21 October 2022 – NED webinar – Happy staff for safer services

This week’s session opened in conversation with Lynne Hunt, chair of Southern Health NHS Foundation Trust.

Lynne said: “During Covid and post-Covid we saw severe exhaustion, pain and trauma in our staff. The difficulty of turning up for work every day, the difficulty of soaking up all that emotion on a daily basis. Of course people who work in health services deal with death and trauma and difficulties all the time but when it comes at you in mammoth waves, tsunamis of trauma and all you can do is just about cling on by your fingertips, we’ve got to try to understand the psychological impact on individual people.

“These are not easy jobs. A shift in Lidl will never be like a shift on a ward. Not only would you never get the highs, but you certainly wouldn’t get the lows. And we don't take enough account of that as boards – about what systems we put in place for psychological health and wellbeing.

“Be visible and look at the data. In your sub-committees you might want to do some deep-dives around where you’re seeing a number of incidents coming out of a ward, or a number of safeguarding concerns coming out of a ward. I think executives are rather good at presenting papers to us that are quite linear – this is the safeguarding data, this is the seclusion data, this is the Mental Health Act data – when actually what you might want to do is something that says let’s cut across it this way and look at where we’ve got a number of concerns and target supportive visits, not to catch people out but just to talk to service users, who are phenomenal at being able to tell you how things are. Spend time with people, talk to staff – particularly junior staff – and find out how it’s feeling for them. What are they really struggling with? Be interested, be curious, dig deep, go and see for yourself.

“The Mental Health Act is incredibly powerful. It deprives people in the most draconian way of even day-to-day liberty. The Mental Health Act review managers who work on behalf of the board are the eyes and the ears from the top of the organisation straight to the bottom with the most valuable insights into do our staff know our patients? Are they writing significant reports that are helpful and detailed? Do they take regard of the fact that the person has lost their liberty? And are they working with them to continue to build that human being into the best human being they can be in difficult circumstances? Are they working closely with the family? Are they looking to discharge plans? Is there a sense of optimism in the care we’re giving to patients or are they simply detained in this long-term situation with no rights?

“It’s a really good idea to think about the structures you have in your organisation for staff to get psychological support for the work that they do. Where is the safety net that protects people – that doesn’t leave people going home from work exhausted and crying and then having to come back the next morning to try and go again?

“You get lots of assurance in boards around numbers, around training programmes and whatever else but when you’re working with staff with hands on the patients, are they getting the right kind of supervision – I don’t mean professional supervision, I mean psychological supervision – to be able to do the work that they do? It’s really difficult looking after people who have sexually abused children. It’s really difficult finding love in your heart for them. It’s really difficult working with them with kindness and compassion. But people do it. These are unusual human traumatic circumstances in which people find themselves and they do it with love and kindness and all the things you would expect. But they can’t keep on soaking it up without support.

“Assurance drives me crackers. Everybody’s seeking assurance – some sort of positive statement that everything’s ok. I think that’s the worst thing that’s ever happened. What you really want is some sort of reality-based discussion. I think for our staff sometimes it feels like the only story they can give is a good one because somebody’s looking for assurance and nobody wants to hear that everything isn’t right. It’s quite difficult for them when they feel lousy sometimes and they’re struggling to maintain really strong, positive therapeutic relationships and they’ve got to go around assuring everybody that it’s all ok. I think we need to find a different language for them. At the board we can talk about assurance but that’s probably the only place. The rest should feel a bit different; the rest should be more tender to our staff and listen to their stories in the way they want to tell them.

“If you’re out and about and you walk into a ward, where are people and what are they doing? What’s the place like? Is it beautifully noisy, with people playing instruments and having fun and singing, or is it just noisy and chaotic? When you speak to the staff, see how welcoming they are, see how much time they can give you, what things they talk to you about. Talk to service users, receptionists and domestics and people serving food – they’re a really vital part of how things work. Then you should probably write a report, then if you’re a NED in my organisation I’d say send it to me and the medical director or director of nursing. Make it balanced but definitely raise what you see. And follow it up too. Because just through your intuition you might pick up something important."

Also overheard during the session:

“Assurance is a great tool when understood properly. It clearly is not performance. We are sometimes the makers of the isolations as we try to alienate the work of the committees, instead of doing cross-fertilisation and cross impact assessment. A key element of assurance is observations – how much time and resource we allocate to the boards to learn techniques of observations. The walks are amazing but sometimes seen as us becoming our own CQC.”

“We must remember that our Health Service is provided by people. Treating them like family helps them to treat others like family. Treating them like an expense to be exploited is a message that tells them that they are not respected and those that are not burnt out will leave.”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk