Published: 27/05/2004, Volume II4, No. 5907 Page 34

The poor availability of counselling is robbing the NHS of functioning staff, says Beverly Malone

NHS human resources frameworks for England and Scotland specify that counselling for staff should be provided.The Royal College of Nursing surveyed 550 acute trust HR directors from across the UK and the findings - published in the report Counselling Service Quality - give an impression of a national structure.

However, we found significant variations in the availability and resources given to running and evaluating counselling services.Staff who seek counselling are often in a vulnerable state and may need prompt access to quality services. It appears that we are not applying the same standards to aspects of staff care as we do to patients, particularly in the way we respond to their psychological health needs.

Some of the data is very encouraging - for example, most counsellors were suitably professionally qualified, supervised and supported to deliver services.Services also rate themselves strongly in determining the suitability of clients for counselling - generally short-term - and for onward referral if appropriate.

Nearly two-thirds of services fail to meet the NHS Executive's recommended resource level of one full-time counsellor per 2,000 staff.The range of target waiting times between referral and first appointment - against the RCN's recommended five to 10 days - varies between immediate access and 42 days.Against this backdrop, the proportion of staff who use counselling services as a percentage of staff employed by the organisation varies from 0.3 per cent to 28 per cent.

However, some respondents report poor availability of specialist help, such as addictions and eating disorder services, and only 56 per cent of counselling services said they were able to refer to specialists.There is evidence of an enormous variation in the average waiting time from referral to first appointment of two to 52 weeks.

The report, which is now on the RCN website, provides a resource for any health service employer or counselling service provider to compare their own service provision confidentially and anonymously against a set of national service characteristics.

Trusts that have poorly resourced services with waiting lists running to months, or those that are poorly perceived by staff (with low uptake as a result) must give this priority.

From the RCN's own counselling service evaluation data, it is clear that many clients - also health service employees - have high levels of distress and poor subsequent performance, and may be on sick leave for weeks or months.Quite simply, the NHS cannot afford to have staff either off work or under-perform where counselling could make a difference.Staff deserve better, and so do patients and employers.

Dr Beverly Malone is general secretary of the Royal College of Nursing. www. rcn. org. uk