The Bristol Cable

In the 70th year of the NHS, an investigation by the Cable reveals that those who care for the nation are in need of serious attention.

Illustration: Fran Hooper

The number of Bristol NHS workers suffering from stress has soared in recent years, an investigation by the Cable shows.

Analysis of NHS data reveals that workers in the North Bristol Trust, that runs Southmead Hospital along with a range of other services, have reported a shocking 80% rise since 2010 in the number of instances of staff taking time off work due to stress-related illness. The South West Ambulance Service who operate ambulances across the region have seen a massive rise of 210%* of instances of stress related absence since 2013, while workers at the University Hospitals Bristol Trust that operates the BRI has seen a 70% increase in working days lost to stress since 2011.

Part of our series: Inside the NHS

Nhs workers, some are outlines indicating they are absent with stressRead more from this campaign.

Across the three employers, the number of working days lost to stress or anxiety has risen by 41%* in the seven years up to the end of 2017, making stress account for the greatest number of working days lost to any type of illness.

In just four years 232,141 days, or 893 working years** have been lost to stress between Jan 2014 and the end of 2017.

Though the data doesn’t show whether the stress is work-related or not, rising stress among NHS staff is widely reported in sector wide staff surveys and and as told to the Cable by staff (see below).

Bristol MPs have responded to the investigation’s findings. Darren Jones, Labour MP for Bristol North West said, “The rising number of stress-related absences of NHS workers in the Bristol area are worrying but unsurprising. The demands on NHS staff have risen sharply whilst rewards and control over work has reduced. This is a recipe for stress and the government needs to listen to these staff and invest in our most treasured public service.”

Kerry McCarthy, Labour MP for Bristol East said, “I have heard directly from constituents – who work across the health service – about the increased pressures they are facing in their jobs and the impact this is having on their own health and their family life.

“We cannot take for granted the hardworking and dedicated staff who are the backbone of our health service. These people deserve the utmost respect for working long and unsociable hours in high-pressure environments to keep patients safe. The government must do more to address the constant funding and staff shortages that have become the norm over the last seven years.”

A spokesperson for the South West Ambulance Service said, “Staff are our most important asset and staff health and wellbeing is a top priority which is why we introduced our acclaimed Staying Well Service and actively encourage staff to report incidents of stress and anxiety.”

The North Bristol Trust’s Director of People & Transformation said, “We are clear that the health of those who work for us as important as our patients’, so already have a host of measures in place to proactively support the wellbeing of our staff and are working to provide even more support. Things we offer include: wellbeing and resilience workshops, mental health awareness raising and support and mental health first aid training from Mind.”

The Director of People at University Hospitals Bristol NHS Foundation Trust said, “The Trust takes the health and wellbeing of its staff extremely seriously, and we are very concerned by this growth in absence due to stress.

“We do our best to support staff and encourage them to talk about any stress they experience and seek help. We have a support programme available which provides advice and guidance to help staff identify and manage potential causes of stress before they become a problem.”

Whatever the root causes, in the 70th anniversary of the service, it’s clear the workers on whose care the population relies are in need of serious attention themselves.

893
years

Working years that have been lost to stress across the three trusts in the four years between January 2014 and December 2017, based on an average working year of 260 days.

Percentage increase number of days lost to stress has increased for all three trusts

view full screen

Percentage increase number of days lost to stress has increased by 41% from 27,700 days in 2011 to 52,600 days in 2017

NBT & UHBT from 2011 onwards; SWAS from 2013 onwards 2017 data for SWAS & UHBT adjusted for incomplete data for 2017
view full screen

Notes on the data:

  • * These figures have been updated and corrected to reflect an inaccuracy in the data. We apologise for the error.
  • **Based on an average of 260 working days in a year.
  • All data has been adjusted to take into consideration Full Time Equivalent staff numbers.
  • The number of ‘calendar days lost’ includes all days from an absence beginning to ending, and therefore may include shifts not scheduled to be worked.
  • See the full breakdown of the analysis, methodology and raw data.


“I’m shortening my life
with every shift”

Serving and retired NHS staff speak about the situation on the ground.

A doctor working in Bristol and speaking to the Cable on the condition of anonymity warned that even this data hid the full picture. “I know very tough and capable colleagues who often throw up while at work due to overwork and stress but would be reluctant to say they’re taking time off for stress, or take time off at all.”

With firsthand experience on the front lines of the NHS, Dr Phillips* is all too aware of the pressures staff face: “If I don’t come into work today, my colleagues just have more to handle. And this is quite literally a life and death situation.” Despite being relatively new to his career, Dr Phillips is seriously considering leaving the service, and in line with analysis by the British Medical Association, observes that colleagues are “leaving in their droves”.

