INVESTIGATION: Why frontline hospital staff seeking mental health support is rising

Story first published in the Western Morning News and broadcast on ITV Westcountry, December 15th, 2018

The number of hospital staff across the Westcountry – particularly in Cornwall – seeking mental health support has risen dramatically prompting a Royal College of Nursing director to warn that increased demands on front line staff are impacting on their wellbeing.

One nurse has described how there are increased pressures facing hospital staff in recent years, citing understaffed wards and bed blocking as chief stress-inducing factors, offering a possible insight into why more and more staff are seeking support.

Figures revealed via a series of Freedom of Information requests (FOIs) show that the number of hospital staff members across Cornwall and Devon accessing their hospital’s in-house staff support and counselling services is increasing.

The regional director for the Royal College of Nursing said that demands from both the government and society for nursing staff to do “more for less” is having a “devastating” impact on the mental wellbeing of nursing teams across the NHS, while the regional organiser for UNISON said that increased workloads are having a “severe impact” on front line hospital staff’s work-life balance.

At the Royal Cornwall Hospitals NHS Trust and the Cornwall Partnership NHS Foundation Trust, the number of staff accessing the staff support and counselling service has risen by more than four times between 2015 and 2017.

Despite repeated requests for a comment, the media team at the Royal Cornwall Hospitals NHS Trust, which also provides the service to the Foundation Trust, failed to respond. As part of the FOI, however, the Trust confirmed that the stark rise can be attributed to changes in the staff population, increased availability of the service and increased awareness of the service.

Data also showed that work related stresses, as the reason given for staff seeking support, had fallen. However Karen Williams, regional organiser for UNISON, said that although staff may be accessing their counselling support service for general anxiety or depression, or for coping with a family breakdown, which may be recorded as a non-work related matter, increased pressures in the workplace may have been the cause or play a part. She has praised efforts made by hospital trusts to encourage staff to seek support.

A spokesperson for the Partnership Trust said that the Trust “actively encourages” staff to speak out if they are facing mental health pressures and has seen a “positive rise” in staff accessing its Staff Support and Counselling Service. The spokesperson added that there has been a decline of staff accessing the service for work related stress.

But David Hope, a nurse at West Cornwall Hospital in Penzance who has been in the profession for 12 years, says he and his colleagues are facing a multitude of challenges and pressures as a result of austerity measures and strains on both the health and social care sectors in recent years.

“Most of my colleagues have accessed the staff mental health service, and many have been off with stress at some point, including myself,” says the 70-year-old. “We’re so understaffed, sometimes it feels like a survival test overnight. We’re seeing more and more occasions when there’s only one nurse covering a night shift looking after a ward with 28 people on it.

“We’ve seen a big increase in dementia patients on the wards over the years and when you have a large number of patients with dementia, things can go wrong very quickly. Recently, we had a gentleman who had an episode of paranoia in the night and was taking swings at us with his walking stick, while in the next bay a lady got out of bed, knocked a dressing off and was bleeding profusely, and then another got out of bed and took all her clothes off. Sometimes dementia patients can be violent at times, and recently I was kicked in the face and cut by someone’s toenail.

“You can see your colleagues slowly deteriorating,” he added. “Many of them aren’t sure they can keep this up, and this is a real concern given the struggle to fill vacancies and because we are losing nurses because of Brexit.”

The NHS is struggling to fill thousands of nursing vacancies each month. The most recent data obtained from NHS Digital reveals that for March 2018, nationwide there were at least 11,483 nursing/midwifery advertised vacancies out of 28,998 and in the South West there were at least 568 nursing/midwifery vacancies out of 1,947. In Cornwall, there were 13 nursing/midwifery vacancies out of 82 vacancies, 44/149 in Plymouth, 46/155 at the Royal Devon and Exeter Hospital and 10/69 in North Devon.

Officials have also warned that the government’s decision to remove the £9,000 bursary for nurses and midwives in 2017 – in the hope that this would allow more nurses to be trained – has made the situation worse, with applications falling.

Bed blocking, or delayed transfer of care (DTOC), is another worsening issue impacting on the morale of staff and patients. DTOC refers to the number of patients who are well enough to be discharged but who can’t be moved on due to various factors such as the difficulty in finding beds in community hospitals or in residential or nursing homes, or arranging home care packages.

