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#ImInWorkJeremy Campaign – Can we change the rhetoric @Jeremy_Hunt ? #NHS staff are Burning out!

So, I feel that I must blog about the #ImInWorkJeremy twitter campaign, which is currently in full force following Jeremy Hunts call for a #7dayNHS. Firstly, I believe that everyone is on the same page in terms of wanting the safest patient care possible. However, I am not so sure that the health and well being of NHS staff is being as valued at present, which as we all know, is surprising given the direct correlation that #NHS staff health has with the quality of patient care.

NHS staff are tweeting this weekend about how they are already working and keeping patients safe. They are doing so largely without breaks, food or a stress free environment – THANK YOU!

However, 65% of NHS staff have attended work when they have felt unwell enough to do so. I am concerned that this is not conducive to safe and effective quality patient care. If more pressure is put on NHS staff to perform for longer/harder hours, how will this statistic be affected? and how will that impact upon patient care? Will we find problems with the Wednesday service if we prop up the Sunday service? How can we deliver a #7dayNHS with more doctors if we don’t also have more nurses/midwives and support staff?

The challenges to achieve this are many… and it is clear by the many tweets I have seen this weekend that a #7dayNHS is already happening….

So why does Jeremy Hunt want NHS staff to work more unsociable hours? Well he has claimed that “Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals.” Yet there are further claims that there is yet to be a source for this claim. Confused yet?

I think the real problem here is that NHS staff may have been made to feel like naughty children who are being told what to do to make things better, rather that being inspired and carried forward by strong leadership. Everybody wants to make the NHS the best it can be. We are on the same team, so why have NHS staff been made to feel devalued?

The Secretary of State for Health (Jeremy Hunt Himself) asked Lord Rose to conduct a review into leadership in the NHS. The review asked:

  • what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS?
  • how could strong leadership in hospital trusts might help transform the way things get done?
  • how best to equip clinical commissioning groups to deliver the Five Year Forward View

This review reported that: “First, the NHS consistently delivers great service through a committed and passionate workforce of 1.38m staff in England . During my Review I heard many great stories (only a few not so great). Mostly I found staff motivated and focused, often running on goodwill in a tough environment; some places felt more positive than others.”

This was great to hear! Our NHS staff are being praised for the amazing work they do! Praised for the service they provide and acknowledged for the sacrifices they make to do so. We are all on the same page to do good things. The service is great! But yes, the environment is tough Jeremy..tougher than you may think it is….NHS hospitals are pushing young medics to brink of ‘burnout’ by relying on them to work extra hours…NHS staff want to work towards an even better service, but they need support in doing this, not be whipped and forced into doing so. Picking a fight is not in anyone’s best interest.

We know that engaging NHS staff will improve patient care and staff absenteeism ….so Jeremy I ask you…can we change the rhetoric here? Can we engage staff in this conversation rather than isolate them? They need to feel valued, inspired and driven in order to perform at their best. There is now an Outcry in the blogging community, calling for Jeremy Hunt to resign… However, I think what may be needed here is a new narrative, where staff feel valued and empowered to engage with the vision for the future NHS services alongside you, rather than feeling as though they are being dragged by their pigtails.

We are on the same team… Let’s be kind to each other.

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How might we apply Isaac Asimov’s “Three Laws of Robotics” to underpin the #NHS?

This week, as usual… my mind has been whirring with a multitude of issues relating to staff well being in the NHS. Except lately I have been trying to look at everything from a different angle. So, being a bit of a Sci-fi geek as well as a Tudor History fan and doctoral researcher, it suddenly dawned on me how I was, in my own mind, equating the professional duties of NHS staff with Isaac Asimov‘s “Three Laws of Robotics“.

This ‘Eureka moment’ happened whilst I was enjoying my morning dippy egg, and I shall translate my thoughts as follows:

In case you were unaware, Asimov’s laws were intended as a fundamental framework to underpin the behavior of robots in human society. These laws are intended to allow the safe use of robots as tools.

They were originally as follows:

  1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.
  2. A robot must obey the orders given it by human beings, except where such orders would conflict with the First Law.
  3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.

I shall now rewrite these laws based upon the analogy of this being applied to NHS relationships in my own mind.

  1. Clinical professionals may not injure a patient or, through inaction, allow a patient to come to harm.
  2. Clinical professionals must obey the orders or ‘needs’ of patients, except where such orders would conflict with the First Law.
  3. Clinical professionals must protect their own existence as long as such protection does not conflict with the First or Second Laws.

In essence, clinical professionals are programmed in this same way to put patients first. I am not necessarily arguing that this is wrong. But again, in doing this we may paradoxically be putting patients at risk if we fail to value clinical professionals as humans too.

Are clinical professionals the subservient robots of humanity?

