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Caring for who? The Covid impact on CPs

21 May 2021

The impact of Covid on families is rightly being put under the spotlight. But what of the pandemic’s toll on those who care for them, particularly community practitioners? Journalist Helen Bird explores the effect on CP wellbeing and the support available.

Have healthcare workers had enough? A recent poll of more than 1000 NHS staff suggested that large numbers of staff are actively considering their future career: 29% of nurses, health visitors and midwives are more likely to quit their job than a year ago due to unhappiness about pay, physical exhaustion and frustration over understaffing (Patel and Thomas, 2021). This is equivalent to approximately 100,000 nurses and HVs saying they are likely to leave their job after a year of struggling with the Covid-19 pandemic.

And in a Unite survey, cited in its evidence to the NHS Pay Review Body (NHSPRB), 85% of members in England, including HVs and school nurses, reported experiencing workplace stress over the last 12 months. One HV said: ‘Increased levels of stress and responsibility does not reflect the rubbish take-home pay! No amount of happy clapping pays the bills. Cannot wait to leave the NHS’ (Unite, 2021).

Other pandemic-related concerns included isolation, home-working and social distancing. As the crisis continues, one year on it seems the toll on healthcare professionals in general (see page 10 for more surveys), and community practitioners (CPs) in particular, is only just coming to light. But what are the issues you have been facing?

Burning out

‘It’s mainly to do with fatigue,’ says Colenzo Jarrett-Thorpe, national officer for health at Unite, speaking of the calls the union is receiving. ‘Caseloads are rising, there are too few HVs and CPs – especially in England, where numbers are plummeting. That is having a profound effect.’

It’s worth noting that 79% of HV members reported staff shortages over the last year in Unite’s survey, while almost three-quarters said that morale and motivation in their workplace was worse, or a lot worse, than the previous year.

One HV, in Unite’s evidence submitted to the NHSPRB, said: ‘I personally have worked harder this year, with the impact of Covid on families and priorities within the team.I will continue to work harder as the impact of lockdown on the behaviour, mental and emotional health of children up to four years becomes more fully known. Already, I have a much fuller workload of toddlers than at any other time in my career’ (Unite, 2021).

‘They’ve had enough,’ Colenzo adds, ‘and after the year they’ve had, it’s going to have a big drain on their spirits. So wellbeing is a key issue for many of our members.’

The ‘superhero narrative’ that surrounds healthcare professionals, particularly during the pandemic, could be exacerbating the problem, says Khadj Rouf, a consultant clinical psychologist and chair of Unite’s applied psychology organising professional committee.

The media and public hailing of NHS staff as superheroes was well intended, but has had unintended consequences, she says. ‘Of course, superheroes don’t need to eat, sleep, rest – all of those biological needs that ordinary people have. As health professionals, we’re often in “doing” mode, which is of course very important, and it’s also very important to bracket off and boundary yourself at work. But there comes a point where that can have a downside if it means nobody talks about when they’re struggling, because it’s human to struggle.

‘A lot of healthcare workers are trained to be occupationally self-reliant, and that can mean it’s very hard to reach out and ask for help if you need it.’

 

 

Guilt-ridden

And it’s likely that other psychological phenomena are having a detrimental effect on worker wellbeing, Khadj suggests. The notion of social comparison and ‘ranking’ of experience, for example, could also be contributing to the reluctance of staff to open up.

One result of comparing yourself to other people and other colleagues, she says – particularly those you perceive to have had a worse experience than you during the pandemic – is to feel guilty: ‘I’ve got no right to feel the way I feel.’

‘But this pandemic has hit everybody. And it’s okay to say that it’s been tough, because it has been really tough,’ Khadj adds.

The sense of guilt may not stop there: a concept known as moral injury, which is touched on in an article looking at the psychological impact of Covid-19 on healthcare staff (Lloyd-Williams, 2021), could be at play.

‘People come into health work because they care deeply about wanting to help others. And when that is compromised, because there isn’t enough resource, they’re overwhelmed by demand on that service. They may feel they could not offer their best, when really they have, but have been working in very tough circumstances,’ Khadj explains.

