An Open Letter to NHS Staff – This ‘crisis’ is not your fault – you’re doing a great job!

If you work in the NHS, in any capacity, this letter is for you, no matter what your role.

 

Dear NHS Staff Member,

 

I write this to you as a GP, who cares for many people who work in the NHS and sees the huge stress many of us feel under. I write it as a ‘system leader’ in my role as Director of Population Health and as someone who has been a patient myself, twice in the last 12 months.

 

We are constantly told that the NHS is in crisis (I’ve even written blogs about it myself!), that we’re not meeting targets, that we’re getting things wrong, that we’re struggling to cope under the strain of demand but not being efficient enough and it can feel like what we’re doing isn’t up to the mark. With all the other current surrounding narratives we live with (like Brexit and Climate Change), things can so easily feel overwhelming.

 

So, I just wanted to write and tell you that the NHS is not in a crisis. We’re just underfunded and understaffed and we’re doing the best we can in those circumstances. Demand is growing year on year and we’re dealing with real complexity. We’ve been under the biggest and longest squeeze on our finances in NHS history, for the last 9 years, and the 3.4% uplift we’ve been promised, although welcome, is not enough to keep us running as we are and do the transformational work required of us. We don’t have enough people to deliver the work we’re being asked to do and so it’s no surprise that morale is low and burn-out levels are high. None of that is your fault. You are doing an amazing job. Every day, you turn up to work, in the context of everything else you have going on in your life and you are helping to deliver a truly world-class health service. Good job!

 

Amidst all the rhetoric you hear, the targets you feel under pressure to meet, the constant flow of people through the doors, the blame and complain (and sometimes bullying) culture that can grind you down, the traumas that you deal with every day, the pain that you help people process, the love and compassion that your pour out, the siloes and frustrations with the clumsiness of the system at times and the long hours – of which you work above and beyond most of the time…..know that you are more than your job and you are valuable just for who you are.

 

So, in all the busyness, remember to listen to and look after your own needs and those of your team around you. You can only do what you can do, and you’re doing a great job. Think about Maslow’s hierarchy of needs and how much you are attending to those things.

 

Physiological Needs – are you listening to your body? Are you getting time to have a drink, eat well, stretch, sleep and get to the toilet ok?

Safety – Are you feeling safe in your work? Do you feel protected? Are you worrying all the time about making mistakes? Do you feel it’s ok to make a mistake and be able to talk about it and learn from it, without fearing some awful consequences?

Love and Belonging – Do you feel like you are an important member of your team – that you matter, that you belong, that people around you care about you? Maybe in the humdrum and mayhem of everyday, we forget to tell each other.

Esteem – How is your self-esteem? Do you feel confident in who you are? Are you treated with respect and kindness and treating others with the same – no matter who they may be?

Cognition – Are you in a place where you can think clearly, make rational choices and in an environment which values learning and development?

Aesthetic Needs – Are you taking time to admire the beauty around you and enjoy life? Without this, it’s really hard to keep motivation alive, especially when things are tough and work feels really pressured. Taking time for this changes your perspective on everything else. How is your perspective? Is it in or out of kilter?

Self-Actualisation – Are you able to be spontaneous, making wise and creative, moral choices, problem solving without prejudice whilst accepting the facts in front of you?

Transcendence – This is the place we are aiming for as human beings – that ability to move out of our ego and into the place of gift from which we can love the ‘other’ and even our ‘enemy’ with the kind of transformative substance that changes the world.

 

The truth is, you can’t get to this place of self-actualisation and transcendence if the other areas aren’t looked after – so what needs attention? What are you noticing that needs taking care of? Don’t worry about all the pressures from on high – it’s all part of a system of biopower that needs to measure things to keep control. You – yes you, are valuable and important and the contribution you are making every day is phenomenal. You will certainly make some mistakes. It’s likely that you’ll feel overwhelmed at times, so listen to what your body, mind and heart needs and give yourself some space to attend to those things. Your own health and wellbeing really matters. So if you need help – and most of us do at different times, then please talk about it and give it some focus. We need to take care of each other – it’s ok not to be ok. Only when we create supportive environments for each other can we bring our ‘A game’ and keep providing the phenomenal care, innovation and transformation that we do every day.

 

Thank you a million times for everything you are doing, despite the struggles and pressure. Together, we need to create a culture of joy and kindness. That is partly the responsibility of leaders, but its incumbent on all of us, to treat ourselves and those around us with gentleness and respect. Go ahead and keep doing the great work you are doing every day – you really are a wonder!

 

Love and gratefulness

 

Andy

 

 

 

 

 

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Solutions for the NHS Workforce Crisis

This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.

 

The latest figures have been published by the regulator, NHS Improvement, for the April to June period.

