Through the COVID-19 response to date, individuals and teams have done a huge amount to support each other, including regular team check-ins, and making space available for colleagues to rest and recuperate. There has also been a widespread outpouring of support from the public and businesses.
Nationally, NHS England and NHS Improvement built on this with an offer made to all NHS staff on the NHS People website with:
- a dedicated health and care staff support service including confidential support via phone and text message
- specialist bereavement support
- free access to mental health and wellbeing apps
- guidance for key workers on how to have difficult conversations with their children
- group and one-to-one support, including specialist services to support our black, Asian and minority ethnic (BAME) colleagues
- mental health resources and support, including for people affected by suicide
- a series of webinars providing a forum for support and conversation with experts.
NHS England and NHS Improvement also developed guidance to equip NHS line managers to effectively support and lead their teams during and after the COVID-19, including:
- coaching and mentoring support
- online resources, toolkits and guidance on topics such as maintaining team and individual resilience; managing stress and maintaining routines; compassionate leadership in a crisis; and creating pause spaces to support teams working under pressure, REACT mental health conversation training for managers, to enable them to support staff through compassionate, caring conversations about mental health and emotional wellbeing.
These interventions helped our people feel more valued and supported. Now, we must build on this, so they can keep feeling this way.
The safety and health of our people is paramount. In the early response to COVID-19, when so little was known about the disease, coming to work required the courage associated more with roles in the military than healthcare. Employers across the NHS must now continue to take all necessary measures and redouble their efforts to keep people safe, or risk them leaving.
Employers’ focus should be on the following areas, which staff have said they care most about:
Infection risk: Employers should put in place effective infection prevention and control procedures, including social distancing and redesigning care procedures that pose high risks for spread of infections.
Providing PPE: Employers should make sure all their people have access to appropriate personal protective equipment (PPE) and are trained to use it.
Flu vaccination: Frontline healthcare workers involved in direct patient care are encouraged to receive seasonal influenza vaccination annually to protect themselves and their patients from influenza. All frontline healthcare workers should have a vaccine provided by their employer. Public Health England will continue to monitor performance on uptake.
Risk assessment for vulnerable staff: All NHS organisations will complete risk assessments for vulnerable staff, including BAME colleagues and anyone who needs additional support, and take action where needed. Organisations are encouraged to expand this to all staff.
Home-working support: Employers should make sure people working from home can do so safely and that they have the support they need, including suitable equipment.
Rest and respite: Employers should make sure their people have sufficient rests and breaks from work and encourage them to take their annual leave allowance in a managed way.
Bullying and harassment: All employers are responsible for preventing and tackling bullying, harassment and abuse against staff, and for creating a culture of civility and respect. By March 2021 NHS England and NHS Improvement will provide a toolkit on civility and respect for all employers, to support them in creating a positive workplace culture.
Violence against staff: Leaders across the NHS have a statutory duty of care to prevent and control violence in the workplace – in line with existing legislation – so that people never feel fearful or apprehensive about coming to work. NHS England and NHS Improvement has developed a joint agreement with government to ensure action in response to violence against staff.
As part of our ongoing commitment to look after our NHS people we have published a national Violence prevention and reduction standard which complements existing health and safety legislation. Employers (including NHS employers) have a general duty of care to protect staff from threats and violence at work.
The standard delivers a risk-based framework that supports a safe and secure working environment for NHS staff, safeguarding them against abuse, aggression and violence.
The standard has been developed in partnership with the Social Partnership Forum and its subgroups, including trade unions and the workforce issues and violence reduction groups. It was endorsed by the Social Partnership Forum on 15 December 2020.
Key areas for NHS organisations under the Violence prevention and reduction standard assessment indicators include:
- board accountability
- workforce and workplace risk assessments
- workforce engagement
- supporting roles
- learning outcomes from management reviews
- audit and assurance.
St. George’s University Hospitals NHS Foundation Trust secured additional occupational health (OH) support through the DPS Framework. This meant that colleagues referred to OH did not experience any COVID-19 related delays to receiving support.