If clinical professionals obey the needs or ‘orders’ of patients at the expense of their own well being, then this may not be conducive to safe clinical care.

Later, Asimov added a “zeroth law”, that preceded the others in terms of priority:

0. A robot may not harm humanity, or, by inaction, allow humanity to come to harm.

Which in this analogy would become:

0. Clinical professionals may not harm humanity or, through inaction, allow humanity to come to harm.

If the well being of clinical professionals is not properly valued or addressed, the quality of patient care may be reduced through “malfunctioning” or “Decommissioned”  practitioners. Therefore, humanity is harmed twice – once in the harm of patients and once in the harm of clinical practitioners. Humanity suffers.

The three laws are intended for robots, and we need to remember that clinical professionals are not robots. We also need to ensure that the well being of NHS staff remains an issue of equal salience in the provision of safe care. If both NHS staff and patients are of equal societal value, then we must value #StaffExperience as much as we value #PatientExperience.

Should this happen, then we may see better quality outcomes for all.

Please let me know your thoughts… Until then, I shall be burying my head in an ethics paper and literature review!

Be kind to yourselves, and each other x

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#BringBackTheNHS Event – London 2015

So, yesterday I toddled on down to Westminster to attend the #BringBackTheNHS event and see what it was all about. The event was filled with great speakers, including some famous ones like: @IanMcKellen @charlottechurch and @marcuschown. This was set to be a ‘Non Political Event’ to celebrate the NHS. Nevertheless, there were some passionate words spoken.

I try not to get too political in my every day research, but it is so important that we all understand the healthcare climate in which we are working, living and healing. I also feel it is important for me to understand the continuously evolving health policies, rhetorics and visions if I am to contribute positively to the #mentalhealth and well being of Healthcare workers.

And so I came to learn about the The Campaign for the NHS Reinstatement Bill 2015 (  ) currently championed by @AllysonPollock among many others!

In a nutshell: The Health and Social Care Act of 2012, forced a commercialised model upon the NHS in England.

This new Bill aims to reinstate the founding vision for the NHS (Freee at the point of use, regardless of a persons ability to pay). A worthwhile cause to become involved with.

However, throughout the event and in listening to the speakers share some powerful NHS stories, I personally was struck by the stories involving NHS Staff. I would just like to summarise the key things I took from the evening.

– The NHS Staff will carry on giving every part of themselves to the care of others.

-The NHS staff do not go to work for themselves, but for the service of others

– NHS Staff are bound to protect/defend/obey the mother of the nation (ie. The NHS) –  as the well being of their family, friends, mothers, aunties, children etc….depend upon it.

– Front line NHS staff see the true nature of life and death. Their eyes see what others cannot comprehend or identify with. They then go back to changing beds….

-They work hard, despite being underpaid (and arguably undervalued).

-They work unsociable hours, any time, anywhere.

– Where resources are strained, they make sure that people still get what they need.

– They are still willing to give more.

The cultures of our healthcare systems and staff clearly show that ‘to give all’ is not enough. They will always give more…..Yet in times of strain, change and challenging circumstances, how will this effect the mental wellbeing of healthcare staff?

Who puts healthcare staff first?

Who makes sure that they are cared for?

Worryingly, this ‘carry on regardless’ mentality may put our healthcare staff on an even higher pedestal to perform and deliver. Will this make it even harder for those in psychological distress to seek help?

Does this ideology accept failure? – Healthcare staff are good people. They will give their all. I just hope there is someone there for them if they fall.

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Hospital Staff Absences for Mental Health Reasons Double – but do the Figures Add Up?

Today I was up early to watch Danny Mortimer NHSE_Danny (Chief Executive Employers) Speak on BBC Breakfast in light of new figures obtained via a Freedom of Information Act Request, that Hospital staff absences for mental health reasons has doubled across England in the last 4 years!

This information is obviously very relevant to my PhD study, and I will be reviewing it in time. However, the initial response that Danny Mortimer gave was that  staff feel comfortable talking about their . Hmm…

Has all of my research to date been wrong? Are #NHS staff comfortable talking freely about their mental ill health? (would love to hear your thoughts, but ironically you may feel unable to speak out – I tell myself this is the reason for a lack of comments on, and interactions with my blog all of the time :P)

Anyway, as you can imagine, I became worried that I was ‘missing something’ and asked Danny if he had any evidence for this? – See our conversation here

As you can see, he did not provide me with evidence for this statement, but agreed that we all need to do more to support our colleagues, and I know that we all share the same constructive goals. Unfortunately people don’t always have an answer, they just know that something needs to be done. I still believe that my PhD research could be the key to effective support, but this project is in its infancy and I will keep the readers of this blog as updated upon its progress as I am able.

