Recognising compassionate care: one means of addressing the staffing crisis in the NHS
By Alistair Hewison (School of Nursing, University of Birmingham)
The number of vacancies for all types of staff – including doctors, scientific, therapists, administrative and clerical personnel – advertised in hospitals across England in the period July to September in 2017 was 87,964. Based on the same analysis by NHS Digital the number of nursing vacancies has risen by 2,626 (8.3%) over the past year from 31,634 to 34,260, the highest level since records began. In 2016-17, just under 33,500 nurses left the service – 3,000 more than joined which is 20% higher than the number who left in 2012-13.
The reasons people leave the NHS include low staffing levels, work pressure, feeling unsupported, not enough time to do the job well, inequity, poor work–life balance, burnout, and increased patient expectations. This has also been identified in a recent Health Select Committee (HCHC) report which noted that nurses reported a lack of recognition for all their efforts, were not paid for doing overtime or staying late, were doing a lot on goodwill (HCHC 2018, page 40), and recommended that the Government must pay greater attention to making nurses feel valued and to improving morale (HCHC 2018, page 11). Although these recommendations are made with regard to nursing, health care is a collective and collaborative endeavour and compassion is not just an issue for frontline staff at the ‘sharp end’ of care delivery. It is something that is accomplished and reproduced at all levels of the healthcare organisation, from ‘bedside to Board’.
Indeed one of the values identified in the NHS Constitution is: we ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering. We find time for patients, their families and carers, as well as those we work alongside. We do not wait to be asked, because we care (page 5). If this is to be achieved staff need to be supported and their contribution recognised. For example West and Dawson found that cultures of engagement, positivity, caring, compassion and respect for all - staff, patients and the public - provide the ideal environment within which to care for patients (executive summary, page 7).
This was a key concern in the approach taken by the healthcare community in Shropshire and Staffordshire, supported by Health Education England West Midlands, to embedding compassion in all aspects of healthcare work. This was initiated at a regional event: Leading with Compassion in September 2015 which was organised to share good practice and innovation across Staffordshire and Shropshire. A fundamental precept of this approach was to increase awareness that compassion is not solely a requirement in face-to-face clinical care. This led to the creation of a Leading with Compassion Recognition Scheme in the local health economy that could be adopted by organisations as part of their staff well-being strategies and/or service improvement plans.
Over the past seven years Yvonne Sawbridge (HSMC) and I have conducted a number of projects investigating staff support and compassion and so were delighted to be commissioned to evaluate the Leading with Compassion Recognition Scheme. The scheme was welcomed by those who were recognised and it was seen as a positive development in the organisations concerned. It was relatively inexpensive to operate and has generated in excess of 2000 nominations (and rising) since its inception. It has raised the profile of compassion as an organisation wide issue and was itself ‘recognised’ when given the Healthcare People and Management Association award for excellence in organisational development in 2017.
Building on this success a ‘How to’ guide was produced by colleagues who developed the scheme, in partnership with University staff, as a resource for others interested in introducing such a scheme. Early feedback from a number of GP practices and other organisations in Milton Keynes and Devon, indicate it is starting to have a wider impact.
Compassionate leadership means paying close attention to all staff; really understanding the situations they face; responding empathetically; and taking thoughtful and appropriate action to help. (NHS Improvement 2016. Summary document, page 3)
The introduction of a compassion recognition scheme can be part of organisational approaches to demonstrating such leadership in action. Although the NHS is undergoing a period of unprecedented pressure and patient demand, with its associated effects on staff and patient well-being, and a recognition scheme may appear to be somewhat peripheral, it is important that staff feel their efforts are appreciated and recognised. Recognising the commitment, dedication and compassion of staff will not on its own address the current staffing crisis, however if integrated into a system of staff support, embedded in a positive working culture, it can be part of the solution.
NB. Further details of the Leading with Compassion Recognition Scheme can be found here: www.nhscompassion.org
NHS Improvement (2016) Developing people - improving care [online]. Available at: https://improvement.nhs.uk/resources/developing-people-improving-care/?utm_campaign=1620737_NLDS%20&utm_medium=email&utm_source=Monitor&utm_orgtype=FT&dm_i=2J9J,YQKH,4ARAUE,2PVYT,1 [Accessed 19 February 2017]