‘Because of the shortages, a number of staff don’t feel they’re able to carry out their duties and provide the service they should be providing,’ adds Colenzo. And for many CPs this is surely inevitable under the weight of safeguarding responsibilities without full access to clients’ homes.


Staying strong

According to clinical and counselling psychologist Khadj Rouf, the three key ingredients for a healthy landscape psychologically are:   

  • Paying attention to the building blocks of your biology – everyone needs to rest, eat, sleep and take regular exercise.   
  • Have social connections – our social relationships can really protect us from ill health.   
  • Doing things that are personally meaningful to us – this can be singing, walking, staying connected with nature and so on. These activities give us value, joy and hope.

Contactless culture

The word ‘community’ is baked into CPs’ roles, yet the pandemic has deprived them of face-to-face contact with both clients and colleagues. Working from home has continued for longer than many anticipated, and the resulting sense of isolation is palpable: Unite reported to Community Practitioner an increase in members calling its representatives simply ‘for a chat’.

Colenzo confirms it is one of the reasons the union launched its coronavirus crisis helpline during the first lockdown (see Resources), ‘where people could do just that – engage with the service’.

But what are governments and employers doing to support staff wellbeing during the extended period of home-working? ‘I think employers are doing the best they can, because they’re hamstrung by the circumstances,’ says Colenzo. ‘In terms of wellbeing support, health services across the UK have provided wellbeing helplines and opportunities for staff to get help (see Resources).’

Professor Amanda Croft, the recently appointed chief nursing officer for Scotland, says the resources introduced for staff in Scotland – including a wellbeing hub and 24/7 helpline – ‘have been welcomed and well used, with more than 82,000 visits’ to the hub since its launch in May last year.

And it’s important not to lose sight of the positive changes to services that the restrictions have necessitated, argues Amanda. ‘Many services have innovated and adapted to the pandemic, and we can learn from, and hold onto, much of that innovation – such as digital and online services – without losing important face-to-face services where needed.’

29% of nurses, HVs and midwives are more likely to quit their job than a year ago due to unhappiness about pay, physical exhaustion and frustration over understaffing

Offsetting the crisis

When it comes to long-term solutions to improving CPs’ sense of wellbeing and preventing those considering quitting from following through, where does responsibility lie? Government initiatives and adequate funding are surely key as restrictions ease and services are increasingly expected to return to ‘normal’.

‘The welfare of the workforce cuts across every aspect of remobilisation planning,’ Amanda says. ‘We will continue to listen to and understand the changing needs of staff through our wellbeing champions, a dedicated mailbox for direct staff feedback, and by other means, as we work to build a sustainable culture that will continue to prioritise wellbeing in the future.’

Compassionate leadership from employers is important, says Khadj. ‘It’s not a doom-laden scenario. There’s a lot of discussion about empathy and creating more helpful spaces for staff to be able to connect with each other and talk about what they need.’

But, she adds, talking is only one aspect. ‘The organisational structure has to feel psychologically and physically safe enough to facilitate that. That means a really psychologically informed workplace, with proper understandings of how people work optimally, and well-supported supervision, reflective practice and wellbeing.’

Colenzo also urges members to report their concerns. ‘If they’ve got issues in the workplace about safe staffing and the quality of services they provide, they’ve got to stand up and speak out. We need more people to contact their local Unite office. And I need to be an effective voice for the services CPs provide, because they’re invaluable and the glue that keeps communities together.’ 


Resources  


References:

Lloyd-Williams K. (2021) Nobody is a superhero. The Psychologist. See: https://thepsychologist.bps.org.uk/nobody-superhero (accessed 7 April 2021).

Patel P, Thomas C. (2021) Recover, reward, renew: a post-pandemic plan for the healthcare workforce. See: https://www.ippr.org/files/2021-03/recover-reward-renew-march-21.pdf (accessed 7 April 2021).

Unite. (2021) Unite evidence to the National Health Service Pay Review Body (NHSPRB) 2021-22. (Supplied by Unite)

Image credit | Shutterstock

 

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