According to the latest figures released by NHS England, in September, at the Royal Cornwall Hospitals NHS Trust there were 1,322 delayed days and at the Cornwall Partnership NHS Foundation Trust, there were 1,643 delayed days. In Devon, at the Royal Devon and Exeter NHS Foundation Trust there were 1,504 delayed days, while in Plymouth there were 957, in Torbay 436, and in North Devon 220 delayed days. The wait for non-acute NHS care, nursing or residential home placements or home care packages were the greatest reasons for the delay.

“We’re seeing delays in assessment, fewer carers in the community and patients getting stuck in hospital,” David continued. “When there is a delay in patients leaving, they start relapsing and become ill again. And we know that the longer someone is in hospital the less likely it will be that they will have a successful discharge. We’re seeing an increased amount of patients dying in hospital.

“We’ve had patients in for many months, this leads to low morale all round, particularly when we can see people getting better.

“We’re having to entertain those patients who are medically fit to leave while caring for those alongside them who are very unwell.”

According to the Royal College of Nursing, since 2010, as a result of below-inflation increases for seven years, wages have decreased by 14 per cent. The government introduced a one per cent pay increase in April but with inflation at 2.3 per cent, in real terms this amounts to a pay decrease.

Another nurse, who wanted her identity to be protected, said: “We work 12.5 hour shifts and due to increased workloads it’s hard to find time to take a break. It’s always been the case that nurses struggle to take breaks because of their sense of duty of care towards patients. It’s this which is keeping the NHS going.

“And there’s definitely less respect for nurses among the general public. This could be the blame culture that’s prevalent now. It seems expectations have gone up and there is an attitude that the NHS is there to serve them.”

Elsewhere across the region, at the Northern Devon Healthcare NHS Trust which is responsible for the North Devon District Hospital in Barnstaple, the number has doubled.

At Plymouth’s Derriford Hospital staff accessing the hospital’s occupational health and wellbeing service has risen by 30 per cent in three years. A spokesperson for the Trust confirmed that its Occupational Health and Wellbeing Department offers a “comprehensive” counselling and mental health service to all staff which includes a duty counsellor, counselling sessions, a drop-in counselling service and assessments and training for line managers to support their staff.

There has only been a small increase at the Royal Devon and Exeter NHS Foundation Trust which looks after the Royal Devon and Exeter Hospital, which extended its Staff Support and Counselling Service to community hospitals at the end of 2016.

Numbers appear to have remained relatively constant at Torbay Hospital, which was only able to provide data from August 2016 when the service was contracted out to private occupational health provider, Optima Health.

Susan Masters, Regional Director for the Royal College of Nursing, said: “Increased acuity of patients, reduced staffing levels, increased demand on services and low morale are having a devastating impact on individuals working in health care, not least the nursing staff.

“In our recent survey 63 per cent of members said they were too busy to provide the level of care to patients that they wanted to. This has a profound effect on individuals whose whole career is about caring for others.  Add to this the fact that they have much higher caseloads of much sicker patients, with vacancies unfilled and it is no wonder the pressure is showing.”

UNISON’s Karen Williams said following austerity measures brought in by the coalition government, the union has witnessed workloads increasing and members experiencing increasing demands put upon them. “Workloads have become higher as the workforce becomes lower, and our members have been working harder for less,” she said. “We’ve witnessed a more punitive approach to sickness management, so often our members, even those with specific health conditions or who need surgery, are still finding themselves subject to a sickness management process – effectively condemnation for taking time off for being ill.

“However we are pleased to see a much more positive approach by employers towards encouraging people to look after their mental health and wellbeing as well as their physical wellbeing.”

A spokesperson for the Cornwall Partnership NHS Trust, added: “Working within the NHS is an incredibly rewarding career, although it can also be challenging at times.

“Recognising this, we strive to create an environment where our staff can take positive steps to access support when they feel concerned for their mental health.

“Our dedicated Health and Wellbeing team work closely with staff across the Trust to ensure that they are able to access the support available to them. In 2018 we expanded the team by a further two Health and Wellbeing Leads, who can work to support staff in all aspects of their life, including physical and mental wellbeing.

“We actively encourage our staff to speak out if they are facing mental health pressures and we have seen a positive rise in staff accessing our Staff Support and Counselling Service over the last three years, often seeking help following bereavement, ill health and personal stressors.

“Additionally, we have seen a decline over the last three years of staff accessing the service for work related stress, including an 11% decline in 2016, when the Trust doubled its size and staffing numbers.”