So… the evidence provided by NHS Employers upon the mental health & well being of NHS staff is this:

MentalHealth Infographic WEB FINAL

A great infographic! However, one thing concerns me…. Apparently 76% of NHS trusts report that they monitor the well being of their staff (RCP, London). Yet 3 out of 4 people suffering from mental illness get NO TREATMENT AT ALL. (www.mentalhealth.org). So, are NHS trusts doing anything about the staff they find to be unwell? or are NHS staff fine? I think not. I worry that there is a lot of good rhetoric out there around NHS staff health and wellbeing, but not many interventions to support staff. The figures don’t add up, and seemingly only smarties have the answer.

I hope I have the answer coming… I hope its not too late.

http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard

http://www.rcplondon.ac.uk/resources/nice-public-health-guidance-workplace-organisational-audit’

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#GoodbyeHeadclutcher campaign significant for Health care professionals in psychological distress

Wow – I have been so impressed with the #GetThePicture campaign this week -> 

I felt that this would also be pertinent for those working within the #NHS who may be struggling with poor mental health. To me, the head in hands image that is used so widely within the media has connotations of those in distress being out of control and unable to manage their condition. Of course there may be times when those in need do hold their head in their hands, but their story will be much wider than this single portrayal of despair. Within the healthcare services, one of the biggest barriers to help seeking is the stigma, and self stigma associated with ‘not coping’ in the professional sense (Renton, 2014). The fear that a healthcare professional may be judged as being professionally as well as mentally unstable means that many health care professionals never seek help or do it after years of suffering (Clark, 1999, Laposa et al., 2003).

The leading reason given for non disclosure in health care professionals is that staff are concerned that the disclosure of mental ill health may negatively affect their careers (Dewa, 2014). With images in the media implying that those with mental ill health are constantly unable to cope and sat in despair, we may see rates of self stigma increase, and rates of help seeking decline. This will paradoxically put patients at risk of compromised care, and drive secrets underground (Moberly, 2014). We all would like to see those in need receive help and feel well. To do do this, they must be willing to seek and receive help. With this in mind, I would be pleased to see future images of those with mental health issues smiling, seeking help, talking and being a part of every day life.

Health care professionals in psychological distress are doing just this, smiling ‘coping’ and working in the #NHS. If we can normalise help seeking, rather than the stigma of not coping, we may be that much closer to healing the healer.

@TimetoChange has suggested the following things to end #Stigma in this area:

  • Picture editors – look for an image that is truly relevant to the story; think about mental health problems as you would when portraying other illnesses; avoid ‘headclutcher’ shots; be sensitive when illustrating stories about suicide and self-harm.
  • Members of the public – take a fun ‘headclutcher’ selfie, and tweet it with #GoodbyeHeadclutcher; if you see a picture you think stigmatises mental health problems in the media, contact that outlet directly, and tweet them with #GetThePicture.
  • Picture agencies – weed out ‘headclutchers’ and other stigmatising pictures from your image libraries; make sure your categories and keywords can help picture editors find appropriate images easily; commission your own range of positive images.
  • Photographers – think of new creative ways to portray mental health problems; use a diverse range of people; take more shots of people being listened to and supported by others.

#TimeToTalk #TimetoChange @TimetoChange

Clark, D. (1999) Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37 (1999), pp. S5–S27

Dewa, C. (2014) Worker Attitudes towards Mental Health Problems and Disclosure. The international journal of occupational and environmental medicine, 2014, Vol.5 (4), pp.175-86

Laposa, J. M., & Alden, L. E. (2003) (1). Posttraumatic stress disorder in the emergency room: Exploration of a cognitive model. Behavior Research and Therapy, 41,49–65.

Moberly  , T (2014) GMC is “traumatising” unwell doctors and may be undermining patient safety, Gerada says, BMJ Careers. Available from http://careers.bmj.com/careers/advice/view-article.html?id=20017662 (Accessed 11.11.14)

Renton, T., Tang HEnnis NCusimano MDBhalerao SSchweizer TATopolovec-Vranic J. (2014) Web-based intervention programs for depression: a scoping review and evaluation. J Med Internet Res. 2014 Sep 23;16(9)

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Health Professionals who Die by Suicide – 5 Tips for Change


If the content of this post has affected you in any way, please visit the support page of this blog….

Yesterday was #NHSChangeDay, and I pledged to #StartTheConversation and raise awareness about health professionals who are in psychological distress. As it happens, @WeDocs conveniently hosted a  #WeDocs Tweetchat on preventing suicide in health care professional populations. It was great to see an issue I feel so passionate about being discussed, shared and given some much needed attention. This kind of innovative Twitter usage is one of the things I love about our NHS radicals!

