national level as services begin to recover from the pandemic are:

• NHS England, in collaboration with the patient group community, should raise awareness within the workforce of the entire range of psychosocial interventions offered by the third sector to both patients and NHS staff alike.
• Given the impact on patient outcomes, all healthcare staff who interact with patients should have the time and space for reflective practice – spaces where they have protected time to come together to talk about the emotional impact of their work. These spaces must be confidential, facilitated and within the working day of healthcare professionals (that is not an added extra which they are expected to do in their own time).
• Local system leaders should explore opportunities to release capacity and improve access to psychological services by upskilling members of multidisciplinary cancer teams - including healthcare assistants, Cancer Clinical Nurse Specialists (CNSs) and surgeons - to provide psychosocial support to patients.

As the NHS continues to tackle the treatment and diagnostic backlog in cancer, meeting the psychosocial needs of both patients and the staff who are supporting them will be critical in ensuring a resilient workforce and improved patient outcomes.

About All.Can

All.Can is a global initiative which brings together experts in cancer care to work collaboratively to ensure policy decisions are focused on what matters most to patients. In the UK, All.Can is driven by a working group of leading health charities and biopharmaceutical companies with a shared ambition for people with cancer to receive world-class, patient-centred care that is sustainable for the NHS to deliver. The working group is governed by an elected steering committee, which is comprised of The Patients Association, Melanoma UK, Brain Tumour Research and funding partners Bristol Myers Squibb (BMS) and MSD.

All.Can UK is a national initiative of All.Can International, a not-for-profit organisation (ASBL) registered in Belgium. The work of All.Can International is made possible with financial support from Bristol Myers Squibb (main sponsor), Roche (major sponsor), MSD and Johnson & Johnson (sponsors), Baxter and Illumina (contributor), with additional non-financial (in kind) support from Helpsy, Intacare and Goings-On. All.Can is a registered trademark of All.Can International.

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[i] Health Education England (2019). ‘Workforce Stress and the Supportive Organisation: A framework for improvement through reflection, curiosity and change’. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Workforce%20stress%20and%20the%20supportive%20organisation%20-%20printer%20friendly%20version.pdf. [Accessed: September 2021]

[ii] Maben, J. (2012). ‘Exploring the links between staff wellbeing and patients’ experiences of care’. The King’s Fund. Available at: https://www.kingsfund.org.uk/sites/default/files/jill-maben-exploring-linkstaff-wellbeing-patient-experience-kings-fund-jun12.pdf. [Accessed: September 2021]

[iii] Ibid. Available at: https://www.kingsfund.org.uk/sites/default/files/jill-maben-exploring-linkstaff-wellbeing-patient-experience-kings-fund-jun12.pdf. [Accessed: September 2021]

[iv] The Health Foundation (2016). ‘Making the case for staff wellbeing in the NHS’. Available at: https://www.health.org.uk/blogs/making-the-case-for-staff-wellbeing-in-the-nhs. [Accessed: September 2021]

[v] Nursing Times (2021). ‘Nursing Times survey reveals state of nurses’ mental health one year into pandemic’. Available at: https://www.nursingtimes.net/news/mental-health/nursing-times-survey-reveals-state-of-nurses-mental-health-one-year-into-pandemic-31-03-2021/  [Accessed: September 2021]

[vi] Nursing Times (2021). ‘Charity shares concerning data on nurse suicide attempts during Covid-19’. Available at: https://www.nursingtimes.net/news/mental-health/charity-shares-concerning-data-on-nurse-suicide-attempts-during-covid-19-21-06-2021/. [Accessed: September 2021]

[vii] Unison (2021). ‘More than half NHS and social care staff in London considering quitting over pandemic impact’. Available at: https://www.unison.org.uk/news/2021/03/more-than-half-nhs-and-social-care-staff-in-london-considering-quitting-over-pandemic-impact/. [Accessed: September 2021]

[viii] All.Can UK (2020). ‘All.Can UK: Placing the psychological wellbeing of people with cancer on equal footing to physical health’. Available at: https://www.all-can.org/national-initiatives/uk/#panel-pub-res. [Accessed: September 2021]

[ix] Ibid. Available at: https://www.all-can.org/national-initiatives/uk/#panel-pub-res. [Accessed: September 2021]

[x] Point of Care Foundation (n.d.). ‘Supporting healthcare staff’. Available at: https://www.pointofcarefoundation.org.uk/topic/supporting-staff/. [Accessed: September 2021]

[xi] Point of Care Foundation (n.d.). ‘About Schwartz Rounds’. Available at: https://www.pointofcarefoundation.org.uk/our-programmes/schwartz-rounds/about-schwartz-rounds/. [Accessed: September 2021]

Document number: ONC-GB-2100773

Date of preparation: September 2021