 

They showed:

  11.8% of nurse posts were not filled – a shortage of nearly 42,000

  9.3% of doctor posts were vacant – a shortage of 11,500

  Overall, 9.2% of all posts were not filled – a shortage of nearly 108,000

 

NHS vacancies a ‘national emergency’

 

This is having a profound impact on staff who are working in the NHS now, with low morale, high stress levels, increasing mental health problems and people leaving the profession (either to go over seas, where pay and work-life balance is considerably better) or retire early. 

 

Increasing the number of doctors, nurses and midwives (all with considerable debt, mind you!), by 25% over the next 5 years is welcome, but it doesn’t solve the problem now, and it is unlikely to be enough, even then!

 

But, let’s take a solutions focussed approach. What can we do now? I think there are a few things we need to consider:

 

  1. I can understand how frustrating it is for the public to find that waits are longer to receive much needed care. When we’re anxious or worried about our own heath or that of a loved one, we are understandably at a position of higher stress. However, this staffing crisis is not of the making of the nurses, doctors and other health professionals who work long hours every day to provide the best health care they can. So, it’s really important that as a country, we treat our NHS staff with kindness, gratitude and respect. The current abuse of NHS staff is making the job even harder and really making people not want to come to work. And that means we also need to make complaints in a way that is perhaps a bit more compassionate or understanding towards people who are working under high stress situations. It is important that we learn from mistakes, but complaints have a huge impact on staff and can hugely affect their confidence, even when they are dealt with in a very compassionate way by those in leadership. 
  2. We need to ensure that we use our appointments appropriately. Yes – sometimes, we have to wait a while to see our GP, but if we get better in the mean time, we really don’t need to be keeping the appointment! And missing appointments costs us all so much time and energy and makes those waiting lists ever longer. If we value our health system, we need to either keep appointments, or take responsibility to cancel them.
  3. We need to take an urgent look at the working day of our NHS staff and work out how we build more health and wellbeing breaks into their days. We need staff to have space to connect, keep learning, be active, be mindful and take appropriate breaks. This means senior leadership teams getting the culture right, when the pressure is on and the stakes are high. 
  4. We need to get smarter with digital and enable patients to make better and more informed choices about their own care and treatment, with better access to their notes. In this way, we waste less time and empower people to become greater experts in the conditions with which they live everyday. There are great examples of where this is happening already. It isn’t rocket science and can be rolled out quite easily. It’s good to see some announcements about this from the new health secretary Matt Hancock MP, but we need to make sure the deals and the products are the right ones. It’s also vital, when it comes to digital solutions that Matt Hancock listens to his colleague and chair of the health select committee, Dr Sarah Wollaston MP, in being careful what he promotes and prioritises.
  5. We need to be thinking NOW about the kind of workforce we are going to need in the next 2-3, and 5-10 years and we need to get the training and expectations right now! There is no point designing our future workforce based on our current needs. Rather, we need expert predictive analysis of the kind of future workforce we will need, in line with the ‘10 year plan’ and begin to grow that workforce now. If it’s healthcoaches we need to work alongside GP practices, then let’s get them ready, if it’s community focussed nursing teams, then let’s adjust the training programmes. This kind is vital and must influence what happens next.
  6. We need to stop putting pressure on NHS staff to deliver that which is currently undeliverable without causing significant stress to an already overstretched workforce. By this I mean centrally driven schemes, such as the intended roll out of GPs working 8-8, 7 days a week. Maybe it’s an aspiration for the future if we can sufficiently reimagine the workforce, but it’s not a priority now and isn’t the answer to the problems we’re facing.
  7. We need to stop the cutting of social care in local governments, and ensure that central funding flows to where it needs to be, to ensure the allied support services are present in local communities to work alongside NHS colleagues in getting the right care in the right place at the right time. This is the single biggest cause of our long ED waits and our problems with delayed discharges from hospital. It isn’t rocket science. It’s the reality of cuts to our social care provision, which have been too deep and this needs to be reversed.

 

Personally, although it is an option, I feel uncomfortable about a ‘recruitment drive’ from overseas, as it is very de-stabilising to health care systems in more deprived parts of the world when we do that. I think there are some win-win initiative we could develop pretty quickly that could also form part of our international development strategy.

 

In summary, we need to treat our NHS staff with kindness, look after their wellbeing, use our services appropriately, use digital technology with wisdom and not for political gain, redesign and start building the workforce of the future now, stop undeliverable initiatives and ensure the right funding and provision of services through social care which means central government funding back into local government. It won’t solve everything, but it will go along way towards giving us a more sustainable future to the NHS.

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Never Let a Good Crisis Go to Waste

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Social Movements and the Future of Healthcare

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Turning To Each Other

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The Art of Hosting Good Conversations – Morecambe

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We Need to Be Ambidextrous in Solving our Health and Social Care Conundrum

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Wake Up to Our Health Crisis

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Here we go round the NHS Mulberry Bush!

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