Catching up with Philips in a rare moment of free time, it is clear that leaving is not something he would take lightly: “Maybe I can do something more useful with my time,” he says, “because this is not what I got into medicine to do.” With at least a full working day every week unpaid and unrecorded, Phillips is tired. But it’s not just his wellbeing that is at risk. It is patient care and safety. “We’re regularly working in unsafe conditions…and stress is the death of empathy.” He adds, “I have been trained to care for people, but I’m not given the time.”

“All the trends were there
back in 2005 and 2013”

This should have been seen coming, says Nick*, a nurse in Bristol with 30 years service and a Royal College of Nursing (RCN) trade union representative. “All the trends were there back in 2005 and 2013. But things haven’t got any better, in fact they’ve got quite a bit worse”.

In the case of some NHS employers, “the attitude from management was just denial when it came to dealing with worsening working conditions,” says Nick, adding: “It was certainly my experience, with colleagues and as a union rep, that we were very much seen as a disposable commodity.”

“From the top down, the message was, ‘we know best and we’re not listening to you’.”

On one occasion, after raising the issue of working conditions and stress, Nick was told by a manager that he “could always find another job” if he didn’t like it.

For someone who has dedicated an entire life to caring for the public, this is hard to hear.Nick feels this sentiment is “a trend at times in the media, and probably coming from the government ultimately, that nurses are to blame for the NHS’s problems.”

Despite this, Nick has stuck at it, though has taken time off for stress related illness himself. One thing that helps him through is seeing his colleagues supporting each other. “But that will only take you so far, you need the right resources,”he adds.

Stress and lack of dignity at work are among a range of factors behind an unprecedented failure to fill vacancies and retain nurses across the NHS. These range from big issues such as years of being battered by pay freezes (notably not alleviated by the government’s recent offer), the removal of bursaries for nursing students who now face a full £9,000 per year in fees and the ‘Brexit Effect’, a drop of 90% of EU nurses applying to work in the NHS since the Brexit vote. To little but significant things such as staff not having time to get a drink of water for several hours, which Nick modestly describes as “a nonsense”.

The pace of change in the NHS, and how that change is managed, are also concerns for Nick, who has witnessed a management culture that seems disconnected from the realities on the ward. “We’ve had very experienced clinicians saying, ‘we’re concerned about the risk of certain changes and don’t feel this will work.’ But from the top down, the message was, ‘we know best and we’re not listening to you’.”

The pursuit of these changes by expensive management consultants has had decidedly mixed results, with researchers from Universities of Bristol, Warwick and Seville finding this year that there was a strong link between consultants and negative efficiency outcomes.

“The way the government is treating
the NHS is like an abusive relationship”

For Peggy Woodward, who worked as a midwife from 1970 until retiring in 2013, the current state of the NHS is not simply an accident or an unfortunate turn of events.

“It’s like an abusive relationship. You’re not given enough money, and when you can’t feed the family you’re punished and more money is taken away…that’s what the government is doing to the NHS.”

In her last years in the service, Peggy said,“I seemed to be working harder and harder, and given more and more paperwork to do, just to meet unrealistic government targets. I would have to go in on weekends, not saying I was coming in, just to catch up. I was doing at least 10 hours a week unpaid and unlogged. But then I decided I better leave before I have a heart attack or stroke.”

From edition 15, OUT NOW!

front cover of the edition 15thRead more from this edition.

While working, Peggy didn’t have the time to keep abreast of all the changes to the service. But once retired she started being active with local campaigners Protect Our NHS (PONHS). The group works to raise awareness of what Peggy describes as “a deliberate destruction of the NHS to get an American style insurance system”.

For Peggy, the answer to the NHS’s woes is to have a fully public and properly resourced service. She says, “most patients still have trust in the NHS, but the staff are creaking…The staff are wonderful, but there’s just not enough of them”.

Not everyone agrees with Peggy. The government and others intently argue that introducing competition and ‘efficiencies’ could strengthen the NHS for the future. The current Health Secretary, Jeremy Hunt, co-wrote a 2005 book with other Tory MPs calling for the “denationalisation” of the NHS, and the introduction of an insurance-based system.

On the other hand, patient and staff groups cite mounting evidence that years of under-funding, privatisation and mismanagement have pushed the NHS to the brink, laying the groundwork and justification for further breaking up and selling off of the service.

In the 70th anniversary year of the NHS, and while it faces such grave threats, it seems apt to remember these words, attributed to the NHS’s founder and Labour MP, Aneurin Bevin: “The NHS will last as long as there’s folk with faith left to fight for it.” There is surely a fight going on, but the question is what sort of NHS will it be? Will it be that of Jeremy Hunt, or that of Peggy and her colleagues?

If you have a story to share or expertise then get in touch at health@thebristolcable.org or just use the form below…



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