The Healthcare Safety Investigation Branch (HSIB) have published a third interim report for its investigation into harm caused by delays in transferring patients to the right place of care, focusing on staff wellbeing across the urgent and emergency care systems and the impact that this has on patient safety.
Key findings of the report
The HSIB investigation team spoke to staff working across the urgent and emergency care system in the NHS.
When staff experience stress, moral injury, incivility and burnout, the investigation found these feelings can have a significant impact on patient safety as a result of reduced emotional resources to undertake work well, physical exhaustion, loss of team cohesion and lack of time for emotional repair or time for staff to ‘fill their cup’.
The HSIB report found that current approaches to staff wellbeing within the NHS are inconsistent and depend upon local initiatives, leadership and personalities. This means that not all staff receive the same level of wellbeing support.
Staff also reported that wellbeing is prioritised by healthcare organisations only when it had time to do so, and only considered fully when it has deteriorated past the point at which they could be supported by colleagues or their local professional health and wellbeing services. The report emphasises that this lack of support can lead to longer-term mental and physical health problems requiring professional interventions and time off work, in turn increasing pressure in the system as remaining staff are left to fill the resulting gaps.
What should employers be doing to address staff wellbeing?
Employers have a general duty of care to ensure the health, safety and welfare of all employees (s. 2 of the Health and Safety at Work Act 1974), and this includes employees’ mental health. This means that employers have to try to remove or reduce stress as far as reasonably practicable notwithstanding the considerable pressure health providers are operating under.
At a minimum, employers and line managers should be proactive in their approach to staff wellbeing and ensure access to support is clearly signposted to employees. However, the HSIB report highlighted that this approach does not go far enough, with staff telling the investigation that whilst they can access support through employee assistance schemes, occupational health and other professional services, these all have ‘significant’ waiting lists. Staff also reported that support services are a reactive approach to maintaining staff wellbeing and rely upon staff seeking support when they feel they really need it, which due to high workloads and the ongoing pressure on the system, can often be once mental health has deteriorated significantly.
Based on the report and findings, healthcare employers should consider implementing time and space for reflective practice, giving staff from all disciplines a protected time to come together to reflect and talk about the emotional impact of their work (this approach will be familiar to many NHS organisations that use ‘Schwartz Rounds’). Staff told the investigation that the opportunity to speak openly, confidentially and within the safety of a facilitated discussion was incredibly helpful and ‘cathartic’.
Direction of travel
NHS England (NHSE) told the investigation that it understands staff need to have time and support in order to provide safe, high-quality care, stating that “positive patient safety and [a] healthy organisational culture are two sides of the same coin”. However, the report found that NHSE’s staff and wellbeing work (part of the NHS People Plan) is not currently linked with its Patient Safety Strategy. The report therefore made a safety recommendation for NHS England to include staff health and wellbeing as a critical component of its NHS Patient Safety Strategy going forward and a joint patient and safety plan is to be developed. This will ensure the intrinsic link between patient safety and staff wellbeing, magnified in the HSIB report, is captured at a national level.
The Hill Dickinson Health employment team have a wealth of experience advising health and social care clients on topics such as the NHS People Plan, staff wellbeing and mental health. If you require assistance in any of these areas, please do get in touch.
For further information, please contact:
Fiona McLellan, Partner, Hill dickinson
fiona.mclellan@hilldickinson.com
