NHS staff go beyond the call of duty to serve patients day in and day out, so if the government is really here to help, it will take more than system level initiatives focused on organisation and care models to improve the health service

At the NHS Confederation conference in June, Jeremy Hunt joked: “I’m from the government and I’m here to help.”

‘Supporting staff with “emotional labour” is critical to staff wellbeing’

In saying this, he appeared to signify a change in approach, whereby this time the government really tries to do something fundamentally different to support healthcare organisations as they work to sustain and change services at a time of major financial challenge.

The health secretary described a range of initiatives as part of this new approach, including:

  • a “success regime” (a concerted effort to enable failing health systems to get back on track);
  • the Carter report which identifies ways in which trusts can secure procurement and other efficiencies; and
  • taking forward Sir David Dalton’s recommendations for establishing hospital chains, whereby successful organisations partner with other hospitals in need of support.

While these initiatives may help solve some of the problems facing NHS commissioners and providers, they remain at the wider organisational level. 

Help at the ground level

What they do not do is help managers address the tough reality of dealing with death, distress, decay and vulnerability on a daily basis.

Supporting staff with this “emotional labour” has been shown to be a critical factor in the level of staff wellbeing, and in turn the quality and compassion of care given in NHS hospitals facing financial and other pressures.

Indeed, research evidence outlines just how important their wellbeing is in order for patients to receive good care.

To continue to provide compassionate care for patients, staff need their emotional bank accounts topped up, which requires support from their organisation.

‘Staff need their emotional bank accounts topped up’

On talking to staff it is clear that they too often skip breaks or cancel training days because the ward is busy, or in the community they fit one more visit into their packed day as that last patient really needs their support.  

While the importance of attending to emotional labour is often hard for frontline nursing, medical and other staff to recognise, it is usually even less obvious at an organisational level.

If it was, it would be more visible in management practice, with managers ensuring that staff are protected and supported emotionally as a prerequisite to delivering care.

Our work indicates this is not the case.

Systems in place

Therefore our research at the University of Birmingham focuses on what systems are needed to support staff in their emotional labour. The need is very real, as GP Jonny Tomlinson captures beautifully.

Staff are under such time pressures that they are often unable to take even a small amount of time to sit quietly, have a cup of tea and collect their thoughts before returning to care for the next patient and their family.

Compare this with the approach taken by the Samaritans – our partners in this research into emotional labour. They ensure a working environment whereby two volunteers have a duty to support one another as well as their clients.

‘Two volunteers support one another as well as their clients’

The Samaritans systemise this support (see box below), not leaving it to chance or the intuition of individuals.

The organisation requires its volunteers to debrief at the end of a shift, by calling their offsite team leader and talking through the emotional impact of the work they have just done. 

If found to be upset, the volunteer is called by their team leader the next day to explore how they are feeling and to see if any additional support may be required.

The Samaritans

Each volunteer undergoes a period of training prior to taking calls. Each shift is 3-5 hours, and the volunteers work in pairs.

The callers are often in highly distressed state, and the volunteers are actively encouraged to share the last call with their partner in the downtime between calls.

If a volunteer needs longer to debrief, the telephones will be turned off to enable this to happen - it is rare that this action is required as most debriefs are possible in a few minutes.

However, it signifies the importance that the organisation gives to the emotional support of volunteers.

They recognise that if a carer is not cared for, then they cannot care for the callers.

At the end of each shift, the volunteer “offloads” to the shift leader. This process involves a summary of the types of calls taken by the volunteer and how the volunteer is feeling.

The leader will make a judgement about the emotional health of the volunteer, and if they feel they were particularly affected, they will call them the next day to see how they are.

Duty of care

It has never been more important for boards of organisations to understand that their responsibility for health and safety goes beyond buying hoists to care for nurses’ backs and includes support for their emotional labour.

It is a tribute to NHS staff that so many continue to go above and beyond the call of duty to give compassionate care, in spite of the pressures they face.

‘Attention will need to be given to the emotional labour performed 24/7 by committed NHS staff’

If the government is really here to help the NHS, and in turn if NHS organisations are really there to help staff, it will take more than a menu of system level initiatives focused on organisation and models of care. 

Attention will need to be given to the emotional labour performed 24/7 by committed NHS staff, and the service would do well to learn from experts in this area such as the Samaritans.   

Yvonne Sawbridge is senior fellow of Health Services Management Centre at the University of Birmingham