‘In a world where you can be anything, be kind’ was a quote posted on the social media account of a well known British celebrity who tragically took her own life 72 days later, in December 2019. The devastation, along with this quote, rippled through the nation in the wake of the disaster. It left people questioning ‘could I do more to be kind?’ – undoubtedly the answer is yes.
We are almost two years into the COVID-19 pandemic and whilst we all hoped it would be a faint memory by now like the Ghost of Christmas Past, Omicron has kept us wondering whether we will ever return to normality as we knew it. The incessant Lateral Flow testing, the living in fear we might see the dreaded double lines, the hoping beyond reason that this Christmas we will be able to spend it with our chosen loved ones, has been overwhelming.
But for some, having just one line appear on a negative Lateral Flow test may ultimately mean the opposite; shattered dreams of driving home for Christmas for 7-10 days of isolation, replaced with driving to work. For some, the Ghost of Christmas Present has bought them an influx of Omicron positive patients into both primary and secondary care, the flurry of COVID-19 vaccinations, the whispers of surge rota’s, the threat of redeployment and the inevitable doning of Personal Protective Equipment (PPE) instead of a Christmas jumper. At least working at Christmas means you get a free Christmas meal…right? Well, only if you are working the day shift on Christmas Day and no medical emergencies coincide with those precious lunchtime hours (fingers crossed!). Those on nightshifts may be fortunate to find any leftover mince pies and redundant chocolates for a snack.
Working the festive season is hard, both inside and outside of a Pandemic. The workforce has been under pressure for many years, suffering with burnout and mental health problems; the BMA reported in 2018 that NHS staff have higher rate of sickness absence compared to the UK average worker across the public and private sector. This will have been exacerbated by the pandemic. The GMC published the report Care for Doctors, Caring for Patients which highlighted that workplace stress in healthcare organisations affects quality of care for patients as well as doctors’ own health. Pre-pandemic, according to this report, around one in four doctors in training in the UK and one in five trainers said they felt burnt out to a high or very high degree as a result of their work. Imagine what those statistics would be now.
When Matt Hancock was Secretary of State for Health and Social Care, he realised the problem. In February 2019, Matt Hancock delivered a speech which marked the publication of the NHS Staff and Learners Mental Wellbeing Commission. During the speech he apologised to the family of Dr Lauren Phillips, a junior doctor who tragically took her own life whilst employed by the NHS. Lauren’s father had said that “During the short time she worked for it the NHS succeeded in sapping Lauren’s strength. Undermining her self-confidence. Attacking her professionalism. And devaluing her commitment. It was not there to give her the help and support she needed to stay alive”. Matt Hancock replied in his speech –
“Why is it that when 1.3 million people have devoted their lives to caring for others, the collective system is uncaring to some? We need to change a culture of carrying on regardless, not asking for help, not looking for signs of burn-out among our colleagues, thinking everything’s OK as long as someone turns up for work and does their job….That isn’t good enough.”
What is the solution? There is not a single answer to this but one thing that is imperative for all NHS staff to get through the pandemic and in order for the NHS to serve the population and workforce, is compassionate leadership at all levels, from the ward to the board, local to national. We need leaders who listen, who empathise and who care – not just about the organisation and it is outcomes, but the people who make up that organisation. Abraham Maslows published a paper called The Theory of Human Motivation in 1943, which outlines Maslow’s Hierarchy of Needs which suggests that people are motivated to satisfy five basic needs (physiological, safety and security, social, esteem and self-actualization needs). The needs are arranged in a hierarchy with each need requiring accomplishment before moving to the next. Whilst achievement is to some degree reliant on the individual, it also requires compassionate leaders who help individuals to progress though each stage by creating the environment which allows you to succeed. For example, does your working environment allow you to fulfil you physiological needs, such as eating, drinking and resting? As a junior doctor, I know I’ve worked many shifts where this has not been possible. And what about safety needs, which includes emotional and personal security? Again, particularly during the pandemic as a frontline doctor, there were many a times when my safety needs were not met. It is unnerving to consider we may not be able to reach self-actualization working for the NHS, and we are reliant on simple acts of kindness, like food donations during the pandemic, instead of the what should be the accepted norm, to try and achieve Maslow’s Hierarchy of Needs.
It is almost 2022, and we will soon be visited by the Ghost of Christmas Future – so what do we want our future to hold for both us and the NHS’s people and the population it serves? Many of us will be thinking about our New Year’s Resolutions; who we hope to be, what we want to do and what we plan to achieve this next year (Covid permitting of course). I ask you all to consider adding one thing to your resolution list… ‘be more kind’. Let the year 2022 be the year that we are collectively more kind and strive to be compassionate leaders in whatever role we hold. Let us be kind to our organisation, to our teams, to our colleagues but also above all else, to ourselves.
Dr Emma Hadley
Dr Emma Hadley is a Geriatric and General Medical Registrar, working across Kent, Surrey and Sussex Deanery. Having undertaken leadership roles within local NHS trusts and participation in local quality improvement projects, Emma applied to the Faculty of Medical Leadership and Management (FMLM) National Medical Directors Clinical Fellow Scheme to continue to develop her leadership and management skills as well as to gain a deeper understanding and appreciation of change management within the NHS at a national level. Emma has a particular interest in the wellbeing and morale of the workforce, which has been at the centre of many of her previous QI projects and Emma feels incredibly privileged to have been placed within the Health Inequalities Team at NHS England. Emma hopes that she can bring both her medical and clinical leadership skills to the team, her holistic approach to addressing tasks and her passion for contributing to positive change, now with a new health inequalities lens. Emma hopes to be an ambassador for the Health Inequalities Team, networking within NHSEI and liaising with the FMLM fellows across other organisations to align the health inequalities work being done nationally.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.