Chief Medical Officer - annual report: 2022

Supporting Our Workforce

Personal reflections Professor Sir Gregor Smith

Even before the pandemic began to exert its unprecedented impact on healthcare, it was evident that aspects of working in health and social care were becoming more challenging for many people. Over the last two years, however, these challenges have become amplified and more widespread.

Colleagues across Scotland have worked tirelessly, often in extremely difficult circumstances, and have continued to provide high quality treatment and care for the people of Scotland. I want to start the final chapter of this report by recognising the incredible contribution of Scotland’s health and social care staff over the past two years and to convey my pride and gratitude to them for their commitment and skills.

But as we recover and restore health and care services we must recognise the toll that caring through the pandemic has had on our workforce. I listen to accounts from colleagues of their experience almost every day and I know that some people feel disenfranchised and undervalued. This has to change if we are to recapture fulfilling careers for all and sustain this remarkable commitment and expertise that people offer day after day.

People are more than employees: they are colleagues, patients, family members and carers. They are sports people, musicians, artists, writers and so much more. They come from diverse backgrounds and cultures, have different preferences and priorities, hopes and concerns. Some feel more able to speak out than others.

We must provide a working environment and culture which recognises this. Retaining and supporting our most valuable resource is vital if we are to deliver the optimal care for those who need our help now and in the future. We must provide our health and care professionals with the support they need to fulfil their roles, achieve their full potential, and ensure that they feel appreciated and valued.

I am highly aware of the pressures that health and social care professionals continue to face. Workplace stress in healthcare is proven to affect both the quality of care and patient satisfaction.^[32] Work, when good, is a protective factor for our mental health yet, contrarily, we recognise mental “distress” as a normal reaction for healthcare workers to some of the events we experience. “Normalising” stress, whether chronic or acute, is not, and cannot become, acceptable. It therefore has become increasingly important to consider how we address both the underlying causes of this and to support our staff emotionally and psychologically in their everyday work, to ensure that they are able to continue delivering the highest standard of patient care.

I know too that consistent access to some basics would help. Access to hot meals and refreshments throughout the working day, changing facilities, adequate car parking and bike storage, for example. These are seemingly simple expectations that I hear feedback about regularly. I’m committed to working collaboratively with representatives and organisations from across the professional spectrum to understand staff experience, and to help build supportive multi-disciplinary teams that are focused on providing fulfilling care and support to patients and colleagues alike.

The GMC undertakes and reports a survey^[33] each year that is valuable in assessing trends in the experience and attitudes across the medical profession. The State of Medical Education and Practice in the UK (SoMEP) uses the GMC’s own in-house data, primary research and other external data sources to help understand and raise awareness of important issues in UK healthcare. Since 2019, the primary research feeding into this report has included an online survey of doctors: the SoMEP barometer survey.

The barometer includes seven burnout assessment questions from the Copenhagen Burnout Inventory. In the last survey, published in November 2021, there are indications that support some of the important and worrying messages I hear directly from colleagues;

• 12% of doctors in Scotland were categorised as being at a high risk of burnout i.e. gave a negative response on 6-7 of the 7 indicators (compared to 17% of doctors surveyed in all UK)
• 15% of doctors in Scotland were categorised as being at moderate risk of burnout i.e. gave a negative response on 4-5 of the 7 indicators (compared to 15% of doctors surveyed in all UK).

Of particular concern is the finding that fewer doctors from a black and minority ethnic background, particularly those who identify as Asian/Asian British doctors, feel that they are supported by their immediate colleagues or agree that they are part of a supportive team. There is also evidence of a widening gap between the experiences of disabled and non-disabled doctors, with almost twice the proportion of disabled doctors reporting dissatisfaction and struggle with workload, or who were categorised as high risk of burnout.

5% of doctors in Scotland had taken steps to leave in 2021 (compared with 7% of doctors surveyed in all UK). This is a rise of 1% in 2019 and a further 1% in 2020. It’s critical that we fully understand the underlying reasons for this and take action to address it – particularly for those groups of doctors who are most at risk of leaving and those who feel less supported.

There is, however, progress despite these challenges. The survey also identifies a rise in the proportion of doctors who agree that they know who to contact to discuss matters relating to occupational health and wellbeing. There is more work to do here but this is encouraging. There are many examples of approaches around the country that are making a difference to staff experience and I share them in the hope that they become more visible and accessible, with consistency, across the country.

Improving retention in the medical workforce

Work to improve retention is central to the overall work to ensure confidence in longer-term medical workforce modelling. Linkage of clinical service demand and workforce provision will be key to ensure recruitment and training of a sustainable future medical workforce throughout the career spectrum, from undergraduate, though training employment and on to retirement.

In hospital specialties, those most at risk of leaving the profession are those in the years before retirement. In General Practice this appears to occur sooner, in the mid-career period.

Factors affecting the retention of medical staff are well documented:

• current vacancies;
• commitments to service expansion;
• acute demands from recovery plans;
• service development requirements (short-medium term); and
• 2015 pension scheme changes, including the alignment of occupational pension with state pension age.

The Health and Social Care National Workforce Strategy, sets out the need for action to improve retention across the health and social care workforce. Analysis of the medical workforce action plan is underway to identify high risk points, initially focused around hospital consultants approaching retirement. In parallel, further work is ongoing to address retention issues among General Practitioners, as well as retention at the early and mid-stage of postgraduate training. This will require co-ordinated policy and decision making from undergraduate training through to retirement.

Delivering these retention priorities is the main focus of the Scottish Shape of Training Transition Group. Work on late-stage consultant career is being developed to help ensure alignment of retention priorities with wider work on medical workforce supply/demand, and longer-term medical workforce planning.

In recognition that the approach will benefit from multi-system input, collaboration is welcomed between Scottish Government, the BMA and partnership input from the GMC and other professional organisations (through the Scottish Academy). They will work collaboratively with leads from NHS Board Executives Groups including Board CEOs Group, Scottish Association of Medical Directors and HR Directors Group. Policy and professional support from Scottish Government Health Workforce Directorate will ensure appropriate support and policy linkage.

Peer-to-peer support — Dr Carlyn Davie

“At the beginning of the pandemic, COVID-19 was a new illness that we knew little about and it’s no surprise that the additional pressure and uncertainty that it brought took its toll on healthcare professionals. I am proud to have been part of a team who started a Peer Support Service in the Emergency Department at the Royal Infirmary of Edinburgh at the start of the pandemic.

Peer Support involves providing the first line of support to healthcare staff after a stressful event or when personal stressors are impacting on your work life. We know from the literature that those who work in healthcare prefer to receive support from their peers.

A multi-disciplinary team have been trained to offer early, confidential, psychological first aid to colleagues when required. Psychological first aid is defined as a compassionate presence, designed to mitigate acute distress and assess the need for continued mental health care.

Staff can contact a peer supporter formally through a dedicated email address or informally by approaching them directly to arrange a time to meet. All Peer Supporters have had formal training to fulfil this voluntary role and are supported through monthly supervision sessions.

Our Peer Support Service has subsequently been supported and rolled out across NHS Lothian and our Health and Social Care Partnerships.

As we take stock of the current challenges facing the NHS and taking steps to recover our staff, we feel that Peer Support is an important piece of the puzzle.

My aspiration going forward would be that Peer Support becomes imbedded in the culture of our organisation and that this training and support is available to staff in all Health Boards across Scotland.”

Case Study 9:

I used the Peer Support Service after the sudden loss of my mother.

I was struggling with work, trying to hold everyone up and life in general.

I’d seen the Peer Support posters in the staff room.

I found the service a truly positive and helpful process.

I was able to talk, cry and more importantly, was listened to.

I did not feel judged. I felt cared for and supported. After getting everything out I was able to process life again and begin to move forward and focus the positives again.

I am not someone who talks about feelings but the peer supporter really made me realise the importance and need for this.

Thank you so much for your help and support. I really would encourage others to engage and I will use again if I need anything.

Following the success of the programme in Lothian, NHS Grampian is in the process of launching their own staff support scheme.

Developing tomorrow’s leaders

Effective leadership, role modelling and embedding values of kindness, compassion and collaborative working creates a psychologically safe environment where all staff can excel, and improve care across Scotland.

But what makes leadership “effective” at this time? Scotland needs leaders who are inspirational, empowering, promote wellbeing, and who understand that it is our people who are tirelessly stepping up to meet the challenges we face in delivering healthcare day in, day out. There are some excellent examples of compassionate leaders like this across the health and social care system, but it also needs more leaders whose backgrounds are truly representative of the diverse workforce it employs.

Our collective aim must be to create and support people in health and social care to become leaders who focus on public sector values and an ethos of integrity and kindness; leaders who understand and enable a diverse, agile and dynamic workforce to respond to future challenges. And leaders who nurture and inspire the next generation to develop their own path towards these critical roles.

I was fortunate to encounter people who inspired and supported me during critical points in my career development. Though I came from a working class background, with a state school education, there were still people in senior roles with similar backgrounds, values and cultural experience that I could identify with and I recognise the privilege conferred by other characteristics that I possessed. Though the gender mix of leadership has undoubtedly improved, the same cannot be said about the presence of leaders from minority ethnic backgrounds and this must be addressed as a matter of urgency.

A key outcome, therefore, will be to create a diverse, inclusive and values-driven workforce in both health and social care that at all levels reflects the diversity in our communities – including socio-economic, ethnicity, gender and disability. Talent identification and succession planning are key tasks for leadership roles and are, in my view, one of the more enjoyable aspects of leadership.

The new National Leadership Development Programme (NLDP) will help to deliver on ambitions in the National Workforce Strategy, NHS COVID Recovery Plan and the new National Care Service, to ensure we nurture our talent and provide them with the skills required to lead and enable change, and deliver better services and ultimately better outcomes.

The NLDP will complement leadership development and support at local levels within health, social work and social care workplaces. It is being designed for leaders at all levels across health, social care and social work, in the public, independent and third sectors.

Key areas that have been identified as a priority for development in year one of the programme include:

• TURAS re-design. Creating a new digital capability allowing all staff across the public and private sectors in health and care access to personalised learning plans and career conversations. The new system will have the functionality to create online communities on specific subject matters such as equality and diversity, collective leadership and wellbeing and signpost to other resources. This will deliver on a platform that enables inclusive learning and accessibility to all staff;
• Creating more diverse workforces – user research will be conducted and may subsequently lead to the design and delivery of an accelerated leadership development programme for ethnic minority staff; a race allyship programme and creation of sustainable ethnic minority networks within health, care and social work;
• Creating a range of resources on a wide variety of leadership and values issues for staff at all grades, and using different mediums that recognises their different needs and time available to commit to this development. This will include, for example: ten-minute webinars, one-hour masterclasses, live sessions and micro-credential courses delivered by the University of Glasgow;
• Sustainable Development Programmes for specific professional cohorts to create a leadership skillset in line with their roles in a post-pandemic environment. In year one, this will include: Managers of Adult Social Care Homes, Directors of Public Health, Chief Executives in Health Boards, Chief Officers of Health and Social Care Partnerships. The focus will be on their individual leadership development needs and how they can be more effective at collaborative working as a cohort. A senior multi-disciplinary cohort will also be piloted including a Senior Systems Leadership Programme. Specific skillsets required to deliver on the National Care Service aspirations and prioritise these will be established; and
• Formal on-boarding in year one of new senior roles within Health including Chief Executives, Workforce and Clinical Executive Directors.

It is expected that this national leadership development offering will be launched in August 2022. The programme will evolve over time and its content and focus will be designed to suit workforce needs, including expanding diversity work into other areas such as disability, gender and socio-economic status.

National Wellbeing Hub — collaboration in action

The experience of health and care staff over the last two years, and the need to support their physical and psychological wellbeing, have highlighted the requirement for the ongoing development of new national resources.

The National Wellbeing Hub has evolved since May 2020. It is a partnership between the Rivers Centre For Traumatic Stress and Scottish Government Health and Social Care, set up with the support and engagement of key partners – NHS Boards, Health and Social Care Partnerships, Professional Bodies and Associations, Coalitions and Trade Unions.

The mission is to develop the National Wellbeing Hub as an evidence-led resource to promote, enhance and support the psychosocial wellbeing and recovery of everyone in Scotland working in health and social care, including unpaid carers. The Hub team aim to continuously improve and promote the Hub as a single point of contact for health and social care practitioners and unpaid carers to obtain advice, information and support in relation to the delivery of evidence-based and best-practice psychological interventions, and to signpost them to other resources or sources of help.

National Wellbeing Hub offer access to a such programmes. Also included are a series of resources developed to assist individuals, and their managers, if they have been affected by a long COVID syndrome. The platform features interviews with health and care workers affected by long COVID, sharing first-hand experiences of how a supportive and successful return to work can be facilitated.

Workforce Specialist Service

The Workforce Specialist Service (WSS) offers confidential mental health assessment and treatment for regulated health and social care professionals in Scotland. Mental ill health is more prevalent in these groups and they often have complex barriers that delay or prevent them accessing treatment so delivering an accessible, confidential and specialist service is an opportunity to protect and retain a vital workforce. This is especially important in the recovery period following the pandemic, when many will be affected by their experiences during that time.

The WSS is delivered by experts with experience of supporting the management of issues such as depression, anxiety, burnout or addiction, in the health care workforce, balancing the issues of patient safety, the needs of the individual and the impact of their regulatory and working environment.

The service supports anyone who belongs to one of the regulated professions within health and social care and when fully established in Scotland, will be the most comprehensive service of its kind in the UK. To date, over 445 health and social care professionals have registered for the service.

Conclusion

The last two years have been extremely demanding for those working in our NHS, but the signs of increasing challenge for staff were present even before this. The pandemic has, however, affected our physical and mental health in an even greater form and further support methods are needed.

I am deeply affected by the experience of our workforce. I celebrate the many successes and plaudits you deservedly receive, but too often now I hear of the circumstances that make your career less fulfilling or less sustainable. I am committed to listening to your experience and advocating on your behalf when this is appropriate and necessary. At the NHS Scotland event last year I spoke of my role as an independent professional adviser being a two-way conversation; to represent the government to the profession but also to represent our profession to the government.

I will continue to advocate that every member of staff in Scotland has access to the basic things they need to do their job to the best of their ability. As a complex but compassionate system we must ensure staff are valued, feel valued and have access to the supports that fulfil them and sustain their careers.

Considerations

• What support do you need to carry out your role to the best of your ability?
• How can the new national leadership strategy support those who wish to be leaders to grow and develop?
• How do we tackle the variation in wellbeing services currently available to NHS Staff?