Executive Summary - British Psychological Society



4th annual NSP/DCP Leadership & Management Faculty Workforce Wellbeing Survey The findings of the 4th Annual NSP/DCP Wellbeing Survey indicate that sustainability and transformation plans in mental health will be undeliverable unless psychological staff wellbeing, capacity and retention issues are urgently addressed. ‘Fewer professionals than in previous years reported feelings of depression or failure, but those feelings remained present in over 40 per cent of respondents’.?72% of respondents did not think the service in which they worked had sufficient staff to deliver a safe and effective service. 33% respondent considered that their service has lost senior staff due to reorganisation, re-tendering, cost saving or other reasons, indicating concerns around the effectiveness of service delivery. 23% of our survey respondents are thinking of leaving NHS.? ‘Experiences of bullying and harassment and staff feeling under pressure to meet unrealistic targets?have increased’.?Wider Context:Stress and burnout in critical care staff – 33% emotional exhaustion, 44% lack of accomplishment, 12% depersonalisation and cynicism, 13.2% PTSD (Colville et al, 2016).CIPD (2018) survey of 4.8 million employees – 37% stresses increased, 86% report observing people at work who are unwell, 66% report working on leave. 12.5 million working days lost due to work-related stress, depression or anxiety in 2016/17 (HSE).The economic costs of work stress to society have been estimated to lie between 0.5% and 1.2% of UK GDP. (British Academy, 2010). ‘One in four respondents reported harassment, bullying or abuse from staff. Around one in eight experienced discrimination – and more of it came from colleagues and managers than patients and service users’. NHS survey.The survey findings within the wider context around workforce wellbeing are worrying as the Mental Health Workforce Plan sets out an expectation for the expansion of mental health workforce by 2020/21. Psychological professionals have an important role to play in rolling out of the Five Years Forward view as they are guided by what works and what the service users say they want. But can they, if the workforce capacity is not adequate. Sustainability and transformation plans in mental health will be undeliverable unless psychological workforce capacity and needs are taken seriously. Staff report feeling like a ‘small cog’ in an organisation struggling to meet unrealistic targets. ‘I feel that the commissioners are like Wizzard of Oz issuing targets without having any idea what it is like at the frontline’. ‘Because of high pressures of workload and an undercurrent of bullying, my brain sometimes turns to scrambled egg at work and it is difficult to think clearly…it is toxic’. These results ask for an urgent action with a spirit of collaborative effort and meaningful engagement with the workforce issues. We know that workforce wellbeing and engagement is linked with enhanced quality, productivity and users experience. Unless this is taken seriously, sustainability and transformation plans will be at risk. The system is not broken but is close to a breaking point. It is not too late. There are many examples resilience, good practice and excellent contribution psychological practitioners are making. The Mental Health Workforce Plan offers opportunities to develop adequate capacity and an enabled, flexible and adaptable workforce to deliver on the Five Years Forward View vision on integrated care across the priority areas alongside emphasis on productivity through quality and workforce wellbeing. Psychological professionals skill set provides a great opportunity to meet this ambition. BUT this requires urgent attention to workforce wellbeing and meaningful engagement with what our staff are telling us. DCP is playing its part in raising awareness, inviting collaborative working and offering its support for shared learning. Leadership & Management Faculty is working with New Savoy Conference and London School of Economics to take forward the work for its Collaborative Learning Network. See Executive Summary below for further details. Executive Summary1. Workforce Wellbeing SurveyThe 2017 Wellbeing Survey included the new Psychological Practitioner Workplace Wellbeing Measure (PPWWM) comprising of 26 questions around wellbeing at work. The Short Warwick Edinburgh Mental Wellbeing Scale was included as a population measure of wellbeing. Demographic, professional and work questions were included. To enable continuity between the new and the old surveys, two questions from the earlier surveys were included on feelings of depression and sense of failure. Questions on bullying and harassment were also repeated. Participants were asked two new questions relating to service delivery. Participants were also asked about their views on continuing employment with the NHS as well as career opportunities within their organisation. The survey was made available online between December 2017 and February 2018. Snowball sampling was used to promote to participants. There were 1678 participants.2. Summary Key Findings:Highest ever participation rate – 1678Most respondents worked for the NHS, are white females aged between 35-44 yearsRelatively lower numbers reporting feelings of depression and feelings of failure compared to previous years but they remain over 40% of respondents.More anxiety & depression in qualitative comments with many reference to threat driven systemWorkforce issues centred around high demand, target driven culture, impact of deletion of senior posts and adequate staffing to deliver safe and effective services.Confidence in staffing levels was low with 72% of respondents saying they did not think the service in which they worked had sufficient staff to deliver a safe and effective service.One in three respondents said the service in which they worked in had lost senior staff and this had contributed to a loss of confidence.The new Psychological Practitioner Workplace Wellbeing measure indicated more positive ratings around clinical supervision compared with the physical environment.?More people reporting being accused of bullying and harassment.A decline in people reporting bullying/harassment by managers.Those who worked in the NHS were asked how often they wanted to leave in the past 12 months.? 