‘Demand, blame and cost cutting’ at NHS

As Bristol24/7 investigates the rise in stress-related illness at overstretched hospitals in Bristol, a former member of staff in the NHS in Bristol, who asked to remain anonymous, explains how recommissioning and targets are driving workers to tears

Having spent 37 years working for the NHS, I became aware that the rate of long term sickness leave taken due to stress seemed to be increasing, so it was no surprise to see the recent figures that evidence this rise.

It is tempting to look back at the ‘old days’ with rose tinted glasses, but I do remember the time when clinical staff were valued and shown appreciation and recognition for their work.

My own experience was that I was given more or less free rein to develop a specialist multiagency service and was for many years encouraged and supported to do so. My managers and clinical consultants became involved with the project and took a genuine interest and there was a sense of pride in providing ‘good practice’

Work could still be stressful, but I felt able to discuss the stressors with my manager and clinical supervisors and gain both practical and emotional support, so it was unlikely to result in long term sick leave. At that point it was possible to achieve promotion and recognition and consequently there was a lot of job satisfaction.

However, over the last eight years or so I have noticed a change in approach from the managers mainly due to targets and recommissioning which has led to a much less supportive managerial approach, towards one of demand, blame and cost cutting.

During the last eight years there was a so-called skills mix, which led to a reorganisation, resulting in a lot of dissatisfied staff who were downgraded, whilst expected to increase their workloads.

The message given was that we were lucky to have a job and they were doing us a favour, rather than providing a sense of value. This internal reorganisation was then followed up a couple of years later when the service was recommissioned, so we were competing with other private agencies to win the contract.

This resulted in a lot of senior managers spending months coming up with a bid with more efficiency savings, which was never going to be completely achievable but won the contract.

The service was once again reconfigured and posts were reduced and again downgraded. At this point, existing staff had to reapply for their jobs, in some cases competing with each other and some staff were redeployed.

Morale was very low at this time and it continued to deteriorate as the new service was rolled out. In order to get anywhere near delivering on the contract caseloads were increased dramatically, which appeared to take no account of clinical effectiveness or safety.

Despite the whistle blowing message from the Francis report, I still think staff find it very hard to raise concerns in the current climate.  As an experienced practitioner, I did raise concerns from time to time and my colleagues would often thank me for it as they felt unable to do it for fear of being overlooked for promotion of being considered not able to cope. 

The other aspect that seems to have changed is that some staff become managers with no management training/experience and sometimes little clinical experience. They may be working as a clinician on the Friday and return on the Monday acting up as a manager. They are often not experienced enough to deal with staff concerns about excessive workload, especially when they are being pressured by senior managers to deliver on targets, so the caseload/safety issues don’t get addressed. They are also wanting to do well and get promotion so are unlikely to ‘raise concern’ themselves.

During the last couple of years in my post the caseloads were the highest I had ever seen and were definitely unmanageable and unsafe.

Staff were, and probably still are, struggling to provide a clinical service and actually see people – and at the same time complete the ever-increasing paperwork. This tension leads to stress and worry, especially when there appears to be no way out.

None of the very professional staff I worked with was happy to provide a substandard service but had little influence in changing this, so this resulted in a reactive, firefighting service where it was hard to stand back and find solutions.

I believe that a result of this, and usually as a last resort for the worker for self-protection, is to remove themselves from work and go off sick. This is a difficult decision to take for most people because the worker is already worried about the poor service provided and feel if they go off sick this will only deteriorate further and impact on the other stressed staff who are left.

I was lucky in that I only had two years left to work when the service was recommissioned which in some way helped me deal with the stress in that there was light at the end of the tunnel, so I never felt the need to take sick leave. I do understand and sympathise with other workers though who feel cornered with nowhere to go, unable to speak up.

I have seen many colleagues having to compromise good practice in order to keep up with the workload and demands from managers. Many of us have experienced sleepless nights worrying about situations at work and, at times, are close to tears (or in tears).

Sometimes managers would try to reassure the staff that the situation would improve and that more staff were being recruited but due to the incredibly bureaucratic NHS system of recruitment this could often take months or wouldn’t happen at all because the new employee had changed their mind – so it left staff feeling despondent and that the situation was unlikely to improve. 

I worked for a ‘mental health’ trust which should understand the issues and encourage and promote care for the people who care but often this was lacking. I understand the pressures the NHS is under to provide services within a budget but by not looking after staff they risk losing them to sickness which in the end is far more costly.

The managers are also under a lot of pressure and often the junior managers feel pulled in both directions, trying to keep both staff and senior managers happy.

I have less sympathy for some of the senior managers who are very good at distancing themselves from the services they manage, especially when things go wrong and I think this blame culture has also contributed to levels of stress for junior staff.