Caring for the carers who face emotional impact of death and tragedy before helping the next patient

Any day can bring both the best of times and the worst of times.

When those worst times call, health professionals and other hospital staff must deal with the aftermath of accidents and disaster and move on to the next patient.

But what happens if they don’t “move on”?

With an ever increasing demand for health care, staff shortages and lack of hospital places for patients in need it is certainly time to ask ‘Who cares for the carers?’

The Lancashire Teaching Hospitals Trust, which runs Royal Preston and Chorley Hospitals, employs 8,000 people. This week it hit the headlines with complaints about understaffing and overwork from accident and emergency unit staff at both Preston and Chorley sites.

The Trust had a sickness rate of 5.11 per cent in the past year.

It says it wants to cut this figure and promote staff health and wellbeing.

Part of its strategy to do this has just been unveiled. A new service to provide a listening ear and help for staff in distress was launched this month.

The new Traumatic Incident Service will provide support and guidance to the Trust’s staff, giving individuals the opportunity to talk about their feelings following an incident.

They will receive information about common experiences and advice on where to access professional support if more help is needed.

Rachel O’Brien, strategic workforce business partner, said: “Our staff work in health care because they are passionate about delivering patient care. Sometimes that really can be challenging, sometimes they experience difficult and sometimes distressing circumstances.

“Sometimes that’s around the capacity, pressures within the hospital, sometimes that’s related to particular patients they are caring for and the circumstances surrounding care.

This is about us an employer providing them with as much support as we possibly can.”

The service forms part of the trust’s existing psychological wellbeing service and was launched, it says, in response to suggestions from staff focus groups.

It is being led by Liz Tallentire, Principal Clinical Psychologist and Mindfulness Practitioner at the Trust, supported by a team of trained incident staff supporters.

Liz said: “These incidents could be anything, as what people find distressing varies greatly and is not related to the objective severity of the incident.”

She lists possible traumatic events as dealing with an unexpected death, someone being taken seriously ill, an accident or an incidence of violence.

Liz added: “It is normal to experience distress following an incident, this may happen for some people and not others. However, if a member of staff or team feel they would benefit from having someone outside the situation to talk to and explain what to expect then we may be able to provide further support.”

She cites the example of staff having flashbacks and who consider this abnormal. She said: “That’s actually quite a normal experience that would occur for a couple of weeks.”

If staff are still having the flashback experiences a month or so later they may need additional help and support.

Rachel O’Brien is responsible for the Trust’s health and wellbeing strategy. She said: “It’s important because in order for our staff to deliver the best possible care to our patients it’s important they themselves are fit and healthy.

As an employer the NHS should be leading the way, putting the focus on the health and wellbeing of our staff.”

She stressed the Trust was not seeing an increase in mental health-related absences and the new service is an additional support measure.

Part of the wider package includes mental health awareness training. A two-day programme called “Mental Health First Aid” educates staff to be aware of mental health problems.

Rachel said: “We’re trying to reduce the stigma around people being willing to acknowledge they may not be feeling that great from a mental health point of view. It’s around recognising the signs of stress, anxiety and depression or something a bit more serious with a colleague or themselves as well and raising awareness of the support services that are available.”

“It’s around us encouraging people to recognise their colleague is not behaving in a way that would be normal for them. Our focus is all about encouraging our staff to support each other.”

Liz said that just asking a colleague how they are can open the doors to a wider understanding.

She said: “Some of the kind of things people might notice is a colleague coming into work later than usual or finding it difficult to concentrate, being nervous, possibly tearful or just unusual behaviours - maybe being just a little bit irritable than would be usual for them, someone having no energy and not doing the normal things they do for example running or a walk.

“They might not be presenting in the same way as usual - for example if they normally have lovely make-up, not coming in with their makeup or hair done. It’s really about noticing things that are different.”

In such circumstances Liz advises: “It’s making some time to talk to the person. It doesn’t have to be anything complicated. It can be just saying ‘I’ve noticed you don’t seem quite yourself I’m wondering if you are OK’, you can’t force someone to talk. You can only give opportunities.”

If more help is needed it might then be appropriate for a person to refer themselves to the psychological wellbeing service or join a mindfulness course. Managers can also help by making small changes to support a person in the workplace.

The trust was accredited with the Workplace Wellbeing Charter in February 2017.

From active travel to work and lunchtime walks to yoga and pilates classes, running and walking groups, health checks, physiotherapy, smoking cessation and weight management sessions, mindfulness training and a clinical psychology service, there are varied opportunities for staff.

Uptake for some of the classes may be modest - staff pay a discounted price on a drop-in basis for weekly activity groups. Rachel said: ”We have higher rates of sickness absence that we would want to have - hence why taking a preventative approach is so important.

“We’ve undertaken lots of work over the last couple of years to try and improve the health and wellbeing of our staff and we are hoping in the long term that will have an impact on sickness absence.”

The Trust is running a walking challenge for May based on the number of “steps” teams amass on pedometers. It’s one step at a time and Rachel is adamant: “We know that health and wellbeing is having an increased focus across the NHS ... We do believe we are leading the way.”