As a good employer, it is our moral imperative to make sure our people have the practical and emotional support they need to do their jobs. Each of us must build on the support given during the COVID-19 response and make sure it continues.
Staff should expect their employers to address the following areas:
All organisations to have a wellbeing guardian: NHS organisations should have a wellbeing guardian (for example, a non-executive director or primary care network clinical director) to consider the organisation’s activities from a health and wellbeing perspective and act as a critical friend, while being clear that the primary responsibility for our people’s health and wellbeing lies with chief executive officers or other accountable officers.
All staff supported to get to work: NHS organisations should continue to give their people free car parking at their place of work for the duration of the pandemic. Organisations should also support staff to use other modes of transport, and hospitals should identify a cycle-to-work lead so that more staff can make use of this option.
Safe spaces for staff to rest and recuperate: Employers should make sure that staff have safe spaces to manage and process the physical and psychological demands of the work, on their own or with colleagues.
Psychological support and treatment: Employers should ensure that all their people have access to psychological support. NHS England and NHS Improvement will continue to provide and evaluate the national health and wellbeing programme developed throughout the COVID-19 response. NHS England and NHS Improvement will also pilot an approach to improving staff mental health by establishing resilience hubs working partnership with Occupational Health programmes to undertake proactive outreach and assessment, and coordinate referrals to appropriate treatment and support for a range of needs.
Support for people through sickness: Employers should identify and proactively support staff when they go off sick and support their return to work. NHS England and NHS Improvement will pilot improved occupational health support, in line with the SEQOHS Working in selected pilot areas, in partnership with the resilience hub and local mental health services, occupational health services will provide a wider wellbeing offer, to ensure that staff are supported to stay well and in work.
Physically healthy work environments: Employers should ensure that workplaces offer opportunities to be physically active and that staff are able to access physical activity throughout their working day – especially where their roles are more sedentary.
Support to switch off from work: Employers should make sure line managers and teams actively encourage wellbeing to decrease work-related stress and burnout. To do this, they must make sure staff understand that they are expected to take breaks, manage their work demands together and take regular time away from the workplace. Leaders should role model this behaviour.
The introduction of a wellbeing room has been brilliant and more focus on staff wellbeing going forward is paramount. What is important is allowing staff the time to reflect and recover from stressful situations. This has been invaluable.
Health and wellbeing conversations and personalised plans
From September 2020, every member of the NHS should have a health and wellbeing conversation and develop a personalised plan.
These conversations may fit within an appraisal, job plan or one-to-one line management discussion, and should be reviewed at least annually.
As part of this conversation, line managers will be expected to discuss the individual’s health and wellbeing, and any flexible working requirements, as well as equality, diversity and inclusion. From October 2020, employers should ensure that all new starters have a health and wellbeing induction.
Our NHS People: Understanding different bereavement practices and how our colleagues may experience grief
Given the impact COVID-19 has had on people, particularly those from black, asian and minority ethnic communities, we know that our NHS people are likely to experience a bereavement during the pandemic. This could be through losing patients when working on the frontline, as well as experiencing personal bereavements of family members, friends and colleagues who have died during the pandemic. In addition to this, the rules around lockdown and social distancing will have had an impact on how colleagues grieve or celebrate the life of a lost one. Next year we may see a lot of memorial services so that people, who haven’t been able to attend the funeral of a loved one, have the opportunity to pay tribute to them.
With support from a wide range of colleagues and staff networks, we have developed a bereavement resource, recognising the diversity of our staff, and a short animation to build on existing managerial cultural competencies. This resource will enable line managers to confidently start conversations with staff who have experienced loss, in a more compassionate way as a result of gaining a deeper understanding of the different ways in which our colleagues may experience a bereavement, noting the different religions, cultures and rituals they may follow.
