The NHS has to endure a toxic mix of deep rooted fears and a high level of work demands, which leads to disengagement. To ensure they deliver compassionate care they themselves must feel attended to, explain Clare Gerada and Rex Haigh

If the NHS were a patient, it would be diagnosed with depression and in dire need of psychological treatment - or to paraphrase the writer Tony Judt: “Something is profoundly wrong with the NHS today”. 

The symptoms and signs of this depression are not hard to find.

‘Nurses and GPs are blamed for the failures of a system that’s outside their control’

High levels of sickness, early retirements, emigration, complaints, referrals to the regulator and low morale are evidence of an organisation in distress.

After teachers, nurses are the most stressed of all in the UK working population and the UK ranks highest of all for stress among the European workforce, blamed - alongside GPs - for the failures of a system that is outside their control. 

The toxic mix

Everywhere you look there is a deep rooted sense of fear:

  • fear of annihilation - job loss, service loss, closure of hospital or practice - or exposure;
  • being named and shamed; or
  • even facing criminal sanctions with the proposed new offence of wilful neglect.

High work demands and disempowerment add to this toxic mix.

‘Staff are not so much seen as “angels” tending to the sick, rather as bullies or cheats, gaming a system’

Staff report feeling overwhelmed by an unnecessary box ticking, target heavy system created by a monitoring and regulatory process somewhat out of control.

Whether patient counsellors delivering psychological treatment, hospital managers spending hundreds of thousands of pounds preparing for an inspection, or GPs drowning in the burden of their day to day work, all give testament to a bloated bureaucratic beast.

Clare Gerada

Clare Gerada

The self-esteem of the NHS is at an all time low, brought down through a daily diet of negative media stories purporting to a health system ostensibly riddled with failure and staff. Staff are not so much seen as “angels” tending to the sick, rather as bullies or cheats, gaming a system and hiding errors behind thickets of lies. 

The ultimate paradox being that the NHS outperforms all other modern health services, coming top of the US Commonwealth Fund league this year.

Cure the sick NHS

For staff to deliver the components of compassion (attentiveness, empathy and intelligent action) they themselves must feel attended to and contained.

This is not just about implementing the 80 or so recommendations made in various reports over the last few years.

Rather it is about embedding a deeper cultural change, led by politicians and involving all agencies in and around healthcare.

‘It is about embedding a deeper cultural change, led by politicians and involving agencies around healthcare’

Leaders must model the culture they seek to promote, creating psychological resilience in the organisation and allowing it to foster trust, commitment, engagement and kinship in others, “psychological responsibility”, as promoted by the psychologist Derek Mowbray.

As healthy staff make for healthy patients, it is important to reverse the effects that are creating our sick NHS.

If left unattended, they will damage the staff goodwill that acts as a sticking plaster, protecting patients from the gaps in funding, staff and services.

Treat the NHS as an object of desire

The NHS constitution commits to providing a positive working environment for staff, and to promote supportive, open cultures to help staff do their job to the best of their ability.

We must hold the NHS to this and remove the culture of fear, suspicion and blame, and urgently create a momentum of change for the benefit of patients and the NHS.

Rex Haigh

Rex Haigh

To this effect, we - together with organisations including the royal colleges of nurses, psychiatrists, GPs, the Royal Society for Public Health, the Institute of Healthcare Management and the Institute of Group Analysis - have formed the Founders Network to try and turn the juggernaut of despair around.

A series of free listening events across the country are being held for staff who work in or around the NHS.

The first of these was held in September and attracted more than 130 delegates. Their voices, and those from other events, will form the basis of a “charter for change, which will be published in March.

Leaders need to work to restore the NHS’s self-esteem and address the causes of distress - at individual but also at an organisational level.

Stability needs to be restored, as without it the NHS cannot develop the resilience and relationships it needs to move forward.

‘Those who deliver compassionate care must also be the recipients of it’

Politicians must understand their moral duty in caring for those who care for the most vulnerable in society - ensuring that those who have to deliver compassionate care, are also the recipients of it.

This is about leaders treating the NHS as an object of desire, to be nurtured and protected, instead of one to be belittled and destroyed.

Please come and help us create a healthier NHS.

More information

Dr Clare Gerada is medical director of the Practitioner Health Programme, and Dr Rex Haigh is a consultant psychiatrist and group analyst at Berkshire Healthcare Foundation Trust