After Mid Staffs: the NHS must do more to care for the health of its staff
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1503 (Published 07 March 2013) Cite this as: BMJ 2013;346:f1503
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It is becoming obvious to all of us with each passing day that the scandals of top down management by numbers, and lack of honesty are not going to be corrected quickly. "In place of fear" seems an ironic title for patients and doctors at the present time.
One way to improve honesty, without fear of retribution, or being pilloried as a whistlebower, and possibly the best is through open debate and I am encouraging this on my new website. In addition, junior nurse, other staff, managers and doctors will then know that there are honest poeple who are prepared to speak out, even if at first those willing to be named are retired.
The first retired consultants and one nameless junior have put their heads above the parapet. They have agreed to digital audio interviews being uploaded and for general consumption. More are in the pipeline
If the witness statements of many NHS employees are available, either retired (named) or working (probably nameless), we might have the narrative evidence to go forward into a new culture. At least our politicians and CEOs might listen.
Can I use your columns to publicize my 3 week old website, with apologies for any errors or omissions, which is at:
It encourages the bottom to lead, and tell the top what they really think. I am wary that I might be opening a "pandora's box" but the issue is too important to ignore. I hope that contributors will emerge from all walks of the NHS and my next problem will be organising the evidence so that a member of the public can read about their own particular area.
It is interesting that the CHCs in Wales and the CQC failed to expose the issues. It also seems appropriate that it is from Wales that this site hopes to promote honest witness to the state of our NHS which originated here.
It would be wonderful if the number of volunteers to speak out became so great that I could not manage the site. Perhaps it could then be taken over by the CQC! I cannot possibly interview everyone. Don't forget you can be interviewed by a friend or colleage and e-mail me the file.
Competing interests: No competing interests
I read the anonymous personal view with great interest and welcome views being shared. On a similar note I posted a pledge to the NHS Change Model website this week as follows “I pledge to promote & protect access to specialist-led occupational health services for all NHS staff to help them be at their best each day”2.
Employee health and wellbeing influences whether people are able to work at their peak and are critical success factors for both individual performance and organisational performance. NHS employees need to be supported at work by programmes that protect and promote the highest attainable level of physical and mental health and wellbeing in order for the NHS to deliver consistently the highest quality care to patients.
Occupational health services focus on enhancing and maintaining the health of people at work, ensuring they operate safely; and the organisational effectiveness of enterprises by providing expert advice to management3. It is BMA Policy that all employees in the NHS and elsewhere must have access to specialist-led occupational health services4. The BMA Occupational Medicine Committee has championed occupational health services for all NHS staff, being involved with the development of NHS Good Practice Guidance5&6. The latter states “providing a first class Occupational Health and Safety Service for NHS staff and GP’s and their staff is the responsibility of all who work in the NHS”. In spite of this GP occupational health services are in jeopardy as the NHS Commissioning Board reviews funding7.
As to Mid-Staffs, the Francis Report8 noted that a Health and Safety Executive inspection report included at least one observation that might have had implications for the standard of care given to patients. It was reported that staff in some departments were experiencing particularly high stress levels and felt poorly supported by the organisation. While occupational health services can help employees who experience stress, the responsibility for identifying and managing stress, for tackling the causes and for creating a stress-free culture rests with leadership.
The Francis Report8 also recommends that an accreditation scheme should be considered for managers. Here occupational health is an exemplar. A professionally-led accreditation scheme9 was launched for occupational health services in December 2010. Over 40 NHS occupational health services are already accredited with a commitment for all to be accredited.
Occupational health services must be provided for all NHS staff and those services must be supported to deliver appropriate care.
1. Anon. After Mid Staffs: the NHS must do more to care for the health of its staff. BMJ 2013; 346.
2.http://www.changemodel.nhs.uk/pg/cv_blog/content/view/58376/42298?cview=...