Throughout the conversation, there were seemingly many people concerned and wanting to prevent clinician suicide, but not many solutions to prevention were put forward. -> See the chat summary here

A recent situational analysis into Suicide by clinicians involved in serious incidents in the NHS has identified the current support services available clinical staff, yet there is no consensus on how to effectively support clinical staff, and nobody has yet taken responsibility for the well being of NHS staff (Strobl et al, 2014). This has been further complicated by the fact that Clinicians often have difficulty in recognising symptoms and risk factors associated with their own suicidal behaviour (Goldney et al, 2002). Clinicians are at a higher risk of suicide than the general population, can be misunderstood and left unsupported whilst under immense pressure (Chan et al, 2014). The GMC have recently published a report in regards to a high rate of professionals dying by suicide whilst under investigation. A tragedy for all.

Psychological safety for NHS staff is critical for patient safety and every shiny new white paper will tell you this. But it is also critical for the NHS’s ‘ethical well being’ to care for it’s staff. If the NHS as an organization lets its staff suffer, how will it ever live with itself? The trauma will inevitably become endemic.

So what changes can we make to prevent suicide?

1. We could treat NHS staff as ‘innocent until proven guilty’ & eradicate ‘Name Blame and Shame’ Cultures.

2. Consider that poor behaviour may actually be ‘ill’ behaviour in need of medical treatment before disciplinary action takes place (Brooks et al, 2014).

3. Consider alternatives to discipline & create psychologically safe work cultures.

4.Expose investigation staff to front line clinical practice to understand organizational cultures and pressures.

5. Develop a tailor made national support programme for NHS staff which is confidential, anonymous and provides professional amnesty (The aim of my entire PhD research project)

Also… please keep the conversation going 🙂

Brooks, S, Del Busso, L, Chalder, T, Harvey, S ,Hatch, S, Hotopf, M, MadanHenderson, M (2014) ‘You feel you’ve been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council BMJ Open 2014;Vol.4 (7) :e005537 doi:10.1136/bmjopen-2014-005537.

Chan, W., Batterham, P., Christensen, H., Galletly, C (2014) Suicide literacy, suicide stigma and help-seeking intentions in Australian medical students. Australas Psychiatry April 2014 vol. 22 no. 2 132-139

Goldney RD, Fisher LJ, Wilson DH (2002). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide Life Threat Behav 2002; 32: 394–403.

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A failing NHS… A self fulfilling prophecy?

“If you want others to be happy, practice compassion. If you want to be happy, practice compassion” (Dalia Lama XIV, The Art of Happiness).

I would firstly like to point out in this post that I am not a psychologist or psychiatrist, but I have always understood the power of the self fulfilling prophecy. It therefore baffles me how the media, political leaders and top think tanks can demonize the NHS front line staff by telling them that they are failing on a daily basis!

These sandbaggers continue to display a strategy, involving the false prediction or feigned demonstration of inability in NHS staff (Gibson et al, 2000). The danger is that NHS staff will begin to believe what they hear, and perhaps even become the terrible people they are being currently described as. Thus, the false prophecy will be fulfilled.

Negative press is inevitably damaging the self esteem of NHS staff, and low self-esteem in itself can become a self-fulfilling prophecy, leading staff to act in negative, unhelpful ways (Marshall et al, 2015). So why does this continue? Has nobody told them of the damage they are doing? (I think not!)

We all deserve compassion, and most of all, self compassion. Nobody goes to work to be mediocre or fail.

Self compassion is described as “being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and failures, so that one’s experience is seen as part of the larger human experience” (Neff, 2003).

When we are predicted lower performance we are more likely to actually perform worse – it works as a self-fulfilling prophecy.

The media and key leaders thus have the capacity to shape the confidence of NHS staff and influence their performance in both positive and negative ways. In particular, by showing that they believe in “our team,” leaders are able not only to make “us” a psychological reality, but also to transform “us” into an effective operational unit (Fransen et al, 2014).

So please, stop battering the NHS staff, but lift them up to believe they are the best thing ever! (which they are by the way)!

Give them a new prophecy to fulfill, and make it a good one.

Gibson, D.A. Sachau (2000) Sandbagging as a self-presentational strategy: Claiming to be less than you are. Personality and Social Psychology Bulletin, 26 (2000), pp. 56–70

Fransen, Katrien, et al. “Believing in “Us”: Exploring Leaders’ Capacity to Enhance Team Confidence and Performance by Building a Sense of Shared Social Identity.” (2014).

Marshall, Sarah L., et al. “Self-compassion protects against the negative effects of low self-esteem: A longitudinal study in a large adolescent sample.”Personality and Individual Differences 74 (2015): 116-121.

Neff, K (2003) Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2 (2003), pp. 85–102