Tactics to support the health workforce

We’ve been supporting a range of health and care systems to plan their response to Covid-19, and what is particularly striking is that a crisis really can bring out the best in humankind. It is a privilege to work alongside people who are working so effectively despite the enormous pressure they are under.

It is also clear that the health and care systems are radically and rapidly changing. Digital developments have been adopted at lightspeed, new ways of working have materialised overnight, and health planners and Public Health England have suddenly emerged as the centre of the world. The removal of organisational, professional and financial barriers to change has enabled change processes to be fast-forwarded, swiftly dismantling the artificial and behavioural constraints that previously prevented them from occurring. Change that has been blocked for years has been delivered in weeks – a valuable insight that must not be lost when this crisis is over.

But right now, the health sector needs to put in place the infrastructure that will enable it to look beyond survival, support its staff and patients through the crisis and maximise the opportunities this pandemic has created. That would be a big ask at any time, but it is made even more challenging by the need to do this during an emergency. However, we believe that this response can usefully be informed from what might be considered an unexpected discipline – mindfulness.

For Professor Mark Williams of the University of Oxford, mindfulness means “knowing directly what is going on inside and outside ourselves, moment by moment”. Knowing everything that is going on is not possible at the current time – things are moving too quickly and there are too many unknowns. But what we can seek to understand is what is going on inside of each of us, and therefore how we can best support others to support themselves.

Using this perspective, we have set out some tactical actions for supporting your workforce through the challenges ahead:

• Plan for sustainable emergency delivery. This is a crisis unlike any other – an end date is nowhere in sight. It is also clear that the emergency delivery mode the sector is in now cannot be sustained for longer than a few weeks. How then to best support exhausted colleagues so that they can sustain their efforts in the medium term and be ready for any future outbreaks? Your plan for increasing sustainability should include ringfencing leave for key staff and setting up Red and Blue teams to spread risk and support the longer-term response.
• Ramp up wrap-around trauma support. Trauma will be highly prevalent amongst health and care staff during and after this event; the negative impacts on both mental and physical health should not be underestimated. Developing a plan to provide support to staff at scale needs to be done now.
• Keep a journal each day. Time has seemingly sped up in terms of the pace of change. Much of what is now being experienced will be crucial for informing the future state of health and care – but we won’t necessarily know what is relevant until after the crisis. Capture a record of what is working well as well as what needs to be done differently.
• Nominate a reformation lead. As my colleague Jeremy Cooper outlined in his recent blogpost, we see ‘reformation’ after the crisis (rather than recovery) as the most helpful framing because it acknowledges that the future state of health and care will be different. For example, resilience – of both systems and workforce – will become a guiding principle going forward. While it’s too soon to know what the future state will be, a nominated senior lead to think about this needs to be put in place now. Their role will be to capture the insights described above and identify which elements are sustainable and consistent with a new way of working. Given the recent removal of barriers to creating change, it would be a wasted opportunity if key system partners were not included in this process. Collective working will be needed if public services are to go beyond simple recovery.

Going forward, there is clearly a great deal of uncertainty over almost every aspect of health and care. But incorporating aspects of mindfulness in the way we approach ourselves and the teams we lead can help us ensure that we use today to inform tomorrow.