3. Nicholson PJ. Occupational medicine: new world, new definition. Occup Med, 2001; 51: 423-4.
4. The Occupational Physician. BMA. London. 2013.
5. Management of Health, Safety and Welfare Issues for NHS Staff HSC1998/064
6. The Effective Management of Occupational Health and Safety Services in the NHS 2001
7. Lind S. GP occupational health services in jeopardy as NHS Commissioning Board reviews funding. Pulse. 2013.
8. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Stationery Office. London. 2013.
9. Occupational Health Service Standards for Accreditation. Faculty of Occupational Medicine. London. 2010.
Competing interests: No competing interests
This is an excellent and timely article. It highlights the real problems faced by some NHS staff and the fact that these problems, and how they are handled, have sadly been neglected. If staff are badly treated, this will inevitably have an adverse impact on patient care. We have a duty to show the same compassion to NHS staff as we are obliged to show to patients.
Competing interests: No competing interests
Your anonymous whistle blower's account of the dire state of Occupational Health in the NHS is an indictment of all the parties involved. These include the Employers, the Unions, The Royal Colleges of Medicine, Surgery and Nursing - it will be interesting to learn how they respond to Anon and in what terms.
The movement to establish statutory Occupational Health Services in the UK may be said to have started with the Gowers Committee in 1949 as an adjunct to the Brave New World ushered in by Beveridge. This was followed in 1951 by the Dale Committee, when, apart from an initiative of the British Employers which was predominantly concerned with primary health care in the workplace, nothing happened until 1966 when the Industrial Health Advisory Committee
reported.
The political will to act effectively on Health and Safety at Work may be said to have been expressed in 1972 with the report of the Robens Committee, following which the Health & Safety at Work Act 1974 was passed. Unfortunately, the seed of deregulation was introduced which allowed outsourcing to wax and policing to wane.
The acceptance of the gross decline in the UK's Occupational Health Practice firmly indicates the disrespect with which it is held. Nothing short of a Ministerial inquiry will remedy the dire state of HSW at Work, whether in Office, Shop, Factory or Hospital.
Competing interests: No competing interests
Re: After Mid Staffs: the NHS must do more to care for the health of its staff
We are not surprised that healthcare workers are much more likely than the general workforce to suffer depression, stress and anxiety. Clinical practice is a high-risk occupation for its emotional burdens. This may at least in part be due to the well-recognised psychological effects of involvement in medical errors and incidents (1).
Clinicians whose patients suffer harm often feel a deep sense of personal responsibility, and may themselves develop psychological symptoms (1). These range from sleep disorders and anxiety through to significant psychiatric symptoms. In the immediate aftermath of serious incidents symptoms are similar to acute stress disorder and affect cognition, concentration and the ability to safely care for patients. Unrecognised or unresolved symptoms may contribute to absenteeism and loss of productivity; in extreme cases clinicians may stop work completely or change careers (2).
An unsupportive or punitive response to incidents (which seems to be common in the NHS) exacerbates the symptoms, leads to reluctance to report future incidents and fosters a closed, secretive culture which is harmful to patient safety (2), as we have seen from recent events.
There are no formal systems in the NHS to detect and support clinicians who are affected in this way despite clear potential benefits for patient safety, staff welfare and NHS productivity.
The Royal College of Physicians is concerned about this phenomenon and eager to support doctors who may be affected by it. We have developed a short survey to help us find out more.
Doctors working in the NHS can take the survey by following this link;
https://www.rcpworkforce.com/se.ashx?s=253122AC56451E7A
Kevin Stewart FRCP
Royal College of Physicians
Reema Harrison PhD
Institute of Psychological Sciences
University of Leeds
References
1. Wu, A. Medical Error; the second victim. Bmj; 2002;320:726-7
2. Sirriyeh R et al. Coping with medical error; a systematic review to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Qual Saf Health Care 2010;19: e43.doi:10.1136
Competing interests: No competing interests