23% said once or twice a week or almost every day with 23% saying once or twice a month.?3. Survey Findings 3.1. Demographics80.3% femaleMost common age range was 35-44 years (28.7%) Most frequently selected ethnic background was White (88.8%) Most participants identified as heterosexual (88.7%) 17.1% responded positively to ‘Do you have a long-standing illness, health problem or disability?’ 3.2. Professional and Work CharacteristicsClinical psychologists formed the largest proportion of respondents (48.5%) followed by Cognitive Behaviour Therapists (17.9%), Psychological Wellbeing Practitioners (13.5%) and Counsellors (5.7%).Over 50% of respondents were within 10 years of qualification. Most had been in their posts for up to 5 years (62.3%).95% of the respondents responded Agenda for Change as their main salary scaleThe primary employer for most was the NHS (88%) and most were on permanent contracts (86%)Most respondents (56.4%) worked close to full-time hours (30 to 37.5 hours per week)Fewer than 10% reported paid overtime or bank work. 28% of the respondents said they did not undertake unpaid overtime or additional unpaid hours. 58% reported working up to an additional 5 hours unpaid with 12% working 6 to11 hours and 2% working over 11 hours unpaid extra per week3.3. Workplace WellbeingSix factors (Professional and Organisational, Support and Flexibility, Professional Role, Physical environment, Clinical Supervision, External Personal) on the new PPWWM were investigated. Mean score was 92 out of a maximum of 130. Higher scores indicate better wellbeing at the workplace. Mean scores on the factors had a minimum possible score of 1 and the maximum of 5. The Physical Environment and Professional & Organisational factors came out to be areas of concern as they were scored the lowest at 2.9 & 3.1 respectively. 43% of the participant indicated that they had felt depressed Some of the time or more frequently over the past week. No significant difference was found between 2015 and 2016 nor between 2014 and 2017. Reported levels of feeling depressed were higher in 2015 and 2016 compared to 2014 and 2017. 42% of the participants had felt like a failure over the past week Some of the time, Often or all the time. The reported feelings of failure were higher in 2015 with significant differences found between 2015 and all other years (2014, 2016, 2017). No significant differences were found between any of the other years. 3.4. Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS)The mean score on the SWEMBS was 22.2 with the population norms for England standing at 23.61, indicating significantly lower reported levels of mental wellbeing.3.5. Experiences at Work28.0% reported bullying and harassment from patients, service users, their relatives or other members of the public more than once in the past 12 months. 3.8% said they had been accused of bullying and/or harassment.6.3% reported experiencing discrimination in the past 12 months from one or more of the patients/service uses, their relatives or members of the public. Most frequently cited reasons were gender, age and ethnic background. If respondents were employed in the NHS, they were asked how often in the past 12 months they had wanted to leave. Responding Once or Twice a week or almost every day was indicated by 23% with a further 23% indicating they thought about this once or twice a month. 25% responded saying they had never thought about it. 33% respondent considered that their service has lost senior staff due to reorganisation, re-tendering, cost saving or other reasons, , indicating concerns around the effectiveness of service delivery.72% of respondents did not think the service in which they worked had sufficient staff to deliver a safe and effective service. 50 % of the participants felt that their organisation acted fairly with regard to career progression in relation to ethnic background, gender, religion, sexual orientation, disability or age. 12% said No and 38% said Don’t know. 4. Comparisons across the four surveys (where applicable)Demographic and Professional CharacteristicsNo significant differences were found by year on gender, sexual orientation, age in the past two yearsReported long-standing illness, health problem or disability significant increased from 2014 to 2015 but has decreased since although not to levels found in 2014. There appears to be an increase in non-white groups completing the survey over the four years from 8% in 2014 to 11% in 2017.There was an increase in the percentage of clinical psychology respondents.An increase in higher bands was found in the most recent surveys which may reflect the greater numbers of clinical psychologists completing the survey.Variation in employer was found over the years but the most commonly reported employer remained the NHS. An increase in working 30 to 37.5 hours was found in comparing 2016 and 2017 where the categories were the same. No significant differences were found for paid overtime or unpaid overtime. 