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Friday 05 February 2021

The genie is out of the bottle

By Jon Restell

This pandemic has seen unprecedented investment in the health and wellbeing of NHS staff. MiP wants to make sure it's one legacy of the crisis.

Jon Restell portrait 2021

As I write this, Simon Stevens has just said the NHS is in the most precarious situation in its history. The peak of the pandemic may still be a month away, the media is reporting the imminent risk of “overwhelm”, and our members are describing the intense and sustained pressure on staff. 

Uncomfortable questions remain about PPE, avoidable risks to staff and decision-making priorities at various stages of the crisis. But, especially given the lack of preparedness and the sheer pace of the crisis, there’s no question that the system has allocated huge resources to supporting the health and wellbeing of staff. 

This has included a massive PPE procurement programme, supporting a large-scale movement to homeworking, interventions for staff groups disproportionately affected by the virus, over a million individual risk assessments, special terms and conditions agreed with unions for staff who are self-isolating or suffering from covid, mass regular testing, and the prioritisation of health and care staff for vaccination.

But what happens when the crisis recedes? Do we go back to business as usual, or has our attitude towards health and wellbeing at work changed for good? 

Insights from the crisis

We know from personal and professional experience that disasters bring new insights and priorities. Staff health and wellbeing has moved centre stage because of the virus, much as quality did after Mid-Staffs. Many players, our union included, want it to be the legacy of the pandemic. And this pandemic has two unique characteristics that make a radical change more likely: there is widespread acceptance that everyone’s wellbeing matters and everyone’s needs are met differently; and the whole country has undertaken a mass experiment in homeworking, a huge component of future flexible working. In short, the genie is out of the bottle.

There is a workforce supply bottom line, too. Exhausted staff will vote with their feet, helped by pension changes which could make leaving earlier more financially attractive. Millennials and Gen Z set greater store by workplace health and wellbeing than previous generations – some will accept lower pay outside the NHS to manage their wellbeing better. Even on pre-pandemic trends, one in five NHS posts was set to be vacant by 2030. The pandemic will only accelerate that trend, jeopardising both the recovery from the virus and ambitious plans to meet the changing health needs of the population.

Recovery, prevention and performance

It’s helpful to look at the new thinking on health and wellbeing in the NHS in terms of recovery, prevention and organisational performance.

On recovery, by the time the vaccine hopefully brings the pandemic under control, staff and their managers will have worked above and beyond for over a year. After the first wave, plans to restart services underplayed the psychological and physical impact on staff. And the virus will have a long tail, with many staff suffering from long covid and ongoing psychological distress such as PTSD, depression and anxiety. Staff will need a radical and well-resourced framework – and specific initiatives like recuperative leave – to help them recover from the pandemic.

On prevention, we need new investment and a fundamental shift in attitudes towards line managers and occupational health provision. The health, wellbeing and development needs of line managers will need dedicated action if their central role in supporting other staff is to be fully realised. No airline asks you to fit someone else’s mask before your own, but that’s exactly what we ask of line managers in the NHS.

But there’s an even bigger prize. Despite being a people business par excellence, the impact of psychological wellbeing on organisational performance in healthcare has been surprisingly neglected. Often, interventions labelled as ‘health and wellbeing’ are just about managing sickness absence. But on issue after issue, policymakers have now realised that it’s culture, not policy and process, that needs to change. This reflects the common wisdom that ‘people leave managers, not jobs’, and it’s why we’re increasingly referring to staff as ‘people’ rather ‘the workforce’.

People need time to understand why an issue matters, longer to work out what do and even longer to act. We’re probably only at the first stage, as demonstrated by operational letters from NHS England which rightly prioritise staff health and wellbeing but lack the detailed instructions issued for other priorities. 

This will be immensely challenging for governments, policymakers, managers and staff alike. Recovery and prevention interventions are important, but they won’t create healthy workplaces on their own. Leaders will need to manage resources, workloads, targets, expectations and staffing levels to promote the health and wellbeing of staff, rather than seeing it as a trade off with performance. Are we ready for that?

Jon Restell is chief executive of Managers in Partnership

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