How Covid increased work-related stress in the NHS

This April marked Stress Awareness Month. As we emerge from the third wave of the Coronavirus, the health system is under visible strain. While the number in hospital with Covid-19 is now, mercifully, lower, it was reported this month that waiting lists are now at the longest they have ever been. The increased backlog that has built up looks set to challenge the system for many years to come. Workload in the NHS – never low before the virus hit – is higher than ever. Reports of burnout from professionals who have already borne the burden of the pandemic are common.

In this context the release of the NHS staff survey data in March gave us a snapshot of morale that we may not find surprising. The numbers, however, make clear that the stories we are hearing are not isolated cases. The figures are taken from October and November 2020 – as the NHS Covid caseload was increasing rapidly for the second time, but well before its peak in early 2021 – and show endemic levels of stress within the NHS, with 44% of respondents reporting that they had felt unwell because of work-related stress. This is up from 40.3% the previous year – or, put another way, there were an additional 10% of people impacted by work related stress compared with the previous (already high) figure.   

The pandemic, unsurprisingly, seems to have been a big contributory factor in this increase. About a third (34.2%) of respondents said they had worked on Covid wards at some point. Many of the stories we have heard from participants in Schwartz Rounds or Team Time have shown the emotional impact of this work. But there was significant impact on wider work patterns as well, with nearly a fifth (18.5%) of staff redeployed and more than a third (36%) working from home. Changes like this are unsettling and give people less control over their working lives. Meanwhile, one in ten staff had to shield, for themselves or a loved one – which we know brought complex feelings of fear and guilt.

These figures should not be read without reference to the unequal impact of Covid-19 on workers from BAME backgrounds, who were much more likely to have served in a Covid ward or area (47% of BAME respondents compared with 31.1% of white respondents), and quite a lot less likely to have worked from home during the pandemic (29% of BAME respondents compared with 37.7% of white respondents). Some of this will stem from the imbalance across job functions (there are fewer BAME managers) but the real disparity may be greater, because of outsourced services such as cleaners who would not register as NHS employees and are therefore not represented in the survey. 

Measures for stress factors including relationships at work and ways of working show that these issues are persistent. A reduced proportion of respondents said they receive the respect they deserve at work (71.4%, down from 72.3% in 2019) and fewer said they got encouragement from their immediate manager (70.3%, down from 70.9%). Fewer than half of respondents (47.1%) said their working relationships were never or rarely strained, though this measure has shown some improvement over time. Factors addressing the amount of control people feel they have over their working life, such as being involved in decisions on changes affecting their work, or being able to decide how to do their work, have both shown a decline in 2020 compared with 2019, and only a quarter of respondents (25.3%) reported never or rarely having unrealistic time pressures (though this improved from just 22.9% in 2019). 

Taken together, these statistics indicate that the impact of the pandemic on stress has been to add an extra layer on top of what is already a highly stressful work environment.

Stress Awareness Month, then, seems even more relevant this year. At the Point of Care Foundation we have seen increased uptake of staff wellbeing programmes such as Schwartz Rounds and Team Time as health organisations – and increasingly organisations from other sectors, including vets, higher education institutions, children’s social services and more – have sought to provide increased support for their colleagues.

 The simple process of sharing what you are experiencing and learning that you are not alone, that your experiences are often not unique, continues to prove powerful for people participating in Schwartz Rounds. This impact was quantified in NIHR research led by Dr Jill Maben at the University of Surrey, who found that people who attended Rounds regularly were only half as likely to suffer psychological distress as a control group of non-attenders. Subsequent research has reinforced the finding that Schwartz Rounds reduce psychological distress.

The development of Team Time during the early stages of the pandemic in 2020, recognised that at a time of acute anxiety and pressure, it is often those closest to you at work, who share the day-to-day reality of what you are going through, who can be of most support.

Interestingly, in the last year we have also identified a particular set of challenges faced by leaders, for whom the act of sharing experiences is complicated by the perceived need to hide any so-called ‘weaknesses’ from the people they manage, for fear of denting morale. This is a challenge we will be seeking to address, as the impact on managers may be different, but is no less real, than for anyone else working in health and care. 

The NHS’s recovery from the shock and dislocation of Covid-19 depends entirely on its workforce. One piece of good news from the staff survey is that the numbers of people contemplating or planning to leave their organisations continued to fall (to 33.8% from 35.8% a year earlier), and those looking to leave the NHS altogether has also reduced (to 18.2% from 19.6% in 2019). But both of these figures are still high. At this time of great challenge, amid clear increases in work-related stress, it is vital that health organisations continue to support their staff’s emotional and psychological health.

All statistics are from NHS Staff survey 2020 unless otherwise indicated.

If you would like to know more about our work to support health and care staff wellbeing, please get in touch: schwartz@pointofcarefoundation.org.uk