The service

The Islington iCope Psychological Therapies and Wellbeing Service is a well-established Improving Access to Psychological Therapies (IAPT) service provided by Camden and Islington NHS Foundation Trust. It provides a range of evidence-based psychological interventions to individuals experiencing depression or an anxiety disorder. IAPT services are designed to deliver high-volume, high-quality care. A team of up to 22 Psychological Wellbeing Practitioners (PWPs), including trainees, offers more than 2,000 appointments every month. The PWP team at Islington iCope was keen to consider how they could support their own health and wellbeing amongst the pressures and challenges of their role.

How it worked

The team appointed a staff wellbeing lead who worked with the senior PWP team to arrange a Wellbeing Action Day for the wider PWP team in January 2017. Emphasis was placed on the term ‘Action’ to signify team members were coming together to focus on the team’s, and their own, wellbeing, and show it was everyone’s responsibility. Focus groups explored questions including:

• What does good staff wellbeing look like?
• What would help you feel more valued and supported, and that your wellbeing was important?
• Why do you come to work as a PWP? How can we make this a bigger part of our role?

Following these discussions action points were agreed at individual, team and service levels. PWPs said they found it helpful to raise issues in a supportive environment and come together with colleagues to acknowledge both the challenges, and positive aspects, of the role. A range of themes was identified from which an action plan was created. Some of the highlights were:

• Line management: PWPs wanted more discussions around their development and performance. As a result the line management structure was changed to shift the focus towards a review of PWP wellbeing and development. Line managers attended a refresher session led by senior PWPs which included a recap of service agreements and protocols to ensure consistency in decisions. In a review one year later, 79% of PWPs said their wellbeing was considered in every line management meeting, with almost all identifying personal development as a key purpose of line management.
• Transparency: PWPs asked to hear more about discussions at management meetings and what could be changing in the service. They wanted more knowledge and understanding on service funding. They asked for greater opportunities to suggest service changes and engage in strategic thinking. As a result, the service added a standing item to meetings where the team is informed of management meeting discussion points. Members of the management team are regularly asked to attend PWP meetings where they can answer questions.
• Supervision: The duty supervision arrangement was updated to include two hours a day where PWPs could discuss assessment cases. This has resulted in case management supervision being freed up to discuss treatment cases and many PWP staff members say they find this beneficial.

• Wellbeing focus: PWPs asked for more information on what is available to staff via the trust. Changes include the circulation of a monthly wellbeing newsletter which promotes trust and local wellbeing events. A wellbeing committee was formed and regular lunchtime socials were arranged and facilitated by the team. These include walking groups, team quizzes and photography classes. Feedback from the team shows there has been a steady progression towards thinking more about staff wellbeing across the service. Although the PWP team is constantly changing, individual members regularly comment they always feel connected with each other and that peer support is strong.

A new wellbeing strategy

The work has generated a number of service changes which the team plans to build upon. They are passionate about embedding staff wellbeing into every aspect of the service and committing to an annual wellbeing strategy for the whole team:

Actions from the Wellbeing Action Day have been implemented. Some of the simpler changes, such as ordering new equipment, were introduced within days whilst forming a wellbeing committee and a new duty supervision system within six months. Others, such as working towards better transparency between the management and wider team, have been developing over time.

In June 2018, the iCope team completed a standardised measure of wellbeing – a Quality of Working Life Survey. This asked questions across several domains which, when compared with a sample of over 1,000 other NHS staff, revealed staff wellbeing at iCope was either average or above average in the majority of areas. It is planned to repeat the quality of working life survey in summer 2019 which will enable staff members’ wellbeing measures to be compared and the results analysed.

The importance of staff wellbeing to PWP team members is shown by some of their comments captured in internal surveys and reports:

Things feel good in comparison to last year because there is more of an emphasis on wellbeing and managing stress.

The management team has made staff wellbeing a clear and visible focus and this has led to some improvements.

Following analysis of the quality of working life survey, the team plans to host open conversations with High Intensity Therapists to identify further areas for change. The framework emphasises the importance of agreeing achievable, measurable goals. Team members are also keen to share their learning and ideas with others, both across the trust and nationally. They have been invited to speak at the National IAPT PWP conference and the Positive Practice in Mental Health specialist interest group.