How do we re-open the NHS to deal with an enormous backlog of care without mindlessly returning to a world of “busyness” –  losing sight of the pandemic experience?

In our society many people’s lives have been changed by their experience of the pandemic.

In the NHS everyone’s lives have been changed by their experience of the pandemic.

In the NHS perhaps as many as 25% of staff have some form of post-traumatic stress which could have a detrimental impact not just on their working life but on the whole of their life.

Most days the news still carries footage of exhausted ICU staff providing care. As with so many of our experiences of the NHS acronyms, by standing in for real words, tend to mask their real meaning.   ICU means intensive care.

Think for a moment about the times when you provide care for someone. After a couple of hours this can get tough. Now think about providing care that is ‘intensive’. And think about doing that day after day, week after week, for months and months – with hundreds of people.

Then think about what it might feel like if, every now and then, the person you were caring for so intensely dies. Then think about someone, under your intensive care, dying, every week – then every day – then 6 on a single shift. People you are caring for intensely.

Many traumas that we think about are acute – the horror of being bombed or shelled and having to flee your home and country. Some are more chronic – a drought that means people in your region start dying of hunger – or prolonged domestic abuse. But there are few experiences where the person experiencing trauma, voluntarily, week after week, returns to the situation that causes it. And no other circumstances where people experiencing that trauma have been publicly applauded for week after week before returning to more trauma.

Yet that is the traumatic experience that many NHS staff are still going through.

The extent of this experience within NHS care providers is the reason why so much current discussion – amongst their leaders – is about how to care for their staff.

Those leaders that recognise the depth and breadth of this problem realise that this care needs to respond to the problem in two quite different ways.

The first should be a continuation and strengthening of normal management relationships. The nature of health and care work is such that managers should be regularly initiating conversations with staff about their experience of their work. “Given that so many of your patients are not in a good way – are you OK? Is there anything we can do?”

In health and social care work this needs to be a regular discussion and whilst it needs to take place at every level of management – it’s at the immediate supervisory level – that it is most important.

All managers have a responsibility to all of their staff irrespective of what they do, but such a conversation recognises that in health and social care work the emotional pressures of working with people in need will be greater.

More than 40 years ago when I started teaching social workers I was struck by how important (and normal) supervision was. When social workers brought particularly difficult cases to their supervisors whilst they (the supervisors) might offer some insights into how to move cases forward, the main aim of their discussions was for the supervised to explore how they felt about what they were doing and how they were doing it. Part of social work training was to educate trainees about how to use sessions like that. How to recognise that there was something difficult emotionally happening here.

A lot of the time a social worker can feel that their practice is failing – the person or the family are less happy, less secure than when I started. Does that mean I’m a useless social worker?

The same is often true for health care. The patient I was treating may have survived but the current experience of their illness seems to be spiralling downward. Does that mean that I’m a useless clinician?

These issues, and the need for managerial and team discussions about them are there all the time in health and social care, but at the time of COVID-19 they are bigger. deeper and longer. What in normal times should be good managerial action becomes even more important.

There will be staff with needs that go beyond this. Sorting out who and what to do between different staff members will be vital. Some will need professional mental health help – but crucially not everyone.

For some the experience has been awful and bruising, but not created a problem for their mental health. Medicalising these experiences will not be useful. We cannot simply expect that all staff who have come through this awful time will have mental health problems because of their experiences, as it will not be true for many.

Some will have had their mental health affected, and some will not and if, being in the business of health and social care, we cannot diagnose one from another – well we are probably in the wrong business.

Everyone needs to talk – a few will need talking therapy.

In these discussions something else I have heard for the first time is the possibility of post-traumatic growth. Post-traumatic growth is a term first coined by Robert Tedeschi and Lawrence Colhoun in the 1990s and defined as “a positive psychological change in the wake of struggling with highly challenging circumstances”[1]

This is NOT ever to claim that the trauma did not happen, nor that it was not a bad experience, but it is to recognise, with the person who has suffered that trauma, that their resilience has got them through. And that that resilience should possibly teach them something about who they are. “What was it like? How did you get through it? What strengths did you draw on during that trauma? What have you learned for the future?”

As the impact of COVID-19 diminishes in most of our lives, we will be asking that question of ourselves as a society. Not just “phew (most of us) we got through it”, but what have we learned about ourselves as a society by doing that.

The same will be true of individuals and teams in health and social care. We have got through it, but each of us has learned a lot about ourselves (and each other) as we have.

After SARS – in the Far East – 8% of nurses left the health service. If that were to happen to our health and social care services in 2021 it would be a disaster and have an impact on those services as great as that of COVID-19.

It will only not happen if the entire system spends time, effort and resources in caring for staff who have been through such awful times. And helping them all learn about how they have worked.

Many NHS leaders recognise this.

But meanwhile, in another part of the forest, performance managers are flexing their muscles to start the process of trying to get the NHS to ‘up their work rate’ to cut into the waiting lists that have grown over the last year. If they focus solely on that and do not give staff time to heal (and grow) from the last years’ experience, we will be in an unbelievably bad place.

More about this in my next post.

 

[1] Tedeschi and Colhoun 2004 Post traumatic growth conceptual foundations and empirical evidence Psychological Enquiry 15 1 (1-18)

One Reply to “How do we re-open the NHS to deal with an enormous backlog of care without mindlessly returning to a world of “busyness” –  losing sight of the pandemic experience?”

  1. As ever, your commentary is on the button, Paul. My next door neighbour, a London ICU Consultant, is off work with stress having worked round the clock since last March. I hear of numerous nurses and doctors hanging up their gowns. NHS colleagues are struggliing to find the attention span to focus on health inequalities and prevention activities that,without whole system attention and collaboration, will likely submerge them in the next health/social care wave of demand. It is harder than ever to create the time to think together at a time when it is ever more critical.

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