What is the psychological impact of caring?

It is hard to open a paper, read Twitter or listen to the radio without hearing about the pressure that the NHS is under, particularly in A&E. The King’s Fund released its Quarterly Monitoring Report of Finance Directors today which also highlighted that not only is A&E under pressure but also elective care.  The report highlights 12.5% of patients waiting more than 18 weeks; the breach of the 18 week outpatient target; only 83.5% of patients accessing cancer treatment within the target access times and the number of delayed discharges hitting 5,000 per day in November, an increase of more than 20% from the January in the same year. The full report can be found here http://qmr.kingsfund.org.uk/2015/14/.

John Appleby’s foreword gives a stark message, “Services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical.”


With all of this media frenzy over missed targets, we may potentially lose sight of the psychological impact of an already overstretched workforce, caring in this environment. Often resulting in them not delivering the kind of care they would professionally and personally want to deliver, which can have its own psychological impact.

‘Staff morale a significant cause for concern’ is a stark and worrying statement. What is the NHS if it’s not the staff who care for the sick and vulnerable patients? Looking after the mental and physical wellbeing of our staff is critical at times of  immense pressure. Unfortunately, the unintended consequences of such times are that the support tools we have in place for our staff i.e. clinical supervision, debriefing and one to ones become the ‘luxury’ that is the first thing to go. This is short-sighted and needs a different approach that gives the staff opportunity to have time to think, reflect, re-gain perspective and access advice and guidance if required.

This is not just confined to clinical staff. Many staff who work in the NHS have difficult roles such as porters, domestics, receptionists, security and managers. All staff need an opportunity to work through the psychology of the challenges they encounter on a day to day basis.

One approach to this is the introduction of Schwartz Rounds.  These give staff an opportunity to share an experience of a situation they have encountered recently with a wider audience and the focus is on reflection rather than advice or guidance to give a greater amount of support. (More information in the Staff Care report from the Point of Care Foundation http://www.engageforsuccess.org/ideas-tools/point-care-foundation-report-nhs-performance/#.VMF0tv-a3IU). This technique is starting to become more frequently undertaken with proven positive results.

Last year, in my previous role as the Exec Director for Development in a mental health and community trust as part of our organisational development strategy we started to become a little bit more flexible in our thinking. We knew that despite best efforts one to ones were not always achievable on the over-stretched wards and this could lead to less reflection time for staff. The Forensics team had implemented an approach, known as See Think Act, with extremely positive results.  Whilst acknowledging the differences in patient cohort and clinical model between Forensics and mental health and even more so community services we decided to pilot learning from this framework. The philosophy is based on a positive approach to relational security and helps staff to manage the psychological impact of caring in a challenging environment. More information is available here


Surprisingly – given the difference in the patient cohort and clinical model – the community teams (physical healthcare) really embraced the approach and could see how this approach could positively impact on how they worked as a team as well as in their interactions with patients. The learning for me throughout this process was that flexibly supporting staff to access the support they need through a range of approaches is crucial rather than just following a single method that may no longer connect with staff needs and ways of working.

How staff feel about their relationships with their patients; the family and carers; their team and the wider organisation has a significant impact on the quality of care delivered. Caring in the best of times can psychologically affect the staff and in challenging times such as these, this can be even more starkly affecting.

Whilst the old mantra ‘keep calm and carry on’ is commendable, organisations need to start looking after the psychological as well as the physical wellbeing of their workforce. This will involve being flexible in approach, recognising the art of the possible and ensuring that staff don’t just ‘carry on regardless’ but are given some space and time to reflect, enabling them to continue to be able to deliver the quality of care they are proud of both professionally and personally.