The resource is meant to be considered as a starting point and is not prescriptive or exhaustive, but it enables conversations that allow proper consideration to be given to the support colleagues may need, as their roles and responsibilities differ culturally due to the diversity of our workforce. Across all religions and cultures there will be differences in how colleagues practice and it is important that, as an organisation, we encourage communication and open and honest conversations where staff feel comfortable to share their beliefs with managers who will in turn respond sensitively and compassionately.
To become a modern and model employer, we must build on the flexible working changes that are emerging through COVID-19. This is crucial for retaining the talent that we have across the NHS. Between 2011 and 2018 more than 56,000 people left NHS employment citing work-life balance as the reason. We cannot afford to lose any more of our people.
Many people in the NHS go on to bank rotas, become locums, or leave us altogether because they are not offered the flexibility they need to combine work with their personal commitments. The NHS has a higher-than-average proportion of people with caring responsibilities and COVID-19 has also changed the responsibilities for many – particularly those with significant caring duties.
Flexible working means different things to different people and can relate to when, where and how we work. It can also include the need for greater predictability, to help people manage their different responsibilities and broader interests.
Getting this right requires managers and leaders to take the time to understand what each person needs. That way, employers can help them incorporate work more easily into the rest of their lives. Making flexible working a reality for all our people will need compassionate conversations between employers and staff representatives.
Home working, for at least some of the time, can suit a lot of people. You can get a lot done at home. This can help manage stress and health conditions, it helps to save the environment and it saves on commuting time and stress too, as well as potential parking costs either for the individual or the trust. I would like to see this as a proper option for at least some of the week in more jobs, due to the positive impact on staff wellbeing as well as helping the environment.
Senior nurse practitioner, South East
Employers are encouraged to make progress in the following areas for their people:
Flexibility by default: Employers should be open to all clinical and non-clinical permanent roles being flexible. From January 2021, all job roles across NHS England and NHS Improvement and HEE will be advertised as being available for flexible working patterns. From September 2020, NHS England and NHS Improvement will work with the NHS Staff Council to develop guidance to support employers to make this a reality for their staff.
Normalise conversations about flexible working: Employers should cover flexible working in standard induction conversations for new starters and in annual appraisals. Requesting flexibility – whether in hours or location – should not require justification, and as far as possible should be offered regardless of role, team, organisation and grade.
Flexibility from day one: NHS organisations should consider it good practice to offer flexible working from day one, as individual circumstances can change without warning.
Role modelling from the top: Board members must give flexible working their focus and support. NHS England and NHS Improvement will add a key performance indicator on the percentage of roles advertised as flexible at the point of advertising to the oversight and performance frameworks.
E-rostering: NHS England and NHS Improvement will support organisations to continue the implementation and effective use of e-rostering systems, accelerating roll-out where possible. These systems promote continuity of care and safe staffing, enable colleagues to book leave and request preferred working patterns up to 12 weeks in advance, and can also be used to support team rostering.
Management support: Working with the national NHS Staff Council, NHS England and NHS Improvement will develop online guidance and training on flexible working by December 2020. This will be aimed at staff and managers alike, reinforcing the benefits and providing the tools to develop and assess applications for flexible working, with a view to supporting flexibility as a default.
Flexibility in general practice: NHS England and NHS Improvement will work with professional bodies to apply the same principles for flexible working in primary care, which is already more flexible than other parts of the NHS. Building on pilots, it will encourage GP practices and primary care networks to offer more flexible roles to salaried GPs and support the establishment of banks of GPs working flexibly in local systems.
Flexibility for junior doctors: During the rest of 2020/21 Health Education England will continue to increase the flexibility of training for junior doctors – such as less than full-time training, out-of-programme pauses and opportunities to develop portfolio careers. Full roll out will happen by 2022/23, so that all junior doctors will be able to apply for flexibility in their chosen training programme.
Supporting people with caring responsibilities: Employers should roll out the new working carers passport to support timely, compassionate conversations about what support would be helpful, including establishing and protecting flexible working patterns. We encourage employers to learn from best practice in this area.