4.1. Workplace WellbeingHigher levels of reported depression were reported in 2015 and 2016 compared with 2014 and 2017. Higher levels of feelings of failure were found in 2015 with significant differences found between 2015 and all other years. No significant differences were found between other years. 4.2. Bullying and HarassmentHigher scores for experiencing bullying or harassment were found in 2015 compared with 2014, 2016 and 2017. The percentage numbers reporting being accused of bullying and harassment has increased (4.1% in 2017 compared to 1.2% in 2014) significantly in the past four years although the numbers are still small. The figures in 2015 and 2016 were 2.2% and 3.5% respectively.4.3. Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS)Scores on the SWEMWBS were better in 2017 than 2016. 5. Qualitative FindingsPreliminary data scan has highlighted the following themes. Target driven cultures is still at the topLess depression more stress and anxietyCuts to resources impacting leadership posts, CPD and delivery on activityLack of leadership/management engagement?& containment More reporting on sickness, health and personal losses?Higher expression of wanting to leave NHS earlier in career and lack of career progressionPosts being down bandedMore on threat focused system- complaints,?grievances, culture of fear & threatAcknowledgement of dual status & of personal?vulnerability.Distinction drawn between work?related & personal stressComment on self care encouraged BUT productivity IdealisedA few negative comments on the design of the questionnaireQuotes from respondents: ‘Because of high pressures of workload and an undercurrent of bullying, my brain sometimes turns to scrambled egg at work and it is difficult to think clearly. You cannot complain about work pressures - that is taken as a sign that you are unable to manage your work-load. You are expected to achieve an unachievable work load but if you work over and above your hours you are seen as inept for not getting the job done in the time available. It's toxic’.‘I sometimes feel I am a small cog in an organisation struggling to meet their unrealistic targets’.‘IAPT seems to have become the dumping ground for all things mental health. People are foregetting we only see mild-moderate cases. Very rarely do you see/work with that on a day to day basis’.‘I feel that the commissioners are like Wizzard of Oz issuing targets without having any idea what it is like at the frontline. Additonally we are penalised if our patietns do not recover but are asked to work with complex patients we know are not going to recover within what we are allowed to offer. To survive many staff are resorting to data manipulation. It is demoralising. We are ticking the boxes rather than focusing on helping people. I am planning to leave’.‘It is a wonderful experience working in my current role and most of my time is spent seeing patients. This is a key factor in enjoying the work I do and this enjoyment is heightened by the recovery rates I achieve. The environment that is provided in term s of management enables me to do this - I just can not fault them - approachable, supportive and we can also have some fun. A great recipe for enjoying work’.I have worked within the NHS for 28 years, …..Never before have I felt so demoralised, not to mention anxious & depressed (on anti-depressants for the 1st time) as I have since IAPT was introduced. The focus is on the stick approach to meet targets and not the developmental 'carrot' approach to improve skills to meet patients' needs…. …… I feel like a production manager in a human factory’.‘I really enjoy my role in IAPT and feel very supported. My service puts lots of thought and action into supporting our wellbeing’.‘I feel I've managed to look after myself by changing role and reducing hours but continuing to witness the deleterious impact of NHS pressures & dominant political attitude on communities, service users and colleagues is distressing and I feel that impacts us all’.‘It's good to see increasing recognition and initiatives around practitioner wellbeing etc however I feel significant stigma remains within our professions which makes it harder for such issues to be recognised or resolved. Prevention would be far better but given we have a psychological workforce now significantly stressed and vulnerable, there needs to be some active push back to management and government, and adequate supports put in place’.‘The lack of respect for clinical expertise and advice inevitably impacts severely on the mental wellbeing of staff. This is an inevitable symptom of the management culture in the NHS which, as far as I can see, has brought no benefits for patients or staff. This deteriotion in staff wellbeing has led to chronic difficulties around recruitment and retention, but these systemic issues remain unaddressed and are even worsened by ongoing management decisions which directly contradict clinical opinion. In this environment, why wouldn't clinicians be de motivated and depressed?’‘ ….PWPs are often treated as second class citizens by managers and CBT Therapists, even though they are specialists in assessment and undertake the vast majority of clinical work in IAPT. The NHS is very punitive towards its workforce. It is also riddled with inconsistency, mismanagement and corruption at managerial and directorship level. It does not care for its workforce’.Amra Rao & Jeremy Clarke - Co-chair Wellbeing Steering Group- NSP & BPS Wellbeing InitiativeWellbeing Steering Group Members – Gita Bhutani, Neelam Dosanjh, Esther Tovee Cohen, Adrian Neal.14th March 2018Contact: Amra Rao – Psychologicalhorizons@ ................
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