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The NHS tops the league table for workplace stress. Staff and patients deserve better.

Roger Kline, 2 May 2013

The recent tragic death of Helen Mann, a Worcestershire primary school head teacher who committed suicide after a period of work-related stress, should be a reminder to us all that teaching, health and social work are the three sectors with the highest levels of stress in the UK.

Work-related stress is defined as a harmful reaction that people have to undue pressures and demands placed on them at work. The latest figures for 2011/12 are shocking.

They show that 1.1 million working people suffered from a work-related illness, with 10.4 million working days lost. What is worse, the number of NHS staff reporting stress through the NHS survey has risen, a fact hardly mentioned.

The Labour Force Survey (LFS) conducted by the Office for National Statistics reports that the prevalence (total) and incidence (new) of cases of work-related stress have remained broadly flat over the past decade.

Moreover, the total number of cases of stress constituted 40% of all work-related illnesses across all sectors:

  • Occupations reporting the highest rates of total cases of work-related stress (three-year average) were health professionals (in particular nurses), teaching and educational professionals, and caring personal services (in particular welfare and housing associate professionals);
  • The main work activities attributed by respondents as causing their work-related stress, or making it worse, were work pressure (tight deadlines, too much work, pressure or responsibility), lack of managerial support, and work-related violence and bullying;
  • On average, each person suffering from this condition took 24 days off work. This is one of the highest average days lost per case figure amongst the recognised health complaints covered in the LFS.

The NHS figures are equally shocking and have implications for the quality and safety of patient care.

The number of NHS staff reporting they had suffered from work-related stress rose sharply in 2012 to 38% from 29% in 2010 and 30% in 2011.  It was highest among staff in ambulance (46%) and mental health trusts (42%).

And only today the British Medical Association (BMA) reported that its Cohort Doctor Study, which tracks the career progress of 430 doctors who qualified in 2006, found 34% of newly qualified GPs stated they had ‘high’ or ‘very high’ work-related stress.

The NHS 2012 Staff Survey results showed correlation between problems experienced by staff and the causes of stress as reported in the LFS:

  • under a third of staff (30%) feel that there are enough staff to enable them to do their jobs properly;
  • one third are not satisfied with the support they get from their immediate manager;
  • a quarter reported they had experienced bullying, harassment or abuse from either their line manager or other colleagues;
  • only one third felt that communication between managers and staff is effective.

Some trusts are getting it right. Too many are not. If we are to move to an open, transparent, learning culture then we have to start by acknowledging and discussing what is going on here, since the work of Michael West and others demonstrates that a workforce that is valued and looked after provides better safer care.

So what can be done? A good start would be for every trust to “drill down” into its own stress, workload, management, and bullying data to identify specific causes and dangerous departments, and to do so jointly with staff. The HSE Management Standards helpfully define the characteristics, or culture, of an organisation where the risks from work related stress are being effectively managed and controlled.

The Management Standards cover six key areas of work design that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence, the primary sources of stress at work. These are:

  • Demands – including issues such as workload, work patterns and the work environment.
  • Control – how much say the person has in the way they do their work.
  • Support – including the encouragement, sponsorship and resources provided by the organisation, line management and colleagues.
  • Relationships – including promotion of positive working to avoid conflict and dealing with unacceptable behaviour.
  • Role – whether people understand their role within the organisation and avoidance of conflicting roles.
  • Change – how organisational change (large or small) is managed and communicated in the organisation.

If the HSE stress survey or a local adaptation is undertaken, and then discussed and acted upon in an open way, that might well start to identify some causes and some immediate areas of change that are needed. The Francis Report makes such inquiry and action a precondition for better and safer care.

Too many NHS staff are damaged by unnecessary stress. Helen Mann’s untimely death should be a wake-up call to all in the public sector professions.

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