Here is a photograph that I took and tweeted on 3^rd January 2018, a day when 14 ambulances were queued up outside the Wrightington, Wigan and Leigh (WWL) A&E department. It had not been my intention to create a news story but the picture was picked up by many of the national media and featured as the first item on BBC TV news that evening as symbolising the strains on the NHS. 

What the picture could not show is what was happening inside the hospital and had indeed been happening for several weeks. Every bed in the hospital was full so that new patients could only be admitted once an existing patient was discharged. This meant that all of the cubicles in A&E were full of patients waiting for beds in the wards to become available. The waiting rooms had overflowed onto the corridors with many patients waiting for A&E cubicles to come free so that they could be assessed. Under these circumstances flow through the hospital seizes up and the unfortunate patient experiences long delays. The government target is that 95% of patients should be seen and treated within 4 hours of arrival. On several days, we achieved this for less than 50% of patients. The least urgent patients could sometimes wait for as much as 12 hours to see a doctor.

This is obviously bad for patients but it is also profoundly exhausting, upsetting and stressful for staff. Apart from the sheer relentless weight of work, staff grow increasingly anxious that these delays put patients at enhanced risk because later diagnosis results in a later start of treatment. The patient’s condition can worsen within what appears to be the safety of a hospital and staff are profoundly aware of the risk, especially when patients are in unsupervised waiting areas. A good definition of stress is feeling responsible for an outcome but not being able to control that outcome. So a very busy A&E department is a place of enormous stress. It is not surprising then that staff in such circumstances have a higher than average sickness rates. Their absence in turn, inflicts even greater stress on those who do come to work and it is remarkable really that almost all staff do still come in to work, day in, day out, despite knowing what to expect. Although this article concentrates mainly on the A&E Department there is a very similar position on the wards with relentless pressures to discharge patients as soon as they are safe to go.

What then, can we do to reduce and manage that stress? The first thing is to acknowledge the problem and take it seriously. One of our main objectives is to maintain a positive and healthy culture and particular priorities are to stamp out anything that looks like blame. When things are tough it is far too easy to find someone to blame but this is deeply corrosive to teamwork and relationships. Another way of generating positive energy is to look for and acknowledge successes, even small ones. There are numerous instances of individuals arriving early, staying late and generally going the extra mile. It is important to recognize these invaluable contributions and to constantly and routinely thank staff.

It is also important as an employer to show that you are concerned about staff welfare so it is vital to have a regular, senior presence on the ‘shop floor’. This also creates the opportunity to listen to staff and ask for their suggestions on what can be done to improve the situation and to improve their health and wellbeing at work. For some time, we have offered practical help such as hand massages, weight loss clubs and classes in mindfulness but this winter, we have wanted to find new ways to demonstrate our appreciation and support. We announced a Winter Wellbeing package consisting of mostly quite small things but, put together, can make a real difference:

• Surveys show that around 30% of staff face financial difficulties with Christmas often being a time of particular pressure. So we have given staff access to a financial advice service which can help for example to consolidate loans and reduce interest costs
• During December, volunteers handed out mince pies to staff
• We announced our intention to put Amazon lockers on each of our Hospital sites so that staff can shop on-line and have their purchases delivered conveniently
• In the 12 days leading up to Christmas we published daily hints tips and advice to help keep staff healthy and happy
• These included the concept of a Power Pause where all staff, no matter how busy, are encouraged to take controlled short breaks during their shifts.
• The gesture that seemed to be appreciated more than anything was what we called “the gift of time”. In recognition of all their hard work in 2017 we announced that all staff would be given their birthday in 2018 as an extra day off.

Perhaps it is the sheer quantity of actions and offers but this appears to have had a genuine positive impact on staff. Our annual national staff survey was conducted over October and November and, despite all the pressures, responses to two thirds of the questions either improved or stayed the same compared to the previous year. The answer to the two all important questions were that 73% of staff would recommend WWL as a place to work compared to 60% in the rest of the sample,  and 77% would recommend care at WWL compared to 69% in the rest of the sample.

Andrew Foster

Chief Executive

Wrightington, Wigan & Leigh NHS Foundation Trust